Nutritional Status Of Patients Research Articles

Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single centre, prospective, observational study.

Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period. This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period. The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008). Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.

Impact of continuity of care based on Triangle theory on nutritional status of patients after pancreatic cancer surgery: a retrospective study.

To evaluate the impact of Triangle theory-based continuity of care on postoperative malnutrition in pancreatic cancer patients. We retrospectively analyzed the data from 184 patients with pancreatic cancer admitted to The Second People's Hospital of Lanzhou City from January 2020 to May 2023. Patients were divided into a control group receiving conventional care (n = 114) and a study group receiving Triangle theory-based care (n = 70). Postoperative nutritional status and prognosis were compared between the two groups. Nutritional indexes included serum total protein (STP), albumin (ALB), and hemoglobin (HB). Self-care ability was assessed using the Exercise of Self-care Agency (ESCA). Quality of life was measured using the Quality-of-Life Questionnaire for Pancreatic Cancer 26 (QLQ-PAN-26), and the incidence of malnutrition was evaluated using the Patient-Generated Subjective Global Assessment (PG-SGA). Multifactorial logistic regression was applied to analyze risk factors for malnutrition. At ten days post-operation, the study group showed significantly better nutritional levels (P < 0.05). After three months, the, study group also exhibited superior self-care ability and quality of life scores (all P < 0.001). The incidence of malnutrition was 42.39%. Independent risk factors for malnutrition included routine care (OR = 3.459), operation time ≥ 90 min (OR = 2.277), intraoperative bleeding ≥ 200 mL (OR = 2.590), postoperative day 1 ALB < 37.5 g/L (OR = 3.975), and HB < 95.5 g/L (OR = 6.068). Triangle theory-based continuity of care significantly improves nutritional status and quality of life in postoperative pancreatic cancer patients, demonstrating its potential for broader clinical use.

РОЛЬ АДИПОКИНОВ В ВОПРОСАХ ДИАГНОСТИКИ НЕАЛКОГОЛЬНОЙ ЖИРОВОЙ БОЛЕЗНИ ПЕЧЕНИ

Introduction. Currently, the main cause of chronic liver diseases and one of the leading indications for transplantation is considered to be non-alcoholic fatty liver disease (NAFLD). The pathophysiology of the disease closely correlates with the abnormal relationship between adipose tissue and the liver, since inflammation is tightly linked to lipid metabolism. Metabolic dysfunction is manifested by insulin resistance of hepatic tissue, processes of fat accumulation in the cell (steatosis), inflammation in the form of steatohepatitis and, as the end of this process, fibrosis. Much attention is now being paid to hormones produced by adipose tissue, namely adipokines, due to their immunometabolic activity. The accumulated clinical database associates adipokines with the progression of NAFLD which may serve to expand the boundaries of diagnosis and the course of this disease. Aim. To determine the diagnostic significance of adipokines as markers of the development and progression of NAFLD in patients taking into account their nutritional status. Materials and methods. The study included a comprehensive assessment of nutritional status, including anthropometric parameters, bioimpedance analysis, assessment of actual nutrition, and evaluation of biochemical and hormonal parameters of patients. The study was performed at the Novosibirsk Regional Clinical Hospital for War Veterans No. 3 and the Research Institute for Therapy and Preventive Medicine, a branch of the Novosibirsk Institute of Cytology and Genetics. A total of 349 people participated in the study, including 113 NAFLD patients without obesity, 122 NAFLD patients with obesity, and 114 conditionally healthy individuals. Results. In patients with NAFLD, both obese and non-obese, compared to the control group, there are changes in body composition, biochemical parameters , as well as non-adherence to diet were detected when assessing actual nutrition. According to the results of the hormonal study, the patients have an increased level of adipokines. Adipsin values are significantly higher in the group of patients with NAFLD combined with obesity compared to the group of patients with NAFLD without obesity. The levels of visfatin, adipsin and PAI-1 confirmed their relationship with the nutritional status of patients with NAFLD, biochemical parameters, and non-invasive steatosis indices, while the level of visfatin was also associated with the fibrosis index FIB-4. Conclusion. The levels of adipokines can be considered as a non-invasive diagnostic marker reflecting the course and progression of NAFLD in patients with different nutritional status.

Factors associated with the malnutrition inflammation score (MIS) among hemodialysis patients in Dhaka city: a cross-sectional study in tertiary care hospitals.

Chronic kidney disease (CKD) is a progressive disease that leads to end-stage renal disease (ESRD). Malnutrition increases the risk of mortality among patients with ESRD. This study aimed to determine malnutrition prevalence and associated factors among twice-weekly (n = 94/120) and thrice-weekly (n = 26/120) hemodialysis patients/HDP. A cross-sectional study was conducted at two tertiary-level public hospitals in Dhaka city using a consecutive sampling technique from April to June 2021. Nutritional status was assessed by Malnutrition Inflammation Score (MIS). Multivariable ordinal logistic regression was performed to determine which socioeconomic, clinical, anthropometric, biochemical, and dietary factors are associated with MIS. The prevalence of malnutrition was very high among HDP (severe 15.5%, mild/moderate 56.7%) with an average dialysis vintage of 28.7 months. Comorbidities (80.8%) and gastrointestinal symptoms/GIS (68.3%) were ubiquitous, and "dialysis frequencies" were not associated with MIS in bivariate analysis. Multivariable ordinal regression showed that anthropometric factors like mid-upper arm circumference/MUAC (adjusted odds ratio/AOR = 0.978), post-dialysis body mass index/BMI (AOR = 0.957), and biochemical parameters like albumin (AOR = 0.733) and TIBC/total iron binding capacity (AOR = 0.996) negatively (P < .05) associated with MIS. Moreover, having "no GIS" (AOR = 0.672, P < .001) was 33.0% less likely to be associated with MIS. Contrarily, as the month of dialysis increases, MIS increases by 22.0% (AOR = 1.22). Significant associations of clinical, anthropometric, and biochemical characteristics with MIS indicate the importance of routine screening of the nutritional status of patients with CKD to improve health status and prevent protein-energy wasting. The MIS could be a simple, noninvasive tool for testing nutritional status in patients with CKD.

Prognostic Nutritional Index (PNI): A More Promising Nutritional Predictor for Patients Undergoing Surgery for Retroperitoneal Liposarcoma.

Extended surgery with multi-visceral resection is the standard treatment for retroperitoneal liposarcoma (RLPS). Malnutrition tends to result in increased surgical complications and reduced survival. The aim of this study was to identify the prognostic role of nutritional status in patients with RLPS. Data from 189 consecutive patients with RLPS who underwent surgical treatment at the Peking University Cancer Hospital Sarcoma Center between April 2011 and August 2022 were retrospectively reviewed. The following nutritional parameters were calculated: nutritional risk index, prognostic nutritional index (PNI) and Nutrition Risk Screening 2002. Time-dependent receiver operating characteristic (time-ROC) curve analysis was conducted to compare the prognostic utility of nutritional indicators. The associations between nutritional indicators and major complications, local recurrence-free survival (LRFS) and overall survival (OS) were investigated. Based on the time-ROC curve analysis, the PNI was superior to other nutritional indices at predicting OS. The optimal cut-off value of PNI was 41.2. The PNI was significantly inversely associated with tumor size, tumor grade, and histological subtype. Patients in the low PNI group (< 41.2) had significantly shorter LRFS and OS than those in the high PNI (≥ 41.2) group, with higher major morbidity and mortality rates. The PNI was found to be a unique nutritional predictor that independently predicted LRFS and OS in the multivariate analysis. The PNI is an effective tool for nutritional assessment in patients with RLPS. A low PNI value in patients with RLPS predicts worse survival outcomes.

Особенности применения и возможности биоимпедансного анализа в нефрологии

The purpose — to determine the features of the body’s biocomposition using bioimpedance analysis in patients with kidney pathology. Material and methods. 39 patients from the Nephrology Department of Republican Clinical Hospital were examined. Among them were patients with acute tubulointerstitial nephritis, chronic glomerulonephritis, and nephropathy of mixed etiology. All patients underwent bioimpedance analysis of body composition using the MEDASS ABC-02 device. The study presents the results of bioimpedance analysis based on different electrical resistance of biological tissues. Bioimpedance analysis allows studying the body composition of patients with different profiles. The possibilities of bioimpedance analysis in nephrology are determined by the assessment of nutritional and volemic status. Results. Approximately half of the patients (47.8%) had an high body mass index. However, when analyzing indicators of fat mass and total body water, it was found that 36.3% of patients had normal to low levels of fat mass, with the increase in total body water being due to fluid overload. Meanwhile, 27.3% with normal body mass index had an increase in fat mass. The lean body mass, reflecting the body’s protein depot, was below normal in 15.2% of patients, which may be associated with nutritional status impairment and the development of protein-energy malnutrition. Conclusion. The study demonstrated the role of bioimpedance analysis in evaluating the volumetric and nutritional status in patients with a nephrological profile.

Monitoring of nutritional status in patients with pressure injuries using the phase angle as an indicator – a study of two cases

Monitoring of nutritional status in patients with pressure injuries using the phase angle as an indicator – a study of two cases

Preventing Pressure Ulcers with the Braden Scale.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times. In the 1980s, Barbara J. Braden and Nancy Bergstrom developed the Braden Scale for Predicting Pressure Sore Risk. The scale consists of six subscales that evaluate a patient's sensory perception, activity level, mobility, and nutrition status and the skin's exposure to moisture, and friction and shear forces. The Braden Scale was adopted internationally and has since served as a foundation for decades of subsequent pressure injury research. In this June 2005 article, Braden and Joann Maklebust provided an update about the scale, reviewing its purpose, when and how often to use it, and why it shouldn't be altered, stating, "Although it's not uncommon for clinicians to shorten or otherwise alter a risk assessment tool, we strongly advise against it . . . even minor alterations may influence reliability or accuracy." Braden passed away on June 24, 2023. Her photo graces our cover this month, and you can read a tribute to her and her significant contributions to health care and nursing in On the Cover.

The Effect of Coronavirus Disease 2019 on the Quality of Associated Care in Patients with Gastric Cancer.

Coronavirus is a new virus that has affected human life on a large scale; it has infected millions of people and killed hundreds of thousands of people. In contrast, among cancers, stomach neoplasia is the most common cancer of the upper gastrointestinal (UGI) tract. COVID-19 disease has disrupted the optimal management of patients with cancer. Metastasis, deterioration of the patient's nutritional status, UGI bleeding, and increased surgical complications are all consequences of delayed treatment of patients with gastric cancer. However, there is still insufficient evidence on the immunogenicity of the vaccine and the protection provided by coronavirus vaccines in patients with cancer, especially those with immunodeficiency or those who are treated for certain types of cancers. Also, as part of the prevention and control of COVID-19 disease, nutritional support for patients with gastrointestinal cancer is particularly important, and the psychological and physiological limitations caused by the disease duration are hurting the well-being of patients. Therefore, the assessment of the impact of the coronavirus on cancer should be treated as an important issue, and healthcare professionals should be prepared to deal with the long-term effects of the coronavirus disease.

SURGICAL SITE INFECTION IN RESECTIONS OF DIGESTIVE SYSTEM TUMOURS.

Postoperative infectious complications are extremely important to surgeons and the entire medical care team. Among these complications, surgical site infection (SSI) appears to be one of the earliest and most prevalent events and is considered an inherent complication of surgical procedures. In oncological patients submitted to resections of digestive system tumors, there is a confluence of several risk factors for SSI, making it necessary to establish measures to maximize the control of this condition to provide a better prognosis for these patients. Some risk factors for SSI are the manipulation of structures hosting the highest density of pathogenic microorganisms, such as the colon, the patient's performance status, the patient's nutritional status, the use of chemotherapy and/or radiotherapy, and the surgical procedure itself, which tends to last longer and be more complex than surgeries for benign conditions of the digestive system. Therefore, this review sought to provide a qualitative analysis and a summary of the literature regarding the SSI of postoperative tumor patients who underwent surgical resection and were well-structured postoperatively, to provide objective data on this problem, and alert about the well-structured needs of individualized pre-, peri-, and post-protocols to avoid the development of these events.

Experience with wound care in a case with ECMO cannulation using a self-made vacuum-sealing drainage device with constant-temperature flushing.

To describe the use of a self-made vacuum-sealing drainage device with constant-temperature flushing to manage wound exudates in the cannulation site, aiming to create an environment conducive to wound healing. Exudates from the wound were processed using the vacuum-sealing drainage technique combined with constant-temperature flushing. Anti-infective agents were systemically administered to control infection and promote wound healing. Additionally, the patient's nutritional status, pain management, psychological well-being, and rehabilitation were assessed and managed as part of the comprehensive care approach. The wound exhibited gradual healing under this multifaceted care strategy. After 48 days of treatment, the patient demonstrated stable disease conditions and achieved wound closure. The patient was subsequently transferred to a general ward for further care. The use of a self-made vacuum-sealing drainage device with constant-temperature flushing, along with comprehensive patient management, proved effective in wound care for a critically ill patient with ECMO cannulation. This approach fosters an optimal environment for wound healing and contributes to patient recovery and stability.

Exploring the link between the Naples prognostic score and the cardio-ankle vascular index.

the Naples Prognostic Score is a novel scoring system designed to provide a comprehensive assessment of patients' inflammation and nutritional status. our aim was to investigate the correlation between the Naples Prognostic Score and arterial stiffness, a factor known to be linked with heart failure and acute coronary syndrome. this prospective study included 142 consecutive patients without a history of cardiovascular disease, inflammatory disease, immunological disease, malignancy, or comorbid conditions other than hypertension. Patients were categorized into two groups based on their Naples Prognostic Scores: Group 1 (score of 0-2) and Group 2 (score of 3 or 4). Arterial stiffness was assessed using the Cardio-Ankle Vascular Index (CAVI) measured with the VaSera VS-1000 device. CAVI values were compared between the groups. the mean age of the patients was 54 ± 9 years. Group 1 comprised 114 (80.3 %) patients, while Group 2 comprised 28 (19.7 %) patients. There were no significant differences in demographic data between the groups (p > 0.005). Additionally, there were no statistically significant differences between Group 1 and Group 2 regarding left CAVI (7.92 ± 1.45 vs. 8.72 ± 1.85; p = 0.295), right CAVI (7.89 ± 1.52 vs. 8.67 ± 1.34; p = 0.332), or left or right ankle brachial index (p > 0.005). despite previous studies indicating a significant association between the Naples Prognostic Score and heart failure or acute coronary syndrome, our study did not observe a significant correlation between this score and arterial stiffness assessed by CAVI.

Risk Factors for Multidrug-Resistant Bacterial Infection in Diabetic Foot Ulcers.

This study aimed to analyze the distribution of multidrug-resistant (MDR) organisms (MDROs) in patients with diabetic foot ulcers (DFUs) and to identify risk factors for MDRO infections. Patients hospitalized with DFUs were enrolled, and ulcer swabs were cultured for bacterial identification and antibiotic susceptibility testing. Hematology and blood biochemistry were also assessed. A total of 228 patients hospitalized with DFUs were enrolled. Out of 150 patients with positive cultures, 123 (82%) were infected with single strains, whereas 27 (18%) had mixed infections. Out of the 177 bacterial strains isolated, 78 (44%) were MDROs. Among the top 5 most common bacteria, coagulase-negative Staphylococcus, Staphylococcus aureus, and Proteus exhibited MDR rates of 92%, 56%, and 55%, respectively. Pseudomonas aeruginosa and Enterobacter cloacae had low MDR rates of 5% and 8%, respectively. Single variable logistic regression analysis showed that neutrophil percent (NEU%), creatinine, C-reactive protein, and fasting plasma glucose (FPG) were risk factors for MDRO infection, whereas hemoglobin and albumin levels were protective factors. Multivariable logistic regression analysis revealed that NEU% and FPG were independent risk factors for MDRO infection. A high percentage of the infections in patients with DFUs were caused by MDROs. To reduce MDRO infections in high-risk patients, it is important to use antibiotics rationally, improve patients' FPG levels and nutritional status, and strengthen hospital sterilization processes.

A review on hospital food waste quantification, management and assessment strategies in the eastern Mediterranean region

BackgroundHospital food wastage has been identified as a significant issue within the foodservice sector. Numerous studies have shed the light on the amount of food waste in hospitals, along with its financial and environmental implications. Consequently, reducing food waste in hospitals has become a priority for the foodservice management sector in the Eastern Mediterranean Region (EMR). AimsThis review aims to examine studies on food waste in the hospitals of the EMR countries, and highlight research gaps in quantification, management, and assessment strategies in this region. MethodsPubMed and Google Scholar databases were searched between January 6 and September 1, 2023, to identify relevant articles published up to 2023 in the EMR. ResultsSix studies were included in this review. Among EMR countries, only Iran, Saudi Arabia, and Qatar have assessed food waste at hospitals. The average food waste in the EMR represents 25.4 % of total food served. Factors contributing to food waste include clinical issues, food preferences, meal timing, and ward sections. Patient's plate waste reduce dietary intake, affects patient's nutritional status and predispose to malnutrition. While some strategies to reduce plate waste have been proposed in many countries, there is a notable lack of food and food-related waste management policies and programs in hospitals food services in the EMR. ConclusionThis review summarizes the hospital's food-related waste assessment, quantifications, and management used by hospitals in the EMR. This review is a benchmark for the EMR's hospitals to work on adopting proactive measures as a general strategy to move toward food and food-related waste reduction.

Nutritional Status and Quality of Life of Hemodialysis Patients in a Hospital in Yogyakarta

Kidney failure is a disease with a moderate prevalence in Indonesia but causes the second highest cost burden in Indonesia. One of the treatments for chronic kidney failure is hemodialysis. The problem with hemodialysis patients is a high incidence of malnutrition, which can affect the patient's quality of life. Therefore, this study will examine the relationship between nutritional status and quality of life in chronic kidney failure patients undergoing hemodialysis. This research is a cross-sectional study by collecting medical record data and filling out questionnaires. Selection of research subjects with inclusion criteria aged ≥18 years, routinely undergoing hemodialysis, willing to participate in the study and complete medical record data. The patient's nutritional status was seen from the Body Mass Index (BMI), and the patient's quality of life was assessed by the Indonesian version of the Kidney Disease Quality of Life Short-Form (KDQoL-SFTM) questionnaire. The average age of the hemodialysis patients in this study was 53.70 years, the average body weight was 57.24 kg and the average height was 10.82 cm. Patients with lean BMI were 20.5%, normal 56.4%, overweight 23.1%, and obesity 2.6%. The domain of employment status is related to nutritional status (p-value 0.005). Nutritional status is related to the quality of life of hemodialysis patients in the occupational status domain.

Updates on the potency and mechanism of glutamine supplementation in oral mucositis management: A narrative review

Introduction: Chemotherapy and head-and-neck radiotherapy administered to cancer patients can lead to the development of oral mucositis (OM), a condition characterized by extensive and excruciating damage to the oral mucosal tissues. Glutamine, an essential amino acid, plays a crucial role in various facets of cellular metabolism, particularly in cell proliferation, wound healing, and leukocyte function, and has been reported to have preventive and therapeutic benefits in oral mucositis. Objective: This study aims to comprehensively review current findings on the potential clinical applications and mechanisms of glutamine in the management of oral mucositis. Review: Several studies have demonstrated the efficacy of glutamine supplementation in diminishing the severity of OM and expediting the healing process. This positive effect is attributed to the modulation of inflammation and the stimulation of pro-regenerative activity in keratinocytes and fibroblasts. Furthermore, glutamine intervention enhances the overall nutritional status of patients, reducing the risk of complications commonly observed in cancer patients. Additionally, it plays a pivotal role in preventing or ameliorating the conditions of sarcopenia and lymphopenia. Conclusion: Glutamine supplementation emerges as a promising intervention for the management of oral mucositis in patients undergoing chemotherapy or head-and-neck radiotherapy. Its multifaceted impact, including inflammation modulation, pro-regenerative activity, and improvement in nutritional status, positions glutamine as a valuable component in the comprehensive care of cancer patients experiencing oral mucositis

Difference between Nutrition Status in First and Recurrent Ischemic Stroke Patients: a Retrospective Cross-Sectional Study

Malnutrition in stroke patients can be caused by neurological deficits such as decreased consciousness, dysphagia, cranial nerve paresis, and hemiparesis/hemiplegia. The condition of malnutrition seriously impacts healing and can exacerbate the underlying disease, in this case, stroke, so malnutrition in stroke patients extends the length of stay and increases morbidity and mortality. This study compares nutritional status between first and recurrent ischemic stroke patients based on body mass index (BMI) and subjective global assessment (SGA). This study is a comparative analysis of the medical records of ischemic stroke patients in Dr. Hasan Sadikin General Hospital Bandung from January 2018 until December 2020. The chi-square and Fisher's exact tests were used for statistical analysis. The significance criteria are the p-value if p≤0.05 means statistically significant. A total of 236 subjects in both groups of first and recurrent ischemic stroke patients consisting of 130 men and 106 women with an average age of 56.64 and 61.75 years, and the majority had risk factors for hypertension. The first ischemic stroke group has a good nutrition status compared with the recurrent stroke group (p&lt;0.05). Thirteen patients (11.02%) of first ischemic stroke and 11 patients of recurrent ischemic stroke (9.32%) were underweight, 67 patients (56.78%) of first ischemic stroke and 74 patients of recurrent ischemic stroke (62.71%) had average weight, 31 patients (26.27%) first ischemic stroke and 33 patients (27.97%) recurrent ischemic stroke were overweight, five patients (4.24%) first ischemic stroke and seven patients (5.93%) recurrent ischemic stroke were obese (p&lt;0.05). In conclusion, there was a significant difference in the nutritional status of first and repeated ischemic stroke patients. The nutritional status of recurrent ischemic stroke patients is worse than that of first ischemic stroke patients.

Development of Health Promotion with The Design of Heart Failure Patient Monitoring Instrument

Heart disease, particularly heart failure, is a prevalent chronic condition requiring regular monitoring to maintain patients' well-being. This study aims to develop and validate a monitoring instrument for heart failure patients. A pilot study was conducted in two main stages: instrument development and pre-test post-test on a sample of outpatient heart failure patients at RSU Muhammadiyah Ponorogo from March to May 2023. The validity test revealed 17 valid questionnaire items, with Cronbach’s Alpha values for routine examination, physical activity, and nutrition domains being 0.729, 0.829, and 0.786, respectively, indicating good reliability. Sample testing demonstrated a significant improvement in patient compliance (p &lt; 0.005) and nutritional status (p &lt; 0.05) after cardiovascular health promotion. However, there was no significant change in physical activity. With a combination of high construct validity, good reliability, and strong content validity, the questionnaire proved to be a robust and reliable measurement tool. The findings depict significant changes in compliance and nutritional status among heart failure patients following health promotion interventions, emphasizing the need for further focus on physical activity aspects. These results can contribute to the development of more effective monitoring and care strategies for heart failure patients.

Tatalaksana Proses Asuhan Gizi Terstandar pada Pasien Diabetes Melitus Tipe 2 dengan Sepsis Pasca Operasi Gangren

Background : Diabetes Mellitus (DM) is a group of metabolic diseases characterized by hyperglycemia that occurs due to abnormalities in insulin secretion, insulin action, or both. One of the complications that can be caused by DM is gangrene, which is an infection of the feet due to a reduction in oxygen flow to the organs. This causes tissue death and if severe can cause amputation in people with DM. The management of managing DM is not only by administering medication, but also by diet therapy. This is aimed at maintaining the patient's nutritional status. It is necessary to carry out a Standardized Nutritional Care Process (NCP) to optimize nutritional services for DM patients Objective : To determine the effect of the Standardized Nutrition Care Process (NCP) on type 2 DM patients with sepsis after gangrene surgery Research Methods : The method used in this research was qualitative descriptive research with a case study approach. The subject in this case study was a 52 year old female patient who was treated at RSUD dr. Soebandi Jember with a medical diagnosis of type 2 DM with sepsis after gangrene surgery. Patients was given a standardized nutritional care process during hospitalization. The research time was 3-7 November 2022. Research analysis uses using descriptive analysis. Research Result : The results of NCP showed that the patient had underweight nutritional status. During monitoring, the evaluation showed that the patient's blood biochemical levels during the nutritional care process had not shown improvement because they were still below normal values. Furthermore, the patient's physical and clinical condition improved even though his appetite was still low. Then the results of the consumption survey with 24-hour food recall show that the patient's food intake is still &lt;80%, still in the severe deficit category during the process of providing nutritional care. Conclusion : NCP provides to patients has not shown significant improvement due to post-surgery. There is a need to modify the food menu and motivate patients to increase the patient's appetite and food intake so that the patient's nutritional status can be improved.

Effects of a low-protein nutritional formula with dietary counseling in older adults with chronic kidney disease stages 3–5: a randomized controlled trial

BackgroundAlthough combining a low-protein diet (LPD) with oral nutritional supplements increases treatment adherence and nutritional status in patients with chronic kidney disease (CKD), the effect of this combination approach in older adults remains unclear. This study examined the impact of a 6% low-protein formula (6% LPF) with diet counseling in older adults with stage 3–5 CKD.MethodsIn this three-month randomized controlled study, 66 patients (eGFR < 60 mL/min/1.73 m2, non-dialysis, over 65 years of age) were randomly assigned to an intervention group (LPD plus a 6% LPF) or control group (LPD alone). The 6% LPF comprised 400 kcal, 6 g of protein, eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and various micronutrients. All data were collected at baseline and after three months, including physical performance based on hand grip strength (HGS) and gait speed, nutritional status using Mini Nutritional Assessment-Short Form (MNA-SF) scores, body composition through bioelectrical impedance analysis, and dietary intake from 24-h dietary records.ResultsThis study incorporated 47 participants (median age, 73; median eGFR, 36 ml/min/1.73 m2; intervention group: 24; control group: 23). The intervention group exhibited significant differences in HGS and gait speed, and micronutrient analysis revealed significantly higher monounsaturated fatty acids (MUFA), EPA, DHA, calcium, iron, zinc, copper, thiamine, riboflavin, niacin, B6, B12, and folic acid intake than the control group. MNA-SF scores, macronutrient intake, and body composition did not differ significantly between the two groups.ConclusionsCompared to LPD counseling alone, an LPD prescription with 6% LPF in older adults with CKD stages 3–5 helped relieve physical deterioration and increased micronutrient intake after three months.Trial registrationClinicalTrials.gov NCT05318014 (retrospectively registered on 08/04/2022).