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Nutrition in Clinical Practice

Celia Laur, Bridget Davidson, Heather Keller
BACKGROUND: Subjective global assessment (SGA) is a standardized diagnostic tool for malnutrition and identifies those who would benefit from nutrition treatment. SGA has been validated in several patient populations; however, implementation in clinical practice is inconsistent. The objective of this study was to understand and contrast the perceptions on use of SGA before and after it became a regular practice for hospital dietitians. METHODS: The More-2-Eat implementation project provided the opportunity to undertake this qualitative study, as 5 hospitals adopted INPAC (Integrated Nutrition Pathway for Acute Care), which includes the use of SGA...
April 17, 2019: Nutrition in Clinical Practice
Samih Raad, Cheryl Smith, Karen Allen
Chronic obstructive pulmonary disease (COPD) represents an important global public health concern. Malnutrition is common in patients with COPD and often leads to worse outcomes for these patients. Recognition of overall nutrition status for patients with COPD is an important aspect of their care and treatment. Several methods have been studied that move beyond the standard/frequent use of body mass index alone. The purpose of this review is to summarize the current evidence for other tools to evaluate nutrition status in patients with COPD and highlight patients who may benefit from nutrition interventions...
April 15, 2019: Nutrition in Clinical Practice
Sara Lehmann, Suzie Ferrie, Sharon Carey
BACKGROUND: The aim of this study was to systematically review effects of nutrition interventions on outcomes in patients with chronic gastrointestinal (GI) motility disorders. There is currently a lack of evidence-based guidelines for nutrition management in this group, likely a result of the rarity of the conditions. METHODS: A systematic review of all study types to evaluate current evidence-based nutrition interventions was performed using Medline, Embase, and CINAHL databases...
April 15, 2019: Nutrition in Clinical Practice
Jann Arends
No abstract text is available yet for this article.
April 9, 2019: Nutrition in Clinical Practice
Catherine Larson-Nath, Praveen Goday
Malnutrition occurs when nutrient intake does not meet the needs for normal body functions and as a consequence leads to alterations of growth and development in children. Chronic illness puts children at risk for developing malnutrition. Because of children's rapid periods of growth and development, early diagnosis, prevention, and management of malnutrition are paramount. The reasons for malnutrition in children with chronic disease are multifactorial and are related to the underlying disease and non-illness-associated factors...
April 8, 2019: Nutrition in Clinical Practice
Kelly Fisher, Deborah Hutcheon, Jane Ziegler
Irritable bowel syndrome (IBS) is classified as a functional gastrointestinal (GI) disorder characterized by abdominal pain, bloating, and changes in bowel function. Although the pathophysiology of IBS is incompletely understood, fermentable carbohydrates are implicated as a potential cause of symptoms. An elimination diet, such as a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet, represents a potential intervention for reducing GI symptoms in patients with IBS. The role of fermentable carbohydrates in symptom onset is well studied in adult patients with IBS; however, less research exists in the pediatric population...
April 1, 2019: Nutrition in Clinical Practice
Keegan J Ziemba, Rajeswari Kumar, Kathryn Nuss, Maria Estrada, Ada Lin, Onsy Ayad
BACKGROUND: Critically ill children in a pediatric intensive care unit (PICU) have unique nutrition needs that are challenging to achieve and thus are at high risk of malnutrition. There is increasing evidence that children who reach caloric goals early have improved outcomes. The purpose of this initiative was to implement an enteral nutrition (EN) algorithm in a tertiary care PICU utilizing clinical decision support tools (CDSTs) and a standardized order set within an electronic health record...
April 1, 2019: Nutrition in Clinical Practice
Tyler J Loftus, Michelle P Brown, John H Slish, Martin D Rosenthal
Preoperative risk stratification has long been developed as a strategy to predict postoperative outcomes and potentially alter or optimize comorbidities and modifiable risk. Malnutrition is among the most common potentially modifiable risk factors and the strongest predictor of poor postsurgical outcomes. Historically, malnutrition has been difficult to address for healthcare providers because of the lack of a cohesive definition. Adding to the confusion has been the use of serum levels of albumin and prealbumin as biomarkers for malnutrition; many fail to understand that these visceral proteins are only valid as markers of nutrition status while at homeostasis...
March 25, 2019: Nutrition in Clinical Practice
Ingrid Schweigert Perry, Lourena C Pinto, Taís Kereski da Silva, Sílvia R R Vieira, Gabriela Corrêa Souza
BACKGROUND: Handgrip strength (HGS) is a potential method to approximate perioperative risk in cardiothoracic surgery patients and correlates well with European System for Cardiac Operative Risk Evaluation (EuroSCORE) values. This study aimed to characterize the functional capacity in preoperative cardiac surgery patients through HGS. METHODS: This cross-sectional study investigated patients aged 18 years or older. The collected data included surgical risk (EuroSCORE), body mass index (BMI), body composition (electrical bioimpedance), and HGS...
March 13, 2019: Nutrition in Clinical Practice
Brian Koenen, Richard Benjamin, Adriana Panciu
Providing parenteral nutrition at home has significant challenges for both patients and providers alike. Some of these challenges are systemic and are secondary to the way the healthcare system is designed to deliver care. Others are more practical and require educating patients and their families to ensure success at home. Overall, the nutrition support team was designed to help deal with these challenges in an effective way. The changing realities of the modern health system are challenging the nutrition support team to adapt to new obstacles...
February 27, 2019: Nutrition in Clinical Practice
Elaine Chiu, Kaleb Marr, Lorian Taylor, Louisa Lam, Melanie Stapleton, Puneeta Tandon, Maitreyi Raman
BACKGROUND: To explore the influence of nourishment state measured by various nutrition assessment tools (NATs) on health-related quality of life (HRQoL) in a pretransplant population with cirrhosis. METHODS: We collected demographic, nutrition assessment, and disease specific data on 81 patients. HRQoL was measured with the Short-Form 36 and divided into 8 subscales. Significant relationships between NATs and HRQoL were examined using independent sample t-tests, χ2 analyses, correlations, and multiple and logistic regression adjusted for age and gender...
February 26, 2019: Nutrition in Clinical Practice
Valeria Dipasquale, Gregorio Serra, Giovanni Corsello, Claudio Romano
Infant formulas are the only suitable substitute for human milk. The most common infant formulas are standard formulas based on cow's milk. In addition, there are formulas for infants showing signs and symptoms of intolerance and for clinical conditions such as allergy, prematurity, and gastrointestinal diseases. A comprehensive review of the literature was made to review the composition of standard and specialized infant formulas and analyze indications for use, real or presumed nutrition differences and properties, and impact on infant growth...
February 11, 2019: Nutrition in Clinical Practice
Hiroko Mori, Mariko Naito, Ayako Nakane, Haruka Tohara
BACKGROUND: Swallowing rehabilitation for patients living with a percutaneous endoscopic gastrostomy (PEG) tube for home enteral nutrition (HEN) is poorly documented, and the quality of caregivers' daily lives is also unknown. METHODS: A qualitative study based on constant comparative analysis was conducted. The study subjects were the caregivers of acquired brain injury survivors residing at home and living with a PEG tube for HEN who had recovered slight oral intake because of swallowing rehabilitation...
February 11, 2019: Nutrition in Clinical Practice
Karen Allen, Leah Hoffman
Mechanically ventilated patients are unable to take food orally and therefore are dependent on enteral nutrition for provision of both energy and protein requirements. Enteral nutrition is supportive therapy and may impact patient outcomes in the intensive care unit. Early enteral nutrition has been shown to decrease complications and hospital length of stay and improve the prognosis at discharge. Nutrition support is unique for patients on mechanical ventilation and, as recently published literature shows, should be tailored to the individuals' underlying pathology...
February 11, 2019: Nutrition in Clinical Practice
Bianca D Arney, Stacey A Senter, Avital C Schwartz, Taylor Meily, Stacy Pelekhaty
BACKGROUND: Adequate nutrition is linked to improved patient outcomes during critical illness. Nutrition care is further enhanced by registered dietitian nutritionist (RDN) order-writing privileges, which improve the implementation of nutrition interventions. The purpose of this performance improvement project was to evaluate the effect of RDN order-writing privileges on enteral nutrition (EN) order compliance and nutrition delivery in selected intensive care units (ICUs) at a university-affiliated teaching hospital...
February 11, 2019: Nutrition in Clinical Practice
Patrizia Calella, Giuliana Valerio, Malcolm Brodlie, Jake Taylor, Lorenzo Maria Donini, Mario Siervo
BACKGROUND: Cystic fibrosis (CF) is characterized by changes in fat mass and lean body mass that may have important prognostic value. We aim to appraise the type and frequency of application of body composition (BC) methods in child and adult patients with CF. METHODS: We used 4 databases (Embase, PubMed, Scopus, and Web of Science) to perform the literature search. The search was conducted from January 2017 to February 2017. Two independent reviewers selected articles based on titles and abstracts to check eligibility for inclusion...
February 7, 2019: Nutrition in Clinical Practice
Joy W Douglas, Jeannine C Lawrence, Lori W Turner, Linda L Knol, Amy C Ellis
BACKGROUND: Current guidelines discourage tube-feeding older adults with advanced dementia (AD), as this practice does not improve nutrition status or survival and decreases quality of life in these patients. Because registered dietitians (RDs) often provide feeding recommendations for patients with AD, this study aimed to identify factors that influenced RDs' feeding tube recommendations for older adults with AD. METHODS: A random sample of RDs who work with older adults in the United States completed a validated, electronic survey...
February 7, 2019: Nutrition in Clinical Practice
Grant E O'Keefe, Marilyn Shelton, Qian Qiu, Jose Cruz Araujo-Lino
BACKGROUND: Published guidelines recommend providing at least 2 g/kg/d of protein for critically ill surgical patients. It may be difficult to achieve this level of intake using standard enteral formulas, thus necessitating protein or amino acid supplementation. Herein, we report our approach to enteral protein supplementation and its relationship with urinary nitrogen excretion and serum transthyretin concentrations. METHODS: This was a retrospective cohort study in which we reviewed critically ill trauma and surgical patients treated with supplemental enteral protein according to a protocol aiming to deliver a total of 2 g/kg/d of protein...
February 7, 2019: Nutrition in Clinical Practice
Allison Gomes, Deborah Hutcheon, Jane Ziegler
The association between body mass index (BMI) and pulmonary function in patients with cystic fibrosis (CF) is well established, yet BMI as the sole indicator of nutrition status fails to assess body composition, specifically fat-free mass (FFM). Reduced FFM is a characteristic of undernutrition and is associated with decreased pulmonary function. A critical review of the literature was undertaken to explore available evidence on the use of FFM derived from dual-energy X-ray absorptiometry (DXA), compared with BMI, to assess pulmonary function and thereby nutrition status in patients with CF...
February 7, 2019: Nutrition in Clinical Practice
Mathias Krogh Poulsen, Lars Pilegaard Thomsen, Søren Kjaergaard, Stephen Edward Rees, Dan Stieper Karbing
BACKGROUND: Indirect calorimetry (IC) is considered the accurate way of measuring energy expenditure (EE). IC devices often apply the Haldane transformation, introducing errors at inspiratory oxygen fraction (FiO2 ) >60%. The aim was to assess measurement reliability and agreement between an unevaluated IC (device 2) (Beacon Caresystem, Mermaid Care A/S, Noerresundby, Denmark) not using Haldane transformation and an IC that does (device 1) (Ecovx, GE, Helsinki, Finland) at varying FiO2 ...
February 4, 2019: Nutrition in Clinical Practice
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