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PubMed2002

Nutritional risk needs assessment of community-living seniors: prevalence of nutrition problems and priorities for action.

A random mailed survey was sent to 425 members of a seniors recreation center in Guelph, Ontario for the purpose of identifying the prevalence of nutritional risk, specific nutrition problems, and educational format preferences of these seniors. This needs assessment was used to plan an education initiative called "Action Nutrition." SCREEN, a 15-item nutritional risk screening instrument, demographic data, participation in current recreation programs, and frequency of visits to the center were included in this survey. The response rate was 62%, average age was 72 years and 59% were female. Respondents attended on average one activity per month, 60% visited the center at least once per month and 79% read the monthly newsletter. 56.7% of respondents were considered to be at nutritional risk using SCREEN and common problems were: significant weight change in 6 months; low intake of fruits and vegetables and milk products; and restriction of the diet due to health reasons. This survey determined that nutrition problems and risk are prevalent among community-living seniors, justifying the development and implementation of educational initiatives in this setting.

Aged↗
PubMed1989

Response of IGF-1 to nutritional support in malnourished hospital patients: a possible indicator of short-term changes in nutritional status.

IGF-1 is a circulating growth factor with hepatic release dependent on nutritional status. To determine if IGF-1 could be a useful nutritional index, 15 malnourished patients were assessed during nutritional support. Patients with protein or protein-calorie malnutrition had lower IGF-1 (39 +/- 7 micrograms/L) than did patients with calorie-only malnutrition (109 +/- 25 micrograms/L, p less than 0.005); transferrin concentrations did not differ between the two groups. Nutritional supplementation produced an increase in IGF-1 (123 +/- 32 micrograms/L, p less than 0.005); the relative increase in IGF-1 (264 +/- 62%, p less than 0.001) exceeded increases in albumin or transferrin (9 +/- 6% and 59 +/- 16%, NS and p less than 0.005, respectively). Reduction or termination of support was followed by a decrease in IGF-1 to 59 +/- 9% of peak values (p less than 0.001) but neither albumin nor transferrin decreased significantly. Changes in IGF-1 were correlated with nitrogen balance (r = 0.45, p less than 0.005). The strong relationship between IGF-1 and nutritional status suggests that IGF-1 determinations may be useful in guiding nutritional therapy in patients whose nitrogen balance is difficult to assess.

Dietary Proteins↗
PubMed1999

Nutritional support and aging in preoperative nutrition.

In the past 20 years, an increased interest geriatric nutrition has induced researchers to document the distribution and magnitude of nutritional problems in the elderly population. It has been observed that the prevalence of malnutrition is greatly affected by the general health status and autonomy of the elderly. Among free-living healthy elderly persons, the prevalence of protein-caloric undernutrition is low. As health and functional capacities deteriorate with age, however, the prevalence increases dramatically to 30-65% of those in home care, nursing homes or in hospital. Formal nutritional assessment has typically been absent from most published programmes of geriatric evaluation and comprehensive geriatric assessment. This is frequently because of the lack of a specific validated tool to assess nutritional status in older persons and, at least partly, to explain this phenomenon. The Mini Nutritional Assessment was developed and validated on large representative samples of elderly persons to address these specific issues. Recent experimental studies have shown that advanced malnutrition is much more difficult to treat in the elderly than in younger adults. Trials of nutritional support using oral supplements or enteral tube feeding have shown improved outcome in those identified as malnourished on admission to hospital.

Administration, Oral↗
PubMed1999

Public nutrition from an approach to a discipline: concern's nutrition case studies in complex emergencies.

The Public Nutrition approach, like that of Public Health, is context specific. It places an emphasis on populations rather than individuals and is inter-disciplinary in nature. Both approaches seek to understand the complex aetiology of a clinical outcome such as malnutrition within the widest possible framework. Public Nutrition uses the UNICEF conceptual framework and adapts and expands it. The authors of this article argue--through the examination of a number of case studies taken from the work of Concern Worldwide (hereafter referred to as Concern) in southern Sudan, Rwanda, Angola, Tanzania and DRC--that there are two critical constituents of the Public Nutrition approach. These are: a contextual analysis (including the use of surveillance information for programme design and advocacy) and community involvement at all stages of the project cycle. Some of the key obstacles to the adoption of the Public Nutrition approach are identified by illustrating two practical programme settings. For the Public Nutrition approach to be more widely used, the authors recommend a number of key strategies including the further dissemination of case studies and the clarification of the scope and boundaries of the approach. These strategies will enable Public Nutrition to evolve both as a practical programme framework as well as an academic discipline.

Africa↗
PubMed1987

Nutritional management of pregnancy in patients on home parenteral nutrition.

Three pregnancies are reported in two patients on home parenteral nutrition for intestinal failure. The nutritional regimen, 2300 kcal (9.63 MJ) (18% as lipid emulsion), 14 g amino acid nitrogen and electrolytes supplied daily in a 'big bag', was based on the measured resting energy expenditure and urinary nitrogen excretion during the third trimester in a 30-year-old woman on home parenteral nutrition. Commercial preparations of trace elements were added to the infusion as dictated by serum levels. Iron, iodine and fluoride were given orally, and vitamin B12 by monthly intramuscular injection. There were no serious deficiencies in trace elements and maternal weight-gain and fetal growth were satisfactory in all three pregnancies. The two pregnancies in one patient went to term and both infants had birthweights at the 50th centile for gestational age. The second patient who had had two spontaneous abortions went into premature labour at 30 weeks and gave birth to a baby with a minor facial deformity who subsequently developed the idiopathic respiratory distress syndrome. All three placentas were histologically normal. The growth and development of all three babies has been satisfactory. This nutritional regimen should be adequate for most pregnant patients who have attained a normal nutritional status on parenteral nutrition.

Adult↗
PubMed1979

Nutritional deficiencies and nutritional support therapy in geriatric cancer patients.

Nutritional deficits and their correction were studied in 45 cancer patients (age range, 60--86 years) who were undergoing various modalities of cancer therapy. Their nutritional status was maintained with a variety of commercially available special diets, and serum albumin concentrations were sequentially determined in order to gauge the efficacy of the nutritional support. Serum albumin levels were preserved when nutritional support was employed in surgical therapy. However, patients undergoing palliative chemotherapy or radiotherapy responded only to adequate levels of the standard hospital diet with or without supplements of special enteral diets. In the survivors, albumin levels were maintained; in the nonsurvivors, albumin levels decreased. This group of older patients tolerated nutritional support therapy, especially when it was carefully monitored. Satisfactory nutritional therapy can be achieved by use of appropriate enteral formulas. The method lends itself to adequate management in the outpatient or nursing-home situation during certain phases of cancer.

Adult↗
PubMed2004

Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis.

OBJECTIVE: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. DATA SOURCES: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. STUDY SELECTION: Randomised controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomised controlled trials and were included for data extraction. DATA EXTRACTION: Six studies with 263 participants were analysed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The meta-analysis was performed with the random effects model. DATA SYNTHESIS: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P = 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P = 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P < 0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P = 0.16) between the two groups of patients. CONCLUSIONS: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

Acute Disease↗
PubMedDate not supplied

Implementation of a nutrition support protocol increases the proportion of mechanically ventilated patients reaching enteral nutrition targets in the adult intensive care unit.

BACKGROUND: Despite the evidence that enteral feeding reduces morbidity in critically ill patients and is preferred to parenteral nutrition, the delivery of enteral nutrition (EN) is often inadequate. The purpose of this study was to determine whether implementation of an evidence-based nutrition support (NS) protocol could improve EN delivery. METHODS: An NS protocol incorporating available scientific evidence; data from a retrospective survey of 30 intensive care unit (ICU) patients; and input from dietitians, intensive care physicians, surgeons, nurses, and pharmacists was developed. The impact of this protocol was evaluated prospectively in 123 consecutive adult patients admitted to a multisystem ICU who were eligible for EN. RESULTS: The percentage of patients who received at least 80% of their estimated energy requirements during their ICU stay increased from 20% before implementation of the NS protocol to 60% after implementation (p < .001). After adjusting for confounders, those in the postimplementation group received significantly more kcal/kg/d than the preimplementation group (3.71 kcal/kg/d; 95% confidence interval, 1.64 to 5.78; p = .001). Parenteral nutrition use [corrected] was reduced in the postimplementation group (1.6 vs 13%, p = .02). There was no difference in time to initiation of enteral nutrition between groups (1.76 days preprotocol vs 1.44 days postprotocol implementation, p = .9). CONCLUSIONS: The development and use of an evidence-based NS protocol improved the proportion of enterally fed ICU patients meeting their calculated nutrition requirements.

Cohort Studies↗
PubMed2002

Nutritional status of patients with advanced cancer: the value of using the subjective global assessment of nutritional status as a screening tool.

In patients suffering from advanced neoplastic disease, malnutrition is a common complication affecting both the survival and quality of life. In order to monitor early dietary interventions, an assessment of patients' nutritional status is essential. We assessed the nutritional status of 46 patients using two different methods: 1) an objective method of nutritional assessment and 2) the subjective global assessment (SGA) technique. It was found that 28 patients were characterized as malnourished by means of the objective method and 30 patients according to the SGA. The correlation of the results of the assessments between the two methods was high and a validation test of the SGA gave a sensitivity of 96% and specificity of 83%. The most frequent symptoms affecting food intake were anorexia, early satiety, dry mouth, pain and nausea. The results show that the SGA represents an easy method for assessment of the nutritional status in such cancer patients and that it can therefore be used as a screening tool. The high incidence of malnutrition in this group of patients, and their rare use of nutrient supplements, both indicate the importance of early nutritional assessment, and nutritional intervention when appropriate.

Adult↗
PubMedDate not supplied

[Nutrition team. Units of nutritional support].

During the VIII National Congress of the Spanish Society of Parenteral and Enteral Nutrition (SENPE) held in Santander on 5th, 6th and 7th of June last, a subject was raised among several others, which for us was of great current interest and not often found in scientific affairs, related to the organizational affairs of the discipline of Artificial Nutrition, namely the Nutritional Teams or Nutritional Support Units. The aim was to respond to the many problems raised by this discipline: What does it consist of? Is it necessary? What is its purpose? Who is involved in it? What qualifications must these people have? Does it enter into competition with Nutritional, Clinical and Dietetic Services? To reply to these and many other questions, we invited a number of professionals with wide experience in nutritional and other fields, in an attempt to form a group of experts in different specialties with interests in the subject. We were also lucky enough to be able to invite Doctor Rombeau, an internationally-recognized expert, in whose country there exists great experience in the organization of these units. This summary of our Round Table was prepared by the organizer, Doctor Ordóñez, and an attempt was made to respect the spirit of each author's contribution.

Enteral Nutrition↗
PubMed1989

[Comparison between oral nutrition and enteral nutrition using a percutaneous endoscopically guided gastrostomy (PEG) in patients undergoing radiotherapy for head and neck tumors].

The nutritional state of 99 patients with tumors in the head and neck area was determined prior to, during and after radiotherapy by anthropometric, laboratory-chemical and immunological parameters. In 73 orally nourished patients, the nutritional parameters deteriorated very quickly during radiotherapy and recovered slowly and incompletely after radiotherapy. In 26 patients treated prospectively by percutaneous endoscopically guided gastrostomy (PEG), however, an improved nutritional state was achieved already during the irradiation in spite of a less favorable starting point. The subjective feeling of patients was questioned by means of the "quality of life" index according to Padilla et al. (1983). The preliminary results show an identical deterioration of the subjective feeling in both groups, but - as opposed to the other patients - force and working capacity did not decrease during radiotherapy in the enterally nourished patients. This corresponds to the objective nutritional parameters. However, an improvement of the subjective feeling after the end of radiotherapy was observed only in the orally nourished patients. Possible reasons are discussed. We have the opinion that an early and constant enteral nutrition by PEG can stabilize the nutritional state of patients with tumors in the head and neck area. Therefore we recommend to establish a prophylactic, pretherapeutic PEG if an aggressive multimodal therapy is planned, especially in case of apparent primary malnutrition.

Body Mass Index↗
PubMed1995

[Graduate education in nutritional medicine in Germany--2 years after organization of the "Nutritional Medicine" teaching curriculum].

Prophylaxis of nutrition-related diseases and therapy of malnutrition are important duties of physicians. While teaching in nutrition for medical students is poor in German universities, progress has been made in regard to postgraduate training. Stimulated by the chamber of physicians of Germany, a "curriculum for Nutritional Medicine" was developed by the Germany Society of Nutritional Medicine. Experience gained by the Academy of Nutritional Medicine Hannover indicates that the postgraduate training based on this curriculum is well received. This may suggest that nutritional medicine is gaining greater acceptance.

Education, Medical, Graduate↗
PubMed1991

Nutritional assessment and indications for nutritional support.

The goal of nutritional assessment is to identify prospectively all those patients who would develop a nutrition-related complication. In practical terms, there is no single test capable of achieving this goal. At present, the best method of nutritional assessment is an organized step-by-step multifactorial approach. This involves assessment of the primary illness, the patient history, and the prognosis. A nutritional status examination is done, and the current intake is compared with the nutritional goals. A decision is then made whether to force feed. If forced feeding is initiated, the effectiveness of the therapy must be monitored frequently until the patient recovers and is able to be sustained by volitional oral intake.

Enteral Nutrition↗
PubMed1994

Nutritional status of elderly patients during recovery from chest infection and the role of nutritional supplementation assessed by a prospective randomized single-blind trial.

We examined changes in the nutritional status of elderly patients with chest infection for a period of 3 months after discharge from hospital, including the effects of nutritional supplementation on well-being and functional status as well as on nutritional indices. Eighty-one subjects admitted to an acute medical ward aged 65 years and over with chest infection were recruited consecutively, and randomized to receive supplement (500 ml of Ensure liquid daily) for 1 month, or no supplement, on discharge. Assessment at baseline, 1, 2 and 3 months included a questionnaire to determine health, mental and functional status, and anthropometric measurements. Biochemical nutritional status was assessed at baseline, 1 and 3 months, and dietary intake (24 h recall method) at 1 and 3 months. During recovery, both supplement and non-supplement groups showed improvement in various measures of well-being and biochemical status. In addition, the former group showed improvement in more anthropometric measurements, in thiamine and pyridoxine status, while the non-supplement group showed a lower level of functional ability after 3 months. Various measures of well-being and biochemical status of the water-soluble vitamins were better in the supplement groups. We conclude that nutritional supplementation may have a role in helping elderly patients to recover from chest infections.

Aged↗
PubMedDate not supplied

Early nutritional screening of older adults: review of nutritional support.

Protein-energy malnutrition and its consequences can have considerable impact on the quality of life of the elderly. Healthcare providers working with older adults are challenged to recognize individuals at risk for undernutrition and to initiate early nutritional assessment and intervention strategies to prevent malnutrition. In so doing, they can assist in improving the quality of life for the older adult and decrease healthcare costs associated with serious outcomes of malnutrition. Current knowledge about the nutritional needs of the elderly, definition of malnutrition, age-related risk factors, and causes of malnutrition in the elderly are presented in this article. A practical approach to preventing the occurrence of malnutrition is suggested through the use of a quick and easy nutritional screening assessment tool, the Mini Nutritional Assessment (MNA). Recommendations for specialized nutritional support, as well as its role in wound healing and immune enhancement, are discussed. Where available, scientific data supporting its use are included.

Aged↗
PubMed2006

Nutrition support for neurologically impaired children: a clinical report of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition.

Undernutrition, growth failure, overweight, micronutrient deficiencies, and osteopenia are nutritional comorbidities that affect the neurologically impaired child. Monitoring neurologically impaired children for nutritional comorbidities is an integral part of their care. Early involvement by a multidisciplinary team of physicians, nurses, dieticians, occupational and speech therapists, psychologists, and social workers is essential to prevent the adverse outcomes associated with feeding difficulties and poor nutritional status. Careful evaluation and monitoring of severely disabled children for nutritional problems are warranted because of the increased risk of nutrition-related morbidity and mortality.

Bone Diseases, Metabolic↗
PubMedDate not supplied

Total parenteral nutrition with fat emulsions during pregnancy--nutritional requirements: a case report.

After a corrosive burn of the upper gastrointestinal tract leading to a severe dysphagia and to a weight loss of 15 kilograms, a 21-year-old female was treated by total parenteral nutrition (TPN) during the last 7 weeks of pregnancy. TPN by complete nutritive mixtures comprised daily crystalline amino acid solutions and as energy sources glucose plus lipids, the latter representing 43% of the nonprotein calories. A term normal 2800 gram female was delivered by cesarian section. This case report demonstrates the absence of any side effects on pregnancy related to fat emulsions used in usual proportions. Among the nutritional parameters studied here, the variations of weight and creatinine height index seem to be the best indicators of the maternal nutritional status in these cases. Approximately 50 kilocalories and 220 milligrams of nitrogen per kilograms body weight daily seem to be sufficient to restore and to maintain the maternal nutritional conditions and fetal growth.

Adult↗
PubMedDate not supplied

[Nutrition and dietary recommendations for the elderly "Public Health" Working Group of the Spanish Nutrition Society].

With the increase of life expectancy, the desire to maintain good health, functionality and maximum quality of life at advanced ages, for which nutrition plays a critical role, is a priority for the elderly. Though genetic factors are a determinant of life expectancy, there are several extrinsic factors which have a great influence on the quality of life of the elderly. Diet and nutritional status have a great influence, especially in the prevention and treatment of several diseases, which affect this heterogeneous and vulnerable age group. The nutritional status and needs of elderly people are associated with age-related biological, psychological and often socio-economic changes. All of these changes can increase the risk of developing a number of age-related diseases. In developed countries the elderly are the most affected by malnutrition, either because of a deficiency (energy and several nutrients) or an excess, leading to obesity and related diseases. This review highlights the most important factors affecting nutritional status in elderly people and focus on the need to maintain adequate physical activity level and an optimal physic, psychic and social functional capacity. It discusses dietary reference intakes and guidelines to improve and/or maintain adequate nutritional status in older people in order to reduce susceptibility to some illness and disease.

Aged↗