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Celiac Disease And Dermatitis Herpetiformis. Regina, Saskatchewan: Case Nutrition Consulting. 2008. pp 13.

Celiac disease is a chronic autoimmune intestinal disorder characterized by a sensitivity to specific proteins in the grains of wheat, rye, and barley; these proteins are collectively known as gluten. Dermatitis herpetiformis (DH) is another form of celiac disease, characterized by a chronic, intense burning; itchy skin; and a blistering rash. This chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. This section of the introductory chapter provides a brief overview of celiac disease and DH, including the prevalence, signs and symptoms, other associated conditions, complications, and diagnosis of each. The author reiterates that the treatment for DH is a strict gluten-free diet for life. Readers are encouraged to work closely with a dietitian when they are first diagnosed; the dietitian can help with nutritional assessment, diet education, meal planning, and assistance with social and emotional adaptation to the new gluten-free lifestyle. 14 references.

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From Trays to Tube Feedings: Overcoming the Challenges of Hospital Nutrition and Glycemic Control. Diabetes Spectrum. 21(4): 233-240. Fall 2008.

This article, from a special issue about the inpatient care of hyperglycemia, reminds readers that nutrition is one of the most complex aspects of glycemic control for hospitalized patients. The authors focus on some of the problems involved in trying to achieve the dual goals of individualization of the nutrition care plan to improve nutritional intake and incorporation of glycemic control targets. They describe creative and practical solutions used by clinicians who have faced this challenge and suggest innovative changes that may be considered as part of hospital improvement initiatives to address glycemic control. Specific recommendations include the inclusion of a registered dietitian (RD) in an interdisciplinary team focused on glycemic control; implementation of less restrictive meal-planning systems; integration of blood glucose monitoring results with nutritional care; coordination of the timing of insulin administration, blood glucose monitoring, and meal service; and ensuring adequate nutritional intake coupled with insulin therapy. Another section discusses glycemic control in patients receiving tube feeding or on total parenteral nutrition (TPN). The authors conclude that an intentional plan for matching insulin with carbohydrate intake will contribute to improvement in blood glucose in the hospital. They call for additional studies of different meal delivery systems, their impact on hospital glycemia, patient nutritional status, and the steps needed to improve patient outcomes. 3 tables. 21 references.

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Gluten-Free Diet. Regina, Saskatchewan: Case Nutrition Consulting. 2008. pp 19-72.

This lengthy chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. In this chapter, the author reviews the details of the gluten-free diet, including foods to include and foods to avoid, labeling of foods and ingredients, and special problem foods, including those with hidden gluten. The first section defines the different types of gluten found in wheat, rye, and barley and considers the controversy about including oats on the list of foods to avoid. The author reprints the position statements on oats from more than a dozen resource organizations, including the National Institutes of Health, the American Dietetic Association, and the Celiac Disease Foundation. The remainder of the chapter provides information in tabular format about the gluten-free diet by food groups, including milk and dairy, grains and starches, meats and alternatives, fruits and vegetables, soups, fats, desserts, sweets, snack foods, beverages, and condiments. Three charts provide specific information about foods that are allowed, foods that are questionable, and foods to avoid in each of the same food groups. Other topics covered include hydrolyzed vegetable protein (HVP), flavor enhancers, spices and herbs, modified food starches, maltodextrin, dextrin, glucose syrup, rice syrup, barley malt, caramel color, labeling of food and food ingredients—in both the United States and Canada—gluten-free labeling, CODEX requirements, websites about food allergen and gluten-free labeling, and food labeling considerations in Canada, Australia, New Zealand, and the European Union. 9 figures. 15 tables. 73 references.

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Introduction to the Gluten-Free Diet. Regina, Saskatchewan: Case Nutrition Consulting. 2008. pp 12.

This introductory chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. This section reviews the structure of the book and briefly summarizes each of the chapters that follow: the introduction to celiac disease, foods allowed, nutritional concerns, meal planning, gluten-free cooking, shopping, eating gluten-free at restaurants, avoiding food cross-contamination, different types of gluten-free products that are available, gluten-free food manufacturers and distributors, and resource organizations. The author notes that this book is an invaluable source of information not only for people with celiac disease, but also for family members and caregivers, dietitians, nutritionists, health educators, physicians, food manufacturers, foodservice staff members, and managers of grocery and specialty food stores.

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Nutrition and the Gluten-Free Diet. Regina, Saskatchewan: Case Nutrition Consulting. 2008. pp 73-140.

This chapter about nutrition is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. The author notes that many people with celiac disease focus on the important issue of eating only gluten-free foods but may lack information and inclusion of vital nutritional concerns in their dietary plans. This chapter covers specific dietary concerns, how to use nutritious gluten-free alternatives, guidelines for healthy eating, and the nutritional composition of a variety of gluten-free ingredients and foods. Specific nutritional concerns discussed include anemia, iron, folate, vitamin B12, bone disease, calcium, vitamin D, lactose intolerance, and dietary fiber. The author reviews nutritious gluten-free alternative grains, including amaranth, buckwheat, flax, mesquite, millet, Montina (Indian ricegrass), quinoa, sorghum, teff, and wild rice. For each, the chapter notes handling and preparation, nutritional contents, and references for additional information. The final section considers dietary guidelines for healthy eating on a gluten-free diet, including the nutrient composition of gluten-free grains, flours, starches, legumes, nuts, and seeds. References are included in each of section of the chapter. 43 tables.

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Sweet Stuff. Diabetes Forecast. 61(4): 58-61. April 2008.

This article reminds readers with diabetes of the role of carbohydrates in meal planning. Carbohydrate is the general term for starches and sugar in foods and is the component of one’s diet that has the biggest and most direct effect on blood glucose levels. The author helps readers identify those foods that have carbohydrates, including sugary foods, grains and bread, milk, beans, and some vegetables. Readers are encouraged to choose foods whose carbohydrates come in tandem with other benefits, primarily dietary fiber, vitamins, or minerals, and to avoid so-called “empty” calories. A final section describes the use of the glycemic index, a system that ranks carbohydrate foods based on their effect on blood glucose levels. One sidebar walks readers through reading a nutrition label, with an emphasis on identifying and understanding carbohydrate contents. 4 figures.

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16 Myths of a Diabetic Diet. 2nd ed. Alexandria, VA: American Diabetes Association. 2007. 259 p.

This book describes the most common myths about diabetes meal plans, where the myths originate, and how to overcome them. The authors emphasize that having diabetes does not sentence one to a life of boring meals. The book offers 16 chapters that cover medical nutrition therapy (MNT) versus the diabetic diet; the incorporation of foods that contain sugar; the role of starch and fiber; protein; dietary fats; sugar substitutes; carbohydrate counting and the glycemic index; nutrition labels on food items; diabetes and body weight; diabetes and the use of dietary supplements; the role of sodium in a healthy diet; snacks and snacking; how to incorporate exercise in a diabetes management plan; dining out with diabetes; diabetes and food cravings; and how to make favorite recipes healthier. At the end of each chapter is a short quiz for readers to test themselves on their understanding of the material being presented; the answers are in an appendix at the end of the book. A second appendix provides a description of the roles of registered dietitians and certified diabetes educators (CDEs), along with suggestions about how to locate these health care professionals. The book is illustrated with charts and figures. A subject index concludes the volume.

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2006 American Diabetes Association Nutrition Recommendations and Interventions for the Prevention and Treatment of Diabetes. Diabetes Spectrum. 20(1): 49-54. Winter 2007.

This article summarizes the guidelines as presented in the 2006 American Diabetes Association Nutrition Recommendations and Interventions for the Prevention and Treatment of Diabetes. These recommendations reaffirm the importance of medical nutrition therapy (MNT) in the prevention of diabetes, treatment of existing diabetes, and prevention and treatment of the complications of diabetes in which MNT plays a role. The authors highlight major points of emphasis in the 2006 recommendations and note changes from previous recommendations—notably, the 2002 recommendations. Topics include overweight and obesity, pre-diabetes, diabetes treatment, nutrition interventions, type 2 diabetes, pregnancy, older adults, and complications of diabetes. The authors conclude by stressing the importance of monitoring individual outcomes from MNT so that appropriate changes in the overall management plan for diabetes can be implemented. 1 table. 12 references.

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Combining Diabetes and Gluten-Free Dietary Management Guidelines. Practical Gastroenterology. 31(3): 68, 70-72, 74-76, 78-83. March 2007.

Type 1 diabetes, celiac disease, and thyroid disease are a triad of autoimmune conditions with a significant comorbidity. This article helps readers combine dietary guidelines for diabetes with those for patients following a gluten-free diet to treat their celiac disease. The authors review nutrition recommendations for diabetes management by the American Diabetes Association (ADA) for healthy meal planning, carbohydrate counting, and potential use of glycemic index or glycemic load, as well as practical tips and suggestions for making the transition to a gluten-free, diabetes meal plan. Topics include the prevalence of celiac disease (CD) in children with type 1 diabetes mellitus, screening for CD, overall goals of medical nutrition therapy (MNT) for type 1 diabetes, basic and advanced carbohydrate counting, the use of commercial gluten-free food, gluten-free flours, oats and the gluten-free meal plan, addressing weight gain, and the use of nutritional supplements. The authors conclude that a healthy eating plan for diabetes should always be individualized based on the patient’s needs and metabolic outcome goals. Regular follow-up with a dietitian specializing in both CD and diabetes is recommended. 5 tables. 18 references.

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Combining Diabetes and Gluten-Free Dietary Management Guidelines. Practical Gastroenterology. 31(3): 68-83. March 2007.

Type 1 diabetes, celiac disease, and thyroid disease are a triad of autoimmune conditions with significant comorbidity. This article helps readers combine dietary guidelines for diabetes with those for patients following a gluten-free diet to treat their celiac disease (CD). The authors review nutrition recommendations from the American Diabetes Association (ADA) for diabetes management, which include healthy meal planning, carbohydrate counting, and potential use of glycemic index or glycemic load, as well as practical tips and suggestions for making the transition to a gluten-free, diabetes meal plan. Topics include the prevalence of CD in children with type 1 diabetes mellitus, screening for CD, overall goals of medical nutrition therapy (MNT) for type 1 diabetes, basic and advanced carbohydrate counting, the use of commercial gluten-free food, gluten-free flours, oats and the gluten-free meal plan, addressing weight gain, and the use of nutritional supplements. The authors conclude that a healthy eating plan for diabetes should always be individualized based on the patient’s needs and metabolic outcome goals. Regular follow-up with a dietitian specializing in both CD and diabetes is recommended. 5 tables. 18 references.

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Diabetes Treatment, Part 1: Diet and Exercise. Clinical Diabetes. 25(3): 105-109. Summer 2007.

This article is the third in a 12-part series reviewing the fundamentals of diabetes care for physicians in training. In this entry, the author reviews the role of diet and exercise in patients with diabetes. Patients with type 1 diabetes, because of their universal need for insulin, must learn to count or at least closely estimate the amount of carbohydrate they consume to help regulate their blood glucose levels and adjust their insulin doses. Lifestyle modification in the form of diet and regular moderate exercise sharply decreases the likelihood of developing type 2 diabetes in high-risk individuals who have impaired glucose tolerance or impaired fasting glucose. The article reviews the role of lifestyle interventions, including nutrition, in the control of existing diabetes; the role of carbohydrates, protein, and dietary fat in meal planning and diet therapy; and the importance of exercise in all patients with diabetes. The author concludes by cautioning that, with many oral and injectable pharmaceutical agents available to help patients control their glucose levels, it is easy for a practitioner to overlook or forget to emphasize and reinforce the importance of lifestyle modification in the treatment of diabetes. 39 references.

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Dietary Challenge: Maximizing Bowel Adaptation in Short Bowel Syndrome. Today's Dietitian. 9(1): 40-44. January 2007.

This article discusses medical nutrition therapy (MNT), including parenteral therapy, to help patients with short bowel syndrome (SBS) maximize their bowel adaptation after surgery. The author notes that initiating parenteral nutrition (PN) therapy is easy, but it requires a skilled dietitian to wean a patient off PN and back to oral nutrition. The registered dietitian (RD) is instrumental in recommending early oral diet advancement and guiding the patient toward appropriate choices that will help maximize bowel adaptation and minimize complications. Topics include SBS and its impact on nutrition, medications, etiologies of SBS, establishing the PN prescription, dietary modification, macronutrients, oral rehydration solutions, vitamins and minerals, glutamine, growth hormone, glucagon-like peptide-2 (GLP2), and intestinal rehabilitation programs. One sidebar lists resources for addition information on oxalate content of foods, on oral rehydration solutions, and on SBS. References are available online. 2 tables.

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Diverticular Disease: Evidence for Dietary Intervention?. Practical Gastroenterology. 31(2): 38-46. February 2007.

This review considers the present evidence supporting the hypothesis that a low-fiber diet is responsible for rising trends in the incidence of diverticular disease and its complications. In addition, a high-fiber diet is thought to prevent the occurrence of symptoms in patients with diverticular disease. The author notes that most of the evidence for a causal relationship is based on observational, uncontrolled studies, and that evidence from the only two randomized controlled trials conducted to test this hypothesis is inconsistent. However, the findings from the epidemiologic observational studies have been consistent and are based on a plausible biologic explanation. The author concludes that more research is needed to test these hypotheses regarding the interplay between dietary fiber and diverticulosis. 18 references.

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Guideline 5: Nutritional Management in Diabetes and Chronic Kidney Disease [KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease]. American Journal of Kidney Diseases. 49 (2 Suppl 2): s95-s108. February 2007.

The management of diabetes and chronic kidney disease (CKD) should include nutritional intervention. In fact, dietary modifications may reduce progression of CKD. This article on nutritional management is from a special supplement to the American Journal of Kidney Diseases that presents the Kidney Disease Outcomes Quality Initiative (KDOQI) Clinical Practice Guidelines and Clinical Practice Recommendations for Diabetes and Chronic Kidney Disease. This is the first set of guidelines that considers the unique aspects of the evaluation, diagnosis, and management of the complex patient with both diabetes mellitus and CKD. The guidelines emphasize these patients’ high risk of cardiovascular disease. This article presents and discusses the fifth guideline: nutritional management in diabetes and CKD. After a brief background and rationale, the article focuses on three specific guidelines: target dietary protein intake for people with diabetes and CKD stages 1 to 4 should be the recommended dietary allowance of 0.8 grams per kilogram of body weight per day; if dietary protein is limited, an increase in carbohydrates or fats is required for adequate caloric intake, and increasing intake of omega-3 and monounsaturated fats may confer benefits on CKD; and people with diabetes and CKD should receive intervention from a specialty-trained registered dietitian that includes individualized management of multiple nutritional aspects. The article also briefly covers other related guidelines and implementation issues. The article features extensive tables that summarize the research studies used to establish the guidelines. 2 figures. 7 tables.

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Irritable Bowel Syndrome: A Natural Approach. 3rd ed. Berkeley, CA: Ulysses Press. 2007. 256 p.

This book helps readers coping with irritable bowel syndrome (IBS) use a holistic approach to manage their symptoms. The book offers six chapters that define IBS, describe the symptoms, consider the role of stress and other causes of IBS, outline antidotes to IBS, review the use of alternative medicine and IBS, and stress the importance of nutrition and dietary strategies to manage the symptoms of IBS. The solutions outlined include creative dietary alternatives and recipes, as well as methods for controlling stress. The treatments discussed include herbal medicine, stress management, relaxation exercises, yoga, and meditation. The book includes numerous charts and questions for readers to answer; it can be used like a workbook to help determine an individual course of action. The author defines many related terms to help patients with IBS understand their physicians and the language they are using during diagnostic and treatment visits. The book helps readers understand the anatomy and function of the gastrointestinal tract and how it reacts to psychological stress. The range of options discussed in the book has two underlying themes about adequate relief of IBS symptoms: A realistic acceptance of the goals of therapy is needed, and patients can do a lot to help themselves. Appended to the six chapters are a list of resources and a subject index.

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Management Of Dialysis Patients With Celiac Disease. Practical Gastroenterology. 31(6): 70-72, 77-82. June 2007.

This article addresses the management of patients with celiac disease who are on dialysis for kidney disease. Celiac disease is characterized by inflammation of the small intestine and, in some patients, malabsorption after the ingestion of gluten. Celiac disease is managed by lifelong adherence to a gluten-free diet, primarily the avoidance of wheat and some other grains. Kidney disease is manifested by fluid and electrolyte imbalances, which also involves lifelong dietary restrictions. The author reviews the dietary guidelines for each of these diseases and offers strategies for successfully combining them in patients with both diseases. Topics include malnutrition, potassium, fluid and sodium, renal bone osteodystrophy, phosphorus, and common medications of dialysis patients. The author concludes by noting that, with careful instruction, patients can become very adept at combining the restrictions of both of these diets. 4 tables. 9 references.

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Management of Dialysis Patients with Celiac Disease. Practical Gastroenterology. 31(6): 70-72, 77-80, 82. July 2007.

This article considers the management of dialysis patients who also have celiac disease, a condition of gluten intolerance. The author notes that these two diseases are not often reported in the same patient, but celiac disease is sometimes listed as one of the associated diseases of IgA nephropathy. There are no written guidelines for managing these combined diseases, because of the rarity of their co-occurrence, or perhaps because they are underdiagnosed. Celiac disease is characterized by inflammation of the small intestine and malabsorption after the ingestion of gluten; thus, celiac disease is managed by life-long avoidance of gluten in the diet. Kidney disease is manifested by fluid and electrolyte imbalance, which also involves life-long dietary restrictions. This article reviews the renal dietary guidelines and provides suggestions on how to combine those guidelines with the required changes to manage celiac disease. Specific topics include malnutrition, potassium, fluid and sodium, renal bone osteodystrophy, phosphorus, common medications of dialysis patients, and socioeconomic considerations. One table provides a renal and gluten-free diet in a chart format. 4 tables. 9 references.

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Medical Nutrition Therapy and Diabetes. IN: Beaser, R.S., ed. Joslin’s Diabetes Deskbook: A Guide For Primary Care Providers. 2nd ed. Boston, MA: Joslin Diabetes Center. 2007. pp 81-126.

This chapter on medical nutrition therapy (MNT) is from a book that gives primary care providers a comprehensive overview of diabetes care. After a definition of MNT, the chapter reviews the recommended clinician’s approach to MNT; the background of using nutrition therapy; quantities and types of foods; carbohydrates, including the glycemic index, carbohydrate content of foods, carbohydrate metabolism, and dietary fiber; protein; dietary fat; sweeteners, including nutritive and non-nutritive sweeteners; vitamins, minerals, and supplements; sodium; the timing of eating; obesity; weight loss; initiating MNT, including the role of the dietitian; patient assessment and the nutrition prescription; meal planning, including healthy eating guidelines, preplanned menus, food choice lists, carbohydrate counting, and the need for carbohydrate counting in patients who use an insulin pump; evaluation of the success of a nutrition plan; food labels; so-called “dietetic” foods; alcohol; vegetarian diets; fasting; and record keeping. The authors stress that the primary challenge is to translate scientifically-based nutritional recommendations into practical daily eating guidelines. Proper adherence to a nutrition program for a person with type 2 diabetes can help reduce the number of medications and the dosage needed to control glucose levels, as well as reduce other problems such as dyslipidemia and hypertension. A nutrition program geared toward calorie reduction can help with weight loss, along with improved glycemic control. 2 appendices. 1 figure. 2 tables.

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Nutritional Assessment in Inflammatory Bowel Disease: Application of Nutrition Strategies to the Management of the Difficult Crohn's Patient. American Journal of Gastroenterology. 102: S88-S93. 2007.

This article reviews the nutritional assessment and medical nutrition therapy (MNT) of patients with Crohn’s disease, a type of inflammatory bowel disease (IBD). The author notes that patients with Crohn’s disease tend to slip into nutritional problems over the course of time, so nutritional deficits may develop slowly and without apparent symptoms. In addition, there is a lack of research data on nutritional concerns in this patient population. Assessment of these patients should include an evaluation of the length and health of the remaining bowel and address factors that may compromise nutritional health. The use of MNT can complement drug therapy used for these patients. The author reviews the changes in modern nutritional assessment, using lessons gained from caring for patients with massive small bowel resection, and then outlines the recommended steps for nutritional assessment of the patient with Crohn’s disease: evaluate nutritional status, evaluate the length and health of the remaining bowel, evaluate potential for gut anatomy, and predict micronutrient deficiencies. The rest of the article discusses the management strategies that can be used to control symptoms, including defining diarrhea, diet therapy, the use of specialized nutritional formulas, and pharmacologic therapy used to complement nutrition strategies. 25 references.

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Symptoms of IBS. IN: Nicol, R.. Irritable Bowel Syndrome: A Natural Approach. 3rd ed. Berkeley, CA: Ulysses Press. 2007. pp 24-48.

This chapter is from a book that helps readers coping with irritable bowel syndrome (IBS) use a holistic approach to manage their symptoms. This chapter describes the symptoms of IBS, focusing on the typical diagnostic tests that may be used to confirm the disorder and outlining some of the medical treatments in current use. The author provides a list of questions doctors may ask during the diagnostic process. Diagnostic tests described include rectal examination, blood tests, sigmoidoscopy, barium enema, and small intestine biopsy. Treatments discussed include antispasmodics, bulk-forming agents, antidepressants, motility drugs, peppermint oil capsules, and strategies to use for longer term symptoms that can alleviate the need for drugs. The author lists warning symptoms that should trigger a visit to a health care provider. The author provides guidelines for lifestyle and nutritional changes that can assist with problems of abdominal pain, gas pain, constipation, and diarrhea; separate sections discuss each type of IBS. A final section cautions readers about the problems with chronic overuse of laxatives.

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What I Need to Know About Eating and Diabetes. Bethesda, MD: National Diabetes Information Clearinghouse. 2007. 45 p.

This booklet helps people with type 1 or type 2 diabetes understand their disease and learn how to take care of themselves and their diabetes with healthy eating. Written in nontechnical language, the booklet covers blood glucose levels; diabetes medications, including insulin, and the recommended timing for medications and meals; the role of physical activity; the diabetes food pyramid; coping with low blood glucose, also known as hypoglycemia; determining a good level of caloric intake; starches; vegetables; fruits; milk; meat, meat substitutes; fats and sweets; alcoholic drinks; meal planning; measuring food portions; and coping with sick days. The sections on specific food types include suggestions for portion control, food preparation techniques, and shopping. The booklet includes spaces for readers to individualize information for their own situation and goals. The booklet offers ideas on where to find additional information about diabetes and self-care. A final section briefly summarizes the activities of the National Diabetes Information Clearinghouse. The booklet is illustrated with black-and-white line drawings and simple graphics of food items. 30 figures. 7 tables.

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What is Irritable Bowel Syndrome? IN: Nicol, R. Irritable Bowel Syndrome: A Natural Approach. 3rd ed. Berkeley, CA: Ulysses Press. 2007. pp 1-23.

This chapter is from a book that helps readers coping with irritable bowel syndrome (IBS) use a holistic approach to manage their symptoms. This first chapter describes and defines IBS, discusses who gets IBS, the symptoms of this condition, the possible causes of IBS, diagnostic approaches that may be used to help confirm the disorder, the interplay between psychological factors and physical symptoms, the terminology that can be used, the physiology of the digestive tract, and the process of digestion. The author defines many related terms to help patients with IBS understand their physicians and the language they are using during diagnostic and treatment visits. A glossary of common terms used in the assessment and diagnosis of IBS is included in this chapter.

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Achieving a Healthy Body Weight: Diet And Exercise Interventions for Type 2 Diabetes. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 43-56.

This chapter about diet and exercise interventions for type 2 diabetes is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors stress that the need to deal with the current obesity epidemic by restoring optimal body mass and composition is well-recognized for all segments of the adult population but is particularly critical for individuals with type 2 diabetes. The risk to mortality posed by obesity is greatly enhanced by the coexistence of diabetes; moreover, diabetes treatment can interfere with the ability to achieve and maintain a healthy body mass. The authors begin by reviewing the healthy benefits of diet and exercise, including the prevention and management of disease, and then outline indications and goals for the lifestyle interventions of weight-reduction diets and exercise. The weight-reduction diet section considers indications and body weight goals for optimal health, calorie-reduction diets, low-fat diets, low-carbohydrate and other nontraditional dietary approaches, and overall diet composition. The exercise intervention section reviews aerobic exercise, resistance training, and combination training. The authors conclude that the potential benefits of weight loss in obesity are remarkable, having few negative side effects and providing a number of indirect benefits, such as improved self-esteem and sense of control, in addition to improvements in health and mortality. The chapter includes black-and-white illustrations and a lengthy list of references. 2 tables. 56 references.

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Carbohydrate Counting: Description and Resources. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. . Boca Raton, FL: CRC Press. 2006. pp 117-123.

Carbohydrate counting is one of several meal planning approaches that can be used for diabetes management. This chapter on carbohydrate counting is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The author notes that the term carbohydrate counting encompasses two meal-planning approaches with different levels of complexity: basic carbohydrate counting and advanced carbohydrate counting. The author describes each of these approaches and discusses the process of building a personal food database. The remainder of the chapter considers resources for carbohydrate and nutrition information, including books, restaurant foods, online information from web sites, downloadable data, cookbooks that use carbohydrate counting, professional resources for teaching carbohydrate counting, and consumer books, including materials on the exchange list system. 3 tables. 7 references.

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Celiac Disease and Dermatitis Herpetiformis. IN: Gluten-Free Diet: A Comprehensive Resource Guide. Expanded Edition. Regina, Saskatchewan: Case Nutrition Consulting. 2006. pp. 15-18.

Celiac disease is a chronic autoimmune intestinal disorder characterized by a sensitivity to specific proteins in the grains of wheat, rye, and barley; these proteins are collectively known as gluten. Dermatitis herpetiformis is another form of celiac disease, characterized by a chronic intense burning, itchy skin, and blistering rash. This chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. This first section of the book provides a brief overview of celiac disease and dermatitis herpetiformis, including the prevalence, signs and symptoms, other associated conditions, complications, and diagnosis of each. 1 table. 14 references.

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Celiac Disease and Type 1 Diabetes. IN: Pediatric Diabetes: Health Care Reference and Client Education Handouts. Chicago, IL: American Dietetic Association. 2006. pp. 33-34.

Celiac disease is an autoimmune disorder characterized by sensitivity to the gliadin fraction of wheat gluten and similar molecules from wheat, rye, barley, and cross-contaminated oats, causing damage to the intestinal epithelium. This chapter on celiac disease and type 1 diabetes is from a resource book that provides health-care professionals with practical, age-appropriate diabetes self-management and nutrition education materials for children and adolescents with type 1 and 2 diabetes. The author notes that individuals with established celiac disease are at greater risk of developing other endocrine disorders, such as type 1 diabetes, thyroid disease, and autoimmune polyglandular syndromes. Growth, bone metabolism, and fertility can also be affected in individuals with celiac disease. The author discusses the interplay of diabetes and celiac disease, noting that the only treatment for celiac disease is adherence to a lifelong, gluten-free diet. The chapter includes specific counseling suggestions for dietitians working with clients who are following both a diabetes meal plan and a gluten-free diet. 11 references.

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Dietary Nutritional Recommendations for Patients with Dumping Syndrome (Rapid Gastric Emptying). Digestive Health Matters. 15(02): 15 p. Summer 2006.

This article presents dietary and nutritional recommendations for patients who are coping with dumping syndrome, or rapid gastric emptying. Dumping syndrome is a collection of symptoms that occur when food is emptied too quickly from the stomach, filling the small intestine with undigested food that is not adequately prepared to permit efficient absorption of nutrients in the small intestine. Dumping syndrome is most common in patients who have undergone gastrectomy, the surgical removal of part or all of the stomach. The author reviews the symptoms and diagnosis of the condition and notes that dietary therapy is usually the initial line of treatment. Guidelines include eating smaller, more frequent meals; choosing foods that are already less solid, such as hamburger rather than steak; limiting fluid consumption during meals; avoiding nutrient-rich drinks; eating fewer simple sugars; eating more complex carbohydrates and foods high in soluble fiber; increasing the amount of dietary fats and protein; and trying lactose-free milk. The author emphasizes that most patients have relatively mild symptoms and respond well to dietary changes. A brief final section reviews some of the medications that may also be recommended for patients with rapid gastric emptying.

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Dietary Reference Intakes: What Are They and What do They Mean?. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 55-62.

This chapter about Dietary Reference Intakes (DRIs) is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders of the stomach, intestines, liver, pancreas, and colon, as well as other diseases that affect the gastrointestinal (GI) tract. The author explains that DRIs are a set of nutrient reference values that have been developed for individuals at specific ages and life stages by the Food and Nutrition Board of the Institute of Medicine, the National Academies of Sciences, and Health Canada. DRIs are quantitative recommendations for planning and evaluating the diets of healthy people. The chapter discusses the importance of DRIs in the field of gastroenterology; categories of DRI reference values; DRI definitions and how the values are derived, covering recommended dietary allowances (RDAs), adequate intake, estimated energy requirement (EER), estimated average requirement (EAR), acceptable macronutrient distribution ranges, and tolerable upper level of intake; the use of DRIs in assessing and planning for individuals and groups; adjustments in DRIs for people who are ill; RDAs and adequate intake suitable for obese as well as normal-weight persons; and nutrition requirements for hospitalized patients. 18 references.

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Dietary Treatment of Gastrointestinal Diseases. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 63-76.

This chapter about the dietary treatment of gastrointestinal (GI) diseases is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the GI tract. The author defines medical nutrition therapy (MNT) as diet modification, nutrient supplementation, nutrition support, and nutrition counseling as modes of therapy for disease. The chapter focuses on dietary modifications that are used to treat hospitalized or ambulatory patients with diseases of the mouth, esophagus, stomach, intestine, liver, and pancreas. The chapter covers modifications in consistency, including the clear liquid diet, the soft low-residue diet, mechanically altered diets, and the liquid diet following oral surgery; a diet for gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD); a diet following gastrectomy, including dietary modifications for dumping syndrome, and those for gastric bypass or gastric stapling for obesity; a diet for lactose intolerance or hypolactasia; a gluten-restricted diet for celiac disease; MNT for inflammatory bowel disease (IBD), including Crohn’s disease and ulcerative colitis, and the role of foods or dietary patterns in the etiology of IBD; a diet for ileostomy and colostomy; a diet for short bowel syndrome; a diet for acute and chronic pancreatitis; a diet to control diarrhea; a diet for constipation and diverticulosis; and sodium and protein restricted diets for liver disease, including concerns about ascites and sodium intake, and the use of protein restriction and branched chain amino acid formulas in patients with chronic liver disease and hepatic encephalopathy. The author concludes by cautioning that these diets should be used with moderation, particularly when they do not provide all nutrients. They may exacerbate existing nutrition problems and malabsorption, altered metabolism, and increased secretory losses of nutrients. 4 tables. 95 references.

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Eating for Optimal Health. PKD Progress. 21(2): 12-13, 24. Summer 2006.

This article reviews the use of dietary modifications to help slow the progression of polycystic kidney disease (PKD). Written primarily for newly-diagnosed patients with PKD who are not yet on dialysis, the article discusses lifestyle and dietary tips that are recommended to help patients stay as healthy as possible. These tips are: reduce stress, avoid inflammation in the kidney, use plant-based proteins that are high in antioxidants, incorporate soybeans in the diet, choose low-sodium foods and condiments, limit caffeine and alcohol, increase potassium consumption, include omega-3 fatty acids in the diet, consume high-fiber carbohydrates, maintain an optimal weight, and limit dietary fat intake. The author reminds readers that all of these recommendations are useful to improve anyone’s health, not just the family member with PKD. Readers are also encouraged to start slowly and to incorporate changes into their overall program of nutrition and health.

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Eight New Ways to Triumph Over the GF Diet. Gluten-Free Living. 11(1): 12-14, 23-24. Spring 2006.

This newsletter article offers eight strategies for a new approach to following a gluten-free diet. Designed primarily for those readers newly-diagnosed with celiac disease (gluten intolerance), the article emphasizes the role of a positive attitude that recognizes that following a gluten-free diet is not a punishment but instead a way to quickly return to health. The author lists eight ideas: emphasize the positive, find out what is allowed first, avoid all processed foods (where gluten may be hard to detect), focus by first eliminating the larger obvious categories of foods that contain gluten (do not obsess about the smaller potential problems like medications), investigate ingredients, deal with contradictions and misinformation, do not blame all gastrointestinal upset to missed gluten in the diet, and do not neglect nutrition. The article concludes by encouraging readers to educate themselves and to work closely in tandem with their health care providers, including a dietitian who has expertise in celiac disease.

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Evidence-Based Nutrition Practice: Gluten-Free Diets. Today’s Dietitian. 8(6): 12-17. June 2006.

This article explains the use of evidence-based nutrition practice when applied to gluten-free diets (GFD). Evidence-based practice is a multistep, dynamic process of patient care that combines the best research evidence with experienced clinical judgment. The author uses the current controversy about the inclusion or exclusion of oats and wheat starch in gluten-free diets as an example of how evidence evaluation can affect dietetic practice. The author discusses evidence analysis, developing practice guidelines, the need for guidelines, evidence-based medicine (EBM) versus traditional medicine, and strategies for incorporating EBM guidelines into daily practice. The author concludes by encouraging readers to use EBM but to individualize any guidelines for each patient. Clinicians must integrate the research evidence with their clinical expertise and then apply it individually to each patient. Evidence-based decisionmaking requires consumers to understand their diagnosis and be involved in making decisions about the treatment options available to them. The article concludes with a post-test with which readers can qualify for continuing education credits. References.

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Gallstone Disease: Primary and Secondary Prevention. Best Practice & Research Clinical Gastroenterology. 20(6): 1063-1073. 2006.

This article reviews the primary and secondary prevention of gallstone disease. The authors first explore several risk factors for cholesterol gallstone formation, including prolonged fasting, rapid weight loss, total parenteral nutrition (TPN), and somatostatin treatment. In both asymptomatic and symptomatic gallstone patients, it has been claimed that treatment with the hydrophilic bile salt ursodeoxycholic acid (UDCA) reduces the risk of biliary colic and gallstone complications such as acute cholecystitis and acute pancreatitis. Prophylactic cholecystectomy may be beneficial in certain subgroups of asymptomatic gallstone carriers. The authors stress that randomized, double-blind, placebo-controlled trials that could support these contentions are lacking. However, in the general population, high fiber intake, low saturated fatty acid consumption, and nut consumption are associated with reduced risk of gallstones. Also, moderate physical activity appears to prevent gallstones. 3 tables. 95 references.

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Gluten-Free Diet. IN: Gluten-Free Diet: A Comprehensive Resource Guide. Expanded Edition. Regina, Saskatchewan: Case Nutrition Consulting. 2006. pp. 19-72.

This lengthy chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. In this chapter, the author reviews the details of the gluten-free diet itself, including foods to include and foods to avoid, labeling of foods and ingredients, and special problem foods. The first section defines the different types of gluten found in wheat, rye, and barley, and considers the controversy over whether or not oats should be included on the list of foods to avoid. The author reprints the position statements on oats from over a dozen resource organizations, including the National Institutes of Health, the American Dietetic Association, and the Celiac Disease Foundation. The remainder of the chapter provides information in tabular format on the gluten-free diet by food groups, including milk and dairy, grains and starches, meats and alternatives, fruits and vegetables, soups, fats, desserts, sweets, snack foods, beverages, and condiments. Three more charts provide specific information about foods that are allowed, foods that are questionable, and foods to avoid in each of the same food groups. Other topics covered include hydrolyzed vegetable protein (HVP), flavor enhancers, spices and herbs, modified food starches, maltodextrin, dextrin, glucose syrup, rice syrup, barley malt, caramel color, labeling of food and food ingredients—in both the United States and Canada—gluten-free labeling, websites on food allergen and gluten-free labeling, and considerations for labeling in Canada, Australia, and the European Union. 9 figures. 15 tables. 53 references.

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Gluten-Free Diet: A Comprehensive Resource Guide. Expanded Edition. Regina, Saskatchewan: Case Nutrition Consulting. 2006. 335 p.

This book is designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. The first section provides a brief overview of celiac disease and dermatitis herpetiformis, including the prevalence, signs and symptoms, other associated conditions, complications, and diagnosis; a list of references for additional information is also included. The book continues with eight chapters that cover the gluten-free diet itself, including foods to include and foods to avoid, labeling of foods and ingredients, and special problem foods; nutritional considerations, including anemia, vitamins and minerals, dietary fiber, and nutritious gluten-free alternative grains; meal planning, including a sample 7-day gluten-free menu; gluten-free cooking, notably substitutions for wheat flour and general baking hints; eating away from home; gluten-free shopping; the problem of cross-contamination; and the different types of gluten-free products that are available for purchase. Two additional chapters list the companies and distributors of gluten-free foods, and resources for people who are following a gluten-free diet, including organizations, research and treatment centers, cooking resources, travel and eating out resources, children's resources, diabetes and celiac disease resources, allergy concerns, and pharmaceutical resources. A subject index concludes the volume.

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Healthy Eating. IN: Mensing, C., ed. Art and Science of Diabetes Self-Management Education. Chicago, IL: American Association of Diabetes Educators. pp. 652-668.

Healthy eating is an effective, but challenging, self-care behavior that improves glycemic control in people with diabetes. This chapter on healthy eating is from a comprehensive text that serves as a resource for all health professionals, community professionals, and individuals who provide education to individuals with diabetes. The author describes how healthy eating behaviors can be supported by well-designed diabetes nutrition self-management education (DSME) that uses the Nutrition Care Process and Nutrition Practice Guidelines. While the goals of medication nutrition therapy (MNT) apply to everyone with or at risk for diabetes, the individual’s circumstances must always be considered. The nutrition issues are different depending on if the goals is diabetes prevention or treatment and if the disease is type 1 or type 2 diabetes. Readers are encouraged to use an individualized and comprehensive nutrition assessment to match the appropriate meal planning resources to the needs of the person with diabetes. The author concludes by discussing current controversies and trends in healthy eating for diabetes, including the use of the glycemic index, complementary and alternative therapies for diabetes, new methods of delivering DSME, and the expanded role of diabetes educators in addressing healthy eating not only for diabetes itself, but also for its comorbidities. The chapter includes a list of key points, a summary of teaching strategies, case studies, suggested Internet resources, a glossary of key terms, and a list of references. 3 tables. 49 references.

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Heart Health and Celiac Disease. Practical Gastroenterology. 30(12): 70-81. December 2006.

People who have been diagnosed with celiac disease, or gluten intolerance, must follow a gluten-free diet for life. A person with celiac disease may feel entitled to eat anything gluten-free, even if the food item is high in fat, sugar, and calories, in an attempt to compensate for the restrictions of the gluten-free diet. This article considers the need for early cardiovascular risk identification and preventive nutrition efforts in this patient population. Advice for individuals with celiac disease follows public policy initiatives and programs such as the National Cholesterol Education Program and the Dietary Guidelines for Healthy Americans. Topics include risk factors for coronary heart disease, saturated and transaturated fats, applying heart-healthy diet principles to a gluten-free diet, meal planning, food choices, dietary fiber, antioxidants and phytochemicals, and reading nutrition labels on food items. The authors conclude that individualized assessment of cardiovascular risk, maintenance of gluten-free diet principles, and appropriate addition of heart-healthy diet recommendations are critical to successful nutrition intervention, often requiring consultation with a registered dietitian. 8 tables. 15 references.

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How Can I Follow My Diabetic and Renal Diet Restrictions?. Kidney Beginnings. 5(2): 22-23, 28-29. June 2006.

Nutrition and proper diet play an important role in the care of patients with diabetes and those with chronic kidney disease (CKD). Unfortunately, many people have both of these chronic diseases and are left to balance the dietary and nutritional recommendations for each. This article helps readers understand the basics of medical nutrition therapy for diabetes and CKD. The author begins with a review of diabetes recommendations, focusing on carbohydrate counting and the importance of learning about proper portion size. The article lists recommended foods and then lists foods that should be avoided or limited, especially for people on both a diabetic and renal diet. The author reminds readers that following a healthy diet can help control blood sugar, potassium, sodium, and phosphorus levels.

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Introduction to the Gluten-Free Diet: A Comprehensive Resource Guide. IN: Gluten-Free Diet: A Comprehensive Resource Guide. Expanded Edition. Regina, Saskatchewan: Case Nutrition Consulting. 2006. pp. 13-14.

This introductory chapter is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. This section reviews the structure of the book and briefly summarizes each of the chapters that follow: the introduction to celiac disease, foods allowed, nutritional concerns, meal planning, gluten-free cooking, shopping, and resources. The author notes that this book is an invaluable source of information not only for people with celiac disease, but also for family members and caregivers, dietitians, nutritionists, health educators, physicians, food manufacturers, food-service staff members, and managers of grocery and specialty food stores.

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Macronutrient Digestion, Absorption, and Metabolism. IN: Buchman, A., ed. Clinical Nutrition in Gastrointestinal Disease. Thorofare, NJ: Slack Incorporated. 2006. pp 77-98.

This chapter about macronutrient digestion, absorption, and metabolism is from a comprehensive textbook that compiles available data, clinical experience, and research on the role of nutrition in the management of patients with disorders that affect the gastrointestinal (GI) tract. The authors describe how the absorptive epithelium of the GI tract serves the dual purpose of providing a barrier that impedes the free passage of ingested toxins and pathogens to the systemic circulation, while digesting and then absorbing ingested nutrients required for life. The primary site of macronutrient absorption is the small intestine. The chapter covers carbohydrate digestion, absorption, and metabolism, including intestinal monosaccharide absorption, regulation of monosaccharide transport, and the assimilation of resistant starch and dietary fiber; protein digestion, absorption, and metabolism, including intestinal peptide and amino acid absorption; and lipid digestion, absorption, and metabolism, including dietary triglyceride digestion, dietary phospholipid and cholesterol ester digestion, intraluminal formation of mixed micelles, intestinal fatty acid absorption, intestinal sterol absorption, intestinal phospholipid absorption, enterocyte lipid metabolism, and enterocyte lipoprotein synthesis. 6 figures. 2 tables. 237 references.

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Management of Obesity-Associated Type 2 Diabetes. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 205-226.

This chapter about the management of obesity-associated type 2 diabetes is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors first consider pathophysiology, discussing the effects of diet on subjects at risk for the development of obesity-induced diabetes mellitus type 2. Both animal studies and human studies focusing on dietary fats and carbohydrates are covered. The remainder of the chapter presents strategies for the nutritional and pharmacologic management of patients with obesity-associated type 2 diabetes. Specific diets described include low-fat diets, modified fat/high monounsaturated fatty acid (MUFA) diets, low-carbohydrate diets, and high-protein diets. Drugs discussed include insulin and oral hypoglycemic agents, including biguanides, sulfonylureas, and thiazolidinediones. The authors conclude that, even as evidence may build in support of individual macronutrient effects on glycemia or weight loss, it is still vital to emphasize the overarching principle of caloric restriction. The chapter includes black-and-white illustrations and a lengthy list of references. 1 figure. 3 tables. 48 references.

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Management of Obesity-Associated Type 2 Diabetes. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 205-225.

This chapter about the management of obesity-associated type 2 diabetes is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors first consider pathophysiology, discussing the effects of diet on subjects at risk for the development of obesity-induced diabetes mellitus type 2. Both animal studies and human studies focusing on dietary fats and carbohydrates are covered. The remainder of the chapter presents strategies for the nutritional and pharmacologic management of patients with obesity-associated type 2 diabetes. Specific diets described include low-fat diets, modified fat/high monounsaturated fatty acid (MUFA) diets, low-carbohydrate diets, and high-protein diets. Drugs discussed include insulin and oral hypoglycemic agents, including biguanides, sulfonylureas, and thiazolidinediones. The authors conclude that, even as evidence may build in support of individual macronutrient effects on glycemia or weight loss, emphasizing the overarching principle of caloric restriction is still vital. The chapter includes black-and-white illustrations and a lengthy list of references. 1 figure. 3 tables. 48 references.

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Medical Nutrition Therapy for Patients with Type-2 Diabetes. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. . Boca Raton, FL: CRC Press. 2006. pp. 81-103.

This chapter on medical nutrition therapy (MNT) for patients with type 2 diabetes is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors stress that nutritional recommendations for diabetes should be based on scientific knowledge, taking into account individual, cultural, and ethnic circumstances and preferences. They discuss the goals and components of MNT and outline specific components of MNT for type 2 diabetes, including caloric restriction, dietary carbohydrate, dietary fiber, dietary protein, dietary fats, alcohol intake, micronutrient intake, and the use of nonsucrose sweeteners. The chapter covers the food pyramid, using exchange lists, diet and diabetes prevention trials, specific diets for people with diabetes, and the synchronization of the diet with medications in type 2 diabetes mellitus. Specific diets reviewed include the Atkins diet, the South Beach diet, the glycemic index, the Zone diet, and the very low-fat/high-carbohydrate diet. The authors conclude that the ideal components of a diet for the person with type 2 diabetes are no different than those for all Americans: primarily, to maintain or attain a healthy weight and increase physical activity to 30 to 90 minutes per day; to consume a total of nine servings of fresh fruit and vegetables; to consume approximately six to nine servings of grains, half of which must be whole grains; and limit saturated fats and eliminate trans-fats. 1 figure. 5 tables. 143 references.

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Metabolic Syndrome: Recognition, Etiology, And Physical Fitness as a Component. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. . Boca Raton, FL: CRC Press. 2006. pp 57-78.

This chapter about the metabolic syndrome is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The authors describe the metabolic syndrome as a clustering of metabolic abnormalities associated with increased risk of cardiovascular disease, diabetes, and hypertension. They provide an overview of current controversies with the definition of the metabolic syndrome, review cross-sectional studies of the importance of physical fitness and exercise to the diagnosis and etiology of metabolic syndrome, and then focus on exercise training and its impact on individual components of the metabolic syndrome, including blood pressure, triglycerides, HDL cholesterol, fasting plasma glucose, insulin sensitivity, and waist circumference. A final section provides the rationale for using cardiorespiratory fitness as a monitoring measurement in metabolic syndrome. The chapter includes black-and-white illustrations and a lengthy list of references. 3 figures. 4 tables. 89 references.

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Nonsurgical Management of Obesity. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. . Boca Raton, FL: CRC Press. 2006. pp 99-109.

This chapter about the nonsurgical management of obesity is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The author first defines obesity and considers the relationship between obesity and diabetes and then reviews the challenges of lifestyle changes in the management of obesity. A brief discussion of the role of exercise and the role of pharmaceutical intervention in the management of obesity is provided. The author concludes by reminding physicians that some patients may have to do much more than others to maintain a healthy weight. Adherence to diet and exercise can be difficult and restrictive. This results in both patients and physicians frequently abandoning dietary interventions in favor of medications and even surgery, despite the many adverse effects and complications, as well as cost, inherent to these therapies. The chapter includes black-and-white illustrations and a lengthy list of references. 2 tables. 51 references.

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Nonsurgical Management of Obesity. IN: Opara, E., ed. Nutrition and Diabetes: Pathophysiology and Management. Boca Raton, FL: CRC Press. 2006. pp 99-109.

This chapter about the nonsurgical management of obesity is from a textbook that highlights the link between the problems of obesity and diabetes mellitus. The author first defines obesity and considers the relationship between obesity and diabetes and then reviews the challenges of lifestyle changes in the management of obesity. A brief discussion of the role of exercise and of pharmaceutical intervention in the management of obesity is provided. The author concludes by reminding physicians that some patients may have to do much more than others to maintain a healthy weight. Adherence to diet and exercise can be difficult and restrictive. This results in both patients and physicians frequently abandoning dietary interventions in favor of medications and even surgery, despite the many adverse effects and complications, as well as cost, inherent to these therapies. The chapter includes black-and-white illustrations and a lengthy list of references. 2 tables. 51 references.

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Nutrition and the Gluten-Free Diet. IN: Gluten-Free Diet: A Comprehensive Resource Guide. Expanded Edition. Regina, Saskatchewan: Case Nutrition Consulting. 2006. pp. 73-126.

This chapter on nutrition is from a book designed to provide practical information, in an easy-to-access format, about celiac disease and the gluten-free diet that is used to manage the disease. The author notes that many people with celiac disease focus on the important issue of eating only gluten-free foods, but may lack information and inclusion of nutritional concerns, which are also vital. This chapter covers specific dietary concerns, how to use nutritious gluten-free alternatives, guidelines for healthy eating, as well as the nutritional composition of a variety of gluten-free ingredients and foods. Specific nutritional concerns discussed include anemia, iron, folate, vitamin B12, bone disease, calcium, vitamin D, lactose intolerance, and dietary fiber. The author reviews nutritious gluten-free alternative grains, including amaranth, buckwheat, flax, mesquite, millet, Montina (Indian ricegrass), quinoa, sorghum, teff, and wild rice. For each, the chapter notes handling and preparation, nutritional contents, and references for additional information. The final section considers dietary guidelines for healthy eating on a gluten-free diet. References are included in each of the sections of the chapter. 43 tables.

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Nutrition and Type-1 Diabetes Mellitus. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 105-116.

This chapter on nutrition and type 1 diabetes is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The author notes that even the most basic questions about diet and glucose management are subject to controversy. Patients must be taught to balance the glucose derived from foods they eat with the exogenous insulin they administer. The author uses the limited scientific data and clinical experience available to establish nutritional strategies for controlling glucose levels in patients with type 1 diabetes. Topics include insulin regimens, modern diabetes management, carbohydrate counting, the glycemic index, glycemic load, protein, fiber, sugar, dietary fats, getting started, the consequences of improved metabolic control, and the use of continuous glucose monitoring systems to evaluate dietary management. The author concludes that continuous glucose monitoring is the best way to understand the relationship between an individual’s diet, insulin, and exercise lifestyle. 2 tables. 50 references.

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Nutrition for Early Chronic Kidney Disease in Adults. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 4 p.

This fact sheet describes nutrition considerations for adults with early chronic kidney disease (CKD). In CKD, the kidneys continue to work, but they are not as efficient as when they are fully healthy. Wastes may build up so gradually that the body even becomes used to that condition. Salts containing phosphorus and potassium may rise to unsafe levels, causing heart and bone problems. Anemia is often present. The fact sheet reviews some of the common causes of CKD, including diabetes; high blood pressure, also called hypertension; or both. The fact sheet also defines medical nutrition therapy (MNT), a term used when treatment for a medical condition includes nutrition advice. Brief suggestions for healthier eating for readers with diabetes and high blood pressure are provided. One section reminds readers of the importance of keeping track of test results and dietary approaches to help determine how foods may affect the kidneys. The fact sheet concludes with a description of the Chronic Renal Insufficiency Cohort study, which is studying the risk factors for rapid decline in kidney function and development of cardiovascular disease. Readers are referred to three resource organizations for more information: American Kidney Fund at www.kidneyfund.org or 1–800–638–8299, Life Options Rehabilitation Resource Center at www.lifeoptions.org or 1–800–468–7777, and the National Kidney Disease Education Program at www.nkdep.nih.gov or 1–866–454–3639. The fact sheet provides a brief summary of the work of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC), a service that provides information about diseases of the kidneys and urologic system to patients and their families, the general public, and health care professionals. Five fact sheets and brochures are also recommended.

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Nutrition for Later Chronic Kidney Disease in Adults. Bethesda, MD: National Kidney and Urologic Diseases Information Clearinghouse. 2006. 8 p.

This fact sheet reviews nutritional needs and approaches for patients with chronic kidney disease (CKD), the permanent loss of kidney function. The fact sheet emphasizes that patients can prevent or delay health problems from CKD by eating the right foods and avoiding foods high in phosphorus, potassium, and sodium. Protein foods such as meat and dairy products break down into nitrogen and creatinine, waste products that healthy kidneys remove from the blood. The fact sheet reviews caloric intake, protein, portion control, medical nutrition therapy (MNT), dietary fats, sodium, potassium, phosphorus, fluids, and recordkeeping. In each section, the fact sheet explains why foods might need to be restricted and offers specific suggestions for incorporating changes into the diet. The fact sheet concludes with a summary of research programs in this area, a list of resource organizations for readers wanting additional information, and a brief description of the activities of the National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). 5 tables.

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Nutrition Strategies for Managing Diarrhea. Digestive Health Matters. 15(2): 6-7. Summer 2006.

Persistent or recurring diarrhea is a symptom of many different digestive disorders. This article presents nutrition strategies that may be useful for readers coping with mild, short-term diarrhea. Readers are advised to consult a physician to obtain a diagnosis and specific treatment for more serious diarrhea. The author discusses the role of diet, certain foods that may produce loose stools, dietary supplements that can worsen symptoms, and foods and supplements that may help to control diarrhea. Each section lists specific foods and supplements. The author concludes by summarizing the general recommendations: identify foods and fluids that cause problems for the individual, drink adequate fluids apart from meal times, include foods with sodium and potassium, and eat less and more often.

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Nutritional Strategies for Patients with Obesity and the Metabolic Syndrome. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 55-80.

This chapter on nutritional strategies for patients with obesity and the metabolic syndrome is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors define the metabolic syndrome as a constellation of cardiovascular risk factors including abdominal obesity, low HDL cholesterol levels, high triglyceride levels, high blood pressure, and impaired fasting glucose. The syndrome is associated with an increased risk of cardiovascular disease and type 2 diabetes that is linked to insulin resistance and abdominal obesity. The chapter covers the scope of the problem, pathophysiology, identification and evaluation of the obese patient, treatment of obesity, weight loss and dietary approaches to the metabolic syndrome, the dyslipidemia component, the impaired fasting glucose component, and the hypertensive component. In each of these three latter sections, the authors discuss prevalence, pathophysiology, and lifestyle management approaches. They conclude that, to achieve improved metabolic control, dietary treatment recommendations must be individualized to the metabolic profile of the patient and must take into consideration the patient’s food preferences, lifestyle, and cultural norms. 2 figures. 9 tables. 162 references.

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Nutritional Strategies for Patients with Obesity and the Metabolic Syndrome. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 55-80.

This chapter on nutritional strategies for people with obesity and the metabolic syndrome is from a book written to advance physicians’ knowledge about nutrition as it relates to diabetes and to help doctors provide evidence-based recommendations to their patients with diabetes. The authors define the metabolic syndrome as a constellation of cardiovascular risk factors including abdominal obesity, low HDL cholesterol levels, high triglyceride levels, high blood pressure, and impaired fasting glucose. The syndrome is associated with an increased risk of cardiovascular disease and type 2 diabetes that is linked to insulin resistance and abdominal obesity. The chapter covers the scope of the problem, pathophysiology, identification and evaluation of the obese patient, treatment of obesity, weight loss and dietary approaches to the metabolic syndrome, the dyslipidemia component, the impaired fasting glucose component, and the hypertensive component. In each of these three latter sections, the authors discuss prevalence, pathophysiology, and lifestyle management approaches. They conclude that, to achieve improved metabolic control, dietary treatment recommendations must be individualized to the metabolic profile of the patient and must take into consideration the patient’s food preferences, lifestyle, and cultural norms. 2 figures. 9 tables. 162 references.

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Nutritional Strategies for the Patient with Diabetic Nephropathy. IN: Brett, E.; Mechanick, J., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 149-169.

This chapter on nutritional strategies for the patient with diabetic nephropathy is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The author defines diabetic nephropathy as albuminuria in the absence of other clear etiologies and notes that it is typically accompanied by hypertension and diabetic retinopathy. The most striking complication of diabetic kidney disease is the high risk of coexistent or subsequent cardiovascular disease. The chapter covers pathophysiology and natural history; treatment considerations, including hypertension control, tobacco cessation, glycemic control, renal and pancreas replacement therapies, kidney transplantation, and pancreas transplantation; nutritional interventions in diabetic nephropathy, including sodium restriction, lipid management, protein energy requirements in different stages of chronic kidney disease (CKD), oral and enteral protein-energy supplementation, peritoneal dialysate amino acid and insulin content, intradialytic parenteral nutrition, anabolic agents and appetite stimulants, phosphate restriction and secondary hyperparathyroidism, potassium and magnesium restriction, vitamins and minerals, and antioxidants; and nutritional issues for transplant recipients. The primary treatment aims of nutritional therapy are to attenuate kidney disease progression and to prevent cardiovascular events. The author concludes that the multidisciplinary approach to care, including a dietitian skilled in CKD management, is most likely to succeed in the highly motivated patient. 4 tables. 115 references.

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Nutritional Strategies in Pregestational, Gestational, and Postpartum Diabetic Patients. IN: Mechanick, J.; Brett, E., eds. Nutritional Strategies for the Diabetic and Prediabetic Patient. Boca Raton, FL: CRC Press. 2006. pp. 133-148.

This chapter on nutritional strategies in pregestational, gestational, and postpartum diabetic patients is from a book written to advance physicians’ knowledge in nutrition as it relates to diabetes and to help them provide evidence-based recommendations to their patients with diabetes. The authors note that medical nutrition therapy (MNT) is now focused on providing adequate calories, nutrients, minerals, and vitamins to maintain a healthy pregnancy while keeping glucose levels as close to normal as possible. The chapter discusses pregestational diabetes and prepregnancy planning; oral medications and insulin; prepregnancy assessment of diabetes-related medical conditions, including retinopathy, renal function, and heart disease; gestational diabetes mellitus and its screening; diets designed to minimize postprandial hyperglycemia for the pregnant diabetic woman; proper weight gain; the role of exercise; insulin therapy; and postpartum care. 6 tables. 57 references.

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Patient Education: Addressing Multiple Risk Factors through Medical Nutrition Therapy. Reducing Cardiovascular Risk in the Patient with Type 2 Diabetes (AADE Proceedings). p. 3-6. 2006.

Medical nutrition therapy (MNT) is integral to both the treatment and prevention of diabetes and its related complications. This article, from the proceedings of a symposium on reducing cardiovascular risk in people with type 2 diabetes, considers how to address multiple risk factors through MNT. The author presents MNT recommendations from various professional organizations in the form of charts, which include descriptions of specific dietary and lifestyle modifications relevant to the management of diabetes through MNT. Research findings in support of each of these recommendations are provided, including the classification of major American Diabetes Association (ADA) nutrition guidelines, according to an evidence-based grading system. The charts are designed to help health care providers translate available research evidence into practicable, real-world recommendations and strategies that can be applied with patients. Topics discussed include recommendations for daily nutrition, the use of a stepwise approach to lower cholesterol levels, ways to reduce cholesterol through MNT, managing hypertension with lifestyle changes, dietary fiber, the need to increase omega-3 fatty acids, guidelines for avoiding mercury exposure, the role of soy protein and flaxseed, the benefits of nuts, cinnamon and dark chocolate, the Portfolio diet, and the importance of engaging in regular physical activity. Throughout the document, the author stresses the need for patient education and involvement in the MNT process, along with an emphasis on the importance of setting realistic, individualized goals and treatment plans for each patient. 12 tables. 10 references.

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American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. 190 p.

This guide provides a resource for health professionals involved in the care of women who develop diabetes during their pregnancy (gestational diabetes mellitus, or GDM). The guide helps readers to promote sound nutrition principles in GDM and achieve optimal outcomes for the woman and her infant. The book offers 10 chapters: historical background, the pathophysiology of GDM, classification, screening and diagnosis issues, maternal and fetal complications associated with GDM, maternal and fetal testing in pregnancy, medical nutrition therapy, medications and supplements, additional concerns in pregnancy complicated by GDM, cultural issues in diabetes management in pregnancy, and postpartum considerations. Each chapter notes a list of learning objectives, includes a summary of the concepts presented, and concludes with an extensive list of references. The book includes three appendixes: forms; case studies; and the energy, carbohydrate, protein, and fat content of selected foods. A glossary of terms and subject index conclude the volume.

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Celiac Disease: Detection and Treatment. Topics in Clinical Nutrition. 20(2): 139-145. April-June 2005.

Celiac disease is an autoimmune disorder characterized by sensitivity to a protein, gluten, found in wheat, rye, and barley. This article discusses the detection of and treatment for celiac disease, also called gluten intolerance. The author stresses that celiac disease requires a comprehensive approach to diagnosis. Individuals who have celiac disease vary from those who are asymptomatic to those with skin manifestations of dermatitis herpetiformis and to patients with severe wasting and malnutrition. Regardless of symptoms, the only treatment for celiac disease is strict adherence to a gluten-free diet for life. The author notes that this can be a significant challenge in the wheat-laden Western diet, greatly affecting one’s quality of life. The author helps dietitians understand their role in helping their patients adjust to and comply with a gluten-free diet. Dietitians are counseled to make sure their patients with newly-diagnosed celiac disease attend at least two teaching sessions: the first session focuses on survival skills, shopping and social issues and the second session on alternate grains, exercise, and general health maintenance. The author concludes that although the overall quality of life of the individual with celiac disease improves with adherence to the gluten-free diet, the social and emotional impact of following the diet may remain an issue. 2 tables. 21 references.

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Diabetes Management in Long-term Care. Today's Dietitian. 7(7): 52-53. July 2005.

The goal of diabetes care in the aging population is to achieve glycemic control and prevent or treat complications while enhancing quality of life. This article helps dietitians understand the positive impact of individualized dietary and nutrition care for older adults with diabetes who are living in a long-term care setting. The author reviews the primary goals of medical nutrition therapy (MNT) for diabetes: to maintain optimal control of blood glucose, lipids, and blood pressure; prevent or treatment any chronic complications; address individual needs; and improve overall health. A vital goal for older diabetes patients who live in nursing facilities is to assure adequate nutrition to prevent malnutrition and the devastating complications that can follow. These patients much be monitored for significant changes in body weight, health status, or laboratory test values. In this population, increased morbidity and mortality are associated with low body weight. The author discusses the management of obesity, MNT recommendations, and working with patients with special needs, such as a liquid diet or enteral feeding. Dietitians are encouraged to be a vital part of the patient care team.

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Healthy Eating for Hemodialysis. Rockville, MD: American Kidney Fund. 2005. 20 p.

This brochure describes the importance of healthy eating for people on hemodialysis, a treatment used to clean the blood for people whose kidneys cannot do it for them. When the kidneys are not working normally, the body loses the ability to get rid of wastes in the urine. These can include excess sodium, potassium, phosphorus, and urea. With careful eating habits, people with kidney disease can reduce the amount of waste that builds up in their body, even prior to dialysis. The brochure discusses the need for a special diet in people with kidney disease; foods that are high in sodium, potassium, phosphorus, or protein; tools for healthy eating; the roles of calories, protein, carbohydrates, and fats; vitamins and minerals; the risk of anemia in people on dialysis; and special considerations for people with kidney disease and diabetes mellitus. A sample menu for a 150-pound person with chronic kidney disease who is on hemodialysis is included. The brochure, illustrated with black-and-white photographs, concludes by encouraging readers to work closely with their health care team, including a renal dietitian. 10 figures. 11 references.

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Historical Background. IN: Thomas, A.M.; Gutierrez, Y.M., eds. American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. pp. 1-8.

This chapter on the historical treatment of gestational diabetes mellitus (GDM) is from a Guide that serves as a resource for health professionals involved in the care of women who develop diabetes during their pregnancy. The Guide helps readers to promote sound nutrition principles in GDM, to achieve optimal outcomes for the woman and her infant. The author of this chapter explains how medical nutrition therapy (MNT) evolved as the scientific community learned more about GDM. GDM is defined as glucose intolerance with onset or first recognition during pregnancy. The author concludes that, although the treatment of GDM has changed since the discovery of insulin, certain morbidities, such as fetal macrosomia, are more prevalent in women with GDM than in healthy women. 1 table. 31 references.

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Intensive Lifestyle Changes May Affect the Progression of Prostate Cancer. Journal of Urology. 174(3): 1065-1070. September 2005.

Men with prostate cancer are often advised to make dietary and lifestyle changes, although the impact of these changes has not been well studied. This article reports on a study that evaluated the impact of comprehensive lifestyle changes on prostate specific antigen (PSA), treatment trends, and serum stimulated LNCaP cell growth in men with early, biopsy-proven prostate cancer after 1 year. Patient recruitment was limited to men who had chosen not to undergo any conventional treatment (n = 93). Participants were randomized into an experimental group that was asked to make lifestyle changes or to a usual care control group. The intensive lifestyle program included a vegan diet supplemented with soy, fish oil, selenium, and vitamin C, moderate aerobic exercise; stress management techniques, and participation in a 1-hour support group once weekly to enhance adherence to the intervention. None of the experimental group patients, but 6 control patients, underwent conventional treatment due to an increase in PSA or progression of disease on magnetic resonance imaging (MRI). PSA decreased 4 percent in the experimental group but increased 6 percent in the control group. The growth of LNCaP prostate cancer cells was inhibited almost eight times more by serum from the experimental than from the control group. These changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle. The authors conclude that intensive lifestyle changes may slow the progression of early, low grade prostate cancer in men. 2 figures. 3 tables. 26 references.

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Meal Planning Groups. Diabetes Spectrum. 18(3): 132-134. Summer 2005.

Medical nutrition therapy (MNT) and meal planning are an integral part of diabetes management. This article discusses some of the issues involved in establishing and running group education for nutrition and meal planning. Topics include reimbursement of group education in diabetes self-management, benefits of group education, development of group education, challenges that may need to be faced, how to initiate a group education program, basic carbohydrate counting, the plate method, and planning the group education process. A final section discusses the importance of evaluating and documenting outcomes of any patient education program. The author emphasizes the need to individualize formats to the participants needs and choices. Adult learners learn best when the information pertains to what they perceive their needs to be. The author concludes that group classes are advantageous and have become an essential method of teaching meal planning, particularly given the reimbursement limitations for diabetes self-management training and MNT. 1 table. 12 references.

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Medical Nutrition Therapy for Hypertension and Albuminuria. Diabetes Spectrum. 19(1): 32-38. Winter 2005.

Lifestyle modifications, including medical nutrition therapy (MNT), play a crucial role in controlling hypertension. And for people with microalbuminuria (microscopic protein in the urine), controlling blood pressure and achieving near-normal blood glucose levels can slow the progression to kidney disease. This article describes MNT for hypertension and albuminuria. The author notes that modest weight reduction, the Dietary Approaches to Stop Hypertension (DASH) eating plan, sodium reduction, physical activity, and moderation in alcohol intake are effective in lowering blood pressure and preventing hypertension. Combining these lifestyle interventions is more effective than single approaches. Potassium supplementation may be helpful in controlling or preventing hypertension. Other dietary factors, including dietary fiber, calcium, magnesium, and fish oil intake, have been studied but have uncertain effectiveness. To delay the progression of nephropathy, the first priority of MNT is to assist in glucose and blood pressure control. In addition, instituting a low-protein diet has been shown to improve kidney function in people with diabetes. 6 tables. 31 references.

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Medical Nutrition Therapy. IN: Thomas, A.M.; Gutierrez, Y.M., eds. American Dietetic Association Guide to Gestational Diabetes Mellitus. Chicago, IL: American Dietetic Association. 2005. pp. 45-64.

This chapter on medical nutrition therapy (MNT) in gestational diabetes mellitus (GDM) is from a Guide that serves as a resource for health professionals involved in the care of women who develop diabetes during their pregnancy. The Guide helps readers to promote sound nutrition principles in GDM, to achieve optimal outcomes for the woman and her infant. The authors of this chapter begin by describing the goals of the American Dietetic Association (ADA) MNT evidence-based nutrition practice guidelines for GDM. The authors then explain the nutritional requirements of women during pregnancy, focusing on macronutrient requirements and their relationship to MNT in GDM. Specific topics include adequate energy consumption, folate recommendations, nutrient adequacy in closely-spaced pregnancies, vegetarianism and plant-based diets, the use of caffeine and nonnutritive sweeteners in pregnancy. A final section offers strategies for implementing MNT in pregnancies complicated by GDM. The authors note that the registered dietitian develops a food plan that promotes normoglycemia, appropriate maternal weight gain, and the nutrient needs of pregnancy, and teaches the woman how to follow this plan. The authors stress that follow-up appointments are critical parts of MNT, because they provide the opportunity to assess whether implementation of the food plan meets clinical outcomes or whether pharmacologic therapy is needed. 3 figures. 6 tables. 53 references.

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Nutrition Care for Hospitalized Individuals With Diabetes. Diabetes Spectrum. 18(1): 34-38. Winter 2005.

This article discusses the role of medical nutrition therapy (MNT) in maintaining glycemic control for hospitalized patients with diabetes. The authors discuss address special challenges related to illness, changes in medications, and erratic meal schedules. They stress that a team approach is required to ensure that patients' nutrition care plans work with their medical plan, not against it. The authors review MNT goals for hospitalized patients, the need for screening and referral of inpatients for MNT services, and the process of providing MNT in the hospital. One table outlines five common nutrition-related issues that may affect glycemic control during hospitalization, including decreased appetite or no oral intake, delayed meals or inconsistent timing, inconsistent carbohydrate intake, decreased activity level, and inconsistent blood glucose monitoring; the authors note recommended care strategies for each. 4 tables. 12 references.

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Challenges of Being on a Dialysis Diet. El Segundo, CA: DaVita Inc. 2004. 2 p.

This patient education fact sheet offers a basic discussion of the challenges of being on a dialysis diet. Dialysis is a treatment that removes wastes and excess fluid from the blood. Patients on dialysis typically need to limit their intake of potassium, phosphorus, and sodium. Written in a question-and-answer format, the fact sheet discusses how to reduce the potassium in some foods (notably vegetables), the use of milk-alternatives, phosphorus binders, herbs and spices to help reduce the use of salt, and establishing an individual diet based on the patient's medical condition and the amount of kidney function remaining. The fact sheet concludes with information about a patient education program sponsored by DaVita (the producer of the fact sheet and a provider of in-center hemodialysis nationally).

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Renal Care: Resources and Practical Applications. Chicago, IL: American Dietetic Association. 2004. 120 p.

This document is an expanded and updated version of the appendices originally published in the American Dietetic Association's Guidelines for Nutrition Care of Renal Patients (2002). This publication is divided into 20 sections, each of which addresses a key factor in the nutrition assessment of individuals with chronic kidney disease (CKD). The 20 sections are: federal regulations, height determination, evaluation of body weight, frame size determinations, body mass index, skinfold measurements, subjective global assessment, laboratory values in dialysis patients, energy estimation, intradialytic parenteral nutrition (IDPN), vitamins and minerals in CKD, physical signs of nutrient deficiencies or excesses, reasons for an inadequate response to erythropoietin (EPO), glomerular filtration rate (GFR) and creatinine clearance, protein catabolic rate (PCR) and protein equivalent of nitrogen appearance rate (PNA), dialysis adequacy, volume and body surface area calculations, cardiovascular disease, exercise and rehabilitation, and immunosuppressant drugs and nutritional side effects. The sections provide in-depth coverage of the available methods for assessing nutritional status and discuss how these methods relate to the care of individuals with CKD. Formulas and tables are included, allowing the practitioner to find in one location all the information needed to provide the nutrition care outlined in the companion publication: Guidelines for Nutrition Care of Renal Patients (3rd edition). Recommendations from the National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) Guidelines have been included in many of the sections.

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Tools and Techniques for Working With Young People With Diabetes. Diabetes Spectrum. 17(1): 8-13. January 2004.

Diabetes is one of the most common chronic conditions in school age children. Each year in the United States, more than 13,000 youth are diagnosed with type 1 diabetes. In addition, more and more children and teens are being diagnosed with type 2 diabetes, a condition previously mostly diagnosed in adults over the age of 40. This article reviews the tools and techniques that are available for working with young people with diabetes, focusing on nutritional approaches (medical nutrition therapy, MNT). The author stresses that for the nutrition component of the overall diabetes treatment plan to be effective, children need to be given realistic goals that are tailored to their unique needs. Diabetes health professionals working with children and adolescents need to design food plans that balance treatment goals with realistic lifestyle choices. The author provides health care professionals with information and tips for working with pediatric populations and includes a review of some of the currently available nutrition education tools and resources specifically developed for use with young people with diabetes. Related web sites and resource organizations are noted. 3 tables. 15 references.

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