Challenges to Provision of Adequate Medical Nutrition Therapy in a Critically Ill COVID-19 Patient Fed in the Prone Position.

Adults with acute respiratory distress syndrome (ARDS) may experience enteral nutrition (EN) intolerance. They often require mechanical ventilation and other specialized management including prone positioning. There is a controversy as to whether patients fed in prone position experience more EN intolerance than when they are in supine position. This narrative review synthesizes the literature published between 2001 and 2021 in adults with ARDS who are fed EN while in the prone position to determine safety and tolerance. A case of an adult patient with Down syndrome who developed ARDS due to COVID-19 and required EN while in prone position is presented.

Case Report: Transitioning to a Mixed-Oil Intravenous Lipid Emulsion in an Adult Patient Receiving Home Parenteral Nutrition.

A potential risk of long-term parenteral nutrition (PN) is intestinal failure-associated liver disease (IFALD). One recommendation for mitigating risk is limiting the fat dose to reduce the harmful effects of the ω-6 fatty acids, which are the main ingredient in traditional fats. SMOFlipid (SMOF) (Kabi-Fresenius, Bad Homburg, Germany) is a combination of soybean oil, medium-chain triglycerides, olive oil, and fish oil emulsion. This fat source may alleviate the risk of IFALD and improve liver function tests. A patient with a long history of PN reliance and IFALD is presented in this case report. After 4 months on SMOF, total and direct bilirubin levels improved.

What should we tell patients with painful temporomandibular disorders about what to eat?

BACKGROUND AND OVERVIEW: Patients with painful temporomandibular disorders (TMD) commonly report problems eating, owing to limited mandibular opening and pain and discomfort with biting and chewing. Consequently, painful TMD may affect dietary intake and nutritional status. CONCLUSIONS: Treatment of painful TMD is multifaceted and involves pharmacologic, physical, and cognitive behavior and dietary therapies. Painful TMD may influence the quality of dietary intake and eating behaviors. There is a dearth of established guidelines and validated measures that clinicians can use to assess and manage diet and nutritional well-being in patients with this disorder. The authors present recommendations in an effort to guide clinicians on how to help patients with painful TMD improve the quality of their diets and avoid or minimize eating-related pain. PRACTICAL IMPLICATIONS: Providing comprehensive care for patients with painful TMD should include diet evaluation and recommendations for eating comfortably and supporting nutrition. An interprofessional approach may help improve treatment outcomes. Research is needed to develop evidence-based guidelines for diet and nutrition that clinicians can use in the care of patients with painful TMD.

Vitamin and mineral supplements: friend or foe when combined with medications?

BACKGROUND: Given the prevalence of vitamin and mineral supplement use among consumers and the potential for vitamin- and mineral-drug interactions, as well as oral and systemic adverse effects of excess consumption, oral health care providers (OHCPs) should ask all patients about their use. The challenges for OHCPs are how to recognize oral and systemic manifestations of these interactions and how to safely manage the care of these patients while avoiding potential interactions. METHODS: The authors reviewed the literature regarding interactions between popular vitamin and mineral supplements and medications used commonly in dentistry. They used clinical databases and decision support tools to classify interactions according to their level of patient risk. They address interactions of greatest clinical concern with a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses. CONCLUSION: Most medications used commonly in dentistry can be prescribed safely without regard to vitamin- and mineral-drug interactions. However, patients taking anticoagulants or cytochrome P450 3A4 substrates (such as clarithromycin, erythromycin, ketoconazole, itraconazole, midazolam and triazolam) in addition to specific vitamin or mineral supplements (vitamins D, E, K, calcium, fluoride, iron, magnesium, selenium or zinc) may face additional challenges. OHCPs need to recognize these potential interactions and know how to manage the care of patients who may be receiving treatment with these combination therapies. PRACTICAL IMPLICATIONS: Recognition and avoidance of potential vitamin- and mineral-drug interactions will help clinicians optimize patient treatment while emphasizing patient safety.

Dietary supplement interactions with medications used commonly in dentistry.

BACKGROUND: Because nearly 70 percent of prescription drug users do not discuss their dietary supplement use with their health care providers, clinicians must be proactive in questioning patients about their use of these agents. A complete and accurate pharmacological history will help clinicians avoid potential interactions between dietary supplements and drugs. METHODS: The authors reviewed the literature regarding interactions between popular dietary supplements and medications used commonly in dentistry. They used clinical databases and decision support tools to classify interactions according to their level of risk for the patient. The authors address the interactions of greatest clinical concern with a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses. CONCLUSIONS: Provided that patients are not taking ginkgo, St. John's wort, evening primrose or valerian, oral health care providers can prescribe or administer any of the medications used commonly in dentistry without concern about possible dietary supplement-drug interactions. PRACTICAL IMPLICATIONS: Recognition and avoidance of potential interactions between dietary supplements and drugs will help clinicians optimize treatment while emphasizing patients' safety.

Position of the Academy of Nutrition and Dietetics: oral health and nutrition.

It is the position of the Academy of Nutrition and Dietetics that nutrition is an integral component of oral health. The Academy supports integration of oral health with nutrition services, education, and research. Collaboration between dietetics practitioners and oral health care professionals is recommended for oral health promotion and disease prevention and intervention. Scientific and epidemiological data suggest a lifelong synergy between diet, nutrition, and integrity of the oral cavity in health and disease. Oral health and nutrition have a multifaceted relationship. Oral infectious diseases, as well as acute, chronic, and systemic diseases with oral manifestations, impact an individual's functional ability to eat and their nutrition status. Likewise, nutrition and diet can affect the development and integrity of the oral cavity and progression of oral diseases. As knowledge of the link between oral and nutrition health increases, dietetics practitioners and oral health care professionals must learn to provide screening, education, and referrals as part of comprehensive client/patient care. The provision of medical nutrition therapy, including oral and overall health, is incorporated into the Standards of Practice for registered dietitians and dietetic technicians, registered. Inclusion of didactic and clinical practice concepts that illustrate the role of nutrition in oral health is essential in education programs for both professional groups. Collaborative endeavors between dietetics, dentistry, medicine, and allied health professionals in research, education, and delineation of practice roles are needed to ensure comprehensive health care. The multifaceted interactions between diet, nutrition, and oral health in practice, education, and research in both dietetics and dentistry merit continued, detailed delineation.

Diet and prevention of oral cancer: strategies for clinical practice.

BACKGROUND: Oral health care professionals can play an important role in preventing oral cancer by performing oral mucosal examinations to detect pre-cancerous changes and by educating patients about oral cancer prevention strategies, including dietary approaches. CONCLUSIONS: Current evidence supports a diet high in fruits, vegetables and plant-based foods for prevention of oral cancer. Dietary supplements-including vitamins and minerals-have not been shown to be effective as substitutes for a diet high in fruits and vegetables. CLINICAL IMPLICATIONS: In addition to discussing tobacco and alcohol use with patients (and, if relevant, betel nut and gutka consumption), as well as the risk of sexual transmission of human papillo-mavirus, clinicians should provide dietary advice for the prevention of oral cancer as part of routine patient education practices.

Multivitamin/Mineral supplementation does not affect standardized assessment of academic performance in elementary school children.

Limited research suggests that micronutrient supplementation may have a positive effect on the academic performance and behavior of school-aged children. To determine the effect of multivitamin/mineral supplementation on academic performance, students in grades three through six (approximate age range=8 to 12 years old) were recruited from 37 parochial schools in northern New Jersey to participate in a double-blind, placebo-controlled clinical trial conducted during the 2004-2005 academic school year. Participants were randomized to receive either a standard children's multivitamin/mineral supplement (MVM) or a placebo. MVM or placebo was administered in school only during lunch or snack period by a teacher or study personnel who were blinded to group assignment. The main outcome measured was change in scores on Terra Nova, a standardized achievement test administered by the State of New Jersey, at the beginning of March 2005 compared to March 2004. Compared with placebo, participants receiving MVM supplements showed no statistically significant improvement for Terra Nova National Percentile total scores by treatment assignment or for any of the subject area scores using repeated measures analysis of variance. No significant improvements were observed in secondary end points: number of days absent from school, tardiness, or grade point average. In conclusion, the in-school daily consumption of an MVM supplement by third- through sixth-grade inner-city children did not lead to improved school performance based upon standardized testing, grade point average, and absenteeism.

Evaluation of diet quality and weight status of children from a low socioeconomic urban environment supports "at risk" classification.

This cross-sectional study evaluated diet quality and weight status in 248 randomly selected low-income urban children, aged 7 to 13 years, who were participating in a larger study on the effectiveness of multivitamin supplementation on school performance. Food frequency questionnaires were used to determine intake of total calories and food groups, selected micronutrients, and amount and percent of calories from sweets. Results were compared to age-appropriate recommendations of the Food Guide Pyramid and to the Dietary Reference Intakes. Height, weight, and ages obtained from current-year student health records were used to calculate body mass index (calculated as kg/m(2)) percentile for age. Of 193 participants with usable food frequencies and available weight, height, sex, and age, 22% (n=43) were at risk for overweight and 36% (n=69) were overweight. More than 75% of participants failed to meet recommended servings for grains, vegetables, dairy, and fruit groups, and mean intake of each of these food groups was significantly less than recommendations (P<0.001). Twenty-five percent or more of subjects did not meet Recommended Dietary Allowances for iron and folate. Mean intake of calcium was below the Adequate Intake for calcium and 76% of children 8 years old and younger and 93% of children 9 years old and older did not meet the Adequate Intake for calcium. Mean calorie intake was 1,723 kcal (standard deviation+/-924) and mean percent of calories from carbohydrate, protein, and fat was 57%, 13%, and 32%, respectively. No correlation was found between total calories, total dietary sugar, or percent of calories from sweets and body mass index. Results of this study suggest that these urban children may be "at risk," based on the high percentage who are overweight and have insufficient food group consumption and micronutrient intake.

Vitamin and mineral supplements: what is the dentist to do?

BACKGROUND: Vitamins and minerals are essential for systemic and oral health and the prevention of nutrient deficiencies. The author reviews recommendations for their use, consumer intake patterns and considerations for dental practice. CONCLUSIONS: Vitamin and mineral supplements are designed to treat and prevent deficiency syndromes and promote health. Consumers frequently misuse them, as they are guided by the belief that these supplements will prevent diseases and cure symptoms. Scientific evidence demonstrates their limited usefulness in systemic disease prevention or treatment. The author reviews demonstrated benefits in select diseases. CLINICAL IMPLICATIONS: Being familiar with the appropriate uses of vitamin and mineral supplements, as well as nutrient-supplement and drug-supplement interactions, will give dental professionals the knowledge to question and advise patients using evidence-based resources.

Role of nutrition in the dental practice.

The current climate of health care delivery emphasizes comprehensive care, with an increased focus on early detection of health risk, disease prevention, and health promotion with referral to specialty providers as needed. The integration of nutrition screening, basic diet education/counseling, and referral in dental practice fits with this climate. Shifting patterns in disease epidemiology, the advent of new therapies and drugs which impact nutrition and oral health status, and greater recognition of the relationship between nutrition and oral health provides dietetics and dental professionals with increasing opportunities to create a new oral health care paradigm. This integration of oral and nutrition health care will yield improved oral, nutritional, and systemic health status.