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Nutrients Dec 2022Genetic components may play an important role in the regulation of nutrient and energy metabolism. In the presence of specific genetic variants, metabolic dysregulation... (Review)
Review
Genetic components may play an important role in the regulation of nutrient and energy metabolism. In the presence of specific genetic variants, metabolic dysregulation may occur, especially in relation to the processes of digestion, assimilation, and the physiological utilization of nutrients supplied to the body, as well as the regulation of various metabolic pathways and the balance of metabolic changes, which may consequently affect the effectiveness of applied reduction diets and weight loss after training. There are many well-documented studies showing that the presence of certain polymorphic variants in some genes can be associated with specific changes in nutrient and energy metabolism, and consequently, with more or less desirable effects of applied caloric reduction and/or exercise intervention. This systematic review focused on the role of genes encoding peroxisome proliferator-activated receptors (PPARs) and their coactivators in nutrient and energy metabolism. The literature review prepared showed that there is a link between the presence of specific alleles described at different polymorphic points in genes and various human body characteristics that are crucial for the efficacy of nutritional and/or exercise interventions. Genetic analysis can be a valuable element that complements the work of a dietitian or trainer, allowing for the planning of a personalized diet or training that makes the best use of the innate metabolic characteristics of the person who is the subject of their interventions.
Topics: Humans; Peroxisome Proliferator-Activated Receptors; Nutrients; Energy Metabolism; Diet; Alleles
PubMed: 36558537
DOI: 10.3390/nu14245378 -
Obesity Facts 2023Obesity affects nearly 1 in 4 European adults increasing their risk for mortality and physical and psychological morbidity. Obesity is a chronic relapsing disease...
European Association for the Study of Obesity Position Statement on Medical Nutrition Therapy for the Management of Overweight and Obesity in Adults Developed in Collaboration with the European Federation of the Associations of Dietitians.
INTRODUCTION
Obesity affects nearly 1 in 4 European adults increasing their risk for mortality and physical and psychological morbidity. Obesity is a chronic relapsing disease characterized by abnormal or excessive adiposity with risks to health. Medical nutrition therapy based on the latest scientific evidence should be offered to all Europeans living with obesity as part of obesity treatment interventions.
METHODS
A systematic review was conducted to identify the latest evidence published in the November 2018-March 2021 period and to synthesize them in the European guidelines for medical nutrition therapy in adult obesity.
RESULTS
Medical nutrition therapy should be administered by trained dietitians as part of a multidisciplinary team and should aim to achieve positive health outcomes, not solely weight changes. A diverse range of nutrition interventions are shown to be effective in the treatment of obesity and its comorbidities, and dietitians should consider all options and deliver personalized interventions. Although caloric restriction-based interventions are effective in promoting weight reduction, long-term adherence to behavioural changes may be better supported via alternative interventions based on eating patterns, food quality, and mindfulness. The Mediterranean diet, vegetarian diets, the Dietary Approaches to Stop Hypertension, portfolio diet, Nordic, and low-carbohydrate diets have all been associated with improvement in metabolic health with or without changes in body weight. In the November 2018-March 2021 period, the latest evidence published focused around intermittent fasting and meal replacements as obesity treatment options. Although the role of meal replacements is further strengthened by the new evidence, for intermittent fasting no evidence of significant advantage over and above continuous energy restriction was found. Pulses, fruit and vegetables, nuts, whole grains, and dairy foods are also important elements in the medical nutrition therapy of adult obesity.
DISCUSSION
Any nutrition intervention should be based on a detailed nutritional assessment including an assessment of personal values, preferences, and social determinants of eating habits. Dietitians are expected to design interventions that are flexible and person centred. Approaches that avoid caloric restriction or detailed eating plans (non-dieting approaches) are also recommended for improvement of quality of life and body image perceptions.
Topics: Adult; Humans; Overweight; Quality of Life; Nutritionists; Obesity; Nutrition Therapy
PubMed: 36521448
DOI: 10.1159/000528083 -
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 -
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 -
Journal of Human Nutrition and... Feb 2023There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This...
BACKGROUND
There is limited understanding of patients' and healthcare professionals' perceptions and experiences of receiving and delivering dietetic care, respectively. This systematic review of the literature used qualitative synthesis to explore the perceptions and experiences of multiple stakeholders involved in the delivery of nutrition care and dietetic service.
METHODS
MEDLINE, Embase, CINAHL, Cochrane Library, Scopus, ISI Web of Science, PsycINFO and ProQuest were systematically searched. Study characteristics and perceptions of stakeholders regarding nutrition care services were extracted. Qualitative synthesis was employed and thematic analysis conducted.
RESULTS
Five themes were identified from 44 studies related to stakeholders' perceptions of dietetic services. Studies included quantitative, qualitative and mixed methods involving patients, families, dietitians and other healthcare professionals. The themes were (1) patients desiring a personalised approach to nutrition care; (2) accessing dietetic service; (3) perceived impact of nutrition care on the patient; (4) relationships between stakeholders; and (5) beliefs about nutrition expertise. Two themes were specific to patients; these were the desire for individualised care and the impact of nutrition care. Within each theme perceptions varied with patients' views often contrasting with those of dietetic service providers.
CONCLUSIONS
Experiences of dietetic service do not always meet stakeholder expectations which impacts on patient engagement. Seeking stakeholder input is imperative to design dietetic services that engage patients in positive and supportive clinical partnerships.
Topics: Humans; Dietetics; Nutritional Status; Nutritionists; Health Personnel; Qualitative Research; Delivery of Health Care
PubMed: 35833488
DOI: 10.1111/jhn.13063