Nutrition-related Symptoms Research Articles

Evaluation of Nutritional Status in Cancer Patients Underwent Radiotherapy: The Results of Biochemical, Body Composition with Bioelectrical Impedance Analysis, Anthropometric Measurements, and Patient-Generated Subjective Global Assessment

Aim: This study aims to evaluate the nutritional status and the effect of radiotherapy (RT) on nutrition in all ambulatory cancer patients. Material and Method: In this prospective observational study 105 cancer patients with various diagnoses treated between 2013 and 2014 were evaluated. All patients were ≥18 years old and had Karnofsky Performance Status ≥70. Anthropometric measurements, body composition with bioelectric impedance, and patient-generated Subjective Global Assessment (PG-SGA) tools were used. The height, weight, body mass index (BMI), triceps skin fold thickness, mid-upper arm circumference, hemoglobin, and serum albumin levels were determined twice before and after RT. Additionally, nutrition-related symptoms and short-term weight loss results were determined by PG-SGA questionnaires. Results: The patients’ median age was 53 years (range, 18-82 years). At initial evaluation 74 patients were well nourished using the PG-SGA global rating. Malnutrition developed in totally 33 of these 74 patients after RT. The PG-SGA results after RT were significantly worse than before treatment. PG-SGA revealed no significant relationship between nutritional status prior to RT and the parameters including gender, age, mean weight, BMI, disease duration, pre-RT hemoglobin and albumin levels. Post-RT evaluation showed a significant relationship between deterioration (PG-SGA B-C) and mean weight, BMI, serum albumin, hemoglobin levels, and concomitant chemotherapy. Gastrointestinal and head and neck cancer patients had the most deterioration after RT. The patients' weight, BMI, fat-free mass, total body water, and the percentage weight loss at the end of RT were significantly lower than the initial assessment. Conclusion: It is considerable to use multiple tools for nutritional monitoring. Patients who received RT to the head and neck and upper abdomen region had a high risk of deterioration after treatment. These patients should be monitored carefully during all treatment periods.

Perceptions, Experiences, Barriers and Facilitators Regarding Nutritional Intake of Patients with Chronic Limb Threatening Ischemia: A Qualitative Study

Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake. In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed. Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning, and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake. Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health-related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.

The Association of Frailty and Malnutrition With Dietary Intake and Gastrointestinal Symptoms in People With Kidney Failure: 2-Year Prospective Study

Frailty and malnutrition are both associated with worsening morbidity and mortality and become more prevalent in the elderly and as kidney function declines. Anorexia and reduced oral intake are common features of both frailty and malnutrition. However, there are sparse data evaluating the impact of other gastrointestinal (GI) symptoms, such as taste changes, on rates of frailty and malnutrition in people with kidney failure. The aim of this study is to describe the prevalence of frailty and malnutrition and their association with dietary intake and nutrition-related symptoms in people with kidney failure. This observational study recruited people with kidney failure who were commencing Conservative Kidney Management or elderly people (aged > 75years) newly commenced on dialysis from 3 renal units. Participants underwent assessments of frailty, nutritional status, dietary intake, and GI symptom burden when they attended clinic appointments, approximately every 6months. Of the 85 participants, 57% were assessed as being frail and 33% were assessed as being malnourished. Participants assessed as frail reported more GI symptoms (3 vs. 2, P<.001) that were more severe (1.75 vs. 1.0, P<.001) compared to nonfrail participants. Being malnourished was associated with a 5 times higher chance of being frail (odds ratio 5.8; 95% confidence interval 1.5, 21.8; P=.015) and having more severe symptoms was associated with a 2 times higher chance (odds ratio 2.8; 95% CI 1.1, 7.0; P=.026) of being frail. In addition to experiencing more GI symptoms, that were more severe, participants who were malnourished consumed significantly less energy (1234kcal vs. 1400kcal, P=.01) and protein (51 g vs. 74 g, P<.001). Frailty and malnutrition are common and are associated with a higher GI symptom burden and poorer dietary intake. Future research is needed to determine effective interventions targeting frailty and malnutrition, including nutrition-related symptoms and optimal protein intake.

Perioperative nutritional risk and its influencing factors in patients with oral cancer: a longitudinal study.

We aimed to investigate the nutritional risk status and dynamic changes in patients with perioperative oral cancer at different stages and analyze the factors influencing nutritional risk and the correlation among body mass index, nutrition-related symptoms, and nutritional risk. In total, 198 patients with oral cancer who were hospitalized in the Head & Neck Surgery Departments of a tertiary cancer hospital in Hunan Province, China, from May 2020 to January 2021, were selected as participants. The Nutritional Risk Screening 2002 scale and Head and Neck Patient Symptom Checklist were used to assess patients on admission day, 7 days post-surgery, and 1 month post-discharge. Multivariate analysis of variance, paired t-test, and generalized estimating equation were used to analyze the trajectory and influencing factors of nutritional risk in patients with perioperative oral cancer. Spearman's correlation analysis was used to explore the correlation among body mass index, symptoms, and nutritional risk. The nutritional risk scores of patients with oral cancer at the three time points were 2.30 ± 0.84, 3.21 ± 0.94, and 2.11 ± 0.84, respectively, and the differences were significant (p < 0.05). The incidences of nutritional risk were 30.3, 52.5, and 37.9%, respectively. The factors influencing nutritional risk included education level, smoking status, clinical stage, flap repair, and tracheotomy (β = -0.326, 0.386, 0.387, 0.336, and 0.240, respectively, p < 0.05). Nutritional risk was negatively correlated with body mass index (rs = -0.455, p < 0.01) and positively correlated with pain, loss of appetite, sore mouth, bothersome smells, swallowing difficulty, taste changes, depression, chewing difficulty, thick saliva, and anxiety (rs = 0.252, 0.179, 0.269, 0.155, 0.252, 0.212, 0.244, 0.384, 0.260, and 0.157, respectively, p < 0.05). The incidence of nutritional risk in patients with perioperative oral cancer was high, and the trajectory of nutritional risk changed over time. Strengthening the nutritional monitoring and management of postoperative patients or those with low education level, advanced-stage cancer, flap repair, tracheotomy, and low body mass index; strengthening tobacco control management; and controlling nutrition-related discomfort symptoms in perioperative oral cancer patients are necessary.

Weight, nutrition, quality of life—Perspective of oncological patients

Nutrition is associated with pleasure and quality of life. The majority of oncological patients experience tumor-associated and treatment-associated nutrition-related symptoms and malnutrition. Consequently, the perception of nutrition during the course of the disease is increasingly more characterized by negative associations, which may persist for years after the end of treatment. This leads to a decreased quality of life, social isolation and aburden for relatives. In contrast, weight loss is initially positively perceived, especially by patients who previously perceived themselves as being overweight, until malnutrition becomes evident and leads to a decreased quality of life. Nutritional counseling can prevent weight loss, relieve adverse side effects, improve the quality of life and reduce mortality. Patients are not aware of this and the German healthcare system lacks structured and firmly established access pathways to nutritional counseling. Therefore, oncological patients need to be informed about the consequences of weight loss at an early stage and low-threshold access to nutritional counseling needs to be comprehensively implemented. Thus, malnutrition can be recognized and treated at an early stage and nutrition can contribute to ahigher quality of life as apositively perceived daily activity.

Evaluating an AI-based nutrition expert platform delivered via SMS-text to support patients with cancer.

1569 Background: Interventions incorporating nutritional strategies can prevent and manage nutrition-related symptoms, however, due to a shortage of oncology dietitians (RD CSO) combined with healthcare access disparities, many patients do not receive the support they need, resulting in poor outcomes and quality of life (QoL). High rates of cell phone utilization among all demographics offers a unique opportunity to provide interventions using mobile technology. Methods: Launched to select groups in 2019, Ina (trademarked by Savor Health LLC) is a virtual nutrition assistant powered by an artificial intelligence (AI)-enabled expert platform, to facilitate self-management of cancer treatment side effects. The platform combines evidence, expertise, and unique patient data to deliver the personalized guidance patients would receive from an RD CSO, “on-demand” via text. This study applied the RE-AIM framework to evaluate the intervention from five dimensions. Results: Reach: The program reached 1,706 users as of 2021. Based on self-report among 1209 users, 78% are patients, 18% are caregivers, and 5% are healthcare professionals with 66% female and 34% male. Ina supports all cancer types, and top diagnoses among users are genitourinary (28%), lung (20%), gynecologic (16%), gastrointestinal (15%), and breast (11%). Disease burden is high, with 62% of users reporting they are experiencing nutrition-addressable symptoms at any given time. Effectiveness: Based on weekly patient reported outcome (PRO) surveys, 87% of respondents report Ina helps them manage symptoms, and 80% report that using Ina has improved their QoL. The cumulative likelihood to recommend is 4.1 on a 5-point scale. Adoption: Users are from over 18 cancer organizations, proving the feasibility and accessibility of this intervention. Implementation: Ina is accessible 24/7 via text, and is offered to patients in a B2B2C model. Users typically receive responses to nutrition-related questions within seconds from the AI platform (or 1-3 minutes with live RD oversight). Each active user (one that engages at least once in a given month) asks an average of 2.8 questions per month. Maintenance: The median time users remain on the platform is 156 days (range 0-884) and 57% of evaluable users stayed on the platform 6 months or longer. The platform’s database, which includes over 54,000 referenced interventions, grows daily via supervised machine learning supported by RD CSOs. When surveyed on future feature development, respondents are most interested in tele-nutrition (57%), mental health (65%), and stress management (62%). Conclusions: Initial data suggests this is a feasible and accessible tool to support cancer patients’ unique nutrition and symptom-management needs. Clinical trials are needed to validate feasibility and assess impact on clinical and QoL outcomes. Product development to integrate language and cultural preferences is ongoing.

Growth and nutrition in pediatric neuromuscular disorders

Little is currently known about the nutrition and growth outcomes in children with neuromuscular disorders (NMDs), and these are likely disease dependent. The aim of this study was to describe the range of nutritional issues in pediatric NMDs and identify similarities and differences in growth outcomes and nutritional needs in children with a variety of NMDs at different ages, with the goal of informing future services. In this cross-sectional study we collected data on growth, dietetic interventions and nutrition-related issues in 160 children who attended a multidisciplinary clinic in a tertiary children's hospital, from February to December 2019. Children with significant weakness affecting mobility before the age of 3 years were clinically grouped into 'early-onset NMDs'. Across our clinic, 42.5% children had a history of chronic gastrointestinal issues, and 34.4% received dietetic care on the day of clinical visit. Children with early-onset NMDs had significantly higher prevalence of swallowing issues, gastroesophageal reflux, and vomiting, as well as higher frequency of dietetic consultations, high energy diet, swallowing assessment and tube-feeding, compared to later-onset NMDs (p<0.05). In total, 49.2% children with NMDs had an abnormal weight, in which the prevalence of underweight (n=24, 19.2%) was significantly higher compared to normal Australian children (8.2%) (p<0.05). In Duchenne muscular dystrophy, over 50% children were overweight/obese. Among children with NMDs, there were many disease-specific nutrition-related symptoms, growth issues, and dietetic practices that were tailored to individual needs. Future studies should focus on measuring the impact of specific dietetic practices on growth and nutritional outcomes, as well as developing a precision medicine approach tailored to the individual nutritional needs of children with NMDs.

End-of-Life Nutrition Considerations: Attitudes, Beliefs, and Outcomes.

To assess the physiological outcomes and interpersonal influences that should be considered when making the decision to provide artificial nutrition and hydration (AN&H) for patients in hospice/palliative programs. A systematic review was conducted using items from the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols 2015 checklist. Distinct search strategies were employed to find primary research articles that addressed: General health outcomes of artificial nutrition and hydration interventions and nutrition therapy interventions (n = 16), nutrition-related symptoms in end-of-life care (n = 8), and the attitudes of patients and providers toward artificial nutrition and hydration (n = 21). The effect of AN&H on health outcomes, quality-of-life measures and nutrition-related symptoms is limited and may vary by patient setting and diagnosis. In the absence of consistent evidence for specific health outcomes, decisions regarding AN&H should be made in context of the desires and beliefs of a patient, their family, and their medical providers. These beliefs may not be consistent with likely outcomes or may be inconsistent between individuals involved in the decision-making process, and individuals of different cultures or geographic regions may approach AN&H decisions from different perspectives. To help navigate the intersection of nutrition-related health outcomes and patient/provider beliefs, palliative care teams may employ a variety of strategies for approaching the decision-making process, and may benefit from specific involvement of a Registered Dietitian to help contribute to or lead these discussions.

Prevalence of Taste Changes and Association with Other Nutrition-Related Symptoms in End-Stage Kidney Disease Patients

Gastrointestinal symptoms are common in end-stage kidney disease (ESKD) and have been associated with reduced health-related quality of life and malnutrition. The aim of this study is to describe the prevalence of taste changes in an ESKD population and to evaluate whether taste changes are associated with the presence or severity of other nutrition-related symptoms and malnutrition. We conducted a retrospective audit of people with ESKD on conservative, nondialysis management or renal replacement therapy who had completed a taste change assessment. Taste change was assessed on a Likert scale from none to overwhelming. Descriptions of taste changes were also collected. Other outcomes included gastrointestinal symptoms collected using the iPOS-renal symptom inventory, nutritional status, and biochemical parameters. In total, 298 patients were included in our analysis. Taste changes were reported in 38% of this cohort. Taste changes were significantly associated with upper gastrointestinal symptoms (nausea, vomiting, anorexia, and dry/sore mouth) and malnutrition. Our findings indicate that taste changes are highly prevalent and probably under-recognized in ESKD. Further investigation of the association with malnutrition is needed. Future trials are needed to evaluate strategies to manage taste changes in this population.

Nutrition-related symptoms in adult survivors of critical illness who are eating orally: a scoping review protocol.

This review will explore and map the current literature on the nutritional impact of symptoms reported by adult survivors of critical illness who are eating orally after discharge from the intensive care unit (ICU). Survivors of critical care often experience ICU-acquired weakness and poor functional recovery. It is plausible that nutrition interventions throughout their recovery could improve outcomes for these patients. Although a growing number of studies aim to explore the effect of nutrition delivered in the early phases of critical illness, this is also important post-ICU discharge, particularly in already nutritionally compromised patients presenting with muscle loss and fatigue. Therefore, the development of targeted nutrition interventions will be informed by a comprehensive insight into the physiological, physical, or psychological difficulties that critically ill patients experience after ICU discharge, which may impede oral intake. This review will consider primary research studies with adult patients 18 years and older, who are in the recovery phase after being critically ill, and eating orally. Studies must report on any symptoms related to the ability to eat, or represent nutrition inadequacy or utilization. A scoping review will be conducted in accordance with JBI methodology using a three-step search strategy of MEDLINE, Embase, CINAHL, AMED, Web of Science, Cochrane Database of Systematic Reviews, and JBI Evidence-based Practice Database to obtain primary research studies that meet the inclusion criteria. Duplicates will be removed, and study selection and data extraction will be conducted and cross-checked by two independent reviewers. Data synthesis will involve presenting the results in tabular form.

SUN-102 NUTRITION-IMPACT SYMPTOM BURDEN IN PATIENTS ATTENDING RENAL SUPPORTIVE CARE

End-stage kidney disease is associated with high symptom burden resulting in increased morbidity and mortality. Renal Supportive Care (RSC) is a multi-disciplinary approach to the management of patients with end-stage kidney disease who have chosen a conservative (non-dialysis) pathway or receiving renal replacement therapies (RRT) (eg. haemodialysis, peritoneal dialysis and transplantation) and suffering a significant symptom burden. Nutritional counselling plays an important role in the management of symptoms affecting a patient’s ability to eat well and prevent or treat malnutrition. Currently, no Australian data exists to describe the nutrition-impact symptom burden suffered by this group and the change in this symptom burden with nutritional counselling. This study aimed to describe the burden of nutrition-impact symptoms suffered by patients attending RSC and to describe the change in number and severity of nutrition-impact symptoms with dietetic intervention. A prospective audit was conducted from August 2015 to December 2017 for patients attending RSC across NSW. The presence and severity of nutrition-impact symptoms (poor appetite, sore or dry mouth, constipation, nausea, vomiting, diarrhoea) was assessed using the Palliative Care Outcome Scale-Renal (IPOS-Renal). Nutrition symptoms were scored from mild (1) to overwhelming (4). Nutrition-impact symptom severity scores were calculated by dividing the total symptom score by the number of nutrition symptoms. In NSW, patients on dialysis attending RSC services suffered from a higher rate of nutrition-impact symptoms than those being conservatively managed. The most frequently reported nutrition-impact symptoms were sore or dry mouth, poor appetite and constipation in both dialysis and conservatively managed patients. Sore or dry mouth was the most frequent symptom (63% of dialysis patients and 59% of conservatively managed patients), followed by poor appetite (54% in both dialysis and conservatively managed patients) and constipation (47% of dialysis patients and 37% of conservatively managed patients). Among dialysis patients, there was a decrease in total number of nutrition-impact symptoms between initial and follow-up nutritional assessments, 2.58 to 2.39 respectively. However, there was no change in the total number of nutrition-impact symptoms among conservative care patients with an average of 2.10 nutrition-related symptoms. The nutrition-impact symptom severity score of patients receiving dialysis (n=59) was 0.85 compared with 0.65 in conservatively managed patients (n=109). In both the dialysis (n=117) and conservative groups (n=251), nutrition-impact symptom severity improved between initial and follow-up dietitian interventions (0.76 and 0.59 respectively). Patients receiving dialysis attending RSC services suffer the highest nutrition-impact symptom burden. The three most common nutrition-impact symptoms experienced in both dialysis and conservatively managed patients being a sore or dry mouth, poor appetite and constipation. This study demonstrated that interventions by a dietitian were associated with reduced total number of nutrition-impact symptoms in dialysis patients and a decrease in nutrition-impact symptom severity in both dialysis and conservatively managed patients.

Prognostic impact of early nutritional support in patients affected by locally advanced and metastatic pancreatic ductal adenocarcinoma undergoing chemotherapy.

The aim of this analysis was to determine the risk of malnutrition and the prognostic value of nutritional intervention in patients affected by pancreatic ductal adenocarcinoma (PDAC) undergoing chemotherapy. Clinical-pathological and nutritional data were correlated with overall survival (OS) using a Cox model. Nutritional status was determined by Malnutrition Universal Screening Tool (MUST), body mass index, weight loss in the past 6 months, presence of nutrition-related symptoms, and current energy intake. Nutritional intervention included appropriate individual dietary counseling. Data from 109 patients were gathered (median age 63 years). The majority of patients (64.2%) presented a MUST value of ≥ 2, corresponding to a high risk of malnutrition. At multivariate analysis for OS in locally advanced and metastatic PDAC patients, the time between the diagnosis and the nutritional intervention (HR 2.22, p = 0.017), the performance status (HR 1.38, p = 0.075), the surgery of the primary (HR 5.89, p = 0.005), and the response to the first line (HR 5.9, p = 0.03) were independent significant predictors of outcome. Furthermore, a weight gain > 2% from the baseline weight was correlated with the time between the diagnosis and the nutritional intervention (p = 0.021): in patients receiving a nutritional support within 3 months from diagnosis, a 2% weight gain was associated with a 2-year OS benefit (50.3% vs. 33.0%, p = 0.04). This analysis suggests that the early nutritional support may contribute to influence the prognosis of patients affected by advanced PDAC undergoing chemotherapy.

AB96. 141. Altered appetite, body weight and quality of life after curative oesophagectomy

Background: Improved oncologic outcomes in oesophageal cancer have resulted in increased survivorship, and a focus on long-term health-related quality-of-life (HR-QL). Gastrointestinal symptoms are common among patients after oesophagectomy, but data regarding the postoperative trajectory of nutrition-related symptoms and their relation to body weight loss (%BWL) and HR-QL are lacking. This study aimed to characterise the prevalence of gastrointestinal symptoms and altered appetite, and their impact on postoperative HR-QL in survivorship.

Managing the nutritional needs of palliative care patients.

The nutritional needs of patients receiving palliative care should be routinely assessed, taking into account disease trajectory and nutrition-related symptoms. The social and emotional aspects of eating and drinking should also be acknowledged; as should the distress that weight loss and anorexia engenders in patients and their families. Practical strategies to optimise nutritional intake are discussed. Open and sensitive communication of patients' needs and wishes is essential, especially when discussing complementary nutrition approaches. A holistic, multidisciplinary approach is key to meeting nutritional needs, and the goals of nutritional intervention should be regularly reviewed in the light of disease progression.

A Cross‐Sectional Study in Rural Areas of Myanmar: The Impacts of Dietary Behaviors and Nutrition Intervention on 6‐ to 72‐Month‐Old Children

BackgroundMyanmar is the largest country in Southeast Asia geographically, with over 50 years of internal conflicts. Over half of the children suffer from malnutrition and face a higher risk of morbidity and mortality. However dietary behaviors in this area are seldom reported and its effects on child's health are still unknown.ObjectivesThe objectives of this study were: 1) to explore the possible dietary behaviors that might be associated with malnutrition, and 2) to assess the health effects of the nutrition promotion program.MethodsNine villages in the mountainous peripheral areas of Kachin, Shan, and Kokang were selected using convenience sampling. A nutrition promotion program by Health Poverty Action (HPA) was conducted in these areas half a year ago, and nutrition packages (FERROVIT, MEGA, Thailand: containing ferrous fumarate, folic acid and vitamin B12) and relief food (rice) were assigned to the head of the village or village doctors, then assigned to the target families according to personal experience. For assessment, a cluster sampling method was used for household selection and 141 children aged 6 to 72 months old participated in this study and provided the blood samples. A food frequency questionnaire was used to obtain data on dietary behaviors. Illness and nutrition related symptoms in the past three months were obtained from local medical records and caregivers' recall. Hemoglobin concentration, blood trace elements and anthropometric indicators were measured. The study was conducted in compliance with the Declaration of Helsinki and approved by local government. Written consent was obtained from all the primary caregivers.ResultsSignificant insufficient intake of food was found in the studied children. In total, 58.3% of children consumed eggs less than once a week and for meat 25.0% of children consumed it less than once a week. In weaned children, 72.4% consumed dairy products less than once a week. The intake frequencies of eggs, meat and dairy products were all positively associated with the height‐for‐age Z score and hemoglobin levels. Children with a higher frequency of egg intake were more likely to have a lower chance of diarrhea and fever. Children with a higher meat intake were more likely to have a lower rate of fever. There were no associations between food intake frequencies and blood trace elements' levels. For the nutrition promotion program, the coverage rate of the nutrition package and relief food in studied children was 37.5% and 4.7% respectively and more were assigned to children under 24 months old. The hemoglobin of children who received or did not receive nutrition package was 91.8±21.4 g/L and 104.1±16.2 g/L respectively. Meanwhile, a lower blood iron level and a higher occurrence of fever were found in children who received the nutrition package.ConclusionChildren in the mountainous peripheral areas of Myanmar still face a threat of food shortage and this contributes to malnutrition. Assign nutrients package by villages head can general cover the target malnourished population. However, the health effects were limited, partly because of the limited intervention time and partly due to a lack of constant following up and assessment.Support or Funding InformationSupported by Health Poverty Action Eastern Asia Programme Office

Nutritional care of cancer patients: a survey on patients' needs and medical care in reality.

Cancer patients represent a patient group with a wide-range of nutrition related problems which are often under-recognized and undertreated. In order to assess the status quo of nutritional care in Germany, we conducted a survey among patients with different types of cancer. A standardized questionnaire was distributed online by two national umbrella organizations for self-help groups. 1335 participants completed the questionnaire. 69% of the participants reported having received information on nutrition and/or specific nutrition-related symptoms. Most often this information was derived from print media (68.5%) or from within self-help groups (58.7%). 57.0% of participants reported having had questions concerning nutrition and/or problems with food intake. most frequently named topics of interest were "healthy diet" (35.0%) weakness/fatigue (24.3%), dietary supplements (21.3%) and taste changes (19.8%). Nutrition information was most often provided by dietitians (38.7%) followed by physicians (9.8%). Women reported receiving nutrition counseling in the hospital nearly twice as often as men (12.5% versus 5.7%; p<0.001). A quarter of the patients (24.1%) reported using dietary supplements and patients who had received some sort of nutrition information more often reported using supplements (p<0.001). Nutrition is an essential element in cancer care and patients report a high interest and need: Yet, many patients do not have access to high quality nutrition therapy during and after cancer therapy. With respect to survival and quality of life, increasing the availability and resources for provision of evidence based nutrition information seems mandatory.

Effects of chemotherapy on quality of life in breast cancer survivors.

112 Background: Women undergoing chemotherapy for breast cancer often experience side effects that can impact quality of life and tolerance of planned therapy. This can lead to poor outcomes. By understanding these changes, we can intervene and improve the treatment for women. We hypothesized that chemotherapy would be associated with changes in functional status and nutrition related symptoms in breast cancer survivors. Methods: Patients were prospectively recruited prior to initiation of their neo-adjuvant or adjuvant therapy. Body mass index (BMI) was abstracted from records. The patient’s functional status was assessed using the Duke Activity Status Index (DASI), and the Patient Generated Subjective Global Assessment (PG-SGA) characterized nutrition-related symptoms of patients. Participants completed these questionnaires prior to initiating the first cycle chemotherapy (time point 1), during the second cycle (time point 2), and during the last cycle of chemotherapy, 12-20 weeks after initiation of treatment (time point 3). Changes in BMI, functional status, and symptomatology were analyzed using linear mixed effects models. Results: Twenty-five women enrolled; 19 women with a median age of 51 (range 33-66) completed the study. There was no significant change in BMI (p = 0.18) over the duration of chemotherapy. Analysis of DASI data indicated that there was a significant decline in peak oxygen uptake (p = 0.005), showing a decrease in functional capacity from before the first cycle to both the second and the last cycles. This suggests that functional capacity dropped significantly once chemotherapy began and stayed below baseline. There was also a significant change in PG-SGA (p = 0.005), indicating significant reported nutrition-related symptoms. PG-SGA scores were significantly higher during the second cycle compared to the other two time points, indicating that patient’s showed the highest degree of symptoms shortly after initiation of treatment and then improved. Conclusions: Chemotherapy is associated with symptomatology and a decrease in functional capabilities. Improved understanding of symptom burden during chemotherapy will allow more specific interventions to be designed that can help improve quality of life.

An investigation into between-meal food desires among hospitalised haematological cancer patients

Hospitalised haematological cancer patients often suffer from reduced appetite and food intake, which negatively influences the patients' well-being and nutritional status. The aim of this study was to identify specific between-meal food desires in a patient group, in order to increase food intake. The study was conducted using a picture-aided questionnaire, and relating the preferences to factors that could easily be implemented in the hospital menu, such as time of the day and texture. Moreover, the results of the questionnaire were verified by acceptance tests on six selected food items. A structured 42 items food questionnaire was developed and used to quantify appetitive food desires in patients during morning (11am) and afternoon (3pm) sessions. Food items were scored according to patients' preferences and immediate desire to eat. A total of 112 hospitalised haematological cancer patients, screened for nutrition-related symptoms, participated. Univariate statistical models were used to investigate the influence of time-of-day and food texture on between-meal desires. Fresh fruit, ice cream, cheese and mashed potatoes with bacon were the most desired food items. Patients showed significant higher desire to eat in the morning as opposed to the afternoon. Moreover, texture had an influence on food desire, where liquid food was more desired than food with soft or coarse texture. Ranking of food desires among hospitalised cancer patients showed inclination for fresh fruit, ice cream, mashed potatoes with bacon, and cheese. Time of the day (morning) and texture (liquid) had the greatest and most positive impact on food desires. The findings may be easily implemented in hospital food service routines for cancer patients, and might positively contribute to patients' well-being and nutrition.

The management of perioperative nutrition in patients with end stage liver disease undergoing liver transplantation.

Malnutrition is found in almost 100% of patients with end stage liver disease (ESLD) awaiting transplantation and malnutrition before transplantation leads to higher rates of post-transplant complications and worse graft survival outcomes. Reasons for protein energy malnutrition include several metabolic alterations such as inadequate intake, malabsorption, and overloaded expenditure. And also, stress from surgery, gastrointestinal reperfusion injury, immunosuppressive therapy and corticosteriods use lead to delayed bowl function recovery and disorder of nutrients absorption. In the pretransplant phase, nutritional goals include optimization of nutritional status and treatment of nutrition-related symptoms induced by hepatic decompensation. During the acute post-transplant phase, adequate nutrition is required to help support metabolic demands, replenish lost stores, prevent infection, arrive at a new immunologic balance, and promote overall recovery. In a word, it is extremely important to identify and correct nutritional deficiencies in this population and provide an adequate nutritional support during all phases of liver transplantation (LT). This study review focuses on prevalence, nutrition support, evaluation, and management of perioperative nutrition disorder in patients with ESLD undergoing LT.

The association between malnutrition and psychological distress in patients with advanced head-and-neck cancer.

Malnutrition and psychological distress are often seen in patients with head-and-neck cancer, but little is known about the interrelationships between those two symptoms. The present study examined the relationship between malnutrition and psychological distress in patients with advanced head-and-neck cancer. Using the Patient-Generated Subjective Global Assessment, 99 patients with advanced-stage head-and-neck cancer were screened for nutrition status. The patients were also screened for psychosocial distress (using the Distress Thermometer) and for psychosocial issues (using the Problem Checklist). Any relationship between malnutrition and psychosocial distress was determined by regression and correlation analysis. We also used t-tests to compare distress levels for patients with and without specific nutrition-related symptoms. The study group included 80 men and 19 women [mean age: 58.4 ± 10.9 years (range: 23-85 years)]. The correlation between poorer nutrition status and level of psychological distress was significant r = 0.37 (p < 0.001). Specifically, reduced food intake and symptoms were both positively associated with distress: r = 0.27 and r = 0.29 respectively, both significant at p < 0.01. After controlling for the effects of psychosocial problems and pain, nutrition status remained a significant predictor of distress, explaining 3.8% of the variance in the distress scores of the patients (p < 0.05). Malnutrition and symptoms were strongly related to distress in patients with advanced head-and-neck cancer. Our results suggest the need for further research into the complex relationship between nutrition status and distress and into the management of both nutrition and distress in cancer care.