Lifestyle Therapies for the Management of Diabetes
James M. Rippe in Lifestyle Medicine, 2019
Strong evidence from 18 studies in the AND’s review of effectiveness reported MNT lowered A1C 0.3% to 2.0% at three months and was continued to 0.6% to 1.8% in studies longer than 12 months. Usual care study arms reported 0 to + 0.2% changes in A1C. Although MNT was effective throughout the disease process, decreases in A1C were largest (0.5% to 2.0%) in newly diagnosed persons and/or persons with baseline A1C > 8.0%.5 Significant improvements in quality of life (improved self-perception of health status, increased knowledge and motivation, and decreased emotional stress), and decreases in doses or number of glucose-lowering medications were also reported. Mixed effects on lipids and blood pressure (50–70% of participants were already on lipid-lowering or anti-hypertensive medications) and body weight outcomes were reported. A minimum of three encounters with an RDN with continued follow-up visits were importan t. A variety of nutrition therapy interventions were implemented and were effective. All interventions resulted in a reduced energy intake.
Assessment – Anthropometrics and Functional Status
Jennifer Doley, Mary J. Marian in Adult Malnutrition, 2023
Anthropometric measurements and functional exams are useful to assess and reassess nutrition status, sarcopenia, and frailty, to provide evidence of a PEM diagnosis, direct appropriate interventions, and monitor patient progress and outcomes. Muscle quality, which changes with age due to myosteatosis and connective tissue changes, as well as other factors in aging and disease, underlies impaired muscle performance that affects the individual’s ability to be independent, recover from illness, and their quality of life. Discovery of functional deficits related to PEM can prompt the clinician to promote activities to improve nutrition intake and physical activity, to slow the rate of deficit, maintain, or ideally improve, skeletal muscle mass, muscle quality, strength, and performance.79 Conversely, early discovery of nutrition deficits can trigger awareness of potential functional deficits, especially in less active patients, older adults, and those with complex diagnoses. Nutrition therapy and physical activity can often help improve functional ability, patient independence, and quality of life. Inclusion and analysis of these measures adds to the importance, depth, and strength of a thorough nutrition assessment of the malnourished patient as well as early identification of functional conditions of those at risk of PEM, sarcopenia, and frailty so that early and prompt intervention can be implemented to maintain or improve declines in health and clinical outcomes.
Nutritional Assessment
Maria A. Fiatarone Singh, John Sutton Chair in Exercise, Nutrition, and the Older Woman, 2000
What about referring an individual for treatment by someone who has nontraditional training? Not everyone needs the same kind of nutritional intervention, and medical nutrition therapy as is suggested (and probably reimbursed by managed care plans) by the traditional route, may have been tried and not been found effective in some situations. Alternative therapy is slowly becoming a legitimate health care option as scientific research validates claims for some products and techniques. It wasn’t until 1995, for example, that the United States Department of Agriculture and the Department of Health and Human Services Dietary Guidelines4 stated that carefully planned vegetarian diets are good for you. Currently, there are intervention studies to evaluate the benefits of a multitude of novel therapies to prevent symptoms of diseases, or even to stop disease progression. Many of these programs involve testing foods or purified food components in human intervention trials.
Educating Future Physicians in Nutritional Science and Practice: The Time Is Now
Published in Journal of the American College of Nutrition, 2019
Gail Cresci, Michelle Beidelschies, Julie Tebo, Alan Hull
Incorporating additional content into the undergraduate medical school curriculum is challenging since there has been a tendency to reduce curriculum hours and to integrate more basic science within clinical training. Often some existing content is eliminated to make room for the new content, but this is frequently unpopular. Another approach used by medical school curriculum committees is to integrate new and updated concepts into the existing curriculum when possible, adding content to case studies, problem-based learning, and clinical activities. This article focuses on outlining a method for integrating nutritional content successfully into an undergraduate medical education curriculum. The aim of this review is to describe the process taken at our facility with the goal of being able to provide future physicians with all aspects in the science of nutrition and medical nutrition therapy as a means to prevent and/or treat chronic disease.
The Effect of Evidence-Based Nutrition Clinical Care Pathways on Nutrition Outcomes in Adult Patients Receiving Non-Surgical Cancer Treatment: A Systematic Review
Published in Nutrition and Cancer, 2018
Evidence-based guidelines have been developed for the nutritional management of a patient with cancer by international experts and are available through traditional publications (12) or through other online platforms (13). Guidelines typically inform care pathway development (14). Several different nutrition pathways for cancer management have emerged in recent years, including surgical care pathways, or enhanced recovery after surgery, where a defined nutrition arm is included. These pathways have been shown to reduce the length of post-operative stay without negatively impacting patient mortality or morbidity (15). Additionally, they have been shown to be a cost effective approach (16), reducing hospital costs (11) without compromising patient safety (15). Medical nutrition therapy pathways aim to improve patient outcomes while decreasing health care costs. Such frameworks define the level, content, and frequency of nutrition care that is appropriate for particular disease states in typical settings (17–19). However, the influence of nutrition care pathways in other cancer patient groups has not previously been analyzed and synthesized to determine the benefits of their implementation.
Current nutritional approaches in managing autism spectrum disorder: A review
Published in Nutritional Neuroscience, 2019
In this compilation, various medical nutrition approaches have been examined, and related studies on the subject have been discussed. It is reported that in individuals with ASD, while the gluten-free casein-free and KDs, camel milk, curcumin, probiotics, and fermentable foods can play a role in alleviating ASD symptoms, the consumption of sugar, additives, pesticides, genetically modified organisms, inorganic processed foods, and difficult-to-digest starches may aggravate symptoms. Further prospective controlled trials with large sample sizes are needed before recommendations can be made regarding the ideal ASD diet. In a medical nutrition therapy approach, it is beneficial to examine the pathophysiology, food intake, food allergies/intolerances, and nutritional behaviours of the individual with ASD to supplement the energy and nutrient deficiencies with food, to ensure a sufficient and balanced diet and to adopt a therapeutic diet approach to alleviate symptoms. This compilation emphasizes the value of identifying current nutritional approaches specific to individuals with ASD and integrating their effects on symptoms into the conversation. It also hopes to pave the way for new therapeutic goals and interventions, providing hope to individuals afflicted with this prevalent developmental disorder.
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