Single-food elimination of cow's milk as a treatment for eosinophilic esophagitis in children aged 2-18 years: A review of the literature.

Cow's milk elimination (CME) is an established treatment, similar to other forms of diet therapy, for eosinophilic esophagitis (EoE). However, there is limited research to support its efficacy as a primary treatment. This review evaluated studies published in the past 10 years that assessed the outcomes after CME on histologic remission, clinical findings, and quality of life (QoL) in children aged 2-18 years with EoE. The evidence demonstrated that CME was effective at achieving histologic remission of disease in 50%-65% of children. This intervention also improved clinical symptoms seen on endoscopy and resulted in increased QoL when self-reported by children. CME can be used as a primary treatment for some children with EoE.

Green tea extract supplementation does not modify plasma concentration of F2-isoprostanes in women who are postmenopause: Findings from a randomized controlled trial.

Green tea extract (GTE) is a potential mitigator of oxidative stress, and F2-isoprostanes are a reliable biomarker of oxidative stress. Genetic polymorphisms in the catechol-o-methyltransferase (COMT) gene may modify tea catechin metabolism, prolonging exposure. We hypothesized that GTE supplementation would decrease plasma F2-isoprostanes concentrations compared with placebo and that participants with the COMT genotype polymorphisms would experience a more significant expression of this outcome. This study was a secondary analysis of the Minnesota Green Tea Trial, a randomized placebo-controlled, double-blinded trial investigating the effects of GTE in women who were generally healthy and postmenopausal. The treatment group consumed 843 mg of epigallocatechin gallate daily for 12 months versus placebo. Participants in this study had a mean age of 60 years, were predominantly White, and most had a healthy body mass index. GTE supplementation did not significantly change plasma F2-isoprostanes concentrations compared with placebo after 12 months (P for overall treatment = .07). There were no significant interactions between treatment and age, or body mass index, physical activity, smoking history, and alcohol intake. COMT genotype did not modify the effect of GTE supplementation on F2-isoprostanes concentrations in the treatment group (P = .85). Among participants in the Minnesota Green Tea Trial, consuming GTE supplements daily for 1 year did not result in a significant decrease in plasma F2-isoprostanes concentrations. Likewise, the COMT genotype did not modify the effect of GTE supplementation on F2-isoprostanes concentrations.

Association between 1st trimester diet quality & gestational weight gain rate among pregnant women in Dhulikhel, Nepal.

BACKGROUND: Despite promising data from high-income countries, the impact of diet quality on gestational weight gain (GWG) has not been investigated in the context of many low-income countries including Nepal. METHODS: We prospectively examined the association between 1st trimester diet quality and GWG rate among a cohort of singleton pregnant women (n = 101; age 25.9 ± 4.1 years) from a community-based periurban hospital in Dhulikhel, Nepal. Diet quality was assessed from the adapted Nepali version of the 21-item PrimeScreen questionnaire in the 1st trimester. The diet quality score is based on consumption frequency of 21 food group components (score ranging 0-42), categorized as healthy (12 groups) versus unhealthy (9 groups), with higher scores indicative of better overall diet quality. The GWG rate was calculated as the measured weight at early-to-mid 3rd trimester (28-35 wks) minus the weight at 2nd trimester (13-25 wks), divided by the number of weeks in between. Linear regression estimated the association between diet quality and GWG rate, adjusting for a priori covariates (i.e. age, education, ethnicity, pre-pregnancy BMI, and nausea/vomiting.) RESULTS: The mean GWG rate in mid-to-late pregnancy was 0.46 ± 0.2 kg/wk and the mean diet quality score was 23.6 ± 2.5. Based on pre-pregnancy BMI, 49.4% of women had excessive GWG rate, while nearly equal numbers had either adequate GWG or inadequate GWG rate. There was no significant association between diet quality and GWG rate [adjusted ß (95% CI) = -0.02 (-0.05, 0.01); p = 0.14]. The mean GWG rate was marginally higher (0.57 vs. 0.44 kg/wk; p = 0.06) among those with high versus low (2 + servings vs. 0-1 serving/wk) intake of red meat; similar findings were seen when comparing red meat intake between women with excessive versus adequate GWG (Cramer's V = 0.2; p = 0.06). CONCLUSIONS: While 1st trimester diet quality is not related to GWG among Nepali women, a high intake of red meat may be a potential risk factor for excessive GWG in this population.

Clinical Outcomes Associated With Commercial and Homemade Blenderized Tube Feedings: A Literature Review.

There is emerging evidence in the pediatric population that blenderized tube feeding (BTF) may improve gastrointestinal intolerance; however, not much is known about the impact of BTF on clinical outcomes in adults. This article presents a review of the literature published in the past 10 years that explored the impact of BTF on nutrition status (ie, weight status, body mass index, and upper-arm circumference) and nutrition adequacy in adults. The results indicate that BTF, compared with commercial enteral formula (CEF), may be inadequate in calories, macronutrients, and some micronutrients, given variability in BTF formula composition. As a result, BTF may result in significantly more weight loss than CEF. Thus, BTF may not be appropriate for adult patients who are malnourished or are at risk for malnutrition due to the potential worsening of clinical outcomes.

The Relationships Between Physical Activity and Cardiometabolic Risk Factors Among Women Participating in a University-Based Worksite Wellness Program.

OBJECTIVE: Associations between changes in physical activity (PA) and cardiometabolic risk factors among women with overweight/obesity enrolled in a university-based worksite wellness program (WWP) were examined. METHODS: Data from 173 women who completed a 26-week WWP were analyzed retrospectively. Participants completed diet and PA assessments and received client-centered diet/lifestyle counseling at baseline, and 12 and 26 weeks thereafter. Anthropometrics, blood pressure, and total cholesterol were measured; PA was self-reported using the International Physical Activity Questionnaire-short form at each visit. RESULTS: Significant improvements in anthropometrics (P < 0.001), blood pressure (P < 0.001), total cholesterol (P = 0.014), and PA (P = 0.007) were found at 26 weeks. In adjusted linear regression models, a 10 metabolic-equivalent-minute increase in PA was associated with 0.01% corresponding decreases in weight and waist circumference. CONCLUSION: Among women who completed this WWP, increased PA was associated with reductions in anthropometric measures.

Health-related quality of life, temperament, and eating behavior among formula-fed infants in the Philippines: a pilot study.

BACKGROUND: The rising prevalence of childhood obesity in Asia has led to interest in potential risk factors such as infant health-related quality of life (HRQoL), temperament and eating behaviors. This pilot study evaluated the utility of administering parent-reported outcome measures (PROMs) to explore these factors in Filipino infants and examined the relationships between these factors and infant sex, formula intake and weight, over time. METHODS: Forty healthy, 4-week-old, formula-fed infants (n = 20 males) were enrolled in this 6-week, prospective, uncontrolled study during which infants were exclusively fed a standard term infant formula enriched with alpha-lactalbumin. On Day-1 and 42, anthropometrics were measured and mothers completed a 97-item measure of HRQoL [Infant Toddler Quality of Life Questionnaire (ITQOL)] covering 6 infant-focused and 3 parent-focused concepts and a 24-item measure of infant temperament [Infant Characteristics Questionnaire (ICQ)]. At Day-42, mothers also completed an 18-item measure of infant appetite [Baby Eating Behaviour Questionnaire (BEBQ)]. A 3-day formula intake diary was completed before Day-42. Nonparametric statistics were used to evaluate correlations among outcomes and compare outcomes by visit and sex. RESULTS: Thirty-nine infants completed the study; similar results were observed in males and females. Completion of PROMs was 100% with no missing responses, but Cronbach's α was low for many concept scales scores. ITQOL scores [range 0 (worst)-100 (best)] were generally high (median ≥ 80) except for Day-1 and Day-42 Temperament and Mood and Day-1 General Health Perceptions scores. ITQOL but not ICQ temperament scores improved significantly between Day-1 and Day-42 (P < 0.01). Mean ± standard deviation BEBQ scores (range 1-5) were high for Enjoyment of Food (4.59 ± 0.60) and Food Responsiveness (3.53 ± 0.81), and low for Satiety Responsiveness (2.50 ± 0.73) and Slowness in Eating (1.71 ± 0.60). Better HRQoL scores were significantly (P < 0.05) associated with high General Appetite scores (3 ITQOL concepts, r = 0.32 to 0.54), greater Enjoyment of Food (4 ITQOL concepts, r = 0.35 to 0.42) and low levels of Slowness in Eating (7 ITQOL concepts, r = - 0.32 to - 0.47). CONCLUSION: Findings demonstrated the utility of the ITQOL, ICQ and BEBQ for measuring HRQoL, temperament and eating behavior, and the need for further adaptations for use in Filipino infants. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02431377; Registered May 1, 2015.

Improvements in Cardiometabolic Risk Factors Among Overweight and Obese Employees Participating in a University Worksite Wellness Program.

OBJECTIVE: To determine immediate changes in weight and cardiometabolic risk of participants in a university worksite wellness program (WWP). It was hypothesized that there would be significant improvements in weight and waist circumference after 12 weeks. METHOD: Employees volunteered for enrollment in a 12-week WWP that provided educational sessions in-person or online. At baseline and after 12 weeks, participants had one-on-one appointments with the study registered dietitian who measured clinical outcome markers (cardiometabolic risk factors) and provided individualized counseling. RESULTS: Among 79 participants who returned for 12-week appointments, there were statistically significant improvements in weight (p < .0001), waist circumference (p < .0001), and other cardiometabolic risk factors from baseline to 12-weeks. CONCLUSIONS: Improvements in cardiometabolic risk factors may be observed in a relatively short period of time among those who enrolled in a WWP.

Nutrient deficiencies associated with nutrition-focused physical findings of the oral cavity.

Conducting nutrition-focused physical examinations and reporting the findings from the perspective of nutrition status strengthen the practitioner's assessments, interventions, and monitoring. The nutrition-focused physical examination of the oral cavity is particularly useful to identify nutrient deficiencies early and with accuracy as the tissues in the oral mucosa have a turnover rate of <1 week. As biomarkers may not always be reliable for identifying micronutrient deficiencies, these physical examinations are important for providing comprehensive nutrition care. The purpose of this article is to discuss the methods of conducting a nutrition-focused oral screening examination and compile and document the evidence regarding the effects of micronutrient deficiencies on the oral mucosa. The information is formatted into a table that can be used as a tool when conducting an oral screening by identifying possible deficiencies based on the observations and other relevant findings. The tool will also guide the practitioner in confirming the physical findings, suggesting interventions to treat the deficiency and how to monitor the outcomes.

Dietary supplements: clinical implications for dentistry.

BACKGROUND: Sales of dietary supplements in the United States continue to increase; patients who seek dental care more than likely are taking or contemplating taking dietary supplements. The author reviews the background of dietary supplements, highlights popular over-the-counter supplements available in the United States and addresses the issues of safety, efficacy and contraindications that merit consideration in clinical practice. METHODS: The author reviewed the literature regarding effectiveness of common dietary supplements and mechanisms of action with drug interactions. The author assessed properties of dietary supplements within the context of clinical implications for oral health care professionals. CONCLUSIONS: Dietary supplement use may be prevalent among patients seeking dental care. While some dietary supplements may be effective and safe, their biological activity may interfere with treatment or medications in oral health care. CLINICAL IMPLICATIONS: Oral health care professionals can ascertain patients' use of dietary supplements and evaluate them with respect to treatment. Resources for additional information are provided.

The bits and bytes to advanced graduate degree programs.

Lifelong learning may afford the dietetics professional more opportunities for career advancement, a richer self-satisfaction, and a revived confidence regarding career choices. The avenue to lifelong learning is a process unique to every health professional because of individual differences in interest and work arenas. Learning activities may take the form of continuing education conferences or certificate programs, advanced or specialty training, or academic degree programs. These programs may be in one's local community or may be accessed via distance learning. This paper will focus on advanced-degree academic programs using the distance education route. Characteristics of technologically savvy programs and learners will be addressed.

Managing atypical antipsychotic-associated weight gain: 12-month data on a multimodal weight control program.

BACKGROUND: The purpose of this study was to test prospectively the feasibility and efficacy of a multimodal weight control program for over-weight and obese severely mentally ill adults who had gained weight while taking atypical antipsychotic medications. METHOD: Thirty-one subjects with schizophrenia or schizoaffective disorder (DSM-IV), on treatment with atypical antipsychotics, participated in a 52-week, multimodal weight control program that incorporated nutrition, exercise, and behavioral interventions. The primary outcomes were measures of body mass index (BMI) and weight. A variety of secondary outcomes, including hemoglobin A(1c) level, systolic and diastolic blood pressure, and cholesterol level, were compared from baseline to endpoint. Weight and BMI changes in the intervention group were also compared with changes in 20 nonintervention patients ("usual care" group) who were contemporaneously treated in the same clinics. RESULTS: Twenty of the 31 subjects in the intervention group completed the program. Statistically significant pre-post improvements in weight (p <.02), BMI (p <.02), hemoglobin A(1c) levels (p <.001), diastolic (p <.001) and systolic (p <.05) blood pressure, exercise level (p <.003), nutrition knowledge (p <.0001), and stage of change (exercise [p <.0001] and weight [p <.008]) were seen in the intervention group. Patients attended a mean of 69% of the sessions during the year of the program. Weight and BMI also decreased significantly (p =.01) in the intervention group compared with the "usual care" group, who gained weight during the observation period. CONCLUSIONS: Individuals with schizophrenia and schizoaffective disorder were willing to attend, and benefited from, a weight control program that focused on nutrition, exercise, and motivation. The program resulted in clinically significant reductions in weight, BMI, and other risk factors for long-term poor health, including hemoglobin A(1c). In contrast, patients who did not receive the weight control intervention continued to gain weight.