Celiac Disease: Epidemiology, Pathogenesis, Diagnosis, and Nutritional Management Detlef Schuppan, MD, PhD, Melinda D. Dennis, MS, RD, LDN, Ciaran P. Kelly, MD
Celiac disease (CD) is an inflammatory small intestinal disorder that can lead to severe villous atrophy, malabsorption, and malignancy. It is triggered by the gluten proteins of wheat, barley, and rye. All patients express the antigen-presenting molecules human leukocyte antigen-DQ2 (HLA-DQ2) and/or HLA-DQ8, which bind gluten peptides and thus activate destructive intestinal T cells. Patients with untreated CD have circulating IgA autoantibodies to the enzyme tissue transglutaminase (tTG), a component of endomysium. Testing for serum IgA tTG has a high predictive value. Therapy of CD is a lifelong gluten-free diet. Counseling by an expert dietitian and association with a celiac support group are important in helping the patient embark on a healthy gluten-free diet. Current research focuses on non-dietary therapies and treatment of refractory (diet-unresponsive) CD.
Nutr Clin Care. 2005;8:54-69
© 2005 International Life Sciences Institute
Nutritional Therapy in Chronic Kidney Disease
Vincenzo Savica, MD, Domenico Santoro, MD, Francesco Ciolino, MD, Agostino Mallamace, MD, Menotti Calvani, MD, Rodolfo Savica, MD, Guido Bellinghieri, MD
In patients with chronic kidney disease (CKD), specialized nutritional therapy may help reduce the risk of electrolyte imbalances, vitamin deficiencies, and protein energy malnutrition. Protein-restricted diets may slow the progression of renal disease and decrease the risk of morbidity and mortality in patients with CKD. In this review, we discuss some of the major nutritional concerns in individuals with CKD and offer practical recommendations for dietary therapy.
Nutr Clin Care. 2005;8:70-76
©2005 International Life Sciences Institute
Childhood Obesity: Etiology, Prevention, and Treatment
Niki G. Philippas, RD, LDN, and Clifford W. Lo, MD, MPH, ScD
The rapid increase in the prevalence of obesity in children and adolescents is alarming, particularly in light of its many medical and psychosocial consequences. In this review, we discuss key concepts of nutrition and physical activity. Etiology, prevention, and treatment strategies are also discussed, focusing on the macronutrient content of the diet, portion control, meal patterns, physical activity, and sedentary behaviors. Television viewing, lack of physical activity, and intake of fast food and soft drinks are also examined as potential contributing factors in the obesity epidemic. Children should be helped to develop healthy nutrition and exercise habits early, since interventions are most effective when behaviors are still being formed.
Nutr Clin Care. 2005;8:77-88
©2005 International Life Sciences Institute
Total Parenteral Nutrition in Cancer Patients: Why and When?
Laura Joque, MD, and Aminah Jatoi, MD
Total parenteral nutrition (TPN) is sometimes utilized in cancer patients. Previous studies suggest that TPN provides clinical benefit in the perioperative setting among severely malnourished cancer patients and among those who are receiving blood or marrow transplants. However, the negative impact of TPN on quality of life, its adverse event profile, and its cost all suggest that this intervention must be used judiciously in cancer patients. Although a few case reports and other studies imply that TPN may benefit select patients with metastatic cancer, this approach represents a departure from the standard of care and therefore must be clearly thought through and justified prior to implementation.
Nutr Clin Care. 2005;8:89-92
©2005 International Life Sciences Institute
Hyperglycemia in the Critically Ill
Colleen Digman, MD, Dara Borto, MS, RD, CNSD, LDN, and Stanley A. Nasraway, Jr., MD, FCCM
Hyperglycemia is frequently seen in acutely ill patients and has historically been viewed as a normal response to stress. Treatment is often not initiated unless blood glucose exceeds 200 to 250 mg/dL. Recent evidence suggests that hyperglycemia is associated with worse outcomes within the population of medical and surgical intensive care units. Hyperglycemia in this population of patients develops from increased gluconeogenesis and insulin resistance. Although the specific mechanisms by which hyperglycemia contributes to poor outcomes are as yet unknown, disruption of normal mitochondrial respiration, direct glucose toxicity, accumulation of asymmetric dimethylarginine, and impairment of immune cell function are among the possibilities implicated. Studies demonstrate that intensive insulin therapy to achieve euglycemia reduces mortality and morbidity in critically ill patients. In addition to recognizing and treating hyperglycemia, it is as important to identify other frequently overlooked factors that contribute to hyperglycemia, such as medications, intravenous fluids, and enteral and parenteral nutrition.
Nutr Clin Care. 2005;8:93-101
©2005 International Life Sciences Institute