Neurological diseases are frequently associated with swallowing disorders and malnutrition. Moreover, patients with neurological diseases are at increased risk of micronutrient deficiency and dehydration. On the other hand, nutritional factors may be involved in the pathogenesis of neurological diseases. Multiple causes for the development of malnutrition in patients with neurological diseases are known including oropharyngeal dysphagia, impaired consciousness, perception deficits, cognitive dysfunction, and increased needs. The present evidence- and consensus-based guideline addresses clinical questions on best medical nutrition therapy in patients with neurological diseases. Among them, management of oropharyngeal dysphagia plays a pivotal role. The guideline has been written by a multidisciplinary team and offers 88 recommendations for use in clinical practice for amyotrophic lateral sclerosis, Parkinson's disease, stroke and multiple sclerosis.

Despite the methodological difficulties in creating non-disease specific guidelines, the evidence behind several important aspects of nutritional support for polymorbid medical inpatients was reviewed and summarized into practical clinical recommendations. Use of these guidelines offer an evidence-based nutritional approach to the polymorbid medical inpatient and may improve their outcomes.

No abstract

No abstract

Background/Objectives: Earlier studies have shown that the addition of vinegar in a carbohydrate-rich meal lowers glucose and insulin response in healthy individuals. The mechanism of how this is accomplished, however, remains unclear. The aim of this study is to examine the effect of vinegar on glucose and insulin response in patients with type II diabetes (T2D) in relation to the type of carbohydrates consumed in a meal. Subjects/Methods: Sixteen patients with T2D were divided into two groups, matched for age, gender and HbA 1c . Patients in the first group (group A) were given a high-glycaemic index (GI) meal (mashed potatoes and low-fat milk) on two different days, with and without the addition of vinegar, respectively. In the second group (group B), patients were given an isocaloric meal with the same nutrient composition, but low GI (whole grain bread, lettuce and low-fat cheese). Postprandial plasma glucose and insulin values were measured every 30 min for 2 h. Results: In group A, the incremental area under the curve of glucose (GiAUC 120 ) was lower after the addition of vinegar (181 ± 78 mmol Á min/l vs 311 ± 124 mmol Á min/l, P ¼ 0.04). The iAUC of insulin (IiAUC 120 ) was also reduced, but the difference was of marginal statistical significance (2368±1061 mU Á min/ml vs 3545±2586 mU Á min/ml, P ¼ 0.056). In group B, the addition of vinegar did not affect either the GiAUC 120 (229 ± 38 mmol Á min/l vs 238 ± 25 mmol Á min/l, P ¼ 0.56) or the IiAUC 120 (2996±1302 mU Á min/ml vs 3007±1255 mU Á min/ml, P ¼ 0.98). Conclusions: We conclude that the addition of vinegar reduces postprandial glycaemia in patients with T2D only when it is added to a high-GI meal.

Cachexia is a major characteristic of multiple non-malignant diseases, advanced and metastatic cancers and it is highly prevalent in pancreatic cancer, affecting almost 70%–80% of the patients. Cancer cachexia is a multifactorial condition accompanied by compromised appetite and changes in body composition, i.e., loss of fat. It is associated with lower effectiveness of treatment, compromised quality of life, and higher mortality. Understanding the complex pathways underlying the pathophysiology of cancer cachexia, new therapeutic targets will be unraveled. The interplay between tumor and host factors, such as cytokines, holds a central role in cachexia pathophysiology. Cytokines are possibly responsible for anorexia, hypermetabolism, muscle proteolysis, and apoptosis. In particular, cachexia in pancreatic cancer might be the result of the surgical removal of pancreas parts. In recent years, many studies have been carried out to identify an effective treatment algorithm for cachexia. Choosing the most appropriate treatment, the clinical effect and the risk of adverse effects should be taken under consideration. The purpose of this review is to highlight the pathophysiological mechanisms as well as the current ways of cachexia treatment in the pharmaceutical and the nutrition field.

Nutritional counselling has been recognised as the first line approach in the management of numerous chronic diseases. Though usually carried out by dietitians, nutritional counselling may be used by nurses, or other healthcare professionals to improve nutritional status and meet healthcare goals. Healthcare professionals require training and education to facilitate a patient centred approach to effective counselling. Advances in digital technology have the potential to improve access to nutritional counselling for some patients such as those in primary care. However, caution is required to ensure that valuable interpersonal relationships are not lost, as these form the cornerstone of effective nutritional counselling. The aim of this narrative review is to explore aspects of effective nutritional counselling, including advances in e-counselling and areas where nursing input in nutritional counselling might enhance overall nutritional care.

Objective-To investigate whether closer adherence to a Mediterranean dietary pattern is associated with metabolic aspects of the Highly Active Antiretroviral Therapy (HAART)-induced metabolic syndrome (fat redistribution, insulin resistance, dyslipidemia) in HIV positive patients. Design-Cross sectional study.Methods-227 HIV-infected patients were evaluated during a single outpatient visit to the General Clinical Research Center of Beth Israel Deaconess Medical Center. Usual dietary intake and physical activity habits were evaluated; the Mediterranean Diet Score (MedDietScore) was calculated. Dualenergy x-ray absorptiometry, CT findings anthropometrics and data from the study interviews and questionnaires were used for the assessment of body composition using specific criteria. A complete metabolic profile was available for all subjects.Results-In the entire study sample, a weak inverse association was found between insulin resistance, estimated using the homeostasis model (HOMA-IR), and MedDietScore (standardized β= -0.15, p = 0.03). Interaction models revealed that this was largely driven by an inverse association in patients with fat redistribution (FR) (standardized β = -0.13, p = 0.02). Moreover, MedDietScore was positively correlated with HDL-cholesterol (standardized β = 0.15, p = 0.01) and marginally negatively associated with circulating triglyceride levels (standardized β = -0.16, p = 0.13) in this group of patients. Conflicts of interest: NoneAuthors' contributions: Dr. Mantzoros designed this study. Drs. Tsiodras, Chimienti and Wadhwa collected the data. Ms. Poulia and Dr. Yannakoulia analyzed the dietary information, performed the statistical analysis and drafted the paper. Drs Mantzoros and Tsiodras contributed to subsequent revisions of the paper and to the responses to the reviewers' comments. Drs. Karchmer and Mantzoros secured funding for this study. All authors critically revised the manuscript and approved the final version submitted.Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. NIH Public Access Author ManuscriptMetabolism. Author manuscript; available in PMC 2010 June 1.