Intensive Dietary Counseling Research Articles

Dietary Management in Patients with Liver Cirrhosis and Renal Failure

Cirrhosis patients are prone to develop kidney dysfunction. Hepatorenal failure (HRS) is one of the most severe complications of cirrhosis. Majority of cirrhosis patients have higher nutritional requirements owing to hyper catabolic state. The macronutrient intake is tailored to suit liver failure in cirrhosis patients with renal failure while regarding fluid and minerals like sodium; potassium etc weightage is given for the renal failure. Energy intake of 30 kcal/kg/day and protein intake of 1.2 g/kg/day for maintenance of nutritional status and 35 kcal/kg/day and 1.5 g/kg/day protein for improvement of nutritional status is recommended. Dietary protein of at least 1.0-1.2g/kg/day may be sufficient to prevent negative nitrogen balance. Multiple meals and snacks containing food rich in carbohydrates should be given to reduce the risk of hypoglycemia, Late evening snacks and a breakfast containing some proteins to shorten the period of fasting is recommended. Medium chain triglycerides should be used in case of fat malabsorbtion. In cirrhotic patients with ascites the recommended intake of sodium is nearly 80 mmol day or 2 g of sodium. Hyperkalemia may occur in HRS (or AKI) and patients using potassium sparing diuretics Hypokalemia has to be avoided as it can precipitate HE Micronutrients and vitamins need to administer for treating confirmed or clinically suspected deficiency Appropriate, adequate and timely nutritional management with individualized and intensive dietary counselling is the key component to prevent malnutrition.

Dietary counselling to reduce moderate sodium intake: effects on cardiovascular and renal biomarkers: primary findings of the COSIP and STICK phase II feasibility randomised controlled trials.

While low sodium intake (<2.3g/day) is recommended, there is uncertainty about long-term feasibility and effects on cardiorenal biomarkers in populations with moderate intake. In two phase IIb, feasibility, randomised, parallel, open-label, controlled, single-centre trials, individuals aged >40 years with stable blood pressure (BP), without heart failure or postural hypotension were randomised to intensive dietary counselling (target sodium intake <2.3g/day) or usual care between March 2016 and July 2018. One trial included participants with chronic kidney disease (CKD); the other excluded those with CKD or cardiovascular disease. All participants received healthy eating advice. Primary outcomes were NT-pro B-type natriuretic peptide (NT-proBNP), high sensitivity troponin T (hsTnT), C-reactive protein (CRP), renin, aldosterone and, creatinine clearance (CrCl) at 2-years. These trials are registered with ClinicalTrials.gov, STICK trial (NCT02458248) and COSIP trial (NCT02738736). 373 participants, with mean 24-h urine sodium 3.16±1.47g/day, were randomised to intervention (n=187) or usual care (n=186). At 3-months, the intervention reduced 24-h urine sodium (intervention-0.11g/day, usual care+0.28g/day, p=0.003), BP (systolic-2.52mmHg, p=0.05; diastolic-1.92, p=0.02) and increased renin (+33.35 mIU/L [95%CI 3.78-62.91]). At 2-years, the intervention significantly reduced self-reported salt use (p<0.001), but not 24-h urine sodium (intervention-0.23g/day, usual care+0.05g/day, p=0.47). At 2-years, there were no significant between-group differences in BP (systolic p=0.66; diastolic p=0.09), NT-proBNP (p=0.68), hsTnT (p=0.20), CRP (p=0.56), renin (p=0.52), aldosterone (p=0.61), or CrCl (p=0.68). Among individuals with moderate sodium intake, intensive dietary counselling resulted in small short-term reductions in sodium intake and BP, but no significant effect on sodium intake, BP, or cardiorenal biomarkers at two years. Our trial suggests that it may not feasible to reduce sodium sustainably in those with a sodium intake around 3.0g/day, through an intensive dietary counselling intervention. The STICK trial was funded by the Health Research Board of Ireland and the COSIP trial was funded by the European Research Council.

The beneficial effects of intradialytic parenteral nutrition in hemodialysis patients with protein energy wasting: a prospective randomized controlled trial

In hemodialysis (HD) patients, protein-energy wasting (PEW) is highly prevalent and firstly treated with oral nutritional supplements (ONS). The extent to which intradialytic parenteral nutrition (IDPN) contributes to improve PEW status in HD patients intolerable to ONS remains unclear. Maintenance PEW HD patients being unable to tolerate ONS adverse effects, and having spontaneous energy and protein intake of ≥ 20 kcal/kg/day and ≥ 0.8 g/kg/day, respectively were randomly assigned 1:1 into IDPN and control groups. In IDPN group, most concentrated 3-in-1, fish-oil based parenteral nutrition was infused during HD for 3 months. The control group received intensive dietary counselling once weekly for 3 months. Both groups were then followed for additional 3 months after intervention. A total of 38 patients were randomized (mean age 67.6 years). After 3 months, serum albumin was significantly higher in the IDPN (n = 18) compared with control group (from 3.5 ± 0.3 to 3.8 ± 0.2 vs from 3.6 ± 0.3 to 3.5 ± 0.3 g/dL, respectively, p = 0.01). Spontaneous dietary intake (p = 0.04), body weight (p = 0.01), and malnutrition inflammation score (MIS, p = 0.01) were improved in the IDPN, but not in the control group. Muscle mass, strength, serum prealbumin, interleukin-6, high sensitivity-c reactive protein, and acylated ghrelin were not significantly different but leptin levels increased in the control group after 3 months (p = 0.03). At 6 months, serum albumin in the IDPN group was persistently higher than baseline (p = 0.04). Neither volume overload nor uncontrolled hyperglycemia was found throughout the study. In conclusion, a 3-month IDPN supplementation demonstrated a significant increase in serum albumin, body weight, spontaneous oral intake, and MIS; and appeared to be superior to continuing intensive dietary counselling among HD patients intolerable to ONS. The impacts of IDPN therapy on clinical outcomes may require larger scale with longer period of study.

A Low Glutamate Diet Improves Cognitive Functioning in Veterans with Gulf War Illness

Abstract Objectives The objective of this research was to investigate a novel low glutamate dietary intervention for Gulf War Illness (GWI), a chronic multi-symptom disorder that includes cognitive dysfunction. Methods Forty GW veterans with GWI were recruited from across the US. As part of a larger clinical trial, participants completed computerized cognitive testing and the Adult ADHD Self-Report Scale (ASRS) using CNS Vital Signs® (CNSVS) software. Before diet initiation, subjects received intensive dietary counseling. Post-diet assessments were completed after 1 month on the diet, and then participants were randomized to a 2-week double-blind placebo-controlled crossover challenge with glutamate (MSG)/placebo administered over 3 days of each week. The CNSVS battery was administered again on the 3rd day of each challenge week. The challenge data have not yet been un-blinded, and therefore will not be included in this abstract. Pre-post testing (t-test or Wilcoxon Signed Rank test) was conducted for each domain in the CNSVS battery, including an overall marker of neurocognitive function (NCI) and the ASRS. Results Several cognitive domains were significantly improved after 1-month on the low glutamate diet, including NCI (P &amp;lt; 0.01), executive functioning (P = 0.01), cognitive flexibility (P &amp;lt; 0.05), motor speed (P &amp;lt; 0.01), processing speed (P &amp;lt; 0.05), and psychomotor speed (P = 0.001). However, reaction time was slower at post-diet testing (P = 0.01). ADHD symptoms were also significantly improved at post-diet (P &amp;lt; 0.0001). Conclusions Veterans with GWI showed major improvements in cognitive function after 1-month on a low glutamate diet, including improvement in overall neurocognitive status. Upcoming analysis of the double-blind placebo-controlled crossover challenge data will provide additional information on which cognitive domains are directly affected by challenge with glutamate relative to placebo. Funding Sources The US Army Medical Research Acquisition Activity, 820 Chandler St, Fort Detrick MD 21,702–5014 is the awarding and administering acquisition office. This work is supported by the Office of the Assistant Secretary of Defense for Health Affairs through the Gulf War Illness Research Program. Opinions, interpretations, conclusions and recommendations are those of the author and are not necessarily endorsed by the Department of Defense.

Nutritional management during treatment for head and neck cancer

Summary Background The majority of patients who suffer from head and neck cancer are malnourished even prior to treatment initiation. In addition, side effects from cancer therapy including change in taste, mucositis, nausea or diarrhea increase patients’ malnutrition. Therefore, early management is crucial to improve nutritional status, prognosis and quality of life of patients. Methods A literature research was performed in PubMed, Medline and other available databases. The guidelines of the German Society for Nutritional Medicine, the European Society for Clinical Nutrition and Metabolism and common recommendations of other countries were selected, analyzed and summarized. Results Early screening for malnutrition is recommended for all cancer patients. Adequate intake of energy and protein should be ensured which may be achieved by consumption of oral nutritional supplements or enteral nutrition such as tube feeding. Conclusion It is important to determine the best course of management to maintain body weight and reduce typical adverse effects of malnutrition to improve quality of life. All patients at any stage of their treatment should receive intensive dietary counseling.

Dietary Counselling Using Nutrition Care Process Pathway in Cancer Patients Receiving Chemotherapy and/or Radiotherapy Improves Nutritional Status, Quality of Life and Patient Experience Compared with Standard Practice - A Randomized Controlled Single Cen

&lt;p&gt;To determine the impact of Intensive Dietary Counselling (IDC) using Nutrition Care Process (NCP) pathway compared with standard practice (general nutrition advice of foods taken ad libitum) on nutritional status and Quality of Life (QoL) in patients receiving chemotherapy and/or radiotherapy. The patient satisfaction with the IDC model was assessed. This prospective, randomized, controlled trial included 150 adult patients undergoing chemotherapy and/or radiation therapy at Cytecare Cancer Hospitals, Bengaluru. Patients were randomized to receive either dietary counselling using NCP pathway (n=80) or standard practice (n=70). Outcome measures were QoL assessed using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 and nutritional status was assessed using Subjective Global Assessment at baseline and after 12 weeks of starting treatment. Patient experience was recorded using organizational patient satisfaction survey tool. The dietary counselling group showed improved QoL compared with the standard practice group at the end of 12 weeks of starting treatment (p&amp;lt;0.01). The body weight and nutritional status significantly improved in the group that received dietary counselling using the NCP pathway compared with standard practice (p&amp;lt;0.01). The dietary counselling group also reported higher patient satisfaction with the nutrition intervention compared with standard practice. Dietary counselling following the nutrition care process pathway result in significant difference in the QoL and nutritional status compared with standard practice in patients undergoing cancer treatment. Nutrition intervention using this model also increased the patient experience.&lt;/p&gt;

Impact of Intensive Dietary Counseling on Serum Albumin in Haemodialysis Patients with Chronic Liver Disease

People on maintenance haemodialysis (MHD) are at risk of developing malnutrition, which is defined as the consequence of insufficient food intake or a suboptimal quality diet. The kidney and the liver play a central role in protein metabolism. The major aim of the study was to evaluate, for the first time in Romania, the impact of intensive dietary counseling and personalised diets on serum albumin (SA) and others nutritional parameters, but also the relationship between albumin level, inflammation and nutritional status in a cohort of haemodialysis patients which associate or not chronic liver disease (CLD). We prospectively analysed the inflammatory status and malnutrition in 162 HD patients, mean age 56�13 years, from a single dialysis centre. At baseline we evaluated: a. calorie-protein intake using patient�s diet history with the help of 72 hrs recall method;b. nutritional status by anthropometric measures- post dialysis body weight (BW), body mass index (BMI), TSF (tricipital skinfold), MAC (mid-arm circumference), MAMC (mid-arm muscle circumference);c. modified subjective global assessment score (mSGA);d. biochemical tests: pre-dialysis serum albumin, serum creatinine, alkaline reserve, Kt/V and Protein C Reactive (CRP). The patients were followed-up for 6 months.

Randomised controlled trial of early prophylactic feeding vs standard care in patients with head and neck cancer

Background:Weight loss remains significant in patients with head and neck cancer, despite prophylactic gastrostomy and intensive dietary counseling. The aim of this study was to improve outcomes utilising an early nutrition intervention.Methods:Patients with head and neck cancer at a tertiary hospital in Australia referred for prophylactic gastrostomy prior to curative intent treatment were eligible for this single centre randomised controlled trial. Exclusions included severe malnutrition or dysphagia. Patients were assigned following computer-generated randomisation sequence with allocation concealment to either intervention or standard care. The intervention group commenced supplementary tube feeding immediately following tube placement. Primary outcome measure was percentage weight loss at three months post treatment.Results:Recruitment completed June 2015 with 70 patients randomised to standard care (66 complete cases) and 61 to intervention (56 complete cases). Following intention-to-treat analysis, linear regression found no effect of the intervention on weight loss (10.9±6.6% standard care vs 10.8±5.6% intervention, P=0.930) and this remained non-significant on multivariable analysis (P=0.624). No other differences were found for quality of life or clinical outcomes. No serious adverse events were reported.Conclusions:The early intervention did not improve outcomes, but poor adherence to nutrition recommendations impacted on potential outcomes.

Intensive nutritional counselling obviates a weight gain in kidney transplant recipients with long-term graft survival in Estonia

Background. After kidney transplantation body weight gain (WG) in patients generally increases and this can be influenced by improved appetite and reversal of the uremic state. Because of a lack of evidence for effective interventions that prevent body WG after kidney transplantation, Ryan et al. recently published a randomized controlled trial design in BMC Nephrology to assess the effects of intensive nutrition interventions on WG and metabolic parameters. Here we are demonstrating a part of a study performed at our transplantation centre where we also performed an intensive nutritional counselling intervention on kidney recipients. We hypothesised that kidney transplant (KTx) patients who received intensive counselling may have better long-term weight control compared with patients who did not receive such counselling. Methods. During intensive counselling the dietician took into consideration the results of anthropometry, densitometry, biochemistry, food frequency questionnaire and an analysis of 3-day dietary records. Anthropometrical measurements were assessed at 18 months, 36 months, and, finally, 10 years after the kidney transplantation. Results. We noticed WG in all KTx patients (n=56) both in males and females, as follows: in the standard care group the mean WG in males (N=21) was 6.4 kg, females (N=15) 7.0 kg and among intensively counselled males (N=9) 4.6 kg, females (N=11) 1.1 kg. Statistically non-significant weight change was found among counselled living KTx patients with long-term graft survival both in males (p=0.0680) and females ( p=0.3166) which was registered 10 years after the KTx compared with the first measurement mean weight. Among standard care control KTx patients, weight change was statistically significant in both males and females (males: p=0.0016; females: p=0.0040) 10 years after the KTx. Conclusions. The long-term WG data clearly showed that in our population of KT patients, the patients who received intensive individual dietary counselling had much more educated behaviour in the long-term, thereby preventing WG which is a well-known risk factor for long-term graft failure as well as for cardiovascular complications and mortality.

Lipid Screening in Childhood and Adolescence for Detection of Multifactorial Dyslipidemia: Evidence Report and Systematic Review for the US Preventive Services Task Force.

Multifactorial dyslipidemia, characterized by elevated total cholesterol (TC) or low-density lipoprotein cholesterol (LDL-C), is associated with dyslipidemia and markers of atherosclerosis in young adulthood. Screening for dyslipidemia in childhood could delay or reduce cardiovascular events in adulthood. To systematically review the evidence on benefits and harms of screening adolescents and children for multifactorial dyslipidemia for the US Preventive Services Task Force (USPSTF). MEDLINE, Cochrane Central Register of Controlled Trials, and PubMed were searched for studies published between January 1, 2005, and June 2, 2015; studies included in a previous USPSTF evidence report and reference lists of relevant studies and ongoing trials were also searched. Surveillance was conducted through April 9, 2016. Fair- and good-quality studies in English with participants 0 to 20 years of age. Two investigators independently reviewed abstracts and full-text articles and extracted data into evidence tables. Results were qualitatively summarized. Outcomes included dyslipidemia (TC≥200 mg/dL or LDL-C≥130 mg/dL) and atherosclerosis in childhood; myocardial infarction and ischemic stroke in adulthood; diagnostic yield (number of confirmed cases per children screened); and harms of screening or treatment. Simulated diagnostic yield was calculated as initial screening yield × positive predictive value from a study with confirmatory testing. Screening of children for multifactorial dyslipidemia has not been evaluated in randomized clinical trials. Based on 1 observational study (n = 6500) and nationally representative prevalence estimates, the simulated diagnostic yield of screening for elevated TC varies between 4.8% and 12.3% (higher in obese children [12.3%] and at the ages when TC naturally peaks-7.2% at age 9-11 years and 7.2% at age 16-19 years). One good-quality randomized clinical trial (n = 663) found a modest effect of intensive dietary counseling for a low-fat, low-cholesterol diet on lipid levels at 1 year in children aged 8 to 10 years with mild to moderate dyslipidemia; mean between-group difference in TC change from baseline was -6.1 mg/dL (95% CI, -9.1 to -3.2 mg/dL; P < .001). Between-group differences dissipated by year 5. The intervention did not adversely affect nutritional status, growth, or development over the 18-year study period. One observational study (n = 9245) found that TC concentration at age 12 to 39 years was not associated with death before age 55 years. The diagnostic yield of lipid screening varies by age and body mass index. No direct evidence was identified for benefits or harms of childhood screening or treatment on outcomes in adulthood. Intensive dietary interventions may be safe, with modest short-term benefit of uncertain clinical significance.

Effects of nutritional intervention in head and neck cancer patients undergoing radiotherapy: A prospective randomized clinical trial.

Head and neck malignant tumors have numerous locations of the disease. After patients receive radiotherapy, their nutritional status is very poor, thus the curative effect is unsatisfactory. The aims of the present study were to investigate and analyze the nutritional status of patients with head and neck cancer undergoing radiotherapy (RT) in order to provide positive nutrition intervention for assisting the radiotherapy effect. A total of 40 patients with head and neck cancer were selected using a method of subjective global assessment (SGA) to assess nutritional status, including calorie intake and energy expenditure. In a randomized, controlled study, 20 patients received intensive dietary counseling and nutritional therapy (G1) and 20 received regular dietary as controls (G0) preradiotherapy and postradiotherapy. The primary endpoint was calorie intake and energy expenditure. The secondary endpoint was SGA rating with nutritional therapy. At the end of RT, energy intake showed a net increase in G1 (1,691±301 kcal) compared with that in G0 (1,066±312 kcal) (P<0.05); energy expenditure increased in G1 (1,673±279 kcal) compared with G0 (1,490±298 kcal) (P<0.05). The prevalence of severe malnutrition following radiotherapy was significantly different between the two study groups (10 patients in G0 and 4 patients in G1; P<0.05). The number of the normal malnutrition patients postRT in G0 decreased from 4 to 2 and conversely, in G1 it increased from 3 to 6 (P<0.05). In conclusion, patients with head and neck cancer were most malnutritioned, which impacted on clinical outcome. Timely nutritional intervention can effectively prevent weight loss and muscle wasting. Additionally, it may improve quality of life by decreasing the frequency of severe malnutrition.

Early and Intensive Dietary Counseling in Lung Cancer Patients Receiving (Chemo)Radiotherapy—A Pilot Randomized Controlled Trial

ABSTRACTMalnutrition is prevalent in patients undergoing (chemo)radiotherapy (RT) for lung cancer. This pilot study tested the feasibility and acceptability of delivering an intensive nutrition intervention for lung cancer patients receiving RT. Twenty-four patients with lung cancer were randomized to receive the intervention which employed a care pathway to guide intensive dietary counseling from pretreatment until 6-wk posttreatment or usual care. Nutritional, fatigue, and functional outcomes were assessed using valid and reliable questionnaires before randomization, at the start and end of RT and 1- and 3-mo post-RT. Consent rate was 57% with an overall attrition of 37%. Subject compliance with the completion of study questionnaires was 100%. A clinically important mean difference indicated greater overall satisfaction with nutritional care in the intervention group (5.00, interquartile range [IQR] 4.50–5.00; 4.00, IQR 4.00–4.00). Clinically important differences favoring the intervention were observed for weight (3.0 kg; 95% confidence interval [CI] −0.8, 6.8), fat-free mass (0.6 kg; 95% CI −2.1, 3.3), physical well-being (2.1; 95% CI −2.3, 6.5), and functional well-being (5.1; 95% CI 1.6, 8.6), but all 95% CIs were wide and most included zero. Recruitment feasibility and acceptability of the intervention were demonstrated, which suggest larger trials using an intensive nutrition intervention would be achievable.

Nutrition support and dietary interventions for patients with lung cancer: current insights.

Malnutrition and weight loss are prevalent in patients with lung cancer. The impact of malnutrition on patients with cancer, and specifically in patients with lung cancer, has been demonstrated in a large number of studies. Malnutrition has been shown to negatively affect treatment completion, survival, quality of life, physical function, and health care costs. Emerging evidence is providing some insight into which lung cancer patients are at higher nutritional risk. In lung cancer patients treated with radiotherapy, stage III or more disease, treatment with concurrent chemotherapy and the extent of radiotherapy delivered to the esophagus appear to confer a higher risk of weight loss during and post-treatment. Studies investigating nutrition interventions for lung cancer patients have examined intensive dietary counseling, supplementation with fish oils, and interdisciplinary models of nutrition and exercise interventions and show promise for improved outcomes from these interventions. However, further research utilizing these interventions in large clinical trials is required to definitively establish effective interventions in this patient group.

Dietary counselling and nutritional support in oropharyngeal cancer patients treated with radiotherapy: persistent weight loss during 1-year follow-ups.

The need for dietary counselling and nutritional support in oropharyngeal cancer patients is generally accepted. However, evidence for the effectiveness is sparse. The aim of this study was to describe dietary counselling, nutritional support, body weight and toxicity during and after treatment, and investigate the effect of pre-treatment body mass index (BMI) on survival in oropharyngeal cancer patients. A retrospective chart review was made in 276 oropharyngeal cancer patients treated with radiotherapy (RT). End points were dietary consultations, weight loss, toxicity, overall survival and disease-free survival. Almost all oropharyngeal cancer patients received dietary counselling (94%) and nutritional support (99%). Dietary counselling decreased sharply shortly after treatment to 38% at 1 year after treatment. Overall weight loss increased during the first year of follow-up and ranged from 3% at start of RT, until 11% at 1 year after RT. Overall survival was significantly longer for patients with a BMI above average (P=0.01). Acute dysphagia (P=0.001), mucositis (P=0.000) and toxicity grade 3 (P=0.002) were significantly more prevalent in patients who had lost 10% or more of their body weight. This study showed that patients continue to lose body weight during and until 1 year after treatment, despite nutrition support and frequent dietetic consultation. A BMI above average appears to increase survival time. Future studies, preferably randomized trials, are needed to compare standard dietary counselling with more intensive dietary counselling that consists of earlier and/or prolonged treatment.

Psychological wellbeing in 20-year-old adults receiving repeated lifestyle counselling since infancy.

This study examined whether there was an association between a repeated dietary and lifestyle intervention that began in infancy and participants' psychological wellbeing at the age of 20. We examined the psychological wellbeing of 457 young adults participating in the Special Turku Coronary Risk Factor Intervention Project (STRIP), a randomised controlled trial conducted in Finland between 1989 and 2011. We assessed potential differences in psychological wellbeing between the intervention and control groups by examining participants' satisfaction with life, how they rated their health, their experiences of stress and the consequences of experiencing stress and symptoms of depression at the age of 20. We also assessed socio-economic status during childhood as a potential confounding factor. We found no association between the long-term dietary and lifestyle intervention and participants' psychological wellbeing in adulthood. Adjusting for sex and childhood socio-economic status did not affect the results and socio-economic status did not moderate the association between the intervention and psychological wellbeing. Our findings showed no association between intensive dietary and lifestyle counselling that was initiated in infancy with psychological wellbeing in adulthood and the initiative did not appear to pose any psychological risks.

Five Recent Expert Recommendations on the Treatment of Childhood and Adolescent Obesity: Toward an Emerging Consensus—A Stepped Care Approach

Various organizations published five sets of expert recommendations recently: 2007 Healthcare Organizations' Four Stage Model; 2006 Canadian Clinical Practice Guidelines; 2008 The Endocrine Society Recommendations; 2009 Seven Step Model; and 2010 US Preventive Task Force Recommendations. We compared the recommendations' approaches and conclusions pertaining to four treatments (self-help groups, outpatient cognitive-behavior therapy [CBT], immersion CBT, and surgery). All of the expert committees supported using intensive dietary, physical activity, and cognitive-behavioral counseling; two of the five groups discouraged reliance on educational interventions alone, and two of the groups explicitly promoted a stepped-care approach. Greatest benefits may accrue by encouraging healthcare providers and parents to view medical management and education as foundations to change, but to pursue increasingly intensive viable options until overweight and obese children make clinically significant progress toward improved health and happiness.

Intensive dietary counseling does not affect oncologic outcome

Intensive dietary counseling does not affect oncologic outcome

Naturopathic medicine for the prevention of cardiovascular disease: a randomized clinical trial

Although cardiovascular disease may be partially preventable through dietary and lifestyle-based interventions, few individuals at risk receive intensive dietary and lifestyle counselling. We performed a randomized controlled trial to evaluate the effectiveness of naturopathic care in reducing the risk of cardiovascular disease. We performed a multisite randomized controlled trial of enhanced usual care (usual care plus biometric measurement; control) compared with enhanced usual care plus naturopathic care (hereafter called naturopathic care). Postal workers aged 25-65 years in Toronto, Vancouver and Edmonton, Canada, with an increased risk of cardiovascular disease were invited to participate. Participants in both groups received care by their family physicians. Those in the naturopathic group also received individualized care (health promotion counselling, nutritional medicine or dietary supplementation) at 7 preset times in work-site clinics by licensed naturopathic doctors. The body weight, waist circumference, lipid profile, fasting glucose levels and blood pressure of participants in both groups were measured 3 times during a 1-year period. Our primary outcomes were the 10-year risk of having a cardiovascular event (based on the Framingham risk algorithm) and the prevalence of metabolic syndrome (based on the Adult Treatment Panel III diagnostic criteria). Of 246 participants randomly assigned to a study group, 207 completed the study. The characteristics of participants in both groups were similar at baseline. Compared with participants in the control group, at 52 weeks those in the naturopathic group had a reduced adjusted 10-year cardiovascular risk (control: 10.81%; naturopathic group: 7.74%; risk reduction -3.07% [95% confidence interval (CI) -4.35% to -1.78%], p < 0.001) and a lower adjusted frequency of metabolic syndrome (control group: 48.48%; naturopathic care: 31.58%; risk reduction -16.90% [95% CI -29.55% to -4.25%], p = 0.002). Our findings support the hypothesis that the addition of naturopathic care to enhanced usual care may reduce the risk of cardiovascular disease among those at high risk. ClinicalTrials.gov, no. NCT0071879.

Treatment of childhood and adolescent obesity: An integrative review of recent recommendations from five expert groups.

To compare and contrast 5 sets of expert recommendations about the treatment of childhood and adolescent obesity. We reviewed 5 sets of recent expert recommendations: 2007 health care organizations' four stage model, 2007 Canadian clinical practice guidelines, 2008 Endocrine Society recommendations, 2009 seven step model, and 2010 U.S. Preventive Task Force recommendations. We described an empirically based sequential model by which expert recommendations may affect weight loss outcomes and then examined the recommendations pertaining to 4 treatments (self-help groups, outpatient cognitive behavior therapy [CBT], immersion CBT, and surgery). All of the expert committees supported using intensive dietary, physical activity, and cognitive-behavioral counseling; 2 of the 5 groups discouraged reliance on educational interventions alone; and 2 of the groups advised referring clients to increasingly intensive interventions, a stepped-care approach. Expert recommendations that include clear, simple, goal-oriented directions may impact the behaviors of health care providers most effectively and, in turn, help decrease childhood and adolescent obesity. Greatest benefits may accrue by encouraging health care providers and parents to view medical management and education as foundations to change but to pursue increasingly intensive viable options until overweight and obese children make clinically significant progress toward improved health and happiness.

Dietary Counseling to Improve Fat Quality during Pregnancy Alters Maternal Fat Intake and Infant Essential Fatty Acid Status

AbstractTo explore the effect of maternal dietary intervention on infant essential fatty acid (FA) status, we conducted a prospective,single-blind, randomized nutrition intervention study. At the first trimester of pregnancy, 90women from families with a history of allergy were randomized either to receive intensive dietary counseling to modify dietary intake according to current recommendations or as controls. Infants' cord and 1-mo isolated serum phospholipid FA were identified and quantified by GC.Detectable levels of eicosatrienoic acid[ETA, 20:3(n-9)]were taken as a biochemicalmarker for essential FA deficiency, and the DHA sufficiency index [22:6(n-3):22:5(n-6)] and the DHA deficiency index [22:5(n-6):22:4(n-6)] were taken as markers for DHA [22:6(n-3)] status. The concentration of ETA was lower in cord blood in the intervention (I) group [median 0.64 (IQR 0.40–;0.78)mg/L; 2.09 (1.31–;2.54) mmol/L] than in the control (C) group [0.92 (0.54–;1.20) mg/L; 3.00 (1.76–;3.92) mmol/L] (P = 0.048). The proportion of ETA in total FA in the I group [0.73% (0.48–;0.85%)] was lower than in the C group [0.93% (0.78–;1.22%)] (P =0.003). A higher DHA sufficiency index and lower DHA deficiency index were detected in cord blood in the I group than in the C group, although the groups did not differ in the DHA concentration or proportion of the total FA. There were no differences among groups at 1 mo for any of the variables measured. Our findings suggest a better supply of essential FA, particularly important during the period of rapid development, in infants whose mothers received dietary counseling. The results thushighlight the importance of maternal diet for child health, calling for dietary counseling for pregnant women in primary health care.