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Alzheimer's disease is recognized as a complex condition influenced by multiple factors, necessitating a similarly multifaceted approach to treatment. Ideally, interventions should prioritize averting the progression to dementia. Given the chronic nature of the disease, long-term management strategies are required. Within this framework, lifestyle modifications and dietary supplements emerge as appealing options due to their minimal toxicity, limited side effects, and cost-effectiveness. This study presents findings from a double-blind, placebo-controlled bicentric pilot clinical trial, demonstrating the significant cognitive preservation associated with genistein, a phytoestrogen found in soy and various other dietary sources, among individuals with prodromal Alzheimer's disease. Our prior investigation utilizing APP/PS1 mice elucidated the specific mechanisms through which genistein operates, including anti-amyloid-β, antioxidant, anti-inflammatory, and antiapoptotic effects. These findings underscore the potential of identifying bioactive compounds from dietary sources for the management of Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Summary: Background: Dietary interventions and increased physical activity are the cornerstones for management of the paediatric non‐alcoholic fatty liver disease (NAFLD). Though, no specific diet has been proven superior, Indo‐Mediterranean diet (IMD) has shown promise in adult literature. Thus, we aimed to compare the effect of IMD and a standard calorie‐restricted diet (CRD) in Indian overweight children and adolescents with biopsy‐proven NAFLD. Methods: Thirty‐nine consecutive biopsy‐proven NAFLD children between the ages of 8 and 18 years were randomized into either IMD or CRD for 180 days, and various parameters were evaluated at baseline and then after 180 days (NCT05073588). Results: A total of 34 subjects (18 in IMD and 16 in CRD group) completed the study. There was a significantly higher decrease in controlled attenuation parameter (CAP) values (as a marker of hepatic steatosis; on transient elastography) (95% CI: 4.2–73.4, p = 0.042), weight (95% CI: 0.75–5.5, p = 0.046) and body mass index (BMI) (95% CI: 0.21–2.05, p = 0.014) (but not in Pediatric NAFLD Fibrosis Index or PNFI; as a marker of hepatic fibrosis) in IMD group compared to the CRD group. Liver stiffness measurement, serum cholesterol and low‐density lipoprotein levels and HOMA‐IR decreased only in the IMD group (p < 0.001). Our statistical model showed that delta‐Weight was the only independent variable associated with delta‐CAP. Conclusion: Both IMD and CRD can improve the various anthropometric, clinical, imaging and biochemical parameters but IMD was superior to CRD in terms of reducing CAP values and weight/BMI over 180 days in overweight/obese NAFLD children. [ABSTRACT FROM AUTHOR]

Summary: Background: Dietary management of patients with inflammatory bowel disease (IBD) involves more than defining a therapeutic diet. The profusion of 'expert advice' is not necessarily built on evidence. Aims: To provide evidence‐based guidance on all clinically relevant aspects of nutritional and dietary management of patients with IBD. Methods: A comprehensive review of the published literature was made. Results: Four pillars of management should be considered in all patients. First, nutritional status should be optimised, since myopenia and visceral obesity are associated with poorer outcomes, which can be improved with attention to their correction. Accurate point‐of‐care measurement of body composition is advocated to identify problems, guide interventions and monitor outcomes. Second, exclusive enteral nutrition and the Crohn's Disease Exclusion Diet with partial enteral nutrition in reducing intestinal inflammation in patients with Crohn's disease have sufficient evidence to be advocated. Multiple other dietary approaches, while promising, have insufficient evidence to be recommended. Third, dietary approaches are important in symptomatic control in many non‐inflammatory scenarios. Finally, guidance on following a healthy diet is fundamental to the general health of patients. Multiple approaches are advocated, but the optimal strategy is unclear. The precarious nutritional status of patients with IBD together with the risks of nutritional inadequacy and maladaptive eating behaviours associated with restrictive diets dictate involvement of expert dietitians in assessment and personalised delivery of dietary interventions. Conclusions: Four pillars of nutritional management require specific assessment and interventional strategies that should be chosen by evidence. Optimal delivery requires the skills of a specialised dietitian. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the effectiveness and safety of nutritional interventions (i.e. nutritional support, dietary patterns and dietary supplements) on cognitive function in cancer survivors. Design: Systematic review. Methods: A systematic and comprehensive search of PubMed, Web of Science, the Cochrane Library, Embase, and CINAHL was conducted from the inception until March 10, 2023. The last search was conducted on December 10, 2023. Reporting Method: PRISMA. Results: A total of 59 randomized controlled trials were included for analysis. Nutritional support, dietary patterns and dietary supplements improved cognitive function in cancer survivors with no apparent safety concerns. The anti‐inflammatory diet, the fasting‐mimicking diet and the web‐based diet significantly improved cognitive function. Whereas the ketogenic diet or dietary advice to consume more soluble dietary fibres and less insoluble dietary fibres and lactose could not. There was evidence from dietary supplements to support the beneficial effects of polyunsaturated fatty acid supplements, traditional herbal medicines and other supplements. Conclusions: Nutritional interventions have great promise for improving cognitive function in adult cancer survivors. Further validation of the nutritional interventions supported in this study in other survivors and exploration of more effective nutritional interventions are needed. Implications for the Profession and/or Patient Care: This work can support the construction of nutritional support interventions and dietary guidance programs to prevent cancer‐related cognitive decline. Impact: This work filled a gap in preventive strategies for cancer‐related cognitive decline from a nutritional perspective. Nutritional support, dietary patterns, and dietary supplements can prevent cancer‐related cognitive decline without serious safety concerns. This work highlighted nutritional interventions that have the potential to improve cognitive function in cancer survivors, benefiting the further construction of evidence‐based nutritional intervention programs. Protocol Registration: PROSPERO. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

Aim: To elucidate the effects of ultra‐processed foods (UPFs) on body weight and ad libitum energy intake compared with non‐UPFs. Materials and Methods: In this randomized, open‐label crossover study conducted at the University of Tokyo Hospital, overweight/obese Japanese male participants were randomly assigned (1:1) to start the study with consumption of either UPFs or non‐UPFs for 1 week, followed by a 2‐week washout period, before crossing over to the alternate food diet for 1 week. Individuals with diabetes, hypertension or any other medical conditions who visited a hospital regularly were excluded. The meals were designed to be matched for the total energy and macronutrient levels. The primary outcome was the difference in the body weight change between the UPF and non‐UPF periods. The differences in the average daily energy intake and chewing frequency were assessed as one of the prespecified secondary outcomes. Results: Nine eligible participants were randomly assigned to start the study with either UPFs or non‐UPFs. All participants completed the study. During the UPF period, participants gained 1.1 kg more weight (95% confidence interval 0.2 to 2.0; P =.021) and consumed 813.5 kcal more per day (342.4 to 1284.7; P =.0041) compared with during the non‐UPF period. Regarding the chewing frequency, the number of chews per calorie was significantly lower during the UPF period (P =.016). Conclusions: Consumption of UPFs causes significant weight gain. Medical nutritional therapy focused on reducing the consumption of UPFs could be an effective strategy for preventing obesity. [ABSTRACT FROM AUTHOR]

This prospective cohort study evaluated the efficacy of omega-3 fatty acid supplementation on arteriovenous fistula patency and systemic inflammation in 220 hemodialysis patients undergoing ultrasound and digital subtraction angiography-guided balloon dilation. The participants were randomized into an intervention group receiving 2,000 mg of omega-3 fatty acids daily and a placebo group. The primary outcome measures were arteriovenous fistula patency at 12- and 24-months post- dilation, while secondary outcomes included thrombosis incidence, changes in inflammatory markers (c-reactive protein and interleukin-6), lipid profiles, and health-related quality of life (HRQoL). Results indicated a significant improvement in arteriovenous fistula patency in the omega-3 group at 24 months (80.9 vs. 68.2%, P < 0.05). Additionally, there was a significant reduction in thrombosis rates (7.3 vs. 16.4%, P < 0.05) and inflammatory markers (c-reactive protein and interleukin-6) in the omega-3 group compared to the placebo. Lipid profile analysis showed a decrease in total cholesterol and low-density lipoprotein levels with omega-3 supplementation, with significant changes at 12 months (P < 0.05). HRQoL scores also improved significantly in the omega-3 group at both 12 and 24 months (P < 0.05). These findings suggest that omega-3 fatty acids can enhance arteriovenous fistula functionality and reduce cardiovascular risk factors in hemodialysis patients. And its integration into standard care protocols for patients with arteriovenous fistulas would improve long-term outcomes. [ABSTRACT FROM AUTHOR]

This prospective interventional study investigated the impact of individualized nutritional interventions on immune function and infection rates in burn patients. This study enrolled 120 burn patients between December 2022 and January 2024. The nutritional interventions focused on protein supplementation, micronutrient replenishment, and inclusion of anti-inflammatory nutrients, specifically omega-3 fatty acids and vitamin C. The nutrients were administered through oral, enteral, and parenteral routes based on dietary preferences and the medical condition of individuals. Protein was prioritized because of its role in leukocyte production; zinc and vitamin C were supplemented to optimize immune function; and omega-3 fatty acids were included to mitigate inflammation and enhance wound healing. The study assessed outcomes through changes in leukocyte and lymphocyte counts, cytokine levels, infection rates, wound healing rates, and the length of hospital stays. Results indicated significant improvements in immune markers and reduced infection rates post-intervention (P < 0.05). Leukocyte count increased significantly, cytokine levels decreased, and the infection rate reduced from 30% to 14.2% (P < 0.05). These outcomes highlighted the efficacy of targeted nutritional interventions in supporting immune health and reducing infections in burn patients. The findings advocated for integrating comprehensive nutritional strategies in managing burn injuries to improve clinical outcomes. [ABSTRACT FROM AUTHOR]

Preterm newborns with very low birth weight, defined as less than 1,500 g, often face challenges in meeting heightened nutritional demands due to physiological and metabolic stress and underdeveloped gastrointestinal systems. This study explored current guidelines and practices in nutritional management for very low birth weight infants, focusing on strategies, including providing human breast milk, donor human milk, parenteral nutrition, and combined nutrition. This retrospective cohort analysis, conducted in an institutional neonatal intensive care unit, reviewed data from medical records of preterm infants weighing 1,000-1,500 g admitted between March-November 2021. Nutritional management involved parenteral or combined nutrition. Data analysis included descriptive statistics, t-tests, Mann-Whitney tests, chi-square tests, and relative risk analysis. Of the 421 reviewed records, 106 met the inclusion criteria. A total of 31 infants received parenteral nutrition, while 75 received combined nutrition. Infants on combined nutrition demonstrated higher weight gain compared to infants on parenteral nutrition (P < 0.05). Relative risk analysis revealed varied associations between nutrition type and comorbidities, suggesting potential benefits and risks of each approach. Combined nutrition effectively met caloric and nutritional needs in very low birth weight infants without increasing morbidity and mortality. It positively impacted weight gain, indicating its viability as an alternative feeding approach. [ABSTRACT FROM AUTHOR]

Introduction: The effects of antioxidant dietary supplements on response to biological therapies for cancer is unknown. We conducted a scoping review of the available systematic review evidence on this question. Methods and analysis: We searched six databases from inception to August 19, 2022 for systematic reviews of randomized controlled trials of antioxidant dietary supplements used by patients receiving curative chemotherapy, radiotherapy, or other biological therapy for cancer and assessing the impact of supplements on survival, treatment response, or disease progression. We focused on results from reviews at high or moderate AMSTAR-2 quality. Records were selected, data extracted, and AMSTAR-2 ratings assessed independently by two authors. Results: We found 24 systematic reviews with relevant evidence. Reviews were heterogenous in cancers, treatments, and antioxidant dietary supplements assessed. Conclusions across reviews were mixed, ranging from negative to no apparent difference to positive, but always with caveats about the limited size and quality of the evidence. One review was rated 'moderate' on AMSTAR-2; it included one small trial of vitamin C and formed no firm conclusions. Conclusions: We did not find reliable systematic review evidence on the effects of antioxidant dietary supplements upon therapies for cancer. More research is necessary to inform clinical recommendations. [ABSTRACT FROM AUTHOR]

The growing incidence rate of cancer and its associated morbidity and mortality prompts the need to identify factors that could improve the quality of life (QoL) and survival of a patient with cancer. Cancer-associated malnutrition is a common complication that could start at the early stages of cancer and could further develop into advanced cachexia. Response to treatment, length of hospital stay, progression of infection, and other complications of cancer including chemotherapy adverse events could all be influenced by the progression of malnutrition. Nutritional interventions may vary from oral to enteral and parenteral therapy. Parenteral nutrition (PN) therapy may benefit patients at certain stages of cancer in whom contraindications or inefficacy of other modalities of nutritional support are present. This method may seem invasive, costly, and risky but at the same time may improve certain patients' QoL and chance of survival. In trained settings with proper facilities, this method of nutritional support can benefit patients; However, the indication for starting PN must be carefully supervised considering that other nutritional support methods may be equally efficient and at the same time easier to access and apply. [ABSTRACT FROM AUTHOR]

Background: Many countries have introduced school food standards to improve the dietary intakes of school-aged children. England has school food standards (SFS) legislation in place but little is known about how well secondary schools comply with this. We aimed to assess compliance with the SFS legislation in English secondary schools and explore the impact of the SFS on pupils' nutritional intake. Methods: We conducted a cross-sectional study with English secondary schools from 2019 to 2022. We compared SFS compliance and pupil nutritional intake in schools mandated or not mandated to comply with the SFS legislation, and explored the association between school compliance and pupil nutritional intake. We assessed the percentage of SFS (%SFS) complied with by reviewing school food menus and observing food served in school canteens. We assessed pupil nutritional intake using a 24-hour dietary recall measure (Intake24) and estimated intakes of free sugar (primary outcome) and other nutrients/foods. We used adjusted multilevel models to compare pupil intakes in the SFS-mandated and SFS-non-mandated schools, and to explore the association between school SFS compliance and pupil intakes. Results: 36 schools (23 not mandated and 13 mandated to comply with the SFS) and 2,273 pupils participated. The median %SFS complied with was 63.9% (interquartile range 60.0–70.0%). This was similar for SFS-non-mandated (64.5%) and SFS-mandated schools (63.3%). Compliance was highest for standards applying to lunchtime (median = 81.3%) and lowest for those applying across the whole school day (median = 41.7%). It was also lower for standards restricting high fat, sugar and energy-dense items (median = 26.1%) than for standards aiming to increase dietary variety (median = 92.3%). Pupils from SFS-mandated schools had a lower mean lunchtime intake of free sugar (g) (adjusted mean difference: -2.78g; 95% CI: -4.66g to -0.90g). There were few significant associations between %SFS complied with and pupil nutritional intake. Conclusions: English secondary schools do not fully comply with SFS legislation regardless of whether they are mandated to comply. Schools and caterers may require monitoring and support to fully comply. There is little evidence that SFS compliance is associated with better pupil nutritional intake. Food environments outside of school also need to be considered. Study registration: ISRCTN68757496 (17-10-2019). [ABSTRACT FROM AUTHOR]

Background: Patient education is a crucial strategy for promoting prevention and diabetes self-management since glycemic control achievement involves taking medications, medical nutrition therapy, physical exercise, and behavior changes. However, patient education programs are still barely implemented in low- and middle-income countries. This trial aims to investigate whether a lifestyle education intervention added to physical exercising is superior to sole physical exercising regarding functional capacity, disease-related knowledge, health behaviors, cardiometabolic health parameters, quality of life, depression, and diet quality in individuals with prediabetes or diabetes. Methods: Multicenter double-blinded randomized controlled trial with two parallel arms involving 12-week intervention and 6-month follow-up. The eligible individuals (≥ 18 years, living with prediabetes or diabetes, literate, no clinical decompensation and/or physical and/or mental limitations that contraindicate physical exercising, written physician permission for exercise, no cognitive impairment, no vision limitations for reading, no confirmed diagnosis of unstable coronary disease or heart failure, no pacemaker and/or implantable cardioverter-defibrillator, no complex ventricular arrhythmias, no intermittent claudication, no recent cardiovascular event or cardiac surgery, and no currently enrolled in a structured exercise program) were recruited from two Brazilian cities and randomized to either (1) an Exercise and Lifestyle Education Program (ExLE) or (2) an Exercise Program (Ex), which can be delivered on-site or remotely based on the participants' internet access and technology literacy. The primary outcomes will be changes in functional capacity and disease-related knowledge. The secondary outcomes will involve changes in health behaviors (health literacy, physical activity level, exercise self-efficacy, and medication adherence) and cardiometabolic health parameters (glycemic control, anthropometric measures, and cardiac autonomic control). Program adherence, satisfaction with the program, diabetes-related morbidity, and changes in quality of life, depression, and diet quality will be the tertiary outcomes. Assessments will occur at baseline, post-intervention, and after 6-month follow-up. Discussion: If superior effectiveness of ExLE compared to Ex program to improve the outcomes measures is found, this program could be delivered broadly in the Brazilian health system, especially in the primary care facilities where most individuals living with prediabetes and diabetes in our country are assisted. Trial registration: ClinicalTrials.gov, NCT03914924. Registered on April 16, 2019. [ABSTRACT FROM AUTHOR]

The primary therapeutic approach for managing hyperglycemia today is diet therapy. Lipids are not only a source of nutrients but also play a role in initiating adipocyte differentiation in the fetus, which may explain the development of fetal macrosomia and future metabolic disorders in children born to mothers with gestational diabetes mellitus (GDM). Alterations in the maternal blood lipid profile, influenced by adherence to a healthy diet in mothers with GDM and the occurrence of fetal macrosomia, represent a complex and not fully understood process. The aim of this study was to examine the characteristics of the blood plasma lipid profile in pregnant women with GDM across all trimesters based on adherence to diet therapy. The clinical part of the study followed a case-control design, including 110 women: 80 in the control group, 20 in a GDM group adhering to the diet, and 10 in a GDM group not adhering to the diet. The laboratory part was conducted as a longitudinal dynamic study, with venous blood samples collected at three time points: 11–13, 24–26, and 30–32 weeks of pregnancy. A significant impact of diet therapy on the composition of blood lipids throughout pregnancy was demonstrated, starting as early as the first trimester. ROC analysis indicated high effectiveness of the models developed, with an AUC of 0.98 for the 30- to 32-week model and sensitivity and specificity values of 1 and 0.9, respectively. An association was found between dietary habits, maternal blood lipid composition at 32 weeks, and newborn weight. The changes in lipid profiles during macrosomia development and under diet therapy were found to be diametrically opposed, confirming at the molecular level that diet therapy can normalize not only carbohydrate metabolism but also lipid metabolism in both the mother and fetus. Based on the data obtained, it is suggested that after further validation, the developed models could be used to improve the prognosis of macrosomia by analyzing blood plasma lipid profiles at various stages of pregnancy. [ABSTRACT FROM AUTHOR]

Background/Objectives: Caregivers play an important role in supporting care recipients to navigate their health needs, including adherence to dietary recommendations, which are complex and multifaceted. This study aims to (i) describe the nutrition knowledge of caregivers of people with chronic kidney disease (CKD), and (ii) explore caregivers' perceptions of their role in providing healthy meals and nutrition support for care recipients. Methods: A cross-sectional study design employed a multi-strategy research approach. Caregivers (n = 78) of people with stage 1–5 CKD or post-transplant were recruited from a single centre. Their nutrition knowledge was assessed quantitatively with the revised General Nutrition Knowledge questionnaire. Theory-informed semi-structured interviews of a sub-sample (n = 12) qualitatively explored caregiver perceptions. Results: Most caregivers were female (75.6%) and cared for a male care recipient (87%; aged 74 (66; 80) yrs.). The caregivers (75.6%) provided a meal ≥6 times/week to their care recipient and had moderate nutrition knowledge (66.1 (60.5; 73.9)%). Four themes emerged describing the caregivers' perceptions of meal provision and nutrition support, including the following: (i) food literacy skills are valued; (ii) social support is important; (iii) caregivers' sense of social responsibility; and (iv) the management of complex and multifaceted dietary needs. Conclusions: The caregivers had moderate nutrition knowledge; they wanted to provide healthy meals and support to their care recipients to adhere to dietary recommendations. Targeted, co-designed nutrition education programs for caregivers may enhance nutrition care delivery to people with CKD. [ABSTRACT FROM AUTHOR]

Introduction: Alzheimer's disease (AD) is the leading cause of dementia, and currently, no effective treatments are available to reverse or halt its progression in clinical practice. Although a plethora of studies have highlighted the benefits of physical exercise in combating AD, elder individuals often have limited exercise capacity. Therefore, mild physical exercise and nutritional interventions represent potential strategies for preventing and mitigating neurodegenerative diseases. Our research, along with other studies, have demonstrated that platycodin D (PD) or its metabolite, platycodigenin, derived from the medicinal plant Platycodon grandiflorus, exerts neuroprotective effects against amyloid b (Ab)-induced neuroinflammation. However, the combined effects of PD and physical exercise on alleviating AD have yet to be explored. The current study aimed to investigate whether combined therapy could synergistically ameliorate memory deficits and AD pathology in 5 x FAD mice. Methods: Five-month-old 5 x FAD mice were randomly assigned to four groups, and received either PD (5 mg/kg/day, p.o.), voluntary running, or a combination of both for 47 days. Nest building test, locomotion test, and Morris water maze test were used to evaluate the cognitive function. Immunohistochemical and ELISA analysis was performed to determine Ab build-up, microglia and astrocytes hyperactivation, and survival neurons in the hippocampus and perirhinal cortex. Real-time quantitative PCR analysis was used to assess the polarization of microglia and astrocytes. HPLC analysis was performed to measure monoamine neurotransmitters in the hippocampus. Results and discussion: The combination of PD and voluntary running synergistically restored nest-building behavior, alleviated recognition and spatial memory deficits, and showed superior effects compared to monotherapy. In addition, the PD and voluntary running combination reduced Ab build-up, decreased hyperactivation of microglia and astrocytes in the hippocampus and perirhinal cortex, promoted the polarization of inflammatory M1 microglia and reactive astrocytes toward beneficial phenotypes, and lowered systemic circulating pro-inflammatory cytokines while increasing anti-inflammatory cytokines in 5 x FAD mice. Furthermore, combined therapy effectively protected neurons and increased levels of 5-hydroxytryptamine (5-HT) and dopamine (DA) in the hippocampus of 5 x FAD mice. In conclusion, the combination of PD and voluntary running holds great potential as a treatment for AD, offering promise for delaying onset or progression of AD. [ABSTRACT FROM AUTHOR]

Background: Prehabilitation, which includes nutritional and exercise therapies, is recommended for patients before surgery to improve physical and cognitive functions. This study aimed to identify the awareness, understanding, and issues among surgeons and anesthesiologists regarding the implementation of prehabilitation. Methods: We conducted a survey on prehabilitation targeting surgeons and anesthesiologists working at a university hospital and two private hospitals. The survey collection period was set for 1 month, commencing on February 5, 2024. Descriptive statistics were employed to summarize the characteristics of the participants. Results: A total of 254 surgeons and 49 anesthesiologists from three hospitals participated, with a response rate of 61.7%. Regarding the understanding of prehabilitation, 16.7% of anesthesiologists and only 2% of surgeons had a good grasp of its content. When enquired about the necessity of prehabilitation, 100% of anesthesiologists indicated it as necessary or somewhat necessary, whereas 98.7% of surgeons responded similarly. Several barriers to the implementation of prehabilitation were identified, with the most common reason being the busy schedule of outpatient services. Conclusion: This study highlights that while both surgeons and anesthesiologists recognize the importance of prehabilitation, significant challenges exist in its practical implementation. This underscores the need for simple explanatory tools for patients, the introduction of remote care options, and simple orders to relevant departments, which are essential and require multidisciplinary collaboration. [ABSTRACT FROM AUTHOR]

Objective: To identify key factors influencing the therapeutic efficacy of the ketogenic diet (KD) for children with drug‐resistant epilepsy and elucidate their interconnected relationships to optimize clinical practice. Methods: Participants were selected from children receiving KD treatment at West Second University Hospital of Sichuan University from September 2015 to October 2023. Clinical factors pre‐KD and post‐KD (at the third month) were analyzed systematically using an analytical framework. Descriptive analyses, univariate analyses, and multivariate regression analyses were performed for the entire cohort and subgroups of genetic and non‐genetic (i.e., structural and unknown) etiologies. Thereby, the most significant predictors were identified for each relevant dependent variable. Path analysis diagrams were used for visual representation. Results: Of 156 patients, genetic etiology was prevalent (38.5%). In the genetic subgroup, channelopathies predicted lower baseline seizure frequency and increased chance of seizure freedom with KD. Frequent seizures and complex history of anti‐seizure medications (ASMs) predicted severe baseline psychomotor abnormalities. Younger age at KD initiation benefited psychomotor improvement. In the non‐genetic subgroup, lower baseline seizure frequency increased the likelihood of seizure freedom post‐KD. Concurrent use of multiple ASMs helped achieve ≥50% seizure reduction. Boys were more likely to experience psychomotor improvement. A significant correlation was found between ≥50% seizure reduction and psychomotor improvement in both subgroups. Delayed KD initiation (longer epilepsy duration at KD start) was related to a greater number of ASMs used, infrequent seizures, and older age at epilepsy onset. In addition, patients with channelopathies had delayed initiation of KD. Significance: Children with genetic epilepsy display more pronounced characteristics of epileptic encephalopathy. Early KD intervention is crucial for channelopathies, notably SCN1A variants. For other drug‐resistant epilepsy cases, KD alongside diverse ASMs may improve seizure control and developmental outcomes. However, the patient population benefiting most from early KD tends to start the treatment later, urging a re‐evaluation of KD decision‐making paradigms. [ABSTRACT FROM AUTHOR]

Background: Wearing complete denture in one or both arches can impact enjoyment of eating and affect quality of life compared with being dentate. Clinicians focus on issuing technically sound dentures but ignore the impact of wearing dentures on the eating‐related quality of life which affects the success of treatment. Objectives: The aim of this research was to qualitatively explore ERQoL in Australian adults wearing complete dentures using a validated questionnaire and through focus groups. Methods: Complete denture wearers (n = 44) were recruited from dental clinics and invited to complete the self‐administered Emotional and Social Issues Related to Eating questionnaire. Responses were categorised under the six questionnaire domains. A subsample of 20 participants who completed the questionnaire were invited to participate in focus groups to identify emerging themes. Results: Twenty‐three participants (52.3%) completed the questionnaire. Most participants expressed a decline in enjoyment of eating due to reduced ability to eat, longer chewing times and the need to frequently clean dentures while eating. Focus groups (n = 2 × 4 participants) indicated educational materials on eating with dentures would increase recognition of eating problems with dentures and reduce trial and error approaches to dealing with these. Conclusion: ERQoL is adversely affected by wearing complete dentures due to functional limitations, restricted food choices and adaptive eating behaviours. Patient support for eating well with a complete denture/s wearers is required. [ABSTRACT FROM AUTHOR]

Objective • To observe the effect of implementing standardized flow management in enteral nutrition therapy for critically ill patients. Methods • We selected 241 critically ill patients admitted to our hospital from January 2020 to January 2023. Patients with enteral nutrition without standard process management were set as the control group (n = 109), while those with enteral nutrition and standard process management were set as the observation group (n = 132). The total protein, albumin, prealbumin, and hemoglobin were compared between the two groups on the 7th and 14th day of nutritional therapy. Immune indicators (IgM, IgA, and IgG), NUTRIC score, and the incidence of infectious complications were compared between the two groups. Results • On the 7th and 14th day of treatment, the total protein, albumin, prealbumin, hemoglobin, and immune indicators in the observation group were higher than those in the control group, and the differences were statistically significant (P < .05). On the 7th and 14th day of treatment, the NUTRIC score of the observation group was higher than that in the control group, with a statistically significant difference (P < .05). The incidence of infectious complications in the observation group was lower than that in the control group, and the difference was statistically significant (P < .05). Conclusion • Implementing standardized process management of EN for critically ill patients improves total protein, albumin, prealbumin, hemoglobin, immune indexes, NUTRIC score, and nutritional status, while reducing the incidence of infectious complications. These findings offer valuable insights for clinical practice and advocate for practical application. [ABSTRACT FROM AUTHOR]

Objective: When asthma and pregnancy coexist, the mother may be severely affected. One of the main reasons for this situation is that it is positively correlated with especially increased oxidative stress due to the co-occurrence of asthma and pregnancy. Even pregnancy alone increases oxidative stress in the body, and with the addition of asthma, an increased chain of events is added. In this sense, diet and nutrition styles can be considered as factors that regulate both events in a controlled way. Increasing anti-oxidant intake in the diet can play a leading role in eliminating the increased Reactive oxygen species; thus, this negative effect in asthma and pregnancy can be alleviated. Studies on the protective role of antioxidants in asthma are limited, but not few. The aim of this study was to reveal the strength of the effects of thymoquinone (TQ) and carob powder administration, which are known to have two different strong antioxidant effects during pregnancy, on the oxidative event in the mother with the diet management strategies. Methods: In this study, it was tried to improve the asthmatic pregnant rat and to determine the direction of oxidant-antioxidant balance with a holistic antioxidant complex Female rats were divided into 3 groups: asthmatic pregnant group (1) sensitized via an intraperitoneal injection of ovalbumin (OVA) with alum on days 0 and 14 and exposed to aerosolized OVA 3 days over the subsequent 1 week then coupled with male rats to get pregnant; asthmatic pregnant with TQ and carob (CS) group (2) sensitized as above then administered each of TQ and CS on the last 5 days of pregnancy; and asthmatic pregnant with dexamethasone group (3) sensitized as above then received dexamethasone by intraperitoneal injection on last 5 days of pregnancy. Results: The co-administration of TQ and CS decreased malondialdehyde levels, increased nitric oxide, ascorbic acid, and glutathione levels in lung tissue. In addition, the levels of some proinflammatory cytokines were decreased in the serum. The cumulative protective effects of TQ and CS were successful in reducing inflammation in the lungs. Conclusion: The administration of TQ and CS may be considered as a candidate for a new herbal blend or adjuvant for asthmatic pregnant, given the side effects of cortisol. [ABSTRACT FROM AUTHOR]

Background/Objectives: The prevalence of gestational diabetes mellitus (GDM) is increasing at an alarming rate worldwide. Delayed management can lead to adverse composite outcomes for both mother and her offspring. To our knowledge, the clinical association between glycemic parameters and the results of the non-pharmacological GDM approach remains limited; thus, this study aimed to address this important clinical issue in the literature. Methods: This was a retrospective cross-sectional study of 174 Vietnamese pregnant women with the positive oral glucose tolerance test (OGTT) for a high fasting glycemic parameter at Hung Vuong Hospital from 04/2022 to 07/2022. This study aimed to evaluate the success rate of GDM with an elevated index of fasting glycemic concentration which was managed after 2 weeks of a dietary regimen combined with adequate physical activities and to reveal its related factors. Results: Out of 174 singleton pregnancies that met the inclusion criteria, 103 GDM pregnant women were successfully managed after 2 weeks of monitoring (59.2%; 95% confidence intervals (CI): 51.9–66.5). The study revealed a fair correlation between the corresponding test of blood glucose at OGTT and after 2 weeks of GDM management (r = 0.270–0.290, p < 0.0001). The GDM pregnant women with an elevated fasting glycemic parameter and with any of elevated 1 h or 2 h blood glucose levels and in cases of three elevated glycemic parameters (fasting, 1 h, and 2 h blood glucose at the initial results of OGTT) reduced the success rate of glycemic control to 56.5%, 49.2%, respectively, compared to the group with solely a high fasting index of blood glucose (69.6%). The pregnant women who participated in high-intensity sports activities related to a two-fold increase in success rate compared with the group engaging in light and moderate-intensity physical activity. Conclusions: The success rate of glycemic control in GDM women was highest in the group with solitary fasting hyperglycemia and lower in the contributory groups with two and three high parameters. The application of diet therapy plus physical activities among GDM pregnant women is potentially necessary to improve the effectiveness of treatment, minimize adverse pregnancy outcomes, and reduce substantially the hospitalization rate. [ABSTRACT FROM AUTHOR]

Aims: To explore the psychosocial experiences during dietary management among Chinese adults with inflammatory bowel disease. Design: Qualitative phenomenological design. Methods: Eighteen adults diagnosed with inflammatory bowel disease for more than 6 months were recruited using purposive sampling from June to December 2023. Two trained researchers used van Manen's approach to analyse the data. Results: The three themes with multiple subthemes emerged: facing the unknown: at a loss and aggrieved, trying to cope: uncertain and distressed, and growing in adaptation: relieved and transcendent. The first theme included unknown relapses, overlooking diet management and the absence of dietary rules. The second theme showed different coping situations, like complex dietary information and ever‐closing worlds. The third theme explores how participants adapted to disease and their eating patterns. Conclusion: The psychosocial experiences during dietary management are complex. The accumulation of diet‐related experience, acceptance of illness and social support facilitate patients in overcoming negative emotions and adhering to dietary management. Implications for the Profession and Patient Care: Nurses should provide tailored dietary guidance and appropriate psychological interventions to promote healthy eating in patients. Impact: This study may enhance healthcare professionals' understanding, particularly those in China, of the diet‐related experiences among patients. Reporting Method: The Consolidated Criteria for Reporting Qualitative Research checklist. Patient or Public Contribution: Participants contributed by sharing their first hand experiences. [ABSTRACT FROM AUTHOR]

Aim: To identify and synthesise qualitative studies on barriers and facilitators perceived by dialysis patients in relation to self‐care and disease management. Design: Systematic review of qualitative studies. Data Sources: Qualitative study articles were extracted from PUBMED, MEDLINE, COCHRANE, WEB OF SCIENCE (WOS), CINAHL PsycINFO and EMBASE and electronic journals of the Spanish Society of Nephrology and Spanish Society of Nephrological Nursing until May 2022. Studies on barriers and/or facilitators affecting self‐care and disease management expressed by people undergoing haemodialysis or peritoneal dialysis were included. Review Methods: The SPICE (Setting, Perspective, Intervention, Comparison and Evaluation) strategy was used to develop issues and subissues through the thematic synthesis of the qualitative findings. GRADE‐CERQual was used to evaluate the articles. Results: From 172 articles, 15 qualitative articles about barriers and facilitators perceived by patients concerning self‐care and disease management were finally included. Identified eight facilitators and four barriers. Conclusion: Patients perceived a significant number of barriers and facilitators. It is possible to identify which aspects facilitate self‐management of their disease and to understand that the processes are individualised. This is why therapeutic strategies should be designed to foster the participation and empowerment of the person in the management of the disease. Implications for the profession and/or patient care: Identifying the barriers and facilitators concerning the management of chronic kidney disease furnishes us with knowledge for individualised clinical practice and improved care processes. Impact: This review is the first to synthesise barriers and facilitators in haemodialysis patients about the management of their disease and treatment. The results enable the proposal of improvements in the training of healthcare personnel, clinical practice guidelines and action protocols to improve the daily life and management of the disease by patients. No patient or public contribution due to this is a systematic review. [ABSTRACT FROM AUTHOR]

Aims: This scoping review aimed to identify and map the available information on the nutrition care process in older adults with delirium to analyse and summarise key concepts, and gaps, including the barriers and enablers to providing nutrition care for this group. Design: Scoping review. Methods: This review was conducted in accordance with the JBI methodology for scoping reviews. Published and grey sources in English were considered. Data sources: Databases searched were CINAHL, Medline, Embase, JBI Evidence‐based Practice, Scopus, ProQuest and Google. The initial search was conducted from October 2021 to March 2022 and repeated in October 2023. Results: The database search identified 1561 articles, 186 underwent full‐text review and 17 articles were included. The grey literature search identified eight articles. Malnutrition and delirium were identified as mutually reinforcing, and nutrition strategies were included as part of multicomponent interventions for delirium management. There was no mention of barriers or enablers to nutrition care and minimal descriptive or empirical data available to guide nutrition care processes in this group. Conclusion: This scoping review revealed a need for further research into nutrition care processes in older patients with delirium, in particular the barriers and enablers, to inform appropriate management strategies in this vulnerable group. Implications for the profession and patient care: Providing nutrition care for older patients with delirium is important and further practical guidance could help patients, healthcare staff and families. Impact: This scoping review yielded instructive data suggesting that delirium is an important risk factor for malnutrition and vice versa, which leads to poor patient and health service outcomes. Reporting method: This scoping review adhered to relevant EQUATOR guidelines and used the Preferred Reporting Items For Systematic Reviews and Meta‐Analyses Extension for Scoping Reviews (PRISMA‐ScR). Patient of public contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

• Minimum dietary diversity is associated with a lower risk of childhood underweight. • Consuming dairy, eggs, fruits, and vegetables lowers the risk of underweight. • Children exclusively fed mother's breast milk are more likely to be malnourished. A lack of consumption of a diversified diet is associated with poor physical and cognitive development in children. Evidence on the relationship between minimum dietary diversity (MDD) and childhood malnutrition remains inconclusive in India. We hypothesized that children aged 6 to 23 months on a diversified diet (five out of eight defined foods and beverages) are less likely to be malnourished (stunting, wasting, and underweight) compared to their counterparts who are not on a diversified diet. This cross-sectional study was based on the 2019-2021 National Family Health Survey of India, comprising a weighted sample of 57,714 children aged 6 to 23 months. Multilevel logistic regression was conducted for data analysis. The results showed a significant protective effect of dietary diversity on underweight (odds ratios [OR] = 0.91; 95% confidence intervals [CI]: 0.86-0.96). In addition, children who did not consume eggs (OR = 1.09; 95% CI; 1.03-1.15), dairy products (OR = 1.22; 95% CI: 1.17-1.27), or fruits and vegetables (OR = 1.11; 95% CI: 1.06-1.17) were more likely to be underweight than children who did. Children who did not consume dairy products, fruits, and vegetables were also more likely to be stunted and wasted. However, we did not find significant associations of MDD with wasting and stunting. Nutritional interventions promoting daily consumption of dairy products, eggs, fruit, and vegetables are recommended to address the growing problem of childhood malnutrition in India. Regions with higher rates of malnutrition and those lacking MDD, such as Uttar Pradesh and Rajasthan, should be prioritized. [Display omitted] The present study includes 57,714 children aged 6 to 23 months. The results reveal that achieving minimum dietary diversity (consumption of five or more food categories out of the eight recommended by WHO) is associated with a reduced risk of underweight in children. Daily consumption of at least one serving of dairy products, one serving of eggs or lean meats, half a serving of fruit, and two to three servings of vegetables is recommended to reduce childhood underweight. [ABSTRACT FROM AUTHOR]

Background: Recently, there has been a growing interest in exploring AI-driven chatbots, such as ChatGPT, as a resource for disease management and education. Objective: The study aims to evaluate ChatGPT's accuracy and quality/clarity in providing nutritional management for Type 2 Diabetes (T2DM), the Metabolic syndrome (MetS) and its components, in accordance with the Academy of Nutrition and Dietetics' guidelines. Methods: Three nutrition management-related domains were considered: (1) Dietary management, (2) Nutrition care process (NCP) and (3) Menu planning (1500 kcal). A total of 63 prompts were used. Two experienced dietitians evaluated the chatbot output's concordance with the guidelines. Results: Both dietitians provided similar assessments for most conditions examined in the study. Gaps in the ChatGPT-derived outputs were identified and included weight loss recommendations, energy deficit, anthropometric assessment, specific nutrients of concern and the adoption of specific dietary interventions. Gaps in physical activity recommendations were also observed, highlighting ChatGPT's limitations in providing holistic lifestyle interventions. Within the NCP, the generated output provided incomplete examples of diagnostic documentation statements and had significant gaps in the monitoring and evaluation step. In the 1500 kcal one-day menus, the amounts of carbohydrates, fat, vitamin D and calcium were discordant with dietary recommendations. Regarding clarity, dietitians rated the output as either good or excellent. Conclusion: Although ChatGPT is an increasingly available resource for practitioners, users are encouraged to consider the gaps identified in this study in the dietary management of T2DM and the MetS. [ABSTRACT FROM AUTHOR]

Irritable bowel syndrome is a common, chronic disorder of gut-brain interaction with complex pathophysiology. It is characterized by abdominal pain and alterations in bowel movements, currently diagnosed based on the Rome IV criteria. If alarm symptoms are present, objective workup may be required to exclude organic etiologies. Irritable bowel syndrome remains a frequent reason to visit primary care physicians and gastroenterologists. It puts a significant burden on patients' quality of life and has high economic costs. Given limited access to gastroenterology consultation, initiating treatment promptly in the primary care setting should be the standard of care to minimize patients' pain and suffering. Treatment requires a patient-centred approach and often multiple treatment options, including dietary management, pharmacotherapy, and psychological approaches, such as cognitive-behavioral therapy and gut-directed hypnotherapy. [ABSTRACT FROM AUTHOR]

Introduction Methods Results Conclusions Arrhythmia occurs as a common heart vascular disease. Functional food is a rich source of natural compounds with significant pharmacological, The aim of this paper is to explore its effect on arrhythmia.By reviewing the literature and summarising the findings, we described the role of functional foods in the alleviation of cardiac arrhythmias from different perspectives.Our study shows that functional foods have anti‐arrhythmic effects through modulation of ion channels, oxidative stress, and Calmodulin‐dependent protein kinase II.We summarize the mechanism of arrhythmia inhibition by the active ingredients of medicinal diets in this review article, intending to provide research ideas for dietary therapy to regulate arrhythmia. [ABSTRACT FROM AUTHOR]

Background: The aim of the study was to use bioelectrical impedance analysis (BIA) to assess nutritional status of elderly patients admitted to hospital and quantitatively measure the impact of the Cardiff and Vale University Health Board (CAVUHB) model ward. Secondary objectives were to assess the feasibility of using BIA in this patient population and compare nutrition risk screening tools against fat‐free mass index (FFMI). Methods: A prospective, comparative, single‐centre, service evaluation of a 'model ward for nutrition and hydration' undertaken in medical and rehabilitation beds in a large UK teaching hospital. Results: A total of 450 BIA measurements were taken using a Bodystat Multiscan 5000 on 162 patients; several patients had repeated measurements during their hospital stay. Patients tolerated the procedure well, but lack of accurate weight, implanted medical devices and tissue viability precluded some participants. Conclusions: BIA is quick, non‐invasive, simple to complete and can elicit huge data about an individual's body composition. In a larger cohort of medical admissions, BIA could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. Although results were not statistically significant, there is an opportunity with the new model of care to better support frail patients and prevent deconditioning. Key points: Bioelectrical impedance analysis could assist in identifying the sensitivity and specificity of the nutrition screening tools. The collective benefit of a series of nutritional interventions preserved nutritional status better in this elderly inpatient population than usual models of care. There is an opportunity with these interventions to better support frail patients and prevent deconditioning. [ABSTRACT FROM AUTHOR]

Background: Diet plays an important role in management of gastrointestinal (GI) symptoms in patients with irritable bowel syndrome (IBS). Restrictive diets have gained popularity as treatment for IBS, but no studies have examined the patients' experiences of implementing such diets. Thus, the present study aimed to explore the experience of patients with IBS undergoing a structured dietary intervention. Methods: Using inductive content analysis, semi‐structured interviews were conducted in 19 patients with IBS, who were recruited from a randomised controlled trial evaluating two different restrictive diets for 4 weeks: a diet low in total carbohydrates; and a diet low in fermentable oligo‐, di‐ and monosaccharides and polyols (i.e., FODMAP) combined with traditional IBS dietary advice. Results: Three main themes developed from the qualitative analysis and together they describe the dietary intervention as supportive, as well as the dietary changes as challenging and contributing to reflection. Patients found the dietary support effective in both initiating and adhering to their dietary changes. Despite the support, the implementation of the diet was perceived as challenging when it interfered with other important aspects of their lives. However, going through the dietary change process, the patients began to reflect on their eating behaviours, which enabled individual dietary adjustments. The adjustments that patients maintained were not only a result of alleviation of GI symptoms, but also based on personal preferences. Conclusions: Patients with IBS undergoing restrictive diets appear to benefit from structured support. However, considering the individual patient's life situation and personal preferences, individualised dietary options should be encouraged to achieve long‐term dietary changes. Highlights: The patients with irritable bowel syndrome (IBS) found the given structured dietary support effective in both initiating and adhering to their restrictive dietary changes.Implementation of the dietary changes was perceived as multidimensional challenging when it interfered with other important aspects of their lives, that is, family and work.When going through the dietary changes process, the patients began to reflect on their eating behaviours that enabled individual dietary adjustments.The dietary adjustments that patients maintained were not only a result of alleviation of gastrointestinal symptoms, but also primarily based on personal and practical preferences. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this article is to assist the pharmacist engaged in nutrition support therapy in staying current with pertinent literature. Methods: Several board-certified nutrition support pharmacists aggregated a list of articles relevant to pharmacy nutrition support published in 2023. The list was compiled into a spreadsheet whereby the authors were asked to assess whether the article was considered important. A culled list of publications was then identified whereby at least 5 out of the 8 author participants considered the article to be important for pharmacists practicing in nutrition support. Guideline and consensus papers, important to practice but not ranked, were also included. Results: A total of 133 articles were identified; 9 from the primary literature were voted by the group to be of high importance. Fourteen guidelines, position, recommendation, or consensus papers were also identified. The top-ranked articles from the primary literature were summarized and a narrative regarding its implications to pharmacy nutrition support practice were provided. Conclusion: We recommend that pharmacists engaged in nutrition support therapy be familiar with these articles as it pertains to their practice. [ABSTRACT FROM AUTHOR]

Objective: Medical nutrition therapy is an essential component of management of type 1 diabetes (T1D). This study evaluated adherence of children with T1D to International Society for Pediatric and Adolescent Diabeties (ISPAD) 2018 dietary recommendations. Methods: Dietary assessment was conducted for 75 children with T1D of duration > 1 year. Results: Adherence to the recommendations was observed in 40% of participants. Mean (SD) calorie intake (%) from carbohydrate, fat and protein was 51.93 (6.08), 32.42 (5.66) and 15.95 (2.45), respectively. 68% participants had an energy deficit of >10% of the estimated average requirement. Children in "Adherent" group had significantly lower energy intake (%) from carbohydrates [50.26 (2.11) vs 53.18 (7.39)], saturated fats (<10%) and higher from proteins [16.74 (1.68) vs 15.42 (2.75)] as compared to "Non-adherent"group (P < 0.05). The mean (SD) HbA1c (%) was significantly lower in the "Adherent" group [7.5 (0.50) vs 9.17 (1.12)]. Conclusions: Diet in a large proportion of Indian children with T1D does not meet the ISPAD recommendations. [ABSTRACT FROM AUTHOR]

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies adequate for gestational-age fetuses. Methods: Retrospective observational study among 447 GDM pregnant women, divided according to their treatment (nutritional therapy (NT), long acting (LA) insulin, combined insulin) and 100 healthy controls with the same gestational age. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results: UA-PI values declined in both GDM and healthy controls at all three time intervals. The combined insulin group showed reduced UA-PI values in comparison to the LA insulin group, but the difference never reached statistical significance. The combined insulin group exhibited significantly reduced UA-PI values at 32- and 36-weeks' gestation compared to the NT groups. Conclusions: A decreased impedance to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed. This was more pronounced during the last trimester. The extent to which umbilical artery PI can predict unfavorable outcomes has yet to be determined. Further additional studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother. [ABSTRACT FROM AUTHOR]

Introduction Studies link hypovitaminosis D to be significantly associated with poor glycemic control, heightened inflammation, and risk of complications. Studies recommend fasting or calorie restriction as a useful measure to achieve diabetic reversal. The present study explores if therapeutic fasting is associated with improvement in the vitamin D levels and other clinical outcomes related to type 2 diabetes mellitus (T2DM). Methods This observational study included 26 T2DM patients exposed to a 10-day medically supervised fasting (≈ 500–1000 Kcal/day) in a complementary medicine facility. Levels of vitamin D, B12, fasting blood sugar (FBS), blood pressure, anthropometric measures, World Health Organization Quality of Life, disease perception (Brief Illness Perception Questionnaire), and self-reported vitality were measured at the baseline and the 10th day. Results Significant improvement in the levels of vitamin D (p = 0.000), B12 (p = 0.03), and reduction in FBS levels (p = 0.001), blood pressure, body mass index, waist and hip circumference (p ≤ 0.05), and improvement in quality of life, vitality, and disease perception (p < 0.001) were observed by the end of 10th day. FBS shared a negative correlation with vitamin D levels (males r = –0.1, females r = –0.48). Conclusion The present findings provide insights into the probable mechanisms by which therapeutic fasting modulates the progression of T2DM. Nevertheless, large-scale randomized controlled trials are warranted to validate the present findings. [ABSTRACT FROM AUTHOR]

Nutritional assessment is important for optimization of patients undergoing elective total joint arthroplasty (TJA). Preoperative nutritional intervention is a potentially modifiable optimization target, but the outcomes of such intervention are not well-studied. The purpose of this study is to assess the impact of nutritional interventions on elective TJA outcomes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were utilized to perform a systematic review of the Ovid Medline, Embase, and Cochrane Library systems. Included studies were comprised of patients greater than 18 years of age undergoing a primary unilateral TJA who received a perioperative dietitian-led intervention. Data analyzed included nutritional intervention protocol, patient demographics, length of stay (LOS), postoperative labs and complications, among others. Our initial search identified a total of 1766 articles. Four studies representing 5006 patients met inclusion criteria. The studies utilized a protein-dominant diet, with or without a carbohydrate solution accompanied by dietitian assessment or education. The 4 studies found that the intervention group had significantly decreased LOS, fewer albumin infusions, less wound drainage, lower rates of hypocalcemia and hypokalemia, reduced C-reactive protein (CRP) values, improved time out of bed, and decreased overall costs. The findings support the potential benefits of perioperative dietitian-led intervention on key outcomes for patients undergoing primary TJA. Surgeons should consider nutritional intervention in their preoperative optimization protocols. Future studies could help elucidate the optimum nutritional regimens and monitoring for idealized intervention and surgical timing. CRD4202338494. [ABSTRACT FROM AUTHOR]

Background: Hepatic steatosis (HS) increases morbidity and mortality associated with liver surgery (LS). Furthermore, patients with HS are more likely to require a blood transfusion, which is associated with worse short and long-term outcomes. Patients with HS requiring LS receive no specific dietary treatment or advice. A very low-calorie diet (VLCD) is commonly used before gallbladder and bariatric surgery to reduce liver volumes and associated intraoperative morbidity. These diets typically provide 800–1200 kcal/day over a 2–4-week period. Limited evidence suggests that a VLCD in patients with LS may result in better outcomes. Methods: This study aims to test the feasibility of delivering a multi-centre randomised clinical trial to compare a dietary intervention (VLCD plus motivational instructions) versus treatment as usual (TAU) in people with HS having LS. This study will provide high-quality data to estimate screening rates, recruitment, randomisation, retention, and intervention adherence. The study will also determine the definitive trial's most clinically relevant primary outcome. The study will also estimate resource use and costs associated with the delivery of the intervention. Seventy-two adults ≥ 18 who are scheduled to undergo elective LS and have a magnetic resonance imaging (MRI) identified HS will be recruited. Acceptability to the dietary intervention will be evaluated with food diaries and focus groups. Clinical and patient-reported outcomes will be collected at baseline, pre- and post-surgery, day of discharge, plus 30- and 90-day follow-up. Discussion: This feasibility study will provide data on the acceptability and feasibility of a dietary intervention for patients with HS having LS. The intervention has been developed based on scientific evidence from other clinical areas and patient experience; therefore, it is safe for this patient group. Patients with experience of LS and VLCDs have advised throughout the development of the study protocol. The findings will inform the design of a future definitive study. Trial registration: ISRCTN Number 19701345. Date registered: 20/03/2023. URL: https://www.isrctn.com/ISRCTN19701345. [ABSTRACT FROM AUTHOR]

Background: Randomized controlled trials have confirmed the effectiveness of four prevalent caloric restriction regimens in reducing obesity-related health risks. However, there is no consensus on the optimal regimen for weight management in adults. Methods: We systematically searched PubMed, Embase, Web of Science, and Cochrane CENTRAL up to January 15, 2024, for randomized controlled trials (RCT) involving adults, evaluating the weight-loss effects of alternate day fasting (ADF), short-term fasting (STF), time-restricted eating (TRE), and continuous energy restriction (CER). The primary outcome was body weight, with secondary outcomes including BMI, fat mass, lean mass, waist circumference, fasting glucose, HOMA-IR, and adverse events. Bayesian network meta-analysis was conducted, ranking regimens using the surface under the cumulative ranking curve and the probability of being the best. Study quality was assessed using the Confidence in Network Meta-Analysis tool. Results: Data from 47 RCTs (representing 3363 participants) were included. ADF showed the most significant body weight loss (Mean difference (MD): -3.42; 95% Confidence interval (CI): -4.28 to -2.55), followed by TRE (MD: -2.25; 95% CI: -2.92 to -1.59). STF (MD: -1.87; 95% CI: -3.32 to -0.56) and CER (MD: -1.59; 95% CI: -2.42 to -0.79) rank third and fourth, respectively. STF lead to decline in lean mass (MD: -1.26; 95% CI: -2.16, -0.47). TRE showed benefits on fasting glucose (MD: -2.98; 95% CI: -4.7, -1.26). Subgroup analysis revealed all four caloric restriction regimens likely lead to modest weight loss after 1–3 months, with ADF ranked highest, but by 4–6 months, varying degrees of weight regain occur, particularly with CER, while interventions lasting 7–12 months may result in effective weight loss, with TRE potentially ranking first during both the 4–6 months and 7–12 months periods. ADF showing fewer and shorter-lasting physical symptoms. Conclusion: All four included regiments were effective in reducing body weight, with ADF likely having the most significant impact. Each regimen likely leads to modest weight loss after 1–3 months, followed by weight regain by 4–6 months. However, interventions lasting 7–12 months achieve greater weight loss overall. Trial registration: PROSPERO: CRD42022382478. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsDiscussionClinical evidence suggests that nutrition interventions can significantly improve symptoms of major depressive disorder; however, the effect on clinical anxiety symptoms in individuals with anxiety disorders has not been studied. The primary objective of the present study was to assess the feasibility and acceptability of a nutrition intervention. The secondary objectives included assessing changes in anxiety symptom severity, diet quality, self-efficacy, mindful eating, quality of life, and biomarkers.This study was a randomized, wait-list controlled pilot trial delivering a 12-week, biweekly dietary counseling intervention and omega-3 supplementation to 50 adult women with generalized anxiety disorder. Questionnaires and blood work were completed at baseline, after the waiting period, and after the intervention.443 individuals expressed interest within eight months; 50 met the criteria for enrollment. The mean number of sessions attended was 6.4. Final questionnaires were completed by 46 participants. Eighty-four percent of participants strongly agreed with the statement ‘My experience during this study was positive’. The mean anxiety symptom severity score in the intervention group was 26.2 (95% CI 22.94–29.48) at baseline and 11.0 (95% CI 8.05–13.87) at week 12. The mean diet quality score was 7.2 (95% CI 6.32–8.10) and 10.5 (95% CI 9.55–11.49) at baseline and week 12, respectively. Among the waitlist participants, the mean baseline anxiety score was 29.3 (95% CI 24.73–33.91) and 26.8 (95% CI 22.09–31.56) at week 12.This study was feasible and acceptable. Participation in the intervention was associated with a decrease in anxiety symptoms. These findings lay the foundation for large-scale studies. Trial registration: ClinicalTrials.gov NCT05573672. [ABSTRACT FROM AUTHOR]

Background: Improving prognosis of BC patients has drawn the attention of health care professionals on disease related long-term side effects and on the multiple treatments BC patients must undergo. Despite advances in procedures, surgery still has multiple detrimental effects, including pain, edema, and limited mobility. For this reason, fostering adapted physical activity (APA) and healthy lifestyle (including a balanced diet and weight management) should become an everyday purpose of healthcare professionals. Fencing may be a well-suited activity to counteract fatigue, pain, and limited arm mobility. Method and analysis: The FENICE study is a mono-center, randomized clinical trial targeting women with BC stages I-III within four weeks from BC surgery. Participants in the control arm will receive the usual recommendations based on the good clinical practice guidelines. In the study arm, participants will be treated with the usual clinical and therapeutic recommendations together with APA and correct lifestyle suggestions. Objective: The primary objective of the study is to compare whether implementation of APA and healthy lifestyle in BC patient after surgery will result in an overall improvement of physical and mental status. Conclusion: Fencing and its early application in postoperative period may represent a feasible strategy to be implemented in the rehabilitation journey of BC patients. Ethics and dissemination: The study protocol FENICE has been approved by an Italian Ethics Committee on May 2023 (R.S 100.23 5th May 2023). [ABSTRACT FROM AUTHOR]

Simple Summary: Feline gingivostomatitis is a common condition affecting the oral cavity of cats, characterized by severe mucosal inflammation. The etiopathogenesis remains not fully clear, but it is known to be multifactorial, involving alterations in immune response which may be related to infectious agents. Other potential triggers include food sensitivity and genetic and environmental factors. This study followed a cat refractory to conventional treatment who was placed on an elimination diet. After the implementation of the elimination diet, the cat showed remission of oral lesions. This report aims to highlight the importance of recognizing food sensitivity as a significant factor in maintaining the chronicity of the disease and how dietary management and switching to a hypoallergenic diet can aid in controlling the lesions. To the authors' knowledge, this is the first documented case demonstrating the impact of food sensitivity on the progression of feline gingivostomatitis. The findings emphasize the importance of incorporating nutritional considerations into the comprehensive management of this challenging condition. Feline stomatitis or gingivostomatitis is a chronic inflammatory condition affecting approximately 0.7% of patients. The cause is multifactorial, involving infectious agents, genetic factors, and environmental influences. Therapeutic strategies include pharmacological and surgical interventions to controlling inflammation and enhancing patient quality of life. There are discussions in the literature regarding the potential involvement of adverse food reactions as a contributing factor to oral cavity lesions, without clear evidence. This case report describes the control of gingivostomatitis with a hypoallergenic diet in a cat that had oral lesions and who was refractory to conventional treatment with prednisolone and cyclosporine, even after periodontal treatment and partial tooth extraction. After 30 days of dietary change, there was complete remission of the lesions. The animal was then re-exposed to the previous food, with new lesions appearing after 7 days. Upon returning to the hypoallergenic food, there was new remission of the lesions. This report suggests that food sensitivity may play a role in the control of feline gingivostomatitis, as periods of hypoallergenic diet coincided with the remission of the condition, even without changes in medication. It reinforces the importance of investigating adverse food reactions as clinical signs in the oral cavity of cats. [ABSTRACT FROM AUTHOR]

Excessive sugar intake poses a significant risk factor for non-communicable diseases. A positive healthy eating (PHE) intervention was developed to promote low-sugar dietary practices in families. The PHE intervention capitalized on positive psychological constructs to overcome barriers to health behavior change by helping families associate feelings of joy, gratitude, and savoring with healthy eating. In a cluster randomized controlled trial, 1983 participants from 1467 families were recruited in Hong Kong. PHE included a core and booster session. Data were collected at pre-intervention, post-intervention, and at 1-month and 3-month follow-up. Compared to the control, PHE showed greater increase in intention to change at post-intervention, engagement in low-sugar dietary practices individually and with family members at 3-month follow-up, and greater reduction in sugar-sweetened beverage intake at 1-month and 3-month follow-up. Intentions to change mediated PHE's effects on low-sugar dietary practices. Focus group interviews revealed the behavior-change process and family quality of life. [ABSTRACT FROM AUTHOR]

Background: There is a lack of literature which assesses both patient and health care provider (HCP) perceptions of barriers and facilitators to diabetes health care in immigrant and refugee populations within the United States. This study uniquely incorporates both cohorts' perceptions on the same topic to assess for congruency and discrepancies in perspectives. Methods: Surveys were deployed to patients with diabetes and HCPs to solicit perceptions of barriers and facilitators to diabetes care, with the intention to determine similarities and differences between cohorts. A literature review was conducted to explore barriers and facilitators to diabetes care in immigrant/refugee populations in the US to aid in development of the survey used in this study, as no validated survey existed. Broad recruitment strategies were used, including snowball sampling. Descriptive statistics were calculated and reported p-values were derived from a chi-squared or Fisher's exact test and used for categorical data and a Wilcoxon rank sum or Kruskal–Wallis rank sum test was used for continuous data. Qualitive analysis was completed using the inductive analysis method. Results: Among 19 immigrant and refugee patients and 35 HCPs, almost all facilitators to diabetes care were endorsed by patients and HCPs as helpful. The highest ranked facilitator among patients and HCPs was having access to health insurance. Patients rated stress, while HCPs rated lack of health insurance as the biggest barriers to diabetes care for immigrants and refugees. Patients and HCPs differed in perspective on who held primary responsibility for diabetes management. Patients wanted more diabetes education and nutrition support, while HCPs thought understanding patients' cultural context/sensitivity, providing more education, and having language/translation services were the most important things HCPs can do to care for patients' diabetes. Conclusions: Immigrant/refugee patients and HCPs largely agree about what factors are most helpful in managing diabetes, with access to health insurance as the greatest facilitator. However, while HCPs identified lack of health insurance as the greatest barrier to care, immigrant and refugee patients cited the role of stress as the greatest challenge in managing their diabetes. There was a striking difference in perception of responsibility for diabetes management, with 89% of patient participants responding that the patient is responsible, while only 17% of HCPs responded that the patient was responsible. Future work should include surveys translated into languages other than English to further elicit the perspective of diabetes care in immigrant/refugee populations. Clinical recommendations based on this study include assessing and supporting patient stressors, assuring patients understand that diabetes management is a partnership, providing culturally tailored diabetes education, and increasing access to health insurance. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions 2‐(2‐Nitro‐4‐trifluoromethylbenzoyl)‐1,3‐cyclohexanedione (NTBC) treatment of alkaptonuria (AKU) leads to increased blood tyrosine levels, causing skin issues and potentially sight‐threatening corneal keratopathy. Adherence to dietary management of NTBC‐induced tyrosinemia, a low‐protein diet with or without protein substitutes, can be difficult for patients. This 28‐day interventional study evaluated a low tyrosine casein glycomacropeptide (cGMP) protein substitute (TYR sphere)®, a 20 g protein equivalent, cGMP‐based protein substitute, in terms of adherence, palatability, usability, comparison to amino acid (AA)–based protein substitutes, gastrointestinal tolerance and metabolic control in adults with NTBC‐induced tyrosinaemia.Four adults (mean 61.1 years, range 53.3–69.3 years) with AKU and NTBC‐induced tyrosinaemia were recruited from the United Kingdom National Alkaptonuria Centre (NAC). The cGMP protein substitute was prescribed based on individual nutritional requirements, replacing ≥1 AA‐based protein substitute. Participants recorded product‐related data in study diaries, using five‐point Likert scales and daily and weekly logs. To determine metabolic control, prestudy blood tyrosine levels were compared to weekly blood spot tests during the study.Median cGMP protein substitute adherence was 98%. Most participants rated palatability and usability positively, and preferred cGMP protein substitute to AA‐based products. There were no notable gastrointestinal changes, and metabolic control was maintained.cGMP protein substitute is a palatable and well‐tolerated option in the dietary management of AKU patients with NTBC‐induced tyrosinaemia. [ABSTRACT FROM AUTHOR]

Background: Lifelong management of phenylketonuria (PKU) centers on medical nutrition therapy, including dietary phenylalanine (Phe) restriction in addition to Phe-free or low-Phe medical foods/protein substitutes. Studies have reported low bone mineral density (BMD) in mixed-age PKU populations, possibly related to long-term Phe restriction. Therefore, a meta-analysis investigating BMD specifically in adults with PKU was conducted. Methods: Studies reporting BMD-related outcomes were identified from a systematic literature review evaluating somatic comorbidities experienced by adults with PKU on a Phe-restricted diet (searched February 1, 2022, updated November 1, 2023). Risk of study bias was assessed (Scottish Intercollegiate Guidelines Network checklists). The primary outcome of the meta-analysis was pooled mean BMD Z-scores of different bones. Secondary outcomes were the prevalence of low BMD Z-scores at pre-specified thresholds. Subgroup analyses of mean BMD Z-scores (decade of study publication, controlled versus uncontrolled blood Phe levels, gender) were conducted. Results: BMD-related data from 4097 individuals across 10 studies rated as at least acceptable quality were included. Mean BMD Z-scores were statistically significantly lower compared with an age-matched control or reference (non-PKU) population, across bones, but still within the expected range for age (> -2.0): lumbar spine (seven studies, n = 304), -0.63 (95% confidence interval (CI): -0.74, -0.52); femoral neck (four studies, n = 170), -0.74 (95% CI: -1.25, -0.22); radius (three studies, n = 114), -0.77 (95% CI: -1.21, -0.32); total body (four studies, n = 157), -0.61 (95% CI: -0.77, -0.45). The small number of observations in the subgroup analyses resulted in a high degree of uncertainty, limiting interpretation. Estimated prevalence of BMD Z-scores ≤ -2.0 was 8% (95% CI: 5%, 13%; four studies, n = 221) and < -1.0 was 42% (95% CI: 35%, 51%; five studies, n = 144). Conclusions: Adults with PKU had lower BMD Z-scores than the reference (non-PKU) population but < 1 in 10 were below the expected range for age. The low number of studies prevents identification of which population characteristics are most impacting BMD. This meta-analysis was supported by BioMarin Pharmaceutical Inc., Novato, CA and is registered with the Research Registry (reviewregistry1476). [ABSTRACT FROM AUTHOR]

Background: Assessing dietary phenylalanine (Phe) tolerance is crucial for managing hyperphenylalaninemia (HPA) in children. However, traditionally, adjusting the diet requires significant time from clinicians and parents. This study aims to investigate the development of a machine-learning model that predicts a range of dietary Phe intake tolerance for children with HPA over 10 years following diagnosis. Methods: In this multicenter retrospective observational study, we collected the genotypes of phenylalanine hydroxylase (PAH), metabolic profiles at screening and diagnosis, and blood Phe concentrations corresponding to dietary Phe intake from over 10 years of follow-up data for 204 children with HPA. To incorporate genetic information, allelic phenotype value (APV) was input for 2965 missense variants in the PAH gene using a predicted APV (pAPV) model. This model was trained on known pheno-genotype relationships from the BioPKU database, utilizing 31 features. Subsequently, a multiclass classification model was constructed and trained on a dataset featuring metabolic data, genetic data, and follow-up data from 3177 events. The final model was fine-tuned using tenfold validation and validated against three independent datasets. Results: The pAPV model achieved a good predictive performance with root mean squared error (RMSE) of 1.53 and 2.38 on the training and test datasets, respectively. The variants that cause amino acid changes in the region of 200–300 of PAH tend to exhibit lower pAPV. The final model achieved a sensitivity range of 0.77 to 0.91 and a specificity range of 0.8 to 1 across all validation datasets. Additional assessment metrics including positive predictive value (0.68–1), negative predictive values (0.8–0.98), F1 score (0.71–0.92), and balanced accuracy (0.8–0.92) demonstrated the robust performance of our model. Conclusions: Our model integrates metabolic and genetic information to accurately predict age-specific Phe tolerance, aiding in the precision management of patients with HPA. This study provides a potential framework that could be applied to other inborn errors of metabolism. [ABSTRACT FROM AUTHOR]

Metabolic dysfunction‐associated steatotic liver disease (MASLD) is the most common liver disease worldwide, affecting 30% of the population in Western countries. MASLD is considered the hepatic manifestation of the metabolic syndrome, pathophysiologically underpinned by insulin resistance and frequently co‐exists with hypertension, central obesity and dyslipidaemia. Currently, safe and effective pharmacotherapies for MASLD are limited, making weight loss with lifestyle changes the mainstay therapy. A Mediterranean diet (MedDiet) has emerged as an effective dietary pattern for preventing and managing MASLD, but most studies have been conducted in Mediterranean countries, necessitating further investigation into its benefits in Western populations. Additionally, the effect of holistic multimodal lifestyle interventions, including physical activity combined with the MedDiet, is not well established. Finally, MASLD's widespread prevalence and rapid growth require improved accessibility to interventions. Digital health delivery platforms, designed for remote access, could be a promising approach to providing timely support to individuals with MASLD. This narrative review summarises the current evidence related to the effects of the MedDiet in Western, multicultural populations with MASLD. This includes a detailed description of the composition, prescription and adherence to dietary interventions in terms of how they have been designed and applied. The evidence related to the role of physical activity or exercise interventions prescribed in combination with the MedDiet for MASLD will also be reviewed. Finally, recommendations for the design and delivery of dietary and physical activity or exercise interventions to inform the design of future randomised controlled trials to facilitate the optimal management of MASLD are outlined. [ABSTRACT FROM AUTHOR]

Background: Cancer remains a leading chronic disease in the United States with a high burden of disease and challenging treatment protocol. Nutrition is critically linked to long-term health outcomes and recovery rates among cancer patients, but there remains a persistent gap in clinician training regarding functional nutrition. This study interviews patients to understand their experiences of nutrition support they received while in cancer treatment. Objectives: Understand patient experiences and needs regarding cancer treatment (i.e., surgery, chemotherapy, radiation, and/or immunotherapy) and available nutrition counseling. Methods: This was a multi-phase study incorporating survey data (n = 50) and follow-up, semi-structured interviews (n = 20) of cancer patients in the Mid-Atlantic United States. Interview participants included those undergoing active cancer treatment (n = 7) and those in remission at the time of contact (n = 13). Participants shared their experiences receiving treatment and their perspectives regarding the quality of care they received in outpatient oncology clinics. Central to this study was a discussion regarding the quality of nutrition counseling they received while in treatment. Results: Five themes emerged through data collection and analysis: (1) patients need additional education regarding nutrition, (2) personalized resources are not readily available, (3) perceptions from patients that oncologists receive little formal nutrition training related to cancer, (4) oncologists' attitude toward nutrition may influence patient care, and (5) patients seek nutrition information through informal sources. Commonly, patients had little access to licensed dieticians or other professionals capable of providing lifestyle recommendations. Conclusions: The results of this study are being used to develop a clinician toolbox of resources, recommendations, and services that can be shared with patients seeking additional information regarding nutrition and diet change. [ABSTRACT FROM AUTHOR]

Background: To reduce neonatal mortality, it is necessary to identify neonates with fetal malnutrition at birth using the clinical assessment score (CAN score). Furthermore, comprehensive summary data that shows burden of fetal malnutrition in Africa is scarce. As a result, this systematic review and meta-analysis aimed to assess fetal malnutrition among newborns in Africa. Method: The PRISMA guidelines were used for this study. Articles were obtained from databases and websites. The outcome of the study was fetal malnutrition, as determined using the CAN score. The meta-analysis of the primary and secondary outcomes was performed using Stata version 18 statistical software. The pooled prevalence with a 95% CI was estimated using the random effect method with the Der Simonian Liard model. Results: This meta-analysis and systematic review included 5356 newborns from 13 studies. The pooled prevalence of fetal malnutrition (FM) among newborns diagnosed using the CAN score in Africa was 19% [95% CI: 17, 22]. Based on subgroup analysis by publication year, the lowest prevalence of fetal malnutrition 17% (95% CI: 9–27) was observed in the studies published in the years 2020–2023. Maternal and fetal factors were significantly associated with fetal malnutrition. Conclusion: Nearly one-fifth of neonates delivered in Africa were found to have fetal malnutrition based on the clinical evaluation of nutritional status. It has also been established that maternal malnutrition, a lack of proper treatment during pregnancy, maternal malnutrition, and newborn morbidities were associated with fetal malnutrition. To prevent fetal malnutrition, integrated efforts should be made for early maternal infection screening. Furthermore, maternal nutritional therapy should be explored for malnourished pregnant women. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Design Results Conclusions Trial Registration This systematic review aims to synthesise existing literature to examine the relationship between natural food chemical components and reported symptoms.A systematic literature review was completed. Databases CINAHL (Ebscohost), Medline (Ovid), Scopus, Informit Health and Google Scholar were searched to identify relevant articles. The population included human studies of adults (≥17 years) and excluded those with IgE‐mediate food allergies. Studies examining food chemical components or ‘food chemical elimination diets’ and symptoms were included. Data was synthesised based on clinical conditions and specific food chemical components examined. The risk of bias was assessed using the Academy of Nutrition and Dietetics ‘Quality Criteria Checklist: Primary Research’.Of the 1659 articles retrieved, 21 met inclusion criteria. This included eight randomised controlled trials, four non‐randomised controlled trials, four cohort studies with placebo‐controlled challenge, one prospective cohort study, three cross sectional cohort studies, one case–controlled study. Available studies support the role of a low‐histamine diet for symptoms in chronic urticaria and low‐salicylate diet for reducing sino‐nasal symptoms in aspirin exacerbated respiratory disease and chronic rhinosinusitis and/or asthma. While further evidence is needed to verify the role of glutamate in respiratory, pain, asthma and gastrointestinal symptoms.Food chemical elimination diets may improve condition‐specific symptoms across the adult cohorts outlined within this review, with the strongest evidence to support the role of a low‐histamine diet for management of symptoms in chronic urticaria and a low‐salicylate diet in aspirin exacerbated respiratory disease and/or asthma. Further well‐designed trials are needed to elucidate the effect of specific natural food chemical components on symptoms.Systematic review number: CRD42022322511. [ABSTRACT FROM AUTHOR]

ObjectivesMethodsResultsDiscussionSome anti-seizure medications (ASMs) are known to induce liver enzymes and impact lipid values that include total cholesterol (TC), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), and triglyceride (TG). In addition, use of ketogenic diet therapies, including the modified Atkins diet (MAD), has also influenced lipids. Here, we explored the combined impact of enzyme inducing ASMs (EIASMs) and MAD on lipid values in adults with epilepsy.Diet-naïve adults with epilepsy who began MAD were divided into three groups based on ASM use: EIASMs, non-EIASMs, and those on no ASMs. Demographic information, epilepsy-specific clinical history, anthropometrics and lipid values were obtained through retrospective chart review at baseline and after a minimum of 12 months of MAD use.Forty-two adults on MAD had baseline and follow up 12-month lipid outcomes. There was a significant increase in median levels of TC, LDL, non-HDL, and HDL after 12 months of MAD use. There was no change in median levels of TG. When separated according to ASM category, adults on non-EIASMs showed significant elevations in TC, HDL, and LDL after 12 months of MAD use. In contrast, adults on EIASMs only showed a significant increase in HDL after 12 months of MAD use.The increase in atherogenic cholesterol levels observed after 12 months of MAD use was most pronounced in adults with epilepsy on non-EIASMs and not observed in adults with epilepsy on EIASMs despite a higher proportion of abnormal cholesterol levels at baseline in those on EIASMs. [ABSTRACT FROM AUTHOR]