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Soares CH, Beuren AG, Friedrich HJ, Gabrielli CP, Stefani GP, Steemburgo T. The Importance of Nutrition in Cancer Care: A Narrative Review. Curr Nutr Rep 2024:10.1007/s13668-024-00578-0. [PMID: 39278864 DOI: 10.1007/s13668-024-00578-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2024] [Indexed: 09/18/2024]
Abstract
PURPOSE OF REVIEW Cancer, a complex disease affecting millions globally, presents considerable challenges for both patients and health care providers. Within the broad spectrum of cancer care, nutrition plays a key role in supporting patients throughout their journey. This narrative review examines the role of nutrition in cancer care, exploring its impact on treatment outcomes, nutritional status, current dietary recommendations, physical activity, palliative care, and finally, as a nutritional encouragement for cancer survivors. RECENT FINDINGS Evidence indicates that cancer and anticancer treatments frequently cause malnutrition and loss of muscle mass, which can exacerbate symptoms, impair immune function, and hamper recovery. Therefore, adequate nutritional support is crucial for maintaining strength, controlling symptoms, and optimizing treatment tolerance in patients with cancer. Several factors influence nutritional needs and dietary recommendations, including cancer type, treatment, and individual patient characteristics. Nutritional care aims not only to ensure sufficient energy and protein intake, but also to manage specific symptoms such as dysgeusia, nausea, and dysphagia. Registered dietitians play a crucial role in providing personalized nutritional guidance, monitoring nutritional status, and implementing interventions to address emerging challenges in cancer care. Furthermore, recent research has underscored the benefits of dietary interventions in cancer treatment. From targeted nutritional supplements to more invasive nutritional support, interest in how nutrition can affect cancer risk and treatment outcomes is increasing. Overall, this review highlights the critical role of nutritional care in comprehensive cancer treatment. By recognizing and meeting dietary demands throughout the entire cancer journey, health care professionals can improve patients' well-being, response to treatment, and long-term prognosis.
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Affiliation(s)
- Camilla Horn Soares
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Amanda Guterres Beuren
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Heloisa Jacques Friedrich
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil
| | - Carolina Pagnoncelli Gabrielli
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Giovanna Potrick Stefani
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil
| | - Thais Steemburgo
- Graduate Program in Food, Nutrition, and Health, Universidade Federal Do Rio Grande Do Sul, Porto Alegre, Rio Grande Do Sul, Brazil.
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande Do Sul, Brazil.
- Department of Nutrition, Universidade Federal Do Rio Grande Do Sul, Porto Alegre , Rio Grande Do Sul, Brazil.
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Lam CJY, Phua QQ, Guo EY, Sia IKM. Impact of a moulded pureed diet on taste, appearance, recognisability, and overall liking among patients in an acute hospital. Front Nutr 2023; 10:1248779. [PMID: 37794967 PMCID: PMC10546055 DOI: 10.3389/fnut.2023.1248779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
Introduction Hospital meals potentially influence patients' nutritional, physical, and emotional well-being during their admission. Patients on pureed diets report poorer meal satisfaction, due to taste, appearance, and recognisability, potentially impacting on their nutritional status. This study compared whether a moulded pureed diet made from modified maize starch led to improved taste, appearance, recognisability, and overall liking, compared to an unmoulded pureed diet made from potato starch in an acute hospital. Methods Patients on texture-modified diets were recruited and presented with two pureed diets - unmoulded and moulded. Participants were asked to identify meat and vegetable dishes prior to eating. After the meal, participants indicated their diet preference in terms of appearance, taste, and overall liking. Results 145 participants were recruited, of which 126 completed data collection. 86% correctly identified moulded meat dishes, 69% correctly identified moulded vegetable dishes, with an overall 77% accuracy in identifying moulded puree side dishes. On unmoulded puree side dishes, participants correctly identified 25% of meat dishes, 4% of vegetable dishes, with an overall accuracy of 14%. In terms of preference, the moulded puree was preferred, with 81% for appearance, 76% for taste and 75% for overall preference. When participants had differing preferences for appearance and taste (e.g., prefers unmoulded puree appearance and moulded puree taste), 95% of them subsequently aligned their overall preference with their taste preference (i.e., overall preferred moulded pureed diet). This suggests that taste has a stronger influence on overall preference compared to appearance. Discussion Findings indicate that a moulded pureed diet made from modified maize starch led to improved recognisability, taste, appearance, and overall liking compared to an unmoulded pureed diet made from potato starch. Taste had a stronger influence on overall preference compared to appearance. These findings capture patient preferences and may have implications on how hospital pureed diets may be improved, potentially improving patient nutrition and health outcomes.
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Affiliation(s)
- Calvin Jun Yan Lam
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
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Papier I, Sagi-Dain L, Chermesh I, Mashiach T, Banasiewicz T. Absence of oral nutritional support in low food intake inpatients is associated with an increased risk of hospital-acquired pressure injury. Clin Nutr ESPEN 2022; 51:190-198. [PMID: 36184204 DOI: 10.1016/j.clnesp.2022.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Hospital-acquired pressure injury (HAPI) incidence is a common burden in hospitals. Decreased food intake leading to malnutrition compromises body tissues involved in pressure injury occurrence. However, most tools for predicting pressure injuries do not include daily food intake monitoring nor consider further nutritional interventions. This study aimed to investigate clinical practices for food intake monitoring and its association with predicting HAPI risk, together with Norton Scale use, and whether the initiation or absence of oral nutritional supplements (ONS), separately from other nutritional interventions, was associated with HAPI incidence in low food intake inpatients, who consumed less than 50% of requirements. METHODS This observational cohort study covered a one-year period (08/2018-07/2019). Demographic and clinical data were extracted from computerized files of patients hospitalized ≥7 days, aged ≥60 years, and who ate orally. Patients receiving enteral or parenteral nutrition were excluded. Differences were studied between groups without and with HAPI grade ≥2. Subgroups divided by Norton Scale and intake, Norton Scale and albumin levels, food intake and initiation (or not) of any nutritional intervention versus ONS only, were examined for the consistency of association with HAPI. RESULTS Of the 5155 admissions during the study period, 895 patients fulfilled the inclusion criteria: 48% female, mean age 77.6 ± 9.1 years, 11% with MUST score ≥2. Nutritional intake was reported in 76% of patients, of them 22% had low food intake, and 9% of the study group developed HAPI grade ≥2. Regarding HAPI incidence, no differences were found between groups divided by MUST scores. Independent risk factors significantly associated with HAPI were Norton <14, albumin levels <3 g/dl, and low food intake. Not providing ONS in low food intake patients had an adjusted 3.49-fold (95%CI 1.57-7.75) increase in HAPI risk (6-fold for non-adjusted relative risk). CONCLUSION Failure to initiate ONS as part of nutritional support in low food intake patients is associated with high HAPI risk in these patients. Consequently, monitoring of daily food intake for identifying low intake patients should be integrated into routinely used tools such as the Norton Scale, and adherence to nutritional protocols should be addressed.
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Affiliation(s)
- Irena Papier
- Nursing Department, Rambam Health Care Campus, Haifa, Israel.
| | - Lena Sagi-Dain
- Genetics Institute, Carmel Medical Center, Affiliated to the Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
| | - Irit Chermesh
- Institute of Gastroenterology, Rambam Health Care Campus, Haifa, Israel.
| | - Tanya Mashiach
- Department of Epidemiology, Rambam Health Care Campus, Haifa, Israel.
| | - Tomasz Banasiewicz
- Department of General, Endocrinological Surgery and Gastroenterological Oncology, Poznan University of Medical Sciences, Poland.
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Dickerson RN, Andromalos L, Brown JC, Correia MITD, Pritts W, Ridley EJ, Robinson KN, Rosenthal MD, van Zanten ARH. Obesity and critical care nutrition: current practice gaps and directions for future research. Crit Care 2022; 26:283. [PMID: 36127715 PMCID: PMC9486775 DOI: 10.1186/s13054-022-04148-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background This review has been developed following a panel discussion with an international group of experts in the care of patients with obesity in the critical care setting and focuses on current best practices in malnutrition screening and assessment, estimation of energy needs for patients with obesity, the risks and management of sarcopenic obesity, the value of tailored nutrition recommendations, and the emerging role of immunonutrition. Patients admitted to the intensive care unit (ICU) increasingly present with overweight and obesity that require individualized nutrition considerations due to underlying comorbidities, immunological factors such as inflammation, and changes in energy expenditure and other aspects of metabolism. While research continues to accumulate, important knowledge gaps persist in recognizing and managing the complex nutritional needs in ICU patients with obesity. Available malnutrition screening and assessment tools are limited in patients with obesity due to a lack of validation and heterogeneous factors impacting nutrition status in this population. Estimations of energy and protein demands are also complex in patients with obesity and may include estimations based upon ideal, actual, or adjusted body weight. Evidence is still sparse on the role of immunonutrition in patients with obesity, but the presence of inflammation that impacts immune function may suggest a role for these nutrients in hemodynamically stable ICU patients. Educational efforts are needed for all clinicians who care for complex cases of critically ill patients with obesity, with a focus on strategies for optimal nutrition and the consideration of issues such as weight stigma and bias impacting the delivery of care. Conclusions Current nutritional strategies for these patients should be undertaken with a focus on individualized care that considers the whole person, including the possibility of preexisting comorbidities, altered metabolism, and chronic stigma, which may impact the provision of nutritional care. Additional research should focus on the applicability of current guidelines and evidence for nutrition therapy in populations with obesity, especially in the setting of critical illness.
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Trinca V, Duizer L, Paré S, Keller H. Investigating the patient food experience: Understanding hospital staffs' perspectives on what leads to quality food provision in Ontario hospitals. J Hum Nutr Diet 2021; 35:980-994. [PMID: 34786772 DOI: 10.1111/jhn.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/25/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision. METHODS Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis. RESULTS Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints). CONCLUSIONS Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.
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Affiliation(s)
- Vanessa Trinca
- Kinesiology Department, University of Waterloo, Waterloo, ON, Canada
| | - Lisa Duizer
- Department of Food Science, University of Guelph, Guelph, ON, Canada
| | - Shannon Paré
- Department of Food Science, University of Guelph, Guelph, ON, Canada
| | - Heather Keller
- Schlegel-UW Research Institute for Aging, Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, Canada
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Cardenas D, Bermúdez C, Pérez A, Diaz G, Cortés LY, Contreras CP, Pinzón-Espitia OL, Gómez G, González MC, Fantin R, Gutierrez J, Sulz I, Tarantino S, Hiesmayr M. Are traditional screening tools adequate for monitoring the nutrition risk of in-hospital patients? An analysis of the nutritionDay database. JPEN J Parenter Enteral Nutr 2021; 46:83-92. [PMID: 33554364 DOI: 10.1002/jpen.2085] [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: 12/01/2020] [Revised: 01/13/2021] [Accepted: 02/02/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Monitoring of adequate food intake is not a priority in hospital patients' care. The present study aimed to examine selective data from the nutritionDay survey to determine the impact of food intake during hospitalization on outcomes according to the nutrition risk status. METHODS We conducted a descriptive analysis of selected data from 7 consecutive, annual, and cross-sectional nutritionDay samples from 2009 to 2015. The impact of food intake on outcomes was assessed by univariate and multivariate Cox models controlling for PANDORA scores. RESULTS A total of 7994 adult patients from Colombia, 7243 patients from 9 Latin American countries, and 155,524 patients worldwid were included. Less than half of the patients worldwide consumed their entire meal on nutritionDay (41%). The number of reduced eaters is larger in the "no nutrition risk group" than in the "nutrition risk group" (30% vs 25%). Reduced eating is associated with higher mortality and delayed discharge in patients, regardless of the nutrition risk status. Patients without nutrition risk at the screening who ate "nothing, but were allowed to eat" had 6 times more risk of mortality (hazard ratio, 6.48; 95% CI, 3.5311.87). CONCLUSIONS This is the first large-scale study evaluating the relationship of food intake on clinical outcomes showing an increase of in-hospital mortality rates and a reduction in the probability of being discharged home regardless of the nutrition risk status. Traditional screening tools may not identify a group of patients who will become at risk because of reduced intake while in the hospital.
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Affiliation(s)
- Diana Cardenas
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogota, Colombia
| | - Charles Bermúdez
- Surgery Department, Clínica La Colina and Clínica del Country, Bogota, Colombia
| | | | - Gustavo Diaz
- Faculty of Medicine, Research Institute on Nutrition, Genetics and Metabolism, Universidad El Bosque, Bogota, Colombia
| | - Lilia Yadira Cortés
- Nutrition and Biochemistry Department, Pontificia Universidad Javeriana, Bogota, Colombia
| | | | - Olga Lucía Pinzón-Espitia
- Facultad de Medicina, Departamento de Nutrición Humana, Universidad Nacional de Colombia, Hospital Universitario Mayor-Méderi, Universidad del Rosario, Bogota, Colombia
| | - Gabriel Gómez
- Surgery Department, Clínica del Country, Bogota, Colombia
| | - Maria Cristina González
- Post-graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Brazil
| | - Romain Fantin
- School of Medicine and School of Public Health, Faculty of Medicine, Universidad de Costa Rica, San José, Costa Rica
| | - José Gutierrez
- Nutritional Support Unit, Instituto Salvadoreño del Seguro Social, San Salvador, El Salvador
| | - Isabella Sulz
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
| | - Silvia Tarantino
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Hiesmayr
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University Vienna, Vienna, Austria
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Reduction of serum albumin in non-critically ill patients during hospitalization is associated with incident hypoglycaemia. DIABETES & METABOLISM 2019; 46:27-32. [PMID: 30981821 DOI: 10.1016/j.diabet.2019.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/16/2019] [Accepted: 03/30/2019] [Indexed: 11/20/2022]
Abstract
AIM Our study looked at the association between changes in serum albumin (SA) levels during hospitalization and incidence of hypoglycaemia among non-critically ill patients. METHODS Included were patients discharged from internal medicine units with hospital stays ≤ 14 days. Patients were allocated to three groups: (1) admission SA > 3.5 g/dL with no decrease during hospitalization; (2) admission SA < 3.5 g/dL with no decrease during hospitalization; and (3) decrease in SA regardless of admission SA level. Incident hypoglycaemia (glucose ≤ 70 mg/dL) was predicted by applying regression analysis, using hypoglycaemia as a dependent variable. Mortality studies were performed using Cox regression. RESULTS Included were 7718 patients (mean age 71.8 ± 17.4 years, 49.9% males, 27.1% with diabetes). Of these patients, 12.7% had at least one documented hypoglycaemia episode during hospitalization. Patients with decreases in SA levels during hospitalization (group 3) had higher rates of incident hypoglycaemia compared with patients in groups 1 and 2 (21.0% vs. 6.0% and 16.3%, respectively; P < 0.001 for both). Results remained significant after controlling for admission SA. Strong negative correlations were observed between SA and serum osmolarity (r = -0.204, P < 0.0001) and, separately, between changes in SA with changes in serum osmolarity (r = -0.157, P < 0.001), indicating that SA changes were not due to haemodilution. Overall 1-year mortality was 16.7%, and Cox regression analysis showed an increased 1-year mortality in patients in group 3 (27.9%) compared with those in groups 1 and 2 (15.2% and 13.8%, respectively). CONCLUSION Changes in SA during hospitalization are associated with an increased risk of hypoglycaemia during hospitalization of non-critically ill patients.
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Sauer AC, Goates S, Malone A, Mogensen KM, Gewirtz G, Sulz I, Moick S, Laviano A, Hiesmayr M. Prevalence of Malnutrition Risk and the Impact of Nutrition Risk on Hospital Outcomes: Results From nutritionDay in the U.S. JPEN J Parenter Enteral Nutr 2019; 43:918-926. [DOI: 10.1002/jpen.1499] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 12/01/2018] [Indexed: 01/07/2023]
Affiliation(s)
| | | | - Ainsley Malone
- Mount Carmel West Hospital Columbus Ohio USA
- The American Society for Parenteral and Enteral Nutrition Silver Spring MD USA
| | | | - Gail Gewirtz
- nutritionDay in the U.S. Northbrook Illinois USA
| | - Isabella Sulz
- Institute for Medical Statistics, Center for Medical Statistics, Informatics and Intelligent SystemsMedical University Vienna Vienna Austria
| | - Sigrid Moick
- Division Cardiac, Thoracic, and Vascular Anaesthesia and Intensive CareMedical University Vienna Vienna Austria
| | | | - Michael Hiesmayr
- Division Cardiac, Thoracic, and Vascular Anaesthesia and Intensive CareMedical University Vienna Vienna Austria
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Weijzen MEG, Kouw IWK, Verschuren AAJ, Muyters R, Geurts JA, Emans PJ, Geerlings P, Verdijk LB, van Loon LJC. Protein Intake Falls below 0.6 g•kg-1•d-1 in Healthy, Older Patients Admitted for Elective Hip or Knee Arthroplasty. J Nutr Health Aging 2019; 23:299-305. [PMID: 30820520 PMCID: PMC6399806 DOI: 10.1007/s12603-019-1157-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 11/07/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Hospitalization is generally accompanied by changes in food intake. Patients typically receive hospital meals upon personal preference within the framework of the food administration services of the hospital. In the present study, we assessed food provision and actual food and snack consumption in older patients admitted for elective hip or knee arthroplasty. DESIGN A prospective observational study. SETTING Orthopedic nursing ward of the Maastricht University Medical Centre+. PARTICIPANTS In the present study, n=101 patients (age: 67±10 y; hospital stay: 6.1±1.8 d) were monitored during hospitalization following elective hip or knee arthroplasty. MEASUREMENTS Energy and protein provided by self-selected hospital meals and snacks, and actual energy and protein (amount, distribution, and source) consumed by patients was weighed and recorded throughout 1-6 days. RESULTS Self-selected meals provided 6.5±1.5 MJ•d-1, with 16, 48, and 34 En% provided as protein, carbohydrate, and fat, respectively. Self-selected hospital meals provided 0.75±0.16 and 0.79±0.21 g•kg-1•d-1 protein in males and females, respectively. Actual protein consumption averaged merely 0.59±0.18 and 0.50±0.21 g•kg-1•d-1, respectively. Protein consumption at breakfast, lunch, and dinner averaged 16±8, 18±9, and 20±6 g per meal, respectively. CONCLUSIONS Though self-selected hospital meals provide patients with ~0.8 g•kg-1•d-1 protein during short-term hospitalization, actual protein consumption falls well below 0.6 g•kg-1•d-1 with a large proportion (~32%) of the provided food being discarded. Alternative strategies are required to ensure maintenance of habitual protein intake in older patients admitted for elective orthopedic surgery.
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Affiliation(s)
- M E G Weijzen
- Prof. L.J.C. van Loon, Ph.D., Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University Medical Centre+, PO Box 616, 6200 MD Maastricht, the Netherlands, E-mail: , Tel: +31 43 388 1397, Fax: +31 43 367 0976
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Valaitis R, Laur C, Keller H, Butterworth D, Hotson B. Need for the Integrated Nutrition Pathway for Acute Care (INPAC): gaps in current nutrition care in five Canadian hospitals. BMC Nutr 2017; 3:60. [PMID: 32153840 PMCID: PMC7050887 DOI: 10.1186/s40795-017-0177-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 07/06/2017] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Malnutrition is common in hospitalized patients and is associated with increased mortality, length of stay, and risk of re-admission. The consensus based Integrated Nutrition Pathway for Acute Care (INPAC) was developed and validated to enhance patients' nutrition care and improve clinical outcomes. As part of the More-2-Eat project (M2E), five hospitals implemented INPAC activities (e.g. screening) in a single medical unit. The purpose of this paper is to demonstrate the care gaps with respect to INPAC activities on these five units prior to implementation. Results were used as part of a needs assessment on each unit, demonstrating where nutrition care could be improved and tailoring of implementation was required. METHODS Cross-sectional data was collected by site research associates (RAs) using a standardized audit form once per week for 4 weeks. The audit contents were based on the INPAC algorithm. All medical charts of patients on the study unit on the day of the audit were reviewed to track routine nutrition care activities (e.g. screening). Data was descriptively displayed with REDCap™ and analyzed using R Studio software. RESULTS Less than half of patients (249/700, 36%) were screened for malnutrition at admission. Of those screened, 36% (89/246) were at risk for malnutrition yet 36% (32/89) of these patients did not receive a dietitian assessment. Also, 21% (33/157) of patients who were not screened at risk were assessed. At least one barrier to food intake was noted in 85% of patient medical charts, with pain, constipation, nausea or vomiting being the most common. Many of these barriers were addressed through INPAC standard nutrition care strategies that removed the barrier (e.g. 41% were provided medication for nausea). Advanced nutrition care strategies to improve intake were less frequently recorded (39% of patients). CONCLUSION These results highlight the current state of nutrition care and areas for improvement regarding INPAC activities, including nutrition screening, assessment, and standard and advanced nutrition care strategies to promote food intake. The results also provided baseline data to support buy-in for INPAC implementation in each M2E study unit. TRIAL REGISTRATION Retrospectively registered ClinTrials.gov Identifier: NCT02800304, June 7, 2016.
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Affiliation(s)
- Renata Valaitis
- University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1 Canada
| | - Celia Laur
- University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1 Canada
| | - Heather Keller
- University of Waterloo, 200 University Ave W., Waterloo, ON N2L3G1 Canada
- Schlegel-University of Waterloo Research Institute for Aging, 250 Laurelwood Drive, Waterloo, Canada
| | - Donna Butterworth
- Concordia Hospital, 1095 Concordia Ave., Winnipeg, MB R2K 3S8 Canada
| | - Brenda Hotson
- Winnipeg Regional Health Authority, GG435 820 Sherbrook St., Winnipeg, MB R3A 1R9 Canada
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