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Background: Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context. Methods: An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised. Results: Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45–60 min per session, 2–3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control. Conclusions: Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions. [ABSTRACT FROM AUTHOR]

Obesity is a complex chronic disease with increasing prevalence across the globe. Medical nutrition therapy (MNT) is an important component of obesity treatment, and low‐calorie diets (LCDs) and very‐low‐calorie diets (VLCDs) are part of the MNT toolbox. This narrative review focuses on the latest evidence and clinical guidelines regarding the use and impact of meal replacements (MRs) as part of LCDs/VLCDs for the treatment of obesity and some associated complications. MRs can be used in conjunction with food as partial diet replacement (PDR) or can be used exclusively to serve as the sole source of dietary energy (total diet replacement [TDR]). Use of MR may be associated with better control of cravings and hunger typically observed during reduced calorie intake through effects of ketosis or stimuli narrowing, although the exact mechanisms for these effects remain unclear. Several clinical guidelines have endorsed the use of MRs as a part of MNT for obesity, primarily based on evidence that shows an average weight reduction of ~10 kg or more with TDR over at least 12 months in large, randomized controlled trials. When compared to usual care controls, these effects are 6–8 kg greater, and when compared to food‐based diets, the effects are nearly twice the effect of a food‐based diet. MR‐based diets have been found to be safe and associated with improvements in quality of life. These diets are also effective for improving key cardiometabolic health outcomes, including dysglycaemia, blood pressure, lipids, and metabolic associated fatty liver. The effectiveness, safety, and associated health improvement makes MRs use a valuable strategy for several higher risk clinical scenarios where weight reduction is indicated. [ABSTRACT FROM AUTHOR]

Background: Neurological diseases resulting from nervous system injuries can significantly impact nutritional status and the physical and cognitive capacities necessary for maintaining a sufficient diet. This study focuses on primary nutritional therapies for neurological illnesses. Methods: An integrative literature review was conducted using three databases: PePSIC, Medline, and LILACS. A comprehensive search strategy was employed, incorporating descriptors such as neuropathies, nutritional therapy, efficacy, and side effects. Results: After applying inclusion criteria, 175 relevant items were identified. While traditional medical interventions for neurological conditions typically involve medication, food therapy has shown promise in enhancing clinical outcomes and alleviating symptoms for certain diseases. Specifically, food therapy has been effective in improving the prognosis of adrenoleukodystrophy and mitigating symptoms of Wernicke-Korsakoff syndrome and epilepsy. Conclusion: Patients with neurological illnesses, such as adrenoleukodystrophy, Wernicke-Korsakoff syndrome, and epilepsy, may benefit from dietary interventions to improve prognosis and alleviate symptoms. Therefore, healthcare professionals should consider incorporating food therapy into the treatment plans for these conditions to optimize patient outcomes. [ABSTRACT FROM AUTHOR]

This article summarises the consensus statement on using Diabetes Specific Nutritional Formulas (DSNFs) for healthcare professionals managing type 2 diabetes (T2D). It examines the role of Medical Nutrition Therapy (MNT) in T2D management, integrating DSNFs as an alternative tool to support individuals in managing their diabetes. Furthermore, the article highlights DSNFs as a valuable short-term dietary option, particularly when adherence to a healthy diet is challenging. The article also considers the current evidence and expert opinions provided by the consensus statement to provide a comprehensive understanding of DSNFs and potential roles for and application in diabetes clinical practice by Credentialled Diabetes Educators. [ABSTRACT FROM AUTHOR]

This study examined the morphometric and clinical aspects as well as the nutritional and dietary management of undernourished adult patients in the Marrakech Tensift Al Haouz region, Morocco. It highlighted the specific challenges faced by these patients, in particular the significant differences in nutritional requirements and management strategies. Our results showed a significant increase in caloric intake from 19.97±0.64 kcal/kg/d to 27.23±0.12 kcal/kg/d for all patients. Muscle mass increased from 16.71±4.76 kg to 18.75±3.58 kg. The mean albumin increased to 35.9 g/L, indicating an improved protein reserve. Similarly, pre-albumin increased to 186.3 mg/dL, suggesting a rapid response to nutritional intake. At the same time, Creactive protein levels fell, indicating a reduction in systemic inflammation. In addition, it is important to note that body mass index differed between the sexes, with women tending to gain muscle mass more slowly than men. The results highlight the urgent need to adopt a personalized approach to improving the health and well-being of undernourished patients by adjusting nutritional and dietary interventions to the specific needs of each individual. [ABSTRACT FROM AUTHOR]

BACKGROUND: Patients who underwent total knee arthroplasty (TKA) often experience muscle loss due to pain and limited mobility. Nutritional supplementation and rehabilitation may positively affect the decline in muscle function. OBJECTIVE: The purpose of this study is to evaluate whether whey protein intervention, in addition to conventional rehabilitation training, is beneficial in improving muscle function and quality of life in patients after TKA. METHODS: 72 patients who met the criteria were selected for this randomized controlled study. For the experimental group, whey protein was used as a daily supplement for 12 weeks, while the control group was given a placebo, during which both groups received conventional rehabilitation training. Muscle strength and each of the secondary observables needed to be measured and statistically analyzed preoperatively and at 4, 8, and 12 weeks post-intervention. RESULTS: In total, 62 subjects completed the study: 32 in the experimental group and 30 in the control group. Both groups showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference after 12 weeks of treatment. Compared to the control group, patients in the experimental group showed significant improvement in muscle strength, VAS, ROM, AKS and leg circumference (p = 0.001, p = 0.002, p = 0.001, p = 0.001, p = 0.001, respectively) after 12 weeks of treatment. CONCLUSION: The 12-week intervention of whey protein nutritional supplement showed significant improvement in muscle mass and function among post-TKA patients besides aiding with conventional rehabilitation exercise. [ABSTRACT FROM AUTHOR]

Recently, more consumers are interested in purchasing probiotic food and beverage products that may improve their immune health. The market for functional foods and beverages that include Bifidobacterium is expanding because of their potential uses in both food and therapeutic applications. However, maintaining Bifidobacterium's viability during food processing and storage remains a challenge. Microencapsulation technique has been explored to improve the viability of Bifidobacterium. Despite the technical, microbiological, and economic challenges, the market potential for immune-supporting functional foods and beverages is significant. Additionally, there is a shift toward postbiotics as a solution for product innovation, a promising postbiotic product that can be incorporated into various food and beverage formats is also introduced in this review. As consumers become more health-conscious, future developments in the functional food and beverage market discussed in this review could serve as a reference for researchers and industrialist. [ABSTRACT FROM AUTHOR]

Background: Advances in neonatal medicine, resulting in improved survival, have brought the concept of extra-uterine growth restriction (EUGR), defined as postnatal growth failure secondary to protein and energy deficits, to the forefront as an important cause of morbidity, particularly in very low birthweight (VLBW) neonates. Objectives: This study's main objective was to determine the prevalence of EUGR in Steve Biko Academic Hospital in VLBW infants. Methods: This was a pre- (epoch 1) and post- (epoch 2) intervention study. The intervention was the introduction of a written nutritional protocol in the neonatal unit in mid-November 2017. Three definitions were used to identify EUGR, namely: (1) discharge weight < 10th percentile, (2) a change by −1.28 z-score in weight at discharge, and (3) the discharge weight percentile below the nadir percentile. Results: The prevalence of EUGR in epoch 1 was 85.7%, 63.5%, and 88.0% using the above definitions, respectively. The prevalence of EUGR in epoch 2 was 73.9%, 65.8%, and 89.4% using the above definitions, respectively. EUGR using the three definitions combined was present in 95.2% and 92.8% of infants in epochs 1 and 2, respectively. None of the differences in EUGR prevalence between the two epochs were significant. Conclusion: The prevalence of EUGR was not significantly different between the two epochs, although it had been proposed that the introduction of a written nutritional protocol would have decreased the prevalence of EUGR in epoch 2. One of the reasons proposed for this finding was poor adherence to the nutritional protocol during epoch 2. [ABSTRACT FROM AUTHOR]

Objectives: Monitoring muscle mass (cross-sectional area [CSA]) and quality (echogenicity) using ultrasound may help optimise nutrition support in the critically ill. However, to date, ultrasound imaging has not been included in the undergraduate training of dietitians, who are mostly responsible for the nutrition care of critically ill patients. This study assessed the accuracy and reliability of bedside imaging performed by a dietitian trained according to standardised methodology, followed by blinded analyses. Methods: Two operators (a trainer and dietitian trainee) performed B-mode ultrasonography of the rectus femoris quadriceps muscle. For inter-rater accuracy, imaging was performed independently on 32 subjects by both operators, and for intra-rater reliability both obtained a second image on 15 subjects. A blinded assessor performed analyses (CSA and echogenicity) on all images. In a subset of 11 subjects, a musculoskeletal sonographer repeated all measurements. Inter- and intra-rater reliability were determined by calculating intraclass correlation coefficients (ICC), based on an absolute-agreement, 2-way mixed-effects model. An ICC > 0.75 was classified as good and > 0.90 as excellent. Results: Intra- (ICC = 0.9–0.94) and inter-rater (ICC = 0.85–0.95) reliability of the imaging performed was good to excellent. No statistically significant differences were found between the two operators (mean difference for CSA = 0.18 cm2, 95% CI = −0.38–0.03, p = 0.08; mean difference for echogenicity = 6.88, CI = −0.71–14.78, p = 0.07). Inter-rater reliability for image analyses was excellent (ICC = 0.97–1.0). Conclusion: Bedside ultrasound performed by a dietitian trained according to standardised methodology shows good to excellent reliability and reproducibility. Training dietitians to perform bedside ultrasound may help to monitor muscle mass and quality in the critically ill. [ABSTRACT FROM AUTHOR]

Inflammatory bowel disease (IBD), which encompasses both ulcerative colitis (UC) and Crohn's disease (CD), is a major health burden worldwide. There are increasing concerns surrounding the impacts of this disease due to significant rises in the prevalence rates of IBD across the world. In consideration of the complexities of managing IBD along with this marked rise in prevalence and incidence, developing new forms of treatment for this condition has become a major priority. In recent years, a potential new form of treatment for IBD has emerged in the form of biologic therapies. While there is a high level of optimism due to the development of these therapies, there is also a clear need to evaluate their effectiveness, and their overall safety profiles. For this review, we have evaluated three specific biologics used for the treatment IBD. More precisely, the focus of this review is to analyze and critically appraise the literature for vedolizumab, ustekinumab, and golimumab, and determine their roles in the management of UC and CD, respectively. After doing so, we have also briefly synthesized important new findings regarding the role of dietary and nutritional approaches. In doing so, we have aimed to contextualize the findings regarding biologics, and, in order to evaluate potential new treatment approaches for the future to augment biologic therapies, we have discussed the potential for combined approaches that incorporate the usage of both biologics and nutritional interventions for patients. [ABSTRACT FROM AUTHOR]

Background/Aims: Lifestyle interventions are recommended in cardiac rehabilitation guidelines to reduce cardiovascular risk and prevent heart attacks. Therefore, it is important to investigate their effectiveness in primary healthcare settings to improve outcomes in individuals with ischaemic heart disease. The aim of this study was to examine the association between adherence and completion of cardiac rehabilitation and outcomes related to waist circumference and physical performance in primary healthcare settings. Methods: A total of 514 individuals diagnosed with ischaemic heart disease were enrolled from ten primary healthcare settings in the Central Denmark Region to participate in cardiac rehabilitation. Participants were categorised based on the completion of a dietary intervention. Changes in waist circumference from baseline to the 12-week follow-up were measured. Adherence to the exercise intervention was assessed based on participation in ≥80% or <80% of training sessions. Changes in physical performance, specifically a 10% improvement in the Watt-max bicycle test, were evaluated over the same period. Linear and logistic regression analyses were conducted, both crude and adjusted for potential confounders. Results: Of the 514 participants, 317 (70.8%) who completed the dietary intervention experienced an average reduction of –1.32 cm (95% confidence interval: –1.91 to –0.74 cm) in waist circumference, compared to –0.50 cm for non-completers (P=0.019). Additionally, 276 (56.2%) participants adhered to ≥80% of the exercise intervention, with 237 (66.7%) showing an improvement of ≥10% in Watt-max from baseline to follow-up. Individuals who adhered to ≥80% of the exercise intervention were twice as likely to achieve a ≥10% improvement in Watt-max compared to those with <80% adherence (P=0.334). Conclusions: Both dietary and exercise interventions administered in primary healthcare settings were associated with positive changes in waist circumference and physical performance. Implications for practice: Dietitians should focus on motivating patients to complete dietary interventions, which can significantly reduce waist circumference. Physiotherapists should emphasise the importance of adherence to exercise programmes. Encouraging patients to meet adherence targets, both in structured rehabilitation and home-based activities, is vital to achieve long-term health benefits. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) affects over 10% of the global population. One crucial complication of CKD is secondary hyperparathyroidism (SHPT), marked by elevated parathyroid hormone levels due to hyperphos-phataemia, hypocalcaemia, and low active vitamin D from impaired renal function. SHPT increases risks of bone deformities, vascular calcification, cardiovascular events and mortality. This review examines SHPT treatment strategies in patients with CKD. First-line treatments include phosphate binders, vitamin D receptor activators and calcimimetics. When these fail, invasive options like parathyroidectomy (PTX) and thermal ablation are considered. PTX effectively reduces symptoms and improves radiological outcomes, outperforming medical treatment alone in reducing cardiovascular risk and mortality. Thermal ablation techniques, such as microwave, radiofrequency, laser or high-intensity focused ultrasound, offer less invasive alternatives with promising results. Future research should explore the molecular mechanisms of parathyroid gland hyperplasia and evaluate various treatments' impacts. [ABSTRACT FROM AUTHOR]

Understanding the co-occurrence of food insecurity and eating disorders is a pressing concern. Several factors have been hypothesized to increase risk for eating disorders in women with food insecurity including dietary restriction, body weight, and weight-related bias, but few studies have tested these factors simultaneously to determine which are associated most strongly with eating disorder status. We tested cross-sectional associations of dietary restriction, current body mass index (BMI), weight suppression (i.e. the difference between current weight and highest weight), and weight bias with eating disorder diagnosis in a sample of 99 self-identified women with current food insecurity (54% White; mean [SD] age = 40.26 [14.33] years). Participants completed two virtual study visits consisting of electronic questionnaires and interviews. A binary logistic regression model was conducted to test relations between the hypothesized correlates and eating disorder diagnostic status in the past 12 months, controlling for age, food insecurity severity, and body dissatisfaction. Higher levels of weight suppression and weight bias, but not current BMI, were significantly associated with the presence of an eating disorder. Contrary to our hypothesis, greater dietary restriction was associated with lower likelihood of eating disorder diagnosis. Results suggest high levels of weight bias and weight suppression characterize women with food insecurity who meet criteria for an eating disorder. Women who experience food insecurity and have lost a relatively great deal of weight and/or hold biases about high weight should be screened for eating pathology in clinical settings. [ABSTRACT FROM AUTHOR]

The article focuses on anorexia nervosa (AN) and its high mortality rate, emphasizing body distortions as a core issue. Topics include the role of interoception in self-perception, disruptions in sensory integration in AN, and the Re-Embodiment Project aimed at developing effective treatments. It also discuses the role of Interoception and Embodiment.

Background Dental caries is a prevalent condition that can significantly affect the quality of life, particularly in children with intellectual disabilities (ID). Understanding the caries risk profile in these children is essential for developing targeted preventive strategies. This study aims to compare the caries risk profile in children with varying levels of intellectual disability using the Cariogram model. Materials and Methods A cross-sectional study was conducted involving 150 children aged 6 to 12 years with different levels of intellectual disability. The participants were divided into three groups: mild, moderate, and severe intellectual disability, with 50 children in each group. The Cariogram model was used to assess caries risk by evaluating factors such as diet, plaque levels, fluoride exposure, saliva secretion, and clinical conditions. Data were collected through clinical examinations and caregiver questionnaires, and analyzed using ANOVA and Chi-square tests to identify differences in caries risk profiles among the groups. Results The study found that children with severe intellectual disability had the highest caries risk profile, with a mean Cariogram score of 75% (±10). In comparison, children with moderate and mild intellectual disabilities had mean scores of 65% (±12) and 55% (±15), respectively. Significant differences were observed in dietary habits and plaque levels among the groups (p < 0.05). The fluoride exposure was similar across all groups, indicating the influence of other factors on the caries risk profile. Conclusion The study highlights the increased risk of dental caries in children with severe intellectual disabilities compared to those with moderate and mild disabilities. Targeted preventive measures focusing on dietary management and oral hygiene practices are crucial for reducing caries risk in these populations. The Cariogram model proved to be an effective tool for assessing and comparing caries risk profiles, facilitating the development of personalized preventive strategies. [ABSTRACT FROM AUTHOR]

To understand the perspectives of key informant experts regarding the relationship between food insecurity and gestational diabetes mellitus risk reduction behaviors among young American Indian and Alaska Native females. Participants were adult key informants with expertise in food/nutrition and health within Tribal communities (N = 58) across the US. Data were collected through 1:1 interviews using a semistructured moderator guide and analyzed using thematic content analysis methods. Three themes included (1) diet and nutrition habits are formed through intergenerational food preferences and are driven by lasting implications of colonization; (2) young people are influenced by what their peers eat and the food environment, including outside of the home; and (3) the methods used to understand household food insecurity and nutrition habits in the parent study were likely limited. Findings provide guidance as to where nutrition education and interventions may best support young Native females. [ABSTRACT FROM AUTHOR]

Objectives: Gastroparesis that is refractory to standard dietary and medical management may benefit from surgical treatment with gastric electrical neurostimulation, which has shown promise in reducing symptoms of the disease. Pyloroplasty may serve an adjunctive role to a gastric stimulator, but the precise benefit remains unclear. The present study compares reported rates of symptom improvement following gastric neurostimulator implantation with and without pyloroplasty. Materials and methods: A single center retrospective analysis of consecutive patients who received operative management for symptom refractory gastroparesis from 1 January 2020 to 31 December 2021 was performed. Subjects were assigned to cohorts based on treatment with gastric electrical stimulation alone (GES-only) or combined with pyloroplasty (GES + PP). A survey-based assessment was administered post-operatively that evaluated cardinal symptoms of gastroparesis (nausea, vomiting, early satiety) before and after treatment. Results: In total, 42 patients (15 GES-only, 27 GES + PP) were included in the study. Both groups reported a high degree of improvement in global symptom control following surgery (93% vs 81%) with no differences between treatment cohorts (p = 0.09). Early satiety demonstrated better improvement in patients who received gastric stimulation alone (p = 0.012). Subgroup analysis of diabetic gastroparesis patients showed a 2.2% decrease in hemoglobin A1c levels in the GES + PP group (p-0.034). Conclusions: Symptom reduction in refractory gastroparesis appears to improve after placement of a gastric neurostimulator with or without the addition of a pyloroplasty procedure. [ABSTRACT FROM AUTHOR]

Cancer is a mysterious disease. Among other alterations, tumor cells, importantly, have metabolic modifications. A well-known metabolic modification commonly observed in cancer cells has been termed the Warburg effect. This phenomenon is defined as a high preference for glucose uptake, and increased lactate production from that glucose, even when oxygen is readily available. Some anti-cancer drugs target the proposed Warburg effect, and some dietary regimens can function similarly. However, the most suitable dietary strategies for treating particular cancers are not yet well understood. The aim of this review was to describe findings regarding the impact of various proposed dietary regimens targeting the Warburg effect. The evidence suggests that combining routine cancer therapies with diet-based strategies may improve the outcome in treating cancer. However, designing individualized therapies must be our ultimate goal. [ABSTRACT FROM AUTHOR]

Context Nutritional interventions substantially improve tuberculosis (TB) treatment outcomes and prevent complications. However, there is limited evidence about the connections between having nutritional support and TB treatment adherence. Objective The aim of this study was to determine the effectiveness of nutritional support in improving treatment adherence among patients with TB. Data Sources Databases, including PubMed, Embase (Ovid), Web of Science, and Scopus, were comprehensively reviewed to identify relevant studies reporting the impacts of nutritional support on TB treatment adherence. Data Extraction Two authors independently screened the title, abstracts, and full article texts to identify eligible studies and assess the risk of bias. Observational and interventional studies were included. Data Analysis A narrative synthesis approach was used to summarize the findings qualitatively. Results From the search, 3059 publications were identified; of these, 8 studies were included in this systematic review. Three types of nutritional interventions were identified: food baskets (eg, energy, micronutrient- or macronutrient-enriched food support), nutritional advice and guidance, and incentives for buying foods. Although 5 studies reported that nutritional support significantly improved treatment adherence in patients with TB, 3 studies showed that nutritional support had no effect on TB treatment adherence. Conclusions Providing nutritional support may improve adherence to TB treatment. However, more well-powered, high-quality trials are warranted to demonstrate the effect of nutrition support on cost-effectively improving adherence to TB treatment. Systematic Review Registration PROSPERO registration no. CRD42023392162. [ABSTRACT FROM AUTHOR]

Considering the significant involvement of insulin resistance in various forms of cancer, it is postulated that the implementation of a diabetic diet, which effectively mitigates insulin resistance, may potentially decrease the susceptibility to breast cancer among female individuals. In this literature review, a comprehensive electronic search of different databases was done using the keywords "Breast cancer" OR "breast tumor" OR "Breast Neoplasms" AND "diet" OR "diabetic diet" OR "Low Carbohydrate Diet" OR "Carbohydrate restricted diet" OR "High-Protein Low-Carbohydrate Diet" OR "diabetes risk reduction diet" OR "DRRD" as the main keywords. Research has shown that the DRRD score is inversely correlated with breast cancer risk. In fact, for every three-point increase in the DRRD score, the risk of breast cancer decreases by 7%. Studies have shown that higher DRRD scores in breast cancer patients are associated with a reduced risk of cancer and a higher chance of survival. The results of this study indicate a positive correlation between a higher level of adherence to the diabetes risk reduction diet (DRRD) and improved survival rates. This suggests that breast cancer survivors may benefit from making dietary modifications in line with a diabetic diet following their diagnosis. [ABSTRACT FROM AUTHOR]

Background: Disease‐related malnutrition is prevalent among hospitalised patients, but not all patients achieve the needed nutritional care. At a Danish University Hospital, focus has been on implementing nutritional practices based on clinical guidelines, but there is continuously variation between the wards regarding the quality of nutritional care. Aim: The aim of this study was to identify the potential barriers and facilitators for implementation of the clinical guidelines for nutritional practices and to recommend suggestions for development of nutritional practices, using a theoretical implementation strategy. Method: The design was a qualitative interview study of employees at a Danish University Hospital, using a semi‐structured interview guide. The participants were nurses, nurse's assistant, nurse nutrition expert, head nurse and dieticians. We recruited 11 employees, representing eight different wards. Findings: The analysis identified six themes: (1) clear allocation of responsibilities and committed management enhances nutrition practices, (2) leadership support is essential, (3) physical settings and tools affect possibilities for action, (4) selection of equivalent staff is core, (5) teaching promotes the knowledge and skills and (6) a dietitian in the ward facilitates implementation of nutritional care. Barriers and facilitators among the themes were identified and has led to suggestions to strengthen nutritional care, based on implementation theory. Conclusion: Various factors were identified as having impact on the implementation of nutrition practices and different suggestions have emerged to accommodate those factors, as well as to apply an implementation strategy to facilitate change in practice. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to capture the complex clinical reasoning process during tailoring of exercise and dietary interventions to adverse effects and comorbidities of patients with ovarian cancer receiving chemotherapy. Methods: Clinical vignettes were presented to expert physical therapists (n = 4) and dietitians (n = 3). Using the think aloud method, these experts were asked to verbalize their clinical reasoning on how they would tailor the intervention to adverse effects of ovarian cancer and its treatment and comorbidities. Clinical reasoning steps were categorized in questions raised to obtain additional information; anticipated answers; and actions to be taken. Questions and actions were labeled according to the evidence-based practice model. Results: Questions to obtain additional information were frequently related to the patients' capacities, safety or the etiology of health issues. Various hypothetical answers were proposed which led to different actions. Suggested actions by the experts included extensive monitoring of symptoms and parameters, specific adaptations to the exercise protocol and dietary-related patient education. Conclusions: Our study obtained insight into the complex process of clinical reasoning, in which a variety of patient-related variables are used to tailor interventions. This insight can be useful for description and fidelity assessment of interventions and training of healthcare professionals. IMPLICATIONS FOR REHABILITATION: The delivery of exercise and dietary programs is not a one-size fits all approach but involves a complex clinical reasoning process. Therefore, protocols should not only describe the intervention content, but also the strategy on how to tailor the intervention to individual adverse effects and pre-existing comorbidities. Education of healthcare professionals delivering the intervention is important as these professionals need to have good clinical reasoning skills to adequately tailor the intervention. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a common chronic autoimmune disease characterized by symmetrical polyarthritis, joint pain, and morning stiffness. It significantly impairs physical condition and increases the risk of functional disability. While conventional treatments include drug therapy, many patients continue to experience symptoms and seek alternative therapies to improve their condition. This article describes two clinical cases of RA patients treated with a comprehensive rehabilitation program, including moderate-intensity walking, yoga, and nutritional therapy. The study aimed to evaluate this approach's effectiveness in improving the patients' functional capacity and quality of life. The first patient (50 year-old female) noted a significant reduction in the number of painful joints (by 14) and swollen joints (by 12) after a three-month rehabilitation course. The visual analog scale (VAS) pain level decreased from 80 mm to 50 mm, and the duration of morning stiffness decreased from several hours to 80 min. The second patient (45 year-old female) also showed improvement: painful joints decreased from 13 to 2, and swollen joints from 7 to 1. VAS pain level decreased from 80 mm to 40 mm, and morning stiffness decreased by 50 min. Both patients reported an average reduction in excess weight by 1.65 kg/m², along with improvements in general well-being and mood. The results confirm that a comprehensive rehabilitation approach, including physical activity, yoga, and diet therapy, significantly improves the condition of RA patients. This approach helps reduce pain, decrease the number of inflamed joints, and improve overall functionality. Further studies with a larger sample are needed to determine the optimal rehabilitation strategies and the most impactful interventions. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Clinical Nursing in Practice is the property of Journal of Clinical Nursing in Practice (Editorial Board, Shanghai Jiao Tong University Press) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Purpose: This study aimed to explore the inaugural experience of using a continuous glucose monitoring (CGM) system in patients with type 2 diabetes. Patients and Methods: This study employed a qualitative design. Thirty-one patients with type 2 diabetes were recruited from a national university hospital and underwent CGM for two weeks. Individual interviews with 28 participants were conducted between August 1 and October 17, 2022, after the CGM. Thematic analysis was used to examine the data. Results: The results revealed transformative shifts in aspects of participants' lives due to CGM use, including alterations in dietary management and interpersonal relationships. During the two-week journey with CGM, participants were able to visually observe exercise effects and other benefits, leading to the discovery of a new utility for this innovative medical device. However, unavoidable drawbacks such as high cost, inaccurate results, and skin irritation have been identified, prompting suggestions for improvement. Conclusion: This study determined that CGM is both feasible and valuable for facilitating lifestyle adjustments to manage diabetes. Nevertheless, the challenge of discomfort associated with CGM use should be addressed in the future. To ensure effective utilization and overcome potential obstacles, it is recommended that a comprehensive and user-friendly CGM education manual be created, with the scope of CGM insurance coverage extended to include this research in the future. [ABSTRACT FROM AUTHOR]

Type 2 Diabetes mellitus (T2DM) is one of the oldest known chronic diseases, characterized by elevated fasting blood sugar (FBS). T2DM is a metabolic disorder that can distort the activities of multiple physiological systems, including the reproductive system. Although different drugs have been designed for managing this disorder, these drugs have been reported to have negative side effects. Hence, this study was designed to explore the possible synergistic effect of vitamin D and exercise on T2DM-induced testicular dysfunction. Thirty-six male Wistar rats were randomized into six (6) groups: control, diabetes untreated, diabetes treated with 1000 IU/kg of vitamin D, diabetes treated with 5 min/day of physical exercise, diabetes treated with vitamin D and exercise, diabetes treated with 180 mg/kg of metformin. T2DM induction led to a significant increase in FBS, lactate, and lactate dehydrogenase, and was reversed by vitamin D supplementation and exercise. Also, vitamin D and exercise synergistically blunted T2DM-induced oxido-inflammatory response evidenced by a significant decrease in testicular malondialdehyde, interleukin 1β, interleukin 6, and tumor necrosis factor alpha, and an increase in superoxide dismutase, catalase, glutathione peroxidase, and interleukin 10. These events were associated with a decrease in T2DM-induced increase in XO, UA, and Nf-κb and an increase in T2DM-induced decrease in Nrf2. Also, vitamin D and EX reversed the observed impairment in sperm quality and testicular histology following T2DM-induction. This study revealed the synergistic effect of vitamin D and exercise on T2DM-induced testicular dysfunction. [ABSTRACT FROM AUTHOR]

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Low-protein diet (LPD) is the core of dietary and nutritional therapy for non-dialysis chronic kidney disease (CKD) patients. In addition, physical exercise could prevent and treat various illnesses and chronic diseases. The objective of the study was to search for and appraise evidence on the effect of additional physical exercise on patients' nutritional status and indicators of disease progression when compared with the LPD alone. PubMed Central, Embase, Cochrane, and Web of Knowledge for randomized controlled trials (published between January 1, 1956 and May 17, 2023) were searched. A total of 8698 identified studies, 9 were eligible and were included in our analysis (N = 250 participants). Compared with the LPD alone, additional physical exercise reduced serum creatinine by a mean of –0.21 mg/dL (95% CI –0.39 to –0.03) in CKD patients. Similarly, blood pressure decreased after physical exercise, with systolic blood pressure decreasing by –7.05 mm Hg (95% CI –13.13 to –0.96) and diastolic blood pressure decreasing by –5.31 mm Hg (95% CI –7.99 to –2.62). Subgroup analyses revealed that resistance exercise (RE) was effective in decreasing estimated glomerular filtration rate (eGFR) of –1.71 mL/min per 1.73 m² (95% CI –3.29 to –0.14). In addition, the VO2peak increasing by 2.41 mL/kg/min (95% CI 0.13 to 4.70) when physical exercise was continued for 24 weeks. The above results suggest that the LPD with additional physical exercise care is more beneficial for patients with CKD. [ABSTRACT FROM AUTHOR]

Background: The South Korean government implemented a multidisciplinary nutritional support team (NST) system to focus on the proper evaluation and supply of nutritional status in hospitalized patients who are at a higher risk of malnutrition. Methods: This nationwide population-based cohort study included patients diagnosed with sepsis who were admitted to hospitals from 2016 to 2020. The NST should consist of four professional personnel (physicians, full-time nurses, full-time pharmacists, and full-time clinical dietitians). The NST group included patients with sepsis admitted to a hospital with an NST system, whereas the non-NST group included patients with sepsis admitted to a hospital without an NST system. Results: A total of 323,841 patients with sepsis were included in the final analysis, and 120,274 (37.1%) admitted to a hospital with an NST system were included in the NST group. In the multivariable Cox regression analysis, the NST group showed a 15% lower 90-day mortality than the non-NST group (hazard ratio [HR]:0.85, 95% confidence interval [CI]:0.83, 0.86; P < 0.001). The NST group shows 11% lower 1-year all-cause mortality than the non-NST group (HR:0.89, 95% CI:0.87, 0.90; P < 0.001). In subgroup analyses, a more evident association of the NST group with lower 90-day mortality was shown in the intensive care unit admission group and age ≥65 years old group. Conclusions: Multidisciplinary NST intervention is associated with improved survival outcomes in patients with sepsis. Moreover, this association was more evident in patients with sepsis aged ≥65 years old who were admitted to the ICU. [ABSTRACT FROM AUTHOR]

This study examined the effects of time restricted eating (TRE) on sex hormones in males and females, versus daily calorie restriction (CR). Adults with obesity (n = 90) were randomized to 1 of 3 groups for 12-months: 8-h TRE (eating only between 12:00 to 8:00 pm, with no calorie counting); CR (25% energy restriction daily); or control. Body weight decreased (P < 0.01) in the TRE and CR groups, relative to controls, in males, premenopausal females, and postmenopausal females, by month 12. Total testosterone, dehydroepiandrosterone (DHEA), and sex hormone binding globulin (SHBG) levels did not change over time, or between groups, in males, premenopausal females, and postmenopausal females. Estradiol, estrone, and progesterone were only measured in postmenopausal females, and remained unchanged. These findings suggest that TRE produces significant weight loss but does not impact circulating sex hormone levels in males and females with obesity over 12 months, relative to CR and controls. [ABSTRACT FROM AUTHOR]

The work was carried out to explore whether the anti-inflammatory effect of n-3 unsaturated fatty acids on patients with rheumatoid arthritis is related to the levels of inflammatory markers CRP and ESR. Studies on the treatment of rheumatoid arthritis with n-3 unsaturated fatty acid diet therapy and the outcome index containing CRP and/or ESR were included, and studies on the subjects suffering from other diseases affecting the outcome index were excluded. PubMed, Web of Science, EMBASE and Google Scholar were systematically searched, and all studies published from the establishment of the library to 2024 were collected. The Cochrane Bias Risk Assessment tool was used to evaluate the quality of the included studies. Data analysis was performed using Stata 16.0 software. Seven studies were included in this analysis. A total of 399 subjects were studied to explore the effect of an n-3 unsaturated fatty acid diet on rheumatoid arthritis. The results showed that there was no significant difference in CRP (Hedges's g = 0.06, 95% CI: −0.48–0.37, P = 0.79) and ESR (Hedges's g = −0.14, 95% CI: −0.61–0.33, P = 0.55) between the intervention and control groups. The results of this study showed that the anti-inflammatory effect of unsaturated fatty acids on rheumatoid arthritis was not correlated with CRP and ESR levels. Due to the small number of included studies, more high-quality studies are still needed to confirm this. [ABSTRACT FROM AUTHOR]

Background: One of the most common food allergies in the pediatric population is allergy to cow's milk protein (CMPA). Treatment consists of avoiding cow's milk proteins in lactating mothers and/or using therapeutic formulas based on hydrolysates or vegetable formulas. In infants with CMPA at diagnosis, a different gut microbial profile has been found compared to healthy children, with a reduction in beneficial bacteria. The aim of this study was to evaluate changes in the gut microbiota profile and its metabolites, dietary patterns and anthropometric variables in a pediatric cohort with CMPA after six months on a restrictive diet compared to healthy controls. Methods: In total, 21 patients diagnosed with CMPA and a control group of 24 healthy infants participated in this study. The fecal microbiota of all participants were investigated by metataxonomic analysis of 16S rDNA amplicons, and fecal short-chain fatty acids were measured by gas chromatography. Epidemiological assessment and dietary questionnaires were carried out for both groups. Results: Regarding growth, no significant differences were found, but differences in dietary intake of some macro- and micronutrients were observed. Patients who were breastfed at six months had higher bifidobacteria and lipid intakes than patients fed with hydrolyzed formulas. Conclusions: Although the growth of CMPA infants fed with therapeutic formula is similar to breastfed CMPA infants, there are differences in microbiota composition and macronutrient intake that underline the importance of continued breastfeeding in CMPA cases. [ABSTRACT FROM AUTHOR]

Abstract 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 .

Purpose: To examine the effects of a high-carbohydrate diet (HCHO), periodized-carbohydrate (CHO) diet (PCHO), and ketogenic low-CHO high-fat diet (LCHF) on training capacity. Methods: Elite male racewalkers completed 3 weeks of periodic training while adhering to their dietary intervention. Twenty-nine data sets were collected from 21 athletes. Each week, 6 mandatory training sessions were completed, with additional sessions performed at the athlete's discretion. Mandatory sessions included an interval session (10 × 1-km efforts on a 6-min cycle), tempo session (14 km with a 450-m elevation gain), 2 long walks (25–40 km), and 2 easy walks (8–12 km) where "sleep-low" and "train-low" dietary strategies were employed for PCHO. Racewalking speed, heart rate, rating of perceived exhaustion, and blood metabolites were collected around key sessions. Results: LCHF covered less total distance than HCHO and PCHO (P <.001); however, no differences in training load between groups were evident (P =.285). During the interval sessions, walking speed was slower in LCHF (P =.001), equating to a 2.8% and 5.6% faster speed in HCHO and PCHO, respectively. LCHF was also 3.2% slower in completing the tempo session than HCHO and PCHO (P =.001). Heart rate was higher (P =.002) and lactate concentrations were lower (P <.001) in LCHF compared to other groups, despite slower walking speeds during the interval session. No between-groups differences in rating of perceived exhaustion were evident (P =.077). Conclusion: Athletes adhering to an LCHF diet showed impaired training capacity relative to their high-CHO-supported counterparts, completing lower training volumes at slower speeds, with higher heart rates. [ABSTRACT FROM AUTHOR]

Background and Objectives: The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Methods and Study Design: Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. Results: The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). Conclusions: The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target. [ABSTRACT FROM AUTHOR]

In recent years, there has been a significant increase in the prevalence of inflammatory bowel diseases. Despite the significant progress made in the instrumental diagnosis of this group of diseases, their treatment in most cases remains formalized, based on fairly strict schemes. In this context, an urgent area of modern research is to study the effectiveness of the use of diet therapy and certain foods in order to modulate the activity of the inflammatory process, which allows avoiding adverse reactions of immunosuppressive, including immunobiological, therapy. Adherence to the Mediterranean diet has proven its effectiveness in the treatment of chronic non-infectious diseases. Recent studies have also established its benefits in the treatment of inflammatory bowel diseases. Recent studies have also established its benefits in the treatment of inflammatory bowel diseases. This article will present the results of modern research on the effect of the use of olive oil and its components on the course of inflammatory processes in the intestine. A number of studies conducted in vitro and in animal models have revealed the mechanisms by which olive oil and its components have a positive effect on the course of inflammation in the intestinal wall through anti-inflammatory, antioxidant, immunomodulatory and antitumor effects. Few clinical studies conducted on patients with inflammatory bowel diseases have shown the possibility of using diet therapy with the addition of olive oil in this group of patients as an additional treatment.

Background: The occurrence of dental caries is influenced by the interplay of host factors, microbial factors, and environment factors collectively forming the epidemiological triad of dental caries. Modification of the caries epidemiological triad limits the caries progression by shifting the equilibrium toward re-mineralization. Aim: The aim of this study was to evaluate the effectiveness of dietary sugar intake modification, plaque control measures, and fluoride toothpaste on the mineralization of enamel using DIAGNOdent™ pen scores. Methodology: 108 children aged 13–15 years, qualified the preset inclusion and exclusion criteria were randomly allocated into one among the three interventional groups such as Group 1: Diet counseling; Group 2: Educational intervention of toothbrushing and oral rinsing; and Group 3: Fluoride toothpaste. The sugar scores from 1 week’s diet history, plaque index scores, the weight of the fluoride toothpaste, and DIAGNOdent™ pen scores were recorded at the baseline visit and subsequently at 6- and 12-week intervals. Statistical analysis was done using Chi-square, repeated measure analysis of variance, and Tukey’s post hoc tests to determine the relationship between the variables. Results: The percentage reduction in DIAGNOdent pen score at 12-week time interval in Group 1 was 25.37%, Group 2 was 6.77%, and Group 3 was 13.37%. Intergroup comparison revealed that Group 1 showed a statistically significant difference (P < 0.05) as compared to Group 2 and Group 3, but Group 2 was as effective as Group 3 in teeth remineralization. Conclusion: the results suggest that among the abovementioned interventions, the dietary sugar restriction group is related to improved mineralization when compared to the instructed toothbrushing, oral rinsing, and fluoride toothpaste groups.

Background: The effectiveness of dietary therapy to induce remission of eosinophilic esophagitis (EoE) has been evaluated over the last decades and summarized in meta-analyses. Choosing the dietary modality, identifying the most suitable patients, and implementing specific prerequisites are essential to ensure long-term success. Summary: Impractical exclusive elemental diets provided the highest remission rates in EoE; however, they are not recommended due to their numerous disadvantages and detrimental effects on patient quality of life. Allergy testing-guided diets for EoE are limited; their insufficient effectiveness and low reproducibility are due to poor accuracy of skin or serum test results in identifying EoE food triggers. Initial experiences with a six-food elimination diet have provided evidence of high and predictive effectiveness rates and paved the way for less restrictive and more efficient step-up approaches, including four-food, two-food, and most recently, milk elimination diets. Dietary treatment for EoE is challenging for patients and families and requires certain skills to ensure success in the short and long term. Key Messages: The selection of appropriate patients is essential to ensure the success of and long-term adherence to dietary treatment of EoE. As normal triggers for EoE are commonly found in the staple diet, it is important to ensure adequate nutritional substitutes to avoid nutrient deficiency risks when long-lasting feeding difficulties or extensive restrictions are present. Specialized facilities in dietary therapy should adopt patient-centered and personalized approaches in order to provide timely monitoring and support for complex cases.

This paper examines nutritional therapy’s (NT) critical role in transforming the aging process and challenges the idea that deteriorating health and loss of autonomy are inevitable outcomes. NT is an organized strategy grounded in scientific principles that use tailored dietary modifications to enhance health outcomes and target certain age-related disorders. Essential nutrients substantially strengthen cellular resilience and the ability to withstand oxidative stress, underscoring the need for a varied and comprehensive diet. NT addresses the physiological effects of aging through dietary adjustments, alleviating cognitive deterioration, and managing malnutrition and frailty. This approach fosters an active and independent lifestyle in older adults. In addition to their considerable calcium content, dairy products play a crucial role in anti-aging measures by supplying necessary nutrients. They enhance cognitive health, bolster immunological function, and promote a balanced gut flora, augmenting their capacity to decelerate aging. Microelements, vitamins, and proteins are recognized as crucial components in anti-aging nutrition. The text emphasizes the intricate equilibrium necessary for cellular resilience and the substantial effect of vitamins on diverse anti-aging mechanisms. Consuming protein of higher quality has been demonstrated to be essential for preserving muscle mass and improving overall metabolic function. Advocacy is given to the necessity of a nutritious and well-balanced diet specifically designed to meet the distinct nutritional requirements of elderly individuals. The strategy stresses maintaining a balanced energy intake, selectively including helpful nutrients, and tailoring the plan to address individual health needs.

Background : Low compliance (LC) with lifestyle modification is a very common obstacle in obesity management. The purpose of the current study was to investigate the effectiveness of obesity management according to compliance with a lifestyle-modification program. Methods : The “Change 10 Habits” program was administered four times over 12 weeks. Eighty-seven participants were divided into LC and high compliance (HC) groups for analysis after intervention. Then, to assess the program’s effectiveness based on compliance, we conducted t-tests and linear regression modeling. Results : In week 12, the scores of two dietary habits—specifically, “eat three meals regularly, adequate amount” and “do not eat after 9:00 PM”—were significantly higher in the HC group than in the LC group. Changes in leg and total body fat percentages were significantly improved in the HC group (−0.2%±0.3% vs. 0.9%±0.3%, P

Background: The human immunodeficiency virus (HIV) and acquired immunodeficiency deficiency syndrome (AIDS) epidemic have left an overwhelming impact on communities worldwide, particularly in Sub-Saharan Africa, where its effects on family structures are particularly pronounced. Caregivers of HIV/AIDS orphans encounter challenges in fulfilling their caring duties. Consequently, they rely on the outreach team leaders (OTLs) for support to care for HIV/AIDS orphans. Aim: This study aimed to explore and describe support provided by OTLs to caregivers of HIV/AIDS orphans in the North West Province of South Africa. Methods: The exploratory, descriptive, and contextual design meaning the study was conducted was in the contexts where caregivers of HIV/AIDS orphans reside. The study was conducted in five local municipalities in the Ngaka Modiri Molema district of the North West Province of South Africa. Ward-based outreach nurses were participants in the study. Semi-structured focus group interviews were used for data collection. Thematic analysis was used to analyze data. Throughout the study, ethical principles were adhered to. The study also adhered to four trustworthiness principles: credibility, confirmability, transferability, and dependability. Results: Three main themes emerged from this study: the conduction of home visits to caregivers of HIV/AIDS orphans, the coordination of a multidisciplinary team for support, and the facilitation of support groups. Conclusions: This study revealed that that caregivers of children orphaned by HIV/AIDS benefitted from the support provided by OTLs in the North West province of South Africa. The support provided by OTLs harnessed positive relationship between caregivers and children orphaned by HIV/AIDS. [ABSTRACT FROM AUTHOR]

Background: The loss of taste and smell is a common symptom of COVID-19, affecting individuals' quality of life and nutritional status. Detecting sweet thresholds during infection and recovery periods can assist in implementing dietary modifications and nutritional strategies for these patients. Objective: To investigate the changes and differences in sweet detection thresholds of confirmed COVID-19 patients on Day 1, Day 10, and Day 14 of the infection and recovery periods. Methods: The demographic factors such as gender, smoking status, BMI, and age group were abstracted on Excel sheet from the medical health records for confirmed COVID-19 patients, who were admitted to King Fahad General Hospital in Jeddah, Saudi Arabia, a COVID-19 care facility, from September 2021 to July 2022. Sweet detection thresholds were determined using a pair-wise comparison procedure and sugar solutions with varying concentrations, arranged in ascending order and presented to participants until the lowest detected concentration was noted after three consecutive positive detections, with the median just noticeable difference (JND) value calculated as the population average threshold. Sensory tests were conducted on COVID-19 patients during their infection and recovery periods to evaluate their taste sensation thresholds. The demographic factors of gender, smoking status, BMI, and age group were considered in the analysis. Results: A total of 37 patients who met the inclusion criteria of the study were enrolled as participants. Significant variances in sweet detection thresholds were observed among the COVID-19 patients, with consistent decreases over the three testing days, indicating increasing sucrose sensitivity. Infected men showed significant returns to sweet detection thresholds on Day 14 compared to women, while infected smokers exhibited greater recoveries than non-smokers. Overweight patients had consistently elevated thresholds and recovery rates that were comparable to those of normal-weight patients by Day 14, while younger patients had lower thresholds than their older counterparts. On Day 14, the thresholds had significantly recovered to a level comparable to that of healthy individuals (approximately 0.23%). Conclusion: These findings suggest that sweet detection thresholds can be used as a marker for assessing the progression and recovery of COVID-19 patients. These findings highlight the importance of recognizing and managing alterations in sweet detection thresholds promptly in COVID-19 patients, as this could positively impact dietary management, nutritional recommendations, and interventions during infection and recovery periods. [ABSTRACT FROM AUTHOR]

Dietary fatty acids (FA) affect metabolic risk factors. The aim of this study was to explore if changes in dietary fat intake during energy restriction were associated with plasma FA composition. The study also investigated if these changes were associated with changes in liver fat, liver stiffness and plasma lipids among persons with non-alcoholic fatty liver disease. Dietary and plasma FA were investigated in patients with non-alcoholic fatty liver disease (n 48) previously enrolled in a 12-week-long open-label randomised controlled trial comparing two energy-restricted diets: a low-carbohydrate high-fat diet and intermittent fasting diet (5:2), to a control group. Self-reported 3 d food diaries were used for FA intake, and plasma FA composition was analysed using GC. Liver fat content and stiffness were measured by MRI and transient elastography. Changes in intake of total FA (r 0·41; P = 0·005), SFA (r 0·38; P = 0·011) and MUFA (r 0·42; P = 0·004) were associated with changes in liver stiffness. Changes in plasma SFA (r 0·32; P = 0·032) and C16 : 1 n -7 (r 0·33; P = 0·028) were positively associated with changes in liver fat, while total n -6 PUFA (r −0·33; P = 0·028) and C20 : 4 n -6 (r −0·42; P = 0·005) were inversely associated. Changes in dietary SFA, MUFA, cholesterol and C20:4 were positively associated with plasma total cholesterol and LDL-cholesterol. Modifying the composition of dietary fats during dietary interventions causes changes in the plasma FA profile in patients with non-alcoholic fatty liver disease. These changes are associated with changes in liver fat, stiffness, plasma cholesterol and TAG. Replacing SFA with PUFA may improve metabolic parameters in non-alcoholic fatty liver disease patients during weight loss treatment. [ABSTRACT FROM AUTHOR]

Gastrostomy feeding is a route of enteral nutrition for children with feeding difficulties. This study investigated caregiver experiences of the transition to gastrostomy feeding. A survey was administered to caregivers of children <18 years in a major pediatric center in Ireland. Experiences of decision-making, support, and adjusting to tube feeding were examined. Seventy-six caregivers participated. Median satisfaction with the information provided by the hospital was high. Almost half (48%) spoke to another caregiver of a child with a gastrostomy prior to their own child's gastrostomy insertion and most (88%) felt reassured by this. Concerns following insertion included managing the tube and their child's oral intake and feelings about the tube. The oral intake of 83% of children who had some intake prior to gastrostomy insertion did not change or increased following insertion. Most (89%) would make the same decision to insert the tube. Feelings associated with the transition included relief and stress. Gastrostomy tube insertion presents logistical and psychosocial challenges for caregivers. Peer support from other caregivers may alleviate some of these challenges. [ABSTRACT FROM AUTHOR]

Maintaining a healthy diet is essential, particularly for diabetic patients who are affected by severe defects. Nutrition therapy is vital to avoid the effects of diabetes and maintain better health. However, high sugar, fatty foods are significantly avoided by the patients to find alternate food from the same group. Despite this, there are still variations in diet that affect diabetic patients. Therefore, this paper proposes an effective food recommendation system to suggest suitable dietary plans for patients affected by diabetes. The personal health information of patients and several food products gathered from the Internet of Medical Things (IoMT) dataset are taken as input data for the proposed integrated recommendation system. To boost unbiased detection, the data noise present in the IoMT dataset is eliminated and regularized using preprocessing steps, including data cleaning, data reduction, data transformation, data enrichment, and data validation. From the preprocessed data, significant feature characteristics that contribute more to diabetes detection and food product recommendation are selected using the Wingsuit Flying Search (WFS) algorithm. These selected features are then classified using the proposed Hybrid Ensemble Support Vector Deep Residual (HESDR) approach. This approach accurately classifies diabetes and non-diabetes patients and suggests top nutrient-dense food products for patients with diabetes. The analytical results show that the proposed HESDR approach achieves a high accuracy rate of about 98.3% compared to other methods. In conclusion, this paper proposes an effective food recommendation system that accurately classifies diabetic patients and suggests suitable dietary plans based on their health conditions. The approach effectively eliminates data noise and selects significant features using the WFS algorithm. The proposed HESDR approach accurately classifies diabetic patients and recommends nutrient-dense food products for them, achieving high accuracy rates. [ABSTRACT FROM AUTHOR]

The Japan Gastroenterological Association published the first version of its clinical guidelines for chronic constipation 2023. Based on the latest evidence, these guidelines describe the definition, classification, diagnostic criteria, diagnostic testing methods, epidemiology, pathophysiology, and treatment of chronic constipation. They include flowcharts for both diagnosis and treatment of chronic constipation. In the treatment of chronic constipation, the first step involves differentiating between secondary forms, such as organic disease-associated constipation, systemic disease-associated constipation, and drug-induced constipation. The next step is to determine whether the chronic constipation stems from a motility disorder, a form of primary chronic constipation. For functional constipation and constipation-predominant irritable bowel syndrome, treatment should be initiated after evaluating symptoms like reduced bowel movement frequency type or defecation difficulty type. The first line of treatment includes the improvement of lifestyle habits and diet therapy. The first drugs to consider for oral treatment are osmotic laxatives. If these are ineffective, secretagogues and ileal bile acid transporter inhibitors are candidates. However, stimulant laxatives are exclusively designated for as-needed use. Probiotics, bulk-forming laxatives, prokinetics, and Kampo medicines, for which there is insufficient evidence, are considered alternative or complementary therapy. Providing the best clinical strategies for chronic constipation therapy in Japan, these clinical guidelines for chronic constipation 2023 should prove useful for its treatment worldwide. [ABSTRACT FROM AUTHOR]