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[Nutrient density as a quality criterion for dietetic regimens].

Nutrient density is a very informative criterion for the evaluation of a diet from the viewpoint of nutritional physiology. One means by nutrient density the physiologically necessary nutrient proportion in an energetic unit (e. g., 4200 kJ = 1000 kcal). The lower the energy requirement, the higher is in general the nutrient density for different nutrients. Dietetic regimens make special demands on nutrient density. As compared to the normal diet for adults, the nutrient density of a dietetic regimen is in part considerably higher, e. g., for protein, calcium, iron, vitamin B1 and vitamin C. The specific demands on energy and nutrient requirements must be met by a food selection and diet composition keyed to nutrient density.

Adolescent↗

Selenium intake of infants and young children, healthy children and dietetically treated patients with phenylketonuria.

In 20 healthy infants and children, 5-20 months old, the Se intake was estimated by analysing food samples by instrumental neutron activation analysis. The intake was calculated by weighing the portions offered and actually consumed. The median Se content of the food amounted to 27 ng/g wet weight (gww) and median daily Se intake to 33.5 micrograms. The Se intake was not equally distributed over the day. About 50% of the daily Se intake was derived from the supper. The main Se sources (41%) for young children were cereal paps. Commercially available meals (30 ng/g) contained less Se than home-made ones (50 ng/g). In nine dietetically treated patients with phenylketonuria the median Se intake amounted only to 6.9 micrograms/day corresponding to a mean Se content of the diet of 7.9 ng/g. The main Se source in the diet was vegetables (36.3%) and 20% derived from their protein supplements. The Se intake of young children, healthy or dietetically treated, cannot be calculated accurately from tables but must be estimated by measuring the Se content of the local food because cereals and vegetables--the main Se sources--exhibit great regional variations.

Age Factors↗

Molecular mechanisms of anticancer activity of natural dietetic products.

The efficiency of dietetic supplements in cancer prevention and treatment is a popular and controversial subject of research. New in vitro and in vivo research results indicate that some dietetic supplements do indeed show anticancer activity. The strongest anticancer action has been demonstrated by natural compounds with multifunctional activity. For instance, antioxidants, which also bind to and modulate the activity of protein kinases involved in signal transduction cascades show both cytostatic and cytotoxic activity towards cancer cells. Other activities such as angiogenesis inhibition, nitric oxide synthase inhibition, and pro-oxidants production have also been observed. Catechins and polyphenols from plant extracts such as green tea show the strongest anticancer activity. The initial clinical trials with some flavonoid molecules are already underway.

Antineoplastic Agents, Phytogenic↗

Position of the American Dietetic Association: the impact of fluoride on health.

Fluoride is an important element for mineralization of body tissues. The use of topical and systemic fluoride for oral health has resulted in major reductions in dental caries and its associated disability. Fluoridation of public water supplies has been endorsed by over 90 professional health organizations as the most effective dental public health measure in existence. Still, about half of the US population fails to receive the maximum benefits possible from community water fluoridation and the use of fluoride products. Fluoride also plays a role in bone health. The role of high doses of fluoride for prevention of osteoporosis is undergoing active study and is considered experimental at this point. Dietetics professionals should routinely monitor and promote the use of systemic and topical fluorides, especially in children and adolescents. The American Dietetic Association strongly reaffirms its endorsement of the use of systemic and topical fluorides, including water fluoridation, at appropriate levels of intake, as an important public health measure. However, clients should be cautioned that experimental use of high intakes of fluoride should be avoided unless they are participating in clinical trials.

Adult↗

Nutritional status at submission for dietetic services and screening for malnutrition at admission to hospital.

This paper presents two studies in a quality management project that aims to diminish malnutrition among hospitalized patients. The objective of study 1 was to investigate what information was available on the nutritional status of patients submitted for dietetic services for reasons other than obesity (n= 167) and of study 2 to evaluate a nine-question screening sheet for malnutrition in patients (n= 115) within 48 h of admission to the hospital. In study 1 sufficient data to evaluate nutritional status was found for 17% of the patients submitted for dietetic services. In study 2 the screening sheet identified 21% of the patients as malnourished and a full nutritional assessment of seven anthropometrical and biochemical measurements 20%. The screening sheet could be simplified to six questions and then had a sensitivity of 0.69, a specificity of 0.91 and a positive predictive value of 0.65. It is concluded that evaluation of nutritional status in hospitalized patients has been disregarded and a simple screening sheet can be used to identify patients in need of further nutritional assessment and treatment.

Aged↗

Influence of dietetic and anthropometric factors and of the type of sport practised on bone density in different groups of women.

OBJECTIVE: The aim of this work was to analyse the influence of dietetic and anthropometric data, as well as the sport practised, on the bone density of different groups of sportswomen. SUBJECTS AND METHODS: Dietetic, anthropometric and bone density data were collected from 74 women who practised different sports (15 skiers, 26 basketball players and 33 ballet dancers), and compared to those of 90 women who led sedentary lifestyles. RESULTS: The sportswomen had higher bone mineral contents and bone densities than controls. However, the dancers showed similar spinal and hip values as those of controls, and lower forearm values. Low body weight and body mass index, and insufficient energy intake-characteristic of the dancers-were associated with poorer bone mineralisation status. Increased energy, protein, vitamin D, calcium, zinc and magnesium intakes were associated with greater bone density and mineral content at different sites. CONCLUSIONS: The worst bone density status was that of the dancers, who, as a group, displayed characteristics that have negative impacts in this respect (low energy intakes and low body weight). Dancers should therefore take steps to avoid suffering fractures and skeleto-muscular lesions which could negatively influence their health and physical performance. The greater consumption of milk products and calcium and better Ca/P ratio seen in the dancers could help this group to avoid bone deterioration.

Adolescent↗

A cross-sectional survey of the opinions on weight loss treatments of adult obese patients attending a dietetic clinic.

OBJECTIVE: To investigate the views and opinions on weight loss treatments of adult obese patients attending a dietetic clinic. DESIGN: Cross-sectional survey. SUBJECTS: 161 adults attending dietetic outpatients clinics in Portsmouth for obesity with a body mass index of at least 30 kg/m2. MEASUREMENTS: Self-administered questionnaire developed from a series of focus groups with obese adults. Key topics were previous attempts to lose weight, methods used, the role of physical activity and patients' views about treatment from health professionals. RESULTS: The preferences and usefulness of different methods to lose weight varied according to the number of attempts to lose weight, gender, age, body mass index and medical condition of the patient. Men were less likely to use special slimming products, attend slimming groups and swimming than women (odds ratios (95% confidence interval), 0.1 (0.03-0.6) for slimming groups other than Weight Watchers, 0.3 (0.1-0.80) for special slimming products and 0.3 (0.1-0.6) for swimming). Men were more likely to use physical activity (2.6 (1.1-6.2)) and in particular walking (3.7 (1.0-13.6)) and cycling (2.8 (1.0-7.6)) and were more likely to see the dietitian (3.8 (1.4-9.9)) than women. Those with more than 10 attempts to lose weight were more likely to see the dietitian (3.6(1.6-8.2)), use Weight Watchers (2.5 (1.1-5. 6)) and newspapers and magazines (4.4 (1.8-10.9)) than those with fewer attempts. The younger age group were more likely to use more vigorous forms of exercise (4.2 (1.6-11.2) for keep fit and 3.7 (1. 5-9.6) for cycling) than the older subjects. The most obese were more likely to have negative views on their treatment by health professionals (4.4 (1.9-9.8) 'chairs are never big enough' and 4.0 (1.8-8.8) 'I am regarded as a second class citizen') than those who were less obese. Those without a medical condition were more likely to exercise (2.8 (1.3-6.3)) and use books (4.8 (2.0-11.2)) than those with a medical condition. CONCLUSION: The views of obese people should be considered when planning services for the treatment of obesity and a variety of options should be available. International Journal of Obesity (2000) 24, 164-170

Adolescent↗

Prebiotic oligosaccharides in dietetic products for infants: a commentary by the ESPGHAN Committee on Nutrition.

This article by the ESPGHAN Committee on Nutrition summarizes available information on the effects of adding prebiotic oligosaccharides to infant and follow-on formulae. Currently there are only limited studies evaluating prebiotic substances in dietetic products for infants. Although administration of prebiotic oligosaccharides has the potential to increase the total number of bifidobacteria in feces and may also soften stools, there is no published evidence of clinical benefits of adding prebiotic oligosaccharides to dietetic products for infants. Data on oligosaccharide mixtures in infant formulae do not demonstrate adverse effects, but further evaluation is recommended. Combinations and dosages in addition to those so far studied need to be fully evaluated with respect to both safety and efficacy before their use in commercial infant food products. Well-designed and carefully conducted randomized controlled trials with relevant inclusion/exclusion criteria, adequate sample sizes and validated clinical outcome measures are needed both in preterm and term infants. Future trials should define optimal quantity and types of oligosaccharides with prebiotic function, optimal dosages and duration of intake, short and long term benefits and safety. At the present time, therefore, the Committee takes the view that no general recommendation on the use of oligosaccharide supplementation in infancy as a prophylactic or therapeutic measure can be made.

Bifidobacterium↗

[Maple syrup disease: a rare entity that we must know. Review of its dietetic management].

Maple syrup disease is secondary to a deficiency of deshydrogenase complex of a cetoacid of branched-chain. This disease has a recessive autosomic inheritance, with an incidence of 1/200,000 newborns, without differences between male and female. Due to clinical presentation and biochemical response to tiamin, these patients can be classified in five clinical entities: classic, intermediate, intermittent, positive response to tiamin and deficiency of dihydrolipoyl deshydrogenase (E3). In these patients, an increase of seric branched-chain aminoacids is detected, it could be detected by (chromatography) during neonatal period. Valine, isoleucine, and aloisoleucine are increased in serum, orine, and cephaloraquideum liquid by ionic changed chromatography, chromatography of high resolution or high voltage electrophoresis. Patients have two phases in this disease (acute phase and maintaining phase). Objectives in acute phase are based in three topics: to eliminate toxic metabolites, nutritional support and to get anabolism. Utilization of hemodialysis/peritoneal dialysis/blood exchange is one of the first treatments. Dietetic support is the second treatment, with a minimum energy intake and controlling blood levels of aminoacids. Modified dietetic formulas is a main device to treat these patients.

Humans↗

Women's Health and Nutrition Position of Dietitians of Canada and The American Dietetic Association.

Within the past ten years, women's health has evolved to a much broader paradigm, beyond reproductive issues. From a physiological perspective, women's health now refers to the prevention, diagnosis, and management of conditions or diseases that may be unique to women, be more prevalent in women, or manifest differently in women than in men. Women's health encompasses emotional, social, cultural, spiritual, and physical well-being. It is determined by the social, political, and economic context of women's lives. Nutrition is involved in the etiology or treatment of half of the ten leading causes of death in women. The incidence of osteoporosis and extremes in body weight are approaching epidemic proportions in women. This position paper reviews the following health problems in relation to women: cardiovascular disease, cancer, osteoporosis, weight, and diabetes mellitus. Dietetics professionals are in the perfect position to understand the issues surrounding women's health in order to deliver a message to women that will allow them to make wise decisions about their health. Nutrition is a critical component of risk reduction and treatment, and must be included in clinical and preventive services for women. Dietetics professionals must work to increase their knowledge about women's health issues, to promote health and education programs, to influence policy makers, to deliver the highest-quality medical nutrition therapy, and to be proactive in documenting the effectiveness of outcomes-based research.

Journal Article↗

[Treatment of malnutrition: dietetic support and enteral nutrition].

Except in case of bowel obstruction or intestinal failure, nutritional support should be performed by oral or enteral route. In hospitalised patients, the decision of nutritional support depends on both nutritional state and spontaneous oral intake. Dietetic support can use energy enriched food and oral supplement. Enteral nutrition can be proposed in case of failure of dietetic support or at once in case of severe malnutrition or dysphagia. An early start and a good technique are conditions in order to improve outcome of patients.

Dietary Supplements↗

[Dietetic determinants on food intake and effects in body weight regulation].

Obesity is a multifactorial pathology currently considered one of the main public health problems. Its prevalence is increasing dramatically in the last decades, reaching huge rates in Brazil and many other countries. Regardless of the factors associated with genetic predisposition, this pathology is often associated with abnormal food intake, and also with high consumption of caloric foods and sedentary habits. Thus, obesity is the result of an imbalance between food intake and energy expenditure. One of the greatest research interests in nutrition has currently been the dietetic determinants that may exert an influence on the process of food intake, as well as the role of foods on physiological, physical and chemical factors most related to the processes of satiation and satiety. Based on these aspects, this paper analyzes several research works to gain a better insight of the dietetic factors affecting food intake and body weight regulation.

Appetite Regulation↗

[Dietetic management of cystic fibrosis: intervention strategies].

Cystic fibrosis is a systemic disease whose prognosis has improved thanks multidisciplinary researches and above all better knowledges and care of nutritional problems. It is important, for a good therapy, considering each case singularly, with a differentiated and individualized dietetic approach, which focuses on its specific needs and features. A "step by step" process could be useful to manage patient suffering from cystic fibrosis; it is based on 5 different patterns of possible nutritional dietetic methods. The development of the nutritional techniques of treatment for this kind of desease both with the individualized and differentiated approach have led to improve prognosis and especially the patient's standard of life.

Cystic Fibrosis↗

Changes in billing for nutrition support services and dietetics staff resources between 1984 and 1986.

Changes in hospital funding resulting from the Prospective Payment System have been recognized as a major force in hospitals in the 1980s. The Dietitians in Nutrition Support (DNS) Practice Group examined these changes using a survey sent to 1,000 clinical nutrition managers at American Hospital Association (AHA) hospitals. The goals of the survey were (a) to evaluate changes in billing for nutrition services and (b) to evaluate changes in resources available to dietetics staff members. Although income from nutrition services to inpatients had increased only 18% since 1984, 45% of respondents reported an increase in payment for outpatient services. Prior to 1984, larger hospitals reported screening for malnutrition more often than smaller hospitals, and the responsibility for screening was handled more often by dietetic technicians than by RDs. Larger hospitals also reported establishment of a home nutrition support company more often than smaller hospitals. Computer and academic course costs were paid more frequently by nonprofit and tertiary hospitals. Although the number of hospitals billing for nutrition services to patients was small, most reported receiving payment. We conclude that charges for nutrition services by dietitians to outpatients have increased, and that most dietitians who bill for services receive payment. Academic and technological resources for RDs have increased in general, though smaller primary-care and for-profit hospitals report such supports less consistently than larger, tertiary-care, and not-for-profit hospitals.

Ambulatory Care↗

[The potentials for the dietetic therapy of alcoholic liver lesions].

Most frequent and typical changes of the food status in patients with alcoholic diseases of the liver have been considered by the author. Typical concomitant gastroenterologic disorders in this category of patients have been described. The changes detected have required an adequate dietetic correction to eliminate the imbalance in nutrition and to stimulate the resources of the affected liver. The dietetic correction has proved to be sufficiently effective in most patients. The investigations conducted have shown the necessity of dietotherapy as an important component of the combined treatment of alcoholic affections of the liver.

Adult↗

Federal nutrition policies: impact on dietetic practice.

Current federal nutrition policies are likely to have a major impact on dietetic practice. Several examples have been selected to explain why and how members of the American Dietetic Association and other nutrition professionals should become involved in policy development and implementation.

Cholesterol↗

Quality assurance and clinical dietetics.

A comprehensive Quality Assurance Programme has been developed in the Department of Dietetic Services at Waikato Hospital. It involves the evaluation of personal performance and of the services provided by the Department. Performance Appraisal and Dietetic Record Audit. The programme has become an established aspect of the service. It has been modified from time to time, but always with the intent to improve performance. Significant gains have accrued to the Department and to the services it provides as a result of the Quality Assurance Programme.

Dietary Services↗

[A new type of creamery butter for pediatric and dietetic nutrition].

The paper presents the data on the chemical composition and the technology of manufacturing a new sort of butter for child's and dietetic nutrition. The butter has high biological value due to the introduction of polyunsaturated fatty acids (PUSFA) with vegetable oils and milk-protein ingredients. The milk-protein ingredients also play the role of the butter structure stabilizers. The chemical composition of the new sort of butter, including the vitamin and mineral content, as well as the amino-acid composition of the butter plasma are described. It is shown that the content of PUSFA in the new sort of butter is 10-fold higher than in the routine butter. Various kinds of dessert butter have been developed with different flavoring additives. One of the butter variant has been enriched with bifidobacteria. The new sort of butter is recommended for the dietetic nutrition of children and adults suffering from obesity, as well as for the nutrition of the middle- and old-aged subjects to prevent lipid metabolism disorders.

Bifidobacterium↗