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At least 271 records · Page 15Linked to original sources
PubMed1997

Surgical Nutritional Team and its impact on total parenteral nutrition in The National University Hospital, Singapore.

The Surgical Nutrition Advisory Team (SNAT) of our hospital, formed in October 1992, decided to study the impact of such a team on the six months before and after its formation on catheter care and nutritional support in total parenteral nutrition. Our study showed that with a dedicated nutritional team, catheter sepsis was reduced from 35.1% to 15.4%. The median lifespan of central catheters was increased from 7 to 11 days. Mechanical complications were reduced from 11% to zero. Better patient selection resulted in more severely malnourished patients receiving preoperative nutrition and fewer postoperative patients being started on total parenteral nutrition. Better monitoring of nutritional requirements, electrolyte and metabolite levels and consequently faster correction of abnormal blood levels, were also obtained.

Bacterial Infections↗
PubMed1999

Preoperative nutritional evaluation of elderly patients: the Mini Nutritional Assessment as a practical tool.

BACKGROUND AND GOAL: Age and malnutrition are each surgical risk factors. Because the Mini Nutritional Assessment (MNA) has been specifically designed for assessing the nutritional status of elderly patients, it can be used for preoperative nutritional evaluation. Therefore, the MNA was included in the preoperative clinical evaluation of patients over 60 years of age to describe their nutritional status. METHODS: Every patient over 60 years of age, scheduled for elective surgery, was seen in anaesthesiology consultation and was submitted to the MNA. The MNA is a clinical score consisting of four additive items: 'Anthropometric assessment' based on BMI, mid-arm and calf circumferences, weight loss; global evaluation; dietetic assessment, and subjective assessment - these last three items being obtained through a specific questionnaire. It requires no biological marker. Awarding to the obtained score, the MNA stratifies patients in the following categories: well-nourished (24 </= MNA </= 30), at risk of malnutrition (17 </= MNA < 23.5), and undernutrition (MNA < 17). Also recorded were: age, gender, type of scheduled operation, and the American Society of Anesthesiologists (ASA) physical status score. Results are given as median (extremes). RESULTS: Four hundred and nineteen patients (50.4% women) were seen between January and October 1996. The mean age was 72 years (range, 60-98 years); BMI: 25.2 (12.8-40.4) kg m(-2). The MNA score was recorded in 408 patients, ranging from 1.5 to 30 (median: 26). According to the score, the patients were stratified in: well-nourished, 276 patients (67.6%), at risk, 104 patients (25. 5%) and suffering from overt malnutrition, 28 patients (6.9%). According to the ASA score, 290 patients were found to be at low or mild risk for anaesthesia and surgery (ASA 1 and 2), and 72 patients (24.8%) were stratified as being at least at risk of malnutrition. One hundred and eighteen other patients were found to be at a higher risk (ASA 3 and 4), and 58 (49.2%) were not well-nourished (MNA < 24). CONCLUSION: The MNA was found to be well-suited for the preoperative assessment during anaesthesia consultation because it required no biological marker. It showed that approximately one-third of all the examined patients, and half of the ASA 3-4 patients, were not well-nourished. The ASA score could not predict poor nutritional status. The results suggested that nutritional assessment should be routinely performed in ASA 3-4 patients over 60 years of age.

Aged↗
PubMed2001

Cancer: impact of nutrition intervention outcome--nutrition issues for patients.

OBJECTIVE: We examined nutritional issues, assessment, and intervention strategies for patients with cancer. METHODS: Reviews of practice guidelines and published reports were used to identify nutritional issues and strategies that can benefit patients with cancer. RESULTS: Assessment tools such as the Patient-Generated Subjective Global Assessment are useful in terms of identifying patients with nutrition issues and guiding intervention. However, quality of life and other measures should also be considered. There is a need for early and ongoing nutrition interventions. CONCLUSIONS: Encourage patients to try a new food or supplement on days when they are not receiving chemotherapy or radiation therapy because it may result in better tolerance. Screen patients to determine their nutritional status. Closely monitor changes in weight, food intake, and symptoms such as nausea and vomiting. Refer to a registered dietitian for a complete nutrition assessment and individualized counseling.

Anorexia↗
PubMed1999

The Mini Nutritional Assessment (MNA) and its use in grading the nutritional state of elderly patients.

The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. Discriminant analysis was used to compare the findings of the MNA with the nutritional status determined by physicians, using the standard extensive nutritional assessment including complete anthropometric, clinical biochemistry, and dietary parameters. The sum of the MNA score distinguishes between elderly patients with: 1) adequate nutritional status, MNA > or = 24; 2) protein-calorie malnutrition, MNA < 17; 3) at risk of malnutrition, MNA between 17 and 23.5. With this scoring, sensitivity was found to be 96%, specificity 98%, and predictive value 97%. The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.

Aged↗
PubMed2001

Effect of perioperative nutrition, with and without arginine supplementation, on nutritional status, immune function, postoperative morbidity, and survival in severely malnourished head and neck cancer patients.

BACKGROUND: Malnourished head and neck cancer patients are at increased risk of postoperative complications. OBJECTIVE: We studied the effect of perioperative, arginine-supplemented nutritional support on nutritional status, immune status, postoperative outcome, and survival in severely malnourished (weight loss >10% of body weight) head and neck cancer patients undergoing major surgery. DESIGN: Forty-nine patients were randomly assigned to receive 1) no preoperative and standard postoperative tube feeding, 2) standard preoperative and postoperative tube feeding, or 3) arginine-supplemented preoperative and postoperative tube feeding. RESULTS: Patients in both prefed groups received approximately 9 d of preoperative tube feeding, resulting in energy intakes of 110% and 113% of calculated needs (compared with 79% in the control group; P = 0.007). Compared with no preoperative feeding, preoperative enteral nutrition did not significantly improve nutritional status or any of the studied biochemical or immunologic indexes. Major postoperative complications occurred in 53%, 47%, and 59% of patients in study groups 1, 2, and 3 (NS). A trend was seen toward better survival in the arginine-supplemented group (P = 0.15). Secondary analysis showed that survivors had better human leukocyte antigen-DR expression on monocytes (P = 0.05) and higher endotoxin-induced cytokine production (P = 0.010 for tumor necrosis factor alpha and P = 0.042 for interleukin 6) at the start of the study than did patients who died. CONCLUSIONS: Nine days of preoperative tube feeding, with or without arginine, did not significantly improve nutritional status, reduce the surgery-induced immune suppression, or affect clinical outcome in severely malnourished head and neck cancer patients. Patients supplemented with arginine-enriched nutrition tended to live longer. Some markers of immune function may distinguish patients with good or bad prognoses.

Aged↗
PubMed1992

Nutritional behaviour and quality of life during oncological polychemotherapy: results of a prospective study on the efficacy of oral nutrition therapy in patients with acute leukaemia.

A total of 29 patients with acute leukaemia were prospectively randomized before starting cytostatic treatment to be nourished either with intensified oral nutrition (intervention group) or ad libitum nutritional intake during the whole tumour therapy (median 22 weeks). All received menus of free choice (daily offer of 1.0-2.0 g protein, 30-50 kcal kg-1 body weight (BW)). Beyond this, intervention patients received nutrition education, daily visits by the dietician and record of food intake, as well as a weekly assessment of subjective well-being (linear analogue self assessment 'LASA'). From the LASA items, the factors: 'malaise', 'psychological distress', 'therapy side-effects' were extracted by principal component analysis, and correlated to nutrient intake and nutritional status. At the end of antineoplastic induction therapy, after continuous hospitalization of 10 weeks (median), 31.3% of the controls had regained their initial nutritional status, and 68.8% of the intervention group. Mean daily energy intake was 23.2 kcal kg-1 BW during weeks with weight loss (constant weight: 30.9, weight gain: 39.3 kcal kg-1 BW). Nutritional behaviour correlated with subjective well-being, low intake with complaints of tumour treatment side effects and weight loss with malaise.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1995

The nutritional response to home enteral nutrition in childhood.

The nutritional response to home enteral nutrition (HEN) was evaluated in a prospective study of 44 consecutive children (median age 48 months) who received HEN for more than 1 month (median duration 6 months). Three groups were studied: 17 children were stunted, 14 were wasted and 13 were adequately nourished but unlikely to maintain oral intake during anticipated nutritional stress. In the stunted group (median duration of HEN 15 months) there was a significant correlation between improvements in height-for-age z scores and duration of feeds (r = 0.63; p = 0.006). In the wasted group (median duration of HEN 4 months) all anthropometric indices improved significantly (p < 0.05). HEN was also successful in maintaining nutritional status in the third group. Thus, supplementary HEN is an effective method of nutritional support for a variety of indications, provided concurrent advice from a nutritional care team is available.

Child, Preschool↗
PubMed2005

Nutritional assessment in cancer: comparing the Mini-Nutritional Assessment (MNA) with the scored Patient-Generated Subjective Global Assessment (PGSGA).

The evaluation of nutritional status in cancer patients is often neglected in spite of the fact that poor nutritional status may adversely affect prognosis and treatment tolerance. In day-to-day oncology practice, a sensitive but simply applied nutritional assessment tool is needed to identify at-risk patients. Several tools exist; however, none has been universally accepted. The aim of this study was to compare two potential tools, the Mini-Nutritional Assessment (MNA) and the scored Patient Generated Subjective Global Assessment (PGSGA). The MNA is more simply applied and does not require a trained dietitian. The PGSGA has been previously validated in cancer patients. One hundred fifty-seven newly diagnosed cancer patients were assessed using both tools. Of these, 126 were reassessed at 4-6 wk, and 104 were reassessed at Weeks 8-12 after initial assessment. A significant negative correlation was found between the tools at all three time periods (at baseline r = -0.76; P < 0.001). Taking the PGSGA as the most accepted nutritional assessment tool, at baseline the MNA demonstrated a sensitivity of 97% and specificity of 54%. At 4-6 wk MNA sensitivity was 79% and specificity was 69%. At 8-12 wk MNA sensitivity was 93% and specificity was 82%. When comparing the tools in elderly patients alone (>65 yr), similar results were obtained. Both tools were able to correctly classify patients as malnourished, although the MNA lacks specificity. Therefore, the PGSGA should be the tool of choice for nutritional assessment in cancer patients.

Adult↗
PubMed2003

Nutritional status using the Mini Nutritional Assessment questionnaire and its relationship with bone quality in a population of institutionalized elderly women.

Malnutrition, a risk factor for osteoporotic fractures, is frequent in elderly people and, is underdiagnosed and undertreated. There are only few studies on the nutritional status of elderly people in Europe. The Mini Nutritional Assessment (MNA) is a non invasive and validated questionnaire to evaluate nutritional status in elderly people, classified in three groups: 1 degree score < 17: malnourished, 2 degrees score >17 and < 24: at risk of malnutrition, 3 degrees score >24: well-nourished, with a maximum of 30 points. Quantitative ultrasound of bone (QUS) is a method for assessing quality of bone which can be easily performed in nursing homes. Therefore, these two tests allowed to study the relationships between nutritional status and ultrasonic parameters of bone in 78 institutionalized women aged 86 +/- 6 years, living in 11 nursing homes around Lausanne (Switzerland). All were assessed by the MNA, had a measurement of the tricipital skin fold and of the grip strength. Functional status was evaluated by the scale "Activity of Daily Living" (ADL), and serum albumin level was measured when permitted. All had QUS of the calcaneus (with an Achilles, GE Lunar). The measured parameters are the Broadband Ultrasound Attenuation (BUA), attenuation of a band of ultrasonic frequencies through the medium, expressed in dB/MHz, and the Speed of Sound (SOS), speed of the ultrasounds through the medium, expressed in m/s. A third parameter, the stiffness index (SI), expressed as a percentage of the values obtained by the manufacturer in a young population and derived from BUA and SOS, was calculated automatically : SI = (0.67xBUA) + (0.28xSOS) - 420, expressed in percent compared to a young adult population (%YA). Fifteen percent of the women were undernourished and 58% were at risk of malnutrition. As expected, compared with the well-nourished minority, undernourished subjects had significant lower body mass index (BMI), tricipital skin fold (TSF), ADL score and albumin level (p < 0,01). The subjects "at risk of malnutrition" had significant lower BMI, ADL score (p < 0.01), tricipital skin fold and serum albumin (p < 0.05). Ultrasound parameters were low independently of the nutritional status. MNA score correlated significantly with tricipital skin fold (r = 0.508, p < 0.01), ADL (r = 0.538, p < 0.01) and albumin serum level (r = 0.409, p = 0.01). There was a trend for a correlation between the MNA and the ultrasound parameter BUA (r = 0.207, p = 0.07), whereas no correlation was found with SOS and SI. A multivariate analysis showed that tricipital skin fold and ADL explained 61% of the variance of the MNA. In conclusion, using simple and non invasive methods, this study showed that malnutrition and osteoporosis are frequent in institutionalized elderly persons in our country, and the ultrasound parameters are influenced by many others factors in addition to nutrition, especially at this age and in elderly residents of nursing homes.

Activities of Daily Living↗
PubMed2003

Nutritional risk and time to death; predictive validity of SCREEN (Seniors in the Community Risk Evaluation for Eating and Nutrition).

BACKGROUND: Undernutrition in community-living seniors is common and has the potential to adversely influence health outcomes. Nutritional risk screening tools can help identify seniors at risk, but few have predicted health outcomes. METHODS: Seniors were recruited from 23 community service providers. The 8-item abbreviated version SCREEN (Seniors in the Community Risk Evaluation for Eating and Nutrition) was used to identify nutritional risk in 367 seniors; demographics, health, activities of daily living, and psychosocial variables were included in a baseline assessment. The seniors were followed-up by telephone for 18 months to determine the occurrence of health outcomes, including death. Cox regression was used to identify predictors of survival time. RESULTS: During the 18-month follow-up there were 27 deaths (approximately 7%). Using the abbreviated tool, nutritional risk was common (42.2%). This low rate of death limited the modeling to only a few key covariates, which were based on bivariate analyses. Nutritional risk was significantly associated with time to death. Gender was also associated with time to death, with men more likely to die sooner than women. Increasing age was also significantly associated with shorter survival times. CONCLUSIONS: Nutritional risk as measured by SCREEN was predictive of time to death. This simple tool may be useful for future epidemiological research on health outcomes of seniors. Further work should confirm these results, as the low event rate influenced the modeling strategy.

Age Factors↗
PubMed2004

[Nutrition and dialysis: how to keep adequate nutrition in dialysis?].

Malnutrition is frequent in dialysis patients and it increases the mortality risk in this setting. There are many causes of malnutrition including protein metabolism impairment, amino acid and nutrient losses in dialysate, dialysis-induced muscle catabolism, metabolic acidosis, increased energy expenditure, resistance to anabolic hormones, comorbidities, oxidant stress and inflammation whose mechanisms are not identified well. Inflammation and malnutrition are associated with vascular complications frequently observed in dialysis patients. Daily nutrient needs have been established from nitrogen balance studies. The recommended intakes are 1,2 g/ kg/day for proteins, and 35 Kcal/kg/day for energy. Food intake in dialysis patients remain far below these recommendations in most of the studies, mainly because of anorexia caused by inflammation and the uremic state. Dialysis dose or frequency increase food intake. Evaluation of the nutritional status relies on biological parameters and anthropometrics, with food intake records. Nutritional scores, established from these data, are well correlated with patient outcomes. Malnutrition treatment includes counselling, and suppression of all inflammation sources. Appetite stimulants have been seldom used in this setting. Oral supplements may be efficient Intradialytic parenteral nutrition in hemodialysis patients and amino acid-enriched dialysate in peritoneal dialysis improve nutritional parameters of malnourished patients but their efficiency to improve patient survival is questioned. Adequate nutrition is an important challenge for dialysis patient outcome. Nutritional status must be regularly assessed and treated if necessary. Close collaboration between dialysis and dietetic staffs remains essential to handle this challenge.

Humans↗
PubMedDate not supplied

Community organized food and nutrition education: participation, attitudes and nutritional risk in seniors.

UNLABELLED: Evergreen Action Nutrition (EAN) is a health promotion program designed to facilitate relatively healthy members of a seniors recreation center to maintain their nutritional health as they age. A main goal of this project was to demonstrate the feasibility and relevance of using the community organization approach to develop a nutrition education program for seniors. METHODS: Using the current membership list, seniors were randomly selected to receive a mailed baseline (n=247) questionnaire. A follow-up survey (n=251) was sent out to randomly selected members three years later to determine participation in EAN and reported behavior change. Although not the same individuals, responses were compared to baseline to determine changes in nutritional risk. Items from the Diet and Health Knowledge survey were compared by EAN participation. RESULTS: The program had a large reach with 162 survey respondents (64.5%) reporting some level of participation and 51% reporting "frequent" participation. Use of informal forms of education predominated (e.g. displays). Significant differences were found between baseline and follow-up for risk attributed to low intake of fruits and vegetables and frequency of eating, with EAN participants having reduced risk of low fruit and vegetable intake. Those participating in formal education (e.g. food workshops) reported more frequent changes in food practices than those participating in informal activities. EAN participants appear to have more healthy nutrition attitudes/beliefs. CONCLUSION: The community organization approach to program planning and delivery leads to the development of diverse and appropriate nutrition education activities for seniors. Informal and formal health promotion activities can be successfully implemented in recreation centers.

Aged↗
PubMedDate not supplied

Nutritional assessment as a quality control of total parenteral nutrition.

Because no single index can characterize a patient's nutritional status, a complete assessment requires a profile of different parameters. This profile incorporates various tests, measurements, and derived parameters, which have been established and adapted to clinical use for identifying the malnourished state, providing guidelines for nutritional support and evaluating the response to nutritional therapy. The quantitative value of anthropometric measurements (weight, triceps skinfold thickness, arm muscle circumference), biochemical determinations (creatinine-height index, serum albumin, serum transferrin total lymphocyte count). Immunological evaluations (skin antigen testing) and their importance in the classification of malnutrition are being discussed. Considerable attention is drawn on monitoring the nutritional assessment by serial measurements. So, a dynamic pattern of the patient's response to parenteral nutritional therapy can be evaluated and a more scientific base is found for determining the nutritional needs for any specific patient.

Blood Proteins↗
PubMed1982

Controlled clinical trials of nutritional intervention as an adjunct to chemotherapy, with a comment on nutrition and drug resistance.

Nutritional intervention in the cancer patient [e.g., total parenteral nutrition (TPN)] might improve durable survival because of increased tolerance to aggressive tumor therapy. To determine whether this assumption is correct, 42 patients with diffuse histiocytic lymphoma were induced with prednisone, high-dose methotrexate, Adriamycin, cyclophosphamide, and VP-16 (ProMACE). Nitrogen mustard-vincristine-procarbazine-prednisone (MOPP) consolidation was then used, followed by late intensification with ProMACE. Patients were selected randomly to receive adjuvant TPN or a standard diet during ProMACE-MOPP treatment. While TPN patients had a greater median weight gain than did control patients, lean body mass and degree of myelosuppression did not improved as a consequence of TPN. There was no significant difference in tumor response or survival between TPN and control patients, whether or not the patients were initially malnourished. In a second trial, 32 young patients with metastatic or other poor-prognosis sarcomas were randomly allocated to receive TP or a standard diet as an adjunct to one very intensive course of combination chemotherapy or chemotherapy plus total body irradiation; autologous marrow transplantation was used with gain than did controls but remained in a negative nitrogen balance. Response rates and median durable survival did not differ between the two groups. In both trials, the maximum nutritional support permitted by currently available technology was offered. Thus, the limiting factor may not be nutritional status but rather the intrinsic biology of the tumors and the limitations of their response to current therapy. In in vitro studies of the possible influence of nutrition on cancer treatment, we have compared sublines of P388 murine leukemia cells which are sensitive or resistant to Adriamycin. The difference in drug sensitivity correlated with differences in lipid composition, with more intracellular lipid, and with greater membrane rigidity in the resistant cells. Resistant cells have a relatively poor transport of drug into the cell; moreover, intracellular Adriamycin is sequestered in lipid depots away from DNA. These results suggest one possible relationship between nutritional phenomena and drug sensitivity.

Animals↗
PubMed1994

[Energy and nutritional intake in young weight lifters before and after nutritional counseling].

A well-balanced diet is an essential component for the development and maintenance of physical performance. Several studies on the dietary status of power athletes have shown, that there are still problems to realize the nutritional recommendations. The purpose of the present study was to analyse the energy- and nutrient intake of 11 young weight lifters aged 14 to 17 years before and after an intensive nutritional counselling (NC). Dietary status was evaluated by 7-day-protocols filled out by the young athletes 4 weeks before and 4 weeks after the NC. Before the NC the athletes (x: age 15, height 174 cm, weight 69.5 kg, BMI 22.2 kg/m2) had a mean energy intake of 179.7 kJ/kg body weight (11.2 MJ/day). The energy percentage of carbohydrate:fat:protein was 48:37:15. The protein consumption was 1.6 g/kg of body weight and the fluid intake was 1.7 l/day. The athletes did not meet the recommendation for niacin, folic acid, vitamin E, magnesium, calcium, iodine and zinc. After the NC the athletes had a significant higher energy percentage of carbohydrate and lower energy percentage of fat. In addition a significantly higher intake of fluid, dietary fiber, vitamins and minerals was observed. This study revealed that the young weight lifters without NC fall short of nutritional recommendations. With the intensive nutritional counselling an improvement of the nutrient intake could be reached. Additional nutritional counselling for the athletes and an intensive teamwork with the coach and parents of the athletes seem necessary to develop and stabilize a good nutritional behavior.

Adolescent↗
PubMed2002

Does nutritive and non-nutritive sucking reduce other oral behaviors and stimulate rest in calves?

After a milk meal, bucket-fed calves show non-nutritive oral activities, including cross-sucking, and this can discourage producers from rearing them in groups. Sucking is known to induce a quiet state in humans and rats. We examined if nutritive sucking affects non-nutritive oral activities in calves, if it reduces arousal (assessed through behavior and cardiac activity), and if sucking a dry teat can compensate for the lack of nutritive sucking. In Exp. 1, the behavior and the cardiac activity of individually housed calves fed milk from a bucket were compared to those of calves fed milk through a teat. During the meal, the heart rate of bucket-fed calves was higher than that of teat-fed calves (P < 0.0001). After the meal, only bucket-fed calves displayed bar sucking. Compared to the teat-fed calves, they spent more time licking their pen or their neighbor (P < 0.001 and P < 0.05), their heart rate was less variable (P < 0.01), and they lay down with the head unsupported by the neck less quickly (latency to lie down: 51 min vs 42 min, P < 0.05). In Exp. 2, individually-housed bucket-fed and teat-fed calves were observed with or without access to a non-nutritive teat after the meal. Bucket-fed calves sucked the dry teat for longer than teat-fed calves (P < 0.001). In bucket-fed calves, access to the dry teat reduced the time spent nibbling (P < 0.01) and tended to shorten the latency to lie down (P < 0.10). In Exp. 3, group-housed bucket-fed calves were compared with group-housed calves fed with an automatic teat feeder system. Bucket-fed calves spent more time nibbling at 1 mo, but at 3 mo they spent less time nibbling and cross-sucking; they drank more milk and put on more weight. We conclude that, for calves housed individually, teat-feeding reduces non-nutritive oral activities after the meal and induces a calmer state than bucket-feeding. Providing calves with a dry teat partly compensates for the lack of nutritive sucking. For calves housed in groups, the use of an automatic teat feeder may not reduce calves' motivation for sucking. No improvement of growth was observed with teat-feeding either with a teat-bucket or with an automatic feeder.

Animal Husbandry↗
PubMed1987

Position of the American Dietetic Association: appropriate use of nutritive and non-nutritive sweeteners.

Moderation in the consumption of nutritive and non-nutritive sweeteners appears to be prudent advice for persons who choose to use sweeteners. The major benefit from use of sweeteners is a perceived improvement in the quality of life. Some nutritive sweeteners also provide important textural properties to many foods. Sweeteners should be used in the context of an otherwise nutritious and well-balanced diet. Excessive intake of any sweetener requires nutrition counseling for basic nutrition reasons. An individual can minimize potential risks from any one sweetener by using a variety of available sweeteners, thus ingesting less of any specific sweetener. Research into possible risks of long-term uses of non-nutritive sweeteners, either alone or in combination, should continue. It is important that the public have a choice of various non-nutritive sweeteners, with safe and reasonable guidelines on how to use each. As new sweeteners become available, they must receive the same rigorous testing to which previously approved sweeteners have been subjected.

Aspartame↗
PubMed2003

Nutritional concerns and possible countermeasures to nutritional issues related to space flight.

The experience obtained in astronauts until now has revealed many nutritional problems during both short- and long-term missions that are still under investigation. When the manned space program evolves to the point where it involves a considerable number of people operating at great distances from the Earth for long periods of time, continuous provision of food as well as physiopathological modifications partly related to nutrition will remain a challenge. Human space missions have outlined the importance of the diet on the quality of an astronaut's life, not only because an appropriate nutritional status can be maintained only through an adequate nutrient intake, but also because food plays an important socio-psychological role.A great amount of research has been done both by the Russian and American teams in order to identify the nutritional requirements for humans during space flights. Crew members should be provided with nutritional adequate diets characterized by many different food items carefully selected according to technological techniques aimed to ensure long shelf-life periods, health, safety, satisfaction and convenience. An astronaut's nutritional status is greatly influenced by important weightlessness, environmental physiological adaptations.Changes in muscle and bone mass, modifications of gastro-intestinal functions and immune alterations may be partly limited by adequate planned dietary countermeasures.

Homeostasis↗