Individual Nutritional Counseling Research Articles

Nutrition and movement to improve quality of life in patients with knee osteoarthritis: the NUMOQUA study protocol for a randomised controlled trial

BackgroundOsteoarthritis (OA) has long been considered as a degenerative disease of cartilage tissue resulting from bodily wear and tear. However, there is accumulating evidence that inflammation plays a key role in the pathogenesis of OA. In knee OA, the most common form of OA, exercise therapy as an effective component of early treatment addresses functional deficits, pain and inflammation. Since inflammation is critical for the development and progress of OA, anti-inflammatory therapies must be combined strategically.In the course of the NUMOQUA project, an anti-inflammatory therapeutic diet named ‘Austrian Osteoarthritis Cuisine’ was developed. It is based on the framework of the New Nordic Diet combined with the food-based dietary guidelines of Austria, the guidelines for OA, the Austrian food culture and the principles of a sustainable diet. The present study examines the implementation of the ‘Austrian OA Cuisine’ combined with the evidence-based training programme GLA:D® (Good Life with osteoArthritis in Denmark) in Austrian patients with knee OA and the effects on quality of life, nutritional and inflammatory status, as well as oxidative stress parameters.MethodsA total of 60 participants aged 50 to 75 with knee OA will be included and randomly assigned either to the intervention group or the control group. All participants will undergo the GLA:D® programme in the first 6 weeks. Additionally, the intervention group will receive nutritional group training and individual nutritional counselling on the ‘Austrian OA Cuisine’ over 9 months. The control group will receive general information about a healthy lifestyle. Measurements at baseline and at 4 follow-up dates include nutritional, inflammatory and oxidative stress markers. Furthermore, anthropometric, behavioural and clinical data will be obtained. The recruitment process lasted from autumn 2022 to January 2024, followed by the intervention until October 2024.DiscussionThe prevalence of OA is expected to increase in the future due to ongoing demographic changes and rising obesity rates. The expected results will provide important evidence on whether this interdisciplinary therapeutic approach could be a new, cost-effective and sustainable strategy to address the disease process of OA without negative side effects.Trial registrationClinicalTrials.gov NCT05955300. Date of registration: 23rd of October 2023.

Mediterranean diet intervention among World Trade Center responders with post-traumatic stress disorder: Feasibility and outcomes of a pilot randomized controlled trial.

Responders of the World Trade Center (WTC) disaster suffer from co-morbidities. A Mediterranean Diet (MedDiet) nutrition intervention with physical activity was implemented among WTC responders with overweight/obesity and post-traumatic stress disorder (PTSD). WTC Health Program members (N=62), 45-65years, males 87%, body mass index (BMI) 27-45kg/m2 randomized to MedDiet (n=31) or usual nutrition counseling (n=31). The 10-week intervention included online nutrition education, text messages, and group experiential cooking; both groups had three in-person individual nutrition counseling. Anthropometrics, serum biomarkers, psychosocial factors, MedDiet score, and PTSD symptoms were assessed at baseline, post-intervention, and 3-months (follow-up). The primary outcome was intervention feasibility and secondary outcomes were within- and between-group changes of all measures at post-intervention and follow-up. Nonparametric Wilcoxon rank sum tests for between-group comparisons and Wilcoxon signed rank tests for pre-post within-group comparisons. A total of 58(94%) and 46(74%) participants completed the post-intervention and follow-up measurements, respectively. Both groups experienced significant improvements in anthropometrics, MedDiet score, oxidized low-density lipoprotein, and PTSD symptoms. Baseline median (range) were weight 100.42 (73.66-135.17)kg, BMI 33.20 (27.50-41.75)kg/m2, and Waist circumference (WC) 109.22 (90.17-150.62)cm. Median % weight loss at post-intervention was MedDiet: -3% (-11%-7%), p=0.0002; Control: -1% (-13%-4%), p=0.008 and at follow-up MedDiet: -2% (-14%-12%), p=0.07; Control: -2% (-20%-3%), p=0.006. The overall BMI was reduced by -0.68kg/m2 (-4.61-2.09)kg/m2 p<0.0001 at post-intervention and by -0.60kg/m2 (-6.91-3.39)kg/m2, p<0.0009 at follow-up. Overall, median WC was reduced (p<0.0001); post-intervention -3.81cm (-33.00-3.30)cm and follow-up -4.45(-38.10-4.57)cm. There were group differences in HbA1c (p=0.019) and serum ω6/ω3 (p=0.029) at post-intervention. Online intervention with personal counseling was feasible in this population. Improvements in anthropometrics, MedDiet score, selected serum biomarkers and PTSD symptoms were found in both groups; group differences in HbA1c and serum ω6/ω3. A larger study with a delayed control is needed to better assess intervention effects.

Short-term effects and long-term changes of FUEL-a digital sports nutrition intervention on REDs related symptoms in female athletes.

www.clinicaltrials.gov (NCT04959565).

The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue

PurposeChronic fatigue (CF) affects 25–30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention.MethodsThis feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1.ResultsSeven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance.ConclusionLymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention.Trial registrationClinicalTrials.gov, identifier: NCT04931407. Registered 16. April 2021-Retrospectively registered. https://www.clinicaltrials.gov/ct2/show/NCT04931407

DETERMINING THE NUTRIENTS CHANGES AFTER UNDERGOING NUTRITIONAL COUNSELING AND COOKING ASSISTANCE AMONG T2DM OUTPATIENTS IN MALANG CITY, INDONESIA

ABSTRACTBackground: Nutrition and diets are critical factors for T2DM patients to maintain health. Nutrition education are considered less effective because most patients have not implemented them. This research tries to develop program innovation by combining nutrition counseling and cooking assistance for T2DM outpatients. This study aimed to know the risk factors for T2DM and determine the effectiveness of programmed nutrition education (NEP) on changes in nutrient intake in patients with T2DM. Methods: A total of 70 participants registered as T2DM outpatients at Kedung Kandang primary healthcare center in Malang city. Subjects were recruited using a 'quota sampling' technique. The design of this study is a quasi-experiment study using a comparison of the control (n=32)-treatment group (n=38). This research was conducted from September to November 2018. Fifty minutes of intensive individual counseling and cooking assistance were provided to T2DM patients and families. The data were analyzed using independent sample t-test, Wilcoxon Mann Whitney U-test, and logistic regression. The patients’ 4-d dietary records of 3 normal days and 1 holiday/weekend were assessed after 24 hours.Results: From this study it can be seen that intake of amino acid lysine was significantly higher in the treatment group than the control group (p = 0.04). The intake of fiber, MUFA, and PUFA was greater in the intervention group, while sodium intake was lower in the intervention group. The risk factors of T2DM incidence were age (p = 0.036), education (p = 0.043), waist circumference (p = 0.015), and carbohydrate intake (p = 0.033). Conclusion: T2DM patients treated with individual nutrition counseling and cooking assistance gained a higher intake of fiber, amino acid lysine, and unsaturated fatty acids. The most influential risk factors of T2DM incidence are age, education, waist circumference, and carbohydrate intake. Keywords: nutrition counseling, cooking assistance, nutritional intake, T2DM.

1206-P: Benefits of Virtual Shared Medical Appointments for Gestational Diabetes

Background: The rate of gestational diabetes (GDM) has increased over the past decade, now effecting up to 14% of pregnancies worldwide. Studies show that these woman benefit from diabetes education, nutrition education and a maternal-fetal medicine (MFM) consultation. However, accommodating this increasing number of women, especially in the middle of a global pandemic, can be challenging. Purpose: First, to develop a curriculum for women with GDM to empower them to optimally manage their diabetes in pregnancy. Second, to evaluate whether this curriculum could be used in a virtual shared medical appointment (SMA) to accommodate more patients while protecting their health during the COVID-19 pandemic. Results: A virtual SMA was created in the electronic medical record using a zoom platform. Up to ten women are seen during this 2-2.5 hour visit. From 1/1/2022 through 12/31/22, 159 women participated in the program. On average, women attended the SMA within 12.9 days of the consult request. All women received a copy of the curriculum via email prior to the visit. During the visit, patients received their MFM consult, diabetes education, and nutrition counseling in a group format. The visit included a one-on-one breakout room with a MFM provider to discuss personal history, glucose levels and use of medication if necessary. Women were billed through insurance for the MFM consultation as well as group nutrition counseling. Of the 159 participants, 139 have delivered. Eighty-nine (64%) women had a vaginal delivery and 50 (36%) had a cesarean delivery. Conclusion: A virtual SMA is an efficient and effective format for educating women with GDM during the COVID-19 pandemic and beyond. Access to these resources was faster for women in the SMA versus those who received individual MFM consultations, nutrition counseling and diabetes education. The rate of cesarean delivery was lower than the rate reported in the literature for women with GDM. Patient reported outcomes regarding this format have also been favorable. Disclosure S.Ehrenberg buchner: Advisory Panel; Dexcom, Inc. H.Hart: None. K.M.Bede: None. D.Isaacs: Speaker's Bureau; Dexcom, Inc., Abbott, Eli Lilly and Company, Medtronic, Novo Nordisk.

Feasibility of nutrition counseling for breast cancer survivors: Results from the force trial.

e24054 Background: Certain dietary choices and body mass index (BMI) are associated with increased risk of breast cancer (BC) recurrence. Most patients (pts) consider nutrition very important but also report feeling confused about nutrition information. Many do not have access to a registered dietitian (RD) and nutrition education in medical schools is often lacking. Health coaching, education, goal-setting, and motivation are factors that can improve healthy habits and increase adherence to lifestyle modifications. We aimed to evaluate the feasibility of a 12-week (wk) pilot program of individualized nutrition counseling by a RD for BC survivors in a community oncology setting. Methods: We conducted a single-center, prospective, single arm trial to evaluate the feasibility of individualized nutrition counseling by a RD in pts with stage I-IV BC. Counseling focused on the American Cancer Society healthy eating pattern recommendations. Stage I-III BC pts must have completed all planned surgery, chemotherapy and radiation. Pts with stage IV/metastatic BC were eligible at any point during their treatment. Participants had three planned visits over a 12-week (wk) period: baseline, 4 wk follow-up visit, &amp; 12 wk follow-up visit. Feasibility was measured by adherence to a three-visit protocol over a 12 wk period. Secondary objectives included effect of nutrition counseling on quality of life using Functional Assessment of Cancer Therapy-Breast (FACT-B) and on physical activity using Godin Leisure-Time Exercise Questionnaire (GLTEQ). Demographic and medical variables were collected. Results: N = 50 participants signed consent for the study, &amp; all had baseline visits. Mean age 56 yrs (33-77). Pts: Stage I (N = 38); Stage II (N = 8); Stage III (N = 1); metastatic (N = 3). Mean BMI: 28.64 (17.7-48). Pts: ER+/HER2- (N = 37); ER+/HER2+ (N = 7); ER-/HER2+ (N = 2); ER-/HER2- (N = 4). 42 pts were on endocrine therapy during their participation on study. 36 pts (72%) completed the 12-wk program in its entirety. Average visit adherence for the whole cohort was 84.7%. Reasons for the 14 pts (28%) who did not complete the program included no virtual option available (N = 6); no time to attend (N = 2); not interested (N = 1) &amp; unknown (N = 5). 9 only attended Visit 1 and 5 attended Visits 2 and 3. Pts who completed the program experienced an improvement in self-reported energy level (p = 0.01) as assessed in FACT-B from baseline to 12 wks. There was no significant difference in GLTEQ from baseline to 12 wks (p = 0.21). Remainder of QoL assessments to be presented. Conclusions: Individualized nutrition counseling in a community oncology program was feasible and led to improvement in self-reported energy levels. It is imperative to expand the reach and access of nutrition counseling to reach a more diverse patient population and maintain continuity. Future work will focus on testing this intervention in larger and more diverse populations of BC survivors and thrivers.

Effects of a 16-Week Digital Intervention on Sports Nutrition Knowledge and Behavior in Female Endurance Athletes with Risk of Relative Energy Deficiency in Sport (REDs).

Female endurance athletes are considered a high-risk group for developing Relative Energy Deficiency in Sport (REDs). Due to the lack of educational and behavioral intervention studies, targeting and evaluating the effects of the practical daily management of REDs, we developed the Food and nUtrition for Endurance athletes-a Learning (FUEL) program, consisting of 16 weekly online lectures and individual athlete-centered nutrition counseling every other week. We recruited female endurance athletes from Norway (n = 60), Sweden (n = 84), Ireland (n = 17), and Germany (n = 47). Fifty athletes with symptoms of REDs and with low risk of eating disorders, with no use of hormonal contraceptives and no chronic diseases, were allocated to either the FUEL intervention (n = 32) (FUEL) or a 16-week control period (n = 18) (CON). All but one completed FUEL, while 15 completed CON. We found strong evidence for improvements in sports nutrition knowledge, assessed via interviews, and moderate to strong evidence in the ratings concerning self-perceived sports nutrition knowledge in FUEL versus CON. Analyses of the seven-day prospective weighed food record and questions related to sports nutrition habits, suggested weak evidence for improvements in FUEL versus CON. The FUEL intervention improved sports nutrition knowledge and suggested weak evidence for improved sports nutrition behavior in female endurance athletes with symptoms of REDs.

Effectiveness of NQ-E index-based individual nutrition counseling for community-care elderly: an intervention study on improving nutritional status, complex chronic diseases, and quality of life

Effectiveness of NQ-E index-based individual nutrition counseling for community-care elderly: an intervention study on improving nutritional status, complex chronic diseases, and quality of life

Intensive Nutritional Counseling and Education for Management of Hyperphosphatemia in Hemodialysis Patients at Al-Khor Hospital- Hamad Medical Corporation - State of Qatar

Objectives: To assess the dietary phosphate intake of hemodialysis patients with hyperphosphatemia and the effects of a dietetic intervention focused on limiting dietary phosphate load. Design: Cross-sectional dietary phosphate intake assessment and prospective intervention study. Setting: Hospital hemodialysis units of AL-Khor hospital – Hamad Medical Corporation, Qatar. Subjects: sixteen stable adult hemodialysis patients, who had phosphorus serum levels ≥1.6 mmol/L. Intervention: Analysis of dietary composition and of the effects of individual dietetic counseling to reduce phosphorus intake while preserving the same or improving protein intake. Main outcome measures: Differences in nutrient intake between pre and post-dietary intervention among hyperphosphatemia patients, and changes in phosphorus–protein ratio, and serum phosphate, after the dietetic intervention. Results: Significant differences in nutrient intake including energy, protein, and phosphorus were detected after the intervention. After dietetic intervention in the hyperphosphatemia patients, a decrease in the dietary phosphate–protein ratio (28.9 -13.4 mg/g, P &lt;0.05) also occurred. Serum phosphate showed a trend of a significant decrease after the dietary intervention (2.2mmol/L-1.68mmol/L), P &lt; 0.05). Conclusion: Individual intensive nutritional education and counseling may be useful in reducing phosphate load and improving serum phosphorus with a positive effect on nutrient intake. A phosphate-controlled diet has a role in an integrated therapeutic approach to hyperphosphatemia and positive calcium-phosphorus balance in hemodialysis patients.

Design and Implementation of a Culturally-Tailored Randomized Pilot Trial: Puerto Rican Optimized Mediterranean-Like Diet

BackgroundAdhering to a Mediterranean Diet (MedDiet) is associated with a healthier cardiometabolic profile. However, there are limited studies on the MedDiet benefits for non-Mediterranean racial/ethnic minorities, for whom this diet may be unfamiliar and inaccessible and who have a high risk of chronic diseases. ObjectivesTo describe the study design of a pilot trial testing the efficacy of a MedDiet-like tailored to adults in Puerto Rico (PR). MethodsThe Puerto Rican Optimized Mediterranean-like Diet (PROMED) was a single-site 4-mo parallel two-arm randomized pilot trial among a projected 50 free-living adults (25–65 y) living in PR with at least two cardiometabolic risk factors (clinicaltrials.gov registration #NCT03975556). The intervention group received 1 individual nutritional counseling session on a portion-control culturally-tailored MedDiet. Daily text messages reinforced the counseling content for 2 mo, and we supplied legumes and vegetable oils. Participants in the control group received cooking utensils and one standard portion-control nutritional counseling session that was reinforced with daily texts for 2 mo. Text messages for each group were repeated for two more months. Outcome measures were assessed at baseline, 2 and 4 m. The primary outcome was a composite cardiometabolic improvement score; secondary outcomes included individual cardiometabolic factors; dietary intake, behaviors, and satisfaction; psychosocial factors; and the gut microbiome. ResultsPROMED was designed to be culturally appropriate, acceptable, accessible, and feasible for adults in PR. Strengths of the study include applying deep-structure cultural components, easing structural barriers, and representing a real-life setting. Limitations include difficulty with blinding and with monitoring adherence, and reduced timing and sample size. The COVID-19 pandemic influenced implementation, warranting replication. ConclusionsIf PROMED is proven efficacious in improving cardiometabolic health and diet quality, the findings would strengthen the evidence on the healthfulness of a culturally-appropriate MedDiet and support its wider implementation in clinical and population-wide disease-prevention programs.

"What Should I Eat?"-Addressing Questions and Challenges Related to Nutrition in the Integrative Oncology Setting.

This review aims to assess how nutrition can be addressed in the integrative oncology setting, taking into account cancer patients' unmet needs as they relate to nutrition in cancer care and the evidence-based information that is available on this topic. During and after cancer treatment, nutrition is an important component of supportive care, for patients and their family members. Current scientific data consistently show that poor nutrition can reduce survival and decrease adherence to cancer treatments. Unfortunately, the limited availability of dietitians makes access to individualized nutrition counseling challenging, and many cancer patients still do not receive adequate nutritional support. As a result, one of the main unmet needs of patients and their families through the whole cancer trajectory is accessible and up-to-date evidence-based nutritional counseling that emphasizes basic healthy nutrition. The popularity of complementary and integrative medicine among patients with cancer makes the integrative oncology setting an excellent avenue for providing such support. A suggested simple approach that utilizes World Cancer Research Fund/American Institute for Cancer Research and American Cancer Society basic information is described. This approach can be easily incorporated into integrative oncology settings, while reserving the role for the registered dietician to address underweight patients, patients with malnutrition, and patients with more complicated dietary situations. The integrative oncology setting is in a unique place in oncology that can be utilized for enhancing dissemination of healthy nutrition information and addressing the unmet needs expressed by patients and families.

Impact of an individualized counseling program on weight loss and quality of life in breast cancer survivors.

1105 Background: Survivors of breast cancer who are obese have a greater than two-fold increase in mortality compared to their counterparts. We assessed the feasibility of an individualized nutrition counseling and exercise program with the goal of helping participants achieve a loss of 10% body weight. Secondary endpoints included impact on multiple metabolic parameters, cardiovascular health, and quality of life. Methods: We present preliminary data from a single-arm pilot trial (NCT04365569) whereby survivors of breast cancer with BMI ≥ 25 kg/m2 participated in a 6-month, individualized counseling program. A registered dietitian (RD) counseled patients based upon recommendations by the American Cancer Society. The intervention included in-person (baseline, months 3 and 6) and telephone visits (months 1, 2, 4, and 5). The nutrition component included weight and body composition measures and blood work, including lipid panel and hemoglobin A1c. Cardiovascular fitness and extrapolated VO2 max were measured using SHAPE study. Quality of life was evaluated using: the Functional Assessment of Cancer Therapy – Breast Cancer (FACT-B), the Brief Pain Inventory (BPI), the Generalized Anxiety Disorder-7 (GAD-7), the Patient Health Questionnaire-9 (PHQ-9), and the NCCN Distress Thermometer. Paired statistics were used to compare changes in these aforementioned outcomes pre-and post-intervention. Results: A total of n=55 female breast cancer survivors (mean age 58.1± 9.13) were enrolled. N=28 completed the trial to date. While 14.3% of participants lost &gt;10% of their baseline weight, 21.4% lost 5-10 % of their weight. Patients had a mean 45.30% drop in body fat composition overall (p&lt;0.001). There was no statistically significant difference in lipids and hemoglobin A1c. In terms of cardiovascular function, a decline in mean VO2 max of -4.71 (SD 4.71, p &lt;0.001) was observed, accompanied by a decline in mean METS of -1.09 (SD 0.84, p &lt;0.001). Higher compliance with the intervention was associated with losing weight (p 0.001). FACT-B scoring revealed improvements in Physical (mean +1.92, SD 3.82), Emotional (mean +1.03, SD 2.71), and Functional well-being (mean +2.70, SD 4.34) (p &lt;0.05). This trial was also associated with lower indicators of depression, as evaluated by PHQ-9 scoring (mean -1.32, SD 3.19, p 0.038). Even in patients with weight gain, improvements in QoL surveys were observed, although not statistically significant, likely due to the small sample size in this subpopulation (n = 7). Conclusions: An individualized counseling program benefits survivors of breast cancer who are overweight by helping them reduce weight and improve their overall quality of life. While no improvements in VO2 max levels were observed, this may be partially explained by a decrease in effort on the part of participants. Further investigation into the utility of extrapolated VO2 max using the SHAPE study is ongoing. Clinical trial information: NCT04365569.

Nutrition guidelines compliance in cardiovascular disease patients attending a long-term exercise-based cardiac rehabilitation program during COVID-19 era

Funding AcknowledgementsType of funding sources: None.IntroductionDietary habits influence cardiovascular disease (CVD) risk, mainly through risk factors such as lipids, blood pressure, body weight and diabetes. Therefore, a healthy diet is recommended as a cornerstone of CVD prevention in all individuals and in reducing risk of recurrent disease, yet few studies have examined diet quality in cardiac-rehabilitation patients on a long-term basis.PurposeTo evaluate the compliance with dietary guidelines in patients who attend a long-term cardiac rehabilitation program (phase III) during COVID-19 era.MethodsThe study was developed between October 2020 and October 2021 in a phase III centre-based cardiac rehabilitation program. To evaluate dietary intake a 24hour recall questionnaire was used. Diet composition was analysed using ESHA’s Food Processor® software. Cunningham equation was used to evaluate resting energy expenditure and physical activity expenditure measured by accelerometery was added to calculate daily energetic requirements. The nutrients and cut-offs considered for the analysis were saturated fat (<10%), sodium (<2g), potassium (≥3.5g), fibre (≥30g), and alcohol (<100g/week), considering the 2021 ESC Guidelines on CVD Prevention in Clinical Practice or the World Health Organization guidelines for a healthy diet. To evaluate weight and height a digital scale SECA 799 and a stadiometer SECA 220 were used, respectively.ResultsA total of 57 patients (78.9% men) with a mean age of 63.8±8.5 were evaluated. Mean body mass index (BMI) was 28.4±3.8kg/m2, being most patients overweight or obese (61.7%). A higher caloric consumption, compared to the individual energy requirements, was found in 26.3% of patients. No statistical differences were found between mean saturated fat intake (10.1±3.6%) and the recommended intake (p=0.85). Mean sodium consumption was 3.42±1.46 grams and mean potassium intake was 3.0±1.0 grams. Sodium intake was significantly higher (p<0.001), and potassium intake significantly lower (p<0.001) than the recommendation. Fibre intake was also significantly lower than the recommendation (median intake was 21.1±12.2 grams, p<0.001). Among patients who drank alcoholic beverages (n=28), the median alcohol intake per day was 17.4±26.3 grams which was significantly higher than the limit recommended (p=0.043).ConclusionOur findings showed that these patients deviated from the recommendations in some key nutrients. The intake of sodium and alcohol was higher than the recommendations, and the intake of potassium and fibre were lower than the recommendations. Moreover, most patients were overweight or obese. This study highlights the need for individual nutritional counselling sessions as a reinforcement of a standard educational program, to effectively promote an adequate diet, which may reduce the risk of recurrent disease. Further research about nutritional intervention in patients undergoing on a long-term basis cardiac rehabilitation is warranted.

Effectiveness of Individual Nutritional Counseling in Improving Biochemical Indices and Nutrition Knowledge of Chronic Kidney Disease Patients

Aim: The aim of the present study was to assess the impact of nutritional counseling on biochemical parameters and nutrition knowledge of chronic kidney disease (CKD) patients. Materials and Methods: The study was conducted on 70 CKD patients, stages 3 and 4, between 25 and 80 years of age. The baseline data were collected from Fortis Hospital, Jaipur, Rajasthan, using interview schedule, which included information on demographic profile, anthropometric measurements, biochemical parameters, medical history, and dietary pattern of the patients. The nutritional counseling was conducted in two phases, the first phase included counseling that was imparted to patients on the basis of their biochemical parameters, followed by monitoring for 4 weeks. Thereafter, second phase counseling, based on results obtained from the first phase, was imparted. The data were once again collected and analyzed after a period of 12 weeks. Results and Conclusion: Hypertensive nephropathy was the most common cause of CKD, followed by diabetes mellitus and glomerulonephritis. Anthropometric measurements showed little change in mean body mass index of the patients, post counseling, however, nonsignificant. On the other hand, a significant decrease was observed in serum creatinine, blood urea nitrogen, serum potassium, and serum phosphorus levels. Nutritional counseling exhibited a strong positive impact on nutrition knowledge of CKD patients.

The impact of nutritional counseling on thyroid disorders in head and neck cancer patients after (chemo)radiotherapy: results from a\xa0prospective interventional trial

ObjectiveTo analyze the impact of nutritional counseling on the development of hypothyroidism after (chemo)radiotherapy in head and neck cancer patients to propose a new normal tissue complication probability (NTCP) model.Materials and methodsAt baseline, at the end of (chemo)radiotherapy, and during follow-up, thyroid-stimulating hormone (TSH) with free thyroxin (fT3 and fT4), nutritional status, and nutrient intake were prospectively analyzed in 46 out of 220 screened patients. Patients received (chemo)radiotherapy within an intervention (individual nutritional counseling every 2 weeks during therapy) and a control group (no nutritional counseling).ResultsOverall median follow-up was 16.5 [IQR: 12; 22] months. Fourteen patients (30.4%) presented with hypothyroidism after 13.5 [8.8; 17] months. During (chemo)radiotherapy, nutritional status worsened in the entire cohort: body mass index (p < 0.001) and fat-free mass index (p < 0.001) decreased, calorie deficit (p = 0.02) increased, and the baseline protein intake dropped (p = 0.028). The baseline selenium intake (p = 0.002) increased until the end of therapy. Application of the NTCP models by Rønjom, Cella, and Boomsma et al. resulted in good performance of all three models, with an AUC ranging from 0.76 to 0.78. Our newly developed NTCP model was based on baseline TSH and baseline ferritin. Model performance was good, receiving an AUC of 0.76 (95% CI: 0.61–0.87), with a sensitivity of 57.1% and specificity of 96.9% calculated for a Youden index of 0.73 (p = 0.004; area = 0.5).ConclusionBaseline TSH and ferritin act as independent predictors for radiotherapy-associated hypothyroidism. The exclusion of such laboratory chemistry parameters in future NTCP models may result in poor model performance.

Diyetisyenlerin Bireysel Beslenme Danışmanlığını Etkileyen Etmenler Hakkındaki Düşünceleri ve İş Doyumu

Amaç: Diyetisyenlerin iş doyumunu etkileyen faktörlerin iyileştirilmesi, iş doyumunun yükseltilmesi, bireylerin/toplumun beslenme ve sağlık durumunun iyileştirilmesine katkıda bulunabilir. İzmir’de çalışan diyetisyenlerin bireysel beslenme danışmanlığı ile ilişkili faktörler hakkındaki düşüncelerinin incelenmesi, iş doyumu ile iş doyumunu etkileyen faktörlerin saptanması amaçlanmıştır.Yöntem: Tanımlayıcı tipteki bu araştırma, İzmir’de çalışan diyetisyenlerle (n=183) yürütülmüştür. Verilerin elde edilmesinde literatür taramasıyla oluşturulan anket formu ve İş Doyumu Ölçeği (Job Satisfaction Survey-JSS) kullanılmıştır. Ki-kare, bağımsız gruplarda t testi, one-way ANOVA, tukey testi, lineer regresyon analizi (enter modeli) kullanılmış, p&amp;lt;0.05 istatistiksel olarak önemli kabul edilmiştir.Bulgular: Diyetisyenlerin yaş ortalaması 31.9±8.84 yıl olup, %89.1’i kadındır. Diyetisyenlerin %34.4’ü kamuda, %38.8’i özel sektörde, %26.8’i kendi iş yerinde çalışmaktadır. Diyetisyenlerin JSS puanı 127.72±34.47 olup, iş doyumu düşüktür. Yüksek lisans mezunlarının, özel sektörde ve klinik alanda çalışanların, gelirini yeterli bulan, mesleğini çevresine öneren diyetisyenlerin ortalama iş doyumu puanı daha yüksektir (p&amp;lt;0.05). Lineer regresyon analizine göre diyetisyenlerin çalışma sektörü; özelden kamuya, kamudan iş yeri sahibine doğru ilerledikçe iş doyumu azalmaktadır. Diyetisyenler beslenme danışmanlığında sosyal medyanın etkili olduğunu, sosyal medyanın insanları beslenme açısından kısmen doğru yönlendirdiğini düşünmekte, medyada beslenme bilgisi verilmesini doğru bulmamakta, internet üzerinden verilen beslenme danışmanlığını yeterli bulmamaktadır. Diyetisyenlere göre danışan motivasyonunda en önemli etmenler; diyetisyenin yüz ifadesi, beden dili, kararlı tutumu, gerçekçi hedefler belirlemesi, görünüşü ve özgüvenidir.Sonuç: Beslenme danışmanlığı ve iş doyumuna ilişkin bu veriler, mesleki kuruluşlar ve eğitim planlayıcıları için yol gösterici olabilir. İş doyumunu etkileyen etmenlerin daha derinlemesine incelenmesi için nitel verilerle desteklenen daha fazla nicel çalışmaya ve iş doyumunu arttıracak faktörlere odaklanan çalışmalara ihtiyaç vardır.

Effect of interval training with non-invasive ventilation in severe chronic obstructive pulmonary disease-a prospective cohort study with matched control group.

In severe chronic obstructive pulmonary disease (COPD), interval training (IT) can be performed with oxygen support, which provides beneficial effect on metabolic processes, tissue perfusion, and peripheral muscle function. A prospective cohort study with matched controls was performed on patients in Budapest at the Department of Pulmonary Rehabilitation of the National Koranyi Institute of Pulmonology between January 1, 2020 and March 1, 2020. After a complex condition assessment, both case and control patients participated in a 3-week long complex pulmonary rehabilitation (PR) program that included individual training, education, nutrition, and psychological counseling. Anthropometric and functional data of patients were recorded at both the beginning and end of the PR program. Our research aimed to assess the effect of non-invasive ventilation (NIV) in patients with severe COPD who underwent IT. A total of 18 [male/female: 10 (55.6%)/8 (44.4%)] patients were enrolled in our study. IT with NIV significantly improved the patients' 6-minute walking distance (6MWD) (m) [216.0 (211.5-233.7) vs. 274.0 (247.5-313.5); P<0.001] and quality of life [COPD Assessment Test (CAT): 29.0 (26.9-32.0) vs. 15.0 (13.5-17.5); P<0.001], [modified Medical Research Council (mMRC): 2.0 (1.5-2.0) vs. 1.0 (1.0-2.0); P=0.009]; in addition, there was a significant increase in inspiratory vital capacity (IVC) (ref%) [65.0 (63.0-69.0) vs. 74.7 (70.5-75.0); P=0.015], in chest kinematics (cm) [3.0 (2.5-4.0) vs. 5.5 (4.0-6.5); P<0.001], work rate (Watt) [25.0 (24.0-27.0) vs. 36.0 (35.0-38.0); P<0.001], volume of oxygen consumption [VO2/kg (mL/kg/min): 8.8 (8.5-9.2) vs. 10.3 (10.2-10.7); P<0.001], and Body-mass index, airflow Obstruction, Dyspnea, and Exercise (BODE) index [5.0 (5.0-6.7) vs. 4.0 (3.0-5.0); P=0.006], while the results of the control group were non-significant [6MWD, maximal inspiratory pressure (MIP), CAT, mMRC, BODE index]. In severe COPD, IT with NIV is well tolerated during PR, it has a significant beneficial effect on the quality of life, improves exercise capacity and respiratory functions, decreases dynamic hyperinflation and dyspnea.

The Importance of Federal Waivers and Technology in Ensuring Access to WIC During COVID-19.

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a nutrition assistance program that promotes the health of pregnant and postpartum women, infants, and children up to aged five years who are nutritionally at risk and live in households below 185% of the federal poverty level (FPL).1 Unlike other federal nutrition assistance programs, WIC reduces structural barriers to healthy eating by providing monthly food benefits while simultaneously promoting good nutrition through regular individualized nutrition counseling and nutrition education. The effectiveness of WIC has been demonstrated by extensive research illustrating improved health outcomes for the women, infants, and children served by the program.2-5 As the third largest US Department of Agriculture (USDA) nutrition assistance program, WIC served about 6.9 million participants per month in fiscal year 2018, including almost half of all infants born in the United States.1. (Am J Public Health. Published online ahead of print April 15, 2021: e1-e4. https://doi.org/10.2105/AJPH.2021.306211).

Evaluation of Measured Resting Metabolic Rate for Dietary Prescription in Ageing Adults with Overweight and Adiposity-Based Chronic Disease.

The primary objective of this study was to compare weight changes in two groups of ageing Irish adults with overweight and adiposity-based chronic disease: participants who had dietary energy requirements prescribed on the base of measured RMR and participants whose RMR was estimated by a prediction equation. Fifty-four Caucasian adults (male n = 25; female n = 29, age 57.5 ± 6.3 years, weight 90.3 ± 15.1 kg, height 171.5 ± 9.5 cm, BMI 30.7 ± 4.6 kg/m2) were randomly assigned to a dietary intervention with energy prescription based on either measured RMR or estimated RMR. RMR was measured by indirect calorimetry after an overnight fast and predicted values were determined by the Mifflin et al. (1990) prediction equation. All participants received individual nutritional counselling, motivational interviewing and educational material. Anthropometric variables, blood pressure, blood glucose and blood lipid profile were assessed over 12 weeks. Body weight at week 12 was significantly lower (p < 0.05) for both groups following dietary interventions, mRMR: −4.2%; eRMR: −3.2% of initial body weight. There was no significant difference in weight loss between groups. Overall, 20.8% mRMR and 17.4% of eRMR participants experienced clinically meaningful (i.e., ≥5% of initial weight) weight reduction. Weight reduction in adults aged ≥50 years over the short term (12 weeks) favoured a reduction in blood pressure, triglycerides and glucose, thus reducing cardiovascular disease risk factors. This research indicates that employing a reduced-calorie diet using indirect calorimetry to determine energy needs when improving weight outcomes in adults (>50 years) with overweight and adiposity-based chronic disease is equal to employing a reduced-calorie diet based on the Mifflin et al. (1990) prediction equation. A reduced-energy diet based on mRMR or eRMR facilitates clinically meaningful weight reduction in adults (≥50 years) over the short term (12 weeks) and favours a reduction in blood pressure, triglycerides and glucose, thus reducing cardiovascular disease risk factors. Moreover, the addition of motivational interviewing and behaviour change techniques that support and encourage small behaviour changes is effective in short-term weight management.