Clinical and nutritional effectiveness of a nutritional protocol with oligomeric enteral nutrition in patients with oncology treatment-related diarrhea

Background: Poor nutritional status and diarrhea are common complications in cancer patients. Methods: This multicenter, observational, prospective study evaluated the effectiveness of an oligomeric enteral nutrition (OEN) protocol in the improvement of nutritional status and reduction of diarrhea symptoms. Nutritional status was assessed with the Subjective Global Assessment (SGA), Body Mass Index (BMI) and albumin levels. Diarrhea was evaluated by the frequency and consistency of stools (Bristol Stool form scale). Results: After 8 weeks of OEN protocol, the nutritional status improved in 48.3% of patients, with an increased proportion of patients at risk of malnourishment (+27.3%) at the expense of a decrease of moderately (-19.9%) and severely (-7.3%) malnourished patients (p < 0.001). Serum albumin and BMI significantly increased after 8 weeks of OEN treatment (p < 0.005). OEN showed a 71.1% effectiveness in the improvement of stool consistency. The mean number of stools per day significantly decreased from baseline (4.17 stools/day) to week 8 (1.42 stools/day; p = 0.0041). The nutritional status significantly improved even in those patients with persistent diarrhea. Conclusion: The proposed OEN protocol seemed to be effective in improving the nutritional status, frequency and consistency of stools in patients with oncology treatment-related diarrhea even in persistent cases

Impact of an oral nutritional protocol with oligomeric enteral nutrition on the quality of life of patients with oncology treatment-related diarrhea

Background: Nutritional status can influence the quality of life (QoL) of cancer patients. Methods: This subanalysis evaluated the impact of an oral oligomeric enteral nutrition (OEN) protocol on the QoL of patients with oncology treatment-related diarrhea (OTRD) in a multicenter, observational, prospective study (DIAPOENO study). QoL was assessed with the Nottingham Health Profile (NHP) at baseline and after eight weeks of OEN treatment. In the overall population, all the NHP categories significantly improved after eight weeks of OEN treatment: energy levels (p < 0.001), pain (p < 0.001), emotional reactions (p < 0.001), sleep (p < 0.001), social isolation (p = 0.023), and physical abilities (p = 0.001). QoL improvement was higher in patients with improved or maintained nutritional status and in those with improved consistency of stools with the OEN protocol. However, QoL did not significantly improve in patients with worse nutritional status and with worse or maintained stool consistency with the OEN protocol. QoL improved regardless of disease severity. Multivariate logistic regression analysis showed that weight change was significantly associated with improved QoL (OR 2.90–5.3), except for social isolation, in models unadjusted and adjusted to age, sex, oncology treatment, and stool consistency. Conclusion: In this subanalysis, the OEN protocol was associated with improved QoL

A socio-ecological approach to reduce the physical activity drop-out ratio in primary care-based patients with type 2 diabetes: the SENWI study protocol for a randomized control trial

BACKGROUND: Physical activity (PA) is a key behaviour for patients with type 2 diabetes (T2DM). However, healthcare professionals' (HCP) recommendations (walking advice), which are short-term and individually focused, did not reduce the PA drop-out ratio in the long run. Using a socio-ecological model approach may contribute to reducing patient dropout and improving adherence to PA. The aim of this study is threefold: first, to evaluate the effectiveness of a theory-driven Nordic walking intervention using a socio-ecological approach with T2DM patients in Spain; second, to explore the feasibility on the PA adherence process in T2DM patients while participating in the SENWI programme; and third, to understand the HCPs' opinion regarding its applicability within the Spanish healthcare system. METHODS: A three-arm randomized control trial (n = 48 each group) will assess the efficacy of two primary care-based PA interventions (Nordic walking vs. Nordic walking plus socio-ecological approach; two sessions per week for twelve weeks) compared to a control group (usual HCPs' walking advice on PA). Inclusion criteria will include physically inactive patients with T2DM, older than 40 years and without health contraindications to do PA. PA levels and drop-out ratio, quality of life and metabolic and health outcomes will be assessed at baseline, post-intervention and at 9- and 21-month follow-ups. The effect of the different interventions will be assessed by a two-factor analysis of variance: treatment group vs time. Also, a two-factor ANOVA test will be performed with linear mixed models for repeated measures. A qualitative analysis using focus groups will explore the reasons for the (in)effectiveness of the new PA interventions. Qualitative outcomes will be assessed at post-intervention using thematic analysis. DISCUSSION: Compared with the general PA walking advice and Nordic walking prescriptions, integrating a socio-ecological approach into Spanish primary care visits could be an effective way to reduce the PA drop-out ratio and increase PA levels in patients with T2DM. Such interventions are necessary to understand the role that multiple socio-complex process in day-to-day PA behaviour has in patients with T2DM in the Spanish context. TRIAL REGISTRATION: ClinicalTrials.gov NCT05159089. Physical Activity Drop-out Ratio in Patients' Living with Type 2 Diabetes. Prospectively registered on 15 December 2021

Assessment of food consumption, energy and protein intake in the meals offered in four Spanish nursing homes Evaluación del consumo de alimentos, ingesta de proteínas y energía en las comidas ofrecidas en cuatro residencias geriátricas españolas

Background/objective: The elderly, and especially those attending nursing homes, are at great risk from certain nutritional deficiencies. The aim of this study was to examine the percentage of energy wasted, energy and protein intake and percentage consumed of meal offered by a group of healthy institutionalized elderly in four nursing homes in Spain. Design and methods: This was a multicentre observational study of a sample of the institutionalized population over the age of 65. Our final sample comprised a total of 62 individuals. Dietary data were collected using double weight method for each meal during 21 days. We calculated the following consumption variables: percentage of food consumed (% food consumed) for each subject in each meal. We also calculated the energy intake (kcal/day), the wasted energy (kcal/day), the protein intake (g protein/ day) and the energy density (kcal/g meal) for each of the meals eaten. To analyse the overall differences we used analysis of variance test (ANOVA). The significance level used was 0.05 (p Antecedentes/objetivos: Los ancianos, y especialmente los institucionalizados en residencias geriátricas, tiene un elevado riesgo de sufrir deficiencias nutricionales importantes. El objetivo de este estudio fue evaluar el porcentaje de comida consumida en cada ingesta así como la ingesta total energética y proteica en un grupo de ancianos sanos institucionalizados en cuatro residencias geriátricas de España. Métodos: Se llevó a cabo un estudio observacional multicéntrico en una muestra de población anciana (edad > 65 años) institucionalizada. La muestra final incluyó un total de 62 individuos sanos. Los datos de consumo se evaluaron mediante el método de registro de doble pesada para cada comida durante un período de 21 días consecutivos. Se calcularon las variables: porcentaje de consumo de alimentos (% ración consumida) para cada individuo en cada comida. También se calculó el consumo de energía (kcal/día), la energía desperdiciada (kcal/día), la ingesta de proteínas y la densidad calórica de las comidas (kcal/g ingesta). Para analizar las diferencias se llevó a cabo un análisis de la varianza (ANOVA). El nivel de significación usado fue de 0,05 (p < 0,05). Resultados: Las comidas más voluminosas fueron el almuerzo (781 g/día) [728,4-833,6] y la cena (653 g/día [612,1-693,9]. El porcentaje de consumo total fue del 81,9% [79,3-84,6]. El consumo de medio de energía fue de 1.575,4 kcal/día [1.508,3-1.642,6]. El porcentaje de distribución calórica varió en función de cada centro. El mayor porcentaje de desperdicio de alimentos fue en las comidas principales (almuerzo y cena). 44% de los ancianos no cubrían las recomendaciones energéticas establecidas. La ingesta de proteínas fue del 63,6 g proteína/día [61,266,1]. Un 12,5% de las mujeres y un 4,55 de los hombres no cubrieron las ingestas recomendadas de proteínas. Discusión/conclusiones: En vista de los resultados, probablemente una buena estrategia para mejorar el consumo de energía y nutrientes y reducir los porcentajes de comida desperdiciada entre los ancianos institucionalizados podría ser planificar comidas menos voluminosas y con una densidad energética y nutricional más elevada

Intake of Mediterranean Foods

The traditional Mediterranean diet is characterized by: (a) high consumption of cereals, vegetables, fruit, nuts, legumes, fish, and seafood; (b) the use of olive oil as the main, if not the only, added lipid; (c) moderate consumption of milk and dairy products; (d) moderate intake of alcohol, in the form of wine and preferably during meals; and (e) low consumption of meat and meat products. The prevalent consumption of olive oil and the low consumption of animal products are reflected in the high ratio of monounsaturated to saturated fat intake, typical of the dietary pattern in the region. There is increasing evidence from observational and experimental epidemiological studies, further enriched by the conclusions of their systematic reviews and meta-analyses, that adherence to the Mediterranean dietary pattern promotes health and reduces the risk of premature death from chronic degenerative diseases. Mediterranean countries and especially the European ones have experienced a “westernization” process of their food habits, and have increased the per capita supply of non-Mediterranean foods (animal fats, vegetable oils other than olive oil, sugar, and meat) and decreased the supply of legumes and alcoholic beverages, including wine. The evidence that Mediterraneans are gradually departing from their traditional eating habits does not only refer to the adult population in the region, but it has also been reproduced in large-scale nutritional surveys among children, adolescents, and young adults – the trend-setters for future generations. Next to the effect on people’s health, the gradual abandoning of the traditional Mediterranean diet cannot support sustainable development in the way the Mediterranean diet does. Being adjusted to the cultural, climatic, and other environmental characteristics of the region, the Mediterranean diet is protective and helpful to biodiversity, accessible and economically affordable, and contributes to food and nutrition security