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At least 217 records · Page 12Linked to original sources
PubMed2004

The path from oral nutrition to home parenteral nutrition: a qualitative interview study of the experiences of advanced cancer patients and their families.

BACKGROUND AND AIM: Little is known about the perspectives that patients with advanced cancer and their family members have concerning nutritional problems and nutritional support. The aim of this study was to investigate their experiences of the nutritional situation prior to introduction of home parenteral nutrition (HPN) in order to understand factors contributing to the decision to accept HPN. METHODS: Semi-structured interviews were conducted with 13 patients with advanced cancer who had received HPN and 11 family members. The constant comparative method was used for data analysis. RESULTS: Patients and family members described the nutritional situation prior to HPN as a source of worry and often desperation. Patients reported wanting and trying to eat, but being unable to do so. Family members experienced powerlessness and frustration, as they could not enable the patient to eat. A lack of attention to nutritional problems by the hospital staff was described. The offer of HPN came when patients and family no longer felt able to solve the nutritional problems within the family. CONCLUSION: The desperate and chaotic nutritional situation in the family led to willingness to accept HPN. Because of the severity of the problems, HPN was viewed as a positive alternative.

Aged↗
PubMed2005

Supportive nutrition on recovery of metabolism, nutritional state, health-related quality of life, and exercise capacity after major surgery: a randomized study.

BACKGROUND & AIMS: The aim of this study was to investigate whether specialized supportive enteral and parenteral feeding have superior effects compared to oral nutrition on recovery during long-term postoperative treatment of cancer patients with preoperative weight loss and reduced maximum exercise capacity. METHODS: One hundred twenty-six patients referred for resection of the esophagus (n = 48), stomach (n = 28), or pancreas (n = 50) were considered to be included before operation. Included patients (n = 80) received supportive enteral or parenteral nutrition postoperatively at home corresponding to 1000 kcal/d until the patients did not wish to continue with artificial nutrition for any reason. Patients randomized to oral nutrition only served as control subjects. Caloric intake, body composition (dual-energy x-ray absorptiometry), and respiratory gas exchanges at rest and during exercise were measured including health-related quality of life. RESULTS: Survival and hospital stay did not differ among the groups, whereas overall complications were higher on artificial nutrition (P < .05). Changes in resting energy expenditure and biochemical tests did not differ during follow-up among the groups. Body weight and whole body fat declined similarly over time in all groups (P < .005), whereas lean body mass was unchanged during follow-up compared to preoperative values. Maximum exercise capacity and maximum oxygen consumption were normalized within 6 months postoperatively in all groups. There was no difference in recovery of food intake among the groups. Parenteral feeding was associated with the highest rate of nutrition-related complications, whereas enteral feeding reduced quality of life most extensively. CONCLUSION: After major surgery, specialized supportive enteral and parenteral nutrition are not superior to oral nutrition only when guided by a dietitian.

Body Composition↗
PubMed2001

Nutrition knowledge and food intake of seven-year-old children in an atherosclerosis prevention project with onset in infancy: the impact of child-targeted nutrition counselling given to the parents.

OBJECTIVE: To compare nutrition knowledge and food intake in 7-y-old intervention and control children in an atherosclerosis risk factor intervention trial after 6.5 y of nutrition counselling given to the parents. DESIGN, SUBJECTS AND METHODS: Intervention families in the Special Turku Coronary Risk Factor Intervention Project received child-oriented nutritional counselling one to three times a year since child's age of 7 months, aimed at reduced saturated fat and cholesterol intake. Children's nutrition knowledge was analysed in a time-restricted cohort of 70 seven-y-old (34 boys) intervention children and 70 control children (40 boys) with a picture identification test. For comparison, children's food intake was evaluated using scores developed for the project that reflected quality and quantity of fat and quantity of salt in children's two or three 4-day food diaries recorded between 5.5 and 7 y of age. RESULTS: Child-targeted nutrition counselling of the intervention families only slightly increased intervention children's knowledge of heart-healthy foods (42.6% vs 34.9% correct answers by the intervention and control children, P = 0.057). Only < or = 20% of the children were able to adequately justify their answers in the test. The food diaries of the intervention children comprised more foods low in saturated fat and high in unsaturated fat than those of the control children (57.1% vs 41.7% of the maximum score for low fat foods, P = 0.0001; 48.9% vs 37.7% for high unsaturated fat foods, P = 0.0009, respectively), but the intervention and control children consumed similar amounts of low-salt foods (P = 0.23). Nutrition knowledge and food use scores correlated poorly (r = -0.20-0.35). CONCLUSIONS: Child-targeted nutrition counselling repeatedly given to the parents during and after child's infancy strongly influenced food choice scores of the 5.5-7-y-old children but failed to influence children's salt intake or scores in a nutrition knowledge picture test.

Arteriosclerosis↗
PubMed2003

Aluminum contamination of parenteral nutrition and aluminum loading in children on long-term parenteral nutrition.

BACKGROUND: Children who are receiving parenteral nutrition are at risk of aluminum overload, which may contribute to such side effects as osteopenic bone disease. The aim of the present study is to determine the aluminum contamination of parenteral nutrition solutions and their components, and to assess the aluminum status of children on long-term parenteral nutrition. METHODS: Aluminum concentrations were determined by graphite furnace absorption spectroscopy in components and in final parenteral nutrition solutions. The urinary aluminum excretion and plasma aluminum concentration were determined in 10 children on long-term parenteral nutrition. RESULTS: The mean aluminum concentration in the administered parenteral nutrition solutions was 1.6 +/- 0.9 micromol x l(-1)(mean +/- standard deviation (SD)). The resulting mean aluminum daily intake of the 10 patients was 0.08 +/- 0.03 micromol x kg(-1) x day(-1). CONCLUSIONS: Compared to two previous studies performed in 1990 and in 1995 in our hospital, the aluminum contamination of parenteral nutrition solutions and the daily aluminum intake of the children seemed to decrease. However, the plasma aluminum concentration and daily urinary aluminum excretion of the children still remain above normal standards. The children had no clinical symptoms of bone disease but aluminum accumulation in tissue can not be excluded. To prevent this iatrogenic toxicity, the aluminum contamination of parenteral nutrition should be assessed regularly.

Adolescent↗
PubMedDate not supplied

Metabolic complications of total parenteral nutrition: effects of a nutrition support service.

BACKGROUND: The effectiveness of Nutrition Support Services in optimizing parenteral nutrition has not been evaluated since the 1980s. METHODS: We prospectively monitored medical and surgical patients on total parenteral nutrition (TPN) in a university hospital who did not receive Nutrition Support Service recommendations to compare the incidence of metabolic complications in 1979 (group 1, n = 100) with that in 1992 (group 2, n = 106). The Service provided automatic recommendations on a subsequent group of medical service patients (group 3, n = 128) and compared them with the patients in group 2 who were on the medical service (group 2B, n = 29). RESULTS: Statistically significant changes between 1979 and 1992 included a decline in the incidence of hyperglycemia from 47% to 22% and in hypokalemia from 12% to 3% of surgical patients and an increase in hypomagnesemia from 0% to 23% of surgical patients and from 2% to 14% of medical patients. The incidence of hypophosphatemia remained > 20% in both medical and surgical patients. Within 1992, the addition of automatic recommendations had little impact on metabolic abnormalities and was associated with slightly but insignificantly lower TPN costs (not counting Service personnel costs). CONCLUSIONS: Factors such as the general integration of parenteral nutrition into tertiary medical care, standard protocols and order forms, automatic Nutrition Support Service consultations in an affiliated hospital, and nutrition curricula may be responsible for the improvements seen since 1979. However, the addition of automatic Service consultation in 1992 had only a marginal effect on metabolic complications and costs of parenteral nutrition.

Blood Chemical Analysis↗
PubMed1989

Metabolic interfaces between growth and reproduction. II. Characterization of changes in messenger ribonucleic acid concentrations of gonadotropin subunits, growth hormone, and prolactin in nutritionally growth-limited lambs and the differential effects of increased nutrition.

Previous studies show that limited nutrition in the ovariectomized lamb results in an impairment of LH and FSH secretion, a phenomenon that is rapidly reversible by increasing the level of nutrition and independent of ovarian steroid feedback. The present study characterizes the biosynthesis of pituitary hormones in the nutritionally growth-limited female lamb by measuring steady state mRNA concentrations. These changes were examined relatively to pituitary and serum hormone concentrations to establish the relationship(s) of synthesis and secretion in response to nutritional manipulation. Ad libitum feeding of nutritionally growth-restricted ovariectomized lambs for 14 days resulted in an increase in the frequency of episodic LH release, thereby increasing mean serum LH concentrations (P less than 0.001). Similarly, mean circulating concentrations of FSH were increased (P less than 0.001). By contrast, serum GH concentrations were lowered significantly as a result of ad libitum feeding (P less than 0.05). Serum PRL concentrations remained unchanged. Although pituitary LH and PRL concentrations were also unchanged in response to increased nutrition feeding, FSH and GH concentrations increased (P less than 0.05). Short-term ad libitum feeding of the chronically food-restricted lamb resulted in significant changes in mRNA concentrations for all hormones except PRL. The concentrations of gonadotropin subunit mRNAs (i.e. alpha, LH beta, and FSH beta) were all significantly higher in response to increased nutrition (P less than 0.001). GH mRNA was also affected; however, feeding decreased concentrations (P less than 0.001). The results demonstrate that an increase in the level of nutrition in the restricted diet lamb produces profound changes in the synthesis, storage, and secretion of LH, FSH, and GH. These changes appear to be coordinated, although the response differs depending upon the hormone.

Animal Nutritional Physiological Phenomena↗
PubMed2003

Interactive learning for congregate nutrition site nutrition education: a pilot study.

Older adults who participate in the Older Americans Act Title III-C Elderly Nutrition Program often are at moderate to high nutritional risk. Although nutrition education is a component of the Elderly Nutrition Program, there are numerous barriers to promoting behavior change in older adults. Nutrition education programs targeted to congregate nutrition site participants must address their unique nutritional needs, while engaging them in activities that promote learning and motivate them to make positive behavior changes. This paper describes a pilot study of a theory-driven, five-lesson educational module designed to promote healthful eating behaviors among congregate nutrition site participants through interactive learning.

Aged↗
PubMed2003

Assessment of the Mission Nutrition nutrition education program.

In 1998, Dietitians of Canada and the team of registered dietitians at Kellogg Canada Inc. partnered to develop Mission Nutrition, a national bilingual nutrition education program that provides curriculum-based resources to teachers. The main objectives of this study were to measure the awareness and utility of the Mission Nutrition program among elementary teachers, and to identify opportunities to enhance the Mission Nutrition resources to increase use. A ten-minute telephone survey was conducted with a representative sample of 203 elementary school teachers. A sub-sample of 20 teachers then participated in a more in-depth 30-minute telephone survey. A need for increased promotion of the Mission Nutrition program was identified on the basis of the 22% awareness among teachers participating in the initial interview. All teachers who had used the educator guides and student activity sheets reported that they would use them again. Teachers found that the Mission Nutrition materials were well-researched and contained useful activities relevant to students. The findings indicate that, to be most effective, nutrition education resources should be provided in a ready-to-use format and integrated with core curricula. Teachers also suggested that materials should include fresh ideas to engage students at different grade levels, and ways to involve parents. Dietitians are ideally positioned to work collaboratively with educators to develop these types of nutrition education resources.

Adult↗
PubMed2000

Nutrition, nutritional behavior, and obesity.

THE PURPOSE: Of this investigation is to explore the effect of several alimentary factors--such as diet, nutritional habits, and personal preferences--upon the occurrence of obesity. SUBJECTS: Of the study were 264 workers (203 men and 61 women) from the ammonium production department of a fertilizer plant, divided into two age groups: under 30 years and over 30 years. METHODS: The data are collected by means of a questionnaire about daily nutrition, including the types and average quantity of food (Food Frequency Questionnaires--FFQ). All collected information is analyzed by means of a computer program with a database that includes the chemical structure of food products and takes into account the losses in their nutritional value that occurs in the course of preservation and thermal processing. The nutritional status is assessed on the basis of a Body Mass Index (BMI): group I--normal body mass--BMI 18.5-25 kg/m2; group II--overweight--BMI 25.1-30 kg/m2; group III--obesity--BMI > 30 kg/m2. RESULTS: The assessment of the individual energy intake shows that hyper-energetic nutrition is typical for 67% of the individuals examined. There is no significant age and/or gender difference. This is the result of extra-intake of fat (over 30 E%), which is observed for 87.9% of all workers, and over 40 E% for almost half of the women examined. All age and gender groups display hyper-protein nutrition with pronounced cellulose (fiber) deficit, high daily intake of sodium, and disbalance of mineral salts as well as a relative deficit of vitamin A, B1, and PP. The frequency of overweight individuals is 43.9%, while that of obese individuals is 23.1%. The majority of workers (70.1% of group I, 63.2% of group II, and 79% of group III) have three meals a day. For 43% of group III individuals dinner is the largest meal. A significantly higher percentage of group III individuals (21.3%) think that they overeat. CONCLUSIONS: Hyper-energetic, disbalanced nutrition, and incorrect nutritional-behavioral model are factors that determine the prevalence of overweight and obesity among the workers examined.

Adolescent↗
PubMed2000

[Evaluation of nutritional habits, nutritional status and physical performance in selected group of adolescents].

The purpose of the study was the assessment of nutritional status and nutritional habits as well as physical fitness in a group of 74 adolescents (44 girls and 30 boys) aged 13-19 years, spending their holidays in a recreation centre in Klodzko Valley and the evaluation of correlation coefficients between these parameters. The nutritional status (NS) was evaluated on the basis of body mass index (BMI), skin folds thickness and total body fat (FM). Nutritional habits (NH) were estimated by the method of dietary history with special attention paid to consumption of selected food products and regularity of meals. Physical performance (PhP) of the group was assessed by Harvard's step-test. Evaluation of nutritional habits indicated only a few cases of improper nutrition but about 33% of total examined group followed nutrition guidelines and the scores of NH received by the main part of this group (ca. 66%) were recognised as sufficient. Differences of NS, in adolescents were found, but there was no case of obesity. Significant number of girls (21-55%) showed low values of BMI (<18.4 kg/m2) which could indicate insufficient energy intake. No correlation between NH and NS was however found. Level of physical fitness of the examined group was quite high and strongly correlated with nutritional habits (r = 0.77, p < 0.001). The results proved that the relationship between NH and PhP can be noticed in relatively young persons and that the evaluation of NS of youngsters should include a simple physical performance test.

Adolescent↗
PubMed1986

Nutritive and non-nutritive sucking in preterm infants.

Nutritive and non-nutritive sucking was studied in 9 preterm infants with postmenstrual ages ranging from 28 to 33 weeks and postnatal ages ranging from 0 to 8 weeks. During nutritive sucking, sucking bursts were longer than sucking pauses. During non-nutritive sucking the opposite was seen. The sucking rate was lower during nutritive sucking. During nutritive sucking the respiratory rate was higher during the pauses than during the bursts. During non-nutritive sucking the respiratory rate was higher during sucking. It is concluded that non-nutritive sucking cannot serve as a model for studying feeding mechanisms in the preterm infant.

Electromyography↗
PubMed1998

Benefits of nutritional intervention on nutritional status, quality of life and survival.

Most cancers in children are acute diseases. Therefore, the incidence of malnutrition, in general, is not different from the incidence in the referral population. Some specific tumors, such as neuroblastoma and those resulting in the diencephalic syndrome, can be exceptions. By contrast, malnutrition is a frequent problem during modern intensive cancer treatment as the result of the associated anorexia, altered taste sensations and catabolic effects of drugs. In addition, there are psychogenic factors and metabolic consequences associated with the tumor itself. Nutritional support does improve the feeling of well-being and performance status, while maintaining or improving the immune competence, thereby potentially affecting survival by limiting infectious episodes. There is no convincing evidence to date that nutritional support has an antineoplastic effect per se, but deficiency of a specific nutrient might be beneficial because of a differential requirement between tumor and normal cells. Theoretically, nutritional support might enhance tumor growth but also susceptibility to chemotherapy. In either case, nutrition is a support modality that must be given with appropriate tumor-directed therapy if curative intent is the goal of treatment. Nutrition remains a consideration after therapy is completed. This generates different challenges. If further tumor-directed therapy is futile, the decision to continue nutritional support is difficult, but if the child is well, nutritional rehabilitation must be pursued. Finally, the cured child continues to benefit from dietary advice. Nutrition should be viewed for what it is: supplying the most basic need of children.

Child↗
PubMed2003

Assessment of nutritional status on hospital admission: nutritional scores.

Malnutrition is still a largely unrecognized problem in hospitals. Malnutrition in hospitalized patients is generally related to increasing morbidity and mortality, and costs and length of stay. The aim of this study was to assess the nutritional status of patients on admission to a general hospital using different nutritional scores and to test the sensitivity and specificity of these scores. Sample population included 60 patients (55% male; 45% female) selected (aged 65.6+/-15.9 y) at random by using a computer software program. The nutritional state assessment was performed within 48 h of admission, using different nutritional indices (Subjective Global Assessment (SGA), Nutritional Risk Index (NRI), Gassull classification, Instant Nutritional Assessment (INA) and a combined index). About 78.3% of patients were found to be malnourished on admission. The frequency of malnutrition degree varied from 63.3% as assessed by the SGA to 90% with the NRI. Malnutrition severity was not related to the diagnosis. However, an elderly population was associated with a higher prevalence of malnutrition. INA was the best single score to identify patients who are malnourished or at risk of malnutrition and who may benefit from nutrition support.

Adult↗
PubMed2002

Incidence of nutritional risk and causes of inadequate nutritional care in hospitals.

BACKGROUND AND AIMS: Many patients in hospitals are undernourished and nutritional care is inadequate in most hospitals. The aim of this investigation was to gain insight into how this situation could be improved. METHODS: Seven hundred and fifty randomly selected patients were screened at admission in three hospitals and surveyed during their entire hospitalization. Each time a patient was not treated according to a clearly defined nutritional standard, the nurse responsible for the patient was interviewed about possible reasons according to preformed questionnaires. RESULTS: The investigators found that 22% of the patients were nutritionally at-risk, and that only 25% of these patients received an adequate amount of energy and protein. The departments had only screened for nutritional problems in 60% of the cases. Only 47% of the patients, who the departments judged to be at-risk patients, had a nutrition plan worked out, and only about 30% of the at-risk patients were monitored by the departments by recording of dietary intake and/or body weight. The main causes for inadequate nutritional care were lack of instructions to deal with these problems, and lack of basic knowledge with respect to dietary requirements and practical aspects of the hospital's food provision. Patient-related aspects and the system of food provision also contributed, but only to a small degree. CONCLUSIONS: These findings form the basis of the strategy to improve nutritional care in these hospitals.

Body Mass Index↗
PubMed1980

Effectiveness of enteral and parenteral nutrition in the nutritional management of children with Wilms' tumors.

The effectiveness of enteral and parenteral feeding in supporting a satisfactory nutrition status and/or reversing protein-energy malnutrition was evaluated in nine children, ages 1 to 7 years (eight female), with Wilms' tumors. At the onset of treatment, eight patients received comprehensive enteral nutrition (CEN) which included intense nutritional counseling and oral supplements while one received total parenteral nutrition (TPN). Despite CEN, the initial, intense treatment period was associated with a decreased energy intake (64 +/- 27% Recommended Dietary Allowances), dramatic weight loss (22 +/- 7% by 26 +/- 17 days from the beginning of treatment), decreased skinfold thickness (< 10th percentile), and decreased albumin concentrations (< 3.2 g/dl). Four of those who initially received CEN subsequently required TPN. A total of five patients received TPN for a mean of 31 days (range 11 to 60); kcal averaged 105 +/- 9% Recommended Dietary Allowances during weight gain. At onset of TPN, the mean albumin, transferrin, total lymphocyte count were 3.02 +/- 0.45 g/dl, 155 +/- 40 mg/dl, and, 655 +/- 437/mm3, respectively; all children had abnormal anthropometric measurements and anergy to recall skin test antigens. TPN for 28 or more days supported weight gain (+ 2.44 kg), increased serum albumin (+ 0.58 +/- 0.47 g/dl) and transferrin (+ 76 +/- 34 mg/dl), and reversed anergy despite low total lymphocyte counts. During maintenance treatment, nutritional status was maintained or restored with CEN in the group who responded. These preliminary data document the severity of protein-energy malnutrition which accompanies initial, intense treatment of children with Wilms' tumors, the nutritional and immunological benefits of TPN during continuing intense treatment and the effectiveness of CEN in maintaining a satisfactory nutritional status during maintenance treatment.

Body Height↗
PubMed1995

Using the Nutrition Screening Initiative to survey the nutritional status of clients participating in a home delivered meals program.

A large percentage of older Americans are at risk for malnutrition. This puts them at risk for premature institutionalization, creating a financial burden. The objective of this survey was to determine the nutritional health of clients receiving home delivered meals in Lake County, Indiana and the impact that home delivered meals had on them. Nutrition Screening Initiative (NSI) Determine Your Nutritional Health Checklists were mailed to recipients of meals; 58.3% were returned. Twenty-eight percent were found to be at no nutritional risk, 39% at moderate nutritional risk and 33% at high nutritional risk. One-hundred-thirty clients that scored three or more on the "Checklist" were visited by a Registered Dietitian for further screening using the NSI Level I Screen. This screen found many nutritional problems but the fact that the clients did receive home delivered meals decreased the risk. It was determined by the author that 68% of these clients could not function in their own homes without home delivered meals.

Adult↗
PubMedDate not supplied

The Nutritional Screening Initiative: meeting the nutritional needs of elders.

Nutritional factors are associated with at least 5 of the 10 leading causes of death in the United States. Older persons are especially vulnerable for nutritional problems, usually resulting from inappropriate (usually inadequate) intake of nutrients or increased need for nutrients. Nutritional assessment and interventions are sometimes overlooked in the focus on more complicated medical care. Yet there are many ways in which nurses can intervene to improve patients' nutritional status. One resource for organizing nutritional assessment and interventions is the Nutrition Screening Initiative. This multidisciplinary initiative provides useful guidelines and tools for assessing nutritional status and for planning the most appropriate interventions.

Aged↗
PubMed2006

Managing children and adolescents on parenteral nutrition: Challenges for the nutritional support team.

Managing infants, children and adolescents, ranging from premature infants to 18-year-old adolescents, on parenteral nutrition (PN) is a challenge. The ability of children to withstand starvation is limited and, unlike adults, children require nutrition for growth. PN in children is often required secondary to a congenital bowel problem rather than because of an acquired condition. Conditions requiring PN include motility disorders, congenital disorders of the intestinal epithelium and short-bowel syndrome (SBS). Intestinal failure may be temporary and children with SBS may be weaned from PN. However, other children require permanent PN. There are no comprehensive guidelines for the nutritional requirements of children and adolescents requiring PN. Practice in individual centres is based on clinical experience rather than clinical trials. Requirements are assessed on an individual basis according to age, nutritional status and clinical condition. These requirements need regular review to ensure that they remain appropriate for the changing age and weight of the child. Assessments of intakes use different methods, e.g. reference tables and predictive equations. Complications of PN include infection, accidental damage to, or removal of, the line and cholestatic liver disease. Home parenteral nutrition (HPN) is associated with fewer line infections and allows continuation of nutritional support in a more normal environment, encouraging normal development and participation in family activities. However, having a child at home on HPN is associated with physical and psychological stresses. A feeling of depression, loneliness and social isolation is common amongst children and their families. Home-care services are essential to supporting children at home and should be tailored to, and sensitive to, the individual needs of each family.

Adolescent↗