Neonatal jaundice in the healthy newborn:Are the guidelines conclusive?

Three cases are reported of term neonates with high serum total bilirubin levels without evident signs indicating hemolytic or other underlying disease. The three patients were treated with phototherapy and/or exchange transfusion. It is discussed that the current consensus guidelines are inconclusive with respect to 'success of phototherapy' and 'signs of underlying disease'. Recommendations are made to improve the practice guidelines.</p

Effect of fibre additions to flatbread flour mixes on glucose kinetics:A randomised controlled trial

We previously found that guar gum (GG) and chickpea flour (CPF) added to flatbread wheat flour lowered postprandial blood glucose (PPG) and insulin responses dose dependently. However, rates of glucose influx cannot be determined from PPG, which integrates rates of influx, tissue disposal and hepatic glucose production. The objective was to quantify rates of glucose influx and related fluxes as contributors to changes in PPG with GG and CPF additions to wheat-based flatbreads. In a randomised cross-over design, twelve healthy males consumed each of three different C-13-enriched meals: control flatbreads (C), or C incorporating 15 % CPF with either 2 % (GG2) or 4 % (GG4) GG. A dual isotope technique was used to determine the time to reach 50 % absorption of exogenous glucose (T-50 %abs, primary objective), rate of appearance of exogenous glucose (RaE), rate of appearance of total glucose (RaT), endogenous glucose production (EGP) and rate of disappearance of total glucose (RdT). Additional exploratory outcomes included PPG, insulin, glucose-dependent insulinotropic peptide and glucagon-like peptide 1, which were additionally measured over 4 h. Compared with C, GG2 and GG4 had no significant effect on T-50 %abs. However, GG4 significantly reduced 4-h AUC values for RaE, RaT, RdT and EGP, by 11, 14, 14 and 64 %, respectively, whereas GG2 showed minor effects. Effect sizes over 2 and 4 h were similar except for significantly greater reduction in EGP for GG4 at 2 h. In conclusion, a soluble fibre mix added to flatbreads only slightly reduced rates of glucose influx, but more substantially affected rates of postprandial disposal and hepatic glucose production

Manipulation of starch bioaccessibility in wheat endosperm to regulate starch digestion, postprandial glycemia, insulinemia, and gut hormone responses: a randomized controlled trial in healthy ileostomy participants

Background: Cereal crops, particularly wheat, are a major dietary source of starch, and the bioaccessibility of starch has implications for postprandial glycemia. The structure and properties of plant foods have been identified as critical factors in influencing nutrient bioaccessibility; however, the physical and biochemical disassembly of cereal food during digestion has not been widely studied. Objectives: The aims of this study were to compare the effects of 2 porridge meals prepared from wheat endosperm with different degrees of starch bioaccessibility on postprandial metabolism (e.g., glycemia) and to gain insight into the structural and biochemical breakdown of the test meals during gastroileal transit. Design: A randomized crossover trial in 9 healthy ileostomy participants was designed to compare the effects of 55 g starch, provided as coarse (2-mm particles) or smooth (0.2-mm particles) wheat porridge, on postprandial changes in blood glucose, insulin, C-peptide, lipids, and gut hormones and on the resistant starch (RS) content of ileal effluent. Undigested food in the ileal output was examined microscopically to identify cell walls and encapsulated starch. Results: Blood glucose, insulin, C-peptide, and glucose-dependent insulinotropic polypeptide concentrations were significantly lower (i.e., 33%, 43%, 40%, and 50% lower 120-min incremental AUC, respectively) after consumption of the coarse porridge than after the smooth porridge (P , 0.01). In vitro, starch digestion was slower in the coarse porridge than in the smooth porridge (33% less starch digested at 90 min, P , 0.05, paired t test). In vivo, the structural integrity of coarse particles (~2 mm) of wheat endosperm was retained during gastroileal transit. Microscopic examination revealed a progressive loss of starch from the periphery toward the particle core. The structure of the test meal had no effect on the amount or pattern of RS output. Conclusion: The structural integrity of wheat endosperm is largely retained during gastroileal digestion and has a primary role in influencing the rate of starch amylolysis and, consequently, postprandial metabolism. This trial was registered at isrctn.org as ISRCTN40517475

Starches, Sugars and Obesity

The rising prevalence of obesity, not only in adults but also in children and adolescents, is one of the most important public health problems in developed and developing countries. As one possible way to tackle obesity, a great interest has been stimulated in understanding the relationship between different types of dietary carbohydrate and appetite regulation, body weight and body composition. The present article reviews the conclusions from recent reviews and meta-analyses on the effects of different starches and sugars on body weight management and metabolic disturbances, and provides an update of the most recent studies on this topic. From the literature reviewed in this paper, potential beneficial effects of intake of starchy foods, especially those containing slowly-digestible and resistant starches, and potential detrimental effects of high intakes of fructose become apparent. This supports the intake of whole grains, legumes and vegetables, which contain more appropriate sources of carbohydrates associated with reduced risk of cardiovascular and other chronic diseases, rather than foods rich in sugars, especially in the form of sugar-sweetened beverages

Starch Digestion and Applications of Slowly Available Starch

Frequent high postprandial glucose concentrations could be a risk factor for the development of type 2 diabetes and/or cardiovascular disease. Starchy products can play a role in the prevention of these hyperglycemic events, if starch-derived glucose is released into the circulation in a more slow and attenuated manner (slowly available starch). In this chapter, we describe the mechanisms that operate to maintain normal plasma glucose levels and the causes and consequences of hyperglycemia. Secondly, possible targets to slow down the rate at which starch-derived glucose becomes available for absorption in the gastrointestinal tract are discussed in more detail. Thirdly, we give an overview over the methods to monitor starch digestion in vitro and in vivo and the current (nutritional) strategies to prevent hyperglycemia. We conclude by describing promising approaches to better characterize starchy food products and to extend the choice of products with slowly available starch

DARE TO ASK! Suicidal patients’ experiences of nurses’ treatment

Introduktion Varje år begås ca 1500 självmord och 20000 självmordsförsök. Som sjuksköterska kommer man med stor sannolikhet att vårda självmordsnära patienter. Patienterna kan reagera på olika sätt och att som sjuksköterska bemöta dem på ett bra sätt är många gånger svårt. Travelbees teorier kan då vara ett gott stöd för sjuksköterskan. Syfte Att belysa hur patienter upplever att de har blivit bemötta av sjuksköterskan efter ett självmordsförsök för att få vägledning i vad som är ett gott bemötande. Metod Litteraturstudie av artiklar sökta och funna via databasen Cinahl med sökorden suicide attempt, patients´ perspective och nursing care. Resultat Det huvudtema som framträdde var bemötande. Därtill hörde underrubrikerna lyhördhet, stöd, kommunikation och bekräftelse med ytterligare tillhörande begrepp. De var väl överrensstämmande med Travelbees begreppsvärld. Sjuksköterskan fyller en viktig funktion och kan med sitt bemötande avgöra om patientens behandling ska lyckas eller inte. Diskussion Det är bara patienten som kan avgöra om sjuksköterskans bemötande är gott eller inte, men är man som sjuksköterska professionell i sitt bemötande blir de allra flesta patienter nöjda. Tyvärr verkar det dock som om mången sjuksköterska räds att närma sig en självmordsnära patient. Göteborgs Universitet bör utbilda sjuksköterskestudenterna mer i att inte vara rädda för att närma sig det som är svårt. Liksom Travelbee anser vi att sjuksköterskans människosyn avspeglas i hur patienterna tas omhand. Konklusion Det är viktigt att våga vara nära självmordsnära patienter – att våga fråga. Att ha en teori/modell att utgå ifrån i sin sjuksköterskeroll underlättar

Influence of a subsequent meal on the oro-cecal transit time of a solid test meal

Oro-cecal transit time (OCTT) is determined for clinical diagnostics of intestinal complaints and research purposes. Ingestion of a subsequent meal during the test period shortens the OCTT of a liquid test meal (glucose solution), as previously reported. This study was conducted to determine whether the same phenomenon occurs after ingestion of a solid test meal. The OCTT of a pancake was measured with the lactose-[C-13]-ureide breath test on two occasions in 28 volunteers. All the volunteers took the same subsequent meal once at 4 h and at 6 h after ingestion of the pancake. In 16 of the 56 tests no increase in breath-(CO2)-C-13 was observed. No statistically significant difference was found between the OCTTs of the test meal after ingestion of the subsequent meal at 4 h or 6 h (367; 311-405 min and 290; 370-405 min, median quartiles, respectively) (P = 0.14, n = 18). Only a subgroup (n = 4) with a short OCTT in the test with the 4-h subsequent meal (278; 259-296 min) tended to have a longer OCTT in the test with the 6-h subsequent meal (390; 379-401 min; P = 0.059). The effect of the ingestion of a subsequent meal on the transit time of a test meal is shown to be dependent on the physical form and/or caloric content of the test meal