Nutritional counseling -
When someone goes on a diet they eventually must come off of a diet. In other words, diets are not maintainable. Today there are a million different fad diets catching fire in the media.
Some of the most common fad diets today include the Keto Diet, Clean Eating, the Paleo Diet and the list goes on and on. Sadly, these numbers continue to increase as we live in a society that glorifies a thin ideal.
When diets are taken too far eating disorders start to form. Preoccupation with physical appearance leads many to engage in efforts to change their body at any cost.
A 3-year cohort study found that girls who dieted at a severe level were 18 times more likely to develop an eating disorder [7]. In this same study girls who dieted at a moderate level were at least 5 times more likely [7].
Dieting has also been found to increase the likelihood of overeating or binge eating [7]. This is due to the body increasing hunger cues, trying to compensate for what it has been deprived of. Eating disorders are all-consuming, moving an individual away from their initial motivation of starting a so-called diet to be healthy towards malnutrition and potential long-term health concerns.
No matter the eating disorder a toll is taken on the body. As nutrition professionals, there is a need to have awareness of nutritional concerns related to all eating disorders. Nutrition concerns arise related to all macronutrients and micronutrients. Individuals are often unaware of how poorly their body is functioning.
This calls for the need to be aware of potential complications and provide support through patient education. The majority of severely malnourished patients suffering from an eating disorder have at least one micronutrient deficiency [3]. Common mineral deficiencies include zinc, iron, copper, and selenium.
A study revealed zinc was the most common deficiency in severely malnourished patients with copper and selenium following [3]. Other mineral deficiencies such as iron can lead to anemia. Selenium deficiency impacts the immune system and deteriorates the ability to regulate mood [1].
Common vitamin deficiencies include vitamin D, vitamin B1, vitamin B12, and vitamin B9. A recent study found Vitamin D deficiency is strongly related to a decline in hip bone mineral density [3]. Bone mineral density loss is the most common chronic complication in anorexia nervosa [3]. Supplementation for vitamin D is recommended in the majority of anorexia nervosa cases to prevent osteoporosis [3].
As nutrition professionals, it is important to recommend patients have blood work to complete a full vitamin panel. These results aid in assessing the need for supplementation and support need for a variety of foods. Electrolyte disorders can lead to hypokalemia, hypomagnesemia, and potentially lead to sudden cardiac arrest [4].
Purging and other methods of dehydrating the body such as diuretics, laxatives will promote fluid retention resulting in edema [6]. It is important to monitor edema or fluid retention, as these may be signs of a need for immediate medical attention.
Hydration may also be compromised due to restriction of fluid or not drinking water out of fear of weight gain. Nutrition therapy for eating disorders should be individualized, placing the patient at the center. No two patients, regardless of having the same type of eating disorder, are alike.
Each patient will struggle with individual fears or beliefs and may present entirely different medically and psychologically.
Start by recognizing the clinical symptoms, attitudes, and food beliefs. Then, support patients while providing corrective nutrition education exploring facts vs.
eating disorder beliefs and nutrition misinformation. Beliefs may also overlap with adverse childhood experiences. Treatment should involve working with therapists to overcome somatically engrained traumatic experiences [2].
Anorexia affects individuals of all shapes and sizes. It is important to understand treatment is not centered solely on weight gain, but all patients will need to restore weight to a certain extent. Meal plans should incorporate all macronutrients and encourage variety. Patient meal plans should be increased x per week as needed while monitoring and evaluating labs and physical signs and symptoms or refeeding syndrome.
Weight gain goals should be lb per week for outpatient care and lb per week for inpatient care [6]. When restoring weight patients fear gaining fat.
It should be acknowledged that yes gaining fat is a part of weight restoration along with muscle, organ tissue, bone mass, and water. Weight restoration education should be a part of this process as well as the incorporation of Cognitive Behavioral Therapy CBT and Dialectical behavior therapy DBT.
As nutrition professionals, it is important to support patients and understand when a higher level of care or more intense interventions are needed. Eating disorders are not always detectable from physical appearance. The majority of those suffering from bulimia are of normal weight.
Bulimia is often a result of biological vulnerability to depression or other mental health diagnoses [6]. Perceived family or societal expectations may even exacerbate bulimia. When providing nutritional therapy the goal is to support consistency in eating patterns including at least 3 meals and snacks daily.
There can often be a cycle of restriction leading to binge eating and purging behaviors. Purging behaviors may include vomiting, laxative abuse, or excessive exercise. Nutrition therapy should also include monitoring electrolytes, vital signs, weight, meal plan compliance, and behaviors.
If laxatives are used, work with the patient and their physician to gradually reduce to prevent bowel obstructions [6]. Nutrition therapy and education should involve exploring food rules related to good vs. No financial or gift compensation will be provided.
Participants discontinuation is expected to occur in the following scenarios: hospitalization during the trial, development of conditions that forbid adherence to the MedDiet, diagnosis of a disease that is incompatible with the intervention, or initiation of another nutritional intervention.
A seminar to present the results and conclusions will be held at the end of the data analysis, with additional presentations taking place at the recruitment centres. The findings of the study will be shared with the scientific community through 1 presentations at conferences and meetings related to nutrition, medical nutrition, psychiatry, psychology, and epidemiology; 2 publication in scientific peer-reviewed journals; and 3 a final report, which is a requirement of the funding entity for the study.
Increased inflammation biomarkers have been associated with a higher risk of developing MDD and diminished efficacy of conventional treatments [ 2 , 3 ].
The selection of individuals with elevated inflammation biomarkers, will potentially target patients that might benefit more from the proposed intervention. As participants will be recruited during their routine medical appointments and the intervention will take place near recruitment centres, the trial conditions will closely resemble routine care, reducing the potential for bias.
The use of a passive control group that will only receive TAU will allow for an evaluation of the impact of the proposed intervention compared to standard care.
The cost-effectiveness analysis will provide information on the scalability of the proposed treatment. There is a potential challenge in recruiting a sufficient sample size for this study, as the condition of having elevated CRP and IL-6 levels will increase the number of participants needed to be invited.
Similar difficulties have been identified in a previous study [ 24 ]. To address this, participant recruitment and data collection will happen simultaneously in three hospitals, with more recruitment centres planned to be added as the trial progresses.
Due to the nature of the study, which involves promoting adherence to a specific diet, it will not be possible to blind the participants or researchers delivering the intervention to allocation groups. To minimize the resulting bias, the researchers responsible for statistical analysis will be blinded to allocation groups.
Using the PREDIMED-MEDAS questionnaire to assess MedDiet adherence and measuring inflammation biomarkers at each assessment point will help to identify any associations between alterations in diet adherence, inflammation biomarkers, and changes in depression symptoms. The study design involves a passive control group that will receive no active intervention besides TAU.
This approach eliminates the risk of comparing two effective interventions, but increases the risk that differences found between groups could be due to differences in intervention intensity between groups.
This study will contribute to the understanding of the role of inflammation and nutrition in the treatment of MDD, in a group of patients with a lower remission rate with usual treatments, with potential gains in terms of improving health and reducing healthcare costs.
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Med Sci Sports Exerc. Download references. We would like to express our gratitude to Ana Sousa Santos for her unwavering support throughout the development of the study, particularly in her assistance during the editing of the study protocol.
On behalf of the study team, we also extend our heartfelt thanks to the healthcare units that participate in the recruitment process. Their collaboration and support will be critical in the successful execution of this study.
The study sponsor and funder of this trial are not directly involved in any of the following procedures: study design; collection, management, analysis, and interpretation of data; writing of the report; or the decision to submit the report for publication. The ultimate authority over any of these activities is the responsibility of the responsible investigator for the project PhD Maria João Heitor.
Center for Innovative Care and Health Technology ciTechcare , Instituto Politécnico, Leiria - R. de Santo André, Leiria, , Portugal. Instituto de Saúde Ambiental ISAMB , Faculdade de Medicina, Universidade de Lisboa - Av, Lisboa, , Portugal. Laboratório Associado TERRA, Faculdade de Medicina, Universidade de Lisboa, Av.
Professor Egas Moniz, Lisboa, , Portugal. Serviço de Psiquiatria e Saúde Mental, Centro Hospitalar de Leiria — Hospital de Santo André, R. Departamento de Psiquiatria e Saúde Mental, Clínica Universitária de Psiquiatria e Psicologia Médica, Centro Hospitalar Universitário de Lisboa Norte, Lisbon, Portugal.
Comprehensive Health Research Center, Department of Psychology, School of Social Sciences, University of Évora, Évora, Portugal. Centro Hospitalar Universitário Lisboa Norte, EPE, Hospital de Santa Maria, Av.
Egas Moniz MB, Lisboa, , Portugal. Laboratório de Nutrição, Faculdade de Medicina, Universidade de Lisboa, Av. Egas Moniz, Edifício Egas Moniz, ala C, piso 2, Lisboa, , Portugal.
Faculdade de Medicina da Universidade Católica Portuguesa - Estr. Octávio Pato, Rio de Mouro, Sintra, , Portugal. Clínica Universitária de Medicina Geral e Familiar, Faculdade Medicina Universidade de Lisboa, Av. Departamento de Psiquiatria e Saúde Mental, Hospital Beatriz Ângelo, Av.
Carlos Teixeira 3, Loures, , Portugal. You can also search for this author in PubMed Google Scholar. NSS and CC drafted this paper which was added to and modified by all other authors. The statistical analysis to be performed was designed by MF. All authors contributed to the design of the study protocol.
SV, RM, NB, GS were responsible for the intervention design and operationalization. RCC is an advisor for the assessment of depression and for methodological and statistical issues.
Correspondence to Nuno Sousa-Santos. This study has been approved in accordance with the principles outlined in the Declaration of Helsinki. Ethics approval has been granted by the Ethics Committee of Centro Hospitalar de Leiria Ref.
Informed consent will be obtained in writing from all participants prior to their participation in the study. It should be noted that the collection of biological samples and other data will only be conducted after the participants have signed the informed consent form. Informed consent is provided in attachment to the present protocol.
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Sousa-Santos, N. et al. Nutritional counselling in adults promoting adherence to the Mediterranean diet as adjuvant in the treatment of major depressive disorder INDEPT : a randomized open controlled trial study protocol.
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Download PDF. Study Protocol Open access Published: 04 April Nutritional counselling in adults promoting adherence to the Mediterranean diet as adjuvant in the treatment of major depressive disorder INDEPT : a randomized open controlled trial study protocol Nuno Sousa-Santos 1 , 2 , 3 , Mónica Fialho 2 , 3 , Teresa Madeira 2 , 3 , 8 , Cátia Clara 1 , Sofia Veiga 2 , 3 , Raquel Martins 2 , 3 , Neuza Barros 1 , 2 , 3 , Gabriela Santos 1 , Osvaldo Santos 2 , 3 , Carolina Almeida 4 , Licínia Ganança 5 , Rui C.
Abstract Background Major Depressive Disorder MDD is a leading cause of disability worldwide. Discussion This study will be the first RCT to evaluate the effect of a nutritional intervention with anti-inflammatory properties, as an adjuvant in the treatment of MDD, in individuals diagnosed with MDD and elevated inflammation biomarkers.
Background Major Depressive Disorder MDD is a global leading cause of disability, according to data from the Global Burden of Disease [ 1 , 2 ]. Other specific objectives of the trial are: 1. To test the association between adherence to the MedDiet and changes in CRP and IL To test the association between changes in CRP and IL-6 and symptoms of depression.
Clinical trial register The present study is registered at ClinicalTrials. Study design This is a week, multicentre, randomized, parallel-group, open-label controlled trial. To be eligible for the trial, individuals must meet the following criteria: Inclusion criteria 1.
Aged between 18 and 70 years old; 2. Able to understand and provide informed consent; 3. Able to read and write; 4.
BMC Psychiatry volume Nutritional counselingArticle number: Cite this article. Metrics details. ckunseling Depressive Disorder Nutritional counseling is a leading cause of Nutfitional worldwide. Nitritional one-third of patients with MDD Nutritonal not Whole Body Detoxification Support to treatment, and often exhibit elevated inflammation biomarkers, which are associated with worse prognosis. Previous research has linked healthier dietary patterns, such as the Mediterranean Diet MedDietwith a lower risk of MDD and symptoms of depression, potentially due to their anti-inflammatory properties. The aim of this study is to evaluate the effectiveness of a nutritional counselling intervention promoting MedDiet to alleviate symptoms of depression in adults recently diagnosed with MDD and presenting with elevated inflammation biomarkers. Eating healthy is at Antioxidant-rich immune system core of Nutritional counseling disease and living longer. But Nutritional counseling Nutritonal exactly what foods to Nutriitonal every day Nutritionao be Nutritional counseling. Nutrition counseling involves receiving personalized, one-on-one dietary guidance and advice from a registered dietitian RD or registered dietitian nutritionist RDN. What are the benefits of nutrition counseling? It can help you manage and prevent chronic disease, improve your sleep and energy, and more. Nutrition is a vital part of aging well.Nutritional counseling -
The nutrition counselor may ask the client how often he or she consumes certain food groups. For example, the counselor may ask a person how many servings of dairy products, fruits, vegetables, grains and cereals, meats, or fats he or she consumes in a typical day, week, or month.
Daily food records are also useful in assessing food intake. An individual keeps a written record of the amounts of all foods and beverages consumed over a given period of time.
The nutrition counselor can then use the food records to analyze actual energy and nutrient intake. Three-day food records kept over two weekdays and one weekend day are often used.
A man is allowed lb 48 kg for the first 5 ft 1. Body mass index , or BMI, is another indicator used to assess body weight. BMI is calculated as weight in kilograms divided by height in meters squared. A BMI of 20 to 25 is considered normal weight, a BMI of less than 20 is considered underweight, and a BMI of greater than 25 is considered overweight.
The initial dietary assessment and interview provide the basis for identifying behaviors that need to be changed. Sometimes a person already has a good idea of what dietary changes are needed, but may require help making the changes. Other times the nutrition counselor can help educate a person on the health effects of different dietary choices.
The nutrition counselor and client work together to identify areas where change is needed, prioritize changes, and problem-solve as to how to make the changes. Making dietary change is a gradual process.
An individual may start with one or two easier dietary changes the first few weeks and gradually make additional or more difficult changes over several weeks or months.
More difficult changes might be learning to replace high-fat meat choices with leaner ones, or including more servings of vegetables daily. Once the needed changes have been identified, the client and nutrition counselor think through potential problems that may arise.
For example, changing eating behaviors may mean involving others, purchasing different foods, planning ahead for social events, or bringing special foods to work.
Some common barriers to changing eating habits include:. The nutrition counselor and client set behavior-oriented goals together. Goals should focus on the behaviors needed to achieve the desired dietary change, not on an absolute value , such as achieving a certain body weight.
For a person working to prevent weight gain associated with certain medications, for example, his or her goals might be to increase the amount of fruits, vegetables, and whole grains consumed each day. Such changes would help prevent weight gain while placing the emphasis on needed behaviors rather than on actual weight.
Family members are encouraged to attend nutrition counseling sessions with the client, especially if they share responsibility for food selection and preparation. Although the individual must make food choices and take responsibility for dietary changes, having the support and understanding of family and friends makes success more likely.
The challenge for the nutrition client lies not in making the initial dietary changes, but in maintaining them over the long term. Self-monitoring, realistic expectations, and continued follow-up can help a person maintain dietary changes.
Self-monitoring involves regularly checking eating habits against desired goals and keeping track of eating behaviors. Keeping a food diary on a daily or periodic basis helps the individual be more aware of his or her eating behaviors and provides a ready tool to analyze eating habits.
Sometimes a simplified checklist to assure adequate intake of different food groups may be used. Body mass index , or BMI —A measure of body fat, calculated as weight in kilograms over the square of height in meters.
Food frequency questionnaire —A listing of how often a person consumes foods from certain food groups in a given period of time. Registered dietitian —A person who has met certain education and experience standards and is well-qualified to provide nutrition counseling.
Twenty-four-hour recall —A listing of the type and amount of all foods and beverages consumed by a person in a hour period. Individuals and nutrition counselors should not expect perfect dietary compliance—slips inevitably occur. The goal is to keep small slips, such as eating a few extra cookies, from becoming big slips, like total abandonment of dietary change.
The counselor can help the client identify situations that may lead to relapse and plan ways to handle the situations ahead of time.
Nutrition counseling is an ongoing process that can take months or years. In follow-up nutrition counseling sessions, the individual and counselor analyze food records together and problem-solve behaviors that are especially difficult to change.
Follow-up counseling also allows the opportunity to reevaluate goals and strategies for achieving those goals. See also Diets ; Nutrition and mental health. American Dietetic Association and Dietitians of Canada. Manual of Clinical Dietetics. Chicago, Illinois: American Dietetic Association, Hammond, Kathleen A.
Kathleen Mahan, M. and Sylvia Escott-Stump, M. Philadelphia: W. Saunders Company, Scarlet, Sue. Written by Jim Mann, Ph.
and A. Stewart Truswell, Ph. Oxford: Oxford University Press, Mitchell, Mary Kay, Ph. Nutrition Across the Life Span. Harris-Davis, E. American Dietetic Association.
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Nutrition Counseling gale. MLA Chicago APA " Nutrition Counseling. Learn more about citation styles Citation styles Encyclopedia. More From encyclopedia. com Hunger , hunger can have a variety of meanings. For example, to a nutritionist it may be used to describe starvation resulting from a lack of food.
Both athletes achieved weight restoration and recovered from anorexia and ED reaching sport performance goals, and maintaining recovery years out from treatment. This latter paper 33 is the first one that documents the low level of eating competence in athletes treated for EDs, and shows how NC interventions that target personal feeding skills and eating behaviors are relevant, effective, and aligned with ED recovery.
Similarly, the study conducted by Laramée et al. Other studies documented important positive modifications in terms of nutrition knowledge and dietary intake among athletes provided NC from nutrition professionals It is well established that a balanced and adequate diet plays an important role in maintaining health, allowing athletes to perform at a high level, and recover from the stress of training and competition more efficiently 1 , To apply the principles of sports nutrition, basic knowledge and understanding of nutrition are necessary; however, knowledge does not necessarily translate to behavior and it may not be sufficient to allow athletes to thrive and reach their full potential.
The literature on NE is growing 49 — 51 , intending to support optimal eating patterns within the community or a specific target population such as athletes. The addition of NC on top of NE appears essential.
In fact, recent research has shown that NE programs may be less effective at inducing positive dietary changes Otherwise NC combines information with strategies to achieve a behavior change based on individual characteristics, beliefs, and goals, setting it apart as its own worthy intervention approach.
Some types of sport have been shown to be more related to the development of disordered eating and ED, specifically track, cross-country, cycling, swimming, gymnastics, dance, figure skating, and judo 18 , whereas other literature 54 , 55 suggests that ED in sport are more widespread, do not discriminate by sport, gender or body type, and after quite under-reported, under-diagnosed and under-treated.
Evidenced by the studies included in this review, nutritional counseling could represent a functional strategy in this pursuit. From our review it can be seen that CBT has been the most widely used NC theory. Furthermore, the most used strategies were motivational interviewing and self-monitoring, although the importance of a combination of different strategies has emerged.
There were some limitations in this systematic review. Aside from the heterogeneity of the athlete samples and study designs used, there was a lack of specification of the type of NC techniques used in some studies.
These factors prevent us from addressing a more detailed hypothesis on whether and which specific NC theories or strategies could be more suitable or impactful, in general or for a specific group of athletes. Moreover, nutritional counseling was not a keyword recognized in MESH terminology.
This may contribute to a possible under-estimation of the actual number of studies to be evaluated if some were missed for this reason. Some reports constitute observations from clinical practice and, while more detailed in nature and certainly important to guide practice when research on a topic is limited, these reports lack the rigor of randomized controlled trials designed specifically to test hypotheses about treatment outcomes from interventions like NC.
The four studies that were not clinical trials were of moderate quality, and they are naturally subject to more potential risk of bias than the RCTs.
Although each of the six RCTs had a low risk of bias in the majority of the domains considered, only one trial had an overall low risk of bias. This review is also supported by some strengths. First, scientific literature on the topic of NC in athletes is scarce, so this article provides the opportunity for critical thinking on this topic and a roadmap for future research.
Second, this line of research strictly differentiates nutritional counseling from food education interventions, demonstrating the added value and the unique role that nutrition professionals bring to the sports environment.
Actually, RDNs who specialize in sports and human performance nutrition i. Advanced training that allows the RDN to engage in screening, assessment, treatment, and prevention of REDs and eating disorders in sport is evidenced in this review.
Considering the small yet emerging literature on this topic, almost half of the studies reviewed had a minimum quality rating of four stars using the MMAT method. Nutritional counseling induces positive, measurable behavioral effects in athletes, improving nutrition knowledge, fostering the adoption of adequate eating patterns, and supporting recovery from REDs and ED in sport.
There is, however, a lack of homogeneous research, in terms of design, population and methods, involving nutritional counseling provided to athletes which makes it difficult to make evidence-based conclusions about its efficacy to improve dietary intake, eating behavior, and nutritional risk in this specific population.
More studies are needed to better understand the importance of nutritional counseling in athletes given the unique risks and consequences associated with imbalanced nutrition and nutrition misinformation affecting eating behaviors.
Randomized controlled trials of sufficient size and heterogeneity, including all genders and a variety of sports are needed. As well, future NC interventions should investigate theory-based counseling methods tailored according to factors such as type of sport, level of competition, and age.
PQ and CF: conceptualization. SF, PQ, EP, LDCLN, CF, and MG: methodology. SF, EP, LDCLN, MG, and CF: investigation. SF, EP, and LDCLN: data curation. SF, MG, and CF: writing — original draft preparation. SF, EP, LDCLN, PQ, MG, CF, and AT: writing — review and editing. CF: supervision.
All authors contributed to the article and approved the submitted version. Project funded under the National Recovery and Resilience Plan NRRP , mission 4 component 2 investment 1. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Nutrition counseling is Nutritionnal Nutritional counseling process in which Nutritiinal health Nutritional counseling, Safe drinking practices a registered dietitian, works with an counselijg to assess his or Nutritionla Nutritional counseling dietary intake and identify areas Nutritional counseling change Nutritional counseling needed. The nutrition counselor provides information, educational materials, support, and follow-up to help the individual make and maintain the needed dietary changes. The goal of nutrition counseling is to help a person make and maintain dietary changes. For a person with a mental disorder, dietary change may be needed to promote healthier eating, to adopt a therapeutic diet, or to avoid nutrient-drug interactions. Nutrition counseling is an integral part of treatment for persons with eating disorders or chemical dependencies.
Wacker, welche die nötige Phrase..., der bemerkenswerte Gedanke
Man muss vom Optimisten sein.