The obesity code: Book review

Dr. Jason Fung presents a novel, comprehensive model of obesity that delivers unexpected insights into healthy eating in this highly accessible and challenging book. Dr. Fung is a nephrologist (kidney doctor) who launched the Intensive Dietary Management program in Toronto. Dr. Jason Fung is regarded as a member of the foremost experts on intermittent fasting, a subject I knew very little about before going through his book. His intermittent fasting approach is his trademark prescription for obesity and type 2 diabetes individuals. Dr. Fung discusses utilizing intermittent fasting to end the cycle of insulin resistance and achieve a healthy weight

IMPACT OF DIET AND PHYSICAL ACTIVITY ON THE GLYCEMIC CONTROL OF DIABETIC CHILDREN: A REVIEW

Although there are lots of improvements are being done in the clinical care of the patients with Type 1 diabetes mellitus but still there is an increase in the prevalence, incidence, and mortality because of diabetes mellitus in children. Diabetes mellitus is a public health problem in both developed and developing countries. It has increased putting this disease in the dimension of an epidemic. Diabetes is associated with several complications which increase the risk of many serious health problems . Therefore, this review was aimed to discuss the antidiabetic effects of diet and physical activity (PA) on children by summarizing the signi?cant studies on this topic. This review found that several studies have been recommended that physical activity , exercise and dietary management are important criterion for the effective management of DM in children . PA is a non-pharmacologic therapy which is a signi?cant strategy for the management of TI DM and is an appropriate lifestyle modi?cation approach to be practiced by these patients. The studies showed that PA has antidiabetic effects which are evidenced by its substantial role in improving the blood glucose (BG) levels of the individuals with TI DM where it helps them to control their levels of glucose in the blood. It plays a signi?cant role in glycemic control . Finally, this review concludes that PA is the cornerstone in the management of T2DM. It also suggests that more attention is needed to its signi?cance in the prevention, glycemic control, and its role in the management of the morbidity and mortality associated with TIDM. Practical PA recommendations and suggestions for the future direction of research in this area are also provided.

Carbohydrate counting in type 1 diabetes mellitus: dietitians' perceptions, training and barriers to use

Objectives A study was undertaken to determine the perceptions, training and barriers regarding the use of carbohydrate counting in the dietary management of type 1 diabetes mellitus (T1DM) among dietitians in KwaZulu-Natal (KZN). Design A cross-sectional, descriptive study was conducted. Setting Dietitians who were registered with the Health Professions Council of South Africa (HPCSA), and working in the province of KZN at the time of the study, were invited to participate. Methods Data were collected using a self-administered electronic questionnaire distributed through SurveyMonkey, an Internet-based survey programme. Results Dietitians agreed that carbohydrate counting was a useful dietary management approach for diabetes (p < 0.05) and that it was essential to manage T1DM (p < 0.05). However, they felt it was a difficult concept for patients with T1DM to understand (p = 0.001) and teaching it to patients was time consuming (p < 0.05). Although dietitians believed that there was a strong evidence base for teaching carbohydrate counting to patients with T1DM (p < 0.05), they indicated a need for further training or education in it (p < 0.05). Barriers to using carbohydrate counting included a lack of training, confidence and experience, financial resources, time, blood glucose records and poor patient motivation and patient illiteracy (p < 0.05). Conclusions Overall, dietitians who participated in the study had a positive perception towards the use of carbohydrate counting in the management of T1DM. However, further training needs to be addressed for carbohydrate counting to be used with confidence by dietitians in KZN to optimize their management of T1DM.

Dietary management of one child with glycogen storage disease type I and severe hyperlipidemia / 中国实用护理杂志

Objective:To summarizes the diet management of one child with GSD I and severe hyperlipidemia.Methods:Key points of diet management include: making an individual diet plan, correcting parents' dietary misunderstanding, adjusting dietary and keeping following up regularly and keeping a food diary.Results:Following up for 11 months, the children basically formed a stable diet pattern, the blood glucose level was basically maintained between 4~6 mmol/L, the indicators of hyperlipidemia, hyperlactic acid and liver function were significantly improved compared with the previous period, and the height increase was guaranteed, while the weight gain was effectively controlled.Conclusions:It shows that individualized dietary guidance has a significant effect on the maintenance of blood glucose level, improvement of growth and development status and metabolic control in children with GSD I.

Application of Team Strategies & Tools to Enhance Performance and Patient Safety for hyperphosphatemic dietary management in outpatients on maintenance hemodialysis / 中国实用护理杂志

Objective To explore the effectiveness of Team Strategies & Tools to Enhance Performance and Patient Safety (TeamSTEPPS) in reducing hyperphosphatemia of outpatients on maintenance hemodialysis.Methods A total of 56 outpatients on hemodialysis received traditional dietary management from April to June,2016 were as control group,and 60 patients from October to December,2016 with TeamSTEPPS implemented in hyperphosphatemic dietary management were as observation group.The difference of the incidence rate of hyperphosphatemia and hypoproteinemia,grasp of knowledge of hyperphosphatemic dietary management were compared between two groups and medical staffs.Results The incidence rate of hyperphosphatemia were dropped from 60.7％(34/56) in control group to 41.7％(25/60) in observation group,difference between two groups had statistical significance(x2=4.20,P=0.036).The hypoproteinemia had no statistical difference between two group(x2=2.72,P=0.102),but still dropped from 39.3％ (22/56) in control group to 25.0％ (15/60) in observation group.Grasp of knowledge of hyperphosphatemic dietary management were rised from (75.1±5.1) points and (69.7 ±6.4)points in control group and medical staffs to (88.4±2.6) points and (80.1±6.5) points in observation group and medical staffs respectively,and there were significant differences(t=15.82,-8.84,P=0.00).Conclusions The application of TeamSTEPPS for hyperphosphatemic dietary management in outpatients on maintenance hemodialysis can effectively decrease the incidence of the hyperphosphatemia.

Hepatic Glycogen Storage Diseases Toward One Global Collaborative Network

Abstract The third international meeting of the Scandinavian Association for Glycogen Storage Disease focused on hepatic glycogen storage disease and was organized for health-care professionals, patient representatives, and representatives from the industry. This report highlights dilemmas in dietary management, differences in monitoring strategies, and challenges with rare disease care, research, and patient participation.

New outpatient mode based on mobile internet for pregnancy nutrition / 医疗卫生装备

Objective To explore a new outpatient mode for pregnancy nutrition to adapt to digital hospital.Methods The outpatient management mode and methods were analyzed for pregnancy nutrition.A new outpatient mode combining the technologies of mobile internet and remote monitoring was developed with consideration on standardization,and the effect of the new mode was discussed on pregnancy nutrition outpatient.Results Mobile internet technology and remote monitoring technology contributed to enhancing the efficiency of pregnancy nutrition outpatient,and facilitated the nutrition service of common pregnant women as well as the precision and individualized nutrition management of high-risk ones such as those with gestational diabetes mellitus.Conclusion The new outpatient mode enhances the doctor's efficiency and pregnancy care,and thus is worthy promoting practically.

Development of the dietary management evaluation instruments for diabetes mellitus patients / 中国实用护理杂志

Dietary management plays an important role in the diabetes mellitus therapies. Effective dietary management can find the deficit of dietary management in patients with diabetes mellitus. Recently these tools primarily were consisted in the comprehensive diabetes mellitus management instruments and a fraction of the ones aim at the evaluation of the dietary management for diabetes. Timely and effective assessment of the effect on diabetes diet management depends on these tools. Therefore, the feasibilities, usefulness and deficit about these instruments were analyzed to prompt the application and investigation of the instruments in the future.

Structured Dietary Management Dramatically Improves Marked Transaminitis, Metabolic and Clinical Profiles in Glycogen Storage Disease Type IXa

Abstract Glycogen storage disease type IXa (GSD IXa) presents in childhood with hepatomegaly, poor growth, and ketotic hypoglycemia. Clinical course is usually mild, often not requiring treatment with attenuation of symptoms with increasing age. The phenotypic spectrum has recently expanded to include more severe involvement with hepatic fibrosis or cirrhosis warranting dietary therapy. We report a 2-year-old boy with a severe phenotype of GSD IXa presenting with a massive hepatomegaly, significant transaminitis, recurrent ketotic hypoglycemia, and short stature. Aggressive dietary management with regular feeds, frequent uncooked cornstarch doses, and protein supplementation resulted in clinical improvements including enhanced growth velocity, energy levels, overall well-being, and reduction in hepatomegaly with restitutions in biochemical parameters. We concur with a recent report which proposed that GSD IXa is not always a mild condition but instead part of an expanding phenotypic spectrum warranting intensive dietary management to optimize metabolic control and quality of life.

Effects of stepwise and fine-grained dietary management on the diet control of liver cirrhosis patients complicated with gastrointestinal hemorrhage / 中国实用护理杂志

Objective To evaluate the effects of stepwise and fine-grained dietary management on the diet control of liver cirrhosis patients complicated with gastrointestinal hemorrhage. Methods Eighty liver cirrhosis patients complicated with gastrointestinal hemorrhage were assigned to experimental group (41 cases) and control group(39 cases) by random digits table method. The patients in experimental group were treated with stepwise and fine-grained dietary management and the patients in control group were given conventional dietary treatments. The compliance diet, mastery of nutrition knowledge, malnutrition risk at admission, intake food, discharge and 2 months after discharge between two groups were monitored. The incidence of rebleeding was tracked after 1 year of discharge. Results The incidence of malnutrition risk in Child-Pugh class C was higher than that in Child-Pugh class B( Z=-4.3, P<0.05 ) . The incidence of malnutrition risk in patients with high education level was lower than that in patients with lower education( r=-0.453, P<0.05 ). The experimental group significantly outperformed control group in mastery of nutrition knowledge at discharge:80(70, 84) points vs. 52(42, 64) points, in compliance diet and malnutrition risk after 2 months after discharge:86(76, 91)%vs. 53(46,57)%, 1(1, 2) points vs. 2(1,3) points, the rebleeding rate in experimental group was significantly less than that in control group within 1 year after discharge 14.6%(6/41) vs. 35.9%(14/39), and the differences were statistically significant between two groups ( χ2 = 4.226- 51.232, all P < 0.05 ). Conclusions Stepwise and fine-grained dietary management can improve the mastery of nutrition knowledge, compliance diet and nutritional status, and reduce the occurrence of rebleeding, worth popularizing further in clinical care of liver cirrhosis patients complicated with gastrointestinal hemorrhage.

Dietary inflammatory index is associated with serum C-reactive protein and protein energy wasting in hemodialysis patients: A cross-sectional study

BACKGROUND/OBJECTIVE: Malnutrition and inflammation are reported as the most powerful predictors of mortality and morbidity in hemodialysis (HD) patients. Diet has a key role in modulating inflammation and dietary inflammatory index (DII) is a new tool for assessment of inflammatory potential of diet. The aim of this study was to evaluate the application of DII on dietary intake of HD patients and examine the associations between DII and malnutrition-inflammation markers. SUBJECTS/METHODS: A total of 105 subjects were recruited for this cross-sectional study. Anthropometric measurements, 3-day dietary recall, and pre-dialysis biochemical parameters were recorded for each subject. Subjective global assessment (SGA), which was previously validated for HD patients, and malnutrition inflammation score (MIS) were used for the diagnosis of protein energy wasting. DII was calculated according to average of 3-day dietary recall data. RESULTS: DII showed significant correlation with reliable malnutrition and inflammation indicators including SGA (r = 0.28, P < 0.01), MIS (r = 0.28, P < 0.01), and serum C-reactive protein (CRP) (r = 0.35, P < 0.001) in HD patients. When the study population was divided into three subgroups according to their DII score, significant increasing trends across the tertiles of DII were observed for SGA score (P = 0.035), serum CRP (P = 0.001), dietary energy (P < 0.001), total fat (P < 0.001), saturated fatty acids (P < 0.001), polyunsaturated fatty acids (P = 0.006), and omega-6 fatty acids (P = 0.01) intakes. CONCLUSION: This study shows that DII is a good tool for assessing the overall inflammatory potential of diet in HD patients.

The Impact of Low Adherence to the Low-iodine Diet on the Efficacy of the Radioactive Iodine Ablation Therapy

To improve the efficacy of radioactive iodine (RAI) therapy for differentiated thyroid cancer patients, a low-iodine diet (LID) prior to the therapy is recommended. In iodine-rich areas such as Korea, however, a strict LID is very difficult to maintain. We experienced the cases of three patients showing low adherence to the LID before initial RAI therapy, and analyzed the main food source supplying iodine during the LID, and examined the influence of the poorly maintained LID on the efficacy of RAI therapy. The dietary intake during the LID periods were assessed using three-day dietary records and remnant thyroid activity after the second RAI administration was also evaluated. All patients' mean daily iodine intake during two-week LID periods exceeded the 100 microg guideline set by the Korean Thyroid Association (median 110.9 microg, ranges 100.4-117.0 microg). Although the typical food sources of iodine intake are seaweeds in Korea, salted vegetables were the main contributor to the patients' iodine intake during the LID periods. Remnant thyroid activity was shown on a follow-up scan in all of 3 patients suggesting low efficacy of RAI therapy. In summary, the patients with low adherence to the LID guideline showed unsuccessful remnant ablation, and the main food source of iodine was salted vegetables. Further studies are necessary to examine the relationship between adherence of the LID and RAI efficacy according to dietary iodine intake levels, as well as food sources that cause low adherence to the LID. These data can then be used to develop more practical LID guidelines.

Doença Celíaca no município de São Paulo: a disponibilidade de um mercado específico / Celiac Disease in São Paulo: the availability of a specific market

Celiac Disease is a genetic enteropathy characterized by permanent intolerance to gluten. Specific and restrictive, gluten-free diet may present a growing demand for products such as breads, pasta, sausages and beverages with special formulations. Whereas no similar studies were found in the literature, the aims of this investigation were to identify the repertoire of gluten-free products available in the market of São Paulo and to estimate the cost difference between a diet consisting of conven¬tional products and other with gluten-free products. Characterized as an exploratory qualitative and quantitative study, it was based on market research. Visits were made to specialty stores in areas of higher population density and/or that concentrate the largest number of establishments in São Paulo. Interviews were carried out with members of associations, universities, hospitals or research and treatment centers of celiac disease. The interview was semi-structured with open questions approaching aspects of the market of gluten-free products and celiac disease. Data analysis was obtained by calculating the percentage difference between the products found and formulated diets. The gluten-free diet represents a significant impact on the cost of food, especially when it contains products such as pasta and flour. In São Paulo, a diet with gluten-free products can be approximately 44% more expensive than a diet with conventional products.

La enfermedad celíaca es una enteropatía de origen genético caracterizada por la intolerancia permanente al gluten. Específica y restrictiva, la dieta del enfermo celíaco puede presentar una demanda creciente de productos tales como panes, pastas, embutidos y bebidas alcohólicas con formulaciones especiales. Considerando que no se encontraron estudios similares en la literatura, los objetivos de esta investigación fueron: identificar el repertorio de productos sin gluten disponibles en el mercado paulistano y estimar la diferencia de coste entre una dieta constituida de productos convencionales y otra sin gluten. Caracterizándose como un estudio exploratorio de tipo cualitativo y cuantitativo, se fundamentó en un estudio de mercado. Se realizaron visitas a las tiendas especializadas en las regiones de mayor densidad poblacional y/o que concentran el mayor número de establecimientos en el municipio de São Paulo, y se entrevistó a los responsables de asociaciones, Universidades, Hospitales o Centros de investigación y tratamiento de enfermos Celíacos. Al responsable se le realizó una entrevista semi-estructurada con preguntas abiertas, donde se abordaban aspectos del mercado de productos sin gluten y de la enfermedad celíaca. El análisis de los datos se obtuvo mediante el cálculo de la diferencia porcentual entre los productos encontrados y las dietas preparadas. La dieta sin gluten representa un impacto significativo en el coste alimenticio, especialmente cuando contiene productos como pasta y harina. En la ciudad de São Paulo, una dieta con productos sin gluten puede ser aproximadamente 44% más cara que una dieta con productos convencionales.

Doença Celíaca é uma enteropatia de origem genética, caracterizada pela intolerância permanente ao glúten. Específica e restritiva, a dieta do Celíaco pode apresentar uma demanda crescente de produtos, como pães, massas, embutidos e bebidas alcoólicas com formulações especiais. Considerando-se que não foram encontrados estudos semelhantes na literatura, os objetivos desta investigação foram identificar o repertório de produtos livres de glúten disponíveis no mercado paulistano e estimar a diferença de custo entre uma dieta constituída de produtos convencionais e outra isenta de glúten. Caracterizando-se como um estudo qualitativo e quantitativo exploratório, fundamentou-se em uma pesquisa de mercado. Foram realizadas visitas a lojas especializadas nas regiões de maior densidade demográfica e/ou que concentram maior número de estabelecimentos no município de São Paulo, e entrevistas com os responsáveis por associações, Universidades, Hospitais ou Centros de Investigação e Tratamento de Celíacos. Com o responsável, foi realizada uma entrevista semiestruturada com perguntas abertas, abordando aspectos sobre o mercado de produtos sem glúten e a Doença Celíaca. A análise dos dados foi obtida a partir do cálculo da diferença percentual entre os produtos encontrados e as dietas elaboradas. A dieta isenta de glúten representa um impacto significativo no custo com alimentação, especial¬mente quando contém produtos como macarrão e farinhas. Na cidade de São Paulo, uma dieta com produtos livres de glúten pode ser aproximadamente 44% mais cara do que uma dieta com produtos convencionais.

Obesity in children & adolescents.

Worldwide, obesity trends are causing serious public health concern and in many countries threatening the viability of basic health care delivery. It is an independent risk factor for cardiovascular diseases and significantly increases the risk of morbidity and mortality. The last two decades have witnessed an increase in health care costs due to obesity and related issues among children and adolescents. Childhood obesity is a global phenomenon affecting all socio-economic groups, irrespective of age, sex or ethnicity. Aetiopathogenesis of childhood obesity is multi-factorial and includes genetic, neuroendocrine, metabolic, psychological, environmental and socio-cultural factors. Many co-morbid conditions like metabolic, cardiovascular, psychological, orthopaedic, neurological, hepatic, pulmonary and renal disorders are seen in association with childhood obesity. The treatment of overweight and obesity in children and adolescents requires a multidisciplinary, multi-phase approach, which includes dietary management, physical activity enhancement, restriction of sedentary behaviour, pharmacotherapy and bariatric surgery. A holistic approach to tackle the childhood obesity epidemic needs a collection of activities including influencing policy makers and legislation, mobilizing communities, restructuring organizational practices, establishing coalitions and networks, empowering providers, imparting community education as well as enriching and reinforcing individual awareness and skills. The implications of this global phenomenon on future generations will be serious unless appropriate action is taken.

Tratamento de erros inatos do metabolismo: [revisão] / Treatment of inborn errors of metabolism: [review]

OBJETIVO: Esta revisão teve por objetivo abordar a situação atual do tratamento dos distúrbios do metabolismo intermediário (principalmente dos aminoácidos, ciclo da uréia e ácidos orgânicos) e das doenças relacionadas a duas organelas subcelulares (lisossomos e peroxissomos). FONTES DOS DADOS: Na abordagem do tratamento dos distúrbios do metabolismo intermediário, foi dada prioridade às principais formas de manejo da intoxicação, em virtude da importância para o pediatra do tratamento de quadros agudos e com risco de vida. O artigo apresenta também uma visão geral do tratamento das doenças lisossômicas e peroxissômicas, com ênfase na terapia de reposição enzimática, uma modalidade de tratamento de uso crescente com a qual o pediatra deve se familiarizar. SÍNTESE DOS DADOS: As principais medidas para manejo da intoxicação presente em muitos erros inatos do metabolismo intermediário foram apresentadas (restrição de aporte de substrato através da dieta ou através de inibição enzimática, remoção do produto tóxico, estímulo da atividade enzimática residual, reposição do produto deficiente). O material elaborado sobre terapia para doenças lisossômicas e peroxissômicas inclui tabelas informativas sobre os tratamentos disponíveis. CONCLUSÕES: O tratamento dos erros inatos do metabolismo é uma situação complexa e que deve ser abordada por uma equipe multidisciplinar, na qual o pediatra é peça-chave. Este capítulo contém informações práticas relativas ao manejo de alguns erros inatos do metabolismo e proporciona ao pediatra uma visão geral dos desenvolvimentos recentes ocorrido nessa área da medicina.

OBJECTIVE: To describe the current state of treatment for disorders of intermediate metabolism (primarily of amino acids, urea cycle and organic acids) and for diseases related to two subcellular organelles (lysosomes and peroxisomes). SOURCES: In covering the treatment of disorders of intermediate metabolism, priority was given to the most important methods for managing intoxication, in view of the importance for pediatricians to treat acute and life-threatening cases. The article also provides a general overview of the treatment for lysosomal and peroxisomal diseases, with emphasis on enzyme replacement therapy, which is a treatment modality that is growing in use and with which pediatricians should make themselves familiar. SUMMARY OF THE FINDINGS: The most important measures used to manage the intoxication present in many inborn errors of intermediate metabolism were presented (restriction of substrate build-up by means of diet or enzymatic inhibition, removal of toxic products, stimulation of residual enzyme activity, replacement of the deficient product). The section on treatment for lysosomal and peroxisomal diseases includes tables providing information on the treatments available. CONCLUSIONS: Treating inborn errors of metabolism is a complex task that should be performed by a multidisciplinary team of which the pediatrician is the key member. This article provides practical information relating to the management of some inborn errors of metabolism and provides pediatricians with a general overview of recent developments in this area of medicine.

Dietary and nutrition management in chronic kidney disease / 中国实用内科杂志

With high incidence and prevalence,high costs and poor outcome.Optimal dietary and nutrition management is an essential part in managing chronic kidney disease (CKD) and is associated with better patient outcome.An appropriate dietary and nutrition management should be based on chronic disease management model,provided by a multidisciplinary team,and implemented continuously with patient education,evaluation and goal-setting,and finally improve patients' clinical outcomes.