Dietary Prescription Research Articles

Association between probiotic, prebiotic, and yogurt consumption and chronic kidney disease: The NHANES 2010-2020.

Previous studies suggested that gut dysbacteriosis may promote the occurrence of chronic kidney disease (CKD), and probiotic, prebiotic, or yogurt supplements may alleviate CKD progression. This study aims to examine the association between probiotic, prebiotic, or yogurt supplements and the risk of CKD using the data from NHANES. This study was designed to prospectively search data from the National Health and Nutrition Examination Survey (NHANES) (2011-2020). We examined dietary supplements and prescription medication labels to identify probiotic, or prebiotic product, and yogurt consumption during the dietary interview. The diagnosis of CKD was determined by the value of glomerular filtration rate (eGFR) and albumin creatinine ratio (ACR). The study enrolled a total of 6,522 individuals. The prevalence of CKD was lower in the probiotic, prebiotic, or yogurt consumption group [age-adjusted odds ratio (OR): 0.77, 95% CI: 0.62-0.95, P = 0.02; multivariable-adjusted OR: 0.86, 95% CI: 0.69-1.07, P = 0.05]. Furthermore, 32% reduced risk was observed in the older group aged 55 years or older, and 32% reduced risk was also observed in the female population. Probiotic, or prebiotic, or yogurt supplements was associated a 12% reduction in moderate risk of CKD and an 11% reduction in very high risk of CKD. Our results suggest that probiotic, prebiotic, or yogurt supplements may contribute to the prevention of CKD and relieve its progression risk, especially in the female population and older population who were aged 55 years or older.

The Effect Of Content Development On Android Applications On Knowledge Of Dietary Prescriptions On Metabolic Syndrome Risk

Metabolic syndrome is generally defined as meeting 3 (three) of 5 (five) criteria including abdominal obesity, hypertriglyceridemia, low HDL (high density lipoprotein) cholesterol, hypertension and hyperglycemia. About 20-25% of the world's adult population has the metabolic syndrome. The purpose of this study was to determine the effect of the android application on knowledge of dietary prescriptions in the community at risk for metabolic syndrome. The research design is a quasi-experimental study (quasi-experimental study), with a non-randomized control group pre-test - post-test test design that aims to determine the possibility of a causal relationship by intervening or giving treatment to one or more experimental groups, then the results (effect) of intervention was compared with a group that was subjected to different treatments (control group). Characteristics of age (p=0.172), gender (p=0.25) and education (p=0.055). Knowledge before intervention p=0,306 and after intervention p=0,009 in both groups. Knowledge before and after intervention in the case group p=0.0005 and knowledge before and after intervention in the control group p=0.0005. The types of outputs produced in this study are application systems for early detection of metabolic syndrome disease and dietary prescriptions, intellectual property rights and research journal articles. Introducing this android application so that it can be better known to the public in general and developing this android application so that it becomes more interesting and easy to understand.

Trends in Overall and Micronutrient-Containing Dietary Supplement Use in US Adults and Children, NHANES 2007–2018

Dietary supplement (DS) use is widespread in the United States and contributes large amounts of micronutrients to users. Most studies have relied on data from 1 assessment method to characterize the prevalence of DS use. Combining multiple methods enhances the ability to capture nutrient exposures from DSs and examine trends over time. The objective of this study was to characterize DS use and examine trends in any DS as well as micronutrient-containing (MN) DS use in a nationally representative sample of the US population (≥1 y) from the 2007-2018 NHANES using a combined approach. NHANES obtains an in-home inventory with a frequency-based dietary supplement and prescription medicine questionnaire (DSMQ), and two 24-h dietary recalls (24HRs). Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income [poverty-to-income ratio (PIR)], and household food security (food-secure vs. food-insecure) using the DSMQ or ≥ 1 24HR. Linear trends were tested using orthogonal polynomials (significance set at P<0.05). DS use increased from 50% in 2007 to 56% in 2018 (P=0.001); use of MN products increased from 46% to 49% (P=0.03), and single-nutrient DS (e.g., magnesium, vitamins B-12 and D) use also increased (all P<0.001). In contrast, multivitamin-mineral use decreased (70% to 56%; P<0.001). In adults (≥19 y), any (54% to 61%) and MN (49% to 54%) DS use increased, especially in men, non-Hispanic blacks and Hispanics, and low-income adults (PIR≤130%). In children (1-18 y), any DS use remained stable (∼38%), as did MN use, except for food-insecure children, whose use increased from 24% to 31% over the decade (P=0.03). The prevalence of any and MN DS use increased over time in the United States. This may be partially attributed to increased use of single-nutrient products. Population subgroups differed in their DS use.

Nutrigenomics: Perceptions of South African Dietitians and General Practitioners

Introduction: Although investigations into the emerging field of nutrigenomics are relatively limited and more research in this field is required, experts agree that there is potential for it to be incorporated into health care practice. If health care professionals can promote healthy dietary behavior based on nutrigenomic testing, it can assist in addressing the health consequences of poor diet and lightning the strain on the South African health care system. Methods: Registered dietitians (RDs) and general practitioners (GPs) registered with the Health Professions Council of South Africa (HPCSA) who obtained their qualification in South Africa (SA) were eligible to participate in this cross-sectional study. Participants were identified using convenience and snowball sampling. A self-administered electronic survey using EvaSys Software® was completed by those that agreed to participate. Results: Nearly all RDs (97.3%), but less than a third of GPs (30.4%), had heard of the term nutrigenomics. Approximately three-quarters of RDs (74.7%) and GPs (73.9%) had or would personally consider undergoing genetic testing. More than 40% (43.5%) of RDs ranked direct-to-consumer genetic testing companies as the most equipped, while 31.8% of GPs ranked RDs as the most equipped to provide patients with nutrigenomic services. Both RDs and GPs ranked similar reasons as “strongly agree” for why consumers were motivated to make use of nutrigenomic services, which included “motivated by a desire to prevent or manage disease” (56.7%), “prevent a disease based on family history” (65.9%), “control health outcomes based on family history” (54.9%), and “improve overall health-related quality of life” (48.6%). Cost concerns were reported as the greatest barrier to implementing nutrigenomic services (75.7%). Other barriers included confidentiality issues (47.8%) and moral concerns (37.3%). Greater individualization of diet prescription (66.5%), stronger foundations for nutrition recommendations (62.4%), and dietary prescriptions that would manage or prevent certain diseases more effectively (59.0%) were all perceived as benefits of including nutrigenomics in practice. Conclusion: This study identified perceived consumer motivators and barriers that might affect the willingness to seek nutrigenomic services in SA. In addition, the need for more nutrigenomic training opportunities, including the planning of personalized diets based on genetic testing results and interpretation of results, was confirmed. However, both RDs and GPs felt that the emerging field of nutrigenomics needs further development before it can be applied effectively in routine private and public health care in SA.

Differences in the Perception of Dietary Supplements between Dietary Supplement/Medicine Users and Non-Users.

Some patients use dietary supplements and medicines concomitantly, with an inappropriate perception of their safety and efficacy. To clarify the perception between dietary supplement and medicine users and non-users, we conducted an internet survey. In this survey, 38.9% of participants used dietary supplements, 32.6% used prescription medicines, and 14.7% used dietary supplements and prescription medicines concomitantly. Then, we conducted a further survey on four groups, dietary supplement and prescription medicine users, dietary supplement only users, prescription medicine only users, and non-users (500 each). Dietary supplement users had favorable outcomes in terms of both the safety and efficacy of dietary supplements compared to dietary supplement non-users. This perception of dietary supplements was independent from medicine use. The awareness of the Health Food Network consumer navigation site, which provides information about dietary supplements for consumers, was the highest among dietary supplement and prescription medicine users, but it was still low (2.2%). In conclusion, consumers who use dietary supplement and prescription medicine concomitantly have favorable outcomes for their safety and efficacy and a low awareness of their interaction. There is a need to provide information, especially regarding the risk of interaction, that takes into account the consumer’s situation.

Approccio nutrizionale all’ipofosforemia post-trapianto di rene: uno studio pilota

Renal transplantation is the gold standard for the treatment of ESRD patients. During the early-stage post-transplantation, metabolic and electrolytic alterations may develop, including hypophosphatemia and the treatment includes a diet rich in phosphorus, sometimes with the addition of oral or intravenous phosphorus supplement. Forty-four kidney transplanted patients with hypophosphatemia were evaluated retrospectively. They were divided into two groups based on whether patients received (group A, 14 patients) or not (group B, 30 patients) dietary prescription for hypophosphatemia. Group A was further divided into two subgroups: group A1 (8 patients), with baseline phosphatemia ≥0.5 mmol/L, treated only with a diet rich in animal phosphorus, and group A2 (6 patients), with baseline phosphatemia ≤0.5 mmol/L, who received a potassium phosphate supplement in addition to the same dietary prescription. Three months after transplantation, group A had a greater increase of phosphatemia compared with group B (group A: 0.58 ± 0.12 vs 0.93 ± 0.22 mmol/L; group B: 0.59 ± 0.11 to 0.8 ± 0.13 mmol/L). Furthermore, in group A2 the increase of phosphatemia was lower than in group A1. In conclusion, dietary approach supported by dietary counseling was effective in treating post kidney transplantation hypophosphatemia. The results of this pilot study might represent a useful working hypothesis for studies with a larger cohort of enrolled patients in order to confirm for these patients the efficacy of the nutritional approach and of the dietary counseling to post renal transplantation hypophosphatemia.

Activating Twenty-four; Time, Space, and Body

Numbers structure reality and define the way people live. Both in Daoism and in Daesoon Jinrihoe they signify key concepts, notably the cardinal numbers from one through nine that classify different dimensions of the cosmos. Beyond these, the number twenty-four plays an important role. In a temporal mode, it marks the divisions or seasonal periods of the year. Consisting of fifteen days each, these periods signal (and are named after) changes in dominant weather patterns and the position of the sun. Generally activated in the body through particular seasonal activities and dietary prescriptions, in Daoism they are also the root of a series of healing exercises and certain refinement practices of internal alchemy. In Daesoon Jinrihoe, moreover, they are activated by chanting a specific incantation that invokes the twenty-four divine rulers of the divisions, originally a group of Tang Dynasty officials that in nature and function resemble the spirit generals of the early Celestial Masters. Beyond this, the number twenty-four also applies to space. Not unlike the twenty-eight lunar stations or mansions, traditional cosmology acknowledges twenty-four directions, made up of six constellations each in the four cardinal directions, complete with starry deities and divine generals. Their powers are activated with the help of written characters rather than vocal incantations, using techniques common both in Daoism and Daesoon Jinrihoe.

The Effect of Diet and Exercise Interventions on Body Composition in Liver Cirrhosis: A Systematic Review

Alterations in body composition, in particular sarcopenia and sarcopenic obesity, are complications of liver cirrhosis associated with adverse outcomes. This systematic review aimed to evaluate the effect of diet and/or exercise interventions on body composition (muscle or fat) in adults with cirrhosis. Five databases were searched from inception to November 2021. Controlled trials of diet and/or exercise reporting at least one body composition measure were included. Single-arm interventions were included if guideline-recommended measures were used (computed tomography/magnetic resonance imaging, dual-energy X-ray absorptiometry, bioelectrical impedance analysis, or ultrasound). A total of 22 controlled trials and 5 single-arm interventions were included. Study quality varied (moderate to high risk of bias), mainly due to lack of blinding. Generally, sample sizes were small (n = 6–120). Only one study targeted weight loss in an overweight population. When guideline-recommended measures of body composition were used, the largest improvements occurred with combined diet and exercise interventions. These mostly employed high protein diets with aerobic and or resistance exercises for at least 8 weeks. Benefits were also observed with supplementary branched-chain amino acids. While body composition in cirrhosis may improve with diet and exercise prescription, suitably powered RCTs of combined interventions, targeting overweight/obese populations, and using guideline-recommended body composition measures are needed to clarify if sarcopenia/sarcopenic obesity is modifiable in patients with cirrhosis.

The Effects of Intermittent Fasting and Continuous Energy Restriction with Exercise on Cardiometabolic Biomarkers, Dietary Compliance, and Perceived Hunger and Mood: Secondary Outcomes of a Randomised, Controlled Trial.

(1) Background: Excess weight in the form of adiposity plays a key role in the pathogenesis of cardiometabolic diseases. Lifestyle modifications that incorporate continuous energy restriction (CER) are effective at inducing weight loss and reductions in adiposity; however, prescribing daily CER results in poor long-term adherence. Over the past decade, intermittent fasting (IF) has emerged as a promising alternative to CER that may promote increased compliance and/or improvements in cardiometabolic health parameters independent of weight loss. (2) Methods: This paper presents a secondary analysis of data from a 12-week intervention investigating the effects of a twice-weekly fast (5:2 IF; IFT group) and CER (CERT group) when combined with resistance exercise in 34 healthy participants (17 males and 17 females, mean BMI: 27.0 kg/m2, mean age: 23.9 years). Specifically, changes in cardiometabolic blood markers and ratings of hunger, mood, energy and compliance within and between groups were analysed. Dietary prescriptions were hypoenergetic and matched for energy and protein intake. (3) Results: Both dietary groups experienced reductions in total cholesterol (TC; mean reduction, 7.8%; p < 0.001), low-density lipoprotein cholesterol (LDL-C; mean reduction, 11.1%; p < 0.001) and high-density lipoprotein cholesterol (mean reduction 2.6%, p = 0.049) over the 12 weeks. Reductions in TC and LDL-C were greater in the IFT group after adjustment for baseline levels and change in weight. No significant changes in markers of glucose regulation were observed. Both groups maintained high levels of dietary compliance (~80%) and reported low levels of hunger over the course of the intervention period. (4) Conclusions: Secondary data analysis revealed that when combined with resistance training, both dietary patterns improved blood lipids, with greater reductions observed in the IFT group. High levels of compliance and low reported levels of hunger throughout the intervention period suggest both diets are well tolerated in the short-to-medium term.

Religion in the Twenty-First Century

Religion in the Twenty-First Century

Nurse-led coaching to improve dietary protein intake and reduce the risk of sarcopenia in middle-aged women

Background and objective: An adequate dietary protein intake is critical to preventing sarcopenia, a condition characterized by reductions in muscle mass, strength, and function. The objectives of this investigation were to determine the effectiveness and how telephone-based diet coaching by a nurse practitioner contributed to improving dietary protein intakes in middle-aged women.Methods: Middle-aged women were recruited, and those randomized to receive nutrition education (including a protein prescription) and weekly diet coaching (focused on improving protein intake) provided weekly responses to three semi-structured interview questions. Qualitative content analysis was used to examine the responses to these questions. Dietary protein intake was analyzed at baseline and the end of the 12-week study from three 24-hour diet recalls at each time point using diet-analysis software and repeated measures analysis of variance.Results: Coached participants (n = 25) significantly increased dietary protein intake (55.3 ± 10.3 g at baseline to 83.7 ± 14.5 g/day at the end of the study); 19 of the 25 participants (76%) met their recommended dietary protein prescription by the study’s end. Three themes “Identifying Opportunities for Behavior Change”, “Beneficial Behavior Changes”, and “Tailoring Individual Interventions” were identified as a result of the coaching and led to the overarching theme “Empowered by Knowledge, Successful by Support” depicting how coaching contributed to the behavior changes.Conclusions: Nurse-led coaching is an effective approach enabling middle-aged women to improve dietary protein intake. These improvements are especially important in reducing the risk for the development of sarcopenia.

Decreasing microbiota-derived uremic toxins to improve CKD outcomes

Chronic kidney disease (CKD) is set to become the fifth-leading global cause of death by 2040. This illustrates the many unknowns regarding its pathogenesis and therapy. A key unknown relates to the therapeutic impact of the interaction between CKD and the gut microbiome. The normal gut microbiome is essential for body homeostasis. There is evidence for multiple interactions between the microbiota and CKD-its causes, comorbidities and therapeutic interventions-that are only starting to be unraveled. Thus uremic retention products, such as urea itself, modify the gut microbiota biology and both dietary and drug prescriptions modify the composition and function of the microbiota. Conversely, the microbiota may influence the progression and manifestations of CKD through the production of biologically active compounds (e.g. short-chain fatty acids such as butyrate and crotonate) and precursors of uremic toxins. The present review addresses these issues and their relevance for novel therapeutic approaches ranging from dietary interventions to prebiotics, probiotics, synbiotics and postbiotics, to the prevention of the absorption of microbial metabolites and to increased clearance of uremic toxins of bacterial origin through optimized dialysis techniques or blockade of tubular cell transporters.

Can dietary flavonoids be useful in the personalized treatment of colorectal cancer?

Activating mutations in the oncogenes KRAS, BRAF and PI3K define molecular colorectal cancer (CRC) subtypes because they play key roles in promoting CRC development and in determining the efficacy of chemotherapeutic agents such as 5-fluorouracil and anti-epidermal growth factor receptor monoclonal antibodies. Survival of patients with cancers displaying these molecular profiles is low. Given the limited efficacy of therapeutic strategies for CRC presenting mutational activations in mitogen-activated protein kinase and/or PI3K pathways, developing combination therapies with natural flavonoids or other phytochemicals with demonstrated effects on these pathways (and little or no toxic effects) may constitute a valuable path forward. Much has been published on the anticancer effects of dietary phytochemicals. However, even an exhaustive characterization of potential beneficial effects produced by in vitro studies cannot be extrapolated to effects in humans. So far, the available data constitute a good starting point. Published results show quercetin and curcumin as possibly the best candidates to be further explored in the context of adjuvant CRC therapy either as part of dietary prescriptions or as purified compounds in combination regimens with the drugs currently used in CRC treatment. Clinical trial data is still largely missing and is urgently needed to verify relevant effects and for the development of more personalized treatment approaches.

Acceptance of Low-Sodium Hospital Diet by Cardiac Patients: A Randomized Controlled Crossover Trial

Background Cardiovascular diseases are the major cause of hospitalization. Dietary salt restriction is indicated as part of clinical treatment, however, it is not always well accepted by the patients, resulting in low food intake and malnutrition. Objective To compare acceptance of a low-sodium diet cooked with salt with a standard low-sodium diet in cardiac inpatients. Methods A randomized controlled crossover trial in patients with low-sodium diet prescriptions (Clinical Trials NCT03481322). Patients were given a control standard low sodium diet [...]

Adherence to dietary prescriptions in patients with acute food protein-induced enterocolitis syndrome.

ABSTRACTFood protein‐induced enterocolitis syndrome (FPIES) is a non‐Immunoglobulin (non‐IgE)‐mediated food allergy. The elimination diet is the only therapy, the culprit food will be reintroduced if tolerance is acquired. However, it is possible that patients do not follow the recommendations given by the healthcare professional. We investigated if our advice to avoid the trigger food in patients with active FPIES and to reintroduce it in the diet in patients who achieved tolerance had been implemented. We interviewed by telephone the parents of children who were diagnosed with acute FPIES. About 23.2% of our patients disregarded our dietary recommendations: 6/42 (14.3%) of patients who passed a tolerance oral food challenge (OFC) did not eat the trigger food, 4/22 (18.2%) of patients who failed OFC ate the trigger food, and 9/18 (50.0%) of patients who did not perform a tolerance OFC ate the trigger food. We have analyzed some possible influencing factors and no difference was found to be statistically significant. Our results are in line with those reported for IgE‐mediated food allergies. As has already been proposed by others, we suggest reassessing food consumption in all patients after a food challenge.

Trends in Overall and Nutrient-Containing Dietary Supplement Use Among the U.S. Population (≥1 y), NHANES 2007–2018

ObjectivesDS use is widespread in the U.S. and contributes large amounts of micronutrients to users. The prevalence of DS use over time has been characterized; however, most studies have relied on data from one assessment method. Combining multiple methods of assessment enhances the ability to capture nutrient exposures from DS; additional studies updating prevalence of DS use estimates using this approach are needed, as well as documentation of a classification system for DS products. Thus, the objective was to characterize the prevalence of DS use over time among a nationally-representative sample of the U.S. population (≥ 1y), using a combined approach of DS assessment and a DS classification system.MethodsNHANES obtains DS use via a 30-day frequency method and an in-home inventory (Dietary Supplement and Prescription Medicine Questionnaire (DSMQ)), and two 24-hr recalls (24 HR). All NHANES cycles with 24 HR and DSMQ data were used to characterize DS use and examine trends in any and nutrient-containing (VM-only) DS use, using the DSMQ or ≥1 24 HR. Trends in the prevalence of use and selected types of products used were estimated for the population and by sex, age, race/Hispanic origin, family income (PIR ≤ 130%, 131 to 350%, and >350%), and household food security (food secure vs. insecure). Linear trends were tested using orthogonal polynomials; significance was set at p < 0.05.ResultsDS use increased from 50% in 2007 to 56% in 2018 (p = 0.001). While use of VM-only products increased (46% to 49%; p = 0.029), multivitamin-mineral use decreased (p < 0.001). Single-nutrient DS (e.g., magnesium, vitamins B12 and D), also increased in use (all p < 0.001). Among adults (≥19 y), any (54% to 61%) and VM-only (49% to 54%) DS use increased, specifically among men, non-Hispanic Blacks and Hispanics, and low-income (PIR ≤ 130%) adults. Among children (1–18 y), any and VM-only DS use remained stable at ∼38%, except for children living with food insecurity, where use increased from 24% to 31% over the decade (p = 0.035).ConclusionsThe prevalence of any and VM-only DS use in the U.S. increased over time and may be attributable to increases in the use of single-nutrient DS. Differences in DS use exist by population subgroup. This study contributes to a small body of literature that utilizes multiple methods of DS assessment designed to increase the accuracy of DS exposure assessment.Funding SourcesN/A.

Clinical assessment for diet prescription.

Accurate nutritional assessment based on dietary intake, physical activity, genetic makeup, and metabolites is required to prevent from developing and/or to treat people suffering from malnutrition as well as other nutrition related health issues. Nutritional screening ought to be considered as an essential part of clinical assessment for every patient on admission to healthcare setups, as well as on change in clinical conditions. Therefore, a detailed nutritional assessment must be performed every time nutritional imbalances are observed or suspected. In this review we have explored different techniques used for nutritional and physical activity assessment. Dietary Intake (DI) assessment is a multidimensional and complex process. Traditionally, dietary intake is assessed through self-report techniques, but due to limitations like biases, random errors, misestimations, and nutrient databases-linked errors, questions arise about the adequacy of self-reporting dietary intake procedures. Despite the limitations in assessing dietary intake (DI) and physical activity (PA), new methods and improved technologies such as biomarkers analysis, blood tests, genetic assessments, metabolomic analysis, DEXA (Dual-energy X-ray absorptiometry), MRI (Magnetic resonance imaging), and CT (computed tomography) scanning procedures have made much progress in the improvement of these measures. Genes also plays a crucial role in dietary intake and physical activity. Similarly, metabolites are also involved in different nutritional pathways. This is why integrating knowledge about the genetic and metabolic markers along with the latest technologies for dietary intake (DI) and physical activity (PA) assessment holds the key for accurately assessing one's nutritional status and prevent malnutrition and its related complications.

Dietary Supplement and Prescription Medication Use Among US Military Service Members With Clinically Diagnosed Medical Conditions: The US Military Dietary Supplement Use Study

BackgroundUse of prescription medications (PMs) with dietary supplements (DSs) can be hazardous because of potential adverse interactions, but patterns of dual use in military service members (SMs) has not been examined. ObjectiveInvestigate dual use of filled PMs (FPMs) and DSs, factors associated with dual use, and dual use among SMs with clinically diagnosed medical conditions (CDMCs). DesignCross-sectional. Data on FPMs and CDMCs were obtained from medical surveillance records. Between December 2018 and August 2019, participants completed a questionnaire on DS use in the previous 6 months. ParticipantsA stratified random sample of 26,880 SMs from all military services. Main outcome measuresPrevalence of dual use of FPMs with DSs within a 6-month period, demographic/lifestyle factors associated with dual use, and prevalence of dual use among SMs with CDMCs. Statistical analysisPrevalences were calculated as percents, χ2 statistics examined differences across various strata of demographic and lifestyle characteristics, and univariable and multivariable logistic regression determined the odds of using FPMs with DSs for various CDMCs. ResultsAbout one-half (49%) of SMs had dual use of FPMs with DSs in the 6-month period. Dual use was higher among women; increased with older age, more formal education, higher body mass index, and more physical activity; was highest among American Indian SMs and lowest among Asian SMs; was higher among former tobacco users; and was highest among Army personnel and lowest among Marine Corps personnel. The overall prevalence of dual use in the 6-month period was higher among those with a CDMC than those without (62% vs 19%), and this relationship was maintained for 20 International Classification of Diseases, Revision 10, code groupings covering virtually all CDMCs. ConclusionThis is the first study to document a high prevalence of dual FPMs and DSs in SMs, especially among those with CDMCs.

Quality of Nutritional Care Assessment among Critically-ill Patients in a Tertiary Government Hospital

Background and Objectives. Malnutrition is prevalent both at baseline admission and because of hospitalization. It is aggravated by adverse hospital practices and results in poor outcomes, reduced quality of life, and higher treatment costs. Improving quality of care involves nutritional intervention as a low-risk, cost-effective strategy which guides providers in improving practices systems-wise. This study aims to assess the quality of nutritional care and the nutritional status of critically- ill patients admitted in a low-resource setting.&#x0D; Materials and Methods. This is a mixed methods study among adults admitted in intensive care units (ICUs) of a tertiary government hospital. Anthropometric and biochemical indicators were obtained through chart review. The degree of malnutrition was assessed using the Subjective Global Assessment. Quality indicators under Donabedian domains were assessed and compared to current standards. The length of ICU stay and mortality rate were recorded. Dietary prescription and provision practices of healthcare providers were supplemented by a focus group discussion (FGD). Factors causing provision interruptions were also identified.&#x0D; Results and Discussion. Sixty-four ICU admissions were included. Staff-to-patient ratio was not ideal. Under process-related factors, out of 49% with actual anthropometric documentations (rest were estimates), 24% had normal body mass indices (BMI), 17% were underweight, and the rest were either overweight or obese. The baseline ICU malnutrition rate was 69%. Malnutrition screening, and assessment of risk and biochemical indicators were not done routinely. Majority (92%) had baseline dietary prescription but only 69% had specific energy and macronutrient breakdown, all done through predictive weight-based equations. Nutritional supplies arrived within 8 hours in 65% of patients. Feeding was initiated within 24–28 hours in 94% of patients. Commercial formula was the preferred type of enteral nutrition (EN). Total duration on nothing-by-mouth (NPO) (hours) throughout ICU stay was significant. Supportive measures to improve gastro-intestinal (GI) tolerance were not standardized. Common factors in delaying feeding initiation were hemodynamic instability, fasting for procedures and GI bleeding. Throughout the ICU stay, fasting for procedures, hemodynamic instability and mechanical ventilation (MV)-related factors were common. ICU mortality rate was 19% and average length of ICU stay was 5 days.&#x0D; Conclusion. Malnutrition is still prevalent in our ICUs and is affected by suboptimal healthcare practices. Staff - to-patient ratios, malnutrition risk screening and assessment, dietary referrals, documentation and minimizing interruptions in nutritional care provision needs improvement. A system review and establishment of a nutrition team is imperative.

The 3x3x3 diet for the management of diabetes and obesity in resource constrained settings.

In times when diseases like diabetes and obesity have attained pandemic proportions, it is essential to introduce lifestyle changes in early stages to prevent progression of these disorders. In health care systems with heavy patient load, time management is of utmost importance. In this communication, we share a simple 3x3x3 rubric based dietary prescription, which is easy to teach, and easy to grasp. It covers the most important dietary principles that are advocated in various evidence based clinical practice guidelines.