Eufemia Silvestri

In Eastern Mediterranean countries, undernutrition and micronutrient deficiencies coexist with overnutrition-related diseases, such as obesity, heart disease, diabetes and cancer. Many Mediterranean countries have produced Food-Based Dietary Guidelines (FBDGs) to provide the general population with indications for healthy nutrition and lifestyles. This narrative review analyses Eastern Mediterranean countries’ FBDGs and discusses their pictorial representations, food groupings and associated messages on healthy eating and behaviours. In 2012, both the WHO and the Arab Center for Nutrition developed specific dietary guidelines for Arab countries. In addition, seven countries, representing 29% of the Eastern Mediterranean Region population, designated their national FBDGs. At the moment several of these guidelines are available only in the English language. In summary, Eastern Mediterranean FBDGs mainly focus on food safety, not all are available in the local Arabic language, and they do not provide specific suggestions for the large number of foreign workers and migrants.

Post-bariatric hypoglycemia (PBH) is an increasingly recognized long-term complication of bariatric surgery. The nutritional treatment of PBH includes a high-fiber diet and the restriction of soluble and high-glycemic index carbohydrates; however, these measures are not always enough to prevent hypoglycemia. We evaluated the efficacy of uncooked cornstarch, a low-glycemic index carbohydrate characterized by slow intestinal degradation and absorption, in addition to a high-fiber diet, for the treatment of PBH. We report the cases of two young women suffering from severe postprandial and fasting hypoglycemia following Roux-en-Y gastric bypass (RYGB). The patients underwent Continuous Glucose Monitoring (CGM) before and 12–16 weeks after the administration of uncooked cornstarch (respectively 1.25 g/kg b.w. and 1.8 g/kg b.w.) in addition to a high-fiber diet. In both patients, CGM showed more stable glucose levels throughout monitoring, a remarkable reduction of the time spent in hypoglycemia (<55 mg/dL) both during the day (−11% for both patients) and the night (−22% and −32%), and the improvement of all glycemic variability indexes. Our report, within the limit of only two cases, suggests that the implementation of a dietary intervention through the addition of uncooked cornstarch reduces daily glycemic fluctuations and hypoglycemic episodes in patients with PBH.