Dietary Counseling Research Articles

Case Report: Case report: Rapidly progressing tooth wear dominated by intrinsic and extrinsic erosion

Tooth wear is multi-factorial presenting as a combination of abrasion, attrition, and erosion. This case report represents a case of combined tooth wear in a 46-year-old Indo-Trinidadian male, with a predominant erosive component with both the clinical signs and features of intrinsic and extrinsic erosion. This patient case is unique since the wear predominated by dental erosion has occurred rapidly evidenced by the physical clinical appearance of a lack of compensation and the upper left premolars and molars relatively unaffected by the overall effects of tooth wear. This lack of compensation, where opposing teeth have not supra-erupted to maintain inter-arch stability, and the maintenance of occlusal vertical dimension on the left due to the non-worn posterior maxillary teeth, provides the benefit of simplifying subsequent restorative management. The medical and diet history corroborates the diagnoses of intrinsic and extrinsic erosion respectively. Complications noted with rapid tooth wear, such as dentine sensitivity and pulpal necrosis are known sequelae of tooth wear however the patient presented in this case report shows a concomitant high caries experience and poor oral hygiene. Cases such as the one presented here require not only comprehensive dental management, utilizing a restorative approach but also medical referral for confirmation of a diagnosis and management of gastroesophageal reflux disease. Inherent to the management of this patient should be a multidisciplinary medical and dental approach, with confirmation and management of the cause of the intrinsic erosion as well as restorative dental management, together with dietary counseling to mitigate the effect of intrinsic and extrinsic sources of acid on dental hard tissue. A key lesson learned from this case is the importance of history and targeted questioning when trying to determine the cause of tooth wear dominated by intrinsic and extrinsic erosion.

Effects of an oral biodegradable device used for 12 weeks on weight reduction, cardiovascular risk factors, satiety, snacking, and meal size

BackgroundThe Epitomee Capsule (EC) is an, oral, self‐use, bio-degradable device for weight management, composed of absorbent polymers that self-expands in the stomach (pH-sensitive) and creates a triangular shape, space-occupying super-absorbent gel structure. A recent study reported that 42 % of study completers obtained >5 % weight reduction at 12 weeks. We performed exploratory analyses of this study to evaluate its effect on cardiovascular risk factors and on self-reported satiety, between-meal snacking and meal-size. MethodsThis single-center observational study (Israel) enrolled 78 volunteers, with mean age 41 years, BMI 32.5 kg/m2, systolic/diastolic blood pressure (SBP/DBP) 124/77 mmHg. The EC was given in addition to diet and physical activity counseling. Assessments included anthropometrics, BP, lipids, and three questions (translated from Hebrew) scored 1 (not at all) to 5 (very much) for “Do you feel the EC - Q1:helps you to consume less snacks in between meals? Q2:helps you to eat less in the meal?; Q3:is causing an early sense of satiety?”. Changes from baseline were assessed using a mixed model and included all patients with at least one measure. Correlation-analysis between weight-change and PROs used Kendall's tau. ResultCompared to baseline, at 12 weeks, SBP/DBP were reduced (ΔSBP: −5.5 mmHg, p = 0.0003/ΔDBP: −1.9 mmHg, p = 0.1341), with a larger effect in people with hypertension at baseline (ΔSBP: −13.2 mmHg, p < 0.00001/ΔDBP: −6.1, p = 0.008). Triglyceride-level was also significantly reduced, but not other lipids. Mean scores to Q1-3 were high throughout, with slight decreases (Q1 at W2 3.9 ± 1.1/W12 3.0 ± 1.6; Q2 at W2 3.7 ± 1.1/W12 3.1 ± 1.6; Q3 at W2 3.8 ± 1.2/W12 2.9 ± 1.6). There was a moderate correlation between PROs and weight reduction, although significance was not observed for all weeks. ConclusionsExploratory analyses of 12 weeks treatment with EC demonstrated significant reductions in SBP, DBP, and triglycerides. The weight reduction correlated with satiety, less snacking, and reduced meal size.

Dietary counselling plus omega-3 supplementation in the treatment of generalized anxiety disorder: protocol for a randomized wait-list controlled pilot trial (the “EASe-GAD Trial”)

BackgroundAnxiety disorders are prevalent and disabling conditions involving excessive worry and tension. Generalized anxiety disorder (GAD), the most common anxiety disorder, affects 5% of individuals from high-income countries and many individuals report that treatment options are not accessible, effective, or tolerable. Clinical evidence suggests that nutrition interventions, based on the Mediterranean diet and supplementation of omega-3 fatty acids, can significantly improve symptoms of depression; however, the effect of nutrition interventions on anxiety symptoms has not been studied in a clinical population. The primary objective of the present study is to assess the feasibility and acceptability of a dietary counselling and omega-3 fatty acid supplementation intervention delivered to adult women with GAD. The secondary objectives include assessing changes in anxiety symptom severity, assessing changes in quality of life, assessing changes in biomarkers, and evaluating the components of the program.MethodsThis study is a randomized, wait-list controlled pilot trial delivering a 12-week, dietary counselling intervention and omega-3 supplementation to 50 adult women with GAD. Participants will complete seven individual counselling sessions which include education, personalized recommendations, mindful eating techniques, motivational interviewing, and goal setting. They will be provided with recipes, instructional videos, and food items. The intervention is designed based on the Social Cognitive Theory and previous research that has been done by the author team to identify dietary constituents with the most evidence to support their use in the treatment of anxiety disorders. Questionnaires and blood work will be completed at baseline, after the waiting period (for those in the waitlist group), and after the intervention.DiscussionResults from this study will lay the foundation for future large-scale studies in this area and may provide preliminary evidence of the role of diet counselling and omega-3 supplementation in the management of GAD. Research on the role of nutrition in psychiatric care has been identified as a priority by a number of international organizations. The present trial directly addresses the call for the research that is most needed to advance the field.Trial registrationThis protocol was registered at ClinicalTrials.gov on October 10, 2022; NCT05573672.Trial sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416–498-1255.Steering committee: Composed of MA, LL, KC, IvdW, SM, UN, AJ. The committee meets monthly to oversee the trial.Protocol identifier: CCNM_EASe-GADCT_2201v4.

PROMISE: effect of protein supplementation on fat-free mass preservation after bariatric surgery, a randomized double-blind placebo-controlled trial

IntroductionProtein malnutrition after bariatric surgery is a severe complication and leads to significant morbidity. Previous studies have shown that protein intake and physical activity are the most important factors in the preservation of fat-free mass during weight loss. Low protein intake is very common in patients undergoing bariatric surgery despite dietary counseling. Protein powder supplements might help patients to achieve the protein intake recommendations after bariatric surgery and could therefore contribute to preserve fat-free mass. This double-blind randomized placebo-controlled intervention study aims to assess the effect of a daily consumed clear protein powder shake during the first 6 months after bariatric surgery on fat-free mass loss in the first 12 months after laparoscopic Roux-en-Y gastric bypass (LRYGB).Methods and analysisInclusion will take place at the outpatient clinic of the bariatric expertise center for obesity of the Maasstad Hospital. Patients will be randomly assigned to either the intervention or control group before surgery. The intervention group will receive a clear protein powder shake of 200 ml containing 20 g of whey protein dissolved in water which should be taken daily during the first 6 months after LRYGB on top of their normal postoperative diet. The control group will receive an isocaloric, clear, placebo shake containing maltodextrine. Postoperative rehabilitation and physiotherapeutical guidance will be standardized and similar in both groups. Also, both groups will receive the same dietary advice from specialized dieticians. The main study parameter is the percentage of fat-free mass loss 6 months after surgery, assessed by multi-frequency bioelectrical impedance analysis (MF-BIA).Ethics and disseminationThe protocol, version 2 (February 20, 2022) has been approved by the Medical Research Ethics Committees United (MEC-U) (NL 80414.100.22). The results of this study will be submitted to peer-reviewed journals.Trial registrationClinicalTrials.gov NCT05570474. Registered on October 5, 2022.

An Innovative Approach to Promote Weight Loss Among Mexican Immigrants: A Pilot Study.

Mexican Americans are among the highest risk groups for obesity and its associated health consequences, including diabetes, heart disease, and cancer.154 overweight/obese Mexican Americans recruited from the Mexican Consulate in New York City were enrolled in COMIDA (Consumo de Opciones Más Ideales De Alimentos) (Eating More Ideal Food Options), a 12-week Spanish-language lifestyle intervention that included a dietary counseling session, weight-loss resources, and thrice-weekly text messages. Participants' weight (primary outcome); dietary intake, physical activity, and nutrition knowledge (secondary outcomes) were assessed pre- and post-intervention.Of the 109 who completed follow-up, 28% lost ≥ 5% of their baseline body weight. Post-intervention, participants consumed more fruit and less soda, sweet pastries, fried foods and red meat; increased physical activity; and evidenced greater nutrition knowledge.A community-based lifestyle intervention with automated components such as text messaging may be a scalable, cost-effective approach to address overweight/obesity among underserved populations.

The role of dietitian follow-ups on nutritional outcomes post–bariatric surgery

BackgroundCurrent evidence recommends dietary counselling with a registered dietitian (RD) for successful weight loss after metabolic bariatric surgery; however, there are limited data on the effect of RD follow-ups on micronutrient deficiencies. This study evaluated the effects of the number of postoperative RD visits on nutritional outcomes, including weight loss and micronutrient deficiencies. ObjectivesThe aim of this study was to evaluate the effects of the number of postoperative registered dietitian visits on nutritional outcomes, including weight loss and micronutrient deficiencies after metabolic and bariatric surgery. SettingCleveland Clinic Abu Dhabi, United Arab Emirates MethodsThis retrospective study included patients who underwent bariatric surgery between September 2015 and June 2020. Demographics, weight loss, micronutrients, and the number of postoperative RD visits were evaluated. Baseline and 12-month postsurgery outcomes were compared based on the number of RD follow-ups. ResultsA total of 174 primary and 46 revisions were included. Patients were 73.6% female, with a mean age of 40 years. The initial mean body mass index was 42.8 kg/m2. Number of RD visits were as follows: 0–1 (39 patients), 2 (59 patients), 3 (55 patients), and 4 or more (67 patients). Baseline (pre-operative) micronutrient values were within normal range. In comparison with the reference group (REF = 0–1 post-op RD visits), patients with 3 RD visits had 7% higher total body weight loss (P < .001) and maintained micronutrients within the normal range at 12 months postoperative. Mean differences in postoperative values were statistically significant (P < .05) for weight, vitamin B12, and vitamin D but not for hemoglobin, ferritin, calcium, folate, vitamin B1, copper, and zinc. ConclusionOur study suggests that three or more RD visits during the first 12 months after bariatric surgery are associated with improved outcomes, including significant percent total body weight loss and lower rates of micronutrient deficiencies.

The Mediterranean Soul Food Diet Intervention After Stroke, a Feasibility Study in the Stroke Belt

The Mediterranean diet has positive effects on primary and secondary prevention of cardiovascular disease including stroke, yet dietary counseling to stroke patients is under-utilized. This study aimed to develop a culturally adapted Mediterranean diet and introduce it to patients admitted to the hospital for acute ischemic stroke with at least one metabolic risk factor (type 2 diabetes mellitus [DM], hypertension [HTN], high low-density lipoprotein [LDL], low high-density lipoprotein [HDL], and/or body mass index [BMI] &gt; 25). Dietary adherence and nutritional knowledge were measured at baseline and 30, 90, and 120 days post-stroke. Weight, hemoglobin A1C [HbA1C], and triglycerides [TG] were assessed at baseline and follow-up. The study enrolled 54 participants, 50 of whom had sufficient data for analysis. Dietary adherence and nutritional knowledge scores increased in 76.4% of participants, with a statistically significant median increase for each. Additionally, participants had significantly lower weight, HbA1C, and TG at follow-up than baseline. This study showcases the potential to introduce a culturally appropriate Mediterranean diet at the point-of-care, and significantly influence dietary adherence and nutritional knowledge and multiple stroke risk factors.

Validation of the Rapid Prime Diet Quality Score Screener (rPDQS), A Brief Dietary Assessment Tool With Simple Traffic Light Scoring.

Dietary pattern is a determinant of chronic disease, but nonregistered dietitian nutritionist (non-RDN) clinicians rarely assess diet because of barriers such as time constraints and lack of valid, brief diet quality assessment tools. The study aimed to evaluate the relative validity of a brief diet quality screener using both a numeric scoring system and a simple traffic light scoring system. A cross-sectional study was conducted using the CloudResearch online platform to compare participants' responses to the 13-item rapid Prime Diet Quality Score screener (rPDQS) and the Automated Self-Administered 24-hour (ASA24) Dietary Assessment Tool. The study was conducted in July and August 2021 and included 482 adults ≥18 years of age or older sampled to be representative of the US population. All participants completed the rPDQS and an ASA24; of these, 190 completed a second ASA24 and rPDQS. Responses to rPDQS items were coded using both traffic light (eg, green= healthiest intake, red= least healthy intake) and numeric (eg, consume < 1 time a week, consume ≥ 2 times per day) scoring methods and were compared with food group equivalents and Healthy Eating Index-2015 (HEI-2015) scores estimated from ASA24s. Deattenuated Pearson correlation coefficients were calculated to account for within-person variation in 24-hour diet recalls. Overall, 49% of participants were female, 62% were ≥35 years, and 66% were non-Hispanic White, 13% non-Hispanic Black, 16% Hispanic/Latino, and 5% Asian. For both food groups to encourage (eg, vegetables, whole grains) and to consume in moderation (eg, processed meats, sweets), there were statistically significant associations with intakes assessed by rPDQS, using both traffic light and numeric scoring methods. Total rPDQS scores correlated with the HEI-2015, r= 0.75 (95% confidence interval [CI]= 0.65, 0.82). The rPDQS is a valid, brief diet quality screener that identifies clinically relevant patterns of food intake. Future research is needed to test whether the simple traffic light scoring system is an effective tool that can help non-RDN clinicians provide brief dietary counseling or make referrals to registered dietitian nutritionists, as needed.

Implementation of malnutrition screening tool initiative in community cancer center for cycle 1 day 1, change in regimen, and new metastatic disease patients from Sept.–March 2022.

367 Background: Identification of patients at risk for malnutrition is imperative to provide early nutrition intervention. Patients undergoing cancer therapy are at risk for developing a variety of side effects that impact their intake, absorption, and nutritional status while undergoing antineoplastic therapy. Methods: 2021 Q4 Pilot: Implemented Malnutrition Screening Tool (MST) to identify patients at risk of malnutrition for C1D1 patients only during the Nurse Navigator visit. If the MST score is &lt;2, but a patient requests Dietitian Counseling, a patient would be referred to the RD. If score is clinically significant, &gt; or = 2, Nurse Navigator referred to the RD, including rationale and additional detail (i.e., amount of weight loss, poor appetite, etc.). RD reviewed all referrals related to the MST and completes further assessment and intervention if appropriate. 2022 Q4: Screening utilizing the MST was standardized during Nurse Navigator visits for all C1D1 patients, patients with new metastatic disease, patients with change in regimen and new oral therapy patients. Results: See table. Conclusions: Of the patients screened with the NCCN Distress Thermometer, 67% of those patients were identified to be screened for Malnutrition. Of the patients who were screened with the MST, ~ 26% of the patients were identified to be at risk for malnutrition. Early identification of malnutrition in treatment will result in early intervention and assessment by the dietitian to prevent poor outcomes.[Table: see text]

Characterizing the microbiome of patients with myeloproliferative neoplasms during a Mediterranean diet intervention.

The gut microbiome serves as an interface between the host and the diet. Diet and the gut microbiome both play important roles in managing inflammation, which is a key aspect of myeloproliferative neoplasm (MPN). Studies have shown that a Mediterranean (MED) diet can reduce inflammation. Therefore, we longitudinally characterized the gut microbiomes of MPN patients in response to Mediterranean or standard 2020 US Guidelines for Americans dietary counseling to determine whether there were microbiome-associated changes in inflammation. We did not find significant changes in the gut microbiome associated with diet, but we did find several associations with inflammation. This research paves the way for future studies by identifying potential mechanistic targets implicated in inflammation within the MPN gut microbiome.

Factors associated with child and maternal dietary diversity in the urban areas of Bangladesh.

Dietary diversity is an indicator of nutrition that has been found positively associated with diet quality, micronutrient adequacy, and improved maternal health and child growth. Due to the cultural responsibility of women in providing food at the household level, their status is very important to perform this role. Hence, this study has been conducted on the status of dietary diversity of the mother and child to understand how it relates to various factors of women in urban settings. Data were obtained from 1978 mother-child pairs living in different cities in Bangladesh. The foods taken by the women and children were categorized into 10 and 7 groups to measure women's dietary diversity (WDD) and children's dietary diversity (CDD), respectively. The study found that more than three-fourths of the mothers and half of the children had low dietary diversity. The household wealth holdings and access to resources by the women were found inadequate, while two-thirds of them had the lowest to medium level of nutritional knowledge. The binomial logistic regression model was used to measure the factors influencing WDD and CDD. The findings also indicated that children's dietary diversity was influenced by the mother's age, education, supportive attitude and behavior of husband, and access to and control over resources. While the household wealth index can enhance both child and mother's dietary variety, nutrition knowledge, dietary counseling, and access to and control over resources can improve maternal dietary diversity. This study recommends improving women's socioeconomic status by increasing their wealth and access to resources and enhancing their nutrition knowledge by providing food and nutrition counseling.

Simply adding oral nutritional supplementation to haemodialysis patients may not be enough: a real-life prospective interventional study.

Protein-energy wasting (PEW) is a common and serious co-morbidity in haemodialysis (HD) patients. Its importance as a prognostic factor has been increasingly recognised during the past decades. Much effort has been invested in the improvement of nutritional status and amelioration of consequences through different therapeutic approaches, either intradialytic parenteral nutrition or more commonly oral nutritional supplementation. In the article, we present the results of a prospective study in HD patients after 12 months of therapeutic intervention with oral nutritional supplements (ONS). A total of 92 HD adult patients were enrolled in the study after 3 months of wash-out period. Baseline nutritional status was assessed using composite scores, laboratory markers, bioelectrical impedance analysis, and hand-grip strength test. Patients recognised as undernourished or at high risk for undernutrition received renal-specific commercially available ONS on HD day in addition to their regular diet. After 12 months, the effect of ONS on surrogate markers of undernutrition, serum albumin level, phase angle, and hand-grip strength was analysed in 71 surviving patients. After 12 months, data for 71 patients, 39 (54.9%) men, 62.4 ± 12.9 years, and median haemodialysis vintage 53.3 (IQR 27.5-92.8) months, were available. Patients were divided into three groups: group A patients were with normal nutritional status at baseline not necessitating ONS; group B patients received ONS; and group C patients were entitled to receive but refused to take ONS. The baseline results showed statistically significant differences between the groups in serum albumin levels and phase angle but not hand-grip strength. Differences between the groups remained statistically significant at month 12; we did not find any statistically significant positive changes within the groups, indicating no positive effect of intervention with ONS. In a prospectively designed interventional single-centre study, we did not find a statistically significant change in surrogate markers of PEW in our cohort of HD patients, receiving ONS for 12 months. Since PEW is an independent risk factor influencing the survival of HD patients, efforts should be directed towards a timely and comprehensive nutritional approach, including intensive, personalised dietary counselling, increase in protein and energy intake and advocating tight control of nutritional status during HD treatment, possibly providing psychological support and motivation.

The Influence of Dietary Counseling Over 20 Years on Tracking of Non-High-Density Lipoprotein Cholesterol from Infancy to Young Adulthood

This 26-year study found that non-high-density lipoprotein cholesterol (non-HDL-C) levels tracked from infancy to young adulthood, suggesting early-life non-HDL-C could predict future levels. However, infancy-onset dietary counseling reduced the odds of maintaining at-risk non-HDL-C, highlighting the potential importance of early interventions in preventing cardiovascular risk associated with high pediatric non-HDL-C.

Nutritional Knowledge and Dietary Habits among Diabetic Patients at the Bono Regional Hospital, Sunyani, Ghana

Background: The rising mortality rate of diabetes mellitus and the upsurge in diabetes complications is very alarming. This has been attributed to the poor knowledge patients living with diabetes have on diabetes and its management, especially the nutritional management.&#x0D; Objective: This study sought to explore the knowledge on knowledge on diabetes and nutrition among patients living with diabetes mellitus who attended clinic at the Bono Regional Hospital.&#x0D; Methods: A cross-sectional descriptive quantitative research design was used for this study. Simple random sampling was used to recruit 150 participants for the study. The participants were interviewed using a semi-structured questionnaire. Respondents were recruited from the clinic until the desired sample size was obtained. A pre-tested interviewer-administered questionnaire was used to collect data. Dietary habits were assessed using food frequency questionnaire and BMI was assessed following standard procedure and compared with the World Health Organization (WHO) standards. Data was analyzed using IBM SPSS (Version 20). Chi-square test was used to determine the association between variables. The level of significance was set at p-value less than 5%.&#x0D; Results: The study revealed that the participants have adequate knowledge on DM and Nutrition. Majority of Participants in had high knowledge on diabetes and nutrition, 77.3%. This was associated with adequate education by their health care providers and with strong beliefs in modern medicines as well as diet therapy, which influenced attitudes and practices on Diabetes. Overall, good dietary practice among the participants was 57.3%. Age and level of education were found to be significantly associated with knowledge of diabetes and nutrition whiles gender, religion, occupation, ethnicity, marital status were not significantly associated with knowledge level of diabetes and nutrition.&#x0D; Conclusion and Recommendation: Dietary counselling will be necessary to improve the dietary pattern and nutritional status of the diabetic patients.

SAT681 Obesity Is A Disease. Maximize Positive Patient Outcome With Medical Treatment

Abstract Disclosure: S. Casula: None. P. Rios Florez: None. L. Oropesa Gonzalez: None. J. Molina: None. V. Nagpal: None. T. Sawyer: None. V.S. Lagari-Libhaber: None. Objective: Obesity has been recognized as a disease by the American Medical Association since 2013. Despite this, medical treatment is currently offered only to 2% of the patients in the USA. In comparison, 86% of the patients diagnosed with Type 2 Diabetes receive pharmacotherapy. Recent studies suggest that one out of every three Veterans (32.7%) have a BMI &amp;gt;30. As obesity is well known to be associated with multiple comorbidities, programs implementing early recognition and treatment are critical. While dietary counseling, behavioral therapy, and lifestyle changes are important components of obesity management, they are often not enough. Nevertheless, only a minority of these patients are offered weight loss medications. This analysis shows the impact of combining medications with lifestyle modifications at one of the largest VA facilities. Methods: From 2020-2022, a multidisciplinary team comprised of endocrinologists and clinical pharmacists at the Miami VA Healthcare System, implemented a weekly weight management clinic offering medications to all those patients who met clinical criteria and had previously tried and failed lifestyle modifications. A follow up in 3 months was provided to monitor effectiveness and/or side effects. Results: A total of 161 patients were evaluated from November 2020 to October 2022; 67% men and 33% women. The average age was 54 years old, ranging between 31 and 86. 39.1% patients were Black, 60.2% White, 0.6% Asian. 28% of the patients were Hispanic. Comorbidities included T2DM (30%), sleep apnea (37%), osteoarthritis (36%), hypogonadism (5%), dyslipidemia (55%), NASH (22%), and 9% of the women had PCOS. Of the 161 patients, 138 were started on one of the FDA-approved weight loss medications available (Orlistat, Phentermine/Topiramate, Naltrexone/Bupropion, Liraglutide or Semaglutide). 35 patients had side effects from the initial medication and 23 patients had a poor clinical response (less than 5% weight loss). These patients were offered alternative treatment. The number of prescriptions for Phentermine/Topiramate increased from 17 (Nov 2019 to Oct 2020) to 52 (Nov 2020-Oct 2021), and to 67 (Nov 2021-Oct 2022). The prescriptions for Semaglutide (for weight loss as main indication) increased from 18 (Nov 2020-Oct 2021) to 91 (Nov 2021-Oct 2022). Of the 102 patients who were on the same medication for at least 3 months (11.4 months average), on average the BMI decreased by 10.1% (-4.2 kg/m2), and their weight decreased by 9.4% ( -26.2 pounds). 46 patients were on the same treatment for at least 12 months (15.4 months average) and on average their BMI decreased by 10.9% (-4.7 kg/m2), and their weight decreased by 11% (-31.4 pounds). Conclusions: The successful implementation of this clinic highlights the importance of approaching obesity as a disease and incorporating pharmacotherapeutic agents to support weight loss in addition to lifestyle changes. Presentation: Saturday, June 17, 2023

SAT173 Insulin Autoimmune Syndrome: A Rare Diagnosis With Unique Features

Abstract Disclosure: S. Naqvi: None. S. Syed: None. A.R. Kasireddy: None. S. Alshami: None. D. Edem: None. J.A. Henske: None. Introduction: Insulin Autoimmune Syndrome [IAS], or Hirata’s disease, is a rare cause of hypoglycemia. It is characterized by positive insulin autoantibodies in an insulin naïve patient and should be considered in the differential for post-prandial hypoglycemia. Case: A 48-year-old male presented with postprandial tremors, sweating, palpitations and episodes of incoherent speech and loss of consciousness at least 6 months prior to his presentation. He had no history of diabetes, however, was found to have severe symptomatic documented hypoglycemic episodes, with resolution of hypoglycemic symptoms upon treatment; fulfilling the Whipple’s triad. Outpatient workup for causes of his hypoglycemia ruled out insulinoma, use of diabetes medications or insulin, adrenal insufficiency, severe illness, infections, thyroid, liver or kidney dysfunction. He never had gastrointestinal or bariatric surgery. Given his symptoms and severity of hypoglycemic episodes, he was admitted for observation and 72 hour fast. Lab work during hypoglycemic episode revealed inappropriately elevated insulin and low to normal c-peptide levels, undetectable proinsulin, elevated beta-hydroxybutyrate, normal IGF-1, IGF-2, and a negative sulfonylurea screen. Importantly, his insulin: c-peptide ratio was more than 1 and his insulin antibodies were elevated, consistent with IAS. He denied any history of autoimmune disorders or use of any medications with sulfhydryl group. CGM sensor clearly showed the relationship between high glycemic index foods, glucose spikes, and drops in his blood glucose several hours later. Dietary counselling was provided, without much improvement. Trials of Acarbose and Octreotide were not tolerated due to side effects like rash. Prednisone 20 mg bid was started; Diazoxide was titrated to 200 mg tid with much improvement. He has been followed by our clinic, and tapered to prednisone 10 mg bid and Nifedipine 30 mg daily with resolution of his symptoms. Conclusions: Severe hypoglycemia in non-diabetic patients requires investigation utilizing a broad differential diagnosis and biochemical evaluation. The findings of post-prandial hypoglycemia and inappropriately high insulin, with low to normal c-peptide and proinsulin levels with an insulin: C-peptide [ICP] ratio &amp;gt;1 in a non-diabetic patient is consistent with IAS. An ICP ratio &amp;gt;1 is a clue that the half-life of insulin has been increased by circulating antibodies. Mechanistically, post-prandial hyperglycemia cause insulin secretion, however, circulating insulin antibodies neutralize its effect. Ongoing hyperglycemia leads to further high levels of insulin, followed by intermittent spontaneous decoupling of insulin-antibody complex and subsequent post-prandial hypoglycemia. IAS may spontaneously resolve over time but may require indefinite length of treatment and dietary modification until this occurs. Presentation: Saturday, June 17, 2023

FRI087 Tuberous Xanthomas And Thrombocytopenia In A Patient With A New Diagnosis Of Sitosterolemia

Abstract Disclosure: S. Grigoryan: None. T. Else: None. Introduction/ Background: Sitosterolemia is a rare autosomal recessive disorder characterized by increased plasma sterol levels, that can lead to xanthomas, premature atherosclerosis, and hematologic abnormalities. It is most commonly caused by pathogenic variants in either ABCG5 or ABCG8 encoding sterol transporters that excrete sterols, leading to increased intestinal absorption and decreased biliary excretion of plan sterols. While patients with sitosterolemia have elevated LDL cholesterol levels, the pathophysiology of this process is still unclear. Clinical Case: A 46-year-old man presented with tuberous xanthomas and hyperlipidemia (HLD). In the past surgical removal had been attempted, but the lesions recurred. Prior labs: total cholesterol level was 235 mg/dL, triglycerides 85 mg/dL, HDL 61 mg/dL, LDL 157 mg/dL and mild thrombocytopenia (88 -127 K/uL) with giant platelets and anemia. Prior to the initial visit he started 40 mg atorvastatin with a subsequent increase to 80 mg daily. Physical exam was notable for periocular xanthelasmas and tuberous xanthomas. Achilles tendons appeared thickened without nodules. There was no family history of premature cardiac disease. Initial labs: Total cholesterol was 206 mg/dL(ref 120-200 mg/dL), TG mg/dL 66 mg/dl (ref 40-200mg/dL), LDL 119 mg/dL (ref 70-130 mg/dL), HDL 62 mg/dL (ref &amp;gt;40), platelets 111 K/uL (ref 150-400 K/uL) with 27.7% immature fraction, Hb 13.6 g/dL (13.5-17 g/dL). Plasma sterols were significantly elevated, campesterol 182.2 mg/L (ref &amp;lt;8mg/L), cholestanol 20.6 mg/L (ref &amp;lt;6 mg/L ), sitosterol 247.2 mg/L (ref &amp;lt;15mg/L ), stigmasterol 11.5 mg/L (ref &amp;lt;0.5 mg/L), indicative of a diagnosis of sitosterolemia. Coronary artery calcification (CAC) revealed a score of 15 which represents 50-75th percentile for age and gender, indicating CAD disease in the patient. Following the diagnosis of sitosterolemia, the patient started ezetimibe 10 mg daily, atorvastatin was decreased to 40 mg daily given the success at decreasing the LDL. Follow up LDL decreased to 58 mg/dL (48% decrease) and non-HLD to 71 mg/dL (53% decrease). Patient was counseled on dietary modification with a focus on avoidance of plant-based oils as well as referred to medical genetics and a dietician for more in-depth counseling. Genetic confirmation is pending. Conclusion: The global prevalence is estimated to be 1/1,000,000∼5,000,000. However, prevalence is likely underestimated due to the significant clinical and biochemical overlap with other hyperlipidemias and great variations in phenotype. Due to the differences in treatment and dietary counseling, it is important to consider this diagnosis, particularly in patients with typical concurrent hematological abnormalities. Presentation: Friday, June 16, 2023

THU145 Prediction Of Metabolic Syndrome Using DEXA Visceral Adipose Index (DVAI) And Pediatric Metabolic Index (PMI) In Children And Adolescents

Abstract Disclosure: K.F. Hearn: None. J.L. Fierstein: None. A. Miller: None. J.A. Canas: None. Introduction: Adverse cardiometabolic risk can be predicted during childhood using risk indices. Dual-energy absorptiometry (DEXA) derived Visceral Adipose Index (DVAI) quantifies Visceral Adipose Tissue (VAT) measured by DEXA in association with dyslipidemia. Pediatric Metabolic Index (PMI) developed for children &amp;lt; 18 years uses anthropometric measures validated against known pediatric markers of insulin resistance. Although Metabolic Syndrome (MetS) is prevalent among children, research on the prediction of MetS using DVAI or PMI is lacking. Aims: 1) To evaluate the predictive accuracy of MetS using DVAI and PMI. We hypothesized models using DVAI would display higher predictive accuracy than models using PMI. Methods: Retrospective review of children aged &amp;gt;5 to &amp;lt;18 years referred for obesity evaluation at Johns Hopkins All Children’s Hospital between 2019- 2022. Anthropometrics, blood pressure, fasting blood samples, and DEXA was collected. MetS were defined using the ATP III, Cook, and International Diabetes Federation (IDF) criteria. DVAI and PMI were calculated using standardized formulas. Multivariable logistic regressions including age, sex, and gynoid-android ratio (GAR), and either DVAI or PMI were fitted. Receiver operating curve (ROC) analyses were used to compare the predictive accuracy of DVAI and PMI models and define VAI and PMI cut-offs for the identification of MetS. Results: Eighty-nine children were included, 53% were female, the median age was 13 years, and 47.9%, 46.8%, and 40.6% had MetS according to, ATP III, Cook, and IDF criteria, respectively. There were significant differences (p&amp;lt;.05) by all criteria of MetS in waist circumference (WC), GAR, DVAI, and PMI, but no differences by any criteria of MetS in the distribution of age, sex, race/ethnicity, or BMI Z-scores. In all regression models, higher both DVAI and PMI were significant predictors for MetS. There were no significant differences in AUC between models based on DVAI and PMI, regardless of MetS criteria. Optimal cut-off values for MetS were 4.3 (C-index [95% Confidence interval {CI}]): (0.69 [0.57 to 0.80]), 2.9 (0.79 [0.69 to 0.89]), and 3.7 (0.76 [0.64 to 0.87]) for DVAI and 5.9 (0.76 [0.66 to 0.87]), 4.7 (0.87 [0.79 to 0.94]), and 5.3 (0.79 [ 0.69 to 0.89]), for PMI based on ATP III, Cook, and IDF criteria respectively. Conclusions: These data suggest that models using PMI to predict MetS defined by Cook criteria had the highest predictive accuracy, while models using DVAI and PMI to predict MetS defined by ATP III and IDF criteria had a similar predictive capability. PMI is a promising score to help identify and manage MetS in children which could be used along with dietary and exercise counseling. Further longitudinal studies are needed to validate the durability of these indices in predicting long-term cardiometabolic risk. Presentation: Thursday, June 15, 2023

Knowledge, Attitude, and Practice on Health Attitude, Exercise, and Dietary Habits of People with Type 1 Diabetes: An Observational, Cross-sectional Study

Introduction: In managing type 1 diabetes (T1D), diet and exercise play a crucial role alongside insulin therapy. Despite their significance in glycemic control and overall diabetes management, there is a notable gap in the awareness and attention toward these aspects among individuals with T1D. Methods: This survey-based, cross-sectional study, conducted as the part of the Kesavadev Trust T1D Project Sweet Stars initiative, aimed to assess the knowledge, attitude, and practice regarding health attitudes, exercise habits, and dietary behaviors among children with T1D. The study utilized a prestructured questionnaire administered by diabetes educators and dietitians during a T1D education camp. Descriptive statistics were used to summarize the findings of the survey. The categorical variables were presented as frequency (%), whereas continuous variables were summarized as mean (standard deviation) or median (Q1–Q3) based on the results of the Shapiro–Wilk’s normality test. SPSS software version 27 was used for all the analyses. Results: Of the 80 individuals approached, 75 responded, with the majority being male (58.7%). The median age was 13 years. Most participants were diagnosed with T1D between 2015 and 2020. Basal insulin usage predominantly comprised Innovator Glargine. Participants demonstrated good health attitudes and diet habits with the majority receiving diabetes education from doctors. While diet counseling was prevalent, access to dietitians was limited. Conclusion: Efforts are needed to raise the awareness and improve access to comprehensive care for individuals with T1D. Emphasizing the importance of ideal exercise and dietary practices through camps and education programs can bridge the knowledge gap. Health-care providers should prioritize T1D care and stay updated on T1D management strategies.

Diet Counselling in Pregnancy Induced Hypertension: Effect on the Status of Serum Trace Elements, Electrolytes and Neonatal Health

Diet Counselling in Pregnancy Induced Hypertension: Effect on the Status of Serum Trace Elements, Electrolytes and Neonatal Health