Trained Dietitian Research Articles

Functional Medicine Approach to Patient Care Improves Sleep, Fatigue, and Quality of Life in Patients With Inflammatory Bowel Disease.

A Functional Medicine program was developed at an inflammatory bowel disease (IBD) center with the goal of integrating strategies to address modifiable lifestyle factors and to complete a 6-week elimination diet under the direction of a trained Functional Medicine dietitian and Functional Medicine providers. From January 2019 to November 2019, patients with controlled, but persistent, symptoms from IBD were offered enrollment. Each of the 5 visits incorporated an educational session focused on nutrition followed by a session focusing on modifiable lifestyle factors. The patients were placed on a supervised 6-week elimination diet. At each visit, patients completed the SIBDQ (Short Inflammatory Bowel Disease Questionnaire), FSS (Fatigue Severity Scale), PSQI (The Pittsburgh Sleep Quality Index), and MSQ (Medical Symptoms Questionnaire). Statistical analysis was performed using the Wilcoxon matched pairs signed-rank test. Nineteen patients enrolled (2 men: 1 ulcerative colitis [UC], 1 Crohn's disease [CD]; 17 women: 3 UC, 14 CD). 15 patients completed all modules. There was improvement in all patient-reported outcomes (PROs) (FSS, P < .001; PSQI, P < .001; SIBDQ, P < .001; MSQ, P < .001). Every patient who completed the last session demonstrated weight loss. The psychoemotional roots to immune disease states, particularly IBD, are complicated and often not addressed in traditional care. We are just beginning to understand the impact of nutrition, sleep, stress, movement, and relationships on IBD. In this cohort, utilizing Functional Medicine as an adjunct to traditional care resulted in improvement in all PROs.

Acceptability and Usefulness of a Web-Based Motivational Interviewing Session to Improve Nutrition and Oral Health Behaviors of Low-Income Children in Connecticut

Background Obesity and dental decay are linked through poor diet. In the United States, &gt;13% of 2-5–year-old children have obesity and &gt;21% have tooth decay, with the highest rates in Black and Latino children and those from low-income families. Conflicting information, barriers, and lack of access to healthy food and dental care influence the risk of poor diet and insufficient oral hygiene. Of particular interest is whether leveraging technology can deliver tailored and motivational interventions to promote a healthier diet and oral hygiene behaviors in young children of high-need families. Objective This study aimed to determine the acceptability and usefulness of a web-based motivational interview (MI) and goal-setting session to promote healthy feeding and improve oral health in young children and to determine how an initial survey with tailored messages informs the session to improve the efficiency and effectiveness of goal-setting. Methods Low-income caregivers of children aged 2-6 years were recruited through multiple community agencies. The caregivers completed a web-based nutrition and dental health survey that delivered 2-3 tailored messages to motivate or reinforce healthier target behaviors for their children. Caregivers reported their willingness to change the target behavior of the messages and were invited to participate in an MI session via a web-based videoconference application, facilitated by trained dietitians and dietetics students. The facilitators used the messages received by the caregiver and their willingness to change, to inform the session. The facilitators also used principles of MI to provide evidence-based recommendations, address barriers to these recommendations, and determine feasible goals with participants. Results Of 142 caregivers who completed the initial survey, 83 indicated an interest in the MI session and were contacted. A total of 48 MI sessions were completed (41 with female participants and 24 with non-Hispanic White participants). Caregivers were willing to attempt to make 62 out of the 64 target nutrition behavioral improvements from the initial survey. A total of 24 out of 40 caregivers who received a tailored message to improve a nutrition behavior set a goal based on that message during the MI session. The most commonly set nutrition goals involved increasing vegetable consumption (n=25/48), increasing lean protein consumption (n=8), and serving healthier snacks (n=8), which highlighted the target behaviors that the caregivers deemed most relevant. Of those who provided feedback on the MI sessions (n=41), most strongly agreed (scale from strongly agree to strongly disagree) that the MI session was easy and convenient to attend (n=33), and the UConn nutritionist made them feel comfortable to talk about their children’s health (n=38), helped them think about why health changes may be important (n=32), and helped them set a goal for positive changes in their children’s health (n=34). Conclusions Our results indicate the acceptability and usefulness of a web-based MI and goal-setting session, and that an initial survey with tailored messages informed the goal-setting session. Conflicts of Interest None declared.

Study Protocol: Effectiveness of the Lifestyle Eating and Performance (LEAP) Program for the Treatment of Irritable Bowel Syndrome (IBS)

Abstract Objectives Cytokine levels may be an important factor in the metabolic pathways of irritable bowel syndrome (IBS) pathophysiology. Current therapies for IBS are often ineffective, underlining the need for alternative treatment options. Studies on personalized dietary approaches for the treatment of IBS are scarce. We plan to evaluate the effectiveness of the Lifestyle Eating and Performance (LEAP) program to improve cytokines levels, gastrointestinal symptoms, and quality of life with three months of treatment in individuals with IBS. Methods We will conduct a prospective single-arm study (NCT05178017), including 60 adults (age 18–75 years) with diagnosis of IBS. The study received approval from an independent Institutional Review Board (IRB). In-person and virtual sessions will be conducted at baseline and follow-up visits (day 15, 30, 45, 60, and 90). Intervention: A trained dietitian will administer the virtual counseling sessions. The LEAP program is a multiphase tailored eating plan that is methodically prepared for individuals with IBS. Foods for each phase are selected based on the degree of Leukocyte Activation Assay-MRT (LAA-MRT®) immune reactivity and clinical response, starting with the least immune reactive foods, and subsequently foods will be added in a nutritionally balanced manner. Outcome Assessments: Gastrointestinal symptoms [IBS-Symptom Severity Scale (IBS-SSS), IBS-Adequate Relief (IBS-AR), IBS-Global Improvement Scale (IBS-GIS), and Global Symptom Survey (GSS)]; quality of life [IBS-36 Quality of Life]; anthropometrics and vital signs [body mass index (BMI), waist and hip circumferences, and blood pressure)]; dietary intake [Walter Willett's food frequency questionnaire (Harvard University) and food symptom diary]. Oxford Biomedical Technologies, a CLIA-certified laboratory, will perform the LAA-MRT® and cytokine analysis from collected venous blood. LAA-MRT® will be conducted using Sony EC 800 Dual-Mode Flow Cytometry Systems. Cytokine panel will include (IL-1β, IL-6, IL-8, IL-10, IL-12, IL-17, and TNF-α) and analyzed using a Bio-Plex 200 System (Bio-Rad). Results N/A (protocol abstract) Conclusions This study will generate evidence and clinical relevance of diet-induced inflammation that could explain changes in biomarkers for IBS and improved treatment outcomes. Funding Sources Oxford Biomedical Technologies.

Evaluation of the Comparative Validity of a Smartphone Weight-Loss Trial App with a 24-Hour Diet Recall

ObjectivesDespite the presence of several weight loss apps on the market, the validity of the diet data collected from these apps has rarely been tested. A granular analysis of app validity at the food-level, rather than overall intake, is needed to closely examine factors that contribute to the variability of diet data between these apps and standard diet assessments. This study investigated the comparative validity of diet data from a weight loss app at the food level.MethodsA weight loss app was used for the Sequential Multiple Assignment Randomization Trial (SMART) to assist participants with tracking their food intake throughout the study. A trained dietitian conducted three 24-hour diet recalls at baseline using the Nutrition Data System for Research (NDSR) protocol. Food items reported by participants were categorized into 9 major NDSR food groups (beverage, dairy, fats, fruits, vegetables, grains, protein, sweets, miscellaneous) and 2 other categories (mixed, restaurant). Intraclass correlation coefficients (ICC) determined agreement of diet data (i.e., calories and macronutrients) for all food items. ICC ranges were defined as: ≥0.90, excellent; 0.75 to <0.90, good; 0.5 to <0.75, moderate; and <0.5, poor agreement. Bland Altman analyses determined the estimated mean bias and standard deviation of differences between the app and recall. A subgroup analysis was conducted to evaluate agreement of energy content by food group.ResultsAgreement between the SMART app and recall ranged from moderate to good for all diet data (ICCs = 0.71 to 0.83). Bland Altman plots also confirmed the ICC results; there were little to modest differences between the SMART app and 24-hour recall for energy (−3.0 ± 94.7 kcal), carbohydrates (−0.2 ± 12.2 g), protein (−0.1 ± 5.5 g), and fat (−0.2 ± 5.1 g). When analyzing energy content by food group, agreement between the two diet assessments was excellent for restaurant and sweet food items (ICCs = 0.93 to 0.94) and good for beverages, dairy, fruits, and miscellaneous items (ICCs = 0.76 − 0.87). There was moderate agreement for vegetables, fat, grains, proteins, and mixed dishes (ICCs = 0.51 to 0.68).ConclusionsThere was moderate to good agreement between the SMART app and recall for all diet data. Results suggest that the variability may stem from the type of food reported in the app.Funding SourcesNIH grants R01DK108678 and T32CA193193.

The Key Role of Nutritional Elements on Sport Rehabilitation and the Effects of Nutrients Intake.

Adequate nutrition is of utmost importance for athletes, especially during rehabilitation after injury in order to achieve fast healing and return to sports. The aim of this narrative review is to define the proper nutritional elements for athletes to meet their needs and facilitate their fast return to sports after surgery or injury, as well as determine the effects of specific nutrients intake. Studies on antioxidants, which are substances that protect against free radicals, for the injured athlete are few and unclear, yet poly-phenols and especially flavonoids might improve healing and inflammation following an injury. Benefits of vitamin C or E on muscle damage are disputable in relevant studies, while optimal levels of vitamin D and calcium contribute to bone healing. Minerals are also essential for athletes. Other supplements suggested for muscle damage treatment and protein synthesis include leucine, creatine, and hydroxymethylbutyrate. Diets that include high-quality products, rich in micronutrients (like vitamins, minerals, etc.) bio-active compounds and other nutritional elements (like creatine) are suggested, while an individualized nutrition program prescribed by a trained dietitian is important. Further studies are needed to clarify the underlying mechanisms of these nutritional elements, especially regarding injury treatment.

Carbohydrate Maldigestion and Intolerance.

This review summarizes dietary carbohydrate intolerance conditions and recent advances on the possible role of carbohydrate maldigestion and dietary outcomes in patients with functional bowel disease. When malabsorbed carbohydrates reach the colon, they are fermented by colonic bacteria, with the production of short-chain fatty acids and gas lowering colonic pH. The appearance of diarrhoea or symptoms of flatulence depends in part on the balance between the production and elimination of these fermentation products. Different studies have shown that there are no differences in the frequency of sugar malabsorption between patients with irritable bowel disease (IBS) and healthy controls; however, the severity of symptoms after a sugar challenge is higher in patients than in controls. A diet low in ‘Fermentable, Oligo-Di- and Monosaccharides and Polyols’ (FODMAPs) is an effective treatment for global symptoms and abdominal pain in IBS, but its implementation should be supervised by a trained dietitian. A ‘bottom-up’ approach to the low-FODMAP diet has been suggested to avoid an alteration of gut microbiota and nutritional status. Two approaches have been suggested in this regard: starting with only certain subgroups of the low-FODMAP diet based on dietary history or with a gluten-free diet.

Bedside post-pyloric tube placement using direct visualisation in mechanically ventilated patients: A single centre case series

IntroductionPost-pyloric feeding tubes are used for intensive care patients unable to tolerate gastric feeding. The Kangaroo Feeding Tube with IRIS Technology (‘IRIS’) uses real-time visualisation of anatomical markers to guide bedside placement, however limited studies currently explore post-pyloric insertions in mechanically ventilated patients. We describe a case series of ‘IRIS’ post-pyloric placements performed by trained intensivists and dietitians. MethodsThis was a prospective, single-centred clinical effectiveness study of mechanically ventilated adults referred for bedside post-pyloric tube placement between May 2020 and May 2021. The feasibility, success rates, anatomical visualisation using ‘IRIS’ and nutritional outcomes were documented. ResultsTwelve patients were included in total. The primary indication for post-pyloric placement was gastric feeding intolerance, with a median of 3.5 (IQR 0–6) days with inadequate nutrition prior to placement. All tubes were inserted within 24 h of referral as there was always a trained clinician available. Post-pyloric placement was successful for 9/12 patients (75%), as identified on the ‘IRIS’ console and X-ray confirmation. Only 3 (25%) patients required parenteral nutrition (mean duration 4 [SD 1] days). Respiratory misplacement occurred in 1 patient (8%) and was clearly differentiated from gastrointestinal anatomy, permitting early removal. Although duodenal placement was possible, no tubes reached the jejunum solely using the ‘IRIS’ method. ConclusionPost-pyloric tube placement using ‘IRIS’ in mechanically ventilated patients was feasible, successful and safe, resulting in reduced durations with inadequate enteral nutrition. Further, larger-scale studies are required to confirm these findings and explore the effectiveness of ‘IRIS’ in achieving deep small-intestinal placement.

Towards the creation of a nutrition and food group based image database

Food classification is critical to the analysis of nutrients comprising foods reported in dietary assessment. Advances in mobile and wearable sensors, combined with new image based methods, particularly deep learning based approaches, have shown great promise to improve the accuracy of food classification to assess dietary intake. However, these approaches are data-hungry and their performances are heavily reliant on the quantity and quality of the available datasets for training the food classification model. Existing food image datasets are not suitable for fine-grained food classification and the following nutrition analysis as they lack fine-grained and transparently derived food group based identification which are often provided by trained dietitians with expert domain knowledge. In this paper, we propose a framework to create a nutrition and food group based image database that contains both visual and hierarchical food categorization information to enhance links to the nutrient profile of each food. We design a protocol for linking food group based food codes in the U.S. Department of Agriculture&#x2019;s (USDA) Food and Nutrient Database for Dietary Studies (FNDDS) to a food image dataset, and implement a web-based annotation tool for efficient deployment of this protocol. Our proposed method is used to build a nutrition and food group based image database including 16,114 food images representing the 74 most frequently consumed What We Eat in America (WWEIA) food sub-categories in the United States with 1,865 USDA food code matched to a nutrient database, the USDA FNDDS nutrient database.

Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study

Insecure Attachment style has been associated with interpersonal problems in persons with Anorexia Nervosa (AN), and it might moderate the recovery of healthy sexuality in these subjects. The aim of the present 2-year follow-up study was to evaluate the role of insecure attachment style as a moderator of the recovery of healthy sexuality in women with AN. 63 Italian women with AN treated with a multidisciplinary approach including Enhanced Cognitive Behavior Therapy were evaluated by means of a clinical interview and self-administered questionnaires. Individual psychotherapy sessions were administered by experienced psychotherapists over the course of at least 40 weeks (median number of sessions=43, range: 38-50); trained dieticians provided personalized nutritional counselling to facilitate weight recovery. The assessment was performed at baseline (T0) and after 1 (T1) and 2 (T2) years. The administered questionnaires investigated general psychopathology (SCL-90-R), eating disorder-specific psychopathology (EDE-Q), female sexuality (FSFI) and adult attachment style (ECR). At baseline, avoidant attachment style was associated with all domains of sexual dysfunction. Longitudinal analysis showed a significant decrease in both eating disorder-specific psychopathology and sexual dysfunctions at follow-up evaluations. However, only 45% of remitted subjects also recovered healthy sexuality: these women reported significantly lower avoidance scores than those who only recovered from AN. Moderation analysis indicated that sexual desire did not increase in participants with higher levels of avoidant attachment. These novel findings highlighted the importance of the assessment of adult attachment in the clinical setting, for better characterization and treatment of persons suffering from AN. The long follow-up duration, the multidisciplinary nature of the treatment, and the novelty of the topic were major strengths of the study, whereas the limited sample size and the absence of biological data were the main limitations. This study highlighted the crucial role of avoidant attachment in the relationship between AN and sexual dysfunctions, underlining the importance of integrating treatments with attachment-focused interventions. Cassioli E, Rossi E, Vizzotto C, et al. Avoidant Attachment Style Moderates the Recovery of Healthy Sexuality in Women With Anorexia Nervosa Treated With Enhanced Cognitive Behavior Therapy (CBT-E): A 2-Year Follow-Up Study. J Sex Med 2022;19:347-355.

Delivering the Diabetes Remission Clinical Trial (DiRECT) in primary care: Experiences of healthcare professionals

The Diabetes Remission Clinical Trial (DiRECT) used a formula total diet replacement programme followed by structured weight loss maintenance to induce and sustain weight loss and remission of type 2 diabetes (T2D) in 36% of participants after 2years. Nurses and dietitians delivering DiRECT in 22 primary care practices in Tyneside and Scotland provided behavioural support to participants. Participant experiences with DiRECT highlighted the key role of support by healthcare professionals (HCPs). We evaluated HCPs' experiences with DiRECT. Healthcare professionals delivering DiRECT were interviewed at 12months, while general practices (GPs) were sent an implementation questionnaire. The interviews were analysed thematically. The questionnaires were analysed using frequencies and a narrative synthesis. Healthcare professionals representing 11 of 22 intervention practices were interviewed and 10 of 22 GPs completed questionnaires. HCPs' initial concerns over perceived potential negative intervention effects, particularly withdrawing anti-diabetes and anti-hypertensive medications, were barriers to engagement. Trust of HCPs towards the research team and perceived credibility of the study facilitated engagement and adoption. Ongoing support by research dietitians was key to the management of participants. Involvement in DiRECT inspired more focus on behaviour modification in the treatment of other people living with T2D in routine practice. Diabetes Remission Clinical Trial was considered highly appropriate for the management of T2D in primary care when supported by trained dietitians. Addressing limitations, including varying training needs of HCPs may improve intervention scale-up and tailoring to clinical contexts.

Association between body mass index and diet quality index-international and mediterranean diet compliance during Covid-19 pandemic

Rationale: Diet Quality Index-International (DQI-I) which consists of diversity, adequacy, moderation, and general balance categories is a tool created to examine the diet quality of populations. Mediterranean diet (MD) is a nutritional model that reduces the risk of many chronic diseases (1). This study was carried out to evaluate the association between body mass index (BMI) and compliance with DQI-I and MD in healthy adults. Methods: This cross-sectional descriptive study included 926 healthy individuals aged 19 to 64, between February and June 2020. The questionnaire, consisting of general demographic information, Mediterranean Diet Assessment Tool (PREDIMED), and a 24-hour dietary recall, was applied by phone due to COVID-19 pandemic restrictions. Body weight and height was self-claimed by participants. DQI-I was calculated according to 24-hour dietary recall by a trained dietitian. Results: The average age of the participants was 35.1±13.40 years and 50.4% of the participants were female. The average BMI was 25.1±4.50, the average DQI-I score was 53.4±9.82 (out of 100 points), and the PREDIMED score was 5.9±2.21 (out of 12 points). There was a significant positive correlation between DQI-I scores and BMI (r=0.094, p=0.004) however there was no correlation between PREDIMED scores and BMI (r=0.022, p>0.05) (Table 1). Average scores for DQI-I subsections were 15±3.59 (78.5%) for diversity (out of 20 points); 26.2±6.11 (65.5%) for adequacy (out of 40 points); 9.9±5.61 (33%) for moderation (out of 30); and 1.7±2.18 (17%) for moderation (out of 10 points).Table 1.Correlations between body mass index and diet quality index-international and Mediterranean diet compliance scoresBMI (kg/m2)rpDQI-I Scores0.0940.004PREDIMED Scores0.0220.496 Open table in a new tab Conclusion: In this study, the average DQI-I score was found low and among sub-sections the minimum score was gathered from the general balance category, which implies an imbalance of fatty acids and macronutrients contributing to energy intake. This study was initially planned to be conducted face to face however it was carried out by phone interviews due to the pandemic. Therefore anthropometric measurements were taken based on personal statements. This may have caused a measurement bias. In order to prevent obesity and obesity-related diseases, more interventions should be carried out to increase diet quality especially during COVID-19 pandemic.

Novel approaches to hypoglycemia and burnt-out diabetes in chronic kidney disease.

Diabetes mellitus is a leading cause of chronic kidney disease (CKD) that confers faster kidney disease progression, higher mortality, and various metabolic derangements including hypoglycemia. Even in the absence of diabetes mellitus, growing research demonstrates that CKD patients are at heightened risk for hypoglycemia via multiple pathways. In CKD patients transitioning to end-stage renal disease (ESRD), spontaneous resolution of hyperglycemia and frequent hypoglycemia resulting in reduction and/or cessation of glucose-lowering medications are frequently observed in a phenomenon described as 'burnt-out diabetes'. In non-CKD patients, it is well established that hypoglycemia is causally associated with mortality, with pathways including arrhythmias, sudden cardiac death, stroke, and seizures. Increasing evidence shows that, in CKD and ESRD patients with and without diabetes mellitus, hypoglycemia is associated with cardiovascular complications and mortality risk. Given the high prevalence of hypoglycemia in CKD patients and the morbidity and mortality associated with this metabolic complication, a multimodal strategy is needed to prevent dysglycemia, including individualization of glycemic targets, selection of glucose-lowering medications less likely to induce hypoglycemia, medical nutrition therapy administered by trained dietitians, and accurate and precise hypoglycemia detection methods, such as self-monitored blood glucose or continuous glucose monitoring including during dialysis treatment.

Celiac Disease.

Celiac Disease.

Association of number of bites and eating speed with energy intake: Wearable technology results under free-living conditions

Personalized weight management strategies are gaining interest. However, knowledge is limited regarding eating habits and association with energy intake, and current technologies limit assessment in free-living situations. We assessed associations between eating behavior and time of day with energy intake using a wearable camera under free-living conditions and explored if obesity modifies the associations. Sixteen participants (50% with obesity) recorded free-living eating behaviors using a wearable fish-eye camera for 14 days. Videos were viewed by trained annotators who confirmed number of bites, eating speed, and time of day for each eating episode. Energy intake was determined by a trained dietitian performing 24-h diet recalls. Greater number of bites, reduced eating speed, and increased BMI significantly predicted higher energy intake among all participants (P < 0.05, each). There were no significant interactions between obesity and number of bites, eating speed, or time of day (p > 0.05). Greater number of bites and reduced eating speed were significantly associated with higher energy intake in participants without obesity. Results show that under free-living conditions, more bites and slower eating speed predicted higher energy intake when examining consumption of foods with beverages. Obesity did not modify these associations. Findings highlight how eating behaviors can impact energy balance and can inform weight management interventions using wearable technology.

BREAST CANCER RESPONSE TO NEOADJUVANT CHEMOTHERAPY AND CALORIC RESTRICTION

Some authors have hypothesized that caloric restriction (CR) could determine a reduction in the onset of some types of cancer and in their progression. The aim of the study is to compare the efficacy of CR combined with neoadjuvant chemotherapy versus a standard diet combined with neo-CT in women with breast cancer (BC). 81 patients were enrolled, 22 in the CR group and 59 in the control group. CR scheme was designed as follow: caloric intake reduced by 50% of total energy expenditure in the 48h before and in the neo-CT day; by 30% the following days until T2 (6 months). The analysis at T2 are showing that in the CR group 72,2% had a complete response to the treatment while in the control group the 28,8% had a complete response. The results highlight a positive effect of the CR on the response to the therapy (OR=4.12 95%CI from 1.29 to 13.11). The results obtained show that CR, monitored by a nutritionist and a trained dietitian, could represent an effective and inexpensive method in strengthening the cytotoxicity of standard neo-CT, both in terms of size reduction and malignancy reduction in BC, leading to a better clinical outcome.

Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study.

BackgroundDietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS).ObjectiveThe aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health.MethodsWe followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16.ResultsAt the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005).ConclusionsThis exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes.Trial RegistrationClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669

How important is dietary management in chronic kidney disease progression? A role for low protein diets.

High dietary protein intake may lead to increased intraglomerular pressure and glomerular hyperfiltration, which in the long-term can lead to de novo or aggravating preexisting chronic kidney disease (CKD). Hence, a low protein diet (LPD, 0.6 to 0.8 g/kg/day) is recommended for the management of CKD. There are evidences that dietary protein restriction mitigate progression of CKD and retard the initiation of dialysis or facilitate incremental dialysis. LPD is also helpful to control metabolic derangements in CKD such as metabolic acidosis and hyperphosphatemia. Recently, a growing body of evidence has emerged on the benefits of plant-dominant low-protein diet (PLADO), which composed of > 50% plant-based sources. PLADO is considered to be helpful for relieving uremic burden and metabolic complications in CKD compared to animal protein dominant consumption. It may also lead to favorable alterations in the gut microbiome, which can modulate uremic toxin generation along with reducing cardiovascular risk. Alleviation of constipation in PLADO may minimize the risk of hyperkalemia. A balanced and individualized dietary approach for good adherence to LPD utilizing various plant-based sources as patients’ preference should be elaborated for the optimal care in CKD. Periodic nutritional assessment under supervision of trained dietitians should be warranted to avoid protein-energy wasting.

Herbal dietary interventions for weight loss among regularly exercising women in Turkey

PurposeObesity is a chronic disease that is conjoined with increased mortality. Parallel to rising obesity rates, herbal dietary interventions to lose weight are also increasing. The purpose of this study is to assess and evaluate the use of herbal dietary interventions for weight loss among regularly exercising women.Design/methodology/approachA total of 545 regularly exercising women (aged 19–64 years) were recruited from several local sports centers. A questionnaire form to evaluate demographic characteristics, nutritional habits and herbal dietary intervention habits was administered by a trained dietitian. Anthropometric measurements including weight, height, fat mass, total body water and fat free mass were measured using a bioelectrical impedance analysis device.FindingsA total of 244 participants (44.8%) used herbal dietary interventions for weight loss within the last year. The most commonly used herbal dietary interventions were green tea (59.4%), lemon juice (27%), herbal tea mix (20.9%) and cinnamon powder (17.6%), respectively. Of the 244 women who used herbal dietary interventions for weight loss, 42.2% claimed that by using these products they experienced weight loss. Herbal dietary interventions were significantly higher among women with obesity (61.9%) than women with a healthy weight (37.5%). The use of herbal supplements increased among women who consider themselves as being overweight (p < 0.001). Furthermore, herbal dietary interventions decreased with more frequent attempts for a weight-loss diet (p < 0.001).Originality/valueTo the best of the authors’ knowledge, this study represents a first attempt at assessing the use of herbal dietary supplements for weight loss among regularly exercising Turkish women. With the increase of body mass index and body perception being as overweight, herbal dietary interventions were also increased. In particular, women with obesity (61.9%) used more herbal dietary interventions than women with healthy weight (37.5%). Moreover, women with an overweight body perception used more herbal supplements than those who thought they had a healthy body weight.

Daily Food Insecurity and Its Impact on Diet Quality in Low-Income Adults in Two Seasons: An Ecological Momentary Assessment Study

Abstract Objectives Chronic food insecurity (FI) is common in low-income adults and is associated with a suboptimal diet. The dynamicity of FI in the short term in relation to diet is not well understood. We aim to examine if there are seasonal shifts in the relationship between FI and diet. Methods Low-income adults (with a household income &amp;lt;185% federal poverty line) were recruited in Central Pennsylvania. An ecological momentary assessment model on smartphones was used to collect daily FI and diet data over two three-week long waves: one during a fall month, and one during a winter month. An adapted USDA adult module was used to assess daily FI (“food secure” if module score = 0 or “food insecure” if module score &amp;gt;0). A food record was recorded on smartphones and verified by a trained dietitian via phone calls on Sunday, Monday, and Tuesday. For each subject, daily caloric intake was calculated using the Nutrition Data System for Research software. Daily Healthy Eating Index 2015 (HEI-2015) score and food group intake were calculated. Generalized estimating equation (GEE) models were used to estimate the associations between daily FI and dietary outcomes, accounting for within-person correlation and adjusting for gender, race/ethnicity, employment, and poverty status. Results 22 participants were recruited in fall 2019, 18 were followed up in winter 2020, with a total of 290 person-days (response rate = 80.64%) of data. Higher FI scores in the winter, but not in the fall, were associated with lower HEI-2015 score [b (95%CI)] [−9.06 (−14.15, −3.96)]. Higher FI in winter was associated with decreased intake of total fruit ([−0.24 (−0.44, −0.05)], whole fruit [−0.27 (−0.48, −0.06)], and whole grain [−0.52 (−1.03, −0.01)]. Higher FI in the fall months was associated with increased dairy consumption [0.65 (0.08, 1.22)]. FI was not associated with calorie intake in either season. Conclusions This pilot study found that higher daily FI was associated with lower diet quality in the winter, but not fall, which may be driven by shifts in food accessibility and altered coping strategies across seasons. Funding Sources The National Center for Advancing Translational Sciences, National Institutes of Health (UL1TR002014) and the Broadhurst Career Development Professorship for the Study of Health Promotion and Disease Prevention.

Dietary nutrients' intake and sleep quality in peritoneal dialysis patients.

Sleep disturbances are common in dialysis patients. However, there is a lack of information on nutritional determinants of sleep disorders in dialysis patients. The objective of the current study was to investigate the association between nutrients’ intake and sleep quality in peritoneal dialysis patients. The cross-sectional study was done on 114 peritoneal dialysis patients referred to Alzahra and Khorshid hospitals, Isfahan, Iran. Information on sleep quality and dietary intakes were collected using Pittsburgh sleep quality index and 168-item food frequency questionnaire respectively. Anthropometric measurements were done by a trained dietitian based on standard protocols. Socio-demographic and clinical data were obtained through a structured questionnaire. The binary logistic regression model was used to detect the association between nutrients’ intake and sleep quality. Our results indicated that there was not any significant difference in basic (socio-demographic and clinical) characteristics between peritoneal dialysis patients with good and poor sleep quality (p>0.05). The results of logistic regression indicated a positive significant association between dietary intake of carbohydrate (OR:3;95% CI:1.32-6.81; p<0.05), fat (OR:3;95% CI:1.32-6.81; p<0.05), and fiber (OR:2.53;95% CI: 1.12-5.67; p<0.05) with poor sleep quality in crude and adjusted models (p<0.05). However, there was not any significant association between dietary intake of protein and poor sleep quality (p>0.05). The results of the present study indicated that dietary intake of nutrients affect sleep quality in dialysis patients. These results help healthcare professionals in making nutritional interventions to improve sleep quality in dialysis patients.