J Am Diet Assoc
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Food and nutrition professionals can play a major role in reversing the diabetes epidemic by helping patients reduce their risk for diabetes and prevent its onset. The Diabetes Prevention Program (DPP) clinical trial, spearheaded by the National Institutes of Health, has provided the research-based evidence needed to demonstrate that type 2 diabetes can be delayed or prevented through a 5% to 7% weight loss and regular physical activity, such as 150 minutes a week of brisk walking. The National Diabetes Education Program, through its "Small Steps. ⋯ The initiative includes a health care professional toolkit, user-friendly weight-loss materials for patients, and a mass media campaign to increase awareness that diabetes can be delayed or prevented. Food and nutrition professionals can access these materials free of charge online or through the National Diabetes Education Program clearinghouse. By applying the lessons learned from the DPP to patients at risk for diabetes, food and nutrition professionals can make a substantial contribution to reversing the diabetes epidemic.
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Intravenous (parenteral) nutrition has been advocated widely as adjunctive care in patients with a variety of underlying diseases. However, the enthusiasm for this therapeutic intervention was based largely on expert opinion. Because the best way to assess the efficacy of any treatment is to test it in a randomized controlled trial, this review will focus on data that was derived from such studies. ⋯ Parenteral nutrition was harmful when provided to patients undergoing radiation or chemotherapy for cancer. Although no randomized controlled trials exist, it is assumed that parenteral nutrition is useful in patients with an inadequate gastrointestinal tract ("short gut"). Thus, for the most part, randomized controlled trials comparing intravenous nutrition to no artificial nutrition have not shown that this medical intervention is of benefit.
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Review Meta Analysis
Preliminary evidence for a medical nutrition therapy protocol: enteral feedings for critically ill patients.
The objective of this study was to evaluate the evidence behind specific but common patient care decisions in support of enteral feedings for patients admitted to intensive care units. Six specific questions were developed and refined to address clinical outcomes specific to clinical practice decisions pertinent to enteral feeding of critically ill patients. The data sources consisted of an intensive literature review from five databases, using standardized search terms. ⋯ Actual delivery of 14 to 18 kcal/kg/day or 60% to 70% of goal is associated with improved outcomes, whereas greater intake may not be in some populations. Blue food coloring should not be used with enteral feedings due to its limited sensitivity for aspiration and some risk of mortality. Well-designed, adequately powered, randomized controlled clinical trials are needed to evaluate any benefit of tube tip position on aspiration pneumonia or mortality, and of early enteral feedings on mortality.