medical nutrition therapy

医学营养治疗
  • 文章类型: Journal Article
    营养不良是腹部大手术患者的危险因素之一。为了减轻并发症的风险,建议对营养不良患者和有严重代谢风险的患者进行营养康复治疗.已经设计了各种方法,从持续7-14天的传统短期条件到更长时间的综合多模式康复计划。然而,一个重大挑战是营养干预措施的相当大的异质性,导致缺乏清晰,特定饮食建议的可合成证据。这篇叙述性综述旨在概述营养康复的概念,为临床实施提供实用建议,并强调了所涉及的障碍和促进者。
    Malnutrition plays a crucial role as a risk factor in patients undergoing major abdominal surgery. To mitigate the risk of complications, nutritional prehabilitation has been recommended for malnourished patients and those at severe metabolic risk. Various approaches have been devised, ranging from traditional short-term conditioning lasting 7-14 days to longer periods integrated into a comprehensive multimodal prehabilitation program. However, a significant challenge is the considerable heterogeneity of nutritional interventions, leading to a lack of clear, synthesizable evidence for specific dietary recommendations. This narrative review aims to outline the concept of nutritional prehabilitation, offers practical recommendations for clinical implementation, and also highlights the barriers and facilitators involved.
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  • 文章类型: Journal Article
    营养干预是2型糖尿病管理的关键组成部分;在饮食模式中进行健康支持的改变可以改善餐后血糖波动并降低HbA1c以降低糖尿病相关的发病率和死亡率。关于实施卡路里限制和/或低碳水化合物饮食的研究是大量的,尽管维持生理和行为变化超过12个月的能力是一个问题。需要了解干预目标和依从性,才能将这项研究应用于患者护理,并将期望转化为现实世界的生活环境。多样化的饮食模式,包括地中海饮食模式,素食或植物性饮食模式,或其他强调高质量碳水化合物(例如,全谷物),蔬菜,整个水果,豆类,和鱼可以支持血糖目标的实现。诸如动机面试之类的咨询策略可以用来建立饮食能力。这些方法优先考虑协作决策,目的是增加患者赋权和自我效能感。强调了在临床环境中纳入这些工具和框架的策略。提供持续的糖尿病和营养教育,配合适当的支持,以应对实施和维持行为变化方面的挑战,是有保证的。Further,健康的社会决定因素,包括环境背景,教育,社会经济地位,获得医疗保健,和系统污名化的经历(例如,种族主义或体重偏见)会干扰个体的糖尿病自我护理和营养行为。提供医学营养治疗和根据个人需求和情况定制营养干预措施可能是医生的重要途径,营养师,糖尿病提供者可以支持2型糖尿病患者。
    Nutritional interventions are a key component of type 2 diabetes management; making health-supporting changes in eating patterns can improve postprandial glycemic excursions and lower HbA1c to reduce diabetes-related morbidity and mortality. Research around implementing calorie-restricted and/or low-carbohydrate diets is plentiful, though the ability to sustain physiologic and behavioral changes for longer than 12 months is a concern. An understanding of intervention goals and adherence is needed to apply this research to patient care and translate expectations to real-world living contexts. Diverse dietary patterns including a Mediterranean eating pattern, vegetarian or plant-based eating pattern, or others that emphasize high-quality carbohydrates (e.g., whole grains), vegetables, whole fruits, legumes, and fish can support achievement of glycemic targets. Counseling strategies like motivational interviewing can be used to build eating competence. These approaches prioritize collaborative decision-making with the goal of increasing patient empowerment and self-efficacy. Strategies for incorporating these tools and frameworks in a clinical setting are highlighted. Providing ongoing diabetes and nutrition education, paired with appropriate support to address the challenges in implementing and sustaining behavior changes, is warranted. Further, social determinants of health including environmental context, education, socioeconomic status, access to healthcare, and experiences of systemic stigma (e.g., racism or weight bias) can interfere with individuals\' diabetes self-care and nutrition behaviors. Providing medical nutrition therapy and tailoring nutrition interventions to individual needs and circumstances can be an important way physicians, dietitians, and diabetes providers can support individuals with type 2 diabetes.
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  • 文章类型: Journal Article
    这篇综述旨在综合现有的关于个性化或精准营养(PPN)干预措施疗效的文献。包括医学营养治疗(MNT),在改善与血糖控制相关的结局方面(HbA1c,餐后葡萄糖[PPG],和空腹血糖),人体测量学(体重,BMI,和腰围[WC]),血脂,血压(BP),糖尿病前期或代谢综合征(MetS)成人的饮食摄入量。系统地搜索了六个数据库(Scopus,Medline,Embase,CINAHL,PsycINFO,和Cochrane),用于2000年1月至2023年4月16日发表的随机对照试验(RCTs)。使用营养与饮食学会质量标准来评估偏倚的风险。七个RCT(n=873),包括五个PPN和两个MNT干预措施,包括持续3-24个月。在检查结果如HbA1c的研究中,报告了有利于PPN和MNT干预的一致和显著的改善,PPG,和腰围。其他措施的结果,包括空腹血糖,HOMA-IR,血脂,BP,和饮食,不一致。更长时间,更频繁的干预产生了更大的改善,特别是HbA1c和WC。然而,需要在样本量较大和PPN定义标准化的研究中进行更多研究。未来的研究还应研究将MNT与当代PPN因子相结合,包括遗传,表观遗传,代谢组学,和宏基因组数据。
    This review aimed to synthesise existing literature on the efficacy of personalised or precision nutrition (PPN) interventions, including medical nutrition therapy (MNT), in improving outcomes related to glycaemic control (HbA1c, post-prandial glucose [PPG], and fasting blood glucose), anthropometry (weight, BMI, and waist circumference [WC]), blood lipids, blood pressure (BP), and dietary intake among adults with prediabetes or metabolic syndrome (MetS). Six databases were systematically searched (Scopus, Medline, Embase, CINAHL, PsycINFO, and Cochrane) for randomised controlled trials (RCTs) published from January 2000 to 16 April 2023. The Academy of Nutrition and Dietetics Quality Criteria were used to assess the risk of bias. Seven RCTs (n = 873), comprising five PPN and two MNT interventions, lasting 3-24 months were included. Consistent and significant improvements favouring PPN and MNT interventions were reported across studies that examined outcomes like HbA1c, PPG, and waist circumference. Results for other measures, including fasting blood glucose, HOMA-IR, blood lipids, BP, and diet, were inconsistent. Longer, more frequent interventions yielded greater improvements, especially for HbA1c and WC. However, more research in studies with larger sample sizes and standardised PPN definitions is needed. Future studies should also investigate combining MNT with contemporary PPN factors, including genetic, epigenetic, metabolomic, and metagenomic data.
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  • 文章类型: Journal Article
    由于在HMs的主要治疗中采取了更积极的方法,并且需要重症监护支持,因此现在比过去更频繁地将血液恶性肿瘤(HMs)患者送入重症监护病房(ICU)。来自HMs和不同血液学治疗的病理生理改变,比如化疗,对胃肠道(GI)功能产生负面影响,新陈代谢,和营养状况。Further,营养不良强烈影响不同血液学治疗的结局和耐受性.因此,这些危重病患者经常出现营养不良和病理生理改变,这给ICU中的医学营养治疗(MNT)的实施带来了挑战.频繁筛查,测量公差,和监测营养状况是强制性的,以提供个性化的MNT和实现营养目标。本综述讨论了HM如何影响胃肠道功能和营养状况,MNT在HM患者中的重要性,以及在入住ICU时向这些患者提供足够的MNT的指导的具体考虑。
    Patients with hematological malignancies (HMs) are more frequently admitted now than in the past to the intensive care unit (ICU) due to more aggressive approaches in primary therapy of HMs and the need for critical care support. Pathophysiological alterations derived from HMs and the different hematological therapies, such as chemotherapy, negatively affect gastrointestinal (GI) function, metabolism, and nutrition status. Further, malnutrition strongly influences outcomes and tolerance of the different hematological therapies. In consequence, these critically ill patients frequently present with malnutrition and pathophysiological alterations that create challenges for the delivery of medical nutrition therapy (MNT) in the ICU. Frequent screening, gauging tolerance, and monitoring nutrition status are mandatory to provide individualized MNT and achieve nutrition objectives. The present review discusses how HM impact GI function and nutrition status, the importance of MNT in patients with HM, and specific considerations for guidance in providing adequate MNT to these patients when admitted to the ICU.
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  • 文章类型: Journal Article
    更年期与肥胖患病率增加有关,代谢综合征,心血管疾病,和骨质疏松症。这些疾病和不利的实验室值,这是女性这个时期的特征,可以通过消除和减少饮食风险因素来显著改善。围绝经期改变饮食习惯是通过营养咨询和干预最有效的方法。为了减少所有这些疾病的危险因素,在已经存在的疾病的情况下,由营养师领导的饮食疗法应该是治疗的一个组成部分。以下综述总结了均衡饮食和液体摄入的建议,心血管疾病的饮食预防,睡眠的作用,以及更年期的关键预防营养素,如维生素D,钙,维生素C,B族维生素,和蛋白质的摄入。总之,在围绝经期和更年期期间,许多生活方式因素可以降低所有疾病(心血管疾病,胰岛素抵抗,2型糖尿病,骨质疏松,和肿瘤)和这一时期的症状特征。
    Menopause is associated with an increased prevalence of obesity, metabolic syndrome, cardiovascular diseases, and osteoporosis. These diseases and unfavorable laboratory values, which are characteristic of this period in women, can be significantly improved by eliminating and reducing dietary risk factors. Changing dietary habits during perimenopause is most effectively achieved through nutrition counseling and intervention. To reduce the risk factors of all these diseases, and in the case of an already existing disease, dietary therapy led by a dietitian should be an integral part of the treatment. The following review summarizes the recommendations for a balanced diet and fluid intake, the dietary prevention of cardiovascular diseases, the role of sleep, and the key preventive nutrients in menopause, such as vitamin D, calcium, vitamin C, B vitamins, and protein intake. In summary, during the period of perimenopause and menopause, many lifestyle factors can reduce the risk of developing all the diseases (cardiovascular disease, insulin resistance, type 2 diabetes mellitus, osteoporosis, and tumors) and symptoms characteristic of this period.
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  • 文章类型: Journal Article
    肥胖,一种具有多因素病因的慢性疾病,其特征在于脂肪组织的过度积累。肥胖患病率在全球以惊人的速度增长。绝大多数肥胖病例是由不适当的生活方式引起的,比如食物过度消耗和体力活动不足。由于肥胖增加引起的代谢和生化变化导致许多合并症,全因死亡率增加,降低了生活质量。2型糖尿病(T2DM)和肥胖有许多共同的致病点,并以恶性循环相互驱动。本文旨在回顾肥胖管理指南并强调最重要的要点。肥胖相关和T2DM并发症的管理在医疗保健系统上产生了巨大的费用。是的,因此,最重要的是提供简化但定制的体重管理,以避免这两种疾病的负面影响。有效的肥胖治疗导致更好的糖尿病控制,因为一些抗糖尿病药物支持减肥。肥胖治疗应由多学科团队监督,为患者提供不可或缺的信息和个性化的治疗方案。体重管理应该是多模式的,主要包括MNT(医学营养治疗),身体活动,和生活方式的改变。全面的肥胖治疗方法可能会给生活质量和合并症带来切实的结果。
    Obesity, a chronic disease with multifactorial etiopathogenesis, is characterized by excessive accumulation of adipose tissue. Obesity prevalence is growing globally at an alarming rate. The overwhelming majority of obesity cases are caused by inappropriate lifestyles, such as overconsumption of food and inadequate physical activity. Metabolic and biochemical changes due to increased adiposity resulted in numerous comorbidities, increased all-cause mortality, and reduced quality of life. T2DM (type 2 diabetes mellitus) and obesity have many common pathogenetic points and drive each other in a vicious cycle. The aim of this article is to review obesity management guidelines and highlight the most important points. Management of both obesity-related and T2DM complications incur enormous expenses on healthcare systems. It is, therefore, paramount to provide streamlined yet custom-tailored weight management in order to avoid the negative ramifications of both diseases. Efficient obesity treatment leads to better diabetes control since some antidiabetic medications support weight reduction. Obesity treatment should be overseen by a multi-disciplinary team providing indispensable information and individually tailored regimens to patients. Weight management should be multimodal and consist chiefly of MNT (medical nutrition therapy), physical activity, and lifestyle changes. A comprehensive approach to obesity treatment may give tangible results to quality of life and comorbidities.
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  • 文章类型: Journal Article
    背景:怀孕,也被称为“妊娠期”,持续37-40周,在女人的一生中被标记为“生理压力”时期。各种各样的症状,从恶心到异位妊娠,通常与堕胎等危险因素相一致,流产,死产,等。据估计,总共有15%的孕妇面临严重的并发症,需要紧急注意以确保怀孕的安全生存。在过去的几十年里,环境和营养习惯的一些变化增加了妊娠期不利变化的可能性.诊断因素,管理和营养干预是有针对性的,并且在这个生理压力阶段,更多的重点已经放在修改或管理营养因素上。目的:这篇综述的重点是饮食调整和营养干预治疗妊娠并发症。除药物治疗外,营养管理已被确定为主要必需品之一。重要的是在整个妊娠期甚至之前通过将关键营养素纳入母体饮食来设定健康的饮食模式。方法:来自包括PubMed在内的各种数据库的已发表文献,GoogleScholar和ScienceDirect用于确定妊娠并发症的管理和治疗事实。结果:膳食补充剂的建议强调了消除母体缺陷和改善代谢状况背后的概念。结论:因此,本综述总结了预防和管理妊娠相关并发症所必需的饮食建议。
    Background: Pregnancy, also known as the \"gestation period\" which lasts for 37-40 weeks, has been marked as the period of \"physiological stress\" in a woman\'s life. A wide range of symptoms, from nausea to ectopic pregnancy, are usually aligned with risk factors like abortion, miscarriage, stillbirth, etc. An estimated total of 15% of total pregnant women face serious complications requiring urgent attention for safe pregnancy survival. Over the past decades, several changes in the environment and nutrition habits have increased the possibility of unfavourable changes during the gestation phase. The diagnostic factors, management and nutritional interventions are targeted and more emphasis has been laid on modifying or managing the nutritional factors in this physiologically stressed phase. Aims: This review focuses on dietary modifications and nutritional interventions for the treatment of complications of pregnancy. Nutritional management has been identified to be one of the primary necessities in addition to drug therapy. It is important to set a healthy diet pattern throughout the gestation phase or even before by incorporating key nutrients into the maternal diet. Methods: The published literature from various databases including PubMed, Google Scholar and ScienceDirect were used to establish the fact of management and treatment of complications of pregnancy. Results: The recommendations of dietary supplements have underlined the concept behind the eradication of maternal deficiencies and improving metabolic profiles. Conclusion: Therefore, the present review summarises the dietary recommendations to combat pregnancy-related complications which are necessary in order to prevent and manage the same.
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  • 文章类型: Systematic Review
    N-of-1试验提供了比随机对照试验更高水平的证据来确定哪种治疗对个体最有效。和设计很容易适应个性化营养的测试。本系统综述的目的是使用N-of-1设计综合营养相关研究。纳入标准是成年参与者;干预/暴露是任何营养素,食物,饮料,或饮食模式;比较器是基线值,未经治疗或安慰剂的对照条件,或者替代治疗,除了饮食变化等任何结果,体重,生化结果,症状,生活质量,或营养条件差异导致的疾病结果。使用的信息来源是Medline,Embase,Scopus,CochraneCentral,和PsychInfo。使用N-of-1试验(CENT)声明或流行病学观察研究增强报告(STROBE)指南评估研究报告的质量,视情况而定。从筛选的211篇文章中,共纳入7项研究,在5个国家进行,共有83名参与者.研究的条件包括糖尿病前期,糖尿病,肠易激综合征,体重管理,并调查了饮食对健康人的影响。报告质量基本足够,饮食评估质量从差到好不等。证据基础很小,但有助于说明N-of-1研究设计的主要特征以及在个性化医学营养治疗时代推进研究的注意事项。
    N-of-1 trials provide a higher level of evidence than randomized controlled trials for determining which treatment works best for an individual, and the design readily accommodates testing of personalized nutrition. The aim of this systematic review was to synthesize nutrition-related studies using an N-of-1 design. The inclusion criterion was adult participants; the intervention/exposure was any nutrient, food, beverage, or dietary pattern; the comparators were baseline values, a control condition untreated or placebo, or an alternate treatment, alongside any outcomes such as changes in diet, body weight, biochemical outcomes, symptoms, quality of life, or a disease outcome resulting from differences in nutritional conditions. The information sources used were Medline, Embase, Scopus, Cochrane Central, and PsychInfo. The quality of study reporting was assessed using the Consort Extension for N-of-1 trials (CENT) statement or the STrengthening Reporting of OBservational Studies in Epidemiology (STROBE) guidelines, as appropriate. From 211 articles screened, a total of 7 studies were included and were conducted in 5 countries with a total of 83 participants. The conditions studied included prediabetes, diabetes, irritable bowel syndrome, weight management, and investigation of the effect of diet in healthy people. The quality of reporting was mostly adequate, and dietary assessment quality varied from poor to good. The evidence base is small, but served to illustrate the main characteristics of N-of-1 study designs and considerations for moving research forward in the era of personalized medical nutrition therapy.
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  • 文章类型: Systematic Review
    肥胖是一种慢性疾病,会损害全球越来越多儿童的身心健康。在高收入国家,儿童肥胖的患病率在低收入家庭等边缘化人群中增长更快,表明这种疾病在很大程度上是系统性的。在这些环境中,应优先考虑适当的治疗,以防止并发症和合并症的发展,并管理已经存在的并发症和合并症。一系列临床实践指南可用于管理儿童和青少年的超重和肥胖,但是还没有系统的审查比较他们的质量或综合他们的建议。我们旨在叙述性地回顾以英语出版的治疗儿童和青少年肥胖的临床实践指南,为了确定最高质量的指导方针,并评估相似性,冲突,和建议的差距。我们系统地搜索了学术数据库和灰色文献,以获取已发布的指南。我们使用AGREEII工具来评估质量,并确定了九项高质量准则,以纳入对建议的叙述性审查。准则主要建议提供旨在改善营养和身体活动的多组分行为改变干预措施。治疗结果通常集中在体重上,较少强调管理并发症或改善生活质量。在最佳交付方式上没有基于证据的共识,设置,或治疗格式。准则很少包括解决行为改变的实际或社会障碍的建议,例如烹饪技能或有监督的身体活动。没有足够的证据来评估儿童的药物和手术干预措施,这些通常不被推荐。应该指出的是,这次审查涉及仅以英文出版的文件,因此,所包含的指南主要适用于高资源环境。
    Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.
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  • 文章类型: Journal Article
    糖尿病病例的患病率在全球范围内有所增加,但是不同类型糖尿病的病理和治疗存在固有差异。2型和妊娠期糖尿病具有最相似的病理生理学。出于这个原因,2型和妊娠期糖尿病之间存在许多类似的管理策略,包括基于营养的干预措施。糖尿病自我管理教育和医学营养治疗已成为管理高血糖的具有成本效益的干预措施。其中许多干预措施,然而,是为2型糖尿病设计的,适用于妊娠期糖尿病。基于营养教育的妊娠期糖尿病干预措施尚未完全阐明。我们通过对最近发表的同行评审研究进行范围审查来审查这一差距,这些研究评估了基于营养教育的干预措施在妊娠糖尿病病例中的临床终点。搜索产生了621篇文章,纳入的12篇文章发表于2012年至2022年之间。营养信息在异质性糖尿病自我管理教育中有所不同,而医学营养治疗研究则更为一致.我们的文献检索显示,在糖尿病妊娠晚期实施的自我管理教育和医学营养治疗干预措施的结果相似。这些结果表明,妊娠期糖尿病营养教育的通用和个性化方法都可以控制高血糖并抵消其不利后果。
    Cases of diabetes mellitus have seen a global increase in prevalence, but there are inherent differences in the pathology and management of different types of diabetes. Type 2 and gestational diabetes have the most similar pathophysiology. For that reason, many similar management strategies exist between type 2 and gestational diabetes, including nutrition-based interventions. Diabetes self-management education and medical nutrition therapy have been advanced as cost-effective interventions to manage hyperglycemia. Many of these interventions, however, were designed for type 2 diabetes and adapted for diabetes in gestation. Nutrition-education-based interventions in gestational diabetes have not been fully elucidated. We scrutinized this gap by conducting a scoping review of recently published peer-reviewed studies that evaluated clinical endpoints in cases of gestational diabetes with nutrition-education-based interventions. The search yielded 621 articles, and the 12 articles included were published between 2012 and 2022. The nutrition information varied across the heterogeneous diabetes self-management education, whereas the medical nutrition therapy studies were more consistent. Our literature search revealed similar outcomes across self-management education and medical nutrition therapy interventions implemented during the third trimester of pregnancies with diabetes. These results suggest that both generalized and personalized approaches to nutrition education in gestational diabetes can manage hyperglycemia and offset its adverse consequences.
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