Tali Sinai

Nutritional Recommendations for Adult Bariatric Surgery Patients: Clinical Practice

Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1) presurgery nutritional evaluation and presurgery diet and supplementation; 2) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications.

Effect of nutrition on growth in short stature before and during growth-hormone therapy.

Objective. Although nutritional counseling is an integral part of the management of rapidly growing children, few studies have focused on the importance of nutritional supervision during growth-hormone (GH) therapy. The objective of this study was to study the effect of caloric intake on growth before and during GH therapy. Methods. A total of 115 short normal prepubertal children who were 7.4 ± 1.2 years of age (mean ± SD) and had height SD score (SDS) of −2.5 ± 0.6 were treated with a GH dose range of 0.13 to 0.52 mg/kg per week for 1 year. A 3-day nutritional recall and blood chemistry analysis were repeated every 3 months. Results. Caloric intake (expressed as % recommended dietary allowance) was positively correlated with the pretreatment growth velocity (SDS) and the increment in growth velocity SDS during the first year of GH therapy (r = 0.363 and 0.493). By stepwise regression analysis, we identified 4 parameters that could predict the 1-year increment in growth velocity SDS: the contribution of each factor (% variability) was pretreatment growth velocity SDS 36%, GH dose (27%), caloric intake 4%, and the integrated concentration of GH 2% (r2 = 0.689). GH therapy induced an alkaline phosphatase increment of 59 ± 49 IU/mL, an insulin-like growth factor-I increment of 32.6 ± 11.9 nmol/L, and a GH binding protein increment of 10.2 ± 2.7%. During GH therapy, an increase in serum transferrin (56.5 ± 35.2 mg/dL) and a decrease in serum iron (20.5.5 ± 20.2 μg/dL) were noted. These changes could not be detected through hemoglobin levels or hematopoietic indexes. Dietary iron supplementation reversed this phenomenon. Conclusions. The nutritional status of GH-treated patients before and throughout the course of GH treatment should be monitored closely to improve the growth response and prevent nutritional deficiencies. Special emphasis should be placed on iron nurture.

Vitamin A and iron supplementation is as efficient as hormonal therapy in constitutionally delayed children

objective  To assess the effect of nutritional supplementation on growth and puberty in constitutionally delayed children.

Risk factors for reduced bone mineral density measurements in milk allergic patients

Earlier studies noted that young adults with IgE‐mediated cows milk allergy (IgE‐CMA) have significantly lower bone mineral density (BMD) than age‐ and gender‐matched controls. We sought to identify additional risk factors contributing to the low BMD in IgE‐CMA patients.