Glucose transporter type 1 (GLUT1) deficiency syndrome (DS) is a metabolic brain disorder caused by a deficiency resulting from SLC2A1 gene mutation and is characterized by abnormal brain metabolism and associated metabolic encephalopathy. Reduced glucose supply to the brain leads to brain damage, resulting in delayed neurodevelopment in infancy and symptoms such as eye abnormalities, microcephaly, ataxia, and rigidity. Treatment options for GLUT1 DS include ketogenic diet (KD), pharmacotherapy, and rehabilitation therapy. Of these, KD is an essential and the most important treatment method as it promotes brain neurodevelopment by generating ketone bodies to produce energy. This case is a focused study on intensive KD nutritional intervention for an infant diagnosed with GLUT1 DS at Gangnam Severance Hospital from May 2022 to January 2023. During the initial hospitalization, nutritional intervention was performed to address poor intake via the use of concentrated formula and an attempt was made to introduce complementary feeding. After the second hospitalization and diagnosis of GLUT1 DS, positive effects on the infant’s growth and development, nutritional status, and seizure control were achieved with minimal side effects by implementing KD nutritional intervention and adjusting the type and dosage of anticonvulsant medications. In conclusion, for patients with GLUT1 DS, it is important to implement a KD with an appropriate ratio of ketogenic to nonketogenic components to supply adequate energy. Furthermore, individualized and intensive nutritional management is necessary to improve growth, development, and nutritional status.
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Resting metabolic rate (RMR) accounts for most daily energy expenditure. The low carbohydrate diet (LCD) attenuates decreases in RMR. This study aims to investigate the relationship between an LCD and RMR status among overweight and obese women. We enrolled 291 overweight and obese women in this cross-sectional study. Body mass index (BMI), fat mass, fat-free mass, visceral fat, and insulin level were assessed. RMR was measured using indirect calorimetry. LCD score (LCDS) was measured using a validated semi-quantitative food frequency questionnaire. Analysis of variance, independent sample t-test, and Multinomial logistic regression tests were used. Results showed no relationship between LCDS and deviation of normal RMR (DNR) even after adjust for confounders (increased [Inc.] RMR: odds ratio [OR], 0.97; 95% confidence interval [CI], 0.92–1.01; p = 0.20; decreased [Dec.] RMR: OR, 0.97; 95% CI, 0.94–1.00; p = 0.14). Some components of LCDS had no significant association with DNR, such as carbohydrate and Dec. RMR in adjusted model (OR, 1.62; 95% CI, 0.98–1.37; p = 0.08) and monounsaturated fatty acids and Dec. RMR in adjusted model (OR, 0.48; 95% CI, 0.21–1.10, p = 0.08). However, refined grains had a significant association with Inc. RMR in crude model (OR, 0.87; 95% CI, 0.77–0.99, p = 0.04). There is no association between LCDS and RMR status.
The enhanced recovery after surgery (ERAS) program aims to maximize the recovery of patients by minimizing pre- and postoperative complications and stress. The program recommends providing preoperative carbohydrate (CHO) supplements and starting an early postoperative diet to reduce the fasting duration. Based on these recommendations, we implemented preoperative CHO supplementation and initiated an early postoperative diet in patients undergoing laparoscopic colorectal resection. We observed 3 patients as follows: a non-ERAS case, preoperative ERAS case, and pre- and postoperative ERAS case. The preoperative well-being and compliance of patients improved after implementation of the ERAS program. Moreover, the length of hospital stay was reduced. Therefore, we consider that the ERAS program may be helpful for the recovery of patients undergoing laparoscopic colorectal resection.
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The aim of this study was to investigate the association between macronutrient composition and metabolic syndrome (MetS) incidence in Korean adults. Data were obtained from a cohort of 10,030 members aged 40 to 69 years who were enrolled from the 2 cities (Ansung and Ansan) between 2001 and 2002 to participate in the Korean Genome Epidemiology Study. Of these members, 5,565 participants, who were free of MetS and reported no diagnosis of cardiovascular disease at baseline, were included in this study. MetS was defined using the criteria of the National Cholesterol Education Program-Adult Treatment Panel III and Asia-Pacific criteria for waist circumference. MetS incidence rate were identified during a 2-year follow-up period. Baseline dietary information was obtained using a semi-quantitative food frequency questionnaire. Multivariate logistic regression analysis was used to evaluate the association between the quartiles of percentages of total calorie from macronutrients consumed and MetS incidence. In analyses, baseline information, including age, sex, body mass index, income status, educational status, smoking status, alcohol drinking status, and physical activity level was considered as confounding variables. Participants with the second quartile of the percentages of carbohydrate calorie (67%–70%) had a 23% reduced odds ratio (95% confidence interval, 0.61–0.97) for MetS incidence compared with those with the fourth quartile after adjusting for confounding variables. The findings suggest that middle aged or elderly Korean adults who consume approximately 67%–70% of calorie from carbohydrate have a reduced risk of MetS.
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Overnight fasting before elective surgery has been the routine to reduce the risk of pulmonary aspiration. Recently, several international guidelines for preoperative fasting recommend to intake carbohydrate-containing fluids up to 2 to 3 hours before the induction of anesthesia to improve postoperative recovery. Based on the recommendations, we developed a "preoperative carbohydrate diet" provided for the preoperative patients. The purpose of this case report is to share our experience of applying preoperative carbohydrate loading prior to surgery.
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We developed nutrition education materials for non-alcoholic fatty liver disease (NAFLD) patients focusing on low-carbohydrate and low-simple sugar diet and assessed subjective difficulty and compliance for the developed materials. The materials were developed in 2 types, a booklet for face-to-face education and a handout for phone education. The booklet covered 4 topic areas of fatty liver, low-carbohydrate and low-simple sugar diet, weight control, and meal plan. The handout material included several eating behavior tips. To assess practical usability of nutrition education using the developed materials, subjective compliance and difficulty levels were examined in a sample for NAFLD patients. A total of 106 patients recruited from 5 general hospitals were randomly assigned to a low-carbohydrate and low-simple sugar weight control diet group or a general weight control diet group. Each participant received a 6-week nutrition education program consisting of a face-to-face education session and two sessions of phone education. The developed materials were used for the low-carbohydrate and low-simple sugar weight control diet group and general weight control information materials were used for the control group. Subjective difficulty and compliance levels were evaluated three times during the education period. Subjective difficulty level was significantly higher in the low-carbohydrate and low-simple sugar diet group compared to the control group at the end of the second week, but such a discrepancy disappeared afterward. No significant difference was found for subjective compliance between the groups at each time. In conclusion, the developed nutrition education materials for low-carbohydrate and low-simple sugar diet are reasonably applicable to general Korean NAFLD patients.
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Low-carbohydrate diets have become increasingly popular in both media and clinical research settings. Although they may improve some metabolic markers, their effects on arterial function remain unclear. Endothelial dysfunction is the well-established response to cardiovascular risk factors and a pivotal feature that precedes atherosclerotic diseases. It has been demonstrated that a high carbohydrate-induced hyperglycemia and subsequent oxidative stress acutely worsen the efficacy of the endothelial vasodilatory system. Thus, in theory, a carbohydrate restricted diet may preserve the integrity of the arterial system. This review attempts to provide insight on whether low-carbohydrate diets have a favorable or detrimental impact on vascular function, or it is perhaps the quality of carbohydrate that should direct dietary recommendations. Research to date suggests that diets low in carbohydrate amount may negatively impact vascular endothelial function. Conversely, it appears that maintaining recommended carbohydrate intake with utilization of low glycemic index foods generates a more favorable vascular profile. Understanding these relationships will aid in deciphering the diverging role of modulating quantity and quality of carbohydrates on cardiovascular risk.
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