Dietetics, Volume 2, Issue 3 (September 2023) – 6 articles

Strenuous exercise can be associated with “Exercise Induced Gastrointestinal Syndrome” (Ex-GIS), a clinical condition characterized by a series of gastrointestinal (GI) disturbances that may impact the physical and psychological performance of athletes. The pathophysiology comprises multi-factorial interactions between the GI tract and the circulatory, immune, enteric, and central nervous systems. There is considerable evidence for increases in the indices of intestinal damage, permeability, and endotoxemia associated with impaired gastric emptying, slowing of small intestinal transit, and malabsorption of nutrients. Heat stress and racing mode seem to exacerbate these GI disturbances. GI symptomatology that derives from strenuous exercise is similar to that of IBS and other GI functional disorders defined in the Rome IV Criteria. To manage Ex-GIS, the exercise modality, state of dehydration, environmental temperature, concomitant therapies, and self-managed diet should be evaluated, and if risk elements are present, an attempt should be made to modify them. Multiple strategies can be successively adopted to manage Ex-GIS. Nutritional and behavioral interventions appear to be the principal ones to avoid symptoms during the exercise. The aim of this review will be to explore the pathophysiology, clinical aspect, and current literature on behavioral and nutritional strategies to manage Ex-GIS, regarding a gluten-free diet and low-fermentable oligo-, di-, and mono-saccharides and polyols (FODMAP) diet. Full article

In the German beverage market, a shift in consumption has become apparent in recent decades: away from alcoholic beverages and towards non-alcoholic alternatives. This indicates a tradeoff between two important and nutritionally relevant substances: alcohol and sugar. This review, therefore, addresses the question of the significance of these developments to the German wine industry, where non-alcoholic wines and sparkling wines are becoming increasingly important. The production of these products is accompanied by a reduction in alcohol content with a simultaneous increase in sugar. Furthermore, these products could also become the focus of health policy efforts when it comes to accusations of possible “alibi marketing”. Here, parallels with the handling of tobacco products become clear, while the tradeoff between alcohol and sugar recedes into the background. Full article

The aim of this paper is to report on the differences in clinical and service engagement outcomes of patients attending the paediatric dietetic outpatient service at a major metropolitan hospital before the outbreak of the coronavirus (using face-to-face care) and during the pandemic (using telehealth). This paper also reports on learning lessons from the rapid implementation of telehealth in this service. This study collected pre- and post-coronavirus pandemic data from 44 paediatric patients. Data on outcomes pre- and post-implementation were analysed. There were no statistically significant differences between pre- and post-coronavirus data for growth (p = 0.92), adherence to dietetic recommendations (p = 0.08) or attendance rate (p = 1.00). This study also found a low uptake of virtual telehealth, technical issues and suboptimal anthropometric data collection associated with this modality of care. Telehealth was not associated with a change in clinical and service engagement outcomes. Thus, telehealth service delivery is not inferior to usual face–face dietetic care and has the potential to be a useful adjunct to usual nutrition care for paediatric health service users after the coronavirus pandemic. Full article

Type 2 diabetes mellitus is a major contributor to morbidity and mortality worldwide. This disease often leads to poor health outcomes, such as neuropathy and diabetic foot ulcers, and increased risk for comorbidities such as cardiovascular complications and renal disease. Lifestyle modifications including diet and physical activity interventions are often explored as prevention and management strategies for T2DM. It is well established that fruits are a rich source of fiber and a variety of phytochemicals, vitamins, minerals, and bioactive compounds that can help optimize human health. Unfortunately, many experts associate the consumption of fruit with a moderate to high glycemic index (GI), which leads to a spike in blood glucose and eventually elevated hemoglobin A1c (HbA1c). The purpose of this comprehensive review is to outline the current clinical literature on the relationship between fruit consumption and various indices of glucose metabolism. A variety of fruits have been clinically studied to determine this relationship, namely in the fresh form (e.g., berries, apples, watermelon, cherries, mangoes), dried fruits (raisins and dates), and juices (derived from cranberry, orange, grape, cherry, and pomegranate). Overall, intake of fruits and fruit-derived products is beneficial for healthy subjects and subjects with T2DM regarding their impact on glucose metabolism and other cardiometabolic markers (e.g., inflammatory responses, lipid profiles). Nonetheless, it is more advisable for diabetic patients to consume fresh or dried fruits rather than fruit-derived products. A special consideration needs to be attributed to both the amount of fruit intake with regards to their respective GI and glycemic load (GL), and when these fruits are consumed. Trials with more a comprehensive design and specific outcomes are required to reveal the mechanisms underlying the beneficial effects of fruit consumption on the T2DM population particularly. Full article

Cocoa beverage and dark chocolate are important dietary sources of polyphenol and have been hypothesised to improve the lipid profile. This systematic review and meta-analysis aimed to investigate the effect of cocoa beverage and dark chocolate intake on lipid profile in individuals living with normal and elevated LDL cholesterol. The question on whether cocoa beverage and chocolate differentially modify the lipid profile was also explored. A systematic literature search was conducted on PubMed and Cochrane Library on 26 February 2022 following the PRISMA guideline. Cocoa beverage and chocolate consumption had no significant effect on circulating concentrations of total cholesterol, LDL cholesterol, and triglycerides (p > 0.05, all), but favourably and significantly increased circulating concentration of HDL cholesterol by 0.05 (95% CI [0.02, 0.09]) mmol/L (p = 0.002). Changes in lipid profile were similar when comparing populations with normal vs. elevated LDL cholesterol (p > 0.05, all). When considering the food matrix, cocoa beverage intake significantly increased HDL cholesterol by 0.11 (95% CI [0.06, 0.17]) mmol/L (p < 0.001), but the improvement in HDL cholesterol was not significant when chocolate (p = 0.10) or a combination of cocoa beverage and chocolate (p = 0.19) (subgroup differences, p = 0.03) was administered. Cocoa consumption could be recommended as part of a healthy diet in the general population with normal and elevated LDL cholesterol. Full article

Aim: To evaluate the nutritional adequacy of the hospital haemodialysis menu, quantify the dietary intake of hospitalised haemodialysis patients and explore patient perceptions of the menu. Methods: The menu analysis compared the default menu to reference standards using a one sample t-test via SPSS. Eight hospitalised haemodialysis patients were purposively interviewed using semi-structured interviews. Thematic analysis was used to identify the dominant themes. The participant’s actual dietary intake was calculated and compared to individual nutrients using evidence-based guidelines. Results: Compared to the reference standards, the default inpatient haemodialysis menu did not provide adequate energy (p < 0.001, mean = 8767 kJ/day ± 362), sodium (p < 0.001, mean = 72 mmol/day ± 9), potassium (p < 0.001, mean = 64 mmol/day ± 4), vitamin C (p ≤ 0.001, mean = 33 mg/day ± 10) and fibre (p < 0.001, mean = 26 g/day ± 3). Inadequate intake of energy and protein occurred in half of the participants. Passive acceptance of the menu, environmental and cultural considerations contributed to missed food opportunities impacting the patient experience and limited intake. Conclusions: The profile of the current default inpatient haemodialysis menu impacts the dietary intake and the experience of haemodialysis inpatients. It is recommended that the default menu is optimised in line with evidence-based guidelines for inpatients. Full article