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Journal of Renal Nutrition : the... Jun 2024Health literacy (HL) encompasses an individual's ability to access, understand, and integrate health-related information. Routine use of functional, critical, and... (Review)
Review
Health literacy (HL) encompasses an individual's ability to access, understand, and integrate health-related information. Routine use of functional, critical, and communicative HL screening questionnaires shows promise in identifying those at risk for poor clinical outcomes. Although it is evident that low levels of HL are associated with poor clinical outcomes in end-stage renal disease, it is unclear how varying HL levels are associated with nutrition-specific adherence. Here, we present a summary of literature published between 2018 and 2023 examining relationships between HL and nutrition-related adherence among individuals on hemodialysis. A positive association between higher HL scores and adherence to nutrition-related recommendations was found in this population. Based on these findings, screening for low levels of HL using validated tools should be integrated into standard practice for nutrition assessment. Future studies are warranted to explore the dietitian's role in improving HL and to develop a standardized measure for nutrition-related adherence.
PubMed: 38942339
DOI: 10.1053/j.jrn.2024.06.008 -
The American Journal of Clinical... Jun 2024Computed Tomography (CT) has an underutilized potential for evaluating body composition in clinical settings. Often conducted with intravenous contrast (IVC), CT scans...
Influence of weight-adjusted contrast enhancement on CT-derived skeletal muscle measures: A retrospective proof-of concept comparative study between Danish females and males.
BACKGROUND
Computed Tomography (CT) has an underutilized potential for evaluating body composition in clinical settings. Often conducted with intravenous contrast (IVC), CT scans yield unused body composition data due to unclear effects on skeletal muscle area (SMA), skeletal muscle index (SMI), and muscle density (SMD).
OBJECTIVE
This study investigates whether weight-adjusted IVC influences SMA, SMI, and SMD differently in female and male compared to non-contrast abdominal CT. Additionally, the study explores associations between contrast and non-contrast assessed SMA, SMI, SMD, and demographic factors.
METHODS
A comparative observational retrospective study was conducted on Danish patients who underwent consecutive four-phased contrast-enhanced abdominal CT scans (non-contrast, arterial, venous, and late venous phases). Muscle measures were evaluated using validated semi-automated threshold-based software by three independent raters.
RESULTS
The study included 72 patients (51 male, 21 female) with a mean age of 59 (55, 62) years. Weight-adjusted IVC increased SMA by up to 3.28 cm (CI: 2.58, 3.98) corresponding to 2.4% (1.8, 2.9) in late venous phase compared to non-contrast CT. Analysis between sexes showed no difference in the effects of IVC on SMA and SMI between female and male. However, females exhibited a higher increase in SMD during the venous by a mean of 1.7 HU 0.9; 2.5) and late venous phases with a mean HU of 1.80 (1.0; 2.6) compared to males. Multivariate regression analysis indicated an association between the differences in SMD and sex during venous (-1.38 , 95%CI: - 2.48, -0.48) and late venous phases (-1.23, 95% CI: -2.27, -0.19) CONCLUSION: Weight-adjusted IVC leads to increased SMA, SMI, and SMD. While SMA and SMI differences were consistent across the sexes, females exhibited a significantly higher SMD increase than male in the venous and late venous phases. Further investigations are necessary to determine the applicability of SMD as a muscle quality proxy in IVC CT scans.
PubMed: 38936776
DOI: 10.1016/j.ajcnut.2024.06.009 -
Journal of Human Nutrition and... Jun 2024Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of...
BACKGROUND
Persons living with dementia and informal caregivers are at a higher risk for malnutrition. Most caregivers are not experts at identifying nutritional complications of dementia. Therefore, we aimed to identify nutrition knowledge and challenges related to feeding and caring for persons with dementia to develop a meaningful intervention.
METHODS
A mixed-methods approach was used. Eight focus groups were conducted with caregivers of persons living with dementia (n = 28) and healthcare professionals (n = 23). Data was analysed using NVivo software. A questionnaire was administered to identify nutritional challenges. A modified food frequency questionnaire assessed food patterns of caregivers and persons with dementia. Results were compared to Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) dietary guidelines. Data were analysed using SPSS software.
RESULTS
Four major themes emerged: forgetting to eat, developing food aversions, strong preferences for sweets and weight changes. Findings revealed common strategies used to improve nutrition intake included cueing, supplements and quiet eating environment. Caregivers were impacted by stress leading to poorer food choices and exhaustion. Recommendations for a caregiver program made by participants included education, resources and support. Findings from the food frequencies questionnaire survey showed most participants had a lower dietary diversity compared to the MIND diet guidelines.
CONCLUSIONS
With both groups being more prone to malnutrition, this research shows that participants were less likely to obtain adequate nutrition for brain health. Additionally, caregivers are dealing with nutrition issues themselves and their person living with dementia. The findings support the need for registered dietitians to provide tailored nutrition interventions for these families.
PubMed: 38935854
DOI: 10.1111/jhn.13344 -
The American Journal of Gastroenterology Jun 2024Life-long adherence to gluten-free diet (GFD) and its assessment is essential for celiac disease (CeD) patients. We have developed and validated a tool for assessing...
OBJECTIVE
Life-long adherence to gluten-free diet (GFD) and its assessment is essential for celiac disease (CeD) patients. We have developed and validated a tool for assessing adherence to GFD which can be used by both physicians and dietitians.
DESIGN
Phase-I: Development, content validation and assessment of reliability of tool. Phase-II: Validation of tool against standard dietary evaluation (SDE) (gold standard), IgA anti-tissue transglutaminase antibody (IgA-anti-tTG Ab) and gluten immunogenic peptides in urine (Urine-GIP). Overall, 380 biopsy-confirmed CeD patients [Derivation-cohort: n=100(Phase:I), n=210(Phase:II) and Independent validation cohort, n=70)were recruited.
RESULTS
Of initial 90-point questionnaire, 84-items (CD-CAT.v1) were retained after content validation and pilot testing. In Phase:I, upon administering CD-CAT.v1on 100 patients, a comprehensive 35-items tool (CD-CAT.v2;α=0.86) was obtained after removing items with low test-retest reliability and item-rest correlation values. In Phase:II, upon administering CD-CAT.v2 on 210patients,22 items were removed having low correlation values (R<0.4) with SDE. Finally, a 13-item tool (CD-CAT.v3;α=0.84) was obtained with high criterion validity with SDE (r=0.806, p<0.001), moderate convergent validity with CDAT (r=0.602, p=0.007) and moderate to weak correlation with urine GIP (r=0.46, p=0.001) and IgA anti-tTG Ab (r=0.39, p=0.008), respectively. The final 13-item tool also strongly correlated with SDE (r=0.78, p<0.001) in an independent validation cohort of 70 CeD patients. Principal component analysis identified three relevant sub-scales with a cumulative-variance of 62%. The sensitivity and specificity of CD-CAT.v3 were 80% and 91%, respectively, with an area under curve of 0.905 with SDE. The obtained cut-off score of <19 from ROC-curve was further categorized as: 13=excellent,14-18=very good, 19-28=average and >28=poor adherence to GFD.
CONCLUSION
CD-CAT is a new and rapid tool for monitoring dietary adherence to GFD with high sensitivity and specificity which can be administered by both physicians and dietitians.
PubMed: 38934507
DOI: 10.14309/ajg.0000000000002911 -
Kidney Research and Clinical Practice Jun 2024Acute kidney disease (AKD) is a critical transitional period between acute kidney injury and chronic kidney disease. The incidence of AKD following acute kidney injury...
Acute kidney disease (AKD) is a critical transitional period between acute kidney injury and chronic kidney disease. The incidence of AKD following acute kidney injury is approximately 33.6%, and it can occur without identifiable preceding acute kidney injury. The development of AKD is associated with increased risks of chronic kidney disease, dialysis, and mortality. Biomarkers and subphenotypes are promising tools to predict prognosis in AKD. The complex clinical situations in patients with AKD necessitate a comprehensive and structured approach, termed "KAMPS" (kidney function check, advocacy, medications, pressure, sick day protocols). We introduce "MAND-MASS," an acronym devised to summarize the reconciliation of medications during episodes of acute illness, as a critical component of the sick day protocols at AKD. A multidisciplinary team care, consisting of nephrologists, pharmacists, dietitians, health educators, and nurses, is an optimal model to achieve the care bundle in KAMPS. Although the evidence for patients with AKD is still lacking, several potential pharmacological agents may improve outcomes, including but not limited to angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, mineralocorticoid receptor antagonists, sodium-glucose cotransporter 2 inhibitors, and glucagon-like peptide 1 receptor agonists. In conclusion, accurate prognosis prediction and effective treatment for AKD are critical yet unmet clinical needs. Future studies are urgently needed to improve patient care in this complex and rapidly evolving field.
PubMed: 38934037
DOI: 10.23876/j.krcp.23.289 -
Journal of Diabetes and Metabolic... Jun 2024Multiple mhealth (mobile health) interventions and mobile applications have been developed to support diabetes self-management. However, most of the apps are developed...
BACKGROUND
Multiple mhealth (mobile health) interventions and mobile applications have been developed to support diabetes self-management. However, most of the apps are developed without the need for assessment and evaluation by experts in the field. This study aimed to design and develop a mobile application (app) supporting diabetes self-management for people with Type 2 Diabetes Mellitus (T2D) using a systematic approach.
METHODS
In this study mixed method design was used to develop the mobile application. The mhealth intervention was designed and developed in five steps: i) Extensive literature search, ii) Needs assessment of patients with T2D with the help of healthcare providers and patients (Interviews with 15 healthcare providers like clinicians, dietitians, and diabetes educators, and 2 focus group discussions with patients) iii) Ideation and content development of app based on outcomes of needs assessment; iv) content validation (by 10 healthcare providers) and v) App development on a hybrid platform. Evaluation of the app by users i.e., type 2 diabetes patients was done using the users' Mobile App rating scale (uMARS). The app was evaluated by 40 patients and rated on the uMARS questionnaire.
RESULTS
A patient-centric mobile app was developed for the nutritional management of diabetes with three modules: The patient module, the Evaluation module, and the Healthcare provider module. The patient module was the app that was provided to the patients with features like diet, physical activity, blood glucose log, education, etc., in addition to, a symptom checker, Stress meter blog, and FAQ. The evaluation module was integrated with the app it works when a user enters any log, it evaluates the entry against the standard cutoffs and flash prompts on the screen. The Healthcare provider module interacts with the server to provide them with patient data, comments, and feedback.
CONCLUSIONS
The users found the app to be satisfactory. Incorporating additional features to enhance the user interface and streamline navigation could potentially enhance user engagement, thereby aiding in the management of T2D.
PubMed: 38932794
DOI: 10.1007/s40200-023-01339-6 -
Nutrients Jun 2024As ChatGPT becomes a primary information source for college students, its performance in providing dietary advice is under scrutiny. This study assessed ChatGPT's...
BACKGROUND
As ChatGPT becomes a primary information source for college students, its performance in providing dietary advice is under scrutiny. This study assessed ChatGPT's performance in providing nutritional guidance to college students.
METHODS
ChatGPT's performance on dietary advice was evaluated by 30 experienced dietitians and assessed using an objective nutrition literacy (NL) test. The dietitians were recruited to assess the quality of ChatGPT's dietary advice, including its NL achievement and response quality.
RESULTS
The results indicate that ChatGPT's performance varies across scenarios and is suboptimal for achieving NL with full achievement rates from 7.50% to 37.56%. While the responses excelled in readability, they lacked understandability, practicality, and completeness. In the NL test, ChatGPT showed an 84.38% accuracy rate, surpassing the NL level of Taiwanese college students. The top concern among the dietitians, cited 52 times in 242 feedback entries, was that the "response information lacks thoroughness or rigor, leading to misunderstandings or misuse". Despite the potential of ChatGPT as a supplementary educational tool, significant gaps must be addressed, especially in detailed dietary inquiries.
CONCLUSION
This study highlights the need for improved AI educational approaches and suggests the potential for developing ChatGPT teaching guides or usage instructions to train college students and support dietitians.
Topics: Humans; Students; Nutritionists; Universities; Female; Male; Health Literacy; Taiwan; Young Adult; Adult; Health Knowledge, Attitudes, Practice; Diet
PubMed: 38931294
DOI: 10.3390/nu16121939 -
Nutrients Jun 2024Kidney stone disease has a multifactorial etiology, and evolving dietary habits necessitate continuous updates on the impact of dietary components on lithogenesis. The... (Review)
Review
Kidney stone disease has a multifactorial etiology, and evolving dietary habits necessitate continuous updates on the impact of dietary components on lithogenesis. The relationship between diseases influenced by lifestyle, such as obesity and diabetes, and kidney stone risk underscores the need for comprehensive lifestyle analysis. Effective management of kidney stones requires a multidisciplinary approach, involving collaboration among nutritionists, urologists, nephrologists, and other healthcare professionals to address the complex interactions between diet, lifestyle, and individual susceptibility. Personalized dietary therapy, based on each patient's unique biochemical and dietary profile, is essential and necessitates comprehensive nutritional assessments. Accurate dietary intake evaluation is best achieved through seven-day, real-time dietary records. Key factors influencing urinary risk include fluid intake, dietary protein, carbohydrates, oxalate, calcium, and sodium chloride. Personalized interventions, such as customized dietary changes based on gut microbiota, may improve stone prevention and recurrence. Current research suggests individualized guidance on alcohol intake and indicates that tea and coffee consumption might protect against urolithiasis. There is potential evidence linking tobacco use and secondhand smoke to increased kidney stone risk. The effects of vitamins and physical activity on kidney stone risk remain unresolved due to mixed evidence. For diseases influenced by lifestyle, conclusive evidence on targeted interventions for nephrolithiasis prevention is lacking, though preliminary research suggests potential benefits. Management strategies emphasize lifestyle modifications to reduce recurrence risks, support rapid recovery, and identify predisposing conditions, highlighting the importance of these changes despite inconclusive data.
Topics: Humans; Kidney Calculi; Life Style; Risk Factors; Diet; Nutrition Assessment; Patient Care Team; Feeding Behavior
PubMed: 38931286
DOI: 10.3390/nu16121932 -
Nutrients Jun 2024Depression is a major global health concern expected to worsen by 2030. In 2019, 28 million individuals were affected by depressive disorders. Dietary and supplemental... (Review)
Review
Depression is a major global health concern expected to worsen by 2030. In 2019, 28 million individuals were affected by depressive disorders. Dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression. B vitamins are crucial for neurological function and mood regulation. Deficiencies in these vitamins are linked to depression. Studies on individual B vitamins show promise in improving depressive symptoms, particularly thiamin, riboflavin, niacin, and folate. Vitamin C deficiency may heighten depressive symptoms, but its exact role is not fully understood. Seasonal Affective Disorder (SAD) is associated with insufficient sunlight exposure and vitamin D deficiency. Vitamin D supplementation for SAD shows inconsistent results due to methodological variations. Further investigation is needed to understand the mechanisms of vitamins in depression treatment. Moreover, more research on SAD and light therapy's efficacy and underlying mechanisms involving photoreceptors, enzymes, and immune markers is needed. Although dietary and supplemental vitamins show overall favorable preventative and therapeutic effects on depression, dietitians treating psychiatric disorders face challenges due to diverse study designs, making direct comparisons difficult. Therefore, this article reviews the current literature to assess the role of dietary and supplemental vitamins in the prevention and treatment of depression. This review found that, although evidence supports the role of B vitamins and vitamins C and D in preventing and treating depression, further research is needed to clarify their mechanisms of action and determine the most effective intervention strategies.
Topics: Humans; Seasonal Affective Disorder; Vitamin D; Dietary Supplements; Vitamins; Depression; Adult; Ascorbic Acid; Vitamin B Complex; Vitamin D Deficiency; Female; Solubility
PubMed: 38931257
DOI: 10.3390/nu16121902 -
Nutrients Jun 2024Testing and evaluating athletes is necessary and should include performance, body composition, and nutrition. The purpose of this study was to report assessments of...
BACKGROUND
Testing and evaluating athletes is necessary and should include performance, body composition, and nutrition. The purpose of this study was to report assessments of dietary intake, V˙O, and body composition in D1 collegiate athletes and examine relationships between these assessments.
METHODS
Dietary intake was assessed with 3-day recalls and compared to recommendations, and body composition was assessed via bioelectrical impedance analysis (BIA) ( = 48). V˙O was evaluated using a graded exercise test (GXT) with a verification bout ( = 35). Reliability between "true" V˙O and verification was determined. Correlations and regressions were performed.
RESULTS
Energy, carbohydrate, and micronutrient intake was lower than recommendations. Mean V˙O was 47.3 and 47.4 mL·kg·min for GXT and verification, respectively. While correlations were apparent among dietary intake, V˙O, and body composition, percent fat-free mass (%FFM) predicted 36% of V˙O.
CONCLUSIONS
Collegiate athletes are not meeting energy and carbohydrate recommendations and exceed fat recommendations. Vitamin D and magnesium were low in all sports, and iron and calcium were low in females. V˙O ranged from 35.6 to 63.0 mL·kg·min, with females below average and males meeting typical values for their designated sport. Assessing D1 athletes can provide guidance for sports dietitians, coaches, and strength and conditioning specialists to track and monitor nutrition in athletes.
Topics: Humans; Female; Male; Body Composition; Athletes; Young Adult; Nutritional Status; Athletic Performance; Energy Intake; Oxygen Consumption; Universities; Adolescent; Electric Impedance; Dietary Carbohydrates; Nutrition Assessment; Exercise Test; Diet; Sports Nutritional Physiological Phenomena
PubMed: 38931251
DOI: 10.3390/nu16121896