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Nutrition Journal Sep 2020The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care... (Review)
Review
BACKGROUND
The use of malnutrition outcome measures (OM) by registered dietitians (RD) with inpatients in hospitals has increased promoting the achievement of nutritional care goals and supporting decision-making for the allocation of nutritional care resources in hospitals. There are 3 commonly used OMs: Subjective Global Assessment (SGA), Patient Generated-Subjective Global Assessment (PG-SGA) and Mini Nutritional Assessment (MNA). The purpose of this current study was to systematically review the evidence of the clinical measurement properties of malnutrition assessment tools for use with patients admitted in hospitals.
METHODS
MEDLINE, Cinahl, EMBASE, and PubMed were searched for articles published between 2000 and 2019. Research articles were selected if they established reliability, validity, and responsiveness to change properties of the SGA, PG-SGA and MNA tools, were written in English, and used any of these OMs as an outcome measure. Abstracts were not considered. The risk of bias within studies was assessed using the Quality Appraisal for Clinical Measurement Study (QA-CMS).
RESULTS
Five hundred five studies were identified, of which 34 articles were included in the final review: SGA (n = 8), PG-SGA (n = 13), and MNA (n = 13). Of the 34 studies, 8 had a quality score greater than 75%; 23 had a quality score of 40-75% and 3 studies had a quality score of less than 40%. PG-SGA was found to have excellentdiagnostic accuracy (ROC: 0.92-0.975; Sensitivity: 88.6-98%; Specificity: 82-100%), sufficient internal consistency (Cronbach's alpha: 0.722-0.73), and strong test-retest reliability (r = 0.866). There was insufficient evidence to suggest adequate diagnostic accuracy and good inter-rater reliability for SGA. Only one study examined the minimum detectable change of MNA (MDC = 2.1).
CONCLUSIONS
The evidence of validity for the existing malnutrition assessment tools supports the use of these tools, but more studies with sound methodological quality are needed to assess the responsiveness of these OMs to detect the change in nutritional status.
Topics: Hospitals; Humans; Malnutrition; Nutrition Assessment; Nutritional Status; Reproducibility of Results
PubMed: 32957989
DOI: 10.1186/s12937-020-00613-0 -
Canadian Journal of Gastroenterology &... 2020In recent years, more and more emphasis has been placed on early diagnosis and adequate treatment of malnutrition in the course of chronic diseases (CP). One of these... (Review)
Review
PURPOSE
In recent years, more and more emphasis has been placed on early diagnosis and adequate treatment of malnutrition in the course of chronic diseases (CP). One of these diseases is chronic pancreatitis in which malnutrition may develop as a consequence of abdominal pain, vomiting, diarrhea, and alcohol abuse. The aim of this review paper is recognized if we can improve the nutritional status of patients with CP.
METHODS
This paper is based on systematic literature review according to the PubMed.
RESULTS
One of the most important problems is lack of "gold standard" in screening of nutritional status in patients with CP, especially in outpatient clinics. Another problem is preventing malnutrition in these patients and beginning treatment already at significant stages of disease. To prevent malnutrition you must first recognize the causes of malnutrition in CP, adequately assess its severity using one of available questionnaires and then apply the appropriate therapeutic management. At each visit, remember to assess the nutritional status of the patient, including laboratory markers and anthropometric measurements. Patients should be advised to stop smoking and drinking alcohol and to use adequate enzyme supplementation.
CONCLUSION
Patients with CP should be led by a team of gastroenterologist, diabetologist, and psychologist and consulted by a dietitian, specialist of pain treatment, and surgeon.
Topics: Alcoholism; Humans; Malnutrition; Nutritional Status; Pancreatitis, Chronic; Surveys and Questionnaires
PubMed: 32832490
DOI: 10.1155/2020/8875487 -
Nutrients Jul 2020Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and...
Maternal nutrition is essential for the development and lifelong health of the offspring. Antenatal care provides unique opportunities for nutrition communication, and health promotion tools (e.g., guidelines, instruments, packages, or resources) might help to overcome several concurrent barriers. We conducted a systematic literature review to map tools that are available for the promotion of a healthy dietary intake in healthy pregnant women in Western countries, and to identify what makes these tools feasible and effective for these women and their healthcare providers. Seventeen studies were included, evaluating tools with various delivery modes, content, and providers. Nine studies employed multiple, complementary delivery methods and almost all studies (n = 14) tailored the content to varying degrees, based on the individual characteristics and lifestyle behaviors of the participants. We found that the feasibility of a tool was dependent on practical issues, time investment, and providers' motivation, skills, and knowledge, while the effectiveness was related more to the type of provider and the content. Most effective interventions were provided by dietitians and nutritionists, and were highly tailored. Based on the results of this review, we believe that custom tools that are sensitive to inequalities are needed to support all women in obtaining or maintaining a healthy diet during pregnancy.
Topics: Adult; Diet, Healthy; Dietetics; Female; Health Promotion; Humans; Maternal Nutritional Physiological Phenomena; Obstetrics; Pregnancy; Prenatal Care
PubMed: 32635332
DOI: 10.3390/nu12071981 -
Nutrients Jun 2020The foundations of neurodevelopment across an individual's lifespan are established in the first 1000 days of life (2 years). During this period an adequate supply of...
The foundations of neurodevelopment across an individual's lifespan are established in the first 1000 days of life (2 years). During this period an adequate supply of nutrients are essential for proper neurodevelopment and lifelong brain function. Of these, evidence for choline has been building but has not been widely collated using systematic approaches. Therefore, a systematic review was performed to identify the animal and human studies looking at inter-relationships between choline, neurological development, and brain function during the first 1000 days of life. The database PubMed was used, and reference lists were searched. In total, 813 publications were subject to the title/abstract review, and 38 animal and 16 human studies were included after evaluation. Findings suggest that supplementing the maternal or child's diet with choline over the first 1000 days of life could subsequently: (1) support normal brain development (animal and human evidence), (2) protect against neural and metabolic insults, particularly when the fetus is exposed to alcohol (animal and human evidence), and (3) improve neural and cognitive functioning (animal evidence). Overall, most offspring would benefit from increased choline supply during the first 1000 days of life, particularly in relation to helping facilitate normal brain development. Health policies and guidelines should consider re-evaluation to help communicate and impart potential choline benefits through diet and/or supplementation approaches across this critical life stage.
Topics: Age Factors; Animals; Brain; Choline; Cognition; Dietary Supplements; Female; Humans; Infant; Infant Nutritional Physiological Phenomena; Infant, Newborn; Male; Maternal Nutritional Physiological Phenomena; Maternal-Fetal Exchange; Pregnancy
PubMed: 32531929
DOI: 10.3390/nu12061731 -
JGH Open : An Open Access Journal of... Apr 2020Inflammatory bowel disease (IBD) refers to a group of complex and chronic conditions that requires long-term care delivered by a group of healthcare professionals...
BACKGROUND AND AIM
Inflammatory bowel disease (IBD) refers to a group of complex and chronic conditions that requires long-term care delivered by a group of healthcare professionals through a multidisciplinary care model. We conducted a systematic review to examine and understand the role of healthcare professionals in the primary care management of IBD, and identify the gaps in IBD management that could be filled by primary care providers such as general practitioners (GPs) and pharmacists.
METHODS
The search strategy retrieved published studies from five databases, and eligible articles were assessed for quality. A gray literature search of the websites of organizations was also undertaken.
RESULTS
Twenty-one studies were included, of which 19 were peer-reviewed research articles and two reports were from organizational bodies. Although studies have shown the roles of GPs, pharmacists, dietitians, and psychologists in IBD management, nurses and gastroenterologists were the key drivers delivering specialized care to IBD patients. Many key services are accessible only for hospital inpatients (tertiary care) or through outpatient clinics (secondary care) with an absence of a multidisciplinary approach including GPs and pharmacists.
CONCLUSION
Gastroenterologists and nurses have an important role in the delivery of care to patients with chronic gastrointestinal diseases including IBD, coeliac disease, irritable bowel syndrome, and functional dyspepsia. The role of nurses includes provision of specialized care to IBD patients, as well as supportive care such as education, monitoring of therapy, and ongoing assistance. The available evidence shows many opportunities for primary care providers to play a more active role in the management of IBD patients.
PubMed: 32280768
DOI: 10.1002/jgh3.12235 -
Nutrition (Burbank, Los Angeles County,... 2020Obesity has been identified as an important risk factor for cardiovascular disease and other chronic diseases. However, dietary treatment of obesity is far from being a... (Review)
Review
OBJECTIVES
Obesity has been identified as an important risk factor for cardiovascular disease and other chronic diseases. However, dietary treatment of obesity is far from being a closed issue. Therefore, it is critical to identify the most appropriate obesity management approaches. The aim of this review was to summarize the effects, potentialities, and limitations of nutritional interventions aimed at managing obesity in primary and secondary health care settings, highlighting the most effective strategies and theories.
METHODS
This systematic review of randomized controlled trials evaluated nutritional interventions aimed at achieving weight loss in primary and secondary health care patients. All screening and extraction processes were conducted according to PRISMA.
RESULTS
From an initial 7816 studies that were identified, 28 met the criteria and were included in the review. Most studies were conducted in a developed country in primary care, with a higher proportion of women. Most of the nutrition interventions maintained continuous contacts during follow-up, and telephone calls were the most commonly used technology. A physical activity component was included in most studies, and the most common dietary approaches used were energy restrictions, changes in macronutrient distribution, and diet self-monitoring. Regarding theories, interventions mainly incorporated Social Cognitive Theory and Motivational Interviewing. Most trials presented significant and moderate weight loss (~5%), in which the key contributors were behavioral theories, the dietary approach of calorie restriction, and interventions delivered by dietitians and psychologists.
CONCLUSIONS
Most trials presented better weight loss results with the association of calorie restrictions and theory-based interventions delivered by dietitians or psychologists. We identified the need to develop interventions in other contexts, such as low- and middle-income countries; further trials comparing a theory- versus not-theory-driven intervention; group-based versus individually based intervention; and intervention using or not using technology.
Topics: Delivery of Health Care; Diet; Exercise; Female; Humans; Obesity; Weight Loss
PubMed: 32259716
DOI: 10.1016/j.nut.2020.110784 -
RMD Open Jan 2020To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and...
OBJECTIVE
To perform a systematic literature review (SLR) about the effect of non-pharmacological interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures.
METHODS
Eight clinical questions based on two criteria guided the SLR: (1) adults≥50 years at high risk of osteoporotic fracture and (2) interventions delivered by non-physician health professionals to prevent and manage osteoporotic fractures. Interventions focused on diagnostic procedures to identify risk of falling, therapeutic approaches and implementation strategies. Outcomes included fractures, falls, risk of falling and change in bone mineral density. Systematic reviews and randomised controlled trials were preferentially selected. Data were synthesised using a qualitative descriptive approach.
RESULTS
Of 15 917 records, 43 articles were included. Studies were clinically and methodologically diverse. We identified sufficient evidence that structured exercise, incorporating progressive resistance training delivered to people who had undergone hip fracture surgery, and multicomponent exercise, delivered to people at risk of primary fracture, reduced risk of falling. The effectiveness of multidisciplinary fracture liaison services in reducing refracture rate was confirmed. There was insufficient evidence found to support the effectiveness of nutrients and falls prevention programmes in this patient population.
CONCLUSION
Despite study heterogeneity, our SLR showed beneficial effects of some interventions delivered by non-physician health professionals and the positive impact of multidisciplinary team working and patient educational approaches to prevent and manage osteoporotic fractures. These results informed a EULAR taskforce that developed points to consider for non-physician health professionals to prevent and manage osteoporotic fractures.
Topics: Accidental Falls; Bone Density Conservation Agents; Dietary Supplements; Exercise; Health Personnel; Humans; Medication Adherence; Nurses; Nutritionists; Occupational Therapists; Osteoporosis; Osteoporotic Fractures; Pharmacists; Physical Therapists; Practice Guidelines as Topic; Primary Prevention; Randomized Controlled Trials as Topic
PubMed: 32144136
DOI: 10.1136/rmdopen-2019-001143 -
Journal of Biomedical Physics &... Dec 2019Nutrition informatics has become a novel approach for registered dietitians to practice in this field and make a profit for health care. Recommendation systems... (Review)
Review
BACKGROUND
Nutrition informatics has become a novel approach for registered dietitians to practice in this field and make a profit for health care. Recommendation systems considered as an effective technology into aid users to adjust their eating behavior and achieve the goal of healthier food and diet. The purpose of this study is to review nutrition recommendation systems (NRS) and their characteristics for the first time.
MATERIAL AND METHODS
The systematic review was conducted using a comprehensive selection of scientific databases as reference sources, allowing access to diverse publications in the field. The process of articles selection was based on the PRISMA strategy. We identified keywords from our initial research, MeSH database and expert's opinion. Databases of PubMed, Web of Sciences, Scopus, Embase, and IEEE were searched. After evaluating, they obtained records from databases by two independent reviewers and inclusion and exclusion criteria were applied to each retrieved work to select those of interest. Finally, 25 studies were included.
RESULTS
Hybrid recommender systems and knowledge-based recommender systems with 40% and 32%, respectively, were the mostly recommender types used in NRS. In NRS, rule-based and ontology techniques were used frequently. The frequented platform that applied in NRS was a mobile application with 28%.
CONCLUSION
If NRS was properly designed, implemented and finally evaluated, it could be used as an effective tool to improve nutrition and promote a healthy lifestyle. This study can help to inform specialists in the nutrition informatics domain, which was necessary to design and develop NRS.
PubMed: 32039089
DOI: 10.31661/jbpe.v0i0.1248 -
Behavioral Sciences (Basel, Switzerland) Dec 2019Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m) is uncertain. The aims... (Review)
Review
Severely energy-restricted diets are used in obesity management, but their efficacy in people with class III obesity (body mass index ≥40 kg/m) is uncertain. The aims of this systematic review and meta-analysis were to determine the effectiveness and characteristics of severely energy-restricted diets in people with class III obesity. As there was a lack of publications reporting long-term dietary interventions and randomised controlled trial designs, our original publication inclusion criteria were broadened to include uncontrolled study designs and a higher upper limit of energy intake. Eligible publications reported studies including adults with class III obesity and that assessed a diet with daily energy intake ≤5000 kJ for ≥4 weeks. Among 572 unique publications from 4 databases, 11 were eligible and 10 were suitable for meta-analysis. Our original intention was to classify comparison arms into short-term (<6 months) and long-term (>1 year) interventions. Due to the lack of long-term data found, comparison arms were classified according to the commonalities in dietary intervention length among the included publications, namely dietary interventions of 4 weeks' duration and those of ≥6 weeks' duration. After a 4-week severely energy-restricted diet intervention, the pooled average weight loss was 9.81 (95% confidence interval 10.80, 8.83) kg, with a 95% prediction interval of 6.38 to 13.25 kg, representing a loss of approximately 4.1 to 8.6% of initial body weight. Diets ≥6 weeks' duration produced 25.78 (29.42, 22.15) kg pooled average weight loss, with a 95% prediction interval of 13.77 to 37.80 kg, representing approximately 10.2 to 28.0% weight loss. Daily dietary prescriptions ranged from 330 to 5000 kJ (mean ± standard deviation 2260 ± 1400 kJ), and had wide variations in macronutrient composition. The diets were administered mostly via liquid meal replacement products. While the included publications had a moderate risk of bias score, which may inflate reported weight loss outcomes, the published data to date suggest that severely energy-restricted diets, delivered via diets of varying composition, effectively produce clinically relevant weight loss (≥10% of initial body weight) when used for 6 weeks or more in people with class III obesity.
PubMed: 31817943
DOI: 10.3390/bs9120144 -
Nutrients Nov 2019A client-centred approach sits at the core of modern healthcare. Exploration of the patients' role within the education of nutrition and dietetic students has not...
A client-centred approach sits at the core of modern healthcare. Exploration of the patients' role within the education of nutrition and dietetic students has not previously been undertaken. This review aimed to synthesise the learning outcomes that result from involvement of patients in nutrition and dietetic student education, and to consider whether these interactions promote patient-centred care. Five electronic databases were searched, supported by hand-searching of references of included studies. Screening of title/abstract and then full text papers was undertaken; key characteristics and outcomes were extracted and synthesised narratively. The likely impact of interventions was evaluated using Kirkpatrick's Hierarchy; study quality was assessed using the Medical Education Research Study Quality Instrument and Critical Appraisal Skills Programme checklist. Of 7436 studies identified through database searching, and one additional study located through hand searching of reference lists, the final library consisted of 13 studies. All studies reported benefits for student learning from patient involvement, while one paper identified patient benefits from student interventions. Patients as recipients of care mostly contributed in a passive role in student education activities. Quality assessment identified methodological limitations in most studies. Patient involvement in the education of dietitians supports skill development and therefore progression to professional practice. Although nutrition and dietetics education has a focus on client-centred care, the translation of these concepts into an interactive student educational experience has been investigated to a limited extent. Collaboration with patients in student education is an area for further development.
Topics: Adult; Dietetics; Female; Humans; Male; Nutritionists; Patient Participation; Patient-Centered Care
PubMed: 31744084
DOI: 10.3390/nu11112798