Intensive Nutritional Intervention Research Articles

Effect of an intensive nutrition intervention of a high protein and low glycemic load diet on weight of kidney transplant recipients: a randomized clinical trial.

The purpose of this study is to evaluate the effect of a high protein and low glycemic load diet in preventing weight gain after kidney transplantation. We designed a prospective, single-center, open-label, randomized controlled study to compare the efficacy of a high protein (1.3-1.4 g/kg/day) and low glycemic load diet versus a conventional diet (0.8-1.0 g/kg/day of protein and no recommendations on glycemic load) in preventing weight gain (ClinicalTrials.gov identifier: NCT02883777). A total of 120 patients were evaluated. Patients were followed for 12 months, and the primary outcome was weight maintenance or weight gain lower than 5%. There were no differences in total energy intake, carbohydrates, and total fats between groups. Intervention group (IG) increased protein intake to 1.38 ± 0.56 g/kg/day and decreased the glycemic load to 87.27 ± 4.54 g/day, while control group (CG) had a dietary protein intake of 1.19 ± 0.43 g/kg/day and a glycemic load of 115.60 ± 7.01 g/day. Total fiber intake was greater and trans-fat was lower in IG. Dietetic cholesterol increased in IG over time and was significantly different between groups. Overall, patients had an increase in body weight over time, with a mean increment of 4.1 ± 5.5 kg (5.75%). The percentage of patients who achieved the primary outcome was 50% of sample size, without differences between groups. The glomerular filtration rate improved over time in both groups. Considering 24-h proteinuria and albuminuria, a similar rise was observed in both groups. The present dietary intervention was safe, but had no effect on weight gain in kidney transplant subjects. Our findings suggest that other strategies, including alternative dietary and/or pharmacological and psychological interventions might be tested in randomized control trials in order to improve patients' body weight outcomes after transplant.

Cardiac Rehabilitation for Prediabetes and Metabolic Syndrome Remission: Impact of Ultraprocessed Food–Intake Reduction and Time-Restricted Eating in the DIABEPIC-1 Study

BackgroundCardiac rehabilitation programs provide a valuable opportunity to promote the adoption of healthy lifestyle behaviors in patients with atherosclerotic cardiovascular diseases (ASCVDs) and metabolic comorbidities, including metabolic syndrome and prediabetes. However, strategies to reverse these conditions remain to be explored. The DIABEPIC-1 study aimed to assess the feasibility of an enhanced 6-month cardiac rehabilitation program for patients with ASCVD while investigating prediabetes and metabolic syndrome remission. MethodsThe study combined exercise training with a comprehensive nutritional intervention, emphasizing reduction in intake of ultraprocessed foods, adoption of a Mediterranean diet, and implementation of time-restricted eating. Baseline, 3-month, and 6-month assessments included segmental body-composition measurements, blood analysis, maximal exercise testing, nutritional diaries recorded with the Keenoa AI app, and lifestyle questionnaires. Remission criteria included a return to an HbA1c level of < 5.7%, and < 3 National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP-III) criteria for prediabetes and metabolic syndrome, respectively. ResultsA total of 36 participants were recruited. The study demonstrated completion rates of 94.4% at 3 months, and 88.9% at 6 months, and a mean compliance rate of 92.5% for planned clinical appointments. Significant reductions in waist circumference (–9.2 cm, P < 0.001) and weight (–8.0 kg, P < 0.001) were observed. Improvement in glycemic and lipid profiles, insulin-resistance marker levels, and liver health were noted. Participants enhanced their cardiorespiratory fitness, reduced their consumption of ultraprocessed food, and increased their adherence to the Mediterranean diet and time-restricted eating. Notably, 50% achieved prediabetes remission, and 70% with metabolic syndrome at baseline achieved remission. ConclusionsThe study demonstrates the possibility of enhancing cardiac rehabilitation with an intensive nutritional intervention, yielding clinically significant outcomes, including remission of key risk factors in a substantial number of ASCVD patients. Clinical Trial RegistrationClinicalTrials.gov, NCT05459987.

Evaluation of Hand Grip Strength Test: As a Reliable, reproducible, Costeffective Tool to Assess the Nutritional Status and Outcomes of Cirrhotic Patients Awaiting Liver Transplant

Abstract Background Malnutrition is common comorbidity in patients with cirrhosis. Its prognostic value is indisputable as it greatly affects the evolution of liver disease. It has a major impact on both morbidity and mortality before and after liver-transplantation. Being now integrated in the definition of malnutrition and recognized as new entity in the international classification of disease, physicians have taken great interest in sarcopenia. Its negative impact on survival of cirrhotic patients is well demonstrated, particularly those on wait-list of liver-transplantation (LT). Aim of the Work The aim of this study is twofold; first, to assess the effect of malnutrition on mortality in patients awaiting Liver transplantation and, second, to evaluate hand grip strength HGS as a reliable, non-invasive, and inexpensive tool that can be used in routine clinical practice for early diagnosis and stratification of severity of malnutrition in patients awaiting Liver transplantation. Patients and Methods This is a prospective observational study, which was conducted at Ain- Shams specialized Hospital, liver transplantation department. The study was conducted after obtaining institutional ethics committee approval. Nutritional status assessment will be made by dominant hand grip strength (HGS) and all patients undergo a detailed nutrition assessment by a qualified Clinical Dietitian and nutritional intervention was recommended based on severity of malnutrition. Disease severity was classified according to the criteria proposed by Child-Pugh and the Model for End stage Liver Disease (CTP and MELD). The scores were noted during liver transplantation evaluation. Results We found in this study that 15 of the 29 included patients (51.7%) were 50-65 years old and 21 were males (72%) and 8 were females (27.6%). Six of the included patients were diagnosed as cryptogenic cirrhosis (21%) while 18 were diagnosed as post0viral cirrhosis (62%). Malnutrition was diagnosed in 25 out of the 29 included patients (86.2%) and only 4 patients were well- nourished (13.9) by SGA. In all included patients HGS was reduced and mean HGS was (21.9 ± 3.85 Kg), reflecting sarcopenia (reduced muscle strength). There was also reduction in MAMC (mean 18.7 ± 4.12 cm) with correlation between MAMC and HGS reflecting reduction in muscle mass and strength. Conclusion Malnutrition as assessed by SGA is very frequent in cirrhotic patients on wait-list for liver transplantation. This malnutrition in negatively affecting survival and should be managed by intensive nutritional intervention to improve post-transplant survival. HGS is reduced in most cirrhotic patients waiting for LT, this can worsen the prognosis independent of other confounders and should be assessed as predicted in all cirrhotic patients. HGS by dynamometer is a simple, cost effective and reasonably reliable to be used as screening tool to diagnose sarcopenia in patients with ESLD and can be followed by more confirmatory methods if needed as CT on Lumber 3 and determination of LMI (Lumber mass index)

Supplemental tube feeding: qualitative study of patient perspectives in advanced pancreatic cancer

ObjectivesMalnutrition is associated with poor quality of life and survival outcomes for patients with cancer, but is challenging to prevent or treat in pancreatic cancer due to the multifactorial drivers...

Comparison of Goal Achievement during an Early, Intensive Nutrition Intervention Delivered to People with Upper Gastrointestinal Cancer by Telephone Compared with Mobile Application.

This study is aimed at exploring whether the mode of nutrition intervention delivery affected participant goal achievement in a three-arm randomised controlled trial of early and intensive nutrition intervention delivered to upper gastrointestinal cancer patients. Newly diagnosed upper gastrointestinal cancer patients were recruited from four tertiary hospitals in Melbourne, Australia. Participants in the intervention groups received a regular nutrition intervention for 18 weeks from an experienced dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Univariate and multiple regression models using STATA determined goal achievement, dose, and frequency of contact between groups. A p value <0.05 was considered statistically significant. The telephone group (n = 38) had 1.99 times greater frequency of contact with the research dietitian (95% CI: 1.67 to 2.36, p < 0.001) and 2.37 times higher frequency of goal achievement (95% CI: 1.1 to 5.11, p = 0.03) compared with the mobile app group (n = 36). The higher dose (RR 0.03) of intervention and more behaviour change techniques employed in the telephone group compared with the mobile app group increased participant goal achievement (95% CI: 0.01 to 0.04, p < 0.001). Discussion. Telephone nutrition intervention delivery led to a higher frequency of goal achievement compared to the mobile app intervention. There was also a higher number of behaviour change techniques employed which may have facilitated the greater goal achievement. Mobile app-based delivery may have poorer acceptance in this population with high levels of withdrawal. Practice Implications. We need to ensure that specifically designed technologies for our target populations are fit for purpose, efficacious, and acceptable to both patients and healthcare providers. This trial is registered with ACTRN12617000152325.

Evaluation of a results-based financing nutrition intervention for tuberculosis patients in Madhya Pradesh, India, implemented during the COVID-19 pandemic

BackgroundReducing malnutrition through food supplementation is a critical component of the WHO End Tuberculosis (TB) strategy. A results-based financing (RBF) initiative in Madhya Pradesh, India—called Mukti—introduced an intensive nutrition intervention, including home visits, counseling, food basket distribution, and assistance in obtaining government benefits. Phase 1 of the program (Dhar District), implemented by ChildFund India (ChildFund) and funded by USAID, coincided with the COVID-19 lockdown in 2020. Under an RBF reimbursement scheme, ChildFund was paid based on treatment retention for 6 months and weight gain of 6 kg for adults.MethodsThe evaluation used a mixed methods approach. Qualitative components included interviews with key informants and focus groups with program participants. Quantitative components included an analysis of program data (i.e., patient demographics, receipt of program services, and weight gain). An impact analysis of retention in treatment used data from a government database. A difference-in-differences model was used to compare results from baseline data and the program period for Dhar District to similar data for the adjacent Jhabua District.ResultsThe program was well implemented and appreciated by patients and providers. Patients received an average of 10.2 home visits and 6.2 food baskets. While all age and sex groups gained weight significantly over their 6-month treatment period, there was no program impact on treatment retention. Seventy-six percent of patients achieved both outcome goals. And though average program costs were under budget, ChildFund experienced a loss in the results-based financing scheme, which was covered by USAID to continue program expansion.ConclusionsImplementing a nutrition supplementation and education program for TB patients in India is feasible. The intervention improved weight gain despite COVID-19-related lockdowns. The Mukti program did not impact treatment retention, which was already high at baseline. Program costs were modest, but the results-based financing reimbursement scheme resulted in a loss for the implementer. Overall, the RBF model led to an increased focus on outcomes for program staff and other stakeholders, which led to more efficient service delivery. Future research should examine total costs (including donated staff time) more extensively to determine the cost-effectiveness of Mukti and similar interventions.

Effect of supplements/intensive nutrition on pressure ulcer healing: a multicentre, randomised controlled study

To investigate the effectiveness of an intensive nutrition intervention or use of wound healing supplements compared with standard nutritional care in pressure ulcer (PU) healing in hospitalised patients. Adult patients with a Stage II or greater PU and predicted length of stay (LOS) of at least seven days were eligible for inclusion in this pragmatic, multicentre, randomised controlled trial (RCT). Patients with a PU were randomised to receive either: standard nutritional care (n=46); intensive nutritional care delivered by a dietitian (n=42); or standard care plus provision of a wound healing nutritional formula (n=43). Relevant nutritional and PU parameters were collected at baseline and then weekly or until discharge. Of the 546 patients screened, 131 were included in the study. Participant mean age was 66.1±16.9 years, 75 (57.2%) were male and 50 (38.5%) were malnourished at recruitment. Median length of stay was 14 (IQR: 7-25) days and 62 (46.7%) had ≥2 PUs at the time of recruitment. Median change from baseline to day 14 in PU area was -0.75cm2 (IQR: -2.9_-0.03) and mean overall change in Pressure Ulcer Scale for Healing (PUSH) score was -2.9 (SD 3.2). Being in the nutrition intervention group was not a predictor of change in PUSH score, when adjusted for PU stage or location on recruitment (p=0.28); it was not a predictor of PU area at day 14, when adjusted for PU stage or area on recruitment (p=0.89) or PU stage and PUSH score on recruitment (p=0.91), nor a predictor of time to heal. This study failed to confirm a significant positive impact on PU healing of use of an intensive nutrition intervention or wound healing supplements in hospitalised patients. Further research that focuses on practical mechanisms to meet protein and energy requirements is needed to guide practice.

The Effects of Nutrition Intervention on Postoperative Patients with Tongue Cancer and Floor of Mouth Cancer.

The aim of this study is to evaluate the effect of intensive nutrition support on patients with tongue cancer and floor of mouth cancer after surgery at K Hospital, Tan Trieu campus. Study the clinical intervention with a control group. We conducted the intensive nutrition intervention for our patients by giving counseling materials, sample menu and nutritional supplements, while the control group had only advice about dietary regimens. We evaluated a group before and after the intervention, at the same time compare the two groups before and after the intervention. After 1 mo, the intervention group increased 0.51±1.43 kg in comparison with their weight at the beginning; the weight of the control group lost -0.59±2.33 kg; the difference had statistical significance (p=0.025). After 1 and 2 mo of intervention, the rates of the participants without risk of malnutrition in the intervention group increased significantly in comparison with that in the control group; the difference has statistical significance with p=0.001 and p=0.003. In terms of quality of life, patients' problems related to areas including health status, functioning, symptoms of the intervention group improved more greatly than those of the control group. Especially, anorexia symptoms and financial impact were improved well in the intervention group (p=0.033, p=0.018). Nutrition intervention in patients with tongue cancer and floor of mouth cancer has shown a beneficial effect of nutrition counseling and intervention to improve patients' status in terms of nutrition and their quality of life.

Handgrip strength: A simple and effective tool to predict mortality after liver transplantation.

Malnutrition is a widely prevalent yet unrecognized problem of patients with end-stage liver disease (ESLD) awaiting liver transplant (LT). The aim of this study was to ascertain pre-LT nutritional status of adult Asian Indian patients with ESLD including functional deficit (frailty) and determine predictor/s of poor post-LT outcome (futility). A prospective, longitudinal, single-center study which enrolled adults listed for LT between October 2014 and April 2018. Consecutive patients who consented, met the inclusion criteria, and underwent LT were included. The demographic data, nutritional, functional and dietary assessments from evaluation till 1-year-post-LT were documented. Data was analyzed using SPSS-25.0. One hundred and fifty two patients, aged 50.6±8.3 years, predominantly men (82.9%), underwent LT (predominantly deceased donor LT (DDLT) 78.3%). One hundred and thirty five patients (88.8%) were discharged alive after LT. The presence of pre-LT hepatorenal syndrome (HRS), baseline handgrip strength (HGS) <20kg and SGA rated malnutrition, 1st-pre-LT follow-up HGS (<20kg), non-achievers of ≥80% targeted energy and protein intake were associated with increasing 1-year-post-LT mortality rate (p<0.05). A cut-off of 18.15kg HGS was found to predict 1-year-post-LT survival, with optimal sensitivity (77.4); specificity (43.5), and an area under a receiver operating curve (ROC) of 0.676 (p=0.008), with a 95% CI [0.545-0.806]. Step-wise binary logistic regression indicated that non-achievers of ≥80% targeted protein at 1st-pre-LT follow-up and baseline HGS (<18.15kg) are two independent factors that predict 1-year-post-LT survival with an odds ratio of 13.168 and 7.041, respectively. A cut-off of 18.15kg baseline HGS before LT was found to be a significant predictor of poor survival in Asian Indian patients with ESLD. It was also instrumental in identifying patients at risk and helping to target intensive nutritional intervention therapy. Patients in whom ≥80% pre-LT nutritional goal was successfully achieved during the waiting period had an improved 1-year-post-LT survival.

Diet therapy along with nutrition education can improve renal function in people with stages 3-4 chronic kidney disease who do not have diabetes: a randomised controlled trial.

The current trial investigates the effect of renal diet therapy and nutritional education on the estimated glomerular filtration rate (eGFR), blood pressure (BP) and depression among patients with chronic kidney disease (CKD). A total of 120 CKD patients (stages 3-4) (15<eGFR < 60) were randomised into an intensive nutrition intervention group (individualised renal diet therapy plus nutrition counselling: 0·75 g protein/kg/d and 30-35 kcal/kg/d with Na restriction) and a control group (routine and standard care) for 24 weeks. The primary outcome was the change in the eGFR. Secondary outcomes included changes in anthropometric measures, biochemistry (serum creatinine (Cr), uric acid, albumin, electrolytes, Ca, vitamin D, ferritin, blood urea nitrogen (BUN), and Hb), BP, nutritional status, depression and quality of life. The eGFR increased significantly in the intervention group compared with the control group (P < 0·001). Moreover, serum levels of Cr and the systolic and diastolic BP decreased significantly in the intervention group relative to the control group (P < 0·001, P < 0·001 and P = 0·020, respectively). The nutrition intervention also hindered the increase in the BUN level and the depression score (P = 0·045 and P = 0·028, respectively). Furthermore, the reduction in protein and Na intake was greater in the intervention group (P = 0·003 and P < 0·001, respectively). Nutritional treatment along with supportive education and counselling contributed to improvements in renal function, BP control and adherence to protein intake recommendations. A significant difference in the mean eGFR between the groups was also confirmed at the end of the study using ANCOVA (β = -5·06; 95 % CI (-8·203, -2·999)).

Nutritional counseling was insufficient to maintain dietary intake and nutritional status in head and neck cancer patients undergoing radiotherapy: A historical control study for future intervention in China

ObjectiveTo determine whether nutritional counseling (NC) affects the dietary intake and nutritional status of head and neck cancer (HNC) patients undergoing radiotherapy (RT) in China. MethodsThis historical control study enrolled 139 HNC patients in the NC group and 146 patients in the control group. Before RT, the latter received usual education about side effects. The former received three sessions (T1, before RT; T2, 3 weeks of RT; and T3, 6 to 7 weeks of RT) of individualized NC. Outcome measures were dietary intake, weight, body composition, and nutritional status. Generalized estimating equation (GEE) models were used to analyze intergroup differences. ResultsThe NC group had higher energy (P ​< ​0.001) and protein intake (P ​= ​0.003). However, some patients in the NC group still could not reach 60% of the recommended caloric goals (22.3% at T2 and 32.4% at T3) or protein goals (23.0% at T2 and 27.3% at T3). Although the NC group had a lower weight loss rate (β ​= ​−0.555, P ​= ​0.037), they still lost 6.15% ​± ​4.08% of weight at T3. At T2, more patients in the control group lost ≥ 5% of weight (26.0% vs 15.8%, P ​= ​0.049). More patients in the control group had malnutrition (P ​= ​0.045), but 77% of the NC group had malnutrition at T3. ConclusionsNC could effectively improve dietary intake, weight loss, and malnutrition in HNC patients receiving RT. Nevertheless, only NC was insufficient to maintain adequate intake and well-nourished status. We should adopt intensive nutritional intervention with a multidisciplinary team to enhance patients’ nutritional status.

Nutrition Intervention in Cardiac Rehabilitation: A REVIEW OF THE LITERATURE AND STRATEGIES FOR THE FUTURE.

Despite guideline consensus that quality of nutrition affects most modifiable cardiovascular disease risk factors, the implementation of dietary interventions varies considerably in cardiac rehabilitation (CR) programs. The purpose of this review is to highlight the current existing literature and provide recommendations on best practices for nutrition interventions and future research that support secondary prevention outcomes. The review examines original investigations, systematic reviews, and guidelines regarding nutrition intervention in CR. Nutrition intervention in CR plays an integral role in the success of patients; however, the literature is limited and standardization of practice is in its infancy. The role of a qualified registered dietician nutritionist, standardization of dietary assessments, individualized and intensive nutrition interventions, and application of specific behavior change techniques are central components in improving diet in CR. This review provides an overview of the evidence-based cardioprotective diets, nutritional interventions and behavioral strategies in CR, and explores areas for best practices and opportunities for innovation in the delivery of nutrition intervention in CR.

Stunting and Its Risk Factors in Under Age Five Children in Ogun State, Nigeria: A Cross-Sectional Study

Background: Nigeria has the second-highest prevalence of stunting in children under five in the world. Stunting can have long-term effects on development, performance, and productivity, and it is, therefore, important to assess who is most at risk so that interventions can be better targeted. The study aimed at assessing the prevalence of stunting in under age five children in Ogun State, Nigeria, and its relationship with age, sex, maternal education, household income, and residence type. Methods: We used cross-sectional secondary data from the 2018 Nigeria Demographic and Health Survey to assess the prevalence of stunting and establish if and how stunting is related to the children’s age, sex, household income, maternal education, and type of residence. We included data on age, sex, height/length, maternal education, household income, and type of place of residence of 274 children, aged 0-59 months. Stunting was calculated using the online version of the World Health Organization (WHO) Anthro Survey Analyser. Data were analyzed using Statistical Package for Social Sciences (v.25). Results: The prevalence of stunting was 23%. Stunting was significantly associated with age (p=0.001). The odds of stunting were significantly highest in children aged 36-47 months (OR 22.61, 95%CI: 2.81, 181.93) relative to other age groups. Stunting was not significantly associated with sex (p=0.079), maternal education (p=0.079), household income (p=0.183) or type of place of residence (p=0.299). Conclusions: Whilst the prevalence of stunting in children aged under five in Ogun State is lower than the average prevalence of stunting in Nigeria, it is still medium according to WHO classification. Intensive nutrition interventions should be targeted to children aged 3-5 years to reduce the stunting prevalence.

Ecological Momentary Assessments as a Tool to Monitor and Promote the Mediterranean Diet Adherence in the Context of the PENSA Study

ObjectivesHigh adherence to the Mediterranean diet (MedDiet) is associated with a risk reduction on cardiovascular and neurodegenerative diseases, cancer and osteoporosis among others. The aim of the present study is to use ecological momentary assessments (EMAs) as a tool to monitor and promote adherence to the MedDiet. MethodsA set of dietary EMAs has been developed aimed at evaluating continuous adherence to the MedDiet. The EMAs are sent daily and enquire about the consumption of 11 key food groups of the Mediterranean diet in the last 24–48 hours in a semi-quantitative way. They have been used to monitor and promote the MedDiet in the frame of a multicomponent life style intervention study which is focused on the prevention of cognitive decline (PENSA study). Participants undergo through a nutritional intervention including individual nutritional sessions and daily EMAs. A total MedDiet adherence score is calculated based on EMAs. Additionally, each food group is monitored individually. On a monthly basis, volunteers receive a personalized feedback including a MedDiet score and its individual components together with recommendations of improvement. Additionally, MedDiet adherence was evaluated at baseline and after 6 months of the intervention using the standardized MEDAS screener. ResultsPreliminary results (n = 11) show that, following 6 months of the intensive nutritional intervention and dietary EMAs, participants increased significantly their adherence to MedDiet (baseline score: 8 (SD = 1.4) vs 6-month score: 10.6 (SD = 0.9); P < 0.001). At baseline, only 2 volunteers met “high adherence” criteria to the MedDiet whereas at the end of the 6 months, 9 volunteers over 11 were categorized into the “high adherence” group. The most important changes observed in MEDAS 6-month score where in the nuts, fruits and vegetable categories; all of them included in the food groups monitored by EMAs. ConclusionsEMAs are a tool to monitor and promote the adherence to the MedDiet. The continuous monitoring of the diet together with the periodic personalized feedbacks send to the volunteers promoted a change in individual’s behaviors in favor of the choice of products in line with MedDiet recommendations. Funding SourcesAlzheimer Association, ISCIII FIS and CIBEROBN

Attitudes of Australian Patients Undergoing Treatment for Upper Gastrointestinal Cancers to Different Models of Nutrition Care Delivery: Qualitative Investigation.

BackgroundAdults diagnosed with cancers of the stomach, esophagus, and pancreas are at high risk of malnutrition. In many hospital-based health care settings, there is a lack of systems in place to provide the early and intensive nutritional support that is required by these high-risk cancer patients. Our research team conducted a 3-arm parallel randomized controlled trial to test the provision of an early and intensive nutrition intervention to patients with upper gastrointestinal cancers using a synchronous telephone-based delivery approach versus an asynchronous mobile app–based approach delivered using an iPad compared with a control group to address this issue.ObjectiveThis study aims to explore the overall acceptability of an early and intensive eHealth nutrition intervention delivered either via a synchronous telephone-based approach or an asynchronous mobile app–based approach.MethodsPatients who were newly diagnosed with upper gastrointestinal cancer and who consented to participate in a nutrition intervention were recruited. In-depth, semistructured qualitative interviews were conducted by telephone and transcribed verbatim. Data were analyzed using deductive thematic analysis using the Theoretical Framework of Acceptability in NVivo Pro 12 Plus.ResultsA total of 20 participants were interviewed, 10 from each intervention group (synchronous or asynchronous delivery). Four major themes emerged from the qualitative synthesis: participants’ self-efficacy, low levels of burden, and intervention comprehension were required for intervention effectiveness and positive affect; participants sought a sense of support and security through relationship building and rapport with their dietitian; knowledge acquisition and learning-enabled empowerment through self-management; and convenience, flexibility, and bridging the gap to hard-to-reach individuals.ConclusionsFeatures of eHealth models of nutrition care delivered via telephone and mobile app can be acceptable to those undergoing treatment for upper gastrointestinal cancer. Convenience, knowledge acquisition, improved self-management, and support were key benefits for the participants. Future interventions should focus on home-based interventions delivered with simple, easy-to-use technology. Providing participants with a choice of intervention delivery mode (synchronous or asynchronous) and allowing them to make individual choices that align to their individual values and capabilities may support improved outcomes.Trial RegistrationAustralian and New Zealand Clinical Trial Registry (ACTRN) 12617000152325; https://tinyurl.com/p3kxd37b.

Effects of circuit training or a nutritional intervention on body mass index and other cardiometabolic outcomes in children and adolescents with overweight or obesity

ObjectiveWe aimed to assess the effectiveness of the first 6 months of a 24 month multidisciplinary intervention program including circuit training and a balanced diet in children and adolescents with obesity.MethodsA quasi-experimental intervention trial included 242 participants (age [mean±standard deviation]: 11.3±2.06 years, 97 girls) of at least 85th percentile of age- and sex-specific body mass index (BMI). Participants were grouped into three to receive usual care (usual care group), exercise intervention with circuit training (exercise group), or intensive nutritional and feedback intervention with a balanced diet (nutritional group). Primary outcome was BMI z-score, while secondary outcomes included body composition, cardiometabolic risk markers, nutrition, and physical fitness.ResultsAmong the participants, 80.6% had a BMI ≥ the 97th percentile for age and sex. The BMI z-score of the overall completers decreased by about 0.080 after 6 months of intervention (p < 0.001). After the intervention, both exercise and nutritional groups had significantly lower BMI z-scores than the baseline data by about 0.14 and 0.075, respectively (p < 0.05). Significant group by time interaction effects were observed between exercise versus usual care group in BMI z-score (β, -0.11; 95% confidence interval (CI), -0.20 to -0.023) and adiponectin (β, 1.31; 95% CI, 1.08 to 1.58); and between nutritional versus usual care group in waist circumference (β, -3.47; 95% CI, -6.06 to -0.89). No statistically significant differences were observed in any of the other secondary outcomes assessed.ConclusionMultidisciplinary intervention including circuit training and a balanced diet for children and adolescents with obesity reduced the BMI z-score and improved cardiometabolic risk markers such as adiponectin and waist circumference.

Prognostic nutrition index affects the prognosis of patients undergoing trimodality therapy for locally advanced non-small cell lung cancer.

Trimodality therapy, comprised of induction chemoradiotherapy (iCRT) followed by surgery, is a highly invasive treatment option for locally advanced non-small cell lung cancers (LA-NSCLCs; defined as a heterogenous disease). We conducted this study to investigate the prognostic nutritional index (PNI) of LA-NSCLC patients undergoing trimodality therapy, which has not been studied in detail before. The subjects of this retrospective study were 127 patients who underwent trimodality therapy between 1999 and 2016. We measured the PNI at three points: before iCRT (pre-iCRT), before the operation, and after the operation. PNIs decreased significantly as treatment progressed. Patients with clinical T3/4 (cT3/4) disease had a significantly lower PNI than those with cT1/2 disease, but the extent of lymph-node metastasis did not affect the PNI at any point. Using the cut-off values of receiver-operating curve analyses, multivariable analyses revealed that a high PNI pre-iCRT correlated significantly with a better survival of LA-NSCLC patients, especially those with cT3/4 disease (hazard ratio 3.84; 95% confidential interval 1.34-12.5, P = 0.012). Measuring the PNI before trimodality therapy is important for predicting the clinical outcome of patients with LA-NSCLC, with differing predictive ability according to the disease extent. Perioperative intensive nutritional intervention must be considered for patients who undergo trimodality therapy for LA-NSCLC.

Pressure ulcer healing with an intensive nutrition intervention in an acute setting: a pilot randomised controlled trial

To investigate the feasibility of recruitment, retention, intervention delivery and outcome measurement in a nutritional intervention to promote pressure ulcer healing in an acute setting. Some 50 tertiary hospital patients with stage II or greater pressure ulcer were randomised to receive either individualised nutritional care by a dietitian, including prescription of wound healing supplements; or standard nutritional care. Relevant nutritional and pressure ulcer (PU) parameters were collected at day 5, 10, 15, 22 and then weekly or until discharge. The median length of hospital stay was 14 days (1-70) with 29 patients discharged by day 15. There were 24 patients discharged before their PU fully healed. Per cent change in valid PU area and score measures from baseline to day 15 were chosen for outcome data analysis to account for varying initial size and severity of the wound and length of stay. There was a larger percentage reduction in PU measures in the intervention group, but this was not statistically significant. Little difference was found in nutritional intake between the control and intervention groups indicating a requirement to focus on effective delivery of the intervention in future studies. Future studies in the acute setting need to account for length of stay and ideally follow patients until full healing. Results indicate a positive association with nutrition intervention and PU healing and that a rigorously designed and adequately powered study is feasible.

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.

Nocturnal enteral nutrition is therapeutic for growth failure in Fanconi-Bickel syndrome.

Fanconi-Bickel syndrome (FBS) is a rare autosomal recessive disorder characterised by impaired glucose liver homeostasis and proximal renal tubular dysfunction. It is caused by pathogenic variants in SLC2A2 coding for the glucose transporter GLUT2. Main clinical features include hepatomegaly, fasting hypoglycaemia, postprandial hyperglycaemia, Fanconi-type tubulopathy occasionally with rickets, and a severe growth disorder. While treatment for renal tubular dysfunction is well established, data regarding optimal nutritional therapy are scarce. Similarly, detailed clinical evaluation of treated FBS patients is lacking. These unmet needs were an incentive to conduct the present pilot study. We present clinical findings, laboratory parameters and molecular genetic data on 11 FBS patients with emphasis on clinical outcome under various nutritional interventions. At diagnosis, the patients' phenotypic severity could be classified into two categories: a first group with severe growth failure and rickets, and a second group with milder signs and symptoms. Three patients were diagnosed early and treated because of family history. All patients exhibited massive glucosuria at diagnosis and some in both groups had fasting hypoglycaemic episodes. Growth retardation improved drastically in all five patients treated by intensive nutritional intervention (nocturnal enteral nutrition) and uncooked cornstarch with final growth parameters in the normal range. The four severely affected patients who were treated with uncooked cornstarch alone did not catch up growth. All patients received electrolytes and l-carnitine supplementation to compensate for the tubulopathy. This is one of the largest series of FBS on therapeutic management with evidence that nocturnal enteral nutrition rescues growth failure.