Malnourished Outpatients Research Articles

Improvement of nutritional parameters in malnourished outpatients after 6-month nutritional intervention with high-protein oral nutritional supplement (ONS)

Improvement of nutritional parameters in malnourished outpatients after 6-month nutritional intervention with high-protein oral nutritional supplement (ONS)

Nutritional Support in Malnourished Outpatients with Chronic Obstructive Pulmonary Disease (COPD): A Randomized Controlled Pilot Study.

(1) Background: The evidence for nutritional support in COPD is almost entirely based on ready-to-drink oral nutritional supplements (ONSs). This study aimed to explore the effectiveness of powdered ONSs alongside individualized dietary counseling in the management of malnutrition. (2) Methods: Malnourished outpatients with COPD were randomized to receive either routine care (Group A: counseling + recommended to purchase powdered ONSs) or an enhanced intervention (Group B: counseling + provision of powdered ONSs at no cost to the patient) for 12 weeks. Outcomes of interest were nutritional intake, weight status, and quality of life. (3) Results: A total of 33 outpatients were included, categorized as follows: Group A (n = 21); Group B (n = 12); severely malnourished (n = 9), moderately malnourished (n = 24), mean BMI 18.0 SD 2.5 kg/m2. No differences were observed between groups at baseline or at week 12; however, analysis of the whole cohort (Group A + B) revealed nutrition intervention resulted in significant improvements in protein intake (+25.4 SD 53.4 g/d; p = 0.040), weight (+1.1 SD 2.6 kg; p = 0.032) and quality of life (-4.4 SD 10.0; p = 0.040). Only 41.2% of Group A and 58.3% of Group B reported consuming ONSs at week 12. Adherence to ONSs was associated with weight gain (+1.9 SD 2.5 kg vs. +0.4 SD 2.5 kg; p = 0.098). (4) Conclusions: Nutritional support results in significant improvements in nutrition status and quality of life in malnourished outpatients with COPD. However, improvements are associated with adherence to ONSs, suggesting the type of ONSs and how they are provided are important considerations in clinical practice and future studies.

Healthcare resource utilization by malnourished outpatients declines following intervention with oral nutrition supplements

Healthcare resource utilization by malnourished outpatients declines following intervention with oral nutrition supplements

Effectiveness of Tailored Dietary Counseling in Treating Malnourished Outpatients with Chronic Obstructive Pulmonary Disease: A Randomized Controlled Trial

BackgroundMalnutrition in patients with chronic obstructive pulmonary disease (COPD) is common and associated with poor prognosis. Nutrition interventions are necessary, but there is a lack of evidence regarding the effectiveness of tailored nutrition advice. ObjectiveThis study investigated whether tailored nutrition counseling could improve dietary intake, nutritional status, functional outcomes, and health-related quality of life (QoL) of malnourished outpatients with COPD. DesignWe conducted a randomized controlled trial in which participants were randomly assigned to either the intervention group (IG) or the control group (CG). Participants/settingOne hundred and twenty malnourished outpatients with COPD participated in the study between May and November 2017 at the National Lung Hospital, Hanoi, Vietnam. InterventionThe IG received tailored nutrition counseling once per month for 3 months based on a specifically developed written nutrition resource for COPD. The CG received the same educational resource at baseline without any discussion. Main outcome measuresThe main outcome measures were energy and protein intakes, body weight change, nutritional status (Subjective Global Assessment score), muscle strength, and QoL. Statistical analysesDifferences between groups before and after the intervention were assessed using two-way repeated measures analysis of variance. Generalized estimating equation modeling was used to investigate the differences between groups over time. ResultsAt baseline, there were no significant differences in outcomes of interest between the two groups. After 3 months of intervention, time–intervention interactions for energy intake, protein intake, and body weight change were significant (945 kcal/day, 95% CI 792 to 1,099 kcal/day, P<0.001; 50.0 g protein/day, 95% CI 43.9 to 56.1 g protein/day, P<0.001; and 1.0 kg, 95% CI 0.5 to 1.5 kg, P<0.001, respectively). Subjective Global Assessment scores improved in the IG and worsened in the CG. Significant improvements were found in inspiratory muscle strength in the IG (5.4 cmH2O, 95% CI 2.3 to 8.6 cmH2O, P=0.001) and significant decreases in handgrip strength were found in the CG after 3 months of the intervention (1.4 kg, 95% CI 0.4 to 2.4 kg, P=0.007). There was a significant interaction effect for all QoL scores (analysis of variance two-way repeated, P≤0.003). The IG also significantly improved all QoL scores from baseline to 3 months (P<0.004). ConclusionsTailored nutritional counseling has the potential to improve dietary intakes, nutritional status, functional outcomes, and QoL in malnourished outpatients with COPD.

The Effect of a Home Delivery Meal Service of Energy- and Protein-Rich Meals on Quality of Life in Malnourished Outpatients Suffering from Lung Cancer: A Randomized Controlled Trial

ABSTRACTUndernutrition is prevalent in cancer patients and associated with increased incidence of complications and mortality. We investigated the effects of a home delivery meal service, providing a selection of energy-dense, protein-rich meals, on quality of life (QoL) in malnourished lung cancer patients. Forty lung cancer patients with nutritional risk score ≥3 (NRS-2002) were randomized to control or intervention. The intervention group was offered energy- and protein-rich main meals and snacks, delivered 3 times per week. The control group continued their habitual diet. Primary endpoint, QoL, and secondary endpoints were assessed at baseline, and after 6 and 12 wk. Data on unplanned readmissions, length of hospital stay, and mortality were collected 3 and 6 mo post-intervention. Intervention group improved standard Chair Stand Test (30-s CST) after 6 and 12 wk (P < 0.01) compared to control. Intervention exerted a significant positive effect on performance score after 12 wk (P = 0.047). Increased energy and protein intakes were strongly associated with improved QoL, functional score, hand grip strength, symptom and performance scores. Food delivery service with energy- and protein-rich main meals and snacks can improve lower body strength and performance status in malnourished lung cancer patients.

ORAL NUTRITIONAL SUPPLEMENTS AND TASTE ADHERENCE IN MALNOURISHED ELDERLY ADULT’S OUTPATIENTS

Abstract: The aim of our study was to evaluate a hypercaloric sweet milkbased oral nutrition supplement in a prospective 3 day-study designed to assess the taste preferences of this oral nutritional supplement (ONS) in elderly malnourished out-patients and the influence on adherence in daily intake during two months.A total of 28 out-patients with recent weight loss were included in this study. One flavour (chocolate, vanilla or strawberry) was administered each day in a random way during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires in order to reflect ONS tolerance and acceptance. Sweet and aftertaste were better for chocolate flavour than for vanilla or strawberry flavours. Patients who chose vainilla took a total of 96.3+7.4 average bricks during outpatient followup (1.60+0.3 per day), patients who chose chocolate took 76.8+15.0 bricks (1.28+0.8 per day) and patients who chose strawberry bricks taken 60.3+19.5 bricks (1.10+0.7 per day), with a significant difference with vainilla flavour (p &lt;0.01). The improvement of weight (vanilla +1.0+0.8 kg vs chocolate +0.5+0.8 kg vs 0.6+1.0 kg:p=0.03), tricipital skinfols (vanilla +1.5+0.3 mm vs chocolate +1.1+0.4 mm vs 0.7+0.3 mm:p=0.03), prealbumin levels (vanilla +4.2+0.8 mg/dl vs chocolate +3.9+0.7 mg/dl vs +3.6+1.0 mg/dl:p=0.01) and transferrin levels (vanilla +100.0+21.8 mg/dl vs chocolate +75.5+18.8 mg/dl vs 63.8+14.1 mg/dl:p=0.03) was higher in patients treated with vanilla ONS than chocolate or strawberry ONS. The three flavoured ONS taste preferences are similar although the consumption is high in vanilla flavoured ONS.

Reversibility of protein-energy malnutrition in agroup of chronically-ill elderly outpatients

Nutritional status was studied in 23 elderly (74 ± 1 years), malnourished outpatients with non-malignant diseases. The patients' recollections and medical records indicated a gradual weight loss of approximately 25% in the preceding 2–15 years; only a small amount (6%) was lost during the final 6 months. At a re-examination after 3 months, all patients were still malnourished but in general the depletion had decreased. An elevated level of serum orosomucoid (orosomucoid positive) was used as evidence of an on-going inflammatory process. The 14 orosomucoid negative patients displayed a more pronounced improvement in their nutritional status than those who were orosomucoid positive. 15 patients were prescribed a protein and energy enriched formula (40 g protein and 400/1.7 kcal/MJ per day). The orosomucoid positive and orosomucoid negative groups did not differ in number of subjects prescribed supplementation. During the follow-up period the patients that were recommended supplementation showed a more prominent improvement in their nutritional status than the ‘non-supplemented’ subjects. Discriminant analysis revealed that prescription of oral supplementation and, to a lesser extent, serum orosomucoid concentrations within the reference range favoured nutritional repletion. The most pronounced recovery was registered in orosomucoid negative patients who had been prescribed supplementation.

Effect of a caloric supplement in malnourished patients with Crohn's disease

The purpose of this work was to evaluate the efficacy of adding a caloric supplement to the daily diet of malnourished outpatients with Crohn's disease in remission. Seven underweight patients following a one month period of weight-maintenance diet took 10 KCal/kg Ideal body weight/day of a nutritionally complete preparation (carbohydrates 82%, proteins 10%) as supplement for 2 months. At the end of this period, a significant increase in body weight (mean 3 ± 0.3%) as well as a sum of 10 skinfolds (mean 13.1 ± 4.0%) were observed. No significant change in arm muscle circumference was recorded. All the patients then continued with their weight-maintenance diet alone for a further 2 months and during this period a mean decrease of 0.65 ± 0.7% of body weight occurred. A caloric supplement may be a means of increasing body weight and anthromometric variables in underweight patients with Crohn's disease.

Colonization of the oropharynx with Gram-negative bacilli in children with severe proteincalorie malnutrition

Oral pharyngeal isolation of Gram-negative bacteria was compared in four groups of Bengali children: acutely ill, severely malnourished outpatients swabbed on hospital admission; ill but less severely malnourished outpatients from the same area as the malnourished children; orphans also less severely malnourished but not acutely ill; and well controls drawn from a priviledged socioeconomic group. The expected weight for height percentage (National Center Health Statistics/Center for Disease Control median) of the four groups was respectively 67, 91, 97, and 97%. Isolation of Gram-negative bacteria from 74 of 87 (85%) severely malnourished children was significantly greater (p < 0.01) compared to 43 of 113 (38%) outpatients, to 20 of 93 (22%) orphans, and to five of 51 (10%) controls. A total of 71 malnourished children under 5 yr of age (90%) had higher rates of Gram-negative throat colonization than did 16 older children (63%) (p < 0.01). Thus there was an increased rate of Gram-negative colonization in severely malnourished children especially among the younger age group. In the subset of ill children, Gram-negative pharyngeal colonization was significantly associated inversely with nutritional indices and age. The high rate of such carriage may be partly responsible for the increased susceptibility of Gram-negative infection demonstrated in these children.