Some aspects of preparing diabetic patients for self-care

BackgroundDiabetes is a lifestyle disease which can cause many complications and organ-related disorders. The aim of the study was to analyze selected aspects of preparing patients with diabetes for self-care.MethodsThe study group consisted of 190 people diagnosed with type 1 and type 2 diabetes, including 101 women and 89 men. The mean age of the respondents was 42.2 ± 13.4 years. The study was conducted using an anonymous self-designed questionnaire containing 50 questions.ResultsAmong the respondents, 23.2% did not control their glucose levels at home. The respondents most often measured glucose once a day (33.6%) or three times a day (26.7%). 64.7% of the respondents declared that they kept a self-monitoring diary. The knowledge of the symptoms of hypoglycemia and the ability to properly manage it was declared by 64.8% of the respondents. 52.1% of the patients did not undertake any activity lasting more than 30 minutes at least 3 times a week. 75.2% described their condition as very good and good. Independent participation in therapy, i.e. taking hypoglycemic drugs or insulin, was declared by 63.7% of the respondents.ConclusionsDespite undergoing therapeutic education, the study population diagnosed with diabetes still show deficiencies in terms of awareness of proper health behaviors. Objective results showed that the patients had insufficient knowledge and skills in terms of self-care and self-observation, blood glucose and blood pressure measurements, physical activity, diet therapy and adherence to pharmacotherapy recommendations. Despite the good general preparation for self-care as declared by the respondents, these patients require further systematic, individual educational activities.Study implicationsThe results of the present study have implications for nursing practice, patient therapeutic education, and the functioning of the public health and healthcare systems. The number of diabetic patients is constantly increasing. Patients require coordinated care and individualized therapeutic education in order to be prepared for self-care and self-management, thus reducing the risk of complications. Delaying the occurrence of potential complications provides patients with a chance to live an active private and professional life, and protects the health care system from carrying the cost burden of expensive highly specialized services.

Nutritional Therapy in Persons Suffering from Psoriasis

Psoriasis is a chronic inflammatory skin disease. Immunological, genetic, and environmental factors, including diet, play a part in the pathogenesis of psoriasis. Metabolic syndrome or its components are frequent co-morbidities in persons with psoriasis. A change of eating habits can improve the quality of life of patients by relieving skin lesions and by reducing the risk of other diseases. A low-energy diet is recommended for patients with excess body weight. Persons suffering from psoriasis should limit the intake of saturated fatty acids and replace them with polyunsaturated fatty acids from the omega-3 family, which have an anti-inflammatory effect. In diet therapy for persons with psoriasis, the introduction of antioxidants such as vitamin A, vitamin C, vitamin E, carotenoids, flavonoids, and selenium is extremely important. Vitamin D supplementation is also recommended. Some authors suggest that alternative diets have a positive effect on the course of psoriasis. These diets include: a gluten-free diet, a vegetarian diet, and a Mediterranean diet. Diet therapy for patients with psoriasis should also be tailored to pharmacological treatment. For instance, folic acid supplementation is introduced in persons taking methotrexate. The purpose of this paper is to discuss in detail the nutritional recommendations for persons with psoriasis.

Diet therapy in patients with metabolically associated fatty liver disease: what is the choice for particular patient?

Metabolically associated fatty liver disease is a widespread disease (MAFLD).The main treatment strategy for MAFLD is the correction of metabolic factors, changes in lifestyle, normalization of body weight, which is achieved by the use of diet therapy and physical activity.The purpose of this review is to present the characteristics of diets that have been studied in the treatment of patients with MAFLD.Results. The greatest evidence base on the effectiveness of treatment of MAFLD and the safety profile is the use of the Mediterranean diet and the diet with a low glycemic index. Patients should be advised to reduce their sugar intake, reduce their intake of saturated fatty acids and trans fats, and increase their intake of dietary fiber. Eating a balanced, calorie-restricted diet can help to provide healthy lifestyle and healthy eating habits, which are essential for the prevention and treatment of MAFLD. Hereditary factors, the composition of the intestinal microbiota, comorbid pathology can affect the results of diet therapy, which emphasizes the urgent need for an individualized approach in the treatment of this disease.

Evaluation of the effectiveness of diet therapy in the elderly with obesity and non-alcoholic fatty liver disease

The aim of the study was to evaluate the effectiveness of a standard reduced-calorie diet in elderly subjects with obesity and nonalcoholic fatty liver disease (NAFLD).Materials and Methods: 60 women with I-III degree obesity and NAFLD were examined. Metabolic status was assessed by indirect calorimetry and body composition indices using bioimpedance spectroscopy. Biochemical indices in blood serum were determined on a biochemical analyzer “KONELAB Prime 60i”. SPSS Statistics 23.0 program was used for statistical data processing.Results and Discussion: It was found that resting energy expenditure was significantly higher in middle-aged women (1896.8±46.5 kcal/d) with obesity and NAFLD than in elderly women (1691.6±34.2 kcal/d). Fat oxidation rate was significantly lower in elderly women (66.8±7 g/day) than in middle-aged women (70.8±9 g/day). The elderly patients received a variant of the standard diet with reduced caloric content for 10 days. Against the background of diet therapy, a significant decrease in glucose, total cholesterol, LDL, triglycerides, as well as fat mass, total fluid and visceral fat area was observed in elderly patients with obesity and NAFLD. However, the use of a standard reduced-calorie diet resulted in a slight elevation of serum uric acid levels and a significant decrease in muscle mass.Conclusions: the selection of specialized diets is recommended for elderly patients with obesity and NAFLD when prescribing diet therapy, which will not only prevent the decrease of muscle mass and increase of uric acid but also improve the effectiveness of treatment measures in obesity by preventing the development and progression of its complications.

DEVELOPMENT OF TECHNOLOGY AND THE POTENTIAL OF DRINKS WITH «ANTI-AGE» EFFECT

Modern trends in the creation of drinks provide for the use of various infusions, plant extracts, as well as vitamin and mineral complexes, organic acids and polysaccharides as part of their bases, which allows to ensure the normalization of physiological and metabolic processes in the human body and prevent a number of diseases and syndromes that lead to a decrease in working capacity. The main problems in the creation of various drinking forms are associated with the purification and preparation of water, the dissolution of components and their possible interaction with each other in the packaging unit during storage. Considering the above, it is relevant to create dry concentrates of health-improving drinks with long shelf life. The developed approach and technology is a promising form of drinks to improve the living standards of the population of Ukraine and other countries. The developed products will improve immunity, prevent a number of nutritional diseases, improve dietary intake during diet therapy and help restore micronutrient balance in the human body. It has been established that the physiological value of dry drinks according to the described production method is preserved in finished product forms (sticks with a metallized backing, sachets, sachets with a “zip-fastener” and a metallized inlay, plastic cans with a screw cap and with polymer backing as a control against preliminary opening) the entire recommended shelf life is from 12 to 24 months. The mixture is a convenient form for transportation and preparation. When diluted in liquid media (purified drinking water, mineral water, milk, fermented milk drinks, drinks based on plants, cereals, legumes, tea, coffee, cocoa), the specified functional properties are preserved and improved due to the activation of biologically active substances contained in the mixture and dilution media. The novelty of individual technological solutions and the indicated physiological and functional properties lies in the use of extracts of plants, fruits, berries, vegetables, as well as additionally introduced vitamins, mineral salts, amino acids, hydrolysates and isolates of plant proteins, natural bioenhancers and bioactiators with unique anti -age "effects.

Case Report: Severe Edema and Marked Weight Gain Induced by Marginal Thiamine Deficiency in a Patient With Alcohol Dependency and Type 2 Diabetes Mellitus

Background: Patients with alcohol use disorder (AUD) may develop peripheral edema due to alcohol-related liver, renal, or heart disease. Thiamine deficiency is reported to occur in AUD and type 2 diabetes mellitus (T2DM). Thiamine deficiency may also cause peripheral edema. Thiamine is essential for optimal glucose metabolism through its role as an essential co-factor for key enzymes in intermediary metabolism. Since glucose metabolism worsens under diabetic conditions, it seems that a relative shortage of thiamine may occur more easily in patients with diabetes mellitus.Case Presentation: A 59-year-old Japanese man was admitted to the hospital with severe peripheral edema. His background history included alcohol liver disease (ALD), chronic renal failure (CRF), and T2DM. His body mass index (BMI) at admission was 37.7 kg/m2 and this represented a 30 kg increase in body weight over 2 months. Laboratory investigations showed anemia, liver and renal injury, hyperglycemia, and marginal hypothyroidism. The plasma thiamine diphosphate concentration was 20 ng/mL (reference range: 24–66 ng/mL). Diet therapy of 1,600 kcal/day and intravenous fursultiamine hydrochloride therapy (50 mg/once a day, seven days) was commenced in combination with intravenous diuretics. After one week, the plasma thiamine concentration was 853 ng/mL, and the patient's body weight had reduced by 18 kg.Conclusions: Patients with T2DM and AUD may develop severe peripheral edema in the context of marginal thiamine deficiency. Fursultiamine hydrochloride (50 mg/once a day, seven days) restored normal plasma thiamine concentrations and may have contributed to the rapid resolution of severe peripheral edema in this case. Empirical treatment with thiamine should be considered in patients with severe peripheral edema in the context of AUD and T2DM.

GLIADOMORPHIN AND CASOMORPHIN LEVELS IN CHILDREN WITH AUTISM SPECTRUM DISORDERS

High frequency of detection of various disorders of the gastrointestinal tract in patients with autism spectrum disorders (ASD) formed the basis of the first attempts to prescribe diet therapy. Despite the fact that diets are not officially included in the complex of therapeutic measures for ASD, the use of gluten-free (GFD) and casein-free diets (CFD) is widespread practice. The aim of the study was to assess the level of gliadomorphins (GM) and casomorphins (CM) in the blood of children with ASD, depending on the eating style and in comparison with healthy peers. Materials and methods of research: a prospective continuous open controlled study with the participation of 230 children aged 3–15 years. The first group included 36 patients with ASD who had been observing GFD for more than 6 months; in addition, 18 children were also on CFD. Boys in the group ware 23 (64%), girls – 13 (36%). The second group included 49 children with ASD who had no dietary restrictions. Boys – 35 (71%), girls – 14 (29%). The third (control) group consisted of 145 apparently healthy children: boys – 83 (57.3%), girls – 62 (42.7%). Determination of CM and GM levels was performed on a Multiskan Go analyzer (Thermo Fisher Scientific, Finland) by enzyme-linked immunosorbent assay using Human Gliadomorphin ELISA Kit and Human Casomorphin ELISA Kit (Hycult Biotech, Netherlands). Results: more boys than girls were included in all study groups; no statistically significant differences in gender distribution were found (p=0.2). The median age values in the 1st group was 6.5 [4.0; 8.0] (3; 15) years, in the 2nd – 6.0 [4.0; 7.0] (3; 15) years, in the 3rd – 8.0 [6.0; 11.0] (3; 15) years, the differences are statistically significant (p=0.0001). The content of GM in the blood serum of children with ASD, adhering to GFD, is statistically significantly lower by 2.6 times compared with children not adhering to diet therapy – 0.61 [0.41; 0.80] (0.12; 6.42) and 1.6 [0.70; 2.38] (0.18; 4.03) ng/ml (p<0.001) and does not differ statistically significantly from the level in the control group – 0.41 ng/ml [0.31; 0.72] (0.14; 4.18) ng/ml (p>0.005). The content of CM in the blood serum of children with ASD, adhering to CFD and GFD, is also 1.25 times lower than in children not adhering to diet therapy 1.85 [1.04; 2.07] (0.16; 3.83) and 2.34 [2.11; 2.72] (0.93; 3.29) pg/ml (p<0.001) and 1.3 times lower than the level of the control group – 2.45 [2.13; 2.89] (1.22; 26.88) pg/ml (p<0.001). Conclusion: the results obtained confirm the theory/possibility of exorphin intoxication of ASD development, which may be pathogenetically significant for some patients with ASD, which must be taken into account when implementing an individual approach to prescribing GFD, CFD.

In Vitro and In Vivo Digestion of Persimmon and Derived Products: A Review

The link between nutrition and health has focused on the strategy of diet-based programs to deal with various physiological threats, such as cardiovascular disease, oxidative stress, and diabetes. Therefore, the consumption of fruits and vegetables as a safeguard for human health is increasingly important. Among fruits, the intake of persimmon is of great interest because several studies have associated its consumption with health benefits due to its high content of bioactive compounds, fiber, minerals, and vitamins. However, during digestion, some changes take place in persimmon nutritional compounds that condition their subsequent use by the human body. In vitro studies indicate different rates of recovery and bioaccessibility depending on the bioactive compound and the matrix in which they are found. In vivo studies show that the pharmacological application of persimmon or its functional components, such as proanthocyanidins, can help to prevent hyperlipidemia and hyperglycemia. Thus, persimmon and persimmon derived products have the potential to be a fruit recommended for diet therapy. This review aims to compile an updated review of the benefits of persimmon and its derived products, focusing on the in vitro and in vivo digestibility of the main nutrients and bioactive compounds.

Food protein-induced enteropathy and its complications

Currently, in pediatric practice, a special place is occupied by patients with severe allergic lesions of the gastrointestinal tract, which often manifest immediately after the birth of a child. Food protein-induced enteropathy reduces the quality of life of the child and family; it is difficult to diagnose and to treat. We present a clinical case of a patient with food protein-induced enteropathy, complicated by severe B12-deficiency anemia and edema syndrome. In the tactics of patient management, attention is paid to the late diagnosis of the underlying disease and complications, the complexity of prescribing diet therapy and the lack of alertness regarding the diagnosis of malabsorption associated with food intolerance.