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Jose Nguyen
Jose Nguyen

Nutrition Therapy And Pathophysiology

Glutaric acidemia (GA) are heterogeneous, genetic diseases that present with specific catabolic deficiencies of amino acid or fatty acid metabolism. The disorders can be divided into type I and type II by the occurrence of different types of recessive mutations of autosomal, metabolically important genes. Patients of glutaric acidemia type I (GA-I) if not diagnosed very early in infanthood, experience irreversible neurological injury during an encephalopathic crisis in childhood. If diagnosed early the disorder can be treated successfully with a combined metabolic treatment course that includes early catabolic emergency treatment and long-term maintenance nutrition therapy. Glutaric acidemia type II (GA- II) patients can present clinically with hepatomegaly, non-ketotic hypoglycemia, metabolic acidosis, hypotonia, and in neonatal onset cardiomyopathy. Furthermore, it features adult-onset muscle-related symptoms, including weakness, fatigue, and myalgia. An early diagnosis is crucial, as both types can be managed by simple nutraceutical supplementation. This review discusses the pathogenesis of GA and its nutritional management practices, and aims to promote understanding and management of GA. We will provide a detailed summary of current clinical management strategies of the glutaric academia disorders and highlight issues of nutrition therapy principles in emergency settings and outline some specific cases.

Nutrition Therapy and Pathophysiology

Short-bowel syndrome is a rare problem in surgical practice and its prognosis depends on the length of intestinal remnants and/or the presence of a jejunostomy. In adults long-term total parenteral nutrition (TPN) can be avoided if the remaining small bowel is longer than 60-100 cm. In all, 50-60% of patients in the long-term follow-up are expected to be adequately nourished with oral feeding, 25% with enteral and parenteral feeding and less than 20% depend on long-term TPN alone. By using a modified diet (glutamine, growth hormone), intestinal absorption and overall prognosis could even be enhanced. The introduction of home TPN by specialized centres has resulted in a remarkable improvement in quality of life (> 80% good). The main complications of long-term TPN are sepsis, thrombosis and metabolic disorders. Medical therapy of diarrhoea consists of H2-receptor antagonists (hypergastrinaemia), loperamide and secretion inhibitors (somatostatin). Several surgical procedures have been performed, either to decelerate intestinal transit or to increase the area of intestinal absorption with overall unsatisfactory results. However, in the presence of small-bowel dilatation, promising surgical results (tapering, stricturoplasty, intestinal lengthening) have been achieved. There may be advances (immunosuppression) in the future that will make intestinal transplantation a good option for some patients; at present, the 1-year patient and graft survival in around 100 patients was 60% and 40%, respectively.

Sunsaneevithayakul P, Kanokpongsakdi S, Sutanthavibul A, Ruangvutilert P, Boriboohirunsarn D, Keawprasit T, Tantawattana R. Result of ambulatory diet therapy in gestational diabetes mellitus. J Med Assoc Thai. 2006 Jan; 89(1): 8-12.

DesignA total of 33 women attended weekly ambulatory care for diet therapy with their family. FBS and two-hour post-prandial blood glucose were monitored every visit for a few weeks. At the end of the program, those with poor glycemic control were admitted for a three-day intensive diet therapy, after which insulin was started if glycemic control remained poor.

With the number of individuals older than 65 years expected to rise significantly over the next few decades, dramatic changes to our society and health care system will need to take place to meet their needs. Age-related changes in muscle mass and body composition along with medical comorbidities including stroke, dementia, and depression place elderly adults at high risk for developing malnutrition and frailty. This loss of function and decline in muscle mass (ie, sarcopenia) can be associated with reduced mobility and ability to perform the task of daily living, placing the elderly at an increased risk for falls, fractures, and subsequent institutionalization, leading to a decline in the quality of life and increased mortality. There are a number of modifiable factors that can mitigate some of the muscle loss elderly experience especially when hospitalized. Due to this, it is paramount for providers to understand the pathophysiology behind malnutrition and sarcopenia, be able to assess risk factors for malnutrition, and provide appropriate nutrition support. The present review describes the pathophysiology of malnutrition, identifies contributing factors to this condition, discusses tools to assess nutritional status, and proposes key strategies for optimizing enteral nutrition therapy for the elderly.

This is an interesting paper studying the positive effects of a structured nutrition therapy programme on various metabolic factors and quality of life in patients with type 2 diabetes during Ramadan. This is a novel study which has in my opinion some major and minor limitations.

The Comparison of Structured Nutrition therapy for Ramadan with Standard Care in Type 2 Diabetes Patients investigates an important topic testing as a novelty the Ramadan Nutrition Plan as proposed by the International Diabetes Federation and the Diabetes and Ramadan International Alliance. However, the manuscript could be improved by a more in depth discussion of the results in relation to previous study protocols and by providing some clarifications:

Response 3.2a: The description about nutrition strategies of the two group are summarized in Table 1 (page 4) as below. We have also added the energy prescription, macronutrient distribution and sample menu in supplementary files (Table S1-S4).

Prerequisite to Graduate WorkA bachelor's degree related to Food and Nutrition is the preferred foundation with coursework in biochemistry, anatomy and physiology, and nutrition. Additional course work may be required as a condition of admission should there exist deficiencies in undergraduate course work.

Degree RequirementsThe Food and Nutrition (F&N) graduate program provides course work and study in basic nutritional sciences, current topics in food and nutrition sciences, and applied areas, such as community/public health nutrition, and clinical/medical nutrition therapy. Supporting course work in a related field, such as biology, chemistry, counseling, exercise science, education, and/or epidemiology, is designed to meet the student's career interests.

Food and Nutrition Graduate CertificateThe Food and Nutrition Graduate Certificate (FNGC) curriculum includes studies in nutrient metabolism, food science, and nutritional principles related to health and disease. The FNGC may be desired by students currently pursuing other graduate degree programs (e.g. public health, exercise science, biological sciences), employed in allied health professions, or in the Dietetic Internship who have an interest in advanced study of food and nutrition but do not wish to complete a graduate degree. Students completing the Food and Nutrition Graduate Certificate Program will be required to take 15 credit hours of food and nutrition graduate-level courses. The FNGC does not carry with it any licensure or privileges, and is not currently approved by any professional organization.

XII--Course Descriptions NutritionDepartment of Animal and Poultry Science Department of Family Studies, Division of Applied Human Nutrition Department of Human Biology and Nutritional Sciences 71-101 Nutrition and Society (formerly: ) F,W(3-0) The significance of nutrition in terms of individuals and societies throughout the world. Factors involved in the application of knowledge of nutritional needs and food selection. Department of Family Studies, Applied Human Nutrition. Also offered through distance education format.71-205 Family and Community Nutrition (formerly: ) F(3-0) Nutritional needs through the life cycle and their significance in family and community health. Department of Family Studies, Applied Human Nutrition. Also offered through distance education format.Prerequisites: 71-101.71-215 Introduction to Nutritional and Food Sciences F,W(3-0) This interdisciplinary course provides an introduction to the Food and Nutritional Sciences from both historical and modern perspectives. Major themes are the nutritional and functional properties of food, nutrient assimilation, food preservation and safety, and the interactions between food processing, diets and health. The course is co-operatively taught by the Department of Nutritional Sciences and the Department of Food Science. Also listed as 42-215.Prerequisites: (19-104 or 19-130 ); ( 17-115 or 65-100 or 92-102).Exclusions: 42-201, 42-215, 71-212.71-302 Nutrition Applications in Food Service Management W(3-0) A study of normal and therapeutic nutrition principles to be applied in volume feeding in health care and other institutional facilities. Department of Family Studies, Applied Human Nutrition. Primarily for Bachelor of Commerce students in the Institutional Foodservice Management Major. (Offered in odd-numbered years.) Prerequisites: 71-205.71-304 Nutritional Aspects of Human Disease I W(3-0) Metabolic and physiologic aberrations in certain disease conditions and principles underlying nutritional therapy. Department of Family Studies, Applied Human Nutrition. Prerequisites: 19-356, 71-205, 71-319..Concurrent: 77-315.71-319 Fundamentals of Nutrition F,W(3-3) This course is the basis for the study of nutrition of all species of animals. The occurrence, uptake and metabolic role of nutrients will be discussed in relation to growth, reproduction and longevity in human subjects, domestic animals and other species; principles of experimentation and the use of analytical techniques to monitor the metabolic fate of nutrients; the integration of chemical analyses of nutrients with physiological measurements; the use of experimental animals for the detection of toxicants and nutrient deficiencies. Limited to students who require 71-319 as part of their degree program. Department of Human Biology and Nutritional Sciences. Prerequisites: 19-258.Exclusions: 71-321.71-321 Fundamentals of Nutrition F,W(3-0) The lecture material of course 71-319. Department of Human Biology and Nutritional Sciences. Prerequisites: 19-258.Exclusions: 71-319.71-323 Animal Nutrition W(3-2) The application of principles of nutrition to the development of diets and feeding programs for the various species of animals of agricultural importance. Department of Animal and Poultry Science. Prerequisites: 71-319.71-333 Micronutrients and Health: Concepts and Controversies W(3-0) The course emphasizes the biochemical basis for the dietary essentiality of vitamins and minerals. The course extends the fundamentals of nutrition to include conditional essentiality of micronutrients, biochemical individuality and the use of micronutrient supplementation to promote human and animal health. Department of Human Biology and Nutritional Sciences.Prerequisites: 71-319 or 71-321.71-334 Nutrition of Fish and Crustacea W(3-0) The nutrition of fish and crustaceans with emphasis on those species used in aquaculture. Nutritional biochemistry, nutritional pathology and comparative nutrition of cold blooded, ammonotelic animals mainly carnivorous, contrasted with warm blooded ureotelic omnivores. Department of Human Biology and Nutritional Science.Prerequisites: 71-319 or 71-321.71-335 Wildlife Nutrition W(3-0) A study of the nutrition of avian and mammalian wildlife with emphasis on North American species. The role of nutrition in survival and population growth of wildlife in their natural habitat. Formulation of diets for wild species in captivity. Department of Animal and Poultry Science. Prerequisites: 71-319 or 71-321.71-401 Nutritional Assessment F(2-2) Principles and methods in nutritional assessment of individuals and groups in health and disease. Department of Family Studies, Applied Human Nutrition.Prerequisites: 71-205, 71-319.71-402 Nutrition, Growth and Development W(3-0) Relation of nutritional and environmental factors to physical and mental aspects of human growth and development through the life cycle. Department of Human Biology and Nutritional Sciences. Prerequisites: (71-319 or 71-321), (75-3941:2 or 77-315).71-404 Nutritional Aspects of Human Disease II F(3-0) A continuation of 71-304. A lecture course concerned with the application of nutrition to clinical problems. Department of Family Studies, Applied Human Nutrition. Prerequisites: 71-304, 77-315.71-406 Clinical Nutrition W(2-2) A study of the role of nutrition in the etiology, pathophysiology, therapy and prevention of selected human diseases. Enteral and parenteral nutritional support systems in trauma, infection, surgery, chemotherapy and radiotherapy, and in organ failure. Department of Family Studies, Applied Human Nutrition. Prerequisites: 71-404.71-407 Nutrition Education (formerly: ) F(3-0) Methods and approaches in nutrition education. Community programs in nutrition for different age groups; dietary counselling; nutrition education in the preschool, in prenatal and other specialized programs. Department of Family Studies, Applied Human Nutrition.Prerequisites: 39-340, 71-205.71-420 Nutrition and Immune Function W(3-0) This course integrates existing knowledge in several areas - nutrition, metabolism and immunology. Of particular interest are the underlying mechanisms of nutritional immunomodulation with particular reference to the human problem of protein-energy malnutrition. Food sensitivities and the immunological functions of milk will also be considered. Department of Human Biology and Nutritional Sciences.Prerequisites: 71-319 or 71-321.71-421 Nutrition, Exercise and Energy Metabolism F(3-0) Energy metabolism will be considered under the headings: thermodynamic principles, energy deposition and hormonal control of metabolism; nutrition, exercise and environmental influences on energy balance and enzyme adaptation; nutrition and exercise in the control of body composition. Department of Human Biology and Nutritional Sciences.Prerequisites: 71-319 or 71-321.71-432 Nutrition and Metabolic Control in Disease F(3-0) A discussion of disorders of metabolism, either inherited or acquired, in which nutrition plays a major role in the etiology, pathogenesis, or treatment. The nutritional control of the affected metabolic pathways and the interaction of nutrition with exercise, drugs and gene therapy will be presented. Department of Human Biology and Nutritional Sciences.Prerequisites: 71-319 or 71-321.71-437 Ruminant Nutrition F(3-0) Rumen microbiology, digestive physiology and nutrition principles will be integrated and related to practical problems in ruminant nutrition. Department of Animal and Poultry Science.Prerequisites: 71-323.71-439 Poultry and Swine Nutrition W(3-0) A study of gastrointestinal manipulation of digesta and utilization of resultant nutrients in fowl and swine. Animal idiosyncrasies as they influence feedstuff value will be considered. Department of Animal and Poultry Science. Prerequisites: 71-323.71-451 Toxicological Aspects of Nutrition F(3-0) The occurrence, metabolism and nutritional implications of non-nutrients, additives and environmental pollutants in foods and feeds. Influence of drugs, environmental contaminants and natural toxicants on nutritional requirements. Department of Human Biology and Nutritional Sciences. Prerequisites: 71-319 or 71-321.71-481 Applied Human Nutrition Thesis I (3-0) Planning, developing and writing a research proposal under individual faculty supervision. Topic to be decided by the student in consultation with the supervisory faculty member before course selection or registration period. Department of Family Studies, Applied Human Nutrition.Prerequisites: 39-307, 71-205, 71-304, and consent of the instructor. 71-485 Field Experience in Nutrition Education W(2-4) Seminar and supervised experience in nutrition education. Students will apply principles of programme planning and nutrition education theory in a community setting under the supervision of a nutritionist. The placements may be arranged in hospital or community health settings, educational facilities, social service agencies, or with industry. Students wishing to enrol in this course must consult with course instructor during Fall course selection. Department of Family Studies, Applied Human Nutrition.Prerequisites: 39-340, 71-404, 71-407.71-490 Selected Topics in Human Nutrition W(3-0) Reading and discussion on selected areas in human nutrition and its application; formal class reports and term papers. Primarily for Applied Human Nutrition majors. Department of Family Studies, Applied Human Nutrition.Prerequisites: 71-304, (71-401 or 71-402)71-4911:2 Applied Human Nutrition Thesis II (3-0:3-0) The student will conduct and write an undergraduate thesis under the direction of a faculty member. This is a double-weighted course. When you select it, you must list both 71-4911 and 71-4912 in the same semester. Department of Family Studies, Applied Human Nutrition. Prerequisites: 71-481.1996-97 Undergraduate CalendarXII--Course Descriptions Last revised: August 28, 1996. Contact: 041b061a72


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