Nutritional Management Of Patients Research Articles

Perioperative and Post-Hospital Whole-Course nutrition management in patients with pancreatoduodenectomy - a Single-Center prospective randomized controlled trial.

Whole-course nutrition management (WNM) has been proven to improve outcomes and reduce complications. We conducted this randomized controlled trial to validate its effectiveness in patients undergoing pancreatoduodenectomy. From December 1, 2020, to November 30, 2023, this single-center randomized clinical trial was conducted at the Department of Hepatobiliopancreatic Surgery in a major hospital in Beijing, China. Participants who were undergoing pancreatoduodenectomy were enrolled and randomly allocated to either the WNM group or the control group. The primary outcome was the incidence of postoperative complications. Subgroup analysis in patients who were at nutritional risk was performed. Finally, a six-month follow-up was conducted and the economic benefit was evaluated using an incremental cost-effectiveness ratio (ICER). A total of 84 patients were randomly assigned (1:1) into the WNM group and the control group. The incidences of total complications (47.6% vs. 69.0%, P=0.046), total infections (14.3% vs. 33.3%, P= 0.040) and abdominal infection (11.9% vs. 31.0%, P= 0.033) were significantly lower in the WNM group. In the subgroup analysis of patients at nutritional risk, 66 cases were included (35 cases in the WNM group and 31 cases in the control group). The rate of abdominal infection (11.4% vs. 32.3%, P= 0.039) and postoperative length of stay (23.1±10.3 vs. 30.4±17.2, P= 0.046) were statistically different between the two subgroups. In the six-month follow-up, more patients reached the energy target in the WNM group (97.0% vs. 79.4%, P=0.049) and got a higher daily energy intake (1761.3±339.5 vs. 1599.6±321.5, P=0.045). The ICER suggested that WNM saved 31,511 Chinese Yuan (CNY) while reducing the rate of total infections by 1% in the ITT population and saved 117,490 CNY in patients at nutritional risk, while WNM saved 31,511 CNY while reducing the rate of abdominal infections by 1% in the ITT population and saved 101,359 CNY in patients at nutritional risk. In this trial, whole-course nutrition management was associated with fewer total postoperative complications, total and abdominal infections, and was cost-effective, especially in patients at nutritional risk. It seems to be a favorable strategy for patients undergoing PD.

Nutritional management of patients during surgical prehabilitation and rehabilitation programs

Undernutrition (UD) increases perioperative morbidity and mortality. Its prevention and treatment are therefore essential in surgical prehabilitation and rehabilitation programs. Nutritional treatment is individualized according to the patient's nutritional status, ingesta and protein-energy requirements. Oral nutrition is optimized to increase intakes through personalized dietary advice and oral nutritional supplements. Artificial nutrition support is indicated in cases of UD or high risk of UD before major surgery. Enteral nutrition is preferred to parenteral nutrition when the digestive tract is functional.

Update nutritional management in patients with pancreatic ductal adenocarcinoma: A literature reviews

Pancreatic ductal adenocarcinoma (PDAC) is one of the most lethal malignancies. Only 20 % of patients are operable at the time of diagnosis. However, the survival rate varies among patients depending on immune response and nutritional status. Weight loss (WL) is frequent and multifactorial, so anorexia-cachexia syndrome and exocrine pancreatic insufficiency (EPI) should be considered. The nutritional care process must be carried out in all cases from the moment of suspected diagnosis and during the disease. The management of patients with PDAC must be personalized, individualizing behaviors, and from a multidisciplinary perspective at each stage of the disease. The objective of the present review is to offer a tool that facilitates the identification of individuals at nutritional risk and to describe the most appropriate nutritional strategies to improve the quality of care for patients with PDAC.

Malnutrition in advanced gastrointestinal cancer patients and nutritional support therapy

The advancement of comprehensive treatment has allowed an increasing number of patients with gastrointestinal tumor to achieve long-term survival. In current clinical practice, there is a growing population of patients with advanced gastrointestinal tumor. Due to various factors, such as tumor burden, treatments including chemotherapy and radiation therapy, as well as underlying diseases, patients with advanced gastrointestinal tumor often experience malnutrition, which negatively impacts their clinical outcomes. The mechanism of malnutrition in patients with advanced gastrointestinal tumor is complex, and conventional nutritional support therapy has shown limited effectiveness. With the continuous progress in the concept and technique of nutritional support therapy, the diversification of treatment strategies, and the strengthening of multidisciplinary collaboration, the nutritional management for patients with advanced gastrointestinal tumor tends to be standardized and rational, leading to effective improvement in patients' nutritional status and clinical outcomes. Based on the latest evidence-based medicine, combined with the author's practical experience and insights, this article aims to explore nutritional support therapy for patients with advanced gastrointestinal tumor.

Development of standardized nursing terminology for the process documentation of patients with chronic kidney disease.

European Nursing care Pathways (ENP) is a professional care language that utilizes software to map care processes and utilize the data for research purposes, process control, and personnel requirement calculations. However, there is a lack of internationally developed terminology systems and subset specifically designed for the nutritional management of CKD. The aim of this study was to create a subset of the standardized nursing terminology for nutrition management in patients with chronic kidney disease (CKD). According to the guidelines for subset development, four research steps were carried out: (i) Translation of version 3.2 of the ENP (chapter on kidney diseases) and understanding of the framework structure and coding rules of the ENP; (ii) Identification of relevant six-dimensional nursing terms; (iii) Creation of a framework for the subset; (iv) Review and validation by experts. A subset for CKD nutritional care was created as part of this project, comprising 630 terms, with 17 causal relationships related to nursing diagnoses, 115 symptoms, 31 causes, 34 goals/outcomes, 420 intervention specifications and 13 resources, including newly developed care terms. All terms within the subset have been created using a six-step maintenance procedure and a clinical standard pathway for nutrition management in the SAPIM mode. This terminology subset can facilitate standardized care reports in CKD nutrition management, which is used to standardize nursing practice, quantify nursing, services, guidance on care decisions, promoting the exchange and use of CKD nutrition data and serve as a reference for the creation of standardized subset of nursing terminology in China.

Influence of Whole-Process Nutrition Management on Nutritional Status of Patients with Esophageal Cancer Undergoing Radiotherapy

To probe the effect of whole-process nutrition management on the nutritional status of patients with esophageal cancer undergoing radiotherapy, 100 patients were allocated to the control group (n = 50) and observation group (n = 50). Patients in both groups underwent routine treatment after admission. The control group adopted conventional nutrition management, while the observation group was given whole-process nutrition management. Compared to the control group, the patient-generated subjective global assessment score in the observation group declined after intervention (P < 0.05). Levels of prealbumin, albumin, transferrin, immunoglobulin A, immunoglobulin G, immunoglobulin M, CD3+, and CD4+ in the observation group were elevated compared to the control group after intervention (P < 0.05). According to the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, the observation group exhibited higher scores in the aspects of family understanding and cooperation, mental condition, appetite, daily life, and sleep quality than the control group after intervention (P < 0.05). Furthermore, the incidence of adverse reactions in the observation group was lessened compared to the control group (P < 0.05). Hence, implementing whole-process nutrition management in patients undergoing radiotherapy can promote their nutritional status and quality of life.

Application of Bioelectrical Impedance Analysis in Nutritional Management of Patients with Chronic Kidney Disease.

Body composition measurement plays an important role in the nutritional diagnosis and treatment of diseases. In the past 30 years, the detection of body composition based on bioelectrical impedance analysis (BIA) has been widely used and explored in a variety of diseases. With the development of technology, bioelectrical impedance analysis has gradually developed from single-frequency BIA (SF-BIA) to multi-frequency BIA (multi-frequency BIA, MF-BIA) and over a range of frequencies (bioimpedance spectroscopy, BIS). As the clinical significance of nutrition management in chronic kidney disease has gradually become prominent, body composition measurement by BIA has been favored by nephrologists and nutritionists. In the past 20 years, there have been many studies on the application of BIA in patients with CKD. This review describes and summarizes the latest research results of BIA in nutritional management of patients with CKD including pre-dialysis, hemodialysis, peritoneal dialysis and kidney transplantation, in order to provide reference for the application and research of BIA in nutritional management of chronic kidney disease in the future.

Quality evaluation index development for nutritional management in patients with nasopharyngeal carcinoma during peri-radiotherapy

ObjectivesIt is necessary to construct an evaluation index for patients with nasopharyngeal carcinoma during peri-radiotherapy to provide a reference for the evaluation of the quality of nutritional management of patients with nasopharyngeal carcinoma during peri-radiotherapy. The aim of this study was to construct a set of scientific, comprehensive, and feasible indicators for evaluating the quality of nutrition management in patients with nasopharyngeal carcinoma during peri-radiotherapy to provide a unified reference basis for objective nutritional evaluation of these patients during the peri-radiotherapy period and to provide insights to the clinical treatment and care of these patients. MethodsA multidisciplinary research team was set up from December 2021 to April 2022. We took the three-dimensional quality structure model as the theoretical framework; based on the literature review, the first draft of the nutrition management quality evaluation index for patients with nasopharyngeal carcinoma during peri-radiotherapy was formed by a semi-structured interview. The Delphi correspondence method was used to survey 18 experts from 12 cities in China. The multidimensional analytical hierarchy process was used to determine the evaluation index and weight of nutrition management quality of patients with nasopharyngeal carcinoma during peri-radiotherapy. ResultsThe effective questionnaire recovery rates of the two rounds of letters were 90.005% and 100%, respectively, and the expert authority coefficients were 0.906 and 0.918, respectively. The Kendall harmony coefficients of the two rounds of letters were 0.271 to 0.313 and 0.309 to 0.349, respectively. The nutrition management quality evaluation index of patients with nasopharyngeal carcinoma during peri-radiotherapy was constructed and included 3 first-level indexes, 10 second-level indexes, and 71 third-level indexes. ConclusionThe evaluation index of the nutrition management quality of patients with nasopharyngeal carcinoma during peri-radiotherapy is scientific and reliable, and it may have a certain guiding significance for nurses to evaluate the quality of nutrition management of these patients during this period.

Dietary intake assessment in children with cystic fibrosis using 3-day food diaries: a single-centre study.

Malnutrition is both a feature and major cause of morbidity in cystic fibrosis (CF). Therefore, nutritional management is an essential element of patient care. In 2016, an international guideline for nutritional management in patients with CF was published. In light of these recommendations, the aim of this study was to investigate the dietary intake of children with CF at the University Hospital of Bordeaux. We conducted a retrospective study at the Paediatric CF Centre of the University Hospital of Bordeaux. Patients aged 2-18 years with CF who completed a 3-day food diary at home between January 2015 and December 2020 were included. A total of 130 patients, with a median age of 11.8 [interquartile range (IQR): 8.3; 13.4] years, were included. The median Z-score for BMI was -0.35 (IQR: -0.9; 0.2) and 20% of the patients had a Z-score for BMI < -1. Recommended total energy intakes were achieved in 53% of the patients, particularly those with nutritional support. Recommended protein intake was met in 28% of the cases, while fat and carbohydrate intakes were met in 54%. Vitamin and micronutrient levels were normal in 80% of the patients, with the exception of vitamin K, which was within the therapeutic range in only 42% of the cases. Recommended nutritional targets are difficult to achieve in patients with CF, and providing nutritional support during follow-up remains a challenge.

Gut dysmotility in children with neurological impairment: the nutritional management.

Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.

Nutritional Management of Patients with Obesity in Critical Care

Nutritional Management of Patients with Obesity in Critical Care

Nutritional Management of Patients with Head and Neck Cancer-A Comprehensive Review.

While surgical therapy for head and neck cancer (HNC) is showing improvement with the advancement of reconstruction techniques, the focus in these patients should also be shifting to supportive pre and aftercare. Due to the highly sensitive and anatomically complex region, these patients tend to exhibit malnutrition, which has a substantial impact on their recovery and quality of life. The complications and symptoms of both the disease and the therapy usually make these patients unable to orally intake food, hence, a strategy should be prepared for their nutritional management. Even though there are several possible nutritional modalities that can be administrated, these patients commonly have a functional gastrointestinal tract, and enteral nutrition is indicated over the parenteral option. However, after extensive research of the available literature, it seems that there is a limited number of studies that focus on this important issue. Furthermore, there are no recommendations or guidelines regarding the nutritional management of HNC patients, pre- or post-operatively. Henceforth, this narrative review summarizes the nutritional challenges and management modalities in this particular group of patients. Nonetheless, this issue should be addressed in future studies and an algorithm should be established for better nutritional care of these patients.

Brazilian guide to nutrition in bariatric and metabolic surgery.

Brazilian nutrition recommendations for bariatric and metabolic surgery aim to provide knowledge, based on scientific evidence, on nutritional practices related to different surgical techniques in the surgical treatment of obesity and metabolic diseases. A systematic literature search was carried out with the appropriate MeSH terms using Medline/Pubmed/LiLACS and the Cochrane database, with the established criteria being based on the inclusion of articles according to the degree of recommendation and strength of evidence of the Classification of Recommendations, Evaluation, Development, and Evaluation System (GRADE). The recommendations that make up this guide were gathered to assist in the individualized clinical practice of nutritionists in the nutritional management of patients with obesity, including nutritional management in the intragastric balloon; pre and postoperative nutritional treatment and supplementation in bariatric and metabolic surgeries (adolescents, adults, elderly, pregnant women, and vegetarians); hypoglycemia and reactive hyperinsulinemia; and recurrence of obesity, gut microbiota, and inflammatory bowel diseases. We believe that this guide of recommendations will play a decisive role in the clinical practice of nutritionists who work in bariatric and metabolic surgery, with its implementation in health services, thus promoting quality and safety in the treatment of patients with obesity. The concept of precision nutrition is expected to change the way we understand and treat these patients.

Principles of Nutritional Management in Patients with Liver Dysfunction—A Narrative Review

According to studies, the liver’s ability to perform its physiological functions in the body determines the diet of patients with liver diseases. Malnutrition results from the liver’s inability to metabolize nutrients as a result of chronic liver dysfunctions. Objectives: Reviewing the data about diets and dietary supplements that manage liver dysfunctions nutritionally. Results: Malnutrition is particularly prevalent in cirrhosis patients, according to clinical studies. Because malnutrition has a significant negative impact on morbidity, mortality, and quality of life, it is crucial to evaluate all cirrhosis patients, regardless of etiology or severity. A term of supplemental enteral nutrition may be suggested for patients who do not achieve their nutritional objectives. A detailed nutritional and exercise assessment will enable the development of an individualized treatment plan that includes dietary and exercise plans. The dietary treatment should outline daily calorie targets with a focus on high-quality protein and address any vitamin and micronutrient deficiencies, with a diet high in those nutrients or supplements. Conclusions: While there is evidence to support the use of particular restricted dietary plans and dietary supplements to manage liver diseases, these findings should be regarded as preliminary until they are confirmed in larger randomized controlled clinical trials.

A survey on nutritional management of critically ill children on continuous renal replacement therapy

We conducted a survey of pediatric nephrologists to examine the knowledge and current practices of and identify challenges in the nutritional management of critically ill children during continuous renal replacement therapy (CRRT). Although it is known that there is a significant effect on nutrition during CRRT, there seems to be a lack of knowledge as well as variability in the practices of nutritional management in these patients, as indicated by our survey results. The heterogeneity of our survey results highlights the need to establish clinical practice guidelines and develop consensus around optimal nutritional management in pediatric patients requiring CRRT. The results as well as the known effects of CRRT on metabolism should be considered during the development of guidelines in critically ill children on CRRT. Our survey findings also highlight the need for further research in the assessment of nutrition, determination of energy needs and caloric dosing, specific nutrient needs, and management.

Predicting dry weight in patients with cirrhotic ascites undergoing large-volume paracentesis

Ascites impairs the correct diagnosis and nutritional management in patients with cirrhosis, because the body weight, which is needed for nutritional assessment and calculation of nutritional needs, is overestimated. To adjust the weight in patients with ascites, dietetic guidances indicate substracting 2.2-14kg or 5-15% of the measured body weight according to the degree of ascites, however, there is a lack of evidence to substantiate these values. The aim of this study was to develop new prediction equations to estimate the dry weight, comparing them with the currently used weight adjustments in patients with refractory cirrhotic ascites. Cross-sectional study, that included patients with decompensated cirrhosis undergoing large-volume paracentesis. Patients were submitted to nutritional risk screening, nutritional assessment, and anthropometric measurements that included body weight, abdominal circumference (both measured before and after paracentesis) height, and upper mid-arm circumference. The volume of ascitic fluid drained was also registered. For the predictions of dry weight, linear regression models were performed using as predictor variables: height, pre-paracentesis weight, pre-paracentesis abdominal circumference, or mid-upper arm circumference, and as response variable: post-paracentesis weight. The capacity of these models to predict the post-paracentesis weight was evaluated by comparing it with the currently used predictions through the intraclass correlation coefficient (ICC) and the mean squared error (MSE). Nineteen patients were included, 15 male, and 18 with high nutritional risk and malnutrition. The difference between post-paracentesis weight and pre-paracentesis weight was-5.0 (-3.6 to-9.9) kg, similar to ascitic fluid volume drained. Two equations were developed to predict post-paracentesis weight. ICC values showed that both prediction equations were strongly correlated (r>0.94) with post-paracentesis weight. Our models also showed lower MSEs (<17.97), compared with the current predictions (MSEs <64.19, when the pre-paracentesis weight is adjusted from absolute values and MSEs <33.24 when adjusted from percentage values), indicating a more accurate prediction. The predictive equations from this study may be better options for dry weight estimation in patients with refractory cirrhotic ascites since they showed higher reliability compared to the currently used weight adjustment. External validation in a larger sample is still needed to confirm the clinical applicability of these equations.

Advances in multidisciplinary team-based collaborative care models in the nutritional management of patients with hepatocellular carcinoma

Liver cancer is a common and highly prevalent malignancy in China, and is a high prevalence of malnutrition. With the continuous innovation of medical technology and nursing model, the multidisciplinary teamwork nursing model has become inevitable for the care of liver cancer patients. This study reviews the concept of MDT nursing model, its development status at home and abroad and its application in the postoperative nutritional management of hepatocellular carcinoma patients, aiming to provide a basis for clinical hepatocellular carcinoma nutritional management.

Research Progress on Malnutrition and Nutritional Management in Patients with Colorectal Cancer Undergoing Chemotherapy

This paper introduces the status quo of malnutrition in patients with colorectal cancer undergoing chemotherapy, and reviews the status quo of nutritional management of patients with colorectal cancer after chemotherapy, in order to provide reference for the whole process of nutritional management in patients with colorectal cancer undergoing chemotherapy.

Nutritional Management in Patients with Chronic Liver Disease Difficulties and Hurdles Faced by Physicians: A Preliminary Survey

Nutritional Management in Patients with Chronic Liver Disease Difficulties and Hurdles Faced by Physicians: A Preliminary Survey

Effectiveness of intensive perioperative nutrition therapy among adults undergoing gastrointestinal and oncological surgery in a public hospital: study protocol for a pragmatic randomized control trial

BackgroundPerioperative malnutrition is common in patients undergoing gastrointestinal-oncology surgery and is associated with longer hospital stays, increased postoperative complications, poorer quality of life, and lower survival rates. Current practice emphasizes the role of early perioperative nutrition therapy as an early intervention to combat the postoperative complications of patients and the implementation is now widely adopted. However, there is still a lack of research on determining the effectiveness of intensive nutrition therapy and providing ONS perioperative locally. This becomes the significance of this study and serves as a basis for management and guideline in the local hospital settings.MethodsThis is a pragmatic randomized control trial study where elective admitted patients will be randomly divided into the intervention (SS) or control (NN) group. All data will be collected during a face-to-face interview, anthropometric measurement, blood sampling (albumin, white blood count, hemoglobin, and c-reactive protein), handgrip strength, and postoperative complications. Group SS will be receiving a tailored lifestyle and intensively supplemented with oral nutrition support as compared to Group NN that will receive standard medical care. The primary outcome for this study is the length of stay in the hospital. Additional outcome measures are changes in biochemical profile and nutritional and functional status. The effects of intervention between groups on the outcome parameters will be analyzed by using the SPSS General Linear Model (GLM) for the repeated measure procedure.DiscussionThe intervention implemented in this study will serve as baseline data in providing appropriate nutritional management in patients undergoing gastrointestinal and oncological surgery.Trial registrationClinicalTrials.gov Protocol Registration and Results System (PRS) NCT04347772. Registered on 20 November 2019.