Medical Nutrition Research Articles

Effects of low-GI biscuits as pre-loads or mid-meal snacks on post-prandial glycemic excursions in women with recent gestational diabetes: A protocol for a randomized crossover trial and an extended tailored intervention.

Increased post-prandial glycemic excursions contribute to the development of diabetes and have been observed in women with recent gestational diabetes mellitus (GDM) and with normal glucose tolerance at post-partum. As a convenient meal replacement, low-GI biscuits are helpful for improving glycemic excursions in patients with type 2 diabetes. However, it is unknown whether low-GI biscuits as pre-loads or mid-meal snacks have a better effect in diminishing post-prandial glycemic excursions from the individual level in women with recent GDM. Therefore, the aim of this trial is to tailor a better dietary strategy utilizing low-GI biscuits (Fitmeal) to improve post-prandial glycemic excursions through within-subject comparison in such a population and observe the long-term effect of a tailored dietary approach in glycemic control. We have designed a two-phase trial including a randomized, crossover, non-blinded trial in the first phase, followed by a 4-week tailored intervention in the second phase. A total of 52 post-partum women with recent GDM will be allocated into four meal plans: (1) Fitmeal pre-load 30 min before standard lunch meal (P+L), (2) Fitmeal as a mid-meal snack 2 h before standard lunch meal (S+L), (3) isocaloric standard control with co-ingestion of Fitmeal and standard lunch meal (CL) at the same time, and (4) placebo control with 200 ml of water taken 30 min before standard lunch meal (W + L), on four consecutive days. Acute post-prandial glycemic response (PGR) measured by continuous glucose monitoring (CGM) will be compared among the four meals. In the second phase, all participants will receive a 4-week tailored intervention using Fitmeal as pre-loads or mid-meal snacks based on within-subject PGR results from the first phase. Glycemic metrics, dietary behaviors, and psychosocial factors (e.g., quality of life, self-efficacy, perceived stress, and depression) will be examined at baseline and end-point. This trial is expected to optimize the use of low-GI biscuits as pre-loads or mid-meal snacks in improving individual post-prandial glycemic excursions among women with recent GDM. Furthermore, the findings of this study will provide novel information on how to deliver an effective dietary intervention at the individual level and guide future clinical practice of medical nutrition therapy for diabetes prevention. Chinese clinical trial registry, ChiCTR2200060923.

The Impact Of Medical Nutrition Therapy For Patients In Hospice Unit

The Impact Of Medical Nutrition Therapy For Patients In Hospice Unit

Do Dutch Primary Care Dietitians Advice Medical Nutrition As Recommended By The National Malnutrition Guideline? Preliminary Results From The Monday Study

Do Dutch Primary Care Dietitians Advice Medical Nutrition As Recommended By The National Malnutrition Guideline? Preliminary Results From The Monday Study

Disciplined appetites: Reimagining food and nutrition programs for people living with HIV and AIDS.

Medical nutrition therapy is recommended for people living with HIV/AIDS to improve health and wellness; however, there is a lack of food and nutrition programs for people living with HIV/AIDS in Nova Scotia, Canada. The aim of this study was to explore the beliefs, values, and experiences of people living with HIV/AIDS in relation to food and nutrition programs. A critical social theory lens with two disciplinary contexts: critical health geography and critical dietetics guided this research. Semi-structured interviews were conducted with 12 people living with HIV/AIDS and analysed for themes. The three main themes were identified: (1) intersections of social determinants of health, wellness, and food security; (2) discursive shaping of food and nutrition in relation to HIV; and (3) the dynamic nature of HIV care. Participants offered recommendations on how food and nutrition programs might be reimagined to be more accessible, inclusive, and effective for people living with HIV/AIDS.

Nutritional management of children with acute kidney injury-clinical practice recommendations from the Pediatric Renal Nutrition Taskforce.

The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.

The Impact of Medical Nutrition Intervention on the Management of Hyperphosphatemia in Hemodialysis Patients with Stage 5 Chronic Kidney Disease: A Case Series

The treatment and interdisciplinary management of patients with chronic kidney disease (CKD) continue to improve long-term outcomes. The medical nutrition intervention's role is to establish a healthy diet plan for kidney protection, reach blood pressure and blood glucose goals, and prevent or delay health problems caused by kidney disease. Our study aims to report the effects of medical nutrition therapy-substituting foods rich in phosphorus-containing additives with ones low in phosphates content on phosphatemia and phosphate binders drug prescription in stage 5 CKD patients with hemodialysis. Thus, 18 adults with high phosphatemia levels (over 5.5 mg/dL) were monitored at a single center. Everyone received standard personalized diets to replace processed foods with phosphorus additives according to their comorbidities and treatment with prosphate binder drugs. Clinical laboratory data, including dialysis protocol, calcemia, and phosphatemia, were evaluated at the beginning of the study, after 30 and 60 days. A food survey was assessed at baseline and after 60 days. The results did not show significant differences between serum phosphate levels between the first and second measurements; thus, the phosphate binders' initial doses did not change. After 2 months, phosphate levels decreased considerably (from 7.322 mg/dL to 5.368 mg/dL); therefore, phosphate binder doses were diminished. In conclusion, medical nutrition intervention in patients with hemodialysis significantly reduced serum phosphate concentrations after 60 days. Restricting the intake of processed foods containing phosphorus additives-in particularized diets adapted to each patient's comorbidities-and receiving phosphate binders represented substantial steps to decrease phosphatemia levels. The best results were significantly associated with life expectancy; at the same time, they showed a negative correlation with the dialysis period and participants' age.

Evaluating a virtual and in-person nutrition interprofessional educational experience for first-year medical students

Nutrition plays a critical role in preventing, managing, and treating noncommunicable diseases; thus it is essential physicians be able to appropriately refer to and collaborate with interprofessional (IP) care team members, like registered dietitian nutritionists (RDNs). This study evaluated the effectiveness of the Nutrition Clinical Experience (NCE) to increase first-year medical students' (M1s′) understanding of RDNs’ roles on the IP healthcare team, common reasons to consult a RDN, and interventions RDNs implement.M1s participated in a 1.5 or 2-h IP clinical observation experience with an outpatient or inpatient RDN. Due to the COVID-19 pandemic, virtual, in-person, and hybrid experiences were offered. Before the experience, students were provided a handout with an overview of a RDN's role, description of medical nutrition therapy, and example cases. During the NCE students shadowed a RDN as they conducted outpatient encounters or inpatient rounds, and were encouraged to discuss real or sample patient cases. Students and RDNs answered post-experience 5-point Likert surveys and free-response questions to evaluate experience effectiveness. Of responding students, 96% agreed or strongly agreed the experience helped them learn about RDNs' roles and 99% agreed or strongly agreed they were more likely to involve a RDN in patient care following the experience. Additionally, after the experience, 78% of participating students identified at least one common reason to consult a RDN and 70% described at least three interventions that RDNs implement. All responding RDNs agreed or strongly agreed the experience is valuable to students and 85% agreed or strongly agreed the NCE allowed them to communicate their roles to students. The ability to deliver the experience virtually makes it a useful curricular program for schools without on-site RDNs to engage preclinical students in IP experiences. This report includes materials required for the experience.

Avoidant/Restrictive Food Intake Disorder (ARFID)

This publication addresses the characteristics, health and nutrition implications, and medical nutrition therapy recommendations for Avoidant/Restrictive Food Intake Disorder (ARFID). Written by Lily Tucciarone, Sara Murphy, and Wendy J. Dahl, and published by the UF/IFAS Food Science and Human Nutrition Department, December 2022.

Improving Adherence to Medical Nutrition Therapy with Behaviour Modification Embedded in Practice

Nutritional assessment, intervention, and result evaluation are all influenced by changes in nutritionrelated behaviour. The combination of medical nutrition therapy and behaviour modification is supported by evidence-based medicine. The evidence is compelling in those with type 2 diabetes and obesity. When compared to CBT self-monitoring, meal replacements, and/or organised meal planning, motivational interviewing was found to be the most superior and highly effective counselling technique. Although goal-setting, problem-solving, and social support are useful tactics, further research in more diverse populations are required. We will focus on increasing adherence to medical nutrition treatment with behaviour modification in this review of the literature.

Medical Nutrition Therapy Interventions Provided by Dietitians for Adult Overweight and Obesity Management: An Academy of Nutrition and Dietetics Evidence-Based Practice Guideline.

Overweight and obesity affect most adults living in the United States and are causally linked to several adverse health outcomes. Registered dietitian nutritionists or international equivalents (dietitians) collaborate with each client and other health care professionals to meet client-centered goals, informed by the best available evidence, and translated through a lens of clinical expertise and client circumstances and preferences. Since the last iteration of the Academy of Nutrition and Dietetics guideline on adult weight management in 2014, considerable research has been conducted and circumstances confronting dietitians have evolved. Thus, updated guidance is needed. The objective of this evidence-based practice guideline is to provide recommendations for dietitians who deliver medical nutrition therapy behavioral interventions for adults (18 years and older) with overweight and obesity to improve cardiometabolic outcomes, quality of life, and weight outcomes, when appropriate for and desired by the client. Recommendations in this guideline highlight the importance of considering complex contributors to overweight and obesity and individualizing interventions to client-centered goals based on specific needs and preferences and shared decision making. The described recommendations have the potential to increase access to care and decrease costs through utilization of telehealth and group counseling as effective delivery methods, and to address other barriers to overweight and obesity management interventions. It is essential for dietitians to collaborate with clients and interprofessional health care teams to provide high-quality medical nutrition therapy interventions using the nutrition care process to promote attainment of client-centered outcomes for adults with overweight or obesity.

New Frontiers in Diabetes Care: Quality Improvement Study of a Population Health Team in Rural Critical Access Hospitals.

Rural populations are older, have higher diabetes prevalence, and have less improvement in diabetes-related mortality rates compared to urban counterparts. Rural communities have limited access to diabetes education and social support services. Determine if an innovative population health program that integrates medical and social care models improves clinical outcomes for patients with type 2 diabetes in a resource-constrained, frontier area. Quality improvement cohort study of 1764 patients with diabetes (September 2017-December 2021) at St. Mary's Health and Clearwater Valley Health (SMHCVH), an integrated health care delivery system in frontier Idaho. The United States Department of Agriculture's Office of Rural Health defines frontier as sparsely populated areas that are geographically isolated from population centers and services. SMHCVH integrated medical and social care through a population health team (PHT), where staff assess medical, behavioral, and social needs with annual health risk assessments and provide core interventions including diabetes self-management education, chronic care management, integrated behavioral health, medical nutritional therapy, and community health worker navigation. We categorized patients with diabetes into three groups: patients with two or more PHT encounters during the study (PHT intervention), one PHT encounter (minimal PHT), and no PHT encounters (no PHT). HbA1c, blood pressure, and LDL over time for each study group. Of the 1764 patients with diabetes, mean age was 68.3 years, 57% were male, 98% were white, 33% had three or more chronic conditions, and 9% had at least one unmet social need. PHT intervention patients had more chronic conditions and higher medical complexity. Mean HbA1c of PHT intervention patients significantly decreased from baseline to 12 months (7.9 to 7.6%, p < 0.01) and sustained reductions at 18 months, 24 months, 30 months, and 36 months. Minimal PHT patients decreased HbA1c from baseline to 12 months (7.7 to 7.3%, p < 0.05). The SMHCVH PHT model was associated with improved hemoglobin A1c among less well-controlled patients with diabetes.

Associations between plant-based diets, plant foods and botanical supplements with gestational diabetes mellitus: a systematic review protocol

IntroductionGestational diabetes mellitus (GDM) is one of the most common health complications during pregnancy. Medical nutrition therapy is the mainstay of treatment for GDM, however, there is no current consensus...

Resting and total energy expenditure of patients with long-chain fatty acid oxidation disorders (LC-FAODs).

The basis of medical nutrition therapy for patients with LC-FAODs is to provide adequate energy to maintain anabolism and prevent catabolism. In practice, energy needs are estimated based on formulas derived from normal populations but it is unknown if energy expenditure among patients with LC-FAODs is similar to the normal population. We measured resting energy expenditure (REE), total energy expenditure (TEE) and body composition in 31 subjects with LC-FAODs ranging in age from 7 to 64 years. Measured REE was lower than estimated REE by various prediction equations and measured TEE was lower than estimated TEE. It is possible that the lower energy expenditure based on prediction formulas from the normal population is due to differences in body composition; we compared body composition to normal data from the 2017-18 National Health and Nutrition Examination Survey (NHANES). Fat free mass and fat mass was similar between subjects with an LC-FAOD and NHANES normal data suggesting no difference in body composition. We then compared measured REE and TEE to normal published data from the Dietary Reference Intakes (DRI). Measured REE and TEE were significantly lower among subjects with LC-FAODs compared to normal published energy expenditure data. Our results suggests patients with a LC-FAOD exhibit a lower REE and therefore actually have a slightly lower TEE than estimated. Current prediction equations may overestimate energy expenditure of patients with a LC-FAOD.

Effects of Intermittent Fasting on Weight Loss and Cardiometabolic Health

Intermittent fasting is a cyclical way of eating that is formed by the succession of eating and fasting period. It includes a long period of fasting, such as 16-48 hours, in which individuals receive little or no energy, and a normal eating period. The most commonly applied methods are alternate day fasting (ADF), time-restricted feeding (TRF) the 5:2 diet and Ramadan fasting. It has been reported that these diet models can be an alternative to continuous energy restriction in the medical nutrition treatment of obesity and are effective in weight loss. Intermittent fasting can have positive effects on reducing the risk of cardiovascular diseases and improving symptoms by causing reductions in blood lipids, oxidative stress and inflammation. In addition, it is observed that intermittent fasting has effects on the prevention of diabetes by causing reductions in insulin resistance and fasting blood glucose levels. In addition to its positive effects, risks such as energy, vitamin, mineral and protein deficiencies may occur. The most important risk is that patients receiving insulin therapy may experience hypoglycemia during fasting periods. It has been reported to be unsafe for use in pregnant and lactating women, eating disorders, underweight individuals, adolescents, and older adults. Intermittent fasting should be applied under the control of a doctor and dietitian, taking into account individual differences and medical treatment. In this review, studies investigating the effects of intermittent fasting on weight loss and cardiometabolic health are summarized.

Tratamiento del deterioro cognitivo

The treatment of cognitive impairment is multidisciplinary and begins with an intervention on risk factors. Non-pharmacological treatment includes measures such as cognitive stimulation and aerobic exercise. In regard to diet, the Mediterranean diet has demonstrated cognitive improvement and only the medical nutrition product souvenaid has managed to show isolated benefits in episodic memory in initial cognitive impairment due to Alzheimer's disease. Among the pharmacological interventions on symptoms, current evidence only supports the use of acetylcholinesterase inhibitors (ACEI) such as donepezil, rivastigmine, and galantamine as well as memantine, a non-competitive NMDA antagonist of glutamate receptors, in mild to moderately-advanced Alzheimer's dementia. ACEI have also shown cognitive benefits in Lewy body dementia, but not in frontotemporal dementia. The treatment of dementia-phase behavioral symptoms improves the quality of life of patients and family members and includes addressing psychosis, agitation, depression, apathy, or sleep disorders.

Dietary interference for the prevention of type 2 diabetes

Medical nutrition therapy (MNT) provided by a registered dietician into primary care of type 2 diabetes mellitus (T2DM). This is necessary to achieve the goals of improving overall metabolic measures beyond calorie restriction and weight loss. Misconceptions about nutrition in T2DM add to the challenges of executing MNT in a culturally sensitive population. The current review provides insights into MNT for the prevention and management of T2DMbased on both evidence and experience. It revisits historical Indian studies and provides information on appropriate dietary intake of carbohydrates (60–70%), proteins 20% and fats 10% that will be acceptable and beneficial in T2DM population. It discusses nuances of types of carbohydrates and fats and explains associations of increased dietary fiber intake, balanced intake of low and high glycemic index foods and substitution of saturated fats with plant-based polyunsaturated fats in improving outcomes of T2DM and attenuating risk factors. The article also deliberates upon special patient populations with comorbid conditions and diseases and the necessary adjustments needed in their nutritional care.

Nutrition practices in intensive care units: nutritionDay from 2007-2021

In intensive care units (ICU), patients who are not able to eat or are considered at nutritional risk typically receive medical nutrition therapy based on partially contradictory guidelines as well as the strategies used in large randomized trials. The aim of this study is to analyze patient data from the nutritionDay project in intensive care to describe current clinical approaches to nutrition support worldwide, in Europe and in the group of German-speaking countries, the DACH (i.e., Germany, Austria, Switzerland) region. From 2007-2021, data of 18,918 adult patients in 1595 ICUs from 63different countries were included in this cross-sectional study. The aim was to recruit all patients present in ICUs. Median stay in the ICU was 4days on nutritionDay. Little difference in patient characteristics were observed between worldwide, Europe, and the DACH region. Patient were 64years old, 40% female, 50% ventilated, 29% sedated, and 10% needed renal replacement therapy. Aquarter of the patients died in hospital within 60days and about half of the patients had been discharged home. Enteral nutrition was given twice as frequently as parenteral nutrition (48% versus 24%). Many patients received oral nutrition (39%) and asubstantial number received no nutrition support (10%). Parenteral nutrition was used more frequently in Europe than in other world regions, the lowest use being observed in North America. The amount of nutrition given is very similar in all regions regardless of the nutrition route with about 1500 kcal and 60 g of protein per day. Aclear association with body weight was not observed and the variation around the median was very large with half of patients receiving amounts 25% below or above the median. Upon completion of data entry, the nutritionDay project allows each ICU to download aunit report summarizing data that allows comparison with worldwide data in numeric and graphical form to permit easy benchmarking of medical nutrition therapy.

Intuition on medical nutrition therapy for type 2 diabetes mellitus: an outlook with a case study: A survey

Intuition on medical nutrition therapy for type 2 diabetes mellitus: an outlook with a case study: A survey

A Review on Medicinal Bamboo: An Ancient Source Towards Healthy Lifestyle

Abstract: Bamboos are reported as the most valuable among other forest reserves, comfortably available and also sustainable. Bamboos are observed to be a group of evergreen perennial flowering plants belonging to the family Poaceae - (subfamilyBambusoideae). As per reports bamboos have huge divergence in nature consisting of around 1400 species and 115 genera. Bamboo species are used over a long ancient period to produce textiles, boats, paper, furniture, and as a food. Their dried leaves are also used to wrap up decorative items and even food items to protect from any contamination. Various bamboo species contains chemical constituents such as flavonoids, phenols, tannins, lignins and polysaccharides. Other characteristic compounds present in bamboo are caffeic acid, orientin, vitexin, p-coumaric acid, isoorientin and chlorogenic acid. There are many reported studies which showing a wide use of bamboo leaves in Ancient history and even in today’s modern world used in the treatment of cardiovascular diseases, hypertension, arteriosclerosis and even few forms of cancer. We have many studies and literature emphasizing upon use of bamboo in medicinal practice in Asian region and Southeast Asian region, but there’s a lot more to be explored in Southern American species. This information shows beneficial results in human health, which are of a great interest in the medical nutrition industry which is an industry that emerged for the convergence between the food and pharma industries.

Застосування кетогенної дієти в педіатрії: спектр можливостей

Purpose - to describe the possibilities of using a ketogenic diet (KD) in the pediatric population for therapeutic purposes in refractory seizure syndrome and congenital metabolic disorders. The historical aspects of the development of special medical nutrition to achieve stable ketosis in children for the treatment of seizures of various genesis are briefly highlighted; the development of the evidence base for the effectiveness of the KD in children is presented. A review of current data on the multifactorial mechanisms of neuroprotective effects of KD is carried out. In particular, individual ways of modulating fundamental biochemical pathways, presynaptic and postsynaptic changes in vesicular transport and release of excitotoxic and inhibitory substrates at synapses are considered. Four types of diets are described according to the distribution of proteins, fats, and carbohydrates: the classic, modified Atkins diet, medium-chain triglyceride diet, and low glycemic index diet. The indications and contraindications for the appointment of medical ketogenic dietary therapy are considered. The most appropriate age periods of childhood for the type of KD are outlined to achieve maximum effectiveness. The authors describe in detail the main objectives of the stages of preparation of the child and family for the start of dietary treatment, the principles of initiation of KD, laboratory and instrumental monitoring and discontinuation of ketogenic dietary therapy. Particular attention is paid to the issue of counseling a child before starting a KD, the main steps in calculating the proportion of macronutrients and the principles of daily nutrition. The possibilities of prescribing medical ketogenic dietary therapy outside of refractory seizures, in particular, in glucose transaminase 1 deficiency syndrome, pyruvate dehydrogenase deficiency, mitochondrial disorders, heart failure, and brain injury, are analyzed. Available special products for medical purposes (clinical nutrition) for the organization of medical ketogenic therapy in pediatric patients, especially in the first years of life, are presented. No conflict of interests was declared by the authors.