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Successful Implementation of Healthful Nutrition Initiatives into Hospitals.
Aggarwal, M, Grady, A, Desai, D, Hartog, K, Correa, L, Ostfeld, RJ, Freeman, AM, McMacken, M, Gianos, E, Reddy, K, et al
The American journal of medicine. 2020;(1):19-25
Abstract
Poor dietary quality is a leading contributor to mortality in the United States, and to most cardiovascular risk factors. By providing education on lifestyle changes and, specifically, dietary changes, hospitals have the opportunity to use the patient experience as a "teachable moment." The food options provided to inpatients and outpatients can be a paradigm for patients to follow upon discharge from the hospital. There are hospitals in the United States that are showcasing novel ways to increase awareness of optimal dietary patterns and can serve as a model for hospitals nationwide.
2.
A plant-based diet for the prevention and treatment of type 2 diabetes.
McMacken, M, Shah, S
Journal of geriatric cardiology : JGC. 2017;14(5):342-354
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Type 2 diabetes is rising worldwide and increasing evidence indicates that dietary and lifestyle choices are key drivers of insulin resistance. Research on plant-based diets (PBDs) shows lower rates of type 2 diabetes, obesity, hypertension, hyperlipidaemia, cardiovascular disease and cancer. The aim of this review is to analyze the evidence supporting the use of PBDs for the prevention and treatment of type 2 diabetes and explore potential mechanisms of action. The existing literature points to the fact that PBDs simultaneously reduce the risk factors for cardiovascular disease including obesity, hypertension, hyperlipidaemia and inflammation. The proposed mechanism by which PBDs reduce insulin resistance is through the high fiber, antioxidant and magnesium content, all of which have been shown to promote insulin sensitivity. Based on this analysis, the authors conclude the PBD is highly beneficial for preventing and treating type 2 diabetes. Additionally, the authors agree with the mounting evidence for utilising a PBD to reduce the burden of diabetes and improve health overall.
Abstract
The prevalence of type 2 diabetes is rising worldwide, especially in older adults. Diet and lifestyle, particularly plant-based diets, are effective tools for type 2 diabetes prevention and management. Plant-based diets are eating patterns that emphasize legumes, whole grains, vegetables, fruits, nuts, and seeds and discourage most or all animal products. Cohort studies strongly support the role of plant-based diets, and food and nutrient components of plant-based diets, in reducing the risk of type 2 diabetes. Evidence from observational and interventional studies demonstrates the benefits of plant-based diets in treating type 2 diabetes and reducing key diabetes-related macrovascular and microvascular complications. Optimal macronutrient ratios for preventing and treating type 2 diabetes are controversial; the focus should instead be on eating patterns and actual foods. However, the evidence does suggest that the type and source of carbohydrate (unrefined versus refined), fats (monounsaturated and polyunsaturated versus saturated and trans), and protein (plant versus animal) play a major role in the prevention and management of type 2 diabetes. Multiple potential mechanisms underlie the benefits of a plant-based diet in ameliorating insulin resistance, including promotion of a healthy body weight, increases in fiber and phytonutrients, food-microbiome interactions, and decreases in saturated fat, advanced glycation endproducts, nitrosamines, and heme iron.
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Does a preoperative medically supervised weight loss program improve bariatric surgery outcomes? A pilot randomized study.
Parikh, M, Dasari, M, McMacken, M, Ren, C, Fielding, G, Ogedegbe, G
Surgical endoscopy. 2012;(3):853-61
Abstract
BACKGROUND Many insurance payors mandate that bariatric surgery candidates undergo a medically supervised weight management (MSWM) program as a prerequisite for surgery. However, there is little evidence to support this requirement. We evaluated in a randomized controlled trial the hypothesis that participation in a MSWM program does not predict outcomes after laparoscopic adjustable gastric banding (LAGB) in a publicly insured population. METHODS This pilot randomized trial was conducted in a large academic urban public hospital. Patients who met NIH consensus criteria for bariatric surgery and whose insurance did not require a mandatory 6-month MSWM program were randomized to a MSWM program with monthly visits over 6 months (individual or group) or usual care for 6 months and then followed for bariatric surgery outcomes postoperatively. Demographics, weight, and patient behavior scores, including patient adherence, eating behavior, patient activation, and physical activity, were collected at baseline and at 6 months (immediately preoperatively and postoperatively). RESULTS A total of 55 patients were enrolled in the study with complete follow-up on 23 patients. Participants randomized to a MSWM program attended an average of 2 sessions preoperatively. The majority of participants were female and non-Caucasian, mean age was 46 years, average income was less than $20,000/year, and most had Medicaid as their primary insurer, consistent with the demographics of the hospital's bariatric surgery program. Data analysis included both intention-to-treat and completers' analyses. No significant differences in weight loss and most patient behaviors were found between the two groups postoperatively, suggesting that participation in a MSWM program did not improve weight loss outcomes for LAGB. Participation in a MSWM program did appear to have a positive effect on physical activity postoperatively. CONCLUSION MSWM does not appear to confer additional benefit as compared to the standard preoperative bariatric surgery protocol in terms of weight loss and most behavioral outcomes after LAGB in our patient population.