RESUMO
BACKGROUND: Eosinophilic gastritis/gastroenteritis (EoG/EoGE) are rare disorders with pathologic gastric and/or small intestinal eosinophilia lacking an approved therapy. An allergic mechanism is postulated but underexplored mechanistically and therapeutically. OBJECTIVE: We evaluated the effectiveness of a food allergen-free diet (elemental formula) in controlling gastrointestinal eosinophilia in adult EoG/EoGE. METHODS: Adults aged 18 to 65 years with histologically active EoG/EoGE (≥30 eosinophils per high-power field) in the stomach and/or duodenum and gastrointestinal symptoms within the month preceding enrollment were prospectively enrolled onto a single-arm clinical trial to receive elemental formula for 6 consecutive weeks. The primary end point was percentage of participants with complete histologic remission (<30 eosinophils per high-power field in both stomach and duodenum). Exploratory outcomes were improvement in symptoms, endoscopy results, blood eosinophilia, quality of life, Physician Global Assessment score, and EoG-relevant gastric transcriptome and microbiome. RESULTS: Fifteen adults (47% male, average age 37.7 years, average symptom duration 8.8 years) completed the trial. Multi-gastrointestinal segment involvement affected 87%. All subjects had complete histologic remission in the stomach (P = .002) and duodenum (P = .001). Scores improved in overall PhGA (P = .002); EGREFS (P = .003); EGDP (P = .002); SODA pain intensity (P = .044), non-pain (P = .039), and satisfaction (P = .0024); and PROMIS depression (P = .0078) and fatigue (P = .04). Food reintroduction reversed these improvements. The intervention was well tolerated in 14 subjects, with 1 serious adverse event reported in 1 subject. CONCLUSION: An amino acid-based elemental diet improves histologic, endoscopic, symptomatic, quality-of-life, and molecular parameters of EoG/EoGE; these findings and disease recurrence with food trigger reintroduction support a dominant role for food allergens in disease pathogenesis. CLINICALTRIALS: gov Identifier: NCT03320369.
Assuntos
Enterite , Eosinofilia , Esofagite Eosinofílica , Hipersensibilidade Alimentar , Gastroenterite , Adulto , Masculino , Humanos , Feminino , Estudos Prospectivos , Aminoácidos , Qualidade de Vida , Enterite/patologia , Eosinofilia/tratamento farmacológico , Alérgenos/uso terapêutico , Alimentos FormuladosRESUMO
Dietary therapy for short- and long-term management of eosinophilic esophagitis is an effective yet poorly understood and underutilized treatment strategy. Despite several prospective trials demonstrating the efficacy of dietary therapies, successful clinical implementation is hampered by the need for a multidisciplinary approach including dietitian support and provider expertise. The availability of these resources is not readily available to most gastroenterologists. Without standardized guidance on starting or completing the diet for gastrointestinal providers and/or consulting dietitians, provider attitudes toward dietary therapy vary greatly depending on familiarity and knowledge gaps in using diet therapy. This review aims to summarize evidence in support of dietary therapy in eosinophilic esophagitis while providing guidance on initiation and implementation of dietary therapy for providers.
Assuntos
Alérgenos , Dieta de Eliminação , Esofagite Eosinofílica , Esofagite Eosinofílica/dietoterapia , Humanos , Alérgenos/efeitos adversos , Guias como AssuntoRESUMO
INTRODUCTION: Eosinophilic esophagitis (EoE) is an immune-mediated inflammatory condition with tissue eosinophilia resulting in esophageal dysfunction. The six-food elimination diet (SFED) is an EoE treatment approach that removes milk, wheat, soy, eggs, tree nuts/peanuts, and fish/shellfish. After histologic remission, food reintroduction occurs to identify a food trigger. Outcomes from large series of adults undergoing SFED and food reintroduction as clinical care are not known. METHODS: A retrospective review (2006-2021) of adult patients with EoE from an academic center was completed. Patients were classified as full responders (<15 eos/hpf) after SFED. If reintroduction was pursued, food triggers identified were recorded. RESULTS: Two hundred thirteen patients completed SFED. One hundred fifteen patients (54%) had response <15 eos/hpf after SFED. Seventy-seven percent of responders had symptom improvement. Thirty-two percent of initial nonresponders underwent repeat dietary elimination. Fifty-eight percent of patients (n = 123) achieved <15 eos/hpf after either initial or extended SFED. Seventy-eight percent of responders underwent food reintroduction. Sixty-nine percent had 1 food trigger identified, 24% had 2 allergens identified, and 4% had 3 allergens identified. The most common food triggers identified were milk, wheat, and soy. DISCUSSION: This study describes the largest cohort reported of adult patients with EoE completing SFED with food reintroduction. The overall SFED histologic response was 54%, which increased to 58% with 1 additional round of dietary therapy, suggesting that 31% may respond in a second attempt. Most patients who completed food reintroduction had a single food trigger identified. Dietary elimination with specific food trigger identification is a feasible alternative to medical therapy for adults with EoE.
Assuntos
Esofagite Eosinofílica , Hipersensibilidade Alimentar , Animais , Humanos , Esofagite Eosinofílica/diagnóstico , Hipersensibilidade Alimentar/diagnóstico , Estudos de Coortes , Dieta , OvosRESUMO
In this article, an expert team of 2 gastro-psychologists, a dietician, and an academic gastroenterologist provides insights into the psychological and social implications of evidence-based and "popular" dietary interventions in disorders of gut-brain interaction (DGBI). We focus on practical approaches for evaluating a patient's appropriateness for a dietary intervention, considering the nutritional, psychological, behavioral, and social context in which a patient may find themselves managing their DGBI with dietary intervention. We also discuss how to identify risk factors for and symptoms of avoidant/restrictive food intake disorder, a growing concern in the DGBI population.
Assuntos
Transtorno Alimentar Restritivo Evitativo , Gastroenterologistas , Gastroenteropatias , Nutricionistas , Gastroenteropatias/epidemiologia , Humanos , Fatores de RiscoRESUMO
BACKGROUND: Food-related quality of life (FRQoL) evaluates the impact of diet, eating behaviors, and food-related anxiety on a person's quality of life. This is the first study to evaluate FRQoL in inflammatory bowel disease (IBD) and irritable bowel syndrome (IBS), two illnesses where food and diet are of importance. METHODS: One hundred seventy-five participants (80 IBS, 95 IBD) participated in the study by completing measures evaluating FRQoL, psychological distress, and health-related quality of life. Primary analyses evaluated differences in FRQoL between IBD and IBS patients. Secondary analyses compared differences based on remission status, dietary use, and dietary consultation, as well as evaluated potential predictors of FRQoL. RESULTS: IBD patients in remission report the highest FRQoL (IBD-remission: 91.2 (26.5) vs. IBD-active: 67.7 (19.6) and IBS-active: 67.6 (18.3), p < .001). Using more dietary treatments is associated with decreased FRQoL for IBS (r = - 0.23, p < .05) and IBD patients (r = - 0.31, p < .01). IBS patients are more likely to use dietary treatments than IBD (IBS = 81% vs. IBD = 64%, p < .01), with self-directed diets being the most commonly used approach. Symptom severity is the strongest predictor of FRQoL in both groups (IBD: R2 = .27, p < .01; IBS: R2 = .23, p < .001). CONCLUSION: FRQoL is a unique construct for IBD and IBS patients that can be influenced by several clinical and dietary factors, including number of diets and type of diet used, depending on the diagnosis. Thus, FRQoL should be considered when working with both IBD and IBS patients.
Assuntos
Dieta/psicologia , Doenças Inflamatórias Intestinais/dietoterapia , Doenças Inflamatórias Intestinais/psicologia , Síndrome do Intestino Irritável/dietoterapia , Síndrome do Intestino Irritável/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Ansiedade/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
OBJECTIVES: Current healthcare systems do not effectively promote weight reduction in patients with obesity and gastroesophageal reflux disease (GERD). The Reflux Improvement and Monitoring (TRIM) program provides personalized, multidisciplinary, health education and monitoring over 6 months. In this study we aimed to (i) measure the effectiveness of TRIM on GERD symptoms, quality of life, and weight, and (ii) examine patient health beliefs related to TRIM. METHODS: This prospective mixed methods feasibility study was performed at a single center between September 2015 and February 2017, and included adult patients with GERD and a body mass index ≥30 kg/m2. Quantitative analysis consisted of a pre- to post-intervention analysis of TRIM participants (+TRIM Cohort) and a multivariable longitudinal mixed model analysis of +TRIM vs. patients who declined TRIM (-TRIM Cohort). Primary outcomes were change in patient-reported GERD symptom severity (GerdQ) and quality of life (GerdQ-DI), and change in percent excess body weight (%EBW). Qualitative analysis was based on two focus groups of TRIM participants. RESULTS: Among the +TRIM cohort (n=52), mean baseline GerdQ scores (8.7±2.9) decreased at 3 months (7.5±2.2; P<0.01) and 6 months (7.4±1.9; P=0.02). Mean GerdQ-DI scores decreased, but did not reach statistical significance. Compared with the -TRIM cohort (n=89), reduction in %EBW was significantly greater at 3, 6, and 12 months among the +TRIM cohort (n=52). In qualitative analysis, patients unanimously appreciated the multidisciplinary approach and utilized weight loss effectively to improve GERD symptoms. CONCLUSIONS: In this mixed methods feasibility study, participation in TRIM was associated with symptom improvement, weight reduction, and patient engagement.
Assuntos
Atitude Frente a Saúde , Refluxo Gastroesofágico/terapia , Obesidade/terapia , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto , Participação do Paciente , Qualidade de Vida , Programas de Redução de Peso , Adulto , Idoso , Estudos de Viabilidade , Feminino , Grupos Focais , Gastroenterologistas , Refluxo Gastroesofágico/complicações , Educadores em Saúde , Humanos , Masculino , Refeições , Informática Médica , Pessoa de Meia-Idade , Análise Multivariada , Nutricionistas , Obesidade/complicações , Equipe de Assistência ao Paciente , Estudos Prospectivos , Pesquisa Qualitativa , Resultado do TratamentoRESUMO
BACKGROUND: The six-food elimination diet (SFED) is an effective treatment approach for eosinophilic esophagitis (EoE), but it can be challenging and affect patients' quality of life. AIM: Assess patients' long-term adherence to SFED and potential factors influencing adherence. METHODS: EoE patients were recruited online via multiple platforms. Patients were classified as reaching the maintenance stage if they responded to SFED and identified specific trigger foods by reintroduction. Maintenance stage patients were categorized into those actively following the elimination diet (ACTIVE) and those no longer on their prescribed diet (FORMER). Participants completed a study-specific questionnaire assessing patient experiences related to SFED use. RESULTS: Forty-two participants were identified as having reached the SFED's maintenance stage. 57% (24/42) of the maintenance stage patients were ACTIVE users. FORMER users rated the SFED's effectiveness at treating symptoms (5.45 ± 3.96, 10 max.) lower than ACTIVE users (8.29 ± 2.76, p = .02). A greater percentage of FORMER users (100%) agreed social situations create challenges in following the diet compared to ACTIVE users (67%, p < .05). Anxiety related to SFED was also higher among FORMER users (64%) compared to ACTIVE users (21%, p < .01). Both ACTIVE (95.8%) and FORMER (81.8%, NSS) users would recommend the elimination diet to other EoE patients. CONCLUSIONS: Understanding SFED adherence is multifactorial and complex. Factors influencing SFED adherence during long-term maintenance with diet therapy include diet effectiveness, social situations, and diet-related anxiety. Despite a lower than expected long-term adherence to maintenance of an elimination diet, the majority would recommend diet therapy as a treatment to other EoE patients.
Assuntos
Dieta/efeitos adversos , Esofagite Eosinofílica/dietoterapia , Hipersensibilidade Alimentar/dietoterapia , Cooperação do Paciente , Adaptação Psicológica , Adulto , Idoso , Ansiedade/psicologia , Efeitos Psicossociais da Doença , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/psicologia , Feminino , Hipersensibilidade Alimentar/diagnóstico , Hipersensibilidade Alimentar/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Indução de Remissão , Comportamento Social , Inquéritos e Questionários , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
Patients with non-eosinophilic esophagitis eosinophilic gastrointestinal diseases (non-EoE EGIDs) are prone to nutritional deficiencies due to food-avoidant behaviors, malabsorption, and high nutrition impact symptoms. Nutrient deficiencies correspond to the segment, depth, and extent of the gastrointestinal tract involved and can impact organs distant from the gut. Patients with non-EoE EGIDs are often atopic, and some appear to respond to dietary avoidance of specific food allergens. Tests to identify food triggers other than response to elimination diets are lacking. Dietary restriction therapy should be considered in such patients and is best implemented through a multidisciplinary approach to avoid nutritional complications.
Assuntos
Enterite , Eosinofilia , Hipersensibilidade Alimentar , Gastrite , Humanos , Enterite/diagnóstico , Enterite/terapia , Gastrite/diagnóstico , Gastrite/terapia , Eosinofilia/terapia , Eosinofilia/diagnóstico , Hipersensibilidade Alimentar/terapia , AlérgenosRESUMO
BACKGROUND & AIMS: Adults with eosinophilic esophagitis (EoE) typically present with dysphagia and food impaction. A 6-food elimination diet (SFED) is effective in children with EoE. We assessed the effects of the SFED followed by food reintroduction on the histologic response, symptoms, and quality of life in adults with EoE. METHODS: At the start of the study, 50 adults with EoE underwent esophagogastroduodenoscopies (EGDs), biopsies, and skin-prick tests for food and aeroallergens. After 6 weeks of SFED, patients underwent repeat EGD and biopsies. Histologic responders, defined by ≤ 5 eosinophils/high-power field (eos/hpf) (n = 32), underwent systematic reintroduction of foods followed by EGD and biopsies (n = 20). Symptom and quality of life scores were determined before and after SFED. RESULTS: Common symptoms of EoE included dysphagia (96%), food impaction (74%), and heartburn (94%). The mean peak eosinophil counts in the proximal esophagus were 34 eos/hpf and 8 eos/hpf, before and after the SFED, and 44 eos/hpf and 13 eos/hpf in the distal esophagus, respectively (P < .0001). After the SFED, 64% of patients had peak counts ≤ 5 eos/hpf and 70% had peak counts of ≤ 10 eos/hpf. Symptom scores decreased in 94% (P < .0001). After food reintroduction, esophageal eosinophil counts returned to pretreatment values (P < .0001). Based on reintroduction, the foods most frequently associated with EoE were wheat (60% of cases) and milk (50% of cases). Skin-prick testing predicted only 13% of foods associated with EoE. CONCLUSIONS: An elimination diet significantly improves symptoms and reduces endoscopic and histopathologic features of EoE in adults. Food reintroduction re-initiated features of EoE in patients, indicating a role for food allergens in its pathogenesis. Foods that activated EoE were identified by systematic reintroduction analysis but not by skin-prick tests.
Assuntos
Esofagite Eosinofílica/dietoterapia , Hipersensibilidade Alimentar/diagnóstico , Adulto , Idoso , Biópsia por Agulha , Endoscopia Gastrointestinal , Esofagite Eosinofílica/diagnóstico , Esofagite Eosinofílica/etiologia , Esofagite Eosinofílica/imunologia , Eosinófilos/patologia , Esôfago/patologia , Feminino , Hipersensibilidade Alimentar/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Testes Cutâneos , Adulto JovemRESUMO
Eosinophilic esophagitis (EoE) is a chronic immune-mediated food antigen-driven disease characterized by tissue eosinophilia and clinical symptoms of esophageal dysfunction. Medical and dietary therapies can be offered as treatment options in both pediatric and adult populations. Advances in nutritional research in EoE have produced different levels of dietary restriction, ranging from elimination of a single food group to more extensive restriction such as the two-food elimination diet, four-food elimination diet, or six-food elimination diet. Efficacy and outcomes vary for each level of restriction. The option of using dietary therapy allows clinicians to partner with patients in shared decision-making to balance the right level of food antigen restriction for the desired outcome. Key considerations when choosing dietary therapy hinge on patient preference and resources, food-related quality of life, and the ability to provide nutritional diversity and maintain nutritional parameters. This article highlights these considerations and offers clinical pearls to guide clinicians who wish to incorporate dietary therapy of EoE into their practice.
RESUMO
This article discusses the role of psychological and nutritional factors in gastrointestinal pelvic floor disorders such as dyssynergic defection and explores the use of multidisciplinary strategies to enhance treatment.
Assuntos
Distúrbios do Assoalho Pélvico , Constipação Intestinal/terapia , Defecação , Humanos , Manometria , Diafragma da Pelve , Distúrbios do Assoalho Pélvico/etiologia , Distúrbios do Assoalho Pélvico/terapiaRESUMO
BACKGROUND AND AIMS: Dietary treatments are growing in popularity as interventions for chronic digestive conditions. Patients with irritable bowel syndrome (IBS) often change their eating behaviors to mitigate symptoms. This can occur under the direction of their physician, a dietitian, or be self-directed. Poorly implemented and monitored diet treatments occur frequently with considerable risks for negative consequences. We aim to review the literature related to dietary treatments and risks associated with nutritional deficiencies and disordered eating. METHODS: Searches were conducted from June to December 2020 on PubMed, MEDLINE, EMBASE, DARE and the Cochrane Database of Systematic Reviews using relevant keywords based on the Patient, Intervention, Comparator and Outcome (PICO) format. Studies included both adult and pediatric populations. Results are synthesized into a narrative review. RESULTS: While dietary approaches are efficacious in many research studies, their translation to clinical practice has been less clear. Patients with IBS are at risk for nutritional deficiencies, disordered eating, increased anxiety, and decreases in quality of life in both adult and pediatric groups. CONCLUSIONS: Physicians prescribing dietary treatment for IBS should be aware of nutritional and psychological risks and implement mitigation measures. These include using a combination of brief, validated questionnaires and clinical history, and collaboration with registered dietitians and/or psychologists. Recommendations for clinical decisions are provided.
Assuntos
Dieta/efeitos adversos , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Síndrome do Intestino Irritável/dietoterapia , Desnutrição/etiologia , Comportamento Alimentar , Humanos , Qualidade de Vida , Fatores de RiscoRESUMO
Irritable bowel syndrome with constipation (IBS-C) and chronic idiopathic constipation (CIC) are two common disorders of gut-brain interaction. Affected patients often first present to their primary care providers seeking care for symptoms of constipation, abdominal pain, and bloating, which have a significant impact on their health-related quality of life. These patients often require extensive counseling and reassurance, and knowledge of reliable diagnostic criteria and treatment options is imperative to managing their conditions. Family medicine practitioners, including nurse practitioners and physician assistants, are uniquely qualified to provide a diagnosis and safe, effective management of these disorders. This article reviews the latest evidence and provides practical advice related to diagnosis and management of IBS-C and CIC.
RESUMO
Gastroparesis (GP) is a chronic, gastric dysmotility disorder with significant morbidity and mortality. The hallmark of GP is the delayed emptying of the contents of the stomach in the absence of any mechanical obstruction. Patients most commonly report chronic symptoms of nausea, vomiting, feeling full quickly when eating, bloating, and abdominal pain. Treatments are limited with relatively poor efficacy. As such, children with GP are at significant risk for the development of psychological co-morbidities. In this paper, we provide a topical review of the scientific literature on the psychological, social, and emotional impacts of gastroparesis in pediatric patients. We aim to document the current state of research, identify gaps in our knowledge with appropriate recommendations for future research directions, and highlight the unique challenges pediatric patients with GP and their families may face as they manage this disease. Based on the current review, research into the psychosocial impacts in children with GP is essentially non-existent. However, when considering research in children with other chronic digestive diseases, children with GP are likely to face multiple psychosocial challenges, including increased risk for anxiety and depression, stigma, and reduced quality of life. These significant gaps in the current understanding of effects of GP across domains of childhood functioning allow for ample opportunities for future studies to address psychosocial outcomes.
RESUMO
BACKGROUND: Esophageal dysphagia is a common symptom in gastroenterology practice. Current rapid assessment tools are limited to oropharyngeal dysphagia and do not translate well to esophageal conditions. We aim to create a novel tool, the dysphagia stress test (DST), to evaluate swallowing in patients with esophageal disease characterized by dysphagia. METHODS: Adults with eosinophilic esophagitis (EoE), gastroesophageal reflux disease (GERD), achalasia, and dysphagia not otherwise specified (NOS) participated. Patient controls with non-esophageal diagnoses and healthy controls were also recruited. Participants completed the DST with five bolus challenges: water, applesauce, rice, bread, barium tablet and rated their swallowing difficulty and pain. A study clinician observed and documented water use and refusal of any challenges. Participants also completed measures of esophageal symptoms, hypersensitivity, and symptom anxiety to evaluate the DST validity. Collinearity of bolus challenges guided item reduction. KEY RESULTS: A total of 132 subjects participated. Both control groups and GERD patients had the best swallowing ability, while achalasia, EOE, and dysphagia NOS scored poorer. About 90% of patients were able to attempt or pass each of the bolus challenges, suggesting high acceptability. Construct validity of the DST is evidenced by modest negative correlations with symptom severity, hypersensitivity, and anxiety. The DST does not appear to be influenced by brain-gut processes. Applesauce, rice, and bread demonstrated collinearity; thus, the DST was reduced to three challenges. CONCLUSIONS & INFERENCES: The DST is the first rapid assessment tool designed for gastroenterology clinics with direct observation of swallowing ability across several conditions to mitigate issues related to patient self-report of esophageal symptoms.
Assuntos
Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/fisiopatologia , Doenças do Esôfago/complicações , Doenças do Esôfago/fisiopatologia , Teste de Esforço/métodos , Adolescente , Adulto , Idoso , Ansiedade/complicações , Ansiedade/fisiopatologia , Estudos Transversais , Transtornos de Deglutição/etiologia , Ingestão de Líquidos , Esofagite Eosinofílica/diagnóstico , Feminino , Refluxo Gastroesofágico/diagnóstico , Humanos , Hipersensibilidade/complicações , Hipersensibilidade/fisiopatologia , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto JovemRESUMO
PURPOSE OF REVIEW: There has been continued interest in the physiological, nutritional and clinical aspects of low-carbohydrate diets. This review will discuss the effects on appetite regulation, metabolic parameters, body weight and body composition, the role of glycemic index and glycemic load, as well as long-term outcomes. RECENT FINDINGS: Low-carbohydrate, high-protein diets appear to improve satiety through their actions on measures of adiposity and gut peptides that influence appetite and caloric intake. Specific macronutrients such as low glycemic index carbohydrates and dietary protein impact appetite, calorie intake and metabolic parameters independent of weight loss. Long-term data, however, continue to support that total weight loss among low-carbohydrate dieters is not significantly different from low-fat dieters. The long-term safety of low-carbohydrate, high-protein diets on cardiovascular disease risk remains undetermined. SUMMARY: Low-carbohydrate, high-protein diets may be an effective choice for weight loss, enhanced satiety and improved metabolic parameters.
Assuntos
Dieta com Restrição de Carboidratos , Regulação do Apetite/fisiologia , Composição Corporal/fisiologia , Peso Corporal/fisiologia , Proteínas Alimentares , Feminino , Índice Glicêmico/fisiologia , Humanos , Metabolismo dos Lipídeos , MasculinoRESUMO
BACKGROUND: The objective of this study was to demonstrate the feasibility and associations with short-term outcomes of a medical nutrition therapy (MNT) intervention in patients with systemic scleroderma (SSc). MATERIALS AND METHODS: Eighteen patients with SSc, gastrointestinal (GI) involvement, and unintentional weight loss were consented and recruited for a 6-week MNT intervention, in addition to their usual medical management. MNT emphasized increased calorie and protein intake, modified textures, and lifestyle modifications. Symptoms, anthropometrics, diet (24-hour recall), and body composition (dual-energy x-ray absorptiometry) were assessed pre- and postintervention. Sarcopenia was defined as appendicular lean height (ALH) for women <5.45 kg/m2 and for men <7.26 kg/m2. Descriptive, parametric, and nonparametric statistics were conducted. RESULTS: Participants (n = 18) were predominantly white (78%), female (89%), malnourished (83%), and 51.3 ± 11.0 years of age with a body mass index of 22.6 ± 6.7 kg/m2. Significant decreases in nutrition symptom scores (12.8 vs 7.6, P < .05) and improvements in ALH (5.6 ± 0.8 vs 5.8 ± 0.8 kg/m2, respectively; P = .05) occurred pre- vs postintervention, respectively (n = 14). Sarcopenia was observed in 54% of participants at baseline and 39% at follow-up ( P = .02). Caloric intake (1400 vs 1577 kcal/d, P = .12) and macronutrient distribution (ie, % fat, protein, carbohydrate) did not change significantly pre- vs postintervention, respectively. CONCLUSIONS: Individually tailored MNT can improve symptom burden and potentially ALH in patients with SSc involving the GI tract. This study underscores the clinical potential of multidisciplinary patient management and the need for larger nutrition intervention trials of longer duration in these patients.
Assuntos
Desnutrição/epidemiologia , Terapia Nutricional , Sarcopenia/epidemiologia , Escleroderma Sistêmico/dietoterapia , Escleroderma Sistêmico/epidemiologia , Absorciometria de Fóton , Adulto , Composição Corporal , Índice de Massa Corporal , Dieta , Exercício Físico , Feminino , Seguimentos , Humanos , Estilo de Vida , Masculino , Desnutrição/diagnóstico , Desnutrição/dietoterapia , Pessoa de Meia-Idade , Avaliação Nutricional , Estado Nutricional , Projetos Piloto , Prevalência , Sarcopenia/diagnóstico , Sarcopenia/dietoterapia , Inquéritos e Questionários , Redução de PesoRESUMO
BACKGROUND: Adult obesity is associated with the metabolic syndrome; however, the prevalence of the metabolic syndrome among young children has not been reported. Clinic-based screening efforts for the metabolic syndrome in low-income neighborhoods, where obesity is prevalent, are limited by minimal health insurance coverage and inadequate access to health care. School-based obesity screening programs may effectively target high-risk populations. OBJECTIVE: The objective was to describe the prevalence of overweight and features of the metabolic syndrome (defined as the presence of > or =3 of the following risk factors: HDL < or = 40 mg/dL, triacylglycerol > or = 110 mg/dL, and blood pressure or waist circumference at or above the 90th percentile) in a pilot, school-based screening program. DESIGN: A cross-sectional study of obesity and the metabolic syndrome was conducted in third- to sixth-grade, low-income, urban, African American children. Lipid and glucose concentrations were measured in fasting capillary finger-stick samples. RESULTS: Age- and sex-specific BMI percentiles were assessed in 385 students, 90 of whom were full participants in this study (participants) and 295 of whom had only height and weight measurements taken (other students). Risk factors of the metabolic syndrome were assessed in the 90 participants (23%). No significant differences in BMI percentiles were found between the participants and the other students. Overall, 44% of the participants had BMIs at or above the 85th percentile, and 59% had an elevated BMI or one metabolic syndrome risk factor. The metabolic syndrome was present in 5.6% of all participants, in 13.8% of participants with BMIs at or above the 95th percentile, and in 0% of participants with BMIs below the 95th percentile. CONCLUSIONS: Most of the African American children attending 2 urban schools in low-income neighborhoods were overweight or had one or more risk factors for the metabolic syndrome. School-based screening programs in high-risk populations may provide an efficient venue for the screening of obesity and related risk factors.