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Jimenez EY, Lamers-Johnson E, Long JM, McCabe G, Ma X, Woodcock L, Bliss C, Abram JK, Steiber AL. Predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition indicators to diagnose malnutrition tool in hospitalized adults: a cohort study. Am J Clin Nutr 2024; 119:779-787. [PMID: 38432715 DOI: 10.1016/j.ajcnut.2023.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The lack of a widely accepted, broadly validated tool for diagnosing malnutrition in hospitalized patients limits the ability to assess the integral role of nutrition as an input and outcome of health, disease, and treatment. OBJECTIVES This study aimed to evaluate the predictive validity of the Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (ASPEN) indicators to diagnose malnutrition (AAIM) tool and determine if it can be simplified. METHODS A prospective cohort study was conducted from August 2019 to September 2022 with 32 hospitals in United States. At baseline, 290 adult patients were evaluated for a diagnosis of malnutrition using the AAIM tool, which assesses weight loss, inadequate energy intake, subcutaneous fat and muscle loss, edema, and hand grip strength. Healthcare outcomes were extracted from the medical record: composite incidence of emergency department (ED) visits and hospital readmissions within 90 d postdischarge; length of hospital stay (LOS); and Medicare Severity Disease Related Group (MS-DRG) relative weight (i.e., healthcare resource utilization). We used multilevel, multivariable negative binomial or generalized linear regression models to evaluate relationships between malnutrition diagnosis and healthcare outcomes. RESULTS After adjusting for disease severity and acuity and sociodemographic characteristics, individuals diagnosed with severe malnutrition had a higher incidence rate of ED visits and hospital readmissions (incidence rate ratio: 1.89; 95% CI: 1.14, 3.13; P = 0.01), and individuals diagnosed with moderate malnutrition had a 25.2% longer LOS (95% CI: 2.0%, 53.7%; P = 0.03) and 15.1% greater healthcare resource utilization (95% CI: 1.6%, 31.9%; P = 0.03) compared with individuals with no malnutrition diagnosis. Observed relationships remained consistent when only considering malnutrition diagnoses supported by at least 2 of these indicators: weight loss, subcutaneous fat loss, muscle wasting, and inadequate energy intake. CONCLUSIONS Findings from this multihospital study confirm the predictive validity of the original or simplified AAIM tool and support its routine use for hospitalized adult patients. This trial was registered at clinicaltrials.gov as NCT03928548 (https://classic. CLINICALTRIALS gov/ct2/show/NCT03928548).
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Affiliation(s)
- Elizabeth Yakes Jimenez
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States; Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; Department of Internal Medicine, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States; College of Population Health, University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, NM, United States
| | - Erin Lamers-Johnson
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Julie M Long
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - George McCabe
- Department of Statistics, Purdue University, West Lafayette, IN, United States
| | - Xingya Ma
- Department of Pediatrics, University of New Mexico Health Sciences Center, 1 University of New Mexico, Albuquerque, NM, United States
| | - Lindsay Woodcock
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Courtney Bliss
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Jenica K Abram
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, IL, United States.
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Raiten DJ, Steiber AL, Dary O, Bremer AA. The Value of an Ecological Approach to Improve the Precision of Nutritional Assessment: Addressing Contributors and Implications of the "Multiple Burdens of Malnutrition". Nutrients 2024; 16:421. [PMID: 38337706 PMCID: PMC10857452 DOI: 10.3390/nu16030421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/17/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Globally, children are exposed to multiple health risks associated with diet and nutrition. Rather than simply being a condition of having too much or too little food, malnutrition is more a syndrome comprising multiple burdens of coexisting and reciprocal malnutrition, infection, or other conditions. Importantly, children with such syndromes (e.g., stunting and anemia, which are neither specific nor necessarily sensitive to nutritional status) are more likely to also have irreversible functional outcomes such as poor growth, impaired immune function, or cognitive delays. The global health community has identified nutrition-related targets (e.g., Sustainable Development Goals (SDGs) and World Health Organization (WHO) Global Nutrition Targets) that, for multiple reasons, are difficult to address. Moreover, as the complexity of the global health context increases with persistent pandemics of infectious diseases and the rising prevalence of noncommunicable diseases, there is a growing appreciation that conditions selected as nutrition/health targets indeed represent syndromes for which nutritional status serves as both an input and outcome. In recognition of the impact of these combined challenges and the role of the multiple manifestations of malnutrition, we suggest an approach to nutritional assessment that is intended to improve the precision of context-specific, equitable approaches to health promotion, disease prevention, and treatment.
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Affiliation(s)
- Daniel J. Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA;
| | | | - Omar Dary
- USAID, Bureau for Global Health, Division of Nutrition and Environmental Health, Washington, DC 20523, USA;
| | - Andrew A. Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20817, USA;
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Lamers-Johnson E, Will VK, Long JM, Woodcock L, Kelley K, Steiber AL, Jimenez EY. Factors Associated with IRB Review Time in a Non-Federally Funded Study Using an sIRB of Record. Ethics Hum Res 2023; 45:16-29. [PMID: 37368522 DOI: 10.1002/eahr.500173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Abstract
From 2018 to 2020, U.S. federal mandates began requiring the use of a single institutional review board (sIRB) of record for federally funded, multisite studies. With an interest in the efficiency of site activation, we compared the frequency with which local review and approval and three different reliance options (ways to establish a reliance agreement between the sIRB and the relying institution) were used during this period in a multisite, non-federally funded study (ClinicalTrials.gov identifier: NCT03928548). Using general linear models, we analyzed the relationships between local reliance or approval and sIRB of record approval times and (a) the regulatory option selected and (b) relying-site and process characteristics. Eighty-five sites received sIRB approval through 72 submissions (40% using local review, 46% using the SMART IRB agreement, 10% using an IRB authorization agreement, and 4% using a letter of support). Median time to establish a local reliance or study approval and sIRB approval were longest for sites using a SMART IRB agreement. Study-site region and the time of submission were significantly associated with local reliance or approval time, which averaged 129 and 107 days faster for Midwestern (p = 0.03) or Western (p = 0.02) sites, respectively, and 70 days slower for Northeastern sites (p = 0.42) compared with sites in the South, and 91 days slower when regulatory communication was initiated during or after February 2019 compared with before (p = 0.02). Similar relationships between sIRB approval time and region and time frame were observed; in addition, approval time was 103 days slower for sites affiliated with a research 1 (R1) university versus not (p = 0.02). Region of the country, time frame, and R1 university affiliation were associated with variations in study-site activation in a non-federally funded, multisite study.
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Affiliation(s)
| | - Vanessa K Will
- Clinical research manager at the University of New Mexico Health Science Center
| | - Julie M Long
- Nutrition Research Contractor for the Academy of Nutrition and Dietetics
| | - Lindsay Woodcock
- ANDHII research project manager at the Academy of Nutrition and Dietetics
| | - Kathryn Kelley
- Nutrition researcher at the Academy of Nutrition and Dietetics
| | | | - Elizabeth Yakes Jimenez
- Director of the Nutrition Research Network at the Academy of Nutrition and Dietetics and a research professor in the Department of Pediatrics at University of New Mexico Health Science Center
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Donovan SM, Aghaeepour N, Andres A, Azad MB, Becker M, Carlson SE, Järvinen KM, Lin W, Lönnerdal B, Slupsky CM, Steiber AL, Raiten DJ. Evidence for human milk as a biological system and recommendations for study design-a report from "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Working Group 4. Am J Clin Nutr 2023; 117 Suppl 1:S61-S86. [PMID: 37173061 DOI: 10.1016/j.ajcnut.2022.12.021] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/06/2022] [Accepted: 12/08/2022] [Indexed: 05/15/2023] Open
Abstract
Human milk contains all of the essential nutrients required by the infant within a complex matrix that enhances the bioavailability of many of those nutrients. In addition, human milk is a source of bioactive components, living cells and microbes that facilitate the transition to life outside the womb. Our ability to fully appreciate the importance of this matrix relies on the recognition of short- and long-term health benefits and, as highlighted in previous sections of this supplement, its ecology (i.e., interactions among the lactating parent and breastfed infant as well as within the context of the human milk matrix itself). Designing and interpreting studies to address this complexity depends on the availability of new tools and technologies that account for such complexity. Past efforts have often compared human milk to infant formula, which has provided some insight into the bioactivity of human milk, as a whole, or of individual milk components supplemented with formula. However, this experimental approach cannot capture the contributions of the individual components to the human milk ecology, the interaction between these components within the human milk matrix, or the significance of the matrix itself to enhance human milk bioactivity on outcomes of interest. This paper presents approaches to explore human milk as a biological system and the functional implications of that system and its components. Specifically, we discuss study design and data collection considerations and how emerging analytical technologies, bioinformatics, and systems biology approaches could be applied to advance our understanding of this critical aspect of human biology.
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Affiliation(s)
- Sharon M Donovan
- Department of Food Science and Human Nutrition, University of Illinois, Urbana-Champaign, IL, USA.
| | - Nima Aghaeepour
- Department of Anesthesiology, Pain, and Perioperative Medicine, Department of Pediatrics, and Department of Biomedical Data Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Aline Andres
- Arkansas Children's Nutrition Center and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Meghan B Azad
- Manitoba Interdisciplinary Lactation Centre (MILC), Children's Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health and Department of Immunology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Martin Becker
- Department of Anesthesiology, Pain, and Perioperative Medicine, Department of Pediatrics, and Department of Biomedical Data Sciences, School of Medicine, Stanford University, Stanford, CA, USA
| | - Susan E Carlson
- Department of Dietetics and Nutrition, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kirsi M Järvinen
- Department of Pediatrics, Division of Allergy and Immunology and Center for Food Allergy, University of Rochester Medical Center, New York, NY, USA
| | - Weili Lin
- Biomedical Research Imaging Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bo Lönnerdal
- Department of Nutrition, University of California, Davis, CA, USA
| | - Carolyn M Slupsky
- Department of Nutrition, University of California, Davis, CA, USA; Department of Food Science and Technology, University of California, Davis, CA, USA
| | | | - Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Raiten DJ, Steiber AL, Papoutsakis C, Rozga M, Handu D, Proaño GV, Moloney L, Bremer AA. The "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Project - executive summary. Am J Clin Nutr 2023; 117 Suppl 1:S1-S10. [PMID: 37173057 DOI: 10.1016/j.ajcnut.2022.12.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 11/30/2022] [Accepted: 12/12/2022] [Indexed: 05/15/2023] Open
Abstract
The public health community has come to appreciate that a deeper understanding of the biology of human milk is essential to address ongoing and emerging questions about infant feeding practices. The critical pieces of that understanding are that 1) human milk is a complex biological system, a matrix of many interacting parts that is more than the sum of those parts, and 2) human milk production needs to be studied as an ecology that consists of inputs from the lactating parent, their breastfed baby, and their respective environments. The "Breastmilk Ecology: Genesis of Infant Nutrition (BEGIN)" Project was designed to examine this ecology as well as its functional implications for both the parent and infant and to explore ways in which this emerging knowledge can be expanded via a targeted research agenda and translated to support the community's efforts to ensure safe, efficacious, and context-specific infant feeding practices in the United States and globally. The five working groups of the BEGIN Project addressed the following themes: 1) parental inputs to human milk production and composition; 2) the components of human milk and the interactions of those components within this complex biological system; 3) infant inputs to the matrix, emphasizing the bidirectional relationships associated with the breastfeeding dyad; 4) the application of existing and new technologies and methodologies to study human milk as a complex biological system; and 5) approaches to translation and implementation of new knowledge to support safe and efficacious infant feeding practices.
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Affiliation(s)
- Daniel J Raiten
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA.
| | | | | | - Mary Rozga
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - Deepa Handu
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | | | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, IL, USA
| | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Raiten DJ, Combs GF, Steiber AL, Bremer AA. Perspective: Nutritional Status as a Biological Variable (NABV): Integrating Nutrition Science into Basic and Clinical Research and Care. Adv Nutr 2021; 12:1599-1609. [PMID: 34009250 PMCID: PMC8483963 DOI: 10.1093/advances/nmab046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 01/26/2021] [Accepted: 03/18/2021] [Indexed: 01/02/2023] Open
Abstract
The field of nutrition has evolved from one focused primarily on discovery of the identities, metabolic functions, and requirements for essential nutrients to one focused on the application of that knowledge to the development and implementation of dietary recommendations to promote health and prevent disease. This evolution has produced a deeper appreciation of not only the roles of nutrients, but also factors affecting their functions in increasingly complex global health contexts. The intersection of nutrition with an increasingly more complex global health context necessitates a view of nutritional status as a biological variable (NABV), the study of which includes an appreciation that nutritional status is: 1) not limited to dietary exposure; 2) intimately and inextricably involved in all aspects of human health promotion, disease prevention, and treatment; and 3) both an input and an outcome of health and disease. This expanded view of nutrition will inform future research by facilitating considerations of the contexts and variability associated with the many interacting factors affecting and affected by nutritional status. It will also demand new tools to study multifactorial relations to the end of increasing precision and the development of evidence-based, safe, and effective standards of health care, dietary interventions, and public health programs.
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Affiliation(s)
| | - Gerald F Combs
- Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA,
USA
| | | | - Andrew A Bremer
- Pediatric Growth and Nutrition Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
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Murphy WJ, Yadrick MM, Steiber AL, Mohan V, Papoutsakis C. Academy of Nutrition and Dietetics Health Informatics Infrastructure (ANDHII): A Pilot Study on the Documentation of the Nutrition Care Process and the Usability of ANDHII by Registered Dietitian Nutritionists. J Acad Nutr Diet 2018; 118:1966-1974. [PMID: 29804870 DOI: 10.1016/j.jand.2018.03.013] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 03/16/2018] [Indexed: 11/19/2022]
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Steiber AL, Davis AT, Spry L, Strong J, Buss ML, Ratkiewicz MM, Weatherspoon LJ. Carnitine Treatment Improved Quality-of-Life Measure in a Sample of Midwestern Hemodialysis Patients. JPEN J Parenter Enteral Nutr 2017; 30:10-5. [PMID: 16387893 DOI: 10.1177/014860710603000110] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previously, we demonstrated that selected groups of hemodialysis patients might be more likely to have abnormalities of carnitine metabolism. The purpose of the present study was to examine the effects of carnitine therapy in these selected groups of hemodialysis patients on quality-of-life measures and erythropoietin dose. METHODS This was a double-blind, randomized, controlled trial, in which 50 hemodialysis patients were treated with either 2 g i.v. carnitine or placebo. The treatment period was for 24 weeks. RESULTS Thirty-four patients (15 in the treatment group) completed the study. The mean age was 69 +/- 15 years, 35% were women, and 44% had diabetes. Mean initial plasma total, free, short-chain acyl and long-chain acyl carnitine concentrations (micromol/L; mean +/- SEM) were 35.9 +/- 1.8, 18.2 +/- 1.1, 11.6 +/- 0.6, and 6.0 +/- 0.3, whereas the plasma acyl-to-free-carnitine ratio was 1.02 +/- 0.05. With respect to the Medical Outcomes Short Form-36 (SF-36), improvements from baseline were noted in the treatment group (n = 13) for role-physical (33.9 +/- 1.9 to 43.2 +/- 3.0, p < .05) and the SF-36 physical component summary score (36.1 +/- 2.7 to 39.7 +/- 2.3, p = .09) relative to changes in the control group (n = 14). The erythropoietin dose over the 24-week period was reduced from baseline in the treatment group relative to the placebo group (-1.62 +/- 0.91 vs 1.33 +/- 0.79 units erythropoietin/dry weight/hemoglobin concentration, respectively, p < .05). CONCLUSIONS After 24 weeks of i.v. carnitine therapy, SF-36 scores were improved and erythropoietin doses were reduced in hemodialysis patients, relative to the control group.
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Affiliation(s)
- Alison L Steiber
- Department of Nutrition, Case Western Reserve University, Cleveland, Ohio 44106, USA.
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Hand RK, Murphy WJ, Field LB, Lee JA, Parrott JS, Ferguson M, Skipper A, Steiber AL. Validation of the Academy/A.S.P.E.N. Malnutrition Clinical Characteristics. J Acad Nutr Diet 2016; 116:856-64. [DOI: 10.1016/j.jand.2016.01.018] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Indexed: 12/15/2022]
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Raiten DJ, Steiber AL, Hand RK. Executive summary: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:599S-605S. [PMID: 26791179 PMCID: PMC6459075 DOI: 10.3945/ajcn.115.124222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Preterm birth (infants born at <37 wk of gestational age) is a significant clinical and public health challenge in the United States and globally. No universally accepted practice guidelines exist for the nutritional care of preterm infants. To address the current state of knowledge and to support systematic reviews that will be used to develop evidence-informed guidance, a consortium consisting of the American Academy of Pediatrics, the ASN, the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, the Food and Drug Administration, the CDC, the USDA/Agricultural Research Service (USDA/ARS), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH initiated the Pre-B Project. The project included the constitution of 4 thematic working groups charged with the following tasks: 1) develop a series of topics/questions for which there is sufficient evidence to support a systematic review process to be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL), leading to the development of new guidelines for nutritional care of preterm infants, and 2) develop a targeted research agenda to address priority gaps in our understanding of the role of nutrition in the health and development of preterm/neonatal intensive care unit infants. This review consists of a project overview including a summary of a workshop hosted by the USDA/ARS Children's Nutrition Research Center and summary reports of the 4 working groups established to address the following themes: 1) nutrient specifications, 2) clinical/practical issues in enteral feeding, 3) gastrointestinal and surgical issues, and 4) current standards for assessing infant feeding outcomes. These reports will serve as the basis for the ultimate guideline development process to be conducted by the Academy of Nutrition and Dietetics' EAL.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD; and
| | | | - Rosa K Hand
- Academy of Nutrition and Dietetics, Chicago, IL
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Raiten DJ, Steiber AL, Carlson SE, Griffin I, Anderson D, Hay WW, Robins S, Neu J, Georgieff MK, Groh-Wargo S, Fenton TR. Working group reports: evaluation of the evidence to support practice guidelines for nutritional care of preterm infants-the Pre-B Project. Am J Clin Nutr 2016; 103:648S-78S. [PMID: 26791182 PMCID: PMC6459074 DOI: 10.3945/ajcn.115.117309] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.
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Affiliation(s)
- Daniel J Raiten
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, NIH, Bethesda, MD;
| | | | | | | | | | | | - Sandra Robins
- Fairfax Neonatal Associates at Inova Children's Hospital, Fairfax, VA
| | - Josef Neu
- University of Florida, Gainesville, FL
| | | | - Sharon Groh-Wargo
- Case Western Reserve University-School of Medicine, Cleveland, OH; and
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Hand RK, Abram JK, Brown K, Ziegler PJ, Parrott JS, Steiber AL. Development and Validation of the Guide for Effective Nutrition Interventions and Education (GENIE): A Tool for Assessing the Quality of Proposed Nutrition Education Programs. J Nutr Educ Behav 2015; 47:308-16.e1. [PMID: 25937019 DOI: 10.1016/j.jneb.2015.03.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 02/27/2015] [Accepted: 03/08/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To develop and validate the Guide for Effective Nutrition Interventions and Education (GENIE), a checklist of research-based quality indicators for nutrition education programs. DESIGN A prospective test of criterion validity and inter-rater reliability of a new tool comparing expert assessments and trained reviewer GENIE scores of the same nutrition education proposals. PARTICIPANTS Ten nutrition education experts; 13 volunteer reviewers. VARIABLES MEASURED GENIE's face, content, and criterion validity and inter-rater reliability compared using expert assessments and reviewer objective and subjective scores. ANALYSIS Reviewer scores compared using Spearman correlation. Inter-rater reliability tested using intra-class correlation (ICC), Cronbach alpha, and ANOVA. Criterion validity tested using independent t test and point bi-serial correlation to compare reviewer with expert scores. RESULTS Correlation found between total objective and total subjective scores. Agreement found between reviewers across proposals and categories considering subjective scores (F = 7.21, P < .001; ICC = 0.76 [confidence interval, 0.53-0.92]) and objective scores (F = 7.88, P < .001; ICC = 0.82 [confidence interval, 0.63-0.94]). Relationship was not significant (r = .564, P = .06) between expert and reviewer proposal scoring groups (high, medium, and low). CONCLUSIONS AND IMPLICATIONS Results support the validity and reliability of GENIE as a tool for nutrition education practitioners, researchers, and program funding agencies to accurately assess the quality of a variety of nutrition program plans.
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Affiliation(s)
- Rosa K Hand
- Academy of Nutrition and Dietetics, Chicago, IL.
| | | | - Katie Brown
- Academy of Nutrition and Dietetics Foundation, Chicago, IL
| | | | - J Scott Parrott
- Department of Interdisciplinary Studies, Rutgers University, Newark, NJ
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Murphy WJ, Hand RK, Steiber AL. Practicalities of Using the Nutrition Care Process in Research. J Ren Nutr 2015; 25:393-4. [PMID: 25753605 DOI: 10.1053/j.jrn.2014.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 12/23/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- William J Murphy
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Rosa K Hand
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
| | - Alison L Steiber
- Department of Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois
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Abram JK, Hand RK, Parrott JS, Brown K, Ziegler PJ, Steiber AL. What Is Your Nutrition Program Missing? Finding Answers with the Guide for Effective Nutrition Interventions and Education (GENIE). J Acad Nutr Diet 2015; 115:122-30. [DOI: 10.1016/j.jand.2014.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Indexed: 11/30/2022]
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Murphy WJ, Steiber AL. A New Breed of Evidence and the Tools to Generate It: Introducing ANDHII. J Acad Nutr Diet 2015; 115:19-22. [DOI: 10.1016/j.jand.2014.10.025] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Indexed: 01/08/2023]
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Hand RK, Steiber AL. Subjective global assessment remains an important nutrition assessment tool: response to Marcelli, DiBenedetto, Ciotola, Grassmann, and Canaud. J Ren Nutr 2014; 25:135. [PMID: 25446838 DOI: 10.1053/j.jrn.2014.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 09/16/2014] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rosa K Hand
- Dietetics Practice Based Research Network, Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Nutrition, Case Western Reserve University, Cleveland, Ohio.
| | - Alison L Steiber
- Research, International, and Scientific Affairs, Academy of Nutrition and Dietetics, Chicago, Illinois; Department of Nutrition, Case Western Reserve University, Cleveland, Ohio
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Steiber AL, León JB, Hand RK, Murphy WJ, Fouque D, Parrott JS, Kalantar-Zadeh K, Cuppari L. Using a web-based nutrition algorithm in hemodialysis patients. J Ren Nutr 2014; 25:6-16. [PMID: 25193109 DOI: 10.1053/j.jrn.2014.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 03/15/2014] [Accepted: 06/12/2014] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES The purpose of this study was to test the ability of a newly developed nutrition algorithm on (1) clinical utility and (2) ability to capture patient outcomes. RESEARCH DESIGN This was a prospective observational study, using a practice based research network structure, involving renal dietitians and hemodialysis [HD] patients. SETTING This study took place in HD outpatient units in five different countries. SUBJECTS Hundred chronic HD patients were included in this study. To select subjects, dietitians screened and consented patients in their facilities until 4 patients "at nutrition risk" based on the algorithm screening tool were identified. Inclusion criteria were patients aged older than 19 years, not on hospice or equivalent, able to read the informed consent and ask questions, and receiving HD. MAIN OUTCOME MEASURE The ability of the algorithm screening tool is to identify patients at nutrition risk, to guide clinicians in logical renal-modified nutrition care process chains including follow-up on relevant parameters, and capture change in outcomes over 3 months. Statistics were performed using SPSS version 20.0 and significance was set at P < .05. RESULTS One hundred patients on HD, enrolled by 29 dietitians, were included in this analysis. The average number of out-of-range screening parameters per patient was 3.7 (standard deviation 1.5, range 1-7), and the most prevalent risk factors were elevated parathyroid hormone (PTH; 62.8%) and low serum cholesterol (56.5%). At the initial screening step, 8 of the 14 factors led to chains with nonrandom selection patterns (by χ(2) test with P < .05). In the subsequent diagnosis step, patients diagnosed within the insufficient protein group (n = 38), increased protein intake by 0.11 g/kg/day (P = .022). In patients with a diagnosis in the high PTH group, PTH decreased by a mean of 176.85 pg/mL (n = 19, P = .011) and in those with a diagnosis in the high phosphorous group, serum phosphorous decreased by a mean of 0.91 mg/dL (n = 33, P = .006). Finally, the relative likelihood of each assessment being completed after making the related diagnosis at the previous visit compared with those for whom that diagnosis was not made was assessed, including the likelihood of a patient's protein intake assessed after a diagnosis in the insufficient protein group was made (odds ratio = 4.08, P < .05). CONCLUSIONS This study demonstrates the clinical utility of a web-based HD-specific nutrition algorithm, including the ability to track changes in outcomes over time. There is potential for future research to use this tool and investigate the comparative impact of nutrition interventions.
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Affiliation(s)
- Alison L Steiber
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Academy of Nutrition and Dietetics, Chicago, Illinois.
| | - Janeen B León
- Division of Nephrology, Center for Reducing Health Disparities, MetroHealth Medical Center, Cleveland, Ohio
| | - Rosa K Hand
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, Ohio; Academy of Nutrition and Dietetics, Chicago, Illinois
| | | | - Denis Fouque
- Département de Néphrologie, Hôpital E.Herriot, Lyon, France
| | - J Scott Parrott
- Department of Interdisciplinary Studies, Rutgers, Newark, New Jersey
| | - Kamyar Kalantar-Zadeh
- Pediatrics and Public Health, University of California, Irvine, Torrance, California
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Erb ED, Hand RK, Steiber AL. SGA Scores Have Poor Correlation With Serum Albumin in Obese Hemodialysis Patients: A Secondary Analysis. J Ren Nutr 2014; 24:268-71. [DOI: 10.1053/j.jrn.2014.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Revised: 03/07/2014] [Accepted: 03/19/2014] [Indexed: 11/11/2022] Open
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Abstract
Chronic kidney disease (CKD) is highly prevalent and has major health consequences for patients. Caring for patients with CKD requires knowledge of the food supply, renal pathophysiology, and nutrition-related medications used to work synergistically with diet to control the signs and symptoms of the disease. The nutrition care process and International Dietetic and Nutrition Terminology allow for systematic, holistic, quality care of patients with this complex, progressive disease. Nutrition interventions must be designed with the individual patients needs in mind while prioritizing factors with the largest negative impact on health outcomes and mortality risk. New areas of nutrition treatment are emerging that involve a greater focus on micronutrient needs, the microbiome, and vegetarian-style diets. These interventions may improve outcomes by decreasing inflammation, improving energy and protein delivery, and lowering phosphorus, electrolytes, and fluid retention.
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Vero LM, Byham-Gray L, Parrott JS, Steiber AL. Use of the Subjective Global Assessment to Predict Health-Related Quality of Life in Chronic Kidney Disease Stage 5 Patients on Maintenance Hemodialysis. J Ren Nutr 2013; 23:141-7. [DOI: 10.1053/j.jrn.2012.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Revised: 03/13/2012] [Accepted: 03/14/2012] [Indexed: 12/28/2022] Open
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Reuter SE, Evans AM, Steiber AL. Effectiveness of l-carnitine supplementation in patients with erythropoietin-resistant anemia. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.04.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Steiber AL, Kopple JD. Vitamin status and needs for people with stages 3-5 chronic kidney disease. J Ren Nutr 2011; 21:355-68. [PMID: 21439853 DOI: 10.1053/j.jrn.2010.12.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 12/10/2010] [Accepted: 12/11/2010] [Indexed: 02/07/2023] Open
Abstract
Patients with chronic kidney disease (CKD) often experience a decline in their nutrient intake starting at early stages of CKD. This reduction in intake can affect both energy-producing nutrients, such as carbohydrates, proteins, and fats, as well as vitamins, minerals, and trace elements. Knowledge of the burden and bioactivity of vitamins and their effect on the health of the patients with CKD is very incomplete. However, without sufficient data, the use of nutritional supplements to prevent inadequate intake may result in either excessive or insufficient intake of micronutrients for people with CKD. The purpose of this article is to briefly summarize the current knowledge regarding vitamin requirements for people with stages 3, 4, or 5 CKD who are not receiving dialysis.
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Affiliation(s)
- Alison L Steiber
- Department of Nutrition, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA.
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Anderson SR, Gilge DA, Steiber AL, Previs SF. Diet-induced obesity alters protein synthesis: tissue-specific effects in fasted versus fed mice. Metabolism 2008; 57:347-54. [PMID: 18249206 PMCID: PMC2323208 DOI: 10.1016/j.metabol.2007.10.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 10/29/2007] [Indexed: 11/28/2022]
Abstract
The influence of obesity on protein dynamics is not clearly understood. We have designed experiments to test the hypothesis that obesity impairs the stimulation of tissue-specific protein synthesis after nutrient ingestion. C57BL/6J mice were randomized into 2 groups: group 1 (control, n = 16) was fed a low-fat, high-carbohydrate diet, whereas group 2 (experimental, n = 16) was fed a high-fat, low-carbohydrate diet ad libitum for 9 weeks. On the experiment day, all mice were fasted for 6 hours and given an intraperitoneal injection of (2)H(2)O. They were then randomized into 2 subgroups and either given a sham saline gavage or a liquid-meal challenge. Rates of protein synthesis were determined via the incorporation of [(2)H]alanine (5 hours postchallenge) into total gastrocnemius muscle protein, total liver protein, and plasma albumin. High-fat feeding led to an increase in total body fat (P < .001) and epididymal fat pad weights (P < .001) and elevated fasting plasma glucose levels (P < .01). Diet-induced obesity (a) did not affect basal rates of skeletal muscle protein synthesis, but did impair the activation of skeletal muscle protein synthesis in response to nutrient ingestion (P < .05), and (b) slightly reduced basal rates of synthesis of total hepatic proteins and plasma albumin (P = .10), but did not affect the synthesis of either in response to the meal challenge. In conclusion, there are alterations in tissue-specific protein metabolism in the C57BL/6J mouse model of diet-induced obesity. This model may prove to be helpful in future studies that explore the mechanisms that account for altered protein dynamics in obesity.
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Affiliation(s)
- Stephanie R. Anderson
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH 44106
| | - Danielle A. Gilge
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH 44106
| | - Alison L. Steiber
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH 44106
| | - Stephen F. Previs
- Department of Nutrition, Case Western Reserve University School of Medicine, Cleveland, OH 44106
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44106
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Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: A review. J Ren Nutr 2004. [DOI: 10.1053/j.jrn.2004.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: a review. J Ren Nutr 2004; 14:191-200. [PMID: 15483778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
Nutritional assessment of patients with chronic kidney disease is a vital function of health care providers. Subjective Global Assessment (SGA) is a tool that uses 5 components of a medical history (weight change, dietary intake, gastrointestinal symptoms, functional capacity, disease and its relation to nutritional requirements) and 3 components of a brief physical examination (signs of fat and muscle wasting, nutrition-associated alternations in fluid balance) to assess nutritional status. SGA was originally used to predict outcomes in surgical patients; however, its use has gone beyond this function and population. In chronic kidney disease patients, SGA is incorporated into the complete nutritional assessment. Validation of SGA as a screening tool for surgical patients was done by Detsky et al in 1984. Since that time, SGA has been altered by different researchers and clinicians to better meet the needs of the patients they served. Validation of the altered SGA formats has not been thoroughly done. Further work in establishing validity and reliability of each version of SGA in different patient populations should be done to enable clinicians and researchers to properly use this nutritional assessment tool.
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Affiliation(s)
- Alison L Steiber
- Department of Nutrition, Case Western Reserve University, Cleveland, OH 44106, USA
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Steiber AL, Kalantar-Zadeh K, Secker D, McCarthy M, Sehgal A, McCann L. Subjective Global Assessment in chronic kidney disease: A review. J Ren Nutr 2004. [DOI: 10.1016/s1051-2276(04)00139-6] [Citation(s) in RCA: 130] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
Carnitine metabolism and the therapeutic use of carnitine has been a major area of interest in dialysis patients. The purpose of this study was to determine whether any correlations exist between carnitine status and selected clinical parameters in hemodialysis (HD) patients. This study was an observational study of data from patients receiving HD at a Midwest dialysis center. The subjects (n=49) were 60+/-16 (mean+/-SD) years of age and 48% male. Fifteen percent of the subjects had type 1 diabetes mellitus (DM), 29% had type 2 DM, and 25% had left ventricular hypertrophy (LVH). The serum-free and total carnitine, and acylcarnitine concentrations were: 40.3+11.8 microm/l, 22.8+/-7.3, and 17.5+/-5.9 microm/l, respectively. The serum acylcarnitine to free carnitine ratio (A/F) was 0.80+/-0.27. Blood urea nitrogen (BUN), parathyroid hormone and ejection fraction were positively correlated and age and left atrial dilation (cm) were negatively correlated with serum total carnitine (P<0.05). BUN and hematocrit were positively correlated (P<0.05) and age was negatively correlated with free carnitine. Subjects who used mannitol or were male had significantly higher concentrations of both free and total carnitine, respectively (P<0.05). Subjects using aspirin had lower concentrations of serum total carnitine (P<0.10). These results suggest certain subgroups of patients may need to be targeted for further studies with carnitine replacement therapy, i.e. long-term patients, older patients, patients with left verticular hypertrophy and left atrial enlargement, females and patients on aspirin therapy.
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Affiliation(s)
- A L Steiber
- Michigan State University, 334 GM Trout Building, Food Science and Human Nutrition Department, East Lansing, MI 48824, USA.
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Steiber AL, Handu DJ, Cataline DR, Deighton TR, Weatherspoon LJ. The impact of nutrition intervention on a reliable morbidity and mortality indicator: the hemodialysis-prognostic nutrition index. J Ren Nutr 2003; 13:186-90. [PMID: 12874742 DOI: 10.1016/s1051-2276(03)00078-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE To determine the prevalence of risk for hospitalization in hemodialysis (HD) patients and examine the impact of oral kilocalorie and protein supplementation in two Midwestern outpatient dialysis centers. DESIGN/SETTING This was a prospective intervention study conducted at 2 outpatient dialysis centers in the Midwest. PATIENTS The inclusion criteria for patients were (1) more than 18 years of age, (2) receiving HD 3 times per week, and (3) a functioning gastrointestinal tract. INTERVENTION Patients who met study criteria and signed an informed consent form were screened using the hemodialysis prognostic nutrition index (HD-PNI) to determine risk for hospitalization. Patients determined to be at high risk (HD-PNI > or =0.8) were included in the treatment group, and patients at low risk did not receive the intervention. They followed their normal nutritional regimen. The intervention group received an oral supplement daily for 3 months. The team of the dietitian, patient, researcher, and physician determined the type of oral supplements based on patient needs and preferences. MAIN OUTCOME MEASURES Before and after HD-PNI, 24-hour recall and subjective global assessments (SGA) were conducted to assess risk for hospitalization, dietary intake, and nutritional status, respectively. RESULTS A total of 117 patients were screened, with a total of 26 in the treatment group (high risk) and 91 in the low-risk group. Baseline SGA distribution was 23% for patients with low nutritional risk (group A), 64% for those with moderate nutritional risk (group B), and 13% for those with severe nutritional risk (group C). When the HD-PNI scores of the treatment group were analyzed using paired t-tests, significant differences were observed between pre- and post-HD-PNI mean scores, 1.92 +/- 1.16 and 1.42 +/- 1.59, (P <.05) respectively. When comparing the responders versus the nonresponders by the dependent and independent variables (pre- and post-HD-PNI, SGA, kilocalorie intake, diabetic status, and presence of hypertension) only post-HD-PNI score was significantly different (0.96 +/- 1.69 and 2.20 +/- 1.09, respectively). CONCLUSION This study succeeded in showing that 22% of the hemodialysis patients in 2 Midwestern centers were at an increased risk for hospitalization. Furthermore, dietitian intervention with oral kilocalorie and protein supplements decreased the patients' hemodialysis prognostic nutrition index scores and thereby decreased the patients' risks for hospitalization.
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Affiliation(s)
- Alison L Steiber
- Food Science and Human Nutrition Department, Michigan State University, East Lansing, MI 48824, USA
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Abstract
OBJECTIVE The objective of this study was to determine whether any differences existed between specific admission variables and uremic status in patients with chronic renal failure receiving dialysis. DESIGN AND SETTING This was a prospective, observational study conducted at BryanLGH Medical Center East Campus in Lincoln, Nebraska. PATIENTS The subjects were hemodialysis and peritoneal dialysis patients admitted to an acute care facility, who met the following inclusion criteria: (1) they had a primary or secondary underlying diagnosis of chronic renal failure, and (2) they were not receiving parenteral or enteral tube feeding nutritional support on admission. INTERVENTION The patients were separated into 2 groups by their blood urea nitrogen (BUN) concentrations. Group 1 had a BUN concentration less than 50 and group 2 had a BUN concentration greater than or equal to 50. Admission data (age, sex, percentage of ideal body weight, reported retrospective weight loss over time, type of dialysis, gastrointestinal history, BUN and creatinine concentrations, and dietary prescription) were collected from patient medical records. Two-day kilocalorie and protein counts were conducted on the patients within 24 hours of admission to the acute care facility. Chi-square and 1-way analysis of variance were performed to compare the groups. RESULTS The total number of participants in the study was 42, with 21 in each BUN group. The mean age was 60 years, and the dietary intake was a mean of 10 kcal/kg and 0.4 g protein/kg. Only 14.3% and 7.1% of the patients met their kcal and protein needs, respectively. The mean percentage ideal body weight was 125 and the mean reported weight loss per week was 2.6 pounds. Gastrointestinal symptoms, specifically nausea and a kilocalorie-restricted diet prescription, were significantly different between the 2 groups. Patients in group 2 were more likely to have gastrointestinal symptoms overall (P < .05) specifically, nausea (P <.05). Group 1 patients were also more frequently placed on a kilocalorie-restricted diet (P < .05) than patients in group 2. CONCLUSIONS A BUN concentration between 50 and 110 has been shown to be associated with a lower risk of death and a better nutritional status. These findings indicate symptoms commonly associated with uremia, such as nausea, may be associated with the dialysis patient's nutritional status when BUN concentrations are greater than 50. These dialysis patients were not receiving sufficient kilocalories and protein on admission into the hospital, and this can affect their nutritional and, eventually, survival status.
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Affiliation(s)
- Alison L Steiber
- Food Science and Human Nutrition Department, Michigan State University, East Lansing, MI 48824, USA
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Abstract
OBJECTIVE The purpose of this study was twofold: (1) to determine the incidence of patients with chronic renal failure (CRF) who consume less than 75% of their estimated nutritional needs, and (2) to identify factors associated with an oral intake less than 75% of the estimated nutritional needs of patients with CRF. DESIGN Prospective, descriptive, correlational study of data obtained from patients with a diagnosis of CRF. SETTING BryanLGH Medical Center East Campus, Lincoln, NE. PATIENTS Sixty-six patients included on this study met the following criteria: (1) a primary or secondary underlying diagnosis of CRF and (2) not receiving parenteral or enteral (tube feeding) nutritional support on admission. INTERVENTION Admission data (age, sex, percentage of ideal body weight, weight loss/time, type of dialysis, gastrointestinal history, blood urea nitrogen and creatinine levels, and diet) were collected from the patients' medical records and 2-day kilocalorie (kcal)/protein counts were conducted on consecutive patients admitted to the hospital. The kcal/protein counts were initiated within 24 hours of admission and consisted of six meals and all snacks the patient received. MAIN OUTCOME MEASURE Only 15% of the patients met 75% or greater of their estimated kcal needs, and 12% met 75% or greater of their estimated protein needs. The mean kcal/kg intake was 11 kcal/kg, with a range of 0 to 27 kcal/kg, and the mean protein/kg intake was 0.42 g of protein/kg, with a range of 0 to 10 g of protein/kg. Of the variables studied for associations with decreased nutrient intake, only emesis mildly correlated with kcal intake. CONCLUSION Less than one quarter of the patients on this study met 75% or greater of their kcal and protein needs. The average kcal and protein intakes found in this study were far less than current recommendations for hemodialysis, continuous ambulatory peritoneal dialysis, and predialysis patients. However, the results of this study could lead to earlier and more aggressive interventions in patients with CRF at risk for poor oral intake.
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Affiliation(s)
- A L Steiber
- BryanLGH Medical Center East Campus, Lincoln, NE, USA
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