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Hickson M, Child J, Collinson A. A case study of the impact of a dietitian in the multi-disciplinary team within primary care: a service evaluation. J Hum Nutr Diet 2023; 36:1760-1770. [PMID: 37526210 DOI: 10.1111/jhn.13217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Expanding the primary care workforce to alleviate general practitioner (GP) workload, improve access and improve quality of care is a current UK strategy. Evidence suggests dietitians can improve patient outcomes and make cost savings. The present study aimed to evaluate a dietitian working as an expert generalist and first contact practitioner (FCP) in a general practice multi-disciplinary team (MDT) to provide appropriate care to patients and reduce GP workload. METHODS A dietitian was employed for 6 months at 0.6 full-time equivalents in a group of general practices in Devon, UK. Data were collected on the referral source, patient satisfaction, health outcomes and changes in prescribing data for all patients seen by the dietitian. Focus groups and interviews provided data to understand the experience of introducing a dietitian into the team. RESULTS This model of service delivery showed the dietitian acting as an expert generalist, a FCP and able to educate the MDT. A range of professionals within the MDT referred patients with a wide range of diagnoses (both paediatric and adults) and the dietitian acted as a FCP for 29% of patients. Saving were made for the optimisation of medicine management. CONCLUSIONS The dietitian can improve patient-centred care for several patient groups; enhance learning for staff around nutrition and dietary issues; and contribute to more efficient working and cost savings around prescription of nutritional products. This was an evaluation of one service and further research is needed to understand the value dietitians can contribute and the factors supporting effective and efficient working in this context.
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Affiliation(s)
- Mary Hickson
- School of Health Professions, University of Plymouth, Plymouth, UK
- NIHR Applied Research Collaboration South West Peninsula (PenARC), University of Plymouth, Plymouth, UK
| | - Jenny Child
- School of Health Professions, University of Plymouth, Plymouth, UK
| | - Avril Collinson
- School of Health Professions, University of Plymouth, Plymouth, UK
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2
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Eshete A, Lambebo A, Mohammed S, Shewasinad S, Assefa Y. Effect of nutritional promotion intervention on dietary adherence among type II diabetes patients in North Shoa Zone Amhara Region: quasi-experimental study. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2023; 42:49. [PMID: 37254151 DOI: 10.1186/s41043-023-00393-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 05/26/2023] [Indexed: 06/01/2023]
Abstract
BACKGROUND Diabetes is a major global public health problem that requires self-management behavior. However, this is difficult to implement in practice and requires new approaches. The purpose of this study was to evaluate nutritional promotion interventions for dietary adherence and lessons learned to improve self-management. METHODS A quasi-experimental study was conducted from January 2020 to February 2021 in North Shoa Zone public hospital. The study enrolled 216 type II diabetic patients from four public hospitals. Study participants were randomly assigned to intervention and control groups at an individual level. Data were measured twice (baseline and end line survey after six months using interviewer-administered questionnaires). Data were entered into Epi Data V.3.1 and analyzed using SPSS version 22. Data were presented as means of standard deviations for continuous variables and percentages for categorical variables. Intervention and control groups were compared before and after intervention using independent t tests. A p-value less than 0.05 was considered significant for all statistical tests. RESULTS A total of 216 type II diabetics participated in this study. Nutritional promotion intervention programs increased adherence to the mean number of days adhering to a healthy diet (p < 0.0001). Specifically, the nutrition promotion program improved daily intake of fruits and vegetables, low glycemic index foods, high fiber foods, healthy fish oils, low sugar foods, and healthy eating plans (p ≤ 0.050). Mean fasting blood glucose levels were significantly decreased after the educational intervention (p ≤ 0.05). CONCLUSION This study demonstrates that a nutrition-promoting intervention can significantly change patients' adherence to healthy eating behaviors and effectively improve their glycemic control. Health care providers should integrate programs that promote nutrition education into existing health systems service. Primary care platforms such as health posts and health centers can play a key role in integrating health promotion programs to improve self-management behaviors.
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Affiliation(s)
- Akine Eshete
- Department of Public Health, Debre Berhan University, Debre Brehan, Ethiopia.
| | - Abera Lambebo
- Department of Public Health, Debre Berhan University, Debre Brehan, Ethiopia
| | - Sadat Mohammed
- Department of Public Health, Debre Berhan University, Debre Brehan, Ethiopia
| | - Sisay Shewasinad
- Department of Pediatric and Child Health Nursing, Debre Berhan University, Debre Brehan, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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3
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Li K, Wang D, Zhang X, Yang J, Chen X. Efficacy of early enteral nutrition versus total parenteral nutrition for patients with gastric cancer complicated with diabetes mellitus: A systematic review and meta-analysis. Nutr Diet 2022; 79:129-139. [PMID: 35233912 DOI: 10.1111/1747-0080.12721] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/28/2021] [Accepted: 01/01/2022] [Indexed: 02/05/2023]
Abstract
AIM This study aimed to synthesise available data and evaluate the clinical evidence regarding the effect of early enteral nutrition versus total parenteral nutrition on nutritional status and blood glucose in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. METHODS This systematic review and meta-analysis was designed, conducted and reported following the PRISMA guideline. We performed searches in PubMed, Embase, Medline, Web of Science, Cochrane Library, Chinese Biomedicine Literature Database, Chinese Scientific Journal Database, Chinese National Knowledge Infrastructure and Wanfang Database. The study designs were randomised controlled trials, quasi-randomised controlled trials, and controlled clinical trials. The trials compared early enteral nutrition (experimental group) with total parenteral nutrition (control group) in patients with gastric cancer complicated with diabetes mellitus after gastrectomy. The risk of bias was assessed using the Cochrane risk of bias tool. RESULTS A total of 19 trials (1255 patients) were included. Meta-analysis showed a significantly shorter length of hospital stay (days; mean difference -5.07, 95% confidence interval [CI] [-6.28, -3.86], p < 0.00001) and a lower post-operative complications rate (%; odds ratio 0.29, 95% CI [0.16, 0.50], p < 0.0001) in the early enteral nutrition group than in the total parenteral nutrition group. Compared with the total parenteral nutrition group, the early enteral nutrition group had lower blood glucose fluctuation values (mmol/L; mean difference -2.03, 95% CI [-2.44, -1.61], p < 0.00001), lower levels of glycosylated haemoglobin (%; mean difference -0.62, 95% CI [-1.22, -0.03], p = 0.04), higher levels of prealbumin (g/L; p = 0.002), transferrin (g/L; p = 0.002), total protein (g/L; p = 0.001) and haemoglobin (g/L; p = 0.005). CONCLUSIONS Early enteral nutrition may maintain stable blood glucose levels and improve nutritional status, leading to better therapeutic effectiveness in gastric cancer complicated with diabetes mellitus patients.
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Affiliation(s)
- Ka Li
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Dan Wang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Xingxia Zhang
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
| | - Jie Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Xinrong Chen
- West China School of Nursing/West China Hospital, Sichuan University, Chengdu, China
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Zhao F, Pan D, Wang N, Xia H, Zhang H, Wang S, Sun G. Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Patients with Type 2 Diabetes Mellitus: a Systematic Review and Meta-analysis. Biol Trace Elem Res 2022; 200:516-525. [PMID: 33783683 DOI: 10.1007/s12011-021-02693-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/24/2021] [Indexed: 12/20/2022]
Abstract
In recent years, the prevalence and incidence of diabetes mellitus (DM) have increased sharply worldwide. In order to evaluate the effect of chromium supplementation on patients with type 2 diabetes, a meta-analysis was conducted by searching the relevant literature. Randomized controlled trials on the effects of chromium supplements on glucose metabolism or lipid profile in patients with type 2 diabetes were retrieved from multiple databases. Literature screening, quality evaluation, and data extraction were conducted according to the inclusion and exclusion criteria, and Review Manager 5.4.0 was used for data analysis. A total of 10 randomized controlled trials involving 509 patients were included, including 269 cases in the experimental group and 240 cases in the placebo control group. Statistical analysis was conducted on the glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), triglyceride (TG), total cholesterol (TC), low-density lipoprotein (LDL), and high-density lipoprotein (HDL) to evaluate the blood glucose and lipid levels. Meta-analysis results showed that the differences between the experimental group and the control group in only one indicator of HbA1c were statistically significant, while there were no statistically significant differences in other indicators. The use of chromium supplements can reduce the glycosylated hemoglobin of type 2 diabetic patients to a certain extent, but it cannot effectively improve the fasting blood glucose and blood lipid levels of type 2 diabetic patients.
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Affiliation(s)
- Fengyi Zhao
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Da Pan
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Niannian Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Hui Xia
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Hong Zhang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
| | - Shaokang Wang
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China.
| | - Guiju Sun
- Key Laboratory of Environmental Medicine and Engineering of Ministry of Education, and Department of Nutrition and Food Hygiene, School of Public Health, Southeast University, 87 Dingjiaqiao Road, Nanjing, 210009, Jiangsu, China
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Balkrishna A, Gohel V, Pathak N, Tomer M, Rawat M, Dev R, Varshney A. Anti-hyperglycemic contours of Madhugrit are robustly translated in the Caenorhabditis elegans model of lipid accumulation by regulating oxidative stress and inflammatory response. Front Endocrinol (Lausanne) 2022; 13:1064532. [PMID: 36545334 PMCID: PMC9762483 DOI: 10.3389/fendo.2022.1064532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/18/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The prevalence of diabetes has considerably increased in recent years. In the long run, use of dual therapy of anti-diabetic agents becomes mandatory to attain euglycemia. Also, the incidences of diabetes-related co-morbidities have warranted the search for new therapeutic approaches for the management of the disease. Traditional herbo-mineral, anti-diabetic agents like Madhugrit are often prescribed to mitigate diabetes and related complications. The present study aimed to thoroughly characterize the pharmacological applications of Madhugrit. METHODS Phytometabolite characterization of Madhugrit was performed by ultra-high performance liquid chromatography. Evaluation of cell viability, α-amylase inhibition, glucose uptake, inflammation, and wound healing was performed by in vitro model systems using AR42J, L6, THP1, HaCaT cells, and reporter cell lines namely NF-κB, TNF-α, and IL-1β. The formation of advanced glycation end products was determined by cell-free assay. In addition, the therapeutic potential of Madhugrit was also analyzed in the in vivo Caenorhabditis elegans model system. Parameters like brood size, % curling, glucose and triglyceride accumulation, lipid deposition, ROS generation, and lipid peroxidation were determined under hyperglycemic conditions induced by the addition of supraphysiological glucose levels. RESULTS Madhugrit treatment significantly reduced the α-amylase release, enhanced glucose uptake, decreased AGEs formation, reduced differentiation of monocyte to macrophage, lowered the pro-inflammatory cytokine release, and enhanced wound healing in the in vitro hyperglycemic (glucose; 25 mM) conditions. In C. elegans stimulated with 100 mM glucose, Madhugrit (30 µg/ml) treatment normalized brood size, reduced curling behavior, decreased accumulation of glucose, triglycerides, and lowered oxidative stress. CONCLUSIONS Madhugrit showed multimodal approaches in combating hyperglycemia and related complications due to the presence of anti-diabetic, anti-inflammatory, anti-oxidant, wound healing, and lipid-lowering phytoconstituents in its arsenal. The study warrants the translational use of Madhugrit as an effective medicine for diabetes and associated co-morbidities.
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Affiliation(s)
- Acharya Balkrishna
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
- Patanjali Yog Peeth (UK) Trust, Glasgow, United Kingdom
| | - Vivek Gohel
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Nishit Pathak
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Meenu Tomer
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Malini Rawat
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Rishabh Dev
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
| | - Anurag Varshney
- Drug Discovery and Development Division, Patanjali Research Institute, Governed by Patanjali Research Foundation Trust, Haridwar, Uttarakhand, India
- Department of Allied and Applied Sciences, University of Patanjali, Haridwar, Uttarakhand, India
- Special Centre for Systems Medicine, Jawaharlal Nehru University, New Delhi, India
- *Correspondence: Anurag Varshney,
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Collins R, Burrows T, Donnelly H, Tehan PE. Macronutrient and micronutrient intake of individuals with diabetic foot ulceration: A short report. J Hum Nutr Diet 2021; 35:786-790. [PMID: 34894370 DOI: 10.1111/jhn.12974] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/19/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adequate nutrition is essential in individuals with diabetic foot ulceration (DFU); therefore, an assessment of dietary intake is critical. A lack of nutrients including protein, zinc and vitamins C and D have all been associated with poor wound healing. However, the comprehensive dietary intake of Australian adults with DFU is poorly understood. The aim of this cross-sectional study was to describe the dietary intake of adults with DFU in an Australian setting. METHODS Participants (n = 115) with diabetes (type 1 and 2), a mean body mass index of 36 and current foot ulceration were recruited from across New South Wales, Australia. Dietary intake was assessed using the Australian Eating Survey, a self-reported validated food frequency questionnaire. RESULTS The mean (SD) reported energy intake was 9.57 (±SD 4.43) MJ day-1 . A mean protein intake of 104 (±SD 49) g day-1 is below recommended intake for wound healing; however, the mean protein intake contribution to energy (19%E) was within recommendations for normal populations. The mean carbohydrate intake (43%E) was within recommended ranges for healthy populations; however, the mean total fat intake (36%E) was above recommendations. Micronutrient intake was adequate, apart from folate, which was below the recommended intake, and sodium, vitamin C, vitamin A and selenium, which were above the recommended intake. CONCLUSIONS A lack of adequate folate may have a negative impact on healing, with folate proposed to play a role in tissue repair. Wound management of individuals with DFU should include a regular assessment of dietary intake to recognise deficiencies in macro- and micronutrients, and subsequently address these inadequacies to optimise healing.
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Affiliation(s)
- Rebecca Collins
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Hailey Donnelly
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
| | - Peta Ellen Tehan
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, NSW, Australia
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7
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Siopis G. The need to improve access to dietetic services for people with type 2 diabetes. Health Promot J Austr 2021; 33:909-911. [PMID: 34698415 DOI: 10.1002/hpja.550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/15/2021] [Accepted: 10/23/2021] [Indexed: 11/07/2022] Open
Affiliation(s)
- George Siopis
- School of Life and Environmental Sciences, The University of Sydney, Sydney, New South Wales, Australia.,Charles Perkins Centre, The University of Sydney, Sydney, New South Wales, Australia
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8
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Burrows T, Teasdale S, Rocks T, Whatnall M, Schindlmayr J, Plain J, Roberton M, Latimer G, Harris D, Forsyth A. Cost effectiveness of dietary interventions for individuals with mental disorders: A scoping review of experimental studies. Nutr Diet 2021; 79:291-302. [PMID: 34510689 DOI: 10.1111/1747-0080.12703] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 08/12/2021] [Accepted: 08/17/2021] [Indexed: 11/28/2022]
Abstract
AIM This scoping review aimed to explore the extent of the evidence of experimental studies evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. METHODS Five databases (CINAHL, EMBASE, MEDLINE, PsycINFO and Scopus) were searched to October 2020 for cost-analysis studies of interventions aiming to improve dietary intake in people with mental disorders. No restriction was placed on participant age, mental disorder type or intervention design. Results are presented narratively. RESULTS Of 2753 articles identified, 13 articles reporting on eight studies were included. Studies were RCTs (n = 5), cluster RCT (n = 1), cluster preference RCT (n = 1), and pre-post test (n = 1). Seven studies were in community settings (eg, outpatient clinics), and one study in the community housing setting. All studies were in adults, seven included male and female participants, and one included only females. Defined mental disorder diagnoses included serious/severe mental disorders (n = 3), major depression (n = 2), schizophrenia, schizoaffective disorder or first-episode psychosis (n = 1), any mental disorder (n = 1), and bulimia nervosa (n = 1). Five interventions were multi-behaviour, two were diet only and one was eating disorder treatment. Cost analyses included cost-utility (n = 3), cost-effectiveness (n = 1), cost-utility and cost-effectiveness (n = 3), and a costing study (n = 1). Two studies (25%) reported positive results in favour of cost effectiveness, and four studies reported a mix of positive and neutral results. CONCLUSIONS There is limited evidence evaluating the cost effectiveness of dietary interventions in individuals with mental disorders. Additional studies in various settings are needed to confirm cost effectiveness of different interventions.
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Affiliation(s)
- Tracy Burrows
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Scott Teasdale
- School of Psychiatry, UNSW Sydney, Kensington, New South Wales, Australia
| | - Tetyana Rocks
- Institute for Mental and Physical Health and Clinical Translation (IMPACT), Food and Mood Centre, Deakin University, Geelong, Victoria, Australia
| | - Megan Whatnall
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Callaghan, New South Wales, Australia.,Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, New South Wales, Australia.,Hunter Medical Research Institute, New South Wales, Australia
| | - Julia Schindlmayr
- Dietitians Australia, Deakin, Australian Capital Territory, Australia
| | - Janice Plain
- Macquarie Hospital, North Ryde, New South Wales, Australia
| | - Michelle Roberton
- Victorian Centre of Excellence in Eating Disorders, Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Georgina Latimer
- Department of Nursing and Allied Health, School of Health Sciences, Swinburne University, Hawthorn, Victoria, Australia
| | - Deanne Harris
- Tamworth Rural Referral Hospital, Hunter New England Health, Tamworth, New South Wales, Australia
| | - Adrienne Forsyth
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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9
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Moutou KE, England C, Gutteridge C, Toumpakari Z, McArdle PD, Papadaki A. Exploring dietitians' practice and views of giving advice on dietary patterns to patients with type 2 diabetes mellitus: A qualitative study. J Hum Nutr Diet 2021; 35:179-190. [PMID: 34370332 DOI: 10.1111/jhn.12939] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 07/28/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dietary guidelines for type 2 diabetes mellitus (T2DM) emphasise weight management and individualised total carbohydrate intake. Evidence on the most effective dietary patterns (DPs) for T2DM management is mixed, potentially leading to variations in the advice that dietitians provide. The present study aimed to explore dietitians' practice of DP advice provision to adults with T2DM, as well as understand their views when advising their patients on the DPs deemed effective for glycaemic management or recommended by current guidelines. METHODS Semi-structured interviews were conducted with 12 UK-registered dietitians, with experience in consulting adults with T2DM. Dietitians were asked for their views on five DPs recommended for glycaemic management of T2DM. Interview transcripts were analysed using deductive and inductive thematic analysis. RESULTS Nine themes were identified that draw attention to DP advice provision practices, the five DPs (low-carbohydrate, low-fat, low-glycaemic index, Mediterranean diet and Dietary Approaches to Stop Hypertension diet), other DPs, the barriers and facilitators to DP advice provision and following this advice, and the factors affecting the provision of DP advice. Participants' current practice of DP advice provision to patients with T2DM was perceived to be individualised and patient-centred. Participants discussed their current practice and perceptions of available evidence and how patients respond to advice on the DPs shown to be effective for glycaemic management. Several barriers to providing advice on specific DPs, including safety and compliance challenges, were identified. Participants also highlighted factors that would facilitate the provision of advice on specific DPs and would help patients to follow this advice, including social support, educational resources and more robust scientific evidence. CONCLUSIONS The findings of the present study provide important insights regarding dietitians' views of promoting whole DPs to patients with T2DM. Emerged barriers and facilitators should be considered when developing future guidance for dietetic practice to support patients with following whole DPs for T2DM management.
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Affiliation(s)
- Konstantina E Moutou
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Clare England
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Callum Gutteridge
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK
| | - Zoi Toumpakari
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Paul D McArdle
- Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Angeliki Papadaki
- School for Policy Studies, Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
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10
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Ismael S, Silvestre MP, Vasques M, Araújo JR, Morais J, Duarte MI, Pestana D, Faria A, Pereira-Leal JB, Vaz J, Ribeiro P, Teixeira D, Marques C, Calhau C. A Pilot Study on the Metabolic Impact of Mediterranean Diet in Type 2 Diabetes: Is Gut Microbiota the Key? Nutrients 2021; 13:nu13041228. [PMID: 33917736 PMCID: PMC8068165 DOI: 10.3390/nu13041228] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/31/2021] [Accepted: 04/04/2021] [Indexed: 12/15/2022] Open
Abstract
The Mediterranean diet (MD) has been recommended for type 2 diabetes (T2D) treatment. The impact of diet in shaping the gut microbiota is well known, particularly for MD. However, the link between MD and diabetes outcome improvement is not completely clear. This study aims to evaluate the role of microbiota modulation by a nonpharmacological intervention in patients with T2D. In this 12-week single-arm pilot study, nine participants received individual nutritional counseling sessions promoting MD. Gut microbiota, biochemical parameters, body composition, and blood pressure were assessed at baseline, 4 weeks, and 12 weeks after the intervention. Adherence to MD [assessed by Mediterranean Diet Adherence Screener (MEDAS) score] increased after the intervention. Bacterial richness increased after 4 weeks of intervention and was negatively correlated with fasting glucose levels and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). Prevotella to Bacteroides ratio also increased after 4 weeks. In contrast, glycated haemoglobin (HbA1c) and HOMA-IR were only decreased at the end of study. Alkaline phosphatase activity was assessed in fecal samples and was negatively correlated with HbA1c and positively correlated with bacterial diversity. The results of this study reinforce that MD adherence results in a better glycemic control in subjects with T2D. Changes in gut bacterial richness caused by MD adherence may be relevant in mediating the metabolic impact of this dietary intervention.
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Affiliation(s)
- Shámila Ismael
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Marta P. Silvestre
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Unidade Universitária Lifestyle Medicine José de Mello Saúde by NOVA Medical School, 1169-056 Lisboa, Portugal
| | - Miguel Vasques
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- Endocrinology Department, Centro Hospitalar e Universitário Lisboa Central, 1069-166 Lisboa, Portugal
| | - João R. Araújo
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Juliana Morais
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CHRC—Comprehensive Health Research Center, CEDOC—Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Maria Inês Duarte
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
| | - Diogo Pestana
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Ana Faria
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- CHRC—Comprehensive Health Research Center, CEDOC—Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | | | - Joana Vaz
- Ophiomics-Precision Medicine, 1600-513 Lisboa, Portugal; (J.B.P.-L.); (J.V.)
| | - Pedro Ribeiro
- Laboratory Medicine Center Germano de Sousa, 1600-513 Lisboa, Portugal;
| | - Diana Teixeira
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Unidade Universitária Lifestyle Medicine José de Mello Saúde by NOVA Medical School, 1169-056 Lisboa, Portugal
- CHRC—Comprehensive Health Research Center, CEDOC—Chronic Diseases Research Center, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
| | - Cláudia Marques
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Correspondence: ; Tel.: +351-21-880-3000
| | - Conceição Calhau
- Nutrition and Metabolism, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal; (S.I.); (M.P.S.); (M.V.); (J.R.A.); (J.M.); (M.I.D.); (D.P.); (A.F.); (D.T.); (C.C.)
- CINTESIS—Center for Health Technology Services Research, NOVA Medical School, Faculdade de Ciências, Universidade NOVA de Lisboa, 1169-056 Lisboa, Portugal
- Unidade Universitária Lifestyle Medicine José de Mello Saúde by NOVA Medical School, 1169-056 Lisboa, Portugal
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