Prader-Willi Syndrome and the Use of Medical Nutrition Therapy

Title: Integrating Consistent Individualized Carbohydrate-Controlled Anti- Inflammatory Nutritional Plan (C-ICAN) in the Management of Prader-Willi Syndrome: A Case Report. Prader–Willi syndrome (PWS) is a rare genetic disorder caused by a loss of function of specific genes on chromosome 15. Patients with this disease present unique challenges in management, particularly regarding obesity and nutritional regulation as the disease symptoms change depending on the age of the patient and the phase of the disease. These challenges pose critical stressors to caregivers and their families. We present a case report of a 5-year-old Caucasian male diagnosed with PWS, exhibiting failure to thrive and uncontrolled weight gain. His caregiver was his elderly grandmother who, by her own admission, was ill-equipped to deal with the patient’s physical symptoms and his behavior in response to dietary restrictions. Through a multidisciplinary approach involving medical nutrition therapy (MNT) involving the implementation of a Consistent Individualized Carbohydrate-Controlled Anti-Inflammatory Nutritional plan (C-ICAN), growth hormone supplementation, and behavioral interventions patient markedly improved physically and emotionally.

RELATIONSHIP BETWEEN HEMOGLOBIN A1C AND BLOOD GLUCOSE THROUGHOUT THE DAY IN WELL-GLYCEMIC-CONTROLLED MEDICAL NUTRITION THERAPY ALONE TYPE 2 DIABETIC PATIENTS

Objective To investigate the relationship between glycosylated hemoglobin A1 c （HbA1 c） and blood glucose levels of eight different points throughout the day in well-glycemic-controlled medical nutrition therapy （MNT） alone type 2 diabetic pafients. Methods Data were collected as＂ capillary blood glucose value of eight different sample points among sixteen observing days in thirty MNT alone type 2 diabetic patients. The correlation between HbAI c and capillary blood glucose value was evaluated by Pearson＇s correlation method. Results The r-values between HbA1c and capillary blood glucose of 3：00, 6：00, and bedtime （22：00-23：00） were 0. 81,0. 79, and 0. 78, respectively（P 〈0. 001 ）. The best correlation was found between the mean value of 8- point blood glucose value throughout the day and HbA1c （ r=0. 84, P 〈0. 001 ）. Conclustion Fasting blood glucose and postabsorptive blood glucose have better correlations with HbAlc compared with other points in this group of well-glycemic-controlled MNT alone type 2 diabetic patients.

Analysis on Nutritional Risk Screening and Influencing Factors of Hospitalized Patients in Central Urban Area

Rational nutritional support shall be based on nutritional screening and nutritional assessment. This study is aimed to explore nutritional risk screening and its influencing factors of hospitalized patients in central urban area. It is helpful for the early detection of problems in nutritional supports, nutrition management and the implementation of intervention measures, which will contribute a lot to improving the patient＇s poor clinical outcome. A total of three tertiary medical institutions were enrolled in this study. From October 2015 to June 2016, 1202 hospitalized patients aged ≥18 years were enrolled in Nutrition Risk Screening 2002（NRS2002） for nutritional risk screening, including 8 cases who refused to participate, 5 cases of same-day surgery and 5 cases of coma. A single-factor chi-square test was performed on 312 patients with nutritional risk and 872 hospitalized patients without nutritional risk. Logistic regression analysis was performed with univariate analysis（P〈0.05）, to investigate the incidence of nutritional risk and influencing factors. The incidence of nutritional risk was 26.35% in the inpatients, 25.90% in male and 26.84% in female, respectively. The single-factor analysis showed that the age ≥60, sleeping disorder, fasting, intraoperative bleeding, the surgery in recent month, digestive diseases, metabolic diseases and endocrine system diseases had significant effects on nutritional risk（P〈0.05）. Having considered the above-mentioned factors as independent variables and nutritional risk（Y=1, N=0） as dependent variable, logistic regression analysis revealed that the age ≥60, fasting, sleeping disorders, the surgery in recent month and digestive diseases are hazardous factors for nutritional risk. Nutritional risk exists in hospitalized patients in central urban areas. Nutritional risk screening should be conducted for inpatients. Nutritional intervention programs should be formulated in consideration of those influencing factors, which enable to reduce the nutritional risk and to promote the rehabilitation of inpatients.

Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.