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Nutrients Oct 2019In recent years, the gut microbiome has become a focal point of interest with growing recognition that a well-balanced gut microbiota composition is highly relevant to...
In recent years, the gut microbiome has become a focal point of interest with growing recognition that a well-balanced gut microbiota composition is highly relevant to an individual's health status and well-being. Its profile can be modulated by a number of dietary factors, although few publications have focused on the effects of what we drink. The present review performed a systematic review of trials and mechanistic studies examining the effects of tea consumption, its associated compounds and their effects on the gut microbiome. Registered articles were searched up to 10th September 2019, in the PubMed and Cochrane library databases along with references of original articles. Human trials were graded using the Jadad scale to assess quality. Altogether 24 publications were included in the main review-six were human trials and 18 mechanistic studies. Of these, the largest body of evidence related to green tea with up to 1000 mL daily (4-5 cups) reported to increase proportions of . Mechanistic studies also show promise suggesting that black, oolong, Pu-erh and Fuzhuan teas (microbially fermented 'dark tea') can modulate microbial diversity and the ratio of to . These findings appear to support the hypothesis that tea ingestion could favourably regulate the profile of the gut microbiome and help to offset dysbiosis triggered by obesity or high-fat diets. Further well-designed human trials are now required to build on provisional findings.
Topics: Bifidobacterium; Clinical Trials as Topic; Dysbiosis; Fermentation; Gastrointestinal Microbiome; Health Status; Humans; National Library of Medicine (U.S.); Plant Extracts; Polyphenols; PubMed; Tea; United States
PubMed: 31623411
DOI: 10.3390/nu11102364 -
PloS One 2019As a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage...
OBJECTIVE
As a result of unhealthy lifestyles, reduced numbers of healthcare providers are having to deal with an increasing number of diabetes patients. In light of this shortage of physicians and nursing staff, new concepts of care are needed. The aim of this scoping review is to review the literature and examine the effects of task delegation to non-physician health professionals, with a further emphasis on inter-professional care.
RESEARCH DESIGN AND METHODS
Systematic searches were performed using the PubMed, Embase and Google Scholar databases to retrieve papers published between January 1994 and December 2017. Randomised/non-randomised controlled trials and studies with a before/after design that described the delegation of tasks from physicians to non-physicians in diabetes care were included in the search. This review is a subgroup analysis that further assesses all the studies conducted using a team-based approach.
RESULTS
A total of 45 studies with 12,092 patients met the inclusion criteria. Most of the interventions were performed in an outpatient setting with type-2 diabetes mellitus patients. The non-physician healthcare professionals involved in the team were nurses, pharmacists, community health workers and dietitians. Most studies showed significant improvements in glycaemic control and high patient satisfaction, while there were no indications that the task delegation affected quality of life scores.
CONCLUSIONS
The findings of the review suggest that task delegation can provide equivalent glycaemic control and potentially lead to an improvement in the quality of care. However, this review revealed a lack of clinical endpoints, as well as an inconsistency between the biochemical outcome parameters and the patient-centred outcome parameters. Given the vast differences between the individual healthcare systems used around the world, further high-quality research with an emphasis on long-term outcome effects and the expertise of non-physicians is needed.
Topics: Biomarkers; Blood Glucose; Community Health Workers; Diabetes Mellitus, Type 2; Female; Glycated Hemoglobin; Glycemic Index; Humans; Male; Middle Aged; Nurse Practitioners; Nutritionists; Patient Satisfaction; Pharmacists; Physicians, Primary Care; Quality of Health Care; Quality of Life
PubMed: 31603900
DOI: 10.1371/journal.pone.0223159 -
The Lancet. Global Health Jun 2019Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Task sharing for the management of hypertension could be useful for understaffed and resource-poor health systems. We assessed the effectiveness of task-sharing interventions in improving blood pressure control among adults in low-income and middle-income countries.
METHODS
We searched the Cochrane Library, PubMed, Embase, and CINAHL for studies published up to December 2018. We included intervention studies involving a task-sharing strategy for management of blood pressure and other cardiovascular risk factors. We extracted data on population, interventions, blood pressure, and task sharing groups. We did a meta-analysis of randomised controlled trials.
FINDINGS
We found 3012 references, of which 54 met the inclusion criteria initially. Another nine studies were included following an updated search. There were 43 trials and 20 before-and-after studies. We included 31 studies in our meta-analysis. Systolic blood pressure was decreased through task sharing in different groups of health-care workers: the mean difference was -5·34 mm Hg (95% CI -9·00 to -1·67, I=84%) for task sharing with nurses, -8·12 mm Hg (-10·23 to -6·01, I=57%) for pharmacists, -4·67 mm Hg (-7·09 to -2·24, I=0%) for dietitians, -3·67 mm Hg (-4·58 to -2·77, I=24%) for community health workers, and -4·85 mm Hg (-6·12 to -3·57, I=76%) overall. We found a similar reduction in diastolic blood pressure (overall mean difference -2·92 mm Hg, -3·75 to -2·09, I=80%). The overall quality of evidence based on GRADE criteria was moderate for systolic blood pressure, but low for diastolic blood pressure.
INTERPRETATION
Task-sharing interventions are effective in reducing blood pressure. Long-term studies are needed to understand their potential impact on cardiovascular outcomes and mortality.
FUNDING
Wellcome Trust/DBT India Alliance.
Topics: Developing Countries; Health Personnel; Humans; Hypertension; Professional Role
PubMed: 31097278
DOI: 10.1016/S2214-109X(19)30077-4 -
The Journal of Spinal Cord Medicine Mar 2021Cardiovascular disease is one of the leading causes of mortality in individuals with spinal cord injury (SCI), highlighting the need for targeted risk minimization...
CONTEXT
Cardiovascular disease is one of the leading causes of mortality in individuals with spinal cord injury (SCI), highlighting the need for targeted risk minimization interventions.
OBJECTIVE
To determine the effect of dietary interventions on CVD risk in adults with SCI.
METHODS
A systematic literature review of studies investigating the impact of dietary intervention on CVD risk in SCI individuals was conducted according to the PRISMA statement. CASP checklists were used for critical appraisal, Academy of Nutrition and Dietetics Quality criteria checklist (QCC) for determining risk of bias and the GRADE approach to ascertain the quality of evidence of the outcomes. The results were reported descriptively.
RESULTS
A total of eight studies were included from the identified 862 articles. Dietary intervention strategies varied across all studies, as did the outcome measures. Adult learning theories were not considered. The lack of controlled trials (two only) meant that while some interventions proved useful, risk of bias was high. Outcome measures were assessed as low to very low quality again identifying that this area is highly under-researched.
CONCLUSION
Despite documented evidence of the benefits of diet on CVD risk reduction, this review has identified a dearth of research in SCI. Nonetheless, the review emphasizes the potential of diet in conjunction with exercise in minimizing CVD risk in SCI. Further good quality research backed by robust data collection, simple, actionable strategies and knowledge translation techniques are essential to ascertain the effects of dietary intervention in lowering CVD risk in SCI.
Topics: Adult; Cardiovascular Diseases; Diet; Exercise; Humans; Spinal Cord Injuries
PubMed: 30945998
DOI: 10.1080/10790268.2019.1592926 -
Nutrients Feb 2019Ramadan involves one month of fasting from sunrise to sunset. In this meta-analysis, we aimed to determine the effect of Ramadan fasting on weight and body composition. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Ramadan involves one month of fasting from sunrise to sunset. In this meta-analysis, we aimed to determine the effect of Ramadan fasting on weight and body composition.
METHODS
In May 2018, we searched six databases for publications that measured weight and body composition before and after Ramadan, and that did not attempt to influence physical activity or diet.
RESULTS
Data were collected from 70 publications (90 comparison groups, 2947 participants). There was a significant positive correlation between starting body mass index and weight lost during the fasting period. Consistently, there was a significant reduction in fat percentage between pre-Ramadan and post-Ramadan in people with overweight or obesity (-1.46 (95% confidence interval: -2.57 to -0.35) %, = 0.010), but not in those of normal weight (-0.41 (-1.45 to 0.63) %, = 0.436). Loss of fat-free mass was also significant between pre-Ramadan and post-Ramadan, but was about 30% less than loss of absolute fat mass. At 2⁻5 weeks after the end of Ramadan, there was a return towards, or to, pre-Ramadan measurements in weight and body composition.
CONCLUSIONS
Even with no advice on lifestyle changes, there are consistent-albeit transient-reductions in weight and fat mass with the Ramadan fast, especially in people with overweight or obesity.
Topics: Body Composition; Fasting; Humans; Islam; Weight Loss
PubMed: 30813495
DOI: 10.3390/nu11020478 -
Nutrients Feb 2019Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant...
Nutritional management is an important component of the treatment of pediatric overweight and obesity, but clinicians struggle to keep abreast with the abundant literature. Therefore, our aim is to provide a tool that integrates the current recommendations and clinical expertise to assist dietitians and other practitioners in their decision making about the nutritional management of pediatric overweight and obesity. To construct this practice-based evidence-informed framework, we conducted a systematic review of the guidelines on nutritional management of pediatric overweight or obesity in 2 databases and in the grey literature. We analyzed and synthesized recommendations of 17 guidelines. We selected the recommendations that were common to at least 30% of the guidelines and added by consensus the recommendations relevant to clinical expertise. Finally, we structured the framework according to the Nutritional Care Process in collaboration with a specialized team of dietitians who assessed its validity in clinical practice. The framework contributes to facilitate the integration of evidence-based practice for dietitians by synthesizing the current evidence, supporting clinical expertise, and promoting structured care following Nutrition Care Process model for children and adolescents with obesity.
Topics: Adolescent; Child; Humans; Nutrition Therapy; Overweight; Pediatric Obesity; Practice Guidelines as Topic
PubMed: 30744122
DOI: 10.3390/nu11020362 -
Healthcare (Basel, Switzerland) Feb 2019Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided individualized weight management counselling for... (Review)
Review
Effective, evidence-based strategies to prevent and treat obesity are urgently required. Dietitians have provided individualized weight management counselling for decades, yet evidence of the effectiveness of this intervention has never been synthesized. The aim of this study was to examine the effectiveness of individualized nutrition care for weight management provided by dietitians to adults in comparison to minimal or no intervention. Databases (Cochrane, CINAHL plus, MedLine ovid, ProQuest family health, PubMed, Scopus) were searched for terms analogous with patient, dietetics and consultation with no date restrictions. The search yielded 5796 unique articles, with 14 randomized controlled trials meeting inclusion criteria. The risk of bias for the included studies ranged from unclear to high. Six studies found a significant intervention effect for the dietitian consultation, and a further four found significant positive change for both the intervention and control groups. Data were synthesized through random effects meta-analysis from five studies (n = 1598) with weight loss as the outcome, and from four studies (n = 1224) with Body Mass Index (BMI) decrease as the outcome. Groups receiving the dietitian intervention lost an additional 1.03 kg (95% CI:-1.40; -0.66, < 0.0001) of weight and 0.43 kg/m (95% CI:-0.59, -0.26; < 0.0001) of BMI than those receiving usual care. Heterogeneity was low for both weight loss and BMI, with the pooled means varying from 1.26 to -0.93 kg and -0.4 kg/m² for weight and BMI, respectively, with the removal of single studies. This study is the first to synthesize evidence on the effectiveness of individualized nutrition care delivered by a dietitian. Well-controlled studies that include cost-effectiveness measures are needed to strengthen the evidence base.
PubMed: 30717197
DOI: 10.3390/healthcare7010020 -
Nutrition & Dietetics: the Journal of... Apr 2019Evidence of the effectiveness of dietetic consultation for the management of cardiovascular disease (CVD) risk factors has not been previously synthesised. A systematic... (Meta-Analysis)
Meta-Analysis
Effectiveness of dietetic consultation for lowering blood lipid levels in the management of cardiovascular disease risk: A systematic review and meta-analysis of randomised controlled trials.
AIM
Evidence of the effectiveness of dietetic consultation for the management of cardiovascular disease (CVD) risk factors has not been previously synthesised. A systematic review and four meta-analyses evaluated the effectiveness of dietetic consultation for lowering blood lipid levels in high-risk individuals in primary health-care settings.
METHODS
Of the 4860 records identified, 10 eligible randomised controlled trials (RCTs, n = 1530) were evaluated for reporting blood lipid outcomes following dietetic consultation (DN)-defined as at least one exclusive individual face-to-face consultation with a dietitian and comparators (C)-defined as no nutrition intervention or usual or minimal care provided by physicians and/or nurses.
RESULTS
DN groups were effective for lowering blood lipid levels across nine studies reporting total cholesterol (TC) and LDL; and across five of six studies reporting triglycerides (TG). Between-group differences were not consistently assessed, with significance levels reported in four studies all in favour of DN, P < 0.05. Meta-analyses for TC and LDL (seven studies) confirmed DN and C groups were equally effective, P > 0.05; and for TG (six studies) DN groups were significantly more effective than C groups, P < 0.05).
CONCLUSIONS
This review provides RCT evidence that dietetic counselling is effective for lowering TG levels and at least as effective as usual and minimal care for improving cholesterol levels in high-risk individuals in primary health care. However, more adequate reporting of methods and greater consistency in timing interventions and data collection will enhance the quality of the evidence and increase confidence in the health benefits of dietetic counselling for the management of CVD risk.
Topics: Biomarkers; Cardiovascular Diseases; Dyslipidemias; Humans; Lipids; Nutritional Support; Nutritionists; Randomized Controlled Trials as Topic; Referral and Consultation; Risk Assessment; Risk Factors; Treatment Outcome
PubMed: 30714668
DOI: 10.1111/1747-0080.12509 -
The International Journal of Pharmacy... Feb 2019The aim of this systematic review was to examine the characteristics of effective lifestyle modification interventions designed for patients with newly diagnosed type 2...
OBJECTIVES
The aim of this systematic review was to examine the characteristics of effective lifestyle modification interventions designed for patients with newly diagnosed type 2 diabetes mellitus (T2DM) in order to determine elements that have the potential to be delivered in the community pharmacy setting.
KEY FINDINGS
Seven studies, comprising three each of the interventions diet and structured education and one of supported exercise, were identified. Interventions were conducted in hospital diabetes clinics and clinics situated in both urban and rural areas. Interventions were delivered face to face by highly skilled personnel including physicians, nurses and dietitians. Duration of interventions ranged from 3 months to 5 years.
SUMMARY
Structured education and dietary interventions in newly diagnosed type 2 diabetes effectively controlled blood glucose levels without pharmacological intervention. Important characteristics included face to face, individualised and multicomponent interventions with a duration of at least 6 months. These characteristics demonstrate potential for delivery in a community pharmacy setting, given its current involvement in delivering face to face, individual services with diet and lifestyle components. Further research is required to provide evidence for ideal intervention duration and frequency as well as training requirements for pharmacists.
Topics: Blood Glucose; Community Pharmacy Services; Diabetes Mellitus, Type 2; Healthy Lifestyle; Humans; Patient Education as Topic; Pharmacies; Pharmacists; Treatment Outcome
PubMed: 30697864
DOI: 10.1111/ijpp.12512 -
European Review For Medical and... Dec 2018Several nutritional strategies for the management of psoriasis are promising. Even if recent data support that nutrition may play a pivotal role in prevention and...
OBJECTIVE
Several nutritional strategies for the management of psoriasis are promising. Even if recent data support that nutrition may play a pivotal role in prevention and co-treatment and despite patient's concerns regarding the best nutritional habits, the consensus regarding the nutritional strategies to be adopted lacks in clinical settings. In this manuscript, the effects of several nutritional strategies for psoriasis patients such as hypocaloric diet, vitamin D, fish oil, selenium, and zinc supplementation were systematically reviewed. Randomized controlled trials (RCTs) on beneficial botanical oral supplements were also included in the analysis.
MATERIALS AND METHODS
For each topic, a search was conducted in MEDLINE electronic databases for articles published in English between January 1, 1990 and September 2018. Two independent reviewers assessed and extracted the data. Only controlled clinical trials were selected.
RESULTS
The evidence regarding the current nutritional strategies for psoriasis patients were summarized and translated into a global, comprehensible recommendation.
CONCLUSIONS
Weight loss combined with a healthy lifestyle was shown to be very beneficial for patients with moderate to severe disease with a significant reduction of the Psoriasis Area and Severity Index (PASI) score. Currently, oral vitamin D supplementation for prevention or treatment of psoriasis in adults with normal vitamin D levels is not recommended; however, psoriasis patients with a deficit in plasma vitamin D levels are advised to complement with oral supplements to prevent psoriasis-related comorbidities. Instead of zinc, selenium, and omega 3 supplements have been proven beneficial for psoriasis patients. Among botanical species, Dunaliella bardawil (D. bardawil), Tripterygium wilfordii (T. wilfordii), Azadirachta indica (A. indica), Curcuma longa (C. longa), and HESA-A are the most beneficial. In conclusion, a close cooperation between nutritionists and dermatologists may be useful for the management of psoriasis.
Topics: Adult; Diet, Reducing; Dietary Supplements; Fish Oils; Humans; Psoriasis; Vitamin D; Vitamins
PubMed: 30556896
DOI: 10.26355/eurrev_201812_16554