Medical Nutrition Research Articles

Dietary intervention in gestational diabetes: a qualitative study of the acceptability and feasibility of a novel whole-diet intervention in healthcare professionals.

Gestational diabetes is treated with medical nutrition therapy, delivered by healthcare professionals; however, the optimal diet for affected women is unknown. Randomised controlled trials, such as the DiGest (Dietary Intervention in Gestational Diabetes) trial, will address this knowledge gap, but the acceptability of whole-diet interventions in pregnancy is unclear. Whole-diet approaches reduce bias but require high levels of participant commitment and long intervention periods to generate meaningful clinical outcomes. We aimed to assess healthcare professionals' views on the acceptability of the DiGest dietbox intervention for women with gestational diabetes and to identify any barriers to adherence which could be addressed to support good recruitment and retention to the DiGest trial. Female healthcare professionals (n 16) were randomly allocated to receive a DiGest dietbox containing 1200 or 2000 kcal/d including at least one weeks' food. A semi-structured interview was conducted to explore participants' experience of the intervention. Interviews were audio-recorded, transcribed verbatim and analysed thematically using NVivo software. Based on the findings of qualitative interviews, modifications were made to the dietboxes. Participants found the dietboxes convenient and enjoyed the variety and taste of the meals. Factors which facilitated adherence included participants having a good understanding of study aims and sufficient organisational skills to facilitate weekly meal planning in advance. Barriers to adherence included peer pressure during social occasions and feelings of deprivation or hunger (affecting both standard and reduced calorie groups). Healthcare professionals considered random allocation to a whole-diet replacement intervention to be acceptable and feasible in a clinical environment and offered benefits to participants including convenience.

Nutrition considerations in the transgender and gender-diverse patient.

The nutrition professional is increasingly providing care to individuals who identify as transgender. However, there are few definitive guidelines on providing medical nutrition care to this population. It is becoming better understood that this population is at elevated nutrition risk secondary to significant health disparities. More recently, the increasing prevalence of gender-affirming medical intervention has resulted in uncertainty when providing medical nutrition assessments and therapies, as many standardized guidelines and assessment tools are sex-specific. This review aims to provide clarity in exploring various gender-affirming methods to providing nutrition care to the transgender and gender-diverse population.

Review Article: Metabolic effects of nutritional therapy in patients with type 2 diabetes mellitus and/or obesity or overweight

Obesity is a chronic metabolic disease with multiple associated factors that has generated a high health impact worldwide; at the same time, rates of type 2 diabetes mellitus also increase with increasing body mass index. Medical nutrition therapy and a focus on lifestyle changes remain key components in the management of overweight and type 2 diabetes mellitus. However, there is little evidence on the different types of nutritional interventions used as a therapeutic strategy in these patients; therefore, the aim of the present review article is to evidence the metabolic effects of nutritional therapy in patients with type 2 diabetes mellitus and/or obesity or overweight. A literature search was conducted for Randomized Controlled Trials published between 2015 and 2021, in English and Spanish languages, conducted with patients aged 18 years or older, with a diagnosis of type 2 diabetes mellitus and/or overweight or obesity, who were intervened with medical nutritional therapy in order to know the metabolic effects of the diet. The search terms (keywords) included: "obesity", "overweight", "type 2 diabetes mellitus", in combination with "very low calorie ketogenic diet", "Mediterranean diet" and "low carbohydrate diet", using the Boolean operator "and". We found 11 published Randomized Controlled Trials that met the eligibility criteria

Comparison of nutrition care services for adult obesity at primary care in two different periods in Saudi Arabia

BackgroundDietitians are healthcare professionals with potential roles and impacts in primary care (PC) settings when applying knowledge and expertise to educate healthcare clients at all levels and treat chronic diseases. This study seeks to compare and evaluate the nutrition care services and practices in obesity management in primary care centres for two periods (2016 and 2019) in Jeddah city, Saudi Arabia.MethodsSurveys with service self-reporting evaluation used responses from 18 and 27 centres in 2016 and 2019. Services evaluation used no reference to a standard, but 18 of the surveyed PC centres in 2019 were previously visited in 2016 to assess the provided nutrition care services for adult obesity in PC centres. The re-visit survey investigated improvements in services achieved in 2019 concerning services for adults with obesity. A chi-square test was used to compare the surveys' results in the two periods, which resulted in a significant difference in the provided nutrition care services for adult obesity between 2016 and 2019.ResultsDietitians' employment has significantly changed (P < .0001) in 2019 compared to 2016. Dietitians were significantly noticed as the primary source of nutrition information after their integration into the services (P < .0001) in 2019. Services provided for adult obesity increased significantly (P value < .0001) in the second phase. However, there was no significant difference in serving adult groups between the two periods (P = .056).ConclusionsIntegrating dietitians into the PC services significantly enhanced their role in supporting PC services for conditions relating to adult obesity, which allowed them to be the most important source of the delivered nutrition information to patients. The employment rate of PC dietitians accredited by the governing body is significantly increasing; the Saudi Commission for Health Specialties will need to monitor it to ensure that dietitians have the qualifications and skills to provide professional medical nutrition therapy to patients. Further research to evaluate the quality of PC dietetic practice and improvements in patient outcomes is required to strengthen the importance of integrating registered dietitians into the services.

Medical nutrition therapy during intensive remission-induction treatment and hematopoietic stem cell transplantation in acute myeloid leukemia patients: Hematologists’ experiences and perspectives

The European Societies for Clinical Nutrition and Metabolism (ESPEN) and Blood and Marrow Transplantation (EBMT) recommend enteral nutrition (EN) as the first-choice medical nutrition therapy in acute myeloid leukemia (AML) patients undergoing intensive treatments, including high-dose remission-induction chemotherapy and hematopoietic stem cell transplantation (HSCT). However, parenteral nutrition (PN) remains the preferred method of nutrition support in current clinical practice. The aim of this qualitative study was to gain insight into hematologists' experiences and perspectives regarding the choice and ESPEN/EBMT recommendations on EN versus PN. Online semi-structured interviews were conducted with one hematologist from each of the 21 hospitals offering intensive AML treatments in the Netherlands, using Microsoft Teams. Interviews were audio-recorded, transcribed verbatim and thematically analyzed using Atlas. ti. One hundred nineteen hematologists working in the same hospitals were invited to complete a short online questionnaire survey (SurveyMonkey®) regarding their knowledge and opinion on the ESPEN/EBMT guidelines recommending EN over PN during intensive AML treatments. The results of this survey are presented in a descriptive way. Fifty-nine hematologists participated in this study (42% overall response rate), of which 21 in the semi-structured interviews (response rate 100%) and 38 in the online survey (response rate 32%). Hematologists considered medical nutrition therapy important for prevention and treatment of malnutrition and associated adverse outcomes in AML patients undergoing intensive remission-induction treatment and HSCT. However, opposed to the ESPEN/EBMT guidelines, the vast majority of hematologists were hesitant or reluctant to use EN instead of PN as the first-choice medical nutrition therapy in these patients. The most frequently cited barriers to use EN were the expected low feasibility and tolerance of EN, feeding tube-related discomfort and bleeding risk, and patient refusal. Other barriers to follow the guidelines on EN were related to personal factors, including hematologists' knowledge (lack of awareness and familiarity) and attitude (lack of agreement, outcome expectancy, experience, success, motivation, and learning culture), guideline-related factors (lack of evidence and applicability), and external factors (lack of collaboration and resources). Facilitators included strategies for nutrition education and dissemination of nutritional guidelines, interprofessional and patient collaboration, availability of feeding tubes that can be inserted without endoscopy and stronger scientific evidence. Hematologists recognized the importance of medical nutrition therapy for reducing malnutrition and related negative outcomes during intensive AML treatments. However, contrary to the ESPEN/EBMT guidelines, they preferred PN instead of EN as the medical nutrition therapy of first choice. To reduce compliance barriers, interventions should focus on improving hematologists' knowledge of medical nutrition therapy and dietary guidelines, enhancing success rates of EN by adequately triaging patients eligible for EN and inserting duodenal feeding tubes using an electromagnetic sensing device without endoscopy, developing decision aids and multidisciplinary guidelines and care pathways. Furthermore, future trials should focus on the feasibility and benefits of EN versus PN both during remission-induction treatment and HSCT.

ESPEN practical and partially revised guideline: Clinical nutrition in the intensive care unit

Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.

Dietary patterns and their associations with glycemic control among type 2 diabetic patients in Jazan, Saudi Arabia: A cross-sectional study

Diabetes is an important global health concern. According to the World Health Organization, the Kingdom of Saudi Arabia (KSA) has 2.8 to 4.3 million diabetic patients between the ages of 27 to 60 in the year 2022. Medical nutrition therapy an essential component of diabetes management, helps improve diabetes outcomes by assisting patients in achieving a target glycated hemoglobin (HbA1c) level of &lt;7. This study aimed to describe the pattern of food consumption in the study population and determine its association with glycemic control. This was a cross-sectional study among health facility attendees at the Endocrinology and Diabetes Center (EDC) in Jazan, KSA. A total of 315 patients with type 2 diabetes (T2D) were enrolled using a systematic random sampling technique. Sociodemographic and dietary habit information gathered through face-to-face interviews, anthropometric measurements, and HbA1c were collected from medical records. Participants were mostly females (55.6%), and more than half of them were above 50 years of age. More than 90% of the patients had poor HbA1c levels, and 2-thirds of the patients were overweight and obese (43.8% and 37.1%, respectively). The most consumed foods were bread (8 times/week) and coffee/tea and vegetables (7 times per week), and the least consumed was soda beverages (once/week). Multivariate logistic regression revealed that the consumption of fruits (consumed 5 times/week) significantly decreased HbA1c, while the consumption of pastries/pizza (consumed twice/week) significantly increased it. The pattern of consumption of fruits and vegetables in the study population conformed to the recommended levels, and that of fruits showed a statistically significant association with the control of HbA1c. Another food item that has a significant negative effect on HbA1c is pastries/pizza. Further studies that include more potentially confounding variables, such as treatment type, are needed.

Monitoring the effect of perioperative nutritional care on body composition and functional status in patients with carcinoma of gastrointestinal and hepatobiliary system and pancreas.

The significance of nutritional care in the management of cancer, particularly in the surgical treatment of abdominal cancer, is increasingly acknowledged. Body composition analysis, such as the Bioelectric impedance assay (BIA), and functional tests, e.g., handgrip strength, are used when assessing nutritional status alongside general and nutritional history, clinical examination, and laboratory tests. The primary approach in nutritional care is individually adjusted nutritional counselling and the use of medical nutrition, especially oral nutritional supplements. The aim of the study was to investigate the effects of perioperative nutritional care on body composition and functional status in patients with carcinoma of the gastrointestinal tract, hepatobiliary system, and pancreas. 47 patients were included, 27 received preoperative and postoperative nutritional counselling and oral nutritional supplements (Group 1), while 20, due to surgical or organisational reasons, received nutritional care only postoperatively (Group 2). The effect of nutritional therapy was measured with bioimpedance body composition and handgrip measurements. Group 2 had a higher average Nutritional Risk Screening (NRS) 2002 score upon enrolment (3 vs. 2 points); however, there was no difference when malnutrition was assessed using Global Leadership in Malnutrition (GLIM) criteria. There was a relative increase in lean body mass and fat-free mass index (FFMI) 7 days after surgery in group 1 (+4,2% vs. -2,1% in group 2). There was no difference in handgrip strength. Our results indicate that combined preoperative and postoperative nutritional care is superior to only postoperative nutritional care. It seems to prevent statistically significant lean mass loss 7 days after surgery but not after 14 days or 4 weeks.

A Methionine-Portioning-Based Medical Nutrition Therapy with Relaxed Fruit and Vegetable Consumption in Patients with Pyridoxine-Nonresponsive Cystathionine-β-Synthase Deficiency.

The main treatment for pyridoxine-nonresponsive cystathionine-β-synthase deficiency is a strict diet. Most centers prescribe low-protein diets based on gram-protein exchanges, and all protein sources are weighed. The purpose of this study is to investigate the effects of a more liberal methionine (Met)-based diet with relaxed consumption of fruits and vegetables on metabolic outcomes and dietary adherence. Ten patients previously on a low-protein diet based on a gram-protein exchange list were enrolled. The natural protein exchange lists were switched to a "Met portion exchange list". Foods containing less than 0.005 g methionine per 100 g of the food were accepted as exchange-free foods. The switch to Met portioning had no adverse effects on the control of plasma homocysteine levels in terms of metabolic outcomes. It resulted in a significant reduction in patients' daily betaine dose. All patients preferred to continue with this modality. In conclusion, methionine-portion-based medical nutrition therapy with relaxed consumption of fruits and vegetables seems to be a good and safe option to achieve good metabolic outcomes and high treatment adherence.

The Effect of Nozzle Temperature on the Low-Temperature Printing Performance of Low-Viscosity Food Ink.

Low-temperature food printing technology is used in many fields, such as personalized nutrition, cooking art, food design and medical nutrition. By precisely controlling the deposition temperature of the ink, a food with a finer and more controllable structure can be produced. This paper investigates the influence of nozzle temperature on printing performance via a numerical simulation and experimental research. The results indicate that the ink gradually changed from a granular state to a fLow-characteristic deposition structure when the nozzle temperature increased from 19 °C to 27 °C. When the nozzle temperature exceeded 21 °C, the ink demonstrated excellent extrusion behavior and tended to flow. The widths of the rectangular frame deposition showed no obvious changes and were 4.07 mm, 4.05 mm and 4.20 mm, respectively. The extrusion behavior of the ink showed a structural mutation in the temperature range of 19-21 °C. Its line width changed from 3.15 mm to 3.73 mm, and its deposition structure changed from a grainy shape to a normal shape. Under the influence of different environmental control capabilities, bulk structure deposition demonstrates an ideal printing performance at 21, 23 and 25 °C, and the latter temperature is more suitable in the case of large external interference. The ink flowed violently when the nozzle temperature reached 27 °C, at which point the deposit structure flowed and deformed seriously. On the other hand, evaporation losses had a strong effect on Low-viscosity ink. To reach the full potential of this promising technology, it is necessary to determine the effect of nozzle temperature on printing performance. This article provides a method for developing and applying Low-viscosity, Low-temperature food printing.

Medical nutrition therapy for diabetes mellitus

Background: Lifestyle modifications including medical nutrition, exercise, and behavioral psychological therapy play a pivotal role in the treatment of diabetes mellitus. In this study, we discuss the fundamental and essential aspects of medical nutrition therapy for treatment of diabetes mellitus based on the medical nutrition recommendations of the Korean Diabetes Association.Current Concepts: Patients with diabetes should receive education for individualized medical nutrition therapy from a qualified clinical dietitian. Overweight adults or those with obesity must lose at least 5% of their body weight. The percentages of carbohydrate, protein, and fat intake are individualized based on treatment goals and preferences. A Mediterranean, vegetarian, low-fat, low-carbohydrate, and Dietary Approaches to Stop Hypertension diet may be used based on individualized plans and priorities. Patients with diabetes are recommended to consume carbohydrates from fiber-rich whole grains, legumes, vegetables, raw fruits, and dairy products and to reduce intake of sweetened beverages. It is not necessary to limit protein intake. Patients with diabetes are recommended to replace foods high in saturated and trans fatty acids with foods rich in unsaturated fatty acids. Routine administration of unsaturated fatty acid supplements is not recommended. Sodium intake should not exceed 2,300 mg/day. Routine use of micronutrient supplements such as vitamins and minerals to improve blood glucose levels is not recommended. Patients using insulin or insulin secretagogues should be counseled to avoid hypoglycemia if they consume alcohol.Discussion and Conclusion: Medical nutrition therapy, which has been shown to treat diabetes and prevent a variety of cardiovascular risk factors and complications, should be utilized aggressively by all healthcare providers who treat patients with diabetes.

Diagnosis and management of gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is a condition characterized by hyperglycemia that is first diagnosed during pregnancy. It increases both fetal and maternal risk and is related to future metabolic abnormalities in women and their offspring. Therefore, appropriate diagnosis and management of GDM are crucial.Current Concepts: There are two strategies to diagnose GDM—a one-step strategy comprising a 75 g oral glucose tolerance test (OGTT), and a two-step strategy involving a 50 g OGTT followed by a 100 g OGTT. The former can detect more glucose abnormality during pregnancy; however, either method is acceptable, considering the evidence regarding pregnancy outcomes. The mainstay of glucose management in GDM is medical nutrition therapy with appropriate physical activity and self-monitoring of glucose. Insulin therapy is required if hyperglycemia cannot be controlled by lifestyle interventions. Generally, insulin therapy is immediately discontinued after childbirth, and 75 g OGTT is recommended at 4 to 12 weeks in the postpartum period and every 1 to 3 years thereafter. Lifestyle intervention is important in women with a history of GDM to prevent future diabetes.Discussion and Conclusion: GDM prevalence is increasing because of higher maternal age and prevalent obesity. Healthcare providers and women of childbearing age need to be more careful with regard to the detection and management of GDM, and treatment strategies should be personalized.

Carbohydrate and Fiber Intake on Fasting Blood Glucose Levels In Patients with Type 2 Diabetes Mellitus after Intervention of Brown Rice Diet

Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterized by hyperglycemia that occurs due to a decrease in insulin secretion by pancreatic beta cells and insulin resistance. One of the pillars in the management of T2DM is medical nutrition therapy in the form of a balanced diet. A good intake of carbohydrates and fiber can help control fasting blood glucose levels of diabetic patients. This study aims to determine the relationship between carbohydrate and fiber intake on fasting blood glucose levels in patients with T2DM after the intervention of brown rice diet. The type used in this study was pre-experimental without control variables and the sample was not selected randomly. The design was one-shot case study by looking at the post-test results. The number of samples was 18 people aged 48–60 years. Data analysis used the Shapiro Wilk normality test and Spearman correlation test. The results showed that most of the respondents had normal carbohydrate intake (88.9%) and all respondents had good fiber intake (100%). Most of the respondents had uncontrolled fasting blood glucose levels (55.6%). There is no relationship between carbohydrate and fiber intake on fasting blood glucose levels after the intervention of a brown rice-based diet menu.

Patients’ Perspectives on Dietary Patterns and Eating Behaviors During Weight Regain After Gastric Bypass Surgery

PurposeFood quality, energy intake, and various eating-related problems have been highlighted as some of the components influencing weight after bariatric surgery. This study aimed to increase our knowledge of patients’ perspectives on dietary patterns and eating behaviors during weight regain after bariatric surgery.Materials and MethodsWe recruited 4 men and 12 women with obesity and the experience of weight regain after bariatric surgery at an obesity clinic in Stockholm, Sweden. Data were collected during 2018–2019. We conducted a qualitative study, carried out individual semi-structured interviews, and analyzed the recorded and transcribed interview data with thematic analysis.ResultsParticipants had regained 12 to 71% from their lowest weight after gastric bypass surgery performed 3 to 15 years before. They perceived their dietary challenges as overwhelming and had not expected weight management, meal patterns, increasing portion sizes, and appealing energy-dense foods to be problematic after surgery. In addition, difficulties with disordered eating patterns, emotional eating, and increased alcohol intake further contributed to the weight management hurdles. Insufficient nutritional knowledge and lack of support limited participants’ ability to avoid weight regain, leading to restrictive eating and dieting without sustained weight loss.ConclusionEating behavior and dietary factors such as lack of nutritional knowledge, emotional eating, or disorganized meal patterns contribute to difficulties with weight management after gastric bypass surgery. Improved counseling may help patients prepare for possible weight regain and remaining challenges with food and eating. The results highlight the importance of regular medical nutrition therapy after gastric bypass surgery.Graphical

P23-069-23 Medical Nutrition Therapy From a Registered Dietitian Nutritionist Improves Outcomes in Adults with Pre-Hypertension or Hypertension: Systematic Review and Meta-Analysis

P23-069-23 Medical Nutrition Therapy From a Registered Dietitian Nutritionist Improves Outcomes in Adults with Pre-Hypertension or Hypertension: Systematic Review and Meta-Analysis

P08-006-23 Effectiveness of Medical Nutrition Therapy for Patients Utilizing a Community Health Clinic To Support Diabetes Management

P08-006-23 Effectiveness of Medical Nutrition Therapy for Patients Utilizing a Community Health Clinic To Support Diabetes Management

P23-025-23 The Effectiveness of Dietitian-Provided Medical Nutrition Therapy in Adults With Prediabetes: A Systematic Review and Meta-Analysis

P23-025-23 The Effectiveness of Dietitian-Provided Medical Nutrition Therapy in Adults With Prediabetes: A Systematic Review and Meta-Analysis

OR11-07-23 Sustainable Eating in Medical Nutrition Therapy for Type 2 Diabetes – Exploring Dietary Guidelines and Registered Dietitians’ Perspectives: A Qualitative Study Protocol

OR11-07-23 Sustainable Eating in Medical Nutrition Therapy for Type 2 Diabetes – Exploring Dietary Guidelines and Registered Dietitians’ Perspectives: A Qualitative Study Protocol

Diagnosis and Non-Invasive Treatment of Obesity in Adults with Type 2 Diabetes Mellitus: A Review of Guidelines.

Obesity, a chronic disease with multifactorial etiopathogenesis, is characterized by excessive accumulation of adipose tissue. Obesity prevalence is growing globally at an alarming rate. The overwhelming majority of obesity cases are caused by inappropriate lifestyles, such as overconsumption of food and inadequate physical activity. Metabolic and biochemical changes due to increased adiposity resulted in numerous comorbidities, increased all-cause mortality, and reduced quality of life. T2DM (type 2 diabetes mellitus) and obesity have many common pathogenetic points and drive each other in a vicious cycle. The aim of this article is to review obesity management guidelines and highlight the most important points. Management of both obesity-related and T2DM complications incur enormous expenses on healthcare systems. It is, therefore, paramount to provide streamlined yet custom-tailored weight management in order to avoid the negative ramifications of both diseases. Efficient obesity treatment leads to better diabetes control since some antidiabetic medications support weight reduction. Obesity treatment should be overseen by a multi-disciplinary team providing indispensable information and individually tailored regimens to patients. Weight management should be multimodal and consist chiefly of MNT (medical nutrition therapy), physical activity, and lifestyle changes. A comprehensive approach to obesity treatment may give tangible results to quality of life and comorbidities.

Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes.

Diet and exercise are a fundamental part of comprehensive care for type 2 diabetes.