Nutrition Care Process Research Articles

Development and Evaluation of a Practiice-Based Assignment in Chronic Kidney Disease to Enhance Clinical Nutrition Coursework

ObjectivesThe objective of this work was to develop and evaluate a novel practice-based clinical nutrition assignment to support competency-based academic nutrition programs that integrate didactic and experiential program components. The target audience was graduate nutrition students enrolled in a clinical nutrition course sequence. MethodsAs an alternative to a traditional “paper and pencil” case study assignment, each student was assigned to conduct an in-person, out-of-class interview with a practicing renal nutritionist. In written assignment directions, students were provided with questions for a structured interview which followed the nutrition care process, i.e., nutrition assessment, diagnosis, intervention, monitoring/evaluation, with application to nutrition management of chronic kidney disease. Subsequently, students responded anonymously to Likert scale questions regarding clinical knowledge and confidence in clinical skills derived from the practice-based assignment compared to their expected gains from a traditional “paper and pencil” case assignment plus an open-ended question. ResultsThe assignment supported clinical nutrition students’ competency in nutrition management of chronic kidney disease and facilitated their networking within the professional nutrition practice community. In class, students shared details of their interview findings from an array of practicing renal nutritionists which generated rich discussions in contrast to a single case study. In evaluating the practice-based assignment, n = 31 students reported on 5 point scales a mean of 4.4 regarding knowledge of clinical nutrition management and a mean of 4.0 regarding confidence in clinical skill derived from the practice-based assignment compared to expectations from a traditional case study assignment (where 5 = better than what I expected and 4 = slightly better than what I expected I would have gained from “paper and pencil” case). ConclusionsThis practice-based assignment in chronic kidney disease provided a unique approach to enhancing clinical nutrition coursework and facilitated an interactive learning environment to support students’ professional growth. Funding SourcesNone.

Evaluation of the Sex-Specific Nature of Nutrition Assessment Within the Nutrition Care Process: Case Study Vignettes of Transgender and Gender Diverse Patients

ObjectivesCertain aspects of nutrition assessment within the Nutrition Care Process (NCP) are sex-specific, meaning they require nutrition professionals to select a male or female sex (i.e., growth charts, body fat percentage, and the normal ranges for certain biochemical markers). This presents a unique question for nutrition professionals working with transgender and gender diverse (TGGD) patients who may be medically transitioning or identify as non-binary.MethodsLB is a 17 year-old, white individual who was assigned male at birth, identifies as non-binary, and uses they/their pronouns. They wear both masculine and feminine clothing and are not interested in pursuing medical interventions. LB is 5’5” and weighs 120 lbs. Which growth chart would be appropriate to assess LB's weight status? JY is a 50 year-old African American individual who assigned female at birth, identifies as transgender male, and uses he/his or they/their pronouns. JY's past medical history indicates he medically transitioned in his mid-20s, has been on masculinizing HT for the past 25 years, and is amenorrheic. Given JY's past medical history, which reference values would be most appropriate to assess hemoglobin and hematocrit? Hemoglobin - 12 g/dl Hematocrit - 37% RBCs - 5.0 ml Platelet count - 250,000 WBC - 6,000 cells/ml MR is a 30 year-old, Hispanic individual who was assigned male at birth, identifies as transgender female, and uses she/her pronouns. She started feminizing HT one month ago, is 5’8” tall and weighs 180 lbs; she would prefer a smaller physique and expressed that she would like to lose about 30 lbs. MR walks her dog for 30 minutes daily. Using the Estimated Energy Requirement (EER) equation, what are MR's energy needs to maintain her current weight? What energy requirement would support MR's weight loss goal?ResultsThe cases of LB, JY and MR illustrate the potential strategies that nutrition professionals can utilize. 1. Use reference values consistent with sex assigned at birth for patients who have not medically transitioned (LB). 2. Individualize nutrition assessment to align with the client's medical transition (JY). 3. Express data as a range between the female-male reference values (MR).ConclusionsNutrition professionals can apply specific strategies and clinical reasoning to address sex-specific aspects of nutrition assessment when caring for TGGD patients.Funding SourcesNone.

The Introduction of ERAS Nutritional Care Can Improve the Quality of Postoperative Care

ObjectivesShortening the length of hospital stay for surgical patients is the goal in many hospitals. Enhanced Recovery After Surgery (ERAS) is a broadly recognized multimodal, multidisciplinary approach. The care protocol is evidenced in various experimental publications. In 2017, the European Society for Parenteral and Enteral Nutrition (ESPEN) included ERAS care guidelines as the focus of surgical nutritional care. The promotion of ERAS has become a global trend. Our hospital began to implement a cross-team ERAS process in 2019. The purpose of this study is to share the observed outcome of postoperative ERAS nutritional care.MethodsOur ERAS medical team established the ERAS nutritional care process and started comprehensive nutritional care perioperative, which included 1) preoperative nutritional screening and intervention; 2) offering of carbohydrate drinks (clear fluid) on the day before surgery until two hours before anesthesia; 3) permission of oral feeding on the day of surgery. Data collection objects: colorectal cancer patients; collection items: age, gender, height, weight, etc., and postoperative eating status, hospitalization time, postoperative complications, and satisfaction. The patients after the administration of ERAS were the experimental group, and before the administration of ERAS were the control group. Two groups of data were collected about one year.ResultsThere were 70–80 patients in each group. No significant statistical difference between groups was observed in basic characteristics, such as age, gender, height, and weight. The average hospital stay in the experimental group decreased by about 5 days (P < 0.001), the time to eat a semi-liquid diet was reduced by an average of 2 days (P < 0.001), the weight change during hospitalization increased from −0.37 to 0.97 kg (P < 0.001), and the medical complications decreased from 20.6% to 2.4%. More than 80% of participants were satisfied with the nutritional care process.ConclusionsThe implementation of ERAS nutritional care shortened the fasting time and length of hospitalization stay and accelerate the return of patients to a normal diet. Through the collaboration between medical and nutritional teams, the postoperative nutritional condition of patients and quality of medical care were substantially improved.Funding SourcesTaichung Veterans General Hospital.

Relationship between perceived stress and emotional eating. A cross sectional study.

Stress-related to self-isolation during the COVID-19 pandemic has shown a strong correlation with issues in the diet and health of the population. In this study, we aimed to relate the perceived stress of a group of Ecuadorian adults with emotional eating. Cross-sectional design study. We applied validated questionnaires of perceived stress and emotional eating to adults of both sexes who virtually completed a form between the months of January and March 2021. The analyzes were carried out using Chi2 statistical tests, Student's t-tests and a multiple linear regression model., the analyzes were performed using the statistical software R. The sample was composed of 2333 participants, the median age was 25 years (interquartile range 21-37 years). Females reported more perceived stress than males (77.91% vs. 22.09%). Nearly 64% of participants who displayed perceived stress were emotional eaters. A statistically significant association was found between the emotional eating score and perceived stress (p<0.001), the effect was an elevation of 0.44 points in the emotional eating score for each stress point perceived. For each unit increase in BMI the emotional eating score increased 0.26 units (p<0.001) and for each unit increase in age the emotional eating score decreased by 0.27 units (p=0.03). It is concluded that stress is associated to emotional eating. Dietary intake that responds to emotions and not to physiological hunger may have long-term problems related to unhealthy diet. It is recommended to consider stress and emotional eating in the nutritional care process of people.

Nutrition Care Process of Surgical Patients in the Context of Enhanced Recovery After Surgery

Dietitians and nutritionists play a key role in optimizing the nutritional status of the patients before and after performing surgery. The importance of nutrition is often overlooked because health professionals lack knowledge about nutritional problems, structured protocols for cooperation between surgeons and clinical nutritionists do not exist, dedicated resources are lacking, and preoperative and postoperative nutrition care protocols have not been disseminated. The purpose of this review is to describe various nutrition care guidelines for use during preoperative and postoperative periods for surgical patients to enhance recovery after surgery based on a review of the literature. It should help nutritionists and surgeons to make appropriate decisions on the management during preoperative and postoperative care, as well as facilitating the understanding and application of medical nutrition therapy.

HOMEFOOD randomised trial – Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge

Malnutrition is common among older adults and is related to quality of life, cognitive function, and depression. To what extent nutrition interventions can improve these outcomes remains unclear. The aim of this study was to investigate the effect of nutrition therapy on health-related quality of life (EQ-5D), self-rated health, cognitive function, and depression in community dwelling older adults recently discharged from hospital. Participants (>65 years) were randomised into an intervention (n=53) and a control group (n=53). The intervention group received individualised nutrition therapy based on the nutrition care process including 5 home visits and 3 phone calls, in combination with freely delivered energy- and protein-rich foods and oral nutrition supplements for six months after hospital discharge. EQ-5D, self-rated health, Mini-Mental-State-Examination (MMSE), and the Centre for Epidemiologic Studies Depression - IOWA (CES-D) scale were measured at baseline and at endpoint. Two subjects dropped out, one from each arm. The control group experienced an increase in depressive symptoms and a decrease in self-rated health during the study period, while the intervention group experienced increases in cognitive function, self-rated health, and EQ-5D resulting in significant endpoint differences between the groups: EQ-5D (0.102, P=0.001); self-rated health: 15.876 (P<0.001); MMSE: 1.701 (P<0.001); depressive symptoms: - 3.072 (P<0.001); all in favour of the intervention group. Improvements during the intervention in MMSE, self-rated health, and CES-D were significantly related to body weight gain in a linear way. Cognitive function and mental well-being worsen or stagnate in older adults who receive standard care after hospital discharge. However, a six-month nutrition therapy improves these outcomes leading to statistically and clinically significant endpoint differences between the groups. As improvements were related to body weight gain after hospital discharge, we conclude that the increase in dietary intake, with focus on energy and protein density, and changes in body weight might have contributed to better cognitive function and mental well-being in older adults after the intervention.

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

An Examination of the Sex-Specific Nature of Nutrition Assessment within the Nutrition Care Process: Considerations for Nutrition and Dietetics Practitioners Working with Transgender and Gender Diverse Clients

Protocol for the IMPACT Trial: Improving Healthcare Outcomes in American Transplant Recipients Using Culturally-Tailored Novel Technology

Kidney transplant (KT) recipients face post-transplant health issues. Immunosuppressive agents can cause hyperlipidemia, hypertension, post-transplant diabetes, and glomerulopathy. Post-transplant weight gain and decreased activity are associated with poor quality of life, sleep, and cardiometabolic outcomes. This study will test the feasibility and acceptability of a culturally tailored diet and exercise intervention for KT patients delivered immediately post-transplant using novel technology. A registered dietitian nutritionist (RDN) and physical rehabilitation therapist will examine participants' cultural background, preferences, and health-related obstacles (with consultation from the transplant team) to create an individualized exercise and meal plan. The RDN will provide medical nutrition therapy via the nutrition care process throughout the course of the intervention. The Twistle Patient Engagement Platform will be used to deliver and collect survey data, communicate with participants, and promote retention. Outcomes to be assessed include intervention feasibility and acceptability and intervention efficacy on patients' adherence, medical, quality of life, and occupational outcomes.

Reimagining Nutrition Care and Mealtimes in Long-Term Care.

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required.

Development of a Practical Tool for Selecting a Nutrition Diagnostic Code in the Nutrition Care Process

Development of a Practical Tool for Selecting a Nutrition Diagnostic Code in the Nutrition Care Process

Case Study Of Standard Nutrition Care Process Of Hypertensive Heart Disease Patients in Pavilion Seroja at Undata Regional Hospital Palu Central Sulawesi Province

Hypertension is a disease that requires a standardized nutritional care process (NCP). This is because hypertension can become an advanced and chronic disease that has a serious impact on the health of the body, causing complications. This study aims to perform NCP on hypertensive patients in the Seroja Pavilion class II UPT. Undata Hospital Palu. This study is a review of research with a case study approach (Case Study), with samples 1, and was diagnosed with Hypertensive Heart Disease (HHD). The data collected were anthropometry (weight and height), food intake, food habits, client history, socio-culture, biochemical examination results, and physical/clinical examination. The data collection technique is obtained from primary data which is collected directly from the patient and the patient's family, and secondary data is obtained through the patient's medical record. The results showed an increase in the patient's food intake, namely 88.0% energy, 113.4% protein, 48.3% fat, and 95.5% carbohydrates, no change in body weight, and an increase in nutritional knowledge. Diagnoses at the start of the study included NI-2.1, NI-5.4, NC-2.2, NB-1.1 until at the end of the study being N-2.1 and NI-5.4. The interventions given included Low Salt Diet III, soft food form, 3 times main meal frequency, 2x interlude, with oral route. In conclusion, there were changes in intake, physical/clinical as well as knowledge/attitudes of patients on hypertension that had been given NCP.

What is the level of nutrition care provided to older adults attending emergency departments? A scoping review protocol.

Introduction: Nutrition status among older adults is an important factor in health and clinical outcomes but malnutrition goes unrecognised in routine health care. Older adults often present to emergency departments (ED) and are subsequently discharged without hospital admission. Discharge is a transitionary time of care when nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways. This protocol outlines a scoping review to identify the level of nutrition care provided to older adults attending emergency departments. Methods: This scoping review will be conducted using the framework proposed by the Joanna Briggs Institute. The Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for scoping reviews (PRISMA-ScR) will be used to guide the reporting. Two researchers will search electronic databases (Medline, CINAHL Complete, EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and website searches (Google, Google Scholar, Pubmed, NICE and LENUS) to identify appropriate data for inclusion within the last 10 years. Key information will be categorised and classified to generate a table charting the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model. A narrative synthesis will be conducted. Conclusions: This scoping review will be used to inform a foundational concept of nutrition care in an ED setting and allow the future examination of nutrition care pathways, practice, policy, and research within models of integrated care for older persons.

Integration of Healthy Eating Habits and Physical Activity through Nutrition Care Process to Tackle the Obesity Epidemic: A Narrative Review of the Evidence

Background: Obesity is a rising global health problem which is already at epidemic proportions. Effective methods of treatment are required and should be imparted by efficient means to dietitians and other health professionals dealing with weight management. Research shows that behavioral modification techniques are the most effective way to achieve and maintain a healthy weight compared to diet and physical activity alone. &#x0D; Aim: This narrative review focusses on diet and physical activity behavioral modification techniques to promote effective weight management for sedentary and active adults using the Nutrition Care Process (NCP). &#x0D; Methods: PubMed, Scopus, Embase, Science Direct, Web of Science and Pro-Quest databases were searched for relevant articles. &#x0D; Results: A healthy eating habit is one of the contributing factors to improved health. Physical activities also help improve and maintain one’s health. This article discusses the importance of eating habits and physical activities among school students. In addition, health issues related to eating habits and the practice of physical activities are also highlighted. Overall, the results revealed that healthy eating habits and regular physical activities help in maintaining good health.&#x0D; Conclusion: NCP is a systematic approach to provide high-quality nutrition care. Using the NCP does not mean that all clients get the same care. Use of a care process provides a framework for the dietitian to individualize care, taking into account clients’ needs and values, and using the best evidence available to make decisions.&#x0D; Keywords: obesity, weight control, physical activity, nutrition knowledge, eating habits, nutrition care process

The Critical Role of Nutrition Care to Improve Pain Management: A Global Call to Action for Physical Therapist Practice.

The nutrition care process for pain management is defined as the basic duty to provide adequate and appropriate nutrition education and counseling to people living with pain. Including the nutrition care process as part of a multimodal approach to pain management provides an opportunity for physical therapists to assert their role throughout the pain management continuum. This includes championing innovative research initiatives and enhancing public health by reducing the impact of chronic pain for over 50 million Americans.

Krause and Mahan’s Food and the Nutrition Care Process – 1st Southeast Asia Edition

Krause and Mahan’s Food and the Nutrition Care Process – 1st Southeast Asia Edition

Effect of Rehabilitation Nutrition Care Process on Physical Function in Lung Cancer Cachexia: A Case Report

Patients with cancer cachexia have poor adherence to treatment, which affects their prognosis. Currently, there are many studies on the effects of rehabilitation on cancer cachexia, but there is a lack of evidence on the effects of nutrition therapy alone or in combination with rehabilitation and nutrition therapy. This article describes a case in which rehabilitation nutrition care process was effective in a patient with lung cancer who developed cancer cachexia. A 68-year-old woman was hospitalized for treatment of lung adenocarcinoma. The patient had moderate malnutrition, sarcopenia, and cachexia at the time of admission, so the authors intervened according to rehabilitation nutrition care process. The physiotherapist mainly prescribed resistance training and aerobic exercise, 40-60 minutes a day, 5-6 days a week. And the dietitian provided oral nutritional supplements (100 kcal, branched-chain amino acid: 3.0 g) in addition to hospital food and adjusted the patient's energy intake to 26.96-33.05 kcal/kg/day and protein intake to 1.07-1.14 g/kg/day. Comparing the initial evaluation with the discharge, nutritional status, such as body mass index and skeletal muscle mass, and physical functions, such as maximum grip strength, gait speed, and functional independence measure (motor items), were improved. Rehabilitation nutrition care process-based interventions may improve nutritional status and physical functions more than exercise therapy alone in patients with lung cancer cachexia.

Enteral Nutrition Support in Management of a Pediatric Patient with Secondary Acute Malnutrition and SARS-CoV-2 Infection : A Case Report

Severe acute malnutrition (SAM) contributes to about one million deaths annually in children under the age of 5 years. Secondary acute malnutrition is common in children with underlying medical conditions. It may pose a great risk in developing severe illness during SARS-CoV-2 infection among children. Proper implementation of nutrition care process is critical in management of secondary acute malnutrition among children in clinical settings. Eight months old male admitted with meningoencephalitis; septic shock, anemia, rickets, osteomyelitis, severe malnutrition and severe SARS-CoV-2 pneumonia complications. On admission, body temperature was 370C, random blood sugars were 17.5mmol/L and with saturation of 98% on room air. He had a body weight of 5.5kg on admission with a z-score of -3sd. Nutrition focused physical examination revealed severe loss of muscle mass and adipose tissue. Nutrition prescription of high calorie high protein diet providing 846 calories and 22.3 g of protein per day was prescribed. The feed of choice was fortified blended flour (FBF) porridge which was administered via nasogastric feeding tube. After fourteen days of nutrition care in the unit, the patient had a weight gain of 100g. The average weight gain rate was 1.29g/kg/day. This case report documents challenges in nutrition management of secondary acute malnutrition with SARS-CoV-2 pneumonia in resource limited clinical settings. The review of existing guidelines and disease specific nutrition commodities in the management of secondary acute malnutrition in clinical settings is recommended. Keywords: Enteral nutrition, Nutrition care process, Secondary acute malnutrition, SARS CoV2 infection, Covid19

Physicians' Knowledge of Clinical Nutrition Discipline in Riyadh Saudi Arabia.

Background: Nutrition plays a major role in the prevention and management of diet-related disease. With the absence of clinical nutrition dietitians, physicians are considered responsible for prescribing nutritional support. Identifying weaknesses in nutritional knowledge among Saudi physicians may provide guidance to improve their nutritional knowledge. Methods: A cross-sectional study that used an anonymous electronic questionnaire to investigate physicians’ knowledge of the clinical nutrition discipline. In addition to demographics, the questionnaire consisted of 15 questions covering six areas in the clinical nutrition discipline (macro- and micronutrients, nutrition and chronic diseases, nutrition and metabolic diseases, nutrition care process, nutrition support therapy, and research). For continuous variables, independent t-tests and one-way ANOVA were used. Results: A total of 332 had completed the questionnaire and were included in the study. Most of the physicians were Saudi (87%), male (73.5%), aged between 26 and 35 years (63.3%), and without health problems (56.3%). The mean score of the physicians’ knowledge was 5.3 ± 1.97 out of 15. Physicians who reported that they received some sort of nutritional training or course (M = 5.57, SD = 2.08) scored significantly more than physicians who did not (M = 5.10, SD = 1.86); t(330) = −2.174, p = 0.30. Conclusions: Nutrition should be reinforced as an important component of continuing medical education. There is a need for hiring more dietitians in health care settings in Saudi Arabia as an integral part of a multidisciplinary team delivering medical care services.

Determinant of child obesity in COVID-19 pandemic and analysis of intervention requirement

The shift in diet and physical activity in modern society has resulted in obesity becoming a public health problem. This problem will be a burden to the state if it is not addressed early on. This study aims to examine and find models of obesity determinants based on consumption, physical activity, lifestyle, social and environmental factors. The sample was randomly selected for elementary school children in the city of Denpasar. The collected data were analyzed by using a structural equation model. Of the 375 elementary school children in the city of Denpasar, it is known that 35.5% are overweight, even one-third of them have entered the obesity stage. Consumption factors have the dominant contribution in increasing the risk of obesity. In the next order, other factors emerged: social factors; lifestyle; physical activity; followed by environmental factors. As a follow-up plan from the results of this study, a Digital-Based Nutrition Care Process for Obese Children will be designed which can later be disseminated on all mass line platforms as an intervention plan. Although the application is designed to be disseminated through the mass line platform, the role of the teacher is still needed to monitor the progress of this program.

A six-month nutrition therapy improves quality of life and cognitive function in old adults after hospital discharge

Rationale: Malnutrition is common among old adults and related to poor quality of life (QoL) and to low cognitive function. It is not known whether a nutrition intervention can improve QoL or cognitive function. Thus, the aim of this six-month randomized controlled study was to investigate the effects of nutrition therapy following the principles of nutrition care process (NCP) in community-dwelling old adults discharged from hospital.