Nutrition in Clinical Practice

Complementary and alternative medicine (CAM), more recently known as integrative health or integrative medicine, is a diverse field comprising numerous treatments and practitioners of various levels of training. This review defines several of the main CAM modalities and reviews some of the research relevant to their clinical application. The goal is to provide healthcare providers with a basic understanding of CAM to start the incorporation of proven treatments into their clinical practice as well as guide them to working with CAM providers; ultimately, such knowledge is a fundamental part of a collaborative approach to optimal patient health and wellness.

The metabolic syndrome (MS) is a cluster of metabolic derangements that are associated with primary disturbances in adipose tissue. Abnormal visceral fat accumulates from physical inactivity and excess calories in genetically susceptible individuals. This increased adipocyte mass acts as an endocrine organ and communicates with other organ systems via increases in inflammatory cytokines. The resulting disorders define MS as increased waist circumference, decreased serum high‐density lipoprotein, and increased serum triglyceride levels, hypertension, and insulin resistance. MS accounts for the majority of cardiovascular disease risk in the U.S. population. Dietary interventions, such as the Mediterranean diet, have been shown to improve these metabolic derangements. Many substances found in these diets are being investigated as specific therapies for MS, and when scientific substantiation is lacking, they may be considered as part of complementary and alternative medicine (CAM). However, as scientific evidence accumulates, these CAM treatments may become part of conventional medicine. This review will scrutinize the emerging evidence behind many, though not all, CAM treatments currently thought to target the various derangements found in MS.

Asthma in children and young adults is a complex disease with many different phenotypic expressions. Diagnosis is often made based on history and lung function including measuring airway reversibility. However, in children younger than 6 years of age, the diagnosis is more difficult because many children wheeze in the first 4‐6 years of life, especially with viral infections. For those children, asthma treatment is often started empirically. Those who go on to develop chronic asthma most likely have a genetic predisposition and exposure to various environmental factors resulting in chronic inflammation of the lower respiratory tract. There are established national guidelines for diagnosing and treating asthma in children and adults. For persistent asthma, it is recommended that medications be taken on a regular basis after identifying and avoiding environmental triggers. Because many factors play a role in developing asthma in children, many nonmedical approaches to asthma and asthma‐like conditions have been promoted even when the diagnosis is at times uncertain. The nonmedical approaches and therapies are often referred to as complementary and alternative medicine (CAM). This review will discuss the conventional therapies recommended for children with asthma in addition to CAM therapies, some of which have supporting scientific evidence. Integrating conventional and CAM therapies can prove to be an effective way to treat pediatric asthma, a common and chronic childhood lung disorder. A case is provided to illustrate how such an integrative approach was used in the successful treatment of a child with moderate persistent asthma.

Women often seek alternative treatment options such as herbs, dietary supplements, and vitamins and minerals to treat women’s health issues across the lifespan. Women may use complementary and alternative supplements for dysmenorrhea, premenstrual syndrome, infertility, nausea and vomiting during pregnancy, and symptoms of menopause. In general, there is a deficit of well‐designed, randomized, controlled trials to evaluate the efficacy and safety of complementary and alternative medicine for these indications, which makes it difficult to provide evidence‐based recommendations. This review outlines the evidence for efficacy and safety that is currently available for dietary supplement use by women to manage health conditions specific to the female patient.

Complementary and alternative medicine is used commonly for respiratory diseases. This review summarizes data that identify potential links between dietary intake and asthma, and results of interventional trials of herbal substances for the treatment of asthma, chronic obstructive pulmonary disease, and acute bronchitis.

Intravenous lipid emulsions (IVLE) are an important source of energy and essential fatty acids and their incorporation into pediatric and adult parenteral nutrition (PN) regimens has revolutionized nutrition therapy. However, their clinical use has not been without risk, and will continue to remain so because of the intravenous route of administration. Pharmaceutical and microbiological concerns are centered around the methods of compounding all‐in‐one (AIO) admixtures, but these can be largely minimized with today’s technologies and advanced understanding of aseptic principles. Modern lipid products, based on olive, coconut, and/or fish oils, have demonstrable formulation and clinical benefits over traditional soybean and safflower IVLE and, when combined in the new multi‐chamber bags, can also offer improvements in stability and safety. This review outlines the rationale for different lipid formulations in PN admixtures, reviews the factors influencing stability and efficacy of lipid‐based AIO regimens and evaluates some technologies for minimizing peroxidation and maximizing stability of AIO admixtures.