Position of the American Dietetic Association: Integration of medical nutrition therapy and pharmacotherapy

AbstractGestational diabetes mellitus (GDM) is a common pregnancy disorder and the incidence is increasing worldwide. GDM is associated with adverse maternal outcomes which may be reduced with proper management. Lifestyle modification in the form of medical nutrition therapy and physical activity, as well as self-monitoring of blood glucose levels, is the cornerstone of GDM management. Inevitably, the search for the “ultimate” diet prescription has been ongoing. Identifying the amount and type of carbohydrate to maintain blood glucose levels below targets while balancing the nutritional requirements of pregnancy and achieving gestational weight gain within recommendations is challenging. Recent developments in the area of the gut microbiota and its impact on glycemic response add another layer of complexity to the success of medical nutrition therapy. This review critically explores the challenges to dietary prescription for GDM and why utopia may never be found.

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Does educating nurses about referrals of patients at risk for pressure sores increase referrals for medical nutrition therapy?

Journal of the American Dietetic Association ◽

10.1016/s0002-8223(01)80107-3 ◽

2001 ◽

Vol 101 (9) ◽

pp. A-36

Author(s):

J.B. Krog ◽

C.O. Mitchell ◽

L.H. Clemens ◽

W.G. Stigall ◽

R.E. Alberson

Keyword(s):

At Risk ◽

Nutrition Therapy ◽

Pressure Sores ◽

Medical Nutrition Therapy ◽

Patients At Risk ◽

Educating Nurses ◽

Medical Nutrition

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Medical Nutrition Therapy for Pediatric Kidney Stone Prevention, Part Two

Journal of Renal Nutrition ◽

10.1053/j.jrn.2016.12.001 ◽

2017 ◽

Vol 27 (2) ◽

pp. e11-e14 ◽

Cited By ~ 2

Author(s):

Jennifer Carvalho-Salemi ◽

Lorrie Moreno ◽

Mini Michael

Keyword(s):

Kidney Stone ◽

Nutrition Therapy ◽

Medical Nutrition Therapy ◽

Stone Prevention ◽

Medical Nutrition

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Medical nutrition therapy for gestational diabetes mellitus based on Mediterranean Diet principles: a subanalysis of the St Carlos GDM Prevention Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2018-000550 ◽

2018 ◽

Vol 6 (1) ◽

pp. e000550 ◽

Cited By ~ 14

Author(s):

Carla Assaf-Balut ◽

Nuria Garcia de la Torre ◽

Alejandra Durán ◽

Manuel Fuentes ◽

Elena Bordiú ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnancy Outcomes ◽

Nutrition Therapy ◽

Normal Glucose Tolerance ◽

Medical Nutrition Therapy ◽

Prevention Study ◽

Normal Glucose ◽

Medical Nutrition

ObjectivesTo assess whether Mediterranean Diet (MedDiet)-based medical nutrition therapy facilitates near-normoglycemia in women with gestational diabetes mellitus (GDMw) and observe the effects on adverse pregnancy outcomes.Research design and methodsThis is a secondary analysis of the St Carlos GDM Prevention Study, conducted between January and December 2015 in Hospital Clínico San Carlos (Madrid, Spain). One thousand consecutive women with normoglycemia were included before 12 gestational weeks (GWs), with 874 included in the final analysis. Of these, 177 women were diagnosed with gestational diabetes mellitus (GDM) and 697 had normal glucose tolerance. All GDMw received MedDiet-based medical nutrition therapy with a recommended daily extra virgin olive oil intake ≥40 mL and a daily handful of nuts. The primary goal was comparison of hemoglobin A1c (HbA1c) levels at 36–38 GWs in GDMw and women with normal glucose tolerance (NGTw).ResultsGDMw as compared with NGTw had higher HbA1c levels at 24–28 GWs (5.1%±0.3% (32±0.9 mmol/mol) vs 4.9%±0.3% (30±0.9 mmol/mol), p=0.001). At 36–38 GWs values were similar between the groups. Similarly, fasting serum insulin and homeostatic model assessment insulin resitance (HOMA-IR) were higher in GDMw at 24–28 GWs (p=0.001) but became similar at 36–38 GWs. 26.6% of GDMw required insulin for glycemic control. GDMw compared with NGTw had higher rates of insufficient weight gain (39.5% vs 22.0%, p=0.001), small for gestational age (6.8% vs 2.6%, p=0.009), and neonatal intensive care unit admission (5.6% vs 1.7%, p=0.006). The rates of macrosomia, large for gestational age, pregnancy-induced hypertensive disorders, prematurity and cesarean sections were comparable with NGTw.ConclusionsUsing a MedDiet-based medical nutrition therapy as part of GDM management is associated with achievement of near-normoglycemia, subsequently making most pregnancy outcomes similar to those of NGTw.

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