Individual Nutritional Counseling Research Articles

Efficacy of myoinositol in treatment of gestational diabetes mellitus in Asian Indian women: A pilot randomized clinical trial

ObjectiveTo compare efficacy of myoinositol as an adjuvant to dietary modification for treatment of gestational diabetes mellitus in Asian Indian women compared to controls. Study DesignSetting: This pilot randomized open label trial was conducted in a single antenatal clinic in India. Subjects: One hundred women with singleton pregnancy and gestational diabetes diagnosed between 14–28 weeks’ gestation were included. Overt diabetes, twin pregnancy, pre-existing renal disease, heart disease and other chronic medical disorders were exclusions. Intervention: Participants were randomized in two groups (1:1 ratio) by opaque envelope method. Individualized nutrition counseling with dietary modification and routine antenatal care was provided to all. Fifty women received myoinositol 1000 mg twice daily; 50 controls did not receive myoinositol. Fasting and postprandial glucose levels were assessed after two weeks. Women not achieving glycemic targets (fasting glucose <95 and postprandial glucose <120 mg/dL) were given pharmacologic therapy. Contributory factors in women requiring additional pharmacologic therapy, maternal and fetal outcomes were noted. Statistical analysis: Between group comparisons reported relative risk and mean difference. To assess predictive factors for need for pharmacologic therapy, univariate and multivariable logistic regression analysis were used. ResultsBaseline characteristics were comparable in both groups. Except one woman in the myoinositol group, all women provided glycaemia data throughout their pregnancy. Glycemic control was achieved in 44/ 49 (89.8 %) women in myoinositol group which was significantly higher than 34/50 (68 %) in the controls ((relative risk 0.31, 95 % confidence interval 0.13 to 0.80, p = 0.008). Mean duration of myoinositol treatment was 17.6 weeks (standard deviation 5.3). Additional treatment with metformin/insulin was needed in all women failing to achieve glycaemic control. The mean (range) dose of insulin was 25.3 units in myoinositol group compared to 14.27 units in controls (p = 0.058). Secondary outcomes were similar in two groups except baby weight which was higher in controls (p = 0.018). ConclusionsOral supplementation with myoinositol in dose of 1 gm twice-daily, when started soon after the diagnosis of GDM, is effective in achieving glycemic control and decreasing the need for additional pharmacological therapy in Asian Indian women.

Effects of Intensive Individualized Nutrition Counseling on Nutritional Status and Kidney Function in Patients With Stage 3 and 4 Chronic Kidney Disease

Although dietary modification is a critical component of chronic kidney disease (CKD) management, compliance with dietary recommendations is often suboptimal. This prospective intervention study was conducted to evaluate the effects and adherence of intensive, individualized nutrition counseling in CKD patients from a single nation Asian ethnic group. Patients with Stages 3 and 4 CKD were recruited from a tertiary hospital outpatient clinic in Korea. The intensive group received 3 monthly sessions of individualized intensive nutrition counseling. The control group received a one-time group program. The intensive group was compared with the control group at 3months. A total of 59 patients were enrolled, and 42 (71.2%) completed the study (23/32 of the intensive group; 19/27 of the control group). The mean age of the patients was 64.7 ± 12.5 years, and 81% were male. The most common nutritional diagnosis was an excessive intake of sodium (Na, 97.6%), followed by potassium (K, 78.6%), protein (52.4%), and phosphorus (P, 31.0%). After 3 months of nutrition counseling, K and P intakes decreased significantly in both the intensive group (K, 2,760.9 ± 677.4 vs. 1,500.7 ± 398.5 mg/d, P < .001; P, 1,010.5 ± 247.4 vs. 631.3 ± 178.1 mg/d, P < .001) and the control group (K, 2,090.8 ± 765.3 vs. 1,703.9 ± 490.0 mg/d, P = .036; P, 807.2 ± 163.8 vs. 679.1 ± 175.9 mg/d, P = .044). Meanwhile, protein (68.3 ± 21.8 vs. 45.4 ± 10.1 g/d, P = .001), Na (4,009.8 ± 1,418.2 vs. 2,224.6 ± 759.8 mg/d, P < .001), and energy intakes (1,857.1 ± 411.5 vs. 1,273.7 ± 231.5 kcal, P < .001) decreased in the intensive group, but were comparable in the control group. Notably, BMI decreased (BMI, 25.4 ± 2.5 vs. 24.9 ± 2.9 kg/m2, P = .014) while eGFR (43.1 ± 11.8 vs. 48.9 ± 13.7 mL/min/1.73m2, P = .002) improved significantly in the intensive group only. Intensive individualized nutrition counseling results in better adherence to dietary recommendations and improvement in kidney function in CKD patients.

Effectiveness of nutrition education and counseling on metabolic control parameters of diabetes mellitus type 2 patients in primary health care centers

Background. Diet compliance is an essential part of the treatment and control of diabetes. The present study aimed to determine the effectiveness of education and face to face diet counseling on metabolic control parameters of patients with type 2 diabetes in primary health care centers. Methods. This quasi-experimental study was conducted on 90 T2DM patients who referred to Andimeshk community health centers in 2018. Patients were randomly divided into two intervention (n = 45) and control (n = 45) groups. Data were analyzed by independent t-test, paired t-test and Chi-square using SPSS-18 software. Results. Sixteen weeks after the implementation of the nutrition education and counseling program, there was a significant decrease in the clinical, anthropometric, and biochemical parameters of the intervention group (P 0.05). Conclusion. The research findings show that the implementation of group education program, along with individual nutrition counseling, is very effective and can lead to weight loss, improved blood pressure and better control of blood glucose and lipids in T2DM patients. Therefore, the combination of education and counseling as two complementary methods in the treatment and control of diseases such as diabetes seems essential and effective.

The effectiveness of healthy lifestyle interventions on weight gain in overweight pregnant women: A cluster-randomized controlled trial.

AimInterventions based on adopting a healthy lifestyle have been less successful. The aim of this study was to investigate the effectiveness of healthy lifestyle interventions on weight gain in overweight pregnant women.DesignA cluster randomized controlled trial.MethodsHealth centres were selected by simple random sampling; then, 66 overweight pregnant women were enrolled by convenience sampling and divided into intervention and comparison groups. Intervention group received individual nutritional counselling and physical activity training. The data were collected in several stages with the demographic and obstetric questionnaire, maternal weight record, food frequency and international physical activity questionnaire.ResultsPregnancy weight gain‐4.75(CI 95%: −4.02, −5.48) was significantly lower in the intervention group (p < .001). Comparing between groups with adjustment for baseline values indicated that there was a statistically significant difference in terms of total calorie 95.46 (CI 95%: −22.37, 213.30), carbohydrate 23.45 (CI 95%: 2.12, 44.78), protein −7.16 (CI 95%: −12.85, −1.47) and fat 8.82 (CI 95%: 2.21, 15.67) intake. Despite the higher level of physical activity in the intervention group, there was no statistically significant difference between the two groups.ConclusionCounselling interventions for healthy living during pregnancy can lead to controlling weight gain, improving dietary habits and increasing the physical activity in overweight pregnant women.

Towards universal coverage for nutrition services in children under five years-A descriptive analysis of the capacity of level one hospitals to provide nutrition services in five provinces of Zambia.

BackgroundMalnutrition continues to be a major public health challenge in Zambia. To effectively address this, health systems must be well strengthened to deliver an effective continuum of care. This paper examines health systems issues and services in relation to nutritional support to children under five years, in order to identify gaps and propose interventions towards universal coverage of essential nutrition services.MethodsThis analysis utilized data from a cross sectional mixed-methods study on factors associated with Severe Acute Malnutrition (SAM) in under-five children to assess health facility nutrition services on offer at select level-one hospitals in five out of ten provinces in Zambia. Stata version 13 was used for analysis. We conducted univariate analysis to assess nutrition services offered, functionality of equipment and tools, availability of human resource and human resource development, and availability of drugs used for assessment and management of nutrition-related health outcomes.ResultsWe found large variations in the level of nutrition services on offer across districts and provinces. Eighty-eight percent of all the hospitals sampled provided group nutrition counseling and 92% of the hospitals in our sample offered individual nutrition counseling to their clients. Overall, the existence of referral and counter-referral systems between the Community Based Volunteers and hospitals were the lowest among all services assessed at 48% and 58% respectively. We also found inadequate numbers of human resource across all cadres with an exception of nutritionists as recommended by the Ministry of Health.ConclusionsThis study has revealed a number of gaps in the health system and health service delivery that requires to be addressed; most notably, a lack of tools, policies and guidelines, drugs and health specialists to help care for malnourished infants and children. Our findings also reveal inadequate referral systems between the community and health facilities in the management of severe acute malnutrition. Achieving universal coverage for nutrition services in Zambia will require a lot more attention to the health systems issues found in this study.

Advancements in Personalized Nutrition Technologies: Guiding Principles for Registered Dietitian Nutritionists

Individualized nutrition counseling and care is a cornerstone of practice for registered dietitian nutritionists (RDNs). The term personalized nutrition (PN) refers to “individual-specific information founded in evidence-based science to promote dietary behavior change that may result in measurable health benefits.” PN technologies, which include the “omics” approaches, may offer the potential to improve specificity of nutrition care through assessment of molecular-level data, such as genes or the microbiome, in order to determine the course for nutrition intervention. These technologies are evolving rapidly, and for many RDNs, it is unclear whether, when, or how these technologies should be incorporated into the nutrition care process. In order to provide guidance in these developing PN fields, International Life Sciences Institute North America convened a multidisciplinary panel to develop guiding principles for PN approaches. The objective of this article is to inform RDN practice decisions related to the implementation of PN technologies by examining the alignment of proposed PN guiding principles with the Code of Ethics for the Nutrition and Dietetics Profession, as well as Scope and Standards of Practice. Guiding principles are described as they apply to each stage of the nutrition care process and include identifying potential beneficiaries, communicating effects transparently, and protecting individual privacy. Guiding principles for PN augment standard guidance for RDNs to pose relevant questions, raise potential concerns, and guide evaluation of supporting evidence for specific PN technologies. RDNs have a responsibility to think critically about the application of PN technologies, including appropriateness and potential effectiveness, for the individual served.

Oral nutritional supplement prevents weight loss and reduces side effects in patients in advanced lung cancer chemotherapy.

Weight loss in patients with cancer is caused by cancer cachexia and chemotherapy-induced nausea and vomiting. Recent developments in antiemetic drugs have substantially improved nausea and vomiting, but this intervention did not reduce weight loss and other more severe side effects of chemotherapy, like anorexia, weakness, cough, dyspnea, hemoptysis, and pain. This study aimed to investigate the effects of nutrition intervention with a food supplement, during chemotherapy in patients with advanced nonsquamous non-small cell lung cancer (NSCLC). Patients received individualized nutrition counseling by a registered dietitian and were provided with oral supplements of Texidrofolico® for 90days. Bodyweight and the mentioned other side effects were evaluated at baseline and after 90days of intervention. To assess the effects of this dietary supplement, a total of 30 patients were retrospectively enrolled as controls, and the bodyweight and change in side effects of chemotherapy were compared with those observed in 30 Texidrofolico®-treated patients. After 90-day intervention, by oral supplement of Texidrofolico®, the patients, during the course of cytotoxic chemotherapy, showed an improved quality of life and not significant weight and BMI loss respect the control group. Furthermore, the number of patients, treated with Texidrofolico® who maintained or increased their body weight, after 90days of treatment was significantly higher than in the control group. The effects of treatment with the food supplement have also been studied from a metabolic point of view. It was possible to find that one of the known markers of tumor growth, plasma polyamines, was reduced after the treatment. A possible relationship between these biogenic amines and the folate cycle is discussed. In conclusion, early intensive nutrition intervention with oral supplements of Texidrofolico® during chemotherapy of NSCLC patients prevents weight loss and it is beneficial for their quality of life.

Starting Early Program Impacts on Feeding at Infant 10 Months Age: A Randomized Controlled Trial.

Background: Disparities in obesity-promoting feeding patterns begin in pregnancy and infancy, underscoring the need for early primary prevention in high-risk groups. We sought to determine the impact of a primary care-based child obesity prevention intervention beginning during pregnancy on maternal infant feeding practices, knowledge, and styles at 10 months in low-income Hispanic families. Methods: The Starting Early Program (StEP) randomized controlled trial enrolled pregnant women at a third trimester visit. Women (n = 533) were randomized to standard care or an intervention with prenatal/postpartum individual nutrition counseling and nutrition and parenting support groups coordinated with pediatric visits. Feeding practices (breastfeeding, family meals, juice, and cereal in the bottle) were assessed using questions from the Infant Feeding Practices Study II. Feeding styles were assessed using the Infant Feeding Style Questionnaire. We analyzed impacts on feeding practices, knowledge, and styles using regression analyses adjusting for covariates. Results: Four hundred twelve mothers completed 10-month assessments. Intervention mothers were more likely to give breast milk as the only milk source [adjusted odds ratio (AOR) 1.65, 95% confidence interval (CI) 1.06-2.58] and have daily family meals (AOR 1.91, 95% CI 1.19-3.05), and less likely to give juice (AOR 0.60, 95% CI 0.39-0.92) or cereal in the bottle (AOR 0.54, 95% CI 0.30-0.97) compared to controls. Intervention mothers were more likely to exhibit lower pressuring, indulgent and laissez-faire feeding styles, and to have higher knowledge. Attending a greater number of group sessions increased intervention impacts. Conclusions: StEP led to reduced obesity-promoting feeding practices and styles, and increased knowledge and provides great potential for population-scalability.

443P - The effectiveness of individual nutritional counselling for patients with advanced cancer undergoing chemotherapy: A preliminary study

BackgroundMany patients with advanced cancer have difficulty eating and need nutritional support. This preliminary study examined the effects of individual nutritional counselling sessions on quality of life (QOL), nutritional status and eating-related distress (ERD) among patients with advanced cancer undergoing chemotherapy. MethodsA survey was conducted in the outpatient chemotherapy center at a university hospital in Tokyo, Japan. Patients were offered individual nutritional counselling by a dietitian specializing in cancer. For the participants who completed at least two counselling sessions, we evaluated changes in their QOL (EORTC-QLQ C30), symptoms and nutritional status (PG-SGA SF) and ERD. Data were analyzed using the Wilcoxon signed rank test to compare mean differences. The ethics committee approved the study (Ethical Review No. M2015-578). ResultsOf 42 patients who applied for nutritional counselling, 8 underwent two sessions. The mean age was 70.6±5.9 years and females accounted for 25.0%. Primary diseases were gastrointestinal cancer (n = 6) and lung cancer (n = 2). “Although family members and friends recommend foods to me, I am just confused” on the ERD and “fatigue” on the EORTC-QLQ C30 significantly improved (p < 0.05, respectively). There were no significant differences in the other items of the EORTC-QLQ C30 or symptoms and nutritional status on the PG-SGA SF. In total, 34 patients did not receive nutritional counselling twice because of death, changing hospitals, disease progression, or lack of coordination among researchers. ConclusionsOur study suggests that individual nutritional counselling is slightly beneficial for patients with advanced cancer receiving chemotherapy. Further research is needed to demonstrate the effectiveness of this intervention in the future. Clinical trial identificationUMIN registration No. UMIN000021540; was carried out prior to the start of the study. Legal entity responsible for the studyTokyo Medical and Dental University. FundingSasakawa Memorial Health Foundation. DisclosureS. Koshimoto: Research grant / Funding (institution): Sasakawa Memorial Health Foundation. All other authors have declared no conflicts of interest.

Effect of Individual Dietetic Intervention on Gestational Weight Gain and Associated Complications in Obese Pregnant Women

(Aust N Z J Obstet Gynaecol. 2018;58:274–277) Obesity in pregnancy is increasingly prevalent and associated with many complications. Dietetic intervention may be useful in optimizing gestational weight gain (GWG) in obese pregnant women and improving maternal and fetal outcomes. A GWG target of 5 to 9 kg is recommended for obese women by the Institute of Medicine (IOM), but lower GWG may be safe for individuals in obesity classes 2 and 3 if guided by a clinician. This study aimed to review the effect of individual nutritional counseling by a dietitian on GWG and obstetric outcomes.

Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach

IntroductionHealth at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. ObjectiveWe qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DesignThe intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. ParticipantsForty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. ResultsLack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. ConclusionHAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.

MANEJO DO EXCESSO DE PESO EM MULHERES NA ATENÇÃO PRIMÁRIA

Objetivo: Comparar duas estratégias de redução ponderal em mulheres com excesso de peso, pautadas na prática regular de exercícios físicos e educação alimentar e nutricional, em serviços da Atenção Primária à Saúde. Metodologia: Realizou-se ensaio comunitário controlado não randomizado durante dez meses com mulheres ≥ 20 anos com excesso de peso. O grupo controle incluiu mulheres que praticavam exercícios físicos e tinham acompanhamento nutricional coletivo; e o grupo intervenção, por aquelas que participaram destas atividades somadas ao aconselhamento nutricional individual. Resultados: Foram avaliadas 52 mulheres (grupo intervenção: 26; grupo controle: 26) com cerca de 50 anos e média de índice de massa corporal de 30kg/m². Após a intervenção nutricional, mulheres do grupo intervenção apresentaram redução do peso (p=0,002), do índice de massa corporal (p=0,002) e da circunferência da cintura (p=0,005). Não houve alterações significativas no grupo controle. Conclusão: O acompanhamento nutricional individual associado ao coletivo e à prática de exercícios físicos possibilitou a melhoria no perfil antropométrico das mulheres, reforçando a necessidade da integração das ações de serviços de saúde para o efetivo manejo do excesso de peso.DOI: 10.12957/demetra.2018.36566

Impact of counseling in knowledge, attitude and practice and association of nutritional status with CD4 count and opportunistic infections of HIV patients of Udupi, India

HIV infection and insufficient nutritional intake form a malicious cycle which leads to immunodeficiency and malnutrition. Thus, this research was done to see the effect of nutritional counseling on knowledge, attitude and practice (KAP) of HIV patients of Udupi district. Also, the rational evidence of association of nutritional status with CD4 counts and opportunistic infections combined are limited which led to design of this study. This interventional study was done in ART Centre, Udupi, India with a sample size of 66 with 33 each in experimental and control group (EG and CG). At first, the biochemical parameters, KAP, 3 day dietary intake and food group intake over Food Frequency Questionnaire (FFQ) were recorded. PG-SGA (Scored Patient-Generated Subjective Global Assessment) scoring was used to categorize patients' nutritional status. Individual nutritional counseling was provided to EG and change in KAP of EG and CG were recorded after 1 month. Pre-KAP mean of EG was 151.56 which increased to 169.13 after intervention. The mean KAP score of EG was statistically different from CG after counseling, P<0.001. Of the total, 15 (22.7%) patients were found to be malnourished. The dietary intake of nutrients and food group was significantly lower than RDA. Tukey HSD post hoc analysis showed significant statistical difference for the CD4 count between moderate and severe malnourished category with P=0.017. Statistically significant nutrient intake differences were also observed between PGSGA groups while odds ratio showed no significant association. Improvement in KAP and poor nutritional status indicates that individual Nutrition and Health Education Counseling be made an integral part in the management of HIV in Udupi. Also, the difference in CD4 count across two PG-SGA stages depicts an association between nutritional status and immune status of HIV patients.

NP31 - Starting Early/Empezando Temprano: Randomized Control Trial to Test the Effectiveness of a Child Obesity Prevention Program

Objective: To improve maternal infant feeding and activity practices and reduce child obesity with the Starting Early Program (StEP): a primary care-based obesity prevention intervention beginning in pregnancy for low-income Hispanic mother-infant dyads. Description: Conduct a randomized control trial of the StEP intervention. Women enrolled in the third trimester of pregnancy at an urban public hospital clinic, randomized to StEP intervention vs. standard primary care. Intervention included: individual nutrition counseling in prenatal/peri-partum periods, nutrition and parenting support groups at every well child visit with 2 individual and 13 group intervention sessions scheduled prior to child age 3 years. Feeding styles, diet and lifestyle patterns, psychosocial stressors, and demographic information collected at baseline in pregnancy and infant age 3, 10, 19, months, 2 and 3 years, with measured length/height and weight. Multilevel modeling used to assess intervention impact on infant weight for length z-scores (WFLz). T tests and chi square used to assess impact on nutrition knowledge and practices. Logistic regression used to assess intervention dose on risk of obesity (BMI ≥ 95th% for age and sex) at age 3. Evaluation: Baseline prenatal assessments (n = 566) found high rates of maternal stress, obesity and unhealthy dietary practices. Five hundred and thirty three pregnant women randomized to StEP vs. standard care. No group differences in baseline mother/infant characteristics. Mean sessions attended by 3 years: 8.5 (range 1–15). At infant age 3 months: higher nutrition knowledge, higher rates of exclusive breastfeeding, tummy time and less early introduction of complimentary foods for intervention group. At 10 months, more exclusive breastfeeding, more responsive feeding styles and less introduction of juice. At age 2, more family meals and less restaurant food. Complete weight data available for infants through age 18 months (n = 433). Intervention group infants had lower mean WFLz between ages 12–18 months (-.21 (.10), p = .046). At 36 months, infants attending >10 sessions were less likely to have obesity, p = .039. Conclusions and Implications: Interventions like StEP have the potential to improve maternal infant feeding and activity practices and reduce childhood obesity. Funding: 2011-68001-30207.

Status gizi, kadar hemoglobin, ureum, dan kreatinin pasien konseling gizi hemodialisa

&lt;p&gt;&lt;strong&gt;ABSTRACT&lt;/strong&gt;&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: Patients who are undergoing hemodialysis therapy must know which foods that may be consumed including foods containing animal protein, low potassium, and low salt. The role of nutritionists is needed to provide nutritional counseling related to dietary adjustment. Studies that have been conducted by previous researchers are about diet from hemodialysis patients and the various factors that affect dietary compliance of patients, but no one has been studying the relation related to nutritional status, hemoglobin, ureum, and creatinine levels before and after doing a counseling that also has a relationship with diet and dietary compliance for hemodialysis patients.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Objectives&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; : To analyze the relationship of nutritional status, hemoglobin, ureum, and creatinine levels of hemodialysis patients before and after doing nutritional counseling in RSUD Ungaran. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods :&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; The study used a descriptive quantitaive method with one group pretest posttest design with cross sectional approach. The research was conducted in Hemodialysis Unit of RSUD Ungaran with a total sampling of 30 hemodialysis patient. Primary data were obtained from respondent’s data entry and FFQ, observation, and interviews. Secondary data were obtained from respondent’s medical records include the level of hemoglobin, urea, and cretinine. Data were analyzed using SPSS programme with Paired t Test. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; : The results of SPSS analysis showed that probability value from urea men 0,016 &amp;lt; 0,05 and urea women – hemoglobin men and women – creatinin men and women overall 0,000 &amp;lt; 0,05, which means that the average levels of those components before and after doing a nutritional counseling is different.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusions&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; : A nutritional counseling indicate any change in the nutritional status of the entire hemodialysis patients, based on hemoglobin levels increased, while urea and creatinine levels decreased; but all those components are not in the normal category. Levels of hemoglobin, urea, and creatinine is changed within a period of one month after the implementation of individual nutritional counseling. It indicates that nutritional counseling efforts were given has a positive benefit for the patients to gain knowledge about dietary adjustments and implement the recommended diet in order to optimize the work of renal function excessively.&lt;/em&gt;&lt;em&gt;&lt;/em&gt;&lt;/p&gt;&lt;strong&gt;KEYWORDS&lt;em&gt; &lt;/em&gt;&lt;/strong&gt;&lt;em&gt;: nutritional status, hemodialysis, eating behavior, nutritional counseling&lt;/em&gt;

Maternal Understanding Regarding Women Nutrition during Breastfeeding

Introduction: Breastfeeding mothers’ nutritional status affects milk quality and children’s nutrition in a key period for life. Objectives: Identifying and describing breastfeeding mothers’ social representations during this period related with nutrition as self-care; connotations referred to food products and supplements; post-partum weight retention and information sources consulted on this matter. Materials and Methods: Ten in depth interviews were performed in healthy adult breastfeeding mothers. Interviews were analyzed with a qualitative methodology considering Health Beliefs, PRECEDE and Health Promotion models, employing the Grounded Theory. Results: Women consider nutrition as a health conditioning factor and refer dietary changes implementation during pregnancy, which are not always kept during breastfeeding. Disorganization was mentioned regarding feeding and commensality, prioritizing their child’s health over their own. Vegetables and liquids are attributed to positive connotations, referring increased consumption. Certain foods are limited as they are considered less healthy (“junk food”, sweets, sodas, cookies, spices, coffee and mate) while others, like milk, have been associated with negative effects. Insufficient weight gain during pregnancy is valorized as an achievement due to pairs approval and appearance. Association between breastfeeding and previous weight recovery is weak and doubted. Lack of information on feeding and breastfeeding even among health professionals is recognized. In case of doubts, mothers follow the closest belief affectively. Conclusions: Identifying and characterizing beliefs and barriers for maternal eating practices allow including socio-cultural aspects both in the design of public health policies and in individual nutritional counseling.

MULTIDISCIPLINARY AND MOTIVATIONAL INTERVENTION FOR THE TREATMENT OF LOW INCOME BRAZILIAN OBESE ADOLESCENTS: PILOT STUDY.

ABSTRACTObjective: To test a multidisciplinary and motivational intervention for the treatment of Brazilian obese and low-income adolescents (Z score>2 BMI-for-age) that used nutritional counseling without dietary control. Methods: An intervention protocol was developed including periodical nutritional education workshops, individual nutritional counseling guided by the stages of eating behavior of the Trans Theoretical Model of Behavior Change, physical exercise, psychological counseling, recreational activities, and clinical follow-up for 13 months in a sample of 21 adolescents (11-17 years old). Results: The rate of treatment withdrawal (9.5%) was lower than that seen in dietary control studies (30-60%). Initially, 70% of the sample was in the pre-contemplation behavior stage and, in the end, 100% of the remaining adolescents were in the stages of action or maintenance. There was a mean reduction in BMI-for-age (p=0.038) and visceral fat (M±SD=3.67±1.19 and 2.78±0.78 cm, p=0.02, initial and final, respectively). The percentage of fat mass decreased and that of lean mass increased (42±5 and 38±8, p=0.04, 58±6 and 61±8%, p=0.03, respectively).Conclusions: The intervention seems to be effective in generating a lifestyle change, accompanied by anthropometric profile and body composition improvement. The intervention protocol may offer easy adaptation and low-cost methodology for health services, with high adherence and low abandonment rates.

Early Intensive Nutrition Intervention with Dietary Counseling andOral Nutrition Supplement Prevents Weight Loss in Patients with Advanced LungCancer Receiving Chemotherapy: A Clinical Prospective Study

Weight loss in patients with cancer is caused by cancer cachexia and chemotherapy-induced nausea and vomiting (CINV). Recent developments in antiemetic drugs have substantially improved CINV, but nutritional intervention did not improve body weight. This study aimed to investigate the effects of nutrition intervention with appropriate antiemetic treatment in patients with non-small-cell lung cancer during chemotherapy. Patients received individualized nutrition counseling by a registered dietitian and were provided with oral supplements for 90 days. Body weight and other parameters were measured at baseline and after 90-day intervention. To evaluate this nutrition intervention, patients were also retrospectively set as control, and then body weight change was compared with inverse probability of treatment weights (IPTW) analysis. Ten patients received individualized nutrition counseling and were provided with oral supplements for 90 days. Of them, 7 patients consumed nutritional supplements, and the mean intake was 130 kcal/day. After 90-day intervention, the patients did not show significant weight and BMI loss during the course of cytotoxic chemotherapy. A total of 38 patients were retrospectively enrolled as controls. The number of the patients who gain the body weight after 90 days in the study cohort was significantly larger than that in the retrospective controls with the IPTW analysis (Odds Ratio (OR) = 8.4; 95% Confidence Interval (CI): 1.6-42; P = 0.01). Early intensive nutrition intervention with appropriate antiemetic treatment prevents weight loss. Nutrition interventions might be also beneficial for quality of life, treatment response and survival.

Effects of nutrition and physical exercise intervention in palliative cancer patients: A randomized controlled trial

Cancer cachexia is multifactorial and should be targeted using a multimodal form of intervention. The purpose of the present trial was to test the effects of a combined nutrition and physical exercise program on cancer patients with metastatic or locally advanced tumors of the gastrointestinal and lung tracts. Patients were randomized into two groups: One group received a minimum of three standardized individual nutritional counselling sessions and participated in a 60-minexercise program twice a week. The second group received their usual care. The intervention spanned a period of three months. Quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire version 3.0), physical performance (hand-grip strength, 6-min walk test, timed sit-to-stand test and 1 repetition maximum leg press), nutritional status (body weight, bioelectrical impedance analysis), dietary intake (three-day dietary record) and clinical data (unexpected hospital days, performance status) were tested at baseline and after three and six months. In total, 18 women and 40 men (mean age 63, range 32-81) with metastatic or locally advanced tumors of the gastrointestinal (n=38) and lung (n=20) tracts were included. Median adherence to the supervised exercise program was 75%. The median number of individual nutritional counselling sessions was 3.0 (range 0-7 sessions). Post intervention, no difference in global health status/quality of life (overall QoL) was observed. Intervention was superior to UC for the patient-rated symptom scale regarding nausea and vomiting (p=0.023) and protein intake (p=0.01). No statistical differences were observed for energy intake, nutritional status and physical performance. The results show good adherence to a combined nutrition and exercise program. The multimodal intervention did not improve overall QoL, but contributed to an adequate protein intake and to the general well-being of the patient by reducing nausea and vomiting.

Randomized controlled trial of an early child obesity prevention intervention: Impacts on infant tummy time.

ObjectiveTo describe infant activity at 3 months old and to test the efficacy of a primary care-based child obesity prevention intervention on promoting infant activity in low-income Hispanic families.MethodsRandomized controlled trial (n=533) comparing a control group of mother-infant dyads receiving standard prenatal and pediatric primary care with an intervention group receiving “Starting Early”, with individual nutrition counseling and nutrition and parenting support groups coordinated with prenatal and pediatric visits. Outcomes included infant activity (tummy time, unrestrained floor time, time in movement restricting devices). Health literacy assessed using the Newest Vital Sign.Results456 mothers completed 3-month assessments. Infant activity: 82.6% ever practiced tummy time; 32.0% practiced tummy time on the floor; 34.4% reported unrestrained floor time; 56.4% reported >1 hour/day in movement restricting devices. Inadequate health literacy was associated with reduced tummy time and unrestrained floor time. The intervention group reported more floor tummy time (OR 2.16, 95% CI 1.44–3.23) and unrestrained floor time (OR 1.69, 95% CI 1.14–2.49) compared to controls. No difference in the time spent in movement restricting devices was found.ConclusionsTummy time and unrestrained floor time were low. Primary care-based obesity prevention programs have potential to promote these activities.