Medical Nutrition Treatment Research Articles

Gestational diabetes mellitus: Multi-disciplinary treatment approaches

Gestational diabetes mellitus (GDM) is the most common metabolic disease of pregnancy, associated with several perinatal complications. Adequate glycemic control has been proved to decrease risk of GDM-related complications. Several studies have shown the beneficial effect of exercise and medical nutrition treatment on glycemic and weight control in GDM-affected women. Moreover, pharmacological agents, such as insulin and specific oral anti-diabetic agents can be prescribed safely during pregnancy, decreasing maternal blood glucose and, thus, perinatal adverse outcomes. Multi-disciplinary treatment approaches that include both lifestyle modifications (medical nutritional therapy and daily physical exercise) and pharmacological treatment, in cases of failure of the former, constitute the most effective approach. Insulin is the gold standard pharmacological agent for GDM treatment. Metformin and glyburide are two oral anti-diabetic agents that could serve as alternative, although not equal in terms of effectiveness and safety, treatment for GDM. As studies on short-term safety of metformin are reassuring, in some countries it is considered as first-line treatment for GDM management. More studies are needed to investigate the long-term effects on offspring. As safety issues have been raised on the use of glyburide during pregnancy, it must be used only when benefits surpass possible risks.

Medical-Nutritional Intervention in a Jordanian Child with Glycogen Storage Disease Type IIIA: Case Report

Abstract Background: Glycogen storage disease (GSD) type IIIa is a rare inborn error of metabolism characterized by a deficiency in glycogen disbranching enzymes. Nutritional intervention is a cornerstone in the medical care plane. Case presentation: A 2-year-old Jordanian male, who is known to have GSD IIIa since he was 4 months was admitted because of infection. The child was on a special diet (small, frequent meals of complex carbohydrates and protein, avoiding simple sugars and fasting is prohibited). The child showed good activity level and a good appetite. Method: The medical-nutritional intervention of GSD IIIa was evaluated by retrograde reviewing the child BMI, blood and biochemical tests on presentation and a month later visit. Results: The biochemical tests included: blood glucose, urea, creatinine, cholesterol, triglycerides, albumin, total bilirubin, aspartate amino transferase (AST), alanine aminotransferase (ALT) and WBCs were decreased after nutritional intervention, however, the RBCs blood test was increased. On presentation, the child’s weight and height were documented as above the 15th and at 97th percentile respectively for his age, no change after the one month later visit was observed. Conclusion: The biochemical and blood tests improved at the one-month follow-up visit vs. baseline. The individualized medical-nutritional intervention is a cornerstone in the management of GSD IIIa as part of a comprehensive medical care process.

Determination of the Effect of the Elimination Diet Applied for Overweight and Obese People with Food Intolerance on Body Composition and Biochemical Parameters

ABSTRACT Food Intolerance, is a reaction against food, but not immunological manner, and may be confused with real food allergies. In this study, effects of special weight-loss diet together with an elimination diet on body composition and biochemical parameters of overweight and obese people who were diagnosed with food intolerance were investigated. The study group consists of 20 patients in total who were followed-up and treated in Yorktest Turkey Laboratory; who were diagnosed with food intolerance, and whose BMI was > 26kg/m2. Bloodletting for these patients was executed with Lancet from their fingertips, and the blood drawn from these patients was assessed via enzyme-linked immunosorbent assay (ELISA) method, and food reactions of patients were determined for each food. Biochemical parameters of these patients are routine tests, which are necessary for food intolerance tests, and they are analyzed at Yorktest Turkey Laboratory for two times: before and after elimination diet plus special weight-loss diet. It has been determined that, the most common sensivity is obtained against yeast, egg yolk and white, cranberry, cow’s milk, chicken, lentils and parsley. Anthropometric measurements and biochemical parameters before and after elimination diet plus special weight-loss diet applied to participants, were significantly improved in statistical manner. Due to positive changes in body composition and biochemical parameters obtained through application of special weight-loss diets together with elimination diet applied to fat and obese people, we think that this diet might be used for medical nutrition treatment of obesity as a treatment option.

A pilot evaluation of group-based programming offered at a Canadian outpatient adult eating disorders clinic

Eating disorder clinics across Canada place heavy reliance on group-based programming. However, little work has examined whether this modality of treatment is well-received by patients and results in clinical improvements. The purpose of this pilot study was to evaluate patient satisfaction and outcomes for group-based programming offered through an adult eating disorders clinic. Participants were 81 adults who met DSM-5 criteria for an eating disorder and participated in the study as part of the clinic’s program evaluation. Participants received medical monitoring, psychiatric follow-up, adjunct nutrition and pre-psychological treatment, and participated in the clinic’s core cognitive behavioural therapy (CBT) group. Demographic information and weight were collected at intake. Participants also completed pre- and post-group programming measures of life satisfaction, depressive and anxiety symptoms, psychological symptoms of the eating disorder, and satisfaction with the programming. Participants’ experienced a significant increase in satisfaction with life, and decreases in depressive symptoms and psychological symptoms of the eating disorder post-group. Adults endorsed feeling fairly satisfied with the group-based services provided. Results draw attention to the importance of program evaluation as an integral component of an adult outpatient eating disorder clinic by providing a voice for patients’ views of the services received and program outcomes.

Feasibility and Efficacy of Defatted Human Milk in the Treatment for Chylothorax After Cardiac Surgery in Infants.

Chylothorax is a well-described complication after cardiothoracic surgery in children. Medical nutritional therapy for chylothorax includes medium-chain triglyceride (MCT) formulas and reduction in enteral long-chain triglyceride intake to reduce chyle production. Human milk is usually eliminated from the diet of infants with chylothorax because of its high long-chain triglyceride content. However, given the immunologic properties of human milk, young infants with chylothorax may benefit from using human milk over human milk substitutes. We performed a retrospective cohort study to describe the feasibility and efficacy of defatted human milk (DHM) for the treatment for chylothorax in infants after cardiac surgery and to compare growth outcomes between infants treated with DHM (n=14) versus MCT formula (n=21). There were no differences in mortality or length of hospital stay between the DHM and MCT formula treatment groups. The DHM treatment group had a significantly higher weight-for-age z-score at hospital discharge compared to the MCT formula group with median z-scores of -1 (-2 to 0.5) and -1.5 (-2 to 0), respectively (p=0.02). In infants with chylothorax after cardiac surgery, DHM is a safe and feasible medical nutritional treatment and may have potential benefits for improved nutrition and growth.

Effects of medical nutritional intervention on clinical outcome of gestational diabetes mellitus: a meta-analysis

Objective To evaluate the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus. Methods A meta-analysis of randomised controlled trials was conducted. PubMed, EMBASE, OVID, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Chinese WanFang Database were searched for the literatures related to the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus from January 2005 to January 2015. At the same time, manual searching and reference review were conducted. Strict screening of the searched literatures was performed based on inclusion and exclusion criteria. All the included trials were divided into two groups based on whether the intervention involved insulin or not. The tool which Cochrane Handbook recommended was used to assess the risk of bias for included literatures. All the studies were graded and extracted by two researchers independently after reading research method in detail. Meta-analysis was conducted using RevMan5.2 software. The effect of medical nutritional intervention was described in terms of fasting blood glucose, birth body mass, and incidences of macrosomia, cesarean section, postpartum glucose intolerance and neonatal long-term chronic disease. Results Totally 27 trials were found, of which 13 met the inclusion and exclusion criteria. 1 trial was excluded because the outcomes were using different sample sizes, and finally 12 trials were included in the final meta-analysis, involving 1 392 patients. Among the 12 included trials, 7 only administered nutritional intervention, while the other 5 added insulin with nutritional intervention. The results showed that in the nutritional intervention group, medical nutritional intervention decreased the incidence of macrosomia [risk difference (RD): -0.35, 95% CI: -0.55--0.15, P<0.001, 1 trial], birth body mass [mean difference (MD): -581.27, 95% CI: -790.32--372.22, P<0.001, 2 trials], the rate of cesarean section (RD: -0.40, 95% CI: -0.58--0.21, P<0.001, 2 trials), fasting blood glucose (MD: -0.32, 95% CI: -0.59--0.06, P=0.02, 5 trials), and the incidence of postpartum glucose intolerance (RD: -0.34, 95% CI: -0.44--0.23, P<0.001, 1 trial). However, in the multiple intervention group (nutritional intervention plus insulin), no significant differences were shown in the incidence of macrosomia (RD: -0.02, 95% CI: -0.07-0.03, P=0.39, 3 trials), birth body mass (MD: 86.06, 95% CI: -104.97-277.09, P=0.38, 2 trials), the rate of cesarean section (RD: 0.02, 95% CI: -0.05-0.08, P=0.64, 5 trials), and fasting blood glucose (MD: -0.03, 95% CI: -0.16-0.11, P=0.71, 3 trials). Conclusion Medical nutritional intervention may be a protective measure against gestational diabetes mellitus, which could help to maintain serum glucose levels within the normal range and improve maternal and neonatal outcomes. Key words: Medical nutritional intervention; Gestational diabetes mellitus; Meta-analysis; Clinical outcome; Insulin

Intracellular leptin signaling following effective weight loss

AimTo investigate the effect of ex-vivo leptin treatment before and after weight loss on key-molecules of intracellular leptin signaling in peripheral blood mononuclear cells (PBMCs) of obese women. Materials and methodsFive healthy obese women underwent a 12-week medical nutrition treatment aiming at inducing 10% weight loss. Isolated PBMCs at baseline, and at weeks 8 and 12 were treated with increasing leptin doses (0, 25 and 75ng/ml) for 30min. The phosphorylation of signal transducer and activator of transcription (STAT)3, extracellular-signal-regulated kinase (ERK), protein kinase B (Akt) and 5' adenosine monophosphate-activated protein kinase (AMPK) of PBMCs was analyzed using Western blotting. ResultsWomen lost 10±1% and 13±1% of weight at week 8 and 12, respectively. Circulating leptin and insulin significantly decreased from 39.5±7.7 to 12.2±2.4ng/ml (p=0.026) and from 13.0±1.6 to 5.4±0.9 μU/ml (p=0.005) at week 12, respectively. In the ex vivo study, a significant decrease in STAT3 phosphorylation was observed in the control group after weight loss. Treatment of PBMCs with leptin 75ng/ml increased significantly ERK, STAT3 and Akt phosphorylation, but no weight loss induced change was observed in response to leptin treatment ex vivo. ConclusionsA 10%–15% weight loss decreases baseline STAT3 phosphorylation ex vivo, but does not alter the effect of increasing doses of leptin on the incremental intracellular phosphorylation of STAT3, ERK, Akt and AMPK. Supraphysiologic leptin doses (75ng/ml) result in higher protein phosphorylation compared to either physiologic doses or no treatment, before and after weight loss.

The Economic Value of Enteral Medical Nutrition in the Management of Disease-Related Malnutrition: A Systematic Review

Economic evaluations for medical nutrition, such as oral nutritional supplements (ONS), are relatively uncommon compared with other health technologies, and represent an area that has not been reviewed so far. In this systematic review, economic evaluations of enteral medical nutrition in the management of disease-related malnutrition (DRM) were reviewed and qualified to estimate the economic value. Initially, 481 studies were found, of which 37 full-text articles were assessed for eligibility and were rated on their quality using the Quality of Health Economic Studies (QHES) instrument. The final review focused on the high QHES quality economic evaluation studies. As both the studied medical nutrition intervention and the form of the economic evaluation varied, a quantitative synthesis (meta-analysis) was not attempted but a critical analysis and comparison of the individual study results were performed. ONS was the most studied intervention, covering several patient populations and different health care settings. Outcomes included cost savings (n = 3), no significant extra costs per unit of clinical and/or functional improvement (n = 1), or significantly higher costs per unit of clinical and/or functional improvement but still cost-effective for the used threshold (n = 4). This review shows that the use of enteral medical nutrition in the management of DRM can be efficient from a health economic perspective.

Psychological and behavioural factors associated with long-term weight maintenance after a multidisciplinary treatment of uncomplicated obesity

Obesity is a multifactorial syndrome and the likelihood of success of a medical nutritional treatment (MNT) over the long term is low. As psychological and behavioural factors have an important role in both pathogenesis and the treatment of obesity, these issues were investigated in individuals with obesity who reported a long-term success or a failure in terms of weight loss following a MNT. Eighty-eight individuals of an original cohort of 251 subjects were re-evaluated 10 years after a MNT with cognitive-behavioural approach for uncomplicated obesity. Fifty-three participants were classified as failure (body weight change ≥0.5 kg) and 35 as a success (10-year body weight change <0.5 kg) of the MNT. Prior to the beginning of the weight-management program, both the Dieting Readiness Test (DRT) and the Hospital Anxiety and Depression Scale (HADS) were administered. At a 10-year follow-up after the MNT, self-reported questionnaires were administered: quality of life was assessed by the Obesity Related Well-Being (ORWELL 97) questionnaire, eating attitudes and behaviours by the Eating Disorder Examination Questionnaire (EDE-Q), the Binge Eating Scale (BES) investigated the presence and severity of binge eating and the Symptom Checklist (SCL 90-R) was used to identify the psychopathological distress. The scores of the ORWELL 97 items concerning symptoms (P = 0.005), discomfort (P = 0.03) and the total score (P = 0.02) were significantly lower in the success group. The depression score of the HADS was positively correlated with the percentage of body weight change observed 10 years after the MNT (r = 0.22; P = 0.045). The scores of the shape concern (EDE-Q) (r = 0.35; P = 0.013) and of the discomfort (ORWELL 97) (r = 0.36; P = 0.012) were significantly correlated with the percentage of body weight change 10 years after the MNT. In conclusion, this study is in agreement with the possibility that the psychological quality of life is associated even with modest amounts of weight loss in the long run. Further research should support identifying successful predictors of weight loss.

Bedarf und Praxis der gezielten Selensubstitution im Rahmen der komplementären Behandlung des Prostatakarzinoms

Hintergrund: Die Selentherapie ist ein populäres und breit angewandtes komplementäres Therapieverfahren in der Onkologie. Ziel der vorliegenden Untersuchung war es, den Bedarf und die Indikation einer Selentherapie nach Therapie eines Postatakarzinoms zu evaluieren. Methoden: 295 konsekutive Patienten nach radikaler Prostatektomie wurden bezüglich allgemein anamnestischer, onkologischer und verhaltenstypischer Kriterien evaluiert und der Substitutionsbedarf über eine Bestimmung des Selenspiegels mittels Graphitrohr- Atomabsorptionsspektroskopie ermittelt. Ergebnisse: Der mittlere Selenspiegel war niedrig und betrug 103,4 (72,9–142,1) mg/l. Es zeigten sich Korrelationen zwischen niedrigem Selenspiegel und lokal fortgeschrittenen Tumorstadien, positivem Lymphknotenstatus, chronischem Nikotin- und Alkoholabusus und einer chronischen Mehrfachmedikation. Schlussfolgerung: Aufgrund nachgewiesener niedriger, suboptimaler Selenspiegel bei 96,3% der untersuchten Patienten und der bekannten Bedeutung einer ausreichenden ein optimal funktionierendes Immunsystem wird eine gezielte Selensubstitution im Kontext ernährungsmedizinischer Interventionen und der Beeinflussung verhaltensbedingter Risikofaktoren in der Komplementärtherapie des Prostatakarzinoms empfohlen.

Effectiveness of medical nutrition treatment delivered by dietitians on glycaemic outcomes and lipid profiles of Arab, Omani patients with Type 2 diabetes

In this randomized controlled trial we evaluated the effectiveness of medical nutritional therapy on Arab patients with Type 2 diabetes in Oman delivered by a dietitian. Patients with Type 2 diabetes (n = 170) were randomly assigned to a group receiving usual nutritional care (n = 85) or a group receiving practice guidelines nutritional care (n = 85). Anthropometric (weight, height, BMI and waist circumference) and biochemical (fasting blood glucose, HbA1c ) variables were measured at baseline and after each appointment. Patients were given 1-3 appointments with a dietitian over 6 months. Those in the group receiving practice guidelines nutritional care (n = 85) had significant changes in HbA(1c) (-0.8%, P = 0.001), fasting plasma glucose (-1.3 mmol\l, P = 0.003) and weight (-5.1 kg, P = 0.05), whereas the patients in the usual nutritional care group (n = 85) had no significant improvements in either HbA(1c) (-0.4%, P = 0.248) or fasting plasma glucose (-0.2 mmol/l, P = 0.638) during the same period. We also found a significant difference between the group receiving practice guidelines nutritional care and the usual nutritional care group, respectively, in waist circumference (96.9 ± 7.9 vs. 100.0 ± 8.7 cm, P = 0.019), triglycerides levels (1.42 ± 0.58 vs. 1.98 ± 0.96 mmol\l, P = 0.001), cholesterol levels (5.1 ± 1.0 vs. 5.5 ± 0.9 mmol/l, P = 0.009) and LDL cholesterol levels (3.58 ± 0.98 vs. 3.89 ± 0.98 mmol/l, P = 0.046). Medical nutrition therapy provided by dietitians to Arab patients with Type 2 diabetes in Oman resulted in significant improvements in anthropometric and biochemical outcomes in both the usual nutritional care group and the group receiving practice guidelines nutritional care. Subjects with Type 2 diabetes tended to do better with practice guidelines nutritional care than with usual nutritional care. Ongoing medical counselling in nutrition by a trained dietitian is important for better long-term metabolic control.

Insulin Need in Gestational Diabetes is Associated with a Worse Cardiovascular Risk Profile after Pregnancy

Women with gestational diabetes mellitus (GDM) treated with insulin are more likely to develop type 2 diabetes after pregnancy compared to mild GDM cases treated with medical nutrition treatment (MNT) alone. We aimed to compare levels of subclinical atherosclerosis markers in women with previous GDM treated with insulin and MNT alone. Eighty-one women with previous GDM (45 treated with insulin, 36 treated with MNT) and 35 age-matched lean controls were included. Fasting glucose, insulin and lipids, circulating fibrinogen, CRP, PAI-1 and IL-6 levels were assayed. Carotid intima media thickness (IMT) was measured. Women with previous GDM treated with insulin in pregnancy had significantly higher fasting glucose, plasma PAI-1 levels and carotid IMT compared to women treated with MNT alone. In multiple regression analysis, insulin need in pregnancy was associated with increased carotid IMT and plasma PAI-1 levels (corrected for age, BMI, postpartum duration, fasting glucose and lipids; model r(2)=0.132; beta=0.297, p=0.014 for carotid IMT; model r(2)=0.198; beta=0.345, p=0.003 for PAI-1). Women with previous GDM treated with insulin in pregnancy had a worse cardiovascular risk profile compared to mild GDM patients. An intensive preventive approach for cardiovascular disorders is particularly essential for this subgroup of women.

Long‐Term Effects of a Multidisciplinary Treatment of Uncomplicated Obesity on Carotid Intima‐Media Thickness

Obesity is associated with well-known cardiovascular risk factors and a lower life expectancy. This study investigated whether nonoperative nutritional treatment of obesity without comorbidities influenced the carotid intima-media thickness (c-IMT) in the long run. Fifty-four subjects of an original cohort of 251 subjects were re-evaluated 10 years after a medical nutritional treatment (MNT) with cognitive-behavioral approach for uncomplicated obesity. Forty subjects were classified as failure (10-year body weight change > 0.5 kg) and 14 (body weight change ≤ 0.5 kg) as a success of the MNT. Ten years after MNT, c-IMT significantly increased (0.06 ± 0.02 mm; P = 0.004) in the failure group and significantly decreased (-0.07 ± 0.03 mm; P = 0.027) in the success group. Ten-year change in c-IMT correlated significantly with 10-year change in body weight (r = 0.28; P = 0.040). Multiple stepwise linear regression analysis demonstrated that age, final BMI, and group (success or failure) influenced independently the 10-year c-IMT. In conclusion, this study is in agreement with the possibility that the successful MNT of obesity may be an effective choice in the long run and seems to indicate that it may be able to reduce the cardiovascular risk as reflected by the change in c-IMT.

The role of elective surgery in children with localized Crohn’s disease

Substantial proportions of children with Crohn’s Disease (CD) are non-responsive to standard medical therapy and/or nutritional treatment. For many children impairment of growth will also be an associated medical problem. Aim: The aim of our study was to investigate a role of elective surgical treatment on the induction and duration of remission, and on growth improvement in paediatric patients with localized CD, who were refractory to conservative treatment. Methods: We retrospectively analyzed the data of 55 newly diagnosed CD patients among whom 22 children (40%) had undergone surgical treatment. Results: Post surgery all patients had significant PCDAI decline and the great majority of them (90.9%) had stable remission for more than 2 years. Following surgery 86.4% patients had a significant improvement in growth: an improvement in Z score for height ranging from 0.2 to 0.5 SD (9 months to 2 years after resection, p&lt;0,01). Conclusion: Elective surgery, if properly timed and in well prepared patients, has a significant relapse preventive and steroid sparing role, and also results in major growth improvement.

Systematic Review of the Evidence Base for the Medical Treatment of Paediatric Inflammatory Bowel Disease

To systematically review the evidence base for the medical (pharmaceutical and nutritional) treatment of paediatric inflammatory bowel disease. Key clinical questions were formulated regarding different treatment modalities used in the treatment of paediatric (not adult-onset) IBD, in particular the induction and maintenance of remission in Crohn disease and ulcerative colitis. Electronic searches were performed from January 1966 to December 2006, using the electronic search strategy of the Cochrane IBD group. Details of papers were entered on a dedicated database, reviewed in abstract form, and disseminated in full for appraisal. Clinical guidelines were appraised using the AGREE instrument and all other relevant papers were appraised using Scottish Intercollegiate Guidelines Network methodology, with evidence levels given to all papers. A total of 6285 papers were identified, of which 1255 involved children; these were entered on the database. After critical appraisal, only 103 publications met our criteria as evidence on medical treatment of paediatric IBD. We identified 3 clinical guidelines, 1 systematic review, and 16 randomised controlled trials; all were of variable quality, with none getting the highest methodological scores. This is the first comprehensive review of the evidence base for the treatment of paediatric IBD, highlighting the paucity of trials of high methodological quality. As a result, the development of clinical guidelines for managing children and young people with IBD must be consensus based, informed by the best-available evidence from the paediatric literature and high-quality data from the adult IBD literature, together with the clinical expertise and multidisciplinary experience of paediatric IBD experts.

Investigation of nutrition status and nursing intervention of 98 pregnant women with abnormal glucose metabolism

Objective To understand nutrition status of pregnant women with abnormal glucose metabolism in communities and provide a basis for conducting nutrition treatment and nursing intervention among the population of pregnant women with abnormal glucose metabolism. Methods An investigation of nutrition status of single-fetus pregnant women in a certain community that had been diagnosed as having abnormal glucose metabolism was conducted through questionnaire. And the result from the inventigation was analyzed by statistics. Results Compared with the reference data, the amount of takeup of energy and three main nutrients of the studied group was relatively higher. And in the meal structure of the studied group, the amounts of takeup of grains and cereals, fruits, lipids, and cholesterol were relatively higher, and the amount of takeup of legumes was relatively lower. The amounts of takeup of other nutrients were different from a woman to anohter woman. Conclusions The meal structure of pregnant women with abnormal glucose metabolism is not reasonable. It needs to develop individualized medical nutrition treatment and nursing intervention in communities, in order to make pregnant women control their blood sugar well, reduce complications, and ensure the health of mothers and babies. Key words: Diabetes mellitus; Pregnancy; Meal survey; Nutrition evaluation; Nursing

Effect of rosiglitazone, metformin and medical nutrition treatment on arterial stiffness, serum MMP-9 and MCP-1 levels in drug naive type 2 diabetic patients

The aim of the study was to evaluate the long-term effect of rosiglitazone and metformin monotherapy with medical nutrition treatment (MNT) and of MNT alone on arterial stiffness, serum monocyte chemoattractant protein (MCP)-1 and matrix metalloproteinase (MMP)-9 in drug naive patients with type 2 diabetes mellitus. Fifty type 2 diabetic patients were randomized to receive rosiglitazone 4 mg/day ( n = 19) or metformin 850 mg/day ( n = 16) with MNT or MNT alone ( n = 15), for 52 weeks. Arterial stiffness was assessed by using large and small artery elasticity index (SAEI and LAEI, respectively). SAEI, LAEI, serum MCP-1 and MMP-9 levels were measured at baseline and following 52 weeks of treatment. SAEI was improved only in the rosiglitazone group, and the difference was still statistically significant when the three groups were compared ( p = 0.024). There were no differences in LAEI in inter- and intragroup comparisons at the end of the study. Serum MMP-9 levels were decreased in the metformin (−13.5 ± 34.8%, p = 0.02) and rosiglitazone (-27.2 ± 51.0%, p = 0.023) groups compared with baseline values, whereas no significant change was seen in serum MCP-1 levels. These results suggest that rosiglitazone monotherapy has favorable effects on arterial stiffness compared with metformin monotherapy independent of glycemic control.

The effect of metformin treatment on VEGF and PAI-1 levels in obese type 2 diabetic patients

The aim of the study was to evaluate the effect of metformin on markers of endothelial function, vascular inflammation and factors of thrombosis in obese type 2 diabetic patients. Twenty-four type 2 diabetic patients (15 female, 9 male) previously under medical nutrition treatment (MNT) + regular exercise programme (REP) without chronic micro or macrovascular complications with the mean age of 50.5 ± 1.5 years, diabetes duration of 17.9 ± 6.3 months and body mass index (BMI) of 31.7 ± 0.8 kg/m 2 were enrolled in the study. In the first 4 weeks, all the patients continued MNT + REP. In the following 12 weeks, metformin (mean daily dosage of 1381 ± 85 mg) was added. After the first period with MNT + REP, BMI, waist circumference, fat percentage, blood pressure and HDL cholesterol decreased significantly. After metformin addition, there was a significant decrement in BMI, waist circumference, fat percentage, fasting and postprandial plasma glucose, hemoglobin A1C, plasminogen activator inhibitor-1 (PAI-1), vascular endothelial growth factor (VEGF) and increment in β cell reserve values of the patients. Our results indicated that, metformin addition had beneficial effect on VEGF and PAI-1 levels in obese type 2 diabetic patients under MNT + REP, independent from its’ favourable effects on BMI and glycemic control.

Development and implementation of the Clinical Privileges for Dietitian Nutrition Order Writing Program at a long-term acute-care hospital

A patient nutrition care plan is of little value unless it is quickly and efficiently implemented. Recognition of the value of appropriate and timely medical nutrition intervention in improving patients’ nutritional status led to the development of the Clinical Privileges for Dietitian Nutrition Order Writing (CPD NOW) program at a long-term, acute-care hospital. CPD NOW is a formalized approach specifying the types of nutrition care orders that may be written by a registered dietitian (RD), allowing nutrition recommendations to be implemented immediately. More than 95% of the facility's primary attending physicians participate in this optional program. Development included an initial evaluation of physician use of RD recommendations, identification of problems in implementing these recommendations, formulation of an efficient nutrition order writing system, and adoption of this system by the medical staff. In the first 5 years of implementation, the benefits achieved by this program were: expedited order implementation, improved patient nutritional response, and increased RD responsibility. A survey demonstrated physician support of this new RD role. CPD NOW may be applicable as a model to develop similar systems in other hospitals. J Am Diet Assoc. 2002;102:72-74,79-81.

Performance improvement in a clinicalnutrition staff's activities: A stratified model of nutritional status classification and timing of medical nutrition intervention therapy to meet the changing healthcare needs of a community teaching health center

Performance improvement in a clinicalnutrition staff's activities: A stratified model of nutritional status classification and timing of medical nutrition intervention therapy to meet the changing healthcare needs of a community teaching health center