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Cardiology in the Young Sep 2023Chylothorax after congenital cardiac surgery is associated with increased risk of malnutrition. Nutritional management following chylothorax diagnosis varies across... (Review)
Review
INTRODUCTION
Chylothorax after congenital cardiac surgery is associated with increased risk of malnutrition. Nutritional management following chylothorax diagnosis varies across sites and patient populations, and a standardised approach has not been disseminated. The aim of this review article is to provide contemporary recommendations related to nutritional management of chylothorax to minimise risk of malnutrition.
METHODS
The management guidelines were developed by consensus across four dietitians, one nurse practitioner, and two physicians with a cumulative 52 years of experience caring for children with CHD. A PubMed database search for relevant literature included the terms chylothorax, paediatric, postoperative, CHD, chylothorax management, growth failure, and malnutrition.
RESULTS
Fat-modified diets and nil per os therapies for all paediatric patients (<18 years of age) following cardiac surgery are highlighted in this review. Specific emphasis on strategies for treatment, duration of therapies, optimisation of nutrition including nutrition-focused lab monitoring, and supplementation strategies are provided.
CONCLUSIONS
Our deliverable is a clinically useful guide for the nutritional management of chylothorax following paediatric cardiac surgery.
Topics: Child; Humans; Infant; Chylothorax; Heart Defects, Congenital; Cardiac Surgical Procedures; Malnutrition; Nutritional Status; Postoperative Complications
PubMed: 36177859
DOI: 10.1017/S1047951122003109 -
Evaluation Review Aug 2023Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence...
Limited research on diabetes education and support implementation in Appalachia, which is a critical knowledge gap considering barriers to care, and high prevalence rates. The aim was to understand what each facility is providing regarding diabetes education and services within West Virginia. This study reports cognitive interview qualitative findings from a multi-methods study. Individuals were recruited through an online search to identify clinics, organizations, and hospital staff that provided diabetes education in the state of West Virginia. Eligible participants were individuals who facilitated and managed diabetes education and support in counties of West Virginia. The interviews followed an 11-item interview guide, approved, and reviewed by a practicing Registered Dietitian and Certified Diabetes Care Education Specialist in West Virginia. All qualitative data from the interviews were hand-coded using grounded theory, by two researchers. 15 participating organizations from the state of West Virginia were included and described three phenomena: Diabetes Education Implementation (differences in: evaluation measures, modality, delivery format, topical areas); Barriers to Care (staffing, lack of training, evaluation, loss of research partnerships and funding); and Facilitators to Care (community-based involvement, interdisciplinary collaboration, capacity building (trainings). There are concerns with program drift and "risky" adaptations such as inconsistent evaluative measures, lack of training for program facilitators, variety of delivery formats, and content material. Findings recommend more alignment in program delivery to better implementation. Further studies should assess patient experiences with implemented diabetes education programs in West Virginia to further support the current research findings.
PubMed: 37615089
DOI: 10.1177/0193841X231195392 -
Journal of Renal Nutrition : the... Nov 2023Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in... (Review)
Review
BACKGROUND
Recent surveys highlight gross workforce shortage of dietitians in global kidney health and significant gaps in renal nutrition care, with disparities greater in low/low-middle income countries.
OBJECTIVE
This paper narrates ground experiences gained through the Palm Tocotrienols in Chronic Hemodialysis (PaTCH) project on kidney nutrition care scenarios and some Asian low-to-middle-income countries namely Bangladesh, India, and Malaysia.
METHOD
Core PaTCH investigators from 3 universities (USA and Malaysia) were supported by their postgraduate students (n = 17) with capacity skills in kidney nutrition care methodology and processes. This core team, in turn, built capacity for partnering hospitals as countries differed in their ability to deliver dietitian-related activities for dialysis patients.
RESULTS
We performed a structural component analyses of PaTCH affiliated and nonaffiliated (Myanmar and Indonesia) countries to identify challenges to kidney nutrition care. Deficits in patient-centered care, empowerment processes and moderating factors to nutrition care optimization characterized country comparisons. Underscoring these factors were some countries lacked trained dietitians whilst for others generalist dietitians or nonclinical nutritionists were providing patient care. Resolution of some challenges in low-to-middle-income countries through coalition networking to facilitate interprofessional collaboration and task sharing is described.
CONCLUSIONS
We perceive interprofessional collaboration is the way forward to fill gaps in essential dietitian services and regional-based institutional coalitions will facilitate culture-sensitive capacity in building skills. For the long-term an advanced renal nutrition course such as the Global Renal Internet Course for Dietitians is vital to facilitate sustainable kidney nutrition care.
Topics: Humans; Nutritional Status; Delivery of Health Care; Surveys and Questionnaires; Renal Dialysis; Kidney; Nutritionists
PubMed: 37597574
DOI: 10.1053/j.jrn.2023.08.003 -
Life (Basel, Switzerland) Oct 2023Due to a continual growth in the world's population and the prohibition of antibiotics in animal production, the livestock industry faces significant challenges in the... (Review)
Review
Due to a continual growth in the world's population and the prohibition of antibiotics in animal production, the livestock industry faces significant challenges in the global demand for meat, eggs, and dairy products. The growing demand for organic products and the prohibition on antibiotic growth promoters (AGPs) have compelled animal nutrition experts to search for natural substitutes that include medical plants and beneficial microorganisms. Natural feed additives like probiotics are found to be more effective than AGPs in reducing the load of harmful intestinal pathogens. One of the probiotics that has generated considerable interest since ancient times is yeast. Yeast is used as a supplement in animal feeds due to its relatively high protein, amino acid, energy, and micronutrient content. Yeast byproducts such as yeast cells and cell walls contain nutraceutical compounds (i.e., β-glucans, mannooligosaccharides, and nucleotides) and have been shown to improve animal growth performance and health. Though the application of yeast supplements has been reviewed to date, only a scarce amount of information exists on the yeast-derived products in non-ruminant nutrition. Additionally, it is difficult for nutritionists to differentiate the characteristics, composition, and optimal feeding among the diverse number of yeast-containing products. Due to the increasing popularity of using yeast-based products in animal feeds, the development of analytical approaches to estimate yeast and its components in these products is greatly needed. Thus, in this review, we intend to provide current knowledge of different categories of commercially available yeast and yeast-derived additives, along with their role in improving animal growth performance and health, their proposed mechanisms of action, and the challenges of quantifying yeast content and biologically active components.
PubMed: 37895419
DOI: 10.3390/life13102037 -
Patient Education and Counseling Oct 2023Patients with cirrhosis suffer from many complications, including malnutrition, which must be managed promptly and effectively by the healthcare team. Educating patients... (Review)
Review
BACKGROUND
Patients with cirrhosis suffer from many complications, including malnutrition, which must be managed promptly and effectively by the healthcare team. Educating patients about their medical condition, the risk of malnutrition and other complications of cirrhosis, could contribute to optimal nutritional status, quality of life and general health.
OBJECTIVE
This review provides an overview of the literature on a variety of nutritional education strategies used with patients suffering from cirrhosis. This review also identifies barriers and facilitators which impact the adherence in using these strategies.
PATIENT INVOLVEMENT
A patient-partner contributed to this review by providing insights on different issues and concerns that patients with cirrhosis might ask themselves regarding nutritional education strategies. The patient-partner was also involved in the overall revision of the review.
METHODS
Articles published between the years 2000-2023 focusing on nutritional education strategies in patients living with cirrhosis were identified using Google Scholar and PubMed and were screened for inclusion in the study. All selected studies were intervention studies. A quality assessment of the included studies was conducted using the Mixed Methods Appraisal Tool (MMAT).
RESULTS
Only a few nutritional education strategies in patients with cirrhosis were documented in the literature. The strategies ranged from using traditional printed materials to advanced technologies. These strategies may prove beneficial in complementing routine interventions provided by health professionals, such as registered dietitians, in their clinical practice.
DISCUSSION
This narrative review clearly highlights the need for further research to elaborate and evaluate nutritional education strategies for people living with cirrhosis.
PRACTICAL VALUE
Elaborating and evaluating educational strategies in nutrition for patients living with cirrhosis will be an adjuvant to health professionals and dietitians in their clinical practice by providing them, and the patients, with targeted education resources.
Topics: Humans; Quality of Life; Nutrition Therapy; Malnutrition; Nutritional Status; Health Education
PubMed: 37421686
DOI: 10.1016/j.pec.2023.107878 -
Behavioral Sciences (Basel, Switzerland) Nov 2023Dietitians are included in eating disorder (ED) treatment teams for their expertise in nutrition. However, little is known about an individual's experience of dietetic... (Review)
Review
Dietitians are included in eating disorder (ED) treatment teams for their expertise in nutrition. However, little is known about an individual's experience of dietetic intervention as part of their ED treatment and what they value as part of dietetic care. Therefore, the aim of this review was to synthesise the available qualitative literature to understand the role and value of a dietitian in ED treatment from the perspective of individuals with lived experience. Six databases and Google Scholar were searched and a thematic synthesis and meta-synthesis of fifteen studies were conducted. Four themes were constructed from the data: (1) "guidance and structure"-Provision of nutrition knowledge and skills; (2) "having all my bases covered"-Dietitians as part of a multidisciplinary team; (3) Challenges in nutritional treatment; and (4) "it was my treatment and my recovery"-Person-centred dietetic treatment. Across all identified themes was the cross-cutting theme of a shared treatment journey between the dietitian and the individual receiving treatment. These findings support dietitians having a role that is not limited only to the provision of nutrition treatment in ED care and illustrates the importance of dietitians engaging with clients by centring on the individual's needs and preferences. Further understanding helpful dietetic treatment components and identifying gaps in training is needed to develop these broader roles for dietetic care.
PubMed: 37998690
DOI: 10.3390/bs13110944 -
The Proceedings of the Nutrition Society Oct 2023The focus of nutritionists is on improvement of the health impact of current diets. Therefore, it is important to ask the question whether healthy diets are more... (Review)
Review
The focus of nutritionists is on improvement of the health impact of current diets. Therefore, it is important to ask the question whether healthy diets are more sustainable. This review provides an overview on the research on synergies between health and sustainability. Synergies are found from shifts from animal-based to plant-based diets, from ultra-processed foods to fresh and whole foods and from reduction of food waste. The importance of looking at sustainability of the present diets has led to steps made in Europe to incorporate sustainability into food-based dietary guidelines. Examples from UK, Nordics, Belgium and the Netherlands are given. World Wildlife Fund has summarised the insides in a future-proof diet: the planet-based diet within planetary boundaries.
PubMed: 37827993
DOI: 10.1017/S0029665123003737 -
Pediatric Nephrology (Berlin, Germany) Nov 2023The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments... (Review)
Review
The nutritional management of children with acute kidney injury (AKI) is complex. The dynamic nature of AKI necessitates frequent nutritional assessments and adjustments in management. Dietitians providing medical nutrition therapies to this patient population must consider the interaction of medical treatments and AKI status to effectively support both the nutrition status of patients with AKI as well as limit adverse metabolic derangements associated with inappropriately prescribed nutrition support. The Pediatric Renal Nutrition Taskforce (PRNT), an international team of pediatric renal dietitians and pediatric nephrologists, has developed clinical practice recommendations (CPR) for the nutritional management of children with AKI. We address the need for intensive collaboration between dietitians and physicians so that nutritional management is optimized in line with AKI medical treatments. We focus on key challenges faced by dietitians regarding nutrition assessment. Furthermore, we address how nutrition support should be provided to children with AKI while taking into account the effect of various medical treatment modalities of AKI on nutritional needs. Given the poor quality of evidence available, a Delphi survey was conducted to seek consensus from international experts. Statements with a low grade or those that are opinion-based must be carefully considered and adapted to individual patient needs, based on the clinical judgment of the treating physician and dietitian. Research recommendations are provided. CPRs will be regularly audited and updated by the PRNT.
Topics: Humans; Child; Kidney; Acute Kidney Injury; Nutritional Support; Nutritional Status; Nutrition Assessment
PubMed: 36939914
DOI: 10.1007/s00467-023-05884-3 -
Contemporary Clinical Trials Dec 2023Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this...
BACKGROUND
Latino families are disproportionately affected by type 2 diabetes (T2D) and lifestyle intervention is the first-line approach for preventing T2D. The purpose of this study is to test the efficacy of a culturally-grounded lifestyle intervention that prioritizes health promotion and diabetes prevention for Latino families. The intervention is guided by a novel Family Diabetes Prevention Model, leveraging the family processes of engagement, empowerment, resilience, and cohesion to orient the family system towards health.
METHOD
Latino families (N = 132) will be recruited and assessed for glucose tolerance as measured by an Oral Glucose Tolerance Test (OGTT) and General and Weight-Specific Quality of Life (QoL) at baseline, four months, and 12 months. All members of the household age 10 and over will be invited to participate. Families will be randomized to the intervention group or a control group (2:1). The 16-week intervention includes weekly nutrition and wellness classes delivered by bilingual, bicultural Registered Dietitians and community health educators at a local YMCA along with two days/week of supervised physical activity classes and a third day of unsupervised physical activity. Control families will meet with a physician and a Registered Dietitian to discuss the results of their metabolic testing and recommend lifestyle changes. We will test the efficacy of a family-focused diabetes prevention intervention for improving glucose tolerance and increasing QoL and test for mediators and moderators of long-term changes.
CONCLUSION
This study will provide much needed data on the efficacy of a family-focused Diabetes Prevention Program among high-risk Latino families.
Topics: Humans; Diabetes Mellitus, Type 2; Glucose; Health Promotion; Hispanic or Latino; Quality of Life; Randomized Controlled Trials as Topic; Family
PubMed: 37852533
DOI: 10.1016/j.cct.2023.107361 -
Cureus Oct 2023Ectodermal dysplasia (ED) is a rare genetic disorder that affects the developmental disturbance of ectoderm-derived tissues, organs, and accessory appendages, i.e. skin,...
Ectodermal dysplasia (ED) is a rare genetic disorder that affects the developmental disturbance of ectoderm-derived tissues, organs, and accessory appendages, i.e. skin, hair, tooth, nail, and sweat glands. ED has two types hypohidrotic or anhidrotic ectodermal dysplasia and hidrotic ectodermal dysplasia. We report this case of classical hypohidrotic ectodermal dysplasia (HED) with clubbing. The association of clubbing with HED is still rare. This case report aims to discuss the etiology, clinical manifestations, and management of ectodermal dysplasia. A multidisciplinary approach is required including dentists, nutritionists, dermatologists, and physicians to manage ectodermal dysplasia.
PubMed: 37927739
DOI: 10.7759/cureus.46530