Clinical Nutrition Services Research Articles

Efficiency of a technology-assisted nutritional screening system: A retrospective analysis of 11,722 admissions in a tertiary hospital

Background and AimNutritional screening is essential for addressing malnutrition and its consequences. However, routine implementation in large hospitals faces several challenges. To overcome these obstacles, the Clinical Nutrition Service of a tertiary hospital developed a technology-assisted nutritional screening system. This study evaluates the system's efficiency in detecting and assessing patients at nutritional risk upon hospital admission. It also examines the association between nutritional risk, clinical outcomes, and sociodemographic characteristics. MethodsThis retrospective, analytical, observational study examined 11,722 hospital admissions of adult patients in 2019, each with a minimum hospital stay of 48 hours in a tertiary hospital. Rates and timing for the detection, referral, and assessment of patients at nutritional risk were calculated. Participants were divided into low (Malnutrition Screening Tool [MST] < 2 points) and moderate/high (MST ≥ 2) nutritional risk groups to evaluate the relationship between nutritional risk and clinical and demographic variables. ResultsWe found that 91% of patients underwent nutritional screening within the first hours of admission, with a median time of 9 hours from admission to screening (interquartile range [IQR] 3-19). The prevalence of nutritional risk (MST ≥ 2) was 21%. All patients identified as being at nutritional risk were immediately referred for a nutritional assessment once identified, with a median referral time of 0 hours (IQR 0-0). This assessment was carried out by a nutritionist for 98% of these patients, with a median time of 19 hours from referral to assessment (IQR 6-24). Compared to the low-risk group, patients with nutritional risk were older, had higher rates of mortality and admission to the intensive care unit (ICU), longer hospital stays, and a higher proportion of men and cancer diagnoses (p=0.00 for all comparisons). After adjusting for age and sex, nutritional risk was significantly associated with a higher probability of ICU admission (Odds Ratio [OR] 1.13; 95% CI 1.02-1.24) and in-hospital mortality (OR 2.32; 95% CI 1.97-2.73). ConclusionThe integration of technology into nutritional screening was highly efficient for early detection and assessment of at-risk patients upon hospital admission. Features of this system could guide other hospitals. The association found between nutritional risk and clinical outcomes emphasizes the importance of prompt and appropriate nutritional interventions.

Clinical nutrition service capacity of 445 secondary or above hospitals in Sichuan, China: the 2021 annual survey.

To investigate the capacity of clinical nutrition services in secondary and tertiary hospitals in the Sichuan Province, China. Convenience sampling was used. E-questionnaires were distributed to all eligible medical institutions in Sichuan through the official network of provincial and municipal clinical nutrition quality control centers. The data obtained were sorted in Microsoft Excel and analyzed by SPSS. A total of 519 questionnaires were returned, of which 455 were valid. Only 228 hospitals were accessible to clinical nutrition services, of which 127 hospitals had independently set up clinical nutrition departments (CNDs). The ratio of clinical nutritionists to beds was 1:214. During the last decade, the rate of constructing new CNDs was maintained at approximately 5 units/year. A total of 72.4% of hospitals managed their clinical nutrition units as part of their medical technology departments. The specialist number ratio of senior, associate, intermediate and junior is approximately 1:4:8:10. There were 5 common charges for clinical nutrition. The sample representation was limited, and the capacity of clinical nutrition services may have been overestimated. Secondary and tertiary hospitals in Sichuan are currently in the second high tide of department establishment, with a positive trend of departmental affiliation standardization and a basic formation of a talent echelon.

Nutritional assessment of birth outcomes of gestational diabetic mothers in Gaza Strip, Palestine

Introduction: Gestational diabetes mellitus (GDM) is the most prevalent metabolic disorder during pregnancy. Numerous studies have dealt with risk factors of GDM, while others studied the health complications associated with GDM. This study aimed to investigate the association between GDM and nutritional birth outcomes in Gaza Strip, Palestine. Materials and Methods: The study utilized the case−control design where 44 GDM mothers and 44 non-GDM mothers were recruited. The study was conducted at the obstetric departments at Al-Shifa Maternity Hospital in Gaza and Mubarak Maternity Hospital in Khan Yunis. Data collection included anthropometric measurement and hematological indicators and other pertinent information through a structured questionnaire. Results: The result reported that the mean age of GDM pregnant women and non-GDM was 31 ± 11.5 and 23 ± 6.75 years, respectively. 13.6% had anemia, 20.5% had previous delivery of macrosomic baby, 15.9% had hypertension, and 11.4% were obese. In addition, 63.6% of GDM mothers had a family history of diabetes and 18.2% had a family history of GDM. 43.2% of GDM mothers delivered by cesarean section (CS) and 13.6% of GDM mothers had a premature delivery. Assessment of dietary intake indicated that 40.9% of GDM mothers have breakfast regularly. The neonatal median birth weight was 3.22 kg for babies of GDM mothers and 3.30 kg for babies of non-GDM mothers, and the median length was 52 cm versus 50 cm; 6.8% of neonates of GDM mothers had low Apgar score. Neonates of GDM mothers expressed significantly lower blood sugar (P = 0.039), lower albumin (P = 0.037), and higher soluble surface receptors – surface transferrin receptor (P = 0.017), but there were no statistically significant differences in the other hematological parameters. Conclusion: The study reflected a significant association between GDM and lower blood glucose, serum albumin, and iron status. Furthermore, the study reflected a significant association between GDM and CS delivery and neonatal hypoglycemia. The study emphasized the need to integrate clinical nutrition services in maternity departments and antenatal clinics and encourage physical activities during pregnancy. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.

Value-based care outcomes in pancreatic cancer patients with and without access to registered dietitians: A retrospective cohort study of patients enrolled in the Oncology Care Model.

e16249 Background: Patients with pancreatic cancer face many nutrition-related concerns, although few guidelines exist to direct clinical nutrition services in this population. Examining quality outcomes for patients in clinics with and without access to a Registered Dietitians (RD’s) can help examine the contributions of RD’s in this area. Methods: A retrospective cohort design was used to compare Total Cost of Care (TCOC), hospital admissions and Length of Stay (LOS), and Emergency Department (ED) and Observation visits for patients with pancreatic cancer who were enrolled in the Oncology Care Model (OCM) during Performance Periods (PP) 1-6 (July 1, 2016–June 30, 2019). Patient deaths during the initial episode of care were also examined. Patients from a geographically concentrated metropolitan hub were divided into cohorts based on clinic access to an RD. Each patient’s initial six-month OCM episode of care was used for analysis. Results: Of the 389 OCM patients identified with pancreatic cancer from PP1-6, 203 were treated at 10 clinics with an RD and 186 in 17 clinics without an RD. In the RD cohort, 43.3% of patients were admitted to the hospital with an average LOS of 8.9 days. By contrast, 52.2% of patients in the non-RD cohort were admitted to the hospital with an average LOS of 10.0 days. TCOC for the 6-month episode was lower in the RD cohort at $37,185 versus the non-RD cohort at $40,907. During the initial 6-month episode of care, 37% of patients in the non-RD cohort died during the initial 6-month episode vs only 28% in the RD cohort. A higher percentage of patients in the RD cohort (35%) had ED or Observation visits, compared with the non- RD cohort (32%). Conclusions: Amongst OCM patients with pancreatic cancers, treatment at a clinic with an RD was associated with lower TCOC, reduced LOS for patients that were admitted to the hospital, and lower percentage of deaths in the first 6-month episode of care. The percentage of patients with ED and Observational visits was slightly higher in the cohort that had access to an RD. This analysis shows the potential benefit of RD services in an outpatient setting and justifies further study. Future multilevel modeling will evaluate the statistical significance of these results.[Table: see text]

Tendency of the nutritional care in inborn metabolic disorders on the clinical nutrition service in a third level hospital in México

Tendency of the nutritional care in inborn metabolic disorders on the clinical nutrition service in a third level hospital in México

Determinants of weight, psychological status, food contemplation and lifestyle changes in patients with obesity during the COVID-19 lockdown: a nationwide survey using multiple correspondence analysis

IntroductionThe corona virus disease 2019 (COVID-19) pandemic forced most of the Italian population into lockdown from 11 March to 18 May 2020. A nationwide survey of Italian Clinical Nutrition and Dietetic Services (Obesity Centers or OCs) was carried out to assess the impact of lockdown restrictions on the physical and mental wellbeing of patients with obesity (PWO) who had follow-up appointments postponed due to lockdown restrictions and to compare determinants of weight gain before and after the pandemic.MethodsWe designed a structured 77-item questionnaire covering employment status, diet, physical activity and psychological aspects, that was disseminated through follow-up calls and online between 2 May and 25 June 2020. Data were analyzed by multiple correspondence analysis (MCA) and multiple linear regression.ResultsA total of 1,232 PWO from 26 OCs completed the questionnaires (72% female, mean age 50.2 ± 14.2 years; mean BMI 34.7 ± 7.6 kg/m2; 41% obesity class II to III). During the lockdown, 48.8% gained, 27.1% lost, while the remainder (24.1%) maintained their weight. The mean weight change was +2.3 ± 4.8 kg (in weight gainers: +4.0 ± 2.4 kg; +4.2% ± 5.4%). Approximately 37% of participants experienced increased emotional difficulties, mostly fear and dissatisfaction. Sixty-one percent reduced their physical activity (PA) and 55% experienced a change in sleep quality/quantity.The lack of online contact (37.5%) with the OC during lockdown strongly correlated with weight gain (p < 0.001). Using MCA, two main clusters were identified: those with unchanged or even improved lifestyles during lockdown (Cluster 1) and those with worse lifestyles during the same time (Cluster 2). The latter includes unemployed people experiencing depression, boredom, dissatisfaction and increased food contemplation and weight gain. Within Cluster 2, homemakers reported gaining weight and experiencing anger due to home confinement.ConclusionsAmong Italian PWO, work status, emotional dysregulation, and lack of online communication with OCs were determinants of weight gain during the lockdown period.

Abstract 156: Nutrition therapy: Evaluating relevant interactions for therapeutic success

Background: Clinical nutrition services focus on calories and when a patient looses weight, it may result in both fat and protein loss. There is a lacunae in incorporating anthropometric data as part of nutritional services.Aim: To evaluate nutritional therapy in Diabetes with anthropometric data beyond weight.Materials and Methods: A total number of 847 diabetes patients in age group 35-71 years referred to Division of Nutrition, St. John's Medical College Hospital, Bangalore were recruited from 2015 to 2017. Anthropometric measurements including Body-Mass-Index (BMI), Waist-circumference (WC), Waist–Hip Ratio (WHR), Mid-ArmCircumference (MAC) were carried out on the patients on the first visit and subsequently on every other visit. A 24-hour dietary and physical activity recall was done by a nutritionist and a specific individualised plan was provided based on current intake. Wherever applicable paired ‘t’ test & univariate regression analysis were carried out between anthropometric, biochemical and dietary variables. The mean follow up was 12 months.Results: There was a significant positive association between BMI, percent body fat and WC, but not with WHR. On 24-hour dietary recall done during follow up, individuals in all the BMI groups consumed diets that closely matched international dietary recommendations for diabetes in terms of fibre intake, carbohydrate:protein:fat ratio. Patient's blood glucose profiles improved with a decrease in fat intake, without significant weight-loss. The mid-arm-circumference remained same through the study period.Conclusion: Clinical nutrition programs should utilize anthropometric data like WC & MAC along with dietary recall. Appropriate counselling with balanced diet beyond calories should be provided to achieve a decrease in fat mass without a decrease in mid-arm-circumference to maintain the protein mass. This data compares favourably with the Finnish Diabetes Prevention Study (DPS).

The experience and outcomes of multidisciplinary clinical pharmacist-led parenteral nutrition service for individuals with intestinal failure in a center without home parenteral nutrition.

Intestinal Failure (IF) is a rare but serious form of organ failure, and patients with IF are dependent on Total Parenteral Nutrition (TPN) to maintain growth and development. This study aimed to describe the experiences of a multidisciplinary clinical pharmacist-led TPN service in the Intestinal Rehabilitation Unit of Shiraz Organ Transplant Center. This prospective study was conducted in Shiraz Organ Transplant Center, Iran from February 2018 to October 2020, including seven months with and 24 months without the clinical pharmacist involvement. Clinical and nutritional outcomes as well as the potential complications of TPN were compared in these two periods. This study was conducted on 107 patients. The most important complication occurred among the patients receiving TPN were catheter infection (42.05%), sepsis, and catheter thrombosis (18.69%). Portal vein thrombosis (OR = 26.56) and length of Intensive Care Unit (ICU) stay (OR = 1.12) were significantly associated with the rate of parenteral nutrition-associated liver disease. The results also revealed an association between the rate of sepsis and history of malignancy, catheter thrombosis, length of the small bowel, length of PN, length of hospital stay, and length of ICU stay. Moreover, the results showed a significant difference regarding the patients' outcomes and TPN complications before and after the clinical pharmacist interventions (P < 0.05). Working as a multidisciplinary team in Intestinal Rehabilitation Unit (IRU) has been suggested to improve patients' outcomes and reduce mortality and morbidity. Presence of a clinical pharmacist in this team can help improve the TPN service provided for individuals with IF.

The impact of the introduction of a clinical nutrition unit in a hospital: a retrospective observational study.

Objectives: the study describes the evolution over the years of the use of artificial nutrition, in particular after the introduction of a dedicated Clinical Nutrition and Dietetic Service. Methods: a single-center, retrospective observational study performed with data collected from 2014 to 2019 at the Regional Hospital of Locarno, Switzerland. Results: from 2014 to 2019, there has been an increase in the number of patients identified as being at risk of malnutrition. We observed a reduction in the use of parenteral nutrition in all services, especially after the introduction of the dedicated Clinical Nutrition and Dietetic Service. There would seem to be a switch from enteral to oral nutrition with increased use of oral nutritional supplements. Conclusions: the introduction of a dedicated Clinical Nutrition and Dietetic Service in the care of patients with nutritional issues would seem to reduce the use of artificial invasive nutrition, despite an increase in the number of patients identified as being at risk of malnutrition.

Navigating the Continuum of Ethical Billing

Clinical nutrition services improve conditions such as diabetes, heart disease, and hypertension and support value-based care, focusing on optimizing cost, quality, and the patient’s care experience. Many registered dietitian nutritionists (RDNs) work to treat and prevent disease by providing medical nutrition therapy (MNT), which is covered by the Medicare Part B program, numerous commercial insurance plans, and many state Medicaid programs. Notably, the US health care system continues to witness changes related to payment for medical and nutrition services.

Association between Degrees of Malnutrition and Clinical Outcomes among Non-critically Ill Hospitalized Adult Patients with Type 2 Diabetes Mellitus.

IntroductionMalnutrition among hospitalized patients is highly prevalent. This adversely affects outcomes with longer length of stay (LOS), higher treatment costs and increased mortality. People with diabetes mellitus (DM) are particularly vulnerable to malnutrition and its consequences.ObjectiveTo determine the association of nutritional status with LOS and mortality among adults with Type 2 DM.MethodologyThis was a retrospective study of 439 adult patients with type 2 diabetes admitted in the medical ward of a tertiary hospital from January 1, 2018 to December 31, 2018. Demographics, anthropometrics, feeding route, LOS and outcomes were taken from the Clinical Nutrition Service database; biochemical data were taken from the Healthcare System, and were analyzed.ResultsIn our analysis, 83.8% were found to be malnourished with 50.3% moderately-malnourished (MM) (Nutrition risk level 1-2) and 33.5% severely-malnourished (SM) (Nutrition risk level ≥3). BMI category and malnutrition were the significant confounders for LOS. After controlling for BMI, LOS was longer by a mean of 2.2 days in SM compared to well-nourished (WN) patients (95% CI=0.49-3.95, p=0.012). Of the malnourished patients, 6.1% of SM and 0.5% of MM patients died. None of the WN patients died. Feeding route, admitted for neoplasm, low albumin levels and malnutrition were the confounding factors associated with mortality. After controlling for these factors, SM had higher odds of dying compared to MM patients [adjusted OR=8.91 (95% CI=1.04-76.18, p=0.046)].ConclusionAmong hospitalized non-critically ill adult patients with type 2 diabetes, SM patients but not MM patients had significantly longer LOS compared to WN patients, and greater degrees of malnutrition were associated with higher mortality.

Is It Time to Retire the Low-Oxalate Diet? Yes.

Journal of EndourologyVol. 35, No. 10 Point/CounterpointIs It Time to Retire the Low-Oxalate Diet? YesKristina L. PennistonKristina L. PennistonAddress correspondence to: Kristina L. Penniston, PhD, RDN, FAND, Department of Urology, University of Wisconsin School of Medicine and Public Health, 1685 Highland Avenue, 3258 Medical Foundation Centennial Building, Madison, WI 53705-2281, USA. E-mail Address: penn@urology.wisc.eduhttps://orcid.org/0000-0001-6427-018XDepartment of Urology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.UW Health University Hospital and Clinics, Clinical Nutrition Services, Madison, Wisconsin, USA.Search for more papers by this authorPublished Online:1 Oct 2021https://doi.org/10.1089/end.2021.0581AboutSectionsView articleView Full TextPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View articleFiguresReferencesRelatedDetailsCited byPatient Perception of Plant Based Diets for Kidney DiseaseJournal of Renal Nutrition, Vol. 29 Volume 35Issue 10Oct 2021 InformationCopyright 2021, Mary Ann Liebert, Inc., publishersTo cite this article:Kristina L. Penniston.Is It Time to Retire the Low-Oxalate Diet? Yes.Journal of Endourology.Oct 2021.1431-1434.http://doi.org/10.1089/end.2021.0581Published in Volume: 35 Issue 10: October 1, 2021Online Ahead of Print:September 14, 2021PDF download

A New Paradigm for Clinical Nutrition Services in the Era of the Fourth Industrial Revolution.

The role of clinical nutrition services is emphasized in the care of chronic diseases; the prevalence of chronic diseases continues to increase due to the living environment change, westernized dietary life and the aging population in Korea. The effectiveness of clinical nutrition services in the treatment of diseases in inpatients has been demonstrated in several studies. However, in recent days, innovative changes are pursued in clinical nutrition services through a convergence with information and communication technology (ICT), a core technology of the fourth industrial revolution such as big data, deep learning, and artificial intelligence (AI). The health care environment is changing from a medical treatment-oriented service to a preventive and personalized paradigm. Furthermore, we live in an era of personalization where we can personalize dietary aspects including food choice, cooking recipes, and nutrition in daily life. In addition, ICT technology can build a personalized nutrition platform in consideration of individual patient's diseases, genetic trait, and environment, all of which can be technical means in personalized nutrition management services. Personalized nutrition based on ICT technology is able to provide more standardized and high-quality clinical nutrition services to the patients. The purpose of this review is to examine the core technologies of the fourth industrial revolution affecting clinical nutrition services, and ultimately discuss how clinical nutrition professional should respond to ICT technology-related fields in the era of the new technological innovations.

328 Targeting food formulation considering nutrient intake

Abstract Since the last publication of NRC (2006), dog and cat nutritionists have a good starting point to formulate pet food, once the Committee included the “recommended allowances” (RA) in the nutrient requirement tables, both expressed per dry matter (DM) or food metabolizable energy (ME). According to the Committee, the RA means “…where applicable, includes a safety factor for nutrients with uncertain bioavailability.” This is certainly important for many situations, but does not solve all concerns related to achieve a complete nutrient supply for a specific individual. This presentation will discuss the implications of the wide diversity of animals’ energy requirements, and consequently food and nutrient consumption that dogs and cats may experience along their life cycle and housing conditions. Thus, Diet Diversity, or products with diverse energy and nutrient densities, is important to drive veterinarians and nutritionists to the better food selection to fulfill nutrient requirements of specific individuals. Although data from NRC (2006) based on food ME correct distortions of DM intake related to available energy content of diets, this approach does not correct for the diversity of energy requirement among individuals, as well known for dogs (Bermingham et al., 2014) and cats (Bermingham et al., 2010). The problem is reinforced by the value assumed by NRC (2006) to estimate energy intake in adult dogs (130k cal/kg 0.75/day) and cats (100k cal/kg 0.67/day), far distant from the real energy expenditure of several (maybe most) home-living animals. A meta-analysis study showed that the NRC (2006) equation quite substantially overestimated energy requirements and food intake for cats under 4.5 kg of BW. House-living dogs (Thes et al., 2016) may need only 98k cal (per kg 0.75/day) when in ideal body condition to keep BW constant, while 120k cal when lean, and 86k cal when obese. The substantial variation among individuals is also important; considering the obese dogs group, for example, the 25% quartile value was lower (62k cal) than the 75% quartile (105k cal), showing that to achieve the adequate nutrient intake for obese animals with low energy requirement might be a challenge, due to the low DM intake (Thes et al., 2016). Based on the clinical experience of the presenter, managing a clinical nutrition service inside a teaching veterinary hospital, and a research experience with energy metabolism of cats and dogs, the presentation will explore the implications of energy requirements on nutrient intake, and how to better address NRC standards in practical formulations.

Factors predicting weight gain during Covid-19 lockdown in patients with obesity: A national survey

Rationale: We hypothesized that Covid-19 epidemics lockdown1,2 might have negatively impacted on weight control in Italian patients with obesity being followed-up at Specialistic Centres. Methods: A survey was carried out at Italian Clinical Nutrition & Dietetic Services by means of a structured questionnaire (77 items) - covering diet, physical activity and psychological aspects - to get information about how their patients with obesity coped with Covid-19 lockdown. Ethical clearance was obtained. The survey has been carried out between 2ndMay and 25th June 2020 during follow-up phone calls by direct questioning or by sending invitations to complete the questionnaire on the Web. Data were analyzed by Chi-square test, ANOVA and MANCOVA as appropriate. Results: 1046 patients from 23 Centers (41% Obesity Class 2 to 3) completed the questionnaires (71% females, mean age 50,5 ± 14,2 yrs, mean BMI 34.7 ± 7.6 kg/m2). During the lockdown period, 49,3% of patients increased and 27.4% reduced their weight, while this was unchanged in 19,6%. Mean weight change was +2.3 ± 4.8 kg (+ 4% in those who experienced weight gain). There was a significant association between reduced physical activity, emotional difficulties during lockdown and weight gain. Moreover, those working from home and those on layoffs experienced a significantly higher weight gain than those allowed to work outside home or retired. Sixty-six% declared to be on a weight control diet before the lockdown, and of these, 40% reported difficulty to follow their diet. More frequent snacking and increased intake of high calorie foods were the most frequent food habits change declared. Only 4% of patients were on obesity medications, but 14% of patients would have liked to be on obesity medications during the lockdown. Conclusion: During Covid-19 lockdown about half of patients with obesity in follow-up at Italian Dietetic Services did not increase their weight or experiences weight loss. However, the remaining half experienced a clinically relevant weight gain. Those who increased their weight likely did mostly so because of reduced physical activity and difficult emotional coping. Working from home was also associated with more difficult weight control.

Patient satisfaction assessment in telemedicine

Rationale: A new specialist telecare system, eViSuS, has been in use, in the Clinical Nutrition Service of S. Lazzaro Hospital (Alba, Italy), for the assessment and management of malnourished patients in Nursing Home through remote video-visits (VV). The target of the study is to assess patients’ satisfaction.

Childhood Obstructive Sleep Apnea: from Diagnosis to Therapy—an Update

Obstructive sleep apnea syndrome (OSAS) is common in childhood and is characterized by recurrent upper airway obstructive events during sleep. It is associated with significant morbidity, potentially influencing long-term neurocognitive and behavioral development, as well as cardiovascular sequelae. Children differ from adults with respect to etiology, clinical presentation, and medical and surgical management. A comprehensive review article concerning the pathophysiology, diagnosis, and treatment of OSAS was undertaken. To date, OSAS is a very common problem in children and is primarily caused by adenotonsillar hypertrophy, and adenotonsillectomy remains the first-line surgical treatment. Clinical and epidemiological studies show that OSAS is a multifactorial and complex disease with a strong genetic basis. OSAS should be recognized as a public health problem due to the increasing incidence of this condition secondary to rising rates of obesity in children. It has a significant impact on the growth and development of a child from a behavioral and neurodevelopmental perspective. This is particularly important in children with secondary medical conditions. It is therefore a crucial tailored approach to pediatric OSAS patients in order to diagnose and treat early this condition with a multidisciplinary team including otolaryngology, respiratory medicine, pediatrics, and clinical nutrition services.

Autophagy suppression plays a role in parenteral nutrition-associated lung injury.

The long-term usage of parenteral nutrition (PN) is associated with the increased incidence of pneumonia. Few studies have focused on the pathogenesis of PN-associated lung injury (PNLI). Previous studies have found that autophagy suppression may be an important mechanism for PN-associated complications. The present study aimed to investigate the effect of PN on lung barrier impairment and its association with autophagy. We retrospectively identified intestinal failure patients admitted to a clinical nutrition service center to determine the morbidity of hospital-acquired pneumonia (HAP) and its association with PN. In animal studies, we established the PNLI mouse model to measure severity of lung injury, lung barrier, pulmonary microbiota in bronchoalveolar fluid (BALF), levels of autophagy and apoptosis, and the inflammatory signaling pathway. Among the 259 patients, 37 (14.3%) patients developed HAP. Multivariate analysis revealed that prolonged PN was an independent predictor for HAP. In animal studies, we found that PN impaired the lung barrier and disturbed pulmonary microbiota homeostasis. The abundance of Actinomycetes and Firmicutes phyla in BALF were significantly increased, while the Bacteroidetes phylum decreased. Bacterial translocations in the lung were observed by fluorescence in situ hybridization. PN caused autophagy suppression and activated the apoptosis level and inflammatory HMGB1/RAGE/NF-kB signaling pathway. The intervention of exogenous rapamycin can attenuate the impairment of the lung barrier, reduce apoptosis and inhibit inflammatory signaling by upregulation of autophagy. PN had a damaging effect on the lung barrier, disturbed pulmonary microbiota homeostasis, and induced bacterial translocation. Autophagy suppression might be a crucial mechanism in inducing PNLI.

A Current Gap Analysis of Education for Clinical Nutrition Managers

Clinical nutrition managers (CNMs) administer clinical nutrition and other services. An online survey was distributed to CNMs to examine the importance of education for specific CNM job tasks, the extent to which educational needs are met, and what opportunities exist to enhance the knowledge and skills of CNM practitioners. Gap analyses were employed to interpret variances in the educational variables. Results indicate that CNMs perceive education as important for all job tasks and that educational needs are not being met for all job tasks. The greatest opportunities for education were with ensuring compliance with regulations and accreditation standards and managing human and financial resources.

200 Evaluation of Nutrition Service Provision in a Day Hospital Setting

Abstract Background Malnutrition, frailty and functional impairment adversely impact individuals and should be considered simultaneously in rehabilitation. Individuals in a Day Hospital (DH) setting require a multidisciplinary approach to rehabilitate and nutrition plays a fundamental role in improving patient outcomes. The aim of this study was to establish the nutritional profile of the patients attending the DH and to measure this against current dietetic referral criteria. Methods A prospective quality improvement analysis of older adults attending the DH was conducted. Nutritional status, using the mini nutritional assessment short-form, demographic and biochemical information was collected from nursing notes and the software Key. Frailty scores were assigned using Rockwood Clinical Frailty Scale. Nutrition service provision was evaluated in relation to the priority rating system for DH Patients. Results Nearly two-thirds of the 57 patients were malnourished (17.5%) or at risk (45.6%), 1 in 4 (26.3%) was obese. Most patients were frail (77.2%). 45.6% of patients were referred to clinical nutrition services. 90% of malnourished patients and 53.8% of those at risk were referred to dietetic services. Patients were seen at 4 ± 2.45 weeks after referral, 19.2% of patients were seen on time. Patients with underweight or obese BMI classifications were at greater risk of malnutrition and frailty. Those referred to the DH for falls review were nutritionally poorer and physically frailer. Conclusion This study highlights the need for a focused nutritional service in this environment. Revision of dietetic referral criteria and streamlining strategies are required to provide quality, timely intervention to those who need it most.