Tuesday, February 21, 2017

Nutrition Therapy for Hepatic Glycogen Storage Diseases

There are many different types of glycogen storage diseases. The first type of glycogen storage disease occurs when the body is missing the enzyme glucose-6-phosphatase which is the enzyme that converts glucose-6-phosphatase to glucose. People with disease can encounter many different side effects including hypoglycemia, lactic acidosis, hyperuricemia, and hyperlipidemia. The main nutritional intervention to treat this disease focuses on controlling hypoglycemia. Increasing blood glucose levels will enable the body to function more efficiently. Infants up to one year of age receive and overnight continuous feeding of a high carbohydrate via a nasogastric tube. During the day they consume formula, instant rice and oatmeal cereals every three hours. At eight months to a year infants receive an uncooked cornstarch therapy. Throughout their life time individuals diagnosed with this disease will continue to receive overnight continuous feedings and are instructed to consume a diet that consists of high complex carbohydrates such as oatmeal, barley, rice, pasta, and legumes; as well as a diet that is low in fat. Nutrition therapy has been proven to help with physical growth, metabolic control, glucose homeostasis, lactic acidosis, cholesterol, and hyperlipidemia. 


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Goldberg, T., & Slonim, A. E. (1993). Nutrition therapy for hepatic glycogen storage diseases. Journal of the American Dietetic Association, 93(12), 1423-1430.

Monday, February 13, 2017

GDM and Medical Nutrition Therapy

Shi, M., Liu, Z. L., Steinmann, P., Chen, J., Chen, C., Ma, X. T., & Han, S. H. (2016).  Medical nutrition therapy for pregnant women with gestational diabetes mellitus—A retrospective cohort study. Taiwanese Journal of Obstetrics and Gynecology55(5), 666-671.

Medical Nutrition Therapy for Pregnant Women with Gestational Diabetes mellitus- A retrospective cohort study

When a pregnant woman develops diabetes mellitus during pregnancy, this is referred to as gestational diabetes. Gestational diabetes (GDM) is described as a glucose intolerance that occurs during pregnancy. Glucose homeostasis is often times restored back to nonpregnancy levels post-partum, however, women diagnosed with GDM are at a high risk of developing type II diabetes later in life. GDM has a negative impact on both mother and baby including problems such as maternal polyhydramnios, pregnancy-induced hypertension syndrome, fetal deformities, and more. Since complications are so common with GDM, it is important to try to manage blood sugar levels during pregnancy in order to decrease the risk for complications. Medical nutrition therapy (MNT) is a key tool in managing GDM. MNT in GDM is meant to guarantee necessary nutritional needs during pregnancy while at the same time achieving acceptable glucose control.
This study looked at 488 GDM cases and assessed prepregnancy weight, weight changes during pregnancy, glucose levels, GDM management, follow-up, and birth outcomes from 2008-2012. Participants in this study were advised to receive MNT counseling as well as follow other nutrition guidelines. Results showed that fasting plasma glucose, 2-hour blood glucose, weight gain at 28 weeks, 32 weeks, and 36 weeks were all lower in the MNT group than with those who did not receive MNT. This study therefore exhibits how MNT can be an effective way to reduce the prevalence of GDM and in addition the consequences that can arise from the disease.

KS

Tuesday, February 7, 2017

Delahanty, L. M., Dalton, K. M., Porneala, B., Chang, Y., Goldman, V. M., Levy, D., ... &  Wexler, D. J. (2015). Improving diabetes outcomes through lifestyle change– A randomized controlled trial. Obesity23(9), 1792-1799.

Improving Diabetes Outcomes Through Lifestyle Change- A Randomized Controlled Trial
The increasingly prevalent issue of obesity has become a costly public health problem, which faces our entire nation and gives rise to an epidemic of type II diabetes and other adverse health problems. One way to prevent prediabetes and treat diabetes is to focus on achieving long-term weight loss. There is a type II diabetes trial called Look AHEAD, which includes an intensive lifestyle intervention (ILI) which resulted in sustained weight loss with improved glycemic control, reduced medication use and cost, and better quality of life when compared to standard diabetes education. The authors of this research adapted Look AHEAD’s concepts and use of an ILI and dietitian-led group session style. Their hypothesis was that a 19-week group lifestyle intervention would be more effective for weight loss of 6 months than dietitian-referral MNT, which is the current reimbursed standard of care in this population.

There were two separate interventions given to study participants. Participants assigned to the MNT group sat with dietitians to review an educational handout, which described benefits of modest weight loss and increasing physical activity. Participants assigned to the group lifestyle intervention attended 19 weekly 1.5-hour group sessions led by dietitians. Results did indeed show that a 19-week group lifestyle intervention was significantly more effective than dietitian-referral MNT when it comes to achieving weight loss in patients with type II diabetes. Additionally, the group lifestyle intervention was seen to result in improved glycemic control and significant medication reduction. Although dietitian-referral, the current reimbursed standard of care, did result in weight loss and some improvement in glycemic control, a more comprehensive dietitian-led group lifestyle intervention that includes for contact time with healthcare professionals can offer a viable model of care at a reasonable cost to eligible patients. The average price of the group lifestyle intervention is around $570, which is comparable to programs like Weight Watchers (doesn’t include weekly physician medication titration and oversight). Results of this study show that a group lifestyle intervention can be effectively translated as a usual standard of care.

KS 

Monday, February 6, 2017

Cinnamon and Glycemic Control


Cinnamon and Glycemic Control
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Cinnamon has been said to help with Type 2 Diabetes Mellitus by aiding in glycemic control. The American Diabetes Association (ADA) states that an HbA1c level of greater than or equal to 6.5 or a FPG level of 7.0 mmol is indicative of diabetes. Cinnamon bark oil has been used for centuries to treat a host of different conditions. It has been suggested that cinnamon activates the insulin receptor by increasing auto phosphorylation of the receptor, increasing glucose transporter 4 receptor synthesis and activation, inhibits amylase and glucosidase, increases glycogen synthesis in the liver, thus improving insulin sensitivity, and glycemic control. A meta-analysis was done on 11 studies that looked at cinnamons effects of HbA1c and FPG levels. Cinnamon doses in these studies ranged from 120-6000 mg/day. All of the studies had to meet specific inclusion criteria. The studies were found from an extensive search on PubMed. There were reductions in the FPG during the cinnamon intervention. The few studies that looked at HbA1c (a better predictor for glycemic control), noted that there were only moderate decreases as compared to the group receiving the placebo. Only 4 out of the 11 studies had lab values that met the criteria from the ADA (FPG <7.2 mmol/L and/or HbA1c <7.0). When the cinnamon was added with a hypoglycemic medication and other lifestyle adjustments were made there were modest effects in the lab values. Due to these results, it is not recommended that RD’s use cinnamon alone as a treatment for Type 2 Diabetes Mellitus. It is recommended that the patient continues using their medications and following certain lifestyle changes.


Do Cinnamon Supplements Have a Role in Glycemic Control in Type 2 Diabetes? A Narrative Review
Costello, Rebecca B. et al.
Journal of the Academy of Nutrition and Dietetics , Volume 116 , Issue 11 , 1794 - 1802

Cancer Malnutrition: What RD's Can Do


Cancer Malnutrition: What RD's Can
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Malnutrition in cancer patients can lead to a host of issues. It can have a negative effect on treatment and therefore the patient's outcome. Malnutrition can lead to increased and more frequent hospital visits, more severe side effects, and a boost in cancer reoccurrence risk. Individuals on cancer treatments may have symptoms that vary. No two cancer cases are identical. For this reason it is important to engage with the patient and learn specifically what is causing their malnutrition. The symptoms can be anything from nausea to constipation or early satiety to mouth sores. Not all facilities have RD's on staff that are certified specialist in oncology nutrition (CSO), so it is important that all RD's know some of the basic information regarding cancer treatment and nutrition. There are even some facilities such as outpatient cancer centers that do not have RD's as part of the healthcare team so patients do not have access to nutrition education/support.  It is important that RD's work hand and hand with all members of the healthcare team to ensure that the patient is receiving the best possible care. Some of the tips on how to combat cancer malnutrition provided by this article are listed below.

 

Combating Cancer Malnutrition
By Suzanne Dixon, MPH, MS, RDN
Today's Dietitian
Vol. 18, No. 11, P. 42

Sunday, February 5, 2017

Ketogenic Diet and the Effects on Epilepsy


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Ketogenic Diet and the Effects on Epilepsy


The ketogenic diet (KD) is a diet that is high in fat and low in carbohydrates. This diet sends the body into a ketogenic state (using ketone bodies instead of glucose as the major source of energy). Using the ketogenic diet for treatment of refractory epilepsy was first reported in the early 1900’s. Epilepsy is the most common neurological disorder in the world. According to a study done in 2008 by the International Ketogenic Diet Study Group, KD may be efficacious for the following types of epilepsy: infantile spasms, tuberous sclerosis complex, myoclonic-astatic epilepsy (Doose syndrome), severe myoclonic epilepsy of infancy (Dravet syndrome), and Rett syndrome. The specific mechanism of how the KD effects seizures is not yet known. What is known is that when the body has elevated ketone bodies, they inhibit neuronal excitability. This slows the firing rates of neurons with decrease seizure activity. If ketone bodies are the reason for decreased seizures, there should be a correlation between serum ketone concentration and the decrease of seizures. However, only one study has shown this correlation. This raises the question of is the KD diet effective due to high ketone bodies or due to the low amount of glucose available. The most common KD uses the 4:1 ratio, this means that the diet is four parts fat, and one-part carbohydrate and protein.
 
The Ketogenic Diet for Epilepsy — Learn About the Diet, the Medical Conditions It's Used to Treat, and Its Mechanism of Action
By Rebecca Randall, MS, RD, and Sue Groveman, MS, RD, LDN
Today's Dietitian
Vol. 18 No. 5 P. 46

Wednesday, February 1, 2017

Solving the Riddle of Gestational Diabetes: Inconsistencies Among Medical Nutrition Therapy Recommendations



                Gestational diabetes (GDM), a type of diabetes experienced during the second half of pregnancy, mimics traditional diabetes mellitus (DM) through increased blood glucose levels and other characteristic symptoms.  However, the incidence of GDM has more widespread and long-term effects, impacting both mother and child.  Negative outcomes for the mother include an increased risk of preeclampsia, cesarean deliveries, type 2 diabetes, and cardiovascular disease, while the child is at risk for macrosomia, neonatal hypoglycemia, type 2 diabetes, and obesity.  In light of the numerous and dangerous risks for both mother and child, interventions must be identified to alleviate potential negative outcomes.  Traditionally, medical nutrition therapy (MNT) in the form of diet and exercise has been used as the first line of defense for GDM; however, multiple healthcare agencies throughout the world now use inconsistent guidelines that impede the decision-making and implementation process for practitioners.
In an effort to untangle the web of inconsistent recommendations, researchers have compiled GDM guidelines from international agencies and have found a lack of consensus for MNT interventions.  Despite inconsistencies, some common themes were identified.  All groups agreed that energy intake throughout pregnancy should follow non-GDM guidelines and specifically warn against severe calorie restriction for weight loss purposes.  Carbohydrate intake recommendations vary from as little as 35% of total calories up to 50% of total calories; however, agencies do agree that fiber, fat, and protein intake, as well as number of meals and CHO distribution, should conform with general guidelines for DM management.  Many agencies recommended the use of a dietitian and daily food logs to aid in the management of GDM.  Others implicated glycemic index (GI) as a major contributor to GDM, indicating that mothers should avoid high GI foods.
                In general, recommendations for the management of GDM do not differ from guidelines for those with DM or healthy pregnant women, suggesting “a broader approach commonly known as a healthy diet, which is based on low GI, high complex CHO and fiber intake, and with a low amount of sugar and saturated fat.”1

1Moreno-Castilla, C., Mauricio, D., & Hernandez, M. (2016). Role of Medical Nutrition Therapy in the Management of Gestational Diabetes Mellitus. Current Diabetes Reports, 16(4), 1-9. doi:10.1007/s11892-016-0717-7

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