Frequent Snacks Research Articles

Peran Ibu dalam Menumbuhkan Ekoliterasi pada Anak Kelompok B TKIT Azkia Aceh Besar

Growing awareness of loving the environment in early childhood is an investment for the future. When children are raised by taking care of the environment, the environment will take care of them in the future, and vice versa. The aim of this research is to analyze the role of mothers in fostering ecoliteracy in TKIT Azkia group B children. This research uses qualitative methodology. Data collection methods are interviews, observation and separate document analysis. The results of this research are that mothers provide examples and get children used to using enough water, turning off the water tap after use, cooking for children and providing tumblers for children to drink in, thus minimizing children's frequent snacks outside and the use of single-use plastic bottles.

Association between academic stress during exam period, dietary behavior and bowel symptoms among medical students in Saudi Arabia

BackgroundThe study evaluated the levels of academic stress in medical students and investigated its association with eating habits and bowel symptoms. MethodsTwo hundred and ninety seven medical students participated in the study. Medical students from all five years of study were recruited using a stratified random sampling technique. A well-structured questionnaire containing three sections on stress levels, eating habits, and bowel symptoms was self-administered. Student t-test and ANOVA were used to quantify the association between variables. ResultsThe medical students showed high levels of stress accounting for low (2%), moderate (72%), and high-stress levels (26%) during exams. Men showed higher stress levels than women. The levels of stress were similar in distribution across all years of study. Poor dietary habits were noted among the medical students. Around 66% reported skipping breakfast, and 69% consumed frequent unhealthy snacks. Reduced consumption of fruits less than three times per week (61.5%) and drinking water less than 2 L per day (82.3%) was noted. Mean dietary scores worsened as the stress levels increased (p = 0.007). Similarly, higher PAC-SYM scores were associated with higher stress levels (p < 0.001). Women showed more severe constipation symptoms than men (8.83 ± 8.0 2; 5.68 ± 5.87; p < 0.001). ConclusionsAlarming levels of academic stress were noted during the exam period. There is an urgent need to frame multidisciplinary strategies involving behavior modification, nutrition education and a special focus on stress reduction programs for the medical students.

Association of Snacking Frequency, Size, and Energy Density with Weight Status among Preschool-Aged Children in the United States.

Snacking (ie, eating between meals) is common among US preschool-aged children, but associations with weight status are unclear. This research evaluated associations of snack frequency, size, and energy density as well as the percent of daily energy from snacking with weight status and sociodemographic characteristics among US children aged 2 to 5 years. Cross-sectional analysis of 2007-2018 National Health and Nutrition Examination Survey data using two, caregiver proxy, 24-hour dietary recalls. US children aged 2 to 5 years (n= 3,313) with at least one snack occasion over 2 days of intake. Snacking parameters included frequency (number of occasions per day), size (kilocalories per occasion), and energy density (kilocalories per gram per occasion) as well as percent of daily energy from snacking. Generalized linear regression models evaluated associations of snacking with child weight status (ie, normal weight and overweight/obesity), adjusting for survey weights, energy misreporting, mean meal size, and sociodemographic covariates. Children with overweight/obesity consumed more frequent snacks (2.8 [0.06] vs 2.5 [0.03] snacks/day, respectively; P < 0.001), larger snacks (188 [4] vs 162 [23] kcal/occasion, respectively; P < 0.001), and a greater percent of daily energy from snacking (29.80% [1.00%] vs 26.09% [0.40%], respectively; P < 0.001) than children with normal weight. Mean snack frequency and size as well as percentage of daily energy from snacking varied with child age, gender, and head of household education. Associations of snacking with child race and ethnicity were less consistent. These nationally representative findings provide evidence that the consumption of larger, more frequent snacks is associated with overweight/obesity among US children aged 2 to 5 years and snacking varies by sociodemographic characteristics.

ODP291 A Series of COVID Reinfections in a Vaccinated Patient leading to Development of Neurogenic Orthostatic Hypotension and Postural Orthostatic Tachycardia

Abstract The recently recognized 'long COVID' syndrome, encompasses symptoms of shortness of breath, chest pain, palpitations and orthostatic intolerance which can last for weeks or more following even mild illness. 'Long COVID' is postulated to be related to a virus- or immune-mediated disruption of the autonomic nervous system resulting in orthostatic intolerance syndromes. We report a 32-yr old female nurse who presented to the endocrinology clinic for symptoms of orthostatic hypotension following two COVID 19 infections. She had received 1 dose of Moderna vaccine in February and March of 2021 respectively. She was hospitalized for COVID June and September of 2021. Following the first hospitalization, she developed severe orthostatic hypotension, chest pain, shortness of breath, fatigue, anxiety, memory, concentration and word finding difficulty. Blood pressure ranged from 110/78 to 124/82 while lying and from 85/45 to 103/59 while standing. HR ranged from 88 to 96 while lying and from 130 to 42 while standing. She was started on midodrine 10 mg three times daily which was discontinued due to patient intolerance. She followed a regimen of adequate hydration, adequate salt intake, fall precautions, physical and speech therapy and high protein/low carb diet with frequent snacks, which improved her symptoms of dizziness and orthostasis, but without complete resolution. However, symptoms of anxiety, dizziness, chest pain and palpitations became even worse after the second hospitalization. She was started on Propranolol 20 mg 2-3 times daily depending on symptoms, and she felt better with this intervention. Evaluation for secondary causes of hypotension were all negative [Cortisol of 19 ug/dL (n=5.3-22.5); ACTH 20 pg/mL (n=0-47); TSH 2.36 uIU/mL (n=0.358 -3.74); Free T4 0.97 ng/dL (n=0.76-1.46); B12 480 pg/mL (n=193-986); Hba1c 4.9%; 25 OH Vitamin D 24.3 ng/mL; tryptase 3.7 mcg/L (n= &amp;lt;11); Sed rate 4 mm/HR (n=0-20). CBC, CMP, TPO and Tg abs, troponin levels, iron studies, ANA panel, Rheumatoid factor, anti-CCP abs, myasthenia gravis panel], CT head and MRI brain, EKG and QTc interval. Echocardiogram= small PFO. 'Post-acute COVID' refers to persistent symptoms 3 weeks after COVID-19 infection, while 'Chronic COVID' describes symptoms lasting more than 12 weeks. Symptoms include fatigue, dyspnea, chest pain, palpitations, dizziness, body aches, presyncope and orthostatic intolerance. Individuals may even develop post-traumatic stress disorder, panic attacks and irritable bowel syndrome. Orthostatic intolerance occurs due to release of epinephrine and norepinephrine leading to development of palpitations, breathlessness, and chest pain. It has been well described that orthostatic intolerance is preceded by viral infections and is associated with the development of autoantibodies α-/β-adrenoceptors and muscarinic receptors. COVID 19 itself can affect the autonomic nervous system through the release of a cytokine storm leading to sympathetic activation. It is crucial to consider the diagnosis of orthostatic intolerance syndromes post COVID infection. Presentation: No date and time listed

ODP626 Weekend Hypoglycemia: A Case of Intermittent Endogenous Hyperinsulinemic Hypoglycemia Caused by Prolonged Interval Between Hemodialysis Sessions in ESRD

Abstract Background Hypoglycemia is a common clinical dilemma with burden of risk to life, bothersome symptoms and expensive workup. With many different causes for hypoglycemia, initial workup includes differentiating insulin-dependent versus non-insulin dependent causes. Elevated insulin levels correlated with a C-peptide level can separate endogenous versus exogenous hyperinsulinemic hypoglycemia. If endogenous hyperinsulinism is discovered, further investigation into a wide array of pathology is warranted. We highlight a case of hyperinsulinemic hypoglycemia in a patient with end-stage renal disease on hemodialysis. Given limited treatment options, this case illustrates the importance of patient specific behavioral modifications. Case A 43-year-old man with T2DM with ESRD on hemodialysis (MWF) presents with recurrent episodes of severe hypoglycemia with altered mental status. On admission, serum glucose was 29 mg/dL and patient was treated with IV dextrose with resolution of symptoms. Patient denied taking anti-hyperglycemic medications. Patient was recently and similarly admitted two weeks prior where his insulin regimen (patient confirmed compliance) was discontinued due to severe hypoglycemia. Serum insulin and C-peptide at the time of this admission were 93.8 mg/dLand 29.57 nmol/L respectively. Insulin antibodies were negative. Although both values indicate an endogenous source for hyperinsulinemia, exact interpretation is unclear given his ESRD. Patient underwent hemodialysis on hospital day one. On hospital day two, patient's labs indicated hyperinsulinemic hypoglycemia again, with glucose of 56 mg/dL and an insulin of 24 mg/dL. Subsequently, an abdominal CT scan with triple phase washout was negative for an intra-pancreatic process. He had normal thyroid function, and history of adrenal insufficiency which was stable on maintenance doses of glucocorticoids. Patient also confirmed good appetite, stable weight, and albumin levels were appropriate. On hospital day 3, patient underwent his normally scheduled dialysis. Both pre- and post-dialysis insulin and C-peptide levels were collected, and insulin levels decreased &amp;gt;50% following dialysis. Patient was also started on diazoxide to reduce endogenous hyperinsulinemia after this session. No further hypoglycemia occurred during hospital stay. He was subsequently discharged home on hospital day 4 and educated on the increased likelihood of hypoglycemia during extended periods of time without dialysis, which in his case was weekends. In order to address this, he was instructed to have small, frequent mixed macronutrient meals and snacks on Sundays, leading up to Monday's dialysis session. Conclusion This case of "weekend hypoglycemia" highlights a perplexing presentation in a patient with ESRD on HD, of hyperinsulinemic hypoglycemia occurring only during prolonged interval (&amp;gt;2 days) between hemodialysis sessions. This is postulated secondary to a combination of ESRD with associated impaired renal clearance of insulin and impaired renal gluconeogenesis and resultant hyperinsulinemia that improved with dialysis sessions. Patient education on compliance with dialysis sessions and dietary counseling to reduce risk of hypoglycemia is key in management. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.

BEHAVIOR OF ELEMENTARY CHILDREN BEFORE AND AFTER EDUCATION ABOUT THE DANGEROUS SNACKING

Elementary school age children are a group of children who are prone to buying food or snacks carelessly because elementary school age children usually only see food from its shape, color and taste without seeing whether the food is good for consumption or not. If elementary school children consume unhealthy food, it can have an impact or effect on health, for example it can cause diarrhea or other digestive system disorders, besides that it can have an effect on their growth and development because the elementary school period is a time when a child needs good and healthy nutrition. . The purpose of this Community Service (PKM) is to provide education to elementary school children to change their behavior not to snack randomly. The PKM activity was carried out at SD N 104242 Lubuk Pakam for 3 days, to see the behavior before and after being given education about the impact of snacking indiscriminately, by distributing questionnaires and observing PKM participants. The results of the PKM show that before education the majority of knowledge is lacking, namely 52.3%, bad attitudes are 70.1% and actions with frequent snacks are 59.7%, and after education most of the knowledge becomes good up to 53%, attitudes become good 68.6% and the act of buying snacks indiscriminately became infrequent up to 58.2%. From the results of this community service, it can be concluded that the behavior of elementary school children is getting better, it is recommended for teachers or parents to keep an eye on their children so they don't snack randomly.

Frequent Snacks Improved Energy Intake and Nutritional Status in Community-Dwelling Older Adults at Risk of Malnutrition, Chiang Mai, Thailand

Background: Inadequate dietary intake and malnutrition are commonly found in older adults. They tend to have early satiety that limits intake from main meals. Some reports indicated that small frequent meals may promote higher intake. From that point of view, snacks may be useful. Therefore, this study aimed to determine the effects of frequent snacks on energy intakes and nutritional status in older adults at risk of malnutrition. Methods: A randomized controlled study was conducted among older adults at risk of malnutrition in a suburban community from November 2020 to March 2021 in Chiang Mai, Thailand. Two villages were randomly assigned to either a control group (n=17) or an intervention group (n=17), and they were matched pairs by age and gender. An intervention snack consisted of 2 desserts and a box of milk (total 548 kcal) was used. For the first 3 weeks, an intervention snack was provided every day although it was too heavy for some participants. Therefore, after that, the intervention snack was provided every other day for 4 weeks. A nutrition survey by the 24-hour recall method for 3 days, body weight, mid-arm circumference (MAC), triceps skinfold (TSF), and grip strength were assessed at weeks 3 and 7 as baseline. Results: Thirty-one participants completed the study (91%). The average age was 71.8±4.8 years, and body mass index (BMI) was 19.0±2.1 kg/m2 . In the intervention snack group, there was an increased daily energy intake by 316 kcal and 214 kcal at weeks 3 and 7, respectively, (P&lt;0.001, effect size: 0.884), with a body weight of 0.8 kg (P&lt;0.001, effect size: 0.314), BMI of 2% (P=0.009, effect size: 0.314), and MAC of 4% (P&lt;0.001, effect size: 0.265) compared with baseline, but such energy intake was not observed in the control group. Conclusion: Providing frequent snacks was an effective way to improve energy intake and nutritional status in community-dwelling older adults at risk of malnutrition.

Risks for development of metabolic disorders in alimentary constitutional obesity

BACKGROUND: alimentary-constitutional obesity due to it’s high prevalence, is the key problem of modern healthcare system. However, obesity is not always accompanied with metabolic disorders, leading to early invalidization and mortality. That’s why it is important to study risks of metabolical nonhealth in obesity.AIM: to detect factors, increasing risks of development of metabolic disbalance in alimentary-constitutional obesity.MATERIALS AND METHODS: In patients with alimentary-constitutional obesity there was performed an examination including anthropometry (body mass index, Waist Circumference, Hip Circumference,waist to hip ratio), blood pressure measurement, laboratory tests – metabolic indexes: glucose, insulin, insulin resistance indexes, leptin, cholesterol, cholesterol of lipoproteins, triglycerides, aspartate aminotransferase, alanine aminotransferase, gamma-glutamiltransferase), body composition measurement by bioelectrical impedance analysis; patients were also interviewed on their behavior (food habits) and physical activity.RESULTS: There were formed two groups depending on metabolic health indexes: main group – metabolically non-healthy obesity (MNHO) - 241 persons (aged 41±12,09, duration of obesity 12,5±9,51 years) with alimentary-constitutional obesity and two or more signs of MS, a comparison group – of metabolically healthy obesity (MHO) – 120 persons (aged 35,5±10,03; p&lt;0,05, duration of obesity 8,0±7,39 years; p&lt;0,05) with alimentary-constitutional obesity and one sign of MS or without it. Data analysis of studied risk factors for development of metabolically non-healthy alimentary-constitutional obesity confirmed that most relevant factor in development of MNHO is abdominal fat mass distribution (increasing of Waist Circumference over 88 sm in females and over 102 sm in mails). At the same time MNHO had correlation not only with classical signs of MS, but also with blood insulin level, insulin resistance indexes, fat metabolism disbalance and liver disfunction. More severed risk for appearance of metabolic disorders have patients over 45 years old with decreased active cell mass (less than 45%), duration of obesity above 10 years and obesity-burdened heredity. In food habits risk of development of metabolically non-healthy obesity was increased in taking of fat milk food, and, on the contrary, - frequent snacks, alcohol free sweet drinks didn’t affect it.CONCLUSION: Development of MNHO is associated not only with the age of patient, duration of obesity, carbohydrate and fat metabolism indexes, but also with decreased percentage of metabolically active tissues and some food habits.

Secondary School Male Students Perception Towards Their Weight, Almethnab Town, Qassim, Saudi Arabia.

ObjectiveTo determine the perception of Almethnab town secondary school male students towards their body weights.MethodologyWe surveyed male secondary school students in Almethnab town in Qassim using a self-administered questionnaire and weighing/height scale. All of the four secondary schools were targeted. The calculated sample size was 256 students. A stratified cluster sampling technique was used to select research participants. Body mass index (BMI) was calculated and interpreted using web-based CDC childhood and adolescent BMI calculator. Weight status perception was assessed by comparing students' opinions about their weight against BMI percentile status.ResultsOut of 363 selected students, all of the available 270 students participated, with a response rate of 74%. Thirty-two (12.2%) of the students were underweight, 143 (54.6%) were normal, 30 (11.5%) were overweight, and 57 (21.8%) were obese. Students perception towards their weight was correct for 159 (65%) of students. Out of the 87 overweight/obese students, 16 (18.4%) perceived their weight as appropriate, 17 (53.1%) of 32 underweight students look at their bodies as normal, while 29 (20.4%) of normal weight students perceive themselves as overweight. Obese students exercise less both in frequency and duration than non-obese ones. Sweetened drinks, fast food and frequent snacks are weakly associated with obesity.ConclusionPrevalence of obesity is very high among male secondary school students in Almethnab town.One-third of students have misperceptions about weight status.

Association of Weight Status With the Types and Quantities of Foods Consumed at Snacking Occasions Among US Adolescents

ObjectivesUS adolescents with overweight (OW) and obesity (OB) consume larger and more frequent snacks (i.e., foods consumed between meals) than adolescents with normal weight (NW); but, the food group sources of these snacks by body weight status remains largely unknown. This research aimed to evaluate snack food group composition by weight status among US adolescents. MethodsCross-sectional analysis evaluated 10 USDA Food Patterns Equivalents Database (FPED) components from snacking occasions using two, 24-hr dietary recalls among U.S. adolescents (n = 6,591;12–19 y) participating in the 2005–2016 National Health and Nutrition Examination Survey. Analysis of covariance was used to evaluate food intakes by weight status, adjusted for energy misreporting and other covariates. ResultsConsumption of added sugars, solid fats, and refined grains from snacks alone represented 64%, 38%, 32%, respectively, of recommended daily limits. Adolescents with OB consumed greater total daily energy from snacks (NW = 441(11)kcal; OW = 540(17)kcal; OB = 645(23)kcal, P < 0.05) and a greater percentage of total daily energy from snacks than adolescents with OW and NW (NW = 22%; OW = 24%; OB = 25%, P < 0.05). Adolescents with OB also consumed significantly higher amounts of refined grains, dairy, protein, oil, solid fat, and added sugar from snacks and total daily intake than adolescents with OW and NW (P < 0.05). ConclusionsUS adolescents consume one to two-thirds of recommended daily limits of added sugar, solid fats, and refined grains from snacks. Adolescents with OB consume higher levels of those and other food components from snacks than adolescents with OW and NW. Funding SourcesNational Institutes of Health; R21HD085137.

The Association Between Obesity, Being Overweight and Socio-economic Status Among School-Age Children Living in Big Cities

Introduction: Obesity has become a serious health concern worldwide. Risk factors of obesity are different in urban and rural areas. The aim of this study was to determine the risk factors related to obesity and being overweight among children in low and high socio-economic groups in a big metropolitan city, Istanbul. Materials and Methods: A cross-sectional study was carried out on 490 schoolage children between 5 and 15 years. Low and high socio-economic groups were determined according to socio-economic status (SES). Socio-demographic characteristics of children were collected from the parents. Results: The effect of having frequent snacks rich in carbonhydrates (p=0,001) and sedentary lifestyles (p=0,001) on BMI was significant in both SES groups. In high SES group, BMI of the <10 years boys was significantly higher than that of the <10 years girls; Boys also had higher BMI at both age groups of either younger or older than 10 years. In low SES group, girls were significantly more overweight than boys. High family income, high paternal BMI and consuming energy rich products increased the obesity risk in children 1,560 times (OR: 1,560, %95 CI: 1,046-2,326), 2,015 times (OR: 2,015, %95 CI: 1,092-3,720), and 4,33 times (OR: 4,330, %95 CI: 2,897-6,472), respectively. Conclusions: As conclusion, high family income, high paternal BMI and consuming energy rich products incre-ased the obesity risk. We suggest that every community has own characteristics but boys tend to have high BMIs in families with high SES.

Effects of glucose ingestion at different frequencies on glycogen recovery in mice during the early hours post exercise

BackgroundWhen a high-carbohydrate diet is ingested, whether as small frequent snacks or as large meals, there is no difference between the two with respect to post-exercise glycogen storage for a period of 24 h. However, the effect of carbohydrate intake frequency on glycogen recovery a few hours after exercise is not clear. Athletes need to recover glycogen quickly after physical exercise as they sometimes exercise multiple times a day. The aim of this study was to determine the effect of carbohydrate intake at different frequencies on glycogen recovery during the first few hours after exercise.MethodsAfter 120 min of fasting, 6-week-old male ICR mice were subjected to treadmill running exercise (20 m/min for 60 min) to decrease the levels of muscle and liver glycogen. Mice were then given glucose as a bolus (1.2 mg/g of body weight [BW], immediately after exercise) or as a pulse (1.2 mg/g of BW, every 15 min × 4 times). Following this, the blood, tissue, and exhaled gas samples were collected.ResultsIn the bolus group, blood glucose concentration was significantly lower and plasma insulin concentration was significantly higher than those in the pulse group (p < 0.05). The plantaris muscle glycogen concentration in the bolus group was 25.3% higher than that in the pulse group at 60 min after glucose ingestion (p < 0.05). Liver glycogen concentration in the pulse group was significantly higher than that in the bolus group at 120 min after glucose ingestion (p < 0.05).ConclusionsThe present study showed that ingesting a large amount of glucose immediately after exercise increased insulin secretion and enhanced muscle glycogen recovery, whereas frequent and small amounts of glucose intake was shown to enhance liver glycogen recovery.

Adolescent eating behaviors in the UAE: Time to intervene.

Background:Obesity is the single most burdensome lifestyle disease, which has reached epidemic proportions. This study aimed to examine the eating behavior patterns and beliefs in a group of adolescents living in the United Arab Emirates (UAE).Procedure:A questionnaire was administered to adolescents (aged 11 and 18 years) attending outpatients' clinics at governmental health facilities. Informed consent was obtained, and the questionnaire was available in English or Arabic languages.Results:In all, 36 adolescent subjects participated in our study with 12 males and 24 females. UAE nationals constituted 72% of our participants and 28% were of other ethnic backgrounds; 75% were overweight to obese with 17% normal and 8% underweight. The majority of patients were healthy with only 6 patients suffering chronic medical diseases. We uncovered that in less than half of our cohort, the decision to eat came directly from the individuals themselves, but it was more influenced by their families. Food consumption was largely in response to physical hunger with the sensation perceived in the upper abdomen by one-third and the remainder localizing it to various other areas. Excessive caloric intake with frequent meals and snacks was also reported. Our study subjects decided what to consume mainly based on what appeared appetizing, followed by availability and cravings and to a lesser extent based on health recommendations. Excessive speed of food ingestion was self-reported in the majority of participants. Moreover, almost half of the adolescents were unable to turn down food offerings from their close family members and over one-fourth were unable to refuse food from other persons. Common symptoms reported included dysphoric mood, disordered sleep, decreased energy and concentration difficulties as well as low self-esteem.Conclusion:Our study uncovered certain eating behaviors in the cohort of adolescents, which may be important in promoting weight gain. These included misconceived hunger signals, excessive frequency, amount and speed of food consumption as well as more focus on food taste, inattentiveness to cravings and a strong social influence on food intake decisions. The findings of our study aim to shed some light on the eating patterns among adolescents and encourage research to investigate eating behaviors on an expanded scale evaluating ethnic, gender and age-related differences.

Preliminary Trajectories in Dietary Behaviors during the COVID-19 Pandemic: A Public Health Call to Action to Face Obesity.

The world is currently struggling to face the coronavirus pandemic (COVID-19), and many countries have imposed lockdowns and recommended quarantine to limit both the spread of the virus and overwhelming demands for medical care. Direct implications include the disruption of work routines, boredom, depression, increased calorie consumption, and other similar harmful effects. The present narrative review article briefly analyzes the preliminary effects of the quarantine lifestyle from the standpoint of dietary habits. In six different databases, we searched for original articles up to 10 August 2020, assessing eating habits among populations during the COVID-19 pandemic, and recorded any change in the intake of major food categories, as well as changes in body weight. The research strategy yielded 364 articles, from which we selected 12 articles that fitted our goal. Our preliminary findings revealed a sharp rise of carbohydrates sources consumption, especially those with a high glycemic index (i.e., homemade pizza, bread, cake, and pastries), as well as more frequent snacks. A high consumption of fruits and vegetables, and protein sources, particularly pulses, was also recorded, although there was no clear peak of increase in the latter. Data concerning the consumption of junk foods lacked consistency, while there was a decreased alcohol intake and fresh fish/seafood consumption. As a possible connection, people gained body weight. Therefore, in the realistic perspective of a continuing global health emergency situation, timely preventive measures are needed to counteract obesity-related behaviors in the long-term, so as to prevent further health complications.

Obesity represents a strong pathogenetic link with the pathology of pregnancy and childbirth

Obesity is a significant health and social problem that is the scale of the growing worldwide epidemic. Over the past 10 years, the number of obese pregnant women has doubled. There are multiple risk factors associated with obesity, which includes poor nutrition, foods that are high in easily digestible carbohydrates and fats, frequent snacks, and widespread fast food consumption. Metabolic changes, especially in women with the genetic predisposition, are manifested by insulin resistance, hyperinsulinemia, arterial hypertension, and hypercoagulation syndrome. The course of pregnancy and childbirth in obese women is associated with a series of successive pathological conditions, such as miscarriage, the occurrence of gestational diabetes mellitus, preeclampsia and eclampsia, infectious complications, prolonged pregnancy, the occurrence of bleeding and much more. We have analyzed modern ideas about womens reproductive health and the course of pregnancy and childbirth in obesity.

The Effect of Chronobiology and Variety of Macronutrients on BMI, Waist, Body Fat and HOMA-IR in Patients with Metabolic Syndrome

Abstract Objectives The aim of this study was to assess the effect of both meal timing and diet composition on BMI, waist, body fat and HOMA-IR in patients with metabolic syndrome (MS). Methods We studied 77 patients with MS (32 men and 45 women). Detailed analysis of baseline food-diaries showed that 43 patients (56%) were mostly eating after 3 p.m., generally skipping breakfast, and had more frequent carbohydrate snacks. We divided patients into two groups. The first group consisted of patients with most caloric intake after 3 PM, and the second group included patients who were evenly consuming their food throughout the day. Following diet were offered: 3-fold meal (food intake was at 7–9a.m., 1–2p.m. and 6–7p.m.) with very low-carbohydrate (LC) breakfast and dinner, lunch consisted of LC, proteins (P), polyunsaturated fatty acids (PUFAs) and non-starchy vegetables(V); there were absolutely no snacks during the day. Daily calorie intake was reduced by 20% from baseline. Diet intervention lasted 12 weeks. No medication were used during this period. Results 60 patients completed the trial (32 and 28 patients in first and second groups respectively). BMI was reduced from 33,1 ± 5,0 kg/m2 to 29,8 ± 4,6 kg/m2, the effect was similar in both groups (Cohen's d = 0,7, P = 0003). Mean body fat decreased from 40,7 ± 7,0% to 35,8 ± 7,5% in 12 weeks and treatment effect was more pronounced in second group (Cohen's d = 0,76, P = 0007). The most significant changes were observed in HOMA-IR, which decreased from 4,0 ± 1,1 to 2,1 ± 1,1, treatment effect was also more pronounced in second group (Cohen's d = 1,22, P = 0001). Waist circumference statistically decreased too (from 100,9 ± 16,8сm to 92,0 ± 14,6сm), although with more modest effect - Cohen's d = 0,58, P = 0003. Maximum effect size was in HOMA-IR changes. whereas minimum in waist circumference. Conclusions Our findings demonstrate that this diet (low carb, hight fat, 3-fold meal diet with lunch before 3 p.m.) is associated with statistically different changes in BMI, waist, body fat and HOMA-IR and the intervention was more effective among patients in second group. Funding Sources Not funded.

SAT-679 Autoimmune Hypoglycemia: A Treatment Challenge

Background: Upon evaluation of patients with recurrent hypoglycemia, both exogenous and endogenous causes should be excluded. Among endogenous hyperinsulinemic hypoglycemia (EHH) pathologies, Insulin Autoimmune Syndrome (IAS), even though extremely rare, must be considered. Most cases of IAS have been reported in the Oriental population, mostly Japanese. No gold standard of care for this condition has been established. Clinical Case: This is the case of an 82 year-old obese female patient with dyslipidemia, obstructive sleep apnea, and osteoarthritis that comes to the Endocrinology clinics for evaluation due to recurrent episodes of hypoglycemia. She refers that for the last three years she had been presenting with multiple episodes of symptomatic hypoglycemia, even levels as low as 30 mg/dL, requiring multiple hospitalizations. Consequently, she refers a 15-pound weight gain because of multiple daily snacks. Home medications were simvastatin and diclofenac. She denies using insulin, sulfonylureas, other hypoglycemic agents, alcohol, or illicit substances. Abdominal MRI and PET CT scan were remarkable only for an atrophic pancreas without focal masses. Patient was hospitalized for a supervised 72-hour fast, resulting in severe hypoglycemia within 14 hours with elevated insulin levels at 46.3 uIU/mL (1.7-31.0 uIU/mL), elevated C-peptide levels at 5.79 ng/mL (0.9-4.3 ng/mL) and elevated insulin antibodies 53µU/mL (<5µU/mL). Patient showed sufficient hepatic reserve after glucagon administration as well as intact cortisol and growth hormone axis upon severe hypoglycemia. With these results, a diagnosis of IAS was made; not associated with other autoimmune diseases, or with medications with sulfhydryl groups, such as the cases already reported on literature. This condition represents a therapeutic challenge because there is no gold standard of care. Literature recognizes diverse treatment options that range from diet modification to more aggressive therapies, including plasmapheresis and immunosupressants. Our patient was managed with diet modification including frequent snacks and Diazoxide with the goal of decreasing insulin levels and inducing hyperglycemia. Diazoxide therapy achieved a steady euglycemic state and decreased insulin antibodies. Patient developed intolerable bilateral lower extremity edema and treatment was modified to complex carbohydrates, frequent snacks in the daytime and Diazoxide only at bedtime, which is the longer fasting period. Patient has remained without episodes of hypoglycemia and diabetes has not been diagnosed since starting treatment two years ago. Conclusion: Early recognition of IAS is essential in order to avoid unnecessary studies and procedures which could delay management. Although no gold standard therapy has been identified for this condition, our case report identifies Diazoxide as a compelling medical treatment.

SUN-929 An Unusual Presentation of Insulinomas-Profound Hypophosphatemia

BACKGROUND: Insulin induces intracellular shift of phosphorus, causing hypophosphatemia. This is mild, transient and quiescent in normal persons. Persistent hyperinsulinemia in patients with depleted phosphorus stores can cause profound symptomatic hypophosphatemia. Clinical Case: A 36yr old man with MEN 1 presented in follow-up. His original manifestation of MEN 1 was familial primary hyperparathyroidism (pHPT) for which he had parathyroidectomy in 2009. At one of his endocrine clinic visits, he was noted to have asymptomatic hypophosphatemia with serum phosphorus of 2.4 (2.7–4.5 mg/dL) and mildly elevated PTH of 89 (9–77 pg/mL). This was presumed to be due to mild persistent/recurrent pHPT, and he was advised to increase dietary phosphorus intake. About a year later, he presented to the emergency room (ER) with palpitations and marked asthenia. Serum phosphorus was 1.0. He was treated with intravenous phosphorus and discharged on oral phosphorus replacement with advice to increase his dietary phosphate intake. Despite this, he continued to have recurrent spells of dizziness, weakness, palpitations, and marked hypophosphatemia several requiring repeat ER visits. His degree of mild pHPT remained stable and imaging studies to identify a possible cause for tumor induced osteomalacia with phosphate wasting was unrevealing. He volunteered at a follow up visit that he had a long history of low blood sugar spells (confirmed by fingerstick) that he had learnt to manage with frequent carbohydrate rich snacks. This prompted the consideration of a possible insulinoma as the cause for his persistent hypophosphatemia. Despite significant hypoglycemia on an abbreviated supervised fast, an OGTT and mixed meal test showed profound severe insulin mediated hypoglycemia. CGMS also showed multiple extended early morning severe hypoglycemic spells <50mg/dl over a 2 wk period. Multiple imaging tests were negative but a Gallium Dotatate scan revealed multiple areas of uptake in his pancreas. Endoscopic ultrasound of the pancreas demonstrated multiple masses in the pancreas: one 7 x 5 cm mass in the body and one 4 x 4 cm mass near the neck of the pancreas. Fine needle aspiration biopsy revealed well-differentiated neuroendocrine tumors. He had distal pancreatectomy and tumor enucleation of 5 tumors identified on intraoperative sonography. Histopathology confirmed multiple neuroendocrine tumors, with immunostaining for insulin. He has had no further episodes of hypophosphatemia since despite being off oral phosphate supplements. Conclusion: Profound hypophosphatemia can be the dominant presentation of persistent hyperinsulinemia seen in patients with insulinoma. Insulinomas and other causes of persistent hyperinsulinemia need to be considered in the differential diagnosis of persistent/recurrent hypophosphatemia.

The association between night shift work and nutrition patterns among nurses: a literature review.

The shift work system may affect the temporal distribution of eating and diet quality. The paper aimed at reviewing a body of research examining the associations between night shift work and dietary habits among nurses. Data from the PubMed and Google Schoolar databases, as well as references lists in selected papers were searched. The authors used the following keywords: nurses, shift work, diet, nutrition. Papers published in English or Polish were selected for the review, and as many as 19 papers published in 2000-2017 were eventually identified. The studies varied greatly with respect to the study size, subjects' age and the duration of night shift work. The major problem was the heterogeneity of the tools used for dietary assessment. Self-administered questionnaires were used and analyses were rarely adjusted for confounders. Alcohol consumption was the most frequently analyzed aspect (N = 8 studies), followed by the total energy (N = 7), protein, fat (N = 6), and carbohydrate intake, coffee and fruit consumption (N = 5). The results showed quite a consistent association of night work with higher coffee (caffeine) consumption, as well as lower alcohol, and fruit and vegetables consumption. Few studies also reported more frequent snacks consumption, later time of the last meal, eating at night, meals irregularity, and a poorer diet quality among night shift nurses when compared to the reference. The review showed some poor nutritional habits among nurses working night shifts. However, the topic warrants further attention, owing to the relatively small number of the studies performed so far, and their numerous methodological limitations. Med Pr. 2019;70(3):363-76.

MON-145 An Unusual Cause of Hypoglycemia in a Non-Diabetic Elderly Male

Introduction: Hypoglycemia (HYPO) in non-diabetic patients is an unusual scenario and presents a diagnostic challenge, resulting in serious consequences for patients. We describe the case of an elderly non-diabetic male who developed severe persistent HYPO. Case: A 78-year-old male with history of macroprolactinoma taking bromocriptine, Hashimoto's hypothyroidism, initially treated with low dose L-thyroxine, followed by Graves' hyperthyroidism, Parkinson’s disease (PD), osteopenia was noted to have hypoglycemia (54 mg/dL) on routine lab work. When questioned, he admitted to having had years of lightheaded episodes, "feeling jittery", which improved within minutes after eating sugary foods. His wife mentioned that he “loved to eat sweets” and high simple carbohydrate meals(CARBS). Physical exam - orthostatic hypotension and mild resting tremors, both attributed to PD. Continuous glucose monitoring (CGMS) was performed for 2 weeks which documented HYPO overnight while sleeping, fasting and between meals. The HYPO was associated more frequently with sweet bedtime snacks. Laboratory- Glucose tolerance test was stopped due to HYPO with symptoms. ACTH=19 pg/mL (nl 0-47), AM Cortisol 19.4 microg/dL (nl 5.3-22.5), fasting blood glucose 83 mg/dL(nl 70-99), fasting insulin 6.9 mIU/L( nl 0-24.9), proinsulin 16.9 pmol/L ( nl <=18.8 pmol/L), c-peptide 1.39 ng/mL( nl 0.81-3.85), beta-OH butyrate 0.072 mmol/L( nl 0.020-0.270). Islet cell Ab was normal. Gastric emptying study was negative. Although the dose of bromocriptine was reduced due to HYPO, it continued. He was advised to decrease intake of CARBS, eat small, high protein and fat meals with frequent snacks. On subsequent visits, he reported less hypoglycemic episodes with improved energy level and general well-being, which was confirmed by CGMS. Discussion: Although a wide range of diseases can cause HYPO in nondiabetic patients, differences in characteristics between non-diabetic HYPO and diabetic HYPO have not been well studied. Common underlying diseases associated with HYPO include malignancies, cerebrovascular diseases, infection, major organ failure, and alcohol-related disorders. In addition, comorbidities linked with HYPO include sepsis, kidney diseases, and alcohol dependence, pneumonia, liver diseases and insulin abuse. Malnutrition, alcohol, infection, and post gastrectomy are the leading causes of nondiabetic hypoglycemia. In addition, methimazole use has been associated with insulin autoimmune syndrome resulting in HYPO due to interaction of sulfhydryl group with disulfide bond in the insulin molecule Conclusion: Clinicians should be aware of the potential for hypoglycemia in non-diabetic patients, due to other etiologies, which can also result in severe and possibly life-threatening sequelae. An in-depth evaluation, including the use of CGMS can assist in determining underlying causes.