Role In Nutritional Management Research Articles

Patient perspectives on dietitians’ role in nutrition management among cancer patients: Implications for proactive care and communication

Objective: This study aimed to determine patients’ perspectives regarding the role of dietitians in nutrition management. Methods: This study was conducted at our hospital’s oncology outpatient clinics. It used a questionnaire previously reported in the literature. One hundred sixty-two adult volunteers were included in this study. Patients’ knowledge of nutritional information, preferences for nutrition care, and perspectives on the dietitian’s role were measured. Descriptive statistics were used to describe the continuous variables. The degree of agreement was assessed using a 5-point Likert scale. Results: Nutritional care was a high priority for most volunteers (74.7%). Almost half of the patients expressed a need for dietitians to address their dietary challenges proactively. Most patients (64.2%) first met with a dietitian during ongoing treatment. They emphasized the need for frequent meetings and were willing to be referred to a dietitian earlier in their treatment. Conclusions: Most patients are referred to a dietitian after malnutrition, indicating the need for earlier intervention. Patients strongly desire improved communication among the healthcare team members regarding their nutritional concerns. Proactive nutritional management can reduce the incidence of malnutrition and enhance patient outcomes.

Role of family medicine physicians in providing nutrition support to older patients admitted to orthopedics departments: a grounded theory approach.

Care of older adults requires comprehensive management and control of systemic diseases, which can be effectively managed by family physicians. Complicated medical conditions in older patients admitted to orthopedic departments (orthopedic patients) necessitate interprofessional collaboration. Nutrition is one of the essential components of management involved in improving the systemic condition of older patients. Nutrition support teams play an important role in nutrition management and can be supported by family physicians. However, the role of family physicians in nutrition support teams is not well documented. This study aimed to investigate the role of family physicians in supporting nutrition management in orthopedic patients. This qualitative study was conducted between January and June 2023 using constructivist grounded theory methodology. Eight family medicine physicians, three orthopedic surgeons, two nurses, two pharmacists, four rehabilitation therapists, four nutritionists, and one laboratory technician working in Japanese rural hospitals participated in the research. Data collection was performed through ethnography and semi-structured interviews. The analysis was performed iteratively during the study. Using a grounded theory approach, four theories were developed regarding family physicians' role in providing nutrition support to orthopedic patients: hierarchical and relational limitation, delay of onset and detection of the need for geriatric care in orthopedic patients, providing effective family medicine in hospitals, and comprehensive management through the nutrition support team. The inclusion of family physicians in nutrition support teams can help with early detection of the rapid deterioration of orthopedic patients' conditions, and comprehensive management can be provided by nutrition support teams. In rural primary care settings, family physicians play a vital role in providing geriatric care in community hospitals in collaboration with specialists. Family medicine in hospitals should be investigated in other settings for better geriatric care and to drive mutual learning among healthcare professionals.

Role of nutrition management in the treatment of acute pancreatitis – comprehensive review

Introduction and purpose
 The treatment of acute pancreatitis remains a clinically significant problem worldwide, as well as in Poland, where the incidence of the condition is nearly twice as high as in the global population. The aim of this study is to present the latest available guidelines regarding conservative management of patients diagnosed with acute pancreatitis, focusing on nutritional management and treatment methods.
 
 Materials and methods:
 The literature available in PubMed, Scopus, Google Scholar databases, and guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) was reviewed using the following keywords: "acute pancreatitis," "AP treatment," "nutritional treatment of acute pancreatitis," "enteral nutrition," "parenteral nutrition."
 
 Description of the state of knowledge:
 The approach to conservative treatment for acute pancreatitis has evolved over the years. Previously, the preferred route of feeding was parenteral with limited lipid content, aimed at reducing the stress on the pancreas. Current guidelines emphasize the superiority of enteral nutrition using a complete nutritional composition.
 
 Conclusions:
 The latest guidelines highlight the advantage of enteral nutrition over parenteral nutrition, with implementation within 48 hours of diagnosis. This approach reduces mortality, the risk of complications, and the duration of hospital stay for patients. The appropriate caloric intake should be adjusted to the individual needs of the patient, considering the severity of the disease and coexisting conditions. Meeting the patient's energy requirements, along with the choice of administration method and precise composition of nutritional formulas, play a crucial role in therapy.

Development of an advanced practice nurse (APN) role for nutrition management: A needs assessment using a mixed methods approach

Development of an advanced practice nurse (APN) role for nutrition management: A needs assessment using a mixed methods approach Abstract. Background: Nurses are attributed to play a key role in nutrition management. This field has emerged to be a subject of advanced nursing practice. Aim: Conducting a needs assessment on the role profile of an advanced practice nurse (APN) in nutrition management according to the PEPPA framework. Methods: Mixed methods design. In a cross-sectional study on the current practice, the diagnostic accuracy of nurses' nutrition screening using Nutritional Risk Screening (NRS 2002) compared with independent assessment by a nutrition expert using NRS 2022 was examined. In case of a positive screening result, reasons were determined using an in-depth assessment. In addition, semi-structured, guideline-based interviews were conducted and content-analysed. Results: The identification of patients at risk by nurses' nutrition screening showed a need for improvement (sensitivity: 56%, specificity: 96%; n = 195). Commonly identified reasons for (risk of) malnutrition (n = 51) were lack of desire to eat/lack of appetite or increased caloric needs due to illness. Development opportunities and expectations for an APN were specified based on the interviews (n = 20). They refer to skill enhancement, support within the interprofessional team in complex treatment cases and a stronger nursing role in nutrition management. Conclusions: Based on the needs assessment, the APN's areas of responsibility were identified and assigned to the Hamric model, and implementation strategies could be derived.

Nurses’ knowledge, attitudes, and practice with regards to nutritional management of diabetes mellitus

BackgroundThe prevalence of diabetes is increasing rapidly worldwide. Nurses work collaboratively with multidisciplinary teams to improve diabetes management. Yet, little is known about nurses’ role in nutritional management of diabetes. This study aimed to evaluate nurses’ knowledge, attitudes, and practice (KAP) toward nutritional management of diabetes.MethodsThis cross-sectional study was conducted with 160 nurses, who were recruited between July 4 and July 18, 2021 from two referral tertiary teaching hospitals in Iran. A validated paper-based self-reported questionnaire was used to assess nurses’ KAP. Data were analyzed using descriptive statistics and multiple linear regression analysis.ResultsThe mean knowledge score of nurses about nutritional management of diabetes was 12.16 ± 2.83, and 61.2% showing a moderate knowledge level on nutritional management of diabetes. The mean attitudes score was 60.68 ± 6.11, with 86.92% of participants demonstrating positive attitudes. The mean practice score of study participants was 44.74 ± 7.81, with 51.9% having a moderate level of practice. Higher knowledge scores were observed among male nurses (B = -7.55, p = 0.009) and those with blended learning as a preferred learning method (B = 7.28, p = 0.029). Having an opportunity to provide education to patients with diabetes during shifts affected nurses’ attitudes positively (B = -7.59, p = 0.017). Practice scores were higher among nurses who perceived themselves competent in the nutritional management of diabetes (B = -18.05, p = 0.008).ConclusionNurses’ knowledge and practice in the nutritional management of diabetes should be increased to help improve the quality of the dietary care and patient education they provide these patients. Further studies are needed to confirm the results of this study both in Iran and internationally.

Promotion of healthy nutrition in primary and secondary cardiovascular disease prevention: a clinical consensus statement from the European Association of Preventive Cardiology.

Poor dietary habits are common and lead to significant morbidity and mortality. However, addressing and improving nutrition in various cardiovascular settings remain sub-optimal. This paper discusses practical approaches to how nutritional counselling and promotion could be undertaken in primary care, cardiac rehabilitation, sports medicine, paediatric cardiology, and public health. Nutrition assessment in primary care could improve dietary patterns and use of e-technology is likely to revolutionize this. However, despite technological improvements, the use of smartphone apps to assist with healthier nutrition remains to be thoroughly evaluated. Cardiac rehabilitation programmes should provide individual nutritional plans adapted to the clinical characteristics of the patients and include their families in the dietary management. Nutrition for athletes depends on the sport and the individual and preference should be given to healthy foods, rather than nutritional supplements. Nutritional counselling is also very important in the management of children with familial hypercholesterolaemia and congenital heart disease. Finally, policies taxing unhealthy foods and promoting healthy eating at the population or workplace level could be effective for prevention of cardiovascular diseases. Within each setting, gaps in knowledge are provided. This clinical consensus statement contextualizes the clinician's role in nutrition management in primary care, cardiac rehabilitation, sports medicine, and public health, providing practical examples of how this could be achieved.

Continuous Glucose Monitoring in Preterm Infants: The Role of Nutritional Management in Minimizing Glycemic Variability.

Glycemic variability (GV) is common in preterm infants. In the premature population, GV is a risk factor for morbidity and mortality. Both hypo- and hyperglycemia can impair neurodevelopment. We investigated the impact of continuous versus intermittent tube enteral feeding on GV. In our prospective observational study, 20 preterm infants with a gestational age ≤ 34 weeks at either continuous or intermittent bolus full enteral feeding. For five days, continuous glucose monitoring (CGM) was utilized, which was achieved through the subcutaneous insertion of a sensor. A total of 27,532 measurements of blood glucose were taken. The mean amplitude of glycemic excursions did not differ between the two cohorts statistically. Continuous feeding resulted in higher positive values, increasing the risk of hypo- and hyperglycemia. Subjects who were small for their gestational age had a higher standard deviation during continuous feeding (p = 0.001). Data suggest that intermittent bolus nutrition is better for glycemic control than continuous nutrition. Nutritional management optimization of preterm infants appears to be critical for long-term health. In the future, CGM may provide a better understanding of the optimal glucose targets for various clinical conditions, allowing for a more personalized approach to management.

Nutrition and Physical Therapy: A Position Paper by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition (Secondary Publication).

Several patients undergoing physical therapy have nutritional problems. Knowledge of nutrition is necessary for addressing nutritional problems, such as malnutrition, sarcopenia, frailty, and cachexia. However, the relationship between physical therapy and nutrition is not fully understood. Physical therapy plays an important role in nutritional management, and evaluations, such as muscle strength and muscle mass evaluations, play an important role in nutritional screening and diagnosis. Exercise, as the core of physical therapy, is essential for nutritional interventions. Several recent studies have suggested that a combination of nutrition and physical therapy interventions can maximize the function, activity, participation, and quality of life of patients. The combination of nutrition and physical therapy interventions is key to addressing the needs of modern and diverse populations. This position paper was developed by the Physical Therapist Section of the Japanese Association of Rehabilitation Nutrition in consultation with the Japanese Society of Nutrition and Swallowing Physical Therapy.

Nutritional Aspects of Pediatric Gastrointestinal Diseases.

In the last decade, the role of nutritional management in pediatric gastrointestinal diseases has gained increasing popularity. Disease-specific diets have been introduced as conventional treatments by international guidelines. Patients tend to more willingly accept food-based therapies than drugs because of their relatively “harmless” nature. Apart from a diet’s therapeutic role, nutritional support is crucial in maintaining growth and improving clinical outcomes in pediatric patients. Despite the absence of classical “side effects”, however, it should be emphasized that any dietary modification might have negative consequences on children’s growth and development. Hence, expert supervision is always advised, in order to support adequate nutritional requirements. Unfortunately, the media provide an inaccurate perception of the role of diet for gastrointestinal diseases, leading to misconceptions by patients or their caregivers that tends to overestimate the beneficial role of diets and underestimate the potential adverse effects. Moreover, not only patients, but also healthcare professionals, have a number of misconceptions about the nutritional benefits of diet modification on gastrointestinal diseases. The aim of this review is to highlight the role of diet in pediatric gastrointestinal diseases, to detect misconceptions and to give a practical guide for physicians on the basis of current scientific evidence.

Health care professionals' views on psychological factors affecting nutritional behaviour in people with motor neuron disease: A thematic analysis.

Five qualitative focus groups were carried out across the United Kingdom in June 2018 with 51 participants, including 47 HCPs involved with MND care and four service user representatives. Data were analysed through thematic analysis. Four overarching themes were identified: psychological adjustment and patient engagement; nutrition and the need for control; knowledge of nutrition and the complexity of MND; and the psychosocial nature of eating. The findings suggest that the nutritional management of pwMND should be mindful of factors such as the impact of distress at the time of diagnosis, the availability of clear information on nutrition and MND, as well as the importance of illness perceptions and coping strategies. Moreover, tailored psychological interventions should be considered to mitigate the impact on MND on the experience of eating. Statement of contribution What is already known on this subject? Since weight loss and reduced body mass index (BMI) have been identified as independent risk factors for prognosis and survival in motor neuron disease (MND), nutritional management represents an important component of the symptomatic care of people with MND (pwMND) aimed at prolonging survival and maintaining or improving quality of life. However, the current guidelines and quantitative and qualitative literature on the topic are mainly focused on issues around enteral feeding and gastrostomy insertion, and very little is currently known about potential psychological enablers or barriers to earlier nutritional management, especially from the perspectives of health care professionals (HCPs) involved in the delivery of nutritional care in pwMND. What does this study add? First qualitative investigation of enablers or barriers to nutritional care in pwMND from the perspective of HCPs. New insight into psychological factors (e.g., adjustment, avoidance, loss of control) in nutritional care for pwMND. Practical implications and novel clinical suggestions for HCPs involved in nutritional care of pwMND.

Effect of an alcohol-free beer enriched with isomaltulose and a resistant dextrin on insulin resistance in diabetic patients with overweight or obesity.

Summary Background & aims The quality of carbohydrates has an essential role in nutritional management of type 2 diabetes mellitus (T2DM) because of its substantial impact on glucose homeostasis. Alcohol-free beer has beneficial bioactive components but it has a relatively high glycemic-index so its consumption is restricted in diabetic subjects. We aimed to explore the effect of an alcohol-free beer with modified carbohydrate composition almost completely eliminating maltose and adding isomaltulose (16.5 g/day) and a resistant maltodextrin (5.28 g/day) in comparison to a regular alcohol-free beer on glycemic control of diabetic subjects with overweight or obesity. Design We randomized 41 subjects into two groups: a) consumption of 66 cL/day of; regular alcohol-free beer for the first 10 weeks and 66 cL/day of alcohol-free beer with modified carbohydrate composition for the next 10 weeks; b) the same described intervention in opposite order. There was a washout period for 6–8 weeks between the two interventions. Participants were counseled to adhere to a healthy diet for cardiovascular health and to increase physical activity. Clinical, biochemical, anthropometric, lifestyle and satiety assessments were performed at the beginning and at the end of each period. Results Subjects showed significantly weight loss after the two ten weeks periods (−1.69 ± 3.21% and −1.77 ± 3.70% after experimental and regular alcohol-free beers, respectively, P = 0.881). Glucose and glycated hemoglobin did not significantly change after any period. Insulin concentrations and HOMA-IR significantly decreased (−11.1 [–21.3−4.64]% and −1.92 ± 32.8% respectively) after the intake of experimental alcohol-free beer but not after regular alcohol-free beer. Reductions remained statistically significant after adjusting for weight loss, energy intake, physical activity and intervention order. Subjects reported higher satiety scores after consuming experimental alcohol-free beer. Conclusions An alcohol-free beer including the substitution of regular carbohydrates for low doses of isomaltulose and the addition of a resistant maltodextrin within meals led to an improvement in insulin resistance in subjects with T2DM and overweight or obesity. Clinical trial registration The clinical trial has been registered in ClinicalTrials.gov (Identifier: NCT03337828 ).

Effect of an alcohol-free beer enriched with isomaltulose and a resistant dextrin on insulin resistance in diabetic patients with overweight or obesity

The quality of carbohydrates has an essential role in nutritional management of type 2 diabetes mellitus (T2DM) because of its substantial impact on glucose homeostasis. Alcohol-free beer has beneficial bioactive components but it has a relatively high glycemic-index so its consumption is restricted in diabetic subjects. We aimed to explore the effect of an alcohol-free beer with modified carbohydrate composition almost completely eliminating maltose and adding isomaltulose (16.5g/day) and a resistant maltodextrin (5.28g/day) in comparison to a regular alcohol-free beer on glycemic control of diabetic subjects with overweight or obesity. We randomized 41 subjects into two groups: a) consumption of 66cL/day of; regular alcohol-free beer for the first 10 weeks and 66cL/day of alcohol-free beer with modified carbohydrate composition for the next 10 weeks; b) the same described intervention in opposite order. There was a washout period for 6-8 weeks between the two interventions. Participants were counseled to adhere to a healthy diet for cardiovascular health and to increase physical activity. Clinical, biochemical, anthropometric, lifestyle and satiety assessments were performed at the beginning and at the end of each period. Subjects showed significantly weight loss after the two ten weeks periods (-1.69±3.21% and-1.77±3.70% after experimental and regular alcohol-free beers, respectively, P=0.881). Glucose and glycated hemoglobin did not significantly change after any period. Insulin concentrations and HOMA-IR significantly decreased (-11.1 [-21.3-4.64]% and-1.92±32.8% respectively) after the intake of experimental alcohol-free beer but not after regular alcohol-free beer. Reductions remained statistically significant after adjusting for weight loss, energy intake, physical activity and intervention order. Subjects reported higher satiety scores after consuming experimental alcohol-free beer. An alcohol-free beer including the substitution of regular carbohydrates for low doses of isomaltulose and the addition of a resistant maltodextrin within meals led to an improvement in insulin resistance in subjects with T2DM and overweight or obesity. The clinical trial has been registered in ClinicalTrials.gov (Identifier: NCT03337828).

Early onset of puberty in cattle: implications for gamete quality and embryo survival.

Advancing the age at which puberty and subsequent sexual maturation is attained in cattle is central to the reproductive and economic efficiency of both beef and dairy production systems worldwide. Onset of puberty in both male and female cattle is regulated by a complex network of biochemical processes and involves interaction among many key metabolic, neuroendocrine and reproductive tissues. Although our understanding of the biochemical interplay that conditions and eventually triggers the pubertal process has improved in recent years, much of the intricate mechanistic detail still eludes us. Environmental factors, such as nutritional management, as well as the genetic makeup of the animal undoubtedly affect the timing of puberty in cattle. In particular, there is now overwhelming evidence to support the importance of early life nutrition in regulating the timing of puberty in both bulls and heifers. For both genders, there is significant evidence that an improved metabolic status, early in calfhood, advances maturation of the hypothalamic-pituitary-gonadal axis, therefore facilitating earlier sexual development. Although advancing sexual maturation is a desirable goal, it is important that any strategy used does not impinge upon normal gametogenesis or postpubertal fertility potential. To this end, the aim of this review is to discuss the underlying biology of puberty in cattle with particular emphasis on the role of nutritional management during early calfhood in: (1) advancing the maturity of the hypothalamic-pituitary-gonadal axis; and (2) implications for the quality of gametes and subsequent fertility.

Malnutrition According to Mini Nutritional Assessment Is Associated With Severe Functional Impairment in Geriatric Patients Before and up to 6 Months After Hip Fracture

ObjectivesHip fractures (HFs) in old age frequently cause severe functional impairment and deteriorating autonomy in everyday life. Many older patients with HFs are malnourished or at risk of malnutrition. In this study, we examined the relationship between nutritional status of geriatric patients before HF and their functional and clinical course up to 6 months after hospital discharge. DesignObservational study with follow-up after 6 months. SettingFour wards of the department of trauma and orthopedic surgery of a large urban maximum care hospital (Klinikum Nürnberg, Nuremberg, Germany). ParticipantsGeriatric patients aged ≥75 years with surgically repaired proximal femoral fracture. MeasurementsPrefracture nutritional status was determined by Mini Nutritional Assessment (MNA). Comorbidities and complications during hospital stay were obtained from medical documentation. Functional status before HF, postoperatively, at hospital discharge, and 6 months later was assessed by Barthel Index for activities of daily living (ADL) and patients' mobility level and related to MNA categories. Associations were evaluated using χ2, Fisher exact, Kruskal-Wallis, Mann-Whitney-U, Jonckheere-Terpstra, and Cochrane-Armitage tests as appropriate, as well as analysis of covariance with repeated measures. ResultsOf 97 included patients, 17% were malnourished and 38% at risk of malnutrition before HF. Participants with (risk of) malnutrition were equally mobile but more dependent in ADL prior to HF than well-nourished patients (P < .001). Independent of nutritional status, after 6 months 68% of participants had not regained their prefracture level of independence in ADL. According to analysis of covariance, the ADL development over time until follow-up 6 months after hospital discharge did not depend on nutritional status. However, at follow-up malnourished patients more often suffered from remaining losses in ADL ≥25% of initial Barthel Index points (P = .033) and less often had regained their prefracture mobility level (P = .020) than well-nourished patients. Clinical course did not differ significantly between the groups with different nutritional status. ConclusionsIn this study with geriatric HF patients from all functional and cognitive levels, worse prefracture nutritional status was associated with worse functional status and more frequent remaining functional loss, whereas the trajectory of ADL recovery and clinical course did not differ significantly. Further studies with sufficient statistical power are needed to substantiate these inconclusive results. In order to clarify the association of nutritional status with functional and clinical course in geriatric patients after HF, they should preferably focus on the role of nutritional management during the hospital stay.

The Role of Nutritional Management in the Clinical Course of Severe Complications Associated with the Pancreas after Abdominal Surgery: Presentation of Four Cases

Background: All surgeons should note that complications associated with the pancreas after abdominal surgery can be severe and can induce life-threatening problems such as sepsis, abdominal abscess, and intra-abdominal hemorrhage. In such situations, nutritional management is a key element of therapy to achieve a favorable clinical course. methods: We reviewed the clinical course of four patients with complications associated with the pancreas after abdominal surgery from January 2012 to March 2013, focusing on nutritional management. Results: Two patients developed postoperative pancreatic fistula (POPF) induced by failure of pancreatoenteric anastomosis after pancreatoduodenectomy. Because we had placed a feeding jejunostomy tube intraoperatively in each of these patients, enteral feeding through these tubes was increased to attenuate catabolic stress in parallel with locoregional therapy, which led to early improvement of the general condition and closure of the fistula in these patients. One of the other two patients developed acute pancreatitis induced by anastomotic stenosis of the duodenojejunostomy after segmental duodenectomy, and the other developed pancreatic fistula after resection of the left kidney and urinary tract with excision of the retroperitoneal soft tissues. These patients had no route for enteral feeding. Prolonged total parental nutrition affected their longer time to recovery. Conclusion: Placement of a feeding jejunostomy tube at the initial operation may play a crucial role not in the prevention but in the management of complications associated with the pancreas.

Impact of a Program to Improve Quality of Diabetes Care in the Caribbean

The aim of this research was to evaluate if the training on the use of the “Protocol for the Nutritional Management of Obesity, Diabetes and Hypertension in the Caribbean” improves the quality of care delivered to patients with Type 2 Diabetes in Jamaica, Guyana, Belize, St. Vincent and the Grenadines, and Suriname. The main goals of the protocol were to improve the standards of care for diabetics in the Caribbean region by providing tools essential for nutrition management. This study looked at healthcare professionals from the five countries and evaluated practice change following continuing professional development (CPD), in the use of the protocol. The training consisted of a two and a half day workshop led by the Caribbean Food and Nutrition Institute (CFNI). The training overviewed noncommunicable diseases in the region and the role of nutrition management; nutrition assessment and the management processes.The 279 participants for the CPD were chosen by the respective Ministries of Health. Of these, 133 were randomly selected by the national coordinators for a chart audit. For each healthcare professional, up to ten patients, medical charts were randomly selected totaling 1140 (25% male and 75% female) charts selected from the five countries. An evaluation instrument was developed and used for the audit and results were analysed using McNemar test to establish change. A statistical improvement in the quality of care following CPD was found through the chart audit, showing that using a protocol of care improves practice in primary care settings in the Caribbean.

Hypocholesterolemic effect of teent (Capparis decidua) in hyperlipidemic obese adults

PurposeAn elevated level of cholesterol in blood is quite common nowadays. People are becoming more health conscious. The purpose of this paper is to study the hypocholesterolemic effect of teent, as it is a rich source of dietary fiber.Design/methodology/approachTeent was processed and analyzed for proximate coposition and dietary fiber constituents. Fifteen obese volunteer subjects having high blood lipid profile were selected for the experiment. Fasting blood samples were analyzed for total, low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) cholesterol initially before start of feeding experiment and at the end of experiment. Teent was processed and various products using teent or teent powder were standardized. Best acceptable products, namely, chutney and biscuits were supplemented in the diets of the subjects for three months.FindingsThe nutritional evaluation of teent indicates that it contains a good amount of protein and fiber. A significant decrease in the total cholesterol (13 percent) and LDL cholesterol (16 percent) was noticed at the end of the experiment. However, no significant change in HDL cholesterol was witnessed.Originality/valueIn the present scenario due to urbanization more and more people are facing problem of obesity and related heart diseases. At the same time they also want to avoid consuming medicines due to their side effects so results indicate that teent supplementation may have an important role in nutritional management of hypercholesterolemia.

The Consultant Pharmacist's Expanded Role in Nutrition Management

Recent changes to the State Operations Manual have expanded the role of consultant pharmacists and other members of the interdisciplinary care team in nutrition management. The increased focus on assessing medications, diseases, and other issues pertinent to nutrition brings both increased opportunity and responsibility for consultant pharmacists serving long-term care facilities.

The Role Of Carbohydrate In Diabetic Nutrition: A Review

This review looks at the definition of carbohydrate and its classification; the type and effect of food processing that affect blood glucose and insulin response to carbohydrate. The glycaemic index of carbohydrate food and its role in nutritional management of diabetes was emphasized. The goals of MNT in diabetes management were briefly mentioned.

Management of perioperative nutrition support

Perioperative nutrition has been extensively studied, but numerous questions remain unanswered. This review focuses on new developments in nutrient delivery in the immediate perioperative period. Issues specifically addressed include which patients are most likely to benefit from perioperative nutritional supplementation, and the optimal route, timing, and quantity of nutrient delivery. Visceral proteins, particularly albumin, play an important role in nutritional and perioperative risk assessment. Although the recommendation to use the enteral route for delivery of nutrition whenever possible is clear, the cautious introduction of enteral feeds in the labile group of patients with circulatory failure is essential. Preoperative use of immune-modulating enteral formulas, preoperative carbohydrate loading, and the concept of early enteral feeding are important developments. Supplementary arginine, glutamine, and omega-3 fats play a potential role in nutritional management, as does 'permissive' hypocaloric feeding. The particulars of nutritional support for perioperative and critically ill patients remain controversial. Recent studies addressing specific issues in this diverse discipline perhaps raise more questions than are answered. However, each new contribution to the literature brings us closer to an understanding of optimal nutritional management in the metabolically stressed patient.