Use Of Dietary Treatments Research Articles

When Is Patient Behavior Indicative of Avoidant Restrictive Food Intake Disorder (ARFID) Vs Reasonable Response to Digestive Disease?

Dietary modification is common in patients with digestive diseases to improve symptoms; however, food avoidance can become problematic. Avoidant Restrictive Food Intake Disorder (ARFID) is characterized as failure to meet one's nutritional needs owing to sensory hypersensitivity, lack of interest in eating, or fear of aversive consequences from eating, and is associated with negative medical and psychosocial outcomes. This study characterizes ARFID behaviors in adults with achalasia, celiac sprue, eosinophilic esophagitis, and inflammatory bowel disease. In this cross-sectional study, 289 adults aged 18 and older completed self-report measures evaluating use of dietary treatment, ARFID symptoms, and psychosocial outcomes. Primary analyses investigated the occurrence of ARFID in patients with achalasia, celiac, eosinophilic esophagitis, and inflammatory bowel disease. Secondary analyses explored the associations between ARFID symptoms and clinical and psychosocial outcomes. More than half (53.7%) of the total sample met the diagnostic criteria for ARFID based on the Nine-Item ARFID Screen (NIAS), with 78.4% of patients with achalasia meeting criteria. Patients on a physician-directed diet showed greater fear of gastrointestinal symptoms (P= .025), less interest in food (P= .046), and a higher total NIAS score (P= .045). For patients using dietary therapy, those who had met with a dietitian reported higher NIAS scores (P= .039). Food avoidance/restriction was associated with increased anxiety and depression, and diminished health-related quality of life. It is likely that ARFID rates, as measured by the NIAS, are inflated in these 4 patient groups. These findings highlight the need for updated assessments of ARFID in patients with complex digestive diseases.

Phloroglucinol Degradation in the Rumen Promotes the Capture of Excess Hydrogen Generated from Methanogenesis Inhibition.

Strategies to manage metabolic hydrogen ([H]) in the rumen should be considered when reducing ruminant methane (CH4) emissions. However, little is known about the use of dietary treatments to stimulate rumen microorganisms capable of capturing the [H] available when CH4 is inhibited in vivo. The effects of the phenolic compound phloroglucinol on CH4 production, [H] flows and subsequent responses in rumen fermentation and microbial community composition when methanogenesis is inhibited were investigated in cattle. Eight rumen fistulated Brahman steers were randomly allocated in two groups receiving chloroform as an antimethanogenic compound for 21 days. Following that period one group received chloroform + phloroglucinol for another 16 days, whilst the other group received only chloroform during the same period. The chloroform treatment resulted in a decrease in CH4 production and an increase in H2 expelled with a shift in rumen fermentation toward higher levels of propionate and formate and lower levels of acetate at day 21 of treatment. Bacterial operational taxonomic units (OTUs) assigned to Prevotella were promoted whilst Archaea and Synergistetes OTUs were decreased with the chloroform treatment as expected. The shift toward formate coincided with increases in Ruminococcus flavefaciens, Butyrivibrio fibrisolvens, and Methanobrevibacter ruminantium species. The addition of chloroform + phloroglucinol in the rumen resulted in a decrease of H2 expelled (g) per kg of DMI and moles of H2 expelled per mol of CH4 decreased compared with the chloroform only treated animals. A shift toward acetate and a decrease in formate were observed for the chloroform + phloroglucinol-treated animals at day 37. These changes in the rumen fermentation profile were accompanied by a relative increase of OTUs assigned to Coprococcus spp., which could suggest this genus is a significant contributor to the metabolism of this phenolic compound in the rumen. This study demonstrates for the first time in vivo that under methanogenesis inhibition, H2 gas accumulation can be decreased by redirecting [H] toward alternative sinks through the nutritional stimulation of specific microbial groups. This results in the generation of metabolites of value for the host while also helping to maintain a low H2 partial pressure in the methane-inhibited rumen.

Dietitian in health care – the missing link of the medical staff

So far forecasting and planning of medical personnel in health care has not included a professional nutritionist, even though it was entered in the International Standard Classification of Occupations (International Standard Classification of Occupations, ISCO) as early as in 1967. It has been determined that this is the person responsible for planning and supervising the preparation of therapeutic diets for individuals and population groups in hospitals, as well as supervising the choice and preparation of food and meals, participating in programs of nutrition and educating the public. The development of medicine and nutritional science has provided evidence that a balanced diet is one of the most important factors that reduce the risk of chronic non-communicable diseases (cardiovascular diseases, diabetes, cancer, obesity, osteoporosis and tooth decay). It has been shown that treatment of most diseases requires the use of dietary treatment, which increases the effectiveness of drug therapy, reduces the risk of complications, shortens hospitalization and rehabilitation, thus reducing health spending. That is why the health care system in Poland should introduce dietary advice to the range of medical services.

Efficacy of Dietary Treatment for Inducing Disease Remission in Eosinophilic Gastroenteritis.

Various dietary interventions have been used to treat patients with eosinophilic gastroenteritis (EGE). Concrete evidence as to the effectiveness of such treatments in inducing disease remission is, however, lacking. The aim of the study was to systematically review the efficacy of dietary therapies in inducing EGE remission. We performed a systematic search for the MEDLINE, EMBASE, and SCOPUS libraries for studies investigating the efficacy of dietary interventions (in both histological and symptomatic remission) for children and adults with EGE and colitis. The search yielded 490 references; 30 were included in the review, with most of these references being "low-quality" individual cases or short case series. No significant publication bias was found. Elemental diets in children were linked to 75.8% of clinical improvement, but few of these patients underwent a histological evaluation. Allergy-testing results have been used scarcely in EGE. Empiric elimination of allergy-associated foods was the most commonly used option. The variable results in terms of symptom relief, however, were scarcely accompanied by histological confirmation. Clinical and methodological heterogeneity hindered the performance of quantitative summaries for the efficacy of dietary therapies in inducing disease remission. Symptomatic improvements reported for dietary treatment in EGE by most of the available literature are questionable because of the lack of objective evaluation of clinical changes and the very limited assessment of histological remission. Because of the relative lack of well-designed, high-quality studies, the unequivocal use of dietary treatment for patients with EGE and colitis cannot be supported. Further research should be undertaken.

3-months elimination diet in childhood EoE: nutritional and immunological aspects

Background The use of dietary treatment in eosinophilic esophagitis (EoE) in children is regularly described in literature. The aim of the study was to evaluate anthropomorphic and biological parameters in EoE children before and after elimination diet. Methods A cohort of 87 consecutive patients with EoE (>15 eosinophils/hpf in esophageal biopsies) was retrospectively analyzed. All children followed the so-called modified six-food elimination diet (SFED), excluding 6 main offending foods retrieved together with those eliciting positive SPT and APT, supplemented with a nutritional support by an amino acid formula. Patients had the following treatment sequence: endoscopy/clinical/biological assessment, 3 months elimination diet and second endoscopy/clinical/ biological assessment. Results Analysis included 49 patients. At enrolment, BMI was significantly lower in females than in males (p<0.05), and total circulating IgG and IgM levels were higher in females (p<0.05). Patients having recovered at the end of the study happened to exhibit at enrolment a BMI significantly higher than those having shown only partial or no recovery (p<0.05). Elimination diet led to complete recovery (no symptoms & <5 eosinophils/hpf) in 53% cases. Following the elimination diet, BMI remained lower in females than in males. Also, blood eosinophils counts (p<0.0001), IgG (p0.003) and IgM levels (p<0.05) showed a significant decrease as well as specific IgE titers against CMP (p<0.02) and egg (p<0.02), with a tendency for decrease with fish (p<0.09) and wheat (p<0.09).

Ketogenic Diets: Evidence for Short- and Long-term Efficacy

The use of dietary treatments for epilepsy (ketogenic, modified Atkins, and low glycemic index diets) has been in continuous use since 1921. These treatments have been well studied in the short term, with approximately half of children having at least a 50% reduction in seizures after 6 months. Approximately one third will attain >90% reduction in their seizures. Animal studies confirm these findings, with broad evidence demonstrating acute anticonvulsant effects of the diet. Furthermore, the diet appears to maintain its efficacy in humans when provided continuously for several years. Interestingly, benefits may be seen long term even when the diet is discontinued after only a few months of use, suggesting neuroprotective effects. This potential antiepileptogenic activity has been recently demonstrated in some animal studies as well. This review discusses the animal and human evidence for both short- and long-term benefits of dietary therapies.

Dietary influences on cognitive development and behaviour in children

There are a number of ways in which food can influence behaviour, including malnutrition, types of diet, eating habits, pharmacological effects, food allergy, fatty acid deficiency and possibly food additives. The range of behaviour affected is also wide, and includes attention, conduct disorder and mood. A particular focus of interest has been the effects of food on hyperactivity in children. There is some initial evidence that fatty acids may influence hyperactivity in children with specific learning disabilities. The findings also suggest that some food additives (colourings, flavourings and preservatives) may increase hyperactivity in children with behaviour problems. For children showing behaviour problems such as hyperactivity the use of dietary manipulation tends to be a more acceptable approach to treatment than the use of drugs. However, there needs to be awareness of the dangers of the use of unsupervised restriction diets with children, and the use of dietary treatments alone is not likely to be sufficient treatment for many children with attention-deficit hyperactivity disorder. A study is currently underway to investigate the possible effects of additives on behaviour in the general population of children.

Dietary influences on cognitive development and behaviour in children

There are a number of ways in which food can influence behaviour, including malnutrition, types of diet, eating habits, pharmacological effects, food allergy, fatty acid deficiency and possibly food additives. The range of behaviour affected is also wide, and includes attention, conduct disorder and mood. A particular focus of interest has been the effects of food on hyperactivity in children. There is some initial evidence that fatty acids may influence hyperactivity in children with specific learning disabilities. The findings also suggest that some food additives (colourings, flavourings and preservatives) may increase hyperactivity in children with behaviour problems. For children showing behaviour problems such as hyperactivity the use of dietary manipulation tends to be a more acceptable approach to treatment than the use of drugs. However, there needs to be awareness of the dangers of the use of unsupervised restriction diets with children, and the use of dietary treatments alone is not likely to be sufficient treatment for many children with attention-deficit hyperactivity disorder. A study is currently underway to investigate the possible effects of additives on behaviour in the general population of children.

Changing Patterns of Medical Practice: Protein Restriction for Chronic Renal Failure

The use of dietary protein restriction for renal failure has fluctuated during the past 125 years. These fluctuations reflect not only the state of medical knowledge but also social, economic, and cultural factors. Factors inhibiting use of dietary treatment have been its status as an aspect of hygiene rather than as active therapy; the opinions of dominant practitioners and scientists around midcentury, including a presumption that renal adaptation to a high-protein diet must be appropriate; fear of malnutrition and a cultural belief in the virtue of dietary protein; unwillingness by physicians and patients to restrict consumption or lifestyle; and professional identification with the technologies of dialysis and renal transplantation. Factors promoting dietary treatment have been rediscovery of previous work on protein-induced renal injury; a sense that homeostatic compensations could have adverse consequences; federal incentives to curb consumption of scarce resources such as renal dialysis; and the integration of research on, and therapeutic use of diet into scientific medicine. A large ongoing study of dietary protein restriction to limit renal injury will add to our knowledge of this treatment; its application will surely be informed by social and cultural considerations.

The use of trichothecene-contaminated grains in feeds

A review is presented describing the relative efficiencies of the various technologies that have been proposed to permit incorporation of mycotoxin-contaminated grains into animal diets without adversely influencing growth rate or resulting in hazardous residues in edible animal tissues. When the degree of contamination is modest, it may be possible to dilute the contaminated materials with uncontaminated grain to lower the concentration of trichothecenes below the threshold of significant biological activity. A less useful alternative to dilution is the other mechanical approach of milling to remove the most heavily contaminated fractions of the grain. Chemical destruction of triochothecenes is also a possibility. An example is the use of sodium bisulfite treatment to destroy deoxynivalenol in contaminated corn. Such treatments may, however, reduce palatability and nutritional value. When the biochemical mechanism of trichothecene toxicity is known, in vivo therapeutic treatments may be possible. It has been shown, for example, that T-2 toxin-induced changes in brain prostaglandin production can be overcome by treatment with dexamethasone resulting in increased survival. A similar effect was seen using the selective platelet activating factor antagonist BN 52021. Another approach is the use of dietary treatments to either promote in vivo detoxification of mycotoxins or to reduce absorption from the digestive tract with the aid of nonnutritive binding agents.