1.
Advancements in Nutritional Strategies for Gestational Diabetes Management: A Systematic Review of Recent Evidence.
Sánchez-García, JC, Saraceno López-Palop, I, Piqueras-Sola, B, Cortés-Martín, J, Mellado-García, E, Muñóz Sánchez, I, Rodríguez-Blanque, R
Journal of clinical medicine. 2023;13(1)
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Gestational Diabetes Mellitus (GDM) causes hyperglycaemia due to the deficit of insulin during pregnancy. Dietary and lifestyle management plays a vital role in maintaining glycaemic control in women with GDM to avoid health risks to the mother and baby. Therefore, this systematic review of fourteen randomised controlled trials evaluated the latest research advancements to identify effective nutritional strategies for managing hyperglycaemia in women with GDM. Among all the dietary strategies implemented in the included randomised controlled trials, probiotic supplementation and supplementation of probiotics and vitamin D were most effective in GDM. Further robust studies are required to evaluate the potential effectiveness of different nutritional strategies for managing GDM. Healthcare professionals can use the results of this systematic review to understand the latest evidence supporting nutritional strategy for women with GDM and the need for personalised support for managing hyperglycaemia in GDM.
Abstract
Gestational diabetes mellitus (GDM) is defined as hyperglycaemia first detected at any time during pregnancy with values lower than those determined by the WHO for diabetes diagnosis in adults. This pathology, with a worldwide prevalence of 13.4%, causes significant maternal and foetal risks. The first line of treatment consists of maintaining normo-glycaemia through an adequate diet and lifestyle changes. The aim is to synthesize the scientific evidence updating the nutritional recommendations for the effective management of GDM. A systematic review of the scientific literature was conducted following the PRISMA guidelines. Randomized clinical trials published within the last five years and providing information on nutritional recommendations to achieve an effective management of gestational diabetes were selected. The databases searched were PubMed, the WOS Core Collection, SCOPUS, and CINAHL, using the MeSH terms: "Diabetes, Gestational"; "Nutrition Assessment (nutrition*)"; "Diet"; "Eating"; and "Food"; with the Boolean operators "AND" and "OR". The PEDro scale (Physiotherapy Evidence Database) was used to assess the scientific quality of the studies, with a mean score of 8.9, indicating an average good scientific quality. Results: A total of 809 papers were collected, of which, after applying the inclusion and exclusion criteria, 14 randomized clinical trials were selected. Probiotic supplementation and co-supplementation with vitamin D have been found to be the most beneficial options for both mothers with GDM and neonates, but the most effective regimens are not known. Diets enriched with extra virgin olive oil (EVOO) and oat bran, as well as some recommendations focused on carbohydrates also seem effective, as well as diets designed for this group of women with GDM such as "CHOICE". Conclusions: Although there are numerous proposals that have been published in recent years focused on the diet of women with GDM in order to improve their results and those of their children, it is the supplementation with probiotics and the co-supplementation with vitamin D that is most agreed upon as beneficial; however, more research is needed into which protocols are most effective. Other proposals that could also be beneficial should be further studied.
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Vegan diets: practical advice for athletes and exercisers.
Rogerson, D
Journal of the International Society of Sports Nutrition. 2017;14:36
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Veganism has increased in popularity in recent years and amongst those converting to a plant-based diet are several high profile athletes. Yet, in sports nutrition little is known about vegan diets and their impact on exercise and athletic performance. A common concern with strict restrictive eating patterns is that a poorly designed diet can predispose to macro-and micronutrient insufficiency. By drawing from other areas of research, this review sought to summarise available evidence to formulate nutritional recommendations that can meet the health and performance needs of those following a vegan diet. Discussed are the macro-and micronutrients most critical in a vegan diet, including total energy intake. Detailed paragraphs address protein adequacy, amino acid profiles, branch chained amino acids and their importance for muscle synthesis and digestibility. Elaborated are issues around carbohydrates and fibre, as well as fat intake and omega-3 fatty acids. The review also covers micronutrients that tend to have insufficient intake in a vegan diet and their role in sports performance. Including Vitamin B12, iron, zinc, iodine, calcium and vitamin D, with a final note on the performance-enhancing amino acids of creatine and beta-alanine. The authors also suggest food sources for the relevant nutrients and included sample meal plans. This review provides a comprehensive and practical guide for those providing nutritional support to vegan sportspeople and athletes.
Abstract
With the growth of social media as a platform to share information, veganism is becoming more visible, and could be becoming more accepted in sports and in the health and fitness industry. However, to date, there appears to be a lack of literature that discusses how to manage vegan diets for athletic purposes. This article attempted to review literature in order to provide recommendations for how to construct a vegan diet for athletes and exercisers. While little data could be found in the sports nutrition literature specifically, it was revealed elsewhere that veganism creates challenges that need to be accounted for when designing a nutritious diet. This included the sufficiency of energy and protein; the adequacy of vitamin B12, iron, zinc, calcium, iodine and vitamin D; and the lack of the long-chain n-3 fatty acids EPA and DHA in most plant-based sources. However, via the strategic management of food and appropriate supplementation, it is the contention of this article that a nutritive vegan diet can be designed to achieve the dietary needs of most athletes satisfactorily. Further, it was suggested here that creatine and β-alanine supplementation might be of particular use to vegan athletes, owing to vegetarian diets promoting lower muscle creatine and lower muscle carnosine levels in consumers. Empirical research is needed to examine the effects of vegan diets in athletic populations however, especially if this movement grows in popularity, to ensure that the health and performance of athletic vegans is optimised in accordance with developments in sports nutrition knowledge.
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Functional biochemical and nutrient indices in frail elderly people are partly affected by dietary supplements but not by exercise.
de Jong, N, Chin A Paw, MJ, de Groot, LC, de Graaf, C, Kok, FJ, van Staveren, WA
The Journal of nutrition. 1999;129(11):2028-36
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Elderly people are at risk of nutritional deficiencies for a variety of reasons including reduced appetite, increased medication, and alterations in the absorption and metabolism of vitamins and minerals with age. The aim of this study was to measure the influence of exercise, and supplementing the diet with vitamins and minerals, on indicators of nutritional and health status in frail elderly people. A 17-week randomised controlled trial was carried out on 145 frail elderly people living in the community. Participants were given either; 1) food products enriched with vitamins D, E, thiamine, riboflavin, B6, folic acid, B12, calcium, magnesium, zinc, iron and iodine; 2) an exercise programme; 3) both enriched food products and exercise programme; or 4) food products that had not been enriched and a social programme (the control group). At the end of the study, significant improvements in the blood levels of vitamins B6, B12, C and D were detected in the groups receiving the enriched food products compared to the controls. There was no additional benefit to be gained from exercise. The improvement in nutritional status did not appear to influence several other biological indicators of health, perhaps because these indicators were already within normal levels at the start of the study. Despite this, the authors concluded that long-term supplementation may help to maintain optimal vitamin and mineral levels in elderly people, and therefore reduce the chance of this population developing health problems related to malnutrition.
Abstract
A decline in dietary intake due to inactivity and, consequently, development of a suboptimal nutritional status is a major problem in frail elderly people. However, benefits of micronutrient supplementation, all-round physical exercise or a combination of both on functional biochemical and hematologic indicators of nutritional and health status in frail elderly subjects have not been tested thoroughly. A 17-wk randomized controlled trial was performed in 145 free-living frail elderly people (43 men, 102 women, mean age, 78 +/- 5.7 y). Based on a 2 x 2 factorial design, subjects were assigned to one of the following: 1) nutrient-dense foods, 2) exercise, 3) both (1) and (2) or 4) a control group. Foods were enriched with micronutrients, frequently characterized as deficient [25-100% of the recommended daily allowance (RDA)] in elderly people. Exercises focused on skill training, including strength, endurance, coordination and flexibility. Dietary intake, blood vitamin levels and nutritional and health indicators, including (pre)albumin, ferritin, transferrin, C-reactive protein, hemoglobin and lymphocytes were measured. At baseline, 28% of the total population had an energy intake below 6.3 MJ, up to a maximum of 93% having vitamin intakes below two thirds of the Dutch RDA. Individual deficiencies in blood at baseline ranged from 3% for erythrocyte glutathione reductase-alpha to 39% for 25-hydroxy vitamin D and 42% for vitamin B-12. These were corrected after 17 wk in the two groups receiving the nutrient-dense foods, whereas no significant changes were observed in the control or exercise group. Biochemical and hematologic indicators at baseline were within the reference ranges (mean albumin, 46 g/L; prealbumin, 0.25 g/L; hemoglobin, 8.6 mmol/L) and were not affected by any of the interventions. The long-term protective effects of nutrient supplementation and exercise, by maintaining optimal nutrient levels and thereby reducing the initial chance of developing critical biochemical values, require further investigation. Other indicative functional variables for suboptimal nutritional status, in addition to those currently selected, should also be explored.