Intensive Nutrition Counseling Research Articles

Nutritional counselling and its effects on diet, nutritional knowledge and status, physical activity and quality of life in a Southern Europe population: evaluation of a health promotion programme

Background: Health promotion and primary prevention are key points for fighting the increase in non- communicable diseases. Aim: To test the effectiveness of a nutritional counselling programme in improving nutritional behaviours, knowledge and status, physical activity and health-related quality of life in a general population. Methods: In the period between January–December 2007, we studied the application of the nutritional counselling programme (NCP) developed by Local Health Agency 10 (Florence-Italy). We compared , diet, nutritional knowledge, physical activity, health related quality of life (measured by SF36 questionnaire), body mass index (BMI) and waist circumference before and after a two months intensive nutritional counselling programme using the paired t test and McNemar test. Diet, nutritional knowledge, physical activity, socio-demographic and morbidity information were collected through questionnaires. BMI and waist circumference were assessed by a medical doctor. Results: We enrolled 74 persons, 59 of whom completed the educational programme. Of these, 34 had a nutritional status assessment after the programme. Mean age was 49 years, 80% were females. BMI, waist circumference and diet, except for water intake, did not change. The percentage of people who had “never exercised in a week" decreased from 46% to 17% (p<0.001). Mean percentage of right answers to nutritional knowledge indicators increased from 64% to 78% (p<0.001). Health related quality of life (HRQL) improved especially with regard to “Physical" and “Emotional Role". Conclusions: The NCP showed important results in promoting physical activity and improving HRQL and nutritional knowledge, moderate/none results in improving diet and nutritional status.

Effect of intensive nutrition education and counseling on hemoglobin level of pregnant women in East Shoa zone, Ethiopia: randomized controlled trial

BackgroundThe aim of this study was to assess the effect of intensive nutrition education and counseling on hemoglobin level during pregnancy.Methods and materialsThe study was a one year two-arm parallel design cluster randomized controlled trial in East Shoa zone, Ethiopia. End-line data were collected from 163 intervention and 163 control group pregnant women. The intervention was a three consecutive trimester based counseling sessions using health belief model, weekly regular SMS sent on mobile phone containing core message and providing leaflet with food menu of Iron rich diet. The women in the control group received routine nutrition education from facilities. After adjusting for potential confounders, a linear mixed-effects model was used to assess the intervention effect.ResultsThere was a significant change in both hemoglobin level and proportion of anemia in the intervention group. The mean hemoglobin level within intervention group before and after intervention was (12.08± 1.15, 12.53± 1.18) with p value of 0.01. The prevalence of anemia among intervention group declined from 14.7 % at the baseline to 9.2% after intervention. At the end of the trial, women in the intervention group had significantly better hemoglobin level than women in the control group (β = 0.50, p < 0.01).ConclusionThe intervention was effective in improving the hemoglobin level and consumption of iron rich diet among pregnant women. Therefore, employing trimester based counseling by using HBM constructs and regular reminding messages have to be provided to pregnant women as part of the regular antenatal care service.

A study protocol for a pilot randomized controlled trial to evaluate the effectiveness of a gene-based nutrition and lifestyle recommendation for weight management among adults: the MyGeneMyDiet® study.

Managing nutrition and lifestyle practices, nutrition phenotypes, and the genome forms the foundation of precision nutrition. Precision nutrition focuses on metabolic variability among individuals, and one approach to achieving its goals is to integrate gene-based nutrition and lifestyle recommendations in nutrition practice. However, scientific evidence proving the effectiveness of such recommendations is limited. This study will examine whether providing nutrition and lifestyle recommendations based on individual genotype can lead to better weight loss, along with reduction in body mass index (BMI), waist circumference, and body fat percentage among overweight and obese adults. A parallel group, single-blind, randomized controlled trial will be conducted. Sixty-two overweight/obese individuals aged 19-59 years old will be recruited. Participants will be randomly allocated to either the intervention (n = 31) or the control arm (n = 31). Participants in the intervention group will receive the MyGeneMyDiet® Recommendation for Weight Management, a gene-based nutrition and lifestyle recommendation that was developed based on existing evidence of the effects of FTO rs9939609 on body weight, BMI, and physical activity; UCP1 rs1800592 on calorie intake; and TCF7L2 rs7903146 on dietary fat intake. Participants in the control group will receive the standard recommendations for weight management. The primary outcomes will be the differences in weight, BMI, waist circumference, and body fat percentage between arms in both the active phase (6 months) and inactive phase (last 6 months) of the trial. Participants in both arms will be evaluated at baseline and in months 3, 6, 9, and 12. To the best of our knowledge, this will be the first gene-based intervention that will adopt a phase of intensive nutrition counseling, followed by a simulation of a free-living state to determine adherence to a gene-based recommendation. This study will contribute to the future implementation of precision nutrition interventions by providing evidence on the effectiveness of a gene-based nutrition and lifestyle recommendation for weight loss. clinicaltrials.gov, identifier [NCT05098899].

Effects of intensive nutrition education and counseling on nutritional status of pregnant women in East Shoa Zone, Ethiopia.

Nutritional status is defined as an individual's health condition as it is influenced by the intake and utilization of nutrients. Maternal malnutrition is widespread throughout the world, with Sub-Saharan Africa and Asia bearing the brunt of the burden. The objective of this study was to evaluate the effect of intensive nutrition education and counseling on nutritional status during pregnancy. The study was a one-year, two-arm parallel design cluster randomized controlled trial conducted in the East Shoa zone, Ethiopia, from January 1, 2021, to February 30, 2022. A total of 374 participants were enrolled in the intervention (n = 185) and control (n = 189) groups. End-line data were collected from 163 women, from each group. The intervention package provided three counseling sessions by trained midwives, three-page take-home brochures prepared in local languages, and the delivery of 18 weekly serial short text messages. The women in the control group received routine nutrition education from the health facilities. After adjusting for potential confounders, a linear mixed-effects model was employed to assess the intervention effect. After the intervention, the mean mid-upper arm circumference in the intervention group increased by 1.8% (23.08 vs. 23.44, p < 0.01). Similarly, the proportion of undernutrition in the intervention group was 11% (25 vs. 36%, p = 0.02) lower compared to the control arm. At the end of the trial, women in the intervention arm had significantly better nutritional status than women in the control group (β = 0.47, p < 0.01). The findings showed that intensive nutrition education and counseling using the health belief model was effective in improving nutritional status and reducing undernutrition among pregnant women. As a result, nutrition education and counseling using HBM constructs, as well as regular reminder messages, should be provided to pregnant women as part of the routine antenatal care service.

The Use of Whatsapp Social Media Group for Nutrition Counselling among Parents with Children of Congenital Heart Defects

Background: Ignorance about appropriate Infant and Young Child Feeding (IYCF) Practices among parents of children with Congenital Heart Defects (CHD) can exacerbate malnutrition in these children leading to significant morbidity and mortality. Use of novel methods for Intensive Nutrition Counselling such as Whatsapp social media group can lead to considerable improvement in nutritional status of the child.&#x0D; Objectives: To assess the efficacy of Whatsapp group for Intensive Nutritional Counselling to parents of children with CHD. &#x0D; Methods: This is a two-year prospective interventional study, one-group before-after study design. Here, intervention is in the form of specialised focussed nutrition counselling for parents of children with CHD through Whatsapp social media group.&#x0D; Results: Majority of the patients 16 (30.0%) were in the age group of 7-12 months, predominant diagnosis (25 patients i.e. 48.9%) was Ventricular Septal Defect (VSD). Sixty-eight percent patient-families belonged to lower socio-economic class. Before intervention, 71.1% of children (37 of 52) were found to be underweight, 35.5% children were stunted and 65.6% children were wasted. Post intervention there was significant improvement in all the 3 anthropometric indicators. This intervention particularly helped improve IYCF habits for the age group of 7-12 months. Post intervention all parents included the 8 food groups in their children’s diet thus providing them wholesome nutrition whereas earlier only 2-3 food groups were given to children on a daily basis.&#x0D; Conclusion: This is the first study to explore use of Whatsapp group to educate parents of children with CHD about specific nutrition counselling, resulting in improvement in child anthropometric indices.

Effects of Nutrition Management on Nutritional Status for Advanced Stage of Nasopharyngeal Carcinoma Patients Undergoing Chemoradiation : Literature Review

Malnutrition is an important clinical factor in the development and treatment of cancer. It results from a state when food intake fails to provide energy requirements. Malnutrition is very common in NPC patients because the original tumor site can significantly reduce food intake. International guidelines suggest intensive nutritional counseling (NC) and supplemental oral nutrition as nutritional interventions for head and neck cancer patients with CRT. It was also suggested that if cancer affects eating or swallowing, enteral nutrition (EN) should be given via a feeding tube. The purpose of this study was to investigate the effect of nutritional management in advanced NPC patients with CRT to evaluate nutritional status, and nutritional index and to observe nutritional status (weight, BMI, hemoglobin, albumin, prealbumin, and lymphocytes, and Quality of life (QOL). The method used is the literature review method with a systematic approach by tracing the results of experimental research in English. The articles used are focused on original empirical research articles or research articles that contain results from actual observations or experiments. The results obtained after a review of 3 articles that match the criteria Inclusion was that two studies gave results if nutritional interventions affected NPC patients after undergoing chemoradiation therapy, while one article stated that nutritional interventions did not affect NPC patients.

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.

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

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

Evaluation of Intensive Telephonic Nutritional and Lifestyle Counseling to Enhance Outcomes of Bariatric Surgery.

To determine the impact of an intensive perioperative nutritional and lifestyle support protocol on long-term outcomes of bariatric surgery. A retrospective observational study was conducted of 955 patients who underwent gastric bypass surgery between 2005 and 2015. Patients were divided into two cohorts: (1) 2005 through August 2013: these 767 patients were required to participate in the intensive telephone-based nutritional support program from 8weeks preoperative through 44weeks postoperative; (2) after August 2013, the program was discontinued and 188 patients did not have intensive telephonic nutritional support. Inverse probability weighting was used to obtain weight loss estimates at 1 and 3years postoperative. Time-to-event analyses were used to investigate hospitalization rates postoperative. Poisson models were used to investigate healthcare utilization. Patients who participated in the program exhibited 1.97% (95% CI 0.7, 3.3) greater %TWL at 1year and 2.2% (95% CI -0.3, 4.1) greater %TWL at 3years postoperative than patients who did not participate. Secondary analyses indicated participation in the program was associated with 44% shorter time to first hospitalization postoperative (p < 0.001). In this health system, intensive nutritional support was associated with greater weight loss at 1 and 3years postoperative and higher hospitalization rates.

A study protocol of a randomized trial evaluating the effect of using defined menu plans within an intensive personal nutritional counseling program on cardiovascular risk factors: The MoKaRi (modulation of cardiovascular risk factors) trial

ImportanceChanges in dietary habits and lifestyle can reduce the risk of cardiovascular disease which is the leading cause of death worldwide. Objectives of the MoKaRi study The MoKaRi (modulation of cardiovascular risk factors) intervention study is designed to evaluate the effectiveness and potential of the developed MoKaRi concept. The MoKaRi concept comprises three components, each designed to improve dietary behavior. The first component entails using daily menu plans to implement a defined “cardioprotective diet”. This diet consists of seasonal menu plans which are characterized by:(i) a personalized energy supply depending on his or her age, gender, level of physical activity.(ii) an adequate intake of carbohydrates, protein, fat, vitamins, minerals, and trace elements according to the guidelines of the German Society of Nutrition (DGE).(iii) a recommended intake of saturated fatty acids (SFA; < 7% of caloric intake (En%)), monounsaturated fatty acids (MUFA; > 10 En%), polyunsaturated fatty acids.(PUFA; approx. 10 En%), and long-chain n-3 PUFA (≥500 mg per day).(iv) measures to encourage consumption of vegetables and fruits, and.(v) eating more than 40 g dietary fiber every day.Half of the participants will be scheduled to consume an additional 3 g of long-chain n- 3 PUFA every day in the form of fish oil.The second component consists of regular one-on-one nutritional counseling, while a variety of further incentives make up the third component of the MoKaRi concept.The MoKaRi study will provide essential insights into the relationship between defined nutrient intake, markers of food intake and health status. Our specific aim is to investigate the influence of dietary and lifestyle choices have on cardiovascular health.The information and practical tools suitable for daily use, such as the personalized menu plans, could help to transfer knowledge on nutritional facts to the general population. In this way, the validated MoKaRi concept may contribute to the prevention and therapy of cardiovascular diseases. MethodsIn line with our power calculation, we will enroll 60 participants and randomly assign them to one of two parallel arms. Each participant will receive personalized menu plans for each day of the study and will be provided with one-on-one nutritional counseling sessions every two weeks for a study period of 20 weeks (140 days). During this period, blood samples will be taken every 14 days (11 time points) and twice during a 20-weeks follow-up period. Incentives such as a supply of foods approved according t the standards of the study, a sports program, individual feedback on study parameters reflecting health status, and group activities round off the MoKaRi concept.Low-density cholesterol is the primary outcome measure of the MoKaRi study, and the secondary endpoints comprise markers of nutrient status (e.g. fatty acid distribution in plasma and erythrocyte lipids), a metabolomic profiling, diabetes risk markers, clotting markers, and further cardiovascular risk factors, such as blood lipids, homocysteine and high-sensitive c-reactive protein.The MoKaRi study was registered before launch at ClinicalTrials.gov (identifier NCT02637778; https://clinicaltrials.gov/ct2/show/NCT02637778).

Vitamin D and iron status in children with food allergy

BackgroundChildren with food allergy are at specific risk for nutritional deficiencies. ObjectiveTo retrospectively determine prevalence of vitamin D and iron deficiencies in children with or without food allergy (FA). MethodsWe compared the markers of vitamin D and iron status of 0 to 17-year-olds with cow’s milk allergy (CMA) (n = 77), those with other FAs (n = 70), and those with atopy without FA (n = 87) at an academic pediatric allergy practice. Multiple linear regression analyses were performed to determine the impact of CMA and other FAs on vitamin D levels and iron markers. ResultsVitamin D deficiency was detected in one-fourth and insufficiency in one-third of children with CMA and other FAs and in those with atopic diseases but no FA, respectively. Vitamin D levels were associated with vitamin D supplementation and consumption of breast milk, cow’s milk, infant formula, or plant-based milk beverage, but not with CMA or other FAs. Older children with FA who did not consume any cow’s milk or alternative milk beverage were at highest risk for vitamin D insufficiency. Children with CMA have a higher rate of iron deficiency anemia (8%) than children with other FAs (1%) or those with no FA (5%, P < .001); however, suboptimal levels of transferrin saturation and iron were detected in up to one-third of children with CMA or other FAs. ConclusionVitamin D deficiency and insufficiency is common in children with atopy overall, but children with CMA are at higher risk for iron deficiency anemia. Intensive nutritional counseling and nutrient intake monitoring, specifically for vitamin D and iron in those avoiding cow’s milk, are necessary to optimize nutritional status.

Low-salt low-protein diet and blood pressure control in patients with advanced diabetic kidney disease and heavy proteinuria.

To assess the associations between effects of low salt, low protein diet supplemented with keto-analogues (sLPD)-on salt intake, blood pressure (BP) and cardiovascular events (CVEs) in patients with advanced diabetic kidney disease (DKD) and heavy proteinuria. Prospective, single-center study (total duration of 15months), enrolling 92 patients with advanced DKD (median eGFR 11.7ml/min) and heavy proteinuria (median 4.8g/g creatininuria). The intervention consisted in a low salt-low protein (0.6g/kg-day) diet (sLPD) under intensive nutritional counselling, and adjustment of antihypertensive therapy. The endpoints of this sub-analysis were a salt intake ≤ 5g/day, a mean blood pressure (MAP) ≤ 97mmHg, corresponding to KDIGO target of 130/80mmHg, and the rate of CVEs. Salt intake decreased with 2.5g/day and the proportion of patients reaching the salt intake endpoint increased with 58%. A salt intake ≤ 5g/day was associated with a reduced MAP, BMI, proteinuria, fractional excretion of sodium, and eGFR, suggesting a salt-related volume contraction but was not related to protein intake. Mean arterial pressure decreased with 13mmHg. MAP ≤ 97mmHg was associated with lower proteinuria, salt, and protein intake, but the contribution of salt intake cannot be differentiated from that of protein intake. CVEs occurred in 20% of patients and were independently related to a lower age and MAP, and increased comorbidities. eGFR only minimally declined and no renal adverse events were noted. sLPD was nutritionally safe. The multifactorial personalized intervention allowed a stable MAP reduction to KDIGO recommended levels (≤ 97mmHg), related to the decrease in salt and protein intake. However, BP lower than 130/80mmHg increased the cardiovascular but not the renal risk in heavy proteinuric patients with advanced DKD. 0341507433: NCT03415074. Registered 02/02/2015 in US National Library of Medicine, ClinicalTrials.gov (NCT).

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.

Intensive nutrition counseling as part of a multi-component weight loss intervention improves diet quality and anthropometrics in older adults with obesity

Obesity significantly impacts older adults. Intensive nutrition counseling can aid in weight reduction and improve diet quality, but data are sparse in this population. The objective of this intervention is to determine how intensive nutrition counseling affects diet quality and anthropometric measures during a multi-component weight loss intervention in rural older adults with obesity. A series of 12-week, single-arm feasibility pilots were conducted in fall 2017 and winter/spring 2018 in a community aging center in rural Northern New England. Adults were eligible if≥65 years old with a Body Mass Index (BMI) ≥30kg/m2. Exclusion criteria included dementia/cognitive impairment, uncontrolled psychiatric illness, weight-loss surgery, weight loss >5% in previous 6-months, life-threatening illness, palliative/hospice services, current participation in another weight-loss study/program, obesogenic medications, or presence of major chronic conditions. Participants received once-weekly nutrition counseling by a registered dietitian nutritionist (RDN), and twice-weekly exercise sessions by a physical therapist (PT). Primary outcomes were diet quality changes measured by total Rapid Eating and Activity Assessment for Patients-Short Version (REAP-S) and Automated Self-Administered 24-h dietary recall (ASA-24). Secondary outcome measures were changes in weight (kilograms) and waist circumference (centimeters). McNemar test was conducted for all paired categorical data while paired t-tests were conducted for all paired continuous data. All analyses were conducted in R; p-value<0.05 was significant. Total n=23. Mean age was 72.2 (5.8) years (73.9% female); mean BMI was 35.9 ± 5.0 kg/m2. At12 weeks, diet quality significantly improved. REAP-S scores increased by 3.53±3.13 points (p<0.001). Kilocalories, grams fat, grams saturated fat, milligrams sodium, grams added sugar, and grams alcohol via ASA-24 significantly decreased (all p<0.05). Significant reductions in weight (-5.22±3.13kg) and waist circumference (-6.88±5.67cm) were observed (both p<0.001). Intensive nutrition counseling significantly enhances diet quality and reduces weight and waist circumference in rural older adults with obesity.

PENGEMBANGAN DAN EVALUASI PROGRAM KONSELING GIZI INTENSIF PADA IBU HAMIL DALAM MENINGKATKAN KUALITAS DIET

Kualitas Diet ibu hamil penting untuk kesehatan ibu, pertumbuhan dan perkembangan janin. Intervensi konseling gizi efektif untuk mencegah komplikasi terhadap ibu dan janin. Penelitian ini bertujuan untuk mengetahui perbedaan kualitas diet ibu hamil pada kelompok perlakuan dan kelompok kontrol, mengetahui perbedaan kualitas diet ibu hamil sebelum dan sesudah diberikan konseling gizi intensif menggunakan media leaflet. Penelitian ini merupakan penelitian quasi eksperimen dengan pendekatan pre post control group one design. Penelitian ini dilakukan di Puskesmas Polongbangkeng Utara Kabupaten Takalar. Teknik pengambilan sampel menggunakan metode simple random sampling. Sampel dalam penelitian adalah ibu hamil trimester I-III yang memenuhi kriteria inklusi dan ekslusi. Kelompok yang mendapatkan konseling gizi intensif 35 orang dan kelompok tanpa konseling gizi intensif 35 orang. Konseling gizi intensif diberikan oleh peneliti dengan alat bantu media leaflet selanjutnya pendampingan dengan target enam kali sesi/pertemuan selama 45 menit. Setiap 7 (tujuh) hari akan dilakukan kembali penilaian kualitas diet per individu Responden mencatat makanan yang dikonsumsi dalam URT (Ukuran Rumah Tangga) atau gram, kemudian peneliti memperkirakan/estimasi URT (estimated food record) kedalam ukuran berat (gram). Perhitungan kualitas diet dihitung dengan menggunakan software Nutrisurvey 2007. Hasil penelitian menunjukkan terdapat perbedaan kualitas diet ibu hamil pada kelompok perlakuan dan kelompok kontrol dengan nilai p=0.002 &lt; 0,05. Hasil uji statistik menggunakan wilcoxon menunjukkan terdapat perbedaan kualitas diet ibu hamil sebelum dan sesudah diberikan intervensi konseling gizi intensif (p&lt;0.05). Konseling gizi intensif menggunakan media leaflet dapat meningkatkan kualitas diet ibu hamil.

Exploring the feasibility of a supportive care intervention for patients undergoing neo-adjuvant chemotherapy for pancreatic cancer: The FEED study (a fish oil supplement, pancreatic enzyme supplement, exercise advice and individualised dietary counselling)

Background: Cachexia is highly prevalent in pancreatic cancer. Development of potent chemotherapy agents has led to a new era in the management of locally advanced and borderline resectable pancreatic cancer. Recent work confirmed that accelerated muscle loss occurs during neoadjuvant chemotherapy, significantly increasing mortality risk. Materials and Methods: An interventional study of a multi-modal package of care designed to prevent loss of muscle in patients with pancreatic cancer, with intensive nutritional counselling, pancreatic enzyme replacement therapy (PERT), an eicosapentaenoic acid enriched oral nutritional supplement (ONS), and individualised daily step target. The primary objective was to determine the feasibility of this 12-week intervention in 20 patients receiving neoadjuvant chemotherapy. Tolerance of supplementation, PERT, and physical activity was measured, alongside barriers to acceptance. Secondary objectives were change in body composition (CT-based assessment), inflammatory cytokines (IGF-1, Il-6, TNF-a), functional capacity (grip strength, Timed-Up-and-Go), and quality of life (EORTC). Results: Between September 2017 and November 2018, 20 of 28 eligible patients undergoing neoadjuvant treatment (Folfirinox or Gemcitabine with Nab-Paclitaxel) at our institution were recruited. Fifteen patients completed the intervention to date. Preliminary analysis of the feasibility of the intervention showed that 100% of patients attended fortnightly dietetic appointments, with 93%, 53% and 67% meeting PERT, ONS and step target prescriptions respectively. Barriers to meeting ONS prescription included taste aversion/fatigue (increased compliance when PERT was established), while barriers to meeting physical activity included chemotherapy-induced neuropathy, treatment related side effects, and fear of acquiring infection. Secondary objectives will be analysed upon study completion, with the remaining three participants due to complete the intervention in February 2019. Conclusion: Preliminary data identified high patient compliance and acceptance of this multi-modal intervention.

Nutritional Counseling for Head and Neck Cancer Patients Undergoing (Chemo) Radiotherapy-A Prospective Randomized Trial.

Background: Locally advanced head and neck cancer is managed either by combined surgery and (chemo) radiotherapy or definitive (chemo) radiotherapy, which may deteriorate nutritional status. Previous data have shown that intensive nutritional intervention by a dietician reduces radiation-induced adverse events including weight loss.Objective: To determine if on-demand nutritional counseling (ODC, control group) would be as efficacious as intensive nutritional counseling (INC, experimental group) in patients undergoing (chemo) radiotherapy.Methods: Fifty-eight patients were randomly assigned to receive INC (n = 26) or ODC (n = 32). Outcome measures were nutritional status (PG-SGA), weight loss, handgrip strength (HGS), body composition, and survival.Results: Weight loss and impaired nutritional parameters during oncological treatment were seen equally in both groups (NS). Leaner patients at baseline maintained their weight, while overweight patients lost both weight and handgrip strength during treatment. Disease-free survival (DFS) (median = 43 months) was not affected by weight loss during treatment. Lower baseline HGS and malnutrition were associated with worse DFS (low vs. normal HGS: 15 vs. 42 months; p = 0.05 and malnutrition vs. good nutrition status: 17 vs. 42 months; p = 0.014, respectively). Survival according to low vs. normal HGS in the INC group was 4 vs. 44 months (p = 0.007) and in the ODC group 28 vs. 40 months (p = 0.944). According to malnutrition vs. good nutritional status in the INC group, DFS was 21 vs. 43 months (p = 0.025) and in the ODC group 15 vs. 41 months (p = 0.03).Conclusions: As for our primary endpoint, individualized on-demand nutritional counseling was as efficacious as intensive counseling in preventing deterioration of nutritional status and incidence of malnutrition during (chemo) radiotherapy. This should be verified with larger number of patients. Additional findings were that overweight patients had more severe weight loss, but not poorer survival. Low HGS and malnutrition at baseline were associated with poor survival.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02159508.

Intensive Prenatal Nutrition Counseling in a Community Health Setting: A Randomized Controlled Trial.

To assess the effect of a culturally appropriate nutritional intervention delivered to overweight and obese patients in a community health setting on gestational weight gain and postpartum weight retention. We conducted a randomized controlled trial of an intensive nutrition counseling intervention for overweight and obese women by a registered dietitian throughout pregnancy and 6 months postpartum. The primary outcome was likelihood of gestational weight gain within Institute of Medicine (IOM, now known as the Health and Medicine Division of the National Academies of Sciences, Engineering, and Medicine) guidelines. Secondary outcomes included birth weight and maternal and neonatal complications. Three hundred patients were randomized. In intent-to-treat analyses, assignment to the intervention group did not have a significant effect on maintenance of gestational weight gain within IOM guidelines (34.2% compared with 27.5%, odds ratio [OR] 1.4, 95% CI 0.8-2.4). Among obese women, assignment to the intervention group was associated with fewer large-for-gestational-age (LGA) neonates (7% compared with 17%; OR 0.3, 95% CI 0.1-0.99). Neither primary nor secondary outcomes were significantly different among overweight women in the intervention group in intent-to-treat analyses. In as-treated analyses, women in the intervention group had lower neonatal birth weights (3,343 g compared with 3,500 g; difference -157.4 g, 95% CI -298.4 to -16.5) and lower likelihood of LGA (6% compared with 14%; OR 0.4, 95% CI 0.2-0.96). Among overweight women, participation in the intervention was associated with lower gestational weight gain (26.1 pounds compared with 31.4 pounds; difference -5.3 pounds, 95% CI -10.0 to -0.6), lower neonatal birth weights (3,237 g compared with 3,467 g; difference -230, 95% CI -452.8 to -7.8), and lower percent of initial body mass index at 6 months postpartum (101% compared with 106%; difference -4.9, 95% CI -8.8 to -0.9). Our intervention did not result in a significant improvement in our primary outcome, the proportion of obese and overweight women who had gestational weight gain within IOM guidelines. However, intensive prenatal nutrition counseling offered in an urban community health setting may decrease LGA births among a group of overweight and obese women from culturally diverse backgrounds at risk for adverse maternal and neonatal outcomes. ClinicalTrials.gov, NCT01056406.

Liidia Kiisk defended her doctoral thesis

"Long-term nutritional study: anthropometrical and clinico-laboratory assessments in renal replacement therapy patients aft er intensive nutritional counselling"

Intensive nutritional counselling obviates a weight gain in kidney transplant recipients with long-term graft survival in Estonia

Background. After kidney transplantation body weight gain (WG) in patients generally increases and this can be influenced by improved appetite and reversal of the uremic state. Because of a lack of evidence for effective interventions that prevent body WG after kidney transplantation, Ryan et al. recently published a randomized controlled trial design in BMC Nephrology to assess the effects of intensive nutrition interventions on WG and metabolic parameters. Here we are demonstrating a part of a study performed at our transplantation centre where we also performed an intensive nutritional counselling intervention on kidney recipients. We hypothesised that kidney transplant (KTx) patients who received intensive counselling may have better long-term weight control compared with patients who did not receive such counselling. Methods. During intensive counselling the dietician took into consideration the results of anthropometry, densitometry, biochemistry, food frequency questionnaire and an analysis of 3-day dietary records. Anthropometrical measurements were assessed at 18 months, 36 months, and, finally, 10 years after the kidney transplantation. Results. We noticed WG in all KTx patients (n=56) both in males and females, as follows: in the standard care group the mean WG in males (N=21) was 6.4 kg, females (N=15) 7.0 kg and among intensively counselled males (N=9) 4.6 kg, females (N=11) 1.1 kg. Statistically non-significant weight change was found among counselled living KTx patients with long-term graft survival both in males (p=0.0680) and females ( p=0.3166) which was registered 10 years after the KTx compared with the first measurement mean weight. Among standard care control KTx patients, weight change was statistically significant in both males and females (males: p=0.0016; females: p=0.0040) 10 years after the KTx. Conclusions. The long-term WG data clearly showed that in our population of KT patients, the patients who received intensive individual dietary counselling had much more educated behaviour in the long-term, thereby preventing WG which is a well-known risk factor for long-term graft failure as well as for cardiovascular complications and mortality.