Sestrinska skrb bolesnika s dekompenzacijom srca Nursing health care for patient with heart decompensation

Zatajivanje srca jedan je od vodećih uzroka pobola i smrtnosti u zemljama modernog svijeta. Prevalencija u Europi iznosi oko 2%, a u osoba starijih od 65 godina doseže i 10%. Rizik obolijevanja od zatajivanja srca u Europi i Sjevernoj Americi do konca života za 40-godišnju osobu jest 1:5. Najčešći simptomi u bolesnika sa zatajivanjem srca jesu osjećaj umora, razni oblici zaduhe i periferni edemi. Osnovna prevencija srčano – žilnih bolesti je zdrav način života koji se usvaja već u ranom djetinjstvu i uključuje zdravu prehranu i redovitu tjelesnu aktivnost. U radu je opisan holistički pristup sestrinske skrbi bolesnika koji boluje od dekompenzacije srca

Bezglutenski proizvodi namijenjeni osobama s celijakijom nisu dobar izvor folata i vitamina B12

The gluten-free diet, the only treatment in coeliac disease, can be nutritionally unbalanced and deficient in several nutrients. Gluten-free products contain much lower levels of B vitamins, especially lower folate concentrations than their gluten-containing counterparts. Folate intake is considered as a major dietary determinant of plasma homocysteine concentration in healthy population. Elevated homocysteine is an independent risk factor for cardiovascular disease and has been associated with osteoporotic fractures, which are an increased risk factor in coeliac disease. The aim of this study is to determine dietary folate intake and plasma homocysteine concentration as metabolic markers of suboptimal intake of folate and B12 in Croatian coeliac patients living on a gluten-free diet. Subjects were 52 coeliac patients (83 % female, age 35±13) adhering to a gluten-free diet. Blood samples were analyzed for plasma homocysteine, serum and red blood cell folate and serum B12. Quantitative food frequency questionnaire was used to measure dietary folate intake. Mean dietary folate intake was 206 mg of dietary folate equivalents (DFE), which was far below the national recommendation of 400 µg of DFE (or 200 μg of folic acid). Mean homocysteine was (9±2) μmol/L (range from 5.42 to 13.90 μmol/L), while elevated homocysteine concentrations (>10 μmol/L) were found in 34 % of subjects. In conclusion, coeliac patients adhering to gluten-free diet included in this study showed low folate intake and suboptimal folate and vitamin B12 status, possibly due to low folate content in gluten-free products. Therefore, folate fortification or enrichment of gluten-free products could be beneficial for coeliac patients and it would be of great interest for the food industry.Bezglutenska prehrana, jedini lijek za oboljele od celijakije, može biti neuravnotežena zbog nedostataka nekih hranjivih tvari. Bezglutenski proizvodi sadrže manju količinu vitamina B, osobito folata, nego slični proizvodi koji sadrže gluten. U zdravih osoba koncentracija homocisteina u plazmi uglavnom ovisi o prehrambenom unosu folata. Povećana vrijednost homocisteina u posljednje se vrijeme povezuje s osteoporozom koja je učestala u osoba s celijakijom. Svrha je ovoga rada utvrditi unos folata i status homocisteina kao metaboličkoga biljega suboptimalnog unosa folata i vitamina B12 u osoba s celijakijom na području Republike Hrvatske. U istraživanju su sudjelovale 52 osobe s celijakijom koje su na bezglutenskoj prehrani (83 % žena, dobi 35±13 godina). Analizom krvi utvrđena je koncentracija homocisteina, folata u serumu i eritrocitima te vitamina B12 u serumu. Kvantitativni je upitnik za procjenu unosa hrane i pića upotrijebljen radi utvrđivanja prehrambenog unosa folata. Prosječni je unos folata bio 206 µg ekvivalenata folata (eng. dietary folate equivalents-DFE), što je kudikamo manje od nacionalne preporuke koja navodi 400 µg DFE odnosno 200 µg folne kiseline. Prosječna vrijednost homocisteina iznosila je 9±2 µmol/L (raspon 5,42-13,90 µmol/L). Povećana vrijednost homocisteina (>10 µmol/L) utvrđena je u 34 % ispitanika. Može se zaključiti da osobe s celijakijom koje se pridržavaju bezglutenske prehrane, a sudjelovale su u ovom istraživanju, imaju mali unos folata i suboptimalan status folata i vitamina B12, vjerojatno zbog unosa folatom siromašnih bezglutenskih proizvoda. Stoga bi obogaćivanje ili dodatak folata u bezglutenske proizvode mogao povoljno utjecati na osobe s celijakijom, te predstavljati izazov prehrambenoj industriji

Influence of Jam Processing Upon the Contents of Phenolics and Antioxidant Capacity in Strawberry fruit (Fragaria ananassa × Duch.)

Seven cultivars of strawberry (Diamante, Elsanta, Honeoye, Madeleine, Marmolada, Miranda and Miss) were analyzed for total phenols (TP), total flavonoids (TF), total nonfl avonoids (TN), total anthocyanins (TA) and antioxidant capacity (AC) before and after low sugar jam production to evaluate their changes after thermal processing. The content of TP, TF and TN were determined according to the Folin-Ciocalteu assay. Anthocyanins were determined by spectral method based on the bisulfite bleaching of monomeric anthocyanins. The antioxidant capacity was evaluated by ,2-diphenyl-1-picrylhydrazil radical (DPPH). Fresh fruits had total phenolics ranging from 251.97 to 713.06 mg gallic acid equivalent GAE/g of dry weight. In all investigated samples, fresh strawberries and jams, nonflavonoids were predominant phenols. Cultivar Honeoye had the highest amounts, while cultivar Miss had the lowest amounts of TP and TN. Cultivar Miranda had TF in the highest concentrations, while the lowest concentrations were found in cultivar Marmolada. TA for investigated cultivars was 63.55-177.71 mg Cy-3-G/100 d.w. with strong differences among cultivars. On the basis of dry weight the processing and heating during jam making generally decreased the contents of TP for 37-70 %. During processing, cultivar Madeleine showed the greatest stability of TP, TN and TF, while cultivar Elsanta showed the greatest anthocyanins stability. In comparison with fresh strawberry fruit, whose antioxidant capacity were in the range of 0.23 mmol TE/kg f.w. to 0.67 mmol TE/kg f.w., the jams also represent a noticeable source of antioxidant compounds, even considering the lower content of phenolic compounds, with the antioxidant capacity of 0.20 mmol TE/kg f.w. to 0.62 mmol TE/kg f.w. Hence, the obtained results showed that besides fresh strawberry fruit, the strawberry jams also possess noticeable content of important bioactive compounds with considerable antioxidant capacity

Influence of Jam Processing Upon the Contents of Phenolics and Antioxidant Capacity in Strawberry fruit (Fragaria ananassa × Duch.)

Seven cultivars of strawberry (Diamante, Elsanta, Honeoye, Madeleine, Marmolada, Miranda and Miss) were analyzed for total phenols (TP), total flavonoids (TF), total nonfl avonoids (TN), total anthocyanins (TA) and antioxidant capacity (AC) before and after low sugar jam production to evaluate their changes after thermal processing. The content of TP, TF and TN were determined according to the Folin-Ciocalteu assay. Anthocyanins were determined by spectral method based on the bisulfite bleaching of monomeric anthocyanins. The antioxidant capacity was evaluated by ,2-diphenyl-1-picrylhydrazil radical (DPPH). Fresh fruits had total phenolics ranging from 251.97 to 713.06 mg gallic acid equivalent GAE/g of dry weight. In all investigated samples, fresh strawberries and jams, nonflavonoids were predominant phenols. Cultivar Honeoye had the highest amounts, while cultivar Miss had the lowest amounts of TP and TN. Cultivar Miranda had TF in the highest concentrations, while the lowest concentrations were found in cultivar Marmolada. TA for investigated cultivars was 63.55-177.71 mg Cy-3-G/100 d.w. with strong differences among cultivars. On the basis of dry weight the processing and heating during jam making generally decreased the contents of TP for 37-70 %. During processing, cultivar Madeleine showed the greatest stability of TP, TN and TF, while cultivar Elsanta showed the greatest anthocyanins stability. In comparison with fresh strawberry fruit, whose antioxidant capacity were in the range of 0.23 mmol TE/kg f.w. to 0.67 mmol TE/kg f.w., the jams also represent a noticeable source of antioxidant compounds, even considering the lower content of phenolic compounds, with the antioxidant capacity of 0.20 mmol TE/kg f.w. to 0.62 mmol TE/kg f.w. Hence, the obtained results showed that besides fresh strawberry fruit, the strawberry jams also possess noticeable content of important bioactive compounds with considerable antioxidant capacity

Combining hand grip strength with nutritional screening tools in elderly patients with chronic kidney disease

Malnutrition in vulnerable patient populations must be rapidly detected using techniques that are easy to incorporate into everyday clinical practice. The new recommendations defined the 7-point Subjective Global Assessment (SGA) as optimal for nutritional assessment in chronic kidney disease (CKD), while Geriatric Nutrition Risk Index (GNRI) demands additional examination in elderly. This study aimed to determine the accuracy of several concise tools used in the clinical practice and the correlation of this tools with functional method hand grip strength (HGS) in elderly patients with CKD. In this cross-sectional study, anthropometric and functional data for 50 elderly hemodialysis patients were analyzed using numerous survey-based tools for screening nutritional status (Malnutrition Screening Tool – MST, Nutritional Risk Screening 2002 - NRS2002, Malnutrition Universal Screening Tool - MUST, Mini Nutritional Assessment - MNA, GNRI), which we compared to the standard 7-point SGA nutritional assessment tool. The sensitivity, specificity, and accuracy of these tools for detecting malnutrition were compared with the standard by using receiver operating characteristic (ROC) curve analysis. 7-point SGA classified 36.6% of participants as well nourished, and 63.4% as mildly to moderately malnourished, while the simplest alternative methods showed lower accuracy, classifying much higher proportions of participants as well nourished (MST, 92.0%; NRS2002, 80.4%). MNA had the highest accuracy based on receiver operating characteristic curves. HGS correlated moderately with 7-point SGA (r = 0.331), MNA (r = 0.410), and GNRI (r = 0.320). Our small study suggests that MNA is the best tool for malnutrition risk screening in elderly with CKD. Combining HGS with concise tools, such as GNRI, may provide better results and unburden healthcare professionals

Nutritional status of hemodialysis patients

Hemodialysis patients are vulnerable population group and they, among other, should take special care on food and fluid intake with emphasis on energy, potassium, phosphorus, sodium and protein intake. The nutritional status of patients (n=14) was assessed through measurement of body weight, body height, upper arm circumference, lower leg circumference and handgrip dynamometry; as well as selected biochemical parameters: urate concentration, calcium and phosphate levels, total protein, creatinine, albumin and globulin ratio and C-reactive protein; and dietary assessment method: 3-day food record (3DD). Using range between 18.5 and 24.9 kg/m2 as cut-off, 35.7 and 57% of patients were classified as adequately nourished and overweight, respectively. According to results of 3DD, most of the subjects are supposed to align their micro- and macro- nutrients intake with the recommendations, with emphasis on the increasing intake of protein and energy as well as on decreasing intake of potassium, phosphorus, sodium and energy

The proportion of differently processed foods in the diet of Croatian school-aged children and its impact on daily energy and nutrient intake

In countries around the world, a dietary shift is observed in which the consumption of highly processed foods increases over unprocessed or minimally processed foods. The objective of this study was to observe the proportion of processed foods in the diet of school-aged children and to assess how this relates to sex, weight status and school meal consumption. The aim was to assess the impact of processed foods on overall diet quality in terms of ultra-processed foods contribution to total daily energy intake. Dietary intake was observed from dietary records for three non-consecutive days of 168 children (50.6% boys) aged 8.3 ± 0.5 years. All foods and beverages were classified into four groups according to NOVA food classification system. The contribution of each NOVA food group to total daily energy intake was calculated and the mean nutrient intake of children divided into terciles according to total daily energy intake from ultra-processed foods was compared. Anthropometric measurements were performed according to standard protocols, while sex and age z-scores were obtained using AnthroPlus software. Results show that unprocessed or minimally processed foods (38.1% kcal) and ultra-processed foods (38.1% kcal) had the highest proportion of dietary intake. There was no difference in NOVA food groups intake by sex or weight status, while number of school meals may contribute to the intake of processed culinary ingredients. Children who had higher energy intake from ultra-processed foods had lower intake of animal proteins (p=0.009), polyunsaturated fatty acids (p=0.014), vitamin A (p=0.027) and most minerals, but higher intake of carbohydrates (p=0.014) and copper (p=0.014) compared to children with lower energy intake from ultra-processed foods. In conclusion, school-aged children had equal share of energy from unprocessed or minimally processed foods and from ultra-processed foods. Higher share of energy from ultra-process foods may contribute to poor overall nutrition

How the number and type of primary school meals affect food variety and dietary diversity?

School meals should encourage a varied and diverse diet, since children may eat up to three meals at school per day. The aim of this study was to assess food variety and dietary diversity among primary school children regarding the number and type of school meals. Dietary records for three non-consecutive days were used to estimate the food variety score (FVS) and dietary diversity score (DDS) of 195 children (52.3% boys) aged 8-9 years from schools in the city of Zagreb. For analysis, children were divided into 5 groups according to the number and type of school meals consumed: non-consumers (23.1%), breakfast consumers (30.3%), lunch consumers (5.6%), breakfast and lunch consumers (13.3%), and breakfast, lunch and snack consumers (27.7%). The children had an average FVS of 14.3 (12.6 - 16.7) and DDS of 5.7 (5.0 - 6.0). The food group with the highest frequency of consumption was starchy staple (99.9% of children), while legumes, seeds, and nuts were consumed least frequently (15.4%). The number and type of school meals were moderately correlated (r = 0.313, p < 0.001) with FVS and weakly (r = 0.230, p = 0.02) with DDS. In addition, children who ate breakfast and lunch or breakfast, lunch, and snack from school meals had significantly higher FVS (p < 0.001) and DDS (p = 0.027) compared to children who ate fewer school meals or ate no school meal. Children (50%) who ate breakfast, lunch, and snacks from school meals were more likely (p = 0.022) to consume dark green leafy vegetables. The number of school meals may affect the food variety and dietary diversity, with children who eat more school meals having better quality. However, the values obtained by the index suggest that both parents and school food services should provide more varied meals in terms of different foods and food groups

THE IMPACT OF EDUCATION ABOUT SPECIFIC COOKING METHODS ON SERUM POTASSIUM LEVELS IN PATIENTS ON HEMODIALYSIS

Progression of chronic kidney disease often results with developing hyperkalemia; the increased serum level of potassium, which causes cardiac, neuromuscular and gastrointestinal complications. Hyperkalemia is generally associated with cardiac arhythmias and higher risk of mortality in patients on hemodialysis. The aim was to determine the impact of education on potassium control among patients on hemodialysis, while basing additional education on potassium-reducing techniques during food preparation and applying diet prepared accordingly to learned techniques. Participants were 47 patients on hemodialysis divided in control (n=22) and intervention (n=25) groups. All participants were educated by trained dietitian and received materials about proper nutrition at the beginning of the 1-year longitudinal study. The intervention group was educated additionally on potassium-reducing food preparation techniques. While both groups received two hospital meals per day during hemodialysis, meals for the intervention group were prepared accordingly to suggested food preparation techniques. Biochemical parameters were monitored during the study according to standard methods. The results showed that there was significant change in reduction of serum levels of potassium in intervention group compared to control group after one year of the study (p=0.037). Also, monthly serum levels of potassium were significantly reduced (p<0.05), compared to baseline of the study, during first 8 months in the control group and during all 12 months in the intervention group. Education about food preparation, proper diet alterations and its implementation can be useful in decreasing serum potassium levels and preventing hyperkalemia in patients on hemodialysis

NUTRITIONAL ASSESSMENT OF PATIENTS WITH PRIMARY PROGRESSIVE DEMENTIA AT THE TIME OF DIAGNOSIS

Background: patients with different types of dementia may experience changes in nutritional status, which are manifested by specific eating habits. The aim of this study was to determine the nutritional status and eating habits of patients at the time of confirmed diagnosis of primary progressive dementia. Subject and methods: The study included 40 outpatients (63% women) diagnosed with either form of dementia. The mean age at diagnosis was 776 years and the mean time between the onset of first symptoms of the disease and diagnosis was 3-36 months. Nutritional assessment was determined at the time of confirmed diagnoses and included dietary habits (non-quantitative modified food frequency questionnaire (FFQ)), anthropometric (body weight and height and body mass index-BMI) and biochemical parameters (serum concentrations of vitamin B12, folic acid and 25-hydroxy vitamin D). Dietary habits were collected over a 12- month period with the help of a spouse or close family member. Results: The results showed that none of the outpatients were malnourished, the largest number of outpatients (43%) were in the normal body mass category followed by 33% in the overweight category. The results of this study confirmed previous findings of higher preference for sweet foods observed in 53% of patients with dementia. Low status of vitamin B12 was observed in 57% of outpatients, folic acid in 24% and 25 (OH) D in 75% of outpatients. Lower frequency of consumption of dark green leafy vegetables and lower consumption of poultry meat, fish and eggs could have an impact on nutrient deficiency. Conclusions: The poor nutritional status of outpatients with primary progressive dementia is associated with unhealthy dietary habits that may lead to micronutrient deficiencies. Dietary monitoring and intervention should be initiated immediately after the diagnosis of primary progressive dementia with the goal of reducing nutritional deficiencies and preventing further and more severe impairment of cognitive function