Dietary Modification Strategies Research Articles

Effect of High-Sucrose Diet on the Occurrence and Progression of Diabetic Retinopathy and Dietary Modification Strategies.

As the most serious of the many worse new pathological changes caused by diabetes, there are many risk factors for the occurrence and development of diabetic retinopathy (DR). They mainly include hyperglycemia, hypertension, hyperlipidemia and so on. Among them, hyperglycemia is the most critical cause, and plays a vital role in the pathological changes of DR. High-sucrose diets (HSDs) lead to elevated blood glucose levels in vivo, which, through oxidative stress, inflammation, the production of advanced glycation end products (AGEs) and vascular endothelial growth factor (VEGF), cause plenty of pathological damages to the retina and ultimately bring about loss of vision. The existing therapies for DR primarily target the terminal stage of the disease, when irreversible visual impairment has appeared. Therefore, early prevention is particularly critical. The early prevention of DR-related vision loss requires adjustments to dietary habits, mainly by reducing sugar intake. This article primarily discusses the risk factors, pathophysiological processes and molecular mechanisms associated with the development of DR caused by HSDs. It aims to raise awareness of the crucial role of diet in the occurrence and progression of DR, promote timely changes in dietary habits, prevent vision loss and improve the quality of life. The aim is to make people aware of the importance of diet in the occurrence and progression of DR. According to the dietary modification strategies that we give, patients can change their poor eating habits in a timely manner to avoid theoretically avoidable retinopathy and obtain an excellent prognosis.

The Influence of Diet on Tinnitus Severity: Results of a Large-Scale, Online Survey.

Optimization of dietary intake is an essential component in the multidimensional effort to prevent and manage chronic disease. Recently, demand has increased for nutrition-focused management strategies for chronic tinnitus. The primary aim of this study was to evaluate 10 dietary items for their association with changes in subjective tinnitus severity. A secondary aim was to develop an algorithm to better identify those individuals who might benefit from dietary modification strategies. A total of 5017 anonymous users of the TinnitusTalk forum completed an online survey regarding how various dietary items affected the severity of their tinnitus. Results suggest that, while intake of caffeine [positive effect (PE): 0.4%; negative effect (NE): 16.2%], alcohol (PE: 2.7%; NE: 13.3%, and salt (PE: 0.1%; NE: 9.9%) was most likely to influence tinnitus severity, it did so only for a small proportion of participants and reported effects were most commonly mild. Further, though a classification algorithm was able to leverage participant demographic, comorbidity, and tinnitus characteristics to identify those individuals most likely to benefit from dietary modification above chance levels, further efforts are required to achieve significant clinical utility. Taken together, these results do not support dietary modification as a primary treatment strategy for chronic tinnitus in the general population, though clinically meaningful effects might be observable in certain individuals.

Gout and Diet: A Comprehensive Review of Mechanisms and Management.

Gout is well known as an inflammatory rheumatic disease presenting with arthritis and abnormal metabolism of uric acid. The recognition of diet-induced systemic metabolic pathways have provided new mechanistic insights and potential interventions on gout progression. However, the dietary recommendations for gouty patients generally focus on food categories, with few simultaneous considerations of nutritional factors and systemic metabolism. It is worthwhile to comprehensively review the mechanistic findings and potential interventions of diet-related nutrients against the development of gout, including purine metabolism, urate deposition, and gouty inflammation. Although piecemeal modifications of various nutrients often provide incomplete dietary recommendations, understanding the role of nutritional factors in gouty development can help patients choose their healthy diet based on personal preference and disease course. The combination of dietary management and medication may potentially achieve enhanced treatment effects, especially for severe patients. Therefore, the role of dietary and nutritional factors in the development of gout is systematically reviewed to propose dietary modification strategies for gout management by: (1) reducing nutritional risk factors against metabolic syndrome; (2) supplementing with beneficial nutrients to affect uric acid metabolism and gouty inflammation; and (3) considering nutritional modification combined with medication supplementation to decrease the frequency of gout flares.

Association Between Dietary Fiber Intake and All-Cause and Cardiovascular Mortality in Middle Aged and Elderly Adults With Chronic Kidney Disease.

Background and AimsDespite accumulating evidence on the benefits of dietary fiber in the general population, there is a lack of representative data on mortality in patients with chronic kidney disease (CKD). This study examined the role of dietary fiber intake on all-cause and cardiovascular mortality in patients with CKD using representative Korean cohort data.MethodsThe study included 3,892 participants with estimated glomerular filtration rates <60 mL/min/1.73 m2 from the Korean Genome and Epidemiology Study. Mortality status was followed by data linkage with national data sources. Nutritional status was assessed using a validated food frequency questionnaire. Dietary fiber was categorized into quintiles (Q). A multivariable Cox proportional hazards regression model was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cardiovascular mortality.ResultsThe average daily fiber intake of patients with CKD was 5.1 g/day. During the 10.1-year follow-up period, 602 (149 cardiovascular) deaths were documented. The HR (95% CI) for all-cause mortality in the highest quintile compared with that in the lowest quintile was 0.63 (0.46–0.87) after adjusting for age, sex, BMI, smoking, alcohol intake, exercise, total calorie intake, hypertension, diabetes, and dyslipidemia (P = 0.005). The HR (95% CI) for cardiovascular mortality in the highest quintile compared with that in the lowest quintile was 0.56 (0.29–1.08) after adjusting for same confounders (P = 0.082).ConclusionIn conclusion, we observed an inverse association between dietary fiber intake and all-cause mortality in CKD patients. Small increments in fiber intake reduced the risk of all-cause mortality by 37%. This finding highlights the need for inexpensive but important dietary modification strategies for encouraging fiber intake in the Korean CKD population.

Abstract MP04: Taste Perception Profiles Are Associated With Patterns Of Adherence To A Mediterranean Diet Among Older Adults With Metabolic Syndrome

Objective: Evidence suggests perception of sweet, salt, sour, bitter, and umami tastes may be independently related to food preferences and intake. Our objective was to determine whether a collective measure of taste perception for all 5 tastes—“taste perception profiles”—was related to adherence to a Mediterranean diet (MedD). Methods: Participants were 367 older adults (55-75 years; 55% female) with metabolic syndrome from PREDIMED-Plus, Valencia. A data-driven clustering approach identified six taste perception profiles from baseline taste perception scores: Low All ( n = 85), High Bitter ( n = 41), High Umami ( n = 61), Low Bitter &amp; Umami ( n = 59), High All But Bitter ( n = 72) and High All But Umami ( n = 49). A MedD adherence score was tabulated from a questionnaire which captured adherence to 17 pre-determined MedD criteria (range = 0-17; 1 point per criteria met). Generalized linear models were used to determine the relations between taste perception profiles and MedD adherence scores, with confounder adjustment. Results: Across profiles, there were no significant differences in MedD adherence scores (unadjusted mean range = 8.1-8.6; ANOVA, p = 0.97); however, there were significant differences in the criteria met by each profile. For High All But Bitter and Low All profiles, 71% vs. 42% of individuals, respectively, met criteria for adequate vegetable intake (chi square = 12.8, p = 0.03); and for High All But Umami and High All But Bitter profiles, 95% vs. 65% of individuals, respectively, reported preferring lean over red meat (chi square = 12.5, p = 0.03). After adjusting for age, sex, physical activity, smoking status, diabetes, medication use and energy intake, compared to individuals with Low All (reference), those with High All But Bitter were more likely to meet criteria for adequate vegetable (OR [95% CI] = 2.9 [1.3, 6.6]), adequate sofrito (2.4 [1.1, 5.4]) and moderate wine (4.1 [1.5, 11.3]) intakes, and less likely to meet criteria for low non-whole grain pasta/rice (0.3 [0.1, 0.8]), white bread (0.3 [0.1, 0.6]) and red/processed meat (0.3 [0.2, 0.7]) intakes, and to report preferring lean over red meat (0.3 [0.1, 0.8]) and using extra virgin olive oil as a main cooking fat (0.4 [0.2, 0.95]); individuals with High Bitter were more likely to meet criteria for adequate fruit (2.7 [1.3, 5.5]) and less likely to meet criteria for low sugar-sweetened beverage (0.4 [0.2, 0.8]) intakes, while those with High Umami were more likely to meet criterion for adequate vegetable intake (2.2 [1.1, 4.5]). Neither Low Bitter &amp; Umami nor High All But Umami were significantly associated with MedD adherence. Conclusions: Among older adults with metabolic syndrome, taste perception profiles were associated with differential patterns of adherence to a MedD, supporting the use of taste perception profiles when developing individualized dietary modification strategies to improve cardiometabolic risk factors.

Diet Modifications in Older Women With Fecal Incontinence: A Qualitative Study.

The aim of the study was to investigate dietary modification strategies used by community-dwelling older women to manage their fecal incontinence (FI). We conducted a qualitative study with focus groups wherein women 65 years and older with FI shared their experiences managing the condition. We explored the following: (1) association between diet and FI symptoms, (2) dietary strategies and modifications used by older women to manage FI, and (3) patient input about disseminating diet modification information and strategies. All focus groups were audio recorded, transcribed, coded, and qualitatively analyzed to identify relevant themes. Twenty-one women participated in 3 focus groups. All participants were aware that diet plays a key role in their experience of FI and women described a method of "trial and error" in identifying specific aspects of their diet that contributed to their FI symptoms. Women reported modifications including avoiding or limiting several foods and food categories, changing certain methods of food preparation, as well as varying the amounts and frequency of meals to manage their FI. Women articulated several suggestions including the importance of physician input, using a balanced approach when making recommendations, and the value of sharing individual experiences. Older women with FI make several dietary modifications to manage their symptoms including limiting certain foods, changing methods of food preparation, and decreasing the amounts and frequency of meals. These strategies may be considered for inclusion in a diet modification plan that is culturally competent for older women with FI.

Incorporation of a multi-modal interactive exercise on student pharmacists’ perceptions of lifestyle modification in weight loss promotion

Background and purposeThe purpose of this project was to evaluate the impact of a calorie tracking and dietary modification activity on students’ perceptions of the challenges associated with weight loss. Educational activity and settingStudents maintained a two-day paper calorie log, then received a weight management lecture, followed by four additional days of calorie tracking using a mobile application. Demographics, self-evaluation of obesity-related knowledge, perceptions on weight loss difficulties, utility of mobile technology, and overall program value were evaluated. FindingsA total of 79% of students completed all three surveys (n = 150). Students’ perceptions regarding their knowledge and comfort with respect to weight loss counseling and dietary modification strategies increased following the lecture and mobile technology-based calorie counting activity. Seventy-eight percent of students either agreed or strongly agreed that this activity was valuable to their professional development while 86% of students agreed or strongly agreed this activity helped them understand the challenges faced by patients trying to lose weight. DiscussionStudent attitudes regarding weight loss, including nutritional tracking, and comfort in establishing a weight loss goal, as well as student's perceived knowledge of the types of dietary fats and empathy, all significantly improved over the course of activity participation. SummaryThis activity improved student pharmacists’ understanding of lifestyle modifications necessary for weight loss, exposed them to novel technologies available to help support patient's weight loss attempts, and provided them with first-hand experience in tracking calories.

Cost-effectiveness of a complex workplace dietary intervention: an economic evaluation of the Food Choice at Work study

ObjectiveTo evaluate the costs, benefits and cost-effectiveness of complex workplace dietary interventions, involving nutrition education and system-level dietary modification, from the perspective of healthcare providers and employers.DesignSingle-study economic evaluation of...

The Low FODMAPS Diet and IBS: A Winning Strategy

Background: Irritable bowel syndrome (IBS) is a common functional disorder characterized by abdominal discomfort and altered bowel habits. IBS can be a debilitating disorder affecting quality of life. Food intolerance is a common complaint among IBS patients and the relationship between diet and abdominal symptoms is well recognized. Objective: Given the growing body of evidence and interest in dietary modifications in the management of IBS, we will review the current literature supporting a diet low in fermentable carbohydrates, discuss methods to assess dietary history, and integrate dietary modification strategies into clinical gastroenterology or primary care practice. Conclusion: Recent evidence supports that dietary manipulation, including a diet low in fermentable carbohydrates, can be beneficial in patients with IBS. We believe that a time investment in dietary counseling is paramount to symptom moderation and quality of life in this population. Physicians should become knowledgeable regarding dietary assessment and counseling in the context of IBS.

Eosinophilic Esophagitis in Two Patients with Systemic Sclerosis.

The gastrointestinal tract (GIT) is the most common extracutaneous organ system damaged in systemic sclerosis (SSc) and is the presenting feature in 10% of patients. The esophagus as the portion of the GIT is the most commonly affected and there is an association of gastroesophageal reflux (GER) with SSc interstitial lung disease (ILD). Thus, an aggressive treatment for GER is recommended in all SSc patients with ILD; however, it is recognized that a long-term benefit to this treatment is needed to understand its impact. In this case report we discuss the presence of eosinophilic esophagitis (EoE) in two SSc patients and discuss the role for early EGD in SSc patients with moderate-severe GER symptoms for tissue study. Assessment of esophageal biopsy specimens for the presence of eosinophils and possibly ANA can help elucidate disease pathogenesis and direct therapy, as the presence of EoE in SSc has important management considerations, particularly with regards to dietary modification strategies.

Impact of Cowpea-Based Food Containing Fish Meal Served With Vitamin C-Rich Drink on Iron Stores and Hemoglobin Concentrations in Ghanaian Schoolchildren in a Malaria Endemic Area.

Nutritional anemia is a public health problem among Ghanaian schoolchildren. There is need to employ dietary modification strategies to solve this problem through school and household feeding programs. To evaluate the effectiveness of cowpea-based food containing fish meal served with vitamin C-rich drink to improve iron stores and hemoglobin concentrations in Ghanaian schoolchildren. The study involved cross-sectional baseline and nutrition intervention phases. There were 150 participants of age 6 to 12 years. They were randomly assigned to 3 groups, fish meal -vitamin C (n = 50), vitamin C (n = 50), and control (n = 50), and given different cowpea-based diets for a 6-month period. Height and weight measurements were done according to the standard procedures, dietary data were obtained by 24-hour recall and food frequency questionnaire, hemoglobin concentrations were determined by Hemocue Hemoglobinometer, and serum ferritin and complement-reactive protein (CRP) were determined by enzyme-linked immunosorbent assay. Participants' blood samples were examined for malaria parasitemia and stools for helminthes using Giemsa stain and Kato-Katz techniques, respectively. Mean ferritin concentration was not significantly different among groups. End line mean or change in hemoglobin concentrations between fish meal-vitamin C group (128.4 ± 7.2/8.3 ± 10.6 g/L) and control (123.1 ± 6.6/4.2 ± 10.4 g/L) were different, P < .05. Change in prevalence of anemia in fish meal-vitamin C group (19.5%) was different compared to those of vitamin C group (9.3%) and the control (12.2%). Levels of malaria parasitemia and high CRP among study participants at baseline and end line were 58% and 80% then 55% and 79%, respectively. Level of hookworm infestation was 13%. Cowpea-based food containing 3% fish meal and served with vitamin C-rich drink improved hemoglobin concentration and minimized the prevalence of anemia among the study participants.

Effect of phytate and iron-binding phenolics on the content and availability of iron and zinc in micronutrients fortified cereal flours

Iron deficiency anaemia is highly prevalent in Tanzania—affecting predominantly children and women. Fortification of cereal flour with micro-nutrients is being carried out as a strategy for combating micro-nutrient deficiencies. Four different cereal flours were fortified with micro-nutrients and evaluated for total and bioavailable iron and zinc, iron binding polyphenolics, phytate content and ascorbic acid. The extractable total phenolics ranged from 1.3 (maize) to 19.4 (redsorghum) mg catechin equivalent (CE) g-1. Catechols ranged from 1.1 (maize) to 11.7 (red-sorghum) mg CE g-1. Red sorghum was the only flour that contained a high amount of galloyls (4.0 mg tannic acid equivalent (TAE) g-1). All samples contained high amounts of phytate (10.7 ± 1.0 imol g-1). The average total iron was 42.26 ± 10.26 mg kg-1 in the unfortified and 52.67 ± 10.19 mg kg-1 in the fortified cereal flours and the average in vitro available iron was 1.03 ± 0.30 mg kg-1 and 1.65 ± 0.31 mg kg-1 respectively. The average zinc content was 21.4 ± 3.10 mg kg-1 and 25.9 ± 2.84 mg kg-1 in the unfortified and fortified flours respectively and the average available zinc was 0.30 ± 0.12 mg kg-1 and 0.53 ± 0.16 mg kg-1 respectively. No ascorbic acid was detected in any of the unfortified flour, and a little amount was detected in the fortified red sorghum (4.5 mg kg-1), compared to the white sorghum (11.1 mg kg-1), finger millet (15.8 mg kg-1) and maize (29.6 mg kg-1). There was no significant increase of in vitro available iron (0.02 mg kg-1) and zinc (0.06 mg kg-1) availability in the red sorghum. The in vitro available iron increased by 3.8 % in finger millet, by 9.2 % in white sorghum, and by 10.1 % in maize four—compared to respective total iron content as a result of fortification. In vitro available zinc increased by 7.9 % in finger millet, by 4.8 % in white sorghum and by 5.9 % in maize flours, compared to respective total zinc content as a result of fortification. It was concluded that other dietary modification strategies that are being carried out for the improvement of native iron and zinc bioavailability (processing for decreasing inhibitory factors, consumption of fruits and green leafy vegetables for enhancing absorption and nutrition education) should accompany fortification of flours with micro-nutrients. The red sorghum is not recommended as a good vehicle for food fortification with iron and zinc.

Nutrition in vulnerable communities in economically marginalized societies

Childhood malnutrition is highly prevalent in developing countries. Globally 35% (3.5 million) of child deaths before the age of five years were attributed to under nutrition in 2004. Vulnerable communities generally consume a diet based mainly on plant-based staples, and a low consumption of animal source foods, fruit and vegetables predisposes these communities to micronutrient deficiencies. In this paper, South African data is used to illustrate the poor diet and consequences thereof in vulnerable communities. Childhood malnutrition and maternal overweight often co-exist in the same community. Dietary modification strategies to address malnutrition should therefore focus on the nutritional quality of the diet, rather than on energy content only. Animal foods are particularly rich sources of bio-available iron, zinc and vitamin A (the micronutrients of greatest concern), and these nutrients are difficult to obtain in adequate amounts from plant foods alone. Foods of animal sources (particularly muscle tissue) also enhance the absorption of the less bio-available non-heme iron. Dietary modification strategies need to be introduced from a very young age. In the developed world, commercially available baby products play an important role in meeting the nutritional requirements of infants, but in developing countries cost and possible contamination (bottle feeds) prohibit the use of baby products. Addition of small amounts of foods of animal sources can improve the nutritional quality of the diet, as well as the nutritional status and functional outcomes of vulnerable populations. A moderate increase in the consumption of animal source foods will provide critical nutritional benefits without a significant increase in the risk of chronic diseases in the poor. Constraints for frequent consumption of animal source foods include availability, affordability and lack of cold storage facilities. Adequate dietary intake is essential for good nutrition, but frequent infections can also lead to malnutrition. The underlying causes of malnutrition, i.e. inadequate care on the one hand, and insufficient health services and an unhealthy environment on the other hand, should also therefore be addressed.