Nutrition Consultation Research Articles

Outcomes of a nutrition service provided by dietitians at a major multi-cultural competition event: An observational study.

The nutrition service available for athletes competing at major events varies significantly and is dependent on advocacy for dietetic inclusion. The aim of this study was to describe the outcomes of a nutrition service designed and led by dietitians at a major international competition: the 2017 Taipei Universiade. Athletes (university students aged 17-25 years) and officials that used the service were invited to participate. Occasions of service were recorded using standard pro formas and dietary analysis of consultations was conducted using Foodworks. The scope of the service included 242 enquiries, 884 weight checks, 25 skinfold measures and 37 consultations. A significantly higher proportion of females asked about food allergy/intolerance (26.2% vs 12.5%, P = .039) than males. Most athletes who sought a nutrition consultation had not received previous nutrition support (86.5%) and wanted performance-related meal plans and advice (81.1%). On average, their diets were adequate in micronutrients with the exception of calcium, and low in serves of vegetables and dairy products. The majority of athletes (72.9%) seeking a consultation reported that they did not follow a specific diet for their sport. Sports supplements, performance enhancers and vitamin-mineral supplements use was 45.9% (n = 17), 13.5% (n = 5) and 13.5% (n = 5), respectively. Most athletes were of a high international calibre, however, reported low confidence in their nutrition knowledge and did not consistently apply knowledge to practice. This demonstrates a need for nutrition services by dietitians at this and similar events to improve the dietary intake of young adult athletes.

S1067 A Retrospective Review: Are We Adequately Screening for Important Outcome Predictors in Pre-Transplant Cirrhotic Patients?

INTRODUCTION: The number of US patients requiring liver transplantation continues to rise. Insufficient screening for alcohol use, nutritional deficiency, sexual dysfunction, and frailty can adversely affect patient outcomes. This study evaluated whether ESLD patients were being adequately screened for important outcome predictors during hospital admission via the hepatology checklist for liver transplantation candidacy. METHODS: A retrospective analysis from July 2017 through September 2018 was conducted on an inpatient hepatology service at a single academic tertiary care center. Hospitalized patients with a diagnosis of cirrhosis and an active hepatology consult were included. Post-liver transplant patients or those with hepatocellular carcinoma were excluded. Data was analyzed with Stata using univariate and multivariable logistic regression and Fisher’s exact test. RESULTS: A total of 382 records were reviewed, of which 174 met criteria for analysis. 118 were male and the average age of both groups was 52.6 years. 73 out of 174 patients (41.9%) had a diagnosis of alcoholic cirrhosis and 126 out of 174 (72.41%) were screened during hospitalization for alcohol use. Only 34 out of 56 (60.71%) females were screened compared to 92 out of 118 (77.97%) males (P = 0.02). Out of 174 patients, 83 (87.9%) were screened for frailty, of which 73 (87.9%) had a physical therapy consult. 58.6% of patients received an inpatient nutrition consult and only 4 patients out of 174 (2.3%) were screened for sexual dysfunction. CONCLUSION: This study suggests that the prevalence of patients screened for important outcome predictors is lacking. Despite alcoholic cirrhosis accounting for nearly half of our cirrhotic population, our institution is under-recognizing patients that would benefit from focused screening for alcoholism. Screening was significantly higher for male patients compared to females showing a gender disparity in screening. Standardized screening criteria must be systematically evaluated and administered in the ESLD population, particularly in overlooked patient populations. Improved interviewing strategies and checklist optimization are crucial to identifying high-risk patients who may be liver transplant candidates. This allows for more effective alcohol cessation, nutritional and physical optimization and management of sexual dysfunction prior to liver transplant evaluation and should be implemented at all institutions in a standardized manner. In this way, overall outcomes and prognoses may be improved.Table 1.: Patient Characteristics.

Trends in the national food supply of absorbable zinc in Ethiopia: 1990-2017.

This study analysed trends (1990-2017) in the availability of absorbable Zn in the national food supply of Ethiopia. The supply statistics of ninety-five food groups were obtained from the Ethiopian Food Balance Sheets compiled by FAO. Zn and phytate contents were determined using multiple composition databases and absorbable Zn estimated via the 'Miller' equation. Estimated average requirement cut-point method was performed to estimate proportions at risk of inadequate intake. Physiological Zn requirements set by Institute of Medicine (IOM) and International Zinc Nutrition Consultative Group (IZiNCG) were applied. Time trend was tested using Mann-Kendall statistics and Z-score and P-values are provided. Ethiopia. NA. Between 1990 and 2017, the supply of total dietary Zn was increased by 33 % from 9·8 to 13·0 mg/person/d (Z = 6·46, P < 0·001). However, that of absorbable Zn remained constant around 2·7 mg/person/d (Z = 1·87, P > 0·05). Over the period, the phytate supply was increased by 48 % from 1415 to 2095 mg/person/d (Z = 6·50, P < 0·001) and fractional Zn absorption declined from 27·0 to 20·9 % (Z = -6·62, P < 0·001). The contribution of animal source foods for bioavailable Zn was reduced by 45 % and the share of cereals raised by 11·3 %. Over the period, prevalence of inadequate Zn intake estimated using IZiNCG and IOM requirements remained constant around 10 and 50 %, respectively. Between 1990 and 2017, Ethiopia considerably increased the total supply of Zn; however, meaningful changes in bioavailable Zn and prevalence of deficiency were not observed due to proportional rise in phytate and concomitant decline in Zn absorption.

Body weight in patients with idiopathic gastroparesis.

The classic clinical picture of gastroparesis is a symptomatic patient losing weight. In addition, a number of patients with delayed gastric emptying are obese and/or gaining weight. Our aim was to investigate the factors impacting body weight in patients with idiopathic gastroparesis. In patients with idiopathic gastroparesis, detailed history and weight were acquired at enrollment and after 48weeks. Questionnaires assessed symptoms, food intake, physical activity, and quality of life. Patients underwent laboratory testing, gastric emptying scintigraphy, and water load testing. Of 138 patients with idiopathic gastroparesis, 10% were underweight (BMI<18.5), 39% were normal weight (BMI 18.5-25), 20% were overweight with BMI 25 to 30kg/m2 , and 29% were obese with BMI>30kg/m2 . Body weight at enrollment was positively associated with oral caloric consumption (P<.001), following a gastroparesis diet (P=.04), nutrition consultation (P=.001), upper abdominal pain (P=.01); and negatively associated with energy expenditure (P=.05), alcohol use (P=.003) and severity of bloating (P<.001). When followed over 48weeks, 53% patients stayed stable (within 5% of baseline weight), 30% gained, and 17% lost weight. Weight gain over 48weeks was positively associated with oral caloric consumption (P=.003) and constipation severity (P=.005) at enrollment, and negatively associated with lower abdominal pain severity (P=.007) at enrollment, and associated with improvement in inability to finish meal score (P<.001) at 48weeks. In this series of patients with idiopathic gastroparesis, 10% were underweight whereas 29% were obese. Over 48weeks, 30% of patients increased their body weight≥5%. Diet, activity, and symptoms are important factors associated with body weight in patients with idiopathic gastroparesis.

Integrative Nutrition CARE in the Community-Starting with Pharmacists.

Dietary supplementation is increasingly sought after by consumers looking to meet the demands of a modern lifestyle. Effective supplementation requires knowledge of the purpose and proper use of nutritional supplements. Unverified or inadequate guidance on supplementation can propagate misconceptions and increase undue fears of side effects. Community pharmacists are best placed to guide consumers on nutritional supplement use. In this review, a panel comprised of community pharmacists, pharmacy academia, and dietitians (n = 6) convened to provide an experience- and evidence-based guidance on rational drug use, patient education, and integrated and personalized nutrition care in both community and hospital pharmacy settings. A novel framework to guide community pharmacist-led consultations on supplementation is proposed. The four-step CARE (Categorize, Assess, Recommend, Empower) guide was developed to facilitate and optimize outcomes of pharmacist-led nutritional supplement consultation. Telehealth advancements in the form of digital health applications and personalized nutrigenomic DNA testing support Integrative Nutrition Care, and will further promote appropriate supplementation use to improve overall well-being in the community. Practical implementation of the CARE guide is necessary to ascertain its applicability for optimizing outcomes of pharmacist-led consultation and the recommendation of nutritional supplements.

Dietary habits and metabolic response improve in obese children whose mothers received an intervention to promote healthy eating: randomized clinical trial

BackgroundLifestyles habits such as eating unhealthy foodscommence at home and are associated with the development of obesity and comorbidities such as insulin resistance, metabolic syndrome, and chronic degenerative diseases, which are the main causes of death in adults. The present study compared changes in dietary habits, behaviors and metabolic profiles of obese children whose mothers attended at the hospital to group sessions, with those who received the usual nutritional consultation.MethodsRandomized clinical trial, 177 mother/obese child pairs participated, 90 in the intervention group and 87 in the control group. The intervention group attended six group education sessions to promote healthy eating, being this an alternative of change of habits in children with obesity. The control group received the usual nutritional consultation; both groups were followed up for 3 months. Frequency of food consumption, behaviors during feeding in the house and metabolic profile was evaluated. Mixed effect linear regression models were used to evaluate the effect of the intervention on the variables of interest, especially in HOMA-IR.ResultsThe intervention group reduced the filling of their dishes (p = 0.009), forcing the children to finish meals (p = 0.003) and food substitution (p < 0.001), moreover increased the consumption of roasted foods (p = 0.046), fruits (p = 0.002) and vegetables (p < 0.001). The children in the control group slightly increased HOMA-IR levels (0.51; 95% CI − 0.48 to 1.50), while the children in the intervention group significantly decreased (− 1.22; 95% CI − 2.28 to − 1.16). The difference in HOMA-IR between the control and intervention group at the end of the follow-up was − 1.67; 95% CI: − 3.11 to − 0.24.ConclusionsThe educational intervention improved some eating habits at home, as well as HOMA-IR levels; why we consider that it can be an extra resource in the management of childhood obesity.Trial registrationClinicaltrials.gov, NCT04374292 (Date assigned: May 5, 2020). Retrospectively registered.

The Effect of Nutritional Consultation on the Level of Malnutrition and Growth Indices in Children with Cystic Fibrosis

Background: Malnutrition is one of the most common disorders among children with Cystic Fibrosis (CF). The present study aimed to investigate the effect of nutritional consultation on the type and severity of malnutrition in children with CF. Materials and Methods: This quasi-experimental study was conducted on 78 children with CF referred to Mofid Pediatric Hospital, Tehran, Iran, in 2017-2018. Their parents filled the demographic questionnaire. Participants with malnutrition were undergoing the assessment on growth indices, including weight, height, ideal body weight, mid-upper arm circumference, and Z-score. Moreover, the nutritional consultations were considered for them (30-45 minutes). Children and their parents were consulted and trained about total daily calorie acquirement, type, number of the meal, amount of food intake, drinks, and avoided eating of any low-calorie food like snacks, during the consultation. All patients were reassessed three months later for growth indices. The data were analyzed using SPSS software version 22.0. Results: We assessed 78 children with CF, 21 (26%) of them had mild, 26 (34%) moderate malnutrition, and 31 (40%) severe malnutrition. The result showed that nutritional intervention was effective. Consequently, 1 (3.8%) of the moderately malnourished child was improved to mild malnutrition and 5 (27.8%) children under five years old were improved from severe to moderate malnutrition. Moreover, 1 (5.6%) child were improved from severe to mild, and 2 (15.4%) of children over five years old were improved from severe to moderate malnutrition. Conclusion: According to the results, the early growth assessment in hospitalized and outpatient, diagnosis of malnutrition and nutritional interventionwill be useful in improving the severity of malnutrition and growth indices in children with CF.

Low Body Mass Index Is a Predictor for Mortality and Increased Length of Stay Following Total Joint Arthroplasty

BackgroundMalnutrition is a devastating condition which disproportionally affects the elderly population. Malnutrition furthers the pre-existing elevated risk for osteoarthritis in this population, thus exacerbating joint damage in patients and furthering the need for total joint arthroplasty (TJA). A marker for malnutrition is a low body mass index (BMI). The purpose of this study is to investigate whether low BMI status increased the risk for 2-year mortality or reoperation, 90-day readmission, or extended length of stay (LOS) following TJA. MethodsA retrospective study was performed using the Partners Arthroplasty Registry which contains data from 2016 to 2019. The registry was queried for primary total hip and primary total knee arthroplasty (TKA) patients that had a minimum of 2-years follow-up data. Demographic, surgical, and clinical outcome variables were obtained from these patients. The association between underweight BMI and objective outcomes of reoperation, 90-day readmission, mortality, and LOS was evaluated by univariate analysis followed by multiple logistic and linear regression analyses. ResultsThe final cohort used for analysis consisted of 4802 TJA cases. After accounting for potential confounders, underweight BMI was found to be independently associated with increased risk of mortality within 2 years following TJA (odds ratio 8.77) (95% confidence interval 2.14-32.0) and increased LOS of 0.44 days (95% confidence interval 0.02-0.86). ConclusionOur findings demonstrate that TJA patients with an underweight BMI experience an 8 times increased risk of 2-year mortality and an increased LOS of 0.44 days. Orthopedic surgeons should consider nutritional consultation and medical optimization in these high-risk patients prior to surgery.

Obesity and malnutrition in critically ill patients with acute myeloid leukemia: Prevalence and impact on mortality.

Obese patients have an increased risk of developing acute myeloid leukemia (AML), which in turn predisposes to malnutrition. Obesity has been associated with improved survival in critically ill patients (obesity paradox), but this effect seems to disappear when adjusting for malnutrition. How obesity and malnutrition interplay to affect mortality in critically ill patients with AML has not been addressed and was the objective of this study. This was a retrospective chart review of adult patients with AML who were admitted to the medical intensive care unit and had a nutrition consultation between 2011 and 2018. Demographic characteristics, comorbidities, severity scores, and laboratory parameters, as well as data on vital organ support, hospital mortality, and long-term survival were collected. Obesity was defined by a body mass index of ≥30 kg/m2 and malnutrition per the American Society for Parenteral and Enteral Nutrition criteria. Patients were compared based on nutrition and weight status, and hospital and long-term mortality were analyzed with logistic regression and Kaplan-Meier curves. We included 145 patients (57% obese, 30% malnourished) in the study. As time from AML diagnosis elapsed, obesity was less frequent and malnutrition more prevalent, with 25% of obese patients also presenting with malnutrition. Hospital mortality was 40% and associated with malnutrition in nonobese patients (odds ratio: 5.1; 95% confidence interval, 1.3-21.8; P=0.02) and sequential organ failure assessment severity score (odds ratio: 1.5; 95% confidence interval, 1.3-1.7; P < 0.0001). Sensitivity analyses confirmed the association between malnutrition, but not obesity, and hospital mortality. Obese malnourished patients had lower long-term survival, but this was not significant (P=0.25). Critically ill patients with AML have a high prevalence of malnutrition and obesity, which are sometimes associated. Malnutrition, but not obesity, was associated with hospital mortality.

Associations of obstetrical characteristics and dietary intakes with iron status among pregnant women in Selangor and Kuala Lumpur

PurposeGlobally, iron deficiency is the most common nutritional deficiency and the most common cause of anaemia during pregnancy. To date, there is lack of established studies investigating factors associated with iron status during pregnancy in Malaysia. Therefore, this study aimed to determine the associations of obstetrical characteristics and dietary intakes with iron status among pregnant women attending selected health clinics in Selangor and Kuala Lumpur.Design/methodology/approachA cross-sectional study was conducted among 436 third-trimester pregnant women aged 18–40 years, from six selected health clinics in Selangor and Kuala Lumpur. Data on obstetrical characteristics were extracted from the antenatal medical records. Dietary intakes were assessed using an adapted semi-quantitative food frequency questionnaire via face-to-face interview. Venous blood samples were collected for the measurement of serum ferritin (SF) using ADVIA Centaur analyser to determine iron status.FindingsApproximately one in four of the pregnant women (25.9%) had iron deficiency, with mean SF of 33.35 ± 25.77µg/l. Factors associated with SF were parity (B = −3.048, p < 0.05), frequency of antenatal care visits (B = 1.456, p < 0.05), haemoglobin (Hb) (B = 3.890, p < 0.05), iron intake (B = 0.010, p < 0.05) and frequency of dietary iron supplementation consumption (B = 3.333, p < 0.05). Hierarchical linear regression analyses revealed that dietary factors were significantly associated with SF, after accounting for the obstetrical characteristics.Originality/valueBesides obstetrical factors, the findings emphasised the importance of dietary factors on iron status during pregnancy. Nutrition consultation service particularly on the sources of iron intake and compliance towards dietary iron supplementation shall be provided to all pregnant women.

Evaluation of the Chilean program "Vida Sana 2017" in participants under 20 years of age after 6 months of intervention

Introduction: the Chilean "Programa Vida Sana" (Healthy Life Program) (PVS) seeks to reduce risk factors for chronic diseases in overweight/obese subjects between 2 and 64 years of age. Objective: to evaluate in 2-20-year-old participants the results of the PVS applied in 2017 in relation to nutritional status and fitness after a 6-month intervention. Methods: an observational study analyzing secondary data. During 6 months the PVS included: medical, nutritional and psychological consultations (PC), laboratory exams, physical activity sessions (PAS), and healthy life workshops (HLW). Subjects were categorized into: 2-5, 6-10, and 11-19 years. We analyzed participation in activities; improvement of nutritional status [BMI-Z] and fitness [standing long-jump test (SLJ), 6-minute walk test (6MWT), 30-second chair stand (30-SCS)] according to initial NS using Student's t-test for paired samples, and the contribution of the program´s activities to NS and fitness (logistic regression, Hosmer-Lemeshow test). The STATA 14.2 program was used, with p < 0.05, 95 % CI, being considered significant. Results: the sample included 13,611 (53 % girls). At 6 months about 50 % of participants improved their EN and CF. From 2 to 5 years, participation in ≥ 48 PAS, 2 PC and ≥ 3 HLW significantly increased the likelihood of improvement in NS and fitness. From 6 to 10 only HLW played a role, and from 11 to 19 only PAS in initially obese subjects. Conclusions: the activities of PVS-2017 contributed significantly to improved NS and fitness in subjects of 2-5 years of age; however, in 6-10- and 11-19-year-old participants its contribution was low. Only half of participants improved their NS and fitness during the 6 months of intervention.

Health professionals donating work hours: an initiative for improving access to healthcare in Brazil: case study and initial results

BackgroundEven with a universal public health system, the Brazilian population faces inequalities on access to healthcare. Long queues for medical appointments, caused by lack of professionals, space and equipment, are...

Survey on the role of nutrition in first-opinion practices in Austria and Germany: An evaluation of knowledge, preferences and need for further education.

A survey was conducted among first-opinion practices in Germany and Austria on dog nutrition consultation, food sold in the practice, recommendations given to owners, most commonly encountered consequences of malnutrition, need for further education and feeding of own dogs. Of the 169 participants, one third was from Austria, two thirds from Germany. Most practiced in the countryside or in suburbs, were female and between 36 and 55years old. The majority felt that nutrition has become an important topic, and that "feeding myths" were on the rise. However, only in 18% of the practices at least one staff member had further education in nutrition, while none of the participants had a national or international degree. Only half of our participants felt qualified to give nutrition advice. A nutritional assessment was not regularly performed, and the Body Condition Score was not regularly assessed, often only when health problems were obvious. If a homemade diet was requested, practitioners rather referred to a nutritionist, while 25% left it up to the owners. Most relied on traditional premium diets for their patients and also for their own dogs. Feeding myths seemed to be widespread among veterinarians, too; even Biologically Appropriate Raw Feeding and diets not complying with EU legislation were recommended. There is obvious need for further education and specialization to establish nutrition consultation as a profitable service in small animal practice.

Management of nutritional consultations in local clinics during SARS-CoV-2 pandemic.

Management of nutritional consultations in local clinics during SARS-CoV-2 pandemic.

The role of the specialist nurse in parenteral nutrition : An observational study of complications with home parenteral nutrition in adult cancer patients

Background : In France, home parenteral nutrition (HPN) is managed by two parallel healthcare systems : in approved specialist centers (HPN > 12 weeks), and outside of these approved specialist centers (HPN<12 weeks). Objective : To prospectively evaluate infectious and vascular complications in adult cancer patients undergoing HPN administered via a central venous line, outside of approved specialist HPN centers. Methods : Our observational prospective study included adult patients with cancer, hospitalized for 48 hours or more, and under HPN. They had a WHO performance status of ≤ 2 and had had a nutritional consultation before discharge. Results : 25 patients were included in the study, with a median age of 63 years [19–74]. Weight loss of ≥ 5% was reported in 79% of patients. The Ingesta score was < 7 in 96% of cases. 87% of patients presented chill or body temperature variation episodes, with a median of 2 episodes [1–6] per patient. The median delay between end of hospitalization and the first chill episode was 11 days [1–85]. A vascular complication (obstruction without thrombosis) was reported in one patient. Discussion : This high number of infectious episodes requires improvement of patient care when it comes to strictly adhering to the recommendations. Getting the approved specialist HPN centers to work together and share care protocols could be the first important step.

Mediterranean-style dietary pattern improves cancer-related fatigue and quality of life in men with prostate cancer treated with androgen deprivation therapy: A pilot randomised control trial.

Cancer-related fatigue (CRF) is a prevalent and persistent symptom from androgen deprivation therapy (ADT) in prostate cancer. The Mediterranean-style dietary pattern (MED-diet) offers a plausible mechanism to mitigate CRF through reducing inflammation and improving body composition. This study aimed to evaluate the effects of a 12-week MED-diet, compared to usual care, on CRF and quality of life in men with prostate cancer treated with ADT. Twenty-three men (65.9±7.8 years; body mass index: 29.6±2.7kg/m2; ADT duration: 33.8±35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 12-weeks of usual care or the MED-diet involving six individualised nutrition consults. Primary outcomes included CRF [Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale (FACIT-F) and quality of life [FACIT-General (FACIT-G)], secondary outcomes included body mass/composition and interleukin (IL)-6 and IL-8 concentrations measured at baseline, 8-weeks and 12 weeks. Intervention feasibility was measured by intervention safety, study completion rate, consult attendance, and adherence to the MED-diet through the Mediterranean-diet adherence screener (MEDAS). Intention to treat linear mixed models were used to determine changes in outcomes between the MED-diet and usual care at baseline, 8-weeks and 12-weeks. The MED-diet improved CRF (FACIT-F) at 8-weeks [+4.8 (0.0, 9.8); P=0.05] and 12-weeks [+7.2 (2.2, 12.0); P=0.005], quality of life (FACIT-G) at 12-weeks [+9.2 (2.7, 15.8); P=0.006], reduced total body mass at 8-weeks [-2.51kg (-4.25,-0.78); P=0.005] and 12-weeks [-2.97kg (-4.71,-1.25); P=0.001], lean mass at 8-weeks [-1.50kg (-2.91,-0.10); P=0.036], and IL-8 at 8-weeks [-0.18ng/ml (-0.34,-0.02); P=0.029] compared to usual care. The MED-diet demonstrated zero adverse events, 91% study completion, 100% attendance, and 81% adherence to the MEDAS. The MED-diet is safe and feasible, and has the potential to improve CRF and quality of life in overweight men treated with ADT compared to usual care. Further exploration of the MED-diet is warranted in a larger powered sample size to consolidate these findings.

Efficacy of a fasting-mimicking diet in functional therapy for depression: A randomised controlled pilot trial.

This randomized controlled trial examined the efficacy of adding a fasting-mimicking diet to a structured psychotherapy protocol for treating depression. Of 20 patients with depression, 10 were randomly assigned to psychotherapy and dieting (i.e., experimental group) and the other 10 to psychotherapy only (i.e., control group). Patients in both groups received 20 individual sessions of functional therapy along with nutrition consultation. Patients in the control group were instructed to maintain their usual daily diets. Both treatments were effective in reducing depression as well as increasing self-esteem and quality of life. The experimental group showed improved self-esteem and psychological quality of life as well as a reduction in their mean body mass index, in comparison to the control group. The study revealed initial evidence of the efficacy of combining psychotherapy with a fasting-mimicking diet to treat depression and its correlates.

Perda de peso em pacientes oncológicos: prevalência e prognóstico relacionados a sexo, idade, localização do tumor e sintomas de impacto nutricional

ABSTRACT Introduction: Cancer causes an increase in nutritional demands and the presence of of nutritional impact symptoms (NIS) contributes to reduction of nutrient intake and absorption, leading to weight loss, malnutrition and predicting overall survival. Assess the prevalence and predict the weight loss related to cancer, the Grade Scheme and the NIS. Methods: Data were collected from 2012 to 2018 from the first nutritional consultation of cancer patients in a clinic linked to SUS in the city of Guarapuava-PR. The primary outcome was to determine the % of weight loss (% WL), NIS and by the Grade Scheme proposed by Martin et. al (2015) the prognosis was determined by univariate and multivariate Multinomial Logistic Regression (MLR) analysis (adjusted for age, sex and tumor location). Results: 1164 patients aged 56.9 years. In the first consultation, a 6.7 %WL was observed, and it was observed that 21.6% of the patients were underweight. The main sites and %WL were, respectively: Lung 140 (12.0%) and 9.4 %WL, Head and Neck 113 (9.7%) and 10.5 %WL, Colorectal 84 (7.2%) and 10.3 %WL, Stomach 90 (7.7%) and 13.7 %WL, Esophagus 85 (7.3%) and 14.0 %WL, Pancreas 24 (2.1%) and 16.1 %WL. The main NIS were: dry mouth (51.0%), abdominal pain (23.0%), constipation (21.7%), nausea (15.3%) and altered taste (10.5%). In the RML for univariate analysis, age, sex, cancer site and SIN and for multivariate analysis, all cancer locations showed significant OR to be classified in grades 3 and 4. Conclusion: Before chemotherapy, weight loss and malnutrition are present. The cancer site and SIN increase the chance of the patient being classified in grades 3 and 4, leading these patients to a worse nutritional status and contributing to adverse results.

PENGEMBANGAN APLIKASI KONSULTASI DAN PENGUKURAN STATUS GIZI USIA REMAJA (SMA) SECARA ONLINE (NUTRI-O)

In Indonesia, the current trends and issues has changed of the malnutrition paradigm. The nutritional status of adolescents in Indonesia is experiencing double burden problems (Riskesdas 2007, 2010, and 2013). This happens due to improper lifestyle and eating habits, thus causing adolescents to be at risk of malnutrition, both deficiency or overnutrition. The nutrient deficiency has an impact on decreasing physical abilities, immune system, thinking and learning concentration. While overnutrition such as overweight and obesity in adolescents, increasing the risk of non-infectious diseases during adulthood such as heart and blood vessel disease, high blood pressure, dyslipidemia, and diabetes mellitus. The purpose of this study is to develop an Android-based m-Health application model as an effort to monitor nutritional status and online consultation. The development method that used is a prototype. Application modeling begins with system requirements analysis, context diagrams, Entity Relational Diagrams (ERD), Table Relational Diagrams (TRD), Flow Charts and User Interface Design. Adolescent nutritional status measured base on Height divided by Age (TB/U), Body Mass Index divided by Age (BMI/U) and other health conditions. The system information formed by the design concept can provide an information of nutritional status and fascinate competent nutritionists to give an interactive nutritional consultation.

"Each one has their own role": Exploratory study on consumers' perceptions about nutritionists services provided in community pharmacies.

The aim of this exploratory study was to characterize the experience of people attending nutrition consultations at two different pharmacies and to understand their perception of the role community pharmacists may have in weight management. To conduct this study, interviews were performed following an interview guide comprised of sociodemographic characterization questions and open-answer questions. Ten people participated in the study, seven females and three males. The average self-reported BMI of the sample was 29.4Kg/m2. The results showed that there is a general satisfaction with nutrition consultations, with all respondents agreeing that community pharmacies are a right place to have these consultations. Accessibility and low cost were found to be the biggest advantages in having nutrition consultations at a pharmacy. On the other hand, these participants felt that the biggest disadvantage was the price of nutritional supplements. Lack of motivation was also seen as a major impediment to continue with the nutrition consultations. When participants were asked about what role community pharmacists may have in weight management, 50% of participants disagreed with the idea of pharmacists providing the service on their own. the results of this study indicate that the degree of satisfaction of those attending the nutrition consultations is high, especially because of pharmacies' accessibility and proximity, hinting at the idea of efficiency as an important factor driving the demand for new health care services. Pharmacists were viewed as having a gatekeeper role, but the nutrition service provision should be exclusively provided by nutritionists, in an example of successful multidisciplinary practice within the community pharmacy setting. Future studies should focus on the effect these consultations have on the loss or maintenance of weight, including the comparison with service provision in the traditional settings.