ESPEN guideline on nutritional support for polymorbid medical inpatients.

BACKGROUND Disease-related malnutrition in polymorbid medical inpatients is a highly prevalent syndrome associated with significantly increased morbidity, disability, short- and long-term mortality, impaired recovery from illness, and cost of care. AIM As there are uncertainties in applying disease-specific guidelines to patients with multiple conditions, our aim was to provide evidence-based recommendations on nutritional support for the polymorbid patient population hospitalized in medical wards. METHODS This update adheres to the standard operating procedures for ESPEN guidelines. We did a systematic literature search for 15 clinical questions in three different databases (Medline, Embase and the Cochrane Library), as well as in secondary sources (e.g. published guidelines), until July 12th. Retrieved abstracts were screened to identify relevant studies that were used to develop recommendations (incl. SIGN grading), which was followed by submission to Delphi voting. RESULTS From a total of 3527 retrieved abstracts, 60 new relevant studies were analyzed and used to generate a guideline draft that proposed 32 recommendations (7x A, 11x B, 10x O and 4x GPP), which encompass different aspects of nutritional support including indication, route of feeding, energy and protein requirements, micronutrient requirements, disease-specific nutrients, timing, monitoring and procedure of intervention. The results of the first online voting showed a strong consensus (agreement of >90%) on 100% of the recommendations. Therefore, no final consensus conference was needed. CONCLUSIONS Recent high-quality trials have provided increasing evidence that nutritional support can reduce morbidity and other complications associated with malnutrition in polymorbid patients. The timely screening of patients for risk of malnutrition at hospital admission followed by individualized nutritional support interventions for at-risk patients should be part of routine clinical care and multimodal treatment in hospitals worldwide. Use of this updated guideline offers an evidence-based nutritional approach to the polymorbid medical inpatients and may improve their outcomes

Economy matters to fight against malnutrition: results from a multicenter survey

Background and Aim: Malnutrition represents a serious health care threat, as it increases morbidity, mortality and health care cost. The effective screening and treatment with enteral (EN) or parenteral (PN) nutrition are the key elements of the policy called Optimal Nutrition Care for All (ONCA). The study tried to analyze the impact of the state’s economy on the implementation of EN and PN to define its role in ONCA. Material and Methods: an international survey in twenty two European countries was performed between January and December 2014. An electronic questionnaire was distributed to 22 representatives of clinical nutrition (PEN) societies. The questionnaire comprised questions regarding country economy, reimbursement, education and the use EN and PN. Return rate was 90.1% (n=20) Results: EN and PN were used in all countries surveyed (100%), but to different extent. The country’s income significantly influenced the reimbursement for EN and PN (p0.05). Education was actively carried out in all countries, however the teaching at the pre-graduate level was the least widespread, and also correlated with the country income (p=0.042). Conclusions: Results indicated that economic situation influences all aspects of ONCA, including education and treatment. The reimbursement for EN and PN seemed to be the key factor of effective campaign against malnutrition

The role of nutrition status of hospitalized patients in the development of hospital acquired infections

Malnutrition in the elderly is a problem caused by several factors, and it has increasedincidence in hospitals and in geriatric care units. The relation between malnutrition andinfections is well documented. The aims of the present study were:1) the assessment of the validity of six malnutrition screening tools for adults and elderly,having in mind the absence of a gold standard in malnutrition screening,2) the investigation of the impact of malnutrition in a group of elderly hospitalized patientson the risk for hospital acquired infections,3) the evaluation of the impact of the hospitalization and other medical procedures on thenutritional status of the patients and the evaluation of the adequacy and quality ofhospital food catering.In the present study, 248 elderly patients were recruited (129 men and 119 women), aged75,2±8,5 years. Nutritional screening was performed on admission with the use of NutritionalRisk Index (NRI), Geriatric Nutritional Risk Index (GNRI), Subjective Global Assessment (SGA), MiniNutritional Assessment – Screening Form (MNA-SF), Malnutrition Universal Screening Tool(MUST), Nutritional Risk Score 2002 (NRS2002) and also the combined risk index was calculated.On admission, full clinical and biochemical evaluation was performed, anthropometricmeasurements and performance status of the patients was recorded. During hospital stay, theoccurrence of healthcare associated infections (HAIs) was also recorded.Malnutrition risk varied greatly, ranging from 47,2 to 97,6% depending on the nutritionscreening tool used. MUST was the most valid [validity coefficient, (VC) = 0,766, CI 95%: 0,690-0,841)], while SGA was in better agreement with the combined index (κ= 0,707, p 1[Hazard Ratio,(HR) 2,08; 95% CI, 1,07-4,02; p= 0,03] and diabetes (HR 2,57; 95% CI, 1,37-4,84; p=0,003) were associated with increased risk for HAIs, whereas GNRI score (per unit increase) had aprotective effect (HR 0,97; 95% CI, 0,95-0,99; p= 0,01). Well – nourished patients on admission(GNRI >98) were significantly more likely to remain free from HAIs during hospitalization(p=0,003).During hospitalization a significant reduction in body weight (1,7±2,6 kg, p 1 [αναλογία κινδύνου,(Hazard Ratio,HR) 2,08; 95% CI, 1,07-4,02; p= 0,03) και η παρουσία Σακχαρώδους Διαβήτη (HR2,57; 95% CI, 1,37-4,84; p= 0,003) σχετίστηκαν με αυξημένο κίνδυνο εμφάνισης HAIs, ενώ τοσκορ στο GNRI (ανά μονάδα αύξησης) είχε προστατευτική δράση (HR 0,97; 95% CI, 0,95-0,99; p=0,01). Οι ασθενείς με καλή κατάσταση θρέψης κατά την εισαγωγή (GNRI >98) είχαν στατιστικάυψηλότερη πιθανότητα να παραμείνουν ελεύθεροι HAIs κατά τη διάρκεια της νοσηλείας τους(p=0,003).Κατά τη διάρκεια της νοσηλείας των ασθενών παρατηρήθηκε στατιστικά σημαντικήμείωση κατά 1,7±2,6 kg (p<0,001) του σωματικού βάρους των ασθενών, του ΒΜΙ [από 25,2±4,4kg/m2 σε 24,5±4,5 kg/m2 (p<0.001)], της μέσης τιμής του GNRI [από 100,6±12,8 σε 98,3±13,3(p<0,001)] και της μέσης τιμής της αλβουμίνης (3,5±0,5 έναντι 3,4±0,6, p<0,001) καθώς και της6προαναφερθείσας μείωσης του σωματικού τους βάρους κατά τη διάρκεια της νοσηλείας. Σε ό,τιαφορά τα ποσοστά τεχνητής υποστήριξης θρέψης, μόλις το 0,4% (1/236) των ασθενών έλαβεπόσιμο συμπλήρωμα διατροφής, αντίστοιχο ποσοστό έλαβε εντερική σίτιση (1/236) ενώ 3% τωνασθενών έλαβε παρεντερική σίτιση (7/236).Συμπερασματικά, η κακή θρέψη αποτελεί σημαντικό πρόβλημα των ηλικιωμένων ασθενώνκατά την εισαγωγή τους στο νοσοκομείο, πρόβλημα που φαίνεται να επιδεινώνεται κατά τηδιάρκεια της νοσηλείας τους. Κρίνεται, συνεπώς, επιτακτική η ανάγκη για υιοθέτηση στηνκλινική πράξη μεθοδολογίας ανίχνευσης διατροφικού κινδύνου, η οποία θα εφαρμόζεται κατάτην εισαγωγή των ασθενών στο νοσοκομείο. Επίσης πρέπει να δοθεί βαρύτητα στηνπαρακολούθηση και επαναξιολόγηση της κατάστασης θρέψης του ασθενούς κατά τη διάρκειατης νοσηλείας, την δημιουργία ομάδων υποστήριξης θρέψης σε κάθε νοσοκομείο αλλά και τηνευαισθητοποίηση των επαγγελματικών υγείας για το θέμα της επαρκούς και ποιοτικής σίτισηςτων ασθενών, προκειμένου να εξασφαλιστεί η έγκαιρη ανίχνευση και αντιμετώπιση της κακήςθρέψης με όλα τα μέσα διατροφικής παρέμβασης και υποστήριξης που διατίθενται

The Impact of Nutritional and Lifestyle Changes on Body Weight, Body Composition and Cardiometabolic Risk Factors in Children and Adolescents during the Pandemic of COVID-19: A Systematic Review

The coronavirus (COVID-19) pandemic and the measures taken by most countries to curb virus transmission, such as social distancing, distance learning, population, home confinement and disruption of all organized activities, has affected children and adolescents worldwide. The aim of this review was to assess the role of diet and lifestyle changes due to COVID-19 measures on body weight/composition and cardiometabolic risk factors in children and adolescents. An electronic search was conducted in PUBMED, COCHRANE, Google Scholar and SCOPUS databases up to 31 October 2021. 15 eligible studies were identified. According to the studies included in the analysis, COVID-19 measures seem to have had a negative impact on the diets and lifestyles of children and adolescents, with a consequent increase in body weight and central fat accumulation. On the other hand, the parental presence and control resulted in better glycaemic control in children with diabetes mellitus (DM) Type 1, but the effect of the pandemic in the glycaemic control of children with DM2 2 is controversial. Finally, diet and lifestyle changes had a differential impact on children&rsquo;s hypertension prevalence. These findings point to the need for public policy measures to prevent obesity and its complications, to and improve diet and lifestyle during the continuing and yet unresolved COVID-19 epidemic

Physiological Alterations in Relation to Space Flight: The Role of Nutrition

Astronauts exhibit several pathophysiological changes due to a variety of stressors related to the space environment, including microgravity, space radiation, isolation, and confinement. Space motion sickness, bone and muscle mass loss, cardiovascular deconditioning and neuro-ocular syndrome are some of the spaceflight-induced effects on human health. Optimal nutrition is of the utmost importance, and&mdash;in combination with other measures, such as physical activity and pharmacological treatment&mdash;has a key role in mitigating many of the above conditions, including bone and muscle mass loss. Since the beginning of human space exploration, space food has not fully covered astronauts&rsquo; needs. They often suffer from menu fatigue and present unintentional weight loss, which leads to further alterations. The purpose of this review was to explore the role of nutrition in relation to the pathophysiological effects of spaceflight on the human body

Challenges and Perspectives in Nutritional Counselling and Nursing: A Narrative Review.

Nutritional counselling has been recognised as the first line approach in the management of numerous chronic diseases. Though usually carried out by dietitians, nutritional counselling may be used by nurses, or other healthcare professionals to improve nutritional status and meet healthcare goals. Healthcare professionals require training and education to facilitate a patient centred approach to effective counselling. Advances in digital technology have the potential to improve access to nutritional counselling for some patients such as those in primary care. However, caution is required to ensure that valuable interpersonal relationships are not lost, as these form the cornerstone of effective nutritional counselling. The aim of this narrative review is to explore aspects of effective nutritional counselling, including advances in e-counselling and areas where nursing input in nutritional counselling might enhance overall nutritional care

Malnutrition-inflammation score VS phase angle in the era of GLIM criteria: A cross-sectional study among hemodialysis patients in UAE

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. (1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria

Effects of Time-Restricted Feeding and Ramadan Fasting on Body Weight, Body Composition, Glucose Responses, and Insulin Resistance: A Systematic Review of Randomized Controlled Trials

Time-restricted feeding (TRF) and Ramadan fasting (RF) have been recently associated with several health outcomes. However, it is not yet clear if they are superior to existing treatments in terms of glucose metabolism, insulin action, and weight loss. This review aims to summarize the current data on the effects of these regimes on body weight, body composition, and glycemia. An electronic search was conducted in PUBMED and SCOPUS databases up to August 2022. Twenty-four records met the inclusion criteria and underwent a risk-of-bias assessment. The main outcomes were: (a) TRF may result in moderate weight loss in individuals with overweight/obesity; when TRF is combined with caloric restriction, weight loss is >5% of the initial body weight, (b) 14 h of fasting may be as effective as 16 h in terms of weight loss, and (c) TRF may lead to improved insulin sensitivity and glycemic responses/variability throughout the day in individuals with overweight/obesity. Concerning RF, only two studies were available and thus, conclusions were not drawn. TRF may be an effective nutritional approach for weight loss, and the amelioration of glycemic control and insulin sensitivity in individuals with overweight/obesity. However, more long-term, well-designed studies are needed

Malnutrition-Inflammation Score VS Phase Angle in the Era of GLIM Criteria:A Cross-Sectional Study among Hemodialysis Patients in UAE

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. (1) Background: Malnutrition is prevalent in hemodialysis (HD) patients and is associated with an increased risk of morbidity and mortality. The aim of this study was to explore the prevalence of malnutrition using the malnutrition-inflammation score (MIS) and phase angle (PhA) and compare their concordance with the new Global Leadership Initiative on Malnutrition (GLIM) criteria for the diagnosis of malnutrition. (2) Methods: Seventy HD patients were assessed. Malnutrition was diagnosed based on the GLIM criteria and MIS questionnaire. The agreement between the diagnostic tools (MIS, PhA derived from the bioelectrical impedance analysis (BIA), and GLIM criteria) was assessed. The optimal gender-specific cutoff points were identified for the PhA according to the GLIM criteria. (3) Results: Almost half of the sample was diagnosed as malnourished according to the MIS (48.57%) and GLIM criteria (54.29%). A fair agreement was observed between the GLIM criteria, MIS (k = 0.202), and PhA (k = 0.279) among the malnourished patients. The PhA had better sensitivity but worse specificity compared to the MIS. The optimum cutoff points of PhA to detect malnutrition according to the GLIM criteria were a PhA value of ≤5.7° for males and ≤3.8° for females. (4) Conclusion: The MIS performed slightly better than PhA in the diagnosis of malnutrition among HD patients within the spectrum of the GLIM criteria

Effectiveness of an Intensive Nutritional Intervention in Patients with Type 2 Diabetes Mellitus: Results from a Pilot Study

The aim of this pilot study was to compare the effects of an intensive nutritional intervention with usual care conditions on dropout rate, body weight, lifestyle changes and glycemic control in patients with type 2 diabetes mellitus (T2DM). Thirty outpatients with T2DM but without insulin treatment (mean age: 57 ± 9 yr) were randomly assigned to one of the two intervention groups: intensive care (IC) or usual care (UC). Patients in the UC group were given advice about dietary and physical activity goals in one consultation session at baseline, while patients in the IC group attended five goal-oriented consultation sessions held approximately every two weeks from baseline onwards. Changes in body weight, T2DM knowledge, dietary intake, physical activity, HbA1c, and percentage of dropouts were evaluated at 1-year follow-up post-intervention. Fifty percent of patients quitted the program and were classified as "dropouts". Program completers were older and included a lower percentage of newly diagnosed T2DM compared with dropouts. A tendency to a negative association between attendance of the IC group and the likelihood of dropping out was found (p = 0.08). No difference was detected between UC and IC groups regarding changes in body weight, HbA1c or other outcome measures, at post-intervention or 1-year follow-up. This pilot study did not confirm advantages of intensive nutritional intervention in T2DM patients in terms of glycemic control, body weight, diet and physical activity. However, the high dropout rate may have hampered its effectiveness