RESUMO
BACKGROUND AND AIMS: The Nutrition Care Process (NCP) and Nutrition Care Process Terminology (NCPT) are currently implemented by dietetics practitioners worldwide, with various advantages, including ensuring consistency and clarity of dietetics-related healthcare records and the possibility to collect and analyse patient outcomes; however, how Saudi dietitians experience the implementation process is poorly understood. The aim of this study was to explore the experiences of Saudi dietitians of NCP implementation in hospitals in Jeddah. METHODS: In this quantitative, cross-sectional study, 56 dietitians were recruited from six principal hospitals in Jeddah. A questionnaire was used to collect data on the characteristics of the dietitians and hospital-related clinical nutrition care performance, the perception and opinions of dietitians towards the NCP, and the status of NCP implementation. RESULTS: Almost all dietitians (98%) were aware of the NCP; however, only 27% had received NCP training. Most dietitians (73%) reported that their department currently follows the NCP, while only 26% reported using the standardized NCP, including International Classification of Functioning, Disability & Health - Dietetics (ICF-D)-WHO and International Dietetic & Nutrition Terminology (IDNT) - USA, with 63% following the hospital's own NCP. Reported reasons for hospitals not following the NCP included insufficient dietitians, lack of experience, or conflict with the hospital's nutrition care system. A majority of dietitians reported no perceived barriers to applying the NCP; however, 23% reported NCP documentation as a challenge. CONCLUSIONS: The majority of dietitians are aware of the NCP and feel confident to practice; however, the NCP model is not currently implemented in Jeddah hospitals as standard. On-going education, a training program, and an implementation plan should be prioritised.
Assuntos
Hospitais , Terapia Nutricional , Fenômenos Fisiológicos da Nutrição , Adulto , Estudos Transversais , Atenção à Saúde , Dietética , Feminino , Implementação de Plano de Saúde/estatística & dados numéricos , Humanos , Masculino , Avaliação Nutricional , Nutricionistas/educação , Nutricionistas/psicologia , Arábia Saudita , Inquéritos e QuestionáriosRESUMO
Vitamin D deficiency is rampant in the Middle East, even in children and adolescents. This study was designed to investigate the effects of different vitamin D repletion strategies commonly used on serum vitamin D levels of Saudi adolescents. STUDY DESIGN: A 6-month multi-center, controlled, clinical study, involving 34 schools in the central region of Riyadh, Saudi Arabia. Different strategies of vitamin D supplementation were tested (200â¯ml fortified milk of different brands or vitamin D tablet (1,000IU). Anthropometrics were taken and fasting blood samples withdrawn at baseline and after intervention for the quantification of serum glucose, lipid profile and 25(OH) vitamin D. A significant increase in 25(OH)D level was observed in subjects supplemented with vitamin D tablet, milk brand 2 and milk brand 4, whereas subjects supplied with fortified milk brands 1 and 3 respectively, exhibited a significant decrease in 25(OH)D levels. Analysis of covariance showed that after adjusting for baseline 25(OH)D, age, gender and BMI, the mean 25(OH)D levels of children who were taking vitamin D tablet (9.1⯱â¯0.8â¯nmol/l) and milk brand 4 were significantly higher (7.3⯱â¯1.1â¯nmol/l) than children taking milk brand 2 (1.6⯱â¯1.0â¯nmol/l). Subjects supplied with milk brands 1 and 2 exhibited a significant increase in total cholesterol level, while it dropped significantly in subjects taking milk brand 3, while no changes were observed in other groups. Different strategies in vitamin D supplementation used in this clinical study elicited varying degrees of improvement in serum 25(OH)D level. The observed outcomes were dependent on the strategy and gender in the Saudi adolescent population, with oral tablet supplementation being favored in boys.
Assuntos
Suplementos Nutricionais , Leite/química , Deficiência de Vitamina D/prevenção & controle , Vitamina D/administração & dosagem , Vitaminas/administração & dosagem , Adolescente , Animais , Feminino , Humanos , Masculino , Arábia Saudita/epidemiologia , Deficiência de Vitamina D/epidemiologiaRESUMO
BACKGROUND: Vitamin D deficiency is common in the Middle East and in Saudi Arabia, in particular. While several international recommendations on the management of vitamin D deficiency have been documented and practiced globally, these recommendations should be adapted to the conditions of the Middle Eastern region. To address this challenge, the Prince Mutaib Chair for Biomarkers of Osteoporosis (PMCO) in King Saud University (KSU), Riyadh, KSA, together with local experts and in cooperation with the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO), organized a panel that formulated unified recommendations in the diagnosis and treatment of vitamin D deficiency in the region. METHODS: The selection of local and international experts commenced during the 2nd International Vitamin D Symposium conducted in Riyadh, Saudi Arabia, last January 20--21, 2016. Reviews of the most recent literature were done, and face-to-face meetings were conducted for revisions and final recommendations. RESULTS: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. RESULTS: Vitamin D sufficiency is defined as circulating serum 25(OH)D ≥50 nmol (≥20 ng/ml) for the general population and vitamin D adequacy as serum 25(OH)D >75 nmol/L l (>30 ng/ml) for the frail and osteoporotic elderly. Despite overwhelming prevalence of vitamin D deficiency, universal screening is not recommended. Recommendations for the general population, children, pregnant/lactating women, post-menopausal women, the elderly, and those with subsequent metabolic diseases were provided. CONCLUSION: Vitamin D supplementation/correction is advised in all persons whose serum 25(OH)D falls below 50 nmol/l (20 ng/ml), and achieving a target of 75 nmol/l (30 ng/ml) is particularly suited for frail, osteoporotic, and older patients. Conducting well-designed clinical trials in the region that will address economic implications and investigations on the treatment persistence and compliance to vitamin D treatment in the region are encouraged.
Assuntos
Deficiência de Vitamina D , Vitamina D , Suplementos Nutricionais , Gerenciamento Clínico , Humanos , Prevalência , Arábia Saudita/epidemiologia , Vitamina D/sangue , Vitamina D/farmacologia , Deficiência de Vitamina D/diagnóstico , Deficiência de Vitamina D/epidemiologia , Deficiência de Vitamina D/terapia , Vitaminas/sangue , Vitaminas/farmacologiaRESUMO
OBJECTIVES: To determine whether 12-month, 2000IU/day vitamin D supplementation cardiometabolically improves treatment naïve type 2 diabetes mellitus (T2DM) Saudi patients with vitamin D deficiency. METHODS: This 12-month interventional study was conducted at primary health centers in 5 different residential areas in Riyadh, Saudi Arabia between January 2013 and January 2014. Forty-five Saudi T2DM patients were enrolled. Baseline anthropometrics, glycemic, and lipid profiles were measured and repeated after 6 and 12 months. All subjects were provided with 2000IU vitamin D supplements for one year. RESULTS: Vitamin D deficiency at baseline was 46.7%, 31.8% after 6 months, and 35.6% after 12 months, indicating an overall improvement in the vitamin D status in the entire cohort. Insulin and homeostatic model assessment-insulin resistance (HOMA-IR) after 12 months were significantly lower than a 6 months (p less than 0.05), but comparable to baseline values. Mean levels of triglycerides increased overtime from baseline (1.9±0.01 mmol/l) to 12 months (2.1±0.2 mmol). This modest increase in serum triglycerides was parallel to the insignificant decrease in circulating high-density lipoprotein -cholesterol levels. CONCLUSION: Twelve-month vitamin D supplementation of 2000IU per day in a cohort of treatment naïve Saudi patients with T2DM resulted in improvement of several cardiometabolic parameters including systolic blood pressure, insulin, and HOMA-IR. Further studies that include a placebo group are suggested to reinforce findings.
Assuntos
Diabetes Mellitus Tipo 2/complicações , Deficiência de Vitamina D/tratamento farmacológico , Vitamina D/administração & dosagem , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Arábia Saudita , Deficiência de Vitamina D/complicaçõesRESUMO
Pistacia integerrima Stewart in traditionally used as folk remedy for various pathological conditions including diabetes. In order to identify the bioactive compound responsible for its folk use in diabetes, a phytochemical and biological study was conducted. Pistagremic acid (PA) was isolated from the dried galls extract of P. integerrima. Strong α-glucosidase inhibitory potential of PA was predicted using its molecular docking simulations against yeast α-glucosidase as a therapeutic target. Significant experimental α-glucosidase inhibitory activity of PA confirmed the computational predictions. PA showed potent enzyme inhibitory activity both against yeast (IC(50): 89.12±0.12µM) and rat intestinal (IC(50): 62.47±0.09µM) α-glucosidases. Interestingly, acarbose was found to be more than 12 times more potent an inhibitor against mammalian (rat intestinal) enzyme (having IC(50) value 62.47±0.09µM), as compared to the microbial (yeast) enzyme (with IC(50) value 780.21µM). Molecular binding mode was explored via molecular docking simulations, which revealed hydrogen bonding interactions between PA and important amino acid residues (Asp60, Arg69 and Asp 70 (3.11Å)), surrounding the catalytic site of the α-glucosidase. These interactions could be mainly responsible for their role in potent inhibitory activity of PA. PA has a strong potential to be further investigated as a new lead compound for better management of diabetes.
Assuntos
Inibidores de Glicosídeo Hidrolases , Pistacia/química , Triterpenos/química , Triterpenos/farmacologia , Animais , Domínio Catalítico , Intestinos/enzimologia , Modelos Moleculares , Estrutura Molecular , Ligação Proteica , Ratos , Saccharomyces cerevisiae/enzimologia , alfa-Glucosidases/metabolismoRESUMO
Concentrations of selenium (Se) in food from local markets of Riyadh, Kingdom of Saudi Arabia (KSA) were measured and daily intake calculated based on information from a questionnaire of foods eaten by healthy Saudis. The daily intake of Se was then compared to concentrations of Se in blood serum. Primary sources of Se in the diet of Saudis were as follows: meat and meat products (31%), egg (20.4%), cereals and cereal products (16%), legumes (8.7%), fruits (6.8%), milk and dairy products (2.0%), beverages (2%), sweets (1.8%), pickles (0.2%), and oil (0.02%). Daily intake of Se, estimated to be 93 µg Se/person/day, was slightly greater than that calculated from the Food and Agriculture Organization (FAO) food balance sheet for KSA, which was approximately 90 µg Se/person/day. The daily intake of Se by Saudis in Riyadh was greater than that of Australians or Dutch but less that of Canadians and Americans. There was a statistically significant correlation (R = +0.38, P < 0.05) between daily intake of Se and concentrations of Se in blood serum of Saudis in Riyadh. The mean concentration of Se in serum was 1.0 × 10(2) ± 30.5 µg Se/l. Taken together, the results suggest that the average Se intake and Se serum concentrations are within the known limits and recommendations, making it unlikely that Saudis are on average at risk of deficiency or toxicity.
Assuntos
Exposição Ambiental , Poluentes Ambientais/análise , Contaminação de Alimentos/análise , Selênio/análise , Dieta , Monitoramento Ambiental , Poluentes Ambientais/sangue , Feminino , Humanos , Masculino , Arábia Saudita , Selênio/sangue , Espectrofotometria Atômica , Inquéritos e QuestionáriosRESUMO
The present study is undertaken to evaluate the protective effect of vitamin E (α-tocopherol) and selenium (Se) against malathion (MTN)-induced oxidative stress and hepatic injuries in experimental rats. Male rats were randomly divided into eight groups comprised of 10 rats each. The 1(st) group served as a negative control (C(N)), whereas the 2(nd) was supplemented with a combination of α-tocopherol (100 mg kg(-1) body weight, b.w.)/Se (0.1 mg kg(-1) bw). The 3(rd), 4(th) and 5(th) groups were respectively administered with increasing doses of MTN equivalent to (1/50 )LD(50) (M(1/50)), (1/25) LD(50) (M(1/25)) and (1/10) LD(50) (M(1/10)), respectively. The 6(th), 7(th) and 8(th) groups were administered the same doses of MTN as in the 3(rd), 4(th) and 5(th) groups with a concomitant supplementation with α-tocopherol/Se. Subchronic exposure of rats to MTN for 45 days resulted in statistical dose-dependent decrease in acetylcholinestrase (AChE) activity, increase in oxidative stress marker lipid peroxidation (LPO) and reduction in reduced glutathione (GSH) level. Moreover, the levels of glutathione persoxidase (GPx), superoxide dismutase (SOD) and catalase (CAT) were significantly decline in response to MTN exposure in a dose-dependent fashion. Furthermore, histopathological studies of liver in the rats which received MTN exhibited, moderate to severe degenerative and necrotic changes in the hepatocytes. Notably, the administration of α-tocopherol/Se protected the liver of rats exposed to MTN as evidenced by the appearance of normal histological structures, significant attenuation of the decline in all antioxidant enzymes tested (i.e. GPx, SOD and CAT), significant recovery in the GSH level and statistical reduction in LPO, as compared to the experimental rat. The effect of α-tocopherol/Se supplementation on transcriptional activity of three key stress and apoptosis-related genes (i.e., Tp53, CASP3 and CASP9), in response to MTN exposure in rats, was investigated. Results revealed a significant concentration-dependent up-regulation in the level of expression for the three genes examined, in response to MTN exposure, compared with the control. Interestingly, the supplementation of MTN-treated rats with α-tocopherol/Se modulates the observed significant dose-dependent up-regulation in the level of expression for three selected genes, indicative of an interfering role in the signaling transduction process of MTN-mediated poisoning. Taken together, these data suggest that the administration of α-tocopherol/Se may partially protect against MTN-induced hepatic oxidative stress and injuries.