The antioxidative protecting role of the Mediterranean diet [Antioksidativno protektivno djelovanje mediteranske dijete]

Recent meta-analysis shows that adherence to a Mediterranean diet (MD) can significantly decrease the risk of overall mortality, mortality from cardiovascular diseases, as well as incidence of mortality from cancer, and incidence of Parkinson's and Alzheimer's disease. All of these diseases could be linked to oxidative stress (OS) as antioxidative effect of MD is getting more attention nowadays. Although a lot of research has been done in this area and it suggests antioxidative protective role of MD, the presented evidence is still inconclusive. The aim of this paper is to review studies investigating the effect of MD on OS, as well as to identify the areas for further research

KIDNEY DISEASE IN DIABETIC PATIENTS – THE ROLE OF FAMILY MEDICINE PHYSICIAN

Unatoč svim dostupnim modalitetima liječenja incidencija i progresija šećerne bolesti je u stalnom porastu. Bubrežno oštećenje kod ovih bolesnika je posebno devastirajuća komplikacija budući da je povezana i s kraćim trajanjem života i sa smanjenom kvalitetom života. Uz dijabetičku nefropatiju, kod oboljelih od šećerne bolesti prisutni su i drugi oblici bubrežnog oštećenja kao što je ishemijsko oštećenje povezano s oštećenjem krvnih žila i hipertenzijom, ali i drugi oblici oštećenja koji nisu povezani s dijabetesom. Nakon detaljnog pretraživanja literature dostupne na PubMed-u u ovom članku ukratko opisujemo ključne trenutke u kojima je posebno bitna uloga liječnika obiteljske medicine (LOM). Tijekom skrbi za oboljele od šećerne bolesti posebnu pozornost zahtijeva probir bubrežnog oštećenja, ispravno praćenje i liječenje i pravodobno upućivanje nefrologu. Na osobu usmjeren holistički pristup karakterističan za rad LOM prepoznat je kao poseban izazov u praćenju ovih bolesnika.The alarming rates of diabetes mellitus incidence and progression continue despite deployment of all current treatments. Kidney disease can be a particularly devastating complication, as it is associated with signifi cant reductions in both length and quality of life. A variety of forms of kidney disease can be seen in people with diabetes, including diabetic nephropathy, ischemic damage related to vascular disease and hypertension, as well as other renal diseases that are unrelated to diabetes. Following an extensive PubMed search, this review provides a brief view on the screening for chronic kidney disease (CKD) in people with diabetes, how to treat them to slow down the progression of CKD and when to refer them to specialist care. This review also emphasizes the basic challenge in treating diabetic patients, which is to shift the main criterion from the disease-oriented to person-centered approach in the context of treating the patient as a whole

Dijetoterapija dispepsije, ulkusne bolesti i gastroezofagealne refluksne bolesti

Kronične nezarazne bolesti povezane s načinom života sve su učestalije. U svakoj zemlji, ovisno o stupnju razvoja, kronične bolesti poput dispepsije, ulkusne bolesti i GERB-a imaju ubrzan porast ili su već na visokoj razini. Debljina, nepravilna prehrana, nedostatak tjelesne aktivnosti, pušenje i alkohol čimbenici su rizika za nastanak bolesti gastrointestinalnog sustava. Upravo zbog toga uz terapiju medikamentima, bolesnicima s ulkusom preporučuje se promjena životnih navika te izbjegavanje hrane koja uzrokuje smetnje. Populacijske studije pokazuju da prehrana znatno utječe na tijek bolesti. Poznato je da namirnice i pića poput kave, alkoholnih pića, gaziranih pića, slastica i oštrih začina mogu pogoršati simptome bolesti. S druge strane, prehrana bogata voćem, povrćem, probioticima te lako probavljivim namirnicama može poboljšati kvalitetu života i nadopuniti medikamentno liječenje

Dijetoterapija bolesti jetre

Kod jetrenih bolesti mijenjaju se metabolički procesi pa se time mijenjaju nutritivne i energetske potrebe. U većine bolesnika s jetrenom bolešću postoji malnutricija najčešće uzrokovana smanjenim unosom hrane zbog povraćanja i mučnine. Dijetoterapijom je potrebno bolesnicima osigurati dovoljnu količinu makronutrijenata i mikronutrijenata kako bi se spriječila malnutricija. U bolesnika s razvijenom slikom jetrene encefalopatije, u kojih s obzirom na patogene mehanizme, veći unos proteina pogoršava postojeće stanje, potrebno je voditi računa o ograničenom unosu proteina. Takvim se bolesnicima preporučuje unos razgrananih aminokiselina koje dovode do poboljšanja kliničke slike. Kod svih bolesnika oboljelih od jetrenih bolesti važno je postići promjenu ustaljenih životnih navika i uspostaviti nove u svrhu poboljšanja kvalitete života

Glycemic Index in Diabetes

The Glycemic Index (GI) is a rating system that ranks carbohydrate-containing foods according to their postprandial blood glucose response relative to the same quantity of available carbohydrate of a standard such as white bread or glucose. The concept of GI was first introduced in the early 80’s by Jenkins and coworkers. Since then, numerous trials have been undertaken, many indicating benefits of a low GI diet on glycemic control, as well as lipid profiles, insulin and C-peptide levels, inflamatory and thrombolytic factors, endothelial function and regulation of body weight. As a result, a low-GI diet may prevent or delay the vascular complications of diabetes. However, despite many studies supporting the benefits of the Glycemic Index as part of the treatment of diabetes mellitus, several areas of controversy have been raised in the literature and are addressed here. Clinicians treating diabetic patients should be aware of the potential benefits of low-GI foods in the prevention and treatment of diabetes and its complications

ULOGA PREHRANE U PREVENCIJI KARCINOMA

Karcinom postaje sve veći javnozdravstveni problem današnjice, čija prevalencija je u kontinuiranom porastu diljem svijeta. Među vodećim je uzrocima smrtnosti, a glavni rizični čimbenici su oni na koje zapravo možemo utjecati te time prevenirati od 30 do 50 % različitih vrsta karcinoma. Jedan od ključnih i glavnih koraka u prevenciji je održavanje normalne/zdrave tjelesne mase, pravilnom, uravnoteženom i raznolikom prehranom uz redovnu tjelesnu aktivnost. Ne postoji „super hrana“ za koju možemo reći da sprječava razvoj karcinoma, kao niti točno određena hrana koja ga uzrokuje, ali postoje načini prehrane koji mogu doprinijeti prevenciji odnosno razvoju ove bolesti u sklopu prevencije. Preporučuje se općenito dati prednost hrani biljnog podrijetla, što je najbolje obuhvaćeno principima Mediteranske prehrane. Takva prehrana obiluje povrćem (osobito zelenim lisnatim, crvenim i narančastim te krucifernim), voćem (bobičastim, citrusima, crvenim i narančastim), mahunarkama i cjelovitim žitaricama te maslinovim uljem. Od hrane životinjskog podrijetla preporučuje se češća konzumacija ribe i mliječnih proizvoda. S druge strane, preporučuje se izbjegavati konzumaciju industrijski procesirane hrane bogate solju, mastima niske nutritivne kvalitete i dodanim šećerom te ograničiti konzumaciju crvenog mesa i paziti na sam proces pripreme hrane kako ne bi došlo do stvaranja štetnih/kancerogenih spojeva. Preporučuje se izbaciti mesne prerađevine, kao i prekomjernu konzumaciju alkohola. Usvajanje preporuka o promjeni načina života, što uključuje pravilnu prehranu i redovitu tjelesnu aktivnost, važan je dio prevencije razvoja karcinoma

Preporuke za praćenje, prevenciju i liječenje proteinsko-energijske pothranjenosti u bolesnika s kroničnom bubrežnom bolesti [Croatian guidelines for screening, prevention and treatment of protein-energy wasting in chronic kidney disease patients]

There is a high incidence of cardiovascular morbidity and mortality among patients with chronic kidney disease (CKD) and malnutrition is a powerful predictor of cardiovascular morbidity and mortality in this population of patients. A multitude of factors related to CKD and renal replacement therapy can affect the nutritional status of CKD patients and lead to the development of malnutrition. In patients with CKD, protein energy wasting (PEW) is a condition that is distinct from undernutrition and is associated with inflammation, increased resting energy expenditure, low serum levels of albumin and prealbumin, sarcopenia, weight loss and poor clinical outcomes. Nutritional and metabolic derangements are implicated for the development of PEW in CKD and leading to the development of chronic catabolic state with muscle and fat loss. Prevention is the best way in treating PEW. Appropriate management of CKD patients at risk for PEW requires a comprehensive combination of strategies to diminish protein and energy depletion, and to institute therapies that will avoid further losses. The mainstay of nutritional treatment in MHD patients is nutritional counselling and provision of an adequate amount of protein and energy, using oral supplementation as needed. Intradialytic parenteral nutrition and total enteral nutrition should be attempted in CKD patients who cannot use the gastrointestinal tract efficiently. Other strategies such as anemia correction, treatment of secondary hyperparathyroidism and acidosis, delivering adequate dialysis dose can be considered as complementary therapies in CKD patients. Multidisciplinary work of nephrologists, gastroenterologist and dietician is needed to achieve best therapeutic goals in treating CKD patients with PEW