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Clinical Nutrition ESPEN Dec 2022Treatments for Gastroesophageal Reflux Disease (GERD) symptoms include pharmaceutical, surgical, dietary, and lifestyle behaviors; however, dietary interventions lack... (Meta-Analysis)
Meta-Analysis
What is the efficacy of dietary, nutraceutical, and probiotic interventions for the management of gastroesophageal reflux disease symptoms? A systematic literature review and meta-analysis.
BACKGROUND
Treatments for Gastroesophageal Reflux Disease (GERD) symptoms include pharmaceutical, surgical, dietary, and lifestyle behaviors; however, dietary interventions lack evidence synthesis.
RESEARCH QUESTION
What is the effect of dietary, probiotic, and nutraceutical interventions on GERD symptoms, with or without pharmaceutical therapy, in adults with a history of GERD or functional dyspepsia compared to no intervention, placebo, or usual care?
METHOD
A systematic review and meta-analysis was performed according to PRISMA. The search strategy was implemented in MEDLINE, CINAHL, CENTRAL, and Embase on the 28th October 2020 and updated to 27th July 2021. Intervention studies were eligible if they evaluated the effect of a dietary, nutraceutical, or probiotic intervention on GERD symptoms in adults with a history of GERD or functional dyspepsia. The internal validity of studies was assessed using the Academy Quality Criteria Checklist; Review Manager software was used to perform meta-analysis; and certainty in the body of evidence was assessed using GRADE.
RESULTS
6,608 study records were retrieved from the search, with 21 studies (n = 24 highly heterogenous intervention groups) included (n = 10 restrictive dietary interventions; n = 3 non-restrictive dietary interventions; n = 8 nutraceutical interventions; and n = 3 probiotic interventions). GERD symptoms were clinically and statistically improved by a test-based elimination diet (n = 1 study), low nickel diet (n = 1 study), probiotic yoghurt (n = 1 study), psyllium husk (n = 1 study), prickly pear and olive leaf extract supplement (n = 1 study), and melatonin, amino acid and b-group vitamin supplement (n = 1 study) according to qualitative synthesis. Ginger-containing supplements could be meta-analyzed, and improved incidence of GERD symptom alleviation (n = 2 studies, OR: 7.50 [95%CI: 3.62-15.54], GRADE: high). No clinically and/or statistically significant effects were found for the remaining n = 16 highly heterogenous interventions.
CONCLUSION
Evidence to guide the dietary management of GERD symptoms is limited in scope, quality, and feasibility. Based on the limited evidence available, dietary GERD management should be long-term, individualized, and consider both dietary restrictions and/or additions.
PROSPERO ID
CRD42021224082.
Topics: Adult; Humans; Dyspepsia; Probiotics; Gastroesophageal Reflux; Dietary Supplements; Diet; Pharmaceutical Preparations
PubMed: 36513474
DOI: 10.1016/j.clnesp.2022.09.015 -
Obesity Facts 2023This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened...
INTRODUCTION
This position statement on medical nutrition therapy in the management of overweight or obesity in children and adolescents was prepared by an expert committee convened by the European Association for the Study of Obesity (EASO) and developed in collaboration with the European Federation of the Associations of Dietitians (EFAD).
METHODS
It is based on the best evidence available from systematic reviews of randomized controlled trials on child and adolescent overweight and obesity treatment and other relevant peer-reviewed literature.
RESULTS
Multicomponent behavioural interventions are generally considered to be the gold standard treatment for children and adolescents living with obesity. The evidence presented in this position statement confirms that dietary interventions can effectively improve adiposity-related outcomes. Dietary strategies should focus on the reduction of total energy intake through promotion of food-based guidelines that target modification of usual eating patterns and behaviours. These should target increasing intakes of nutrient-rich foods with a lower energy density, specifically vegetables and fruits, and a reduction in intakes of energy-dense nutrient-poor foods and beverages. In addition, higher intensity, longer duration treatments, delivered by interventionists with specialized dietetic-related skills and co-designed with families, are associated with greater treatment effects.
DISCUSSION
Such interventions should be resourced adequately so that they can be implemented in a range of settings and in different formats, including digital or online delivery, to enhance accessibility.
Topics: Child; Adolescent; Humans; Overweight; Pediatric Obesity; Nutritionists; Diet; Nutrition Therapy
PubMed: 36349767
DOI: 10.1159/000527540 -
FP Essentials Oct 2022A comprehensive geriatric assessment (CGA) is a systematic, multidisciplinary evaluation of older adult patients with the goal of identifying and managing geriatric...
A comprehensive geriatric assessment (CGA) is a systematic, multidisciplinary evaluation of older adult patients with the goal of identifying and managing geriatric conditions and syndromes. It focuses on various medical, social, and environmental issues. A CGA ideally is performed as an in-person outpatient visit, either in a clinical setting or the home of the patient. The physician, family members and/or caregivers, and a social worker are key contributors. Involvement of family members or caregivers particularly is important if cognitive issues or mood disorders are of concern. Physical therapists, occupational therapists, nurses, speech-language pathologists, dietitians, audiologists, and pharmacists also can provide additional expertise. Many questionnaires and assessment tools are available to simplify data gathering, including assessments of functional status, frailty, mobility, fall risk, nutritional status, polypharmacy, and cognition. These assessments can be completed by patients, family members, or caregivers with assistance from members of the medical team. CGAs should be guided by the Geriatric 5M's framework: mind, mobility, medications, multicomplexity, and matters most. A systematic review of these elements can help identify areas of need and requirements for support for older adult patients.
Topics: Aged; Caregivers; Geriatric Assessment; Humans; Nucleotidyltransferases; Polypharmacy
PubMed: 36201650
DOI: No ID Found -
Journal of Crohn's & Colitis Apr 2023The utility of real-world data is dependent on the quality and homogeneity of reporting. We aimed to develop a core outcome set for real-world studies in adult patients...
BACKGROUND AND AIMS
The utility of real-world data is dependent on the quality and homogeneity of reporting. We aimed to develop a core outcome set for real-world studies in adult patients with inflammatory bowel disease [IBD].
METHODS
Candidate outcomes and outcome measures were identified and categorised in a systematic review. An international panel including patients, dietitians, epidemiologists, gastroenterologists, nurses, pathologists, radiologists, and surgeons participated in a modified Delphi consensus process. A consensus meeting was held to ratify the final core outcome set.
RESULTS
A total of 26 panellists from 13 countries participated in the consensus process. A total of 271 items [130 outcomes, 141 outcome measures] in nine study domains were included in the first-round survey. Panellists agreed that real-world studies on disease activity should report clinical, endoscopic, and biomarker disease activity. A disease-specific clinical index [Harvey-Bradshaw Index, Partial Mayo Score, Simple Clinical Colitis Activity Index] should be used, rather than physician global assessment. In ulcerative colitis [UC], either the UC Endoscopic Index of Severity or the Mayo Endoscopic Score can be used, but there was no consensus on an endoscopic index for Crohn's disease, nor was there consensus on the use of the presence of ulcers. There was consensus on using faecal calprotectin and C-reactive protein. There was no consensus on the use of histology in real-world studies.
CONCLUSIONS
A core outcome set for real-world studies in IBD has been developed based on international multidisciplinary consensus. Its adoption will facilitate synthesis in the generation of real-world evidence.
Topics: Adult; Humans; Crohn Disease; Inflammatory Bowel Diseases; Colitis, Ulcerative; Endoscopy; Outcome Assessment, Health Care
PubMed: 36190188
DOI: 10.1093/ecco-jcc/jjac136 -
The Medical Journal of Australia Oct 2022To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review recent published trials of nutrition and dietary interventions for people with serious mental illness; to assess their effectiveness in improving metabolic syndrome risk factors.
STUDY DESIGN
Systematic review and meta-analysis of randomised and non-randomised controlled trials of interventions with a nutrition/diet-related component delivered to people with serious mental illness, published 1 January 2010 - 6 September 2021. Primary outcomes were weight, body mass index (BMI), and waist circumference. Secondary outcomes were total serum cholesterol, low-density lipoprotein (LDL) and high-density lipoprotein (HDL) cholesterol, triglyceride, and blood glucose levels.
DATA SOURCES
MEDLINE, EMBASE, PsycINFO, CINAHL, and CENTRAL databases. In addition, reference lists of relevant publications were examined for further additional studies.
DATA SYNTHESIS
Twenty-five studies encompassing 26 intervention arms were included in our analysis. Eight studies were at low or some risk of bias, seventeen were deemed to be at high risk. Eight of seventeen intervention arms found statistically significant intervention effects on weight, ten of 24 on BMI, and seven of seventeen on waist circumference. The pooled effects of nutrition interventions on metabolic syndrome risk factors were statistically non-significant. However, we identified small size effects on weight for interventions delivered by dietitians (five studies; 262 intervention, 258 control participants; standardised mean difference [SMD], -0.28; 95% CI, -0.51 to -0.04) and interventions consisting of individual sessions only (three studies; 141 intervention, 134 control participants; SMD, -0.30; 95% CI, -0.54 to -0.06).
CONCLUSIONS
We found only limited evidence for nutrition interventions improving metabolic syndrome risk factors in people with serious mental illness. However, they may be more effective when delivered on an individual basis or by dietitians.
PROSPERO REGISTRATION
CRD42021235979 (prospective).
Topics: Blood Glucose; Cholesterol; Humans; Lipoproteins, HDL; Lipoproteins, LDL; Mental Disorders; Metabolic Syndrome; Prospective Studies; Triglycerides
PubMed: 36183316
DOI: 10.5694/mja2.51680 -
Nutrients Sep 2022this systematic review aimed to assess the effects of dietary liberalization following tetrahydrobiopterin (BH) treatment on anthropometric measurements, nutritional... (Review)
Review
PURPOSE
this systematic review aimed to assess the effects of dietary liberalization following tetrahydrobiopterin (BH) treatment on anthropometric measurements, nutritional biomarkers, quality of life, bone density, mental health and psychosocial functioning, and burden of care in PKU patients.
METHODS
the PubMed, Cochrane, and Embase databases were searched on 7 April 2022. We included studies that reported on the aforementioned domains before and after dietary liberalization as a result of BH treatment in PKU patients. Exclusion criteria were: studies written in a language other than English; studies that only included data of a BH loading test; insufficient data for the parameters of interest; and wrong publication type. Both within-subject and between-subject analyses were assessed, and meta-analyses were performed if possible.
RESULTS
twelve studies containing 14 cohorts and 228 patients were included. Single studies reported few significant differences. Two out of fifteen primary meta-analyses were significant; BMI was higher in BH-treated patients versus controls ( = 0.02; standardized mean difference (SMD) (95% confidence interval (CI)) = -0.37 (-0.67, -0.06)), and blood cholesterol concentrations increased after starting BH treatment ( = 0.01; SMD (CI) = -0.70 (-1.26, -0.15)).
CONCLUSION
there is no clear evidence that dietary liberalization after BH treatment has a positive effect on anthropometric measurements, nutritional biomarkers, or quality of life. No studies could be included for bone density, mental health and psychosocial functioning, and burden of care.
Topics: Biopterins; Humans; Phenylalanine; Phenylketonurias; Quality of Life
PubMed: 36145250
DOI: 10.3390/nu14183874 -
Frontiers in Nutrition 2022Soy consumption has health benefits, but the relationship between soy and uric acid remains uncertain. This meta-analysis and systematic review evaluated the effects of...
BACKGROUND
Soy consumption has health benefits, but the relationship between soy and uric acid remains uncertain. This meta-analysis and systematic review evaluated the effects of soy intake on plasma uric acid.
METHODS
PubMed, Embase, CNKI, and the Cochrane Library were searched for studies evaluating the effects of soy, soy products, soy protein, and soy isoflavones on uric acid levels. The primary outcome was serum or plasma uric acid concentration. Study quality was evaluated by the Cochrane Collaboration and SYRCLE risk-of-bias tools.
RESULTS
A total of 17 studies were included. Qualitative analysis of three human clinical studies of acute effects revealed that soy consumption increased serum uric acid concentration; however, soy-derived products, including tofu, bean curd cake, and dried bean curd sticks, had no significant effect on serum uric acid. A meta-analysis of five long-term human studies (10 data sets) revealed that soy protein and soy isoflavones had no significant effects on uric acid levels [weighted mean difference (WMD) = -2.11; 95% confidence interval (CI): -8.78, 4.55; = 0.53]. However, most epidemiological data revealed that soy intake is inversely associated with uric acid levels. Meta-analysis of nine animal trials (29 data sets) revealed that soy protein and soy isoflavones significantly reduced serum uric acid concentrations (vs. controls; MD = -38.02; 95% CI: -50.60, -25.44; < 0.001).
CONCLUSION
Soy and its products have different effects on serum uric acid. Soy products like tofu, bean curd cake, and dried bean curd sticks could be high-quality protein sources for individuals with hyperuricemia or gout. It can be beneficial to nutritionists and healthcare decision-makers reconsider their conceptions about the relationship between soy and uric acid levels according to the latest and further scientific study results.
SYSTEMATIC REVIEW REGISTRATION
[www.crd.york.ac.uk/PROSPERO], identifier [CRD42022331855].
PubMed: 36118757
DOI: 10.3389/fnut.2022.975718 -
Obesity Reviews : An Official Journal... Nov 2022This systematic review with meta-analyses assessed the effects of total diet replacement (TDR) programs on mental well-being in clinical trial participants with a body... (Meta-Analysis)
Meta-Analysis Review
This systematic review with meta-analyses assessed the effects of total diet replacement (TDR) programs on mental well-being in clinical trial participants with a body mass index greater than or equal to 25 kg/m . TDR programs involve replacing all dietary requirements with nutritionally replete formula foods and are generally administered to induce rapid weight loss. To date, it is largely unclear what effects TDR programs may have on mental well-being, particularly in the long-term. To address this, we screened 25,976 references across six databases and extracted 35 publications. These 35 publications provided sufficient data to evaluate the effects of TDR programs on depression, anxiety, stress, positive affect, negative affect, vitality, role-emotional, social functioning, mental health, mental composite summary score, self-esteem, and general psychological health in 24 meta-analyses. Due to the lack of research comparing TDR programs to comparator groups, 22 of our 24 meta-analyses explored change in these mental well-being sub-domains over time in TDR programs without comparators. Specifically, we assessed the change from pre-diet (before the TDR program) to either post-diet (up to and including two months after the TDR program); and/or follow-up (more than two months after the TDR program). For depression and anxiety, we were also able to assess the change from pre-diet to mid-diet (which fell within two weeks of the diet half-way point). The remaining two meta-analyses assessed the difference in depression scores between a TDR group and a food-based comparator group from pre-diet to post-diet and from pre-diet to follow-up. Across all meta-analyses, our results found no marked adverse effects of TDR programs on any mental well-being sub-domain. In fact, clear improvements were observed for depression, anxiety, stress, vitality, role-emotional, and social functioning at post-diet. Interestingly, the improvements for depression, vitality and role-emotional were maintained at follow-up. All improvements were observed in meta-analyses without comparators. While the two comparator-based meta-analyses showed no difference between TDR programs and food-based diets in depression symptoms, there was low statistical power. For all meta-analyses containing three or more independent samples, we constructed prediction intervals to determine the range within which the mean of the true effects may fall for future populations. While these prediction intervals varied between sub-domains, we found that mean depression scores are only likely to increase (i.e., depression will worsen) in less than 3% of future TDR interventions which meet our inclusion/exclusion criteria. Taken together, we concluded that for adults with a body mass index greater than or equal to 25 kg/m , TDR programs are unlikely to lead to marked adverse effects on mental well-being. These findings do not support the exclusion of participants from trials or interventions involving TDR programs based on concerns that these programs may adversely affect mental well-being. In fact, by excluding these participants, they may be prevented from improving their metabolic health and mental well-being.
Topics: Adult; Anxiety; Depression; Diet; Humans; Mental Health; Self Concept
PubMed: 35997170
DOI: 10.1111/obr.13465 -
Journal of Human Nutrition and... Feb 2023The Australian 2021 Royal Commission identified that the dietetic workforce needs to grow in size and capacity to support nutrition care in older adults. However, little... (Meta-Analysis)
Meta-Analysis Review
Examining dietitians' knowledge, skills and attitudes regarding working with older adults in residential aged care facilities and home care services: An integrative review.
BACKGROUND
The Australian 2021 Royal Commission identified that the dietetic workforce needs to grow in size and capacity to support nutrition care in older adults. However, little is known about dietitians' knowledge, skills and attitudes (KSA) regarding working with older adults in residential aged care facilities (RACFs) or their homes. This review describes dietitians' KSA regarding older adults in RACFs and home care services.
METHODS
A systematic literature search was conducted in August 2021 to identify studies examining any aspect of dietitians or student dietitians' KSA working in RACFs and home care services. No restrictions were applied to methodological design, language, location or publication year. Studies were assessed for quality using the Johanna Briggs Institute Quality Appraisal Tools. Study findings were analysed thematically using meta-synthesis.
RESULTS
All 17 studies that met the inclusion criteria explored dietitians' attitudes towards their role, three studies examined perceived knowledge, although no studies objectively explored dietitians' skill levels. Five themes were developed inductively: (1) recognising their contribution as dietitians; (2) lacking clarity about the boundaries of their role; (3) all team members have a role to play in nutrition care; (4) assumptions and biases about working with older people; and (5) needing to build capacity in the workforce.
DISCUSSION
Dietitians have mixed attitudes about working in RACFs and home care services. Future directions include evaluating dietitians' role in RACFs, reviewing education and training and practical opportunities for student dietitians, and assessing the impact of more dietitian support on an older person's dietary intake and nutrition.
Topics: Aged; Humans; Australia; Dietetics; Home Care Services; Homes for the Aged; Nutritionists
PubMed: 35922141
DOI: 10.1111/jhn.13073 -
Obesity (Silver Spring, Md.) Sep 2022Behavioral weight management programs (BWMPs) for adults lead to greater weight loss at 12 months than minimal-intervention control treatments. However, there is... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
Behavioral weight management programs (BWMPs) for adults lead to greater weight loss at 12 months than minimal-intervention control treatments. However, there is considerable heterogeneity in the content of BWMPs and outcomes of treatment. This study assessed the contribution of individual components of BWMPs, using Bayesian component network meta-analysis.
METHODS
Randomized controlled trials of BWMPs in adults were identified (latest search: December 2019) and arms coded for presence or absence of 29 intervention components grouped by type, content, provider, mode of delivery, and intensity.
RESULTS
A total of 169 studies (41 judged at high risk of bias) were included in the main analysis. Six components had effect estimates indicating clinically significant benefit and credible intervals (CrIs) excluding no difference: change in diet (mean difference [MD] = -1.84 kg, 95% CrI: -2.91 to -0.80); offering partial (MD = -2.12 kg, 95% CrI: -3.39 to -0.89) or total meal replacements (MD = -2.63 kg, 95% CrI: -4.58 to -0.73); delivery by a psychologist/counselor (MD = -1.45 kg, 95% CrI: -2.81 to -0.06) or dietitian (MD = -1.31 kg, 95% CrI: -2.40 to -0.24); and home setting (MD = -1.05 kg, 95% CrI: -2.02 to -0.09).
CONCLUSIONS
Future program development should consider including these components; other approaches continue to warrant evaluation of effectiveness.
Topics: Adult; Bayes Theorem; Behavior Therapy; Bias; Humans; Network Meta-Analysis; Randomized Controlled Trials as Topic; Weight Loss
PubMed: 35918886
DOI: 10.1002/oby.23505