Development of a Tool for Determining the Equivalence of Nutritional Supplements to Diabetic Food Exchanges.

Malnutrition is a prevalent issue in hospitals, nursing homes and the community setting. Nutritional products can be used by dietitians to supplement people's diet by adding energy, macronutrients and other constituents. The aim of the present work was (i) to create a database of nutritional products with information on their energy and macronutrient content, (ii) to estimate the food exchanges of each product and assist in diet plan development for malnourished persons and (iii) to provide a tool for calculation of food exchanges of newly developed products not included in the database. We searched the web for nutritional supplements, and an electronic database with 461 products was generated with data regarding the contained energy and macronutrients of each entry. The following companies were included: Abbott Nutrition, Nestle Nutrition, Nutricia North America, Nutricia Global, Nutricia Europe & Middle East, Axcan Pharma Inc., Kate Farms, Global Health, High Protein, NutriMedical BV, Hormel Health Labs, Hormel Health Labs/Diamond Crystal Brands, Lyons Magnus, Mead Johnson, Medical Nutrition USA Inc., Medtrition, Nutritional Designs Inc., Nutrisens, Humana (Germany), and Vitaflo USA. The created database facilitates product comparisons and categorization into several groups according to energy and protein content. In addition, a tool was created to determine food exchanges for each supplement per serving and/or food exchanges for newly developed products by simply inserting their macronutrient content. The developed tool can facilitate dietitians in comparing products and incorporating them into diet plans, if needed. Such tools may thus serve clinical practice, may be used in dietary or other smart applications and can familiarize dietitians with the digital epoch.

Formulation of the Menu of a General Hospital After Its Conversion to a "COVID Hospital": A Nutrient Analysis of 28-Day Menus.

Aim: The aim of the present study was to modify the hospital menu to increase energy and protein provision in COVID-19 patients. Methods: After the conversion of our hospital to a COVID-19 hospital, eggs, and comfort foods such as vanilla pudding were added to the menu to boost energy and protein intake of patients. All meals of the standard menu of the hospital, i.e., breakfast, lunch, and dinner were recorded for 14 consecutive days during two periods: pre-COVID-19 and after being converted to a "COVID hospital." The menus were analyzed with the use of the USDA database. Results: The total content of energy (1,873 ± 87 vs. 2,489 ± 137 Kcal), protein (97 ± 11 vs. 126.4 ± 18.7 g), fat (55 ± 9 vs. 74.1 ± 12.8 g), and carbohydrate (241.0 ± 16.0 vs. 323.0 ± 16.0 g) of the provided menus was increased in the COVID-19 period compared to the pre-COVID period. The leucine provision was also increased (4.8 ± 1.08 vs. 7.2 ± 1.3 g). Changes in protein and leucine were greater for breakfast (10 vs. 21 g protein and 0.8 vs. 1.7 g of leucine). The menu during COVID-29 provided more vitamin C (69.5 vs. 109.4 mg), thiamine (1.5 vs. 1.6 mg), riboflavin (2.1 vs. 2.6 mg), niacin (20.6 vs. 27.2 mg), pantothenic Acid (5.7 vs. 7.9 mg), vitamin B6 (2 vs. 2.6 mg), folate (274 vs. 334 µg), B 12 (4.8 vs. 6.2 µg), choline (296 vs. 458 mg) as well as vitamins A (8,564 vs. 21,258 IU), D (3.9 vs. 4.7 µg), and K (59.3-111.5 µg). As far as micronutrients are concerned, the provisions of calcium (972 vs. 1375 mg), iron (10.2-12.8 mg), magnesium (236 vs. 294 mg), phosphorus (1,325 vs. 1,807 mg), copper (1.0 vs. 1.3 mg), manganese (2.1 vs. 2.4 mg) and selenium (148 vs. 183 µg) were increased during the COVID-19 period. Conclusion: Simple menu changes and addition of comfort foods can substantially boost the nutrient content of a hospital diet, which in concert with provision of oral nutritional supplements could have an impact on patients' nutritional status.

Gastrointestinal bleeding after high intake of omega-3 fatty acids, cortisone and antibiotic therapy: a case study.

Omega-3 fatty acids exert a plethora of physiological actions including triglycerides lowering, reduction of inflammatory indices, immunomodulation, anti- thrombotic effects and possibly promotion of exercise performance. Their use is widespread and for commonly ingested doses their side- effects are minimal. We report a case of a 60 y amateur athlete who consumed about 20 g omega-3 fatty acids daily from supplements and natural sources for a year. After the intake of cortisone and antibiotics he presented duodenum ulcer and bleeding although he had no previous history of gastrointestinal problems. Although several animal data support gastro-protective effects of omega-3 fatty acids in the present case they were not able to prevent ulcer generation. The present observation may be explained by (i) the high dose of omega-3 fatty acids and their effect on bleeding, (ii) the fact that cortisone increases their oxidation and may render them proinflammatory, (iii) other antithrombotic microconstituents included in the consumed cod-oil and/or the diet of the subject and (iv) the differences in the coagulation and fibrinolytic systems of well- trained subjects. Further studies are needed to substantiate any possible interaction of cortisone and omega-3 fatty acids in wide ranges of intake.