Emilie Aubry

A Comparative Study on Carbohydrate Estimation: GoCARB vs. Dietitians

GoCARB is a computer vision-based smartphone system designed for individuals with Type 1 Diabetes to estimate plated meals’ carbohydrate (CHO) content. We aimed to compare the accuracy of GoCARB in estimating CHO with the estimations of six experienced dietitians. GoCARB was used to estimate the CHO content of 54 Central European plated meals, with each of them containing three different weighed food items. Ground truth was calculated using the USDA food composition database. Dietitians were asked to visually estimate the CHO content based on meal photographs. GoCARB and dietitians achieved comparable accuracies. The mean absolute error of the dietitians was 14.9 (SD 10.12) g of CHO versus 14.8 (SD 9.73) g of CHO for the GoCARB (p = 0.93). No differences were found between the estimations of dietitians and GoCARB, regardless the meal size. The larger the size of the meal, the greater were the estimation errors made by both. Moreover, the higher the CHO content of a food category was, the more challenging its accurate estimation. GoCARB had difficulty in estimating rice, pasta, potatoes, and mashed potatoes, while dietitians had problems with pasta, chips, rice, and polenta. GoCARB may offer diabetic patients the option of an easy, accurate, and almost real-time estimation of the CHO content of plated meals, and thus enhance diabetes self-management.

Is testing for postprandial hyperinsulinemic hypoglycemia after gastric bypass necessary

INTRODUCTIONnPostprandial hyperinsulinemic hypoglycemia (pHH) is an increasingly reported complication after Roux-en-Y gastric bypass (RYGB). As pHH can cause life-threatening emergencies if occurring without warning symptoms, challenge testing may detect patients at risk. The study objective was to determine the frequency of occurrence of pHH with or without symptoms of hypoglycemia after RYGB.nnnMETHODSnWe undertook an observational cohort study of consecutive, unselected patients approximately one year after uncomplicated RYGB. To simulate normal habits, all patients received a standardized carbohydrate-rich solid mixed meal. Plasma glucose and insulin were measured at 30, 60, 90, 120, and 150xa0min thereafter. Symptoms were classified as autonomous or neuroglycopenic. Patients with hypoglycemia (plasma glucose <3.0xa0mmol/L [55xa0mg/dL]), were tested a second time with a protein-rich solid mixed meal.nnnRESULTSn113 patients were included. Total weight loss at the first follow-up check (14xa0±xa00.4 months) was 33.97xa0±xa09.3%. After the carbohydrate-rich meal, glucose dropped to <3.0xa0mmol/L in 13.2% (nxa0=xa015) of patients vs no drop to <3.0xa0mmol/L after a protein-rich meal. The pHH occurred in 11.5% (nxa0=xa013) of patients. Asymptomatic patients (5.3%, nxa0=xa06) carried an increased risk (pxa0=xa00.008) for pHH. One patient needed emergency treatment after sudden loss of consciousness after the carbohydrate-rich meal.nnnCONCLUSIONSnThe occurrence of pHH was quite high in our study population with 11.5% thereof 5.3% asymptomatic. We therefore suggest that detection of these patients warrants a screening of patients after RYGB. At-risk patients should than be adequately advised to avoid carbohydrate-rich meals in order to optimize risk management.

Are Patients Affected by Mitochondrial Disorders at Nutritional Risk

OBJECTIVESnPatients with mitochondrial disorders (MD) frequently present with gastrointestinal complaints, mainly gastrointestinal dysmotility, that interfere with their food intake. A deterioration of their nutritional state may worsen the course of the disease. Our study aimed to evaluate a simple screening tool to identify nutritional risk and perform an extended nutritional assessment to explore the potential presence of deficiencies in this population compared with controls.nnnMETHODSnA prospective cohort study was conducted to compare outpatients with MD to matched healthy controls. Nutritional screening and full nutritional assessments were performed, including quantitative and qualitative dietary habits (7-d food log), body function and composition, and resting energy expenditure and quality of life (QoL) measurements. Blood and 24-h urine sample analyses were performed in the patient group.nnnRESULTSnTwenty-six subjects were included in the study, with 11 in the patient group and 15 in the control group. No patient was deemed malnourished according to the nutritional risk score NRS-2002. When compared with the controls, however, the patients with MD had significantly lower muscle mass (Pxa0=xa00.04), reduced handgrip strength (Pxa0=xa00.07), and significant changes in QoL and pathologic creatinine height index, which indicate malnutrition. The patients with MD also had a significantly lower protein intake (Pxa0=xa00.01).nnnCONCLUSIONSnAccording to the current definition by the European Society of Clinical Nutrition and Metabolism (ESPEN) and the American Society of Parenteral and Enteral Nutrition (ASPEN), all patients fulfilled the criteria for malnutrition. Thus, the usual nutritional screening tool is less sensitive for chronically ill outpatients. These results provide a rationale to increase protein intake and adapt patients energy stores to improve symptoms and QoL.

Vitamin-D-Mangel in der Schweizer Sonnenstube?

Zusammenfassung. In dieser Studie wurden die Pravalenz sowie saisonale Fluktuationen des VitD-Mangels bei Bewohnern des Tessins evaluiert. Klinische Indikatoren zur Erkennung eines VitD-Mangelzustands wurden untersucht (Alter, Geschlecht, Hauptdiagnose, Komorbiditaten, Medikamentenanzahl). Beim Eintreffen auf der Notfallstation des Regionalspitals Bellinzona wurde bei je einer Population alterer internistischer Patienten eine einmalige VitD-Serumspiegelbestimmung im Fruhling (n = 58) und im Herbst (n = 49) durchgefuhrt. Die Pravalenz des VitD-Mangels im Fruhling betrug 98 % (Serumspiegelmittelwert 21,4±12,2 nmol/l) versus 63 % im Herbst (Serumspiegelmittelwert 43,7±18,6 nmol/l). Auch nach dem Sommer litten 66 % der Patienten an einem VitD-Mangel. Es konnten keine verlasslichen Indikatoren eruiert werden. Angesichts dieser Ergebnisse und der BAG-Empfehlungen ist eine Prophylaxe mit 800 IE taglich bei allen alteren Schweizern, v.a. im Winter, sinnvoll. Diese Praventionsmassnahme ist kostengunstig, einfach, ...

Dehydration in Dysphagia

Dehydration--increased depletion of bodily fluids--is a major problem in the elderly. In patients with dysphagia, this imbalance of body fluids is often accelerated due to restricted fluid intake, leading to increased mortality in hospitalized older adults. As a result, the hydration status of patients with a swallowing disorder must be closely monitored and rapidly corrected. In the following, dehydration and fluid balance, as well as their pathophysiology and disorders, will be discussed in detail. Furthermore, risk factors for and signs and symptoms of dehydration in the elderly in general and in dysphagic patients in particular will be outlined. In addition, management of dehydration with oral, enteral and parenteral replacement of fluids will be explained. Parenteral hypodermoclysis, for example, has been shown to be as safe and effective as intravenous replacement, with a similar or better adverse event profile in a number of systematic reviews.