1
|
Romano-Andrioni B, Martín Lleixà A, Carrasco-Serrano M, Barba Valverde S, Quintela M, Pérez I, Bayés Genís B, Arias-Guillén M. [New nutritional screening tool for hospitalized patients with chronic kidney disease: translation, cross-cultural adaptation of Renal iNUT into Spanish and comparison with classic questionnaires]. NUTR HOSP 2023; 40:1192-1198. [PMID: 37522452 DOI: 10.20960/nh.04538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023] Open
Abstract
Introduction Introduction: Chronic kidney disease (CKD) is characterized by its high prevalence of malnutrition, difficult to detect as it is underestimated by the usual tools. There is no valid or hospital-level nutritional screening tool in Spanish to identify patients with CKD at risk of malnutrition. Objective: to translate and accomplish the transcultural adaptation of Jackson's questionnaire (Renal Inpatient Nutrition Screening Tool [Renal iNUT]) to Spanish, which detects the risk of malnutrition in CKD inpatients and compares it with other nutritional tools. Methods: phase 1: translation, back-translation and transcultural adaptation of the questionnaire from the English to the Spanish version. A pilot test was carried out by nursing staff together with a satisfaction questionnaire. Phase 2: comparison of Renal iNUT with Malnutrition Universal Screening Tool (MUST) and Subjective Global Assessment (SGA). Results: phase 1: the nursing staff's perception was highly favorable. They found it easy or very easy to use and 90 % of them did it in a maximum of ten minutes. Phase 2: from 48 patients included, Renal iNUT detected 44 % at low risk of malnutrition, 28 % at intermediate risk and 28 % at high risk. Increased sensitivity of Renal iNUT (p < 0.007) vs MUST (62.5 vs 33.3 %) and similar specificity (87.1 vs 90.6 %) were found, together with an acceptable correlation compared to SGA (r = 0.75, 95 % CI: 0.67 to 0.83). Conclusions: the Spanish version of Renal iNUT is a useful and easy-to-understand tool for health professionals. We also confirm its good correlation with SGA, with greater sensitivity than MUST for the risk of malnutrition detection in CKD inpatients.
Collapse
Affiliation(s)
- Bárbara Romano-Andrioni
- Nutrición y Dietética Clínica. Servicio de Endocrinología y Nutrición. Hospital Clínic de Barcelona
| | | | - Marcos Carrasco-Serrano
- Nutrición y Dietética Clínica. Servicio de Endocrinología y Nutrición. Hospital Clínic de Barcelona
| | | | - Marta Quintela
- Servicio de Nefrología y Trasplante Renal. Hospital Clínic de Barcelona
| | - Inmaculada Pérez
- Servicio de Endocrinología y Nutrición. Hospital Clínic de Barcelona
| | | | | |
Collapse
|
2
|
Xiang X, Zhu X, Zhang L. Association of Malnutrition with Risk of Acute Kidney Injury: A Systematic Review and Meta-Analysis. Int J Clin Pract 2023; 2023:9910718. [PMID: 37795077 PMCID: PMC10547578 DOI: 10.1155/2023/9910718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 09/09/2023] [Accepted: 09/11/2023] [Indexed: 10/06/2023] Open
Abstract
Background Acute kidney injury (AKI) is a complex clinical syndrome of hospitalization that may be affected by undernutrition and metabolic changes. The aim of this meta-analysis was to systematically assess the association between malnutrition and the risk of prevalent AKI. Materials and Methods We searched PubMed, Embase, Ovid MEDLINE, Web of Science, and Chinese databases (WANFANG, VIP, and CKI) from database inception until May 1, 2023, for studies evaluating the association of malnutrition with the risk of AKI. Summary odds ratios (ORs) were estimated using a random-effects model. Results We identified 17 observational studies, which included 273,315 individuals. Compared with patients with normal nutritional status, those with malnutrition had a 125% increased risk of prevalent AKI (pooled ORs, 2.25; 95% confidence interval, 1.80-2.82). Malnutrition was also significantly associated with prevalent AKI across all subgroups when subgroup analyses were performed on covariates such as region, study design, age, sample size, malnutrition assessment method, patient characteristics, covariate adjustment degree, and risk of bias. Meta-regression models demonstrated no significant differences in AKI risk between patients with malnutrition and without malnutrition. Conclusions Our results suggest that malnutrition may be a potential target for AKI prevention. However, well-designed studies with ethnically or geographically diverse populations are needed to evaluate strategies and interventions to prevent or slow the development and progression of AKI in malnourished individuals.
Collapse
Affiliation(s)
- Xiang Xiang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Critical Care Medicine, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu 611137, China
| | - Xinchen Zhu
- Department of Internal Medicine, Traditional Chinese Medicine Hospital of Wenjiang District, Chengdu 611130, China
| | - Lijuan Zhang
- Geriatric Diseases Institute of Chengdu/Cancer Prevention and Treatment Institute of Chengdu, Department of Critical Care Medicine, Chengdu Fifth People's Hospital (The Second Clinical Medical College, Affiliated Fifth People's Hospital of Chengdu University of Traditional Chinese Medicine), Chengdu 611137, China
| |
Collapse
|
3
|
Jackson H. Enhancing nutrition screening in patients with kidney disease. Nurs Stand 2023; 38:77-81. [PMID: 37547939 DOI: 10.7748/ns.2023.e11934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 08/08/2023]
Abstract
Malnutrition is common in patients with kidney disease, and can exacerbate the individual and economic burden of the condition. The identification of malnutrition is essential to inform management interventions and improve patient outcomes, and nutrition screening can be considered the first stage in this process. The development of simple nutrition screening tools has assisted nurses in undertaking widespread, rapid assessments of patients' malnutrition risk. However, generic tools may not be appropriate or accurate in patients with kidney disease. This article explains some of the challenges of identifying malnutrition in this patient group and outlines some disease-specific tools that nurses can use to enhance nutrition screening.
Collapse
Affiliation(s)
- Helena Jackson
- St George's University Hospitals NHS Foundation Trust, London, England
| |
Collapse
|
4
|
Huang L, Lu J, Shi L, Zhang H. Regulation, production and clinical application of Foods for Special Medical Purposes (FSMPs) in China and relevant application of food hydrocolloids in dysphagia therapy. Food Hydrocoll 2023. [DOI: 10.1016/j.foodhyd.2023.108613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
5
|
Association of the nutritional risk index for Japanese hemodialysis with mortality and dietary nutritional intake in patients undergoing hemodialysis during long-term hospitalization. Clin Exp Nephrol 2022; 26:1200-1207. [PMID: 36040556 DOI: 10.1007/s10157-022-02259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/24/2022] [Indexed: 11/03/2022]
Abstract
AIM The nutritional risk index for Japanese hemodialysis (NRI-JH) is a nutritional screening tool for predicting mortality in patients undergoing hemodialysis; however, its utility in patients undergoing hemodialysis during long-term hospitalization who have a high risk of protein-energy wasting, is unclear. METHODS This retrospective study assessed hospitalized patients undergoing hemodialysis during long-term care at a single hospital. The NRI-JH was calculated using body mass index, serum albumin level, total cholesterol level, and serum creatinine level. The patients were categorized into three risk groups-low, medium, and high. Dietary energy and protein intake were evaluated by dietitians. The association of NRI-JH risk with nutritional intake and mortality were examined. RESULTS In total, 133 patients were analyzed. The NRI-JH risk was low in 24%, medium in 26%, and high in 50% of the patients. The patients in the high-risk group were older and had lower energy and protein intakes than those in the low- and medium-risk groups. High-risk patients showed shorter survival times than low- and medium-risk patients, and a high NRI-JH risk was associated with a high mortality rate (hazard ratio [HR], 2.12; 95% confidence interval [CI], 1.08-4.77; p < 0.05). The association weakened when protein intake and C-reactive protein level were added as covariates (HR, 2.01; 95% CI, 0.95-4.28, p = 0.07). CONCLUSIONS High NRI-JH risk was associated with low dietary nutritional intake and poor survival in patients undergoing hemodialysis during long-term hospitalization. Nutritional status evaluation and nutritional interventions may improve prognosis in this population.
Collapse
|
6
|
Lambert K, Bahceci S, Harrison H, Chan M, Scholes-Robertson N, Johnson DW, Yip A, Viecelli AK. Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease. Nephrology (Carlton) 2022; 27:537-540. [PMID: 35118773 PMCID: PMC9303594 DOI: 10.1111/nep.14025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/20/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Kelly Lambert
- Discipline of Nutrition and Dietetics, School of Medicine, Indigenous and Health Sciences, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Su Bahceci
- Department of Nutrition and Dietetics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Harriet Harrison
- Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Maria Chan
- Departments of Renal Medicine and Nutrition and Dietetics, The St. George Hospital, Kogarah, New South Wales, Australia
| | | | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | - Adela Yip
- CARI (Caring for Australians and New ZealandeRs with Kidney Impairment) Guidelines Office, Centre for Kidney Research, Westmead, New South Wales, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia
| | | |
Collapse
|
7
|
Martins C, Saeki SL, Nascimento MMD, Lucas Júnior FM, Vavruk AM, Meireles CL, Justino S, Mafra D, Rabito EI, Schieferdecker MEM, Campos LF, Aanholt DPJV, Hordonho AA, Fidelix MSP. Consensus on the standard terminology used in the nutrition care of adult patients with chronic kidney disease. ACTA ACUST UNITED AC 2021; 43:236-253. [PMID: 33836040 PMCID: PMC8257272 DOI: 10.1590/2175-8239-jbn-2020-0210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 12/07/2020] [Indexed: 11/22/2022]
Abstract
This nutrition consensus document is the first to coordinate the efforts of three professional organizations - the Brazilian Association of Nutrition (Asbran), the Brazilian Society of Nephrology (SBN), and the Brazilian Society of Parenteral and Enteral Nutrition (Braspen/SBNPE) - to select terminology and international standardized tools used in nutrition care. Its purpose is to improve the training delivered to nutritionists working with adult patients with chronic kidney disease (CKD). Eleven questions were developed concerning patient screening, care, and nutrition outcome management. The recommendations set out in this document were developed based on international guidelines and papers published in electronic databases such as PubMed, EMBASE(tm), CINHAL, Web of Science, and Cochrane. From a list of internationally standardized terms, twenty nutritionists selected the ones they deemed relevant in clinical practice involving outpatients with CKD. The content validity index (CVI) was calculated with 80% agreement in the answers. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework was used to assess the strength of evidence and recommendations. A total of 107 terms related to Nutrition Assessment and Reassessment, 28 to Diagnosis, nine to Intervention, and 94 to Monitoring and Evaluation were selected. The list of selected terms and identified tools will be used in the development of training programs and the implementation of standardized nutrition terminology for nutritionists working with patients with chronic kidney disease in Brazil.
Collapse
Affiliation(s)
- Cristina Martins
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil.,Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Grupo de Trabalho Internacional da NCPT, Subcomitê Internacional da Academy of Nutrition and Dietetics (Academy) para a TPCN, Curitiba, PR, Brasil.,Instituto Cristina Martins de Educação e Pesquisa em Saúde, Curitiba, PR, Brasil
| | - Simone L Saeki
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Instituto Cristina Martins de Educação e Pesquisa em Saúde, Curitiba, PR, Brasil
| | - Marcelo Mazza do Nascimento
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Curitiba, PR, Brasil
| | - Fernando M Lucas Júnior
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Hospital das Clínicas da Universidade Federal de Minas Gerais/Grupo Nefroclínicas, Belo Horizonte, MG, Brasil
| | - Ana Maria Vavruk
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Hospital e Maternidade Municipal de São José dos Pinhais, São José dos Pinhais, PR, Brasil
| | - Christiane L Meireles
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,University of Texas Health Science Center, School of Nursing, San Antonio, USA
| | - Sandra Justino
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Complexo do Hospital de Clínicas da UFPR, Curitiba, PR, Brasil
| | - Denise Mafra
- Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Federal Fluminense, Rio de Janeiro, RJ, Brasil
| | - Estela Iraci Rabito
- Consórcio de Pesquisa e Implementação da TPCN no Brasil, Curitiba, PR, Brasil.,Universidade Federal do Paraná, Curitiba, PR, Brasil
| | | | | | - Denise P J van Aanholt
- Sociedade Brasileira de Nutrição Parenteral e Enteral, Curitiba, PR, Brasil.,Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo, Ecuador
| | - Ana Adélia Hordonho
- Associação Brasileira de Nutrição, Curitiba, PR, Brasil.,Sociedade Brasileira de Nefrologia, Comitê de Nutrição, Curitiba, PR, Brasil.,Universidade Estadual de Ciências da Saúde, Hospital Escola Hélvio Auto e Hospital Metropolitano de Alagoas, Maceió, AL, Brasil
| | | |
Collapse
|
8
|
Lambert K, Bahceci S, Harrison H, Chan M. Implications for Australasian dietitians regarding the 2020 Academy of Nutrition and Dietetics and Kidney Disease Outcomes Quality Initiative Clinical Practice Guidelines for Nutrition in Chronic Kidney Disease. Nutr Diet 2021; 78:374-379. [PMID: 33786973 DOI: 10.1111/1747-0080.12668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Kelly Lambert
- Discipline of Nutrition and Dietetics, School of Medicine, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, New South Wales, Australia
| | - Su Bahceci
- Renal Dietitian, Dietetics Department, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Harriet Harrison
- Renal Dietitian, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Maria Chan
- Department of Renal Medicine, The St. George Hospital, Kogarah, New South Wales, Australia.,Department of Nutrition and Dietetics, The St. George Hospital, Kogarah, New South Wales, Australia
| |
Collapse
|
9
|
The effect of an arteriovenous fistula and haemodialysis on anthropometric measurements of the upper arm. Eur J Clin Nutr 2020; 74:1240-1242. [PMID: 31896824 DOI: 10.1038/s41430-019-0548-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 11/09/2022]
Abstract
Haemodialysis (HD) patients are at increased risk of sarcopenia. Measurements of triceps skinfold thickness (TSFT) and mid-upper arm circumference (MUAC) are used to estimate muscle mass. An arteriovenous fistula is the preferred vascular access for HD patients, and we wished to determine whether anthropometric measurements were affected by the fistula and HD treatment. One hundred and forty-four HD patients, 90 (62.5%) males, mean age 63.1 ± 15.4 years, had measurements pre- and post-HD. TSFT was similar in the arms, whereas MUAC and corrected mid-upper arm muscle circumference (CMUAMC) were greater in the fistula compared with the non-fistula arm (MUAC pre-HD 30.0 ± 5.2 vs 29.2 ± 4.7 and post-HD 29.6 ± 5.1 vs 28.5 ± 4.7, p < 0.001; MUAMC 23.5 ± 4.0 vs 22.5 ± 4.1, and post-HD 22.9 ± 4.0, and 22.0 ± 3.7 cm p < 0.01). Following HD; TSFT did not change, but MUAC and CMUAMC fell significantly in both arms (p < 0.01). When screening for sarcopenia in HD patients, anthropometric measurements should be taken post-HD in the non-fistula arm.
Collapse
|
10
|
Wright M, Southcott E, MacLaughlin H, Wineberg S. Clinical practice guideline on undernutrition in chronic kidney disease. BMC Nephrol 2019; 20:370. [PMID: 31619185 PMCID: PMC6796390 DOI: 10.1186/s12882-019-1530-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 08/21/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
| | | | | | - Stuart Wineberg
- Patient Representative, c/o The Renal Association, Bristol, UK
| |
Collapse
|
11
|
Miller J, Wells L, Nwulu U, Currow D, Johnson MJ, Skipworth RJE. Validated screening tools for the assessment of cachexia, sarcopenia, and malnutrition: a systematic review. Am J Clin Nutr 2018; 108:1196-1208. [PMID: 30541096 DOI: 10.1093/ajcn/nqy244] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 08/17/2018] [Indexed: 11/13/2022] Open
Abstract
Background There is great overlap between the presentation of cachexia, sarcopenia, and malnutrition. Distinguishing between these conditions would allow for better targeted treatment for patients. Objectives The aim was to systematically review validated screening tools for cachexia, sarcopenia, and malnutrition in adults and, if a combined tool is absent, make suggestions for the generation of a novel screening tool. Design A systematic search was performed in Ovid Medline, EMBASE, CINAHL, and Web of Science. Two reviewers performed data extraction independently. Each tool was judged for validity against a reference method. Psychometric evaluation was performed as was appraisal of the tools' ability to assess the patient against consensus definitions. Results Thirty-eight studies described 22 validated screening tools. The Cachexia score (CASCO) was the only validated screening tool for cachexia and performed well against the consensus definition. Two tools assessed sarcopenia [the Short Portable Sarcopenia Measure (SPSM) and the SARC-F (Strength, Assistance with walking, Rise from a chair, Climb stairs, and Falls)] and scored well against the 1998 Baumgartner definition. The SPSM required large amounts of equipment, and the SARC-F had a low sensitivity. Nineteen tools screened for malnutrition. The 3-Minute Nutrition Score performed best, meeting consensus definition criteria (European Society for Clinical Nutrition and Metabolism) and having a sensitivity and specificity of >80%. No tool contained all of the currently accepted components to screen for all 3 conditions. Only 3 tools were validated against cross-sectional imaging, a clinical tool that is gaining wider interest in body-composition analysis. Conclusions No single validated screening tool can be implemented for the simultaneous assessment of cachexia, sarcopenia, and malnutrition. The development of a tool that encompasses consensus definition criteria and directs clinicians toward the underlying diagnosis would be optimal to target treatment and improve outcomes. We propose that tool should incorporate a stepwise assessment of nutritional status, oral intake, disease status, age, muscle mass and function, and metabolic derangement.
Collapse
Affiliation(s)
- Janice Miller
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Liz Wells
- Diabetes, Endocrinology, and Metabolism, Hull Royal Infirmary, Hull, United Kingdom
| | - Ugochinyere Nwulu
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - David Currow
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom.,Improving Palliative Care through Clinical Trials (IMPACCT), Faculty of Health, University of Technology, Sydney, New South Wales, Australia
| | - Miriam J Johnson
- Wolfson Palliative Care Research Center, Hull York Medical School, University of Hull, Hull, United Kingdom
| | - Richard J E Skipworth
- Clinical Surgery, University of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| |
Collapse
|
12
|
MacLaughlin HL, Twomey J, Saunt R, Blain S, Campbell KC, Emery P. The nutrition impact symptoms (NIS) score detects malnutrition risk in patients admitted to nephrology wards. J Hum Nutr Diet 2018; 31:683-688. [DOI: 10.1111/jhn.12553] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- H. L. MacLaughlin
- Department of Nutritional Sciences; King's College London; London UK
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - J. Twomey
- Department of Nutritional Sciences; King's College London; London UK
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - R. Saunt
- Nutrition and Dietetics; King's College Hospital NHS Foundation Trust; London UK
| | - S. Blain
- Department of Nutritional Sciences; King's College London; London UK
| | - K. C. Campbell
- Faculty of Health Sciences and Medicine; Bond University; Gold Coast, QLD Australia
| | - P. Emery
- Department of Nutritional Sciences; King's College London; London UK
| |
Collapse
|