Category: Diet

Introduction

Chronic kidney disease (CKD) is the impairment of renal function that has adverse outcomes for the overall health and leads to ESRD (end-stage renal disease). According to Kazley, Hund, Simpson, Chavin, and Baliga (2015), today, the disease affects “nearly 5.5 million Americans” (p. 85). The situation when the kidneys are functioning at their minimum capacity has two solutions – dialysis and kidney transplantation, neither of which is cheap or easy for the patient.

A kidney transplant is generally preferred over dialysis as it provides better health outcomes and longer life expectancy. However, transplantation is a lengthy and costly process that requires measuring and controlling a number of health parameters. Although quality of life improves significantly after transplantation, people still need to adhere to specific rules to prevent kidney rejection. As the immune system struggles to fight a new organ, people need to take immunosuppressive medication and follow a special diet. A well-designed nutrition plan is the best option to mitigate the side effects of immunosuppressant drugs.

Specific renal diets focus on the factors that reinforce kidneys’ well-being, manage microelements reduced or increased by medication, and control macronutrient intake. The overall nutrition level is the primary factor to consider, as both over- or undernutrition can worsen health outcomes. Meeting protein requirements is essential at all the stages of post-surgery treatments, as it helps to enhance wound healing and prevents muscle breakdown caused by prednisone. Management of sugar, sodium, and potassium intake is a typical characteristic of a renal diet. Moreover, kidney disease is often accompanied by different health conditions, such as diabetes or heart problems that put additional requirements on a diet.

Although renal diets are necessary components of the post-transplantation stage of treatment, they are often perceived as complicated and unclear for the patients resulting in non-adherence. The study of CKD patients conducted by Lambert et al. (2019) demonstrated critical rates of dietary non-adherence, finding that only 32% of the analyzed population follow their diet plans correctly. Scholars also suggest that post-transplantation patients have lower adherence due to the reduction in symptoms and improved quality of life (Lambert et al., 2019). People violate their diet plans due to multiple reasons.

They often cannot assess their health condition and what outcomes improper nutrition might have on their body. The problem of low levels of overall health literacy of the population significantly contributes to non-adherence. Thus, patient education before the discharge and subsequent long-term communication about a renal diet is a fundamental solution to enhance renal diet efficiency.

The primary step of patient education should address the way the organism functions after the transplantation and how different drugs affect it. Sharing such information is necessary to motivate people to follow their nutrition plans and prioritize their diets. The key goals of such an education are to develop lasting and strong knowledge and to provide the support that enhances adherence. The educational program based on visual aid can help to achieve the desired effect. Such resources can include the lists of foods that are to be eaten or excluded from the menu. Sharing the information in such a format is easy for comprehension and memorizing. Moreover, patients can take the schemes and lists home to consider them when choosing foods.

Problem Statement

Dietary non-adherence among post-transplantation patients compromises treatment efficiency and is often caused by limited knowledge and low overall health literacy. Moreover, patients often show a lack of motivation to follow a renal diet due to a misunderstanding of its necessity. Such factors cause adverse health outcomes for the patients who suffer from side-effects of immunosuppressive treatment along with diabetes or heart problems and even lead to organ rejection.

Current patient education programs are not enough to accomplish the tasks. That is why new approaches are needed to enhance patient knowledge and adherence. The problem is complicated by the fact that healthcare workers often feel resistant to changes because of the discomforts they add to the daily challenges (Ellis & Abbott, 2018). Lewin’s model that implies unfreeze-change-freeze stages will be applied for the introduction of new approaches. A visual aid, which patients find easy to interpret, can be used to explain what products have to be limited and what should be consumed.

Background

Following a prescribed nutrition plan reinforces one’s chances to have a successful post-transplantation therapy. However, a problem of dietary non-adherence among renal patients is clamant today, and it often compromises positive health outcomes. The scholars assume that there is a distinct connection between non-adherence and low health literacy of the population (Lambert et al., 2019). According to Escobedo and Weismuller (2013), almost 50% of Americans have difficulties with meaningful participation in making decisions about their healthcare. These problems mainly include the inability to “fully understand informed consent for procedures, and effectively follow health care recommendations and treatment” (Escobedo & Weismuller, 2013, p. 47). Many patients find the information given in their treatment centers overwhelming and need additional guidance to navigate through it.

Specific education interventions are designed to teach patients about renal diets before discharge from a medical institution. They receive the information about the products and nutrient levels they need to consume to mitigate side effects of immunosuppressive treatment and to “prevent obesity, hyperlipidemia, hypertension, diabetes, and osteoporosis” (Hong, Kim & Rha, 2019, p. 75). However, without proper knowledge about food, calories, protein, and micronutrients, people find it confusing to follow the prescriptions. Given the inability to interpret food labels and to assess food components and their quantity in a serving, the information shared in treatment centers should be simplified and visualized.

The problem of non-adherence has a number of severe implications that include potential kidney rejection, obesity, and illnesses related to the immunosuppressant regimen. The stress caused by the surgery and the need for recovery and healing increase the caloric requirements. Pedrollo et al. (2017) claim that the first year after the transplantation is often characterized by excessive weight gain that leads to health complications, including cardiovascular events and graft loss. According to Hasse (2001), “severe obesity may decrease graft function and survival in kidney transplant recipients” (p. 120). That is why weight management is a key component of the renal diet alongside with micro and macronutrient intake.

Currently, U.S. transplantation centers offer extensive education programs about nutrition after getting a new kidney. Such training focuses on the explanation of the therapeutic purpose of the diet, the recommended nutrient intake at each of the treatment stages, food restrictions, and glucose control. Nevertheless, the efficiency of this training is questioned regarding low diet adherence levels. Despite sharing useful information, modern renal diet education fails to increase patient engagement.

The knowledge of complicated processes is inaccessible for people with a limited understanding of basic concepts and low health literacy levels. Furthermore, patients find it challenging to communicate with medical staff about their care, as they have a limited understanding of what they might ask. Many of them report shame and confusion caused by insufficient knowledge, so it is difficult for them to engage in healthcare decisions (Lambert et al., 2019). Moreover, current education programs do not focus on empowerment and motivation, which might tackle the uncertainty and confusion.

The described above situation suggests that the current approach to patient education about the renal diet should be improved. Kazley et al. (2015) suggest that “clinicians should keep health literacy limitation in mind when presenting information to patients” (p. 89). Facing this problem is the first step to the development of an accessible education plan that would adapt to the needs of patients with limited health literacy. Moreover, group education should be combined with individual sessions where the patients would have the opportunity to ask questions regarding the personal details of their health. Lastly, motivation and empowerment should be integrated into the teaching process to encourage patients to seek information, ask questions, and make adequate health-related decisions.

The main concern of the recommendations for the quality improvement of patient education intervention is the adaptation of the material to patients’ health literacy levels. The use of visual aid can improve understanding of the provided information and enhance memorization. Escobedo and Weismuller (2013) state that visual aid is a helpful method to improve patient comprehension and communication. Moreover, patients can take home different schemes and checklists and consult every time before cooking, taking a serving of a meal, or going to shop for groceries. Sharing additional information sources, useful applications for tracking calories and nutrient intake can increase the likelihood of patient adherence to the diet.

Purpose

The project is conducted to promote a quality improvement intervention in a medical center that focuses on patient education after kidney transplantation. The main goal is to raise awareness of a dietary non-adherence problem and justify the need for change in the current education system. The goal will be achieved with the help of visual aid that teaches patients about food recommendations and restrictions before and after kidney transplant. As there is a connection between low health literacy and non-adherence to treatment and diet, simple graphs and images will provide concise and understandable information for patients with different educational opportunities. Moreover, they will suggest that diet management is not as overwhelming as it seems, and thus provide empowerment and motivation.

The project is essential for nursing as it advocates for improvements, facilitates progress, and promotes evidence-based transformation. According to Lewin’s unfreeze-change-freeze theory, the initial step implies the problem statement that aims at convincing the staff about the necessity of the change.

Analyzed evidence from the recent research provides justification for the project. The current education model should be adapted concerning the health literacy issue, and a visual aid is a recognized tool that allows this adaptation. According to Ellis and Abbot (2018), the ‘change’ stage of the model is when kidney center staff is likely to “feel resistant to adjustments” (p. 331). The reference to evidence is the tool that can motivate people to pursue the change. The final stage of the intervention implies collecting qualitative feedback from the patients.

The Nature of the Project

The project has an innovative nature, and it aims at bringing changes to the medical environment by introducing new ways of patient education about the renal diet. Transforming the existing processes is a challenging task that is often met with resistance, stress, and low support of healthcare workers. According to Lewin’s model, the changes have to be implemented in three stages, which are unfreezing of the old shape, the change itself, and freezing that fixes the new form (Ellis & Abbot, 2018).

That is why this project is going to consist of three steps. At the initial stage, it is necessary to ‘unfreeze’ the existing model, understand its drawbacks, develop a plan for the improvement, and convince the staff to support it. The second phase is crucial as it implies the change itself. Lastly, successful transformations should be consolidated to ensure that the improvement will not be abandoned.

The design of the visual aid tool that addresses all the issues missing from the previous education program is a crucial element of the first stage. The fundamental requirement for a visual aid tool is to make the presented information clear, simple, and concise. Verseput and Piccoli (2017) suggest the use of the so-called ‘renal plate’ for the education of patients with CKD (Figure 1). The green side depicts the foods that can be eaten, while the restricted products are placed on the red side. The visual aid tool will be presented as relatively small 6x10in postcards with the renal plate on one side and a list of recommended foods organized according to different product groups on the other. The additional motivation aspect of the design is to include more products on the allowed list while keeping the restricted food count lower.

The idea is to make the postcard useful for patients in everyday life. While they can easily forget the information presented to them on the slides in the care unit, this simple solution will remind them what foods to pick. The size was chosen so that the images were comfortable for practical use by the patients. They can stick them on the fridge and consult the lists while cooking, or they can take them along when going to shop for food. Given the relatively low health literacy, it is better to provide patients with ready solutions that are always at hand, than to spend hours teaching complicated concepts to them.

At the second stage of the transformation process, the change takes place, which in the case of this project, implies the education procedure and the feedback collection among the education intervention participants. At this stage, it is necessary to gain the support of the staff. Although the changes seem burdensome and cause additional concerns to the daily tasks, testing the new model, and finding the meaning in it will result in the acceptance (Ellis & Abbot, 2018). For these purposes, the intervention itself will perform the role of a test, and the process of feedback collection will help to find a meaning of the improvement.

The visual aid will be presented and explained additionally to the routine education procedure, while the printed version of the scheme will be distributed among patients for further use. The patients who will consent to engage in the interviewing will be asked five questions regarding their experience with a visual aid. The extensive feedback and commentary will be encouraged. The main message of the questions will be to evaluate how visual aid contributed to a routine education procedure. These questions are listed below:

• Assess how the visual aid tool clarified your understanding of the renal diet.
• How do you see the further practical use of visual aid?
• How has the visual aid influenced your motivation to self-manage your nutrition?
• What details of the visual aid do you find the easiest to memorize?
• What information do you find missing from the scheme?

The ‘freezing’ stage is crucial for the improvement intervention as it helps to consolidate the success of the change process. In the case of this project, it has a double purpose. First, it is vital to motivate the nurses to include the new approach to the routine education program for all patients and will use it in the future. For this purpose, the nurses should be taught additionally on how to speak with the patients about their nutrition management with the help of the visual aid.

Secondly, the results of the intervention will be reinforced through the follow-up patient screening about the use of the visual aid. The future recommendation for the nurses is to provide reminders for the patients about the use of the tool, answer their questions, and monitor the adherence to the recommendations. This stage is necessary to prevent patient readmission and promote adherence. Moreover, the follow-up will help to detect the issues and the limitations of the intervention that will facilitate further improvements.

Research Question

The research question for the project is:

How will the implementation of visual aid in a routine patient education session improve the dietary adherence and understanding among the patients after kidney transplantation?

The question is derived from these hypotheses:

• The renal diet adherence depends on how well patients comprehend the prescriptions and how motivated they are to follow them.
• The use of visual aid simplifies the presented information and makes it easier to understand for the patients.

Summary

The problem of dietary non-adherence among patients who have undergone kidney transplantation is urgent and requires immediate attention. It poses a significant threat to patients’ health outcomes and bears an unnecessary burden for the healthcare system. The research background suggests that limited health literacy is the primary reason why people find it challenging to follow their diet. The project aims at the exploration of the potential influence of education interventions on the understanding of posttransplant nutrition and the ability of this change to improve adherence.

Literature review

Introduction

This chapter intends to review the literature that constitutes the evidence for the project. The section is designed to summarize the historical scope of the problem and synthesize recent findings. The current state of research provides evidence that supports the need for change in patient education about renal diet. The studies prove the connection between health literacy and patient outcomes, thus emphasizing the significance of the problem. Current findings suggest that dietary non-adherence is the clamant issue that can be solved through improved patient education programs.

Historical Overview

Chronic kidney disease has long been burdensome for the U.S. healthcare system. That is why many studies were focused on treatment recommendations that help to improve health outcomes. The importance of nutrition management after kidney transplant is currently recognized with numerous researches studying specific aspects of the problem. Zeltzer, Taylor, and Tang (2015) analyze these studies and conclude that the majority of publications address short-term interventions during the acute phase, while a limited group of scholars explores long-term nutrition management.

Kazley et al. (2015) claim that the issue of non-adherence to renal diets is the subject of even fewer studies. However, most of them have been conducted recently, and the tendency suggests that the attention to the problem escalates. Several studies have been published recently that asses the state of health literacy among renal patients and its impact on health outcomes. Some scholars have also designed educational interventions that explore the potential of teaching and empowerment to solve the problem of non-adherence.

Current Findings

Understanding the importance of nutrition following kidney transplantation is an essential aspect of the problem statement of this research. The exploration of the renal diet and its impact on the recovery after the surgery and long-term nutrition plan for the patients with new kidneys has been a subject of several studies. Hasse (2001) investigates the literature regarding nutrition support of the patients on different stages of transplantation and summarizes the recommendations for dietary interventions.

The researcher highlights the importance of pretransplant nutrition support aimed at the “include optimization of nutritional status and treatment of nutrition-related symptoms induced by organ failure” (p. 120). The proposed guidelines also focus on the posttransplant nutrition support that provides electrolyte management, controlling glucose levels, and enhancing wound healing.

Weight gain is a factor that compromises positive health outcomes for many posttransplant patients. Pedrollo et al. (2017) designed a randomized clinical trial to address the issue and to discover the solution. The sample of 120 patients two months after the kidney transplant complied with a specific high protein diet based on foods with low glycemic-index. The patients underwent 12 months of observation to “evaluate the effect of a high protein and low glycemic-index diet on preventing weight gain after kidney transplantation” (Pedrollo et al., 2017, p. 1). The scholars concluded that long term increased protein intake is connected to weight loss among posttransplant patients. Thus, weight control is another goal of renal diet after kidney transplantation that can be achieved through protein intake management.

Nutrition management after kidney transplantation should go beyond the post-surgery recovery period and continue during the entire patient’s life. However, Zeltzer et al. (2015) claim that there are few studies addressing long-term dietary interventions after organ transplantation. The scholars have conducted a literature review research to find evidence on the impact of nutrition management more than a year after transplantation. Zeltzer et al. (2015) claim that compliance with the dietary prescriptions is significantly lower in long-term interventions than in those that focus on the post-surgery period.

The previously discussed studies justify the effectiveness and necessity of diets for patients undergoing kidney transplantation. Nevertheless, people often do not adhere to prescribed renal diets. Scholars often connect non-compliance with dietary prescriptions to low health literacy of the population. Escobedo and Weismuller (2013) conducted a study of 44 patients in a single treatment center in California to investigate the health literacy level among patients with kidney transplantation or renal failure.

The study showed that 41% of the population had insufficient health literacy levels. The researchers report that limited health literacy poses a threat to health and is connected to poor adherence to the prescribed treatment, increased healthcare costs, and health disparities (Escobedo & Weismuller, 2013). Thus, the study proves that inadequate health literacy compromises adherence and leads to adverse health outcomes.

Given that the health literacy rates are low, it is essential to investigate the health risks of this phenomenon for kidney transplant patients. The purpose of the cross-sectional study by Kazley et al. (2015) was to “assess the relationship between health literacy and transplant outcomes” (p. 85). The sample of 92 people consisted of equal groups of dialysis, posttransplant, and pretransplant patients in a single transplant center. The researchers found a direct relationship between health literacy and positive transplant outcomes, thus highlighting the importance of this factor for patient management and education.

The previous studies provide evidence that health literacy is a pressing problem among kidney transplant patients. As there is a connection between diet and treatment non-adherence and low health literacy, patient education programs should be designed to tackle this issue.

Thus, several education interventions have been conducted recently to evaluate what measures can close the gap in health literacy. Lambert et al. (2019) suggest that difficulties in communication with healthcare professionals combined with low health literacy lead to dietary non-adherence. The scholars developed a list of questions about a renal diet that would facilitate dialogue. A qualitative study of eighteen patients showed that they found the question list to be an efficient tool to guide communication about one’s nutrition (Lambert et al., 2019). The prompt list demonstrated that the use of additional tools and resources could provide guidance for the patients, give them confidence, and motivate them to be engaged in their treatment.

Several studies consider the role of dietitians in patient education. Tsai et al. (2015) developed a survey of the specific training conducted by dietitians in addition to the routine program. Scholars found that the experimental interventions positively influenced dietary adherence (Tsai et al., 2015). Lambert, Mansfield, and Mullan (2018) have conducted a qualitative study to explore what experience renal dietitians have regarding patient education.

The interviewed healthcare professionals described the process as challenging, both professionally and emotionally. The key difficulty lies in simplifying complexity as the majority of the patients find renal diets “burdensome, challenging and overwhelming” (Lambert et al., 2018, p. 126). The participants have reported that empathy and empowering are essential when communicating with patients. A Korean-based case study by Hong et al. (2019) demonstrated that comprehensive training that combines both individual sessions and group education enhances understanding and promotes dietary adherence.

Visual aid is assumed to be a useful tool for patient education in the context of low health literacy. The research by Verseput and Piccoli (2017) has a particular value, proving the efficiency of such interventions. The scholars suggest using a specially designed ‘renal plate’ that graphically demonstrates what foods are preferable for patients with kidney disease. The research took place in South Africa in a complex cultural environment and aimed to target various population groups.

Verseput and Piccoli (2017) conclude that “simple visual aids may be of great help not only in recalling diet-related concepts but also in reassuring patients, thus ensuring empowerment and compliance even in difficult settings” (p. 11). Similar images can be used to demonstrate the principles of posttransplant nutrition, as they can provide understandable and straightforward guidelines and empowering patients to self-manage their diets.

Conclusion

The literature review section contributes to the project by providing evidence that supports the problem statement. The analyzed studies justify the importance of dietary adherence to the health outcomes of patients after kidney transplantation. The current findings prove the hypothesis that misunderstanding of the concepts and low health literacy negatively affect patient adherence to the renal diet. They also provide an overview of educational interventions that focus on adapting patient education to correspond to the requirements of patients with limited levels of health literacy.

Summary

Although renal failure and its treatment are extensively presented in the scholarly literature, it is only recently that attention has shifted towards patient education and health literacy problem. The current studies provide an analysis of these factors and their influence on adherence to diet and therapy. Based on these findings, different investigations have been developed to design interventions that remove barriers to understanding. Thus comprehensive education programs, question checklists, patient guides, ad visual aid proved to be efficient in closing the literacy breach.

References

Ellis, P., & Abbott, J. (2018). Applying Lewin’s change model in the kidney care unit: Movement. Journal of Kidney Care, 3(5), 331-333. Web.

Escobedo, W., & Weismuller, P. (2013). Assessing health literacy in renal failure and kidney transplant patients. Progress in Transplantation, 23(1), 47-54. Web.

Hasse, J. M. (2001). Nutrition assessment and support of organ transplant recipients. Journal of Parenteral and Enteral Nutrition, 25(3), 120-131. Web.

Hong, S. H., Kim, E. M., & Rha, M. Y. (2019). Nutritional intervention process for a patient with kidney transplantation: A case report. Clinical Nutrition Research, 8(1), 74. Web.

Kazley, A. S., Hund, J. J., Simpson, K. N., Chavin, K., & Baliga, P. (2015). Health literacy and kidney transplant outcomes. Progress in Transplantation, 25(1), 85-90. Web.

Lambert, K., Lau, T. K., Davison, S., Mitchell, H., Harman, A., & Carrie, M. (2019). Development and preliminary results on the feasibility of a renal diet-specific question prompt sheet for use in nephrology clinics. BMC Nephrology, 20(1), 1-8. Web.

Lambert, K., Mansfield, K., & Mullan, J. (2018). Qualitative exploration of the experiences of renal dietitians and how they help patients with end-stage kidney disease to understand the renal diet. Nutrition & Dietetics, 76(2), 126-134. Web.

Pedrollo, E. F., Nicoletto, B. B., Carpes, L. S., Júlia De Melo Cardoso De Freitas, Buboltz, J. R., Forte, C. C., … Leitão, C. B. (2017). Effect of an intensive nutrition intervention of a high protein and low glycemic-index diet on weight of kidney transplant recipients: study protocol for a randomized clinical trial. Trials, 18(1), 1-6. Web.

Tsai, W.-C., Yang, J.-Y., Luan, C.-C., Wang, Y.-J., Lai, Y.-C., Liu, L.-C., & Peng, Y.-S. (2015). Additional benefit of dietitian involvement in dialysis staffs-led diet education on uncontrolled hyperphosphatemia in hemodialysis patients. Clinical and Experimental Nephrology, 20(5), 815-821. Web.

Verseput, C., & Piccoli, G. (2017). Eating like a rainbow: The development of a visual aid for nutritional treatment of CKD patients. A South African Project. Nutrients, 9(5), 435. Web.

Zeltzer, S. M., Taylor, D. O., & Tang, W. W. (2015). Long-term dietary habits and interventions in solid-organ transplantation. The Journal of Heart and Lung Transplantation, 34(11), 1357-1365. Web.

For some women, hormone replacement therapy (HRT) introduces various life-threatening risks and should be avoided. Here are the most frequent medical problems that prohibit usage of this treatment:

• One of the common risks is a chance of breast, endometrial, and other hormone-dependent cancers. This treatment is only suggested after a thorough examination of existing medical problems and cancer cases in family history.
• There is an increased risk of venous thromboembolism (VTE) associated with HRT in women who are sedentary, overweight, or active smokers (Akter & Shirin, 2018).
• The risk of cardiovascular disease greatly increases in patients who had their last menstrual periods more than 10 years ago or who are 60 years old or older (Akter & Shirin, 2018).

Non-hormonal treatments, although less effective than HRT, are generally less dangerous and have less severe adverse effects. Clonidine is in a class of medications called centrally-active α2 agonists and anti-hypertensives. The dose usually starts at 25μg twice a day, increased, if tolerated, to 50-75μg twice a day over a two-week period. Side effects include problems with sleeping, dry mouth and constipation. The treatment lasts four weeks unless side effects are too severe.

Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are a class of antidepressant medications that are often prescribed by doctors first because of the least amount of side effects (Tsiligiannis, Maclaran, & Panay, 2018). The dosage starts at 10mg per day, increased to 20mg per day after one week. Side effects of SSRIs often include drowsiness, nausea, tremor, and weight fluctuations. If no benefits are observed after four weeks of treatment or side effects are too severe, it should be stopped.

A suggested healthy diet to reduce vasomotor symptoms (VMS) is a low-fat, high fruits, vegetables, and whole-grain diet. The Women’s Health Initiative Dietary Modification trial has shown that women with mild symptoms who lost weight were more likely to eliminate VMS at one year (Schwarz, 2017). Participants who lost ≥ 10% of body weight were 56% more likely to no longer report hot flushes and night sweats after one year (Schwarz, 2017). To reduce the symptoms, it is advised to avoid consumption of spicy food, alcohol, caffeine or hot foods/drinks.

References

Akter, M.J., & Shirin, E. (2018). Latest evidence on using hormone replacement therapy in the menopause. Journal of Bangladesh College of Physicians and Surgeons, 36(1), 26-32. Web.

Schwarz, R. (2017). A guide to treating the symptoms of menopause. Osteopathic Family Physician, 9(5). Web.

Tsiligiannis, S., Maclaran, K., & Panay, N. (2018). Treatment options for menopausal symptoms. The Pharmaceutical Journal, 300. Web.

Discussion

Diarrhea is a condition that is characterized by frequent passage of watery stool. It is the way one’s body gets rid of substances that are harmful (Collins 121). When one has diarrhea, the body quickly flushes out food containing bacteria or viruses. One may also suffer from diarrhea when he or she takes certain foods that don’t agree with them. Diarrhea complications normally last a day or two and in most cases reside without complications.

If diarrhea persists on for more than five days, one may have a medical problem that requires attention. Persistent and serious cases of diarrhea may lead to severe dehydration and may also cause electrolyte imbalances (Niedert 68). Thus, the patients must get medical attention within three days to avoid rapid and dangerous dehydration. Chronic and excessive diarrhea can result to weight loss and serious malnutrition. Quite often, persistent cases are followed by symptoms such as; cramps, fever, or dyspepsia (DeBruyne 517). These symptoms help in diagnosing the causes of diarrhea. This paper discusses the diarrhea causes, and its medical treatment.

Causes of Diarrhea

Diarrhea is a disease of different medical conditions. Diarrhea complications can be induced by infectious, dietary substances or medications. The condition occurs due to inadequate re-absorption of fluids in the intestines, sometimes accompanied with rise in intestinal secretions. Majority of diarrhea complications are classified under osmotic or secretory diarrhea. Osmotic diarrhea occurs as a result of unabsorbed nutrients or other substances attracting water to the colon and increasing fecal water content. In effect, this causes deficiency in lactase, enhanced intake of sugar that is poorly absorbed such as fructose, sorbital, and ingestion of laxatives that have magnesium or phosphates (DeBruyne 518).

In secretory diarrhea, fluids secreted by the intestine surpass the amount that can be re-absorbed by intestinal cells. Secretory diarrhea is often caused by bacterial food poisoning. It can also occur as a result of various chemical substances and inflammatory conditions (DeBruyne 518).

Diarrhea can also be caused by motility disorders; rapid movement within the colon shortens the contact period required for fluid re-absorption, whereas slow movement within the colon may enhance bacterial overgrowth and thereby alter intestinal secretions. Diarrhea of acute nature normally occurs suddenly, and may persist for several weeks. In most cases, such diarrhea is caused by bacterial, viral or protozoan infections or come about as a side effect of medications (Collins 121).

Medical Treatment of Diarrhea

Diarrhea can be treated a number of ways. The first step in diarrhea treatment requires correction of underlying medical disorders. Antibiotics should be administered to treat infections. Diarrhea resulting from a medication side effect should be treated by prescribing alternate drug. Incase certain foods are responsible for diarrhea; these foods can be omitted from the patient’s diet. We can also make use of bulk-forming agents such as psyllium to help reduce stool liquidity (Niedert 68).

Anti-diarrheal drugs can be prescribed to slow GI motility or reduce intestinal secretions incase chronic diarrhea does not respond to treatment (Collins 122). Nutrition therapy can also be used for treatment of diarrhea. However, this will depend on the cause of diarrhea, its severe nature, duration, and degree of water loss. Incase of rehydration development, it is necessary to apply rehydration therapy. In some individuals, a low fiber diet may be necessary to improve symptoms. Restriction of fiber is necessary during periods of active intestinal inflammation, which can reduce tolerance to fiber. Patients must be advised to avoid foods and beverages that contain fructose, sugar alcohols or lactose that may worsen symptoms (Niedert 68).

Conclusion

In sum, a condition is considered diarrhea if one has more than two loose stools in a day. Viral illness is the common cause of diarrhea. Diarrheas resulting from viral illnesses can last duration of up to two weeks. Although antibiotics can be used for treatment, they do not assist much. In some situations, antibiotics may actually worsen diarrhea. Mild diarrhea causes may include; emotional upsets, travel, dietary changes, changes in routines, food intolerances or allergies, or bacterial illnesses. Medical treatment must be sought immediately if diarrhea is accompanied by symptoms such as; blood and mucus an indication of a severe bacterial cause; high fever; and dehydration (Collins 122).

Works Cited

Collins, Douglas. Differential diagnosis in Primary Care. Sydney: Wolter Kluwer Health, 2007.

DeBruyne, Pinna K. Nutrition and Diet Therapy. New York: Cengage Learning, 2007.

Niedert, Dorner B. Nutrition Care of the Older. New York: American Diabetic Association, 2004.

Emily Brown has been facing a health problem for three years. She is known to be suffering from celiac disease. Since the diagnosis, Emily has been recommended a gluten-free diet, which she is trying to stick to.

Many people suffer from gluten intolerance. Gluten is a protein found in food items such as wheat, rye, and barley; however, it can also be present in certain medicines. The reason why gluten is prohibited in the diet plans of celiac patients is that their small intestines cannot absorb this protein, and gives rise to intestinal disorders, which leads to further complications (NIDDK, 2008). The small intestines are lined with hair-like structures named ‘villi’. These villi are damaged by the immune system’s reaction to gluten when taken in. Thus the villi are unable to carry out their regular functioning of absorption of nutrients into the bloodstream (NIDDK, 2008).

Emily Brown is full-time employment as a nurse, with her partner with the same job. They are both working in shifts. Previously, she was living with her mother, and ever since she was told to stick to a gluten-free diet, her mother used to make sure she cooked something that would not harm her daughter’s internal systems. A gluten-free diet was provided to Emily, which kept her safe and healthy.

A few months back, Emily moved out of her house to live with her partner, and now her routine seems so tough that she finds it difficult to meet the demands of the shift jobs, plus make sure that she cooks herself a meal that is free from gluten. The busy schedule and lack of cooking experience lead them to takeaway meals, and gluten foods are taken into the body, causing harm. Food items such as pizza and burgers would be harmful to Emily’s health, as they contain gluten from the wheat in their crusts and buns respectively (Mayo Clinic Staff, 2008).

Emily had an annual medical review to keep track of where her health is heading. The last review she had shows her to weigh 69kg, whereas the recent weight taken by the dietician is 64kg. This record shows a decline of weight by 5kg, which is meaningful and must be given attention to. She has come for an annual review. She had been with the gastro team of the hospital four years ago and has now been discharged to the GP care. No drug therapy or recent blood tests has been recorded.

The diet pattern Emily must follow now has to be pure gluten restricted one because her health is being affected by the present defect in her body. She will have to take proper care of herself and sustain the activity she has in her life currently. Emily takes in all the food groups which are present in the basic food guide. From the meat group to the vegetable group, she takes a little of all each day. We can see that she consumes any sort of oil or butter, takes fruits or vegetables daily, and also uses semi-skimmed and low-fat milk. Milk is consumed as part of a drink; she does not like to take it on its own. In cooking, she uses evaporated milk.

Apart from these food items, Emily eats crisps, chips, nuts, and other savory food when she is at work. She has to be alert while buying, to opt for those food items which do not contain gluten. This can be done by reading the label of that product, which states the ingredients that the food product possesses. The ingredients of food products may change with time; therefore it is necessary to keep a recheck if a product had been rejected earlier. Another option for Emily is to call the manufacturer and ask for the gluten-free products, this can save time while shopping, and with a routine such as Emily’s, it will be worthwhile.

For the breakfast menu, Emily could make porridge in milk. Gluten-free porridge has to be purchased. For mid-morning snacks, she can buy gluten-free cookies which are widely available, with a cup of coffee containing milk and sugar. For lunch, she could have gluten-free cereals with milk and fruit pieces. The evening meal could comprise of a piece of grilled fish with gluten-free bread slices, and a bowl of salad.

The vegetables which have been opted for the salad have to be gluten-free, and for that, she should prefer fresh or frozen raw vegetables, rather than canned ones (Hondros, 2008). Since Emily hates cheese, she may add it to the salad for nourishment, and not be put off by its taste. For dessert, a bowl of gluten-free fruit custard could be a good option. These are easy to prepare food items, and not time-consuming. For supper, Emily could have a plate of fruits and nuts, followed by a glass of milk.

Gluten-free diets may be very irritating to follow, but with some perseverance, the results are rewarding.

References

Celiac Disease (2008). National Institute of Diabetes and Digestive and Kidney Diseases. Web.

Gluten-free Foods. Web.

Hondros, M. (2008). Healthy Food Choices: Gluten-Free Vegetables. Web.

Mayo Clinic (2008) Celiac Disease. Web.

Wrapped within the comfort of youth, thoughts of aging yield to freedoms associated with unknowingly, knowing the inevitable is decades into the future. Our lives take on twists and turns until one day a slow progression begins to race to an unwanted finish line; or at best the marker that states GRAY HAIR UP AHEAD, DEBILITATING HEALTH TO THE RIGHT, and POSSIBLE MEMORY LOSS.

Medical advances have lengthened the human lifespan to extend past common illness and viral conditions. The adult population 65 and older has increased by 20% and continues to rise at a rapid rate. Surprisingly, the medical community is ill-equipped to handle this living trend as a result of minimal amount of physicians who specialize in the field of Gerontology. Responsibilities in this area require sensitivity, compassion, and patience when dealing with older adults who may suffer from weakening mental faculties. It would require someone who can identify concerns without full competent consultation from the patient. (Ryder, & Ryder)

Prior generations dealt with medical issues that have been, practically, diminished as a concern because of the advancements in treatment. Thus, the limit on trained professionals equipped to handle this increase. The life expectancy was shorter prior to the onset of research and studies that opened a floodgate to medical cures increasing health and extending life.

This extension crosses over the line into chronic and debilitating diseases. Arthritis, dementia, osteoporosis, and respiratory failure, to name a few, require management that is not an easy task for the senior community. These chronic attackers compromise living independently without assisted care. Subsequently, the question of quantity over quality of life is answered with decisions that challenge ethical or moral judgment.

There are many factors that play a role in chronic illness but three lead the way as key; genetics or family history, physical activity, and diet. Benefits of physical activity aid in the decrease in functional decline, along with improving pulmonary health. Dietary management, be it over nutrition or under nutrition, can be the cause and effect to fractures, bone density, deficiency, and malignancy. Add on the oversight of ancestral ailments and the gap in life expectancy shortens.

Unfortunately, with age factored into the equation limited is the ability to manage the affects of these predisposed conditions. Partnered with mental incapacities, weigh the burden of adequate care for senior loved ones on their families. Painstaking decisions surround location, due to the open discussion of minimal training of caregivers in a facility, in addition to provisions for caregivers to provide in house care for seniors who want the comforts of home. I learned there are more who choose to complete their life journey in their own home even if it means bypassing the necessities for their survival. In our youth we speak of living our fullest life well into the golden years, but the harsh reality is more and more elderly adults just want a restful peace and freedom from aging. (Woo, 2000)

My role as a nurse comes with many rewards and heartaches. The topic of aging and the many factors that are never-ending conversations in the world of health care, inspire me to continue formal education in this industry. The importance to remain updated on new technologies, information, and advances in treatment could be the dynamic in the quantity; decision to continue the fight or quality; decision to resign at home with or without care. The capacity to view aging and every corner of the process in various stages has a lasting impression on how I can be beneficial to the life of another.

References

Ryder, RJ, & Ryder, RP. Selecting a doctor [Web log message]. Web.

Woo, J. (2000). Relationships among diet, physical activity and other lifestyle factors and debilitating diseases in the elderly. European Journal of Clinical Nutrition, 54(Suppl 3), Web.

According to recent research findings, it is likely that the flavors in a mother’s diet during pregnancy influences the dietary preferences of her infant after birth (Hepper, Wells, Dornan, & Lynch, 2013). Scientists from the Queen’s University of Belfast in Ireland and the Royal Jubilee Maternity Services in the UK made these findings. The researchers published the study in the Journal of Developmental Psychobiology. These findings assert that the human fetus can learn about its chemosensory surrounding. The fetus can then carry on certain behavioral characteristics, which might be evident at birth and during the early postnatal period. Thirty-three mothers and their children took part in the study. Sixteen mothers in the prenatal exposure group consumed three to four meals per week containing fresh garlic from the fourth week of gestation to the thirty-fifth week. The remaining seventeen mothers in the control group did not consume garlic during the same period. The children involved in the study were between eight and nine years old. The scientists gave the thirty-three children, two servings of potato gratin. The scientists added garlic flavor to one of the potato gratin servings.

The children that were exposed to garlic during their prenatal stage consumed significantly more potato gratin with garlic flavor compared to their counterparts. This led to the conclusion that children with prenatal exposure to garlic recognize its flavor after birth. Therefore, the study suggests that the prenatal environment has the potential of triggering the chemosensory stimuli of fetuses. This can influence their dietary preferences well into infancy. This finding is consistent with suspicions held by healthcare providers concerning the effects of a mother’s diet on the dietary preferences of an infant after birth (Glenn, 2007).

Previous research suggests that a growing fetus often receives flavor stimuli from the mother’s intestines during pregnancy (Kehoe, 2009). The fetus normally starts swallowing amniotic fluid during the twelfth week of gestation. The environment in which the fetus develops often changes because of the mother’s diet (Ulmer, 2010). The food she consumes at any time influences the flavor of the amniotic fluid.

The decision to use garlic in the study arose from demonstrable evidence that its smell is detectable in the amniotic fluid. For instance, garlic alters the odor of a woman’s amniotic fluid if she ingests it during pregnancy. The effect of prenatal exposure to garlic on the children’s consumption of garlic-flavored foods after eight to nine years offers great promise for influencing the dietary choices of the unborn child through prenatal chemosensory stimuli. It may be possible for mothers to influence their children to adopt certain foods during infancy by making deliberate dietary choices during pregnancy. The impact of this finding on health care delivery means that health workers can develop programs to alleviate diseases arising from dietary factors (Omachonu & Einspruch, 2010). The findings also suggest that prenatal experiences of a fetus may play a critical role in determining the long-term behavioral characteristics of the infant (Jekel, 2007).

References

Glenn, R. (2007). Bringing User Experience to Healthcare Improvement: The Concepts, Methods and Practices of Experience-based Design. Oxon: Radcliffe Publishing.

Hepper, P. G., Wells, D. L., Dornan, J. C., & Lynch, C. (2013). Long-term Flavour Recognition in Humans with Prenatal Garlic Experience. Developmental Psychobiology, 2(1), 568-574.

Jekel, J. F. (2007). Epidemiology, Biostatistics, and Preventive Medicine. New York, NY: Elsevier Health Sciences.

Kehoe, S. N. (2009). Maternal and Infants Death: Chasing Millennium Goals 4 and 5. London: Royal College of Obstetricians and Gynaecologists.

Omachonu, V. K., & Einspruch, N. G. (2010). Innovation in Healthcare Delivery Systems: A Conceptual Framework. The Innovation Journal: The Public Sector Innovation Journal, 15(1), 1-20.

Ulmer, C. (2010). Future Directions for the National Healthcare Quality and Disparities Reports. Washington DC: National Academies Press.

A balanced diet is important in the attainment of good nutrition. A balanced diet provides the body with energy, proteins, fats, vitamins and minerals, which should be in right proportions to avoid excesses and inadequacies that lead to diseases. Deficiency diseases such as osteoporosis result from an extended period of time without taking the right amounts of nutrients in food (Meier & Kranzlin 2011). Good nutrition is a step towards achieving millennium development goals. Good nutrition reduces morbidity and mortality rates, and is important in the fight against poverty. In the contemporary world, lifestyle diseases have become a great cause of death, illness and disability (National Health and Medical Research Council 2013). This paper will discuss the essence of maintaining a healthy diet by demonstrating the effects of deficiencies and excesses of certain nutrients.

Nutrient Deficiencies and Excesses

Lisa is obese with a BMI of 39.6. The nutrients that will be of concern based on her diagnosis and weight are the macro nutrients, calcium, magnesium, fluoride, phosphorus and vitamin D. She has failed to commit to an exercise regime that could help her shed off some of her weight, yet her total calorie consumption exceeds her estimated energy requirement in relation to her age, weight and activity level. The estimated energy requirement for Lisa is 9883 kilojoules, yet upon analysis of her dietary intake, she consumes 14087.9 kilojoules. According to Savica, Belllingheri & Kopple (2010), physical activity, reduced intake of energy-dense foods and high fiber are protective factors against obesity. Obesity predisposes one to diabetes type II: insulin sensitive diabetes, hence poor regulation of sugar.

Osteoporosis is a disease marked by weak and brittle bones; hence, the reason for focusing on calcium, vitamin D and phosphorus. Calcium makes bones and teeth hard and supports their structures since it is deposited here. According to Lisa’s diet, the amount of calcium consumed is adequate because she consumes 922.2 mg per day in comparison to the estimated average requirement of 840 mg/day (foodzone 2013). But, according to the recommended dietary intake, it falls below 1000mg. This means that her intake is commensurate with her needs but inadequate in relation to the RDIs. Alternatively, there may be an issue with the absorption of calcium due to low amounts of vitamin D. Vitamin D is very important for the absorption of calcium and it recently has been linked to diabetes (National Institute of Health n. d.). This could be due to the fact that vitamin D is important in the transmission of messages between the brain and the body. Therefore, low amounts of vitamin D could mean poor transmission of messages; hence, poor regulation of blood sugar.

An analysis of Lisa’s diet shows that she consumes more proteins, less carbohydrates and upper limit amount of fat. Sodium is in excess and exceeds the upper limit requirement of 2300mg/day. Vitamin D, vitamin C, vitamin E and linolenic polyunsaturated fatty acids are inadequate. The high blood pressure is a result of excessive consumption of sodium (National Library of Medicine 2013; Frisoli, et al. 2012). According to Zhu, Kaneshiro & Kaunitz (2010), premenopausal women are at risk of iron deficiency due to menstrual loss and irritable bowel syndrome. Lisa’s diet is also characterized by inadequate intake of iodine; her intake is 132.9 micrograms in comparison to the recommended intake of 150 micrograms.

Signs for Nutrient Imbalances

The fact that Lisa has a BMI of 39.6 shows an imbalance in energy consumption. This could explain why she feels fatigued; when one is obese, insulin fails to function properly and, as a result, does not facilitate the uptake of sugar by the cells. Since the cells do not take up sugar, one feels fatigued and hungry; hence the reason why Lisa craves for sugar and feels light-headed as she lacks sugar that ought to provide her with energy. In addition, obesity is the reason why Lisa is hypertensive. Obesity is linked to fat deposition in the blood vessels. Subsequently, the volume of the blood vessels is constricted and blood is pumped with difficulty. The heart pumps little blood at a great speed resulting in hypertension. The heart is overworked, and this has detrimental effect on the heart. The high amount of LDL cholesterol is due to the high amounts of saturated fats consumed. According to Siri-Tarino (2010), saturated fatty acids are able to raise the levels of LDL by lowering the levels of LDL receptor-mediated clearance.

Dull hair and cutaneous changes are signs for multiple nutrient deficiencies: vitamin K, protein, vitamin A, vitamin C, biotin, pyridoxine, fatty acids, zinc, cyanocobalamin (vitamin B 12), niacin and riboflavin (Basavaraj, Seemanthini & Rashmi 2010). Conjuctiva pallor is due to the lack of iron. In addition, unhealthy skin is due to iron deficiency (Scientific Advisory Committee on Nutrition 2010). Vitamin B 12, which is predominantly from animals, is responsible for healthy skin and hair. Despite the fact that protein intake is adequate, high intake is associated with counterproductive effects. Cao & Nielsen (2010) have shown that a high protein intake results in mild metabolic acidosis. Metabolic acidosis interferes with the synthesis of protein, and instead, triggers breakdown that produces a negative nitrogen balance. In addition, metabolic acidosis reduces thyroid function and the result is fatigue. Dull hair and fatigue are indicators for iodine inadequacy. Iodine is important for the functioning of the thyroid hormone and is responsible for healthy growth of hair (State Government of Victoria 2013; Hessy 2010). Hypothyroidism results in reduced energy and it becomes difficult for one to engage in physical activity.

Recommendation

Short-term Goals

To develop a healthy diet

This is the first step to attaining good health for Lisa. An analysis of her diet indicates a disproportionate consumption of the macronutrients, which are key determinants of hypertension, high LDL cholesterol levels. These subsequently predispose her to more serious diseases such as cardiovascular disease and diabetes. She needs to maintain the recommended proportions of the macronutrients in relation to her estimated energy requirements: CHOs (45-65%), Proteins (15-35%) and fats (20-35%). Lisa’s CHOs should consist of complex carbohydrates. The largest percentage of fats (80%) should come from monounsaturated and polyunsaturated fats (American Heart Association 2013).

To increase calcium and vitamin D intake and reduce consumption of sodium

Lisa will place special focus on her vitamin D and calcium levels due to her weak and brittle bones. Sodium will be reduced to lower hypertension.

Iron, Iodine, vitamin C and E

These micronutrients are meant to aid in attainment of a healthy skin, lowered LDL and radiance of the general body. Adequate iodine will promote proper thyroid functioning, and thereby, Lisa will engage in physical activity.

Long-term Goals

1. Lowered blood pressure.
2. Increased HDL (Brehm 2013).
3. Healthy bones and skin (Goldberg & Lenzy 2010).

Dietary Recommendations

1. Lisa should observe the proportions of macronutrients in her diet. These nutrients are very important in controlling the morbidities of some fatal and chronic illnesses.
2. Lisa should increase her consumption of calcium by eating milk and milk products, cruciferous vegetables and fortified cereals. Lisa should increase her consumption of vitamin D (Lv & Brwon 2011). Rich sources of vitamin D include animal products, fortified products and mushrooms. The use of supplements will help Lisa get her recommended amount of calcium intake, but she should seek the professional help of a dietitian (Meier & Kranzlin, 2011). The dietitian will advise her on good feeding habits to ensure maximal absorption of calcium and prevent toxicity.
3. Lisa should reduce her consumption of sodium to lower her blood pressure. Lisa should reduce her consumption of processed foods to do this. In addition, she should consume home-made food containing an amount of sodium commensurate to her need.
4. Lisa should increase her consumption of iodine to promote proper thyroid functioning.
5. Increase consumption of animal products to increase her ferritin levels. In addition, she should take fruits and vegetables alongside these animal products to enhance absorption of iron.
6. Replace refined foods with high fiber food, for example, wholegrain bread instead of white bread. This will help in excretion of cholesterol hence lower cholesterol levels and reduce susceptibility to cardiovascular disease (Dhingra, et al. 2012).

Conclusion

Good nutrition is fundamental in the achievement of good health; nutrients work collaboratively to support each other and produce collective beneficial results. The diet dictates who one is and, therefore, healthy dietary practices are important. As can be seen from the analysis of Lisa’s diet, it is possible to maintain good health with just a healthy diet. Most of the ailments that Lisa has can be prevented by adopting a healthy diet; hence, increasing one’s quality of life, reducing hospital bills and expenses, reducing poverty and stays in hospitals due to associated comorbidities.

References

American Heart Association 2013, Know Your Fats, Web.

Basavaraj, KH, Seemanthini, C, & Rashmi, R 2010, Diet in Dermatology: Present perspectives, Indian Journal of Dermatology, vol. 33. No. 3, pp. 205-210.

Brehm, BL 2013, Rising Interest in HDL-the “Good Cholesterol”, Web.

Cao, JJ & Nielsen, FH 2010, ‘Acid diet (high-meat protein) effects on calcium metabolism and bone health’, Current Opinionin Climical Nutrition and Metabolic Care, vol 13. No. 6, pp. 698-702.

Dhingra, D, Michael, M, Rajput, H, & Patil, RT 2012, ‘Dietary fiber in foods: a review’, Journal of Food Science and Technology, vol. 49. No. 3, pp. 255-66.

Foodzone 2013, Web.

Frisoli, TM, Schmieder, RE, Grodzicki, T, & Messerli, FH 2012, ‘Salt and hypertension: is salt dietary reduction worth the effort?’ The American Journal of Medicine, vol. 125. No. 5, pp. 433-9.

Goldberg, LJ, Lenzy, Y 2010. ‘Nutrition and hair’, Clinics in Dermatology, vol. 28. No. 4, pp. 412-419.

Hessy, SY 2010, The impact of common micronutrient deficiencies on iodine and thyroid metabolism: the evidence from human studies, Best Practice and Research, vol. 24, no. 1, pp. 117-132.

Lv, N, & Brown, JL 2011, ‘Impact of a nutrition education program to increase intake of calcium-rich foods by Chinese-American women’, Journal of American Dietetic Association, vol. 111, no. 1, pp. 143-9.

Meier, C, & Kranzlin, ME 2011, ‘Calcium supplementation, osteoporosis and cardiovascular disease’, Swiss Medical Weekly, vol. 141. Web.

National Health and Medical Research Council 2013, Nutrition, Web.

National Institute of Health 2013, Dietary Supplement Fact Sheet: Vitamin D, Web.

National Library of Medicine 2013, Sodium in diet, Web.

Siri-Tarino, PW, Sun, Q, Hu, FB, & Krauss, RM 2010, ‘Saturated fatty acids and risk of coronary heart disease: modulation by replacement nutrients’, Current Atherosclerosis Reports, vol. 12. No. 6, pp. 384-390.

Savica, V, Belllingheri, G & Kopple, JD 2010, The effect of nutrition on blood pressure’, Annual Review of Nutrition, vol. 300, pp. 365-401.

Scientific Advisory Committee on Nutrition 2010, Iron and Health, Web.

State Government of Victoria 2013, Iodine, Web.

Wang, L, Manson, JE, Gziano, JM, Buring, JE, & Sesso, HD 2012, ‘Fruit and vegetable ntake and the risk of hypertension in middle-aged and older women’, American Journal of Hypertension, vol. 25. no. 2, pp. 180-9.

Zhu, A, Kaneshiro, M, Kaunitz, JD 2010, ‘Evaluation and Treatment of Iron Deficiency Anemia: A Gastroenterological Perspective’, Digestive Diseases and Sciences vol. 55. No. 3, pp. 548-559.

Hinderliter, A. L., Babyak, M. A., Sherwood, A., & Blumenthal, J. A. (2011). The DASH diet and insulin sensitivity. Current Hypertension Reports, 13, 67-73.

Research Problem/Purpose

The researchers have identified high blood pressure as one of the underlying risk factors for cardiovascular disease. The authors have indicated that hypertension increases the risk of diabetes and insulin resistance. In addition, the article has illustrated how the combination of diabetes and high blood pressure predisposes patients to multiple illnesses. These medical conditions include coronary heart disease, heart failure, stroke, and chronic kidney disease (Hinderliter, Babyak, Sherwood, & Blumenthal, 2011). According to Hinderliter et al., these conditions constitute the adverse effects of hypertension. Thus, the identified problem has established the basis that maps the direction of the article.

The investigators have used the introduction section to contextualize the problem within the framework of the existing knowledge. Thomas and Harden (2008) have asserted that an excellent introduction provides the foundation for the research article. For instance, Hinderliter et al. have identified the limitations of antihypertensive medications in treating high blood pressure. The inclusion of this information in the introduction has justified lifestyle modifications. Hinderliter et al. have explored this issue further by citing examples from the Joint National Committee’s seventh report (JNC-7). The findings from the JNC-7 report have shown how the adoption of healthy behaviors reduces the risk of hypertension. This information has framed the research question and purpose in context.

The purpose of this review was to evaluate the combined and independent effects of different lifestyle modifications on insulin insensitivity and blood pressure. The interventions included the DASH diet, as well as physical activity and weight loss. The authors included the aspects of weight loss and exercise in the study because the baseline research had specifically recommended the DASH diet to lower high blood pressure. The findings from this review will solve a nursing problem because it will validate behavior modification as one of the preventive measures for high blood pressure. According to Peterson, Gaziano, and Greenland (2014), hypertension is a significant risk factor for a myriad of diseases. As such, it is imperative to prevent the onset of this condition.

Review of the Literature

The literature review of research supports the phenomenon under study by analyzing the previous studies and models in the area of interest (Beck, 2013). The article has not provided a dedicated section to review the literature. Nonetheless, the authors have identified three thematic areas in their discussions. First, the researchers have examined the correlation between lifestyle modifications and the risk of insulin sensitivity and diabetes. Second, the researchers have explored the influence of the DASH diet plan on blood pressure. Finally, they have also measured the effect of this diet on insulin sensitivity. The references included in this review are from both the previous and current studies. Incorporating the two groups of studies into the article was essential to examine how past practices are influencing the present.

Theoretical Framework

The inclusion of a theoretical framework in a study provides fundamental clues regarding the possible answers to the research question (LoBiond-Wood & Haber, 2013). The authors have not provided a conceptual framework to guide this review. The Health Belief Model (HBM) would have been an appropriate theory for this review. This model identifies the perceived susceptibility, severity, benefits, and barriers that influence people’s decisions to adopt a healthy lifestyle (Yates, Davies, Gorely, Bull, & Khunti, 2009). The authors should have included this theoretical framework to determine how health beliefs affect the adoption of lifestyle modifications. Conversely, Thomas and Harden (2008) have argued that the purpose of systematic reviews is not to test any theory but to generate them instead.

Variables/Hypotheses/Questions/Assumptions

The independent variables in the review were blood pressure and insulin sensitivity. On the other hand, the dependent variables included the DASH diet plan, weight loss, and exercise. The rationale for the preceding statements is that the DASH diet, weight loss, and physical activity affect blood pressure and insulin sensitivity. In contrast, high blood pressure and insulin sensitivity may motivate people to adopt lifestyle modifications. Keele (2011) has asserted that the manipulation of dependent variables may influence the dependent variables and vice versa. It is imperative to note that the researchers did not identify these components explicitly. In addition, they have not provided the operational definitions and measures of these variables.

The authors have stated neither the research question nor the hypothesis in precise terms. Farrugia, Petrisor, Farrokhyar, and Bhandari (2010) have argued that research questions frame the study within the appropriate context. In addition, Farrugia et al. have posited that the hypothesis influences the formulation of the thematic question. Conversely, the purpose of the review provides an indirect link to the research question. Accordingly, the research question would have been, do lifestyle modifications reduce the risk of blood pressure and insulin sensitivity?

Methodology

The purpose of the methods section is to provide sufficient information, which facilitates the replication of the study findings in external settings (Coughlan, Cronin, & Ryan, 2007a). LoBiond-Wood and Haber (2013) have indicated that the components included in the methods section determine whether the chosen design is appropriate to meet the research objectives and answer the research question(s) efficiently. The authors employed the systematic review design using both quantitative and qualitative methods. The researchers used the deductive reasoning approach to generate accurate information from the ENCORE and other studies. The authors intended to confirm the findings reported in both the ENCORE study and the JNC-7 report.

The authors have not indicated the number of studies they reviewed in this analysis. In addition, the reviewers have not identified the sampling techniques they used to select the studies. Thus, it is difficult to determine if they used the probability or non-probability sampling methodologies. Despite these limitations, the reviewers have included the sample size and sampling procedures of the studies included in the review. The inclusion of this information in this review was essential to determine the rigor of the original studies. Further, the authors have provided the setting for the previous studies, which is critical to facilitate the generalization of the combined results.

Although the authors have not provided their data collection procedures, they have identified the ones used in the previous studies. Some of these tools included interviews, surveys, and observations. Coughlan, Cronin, and Ryan (2007b) have reported that interviews and observations are crucial tools for collecting both qualitative and quantitative data. The significance of observations and interviews is that they provide subjective data about the subjects and study settings. Conversely, individual biases might affect the validity and reliability of the findings. The review did not conform to any ethical considerations because it did not include human subjects. The authors did not seek approval from the review board to conduct this review.

Data Analysis

The choice of appropriate data collection and analysis techniques is a crucial step in research processes (Coughlan, Cronin, & Ryan, 2007a). Despite this fact, the researchers have not identified the tools or models they used to analyze their findings. The authors have presented their studies under three themes. First, they have evaluated the effects of exercise and weight loss on the development of diabetes and insulin sensitivity. Second, the researchers have explored the influence of the DASH diet plan on blood pressure. Finally, they have also measured the effect of this diet on insulin sensitivity in patients who have a higher risk of diabetes.

The purpose of this review was to evaluate the combined and independent effects of different lifestyle modifications on insulin insensitivity and blood pressure. The researchers conducted this review based on the findings from the ENCORE study. The researchers have found out that the DASH diet and weight management reduced the level of glucose. This finding was consistent with the one in the ENCORE study, as well as the other studies included in the review. In addition, the authors also found out that the DASH diet recommended in the JNC-7 report lowered blood pressure significantly. The researchers have validated these results in the review.

Summary/Conclusions, Implications & Recommendations

One of the principal strengths of this research is that the researchers have conducted a systematic and extensive literature search. The reviewers used the data published recently in the ENCORE study. The use of the ENCORE study as a reference was essential to validate the results generated in the preceding research. Another advantage of this review is that the results will be extrapolated and generalized to the broader population. Beck (2013) has asserted that the combination of findings in a systematic review facilitates the generalization of the results to the general population more compared to individual studies. In essence, the researchers have used the findings from multiple studies to corroborate those presented in the ENCORE study.

Conversely, Hinderliter et al. have not provided explicit inclusion and selection criteria. In the same vein, they have not revealed if they used a transparent approach to select the articles for review. LoBiond-Wood and Haber (2013) have argued that selection bias may affect the validity and reliability of the results. For example, the authors have not specified if one or more researchers assessed each study. Consequently, personal preferences and prejudices may have had an adverse influence on the selection of the studies. Secondly, the limitations of each study included in the review may have affected the reliability of this review. For instance, the non-responder biases and low response rates of the surveys included in the analysis could have influenced the rigor of the findings.

The researchers have found out that the DASH diet plan lowers blood pressure that has surpassed the optimal level. In addition, the combination of diet and physical activity reduces the risk of diabetes in vulnerable individuals. Diabetes and hypertension are lifestyle conditions that have unfavorable clinical implications (Yates et al., 2009). Thus, the findings from this review support the promotion of lifestyle and diet modifications to reduce or prevent the incidences of these diseases. Nurses and other health care providers should use this evidence to promote the best clinical practices.

References

Beck, T. C. (2013). Critiquing qualitative research. AORN Journal, 90(4), 543-554.

Coughlan, M., Cronin, P., & Ryan, F. (2007a). Step-by-step guide to critiquing research. Part 1: Quantitative research. British Journal of Nursing, 16(11), 658-663.

Coughlan, M., Cronin, P., & Ryan, F. (2007b). Step-by-step guide to critiquing research. Part 2: Qualitative research. British Journal of Nursing, 16(12), 738-744.

Farrugia, P., Petrisor, B. A., Farrokhyar, F., & Bhandari, M. (2010). Research questions, hypotheses and objectives. Canadian Journal of Surgery, 53(4), 278-281.

Keele, R. (2011). Nursing research and evidence-based practice: Ten steps to success (3rd ed.). Sudbury, MA: Jones and Bartlett.

LoBiond-Wood, G., & Haber, J. (2013). Methods and critical appraisal for evidence-based practice (8th ed.). London: Elsevier.

Peterson, E. D., Gaziano, J. M., & Greenland, P. (2014). Recommendations for treating hypertension: What are the right goals and purposes? JAMA, 311(5), 474-476.

Thomas, J., & Harden, A. (2008). Methods for the thematic synthesis of qualitative research in systematic reviews. BMC Medical Research Methodology, 8, 45-49.

Yates, T., Davies, M., Gorely, T., Bull, F., & Khunti, K. (2009). Effectiveness of pragmatic education program designed to promote walking activity in individuals with impaired glucose tolerance. Diabetes Care, 32(8), 1404-1410.

Diet therapy is a means of using diets prescribed by a dietician to enhance health. Several diseases are treated or managed to some extent by therapeutic diets. Managing or treating certain conditions involves including foods that enhance certain health conditions. On the other hand, one should avoid foods, which deteriorate health conditions. Some health issues may need temporary diet therapy. On the other hand, diet therapy may become a permanent form of intervention required to ensure healthy lifestyles. Diet therapies have become specialized and require the inputs of professionals such as physicians or dieticians. It is imperative to note that diet therapies may be altered depending on the health changes observed.

A gluten-free diet, for instance, maybe necessary for one to stay healthy because such persons must avoid diets rich in gluten to protect their intestines. In addition, individuals with obesity may require ketogenic diets or avoid high-sugar foods to manage their conditions, specifically blood sugar levels. Intakes of certain nutrients such as salts and saturated fats may be restricted to manage blood pressure and cholesterol respectively. It is not simple to adapt to new restrictive diets and therefore individuals are advised to work with their physicians or dieticians to ensure that they make gradual changes and adhere to diet therapies. According to nutrition specialists, ‘recommended balanced diets’ should contain the right “macronutrient composition, micronutrients, and dietary quality to ensure adequate nutrition, energy balance for health and weight maintenance and prevention of non-communicable diseases (NCDs) in healthy populations” (Naude et al., 2014). This study focuses on diet therapies and cardiovascular diseases.

Various factors drive cardiovascular disease, including stroke. According to Roth et al. (2015), the global cases of cardiovascular and circulatory conditions have increased. The authors have attributed the increase to “the combined effect of population growth, the aging of populations, and epidemiologic changes in cardiovascular disease” (Roth et al., 2015). They further note that drivers of cardiovascular disease should be separated to understand regional and national interventions for cardiovascular disease. Disentangling these drivers also leads to improved comprehension of roles and relative of various demographic and epidemiologic trends to understand current policies. Finally, disentangling also assists in evaluating the relevance of aging and growth in people and progresses achieved towards the reduction of premature deaths associated with cardiovascular disease. Among all these factors, diets have critical roles in cardiovascular disease.

Diets rich in sodium are known risk factors for cardiovascular disease (Packham et al., 2015). Hyperkalemia (serum potassium level, >5.0 mmol per liter) associated with renal diseases is a notable electrolyte condition that is also responsible for serious cardiac dysrhythmias and increased mortality (Packham et al., 2015). It has been observed that individuals with renal dysfunction and others with diabetes are highly susceptible to hyperkalemia. It has been noted that some specific therapies for controlling the renin-angiotensin–aldosterone system (RAAS) are linked to hyperkalemia in patients with kidney conditions or heart failure, although such therapies are vital for “proteinuric chronic kidney disease, diabetic nephropathy, and systolic heart failure” (Packham et al., 2015). In addition, studies have also established that the application of available polymer resins such as sodium polystyrene sulfonate leads to unfavorable side effects with unknown effectiveness (Packham et al., 2015). On this note, it is clear that such therapies to control hyperkalemia are responsible for certain chronic diseases such as cardiovascular disease and other acute conditions. Hence, Packham et al. (2015) concluded that new additional agents are required to manage hyperkalemia safely in patients with chronic and acute conditions.

Obesity is also a risk factor for several conditions, including cardiovascular disease, type-2 diabetes, and metabolic syndrome. In this regard, some interventions have focused on diet therapies to manage obesity, particularly in individuals with cardiovascular disease. A study by Hu and Bazzano (2014) indicates that obesity remains a critical public health issue and by 2005, there were nearly 937 million cases of overweight and 396 million cases of obese people globall,y and these numbers were projected to increase. Hence, obesity needs a careful approach and effective management. On this note, diet therapies have been adopted to control obesity and perhaps cardiovascular disease and other chronic conditions.

The growing interest in the low-carbohydrate diet (ketogenic diet) to manage obesity and facilitate weight loss is important for this study. According to Hu and Bazzano (2014), despite thisrealizationn, some experts have failed to recommend low-carbohydrate diets to control cardiovascular disease. A perception exists that such diets could lead to adverse outcomes on cardiovascular disease risk factors specifically because of the assumption that the level of saturated fats will increase in low-carbohydrate diets relative to weight loss diets (Hu & Bazzano, 2014). It is noted that certain professional organisations, including the American Dietetic Association have warned the public against the use of a low-carbohydrate diet. Recent studies, however, have shown that low-carbohydrate diets have a dual effect of reducing body weight and enhancing cardiovascular risk factors (Hu & Bazzano, 2014). Consumption of diets with low carbohydrate contents leads to low total energy intake, which is a significant risk factor for obesity. A major source of concern has been whether effects of a low-carbohydrate diet on cardiovascular disease emanate from the decreased consumption of carbohydrates or total energy intake (Hu & Bazzano, 2014). On this note, a study by Hu and Bazzano (2014) demonstrated that “low-carbohydrate diets not only decrease body weight but also improve cardiovascular risk factors” (p. 337). Based on this new evidence, it is necessary to encourage the consumption of healthy low-carbohydrate diet as an effective, alternative diet therapy for managing conditions of cardiovascular and obesity risk factors. Some studies have confirmed that ketogenic diets have shown effectiveness in obesity, cardiovascular risk factors and hyperlipidemia management in short-term to medium-term interventions (Paoli, 2014). At the same time, physicians have also raised some concerns about the use of ketogenic diets to manage chronic diseases and obesity. Many challenges about the use of ketogenic diets could be related to a lack of sufficient evidence because the study is relatively new, particularly the physiological processes involved.

The media have also promoted certain weigh loss diets such as Atkins diet. These diets have however focused on restricting carbohydrate intakes, protein rich diets, and total and saturate fat consumption (Naude et al., 2014). Contrary to their intended goals, many experts have asserted that such diets are more important for weight loss relative to improving cardiovascular health, balanced diets for weight management and managing or curing diabetes (Naude et al., 2014). As these diets strive for extremely low carbohydrate contents, they focus on restricting consumption of most fruits, vegetables, legumes, whole grains and other types of foods rich in carbohydrates. Hence, it becomes apparent that these forms of diets could have detrimental effects over a long period. Generally, low carbohydrate diets require people to substitute carbohydrate rich foods with high protein and fat foods. However, since there are various forms and guidelines for these diets, definitions for ‘low’, implementation strategies, guidelines and health outcome claims for these substitutes differ significantly. Naude et al. (2014) identified two forms of very low carbohydrate diets. The first category of very low carbohydrate diet consists of high fat variant (high fat and protein contents). The second category is referred to as high protein variant, which has high protein content with recommended amount of fat contents and therefore not extreme in terms of carbohydrate restriction. These diets remain controversial as means of managing cardiovascular disease and weight management. In fact, researchers have focused on determining their benefits and harmful outcomes relative to healthy balanced diets (Naude et al., 2014). The researchers concluded that there was perhaps little or no variation in weight loss and improvement in cardiovascular risk factors after two years of follow up when obese adults without or without diabetes were subjected to low carbohydrate diets and isoenergetic balanced weight loss diets (Naude et al., 2014).

Diet therapies for cardiovascular disease have also extended to highlight the relationship with the chronic kidney disease (CKD) and its related morbidity. Such conditions are public health problems associated with end stage renal disease. They require effective renal therapies. On this note, it has been observed that cardiovascular disease is a major contributing factor for premature deaths among individuals with CKD, particularly in cases of dialysis-dependent and renal transplant patients (Currie & Delles, 2014). The presence of end stage renal disease is a strong indicator of adverse health outcomes. In most cases, a small percentage of patients with chronic kidney disease may progress to the end stage renal disease, which often requires renal replacement therapy. In such conditions, available evidence has shown that proteinuria (urinary protein excretion) has critical role in all-cause deaths and cardiovascular effects in chronic kidney disease patients and other general patients. While proteinuria has been identified as major risk factor for cardiovascular disease, little evidence exists to show its onset and progression (Currie & Delles, 2014). More often, some studies have shown the link between proteinuria and other significant cardiovascular risk factors as cross-sectional and therefore conclusive results cannot be provided (Currie & Delles, 2014). Nevertheless, interests have been demonstrated by using dietary therapies to manage cardiovascular risk factors in patients with proteinuria. Specifically, interventions concentrate on reducing the levels of proteinuria and changes in other related risk factors such as obesity, diabetes, smoking, blood pressure and lipid saturation (Currie & Delles, 2014). Results had shown that diet changes in patients with renal disease also required controls of blood pressure. While diet therapy is recommended to control the condition as well as related cardiovascular disease, concerns have been raised because of the delicate management between good healthy diets and reduction of protein to control proteinuria in patients. While a good protein diet may be restricted to 1.0 g/kg/day in the later stages of a renal disease, in some instances, diet therapies may be indigestible and adherence among patients may vary. Further, sodium intake is restricted to slow down the progress of cardiovascular risks in patients with chronic kidney disease. Currently, there are no clear dietary guidelines on sodium consumption for individuals with proteinuria, but available findings have demonstrated that dietary sodium therapy can improve the outcome of “renin-angiotensin-aldosterone system (RAAS) agents in limiting urinary protein excretion” (Currie & Delles, 2014). On this note, it is necessary to provide a dietetic therapy for individuals with cardiovascular disease, chronic kidney disease and proteinuria, as well as to develop guidelines to facilitate diet changes in patients.

Heart failure is also a contributing factor for cardiac output. Dietary sodium therapy is perhaps the most effective way to enhance self-care behaviours and generally encouraged for patients with heart failure (Colin-Ramirez et al., 2015). In this regard, all heart failure guidelines have recommended dietary restriction of sodium intakes. High sodium rich diets are normally related to fluid retention in the body. Heart failure affects cardiac activities, increased systemic venous pressure or block blood away from the kidney. All these outcomes may negatively affect renal functions and as a result, trigger nervous system and the RAAS, and then develop a constant cycle of sodium and water retention irrespective of fluid already presence in the body.

Diet therapies also include a Mediterranean diet to control cardiovascular disease (Yang, Farioli, Korre, & Kales, 2014). The Mediterranean diet consists of the same feeding habits conventionally adhered to by natives along the Mediterranean Sea. The diet usually is associated with high intake of “fruits, olive oil, cereals, vegetables, nuts, non-refined breads, legumes and potatoes” (Yang et al., 2014). In addition, the diet encourages modest consumption of fish and poultry; low consumption of dairy products, meat, processed meat, red meat and sweets; and restricted consumption of wine with food (Yang et al., 2014). According to Yang et al. (2014), many studies have evaluated Mediterranean diet adherence using a scoring rubric and they have found contrary links with cardiovascular disease morbidity and mortality. However, such studies had focused on older adults or individuals with existing health problems among Mediterranean people. While little was known about the efficacy of a Mediterranean diet on young working individuals outside non-Mediterranean regions, a study by Yang et al. (2014) showed that young and active adults who greatly observed the diet requirements experienced reduced cases of metabolic syndrome and other chronic conditions. The authors concluded that Mediterranean diet was effective for the subjects and therefore further studies were required to justify the use of the diet among young, working populations (Yang et al., 2014).

In fact, studies on Mediterranean subjects, adults or others with existing health conditions have indicated that individuals who greatly adhered to the diet had lower risk for developing cardiovascular morbidity or mortality (Yang et al., 2014). In addition, diets included changes to lifestyles, which were associated with reduced cases of cardiovascular disease risk. The Mediterranean diet has, over the time, been linked to improved “health status, low cases of all-cause mortality and protective/ameliorative effects on chronic diseases” (Yang et al., 2014). Mediterranean diet was therefore found to be beneficial to individuals with cardiovascular risks factors such as “hypertension, obesity, diabetes and other metabolic conditions in addition to risks of cardiovascular related morbidity and mortality” (Yang et al., 2014).

Diets rich carotenoids have also been suggested to manage cardiovascular disease. Carotenoids consist of a group of natural, fat-soluble elements found primarily in certain plants. Carotenoids have antioxidants biological properties due to their chemical composition and association with biological membranes (Gammone, Riccioni, & D’Orazio, 2015). Some studies have acknowledged the use of antioxidants as affordable ways for both major and secondary interventions for cardiovascular disease. Specifically, it has been demonstrated that the oxidation of “low-density lipoproteins (LDL) in the vessels has a critical influence in the formation of atherosclerotic lesions” (Gammone et al., 2015). LDLs are resistance to oxidation and are enhanced by diets rich in antioxidant foods. Carotenoids, which are constituents of the Mediterranean diet, provide beneficial outcomes to individuals with cardiovascular disease. Other properties of carotenoids that could possible result in reduction of cardiovascular risk are mainly associated with reduced blood pressure, reducing the levels of cytokines responsible for inflammation and their markers and improving insulin sensitivity in muscles, liver and in other parts of the body organs (Gammone et al., 2015).

In conclusion, diet therapy exists to manage various health risks, including cardiovascular disease. Based on nutritionists’ views recommended balanced diet should have the right amount of nutrients to enhance health, sustain the right body weight and prevent non-communicable diseases in healthy individuals. Some diet therapies are effective, but others could be extremely harmful or their side effects or benefits remain unknown. Such dietetic therapy restricts intake of certain foods such as protein, carbohydrate, and nutrients such as sodium. This situation leads to poor consumption of the necessary nutrient constituents and as a result, dieticians have expressed their concerns about certain diet therapies because of their potential side effects. Other conditions such as obesity and hyperkalemia are linked to cardiovascular disease and therefore diet therapies meant for such conditions have effects on cardiovascular disease management.

References

Colin-Ramirez, E., McAlister, F., Zheng, Y., Sharma, S., Armstrong, P. W., & Ezekowitz, J. A. (2015). The long-term effects of dietary sodium restriction on clinical outcomes in patients with heart failure. American Heart Journal, 169(2), 274- 281.e1.

Currie, G., & Delles, C. (2014). Proteinuria and its relation to cardiovascular disease. International Journal of Nephrology and Renovascular Disease, 7, 13–24.

Gammone, M. A., Riccioni, G., & D’Orazio, N. (2015). Carotenoids: potential allies of cardiovascular health? Food Nutrition Research, 59.

Hu, T., & Bazzano, L. A. (2014). The low-carbohydrate diet and cardiovascular risk factors: Evidence from epidemiologic studies. Nutrition Metabolism and Cardiovascular Diseases, 24(4), 337–343.

Naude, C. E., Schoonees, A., Senekal, M., Young, T., Garner, P., & Volmink, J. (2014). Low Carbohydrate versus Isoenergetic Balanced Diets for Reducing Weight and Cardiovascular Risk: A Systematic Review and Meta-Analysis. PLoS One, 9(7), e100652.

Packham, D. K., Rasmussen, H. S., Lavin, P. T., El-Shahawy, M. A., Roger, S. D., Block, G.,… Singh, B. (2015). Sodium Zirconium Cyclosilicate in Hyperkalemia. New England Journal of Medicine, 372, 222-231.

Paoli, A. (2014). Ketogenic Diet for Obesity: Friend or Foe? International Journal of Environmental Research and Public Health, 11(2), 2092–2107.

Roth, G. A., Forouzanfar, M. H., Moran, A. E., Barber, R., Nguyen, G., Feigin, V. L., … Murray, C. J.L. (2015). Demographic and Epidemiologic Drivers of Global Cardiovascular Mortality. New England Journal of Medicine, 372, 1333-1341.

Yang, J., Farioli, A., Korre, M., & Kales, S. N. (2014). Modified Mediterranean Diet Score and Cardiovascular Risk in a North American Working Population. PLoS One, 9(2), e87539.

Proteins

Proteins are referred to as “the building blocks of life” (Protein in Diet Para 1). Protein is required by the body for repair and maintenance. The building blocks for protein are amino acids, whose structure is in the form of long chains. Dietary proteins cannot be directly absorbed from the GIT due to their large and complex nature. They are therefore absorbed in the form of amino acids, which are small and simple molecules. Amino acids are divided into three groups:

• Essential.
  • These include histidine, leucine, methionine, threonine, isoleucine, lycine, methionine, tryptophan, phenylalanine and valine.
• Nonessential
  • These include alanine, asparagines, aspartic acid and glutamic acid.
• Conditional
  • These include glutamine, ornithine, proline, arginine, cysteine, tyrosine, glycine and serine.

Function

Proteins are important constituents of the body tissues and organs. They contribute greatly towards “the structure, function and regulation of body tissues and organs” (What are proteins and do they do Para 3). The amino acid sequence is very important because it defines the function and structure of every protein.

Proteins and their Functions

Antibodies like Immunoglobulin G (IgG)

These bind to certain foreign bodies for example bacteria and viruses. They protect the body from harm.

Enzymes like hydrolases

They are the drivers of most chemical reactions in the cells. DNA contains genetic information. Enzymes read this information during the formation of new molecules.

Phenylalanine hydroxylase, which contains four identical subunits converts phenylalanine to tyrosine.

Messengers like hormones

These are involved in the coordination of biological processes by “transmitting signals between cells, tissues and organs” (What are proteins and do they do Para 5).

The growth hormone is produced by the pituitary gland and binds to a growth hormone receptor (a protein) to aid in the regulation of cell growth.

Structure

Proteins are involved in the structuring of cells, and this forms a basis for support. E.g., actin shown below:

The actin filaments help in muscle contraction and maintain the shape of muscle cells.

Transport/ Storage like ferritin for iron storage

They bind to and are carriers of atoms and small molecules in cells and the entire body.

Ferritin consists of 25 subunits

Food Sources

The food sources of proteins include fish, milk, eggs, meat, beans, nut butter, some grains like wheat germ and legumes. A nutritionally adequate protein diet concerning the RDA can meet one’s daily needs for protein.

The various plant sources for protein can meet the protein needs of vegetarians. One’s age and health determine how much protein is necessary.

Age

The daily requirements of proteins for adults are 2 to 3 servings. The myfoodguide pyramid (The Food Guide Pyramid 3) is a good guide to what each serving of protein contains. However, it is worth noting that all protein sources fall under either one of the following food groups:

• Milk and milk products
• Nuts and seeds
• Meat

Protein Digestion

The digestion of proteins starts in the stomach. Gastric juice in the stomach triggers subsequent activities involved in the digestive modification of proteins. It denatures the proteins, triggers the conversion of pepsinogen to pepsin, is involved in the conversion of proteins to easily digestible metaproteins and creates a suitable environment for pepsin due to its pH. Digestion of proteins in the stomach completes with “peptones, proteoses and large polypeptides” as the end products (Protein in diet Para 7). Protein digestion ends in the small intestines by proteolytic enzymes. These are contained in pancreatic and intestinal juices. The end products at the small intestines are amino acids.

Protein absorption is an active process that requires energy, which is obtained from ATP hydrolysis. Protein absorption occurs in the small intestines. Protein is rapidly absorbed in the duodenum as well as in the jejunum. The converse is the case in the ileum (see below).

Two mechanisms define amino acid absorption. They are:

Carrier protein transport system

Glutathione transport system (γ Glutamyl cycle)

Inadequate Protein Intake

Inadequate intake of proteins leads to “decreased immune function. Poor healing/recovery reduced reserve capacity, longer recuperation from illness, and increased skin fragility” (Chernoff Para 1).

Glucose

Glucose/dextrose is a carbohydrate and essential in human metabolism (Nave Para 1). It is a hexose, aldose, and monosaccharide meaning it is among the smallest units. It is the main source of energy for virtually every body cell including brain cells. It is metabolized into the water, carbon dioxide and nitrogenous compounds in the release of energy (Nave Para 4-5). The following chemical reaction equation indicates how oxidation of glucose takes place:

C₆H₁₂O₆ + 6O₂ –> 6CO₂ + 6H₂O

Sources

Carbohydrates are either simple or complex. The simple carbohydrates are easily broken down and absorbed into the blood.

Most foods contain carbohydrates, proteins and fats. The amount of nutrients in the food is what determines the rate at which the body converts the food into glucose. Protein-rich foods (discussed in the first section) do not have a major impact on the levels of blood sugar. This is because some of it is stored in the liver without being released into the bloodstream. Fats are also sources of glucose. Less than 10% of fats consumed are converted into glucose (Augustine para 5). This glucose is absorbed into the blood at a slow rate, hence does not lead to an immediate elevation of blood sugar.

Insulin is the hormone required to enable the uptake of glucose into the body cells. If glucose is not being used for energy, it is stored as glycogen in the liver and muscles, or stored as fat as shown below (Iowa State University Extension and Outreach Para 6-7):

Glucose in the blood is very important in the medical world because of its associated effects.

Inadequate intake of Glucose

Inadequate intake of glucose results in dizziness, weakness, and hypoglycemia. A reduction in blood glucose levels during exercise leads to poor performance and mental and physical fatigue.

It is very important to replenish muscle glycogen, failure to which leads to fatigue (Dunford and Andrew 190). The brain uses glucose for its mental activity. Inadequate glucose intake results in a drop of glucose in the brain. A steady supply of glucose to the brain is crucial because neurons are not able to store glucose, therefore lack of continuous replenishment results in adverse effects. The effects of glucose deficit in the brain are a feeling of spaced–out, confusion, nervousness, and inability to focus due to hypoglycemia. The deficit can be so serious to the point that one loses consciousness (Nourish-Carbohydrates Fuel Your Brain Para 22).

Lipids

Lipids are organic constituents in both plants and animals such as wax, fats and oils. They are esters of fatty acids (moderate or long). They are not soluble in water but are soluble in organic solvents. Fats are the lipid form commonly ingested in food. Fats aid in the absorption of fat-soluble vitamins; cushion and protect the heart, kidney and liver by acting as a shock absorber; and prevents loss of heat from the skin by acting as an insulator. Individuals should get the recommended allowances for fats. Age, indicated by the different percentages in the table below as obtained from CDC (Dietary Fat Para 2) affects the allowances for fats.

The rate of carbohydrate digestion is affected by lipids. This is because it slows down carbohydrate digestion and simultaneously slows the rise in blood sugar levels (Augustine, para 6).

Digestion of Lipids

Digestion of lipids begins in the small intestines. This is made possible by the emulsifying salts in bile. Emulsification of fats helps in their digestion because then they can be readily hydrolyzed to glycerol and fatty acids by lipases. Hydrolyzed lipids from the small intestines are absorbed into the bloodstream for transportation to the other organs, especially the liver. In the liver, further metabolism of fat takes place. The ultimate end products of fat metabolism are carbon dioxide and water with the release of energy (The Importance of Fats (Lipids) Para 4).

Sources

The fatty acids define the type of lipid. Depending on the type, there are either saturated, monounsaturated, or polyunsaturated. Animal products for example meat and cheese are good sources of saturated fats. Coconut oil and palm oil are vegetable sources of saturated fats. Olive oil is an example of monounsaturated fats while corn oil is an example of saturated fats.

Inadequate intake

Inadequate intake of fats leads to:

Intramuscular fat stores are poorly replenished

Intramuscular fat stores should be replenished after physical activity. Inadequate replenishment of these stores leads to poor performance and fatigue.

Sex-related hormones are not manufactured

Various studies have shown the relationship between fat intake and the manufacture of sex hormones (Dunford and Andrew 190). One study of healthy men showed that a low-fat diet, consisting of 18 to 25% fat out of the total calories with a lower ratio of saturated to polyunsaturated fats, was associated with reduced testosterone levels.

The ratio of high and low-density lipoproteins is altered

Following the CDC table given above, Dunford and Andrew (190) suggest that the daily intake of fats should not be less than 20% of total calories in a diet. Evidence from research studies indicates that a low-fat diet leads to reduced levels of HDL. This has a detrimental effect on the human body because HDL is a lipid carrier that protects arteries by removing cholesterol and transporting it to the liver for metabolism. This prevents the occurrence of CVD.

There is inadequate uptake of fat-soluble vitamins.

Vegetables

Vegetables are associated with many health benefits that include reducing the risk of CVD and some cancers; decreasing blood pressure; reducing problems of the eyes and digestive tract; and they have a mellowing effect on blood sugar, which prevents suppression of appetite especially in children (Vegetables and Fruits Para 3). Vegetables are obtained from plants. It is important to name vegetables about the parts of the plant they signify. This helps to understand the vegetable better and to speculate on some of its properties. The table below Fruit and vegetable processing Para 6) represents a classification of vegetables, factoring in their morphological features:

Nutrients and Sources

The natural characteristics of vegetables are that they are low in fat and calories and none of them has cholesterol. However, fat, calories and cholesterol may be derived from seasonings or sauces.

With the associated benefits of vegetables given above, an inadequate intake of vegetables leads to the occurrence of chronic diseases. According to WHO (Promoting Fruit and Vegetable consumption around the world Para 1), “14% of worldwide GIT cancer deaths and 11% of deaths as a result of ischemic heart disease and 9% deaths due to stroke” are attributable to an inadequate intake of fruits and vegetables. It is estimated that a worldwide mortality rate of 2.8% is due to an inadequate intake of fruits and vegetables (Promoting Fruit and Vegetable consumption around the world Para 1).

Recommendation

It is very important to maintain a healthy and balanced diet. Every nutrient when taken in appropriate quantities and portion sizes yield maximum health benefits to the body. Below is an ideal illustration of how a plate of food should look like as obtained from “Promoting Fruit and Vegetable consumption around the world”:

Works Cited

Augustine, Jodi. “Sources of Glucose.” Group Health Cooperative, 2012. Web.

Chernoff, Ronnie. “Protein and older adults.” J Am Coll nutr. 23.6 (2004): n. pag. Web.

Dietary Fat. CDC, 2012. Web.

Dunford, Marie, and Andrew Doyle. Nutrition for Sports and Exercise. Belmont: Thomson Higher Education, 2008. Print.

Fruit and vegetable processing. FAO Corporate Document Repository, 1995. Web.

Nave, Carl Rod. “Glucose.” HyperPhysics. Georgia State University, 2012. Web.

Nourish-Carbohydrates Fuel Your Brain. The Franklin Institute, 2004. Web.

Promoting Fruit and Vegetable consumption around the world. WHO, 2013. Web.

Protein in diet. MedlinePlus, 2013. Web.

The Food Guide Pyramid. United States Department of Agriculture, n.d.

The Importance of Fats (Lipids). Diet-and-Health.net, n.d. Web.

Vegetables and Fruits. Harvard School of Public health, 2013. Web.

What are proteins and do they do? Genetics Home Reference, 2013. Web.