Specific Nutritional Guidelines Research Articles

Developing a consensus to support health and social care professionals and patients manage nutrition in the context of COVID-19 recovery.

The long-term effects on people who have had COVID-19 affect nutrition and can be influenced by diet conversely. Specific nutritional guidelines, however, were scarce at the beginning of 2020, and empirical literature was also lacking. Conventional research methodologies needed to be adapted to review the available literature that could be relevant to the United Kingdom and policy documents as well as collect the views of health and care staff. The aim of this paper is to describe the method to develop consensus statements from experts to address the necessary nutritional support and what emerged from this. A nominal group technique (NGT) was adapted to the virtual world; we purposefully selected a range of professionals (dietitians, nurses, occupational therapists, etc.) and patients with long-term effects of COVID to present them with the most updated evidence and aim to reach key guidelines to address COVID-19 recovery. We were able to reach consensus statements that were developed and reviewed by relevant healthcare staff at the front line to address the nutritional needs of patients recovering from COVID-19 and those suffering from its long-term effects. This adapted NGT process led us to understand that a virtual repository of concise guidelines and recommendations was needed. This was developed to be freely accessed by both patients recovering from COVID-19 and health professionals who manage them. We successfully obtained key consensus statements from the adapted NGT, which showed the need for the nutrition and COVID-19 knowledge hub. This hub has been developed, updated, reviewed, endorsed and improved across the subsequent 2 years.

Effect of dietary counseling on patients with chronic obstructive pulmonary disease admitted to a tertiary care hospital, Middle Delta, Egypt

Objectives: is to assess the impact of dietary advice on malnourished patients with COPD. Methods: an intervention study conducted at the chest hospital of Tanta university. One hundred patients with stable COPD were chosen. Patients received dietary counseling once a week for 6 months based on specific nutritional guidelines for patients with COPD. Results: After 6 months of the intervention, the mean difference of COPD assessment test (CAT) improved from (19.47± 5.759) preintervention to (12.98±5.635) postintervention, both had moderate respiratory impairment as measured by CAT score and the mean difference of Modified Research council (MRC) dyspnea scale improved from (2.70±.689) preintervention to (1.99±.772) postintervention, both had mild score on (MRC) dyspnea scale, with significant difference p (

Diet-related complications according to the timing of enteral nutrition support in patients who recovered from out-of-hospital cardiac arrest: a propensity score matched analysis.

A proper nutritional plan for resuscitated patients is important in intensive care; however, specific nutritional guidelines have not yet been established. This study aimed to determine the incidence of diet-related complications that were affected by the timing of enteral nutrition in resuscitated patients after cardiac arrest. This retrospective and 1:1 propensity score matching study involved patients who recovered after nontraumatic, out-of-hospital cardiac arrest at a tertiary hospital. Patients were divided into an early nutrition support (ENS) group and a delayed nutrition support (DNS) group according to the nutritional support time within 48 hours after admission. The incidence of major clinical complications was compared between the groups. A total of 46 patients (ENS: 23, DNS: 23) were enrolled in the study. There were no differences in body mass index, comorbidity, and time of cardiopulmonary resuscitation between the two groups. There were 9 patients (ENS: 4, DNS: 5) with aspiration pneumonia; 4 patients (ENS: 2, DNS: 2) with regurgitation; 1 patient (ENS: 0, DNS: 1) with ileus; 21 patients (ENS: 10, DNS: 11) with fever; 13 patients (ENS: 8, DNS: 5) with hypoglycemia; and 20 patients (ENS: 11, DNS: 9) with hyperglycemia. The relative risk of each complication during post-resuscitation care was no different between groups. There was a similar incidence of diet-related complications during post cardiac arrest care according to the timing of enteral nutrition.

Benchmarking Diet Quality to Assess Nutritional Risk in Hemodialysis Patients: Applying Adequacy and Moderation Metrics of the Hemodialysis-Healthy Eating Index

This study modified Healthy Eating Index (HEI) based on hemodialysis (HD)-specific nutritional guidelines and investigated associations between the diet quality (DQ) and nutritional risk in HD patients. The HD-HEI tool adapted the Malaysian Dietary Guidelines 2010 framework according to HD-specific nutrition guidelines. This HD-HEI was applied to 3-day dietary records of 382 HD patients. Relationships between HD-HEI scores and nutritional parameters were tested by partial correlations. Binary logistic regression models adjusted with confounders were used to determine adjusted odds ratio (adjOR) with 95% confidence interval (CI) for nutritional risk based on HD-HEI scores categorization. The total HD-HEI score (51.3±10.2) for this HD patient population was affected by ethnicity (Ptrend < .001) and sex (P=.003). No patient achieved "good" DQ (score: 81-100), while DQ of 54.5% patients were classified as "needs improvement" (score: 51-80) and remaining as "poor" (score: 0-51). Total HD-HEI scores were positively associated with dietary energy intake (DEI), dietary protein intake (DPI), dry weight, and handgrip strength, but inversely associated with Dietary Monotony Index (DMI) (all P<.05). Individually, scores for refined grain, total protein, and animal protein were positively associated with DEI (all P<.05), while total, animal, fish, and vegetable proteins indicated positive associations with DPI (all P<.05). Moderating metrics for convenience meals, saturated fats, sodium, and fluid negatively correlated toward DEI with similar trends for DPI excepting convenience meals and fluids. "Poor" DQ was associated with DMI ≥ 29.2 (adjOR 18.83, 95% CI 9.36-37.86, P<.001), Malnutrition Inflammation Score ≥ 5 (adjOR 1.78, 95% CI 1.01-3.15, P=.045), and protein energy wasting (adjOR 1.96, 95% CI 1.14-3.34, P=.031), but became nullified with covariate adjustments. "Poor" DQ was also associated with low lean tissue mass (<32.6kg) in men (adjOR 2.38, 95% CI 1.01-5.58, P=.046) but not women. "Poor" DQ was associated with poor nutritional status in Malaysian HD patients, who should be targeted for nutritional counseling.

School Meals Energy and Nutritional Composition According to Age Specific Nutritional Guidelines - Eat Mediterranean Program (P04-154-19)

ObjectivesEat Mediterranean (EM), a community-based Public Health Program, was developed with the goal to reduce nutritional inequalities in school children through the promotion Mediterranean Diet, giving priority to the school environment1 The present study addresses the evaluation of school meals nutritional composition, before and after the intervention of the EM, considering the age-specific nutritional recommendations. MethodsEM was developed in three School Groups in the years 2015/16 (1st Phase – Diagnostic) and 2016/17 (2nd Phase – post-intervention) in a total of 25 schools with all educational levels (pre-school through secondary education) considering ages between 2 and 21 years. The meal components collected were: bread, soup and main course (with salad or cooked vegetables). For this study, ten random schools were selected at each phase representing 60 samples analyzed.Macronutrients, energy and salt contents were determined by internal methods developed and validated by the laboratory and according to European or International Standards EN ISO/IEC 170252,3. School meals nutritional composition evaluation was performed considering that a lunch meal should contribute 30% of the daily energy intake4, and by checking the deviations related to the age-specific nutritional recommendations5. ResultsIn the 1st phase, school meals showed a negative deviation for total energy and for carbohydrate content, for the groups 6–10 and 16–21 ages (with and without bread). In contrast, with the exception of the age group of 16–21, protein content presented positive deviations. Regarding salt content, different deviations were observed among the studied age groups being these deviations higher than 40% for the age group of 2–5. In the post-intervention phase, corrections were achieved for total energy and carbohydrate content particularly for the age groups of 2–5 e 6–10, for protein values, the positive deviation was still observed and the salt content decreased for all age groups. The fat content was always within the reference intervals. ConclusionsThe EM program has proved to have an overall positive impact on the nutritional quality of the school meals provided. However, the reduction of salt content, the provision of adequate amounts of protein as well as the adjustment of the portion served to the respective age group should be reinforced, adjusted and monitored. Funding SourcesNot applicable.

Maternal Weight Variation in Different Intrauterine Environments: An Important Role of Hypertension.

Different intrauterine environments may influence the maternal prepregnancy body weight (BW) variation up to 6 months postpartum. The objective of the present study was to verify the association of sociodemographic, obstetric, nutritional, and behavioral factors with weight variation in women divided into four groups: hypertensive (HM), diabetic (DM), smokers (SM), and control mothers (CM). It was a convenience sample of 124 postpartum women recruited from 3 public hospitals in the city of Porto Alegre, state of Rio Grande do Sul, Brazil, between 2011 and 2016. Multiple linear regressions and generalized estimating equations (GEE) were conducted to identify the factors associated with maternal weight variation. For all GEE, the maternal weight measurements were adjusted for maternal height, parity, educational level, and the type of delivery, and 3 weight measurements (prepregnancy, preceding delivery, and 15 days postpartum) were fixed. A hierarchical model closely associated the maternal diagnosis of hypertension and a prepregnancy body mass index (BMI) classified as overweight with maternal weight gain measured up to the 6th month postpartum (the difference between the maternal weight at 6 months postpartum and the prepregnancy weight). These results showed that the BW of the HM group and of overweight women increased ∼ 5.2 kg 6 months postpartum, compared with the other groups. Additionally, women classified as overweight had a greater BW variation of 3.150 kg. This evidence supports the need for specific nutritional guidelines for gestational hypertensive disorders, as well as great public attention for overweight women in the fertile age.

Nutritional Requirements of Lung Transplant Recipients: Challenges and Considerations.

An optimal nutritional status is associated with better post-transplant outcomes and survival. Post-lung transplant nutrition management is however particularly challenging as lung recipients represent a very heterogeneous group of patients in terms of age, underlying diseases, weight status and presence of comorbidities. Furthermore, the post-transplant period encompasses several stages characterized by physiological and pathophysiological changes that affect nutritional status of patients and necessitate tailored nutrition management. We provide an overview of the current state of knowledge regarding nutritional requirements in the post-lung transplant period from the immediate post-operative phase to long-term follow-up. In the immediate post-transplantation phase, the high doses of immunosuppressants and corticosteroids, the goal of maintaining hemodynamic stability, the presence of a catabolic state, and the wound healing process increase nutritional demands and lead to metabolic perturbations that necessitate nutritional interventions. As time from transplantation increases, complications such as obesity, osteoporosis, cancer, diabetes, and kidney disease, may develop and require adjustments to nutrition management. Until specific nutritional guidelines for lung recipients are elaborated, recommendations regarding nutrient requirements are formulated to provide guidance for clinicians caring for these patients. Finally, the management of recipients with special considerations is also briefly addressed.

Anti-inflammatory Activity of Extra Virgin Olive Oil Polyphenols: Which Role in the Prevention and Treatment of Immune-Mediated Inflammatory Diseases?

Altered inflammatory response characterizes chronic immunemediated inflammatory diseases (IMID) such as rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, systemic lupus erythematosus, and psoriasis. Accumulating evidence indicates that regular consumption of extra virgin olive oil (EVOO), the main source of fat in the Mediterranean diet, is associated with a reduced risk of developing chronic degenerative disorders such as cardiovascular diseases, type 2 diabetes and cancer. The beneficial effects on health of EVOO have been attributed, besides to the monounsaturated fats content, to the presence of phenolic compounds that have antioxidant, anti-inflammatory and immunomodulatory properties. The purpose of this review is to provide an overview of the effects of EVOO polyphenols on IMID highlighting the potential mechanisms of action. Scientific papers were found by searching in PubMed up to May 2017 using the following key words: rheumatoid arthritis, inflammatory bowel disease, multiple sclerosis, systemic lupus erythematosus, and psoriasis also in combination with EVOO, phenolic compounds, oleuropein, oleocantal, hydroxytyrosol,tyrosol and oleochantal. In vitro and in vivo studies indicate that EVOO and its polyphenols can improve diseases symptoms in IMID, by acting both at local and systemic levels and by modulating several molecular pathways. Nevertheless, there are not sufficient data to achieve specific nutritional guidelines. Further research is needed to evaluate the real contribution of EVOO and its phenolic compounds in modulating the IMID-associated inflammatory perturbations, in order to develop appropriate nutritional recommendations.

Current Indicators of Nutritional Care in Children with Type 1 Diabetes in India: Do we Need a National Nutritional Guideline?

Background:Nutrition is an important pillar of management in children with type 1 diabetes. Indian food is heavily influenced by region, religion, traditions, seasons, and cultural choices. This survey was done to assess current practices and the need for India specific nutritional guidelines for children with type 1 diabetes.Materials and Methods:Two 12-item questionnaires were administered to forty health-care professionals across India. The first questionnaire evaluated current clinical practice indicators for nutrition in these children and second assessed practices for counseling a child on dietary habits.Results:There is great heterogeneity across the country with regard to dietary advice offered to children with type 1 diabetes. 97.5% of the respondents feel there is a need for an Indian dietary guideline for children with type 1 diabetes.Conclusion:There is need of India specific nutritional guidelines that should be made considering key variants such as age, region, cultural preference, economic burden and psychosocial beliefs, to offer guidance to diabetes care professionals.

Impact of decreasing energy intakes in major burn patients: A 15-year retrospective cohort study

Nutritional therapy is particularly important after major burn injury and specific nutritional guidelines have been developed. The study aimed at evaluating the impact of the changes in our nutritional practice, general compliance with the guidelines and potential consequences. Retrospective analysis of prospectively collected data in burn patients requiring intensive care (ICU) between 1999 and 2014. admission on day 1, full treatment and length of ICU stay >7 days. Four periods (P) were defined by protocol changes (P1: 1999-2001, P2: 2002-2005, P3: 2006-2010, P4: 2011-2014). Collected data: demographic and nutritional data, infectious complications, weights, CRP and prealbumin concentrations during the first 21 days. 240 patients were included (median age 43 years, burned area 25%). Measured energy expenditure (MEE) was stable through all periods but the prescribed caloric target decreased significantly, and below MEE (P1: 33kcal/kg, IQR 7, P4: 28kcal/kg, IQR 8, p<0.001). Energy delivery ended decreasing below 30kcal/kg/day (P1: 30kcal/kg, IQR 23, P4: 25kcal/kg, IQR 12, p<0.001). Protein intakes increased due the use of high protein solutions and glutamine (P1: 1.04g/kg, IQR 0.90, P4: 1.26, IQR 0.99, p<0.001). Weight loss by day 21 increased significantly according to area under the curve (P1: 701, IQR 38, P2: 722, IQR 51, P4: 689 IQR 63, p=0.02). Prealbumin levels decreased with energy decrease (P1: 150mg/L, IQR 110, P4: 80mg/L, IQR 70, p=0.003). The observed reduction of the energy delivery <30kcal/kg was associated with a supplemental weight loss and lower prealbumin concentrations.

Professional training and research: which resources?

The National Plan of Prevention (PNP 2014-2018) [1], which is the key document for the Italian Public Health, underlines the need to realize for all people an empowerment level able to increase or maintain the health control. At international level, the Ljubljana Charter [2] contains the sanitarian systems commitment to rearrange, in the aim to improve continually the quality, with reference to, in particular, the rate cost /efficacy of the system. The manual for medical practitioners and pediatricians (Ministry of Heath, 2010) [3] acknowledges the seven fields of skills for operators, as defined by the Canadian Patient Safety Institute, the CPSI. Continuous training for health professionals started as a national program in Italy in 2002; some years later (2007) administrative control had been transferred from the Ministry of Health to the National Agency for Health Services, Agenas. At distance training and online updating are now becoming very common, close to traditional kinds of events for training, always in respect of the Evidence Based Medicine (EBM). We can identify, in the continuous sanitarian training system, different roles and various kinds of providers. Relevant organisations include the National Committee for Training, in the Ministry of Health, the Warranty Committee, and the National Observatory about Quality of Training. Regarding research in the field of health, we can consider it as the architrave of the National Health Service; the Report on Health Status in Italy 2012-13 [4] defines some essential aspects of it, such as the improvement of criteria of selection of the projects, to simplify bureaucratic procedures, evaluation and the rapid spread of the results. The National Committee for Sanitarian Research defines the program and initiatives, monitors and evaluates the results. Research institutes involved in Italy must accept different challenges, according with the Singapore Declaration [5], which defined some criteria about loyalty and professional honesty. The European Union invested 80M Euro in research with Horizon 2020, in the aim of destroying barriers and realising, all over the world, a common environment concerning knowledge, research and innovation. A recent piece of research related to the food habits in the age of complementary feeding is Nutrintake 6/36 [6], the first Italian study which confirms some excesses and deficiencies in the diet. It suggests the opportunity of the definition of specific nutritional guidelines.

Diversity of eating patterns and obesity in older adults—A new challenge

The increase in the variety of food choices influences the eating patterns of older adults, which is in turn increases the occurrence of obesity. This study aimed at identifying eating patterns and their association with obesity in a representative sample of older adults living in an urban area and registered in the basic health unit in the city of Botucatu, S?o Paulo, Brazil. This is a cross-sectional study and data collection took place from March to June of 2011 through the application of a validated food frequency questionnaire for older adults, a socio-demographic survey and an anthropometric evaluation. Eating patterns were identified through principal component analysis. Scores of individual consumption were divided in tertiles, characterizing as low, moderate or high adherence of the individuals to each pattern. Logistic regression models were fitted for the outcomes “general obesity” and “abdominal obesity” and the tertiles of consumption adjusting by sociodemographic variables. Six eating patterns were identified: Healthy foods, Snacks and weekend meals, Fruits, Light and whole foods, Mild diet and Traditional diet. It was found that the adherence to healthy foods is protective against obesity as well as adherence of snacks and weekend meals are risk of obesity. Eating patterns and their recognized influence on obesity comprise an issue that deserves continuous attention in order to evaluate collectively the eating profile, and develop specific nutritional guidelines for older adults.

Sports Nutrition for Young Athletes

CME EDUCATIONAL OBJECTIVES 1. Identify an effective means to assess the nutritional status of a young athlete during the office visit. 2. Review the most common performance detractors associated with nutritional inadequacies in children and adolescents. 3. Discuss specific nutritional guidelines for the young athlete and how best to motivate the affected child to improve their overall nutritional health.

Meals at medical specialty society annual meetings: a preliminary assessment.

Little isd known about how meals are chosen for medical meetings. We surveyed the annual meeting planners for 20 major specialty societies. Thirteen (65%) responded; all were currently planning their next meeting. Attendance in 2000 was reported at 113,477 physicians, with 2 million planned meals and snacks. No physician was named as responsible for food choices; the meeting planner and staff were primarily responsible for deciding what food to serve, excluding exhibit halls. Twelve (92%) respondents rated "available budget" as the most important factor. "Nutritional guidelines" were rated "very important" by eight of 13 (63%). However, no specific nutritional guidelines could be identified by any planner. All respondents indicated that members would attend a meeting if "healthy" food were the only option. For 2000, 100% of respondents indicated that for each lunch and for each dinner, a dessert had been included. No annual meeting and no planned 2001 meeting excluded potato chips, snack mixes, or candies at breaks; soda pop was offered at each break. Most respondents (89%) relied on a concluding questionnaire about the meeting facilities to evaluate the food. Respondents reported no difference in charges for "special meals," including vegetarian and kosher meals. Physicians may be unaware that some food served at medical meetings may impair learning, with excessive calorie, fat, and carbohydrate consumption. Small changes can improve the quality of food and beverages selected, without increased cost, and provide choices that conform to national nutritional guidelines. Medical meetings should serve flavorful, healthful food.