Nutritional and Metabolic Diseases Commons^™

Improving Primary Care Providers Awareness, Knowledge, Attitude, And Intention To Change Practice About Uncontrolled Obstructive Sleep Apnea And Its Effect On Metabolic Dysfunction-Associated Steatotic Liver Disease, Formerly Non-Alcoholic Fatty Liver Disease Prognosis, Olivia Amoakowaa-Senya

Doctoral Scholarly Projects & Capstones

Non-alcoholic fatty liver disease (NAFLD), now known as metabolic dysfunction-associated steatotic liver disease (MASLD), is the leading cause of chronic liver disease in the world. The mechanisms involved in its development and progression continue to be a mystery that scientists are trying to unravel. However, many research studies found a correlation between uncontrolled obstructive sleep apnea (OSA) and worsening of NAFLD. Chronic intermittent hypoxia and sleep fragmentation in OSA increase sympathetic activity and promote oxidative stress, pro-inflammatory cytokine production, and metabolic dysregulation, which increases the risk of various diseases, including NAFLD/MASLD progression. Early assessment and screening for OSA in patients …

American Society For Metabolic And Bariatric Surgery Review Of Body Composition, Jonathan Carter, Farah Husain, Pavlos Papasavas, Salvatore Docimo, Vance Albaugh, Laura Aylward, Cynthia Blalock, Sue Benson-Davies

School of Medicine Faculty Publications

Although the body mass index (BMI) has been used as a measure of obesity for decades, it is now possible to measure adiposity more directly with technologies that can quantitate body fat and other tissues. The purpose of this review is to understand body composition, describe the different ways to measure it, review changes in body composition after metabolic and bariatric surgery (MBS), and provide guidance on how providers can introduce measurements of body composition into their everyday practice.

American Society For Metabolic And Bariatric Surgery Review Of The Body Mass Index, Jonathan Carter, Farah Husain, Pavlos Papasavas, Salvatore Docimo, Vance Albaugh, Laura Aylward, Cynthia Blalock, Sue Benson-Davies

School of Medicine Faculty Publications

The body mass index was first described almost 200 years ago and has since been used as a measure of obesity. This review describes the history, advantages, disadvantages, and alternatives to the body mass index in the care of the metabolic and bariatric surgical patient.

Fgf21 Acts In The Brain To Drive Macronutrient-Specific Changes In Behavioral Motivation And Brain Reward Signaling, Md Shahjalal H. Khan, Sora Q. Kim, Robert C. Ross, Florina Corpodean, Redin A. Spann, Diana A. Albarado, Sun O. Fernandez-Kim, Blaise Clarke, Hans Rudolf Berthoud, Heike Münzberg, David H. Mcdougal, Yanlin He, Sangho Yu, Vance L. Albaugh, Paul L. Soto, Christopher D. Morrison

School of Medicine Faculty Publications

Objective: Dietary protein restriction induces adaptive changes in food preference, increasing protein consumption over carbohydrates or fat. We investigated whether motivation and reward signaling underpin these preferences. Methods and Results: In an operant task, protein-restricted male mice responded more for liquid protein rewards, but not carbohydrate, fat, or sweet rewards compared to non-restricted mice. When the number of responses required to access protein reward varied, protein-restricted mice exhibited higher operant responses at moderate to high response requirements. The protein restriction-induced increase in operant responding for protein was absent in Fgf21-KO mice and mice with neuron-specific deletion of the FGF21 co-receptor …

Emerging Diagnostics And Therapeutics For Non-Alcoholic Fatty Liver Disease, Kiarra Krulikowski, Jake Darbhanga, Suzanne Riskin

HCA-NSU MD Research Day

Introduction: The obesity epidemic has pushed fatty liver disease to the forefront of the 21st century. Disease identification can be done invasively with a liver biopsy or noninvasively through elastography and measurements of biomarkers. Presently, there are no FDA-approved drugs on the market to treat the disease. Alternative medicinal treatments have been investigated, which include altering the intestinal microbiota and consuming anti-inflammatory, herbal-based, vitamin-based, and plant-based medications. Methods: In this study, multiple databases were used to identify articles pertaining to fatty liver disease (FLD). All articles gathered from the databases were peer-reviewed and less than 10 years old to ensure …

Cutaneous Adverse Effects From Diabetes Devices In Pediatric Patients With Type 1 Diabetes Mellitus: Systematic Review, Alicia Podwojniak, Joseph Flemming, Isabella J Tan, Hira Ghani, Zachary Neubauer, Anne Jones

Rowan-Virtua School of Osteopathic Medicine Departmental Research

BACKGROUND: Continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusions (CSIIs) are the current standard treatment devices for type 1 diabetes (T1D) management. With a high prevalence of T1D beginning in pediatrics and carrying into adulthood, insufficient glycemic control leads to poor patient outcomes. Dermatologic complications such as contact dermatitis, lipodystrophies, and inflammatory lesions are among those associated with CGM and CSII, which reduce glycemic control and patient compliance.

OBJECTIVE: This systematic review aims to explore the current literature surrounding dermatologic complications of CGM and CSII as well as the impact on patient outcomes.

METHODS: A systematic review of the …

Two- Versus One-Bag Fluid Delivery In Pediatric And Adolescent Diabetic Ketoacidosis: A Systematic Review And Meta-Analysis, Maya Nasser, Joseph Nasr, Reem Zalloum, Nathanael Yap, Natalie Bourdakos, Shahid Miangul, Tara Betts, Hayato Nakanishi, Christian Than, Serge Jabbour

Division of Endocrinology, Diabetes and Metabolic Diseases Faculty Papers

Two rehydration protocols currently exist to treat diabetic ketoacidosis (DKA) in pediatric patients aged"one-bag" system and the more recent "two-bag" system. This study aimed to evaluate the safety and efficacy of the newer two-bag system versus the well-established one-bag system. The CiNAHL, Cochrane Library, Embase, PubMed, Scopus, and Web of Science databases were comprehensively searched from inception to June 2023 by 2 independent reviewers using the Preferred Reporting Items for Systematic Reviews and Meta-analysis framework. Eligible studies were those that reported participants(CRD42023427551). From the initial screening of 42 studies, 8 unique studies encompassing 583 patients met the eligibility criteria. The …

Effects Of Synergistic Application Of Viscozyme L–Wet Ball Milling On Structural, Physicochemical And Functional Properties Of Insoluble Dietary Fiber From Ginseng Residue, Guihun Jiang, Kashif Ameer, Karna Ramachandraiah, Xiaoyu Feng, Chaoyi Tan, Nanjie Cai

School of Medicine Faculty Publications

Synergistic effect of Viscozyme L with wet ball milling treatment on structural, physicochemical and functional aspects of insoluble dietary fiber (IDF) from ginseng residue were examined. SEM examination showed that IDF extracted by Viscozyme L in conjunction with wet ball milling (WBE-IDF) exhibited loose microstructural arrangement, and particle size of WBE-IDF was much smaller than that of IDF extracted by Viscozyme L (E-IDF) and along IDF (untreated). The FTIR spectra demonstrated the variations in the peak intensities in three modified ginseng IDFs. Besides, the highest thermal stability and viscosity was displayed by WBE-IDF among examined samples. In addition, WBE-IDF has …

Preventive Effects Of Quercetin On The Leaky Gut By Suppression Of Il-1beta-Induced Transcription Factors Involved In An Inflammatory Pathway In Colonic Epithelial Cells, Wannaporn Chayalak, Sumpun Thammacharoen, Chatsri Deachapunya, Sutthasinee Poonyachoti

The Thai Journal of Veterinary Medicine

Flavonol quercetin (Q), found in vegetables and fruits, demonstrates the most potent anti-inflammatory effect. The preventive effect and cellular mechanisms of Q (Q1, Q10, and Q100 µM) on IL-1β induced leaky gut via the signaling molecules of inflammatory pathway, NF-κB p65-iκB/or p38/ERK1/2/MLCK/phospho(p)-MLC were investigated in Caco-2 cells. The cytotoxic effect of Q was initially determined by MTT assay. Transepithelial electrical resistance (TER) and apical-to-basolateral fluorescein isothiocyanate-labeled dextran (FD-4) flux were used to determine paracellular permeability. The protein expression of signaling molecules was examined by Western blot analysis, and their target MLCK mRNA expression was determined using real-time PCR. All Q …

Renal Mass Imaging Modalities: Does Body Mass Index (Bmi) Matter?, Young Son, Mark E Quiring, Raeann M Dalton, Brian Thomas, Noah Davidson, Dayna Devincentz, Collin Payne, Sahil H Parikh, Benjamin A Fink, Thomas Mueller, Gordon Brown

Rowan-Virtua School of Osteopathic Medicine Departmental Research

PURPOSE: Accurate measurement of renal mass size is crucial in the management of renal cancer. With the burdensome cost of imaging yet its need for management, a better understanding of the variability among patients when determining mass size remains of urgent importance. Current guidelines on optimal imaging are limited, especially with respect to body mass index (BMI). The aim of this study is to discern which modalities accurately measure renal mass size and whether BMI influences such accuracy.

METHODS: A multi-institutional chart review was performed for adult patients undergoing partial or radical nephrectomy between 2018 and 2021, with 236 patients …

Enriching The Pcos Lifestyle, Callie Coleman

Electronic Theses and Dissertations

Polycystic Ovary Syndrome (PCOS) is an endocrine disorder affecting approximately 4 – 20% of women worldwide. It is associated with insulin resistance, fertility problems, and an increased susceptibility to chronic conditions through multiple inflammatory pathways. Women with PCOS are also at increased risk for disordered eating. The Mediterranean diet is associated with decreased inflammation and risk of chronic conditions, and intuitive eating principles are associated with decreased disordered eating patterns. The purpose of this study was to determine if a six-week nutrition education workshop incorporating information and skills related to both the Mediterranean lifestyle and intuitive eating principles can improve …

Voices Of Wisdom: Geriatric Interviews On Self-Management Of Type 2 Diabetes In The United States-A Systematic Review And Metasynthesis, David F Lo, Ahmed Gawash, Kunal P Shah, Jasmine Emanuel, Brandon Goodwin, Don D Shamilov, Gaurav Kumar, Nathan Jean, Christian P White

Rowan-Virtua School of Osteopathic Medicine Departmental Research

This review is aimed at unraveling the intricacies of diabetic self-management among geriatric people, drawing on current insights and understanding the complex paths geriatric people navigate. A wide search was conducted in health-oriented databases, including CINAHL, Embase, PsycINFO, MEDLINE, PubMed, Web of Science, and Cochrane Library, while gray literature was excluded. The search combined keywords and subject headings, focusing on the geriatric population, diabetes, self-management, and qualitative research. A three-tiered screening process was employed, with titles and then abstracts initially reviewed. Full-text analysis followed, with disagreements resolved among reviewers. In total, there were 248 participants included across these eight studies. …

Unveiling The Nexus Of Cellular Quality Control: Exploring The Interplay Between Ribosome-Associated Protein Quality Control And Mitochondrial Quality Control Pathways, Foozhan Tahmasebinia

Biological Sciences Theses and Dissertations

In eukaryotic cells, the intricate interplay between cellular quality control mechanisms is crucial for maintaining homeostasis and safeguarding the integrity of vital processes, spanning from macromolecule synthesis to the renewal of entire cellular organelles.

Disruption of these networks can lead to severe diseases such as metabolic disorders, underscoring the interconnected nature and feedback control mechanisms inherent in biological systems, including cellular quality control systems. This interconnectedness extends to the intricate communication between organelles, enabling coordinated functioning and adaptation to changing cellular conditions, particularly in response to stressors.

While the exact mechanisms governing these communications within cellular quality control systems remain …

Clinical Considerations And Outcomes Of Robotic Urologic Surgery In Obese Patients, Nazih Khater, Anna G. Morris, Delena M. Vanvalkenburg, Andrew J. Garcia, Kevin Jin, Shahab Ahmadzadeh, Sahar Shekoohi, Elyse M. Cornett, Alan David Kaye

School of Medicine Faculty Publications

Obesity is associated with many significant physiological changes. These considerations are important to surgery, especially in urological procedures. Obese patients often undergo surgical procedures and are at higher risk of complications. This investigation reviews physiological and anaesthesia considerations for obese and morbidly obese patients. In addition, urological surgeries and procedures should be considered for these higher risk patients. Clinical anaesthesiologists must use detailed assessment and, when appropriate, consultation in developing safe anaesthesia plans for these patients. Newer technologies have improved safety related to airway management, advanced airway devices, and regional anaesthesia with ultrasound-guided nerve blocks, which can reduce the need …

Clinical Outcomes For Patients With Nafld And Acute Hepatitis: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Peter Senatore

Rowan-Virtua Research Day

Introduction: Non-alcoholic fatty liver disease (NAFLD) is the most common form of chronic liver disease in the United States and has been found to play a significant role in cardiovascular disease risk through several mechanisms including dyslipidemia, insulin resistance, coagulability, and inflammation. Acute-on-chronic liver disease continues to contribute to worse health outcomes via acute hepatitis.

Methods: This case-control study investigated the relationship between NAFLD and acute hepatitis using data extracted from the National Inpatient Sample (NIS) Database for the years 2019 and 2020. The NIS was searched for hospitalizations of adult patients with acute hepatitis with and without NAFLD. Using …

Clinical Outcomes For Va-Ecmo Patients Associated With Hyperlipidemia: An Analysis Of The National Inpatient Sample, Dakota B. Pastore, Tony Elias, Rafail Beshai, Kyrillos Girgis, Maziyar Daneshvar, Keith Anacker

Rowan-Virtua Research Day

Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is considered the most advanced temporary life support which provides complete hemodynamic support in addition to gas exchange. There is limited data available on the impact of hyperlipidemia (HLD) on VA-ECMO patients. We sought to examine the national inpatient sample (NIS) database to describe in-hospital outcomes among these patients.

Methods: The NIS was searched for hospitalizations of adult VA-ECMO patients with and without a concomitant diagnosis of HLD for the years 2019 and 2020. The primary outcome was inpatient mortality.

Results:This study included 3,885 VA-ECMO patients, of which 1,082 (27.8%) patients had HLD. …

Impact Of Diabetic Education On Reducing Hospital Readmission Rates: A Literature Review Of Adults With Diabetes, Frank Camarda

Rowan-Virtua Research Day

According to 2018 data from the Diabetes Institute Foundation, adults in the U.S. diagnosed with diabetes accounted for 17 million emergency department visits. The readmission rate for patients with diabetes far exceeds the general readmission rates for hospitalized patients. While there is recognition of the need for diabetic education to reduce hospital readmissions, optimizing long-term self-management of diabetics remains a focus of ongoing research.

Brief Review: The Refeeding Syndrome, Jose Gerald Aragon, Mohammed A. Rattu, Alex Gechlik, Nicholas Coan, James A. Espinosa, Alan Lucerna

Rowan-Virtua Research Day

Here we briefly review the definition, epidemiology, pathophysiology, clinical risk scenarios, prevention and treatment of the refeeding syndrome. Refeeding syndrome is a condition which arises when a severely malnourished individual has been restarted with increased nutrition in a relatively short period of time. The refeeding process can lead to shifts in a number of fluids and electrolytes. The hallmark feature is hypophosphatemia. The true incidence of refeeding syndrome is unknown. This is said to be partly due to the lack of a universally accepted definition. Populations that are likely to experience this syndrome include patients with maladaptive eating disorders, chronic …

The Impact Of Stress During Adolescence And The Prevalence Of Pediatric Obesity, Olatunbosun Olakunri, Venkat Venkataraman

Rowan-Virtua Research Day

Obesity is a chronic condition that can be attributed to myriad factors including socioeconomic status, biological risk factors, and various environmental factors. These factors can be considered stress factors, and exposure to various levels of stress can impact the development of stress within the pediatric patients. The purpose of this study is to assess the association between the environmental, mental, social, physical, and psychological stress adolescents are exposed to and how they contribute to the prevalence of pediatric obesity throughout the United States. Understanding these risk factors can help us as a community and most importantly as clinicians develop better …

Diabetes Health Education For South Jersey Communities, Heaven Chu, Sarah Tamous, Ashhabal Kavvi, Amin Khan

Rowan-Virtua Research Day

Diabetes is a chronic health condition that hinders the body’s metabolic process using insulin to maintain glycemic homeostasis. It is prevalent worldwide, with about 10% of the global adult population affected. Socio-economic and cultural factors and determinants make diabetes and diabetes management more of a health risk for certain populations rather than others. The prevalence of diabetes in the United States is higher than the global average and the risk factors disproportionately affect disadvantaged communities.

This study was designed to investigate health disparities in diabetes among a diverse population sample. The study included researching the disparities of diabetes patients in …

Effects Of Obesity On Patients Undergoing Cardiomems Procedure: Retrospective Cohort Study, Tony Elias, Mena Elmalh, Priya Brahmbhatt, Kyrillos Girgis, Taha Syed, Michael Valderrama, Rafail Beshai

Rowan-Virtua Research Day

★ Remote hemodynamic monitoring (CardioMEMs) is becoming increasingly important for management of chronic heart failure patients.

★ There is limited data looking specifically for obese patients who undergo CardioMEMs implantation.

★ We sought to examine the national inpatient sample database to describe in-hospital outcomes for this demographic

Community Healthcare Workers (Chw) High-Risk Stabilization Study: Does The Ability Of Chws At Mobile Covid Clinics To Link Patients With Uncontrolled Diabetes To A Physician Improve Short Term Outcomes?, Mo Hadaya, Venkateswar Venkataraman, Jaimy D. Jabon, Kenneth W. Stagliano, Richard T. Jermyn

Rowan-Virtua Research Day

Uncontrolled diabetes may cause preventable but significant effects. One major preventative measure is early screening; there are hopes that community healthcare workers can increase awareness and screening availability, especially in underserved populations. We hosted and recorded logs of patients at mobile COVID health clinics, educating those with uncontrolled diabetes and connecting them to healthcare. We then looked to see if any patients had improvements in blood glucose to non-diabetic levels. 378 patients were logged, but only 138 were in events that had a significant amount of repeat visits. Twenty-five of them had blood sugar indicative of uncontrolled diabetes. Out of …

Exploring Geriatric Self Management Of Type 2 Dm: A Systematic Review, Ahmed Gawash, David F. Lo, Kunal P. Shah, Jasmine Emanuel, Brandon Goodwin, Don D. Shamilov, Gaurav Kumar, Nathan Jean, Christian P. White

Rowan-Virtua Research Day

This review explores diabetic self-management in geriatric individuals, focusing on positive attitudes and support from family/friends as crucial for self-care optimization. A comprehensive search in health databases was conducted, which involved screening 248 participants across eight qualitative research studies. Themes emphasizing the importance of listening to one’s body, acknowledging hidden issues, and recognizing the impact of various factors on diabetes self-care were established. A holistic approach to self management, emphasizing the significance of positive attitudes, cultural sensitivity, and individual values in healthcare practices is recommended. Embracing cultural diversity and addressing barriers can enhance self-management and quality of life for geriatric …

What Stigmas Still Exist For Weight Loss Medications?, Abdullah Panah, Philip Collins Do

Rowan-Virtua Research Day

Background and Hypothesis:

Medications for weight loss are becoming far more common as more tolerable formulas have come to the market with some medications offering results almost on par with bariatric surgery. However, studies show a stigma still persists around the discussion and perception around using weight loss medications. The authors of this study hypothesized that one of the biggest hurdles patients face for weight loss medications are the stigmas associated with taking these medicines and approaching the topic.

Methods:

This was a survey-based project that consisted of an anonymous, voluntary questionnaire which was provided to patients during their regular …

Effect Of Food Selectivity On Dyslipidemia In Autism Spectrum Disorder, Ankith Rao

Rowan-Virtua Research Day

This survey-based study sought to determine whether there is a correlation between food selectivity and blood lipid levels in autistic patients.

Exploring The Connection Between Diabetes Distress And Diabulimia, Stephen Poos, Misha Faerovitch, Celeste Pinto, Nima Jamalkhani, Fahad Chaudhri, Satara Khan, David F. Lo, Kaitlin Mcgowan, Ashaki Martin, Don D. Shamilov

Rowan-Virtua Research Day

Diabulimia is a disordered eating behavior that involves an individual with type 1 DM withholding insulin injection to lose weight. Diabetes distress, a term used to describe the psychological stress associated with managing diabetes, is believed to be the cause of this condition. This review aims to assess whether individuals with diabulimia have measurable evidence of diabetes distress. Studies that described patients qualitative experiences with Diabulimia were matched and compared to the criteria in the Diabetes Distress Scale. Over 40 of the 185 individuals across twelve studies were found to meet one or more criteria from the Diabetes Distress Scale. …

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Different Smoking Status: An Analysis Of National Health And Nutrition Examination Survey (Nhanes) Data From 2005 To 2018, Ting Luo, Tung Sung Tseng

School of Public Health Faculty Publications

Background: Combining smoking with poor eating habits significantly elevates the risk of chronic illnesses and early death. Understanding of how dietary quality shifts post-smoking cessation remains limited. The objective of this study is to examine dietary quality – using Healthy Eating Index (HEI – 2020) and its 13 components, among current, former, and never smokers, and particularly the impact of quitting and the duration of cessation on dietary habits. Methods: A cross-sectional analysis of 31,569 adults from the National Health and Nutrition Examination Survey (NHANES) 2005–2018 was conducted. Dietary quality was assessed using HEI-2020 scores, which were determined by NIH …

Management Of Macrovascular Diabetic Complications: A Single-Center Case Series Analysis Of Consecutively Attending Patients In Primary Care, Sanda Maria Crețoiu, Mihaela Adela Iancu, Laura Maria Condur, Teodor Salmen, Andreea Steriu, Ana Maria Alexandra Stănescu, Irina Anca Eremia, Cristina Mihaela Olariu, Eliza Elena Cinteză, Camelia Cristina Diaconu

Journal of Mind and Medical Sciences

Introduction. The prevalence of diabetes mellitus is increasing, with type 2 diabetes (T2DM) being a major health priority for any public health system. Increased arterial stiffness in patients with diabetes will lead to the appearance of vascular complications. Increased arterial stiffness in patients with diabetes usually leads to vascular complications. Any earlier diagnosis of impaired macrovascular evidence may lead to improved outcomes in patient care. The objective of our study was to assess and evaluate the finger-toe pulse wave velocity (ftPWV), as a measure of arterial stiffness, in order to assist with early detection of macrovascular diabetic complications. Materials and …

Association Between Monosodium Glutamate Consumption With Changes In Gut Microbiota And Related Metabolic Dysbiosis—A Systematic Review, Hossein Ahangari, Behnam Bahramian, Arezou Khezerlou, Milad Tavassoli, Narges Kiani-Salmi, Vahideh Tarhriz, Ali Ehsani

School of Medicine Faculty Publications

Monosodium glutamate (MSG) is used as a common food additive in some foods. However, based on our search and knowledge, no comprehensive study discussed the effect of MSG on the human gut microbiome. In this study, the effects of MSG on the gut microbiome, liver, and kidney were performed. Data were collected from databases including PubMed, Scopus, Web of Science, and ScienceDirect using the search strategy and keywords. Finally, 14 eligible studies were selected for systematic review. This study provides a new perspective on the effects of MSG on the gut flora, shedding light on the potential relationship between MSG …

Education Of The Effects Of Obesity Medications And A Stepwise Approach To Mitigate Prevalence And Encourage Lifestyle Medicine For Primary Care Physicians, Kiely M. Curran

Department of Nutrition Student Projects

My Capstone project is an Educational Manual that emphasizes a healthcare team approach to the treatment and management of obesity. The Educational Manual consists of a standardized protocol in management of obesity in patients and a document with summarized references for primary care providers; and a simplified document for patient education. There is a growing interest in the usage of obesity medications. The purpose of my Capstone project is to provide a simplified manual for the primary care provider to reference to make knowledgeable and patient-centered decisions in the prescription of obesity medications and decisions in weight-management. My methodology included …