Nutritional Care Program Research Articles

Adherence to home visit protocol in the nutritional care program for individuals with special dietary needs

Adherence to home visit protocol in the nutritional care program for individuals with special dietary needs

Implementasi Asuhan Gizi Berbasis Pangan Lokal sebagai Upaya Peningkatan Kognitif (Pengetahuan) Gizi Ibu yang memiliki Balita Stunting di Kepulauan Kabaena Timur

The problem of stunting is one of the determinants of the quality of human resources because it has a fatal impact on increasing infant and child mortality rates. Stunting causes sufferers to get sick easily and have a body posture that is not optimal as an adult. Indirectly this is caused by a lack of knowledge of nutrition. Efforts to increase knowledge can be made by implementing a local food-based nutritional care program which is carried out by providing intensive counseling, accompanied by recommendations for local food menus and demonstrations of local food menus so that it can increase maternal nutritional knowledge. The purpose of this study was to determine changes in mother's nutritional knowledge before being given local food-based nutritional care. This type of research is a pre-experimental one group pre-test-post test design. The population was 30 toddlers aged 0-23 months who experienced stunting during the July period in the East Kabaena Islands and a sample of 27 people. The sampling technique uses simple random sampling. Knowledge data obtained using a questionnaire. The results of this research showed that from 27 samples the average knowledge score about nutrition was 5.2 and after implementing nutritional care the score was 10.2. The conclusion of this study is that local food-based nutrition care can improve maternal nutrition cognitive (knowledge).

Adequacy of Nutrient Intake and Malnutrition Risk in Older Adults: Findings from the Diet and Healthy Aging Cohort Study.

There is a lack of data on the adequacy of nutrient intake and prevalence of malnutrition risk in Asian populations. The aim was to report on the nutrient intake and prevalence of malnutrition risk in a community sample of older adults in Singapore. Analysis was performed on 738 (n = 206 male, n = 532 male, aged 67.6 ± 6.0 years) adults 60 years and above. Intakes of macro- and micronutrients were evaluated against the Recommended Dietary Allowances (RDAs). Malnutrition risk was assessed using the Nutrition Screening Initiative Determine Your Nutritional Health checklist. It was found that 90.5% older adults exceeded the sugar intake, 68.5% males and 57.1% females exceeded the intake limit for saturated fat, and 33% males had inadequate dietary fiber intake when compared to the RDAs. Inadequate dietary calcium intake was found in 49.5% males and 55.3% females. There were 22.3% of older adults at moderate to high malnutrition risk. Singaporean older adults need to reduce their dietary intakes of sugar and saturated fat and increase their intakes in dietary fiber and calcium. Current findings provide public health awareness on the importance of healthy eating and will facilitate decision making by health promotors to deliver targeted nutrition care programs.

Impact of the strengthening of PAISN on the reduction of child malnutrition in Alta Guajira

The objective of this research project is to evaluate the effectiveness of the Comprehensive Health and Nutrition Care Program with Community Approach (PAISN) in reducing child malnutrition in Alta Guajira, in two phases: Phase 1: Diagnosis of the current situation of child malnutrition in Alta Guajira. Phase 2: Implementation of actions to strengthen (PAISN). In Phase 1, surveys and interviews with families and communities will be used, as well as a review of administrative records to identify the factors that contribute to child malnutrition in Alta Guajira. In phase 2, actions to strengthen the (PAISN) will be implemented in the following aspects: Integration of health, nutrition, education, basic sanitation and social development actions.

EE220 Comprehensive Nutrition Program Informs Potential Cost-Savings for Latin American Hospitals: A Budget Impact Analysis

In Latin America, approximately half of hospitalized patients experience malnutrition or its risk, while many others experience deterioration of their nutritional status while in the hospital. These patients often experience poor health outcomes resulting in increased costs of care. We estimated potential savings associated with the implementation of an early nutritional care program in malnourished or at-risk hospitalized patients via a budget impact model analysis.

Are Telehealth-Delivered Nutrition Care Interventions Cost-Effective for Managing Chronic Diseases? A Systematic Review of All Payer Perspectives

ObjectivesTo systematically evaluate the cost-effectiveness of telehealth-delivered nutrition interventions for improving health outcomes in adults living with chronic disease.MethodsPubMed, CENTRAL, CINAHL and Embase were systematically searched from database inception to November 2021. Included studies were randomized controlled trials implementing a telehealth-delivered diet intervention in adults with chronic disease compared to non-telehealth (either alone or in combination with an exercise prescription), which reported on cost-effectiveness or cost-utility analysis. All studies were independently screened, and data extraction and quality appraisal adhered to the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist by two review authors. Data analysis was conducted by grouping studies according to their telehealth modality and payer perspective.ResultsTwelve randomized controlled trials; five phone-only interventions, three mobile health (mHealth), two online, and one each using a combination of phone-online or phone-mHealth interventions) were included in the review. mHealth interventions were found to be the most cost-effective intervention (in 100% (n = 3) of studies. Across all telehealth interventions analyzed from health system perspectives (n = 10), 60% studies were found to be cost-effective. One of the three (33%) studies analysed from societal perspectives reported that the intervention was cost-effective. Cost-utility analyses (n = 10) found 30% of studies were cost-saving and more effective, making the interventions dominant over usual care. One study reported no difference in costs or effectiveness and the remaining six studies reported increased cost and effectiveness, requiring payers to determine whether the incremental cost per additional quality-adjusted life year (QALY) gained falls within an acceptable willingness-to-pay threshold. Quality of study reporting varied with between 63% to 92%.ConclusionsTelehealth-delivered nutrition care programs appear to be cost-effective from a health system perspective, particularly mHealth modalities for managing chronic disease nutrition care. These findings support telehealth-delivered nutrition care as an effective intervention to deliver high-quality care in a cost-effective way.Funding SourcesNone.

Barriers and potential facilitators to implement nutrition care program in athletes' training centers in Indonesia.

Background: In order to improve national sport achievement in Indonesia, a new policy of nutritionist placement in every training center in Indonesia was proposed. The understanding of barriers and potential facilitators was needed to identify problems and arrange policy implementation strategies. Aim: This study aims to determine the barriers in nutrition intervention practices for athletes and opportunities in implementing the proposed policy of sport nutritionist placement in athlete training centers. Methods: The study was conducted using Consolidated Framework of Implementation Research (CFIR) as the guideline for data collection and analysis. In-Depth Interview (IDI) and Focus Group Discussion (FGD) were conducted on 9 participants from the Ministry of Youth and Sport, the Republic of Indonesia. Results: This study indicates that there are several potential barriers, which are influential on the implementation of nutrition support for athletes. These include the lack of facilitation of athletes' nutritional needs, lack of supervision for food catering service, lack of communication, and limited funding. In contrast, the potential facilitators are strong relationship with sport-related stakeholders, compatibility with the existing policy, relative advantages, and trialability of the proposed policy. Conclusions: The Indonesia Ministry of Youth and Sports should utilize these facilitators as opportunities to design, develop, and implement a policy that requires nutrition support available for all athletes at every PPLP in Indonesia.

Nutrition program for outpatient Colombian older adults at malnutrition risk improved nutritional and functional outcomes

Rationale: Malnutrition leads to multiple adverse outcomes and poses a significant economic burden among older adults residing in the community. Addressing malnutrition through nutrition care programs can improve overall patient health and reduce healthcare costs. We assessed the impact of comprehensive, nutrition-focused quality improvement program (QIP) on nutritional and functional outcomes of Colombian older adults presenting for outpatient care post a recent hospitalization and/or for chronic disease management.

Evaluation of nutritional risk according to screening (NRS.2002) in multiple trauma patients admitted to ICU of Alzahra Hospital in Isfahan in 2018

Introduction: Undernutrition of patients is one of the most important and effective issues in response to treatment and mortality rate. The prevalence of undernutrition in hospitalized patients is 22 to 50%. Little attention has been paid to this issue due to lack of a proper nutritional screening system. Nutrition of the patients admitted to ICU and maintaining their homeostasis requires proper and scientific management. Early nutritional support reduces the severity of disease, complications, and length of hospital stay in the intensive care unit. The aim of present study was to use the Nutritional Screening System (NRS 2002) in multiple trauma patients admitted to ICU. Methods: The present study was conducted on 100 multiple trauma patients admitted to the ICU of Al-Zahra Hospital in Isfahan in 2018. The required information form was completed for each patient. In this nutritional system, the severity of disease and level of undernutrition of patients are divided into three categories: mild, moderate and severe. In the NRS 2002 system, the final score varies from 0 to 7. The nutrition care program starts with a final score of ≥ 3. Results: In the present study, the results showed that weight loss in the last three months was 32%, and the level of nutrients received during the last week was 30%. Also, 42% of patients were severely ill and 45% needed nutritional support. Also, 68% of patients did not have undernutrition problems. Based on the independent t-test, weight loss during the last three months, reduction of calorie intake and severity of previous disease were effective in the type of treatment. Conclusion: The NRS 2002 method is very valuable and reliable due to the rapid and easy identification of undernutrition patients based on items that are readily available and its applicability if the reporter is not a nutritionist. Keywords: Nutritional Screening, Nutrition Risk, Intensive Care Unit, Multiple Trauma

The Analysis of Lamongan Toddler Nutrition Care (PELITA LA) Program in Dradah Health Center Lamongan

Introduction: The prevalence of stunting in Lamongan is reaching 35,5%, so the efforts to reduce the prevalence of stunting in Lamongan was implementing the Lamongan Toddler Nutrition Care program. There is no evidence of the successes of that program. The purpose of this study is to analyze the process of the Lamongan Toddler Nutrition Care (PELITA LA) program on stunting in Lamongan, East Java.Methods: This research uses qualitative methods with in-depth interview data collection techniques and includes descriptive research. The sample of this research is 5 respondents who are selected using purposive sampling. This research has been approved as ethical by the ethics committee. The process of data analysis in this study starts by collecting data from the interview results and then reducing the data that has been generated. After that, the data are presented and concluded.Result: The results showed that not all the the village health workers had received training, the infrastructure was insufficient and there were no program implementation guidelines so can influence prevalence stunting. However, the process of management like planning, organizing, actuating, and controlling have been good. In another statement about the successes of the program is decreasing the prevalence of the stunting and increasing the participants’ knowledge but the participants are not measured with certainty to find out their knowledge.Conclusion: The conclusion is the nutrition care program for Lamongan toddlers at the Lamongan Health Center has not been running optimally because the input and output aspects have not been going well

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

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

Current Situation of Nutrition Services in Selected Drug Treatment and Rehabilitation Centers in the Philippines

Background: People who used drugs (PWUDs) use excessive alcohol and illicit drugs that pose a serious threat to families, society, and the nation’s health and socioeconomic status. They are also vulnerable to vitamin and mineral deficiencies that may threaten their physical and mental health and weaken their immune system. Nutrition plays an important role in the rehabilitation of PWUDs; hence, it must be integrated into the recovery programs in treatment and rehabilitation centers (TRCs). Objectives: This study was done to assess and benchmark the nutrition care processes offered to PWUDs in selected government-owned and private TRCs in the Philippines. Patients and Methods: This cross-sectional study was conducted in 19 TRCs coming from both government (n = 9) and private (n = 10) rehabilitation centers as samples from Regions I, III, IV-A, VI, XI, and National Capital Region. A total of 45 key personnel from the selected TRCs were interviewed. The information gathered by interview of the director and other key personnel on the nutrition care processes and programs offered in the center, ocular observation on dietary facilities, as well as document reviews of existing hospital policies and services. Results: Nutrition services, such as anthropometric measurements (weight and height) were only conducted in 17 TRCs, while dietary assessment (plate waste) was done only in four TRCs. None of the TRCs were able to provide nutrition counseling or education for the PWUDs. Most TRCs (57.9%) did not have their own Registered Nutritionist Dietitians (RND), and the majority (78.9%) provided uncalculated diet to PWUDs. The mean cost of meals per day was higher in the private TRCs (USD 0.96) than the government TRCs (USD 0.8). In terms of facilities, most of the TRCs had no dietary rooms (68.4%), and some of the government TRCs had no appropriate dining areas (33.3%). Conclusions: TRCs do not follow the nutritional care process in the management of PWUDs, even in some TRCs with RNDs, because they lack the environment and infrastructure to do this. These services are vital for the holistic management of PWUDs for improved quality of life. A viable recommendation is to develop a Nutrition Management Guidelines to be integrated into the manual of operations of the department of health for TRCs.

Process Evaluation of a National Elderly Nutrition-Care Program in Iran: Perspectives of Clients and Providers.

ObjectiveAs aging populations increase, many countries have begun implementation of policies to improve elder health and nutrition. This study evaluated key process components of nutrition sections of a national elderly integrated–care program in health-care centers in Iran.MethodsWith stratified three-stage random cluster sampling, a total of 256 elderly subjects (clients) and 76 staff members of health-care centers (providers) participated in the study. Quantitative and qualitative data were collected using two self-administrated questionnaires to evaluate various components of process evaluation for clients and providers. Program reach was measured by the ratio of the number in the target group who underwent the program to the number of eligible individuals. Exposure rate was measured as clients’ awareness of program services. Delivery and fidelity were assessed from providers' reports for each service. Satisfaction rates were assessed for the whole program and for each service of the program. All reasons behind strengths and weaknesses in each of the process-evaluation components were examined and are reported in detail.ResultsThe clients reported low-reach (20.0%) and moderate-exposure rates of 77.5%, with a program target of 90%. Primary training sessions were delivered to the providers as intended (100%), but most planned services for clients, especially vitamin and mineral supplementation, follow-up, and physical activity sessions, were poorly implemented, as they were delivered correctly to 24.7% (n=63, vitamin and mineral supplementation), 24% (n=62, follow-up), and 40.3% (n=103, physical activity sessions) of the clients, with a set program goal of 60%. An overall low level of implementation fidelity was observed, and 39.3% (n=30) of the providers believed that most clients did not benefit from the nutritional services. Overall, less than half (42.8%, n=101) the clients were highly satisfied with the program.ConclusionThe process evaluation showed insufficient reach, exposure, and fidelity of the program, as well as imprecise delivery of some services, which resulted in low levels of client satisfaction. The findings may have implications for further reinforcement of the program, and indicate the importance of continuous monitoring and evaluation of such programs.

The State of Maternal and Infant Health and Mortality in Chad.

The level of Chad's government expenditure on health is a predictor of the general health of the population and, consequently, life expectancy. We used data from the World Bank's World Development Indicators and publications from the World Health Organization to assess the state of maternal and infant health and mortality. The primary objective of this research was to investigate whether Chad had reduced the risk of maternal and infant mortality after signing the Abuja Declaration in 2001. We hypothesised that increased general government health expenditure was associated with improved health mediated by increased numbers of skill health workers and minimum out-of-pocket health expenditure. Our secondary objective was to assess effective implementations of health policies in line with the Millennium Development Goals that Chad has agreed to achieve by 2015. We observed that, as of 2015, the government health expenditure was only 6.28% and the population out-of-pocket spending was over 56%. Furthermore, only 20% of women give birth in a hospital. These results led to three major policies recommendations in order to improve maternal and infant health in Chad: skilled birth attendants training, enhanced social status of nurses, and the development of a supplemental nutrition care program for women.

Targeting malnutrition: Nutrition programs yield cost savings for hospitalized patients.

Between 30 and 50% of Colombian patients are malnourished or at-risk of malnutrition on hospital admission. Malnutrition is associated with poor outcomes and increased costs. We used cost modeling to estimate savings that could be derived from implementation of a nutrition therapy program for patients at malnutrition risk. The budget impact analysis was performed using previously-published outcomes data. Outcomes included length of stay, 30-day readmissions, and infectious/non-infectious complications. We developed a Markov model that compared patients who were assigned to receive early nutrition therapy (started within 24-48h of hospital admission) with those assigned to receive standard nutrition therapy (not started early). Our model used a 60-day time-horizon and estimated event probabilities based on published data. Average total costs over 60 days were $3770 US dollars for patients with delayed nutrition therapy vs $2419 for patients with early nutrition therapy-a savings of $1351 (35.8% decrease) per nutrition-treated patient. Cost differences between the groups were: $2703 vs $1600 for hospital-associated costs; $883 vs $665 for readmissions; and $176 vs $94 for complications. Taken broadly, the potential costs savings from a nutrition care program for an estimated 638,318 hospitalized Colombian patients at malnutrition risk is $862.6 million per year. Our budget impact analysis demonstrated the potential for hospital-based nutrition care programs to improve health outcomes and reduce healthcare costs for hospitalized patients in Colombia. These findings provide a rationale for implementing comprehensive nutrition care in Colombian hospitals.

Diabetics at Risk for Malnutrition: Improving Hospitalization Rates through a Comprehensive Nutrition Care Program

Diabetics at Risk for Malnutrition: Improving Hospitalization Rates through a Comprehensive Nutrition Care Program

Evaluation of a Nutrition Care Program on Preventive Long-term Care Project for Community-dwelling Older Adults

Evaluation of a Nutrition Care Program on Preventive Long-term Care Project for Community-dwelling Older Adults

Efficacy of mobile healthcare application and wearable device in improvement of exercise capacity in prostate cancer patients undergoing hormone therapy

Androgen ablation therapy (ADP) in prostate cancer patients may cause complications such as cardiovascular disease, metabolic syndrome and fatigue. The study aimed to evaluate the effect of regular rehabilitation exercise using smart after care in improvement of exercise capacity in prostate cancer patients undergoing ADP. The prostate cancer patients under ADT with age of or over 40 years were recruited and randomly allocated. The exercise group was provided with a smart aftercare program application and wearable device, providing general health information, nutritional and medication care and rehabilitation program which was adjusted in level according to the test results at 6 weeks follow up. The patients visited at time of enrollment, 6 weeks and 12 weeks and their physical performance status (2 minutes’ walk test, 30-second chair stand test, grip strength test, short physical performance battery) was tested. The quality of life and satisfaction was evaluated with questionnaires (EORTC QLQ C30, PR 25) and body composition was additionally measured. After 12 weeks, the exercise group showed significant improvement in social functioning ( P = 0.016) as well as in appetite loss ( P = 0.048) ( Table 1 ). Both groups showed significant improvement in urinary symptom, whereas the exercise group additionally showed significant improvement in sexual functioning ( P = 0.032). In the aspect of physical performance, both groups showed significant improvement in 30s chair stand test and 2 minutes’ walk test after 12 weeks of smart aftercare program, whereas the exercise group had additional significant improvement in right hand grip strength ( P = 0.047) and reduction in body fat percentage ( P = 0.003)( Table 2 ). The smart aftercare program is a safe, highly satisfied method that also helps increase compliance among participants. Therefore it is an effective method in prostate cancer patients under hormone therapy in improving exercise capacity and general health related quality of life.

Multiple-micronutrient supplementation for women during pregnancy.

Multiple-micronutrient supplementation for women during pregnancy.

A Dedicated Nutritional Care Program (NUTRICARE) to reduce malnutrition in institutionalised dysphagic older people: A quasi-experimental study.

To assess the effects of a texture-modified food program for dysphagia on the nutritional, biochemical and functional profile in a cohort of institutionalised older people in Italy. Dysphagic institutionalised older people, often also affected by dementia, are frequently exposed to malnutrition. Malnutrition in older people has negative effects on mortality, days of hospitalisation, infection, wound healing and risk of pressure injuries. Therefore, it is very important to prevent malnutrition in this frail population. A pre-post study without a control group. The study included 479 dysphagic institutionalised older people from 20 nursing homes. Anthropometrical, biochemical, nutritional and functional parameters were collected retrospectively, 6months before the study intervention, at time zero and, prospectively for 6months after implementing the NUTRICARE food programme, for a total of nine evaluations. The NUTRICARE programme includes meals without nutritional supplementation, and personalised levels of density, viscosity, texture and particle size. The total mean body mass index of our sample passed from 17.88-19.00; body weight averagely improved by 7.19%, as well as their nutritional and biochemical profiles. There was a progressive improvement of total protein and serum albumin values. Nutritional parameters (serum transferrin and lymphocytes) displayed similar changes. Plasma lymphocytes reached normal levels in 98.23% of the sample. Plasma creatinine levels remained steady throughout the study and within the normal range. No side effects were reported. The NUTRICARE food programme with a adequate proteins, calories, balanced nutritional and bromatological properties, and appropriate texture and palatability significantly improved the nutritional, biochemical and functional profile in a cohort of institutionalised dysphagic older people. The introduction of a balanced nutritional programme, using high-quality natural ingredients, appropriate texture and palatability can significantly improve health and quality of life in dysphagic older people.