Lifestyle Modification Therapy in Diabetes Disease: A Review Article

Introduction: Diabetes mellitus (DM) is a metabolic disease characterized by high blood glucose levels (hyperglycemia) resulting from disturbances in insulin secretion, insulin action or both. Insulin is a hormone produced by pancreatic beta cells, which is needed to utilize glucose from digested food. Comprehensive care is taken to treat patients with either prediabetes or diabetes. Diabetes management includes lifestyle interventions along with pharmacologic therapy and routine blood glucose monitoring. So that a decrease in blood glucose can occur and can be stable for a long time. Discussion:Lifestyle modification is an economical treatment that saves costs to prevent or delay the onset of diabetes. On the other hand, nutritional management provided by a dietitian is also recommended. Moderate weight loss goals are an important component of diabetes prevention and treatment, as large body weight can increase blood glucose levels, and can also have an increasing impact on blood pressure and cholesterol levels. Weight loss can be achieved through a balanced diet, with total control of calories and free carbohydrates. However, for diabetic patients following a low-carbohydrate diet, they should be informed about possible side effects such as hypoglycemia, headaches and constipation. Other studies have suggested the consumption of complex dietary fiber and whole grains to improve blood sugar control. Greater adherence to diet combined with light physical activity was associated with a lower likelihood of diabetes after adjusting for various factors. Conclusion:Lifestyle modification is a fairly cost-effective treatment to prevent or delay the onset of diabetes, with a risk reduction of about 58% in 3 years. It is strongly recommended by the ADA that patients with IGT, IFG or HbA1C levels of 5.7-6.4% be counseled on lifestyle changes such as diet and exercise. On the other hand, nutritional management provided by a dietitian is also recommended.

First record of Trichodina heterodentata (Ciliophora: Trichodinidae) in banded knifefish Gymnotus carapo (Gymnotidae) cultured in Brazil

The aim of this study was to report the first record of Trichodina heterodentata in banded knifefish Gymnotus carapo. Banded knifefish cultivated in the municipality of Jataí, state of Goiás, in the central western region of Brazil, experienced fish mortality rates of 3-4% per tank. Macroscopic analysis found that fish had lesions on their skin and gills. Smears of the integument and gills were confectioned and air-dried at room temperature and impregnated with silver nitrate to identify the Trichodinidae species causing the lesions. The trichodinid were identified as T. heterodentata, and their characteristics were compared to those from T. heterodentata recorded from other species of host fish. It was observed that the presence of T. heterodentata was associated with inadequate fish management, low water quality, high rates of stocking density, and inadequate nutritional management.

Telenutrition

In the last 20 years, telenutrition has gained popularity and visibility. This term refers to the incorporation of tools and skills of telecommunication into nutritional management. Telenutrition already had many reported uses even before the COVID-19 pandemic. In the present chapter, Telenutrition will be addressed considering important aspects such as differences with traditional care, the most relevant findings in pathologies relevant to the area, some suggestions for tools and marketing, as well as some ethical aspects.

Heat stress in dairy cattle – Some potential health risks associated with the nutritional management of the condition

Heat stress occurs when animals are exposed to environmental temperatures in excess of 25oC (the upper critical temperature), particularly in combination with high relative humidity or direct sunshine. Prevention is by providing plenty of good-quality drinking water, providing shade (natural or artificial), and using water sprinklers and/or fans. Changes to the diet, i.e., high energy density and low protein, are also beneficial and often implemented. However, there may be some potential risks associated with the nutritional management of heat stress in dairy cattle; i.e., the animals are at increased risk of developing subacute rumen acidosis, with ensuing laminitis/lameness, and displaced abomasum. This paper discusses how increasing the energy density of the diet (i.e., increasing the grain/forage ratio), as part of the nutritional management of heat stress, may put cows at greater risk of the above-mentioned digestive disorders.

Standards of Nutritional Care for Patients with Cystic Fibrosis: A Methodological Primer and AGREE II Analysis of Guidelines

Although many Clinical Practice Guidelines (CPGs) have been published for the care of patients with Cystic Fibrosis (CF), including a variety of nutrition recommendations, the quality of these CPGs has never been evaluated. The aim of this study was to compare, review, and critically appraise CPGs for the nutritional management of CF, throughout the lifespan. We searched PubMed, Guidelines International Network (GIN), ECRI Institute, and Guidelines Central for CPGs, with information on the nutritional management of CF. Retrieved CPGs were appraised by three independent reviewers, using the Appraisal of Guidelines, Research and Evaluation II (AGREE II) instrument and checklist. A total of 22 CPGs (seven solely nutrition oriented), by 14 different publishers, were retrieved. The Thoracic Society of Australia and New Zealand CPGs scored the highest overall quality (94.4%), while the Paediatric Gastroenterology Society/Dietitians Association of Australia CPGs had the lowest score (27.8%). Great variation in AGREE II domain-specific scores was observed in all CPGs, suggesting the existence of different strengths and weaknesses. Despite the availability of several CPGs, many appear outdated, lacking rigor, transparency, applicability, and efficiency, while incorporating bias. Considering that CPGs adherence is associated with better outcomes and the need for improving life expectancy in patients with CF, the development of CPGs of better quality is deemed necessary.