Methods for assessing protein-energy malnutrition for patients on hemodialysis

Prema literaturi, proteinsko - energetska malnutricija jedna je od najčešćih komplikacija kod pacijenata na hemodijalizi. Cilj ovog rada bio je procijeniti nutritivni status pacijenata na hemodijalizi te odrediti optimalni način procjene. U istraživanju je sudjelovao 71 ispitanik, 40 muškaraca i 31 žena, čiji medijan trajanja hemodijalize iznosi 31 mjesec. Nutritivna procjena provedena je pomoću antropometrijskih i biokemijskih metoda, upitnika za procjenu nutritivnog statusa i kliničkog pregleda. Rezultati pokazuju da najveći broj ispitanika ima normalnu (47,9 %), a 38 % prekomjernu tjelesnu masu. SGA metodom (eng. Subjective Global Assessment) utvrđena je izrazita malnutricija kod 38 % ispitanika čime se ova metoda pokazala kao najrigoroznija, dok je MST (eng. Malnutrition Screening Tool) najmanje stroga i ujedno, uz MUST (eng. Malnutrition Universal Screening Tool), najjednostavnija i najbrža metoda za provedbu pri procjeni nutritivnog statusa pacijenata na hemodijalizi. Čak 96 % pacijenata ima hipoalbuminemiju koja se javlja kao rezultat lošeg prehrambenog unosa i smatra se jakim prediktorom mortaliteta kod pacijenata na hemodijalizi.According to literature, protein - energy malnutrition is one of the most common complications for patients on hemodialysis. The aim of this study was to assess nutritional status of patients on hemodialysis and determine the optimal way of assessment. The study included 71 patients, 40 males and 31 females, whose median of hemodialysis duration is 31 months. Nutritional assessment was carried out with anthropometric and biochemical methods, questionnaires for assessing nutritional status and clinical examination. The results have shown that most of the respondents have normal body mass (47,9 %) while 38 % are overweight. SGA method (Subjective Global Assessment) determined severe malnutrition for 38 % of respondents which makes it the most rigorous method, while MST (Malnutrition Screening Tool) is the least strict and also, with MUST (Malnutrition Universal Screening Tool), the easiest and fastest method for assessing nutritional status of patients on hemodialysis. Even 96 % of patients have hypoalbuminemia which is the result of bad nutritional intake and is considered to be a strong mortality predictor for patients on hemodialysis

Percepcija tijela i učestalost ortoreksije nervoze u mladih osoba u Hrvatskoj

The prevalence of eating disorders in young people is steadily increasing, which brings orthorexia nervosa into focus, especially in pandemic and stress-related periods. Therefore, the aim of this study was to determine the prevalence of orthorexia nervosa in young people and relate it to anthropometric parameters, eating habits and perception of body appearance. This study included 191 participants aged 18-24 years, of which 85,9 % females. Data on body mass and height were collected, from which body mass index was calculated, while their eating attitudes were evaluated by using 5-point scale. The prevalence of orthorexia nervosa was assessed using the ORTO-15 questionnaire, while the Physical Appearance Comparison Scale - Revised (PACS-R) was used to assess participant’s appearance comparison tendencies with other people. It was found that 38.2% of the respondents had orthorexia nervosa. There were no statistically significant differences in the body mass index between the participants with or without the diagnosis of orthorexia (p=0.276). Nevertheless, in the group of participants not diagnosed with orthorexia, those with adequate body weight predominated (89.9%), while among subjects diagnosed with orthorexia the proportions of undernourished (8.2%) and overweight participants (15.1%) were higher. Participants with orthorexia found a healthy diet more important than subjects without orthorexia (p=0.001), while there were no statistically significant differences in self-rated diet quality between the two groups (p=0.815). Furthermore, there was a statistically significant negative correlation between the results of PACS-R and ORTO-15 (p<0.01). Ultimately, there was a statistically significant difference in the results of PACS-R between participants with or without the diagnosis of orthorexia (p=0.032). High share of participants was diagnosed with orthorexia nervosa. Even though young people who developed orthorexia nervosa mostly had normal body weight, they had a greater tendency to compare their physical appearance to the appearance of others, what indicated distorted perception of their own body image. This brings to attention the importance of educating young people, especially female, about healthy diet, and confirms the necessity of an interdisciplinary approach in treating orthorexia nervosa, including psychological support.Prevalencija poremećaja hranjenja u mladih ljudi u stalnom je porastu, što dovodi u fokus ortoreksiju nervozu, osobito u razdobljima pandemije i stresa. Stoga je cilj ovog istraživanja bio utvrditi prevalenciju ortoreksije nervoze u mladih ljudi i povezati je s antropometrijskim parametrima, prehrambenim navikama i percepcijom tjelesnog izgleda. Ovo istraživanje uključivalo je 191 ispitanika u dobi od 18-24 godine, od čega je 85,9 % ženskog spola. Prikupljeni su podaci o tjelesnoj masi i visini ispitanika iz kojih je izračunat indeks tjelesne mase. Prevalencija ortoreksije nervoze procijenjena je pomoću upitnika ORTO-15, dok je upitnik PACS-R (eng. Physical Appearance Comparison Scale – Revised) korišten za procjenu tendencije usporedbe tjelesnog izgleda ispitanika s drugim osobama. Utvrđeno je da 38,2 % ispitanika ima ortoreksiju nervozu. Nije bilo statistički značajnih razlika u indeksu tjelesne mase između ispitanika s obzirom na ortoreksiju nervozu (p=0,276). Ipak, u skupini ispitanika bez utvrđene ortoreksije prevladavali su oni s adekvatnom tjelesnom masom (89,9 %), dok je među ispitanicima s utvrđenom ortoreksijom bio veći udio pothranjenih ispitanika (8,2 %) i onih s prekomjernom tjelesnom masom (15,1 %). Ispitanicima s ortoreksijom pravilna prehrana je važnija nego ispitanicima bez ortoreksije (p=0,001), dok statistički značajne razlike u samoprocjeni kvalitete prehrane nije bilo (p=0,815). Nadalje, utvrđena je statistički značajna negativna korelacija između rezultata PACS-R i ORTO-15 (p<0,01). U konačnici, postojala je statistički značajna razlika u rezultatima PACS-R između ispitanika obzirom na utvrđenu ortoreksiju (p=0,032). Ortoreksija nervoza utvrđena je kod velikog broja ispitanika. Iako su mlade osobe koje su razvile ortoreksiju nervozu uglavnom adekvatne tjelesne mase, imaju veću sklonost uspoređivati svoj fizički izgled s izgledom drugih, što upućuje na iskrivljenu percepciju vlastitog tijela. Ovime se skreće pozornost na važnost educiranja mladih osoba o pravilnoj prehrani, posebice žena, te se potvrđuje važnost interdisciplinarnog pristupa u liječenju ortoreksije nervoze, koja bi trebala uključivati i psihološku podršku

Breastfeeding: Health benefits and dietary recommendations

Dojenje je prirodan način hranjenja novorođenčeta jer mu pruža sve neophodne hranjive tvari potrebne za odgovarajući rast i razvoj. Također, dojenje je osjetljivo razdoblje kada se stvara emocionalna i tjelesna veza između majke i djeteta, pružajući djetetu osjećaj sigurnosti, opuštenosti i nježnosti. U skladu s navedenim, posvećenost institucija i raznih udruga za podizanje društvene i zdravstvene svijesti te promicanje važnosti dojenja neprestano rastu. Svjetska zdravstvena organizacija (SZO) preporučuje isključivo dojenje tijekom prvih šest mjeseci djetetovog života, što djetetu pruža brojne kratkoročne i dugoročne koristi. Kada se govori o koristima dojenja, naglasak se stavlja prvenstveno na dobrobit djeteta, dok bi potrebe dojilja trebale biti od jednake važnosti. Razdoblje laktacije i dojenja zahtijeva veći majčin energijski unos u usporedbi s razdobljem posljednjeg tromjesečja trudnoće kako bi se zadovoljile sve potrebe majke i djeteta za mikro- i makronutrijentima. Količina i sastav mlijeka, odnosno kvaliteta prehrane dojenčeta, dijelom ovisi o kvaliteti majčine prehrane, a dijelom o majčinim tjelesnim zalihama iz kojih se nadoknađuju hranjive tvari u slučaju nedovoljnog prehrambenog unosa. Kako bi se izbjegli negativni učinci laktacije i dojenja na prehrambeni i zdravstveni status majke u nadolazećim životnim razdobljima, presudno je posvetiti posebnu pozornost raznovrsnoj, uravnoteženoj i energijski zadovoljavajućoj prehrani. Iako je primarni cilj postići preporučeni unos svih esencijalnih hranjivih sastojaka prehranom, u slučajevima neuravnotežene prehrane, zdravstvenih problema ili prakticiranja restriktivne dijete, potrebna je primjena dodataka prehrani. Zbog povećanih bioloških potreba i utvrđenih deficita, u dodacima prehrani za trudnice često se mogu naći željezo, kalcij, cink, jod, folat te vitamini B12, C i D

Combining hand grip strength with nutritional screening tools in elderly patients with chronic kidney disease

Malnutrition in vulnerable patient populations must be rapidly detected using techniques that are easy to incorporate into everyday clinical practice. The new recommendations defined the 7-point Subjective Global Assessment (SGA) as optimal for nutritional assessment in chronic kidney disease (CKD), while Geriatric Nutrition Risk Index (GNRI) demands additional examination in elderly. This study aimed to determine the accuracy of several concise tools used in the clinical practice and the correlation of this tools with functional method hand grip strength (HGS) in elderly patients with CKD. In this cross-sectional study, anthropometric and functional data for 50 elderly hemodialysis patients were analyzed using numerous survey-based tools for screening nutritional status (Malnutrition Screening Tool – MST, Nutritional Risk Screening 2002 - NRS2002, Malnutrition Universal Screening Tool - MUST, Mini Nutritional Assessment - MNA, GNRI), which we compared to the standard 7-point SGA nutritional assessment tool. The sensitivity, specificity, and accuracy of these tools for detecting malnutrition were compared with the standard by using receiver operating characteristic (ROC) curve analysis. 7-point SGA classified 36.6% of participants as well nourished, and 63.4% as mildly to moderately malnourished, while the simplest alternative methods showed lower accuracy, classifying much higher proportions of participants as well nourished (MST, 92.0%; NRS2002, 80.4%). MNA had the highest accuracy based on receiver operating characteristic curves. HGS correlated moderately with 7-point SGA (r = 0.331), MNA (r = 0.410), and GNRI (r = 0.320). Our small study suggests that MNA is the best tool for malnutrition risk screening in elderly with CKD. Combining HGS with concise tools, such as GNRI, may provide better results and unburden healthcare professionals

Nutritional status of hemodialysis patients

Hemodialysis patients are vulnerable population group and they, among other, should take special care on food and fluid intake with emphasis on energy, potassium, phosphorus, sodium and protein intake. The nutritional status of patients (n=14) was assessed through measurement of body weight, body height, upper arm circumference, lower leg circumference and handgrip dynamometry; as well as selected biochemical parameters: urate concentration, calcium and phosphate levels, total protein, creatinine, albumin and globulin ratio and C-reactive protein; and dietary assessment method: 3-day food record (3DD). Using range between 18.5 and 24.9 kg/m2 as cut-off, 35.7 and 57% of patients were classified as adequately nourished and overweight, respectively. According to results of 3DD, most of the subjects are supposed to align their micro- and macro- nutrients intake with the recommendations, with emphasis on the increasing intake of protein and energy as well as on decreasing intake of potassium, phosphorus, sodium and energy

THE IMPACT OF EDUCATION ABOUT SPECIFIC COOKING METHODS ON SERUM POTASSIUM LEVELS IN PATIENTS ON HEMODIALYSIS

Progression of chronic kidney disease often results with developing hyperkalemia; the increased serum level of potassium, which causes cardiac, neuromuscular and gastrointestinal complications. Hyperkalemia is generally associated with cardiac arhythmias and higher risk of mortality in patients on hemodialysis. The aim was to determine the impact of education on potassium control among patients on hemodialysis, while basing additional education on potassium-reducing techniques during food preparation and applying diet prepared accordingly to learned techniques. Participants were 47 patients on hemodialysis divided in control (n=22) and intervention (n=25) groups. All participants were educated by trained dietitian and received materials about proper nutrition at the beginning of the 1-year longitudinal study. The intervention group was educated additionally on potassium-reducing food preparation techniques. While both groups received two hospital meals per day during hemodialysis, meals for the intervention group were prepared accordingly to suggested food preparation techniques. Biochemical parameters were monitored during the study according to standard methods. The results showed that there was significant change in reduction of serum levels of potassium in intervention group compared to control group after one year of the study (p=0.037). Also, monthly serum levels of potassium were significantly reduced (p<0.05), compared to baseline of the study, during first 8 months in the control group and during all 12 months in the intervention group. Education about food preparation, proper diet alterations and its implementation can be useful in decreasing serum potassium levels and preventing hyperkalemia in patients on hemodialysis

Methods for assessing protein-energy malnutrition for patients on hemodialysis

Prema literaturi, proteinsko - energetska malnutricija jedna je od najčešćih komplikacija kod pacijenata na hemodijalizi. Cilj ovog rada bio je procijeniti nutritivni status pacijenata na hemodijalizi te odrediti optimalni način procjene. U istraživanju je sudjelovao 71 ispitanik, 40 muškaraca i 31 žena, čiji medijan trajanja hemodijalize iznosi 31 mjesec. Nutritivna procjena provedena je pomoću antropometrijskih i biokemijskih metoda, upitnika za procjenu nutritivnog statusa i kliničkog pregleda. Rezultati pokazuju da najveći broj ispitanika ima normalnu (47,9 %), a 38 % prekomjernu tjelesnu masu. SGA metodom (eng. Subjective Global Assessment) utvrđena je izrazita malnutricija kod 38 % ispitanika čime se ova metoda pokazala kao najrigoroznija, dok je MST (eng. Malnutrition Screening Tool) najmanje stroga i ujedno, uz MUST (eng. Malnutrition Universal Screening Tool), najjednostavnija i najbrža metoda za provedbu pri procjeni nutritivnog statusa pacijenata na hemodijalizi. Čak 96 % pacijenata ima hipoalbuminemiju koja se javlja kao rezultat lošeg prehrambenog unosa i smatra se jakim prediktorom mortaliteta kod pacijenata na hemodijalizi.According to literature, protein - energy malnutrition is one of the most common complications for patients on hemodialysis. The aim of this study was to assess nutritional status of patients on hemodialysis and determine the optimal way of assessment. The study included 71 patients, 40 males and 31 females, whose median of hemodialysis duration is 31 months. Nutritional assessment was carried out with anthropometric and biochemical methods, questionnaires for assessing nutritional status and clinical examination. The results have shown that most of the respondents have normal body mass (47,9 %) while 38 % are overweight. SGA method (Subjective Global Assessment) determined severe malnutrition for 38 % of respondents which makes it the most rigorous method, while MST (Malnutrition Screening Tool) is the least strict and also, with MUST (Malnutrition Universal Screening Tool), the easiest and fastest method for assessing nutritional status of patients on hemodialysis. Even 96 % of patients have hypoalbuminemia which is the result of bad nutritional intake and is considered to be a strong mortality predictor for patients on hemodialysis

Važnost interdisciplinarnog pristupa liječnika i nutricionista u zbrinjavanju pacijenata

Interdisciplinaran pristup koji uključuje suradnju između liječnika i nutricionista ključan je u liječenju bolesti i stanja povezanih s prehranom. Taj holistički pristup omogućuje cjelovitu brigu o pacijentima, uzimajući u obzir njihove prehrambene potrebe i ciljeve. Cilj ovog rada bio je procijeniti opće znanje o prehrani među liječnicima, specijalistima gastroenterologije, endokrinologije, medicine rada, opće prakse te nutricionistima. Podaci o znanju prikupljeni su pomoću validiranog upitnika modificiranog za potrebe istraživanja kako bi se procijenili različiti aspekti znanja o prehrani. Rezultati su pokazali značajne razlike u odgovorima s obzirom na liječničku specijalizaciju, pri čemu su endokrinolozi postigli najbolje rezultate (71,5 ± 3,54). Nutricionisti su postigli općenito bolje rezultate (71,31 ± 3,59) u usporedbi s liječnicima (63,23 ± 6,23), što ukazuje na važnost njihove uključenosti u područje prehrambene skrbi. Dobiveni rezultati naglašavaju važnost multidisciplinarnog pristupa i uspostavljanja suradnje između liječnika i nutricionista kako bi se osigurala optimalna prehrambena skrb za pacijente