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International Wound Journal May 2024Determine how healthcare professionals perceive their role in nutrition assessment and management, and explore barriers and enablers to assessment and management of...
'Nutrition has everything to do with wound healing'-health professionals' perceptions of assessment and management of nutrition in individuals with diabetes-related foot ulceration.
Determine how healthcare professionals perceive their role in nutrition assessment and management, and explore barriers and enablers to assessment and management of nutrition in individuals with DFU. Mixed methods including a cross-sectional online survey derived from current international guidelines and theoretical domains framework, and semi-structured interviews with conventional content analysis was performed. One hundred and ninety-one participants completed the survey, with 19 participating in interviews. Many health professionals are not confident in their ability in this area of practice, are uncertain their nutrition advice or management will be effective in assisting wound healing outcomes and are uncertain their intervention would result in adequate behaviour change by the individual with DFU. Major barriers to implementation of nutrition assessment and management were: inadequate time, lack of knowledge and lack of clinical guidance and enablers were as follows: professional development, a standardised clinical pathway and screening tool and a resource addressing wound healing and diabetes management. Nutrition assessment and management in individuals with DFU is not consistently applied. Whilst health professionals believed nutrition was important for wound healing, they lacked confidence in implementing into their practice. Further dissemination of existing guidance and implementation of education programs and resources would help overcome cited barriers.
Topics: Humans; Wound Healing; Cross-Sectional Studies; Diabetic Foot; Male; Female; Nutrition Assessment; Attitude of Health Personnel; Adult; Middle Aged; Health Personnel; Surveys and Questionnaires; Aged
PubMed: 38745257
DOI: 10.1111/iwj.14898 -
PloS One 2024Dietitians are nutrition professionals equipped with specialised skills required to prevent and treat malnutrition in cancer. Optimisation of dietary intake is...
BACKGROUND
Dietitians are nutrition professionals equipped with specialised skills required to prevent and treat malnutrition in cancer. Optimisation of dietary intake is recommended as the primary nutrition strategy for the treatment of cancer-related malnutrition. However, it is unclear whether dietary patterns, described as the combination, quantity, and frequency of food consumption, are considered. This study examined dietitians' current food-based management of malnutrition; explored dietitians' awareness of dietary patterns and assessed barriers and enablers to the use of dietary patterns in clinical practice.
METHODS
This qualitative study consisted of semi-structured interviews with oncology dietitians. Dietitians were recruited through national nutrition societies, social media, and professional networks. Audio-recorded interviews were transcribed verbatim and analysed using inductive thematic analysis.
RESULTS
Fourteen oncology dietitians from across four Australian states and territories participated. Three themes were identified: (i) principles to guide nutritional care, (ii) dietary patterns as a gap in knowledge and practice, and (iii) opportunities for better care with systems as both a barrier and enabler. Dietetic practice was food-focussed, encouraging energy and protein-rich foods consistent with nutrient-focussed evidence-based guidelines. Dietitians encouraged one of two nutrition-related approaches, either encouraging intake of 'any tolerated food' or 'foods supportive on longer-term health'. Dietitians were generally unaware of dietary patterns and questioned their relevance in certain clinical situations. A multidisciplinary team approach, adequate food service and dissemination of dietary patterns research and education were identified as opportunities for better patient care.
CONCLUSIONS
Recommendations for the treatment of malnutrition vary between oncology dietitians and uncertainty exists regarding dietary patterns and their relevance in clinical practice. Further exploration into the role of dietary patterns to treat cancer-related malnutrition and education for dietitians are required prior to implementation of a dietary patterns approach into clinical practice.
Topics: Humans; Nutritionists; Neoplasms; Qualitative Research; Male; Female; Australia; Malnutrition; Adult; Middle Aged; Dietetics; Diet; Dietary Patterns
PubMed: 38743744
DOI: 10.1371/journal.pone.0302107 -
Clinical and Translational Radiation... Jul 2024The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our...
BACKGROUND
The impact of body composition and sarcopenia in locally advanced rectal cancer (LARC) is still unclear, even several studies have been published on this issue. Our study aims to analyze the impact of sarcopenia on neoadjuvant chemoradiotherapy (nCRT) tolerance and survival outcomes.
METHODS
This is a retrospective, monocentric study where LARC patients treated between 2010 and 2020 were enrolled. A single slice, from the pre-therapy simulation computed tomography (CT) scan, was used to perform the body composition analysis with dedicated software. The primary endpoint was the impact of body composition on radiotherapy (RT) interruption secondarily on overall survival (OS), disease-free survival (DFS), and local control (LC).
RESULTS
The study included 628 LARC patients (40.9 % female, mean age 63.4 years): 24 % had low skeletal muscle index (SMI), 30 % had low muscle density (MD) and 17 (10.3 % of obese) were sarcopenic obese. Higher BMI (OR 2.38, 95 % CI 1.36-4.01) and lower SMI (0.73, 95 % CI 0.55-0.94) resulted as independent predictors of RT interruption. Sarcopenic obesity (HR 2.83, 95 % CI 1.24-6.45) was related to worse OS, while MD (0.96, 95 % CI 0.93-0.98), and higher SMI (0.97, 95 % CI 0.95-0.99) were related to better OS; a lower MD remained also associated even in adjusted multivariable analysis (0.96, 95 % CI0.93-0.98). Moreover, higher visceral adipose tissue (VAT) resulted associated with worse DFS (1.02, 95 % CI 1.01-1.03), while higher SMI was related to better Local Control (0.96, 95 % CI 0.93-0.99).
CONCLUSIONS
Body composition analysis, particularly of muscle and fat masses, may be a useful tool for better management of LARC patients undergoing RT. Increased collaboration between radiation oncologists and clinical nutritionists is advisable, to enable early nutritional support of LARC.
PubMed: 38741926
DOI: 10.1016/j.ctro.2024.100789 -
Journal of Medicine and Life Jan 2024This study provides a conceptual exploration of an innovative telemedicine-enhanced team-based care (TETC) model, tailored to prenatal care, integrating a...
This study provides a conceptual exploration of an innovative telemedicine-enhanced team-based care (TETC) model, tailored to prenatal care, integrating a multidisciplinary team approach with advanced telemedicine technologies. The algorithm developed for TETC aims to optimize communication and coordination among healthcare professionals, including obstetricians, midwives, nutritionists, and mental health experts. This cohesive team structure ensures a comprehensive care plan encompassing all facets of maternal and fetal health. Leveraging telemedicine tools like video conferencing and digital health records, the model supports remote consultations and coordinated care, proving particularly advantageous during pandemics or in regions with limited healthcare access. Central to the TETC model is patient-centered care, focusing on personalized care plans attuned to the individual needs, health status, and socioeconomic backgrounds of pregnant women. This approach not only enhances accessibility and convenience by diminishing the necessity for physical consultations but also ensures continuity of care throughout pregnancy. This continuity is crucial for consistent health parameter tracking and early risk identification. The paper discusses the model's design, operational workflow, and ethical and legal considerations, providing implementation guidelines and potential applications. The TETC model, rooted in current technological capabilities and healthcare frameworks, underscores the need for close collaboration with healthcare professionals to adhere to medical standards and address real-world requirements effectively.
Topics: Humans; Telemedicine; Female; Pregnancy; Prenatal Care; Patient Care Team; Algorithms; Patient-Centered Care
PubMed: 38737663
DOI: 10.25122/jml-2024-0145 -
JIMD Reports May 2024Pyridoxine-dependent epilepsy (PDE-ALDH7A1) is a neurometabolic disorder in the lysine metabolism pathway. In 2014 and 2021, the International PDE consortium published...
Dietary management for pyridoxine-dependent epilepsy due to α-aminoadipic semialdehyde dehydrogenase deficiency, a follow-on from the international consortium guidelines.
Pyridoxine-dependent epilepsy (PDE-ALDH7A1) is a neurometabolic disorder in the lysine metabolism pathway. In 2014 and 2021, the International PDE consortium published consensus guidelines about diagnosis and management. In this follow-on, a literature review was performed and nutrition management was evaluated through an international dietary questionnaire with 40 respondents. This manuscript discusses consensus dietary statements and the practical provision of lysine reduction therapies. Results from the questionnaire, statements from the PDE consensus guidelines, new data from the literature, as well as clinical practice experience of the metabolic dietitian group form the basis of these updated practical diet recommendations. These dietary management recommendations can support dietitians, nutritionists, and physicians in initiation and monitoring of lysine reduction therapies for PDE-ALDH7A1 patients and families.
PubMed: 38736635
DOI: 10.1002/jmd2.12418 -
AJPM Focus Jun 2024Culinary interventions (cooking classes) are a potential educational tool for salt reduction in the home diet, but their content has never been reported in detail. This...
INTRODUCTION
Culinary interventions (cooking classes) are a potential educational tool for salt reduction in the home diet, but their content has never been reported in detail. This study aimed to develop a cooking class for salt reduction, describe its rationale and structure so that other parties could replicate it, and preliminarily assess its impact on salt intake.
METHODS
A multidisciplinary research team developed a cooking class package to reduce salt content in the Japanese home diet. The package comprised its developmental policy, teaching methodology, a menu and recipes, and an implementation manual and aimed to allow third parties to replicate and modify the content. The team took the following step-by-step developmental approach. First, traditional home meals were modeled to create strategies contributing to a target of 2 g salt/meal. Then, educational topics were developed through these strategies, and finally, a dietitian produced menus and prepared documents for the class. The impact of the cooking class was assessed in a nonrandomized study of community residents. The outcome was differences in urinary salt excretion before and after the intervention. General linear models were used to account for the possible confounders.
RESULTS
The authors assumed 4-7 g salt/meal from analyzing typical Japanese home diets and developed 3 strategies: (1) restricting salt content in the main dish, (2) maintaining good tastes without salty dishes, and (3) balancing nutrition with low-salt dishes. On the basis of these strategies, the authors selected a total of 5 educational topics that participants could learn and apply at home: 1a, a simple and reliable technique to limit salt in a serving; 2a, excluding salty dishes; 2b, staple foods with notable flavor and aroma; 3a, flavoring without salt in side dishes; and 3b, ingredients that should be used intentionally. The team dietitian translated these educational topics into a menu and recipes for hands-on training and prepared a manual for conducting the class. The class developed using this approach was successfully overseen by a dietitian outside the research team. In the validation study, the intervention group (=52) showed a greater decrease in urinary salt excretion than the control group (=46), with an adjusted difference of -1.38 g (=0.001).
CONCLUSIONS
The authors developed a cooking class package for salt reduction so that third parties could replicate and modify the class. The significant salt reduction noted in this study warrants further studies to apply this cooking class to other populations.
PubMed: 38736567
DOI: 10.1016/j.focus.2024.100227 -
Scientific Reports May 2024This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study...
This study assessed the association between arthritis, functional impairment, and nutritional risk (NR). Cross-sectional data were from the Canadian Longitudinal Study on Aging, a nationally representative sample of 45-85-year-old community-dwelling Canadians (n = 41,153). The abbreviated Seniors in the Community: Risk Evaluating for Eating and Nutrition II (SCREEN II-AB) Questionnaire determined NR scores (continuous), and high NR (score < 38); the Older American Resources and Services scale measured functional impairment. NR scores and status (low/high) were modelled using multiple linear and logistic regressions, respectively. Analyses adjusted for demographic characteristics, functional impairment, and health (body mass index, self-rated general and mental health). Additional analyses stratified the models by functional impairment. People with arthritis had poorer NR scores (B: - 0.35, CI - 0.48, - 0.22; p < 0.05) and increased risks of high NR (OR 1.11, 95% CI 1.06, 1.17). Among those with functional impairment, the likelihood of high NR was 31% higher in people with arthritis compared to those without arthritis (95% CI 1.12, 1.53). Among those with no functional impairment, the likelihood of high NR was 10% higher in people with arthritis compared to those without (95% CI 1.04, 1.16). These relationships differed based on the type of arthritis. Arthritis is associated with high NR in community-dwelling older adults, both with and without functional impairment. Findings highlight the need for further research on these relationships to inform interventions and improve clinical practices.
Topics: Humans; Canada; Aged; Female; Male; Longitudinal Studies; Arthritis; Aged, 80 and over; Middle Aged; Nutritional Status; Aging; Cross-Sectional Studies; Risk Factors; Surveys and Questionnaires
PubMed: 38734730
DOI: 10.1038/s41598-024-58370-7 -
Nutrients May 2024Nutritional therapy (NT) based on a controlled protein intake represents a cornerstone in managing chronic kidney disease (CKD). However, if a CKD patient is at the same...
Nutritional therapy (NT) based on a controlled protein intake represents a cornerstone in managing chronic kidney disease (CKD). However, if a CKD patient is at the same time affected by cancer, oncologists and nutritionists tend to suggest a dietary regimen based on high protein intake to avoid catabolism and malnutrition. International guidelines are not clear when we consider onco-nephrological patients and, as a consequence, no clinical shared strategy is currently applied in clinical practice. In particular, no precise nutritional management is established in nephrectomized patients for renal cell carcinoma (RCC), a specific oncological cohort of patients whose sudden kidney removal forces the remnant one to start a compensatory mechanism of adaptive hyperfiltration. Our study aimed to investigate the efficacy of a low-normal-protein high-calorie (LNPHC) diet based on a Mediterranean model in a consecutive cohort of nephrectomized RCC patients using an integrated nephrologist and nutritionist approach. A consecutive cohort of 40 nephrectomized RCC adult (age > 18) patients who were screened for malnutrition (malnutrition screening tool, MST < 2) were enrolled in a tertiary institution between 2020 and 2022 after signing a specific informed consent form. Each patient underwent an initial nephrological and nutritional evaluation and was subsequently subjected to a conventional CKD LNPHC diet integrated with aproteic foods (0.8 g/Kg/die: calories: 30-35 kcal per kg body weight/die) for a period of 6 months (±2 months). The diet was structured after considering eGFR (CKD-EPI 2021 creatinine formula), comorbidities, and nutritional status. MST, body mass index (BMI), phase angle (PA), fat mass percentage (FM%), fat-free mass index (FFMI), body cell mass index (BCMI), extracellular/intracellular water ratio (ECW/ICW), extracellular matrix/body cell mass ratio (ECM/BCM), waist/hip circumference ratio (WHC), lab test exams, and clinical variables were examined at baseline and after the study period. Our results clearly highlighted that the LNPHC diet was able to significantly improve several nutritional parameters, avoiding malnutrition and catabolism. In particular, the LNPHC diet preserved the BCM index (delta on median, ΔM + 0.3 kg/m) and reduced the ECM/BCM ratio (ΔM - 0.03 *), with a significant reduction in the ECW/ICW ratio (ΔM - 0.02 *), all while increasing TBW (ΔM + 2.3% *). The LNPHC diet was able to preserve FFM while simultaneously depleting FM and, moreover, it led to a significant reduction in urea (ΔM - 11 mg/dL **). In conclusion, the LNPHC diet represents a new important therapeutic strategy that should be considered when treating onco-nephrological patients with solitary kidney due to renal cancer.
Topics: Humans; Nutritional Status; Male; Kidney Neoplasms; Female; Nephrectomy; Middle Aged; Aged; Carcinoma, Renal Cell; Malnutrition; Kidney; Diet, Mediterranean; Treatment Outcome; Renal Insufficiency, Chronic
PubMed: 38732632
DOI: 10.3390/nu16091386 -
Nutrients Apr 2024Nutrition periodization in football training is an important determinant of adaptation to cyclic training loads. Personalizing an athlete's diet is crucial to ensure... (Review)
Review
Nutrition periodization in football training is an important determinant of adaptation to cyclic training loads. Personalizing an athlete's diet is crucial to ensure optimal performance and body composition, depending on the phase of training. The purpose of this review is to answer the question of how the body composition of football players changes over the training macrocycle and how dietary recommendations should be tailored to specific training periods. The review of scientific evidence was conducted based on the available literature, typing in phrases related to training and nutrition periodization using the PubMed and Google Scholar database methodology tools. A literature search resulted in the selection of 346 sources directly related to the topic of the study, and then those with the highest scientific value were selected. There is a need to adjust energy and nutrient intake according to the different training phases in a football player's preparation cycle. During the preparatory phase, it is recommended to increase protein and energy intake to support anabolic processes and muscle mass development. During the competitive period, due to the intensity of matches and training, the importance of carbohydrates for glycogen replenishment and recovery is emphasized. The transition phase requires the regulation of caloric intake to prevent adverse changes in body composition. Hydration has been identified as a key element in each phase of training. Cooperation between coaches, nutritionists, and players is essential to optimize sports performance and rapid recovery, and the authors recommend continuous adaptation and nutritional optimization as an integral part of football training.
Topics: Humans; Body Composition; Soccer; Athletic Performance; Energy Intake; Sports Nutritional Physiological Phenomena; Athletes; Adaptation, Physiological; Diet; Nutritional Status; Male
PubMed: 38732581
DOI: 10.3390/nu16091332 -
The Lancet. Planetary Health May 2024Health care contributes 4·4% of global net carbon emissions. Hospitals are resource-intensive settings, using a large amount of supplies in patient care and have high...
Health care contributes 4·4% of global net carbon emissions. Hospitals are resource-intensive settings, using a large amount of supplies in patient care and have high energy, ventilation, and heating needs. This Viewpoint investigates emissions related to health care in a patient's last year of life. End of life (EOL) is a period when health-care use and associated emissions production increases exponentially due primarily to hospital admissions, which are often at odds with patients' values and preferences. Potential solutions detailed within this Viewpoint are facilitating advanced care plans with patients to ensure their EOL wishes are clear, beginning palliative care interventions earlier when treating a life-limiting illness, deprescribing unnecessary medications because medications and their supply chains make up a significant portion of health-care emissions, and, enhancing access to low-intensity community care settings (eg, hospices) within the last year of life if home care is not available. Our analysis was done using Canadian data, but the findings can be applied to other high-income countries.
Topics: Humans; Canada; Greenhouse Gases; Terminal Care
PubMed: 38729672
DOI: 10.1016/S2542-5196(24)00048-2