Nutritional Care Of Patients Research Articles

Collaborative, interprofessional nutritional care within head and neck cancer teams: an international multi-site qualitative study

ABSTRACT Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

Hospital nutrition care informs potential cost-savings for healthcare: A budget impact analysis.

In Mexico, about half of hospitalized patients are malnourished or at risk of malnutrition upon hospital admission, while many others experience deterioration of their nutritional status while in the hospital. Such patients often experience poor health outcomes and have increased hospital costs. The aim of our budget-impact analysis was to estimate potential savings associated with the implementation of a Mexican hospital-based program of nutrition care for patients at malnutrition risk or malnourished. The budget-impact model was based on data published previously. Our model compared patients assigned to receive individualized early nutrition therapy (initiated within 24-48h of hospital admission) with those who received standard delayed nutrition therapy (not initiated early). Outcomes included length of stay, infectious complications, and 30-day readmissions. We modeled a 30-day time-horizon, estimated event probabilities on the basis of published data, and projected costs in 2020 US dollars. Average total healthcare costs over 30-days were $3527 for patients with early nutrition therapy vs $6032 for patients with standard nutrition therapy-a savings of $2505 per early nutrition-treated patient (41.5% lower). Cost differences between the groups were $2336 vs $3065 for hospital-associated costs (23.8% lower), $262 vs $780 for 30-day readmissions (66.4% lower) and $1348 for malnutrition-associated infections. Applying these potential savings from individualized early nutrition care to a one-year estimate of 3.22 million Mexican hospital patients with malnutrition or its risk, the total overall savings for public health expenditures was equivalent to $8.1 billion per year or 32.1% of total healthcare expenditures. The results demonstrated the potential for hospital-based nutrition care programs to reduce costs of patient hospitalizations. These notable findings provide a rationale for Mexican healthcare institutions to implement programs of comprehensive nutrition-focused care for inpatients with malnutrition or its risk. To this end, we advise implementation of professional programs for education and training in order to increase awareness of patients' nutritional needs and to better prepare clinical personnel to identify, treat, and monitor patients at-risk/malnourished.

ESPEN guideline on clinical nutrition in hospitalized patients with acute or chronic kidney disease

Acute kidney disease (AKD) - which includes acute kidney injury (AKI) - and chronic kidney disease (CKD) are highly prevalent among hospitalized patients, including those in nephrology and medicine wards, surgical wards, and intensive care units (ICU), and they have important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, whatever is the modality used, the possible impact on nutritional profiles, substrate balance, and nutritional treatment processes cannot be neglected. The present guideline is aimed at providing evidence-based recommendations for clinical nutrition in hospitalized patients with AKD and CKD. Due to the significant heterogeneity of this patient population as well as the paucity of high-quality evidence data, the present guideline is to be intended as a basic framework of both evidence and - in most cases - expert opinions, aggregated in a structured consensus process, in order to update the two previous ESPEN Guidelines on Enteral (2006) and Parenteral (2009) Nutrition in Adult Renal Failure. Nutritional care for patients with stable CKD (i.e., controlled protein content diets/low protein diets with or without amino acid/ketoanalogue integration in outpatients up to CKD stages four and five), nutrition in kidney transplantation, and pediatric kidney disease will not be addressed in the present guideline.

Level of Knowledge, Practice and Attitudes of Taking Anthropometric Measurements for Nutritional Assessments Among Nurses

The nutritional care of patients is one of the primary responsibilities of the nurses in any hospital. Nursing ability to early detect nutritional failure is the key factor for minimizing impurities in practice and attaining nutritional goals. The objective of this study is therefore to determine the level of knowledge, practice, and attitudes of taking anthropometric measurements for nutritional assessments by registered staff nurses. A descriptive cross-sectional study was done using a random sample of 125 nurses at a teaching hospital in the Western Province. Self-administered questionnaire with both open and close ended questions were used to gather information. A scoring method was introduced to assess the knowledge of the nurses based on answers for the questions. Majority (88%) of the nurses are females and 47% are less than 30 years. Results found that the level of knowledge of getting measurements by the nurses can be ranked as good (52.8%) > average > (38.4%) and poor > (8.8%) irrespective of demographic factors of the nurses. Level of knowledge is significantly associated only with the educational level. The percentage of having good knowledge among those having B.Sc. degree is significantly higher than that of having those diploma qualifications either from government or private organization. The two main constraints to take anthropometric measurements are the lack of time and lack of resources. There is a significant association between the level of confidence and the type of measurement. The percentage of confidence for weight measurement (93.5%) is significantly higher than the percentage of confidence for taking other measurements. Almost all nurses (98.4%) are not confident in measuring hip circumference. The measure of waist, hip and head circumference are hardly considered as a measure of anthropometric measurements.

Clinical Nutrition Research and the COVID-19 Pandemic: A Scoping Review of the ASPEN COVID-19 Task Force on Nutrition Research.

The purpose of this scoping review by the American Society for Parenteral and Enteral Nutrition (ASPEN) Coronavirus Disease 2019 (COVID-19) Nutrition Task Force was to examine nutrition research applicable to the COVID-19 pandemic. The rapid pace of emerging scientific information has prompted this activity to discover research/knowledge gaps. This methodology adhered with recommendations from the Joanna Briggs Institute. There were 2301 citations imported. Of these, there were 439 articles fully abstracted, with 23 main topic areas identified across 24 article types and sourced across 61 countries and 51 specialties in 8 settings and among 14 populations. Epidemiological/mechanistic relationships between nutrition and COVID-19 were reviewed and results mapped to the Population, Intervention, Comparator, Outcome, and Time (PICO-T) questions. The aggregated data were analyzed by clinical stage: pre-COVID-19, acute COVID-19, and chronic/post-COVID-19. Research gaps were discovered for all PICO-T questions. Nutrition topics meriting urgent research included food insecurity/societal infrastructure and transcultural factors (pre-COVID-19); cardiometabolic-based chronic disease, pediatrics, nutrition support, and hospital infrastructure (acute COVID-19); registered dietitian nutritionist counseling (chronic/post-COVID-19); and malnutrition and management (all stages). The paucity of randomized controlled trials (RCTs) was particularly glaring. Knowledge gaps were discovered for PICO-T questions on pediatrics, micronutrients, bariatric surgery, and transcultural factors (pre-COVID-19); enteral nutrition, protein-energy requirements, and glycemic control with nutrition (acute COVID-19); and home enteral and parenteral nutrition support (chronic/post-COVID-19). In conclusion, multiple critical areas for urgent nutrition research were identified, particularly using RCT design, to improve nutrition care for patients before, during, and after COVID-19.

Improving nutritional care in patients with liver cirrhosis: a quality improvement project

Improving nutritional care in patients with liver cirrhosis: a quality improvement project

Gastrointestinal Manifestations of COVID‐19: Impact on Nutrition Practices

Although Coronavirus disease 2019 (COVID‐19) is primarily a respiratory disease, growing evidence shows that it can affect the digestive system and present with gastrointestinal (GI) symptoms. Various nutrition societies have recently published their guidelines in context of the pandemic, and several points emphasize the impact of these GI manifestations on nutrition therapy. In patients with COVID‐19, the normal intestinal mucosa can be disrupted by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus, and this could result in GI symptoms and a compromise in nutrient absorption. Optimization of oral diet is still recommended. However, given the GI effects of COVID‐19, a fraction of infected patients have poor appetite and would not be able to meet their nutrition goals with oral diet alone. For this at‐risk group, which includes those who are critically ill, enteral nutrition is the preferred route to promote gut integrity and immune function. In carrying this out, nutrition support practices have been revised in such ways to mitigate viral transmission and adapt to the pandemic. All measures in the GI and nutrition care of patients are clustered to limit exposure of healthcare workers. Among patients admitted to intensive care units, a significant barrier is GI intolerance, and it appears to be exacerbated by significant GI involvement specific to the SARS‐CoV‐2 infection. Nevertheless, several countermeasures can be used to ease side effects. At the end of the spectrum in which intolerance persists, the threshold for switching to parenteral nutrition may need to be lowered.

The Optimal Nutritional Programme for Bariatric and Metabolic Surgery.

Bariatric surgery is the most effective treatment for severe and complex obesity; however, the risk of developing nutrient deficiencies varies based upon the type of surgery, degree of malabsorption, and level of nutrition intervention. There are numerous factors that can impact the nutrition status of a patient during their pre- and postoperative journey. We review the critical components and considerations needed in order to provide optimal nutrition care for patients with bariatric surgery. A dietitian, specializing in bariatric surgery, is the best equipped healthcare provider to prepare and support patients in achieving and maintaining optimal nutrition status. We present best practices for both the pre- and postoperative nutrition-related phases of a patient's journey. The dietitian specialist is integral in the assessment and ongoing nutrition care of patients with bariatric surgery. Further consideration should be given to enable access for lifelong follow-up and monitoring.

Early nutritional supplementation in non-critically ill patients hospitalized for the 2019 novel coronavirus disease (COVID-19): Rationale and feasibility of a shared pragmatic protocol.

ObjectivesBeginning in December 2019, the 2019 novel coronavirus disease (COVID-19) has caused a pneumonia epidemic that began in Wuhan, China, and is rapidly spreading throughout the whole world. Italy is the hardest hit country after China. Considering the deleterious consequences of malnutrition, which certainly can affect patients with COVID-19, the aim of this article is to present a pragmatic protocol for early nutritional supplementation of non-critically ill patients hospitalized for COVID-19 disease. It is based on the observation that most patients present at admission with severe inflammation and anorexia leading to a drastic reduction of food intake, and that a substantial percentage develops respiratory failure requiring non-invasive ventilation or even continuous positive airway pressure.MethodsHigh-calorie dense diets in a variety of different consistencies with highly digestible foods and snacks are available for all patients. Oral supplementation of whey proteins as well as intravenous infusion of multivitamin, multimineral trace elements solutions are implemented at admission. In the presence of 25-hydroxyvitamin D deficit, cholecalciferol is promptly supplied. If nutritional risk is detected, two to three bottles of protein-calorie oral nutritional supplements (ONS) are provided. If <2 bottles/d of ONS are consumed for 2 consecutive days and/or respiratory conditions are worsening, supplemental/total parenteral nutrition is prescribed.ConclusionWe are aware that our straight approach may be debatable. However, to cope with the current emergency crisis, its aim is to promptly and pragmatically implement nutritional care in patients with COVID-19, which might be overlooked despite being potentially beneficial to clinical outcomes and effective in preventing the consequences of malnutrition in this patient population.

"Completely and utterly flummoxed and out of my depth": patient and caregiver experiences during and after treatment for head and neck cancer-a qualitative evaluation of barriers and facilitators to best-practice nutrition care.

Malnutrition is prevalent in patients with head and neck cancer (HNC), impacting on outcomes. Despite publication of best-practice nutrition care clinical guidelines, evidence-practice gaps persist. This project aimed to understand the perspectives of patients and their caregivers about nutritional care and how their unmet supportive care needs can be better addressed in designing a new model of care (MOC). The results will contribute to documenting the barriers and enablers to implementing best practice nutrition care for patients with HNC. Qualitative interviews were conducted with patients who had completed radiotherapy with or without (+/-) other treatment modality (surgery and/or systematic therapy) of curative intent for HNC. Patients were purposively sampled from a major tertiary referral centre in Sydney, Australia. Patients' primary caregivers were also invited to participate if both parties consented. A semi-structured interview schedule was developed to elicit information about barriers and facilitators to change and inform development of the new MOC. Interviews were transcribed verbatim then analysed using an inductive thematic approach. This study was one component of a mixed methods design to explore the barriers and facilitators to best-practice nutrition care in a head and neck oncology unit. Eleven participants (seven patients, four caregivers) took part in the interviews. Four key themes were identified with branching themes within each: (1) being ill-prepared for the impact of treatment, even when advised; (2) navigating complex systems to meet significant care needs; (3) depleted by overwhelming and prolonged suffering; and (4) information lost in translation. This study highlights the unique and complex care needs of people with HNC and those caring for them. To design and successfully deliver a patient-centred MOC, specific strategies will be required to address: early and ongoing access to expert supportive care clinicians; integrated and coordinated care; individual information, education and support needs and; and education of MDT staff in accurate and consistent messaging, ensuring nutrition care is a collective responsibility. Nutrition care did not appear to be viewed separately to overall care from the patient perspective as the importance of nutrition ultimately became viewed as vital treatment.

Knowledge and competencies regarding artificial nutrition among ward nurses and doctors: results of a pilot questionnaire

Background: Ward staff often lack basic nutritional knowledge in the care of artificially fed patients. Clinical guidelines and training aim to improve nutritional perceptions and maintain patient safety. Aim: To evaluate the level of nutritional knowledge and competencies among ward staff and improve the standard of teaching available to healthcare professionals. Method: A staff questionnaire was piloted to measure content validity and evaluate study objectives. Nine questions were thought to be essential standards in the care and management of both enteral and parenteral patients. Four multiple-choice and five open-ended questions were used. Results: A 100% response rate was achieved from nine nurses and one doctor. They had been qualified for an average of 3.3 years (range 1–6, median 2), and their nutritional knowledge was defined as acceptable. Conclusion: Guidelines and recommendations were not being implemented, and nutritional care of patients was a low priority. Health professionals need to be more aware of the role of the nutrition support team to prevent role ambiguity.

Australian and New Zealand Medical Students' Attitudes and Confidence Towards Providing Nutrition Care in Practice.

The prevalence of lifestyle-related chronic disease is increasing. Doctors in primary care are ideally placed to support patient nutrition care, but recent reviews show education is still lacking. This study aimed to identify medical students’ attitudes towards the role of nutrition in health, nutrition knowledge, and perceptions of nutrition education, in postgraduate (Australia) and undergraduate (New Zealand) programs in order to identify gaps in nutrition knowledge and skills to better inform future education. Second-year graduate and third-year undergraduate students participated in semi-structured focus groups and interviews. A general inductive approach was used to investigate students’ (1) attitudes toward the role of nutrition in health, (2) nutrition knowledge based on nutrition-specific competencies and (3) perceived adequacy of nutrition education received. Interviews (nine) and focus groups (seven) identified four common themes: (1) role of medical practitioners in nutrition care, (2) barriers to nutrition education, (3) nutrition knowledge, and (4) nutrition-related skills. Students perceive that doctors are well-placed to provide some level of nutrition care, but poor translation of nutrition knowledge to clinical contexts is a key limitation in nutrition education. In summary, nutrition education may be insufficient to support the nutrition-related competency development of the undergraduate and postgraduate student participants in this study. Focusing on the integration of these skills into the curriculum may be a priority.

Role of Nurses in Nutrition Care in Hospitals in Srinagar City (Jammu and Kashmir, India)

The nurse is the hub of all activities in a hospital, centered on the patient, who makes the patient get more individualised care. The present study was carried out in hospitals of Srinagar city (Jammu and Kashmir) to know the role of nurses in nutrition care of patients. A total of 11 hospitals registered under the Directorate of health services (Srinagar) capital of Jammu and Kashmir, India were included in the study. Hospitals were coded as (H1- H11) in order to maintain confidentiality. Data was collected using interview schedule through observation and discussion as well. The sample consisted of 62 nurses, representing 2% from each hospital. It involved gathering of both qualitative and quantitative data. A scoring pattern was formed to evaluate the nutrition care of patients by nurses. Senior staff nurses were interviewed taken from each hospital. Recommendations were developed after the conclusion was derived from the study. Results revealed that it was seen that most of the hospitals, nurses assisted patients only when the patient asked for help at meal time. Patients were not monitored by nurses at meal times and they were looked after by their own attendants. The nurses did not feel that it was their responsibility to ensure or oversee meal service. They responded that this was the job of stewards or delivery boys. It appeared that assisting patients for meals was not considered a major responsibility of nurses and this task was mostly left to the patients’ attendants. Only at H7, nurses performed their role in nutrition care. At most of the hospitals, patients’ food intake was overseen by their attendants as indicated by 97% nurses. The scoring pattern revealed that out of 11 hospitals, nurses at H7 were performing most jobs for patient’s nutrition care and thus received a score of 2. In all other hospitals, a score of 0 was received as nurses were found to be involved only to a minimal extent, if at all, with nutrition care of patients, indicating that their involvement needs to be increased to improve the quality of care. It involved gathering of both qualitative and quantitative data. A scoring pattern was formed to evaluate the nutrition care of patients by nurses. Senior staff nurses were interviewed taken from each hospital. Recommendations were developed after the conclusion was derived from the study. They were however convinced of the need for implementing the recommendation and expressed that they would attempt to bring out the changes such as having a dietetic department and dieticians in hospitals.

Nutritional Care for Patients with Ebola Virus Disease.

During the Ebola virus disease (EVD) outbreak of 2014–2016 in West Africa, practitioners faced challenges providing nutritional care for patients in Ebola treatment units (ETUs). The current EVD outbreak in the Democratic Republic of the Congo demonstrates the need to understand lessons learned from previous outbreaks and to update nutritional guidelines. We conducted a literature review to identify articles that included nutrition as an integral part of supportive care. We found little information on the specific nutritional care or practical challenges within an ETU. This review showed that nutritional care for EVD patients is poorly described, and therefore the optimal composition and implementation of nutritional care remain unknown. We recommend that researchers and practitioners share specific and practical details of their experiences in providing nutritional support within ETUs to expand the knowledge base and ultimately improve the nutritional care for an increasingly prevalent patient population.

Nutritional Care for Patients with Ebola Virus Disease in Ebola Treatment Units – Past and Current Experiences from Practitioners

Background In November 2014, the World health Organization (WHO), in collaboration with United Nations Children's Fund (UNICEF), and the World Food Programme, produced interim guidelines (iGL) on providing nutritional support to patients in Ebola treatment units (ETUs). They have been translated into French and issued by the Ministry of Health, UNICEF and WHO in adapted versions to be used in the current outbreak in the Democratic Republic of the Congo (DRC). This paper evaluates the use and usefulness of the 2014 iGL in the West Africa and current DRC Ebola virus disease (EVD) outbreaks and identifies experiences and lessons learned from practitioners on the operational aspects of nutritional care and support in ETUs. Methods Key-informants (n=26), from 12 organizations (Non-Governmental Organizations, United Nations, Red Cross Red Crescent Movement) were interviewed who were actively engaged in the nutritional and/or clinical care of EVD patients. Results There was a consensus among key informants that the 2014 iGL initially served a guiding purpose. However, the vast amount of learning from the 2014-2016 and current EVD outbreaks indicates that the interim guidelines need to be revised. Practitioners struggled to find operational solutions for nutritional care, and the challenges were plentiful, especially regarding 1) the different perceptions of the importance of nutritional care among ETU staff; 2) the difficulties around food preparation and distribution for EVD patients; 3) how to take into account the patients’ dietary preferences; 4) the nutritional care needed in relation to specific EVD symptoms; 5) who assumed roles in nutritional care in ETUs; 6) if and how feeding support was organized; 7) whether malnutrition needed to be addressed and how; and 8) whether the intake of specific nutrients could contribute to improved treatment outcomes. Information from the key-informants interviews resulted in numerous lessons learned and recommendations for nutritional support during current and future outbreaks. Conclusions This investigation underscored the importance of documenting experiences of practitioners on nutritional care in emerging infectious diseases for which limited scientific evidence exists and for which interim guidelines are produced to fill in knowledge gaps. It also emphasized the importance of nutritional care in ETUs during treatment.

Growth failure and treatment in cystic fibrosis

Poor growth has long been a characteristic feature of cystic fibrosis (CF) and is significantly linked to lung function and overall health status. Improvements in pulmonary and nutrition care for patients with cystic fibrosis (CF) have resulted in better growth outcomes; however, height gains have not paralleled the improvements in weight in children with CF, and patients with more severe CF mutations remain significantly more affected. Many factors affect the growth hormone-IGF-1 axis and the growth plate of the long bones, including the chronic inflammatory state associated with CF. There are also increasing data on the direct effects of CFTR on bone and implications for CFTR modulators in attaining optimal growth. Treatments aimed at improving growth in CF are also reviewed here.

Evidence-based nutrition for the malnourished, hospitalised patient: one bite at a time.

Although malnutrition is a highly prevalent condition in the inpatient setting, particularly in older patients with multiple morbidities, the medical community has struggled to find efficient, evidence-based approaches for its prevention and treatment. From an evolutionary perspective, illness-related low appetite may be seen as a protective response with the goals to accelerate recovery from disease by improving autophagy. In line with this, earlier trials in the intensive care setting including severely ill patients have demonstrated unwarranted effects of overnutrition on patient outcomes. Uncertainties regarding the best approach to the malnourished inpatient in conjunction with a lack of strong trial data may, in part, explain the low level of attention that hospital medical staff have paid to the issue of malnutrition in the non-critical care inpatient setting. The recent Effect of early nutritional support on Frailty, Functional Outcomes and Recovery of malnourished medical inpatients Trial (EFFORT) study, however, has shown that individualized nutritional support reduces severe complications and improves mortality in medical inpatients, with positive effects on functional outcomes and quality of life. These results from a high quality effectiveness trial in conjunction with other studies, such as the NOURISH trial, should prompt us to improve our management of malnutrition in the inhospital setting. This procedure should start with a systematic screening for risk of malnutrition of admitted patients, effective assessment of nutritional status in multidisciplinary teams including dieticians, nurses and physicians, and early start of individualized adequate nutritional support of at risk patients to reach nutritional goals. Understanding the optimal use of nutritional support in patients with acute illness is complex because timing, route of delivery, and the amount and type of nutrients may all affect patient outcomes. Also, particularly for patients on the medical ward, factors like the logistics of catering, staffing to provide food and support the patient (i.e., number of nurses and dieticians), motivation/understanding of the patient to eat in defiance of appetite, the empathic human factor of nutritional care, the quality of meals, the taste of supplements, and unnecessary fasting for diagnostic or therapeutic procedures have a strong influence on nutritional care of patients. Further research and clinical trials are required to better understand, step by step, how we can use clinical nutrition best to maximize recovery of our patient and improve their functional status and their quality of life. Such evidence regarding nutritional therapy may allow us to implement personalized nutrition-driven interventions in the future.

Postoperative nutritional support of the patient with gut gangrene\u2014a case report

BackgroundBowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team.Case presentationThe case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues.ConclusionNeglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts.

Doctors as a Part of Nutrition Care of Patients (Srinagar, Jammu and Kashmir)

Doctor’s main role and prior responsibility is medical treatment of patients. Doctors can also share their expertise in nutrition care of patients in hospitals. Optimum nutrition affects both the response to medical treatments and eventually recovery. Doctors are usually perceived as the best source of information, by patients. In addition, they must provide some nutrition information to patients, in order to provide good care to patients. Doctors can motivate patients to eat healthy and also guide patients for dietary modifications to help in recovery. The present study, exploratory in nature, was carried out in Srinagar to have an insight and know the role and perspective in patient care especially in context of nutrition services, in the hospitals. The objective of the study was to investigate about if doctors were a part of nutrition care. Study sample consisted of 62 doctors, representing 2% from each hospital. Data was gathered using an interview schedule followed by observation and discussion with doctors. A scoring pattern was formed to evaluate doctor’s perspective and their role in nutrition care of patients. Data was collected from 11 hospitals which provided nutrition services to patients which were included in the study. It was seen that doctors appeared to have a minimal role and little awareness of the assessment of nutritional needs of patients. Doctors reported that they briefly discussed the diet with some of their patients. Nutritional assessment was not done during the patients hospital stay. Their interaction with dietitians was also not adequate about patients nutrition care. It was concluded that there was a need to increase the awareness of doctors about the importance of nutrition care of patients. However what was encouraging was the response of the doctors towards the need for dietitians, providing a balanced diet and nutrition counselling, perhaps indicating some realization that dietitians were required for improving nutrition care of patients.

AB020. S3B-6. Nutrition care in patients with cancer

: Patients with cancer are at particularly high risk for malnutrition because both the disease and its treatments threaten their nutritional status. Malnutrition, anorexia, and cachexia are a common finding in patients with cancer. They become more evident with tumor growth and spread. These mechanisms can involve primary tumor or damage by specific treatment such as anticancer therapies (surgery, chemotherapy, radiotherapy) also in cancers that usually are not directly responsible for nutritional and metabolic status alterations. Cancer cachexia is defined as a multifactorial syndrome characterized by an ongoing loss of skeletal muscle mass that cannot be fully reversed by the conventional nutritional support and leads to progressive functional impairment. It is common among patients with cancer who often experience marked unintentional weight loss, sarcopenia, anemia, anorexia, and fatigue. The pathophysiology is characterized by a negative protein and energy balance driven by a variable combination of reduced food intake and abnormal metabolism. The metabolic changes seen are distinctly different from starvation, reduced caloric intake, or from tumor burden alone. Patients with upper gastrointestinal, head and neck, and lung cancer are among the most severely affected by cancer cachexia. Cancer cachexia has detrimental effects on quality of life (QOL), performance status, and physical function. Cachexia is defined as >5% involuntary weight loss over the preceding 6 months or a body mass index (BMI) <20 kg/m2 and ongoing weight loss >2% or signs of sarcopenia and ongoing weight loss >2%. Sarcopenia has been defined by a variety of assessment tools, including mid-arm muscle area or circumference, appendicular skeletal muscle index determined by dual-energy X-ray absorptiometry, lumber skeletal muscle index determined by oncological computerized tomography, or whole-body fat-free mass index without bone determined by bioelectrical impedance. The use of optimized nutrition intervention programs such as dietitian consults, periodic monitoring, appropriate nutrition supplements, and feeding tube placements as needed throughout the treatment period markedly improves treatment tolerance and outcomes in head and neck cancer patients. The procedures of nutritional interventions were included in climbing order as followings: dietary adaptations or changes, oral supplements, enteral feeding through a feeding tube and parenteral nutrition. Recently, nutrient support, such as omega-3 rich food components, has attracted attention as a potential anti-tumor immunonutrition therapy. As cancer cachexia is a multifactorial process, the treatment approach should be multi-targeted. Further large prospective studies are needed to investigate whether immune enhanced oral nutritional supplements, enriched by a variety of micronutrients, are a beneficial intervention for the metabolic disturbances induced by cachexia.