Clinical nutrition in internal medicine: An Italian survey by the scientific societies FADOI and SINPE

Objectives: Patients hospitalized in internal medicine are frequently malnourished or at risk for malnutrition. The aim of this study, conducted by the Federation of Associations of Hospital Internists (FADOI) and the Italian Society of Artificial Nutrition and Metabolism (SINPE) was to assess the nutritional management of internal medicine inpatients in Italy, to identify critical issues and formulate practical proposals to improve nutritional treatment.Methods: From February to April 2021, FADOI and SINPE conducted a national web-based survey, including a 13 multiple-choice item questionnaire related to three key areas:screening and assessment of malnutrition and associated/overlapping sarcopenia and dysphagia;specialist consultations; andmanagement of nutritional support.Results: Responding to the questionnaire were 266 physicians among FADOI members (10.76%). Screening for malnutrition is performed with validated tests, within standardized care pathways, or routinely, only by 22% of participants. Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition are little used (20%). Screening for sarcopenia was insufficient as the systematic use of assessment tools (handgrip/chair test) was minimal (3%). Screening for dysphagia is not a routine procedure for at-risk patients according to 33% of participants. Systematic involvement of clinical nutrition services/units in the management of malnourished/sarcopenic patients was reported by only 17% of internists.Conclusions: To overcome the critical issues that emerged from the present study, FADOI and SINPE experts proposed practical solutions to promote the application of the most recent guidelines and to improve awareness and sensitivity to nutritional management in internal medicine real-life settings

Development of home artificial nutrition in Italy over a seven year period: 2005–2012

BACKGROUND: In 2005, the Italian Society for Artificial Nutrition and Metabolism carried out a national survey on the prevalence of home artificial nutrition (HAN), enteral (HEN) and parenteral (HPN). A second survey was carried out in 2012 to investigate the development of HAN in Italy. METHODS: The Local Health Care Units (LHCUs) were required to record the ongoing cases of HAN using a structured questionnaire. The point prevalence (n./million inhabitants) was analysed according to patient age and disease categories. Data were compared with those obtained in 2005. RESULTS: Data were obtained from 65% of the LHCUs, representing 73% of the Italian population. The prevalence of HAN was 325.5 (90.3% adults, 84.6% HEN). As in 2005, a wide range of prevalence was observed among the administrative regions. The most frequent disease category for HPN was oncological in adults and intestinal failure in children; for HEN, it was neurological in both age groups. A positive correlation was observed between the regional prevalence of HAN and the regional population aging index (p = 0.018). The prevalence of HAN in 2012 was 66% higher than that in 2005. In the individual regions, a negative association was observed between the 2012% prevalence increase of HAN (2012:2005 ratio) and the HAN prevalence in 2005 (p = 0.020). CONCLUSIONS: A two-thirds increase in HAN prevalence was observed over seven years, probably due to improved HAN organisation and management in those regions which showed a low prevalence in 2005. Population aging seemed to be one of the main factors necessitating HAN

Development of home artificial nutrition in Italy over a seven year period: 2005–2012

BACKGROUND: In 2005, the Italian Society for Artificial Nutrition and Metabolism carried out a national survey on the prevalence of home artificial nutrition (HAN), enteral (HEN) and parenteral (HPN). A second survey was carried out in 2012 to investigate the development of HAN in Italy. METHODS: The Local Health Care Units (LHCUs) were required to record the ongoing cases of HAN using a structured questionnaire. The point prevalence (n./million inhabitants) was analysed according to patient age and disease categories. Data were compared with those obtained in 2005. RESULTS: Data were obtained from 65% of the LHCUs, representing 73% of the Italian population. The prevalence of HAN was 325.5 (90.3% adults, 84.6% HEN). As in 2005, a wide range of prevalence was observed among the administrative regions. The most frequent disease category for HPN was oncological in adults and intestinal failure in children; for HEN, it was neurological in both age groups. A positive correlation was observed between the regional prevalence of HAN and the regional population aging index (p = 0.018). The prevalence of HAN in 2012 was 66% higher than that in 2005. In the individual regions, a negative association was observed between the 2012% prevalence increase of HAN (2012:2005 ratio) and the HAN prevalence in 2005 (p = 0.020). CONCLUSIONS: A two-thirds increase in HAN prevalence was observed over seven years, probably due to improved HAN organisation and management in those regions which showed a low prevalence in 2005. Population aging seemed to be one of the main factors necessitating HAN

To fast, or not to fast before chemotherapy, that is the question

Abstract Fasting in disease prevention and treatment has recently become a popular topic, particularly in the context of oncology. Unfortunately, the growing attention paid by the media has created a background of speculations and ambiguous messages. The attitude towards the role of fasting in cancer patients should be very cautious, as the risk of malnutrition/sarcopenia and disinformation may be associated with this approach. Whether the results obtained by fasting in the cellular and animal models can be transferred to cancer patients is still to be ascertained. At the moment, more preclinical studies are required to determine in which cancers, at which stage, and in what combinations fasting, fasting-mimicking diets or caloric restriction mimetics may prove effective. So, despite the “rumors” of marketing and media, nowadays fasting and calorie restriction around CT represent only a promising intuition, which requires proper efforts and time to be validated by evidence-based clinical data

Changes in food habits in cancer patients in Italy, AIOM-SINPE-FAVO

OBJECTIVES: The aim of this study was to investigate the prevalence of cancer patients changing their diet in relation to cancer site, sex, age and geographic distribution. Furthermore, we aimed to explore the rationale behind dietary changes and to identify sources of information in order to plan specific educational training. METHODS: Patients ≥18 y of age who accessed the Italian Cancer Patients, Families and Friends Association information points were invited to participate. An ad hoc self-report questionnaire was used. The questionnaire asked patients about changes made to the major food groups. A minimum sample of 100 patients for the most common cancers was planned. We analyzed 1257 questionnaires. We assessed the prevalence of, reasons for, and type of dietary changes. Logistic regression was used to analyze the main determinants of dietary changes. RESULTS: Of the 1257 patients, 705 (56.1%) reported changes since receiving the diagnosis of cancer. On the logistic regression analysis, age and tumor site were significantly associated with dietary changes (P <0.001), mainly in patients <50 y of age and in those with upper gastrointestinal cancers. Slightly more than half (50.8%) of patients adopted a healthier diet, with 31.3% doing so to deal with eating-related side effects and 17.9% due to cancer sites. Regardless of the reasons for changing, the most common food items to result in a decrease in consumption were alcohol, red and processed meats, and sugary drinks. Only 15% of patients reported receiving specific nutrition indication. CONCLUSION: Italian patients are attentive to the importance of diet during cancer treatment. Personal choices reflect some indications for cancer prevention as there is still a shortage of guidelines for a correct diet during treatment. Nutrition indications are rarely given within the oncologic center

Prevalence of home artificial nutrition in Italy in 2005: A survey by the Italian Society for Parenteral and Enteral Nutrition (SINPE).

Aim: To determine the prevalence (cases per million inhabitants) of home artificial nutrition (HAN), enteral (HEN) and parenteral (HPN), in Italy, grouped according to administrative regions, patient age and primary disease, and to analyze the impact both of the presence of an HAN regional regulation and of demographic characteristics. Methods: In April 2005, the Regional Coordinators of the Italian Society for Parenteral and Enteral Nutrition (SINPE) recorded all the ongoing cases of HAN using a structured questionnaire and were asked to estimate the representativeness of the collected sample with respect to the total expected HAN. Results: A total of 6955 cases of HAN (93.5% adults, 6.5% pediatric patients p18 years) were recorded in 16 of the 20 Italian regions (80% of the Italian population; sample representativeness 78%). HAN prevalence 152.6 (83.9% HEN, 16.1% HPN); the HAN range among the regions was: prevalence 28.1–519.8; oncological disease 13.8–75.7%, neurological disease 15.5–79.9%, intestinal failure 1.3–14.0%. An HAN regulation was present in 11 regions. A positive association (P ¼ 0:012) was found between the number of years since the regulation was issued and the HAN prevalence, and also between the % neurological patients and the population density (P ¼ 0:130) and the % inhabitants X75 years (P ¼ 0:040)

Prevalence of home artificial nutrition in Italy in 2005: A survey by the Italian Society for Parenteral and Enteral Nutrition (SINPE)

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