Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome

Disease-related malnutrition is highly prevalent among cancer patients, with 40-80% suffering from it during the course of their disease. Malnutrition is associated with numerous negative outcomes such as: longer hospital stays, increased morbidity and mortality rates, delayed wound healing, as well as decreased muscle function, autonomy and quality of life. In cancer patients, malnutrition negatively affects treatment tolerance (including anti-cancer drugs, surgery, chemo- and radiotherapy), increases side effects, causes adverse reactions, treatment interruptions, postoperative complications and higher readmission rates. Conversely, anti-cancer treatments are also known to affect body composition and impair nutritional status. Tailoring early nutritional therapy to patients' needs has been shown to prevent, treat and limit the negative consequences of malnutrition and is likely to improve overall prognosis. As the optimisation of treatment outcomes is top priority and evidence for nutritional therapy is growing, it is increasingly recognized as a significant intervention and an autonomous component of multimodal cancer care. The proactive implementation of nutritional screening and assessment is essential for patients suffering from cancer - given the interaction of clinical, metabolic, pharmacological factors with systemic inflammation; and suppressed appetite with accelerated muscle protein catabolism. At the same time, a nutritional care plan must be established, and adequate individualized nutritional intervention started rapidly. Screening tools for nutritional risk should be validated, standardized, non-invasive, quick and easy-to-use in daily clinical practice. Such tools must be able to identify patients who are already malnourished, as well as those at risk for malnutrition, in order to prevent or treat malnutrition and reduce negative outcomes. This review investigates the predictive value of commonly used screening tools, as well as the sensitivity and specificity of their individual components for improving clinical outcomes in oncologic populations. Healthcare professionals' awareness of malnutrition in cancer patients and the pertinence of early nutritional screening must be raised in order to plan the best possible intervention and follow-up during the patients' ordeal with the disease

Nutrient and fluid requirements in post-bariatric patients performing physical activity: A systematic review.

OBJECTIVES The evidence for the benefits of physical activity in post-bariatric patients is growing. Nevertheless, it remains unclear whether nutritional regimens should be adapted to physical activity levels. The aim of this systematic review was to summarize current evidence regarding nutrient and fluid requirements in physically active post-bariatric patients. METHODS We conducted this systematic review according to the PRISMA guidelines. We searched MEDLINE, Embase, and the Cochrane Library for studies assessing nutritional aspects in physically active post-bariatric patients. Data were extracted based on a predefined, standardized form, and assessed for risk of bias. RESULTS Of 582 records, 8 studies were included, mostly implementing general fitness programs (30-60 min/d, 3-4 × /wk). There is no evidence for increased energy requirements in physically active post-bariatric patients. None of the studies determined energy, fat, or carbohydrate requirements. Most studies focused on protein, recommending a minimum intake of 60 g/d to preserve or increase muscle mass (upper limit 1.5 g protein/kg ideal body weight/d). Higher protein intake (108 g/d, thereof 48 g whey protein) combined with physical activity increased muscle strength. The effects of physical activity on micronutrient requirements remain unstudied, whereas fluid requirements appear to be increased. CONCLUSION The present findings strengthen the importance of adequate protein intake in physically active post-bariatric patients. Nutrient reference values for physically active post-bariatric patients are not definable based on the current evidence. Consequently, clinicians should pay special attention to the monitoring of macro- and micronutrients and fluid balance, especially when post-bariatric patients engage in high levels of physical activity

The influence of patients' nutritional risk, nutritional status, and energy density in MEDPass versus conventional administration of oral nutritional supplements - A secondary analysis of a randomized controlled trial.

OBJECTIVES The clinical influence of nutritional risk, nutritional status, and energy density of oral nutritional supplements (ONS) in MEDPass versus conventional administration of ONS is currently unknown. The aim of this analysis was to examine whether these variables have an impact on clinical outcomes. METHODS Secondary analysis of the intention to treat dataset of the randomized controlled MEDPass Trial in geriatric and medical inpatients. Patients in the intervention group received 4 × 50 ml ONS during the medication rounds (MEDPass mode), while those in the control group received ONS in a non-standardized manner. The examined endpoints included energy and protein coverage, ONS intake, handgrip strength (HGS), weight, appetite nausea and 30-day mortality. Three subgroup analyses for NRS 2002 total score (3, 4 or 5-7 points), NRS 2002 impaired nutritional status score (0, 1, 2 or 3 points) and energy density of the ONS (1.5 kcal/mL or 2 kcal/mL) were performed using linear and logistic regression with interaction and mixed effect models. RESULTS The data of 202 patients (103 women and 99 men) at nutritional risk (NRS total 2002 score ≥3), mean (SD) age 82.2 (6.5) years were included. There was no significant difference between the groups in the primary endpoint energy coverage in all three subgroup analyses. There were also no significant differences between the groups in the secondary endpoints of protein coverage, ONS intake, HGS, weight, appetite, nausea, and 30-day mortality. CONCLUSION The MEDPass mode of ONS administration was not superior to the conventional mode of administration in this study. ONS with high energy density (≥2 kcal/mL) should be offered since current evidence shows a tendency towards improved appetite, increased ONS and increased energy intake

Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study

BACKGROUND: Digital technologies have evolved dramatically in the recent years finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are steadily used for more and more tasks including health monitoring. A large amount of "Nutrition and Diet" apps are available with some of them being very popular in terms of user downloads highlighting a trend towards diet monitoring and assessment. OBJECTIVE: We sought to explore the perspectives of end-users on the features, current use, and acceptance of "Nutrition and Diet" mHealth apps with a survey. We expect that such a study can provide user insights, assisting researchers and developers towards innovative dietary assessment. METHODS: A multidisciplinary team designed and compiled the survey. Before its release, it has been pilot-tested by 18 end-users. A 19-question survey was finally developed which has been translated into six languages: EN, DE, FR, ES, IT, EL. The participants were mainly recruited via social media and mailing lists of universities, university hospitals and patient associations. RESULTS: Respondents (n=2382) (79.4% female, 19.9% male, 0.7% neither) with a mean age of 27.2 (SD: 8.5) completed the survey. Around half of the participants (51.5%, 1227 out of 2382) have used a "Nutrition and Diet" app. The primary criteria for selecting such an app were to be easy to use (65.9%, 1570 out of 2382), free of charge (59.3%, 1413 out of 2382) and also produce automatic readings of caloric (51.7%, 1231 out of 2382) and macronutrient content (46.9%, 1117 out of 2382) (i.e., food type and/or the portion size are estimated by the system without any contribution by the user). An app is less likely to be selected if it incorrectly estimates portion size, calories or nutrient content (33.5%, 798 out of 2382). Moreover, other important limitations include the use of a database that comprises of non-local foods (27.5%, 655 out of 2382) and which may omit major foods (41%, 977 out of 2382). CONCLUSIONS: This comprehensive study in a mostly European population assessed the preferences and perspectives of (potential) "Nutrition and Diet" app users. Understanding user needs will benefit both researchers who work on tools for innovative dietary assessment, as well as those who assist research on behavioural changes related to nutrition

Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial

Abstract Background Disease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization. Discussion To our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question

Body mass index in young men in Switzerland after the national shutdowns during the COVID-19 pandemic: Results from a cross-sectional monitoring study at the population level since 2010

Background: Owing to the COVID-19 pandemic, the Swiss goverment imposed a shutdown twice, which may have changed diet and physical activity. Regarding the question of weight change during the pandemic, little information based on measured weight data is available. We aimed to investigate whether the body mass indices (BMIs) of young Swiss men after the two shutdowns in spring and fall 2020 differed from those of young men examined before the shutdowns. Methods: We analysed young Swiss men's BMIs taken during mandatory recruitment for the Swiss Armed Forces at the cross-sectional (not individual longitudinal) monitoring level and across weeks of conscription between January 2010 and July 2021 (n = 373,016). These data allow for continuous health monitoring of young men at almost the population level (coverage, >90%). For statistical modelling, we used the generalised additive model (GAM) framework. Results: We showed that the BMIs of the conscripts examined in the 15 weeks after the two shutdowns in spring and autumn 2020 were not or only slightly different from their baseline values. Sensitivity analyses revealed that this conclusion also holds if the BMI distribution or prevalence of excess weight is assessed. The GAM further showed the significant effects of individual and area-based measures of socioeconomic position and age on BMI. Conclusion: Our results suggest that lifestyle changes during the pandemic in young men might have been too modest to be reflected in body weight. However, longitudinal data and/or data on women, children, or the elderly may lead to different conclusions. Keywords: BMI; GAM; Lockdown; Monitoring; Obesity; Swiss Conscription

Prolonged Isolated Soluble Dietary Fibre Supplementation in Overweight and Obese Patients: A Systematic Review with Meta-Analysis of Randomised Controlled Trials.

The prevalence of overweight and obesity is rising rapidly, currently affecting 1.9 billion adults worldwide. Prebiotic dietary fibre supplementation is a promising approach to improve weight loss and reduce metabolic complications in overweight and obese subjects due to modifications of the microbiota composition and function. Previous systematic reviews and meta-analyses addressing similar questions revealed discordant evidence and/or are outdated. We searched MEDLINE, Embase, Google Scholar, and forward and backward citations for randomised controlled trials (RCTs) with isolated soluble dietary fibre supplementation for at least 12 weeks in overweight and obese patients measuring body weight, published through April 2022. We expressed the results as mean differences (MDs) using the random-effects model of the metafor package in R and assessed risk of bias using the Cochrane RoB2 tool. We conducted the study according to the PRISMA guidelines and registered the protocol on PROSPERO (CRD42022295246). The participants with dietary fibre supplementation showed a significantly higher reduction in body weight (MD -1.25 kg, 95% CI -2.24, -0.25; 27 RCTs; 1428 participants) accompanied by a significant decrease in BMI, waist circumference, fasting blood insulin, and HOMA-IR compared to the control group. Certainty of evidence was high, paving the way for the implementation of isolated soluble dietary fibre supplementation into clinical practice

Body mass index in young men in Switzerland after the national shutdowns during the COVID-19 pandemic: Results from a cross-sectional monitoring study at the population level since 2010.

BACKGROUND Owing to the COVID-19 pandemic, the Swiss goverment imposed a shutdown twice, which may have changed diet and physical activity. Regarding the question of weight change during the pandemic, little information based on measured weight data is available. We aimed to investigate whether the body mass indices (BMIs) of young Swiss men after the two shutdowns in spring and fall 2020 differed from those of young men examined before the shutdowns. METHODS We analysed young Swiss men's BMIs taken during mandatory recruitment for the Swiss Armed Forces at the cross-sectional (not individual longitudinal) monitoring level and across weeks of conscription between January 2010 and July 2021 (n = 373,016). These data allow for continuous health monitoring of young men at almost the population level (coverage, >90%). For statistical modelling, we used the generalised additive model (GAM) framework. RESULTS We showed that the BMIs of the conscripts examined in the 15 weeks after the two shutdowns in spring and autumn 2020 were not or only slightly different from their baseline values. Sensitivity analyses revealed that this conclusion also holds if the BMI distribution or prevalence of excess weight is assessed. The GAM further showed the significant effects of individual and area-based measures of socioeconomic position and age on BMI. CONCLUSION Our results suggest that lifestyle changes during the pandemic in young men might have been too modest to be reflected in body weight. However, longitudinal data and/or data on women, children, or the elderly may lead to different conclusions

Management of Hyperglycemia in Hospitalized Patients Receiving Parenteral Nutrition.

Almost half of inpatients on parenteral nutrition experience hyperglycemia, which increases the risk of complications and mortality. The blood glucose target for hospitalized patients on parenteral nutrition is 7.8 to 10.0 mmol/L (140 to 180 mg/dL). For patients with diabetes, the same parenteral nutrition formulae as for patients without diabetes can be used, as long as blood glucose levels can be adequately controlled using insulin. Insulin can be delivered via the subcutaneous or intravenous route or, alternatively, added to parenteral nutrition admixtures. Combining parenteral with enteral and oral nutrition can improve glycemic control in patients with sufficient endogenous insulin stores. Intravenous insulin infusion is the preferred route of insulin delivery in critical care as doses can be rapidly adjusted to altered requirements. For stable patients, insulin can be added directly to the parenteral nutrition bag. If parenteral nutrition is infused continuously over 24 hours, the subcutaneous injection of a long-acting insulin combined with correctional bolus insulin may be adequate. The aim of this review is to give an overview of the management of parenteral nutrition-associated hyperglycemia in inpatients with diabetes

MEDPass versus conventional administration of oral nutritional supplements - A randomized controlled trial comparing coverage of energy and protein requirements.

BACKGROUND & AIMS The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. METHODS The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. RESULTS From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ - 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results. CONCLUSION Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste. TRIAL REGISTRATION ClinicalTrials.gov: NCT03761680