Nutrition and dietetics practice should be based on the highest-quality and most recent available evidence. Unfortunately, translating research to day-to-day practice often involves long lag times. ...Implementation science is an emerging field that evaluates methods that promote uptake of research findings into daily practice. Numerous theories and frameworks have been developed to provide guidance for implementation research and operationalization of recommendations. This paper provides a broad overview of implementation science and highlights frameworks such as the Normalization Process Theory that can be used by registered dietitian nutritionist (RDNs) to encourage systematic uptake of evidence into practice.
Mediterranean Diet (MD) is an eating pattern associated with multiple healthy benefits, including the conservation of skeletal muscle. Frailty is a major geriatric syndrome characterized by low ...muscle strength. The Hand Grip Strength (HGS) is the most frequently used indicator of muscle functional capacity for clinical purposes. The association between the adherence to the MD and HGS in elderly has not yet fully investigated. The goal of this study was to examine the association between the adherence to the MD and HGS in a not hospitalized elderly who participated in the project PERsonalised ict Supported Services for Independent Living and Active Ageing (PERSSILAA).
Eighty-four elderly women were consecutively enrolled (aged 60–85 years) in this cross-sectional observational study. Anthropometric measures were evaluated. A validated 14-item questionnaire PREDIMED (PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the MD. Dietary data were collected by a 7-day food records. Muscle strength was measured by HGS using a grip strength dynamometer (KERN & SOHN GmbH).
The majority of participants were overweight (46.4%). An average adherence to the MD was found in 52.4% of participants, while the minority of them showed a low adherence (21.4%). HGS > cut-point of 20 kg were found in 43 subjects (51.2%). According to the adherence to MD, 39% participants with HGS values higher than cut-point presented a high adherence score compared with 14% of those with lower values of HGS (p = 0.018). The participants with HGS > cut-point presented significantly higher PREDIMED score than those with HGS < cut-point (p < 0.001). Based on ROC curves, the most sensitive and specific cut-point for the PREDIMED score to predict HGS categories was ≥8. No evident correlations were observed between HGS and age, while HGS was negatively correlated with hip circumference (r = −0.233, p = 0.033) and BMI (r = −0.219, p = 0.045), and positively correlated with PREDIMED score (r = 0.598, p < 0.001). At binomial logistic regression analysis almost all 14-items of PREDIMED questionnaire were significantly associated with HGS adjusted for BMI. At multinomial logistic regression analysis to assess the association of the three classes of adherence to the MD with the HGS, after adjusting for BMI the lowest adherence to MD was associated with the lowest Odds Ratio of HGS (p < 0.001).
This study evidenced a positive association between the adherence to the MD and muscle strength in a sample of active elderly women, stratified according to the HGS > cut-point of 20 kg. Our study highlights the usefulness of the developing health services to detect and prevent age-associated decline in physical performance in elderly subjects by addressing nutritional and physical intervention.
Obesity is an emerging non-communicable disease associated with chronic low-grade inflammation and oxidative stress, compounded by the development of many obesity-related diseases, such as ...cardiovascular disease, type 2 diabetes mellitus, and a range of cancers. Originally developed for the treatment of epilepsy in drug non-responder children, the ketogenic diet (KD) is being increasingly used in the treatment of many diseases, including obesity and obesity-related conditions. The KD is a dietary pattern characterized by high fat intake, moderate to low protein consumption, and very low carbohydrate intake (<50 g) that has proved to be an effective and weight-loss tool. In addition, it also appears to be a dietary intervention capable of improving the inflammatory state and oxidative stress in individuals with obesity by means of several mechanisms. The main activity of the KD has been linked to improving mitochondrial function and decreasing oxidative stress. β-hydroxybutyrate, the most studied ketone body, has been shown to reduce the production of reactive oxygen species, improving mitochondrial respiration. In addition, KDs exert anti-inflammatory activity through several mechanisms, e.g., by inhibiting activation of the nuclear factor kappa-light-chain-enhancer of activated B cells, and the inflammatory nucleotide-binding, leucine-rich-containing family, pyrin domain-containing-3, and inhibiting histone deacetylases. Given the rising interest in the topic, this review looks at the underlying anti-inflammatory and antioxidant mechanisms of KDs and their possible recruitment in the treatment of obesity and obesity-related disorders.
The incidence of differentiated thyroid cancer has been increasing in the last decades all over the world. Such a steady growth cannot be entirely attributable to more intensive thyroid nodule ...screening and more sensitive diagnostic procedures. Several environmental factors have changed with sufficient rapidity in the same time frame and may represent credible candidates for this increase. They include modified iodine intake, lifestyle-associated risk factors, exposure to various toxic compounds, pollutants and xenobiotics, nutritional deficiencies, eating habits and comorbidities. Foremost, nutritional patterns have gained high interest as possible promoters and modifiable risk factors for thyroid cancer in recent years. The aim of this narrative review is to focus on the relationship between thyroid cancer and nutritional factors, dietary habits and obesity. Low iodine intake has been associated to increased risk of thyroid cancer, favoring the development of more aggressive histotypes. Moreover, correction of iodine deficiency can shift thyroid cancer subtypes toward less aggressive forms, without affecting the overall risk for cancer. Actually, evidence regarding the association between selenium and vitamin D deficiency and thyroid cancer is very limited, despite their well-known anti-cancer potentials, and the clinical usefulness of their supplementation is still uncertain in this setting. Albeit the relationship between single foods and thyroid cancer is difficult to examine, fish and iodine-rich foods, vegetables, and fruits might exert protective effects on thyroid cancer risk. Conversely, no clear association has been found for other foods to date. Lastly, a clear association between obesity and the risk of thyroid cancer, with more aggressive behavior, seems to emerge from most studies, likely involving variations in thyroid function and chronic inflammation mediated by cytokines, insulin, leptin and adiponectins. Although no definite association between dietary factors and thyroid cancer has been firmly established so far, some nutritional patterns, together with excessive weight, seem to play a relevant role in thyroid cancer carcinogenesis as well as in its severity and aggressiveness. These effects may play an additive role to the well-established one exerted by environmental carcinogens, such as pollutants and radiation exposure.
Resumen Antecedentes: los pacientes mayores no institucionalizados a los que se les prescribe un suplemento nutricional oral (SNO) suelen tener dificultades con el cumplimiento, lo que origina ...deterioro físico e incrementa el riesgo de desnutrición. Objetivo: evaluar la proporción de pacientes mayores de 60 años que mejoran su categorización de la versión completa del Mini Nutritional Assessment (MNA) desde el inicio hasta la visita final tras la intervención de un nutricionista en el seguimiento de pacientes desnutridos y con indicación de SNO a lo largo de 6 meses. Demostrar que la intervención de un nutricionista aporta mejoras a largo plazo en el estado nutricional de los pacientes desnutridos que están tomando un SNO. Resultados: la intervención nutricional mejoró significativamente el IMC (de 22,9 ± 4,5 a 24,0 ± 4,1; p = 0,001), y la puntuación MNA (de 14,7 ± 4,4 a 20,4 ± 5,8 p < 0,001) de los pacientes, así como su percepción de la salud (medida mediante una EVA). Conclusiones: el consejo nutricional proporcionado por un nutricionista en los pacientes que ewstán tomando un SNO, consiguió una elevada adherencia al tratamiento, lo que produjo una mejora en el estado nutricional de los pacientes.
Growing evidence reported that vitamin D deficiency is a common finding in obesity. Vitamin D status also seems to be sex-related, although little is known regarding this association. Therefore, the ...aim of this study was to investigate the sex-related differences of serum 25OH vitamin D (25OHD) concentrations across body mass index (BMI) classes and, if there were any differences, whether they could be explained by sex-related differences in body composition. We enrolled 500 subjects (250 males, age 37.4 ± 11.8 years; 250 females, age 36.6 ± 11.8 years). Body composition was assessed by bioelectrical impedance analysis (BIA) phase-sensitive system. Serum 25OHD concentration was quantified by a direct, competitive chemiluminescence immunoassay. Vitamin D deficiency was defined as a serum 25OHD concentrations < 20 ng/mL (50 nmol/L). Stratifying the sample population according to sex and BMI categories, 25OHD concentrations were significantly higher in males compared to females in all BMI classes and decreased along with the increase of BMI values. Females with vitamin D deficiency had higher fat mass (FM) % compared to males with vitamin D deficiency. The 25OHD concentrations inversely correlated with FM % in both sexes. In a multiple regression analysis model, sex, FM %, and BMI were predictive factors of 25OHD concentration. In conclusion, our study suggests that 25OHD concentrations were lower in females than males across all BMI categories. Given the tight correlation between 25OHD concentrations and FM %, it can be hypothesized that the lower 25OHD concentrations in females than males can be explained by the fact that females have a higher amount of fat than males.
Perioperative malnutrition is associated with increased complications and mortality following revision total joint arthroplasty (rTJA). Nutritional consultations are useful in characterizing patient ...nutritional status but are inconsistently utilized post rTJA. We sought: 1) to describe the prevalence of nutritional consultations post rTJA, 2) to determine if septic rTJA patients needed consultations more often, and 3) if a diagnosis of ‘malnutrition’ from the nutritionist conferred increased readmission rates.
A retrospective study of 2,697 rTJAs performed in a single institution over a 4-year period was performed. Patient demographics, reasons for rTJA, occurrences of nutritional consultation (indicated if body mass index < 20, malnutrition screening tool score ≥ 2, or poor oral intake postoperatively), specific nutritional diagnosis (according to 2020 Electronic Nutrition Care Process Terminology and 90-day readmission rates were recorded and analyzed). Rates of consultations and adjusted logistic regressions were calculated.
There were 501 patients (18.6%) who required nutritional consultations, with 55 (11.0%) of these patients receiving a ‘malnutrition’ diagnosis. Septic rTJA patients required significantly more nutritional consultations (P < .01) and were significantly more likely to have ‘malnutrition’ (P = .49). A diagnosis of malnutrition was associated with the highest odds of all-cause readmission (odds ratio (OR) = 3.89, P = .01), which was even higher than undergoing a septic rTJA.
Nutritional consultations occur frequently following rTJA. Patients who receive a diagnosis of ‘malnutrition’ through consultation are at significantly higher risk for readmission and require close follow-up. Future efforts are needed to further characterize these patients in order to identify as well as optimize them preoperatively.
Type 2 diabetes mellitus (T2DM) and obesity represent a global public health problem. Current nutritional recommendations focused on weight loss and overall dietary quality. However, there is no ...consensus on the optimal macronutrient composition of the diet, particularly for the long-term management of T2DM in subjects with obesity. An international panel of experts reviewed and critically appraised the updated literature published on the topic. This review primarily examines the evidence for areas of consensus and uncertainty about nutritional therapy in patients with T2DM and obesity. The aim of this article is to provide nutritional advice to manage these patients in clinical practice.
•Gender exerts an important influence on food preferences.•Gender difference between Trimethylamine N-oxide and Mediterranean diet in healthy adults.•Trimethylamine N-oxide allows an accurate ...monitoring of changes in dietary patterns.•Trimethylamine N-oxide allows an accurate monitoring of changes in dietary patterns.•Gender-specific cut-points of adherence to Mediterranean diet might help identifying subjects at high-risk for high levels of Trimethylamine N-oxide.
Sex exerts an important influence on food preferences. The Mediterranean diet (MD) is based on the common dietary characteristics and lifestyle behaviors of the Mediterranean countries. Trimethylamine N-oxide (TMAO), a marker of gut dysbiosis linked to the development of atherosclerosis and cardiovascular risk, is mainly dependent on dietary pattern and gut microbiota metabolism. The aim of this study was to evaluate the association between levels of TMAO and adherence to the MD as a function of sex.
We enrolled 144 healthy adults, of which 67 were men. Participants were 31.55 ± 6.19 y of age and had an average body mass index of 22.84 ± 1.51 kg/m2. TMAO levels were detected using high-performance liquid chromatography-mass spectrometry analysis. PREDIMED (PREvención con DIeta MEDiterránea Prevention with Mediterranean Diet) questionnaire was used to assess the adherence to the MD. Dietary data were collected by a 7-d food records. Receiver operator characteristic curve analysis was performed to determine the predictive values for PREDIMED score in detecting high TMAO values.
Compared with women, the men presented higher levels of TMAO (P < 0.001), lower adherence to the MD (P = 0.017) and higher energy intake. The men consumed a greater quantity of animal proteins, carbohydrates, and ω-3 polyunsaturated fatty acids, and less plant proteins and ω-6 polyunsaturated fatty acids than the women. At the receiver operator characteristic analyses, the lowest levels of TMAO were well predicted by a score of adherence of ≤10 in men and ≤9 in women (P < 0.001).
A clear sex difference was observed in the apparently novel association between levels of TMAO and MD in healthy adults. Although dietary intervention trials on large series population are mandatory, sex-specific cutpoints of adherence to MD might help identify individuals at high risk for high levels of TMAO who would benefit from personalized dietary interventions.
Background:
Political advocacy surrounding healthcare policy has become increasingly relevant as key platform issues focus on preventive care and the impact of nutrition on health outcomes. ...Contributions from individuals and political action committees are pivotal in determining the direction of political advocacy.
Objective:
This study aimed to examine the trends of political contributions of U.S. dietitians from the years 2003-2021.
Methods:
This study was a retrospective review using the 2003-2021 cycles of the U.S. Federal Election Commission (FEC) database. Contributions were filtered for occupation lines matching either “registered dietitian nutritionist,” “registered dietitian,” “rdn,” “rd,” “dietitian,” and “dietetic.” Each contribution is designated to a recipient committee associated with a political candidate, group, or political action committee. The party designations of these committees were used to catalog donations as “Republican,” “Democratic,” or “Independent.”
Results:
From 2003-2021, a total of 1,612 political contributions were made to ADAPAC/ANDPAC by self-identified dietitians. ADAPAC/ANDPAC then directed these donations, making a total of 1,372 contributions to Democratic (857) or Republican (514) candidates and only 1 donation to an independent candidate for a total of $1,685,977. Excluding contributions to ADAPAC/ANDPAC, from 2003-2021, a total of 115,407 individual dietetic contributions were made to Democratic (103,061), Republican (12,010), Independent (34), bipartisan/nonpartisan (1,896), Green (7), and Libertarian (8) candidates or committees. Individual contributions from individual dietitians to political parties totaled $3,148,371, with Democratic contribution dollar amount ($2,304,918) almost triple the Republican amount ($792,516).
Conclusion:
Dietitian political contributions in the U.S. have increased over the past two decades. Donations from dietitians are largely polarized and skewed towards the Democratic Party. Future studies are warranted to identify how this changes preventive care policies.
PDF
