Search

Purpose of Review: Referral to nutrition care providers in the USA such as registered dietitian nutritionists (RDNs) for medical nutrition therapy (MNT) remains low. We summarize research on the effectiveness of MNT provided by dietitians versus usual care in the management of adults with dyslipidemia. Improvements in lipids/lipoproteins were examined. If reported, blood pressure (BP), fasting blood glucose (FBG) glycated hemoglobin (A1c), body mass index (BMI), and cost outcomes were also examined. Recent Findings: The synthesis of three systematic reviews included thirty randomized controlled trials. Multiple MNT visits (3–6) provided by dietitians, compared with usual care, resulted in significant improvements in total cholesterol (mean range: − 4.64 to − 20.84 mg/dl), low-density lipoprotein cholesterol (mean range: − 1.55 to − 11.56 mg/dl), triglycerides (mean range: − 15.9 to − 32.55 mg/dl), SBP (mean range: − 4.7 to − 8.76 mm Hg), BMI (mean: − 0.4 kg/m2), and A1c (− 0.38%). Cost savings from MNT were attributed to a decrease in medication costs and improved quality of life years (QALY). Summary: Multiple MNT visits provided by dietitians compared with usual care improved lipids/lipoproteins, BP, A1c, weight status, and QALY with significant cost savings in adults with dyslipidemia and justify a universal nutrition policy for equitable access to MNT. [ABSTRACT FROM AUTHOR]

Background Though in-person contacts in the home have demonstrated efficacy in improving breastfeeding outcomes in peer counseling programs, home contacts are resource-intensive. Objective To compare the feasibility and effectiveness of an Integrated Model of peer counseling breastfeeding support characterized by select home visits augmented with individual WIC clinic visits and group education, in contrast to the Standard Model which includes a standard number of in-person home contacts. Methods Six counties (n = 226 participants) and nine counties (n = 472 participants) were assigned to the Standard Model and the Integrated Model, respectively. Differences in demographic characteristics and breastfeeding outcomes were tested using Chi square tests and Cox proportional hazards regression models. Results Participants in counties where the Integrated Model was implemented had fewer home contacts ( p = 0.03) and were more likely to have a hospital ( p = 0.03) or group education ( p < 0.001) contact, whereas Standard Model participants were more likely to receive an individual WIC clinic contact ( p < 0.001). While there was no difference in the hazard of discontinuing any breastfeeding between groups, participants in the Integrated Model group had a lower hazard of discontinuing exclusive breastfeeding by 3 months postpartum ( p = 0.02). Among participants within the Integrated Model, group education classes were associated with higher hazard of discontinuation ( p = 0.04 and p = 0.003 for any and exclusive breastfeeding, respectively). Conclusions It was feasible for peer counselors to implement changes in program delivery to achieve fewer home visits without a detrimental impact on breastfeeding outcomes. However, group education classes did not appear to be beneficial for improving breastfeeding outcomes in this population. [ABSTRACT FROM AUTHOR]

Cannabinoids affect immune responses in ways that may be beneficial for autoimmune diseases. We sought to determine whether chronic Cannabis use differentially modulates a select number of immune parameters in healthy controls and individuals with multiple sclerosis (MS cases). Subjects were enrolled and consented to a single blood draw, matched for age and BMI. We measured monocyte migration isolated from each subject, as well as plasma levels of endocannabinoids and cytokines. Cases met definition of MS by international diagnostic criteria. Monocyte cell migration measured in control subjects and individuals with MS was similarly inhibited by a set ratio of phytocannabinoids. The plasma levels of CCL2 and IL17 were reduced in non-naïve cannabis users irrespective of the cohorts. We detected a significant increase in the endocannabinoid arachidonoylethanolamine (AEA) in serum from individuals with MS compared to control subjects, and no significant difference in levels of other endocannabinoids and signaling lipids irrespective of Cannabis use. Chronic Cannabis use may affect the immune response to similar extent in individuals with MS and control subjects through the ability of phytocannabinoids to reduce both monocyte migration and cytokine levels in serum. From a panel of signaling lipids, only the levels of AEA are increased in individuals with MS, irrespective of Cannabis use or not. Our results suggest that both MS cases and controls respond similarly to chronic Cannabis use with respect to the immune parameters measured in this study. [ABSTRACT FROM AUTHOR]