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

VAŽNOST PROCJENE NUTRITIVNOG STATUSA BOLESNIKA S KOLOREKTALNIM KARCINOMOM

Kolorektalni karcinom (engl. Colorectal Cancer, CRC) je treći najčešći maligni tumor na svijetu. Procjenjuje se da 10-20 % pacijenata oboljelih od karcinoma umire zbog posljedica pothranjenosti, a ne zbog samog karcinoma. Nutritivni status bolesnika znatno utječe na ishod liječenja bolesnika s CRC-om, bez obzira na to je li riječ o pothranjenosti, gubitku potporne mišićne mase, normalnoj ili prekomjernoj tjelesnoj masi. Problemi s prehranom trebaju se uzeti u obzir i rješavati od vremena postavljanja dijagnoze, kirurškog liječenja te paralelno s antineoplastičnim liječenjem (kemoterapija, imunoterapija i endokrina terapija) i radioterapijom. Pri tom je važno imati multidisciplinarni tim jer postupci uključuju procjenu statusa validiranim probirnim upitnicima na malnutriciju NRS 2002 (engl. Nutritional Risk Screening 2002) i sarkopeniju SARC-F (engl. Strength, assistance with walking, rising from a chair, climbing stairs and falls), mjerenje mišićne snage i funkcije dinamometrijom šake, analizu sastava tijela bioelektričnom impedancijom, procjenu prehrambenih navika i unosa hrane te savjetovanje o prehrani. Studije daju ohrabrujuće rezultate u primjeni fitonutrijenata zelenog čaja, ekstrakta kvercetina, omega-3 masnih kiselina, probiotika, prebiotika, prehrambenih vlakana i orašastih plodova zahvaljujući njihovim protuupalnim i antioksidativnim svojstvima. Osnovni princip periopeartivne dijetoterapije je adekvatnim namirnicama smanjiti ili spriječiti pojavu nutritivnih deficita i komplikacija koje se povećavaju promjenom nutritivnog statusa, dok u poslijeoperacijskoj i terapijskoj fazi liječenja pozitivno utjecati na bolesnikov oporavak i povratak svakodnevnim aktivnostima

Nutrition in Pancreatic Diseases

Pankreatitis je upalno stanje gušterače koje često iz svojeg akutnog oblika može prijeći u kroničnu bolest. Bolesnici s pankreatitisom imaju povećane nutritivne potrebe zbog upale, dok, s druge strane, zbog boli, mučnine i povraćanja pate od energijskog, proteinskog ili nutritivnog deficita. Hipokalcemija i hipomagnezemija mogu se pojaviti već u prvim fazama akutnog pankreatitisa. Bolesnici s dugotrajnim i prekomjernim unosom alkohola mogu, uz proteinsko-energijsku malnutriciju, imati i deficit vitamina i minerala: tiamina, folne kiseline, cinka, vitamina D, K, E, A i B12 te karotena. Osnovni cilj nutritivne njege bolesnika s pankreatitisom jest osigurati adekvatan unos energije. To je osobito važno u bolesnika s akutnim pankreatitisom u kojih se pokazalo da pravilna nutritivna njega može smanjiti komplikacije i skratiti vrijeme boravka u bolnici.Pancreatitis is inflammation of the pancreas that can be acute and often progress to chronic pancreatitis. Like in most diseases, patients with pancreatitis have a negative energy balance. They have an increased caloric expenditure due to inflammation and a decreased intake due to abdominal pain, nausea and vomiting. Hypocalcaemia and hypomagnesaemia can occur even with the first episode of acute pancreatitis. Patients with long-standing excessive alcohol intake may have thiamine and folate deficiencies in addition to protein-calorie malnutrition. Patients with chronic pancreatitis can have deficiency of fat-soluble vitamins, particularly vitamins D, E, A, K, β-carotene and B12. The basis of nutritional management in pancreatitis is to meet the energy needs of the patient through appropriate calorie administration. This is particularly important in acute pancreatitis because it may reduce complications and decrease hospital stays

NUTRITIONAL ASSESSMENT OF PATIENTS WITH PRIMARY PROGRESSIVE DEMENTIA AT THE TIME OF DIAGNOSIS

Background: patients with different types of dementia may experience changes in nutritional status, which are manifested by specific eating habits. The aim of this study was to determine the nutritional status and eating habits of patients at the time of confirmed diagnosis of primary progressive dementia. Subject and methods: The study included 40 outpatients (63% women) diagnosed with either form of dementia. The mean age at diagnosis was 776 years and the mean time between the onset of first symptoms of the disease and diagnosis was 3-36 months. Nutritional assessment was determined at the time of confirmed diagnoses and included dietary habits (non-quantitative modified food frequency questionnaire (FFQ)), anthropometric (body weight and height and body mass index-BMI) and biochemical parameters (serum concentrations of vitamin B12, folic acid and 25-hydroxy vitamin D). Dietary habits were collected over a 12- month period with the help of a spouse or close family member. Results: The results showed that none of the outpatients were malnourished, the largest number of outpatients (43%) were in the normal body mass category followed by 33% in the overweight category. The results of this study confirmed previous findings of higher preference for sweet foods observed in 53% of patients with dementia. Low status of vitamin B12 was observed in 57% of outpatients, folic acid in 24% and 25 (OH) D in 75% of outpatients. Lower frequency of consumption of dark green leafy vegetables and lower consumption of poultry meat, fish and eggs could have an impact on nutrient deficiency. Conclusions: The poor nutritional status of outpatients with primary progressive dementia is associated with unhealthy dietary habits that may lead to micronutrient deficiencies. Dietary monitoring and intervention should be initiated immediately after the diagnosis of primary progressive dementia with the goal of reducing nutritional deficiencies and preventing further and more severe impairment of cognitive function

NUTRITIONAL ASSESSMENT OF PATIENTS WITH PRIMARY PROGRESSIVE DEMENTIA AT THE TIME OF DIAGNOSIS

Background: patients with different types of dementia may experience changes in nutritional status, which are manifested by specific eating habits. The aim of this study was to determine the nutritional status and eating habits of patients at the time of confirmed diagnosis of primary progressive dementia. Subject and methods: The study included 40 outpatients (63% women) diagnosed with either form of dementia. The mean age at diagnosis was 776 years and the mean time between the onset of first symptoms of the disease and diagnosis was 3-36 months. Nutritional assessment was determined at the time of confirmed diagnoses and included dietary habits (non-quantitative modified food frequency questionnaire (FFQ)), anthropometric (body weight and height and body mass index-BMI) and biochemical parameters (serum concentrations of vitamin B12, folic acid and 25-hydroxy vitamin D). Dietary habits were collected over a 12- month period with the help of a spouse or close family member. Results: The results showed that none of the outpatients were malnourished, the largest number of outpatients (43%) were in the normal body mass category followed by 33% in the overweight category. The results of this study confirmed previous findings of higher preference for sweet foods observed in 53% of patients with dementia. Low status of vitamin B12 was observed in 57% of outpatients, folic acid in 24% and 25 (OH) D in 75% of outpatients. Lower frequency of consumption of dark green leafy vegetables and lower consumption of poultry meat, fish and eggs could have an impact on nutrient deficiency. Conclusions: The poor nutritional status of outpatients with primary progressive dementia is associated with unhealthy dietary habits that may lead to micronutrient deficiencies. Dietary monitoring and intervention should be initiated immediately after the diagnosis of primary progressive dementia with the goal of reducing nutritional deficiencies and preventing further and more severe impairment of cognitive function

Assessing the effect of nutritional interventions on glycemic control and lipid profile in adults with diabetes type 2

Svrha rada bila je: (i) odrediti utjecaj nutritivne intervencije u osoba oboljelih od šećerne bolesti tipa 2 na regulaciju glikemije (glukoza u plazmi, glikirani hemoglobin HbA1c), lipidnoga profila (ukupnog kolesterola, LDL-kolesterola, HDL-kolesterola i triglicerida) i antropometrijske parametre (tjelesnu masu i indeks tjelesne mase- ITM), (ii) odrediti odnos između prehrambenih navika i znanja o prehrani u šećernoj bolesti tipa 2 te njihov utjecaj na regulaciju glikemije i lipidnoga profila kroz dvanaest mjeseci, (iii) analizirati jelovnike i odrediti adekvatnu bazu podataka za planiranje prehrane u šećernoj bolesti, (iiii) validirati upitnik znanja o prehrani. U istraživanje je bilo uključeno 160 bolesnika s nereguliranom šećernom bolešću tipa 2 (HbA1c > 7,5 %) prosječne dobi 61,8 ± 8,5 godina; ITM 32,57 ± 6,48 kg/m² te duljine trajanja bolesti 10,9 ± 7,6 godina. Bolesnici su sudjelovali u petodnevnom programu dijabetološke dnevne bolnice u kojoj su prolazili intenzivnu nutritivnu intervenciju i edukaciju te su praćeni kroz kontrolne preglede nakon 3, 6 i 12 mjeseci. Validiranim upitnikom provjeravalo se znanje o prehrani u šećernoj bolesti, a prehrambene navike praćene su kroz odabir jelovnika mediteranske, dijabetične ili dijete s većim udjelom ugljikohidrata. Rezultati istraživanja pokazali su kako primjena nutritivne intervencije statistički značajno utječe na smanjenje koncentracije HbA1c (p 7.5 %), median age 61.8 ± 8.5 years, BMI 32.57 ± 6.48 kg/m² and disease duration 10.9 ± 7.6 years. All subjects have participated in an intensive 5-day program in daily hospital, involving education and nutritional intervention, followed by three follow-up visits after 3, 6, and 12 months. A validated questionnaire was used to determine knowledge about nutrition in diabetes and dietary habits were monitored through patient’s selection of menus from diabetic, Mediterranean or higher-carbohydrate diets. The study showed that nutritional intervention had a statistically significant effect on lowering concentrations of HbA1c (p <0.001); plasma glucose (p = 0.003); LDL cholesterol (p = 0.022); triglycerides (p = 0.019) and total cholesterol (p = 0.021) during the observed period. At the end of the study, there was a statistically significant increase the number of patients (10.3 vs. 23.1 %; p <0.05) with normal weight (BMI < 25 kg/m²) and a decrease in the number (64.5 vs 53, 8 %, p < 0.05) of obese patients (obese class I, II, III) in the examined sample. It was found that dietary habits correlate with the biochemical parameters of the patients at the beginning, during the follow-up period and at the end of the study. In patients who chose menus of the Mediterranean diet the most during the five-day education, after three, six and twelve months they had the lowest values of all biochemical parameters compared to other patients (p < 0.05). There was a statistically significant (p < 0.05) influence of nutritional intervention on changing dietary habits and knowledge about nutrition in patients with type 2 diabetes, and the influence on the decreasing levels of HbA1c and lipid profile. The study found that nutritional intervention, which includes education, testing of knowledge about nutrition and eating habits, results better regulation of diabetes, established reduction of HbA1c and has a beneficial effect on weight loss and lipid profile in patients with diabetes type 2. The obtained results increase the understanding how education and knowledge about nutrition enable better control of diabetes type 2

Assessing the effect of nutritional interventions on glycemic control and lipid profile in adults with diabetes type 2

Svrha rada bila je: (i) odrediti utjecaj nutritivne intervencije u osoba oboljelih od šećerne bolesti tipa 2 na regulaciju glikemije (glukoza u plazmi, glikirani hemoglobin HbA1c), lipidnoga profila (ukupnog kolesterola, LDL-kolesterola, HDL-kolesterola i triglicerida) i antropometrijske parametre (tjelesnu masu i indeks tjelesne mase- ITM), (ii) odrediti odnos između prehrambenih navika i znanja o prehrani u šećernoj bolesti tipa 2 te njihov utjecaj na regulaciju glikemije i lipidnoga profila kroz dvanaest mjeseci, (iii) analizirati jelovnike i odrediti adekvatnu bazu podataka za planiranje prehrane u šećernoj bolesti, (iiii) validirati upitnik znanja o prehrani. U istraživanje je bilo uključeno 160 bolesnika s nereguliranom šećernom bolešću tipa 2 (HbA1c > 7,5 %) prosječne dobi 61,8 ± 8,5 godina; ITM 32,57 ± 6,48 kg/m² te duljine trajanja bolesti 10,9 ± 7,6 godina. Bolesnici su sudjelovali u petodnevnom programu dijabetološke dnevne bolnice u kojoj su prolazili intenzivnu nutritivnu intervenciju i edukaciju te su praćeni kroz kontrolne preglede nakon 3, 6 i 12 mjeseci. Validiranim upitnikom provjeravalo se znanje o prehrani u šećernoj bolesti, a prehrambene navike praćene su kroz odabir jelovnika mediteranske, dijabetične ili dijete s većim udjelom ugljikohidrata. Rezultati istraživanja pokazali su kako primjena nutritivne intervencije statistički značajno utječe na smanjenje koncentracije HbA1c (p 7.5 %), median age 61.8 ± 8.5 years, BMI 32.57 ± 6.48 kg/m² and disease duration 10.9 ± 7.6 years. All subjects have participated in an intensive 5-day program in daily hospital, involving education and nutritional intervention, followed by three follow-up visits after 3, 6, and 12 months. A validated questionnaire was used to determine knowledge about nutrition in diabetes and dietary habits were monitored through patient’s selection of menus from diabetic, Mediterranean or higher-carbohydrate diets. The study showed that nutritional intervention had a statistically significant effect on lowering concentrations of HbA1c (p <0.001); plasma glucose (p = 0.003); LDL cholesterol (p = 0.022); triglycerides (p = 0.019) and total cholesterol (p = 0.021) during the observed period. At the end of the study, there was a statistically significant increase the number of patients (10.3 vs. 23.1 %; p <0.05) with normal weight (BMI < 25 kg/m²) and a decrease in the number (64.5 vs 53, 8 %, p < 0.05) of obese patients (obese class I, II, III) in the examined sample. It was found that dietary habits correlate with the biochemical parameters of the patients at the beginning, during the follow-up period and at the end of the study. In patients who chose menus of the Mediterranean diet the most during the five-day education, after three, six and twelve months they had the lowest values of all biochemical parameters compared to other patients (p < 0.05). There was a statistically significant (p < 0.05) influence of nutritional intervention on changing dietary habits and knowledge about nutrition in patients with type 2 diabetes, and the influence on the decreasing levels of HbA1c and lipid profile. The study found that nutritional intervention, which includes education, testing of knowledge about nutrition and eating habits, results better regulation of diabetes, established reduction of HbA1c and has a beneficial effect on weight loss and lipid profile in patients with diabetes type 2. The obtained results increase the understanding how education and knowledge about nutrition enable better control of diabetes type 2