Oral Nutritional Supplements Research Articles

ESPEN guideline on nutrition and hydration in dementia – Update 2024

Background & aimsDementia is accompanied by a variety of changes that result in an increased risk of malnutrition and low-intake dehydration. This guideline update aims to give evidence-based recommendations for nutritional care of persons with dementia in order to prevent and treat these syndromes. MethodsThe previous guideline version was reviewed and expanded in accordance with the standard operating procedure for ESPEN guidelines. Based on a systematic search in three databases, strength of evidence of appropriate literature was graded by use of the SIGN system. The original recommendations were reviewed and reformulated, and new recommendations were added, which all then underwent a consensus process. Results40 recommendations for nutritional care of older persons with dementia were developed and agreed, seven at institutional level and 33 at individual level. As a prerequisite for good nutritional care, organizations caring for persons with dementia are recommended to employ sufficient qualified staff and offer attractive food and drinks with choice in a functional and appealing environment. Nutritional care should be based on a written care concept with standardized operating procedures. At the individual level, routine screening for malnutrition and dehydration, nutritional assessment and close monitoring are unquestionable. Oral nutrition may be supported by eliminating potential causes of malnutrition and dehydration, and adequate social and nursing support (including assistance, utensils, training and oral care). Oral nutritional supplements are recommended to improve nutritional status but not to correct cognitive impairment or prevent cognitive decline. Routine use of dementia-specific ONS, ketogenic diet, omega-3 fatty acid supplementation and appetite stimulating agents is not recommended. Enteral and parenteral nutrition and hydration are temporary options in patients with mild or moderate dementia, but not in severe dementia or in the terminal phase of life. In all stages of the disease, supporting food and drink intake and maintaining or improving nutrition and hydration status requires an individualized, comprehensive approach. Due to a lack of appropriate studies, most recommendations are good practice points. ConclusionNutritional care should be an integral part of dementia management. Numerous interventions are available that should be implemented in daily practice. Future high-quality studies are needed to clarify the evidence.

How Can We Improve the Appetite of Older Patients on Dialysis in Japan?

It is necessary to ensure adequate energy and protein intake in dialysis patients. However, in addition to the decline in dietary intake in older dialysis patients due to aging, the rate of anorexia is high in dialysis patients, which increases the risk of protein–energy wasting (PEW), sarcopenia, and frailty. There are many causes of anorexia in dialysis patients, including older dialysis patients, and approaches to improve the appetite of such patients have been reported; however, there has been no established approach to improve appetite adequately. Therefore, a key practical goal is to identify anorexia early and implement timely interventions before weight loss occurs. Appetite assessment tools and weight loss assessments are helpful for the screening and early identification of anorectic signs. Nutritional interventions include reducing dietary restrictions, using oral nutritional supplements, and intradialytic parenteral nutrition, as well as replenishing energy, protein, and zinc to prevent the development of nutritional disorders among older dialysis patients. Appetite assessments, early intervention, and dietary and nutritional counseling are key to improving appetite in these patients. The aging rate of dialysis patients in Japan is unprecedented globally, and I believe that this is a situation that will eventually occur in other countries as well. I discuss the factors that contribute to anorexia, especially in older dialysis patients, and Japan’s efforts to address this problem, such as the relaxation of dietary restrictions and the use of oral nutritional supplements.

Effect of nutrition impact symptoms on oral nutritional supplements energy intake and use days in patients with head and neck cancer: A cross-sectional study.

This study aims to explore the effect of nutritional impact symptoms (NIS) on oral nutritional supplements (ONS) energy intake and use days among head and neck cancer (HNC) patients. A cross-sectional study was conducted among HNC patients in a hospital in western China between January 2019 and June 2020. The NIS was from the Patient-Generated Subjective Global Assessment (PG-SGA) scale. Mann-Whitney test was used to examine the differences between different kinds of NIS and ONS use days. Binary logistic regression was used to determine the effect of NIS on ONS energy intake. The most prevalent four NIS were no appetite (35.3%), dysphagia (29.4%), vomiting (13.2%) and oral pain (12.5%), respectively. All patients in the study were malnutrition. Patients with xerostomia or oral pain had less ONS use days than those without these symptoms. Patients with vomiting (OR 0.09, 95% CI 0.02-0.50) or pain (OR 0.15, 95% CI 0.02-0.89) were less likely to have ONS energy intake ≥400 kcal/day than those without these symptoms after adjusting the confounding factors. In addition, one-point increase in total NIS score was associated with a lower proportion of ONS energy intake ≥400 kcal/day (OR 0.77, 95% CI 0.59-0.99). Xerostomia, oral pain, vomiting and pain should be strengthened and intervened to improve ONS use and nutritional status among HNC patients with malnutrition.

The benefits of oral nutritional supplements in patients with cancer receiving chemotherapy.

The benefits of oral nutritional supplements in patients with cancer receiving chemotherapy.

Enhancing Nutritional Status and Addressing Micronutrient Deficiencies: Evaluating the Impact of Workplace Nutrition Program on Female Workers in Vietnam.

This randomized controlled clinical study aimed to assess the effectiveness of a nutrition intervention program for non-pregnant female workers in Vietnam. A total of 500 female workers were randomly assigned to the intervention and control groups. Participants in the intervention group were provided nutrition education, personalized specific dietary, and received oral nutrition supplements (ONS)-which contained multi-minerals and vitamins according to recommendations for adults for a duration of 12 wk, while participants in the control group received only nutrition education. The result shows the percentage of malnutrition by BMI in the control group rose from 15.6% to 21.3% after 12 wk; the figure for counterpart experienced a remain unchanged (p<0.05). Additionally, the mean of serum zinc in the intervention group significantly increased from 49.0±21.2 μg/dL to 53.6±19.5 μg/dL after 12 wk. Moreover, the intervention group demonstrated significant increases in serum iron and total serum calcium levels (p<0.05), with from 13.9±5.6 μmol/L to 15.3±5.8 μmol/L, and from 2.36±0.15 mmol/L to 2.4±0.09 mmol/L, respectively. The participants of the intervention group were more likely to have higher total serum calcium (Coef=0.04, p<0.05), serum iron (Coef=1.99, p<0.05), and serum zinc (Coef=18.9, p<0.05), which presents a reduce micronutrient deficiency. In conclusion, workplace nutrition interventions effectively mitigate micronutrient deficiencies and improve the nutritional status of female workers.

Actions alimentation-nutrition pratiquées dans les établissements médicosociaux et de santé de Nouvelle-Aquitaine, intérêt et utilisation des services proposés par le centre de ressources en nutrition (Cerenut) de cette région

Introduction and objectiveThe functioning of establishments for elderly or disabled people regarding food and nutrition is poorly understood. In the French Nouvelle-Aquitaine region, there is a Nutrition Resource Center (Cerenut) responsible for helping establishments on these issues. The study aimed to find out the main food and nutrition actions practiced in medico-social and health establishments in Nouvelle-Aquitaine, their perception of the interest of the various services offered by Cerenut and the levels of use of these services. MethodA secure questionnaire was sent electronically to 2625 establishments. Declarative data was collected automatically over a period of one month. ResultsThe number of responding establishments was 172 (6.6% of establishments contacted). The use of oral nutritional supplements, weighing at least once a month and the presence of a menu committee were the most frequent actions. Nutritional issues were an important concern for establishment budgets. The nutritional assessment of residents upon entry and the use of dietary time remained infrequent, as did the practice of enteral nutrition. Establishments for people with disabilities were the worst off. Cerenut's services relating to team training were considered the most interesting and the most used. ConclusionSeveral fundamental food and nutrition actions were not carried out in the establishments surveyed, likely to hamper the nutritional assessment of residents, their care and the enhancement of their stays. Cerenut offers training and can provide structures with appropriate assistance in many cases.

Malnutrition management and the application of medical nutrition therapy in hospitalized patients at the end of life

Objectives(1) To determine the prevalence of malnutrition risk in hospitalized patients at the end of life (EOL), (2) to evaluate which nutritional interventions are administered in hospitalized end-of-life patients with malnutrition risk and (3) to assess the association of end-of-life care and the administration of medical nutrition therapy in patients with malnutrition risk. DesignCross-sectional multi-center study SettingHospital ParticipantsHospitalized adult patients MeasurementsBased on the valid and reliable questionnaire of the Nursing Quality Measurement 2.0 (LPZ), the parameters of demographic data, medical diagnoses, end-of-life phase, care dependency, malnutrition risk according to the Malnutrition Universal Screening Tool (MUST) and nutritional interventions conducted in patients at risk of malnutrition were assessed. Descriptive statistics and statistical tests were conducted. Logistic regression models were established to identify odds ratios (OR) and confidence intervals (CI) for the association of end-of-life care and the provision of medical nutrition therapy. This was done separately for oral nutritional supplements (ONS), enteral nutrition and parenteral nutrition as the respective dependent variables. ResultsOf all 12,947 participants, 706 (5.5%) were in an end-of-life phase. The prevalence of malnutrition risk in end-of-life patients was 41.1% compared to 24.7% in other patients (p < 0.001). End-of-life patients with malnutrition risk received more nutritional interventions than other patients with malnutrition risk. The regression models showed that being at the end of life (CI 1.30, 2.63; p < 0.001), being treated by a dietitian (OR 6.02; CI 4.86, 7.45; p < 0.001), suffering from dementia (OR 1.85; CI 1.10, 3.12; p = 0.02) or cancer (OR 1.56; CI 1.25, 1.96; p < 0.001) increased the chance of receiving oral nutritional supplements. For receiving parenteral nutrition, being at the end of life (OR 1.68; CI 1.04, 2.71; p = 0.04), being treated by a dietitian (OR 5.80; CI 4.07, 8.25; p < 0.001), surgery within the previous two weeks (OR 1.58; CI 1.09, 2.30; p = 0.02), younger age (OR 0.99; CI 0.98, 1.00; p = 0.04), care dependency (OR 0.97; CI 0.96, 0.98; p < 0.001), suffering from a disease of the digestive system (OR 2.92; CI 2.07, 4.11; p < 0.001) or cancer (OR 2.44; CI 1.71, 3.49; p < 0.001) were independent predictors. Being at the end of life did not influence the application of enteral nutrition. ConclusionThis study showed that nutritional interventions are often applied in end-of-life patients admitted to general hospitals. Being at the end of life was positively associated with the application of oral nutritional supplementation and parenteral nutrition. This data does not allow a conclusion about the appropriateness of using medical nutrition therapy in this study sample. Judging the appropriateness of medical nutrition therapy at the end of life is challenging because of the high variability of prognostication as well as the wishes and needs of the specific patients and their relatives that influences the appraisal of adequate interventions. Every decision about nutrition and hydration in end-of-life patients should be a shared decision and be based on advanced care planning principles.

A case of nutritional management and challenges after esophageal cancer surgery

Malnutrition and cachexia are common in cancer patients. Malnutrition rates of cancer patients vary according to the location of the tumor. In esophageal cancer, severe cachexia and sarcopenia are seen at the time of diagnosis. The defense of nutritional therapy (NT) against cancer, especially gastrointestinal cancer, is very difficult. NT should start with the diagnosis of the disease. The aim of NT should be to prevent cancer cachexia, related complications, and mortality. In Türkiye, squamous cell esophageal cancer is often seen, especially due to dietary habits (hot drinks, meat-based diet low in vegetables). This is a case report of a 55-year-old male patient who had lots of challenges during the nutritional management after esophageal cancer surgery. The patient’s complaints did not improve after neoadjuvant therapies and minimally invasive esophagectomy (MIE) was performed. Inflammation and fistula were seen after major abdominal surgery. As long as the fistula and drainage were continued, parenteral nutrition (PN) remained the only option for NT allowing the bowel to rest in the presence of a fistula. In case of contraindication to oral or enteral nutrition (EN), PN was started on day 6 of MIE. Since it was thought that oral or EN could not be started for more than 10 days, a central catheter was placed, and the patient was fed with CPN (central parenteral nutrition). After the insertion of a stent and a nasojejunal (NJ) tube, EN combined with CPN could be applied. Because of anastomotic leakage, oral nutrition couldn’t be continued. Short-term peripheral parenteral nutrition (PPN) therapy was continued until the leakage stopped. The patient was discharged with oral and oral nutritional supplements. Two years after the MIE, no significant difference from previous radiological reports was found and there were no problems with oral nutrition.

A novel multi-ingredient supplement significantly improves ocular symptom severity and tear production in patients with dry eye disease: results from a randomized, placebo-controlled clinical trial.

Dry eye disease (DED) is multifactorial and characterized by a loss of tear film homeostasis that causes a cycle of tear film instability, tear hyperosmolarity, and inflammation. While artificial tears are the traditional mainstay of treatment, addressing the underlying pathophysiology could relieve symptoms and prevent progression. Increasing evidence indicates a role for oral nutritional supplementation in multiple ophthalmic diseases, including DED. Lutein, zeaxanthin, curcumin, and vitamin D3 have demonstrated protective and anti-inflammatory properties in ocular models. This prospective, randomized, double-blind, parallel, placebo-controlled study evaluated the efficacy and safety of a proprietary blend of lutein, zeaxanthin isomers, curcumin, and vitamin D3 (LCD) as a daily supplement in adult participants with DED. Participants were randomized to receive one LCD supplement capsule (lutein 20 mg, zeaxanthin isomers 4 mg, curcumin 200 mg curcuminoids, and vitamin D3 600 IU) or placebo per day for 8 weeks (LCD, n=77; placebo, n=78). Primary outcomes were changes in tear volume (Schirmer's test) and ocular symptoms (Ocular Surface Disease Index [OSDI]). The study met its primary endpoints: the LCD group demonstrated significantly better Schirmer's test scores and improvement in overall OSDI score, versus placebo, at Day 56 (p<0.001 for both). Scores for total OSDI, and symptoms and vision domains, significantly improved by Day 14 for LCD versus placebo, (p<0.05 for all) and were maintained to Day 56 (p<0.001). In addition, the LCD group demonstrated significantly improved tear film break-up time (TBUT) and tear film osmolarity, versus placebo, by Day 56 (p<0.001), along with significant improvements in corneal and conjunctival staining (p<0.001 for both), and inflammation (matrix metalloproteinase-9; p<0.001 for each eye). Total Standard Patient Evaluation of Eye Dryness (SPEED) score, and scores for the frequency and severity domains, were significantly improved by Day 14 for LCD versus placebo (p<0.05 for all) and maintained to Day 56 (p<0.001). There was no difference between groups for artificial tear usage. The supplement was well-tolerated. Once-daily LCD supplementation significantly improved tear production, stability and quality, reduced ocular surface damage and inflammation, and improved participants' symptoms. LCD supplementation could offer a useful adjunct to artificial tears for patients with DED (NCT05481450).

A Prospective, Observational Study of the Effect of a High-Calorie, High-Protein Oral Nutritional Supplement with HMB in an Old and Malnourished or at-Risk-of-Malnutrition Population with Hip Fractures: A FracNut Study.

Hip fractures are prevalent among older people, often leading to reduced mobility, muscle loss, and bone density decline. Malnutrition exacerbates the prognosis post surgery. This study aimed to evaluate the impact of a 12-week regimen of a high-calorie, high-protein oral supplement with β-hydroxy-β-methylbutyrate (HC-HP-HMB-ONS) on nutritional status, daily activities, and compliance in malnourished or at-risk older patients with hip fractures receiving standard care. A total of 270 subjects ≥75 years of age, residing at home or in nursing homes, malnourished or at risk of malnutrition, and post hip fracture surgery, received HC-HP-HMB-ONS for 12 weeks. Various scales and questionnaires assessed outcomes. During the 12 weeks of follow-up, 82.8% consumed ≥75% of HC-HP-HMB-ONS. By week 12, 62.4% gained or maintained weight (+0.3 kg), 29.2% achieved normal nutritional status (mean MNA score +2.8), and 46.8% improved nutritional status. Biochemical parameters improved significantly. Subjects reported good tolerability (mean score 8.5/10), with 87.1% of healthcare providers concurring. The administration of HC-HP-HMB-ONS markedly enhanced nutritional status and biochemical parameters in older hip-fracture patients, with high compliance and tolerability. Both patients and healthcare professionals expressed satisfaction with HC-HP-HMB-ONS.

Oral nutritional supplements in older outpatients with heart failure: rationale and design of the ALIMENT-HF trial.

The ALIMENT-HF trial aims to determine whether high-calorie and high-protein oral nutritional supplements (ONS) are safe and beneficial for older adult outpatients with heart failure (HF). This multicentre, single-arm, interventional pilot trial is designed to evaluate the tolerance, efficacy, and safety of ONS in older adult outpatients with chronic HF, malnutrition, and anorexia. In total, 80 outpatients with HF regardless of their left ventricular ejection fraction will be treated with ONS, including high-energy (900kcal/day) and high protein (36g/day) supplementation, at eight sites in Japan. Inclusion criteria are as follows: age, ≥65years; outpatients receiving maximally tolerated guideline-directed medical therapy for HF and without change in their diuretic dosage during the last 3months; outpatients at risk of malnutrition, defined as a Malnutrition Universal Screening Tool score ≥1 point, and anorexia, defined using a Simplified Nutritional Appetite Questionnaire for the Japanese Elderly (SNAQ-JE) score of ≤14 points. Nutritional intervention will continue for up to 120days, with an observational period lasting for a further 60days. The primary outcome is a change in body weight between baseline and day 120. The ALIMENT-HF trial will evaluate the tolerance, efficacy, and safety of high-calorie and high-protein-rich ONS in older outpatients with HF co-morbid with malnutrition and anorexia and will provide insightful information for future randomized controlled trials.

Ketogenic diet therapies as a non-pharmacological adjuvant in resistant epilepsy: retrospective analysis of adult outpatients in Colombia

ABSTRACT Twelve patients between 18 and 53 years of age were included. MAD plus nutritional supplementation was administered to 75% (n = 10) of the participants, one (8.3%) received MAD alone, and 16.7 (n = 2) received Classic Ketogenic Diet (cKD) plus nutritional supplementation. Oral nutritional supplementation, administered in the outpatient setting, provided patients with between 31 and 55% of the total caloric value. In the first month of KDT treatment, 83.3% (n = 10) of patients reduced the number of weekly seizures by 40% (median). At six months of treatment, 75% of patients had at least halved the number of weekly seizures. At 12 months of treatment, the number of weekly seizures had been reduced by 85.7% (median). KDT was well tolerated, and there was no need to discontinue treatment. This study provides real-world information on the use of KDT, particularly MAD in adults, in developing countries. Future studies in larger cohorts will provide further information on different types of KDT, adherence, and patient-reported outcomes.

Use of a novel bluetooth-connected device to measure handgrip strength: A practical tool to help healthcare professionals identify adults at nutritional risk

Background and AimsLow muscle strength is strongly tied to poor nutrition status, and nutritional interventions are likewise linked to maintenance and restoration of muscle strength and functional status. Nutrition plays a vital role in muscle mass, strength, and function, and losses in muscle (strength, function, and mass) are associated with poor health outcomes and added costs for healthcare services. For this study of outpatients, the main objective was to identify those at risk for low muscle strength, as evidenced by low handgrip strength (HGS) measures with risk stratified by age and sex. MethodsThis was a two-part study on HGS measures in adults attending outpatient clinics in India. In part one, we conducted HGS tests on dominant and non-dominant hands of patients who qualified for the study. For HGS measures, we used a validated tool, the SQUEGG device, a smart handgrip trainer, along with its companion Bluetooth-connected app, the Muscle Strength Assessment Tool (MSAT) app. In part two, we collected Healthcare Practitioners’ (HCP) feedback via a short digital survey on the use of the SQUEGG device + the MSAT app to do HGS risk screening as an indicator of needed nutritional intervention. ResultsNearly a third of community-living adults in India exhibited low HGS among the 3036 sampled. At each age stratum, dominant-hand HGS in women was lower by 25% to 35% compared to men. Among 353 HCPs, 293 (83%) provided insights via survey, and 85% of surveyed HCPs (n=249) strongly agreed or agreed that the SQUEGG device + MSAT app helped them identify HGS issues among their patients, and 85% (n=248) agreed or strongly agreed they would like to continue using the SQUEGG device + MSAT app to inform their practice. Nearly all surveyed HCPs (98%, n=288) recommended an oral nutritional supplement (ONS) to their patients with identified low HGS. ConclusionsOur findings demonstrate that HCPs would like to continue use of the SQUEGG device + MSAT app as it helped them identify adult patients who had decreased HGS (about 30% of the study population), in turn identifying opportunities to use nutritional interventions such as ONS to address nutrition shortfalls and to restore functional status.

Prevalence of malnutrition, dietary trends, and oral nutritional supplements use among Algerian cancer outpatients undergoing chemotherapy

ObjectiveIt is widely acknowledged that patients with cancer commonly experience malnutrition, and some individuals may adopt specific dietary trends. This study investigated the prevalence of malnutrition and dietary trends among Algerian cancer outpatients undergoing chemotherapy. Material and methodsThis cross-sectional, descriptive study was conducted from January to October 2023 with 71 cancer outpatients undergoing chemotherapy. Malnutrition risk was evaluated using the Malnutrition Screening Tool (MST). The questionnaire also collected the occurrence of nutrition impact symptoms, the avoidance of specific food groups, and the use of oral nutritional supplements and dietary supplements. ResultsMalnutrition risk was identified in 57.7% (41 cases) of participants. Nutrition impact symptoms were reported by 59.2% (42 cases) of patients. A total of 36 of the patients (50.7%) altered their eating habits by avoiding at least one food group. Among malnourished cancer outpatients, only five used oral nutritional supplements. Dietary supplements were used by 23.9% (27/71) of the patients after cancer diagnosis. ConclusionOur findings underscore the necessity for a systematic malnutrition assessment in cancer patients. Qualified clinicians should provide nutritional awareness to enhance the quality of life for these patients.

Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: an Evidence-based Nutrition Practice Guideline

Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.

Effectivity and cost-effectiveness of oral nutrition supplement on malnourished children: A literature review

&lt;p&gt;&lt;strong&gt;&lt;em&gt;Background:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Child undernutrition has been a global problem that could be potentially treated with the support of food for special medical purposes, including oral nutrition supplements (ONS). This literature review aims to examine the effectiveness of ONS on growth indicators, length of stay, and the occurrence of adverse events and explore the cost-effectiveness of ONS. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Methods:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; This review summarized findings from 16 articles. The articles were experimental, with or without comparison or control group, and examine nutrition status, other outcomes directly or indirectly related to malnutrition, and cost-effectiveness. Articles were collected from electronic database including PubMed, ProQuest, and Google Scholar with additional articles from Google search engine.&lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Results:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Some articles reported that ONS administration, good ONS consumption, and higher ONS density resulted in weight and height gain, improvements in nutrition status, and shorter length of stay compared to those who don’t receive ONS, had poor ONS consumption, and had lower ONS density, although several adverse events of ONS consumption such as gastrointestinal symptoms, diarrhea, and vomiting were also recorded. &lt;/em&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;&lt;em&gt;Conclusion:&lt;/em&gt;&lt;/strong&gt;&lt;em&gt; Studies on the cost-effectiveness of ONS are limited, yet available studies suggest ONS might potentially be a cost-effective nutrition intervention in child malnutrition treatment due to its relatively low cost which potentially reduces direct medical costs.&lt;/em&gt;&lt;/p&gt;

Nutritional management of patients during surgical prehabilitation and rehabilitation programs

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

Effect of nutritional supplementation on bone mineral density in children with sickle cell disease: protocol for an open-label, randomised controlled clinical trial

IntroductionChildren with sickle cell disease show a significant decrease in bone mineral density, an increase in resting energy expenditure of more than 15%, a decrease in fat and lean mass...

Impact of Oral Nutritional Supplementation in Chronic Kidney Disease Patients on Maintenance Hemodialysis: An Open-label, Single-arm Study among Indian Patients.

Protein-energy wasting (PEW) affects about 50-75% of patients with chronic kidney disease (CKD), particularly those who are on maintenance hemodialysis (MHD). This study evaluated the efficacy and tolerability of an oral nutritional supplement in Indian patients receiving MHD. This was a 3-month, prospective, open-label, and single-centered study. Eligible participants supplemented their regular diet with one sachet (40 gm) of oral nutritional supplement powder twice daily for 90 days. The study efficacy endpoints were mean change in acute phase proteins (albumin and prealbumin), anthropometric measurements [weight, body mass index (BMI), and triceps skin fold thickness], handgrip strength, hemoglobin, total iron binding capacity (TIBC), potassium, and phosphorus levels, malnutrition score (MS)-modified subjective global assessment (modified SGA), malnutrition inflammation score (MIS), and nutritional status. The study population comprised 36 (42.9%) men and 48 (57.1%) women with a mean age of 54.85 ± 15.50 years. A paired sample t-test was used to compare the baseline with end-of-study values for continuous variables. Serum albumin, prealbumin, hemoglobin, and phosphorus levels remained stable throughout the study period. The mean change in weight, BMI, triceps skin fold thickness, handgrip strength, and TIBC for the overall study population was 1.11 kg (1.82%, p < 0.0001), 0.46 kg/m2 (1.98%, p < 0.0001), 3.47 mm (30.78%, p < 0.0001), 6.05 kg (44.98%, p < 0.0001) and 11.80 µg/dL (6.06%, p < 0.0001), respectively. At the end of the study period, there was a significant (p < 0.0001) improvement in the SGA and MIS scores. Further, there was a significant improvement in nutritional status as demonstrated by the overall intake of calories (p < 0.001), proteins (p < 0.0001), carbohydrates (p = 0.003, and fats (p < 0.0001). Protein-energy malnutrition is a strong predictor of morbidity, mortality, and poor outcomes in CKD patients. A scientifically designed formula in accordance with KDOQI standards was able to improve the nutritional status, overall body composition, sarcopenia, and quality of life in CKD patients on MHD.

ORAL NUTRITION SUPPLEMENT (ONS) BERBASIS BAHAN PANGAN LOKAL UNTUK PASIEN MALNUTRISI RUMAH SAKIT

Hospitalized patients with malnutrition are at risk of experiencing prolonged healing processes, extended hospital stays, and a decline in quality of life. One effort to enhance energy and protein intake is through oral administration using Oral Nutrition Supplements (ONS). ONS can be developed as a liquid food formula based on local ingredients, such as tilapia fish and sweet potato. This research aimed to determine the impact of tilapia fish flour and sweet potato flour formulations on the quality of ONS, including organoleptic properties, nutritional value, physical quality, microbiology, and shelf life. The experimental design involves three formulations of tilapia fish and sweet potato flour: 80%:20% (F1), 60%:40% (F2), and 40%:60% (F3). Organoleptic properties are analyzed using hedonic tests by 30 semi-trained panelists. The results showed that ONS with the best organoleptic properties was F2, with an average hedonic score of 5.60 (overall). Kruskal-Wallis test results showed that the formulation significantly influences the taste, aroma, color, and overall of ONS. Nutritional analysis revealed that ONS F2 per 100 mL contains 112 Kcal of energy, 5.4 g of protein, 3.8 g of fat, and 14.1 g of carbohydrates. The viscosity of ONS F2 was 226.5 cP, and the osmolality was 589 mOsmol/kg H2O. ONS F2 also complied with microbiological quality standards. The shelf life of ONS F2 at 2°C was estimated to be 24 days, with an expected selling price of Rp. 23,000 per serving. The research results are expected to apply to malnourished patients in hospitals.