Clinical Nutrition Management Research Articles

Jejunostomy feeding plus oral feeding versus intravenous nutrition plus oral feeding after esophageal cancer resection: a comparative retrospective cohort study.

There are multiple choices for the nutritional management mode after esophageal cancer surgery. Currently, there is still controversy regarding which nutritional management mode has an impact on the postoperative recovery and overall survival (OS) of patients. This study aims to compare the differences between two commonly used clinical nutritional management modes: jejunostomy feeding plus oral intake (JF plus OI) and intravenous nutrition plus oral intake (IN plus OI), in terms of short-term efficacy and 3-year OS, in order to further explore the optimal mode of enteral nutrition management after esophageal cancer surgery. We evaluated esophageal cancer patients who underwent radical surgery at Union Hospital of Fujian Medical University between January 1, 2010 and January 1, 2020. The purpose of this analysis was to compare the perioperative complications, Nutritional Risk Screening 2002 (NRS2002) nutritional scores at 1 week, 2 weeks, 1 month, and 3 months after surgery, as well as the 3-year OS rates, between two different nutritional management approaches: JF plus OI and IN plus OI following esophageal cancer surgery. Among the 822 patients included, 668 and 154 patients belonged to JF plus OI and IN plus OI groups, respectively. After propensity score matching, 149 patients per group were evaluated. The amount of gastric drainage fluid was higher in the IN plus OI group (P<0.05), and the incidence of postoperative gastrointestinal emptying disorder and intestinal obstruction was significantly higher in the JF plus OI group (P<0.05). The IN plus OI group had a higher incidence of perioperative hypoproteinemia (P<0.05), and a higher risk of malnutrition in 2 weeks after surgery (P<0.05). The 3-year OS was not significantly different (P>0.05). JF plus OI may be the preferable nutritional management approach after esophageal cancer resection as it can potentially reduce perioperative nutritional deficiency. However, attention should be paid to the risk of gastrointestinal emptying and intestinal obstruction associated with JF.

Factors of food choice and nutritional intake of Brazilian older adults according sociodemographic and health characteristics

The rapid demographic transition in developing countries has always posed a challenge for the social and economic policies of these nations. The increase in longevity poses new challenges for understanding dietary consumption among different age groups at the old age population. The aim of this study was to evaluate the reasons for food choice and the composition of nutritional intake of older adults and its relationship to individual characteristics. Community-living older adults aged 60 and older were interviewed in their homes at the southeastern region of Brazil, between December 2021 and February 2022. The Food Choice Questionnaire and a Food Frequency Questionnaire were administered to obtain data on the reasons for food choice and nutritional intake. A structured interview was employed to gather information on individual characteristics. 168 older adults (mean age of 72.6 ± 8.9; 69.6% women) participated. The reasons for food choice differed significantly, with weight control being one of the least important and health being one of the most important. But older adults aged 80 and over valued the health criterion less than younger participants (60–69 years old). The intake of macronutrients and energy were below nutritional recommendations. Carbohydrate consumption was positively correlated with the mood motive. There was a relationship between the reasons for choosing food and/or the components of nutritional intake with: gender, age, living with a partner, self-report of depression/anxiety, self-perception of health and nutritional status anthropometric. The results are important to be considered in prevention policies and clinical-nutritional management, with special attention to the oldest-old.

Shortages of clinical nutritional components and management strategies

Parenteral nutrition (PN) solution is a medication of high concern due to its intricate drug utilization procedure. It has been reported that since 2010, nearly every component involved in the preparation of PN admixtures has experienced a shortage at least once. Shortages may lead to therapy delays in hospitals, clinics and other health-related facilities or reductions in quality, prompting healthcare providers to recommend alternative treatments, potentially leading to medication errors, negatively influencing patient outcomes, and consume healthcare assets. The causes of medication shortages are diverse and encompass unidentified factors (44%), manufacturing complications (36%), supply and demand imbalances (8%), discontinued product lines (8%), insufficient access to raw materials (4%), and natural disasters. The duration for the resolution of these shortages was inconsistent, with certain product shortages that were resolved experiencing a recurrence, while others persisted for several months to years. The pharmacy department can take the lead in efficiently managing drug shortages by guaranteeing that its institution possesses the essential infrastructure and a clearly outlined management strategy well in advance of any shortages arising. During periods of shortages, it is extremely important to limit the use of nutritional products to patients with valid indications and those with nonfunctional gastrointestinal systems. Effective management of drug shortages, including PN components, necessitates a comprehensive plan and the involvement of an interprofessional team. This team should contribute to the development of the plan and be ready to implement it swiftly in case of a shortage or outage. Once the shortage of PN components is deemed resolved, all rationing and conservation strategies should be halted, as these measures are meant to be employed exclusively during shortages. Once the PN component shortage has been resolved, it is crucial to resume providing the full dosage of PN components to all patients in need of PN therapy.

Eat to Treat: The Methods and Assessments of a Culinary Medicine Seminar for Future Physicians and Practicing Clinicians.

Nutrition-associated chronic disease is an epidemic in the United States (US), yet most medical schools lack adequate nutrition education. We developed a six-session culinary medicine (CM) seminar entitled "Eat to Treat: A Nutrition Course for Future Clinicians" that teaches culinary skills, nutrition science, and counseling techniques to improve clinical nutrition management. The seminar was offered in-person to first-year medical students in a medical school-based teaching kitchen from 2017 to 2019. A virtual three-session course was also offered to practicing clinicians in 2020. Voluntary self-efficacy questionnaires were collected at the beginning of the first and last sessions of the student seminar, and paired t-tests determined the course's effect on survey items. A total of 53 first-year medical students attended the program over five semesters, and 39 students (73.6%) completed both surveys. All except one measure of self-efficacy were significantly higher at session 6 than session 1 (p < 0.05). A post-course survey was utilized for the clinician seminar and of the 31 participants, 14 completed the surveys; 93% and 86% of respondents agreed the course was clinically relevant and improved their confidence, respectively. We developed a CM curriculum that improved nutrition knowledge and confidence among a professionally diverse cohort and may represent a scalable education model to improve nutrition education in US medical schools.

Advances in multidisciplinary team-based collaborative care models in the nutritional management of patients with hepatocellular carcinoma

Liver cancer is a common and highly prevalent malignancy in China, and is a high prevalence of malnutrition. With the continuous innovation of medical technology and nursing model, the multidisciplinary teamwork nursing model has become inevitable for the care of liver cancer patients. This study reviews the concept of MDT nursing model, its development status at home and abroad and its application in the postoperative nutritional management of hepatocellular carcinoma patients, aiming to provide a basis for clinical hepatocellular carcinoma nutritional management.

Preterm infant nutrition: considerations for infants at risk of refeeding syndrome.

Refeeding syndrome (RS) in preterm infants is a scenario of fetal malnutrition, primarily resulting from placental insufficiency, followed by a postnatal physiologic adaptation and response to an imbalance of nutrients provided parenterally. Growth restriction and small gestational age status are common findings in infants at risk of developing RS. Adverse clinical outcomes associated with RS may be severe and life-threatening. The biochemical abnormalities that occur in RS may be mitigated through careful monitoring and adaptation of the clinical management of parenteral and enteral nutrition. This perspective reviews the physiology and metabolism in infants with RS and provides suggested approaches to their clinical monitoring and nutritional management.

Effect of Integrated Nurse-Guided Psychological Intervention on Nutritional Status of Head and Neck Cancers (HNC) Patients Undergoing Radiotherapy: A Randomized Controlled Study

<h3>Purpose/Objective(s)</h3> Malnutrition is common in HNC patients and was considered as a poor prognostic factor of radiotherapy (RT). Studies have shown that psychological intervention may improve the nutritional status of cancer patients during treatment. We hypothesize that the compliance with nutritional advice and nutrition status of HNC patients during RT can be improved by integration of nurse-guided psychological intervention into clinical nutrition management. <h3>Materials/Methods</h3> From October 2020 to February 2021, a total of 70 HNC patients who received postoperative radio(chemo)therapy in our department were randomly divided into two groups. Compared with patients in control group, patients in study group received psychological intervention under the guidance of nurses (at least once a week) on the basis of routine nutritional support. Anxiety (SAS scale), depression (SDS scale), nutritional status (PG-SGA score, body weight, BMI, albumin, and hemoglobin) and treatment dependence scale (treatment dependence scale) of patients were collected before radiotherapy (within 1 week), during radiotherapy (at the 20th treatment), at the end of radiotherapy, and 3 months after radiotherapy, respectively. <h3>Results</h3> There were no significant differences in anxiety and depression scores, nutritional status, and treatment dependence between the two groups before RT. In study group, the scores of anxiety and depression decreased significantly after RT than before RT (SAS: 52.46 ± 7.23 vs 60.05 ± 6.54, <i>p</i> =0.032; SDS: 50.66 ± 6.92 vs 59.55 ± 5.98, <i>p</i> = 0.037), while there was no significant difference in the scores before and after RT in control group (SAS, 60.22 ± 6.97 vs 59.91 ± 6.69, <i>p</i> = 0.648; SDS, 59.26 ± 6.01 vs 58.62 ± 8.33, <i>p</i> = 0.675). The nutritional status of the study group during and after radiotherapy were significantly better than those of the control group (body weight (kg), 62.33 ± 4.27 vs 60.24 ± 4.76, <i>p</i> = 0.037, BMI (kg/m²), 20.24 ± 3.72 vs 20.33 ± 2.25, <i>p</i> = 0.043; Alb (g/L), 35.41 ± 4.36 vs 34.27 ± 4.19, <i>p</i> = 0.028; Hb (g/L), 130.60 ± 15.63 vs 122.43 ± 13.98, <i>p</i> = 0.041). During RT, the compliance with nutritional advice was better in study group than in control group (3.56 ± 0.63 vs 1.42 ± 0.28, <i>p</i> = 0.013). <h3>Conclusion</h3> The integration of psychological intervention under the guidance of nurses into clinical management can relieve anxiety and depression in HNC patients undergoing RT, and improve the nutritional status and therapeutic compliancy of patients.

CAREER MOTIVATIONS (CAREER INSIGHT, CAREER IDENTITY, AND CAREER RESILIENCE) BASED ON AREA OF INTERESTS OF NUTRITION STUDENTS

Background: Nutrition-related career exists in various work sectors, from health care and education to food manufacture and business. No studies have been conducted on career motivations of nutrition students in three main areas of nutrition field. This study aimed to identify career motivations (career insight, career identity, and career resistance) in nutrition students of Universitas Gadjah Mada (UGM) with an interest in either of three nutrition main areas, i.e. clinical nutrition, community nutrition, or foodservice management. Methods: This study used a quantitative method and involved 75 college students of nutrition major in UGM. Variables in this study were nutrition students’ interest toward nutrition main areas and career motivations which consisted of career insight, career identity, and career resilience. Data collection used a validated questionnaire. Data analysis was performed using descriptive and analytical statistics. Results: Subjects with an interest in clinical nutrition, community nutrition, or foodservice management had career insight in medium category with almost equal proportions (i.e. 73.9%, 71.9% and 75%, respectively), career identity in medium category (73.9%, 53.1% and 70%, respectively) and career resilience in high category (60.9%, 56.3% and 50%, respectively).Conclusion: Career insight levels of UGM nutrition students are relatively equal in each area of interest in the nutrition field. Students with a clinical nutrition interest have the highest career resilience while students with a community nutrition interest have the highest career identity. Future studies need to employ a qualitative technique to better understand factors underlying students’ motivation in choosing area of interests in nutrition field.

Use of SmartIRB Does Not Reduce IRB Review Time in a Non-federally Funded, Multi-Site Malnutrition Study

ObjectivesWe evaluated the efficiency of using the SmartIRB platform compared to other site IRB approval mechanisms in the multi-site Academy and ASPEN Indicators to Diagnose Malnutrition (AAIM) Validation and Staffing Optimization Study.MethodsProcess data on the time to execute reliance agreements were collected when on-boarding sites for the AAIM Study (ClinicalTrials.gov: NCT03928548). Acute care hospital site recruitment occurred from September 2018 to December 2021. Research sites joined the study by either executing a reliance agreement with the single IRB of Record (sIRB) or by obtaining full local IRB approval from their institution. Reliance agreements were established through the SmartIRB model, an IRB authorization agreement (IAA), or a Letter of Support. Data are presented descriptively as number of observations and respective percentages or means ± standard deviations (SD).ResultsAs of September 2021, 82 sites received IRB approval for the AAIM Study through the submission of 69 individual IRB applications. Sixty sites were affiliated with SmartIRB. Forty-one applications established a reliance agreement with the sIRB: 31 of 69 used the SmartIRB model (44.9%), 7 used an IAA (10.1%), and 3 used a Letter of Support (4.3%). Twenty-eight applications were submitted for full local review (40.6%). For all 69 submissions, the average time from the initial contact to site activation by the sIRB was 496.9 ± 213.6 (SD) days. SmartIRB had the longest review period of 546.1 ± 220 days; followed by full local review (492.6 ± 213.9 days), then IAA (377.4 ± 143.7 days), and Letter of Support (306.3 ± 58.2 days).ConclusionsThe use of an sIRB and the SmartIRB platform did not to reduce the time required for IRB review of this non-federally funded study. These findings should be interpreted acknowledging several disruptions to IRB activity during the study recruitment timeframe (e.g., accelerated implementation of single IRB review starting in 2018, Common Rule changes in 2019, and the COVID-19 pandemic starting in 2020).Funding SourcesThe AAIM Study was funded by the Academy of Nutrition and Dietetics Foundation, the Commission on Dietetic Registration, the Pediatric Nutrition Practice Group, the Clinical Nutrition Management Dietetic Practice Group, and the Renal Dietitians Practice Group.

Development and Evaluation of a Practiice-Based Assignment in Chronic Kidney Disease to Enhance Clinical Nutrition Coursework

ObjectivesThe objective of this work was to develop and evaluate a novel practice-based clinical nutrition assignment to support competency-based academic nutrition programs that integrate didactic and experiential program components. The target audience was graduate nutrition students enrolled in a clinical nutrition course sequence. MethodsAs an alternative to a traditional “paper and pencil” case study assignment, each student was assigned to conduct an in-person, out-of-class interview with a practicing renal nutritionist. In written assignment directions, students were provided with questions for a structured interview which followed the nutrition care process, i.e., nutrition assessment, diagnosis, intervention, monitoring/evaluation, with application to nutrition management of chronic kidney disease. Subsequently, students responded anonymously to Likert scale questions regarding clinical knowledge and confidence in clinical skills derived from the practice-based assignment compared to their expected gains from a traditional “paper and pencil” case assignment plus an open-ended question. ResultsThe assignment supported clinical nutrition students’ competency in nutrition management of chronic kidney disease and facilitated their networking within the professional nutrition practice community. In class, students shared details of their interview findings from an array of practicing renal nutritionists which generated rich discussions in contrast to a single case study. In evaluating the practice-based assignment, n = 31 students reported on 5 point scales a mean of 4.4 regarding knowledge of clinical nutrition management and a mean of 4.0 regarding confidence in clinical skill derived from the practice-based assignment compared to expectations from a traditional case study assignment (where 5 = better than what I expected and 4 = slightly better than what I expected I would have gained from “paper and pencil” case). ConclusionsThis practice-based assignment in chronic kidney disease provided a unique approach to enhancing clinical nutrition coursework and facilitated an interactive learning environment to support students’ professional growth. Funding SourcesNone.

Process of medical nutrition therapy

Medical nutrition therapy is a very useful tool in maintaining and recovering the health of patients with disease-related malnutrition, although its implementation can be complex and is not without risks. Quality processes are understood as sets of activities that are related or interact to transform input elements into results. From the SENPE Management Work Group we present the process of medical nutrition therapy (PMNT), which aims to facilitate the management of clinical nutrition of a multidisciplinary nutrition support team in a hospital setting. This paper describes the seven sub-processes PMNT is comprised of, in addition to a previous nutritional screening sub-process. Each sub-process is divided into a first section with a technical sheet detailing its general aspects, while a second section proposes key objectives, quality indicators, and standards for their evaluation. .

The Importance of Nutrition in Neurological Disorders and Nutrition Assessment Methods.

Neurological disorders can change patients' nutritional status by directly or indirectly affecting dietary intake through mechanisms such as dysphagia, movement disorders, cognitive impairment, and depression. Malnutrition contributes to complications, resulting in delayed rehabilitation and increased morbidity and mortality. It is important to prevent malnutrition in patients with neurological disorders and to improve their nutritional status by identifying nutritional deterioration at an early stage and implementing appropriate nutritional interventions. This review examines the nutritional screening and assessment process in patients with neurological disorders, with a particular focus on stroke patients undergoing rehabilitation. Nutritional assessment, the first step of clinical nutrition management, identifies nutritional problems and their causes, signs, and symptoms through an overall evaluation including anthropometric measurements, dietary assessments, biochemical assessment, nutrition-related physical examinations, and functional assessment data. Based on the assessment, a nutritional intervention plan is established. By synthesizing the assessment results of selected subjective and objective indicators, nutritional screening tools to screen patients at risk of malnutrition and nutritional assessment tools to diagnose malnutrition were developed. It is important to use those tools with a clear understanding of their characteristics and scope.

Enteral nutrition management in stroke patients: a narrative review.

We aimed to summarize the enteral nutrition (EN) management of stroke patients according to recent evidence. Stroke patients have a high incidence of dysphagia, which is the main cause of malnutrition, and stroke with malnutrition leads to high recurrence and mortality. Insufficient food intake caused by dysphagia is the main cause of malnutrition in stroke patients, which is associated with poor prognosis, increased mortality, and deteriorated outcomes in patients with stroke. Dehydration is also worthy of attention. Non-systematic searches of the PubMed database were conducted to retrieve relevant English-language articles, and the CNKI and Wanfang database were searched for relevant Chinese-language articles. Fifteen recent guidelines or expert consensuses on the clinical nutritional management of stroke patients were published between 2013 and 2021, of which eight are from China. Before providing nutritional support, swallowing, hydration, and risk of malnutrition need to be screened by a dietitian or professional. Although the initiation time of nutritional support is different in each guideline, tube feeding is preferable for patients with dysphagia. The appropriate dosage, formula, and treatment of complications need to be further studied. Also, nutritional support for stroke patients at different stages needs to be further improved. The continuous improvement and details of stroke nutrition guidelines contribute to standardized clinical nutrition practices and benefit patients.

Assessment of the Quality Management System for Clinical Nutrition in Jiangsu: Survey Study

BackgroundAn electronic system that automatically collects medical information can realize timely monitoring of patient health and improve the effectiveness and accuracy of medical treatment. To our knowledge, the application of artificial intelligence (AI) in medical service quality assessment has been minimally evaluated, especially for clinical nutrition departments in China. From the perspective of medical ethics, patient safety comes before any other factors within health science, and this responsibility belongs to the quality management system (QMS) within medical institutions.ObjectiveThis study aims to evaluate the QMS for clinical nutrition in Jiangsu, monitor its performance in quality assessment and human resource management from a nutrition aspect, and investigate the application and development of AI in medical quality control.MethodsThe participants for this study were the staff of 70 clinical nutrition departments of the tertiary hospitals in Jiangsu Province, China. These departments are all members of the Quality Management System of Clinical Nutrition in Jiangsu (QMSNJ). An online survey was conducted on all 341 employees within all clinical nutrition departments based on the staff information from the surveyed medical institutions. The questionnaire contains five sections, and the data analysis and AI evaluation were focused on human resource information.ResultsA total of 330 questionnaires were collected, with a response rate of 96.77% (330/341). A QMS for clinical nutrition was built for clinical nutrition departments in Jiangsu and achieved its target of human resource improvements, especially among dietitians. The growing number of participating departments (an increase of 42.8% from 2018 to 2020) and the significant growth of dietitians (t93.4=–0.42; P=.02) both show the advancements of the QMSNJ.ConclusionsAs the first innovation of an online platform for quality management in Jiangsu, the Jiangsu Province Clinical Nutrition Management Platform was successfully implemented as a QMS for this study. This multidimensional electronic system can help the QMSNJ and clinical nutrition departments achieve quality assessment from various aspects so as to realize the continuous improvement of clinical nutrition. The use of an online platform and AI technology for quality assessment is worth recommending and promoting in the future.

The Power of Data: Transforming Clinical Nutrition Practice by Building a Custom Platform for RDN Productivity Reporting

Describe the process used to develop a data-driven productivity platform. Clinical Nutrition Managers (CNMs) and Registered Dietitian Nutritionists (RDNs) rely on productivity data to drive decisions, provide timely patient care, allocate resources, and meet compliance standards. Excel is widely used to collect productivity data; however, using such manual reporting systems can be time-consuming and cumbersome. Web-based data analytics tools like Tableau are increasingly used to provide dynamic, real-time data. Our team succeeded in creating an adaptable, customized automated data collection tool for RDN clinical productivity reporting. A team of ambulatory RDNs, the CNM, and IT specialists at Memorial Sloan Kettering (MSK) collaborated to build a clinical productivity data tool using the electronic medical record and Tableau. Documentation notes were modified to collect productivity data and automatically export it to Tableau. Previously, MSK RDNs recorded individual clinical productivity daily in Excel; these were sent to the Clinical Nutrition Manager to analyze monthly. Following the change from Excel to Tableau, RDN productivity data was automated, up to date, could be viewed in real-time, and showed historical trends. This change helped the CNM justify positions and manage resources. It also saved each RDN an average of 20-30 minutes daily. Automating RDN productivity data has been beneficial in budgeting and saving RDN time and apportioning resources. A similar tool is being developed for the inpatient RDNs and includes data on patients with documented malnutrition. Automating data collection is a process that can be easily replicated or adapted, is customizable, and adds value for Clinical Nutrition Managers and Registered Dietitian Nutritionists.

Photocatalytic TiO2/CdS/ZnS nanocomposite induces Bacillus subtilis cell death by disrupting its metabolism and membrane integrity.

The online version contains supplementary material available at 10.1007/s12088-021-00973-z.

International Dysphagia Diet Standardization Initiative: Collaboration between Singapore, United Kingdom and United States -Sodexo Healthcare

Coordinate and compare IDDSI best practices between US, UK and Singapore. In the US, Sodexo Healthcare Clinical and Culinary Teams have worked in partnership to produce new International Dysphagia Diet Standardization Initiative (IDDSI) recipes for our accounts. Over 500 Sodexo IDDSI recipes have been developed. To ensure patient safety on a global front, we recently joined forces to help our Singapore Sodexo accounts transition to IDDSI. During their exploration stage, Singapore reached out to Sodexo US and UK experts to gather relevant skills and resources for a food tasting and recipe development experiment. The Clinical Nutrition Manager lead her team to IDDSI Implementation for Sodexo in Singapore. Sharing of tools and resources was helpful but much of the information needed tweaking to adhere to local cultural preferences. Although the IDDSI guidelines remain universal, cultural food variations exist. An IDDSI Implementation Gantt Chart was created by Site Registered Dietitians in Singapore as they tested a variety of vegetables and protein foods offered on their menus (Chinese, Malay, Indian, and Western cuisines). They worked closely with the internal kitchen team and external stakeholders to access and evaluate vegetables and protein items' suitability based on IDDSI standards. Discussions and trials were conducted regularly. Favorite vegetables like beansprout, beetroot, black fungus, brinjal, capsicum, green pea and tomato skin had to be removed from MM5 & SB6 blending due to unsuitability to meet IDDSI standards. They tested new recipes and new mock meat alternatives that offered a variety for patients/residents. Sodexo Singapore moved quickly to the validation and deployment stage of IDDSI implementation. Thanks to the collaboration with US and UK , patients with dysphagia will be provided nutritious, healthy, and safe meals.

Study Protocol To Establish Validity and Reliability of Consensus-Derived Diagnostic Indicators for Malnutrition in Hospitalized Adult and Pediatric Patients

ObjectivesThe Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition have developed a set of consensus-derived indicators (the AACI) for the diagnosis of malnutrition in hospitalized adult and pediatric patients. This study aims to establish the predictive criterion and construct validity and reliability of the adult and pediatric AACI. MethodsWithin the context of a larger cohort study, 600 adult and 600 pediatric patients will be enrolled at ∼120 acute care hospital sites. Patients will be randomly selected and stratified approximately 1:1 as high- and low-risk for malnutrition based on the Malnutrition Screening Tool (adults) and STRONGkids screening tool (children). Registered dietitian nutritionists (RDNs) will collect AACI indicators and complete a Nutrition Focused Physical Exam for these patients. At a subset of 10–20 sites, bioelectrical impedance analysis (BIA) data will be collected to serve as an objective measure of body composition. After 90 days, follow-up data on nutrition care and medical outcomes (e.g., mortality, morbidity, hospital readmissions, length of stay, and healthcare costs) will be extracted from the medical record. Multilevel linear, logistic, multinomial, Poisson, or Cox regression models will be used to assess AACI validity as appropriate for each medical and BIA outcome, controlling for measures of disease severity, RDN-delivered medical nutrition therapy and other important patient-, RDN-, and site-level covariates as appropriate. The interrater reliability of the AACI will be evaluated by having multiple RDNs independently complete the AACI on the same patient to assess the agreement, using Cohen’s kappa, on specific indicators and overall malnutrition diagnosis. This study design follows recently published recommendations for assessing the validity and reliability of criteria for diagnosing malnutrition in hospitalized patients. ResultsN/A. ConclusionsValidation and reliability results will allow clinicians to standardize the way they diagnose malnutrition in hospitalized patients. Funding SourcesThis study is funded by the Academy of Nutrition and Dietetics Foundation, the Commission on Dietetic Registration, and the Pediatric Nutrition, Clinical Nutrition Management, and Renal Dietitians Dietetic Practice Groups.

Polycystic ovary syndrome and obesity: clinical aspects and nutritional management.

Polycystic ovary syndrome (PCOS) is a multifactorial endocrine and metabolic disorder characterized by androgen excess, oligo-anovulatory infertility, polycystic ovaries in ultrasound examination, insulin resistance, and cardiometabolic disorders, with overweight/obesity and visceral adiposity. This review aims to provide an overview of the clinical characteristics and nutritional therapy of PCOS and obesity. The authors analyzed the updated and relevant publications found on PubMed about clinical aspects and nutritional management of PCOS and obesity in studies done in animal and human models. It is crucial an early detection and intervention in PCOS patients to avoid the more challenging control of the onset of more impaired-health conditions that this pathology causes. It is presented evidence that clearly shows the close interaction among oxidative stress, low-grade inflammation, and PCOS. It is also analyzed the relevance of treating metabolic and nutritional correlations of PCOS with a complete therapeutic strategy that includes individualized medication, diet, and healthy habits. By an integral approach and treatment that includes not only medications for PCOS symptoms, supplementation of minerals and vitamins to control PCOS complications but an anti-inflammatory diet, nutritional education, exercise individualized program, lifestyle changes, it is possible to improve insulin resistance, sustained weight loss, ovulation rates, among other goals for the management of this disease. Further studies are needed to clarify mechanisms, beneficial effects, and doses of supplements and precise medication to determine the best combination of diets and exercise programs according to these patients' specific requirements.

Evidence summaries for nutritional screening of head-and-neck cancer patients

The guidelines for nutritional screening of head-and-neck cancer patients were systematically searched and screened from BMJ Best Practice, National Comprehensive Cancer Network, Britain's National Institute for Health and Clinical Excellence, National Guideline Clearinghouse, Scottish Intercollegiate Guidelines Network, Guidelines International Network, New Zealand Guidelines Group, Australian National Health and Medical Research Council, Medlive, PubMed, Embase, CINAHL, China Biology Medicine, VIP, Chinese National Knowledge Infrastructure, and Wanfang. Four researchers evaluated the quality of the included literature and extracted evidence from the literature that met the quality standards. Finally, a total of six guidelines were included and ten best evidences were concluded. As only one guideline in this study is from China, and the rest are from other countries, the applicability and effectiveness of some evidence in the Chinese population still need to be further explored and studied. Therefore, when using evidence, medical staff should make appraisal on working environment in their hospital, factors that facilitate or hinder the use of evidence, and willingness of patients, and thus scientifically provide the best evidence for the management of clinical nutrition for head-and-neck cancer patients and provide a reference for the establishment of the standard process of nutritional screening for head-and-neck cancer patients.