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

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

Nutritional Management and Outcomes in Malnourished Medical Inpatients: Anorexia Nervosa

BACKGROUND: Anorexia Nervosa (AN) is a psychiatric disorder characterised by a physical and psychosocial deterioration due to an altered pattern on the intake and weight control. The severity of the disease is based on the degree of malnutrition. The objective of this article is to review the scientific evidence of the refeeding process of malnourished inpatients with AN; focusing on the clinical outcome. METHODS: We conducted an extensive search in Medline and Cochrane; on April 22; 2019; using different search terms. After screening all abstracts; we identified 19 papers that corresponded to our inclusion criteria. RESULTS: The article focuses on evidence on the characteristics of malnutrition and changes in body composition; energy and protein requirements; nutritional treatment; physical activity programmes; models of organisation of the nutritional treatment and nutritional support related outcomes in AN patients. CONCLUSION: Evidence-based standards for clinical practice with clear outcomes are needed to improve the management of these patients and standardise the healthcare process

A feasibility study to assess Mediterranean Diet adherence using an AI-powered system.

Mediterranean diet (MD) can play a major role in decreasing the risks of non-communicable diseases and preventing overweight and obesity. In order for a person to follow the MD and assess their adherence to it, proper dietary assessment methods are required. We have developed an Artificial Intelligence-powered system that recognizes the food and drink items from a single meal photo and estimates their respective serving size, and integrated it into a smartphone application that automatically calculates MD adherence score and outputs a weekly feedback report. We compared the MD adherence score of four users as calculated by the system versus an expert dietitian, and the mean difference was 3.5% and statistically not significant. Afterwards, we conducted a feasibility study with 24 participants, to evaluate the system's performance and to gather the users' and dietitians' feedback. The image recognition system achieved 61.8% mean Average Precision for the testing set and 57.3% for the feasibility study images (where the ground truth was taken as the participants' annotations). The feedback from the participants of the feasibility study was also very positive

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

The Nutritional Content of Meal Images in Free-Living Conditions-Automatic Assessment with goFOODTM.

A healthy diet can help to prevent or manage many important conditions and diseases, particularly obesity, malnutrition, and diabetes. Recent advancements in artificial intelligence and smartphone technologies have enabled applications to conduct automatic nutritional assessment from meal images, providing a convenient, efficient, and accurate method for continuous diet evaluation. We now extend the goFOODTM automatic system to perform food segmentation, recognition, volume, as well as calorie and macro-nutrient estimation from single images that are captured by a smartphone. In order to assess our system's performance, we conducted a feasibility study with 50 participants from Switzerland. We recorded their meals for one day and then dietitians carried out a 24 h recall. We retrospectively analysed the collected images to assess the nutritional content of the meals. By comparing our results with the dietitians' estimations, we demonstrated that the newly introduced system has comparable energy and macronutrient estimation performance with the previous method; however, it only requires a single image instead of two. The system can be applied in a real-life scenarios, and it can be easily used to assess dietary intake. This system could help individuals gain a better understanding of their dietary consumption. Additionally, it could serve as a valuable resource for dietitians, and could contribute to nutritional research

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

Management of Refeeding Syndrome in Medical Inpatients

Refeeding syndrome (RFS) is the metabolic response to the switch from starvation to a fed state in the initial phase of nutritional therapy in patients who are severely malnourished or metabolically stressed due to severe illness. It is characterized by increased serum glucose, electrolyte disturbances (particularly hypophosphatemia, hypokalemia, and hypomagnesemia), vitamin depletion (especially vitamin B1 thiamine), fluid imbalance, and salt retention, with resulting impaired organ function and cardiac arrhythmias. The awareness of the medical and nursing staff is often too low in clinical practice, leading to under-diagnosis of this complication, which often has an unspecific clinical presentation. This review provides important insights into the RFS, practical recommendations for the management of RFS in the medical inpatient population (excluding eating disorders) based on consensus opinion and on current evidence from clinical studies, including risk stratification, prevention, diagnosis, and management and monitoring of nutritional and fluid therapy