Implementation of an Evidence-Based Renal Nutrition Practice Guideline: The AUGmeNt Study.

Phosphate balance could be reached only by an optimized combination of dietary restriction and the careful use of phosphate binders for patients receiving standard hemodialysis treatment. Little is known about individual variability of phosphorus intake and phosphate binder use in hemodialysis patients. The purposes of this study were to quantify phosphorus intake and to describe individual phosphate-binder use in hemodialysis patients. This was a cross-sectional study. The dietary phosphorus intake was assessed using a 3-day duplicate portion sampling method combined with chemical analysis. Patients' adherence to phosphate binders was evaluated by the Morisky Medication Adherence Scale, with a score of <6 being considered as an indicator of inadequate adherence. A total of 101 food samples from 36 patients were collected and analyzed. The mean daily phosphorus, protein, and energy intake was 15.1 mg/kg/d, 1.0 g/kg/d, and 28.9 kcal/kg/d, respectively. There was a higher consumption of phosphorus on dialysis days (DDs) than on non-dialysis days (NDDs) (16.2 mg/kg/d vs. 14.0 mg/kg/d, P = 0.035); however, such a trend was not observed for dietary protein and energy intake (1.1 g/kg/d vs. 1.0 g/kg/d, P = 0.706; 30.3 kcal/kg/d vs. 27.6 kcal/kg/d, P = 0.225). A significantly higher percentage of patients on low phosphorus intake (<1000 mg/d) reported inadequate phosphate-binding adherence than those on high phosphorus intake (60% vs. 18%, P = 0.031). Patients receiving hemodialysis had a higher consumption of phosphorus on DDs than on NDDs; such a pattern was not obviously observed for protein and energy intake. For patients achieving phosphorus intake recommendation, medication nonadherence that possibly being attributed to the patient's necessity beliefs may pose extra hurdles for phosphate control.

The Importance of Nutrition Post-Discharge Interventions

Unleashing the Power of Renal Nutrition in Value-Based Models of Kidney Care Choices: Leveraging Dietitians’ Expertise and Medical Nutrition Therapy to Delay Dialysis Initiation

Customized nutrition intervention and personalized counseling helps achieve nutrition targets in perioperative liver transplant patients

Effect of two different nutritional supplements on postprandial glucose response and energy- and protein intake in hospitalised patients with COPD: A randomised cross-over study

Information regarding attenuation of weight loss in patients with head and neck cancer consuming energy and protein intakes at levels recommended by the European Society of Parenteral and Enteral Nutrition (ESPEN) is limited. Newly diagnosed patients with head and neck cancer (n = 38) consuming food orally had weight and 3-day diet records prospectively collected at baseline, the end of treatment, and at the 2.5-month follow-up. Weight loss of patients consuming the ESPEN recommendations of ≥30 kcal/kg/d energy and 1.2 g/kg/d protein versus those consuming less were compared. Weight loss of oral nutrition supplement consumers versus oral nutrition supplement nonconsumers was also compared. Despite ≥30 kcal/kg/d intakes at posttreatment and follow-up, mean weight loss was 10.3% from baseline to posttreatment, and 4.0% from posttreatment to follow-up. At posttreatment, oral nutrition supplement consumers with intakes ≥30 kcal/kg/d lost twice as much weight as nonconsumers with intakes of ≥30 kcal/kg/d (p = .001). Current ESPEN recommendations may not attenuate weight loss in patients with head and neck cancer, especially those consuming oral nutrition supplements. © 2016 Wiley Periodicals, Inc. Head Neck 38:1248-1257, 2016.

This study aimed to evaluate the effects of high-protein oral nutritional supplements (ONS) on nutritional status, physical function, and quality of life in older gastric cancer patients undergoing neoadjuvant chemotherapy (NAC). A prospective, randomized controlled trial was conducted between February 2023 and February 2024, including 46 patients aged 65 or older with newly diagnosed, locally advanced gastric cancer. Participants were randomized into two groups: an intervention group receiving high-protein ONS in addition to standard nutrition care, and a control group receiving only standard nutrition care. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), physical function was evaluated through handgrip strength, Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) scales, and health-related quality of life was measured using the EORTC QLQ-C30. Bioelectrical impedance was used to analyze body composition. Among the 46 patients (23 in each group), baseline characteristics were similar between the groups (p > 0.05). The ONS group showed significantly higher energy and protein intake than the control group (p < 0.05). MNA scores improved significantly in the ONS group after 8weeks (p < 0.001), with a reduction in malnutrition risk to 4.3%, compared to 17.4% in the control group (p = 0.003). ADL and IADL scores remained stable in both groups, and both groups reduced functions and increased symptoms of HRQL over 8weeks. Emotional functioning scores significantly declined in both groups over the 8-week period (ONS group: from 91.7 [16.67] to 83.3 [8.33], p = 0.001; non-ONS group: from 91.7 [8.33] to 83.3 [16.67], p = 0.011). Fatigue levels also increased markedly in both groups (ONS: from 11.1 [11.11] to 49.3 ± 17.02; non-ONS: from 22.2 [11.11] to 44.4 [22.22], p < 0.001). Additionally, constipation symptoms worsened significantly in the non-ONS group by week 8 (p = 0.008). High-protein ONS improved nutritional status and reduced malnutrition risk in older gastric cancer patients undergoing NAC. Further research is needed to assess the long-term effects of ONS on physical function and quality of life. Registered under ClinicalTrials.gov Identifier no. NCT06645912.

Associations of Dietary Protein and Energy Intakes With Protein-Energy Wasting Syndrome in Hemodialysis Patients

Current management of malnutrition can include prescribed oral nutritional supplements (ONS); however, there is uncertainty whether these supplements are effective in people who are older (≥65 years) and frail. We assessed the effectiveness, cost-effectiveness, and adherence and acceptability of ONS in frail older people who are malnourished or at risk of malnutrition. In this systematic review and meta-analysis, five bibliographic databases (MEDLINE, EMBASE, Cochrane Library, Scopus, and CINAHL) and grey literature sources were searched from inception to Sept 13, 2021, to identify studies assessing the effectiveness and cost-effectiveness of ONS (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. Multiple reviewers independently did study screening, data extraction, and risk of bias assessment. Quality was assessed using version 1.0 of the Cochrane risk of bias tool for randomised controlled trials (RCTs), and the BMJ Drummond checklist was used to assess the quality of the included cost-effectiveness study. A meta-analysis was done for the effectiveness review; for the other reviews, a narrative synthesis approach was used. This systematic review and meta-analysis was registered on PROSPERO, CRD42020170906. Of 8492 records retrieved and screened, we included 11 RCTs involving 822 participants, six of which were fully or partly funded by industry. For the majority of the outcomes for which meta-analyses were possible (11/12), Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) assessments suggested that the evidence was of very low certainty. Results suggested that ONS might have a slightly positive effect on energy (kcal) intake (standardised mean difference 1·02 [95% CI 0·15 to 1·88]; I2=87%; four studies), protein intake (standardised mean difference 1·67 [-0·03 to 3·37; I2=97%; four studies), and mobility (mean difference 0·03 [0·02 to 0·04]; I2=0%; four studies), compared with standard care. Narrative syntheses suggested that the effect of ONS on quality of life, compared with standard care, was mixed. In the identified studies, there was very little information related to active components, determinants, or acceptability of interventions. One economic evaluation, done in a care home setting, showed that ONS could be cost-effective. We found little evidence of ONS reducing malnutrition or its associated adverse outcomes in older people who are frail. High-quality, non-industry-funded, adequately powered studies reporting on short-term and long-term health outcomes, determinants, and participant characteristics are needed. UK National Institute of Health and Care Research (NIHR) Health Technology Assessment (NIHR128729).

Oral nutritional supplements (ONS) are high-energy and protein-rich nutrition drinks that are commonly prescribed to individuals with compromised nutritional status. Aged care residents requiring texture-modified diets are exposed to poor oral intake and malnutrition. This study aimed to investigate the dietary intake and nutritional status of residents consuming texture-modified diets with and without ONS. This multicentre cross-sectional study included 85 residents consuming texture-modified diets (86.0 ± 8.7 y; n = 46 requiring ONS and n = 39 without ONS). A one-day dietary record was completed using a validated visual plate waste estimation method. To determine the adequacy, nutrition intake was then calculated using FoodWorks (Xyris Ltd., Brisbane, Australia) and compared to the recommended dietary intake for Australia and New Zealand. The Mini-Nutritional Assessment Short Form was collected to assess nutritional status. Residents receiving ONS had significantly higher energy, protein, carbohydrates and fat intake than those who did not consume ONS (p < 0.05). No significant differences were found in saturated fat, fibre or sodium intake. With the administration of ONS, residents were able to meet their protein requirement but fell short of their energy and carbohydrates requirements. Both groups had inadequate fibre intake and a high saturated fat intake. A total of 48% of the residents were at risk of malnutrition and 38% were malnourished. Aged care residents requiring texture-modified diets are at high risk of malnutrition as a result of inadequate dietary intake. Administration of ONS may be an effective strategy to optimise nutrition intake.

Background and purpose: Diarrhea is a common side effect in cancer patients, especially during chemotherapy or antibiotic treatment. Managing this symptom is important for patient comfort, hydration, and nutritional status. Fibre, an important component of many oral nutritional supplements (ONS) formulations, has been shown to influence bowel function, including diarrhea. This case study examines the role of fibre proportion in ONS for managing diarrhea in two cancer patients undergoing treatment. Case presentation: Both patients initially experienced persistent diarrhea despite switching to fibre-based ONS. Upon transitioning to an ONS with an equal ratio of soluble to insoluble fibre, both patients showed improved stool consistency and bowel open frequencies with optimal energy and protein intake. Discussion: The proportion of soluble to insoluble fibre in ONS may play a crucial role in managing diarrhea among cancer patients. While achieving adequate total fibre intake is important, healthcare providers may need to consider not just the quantity but also the quality and proportion of fibre in nutritional interventions. Soluble fibre-enriched ONS may offer benefits for reducing diarrhea, while high insoluble fibre content could aggravate the condition. Conclusion: A careful consideration of the types and proportions of fibre may be necessary for optimal symptom management. A tailored approach that accounts for the patient’s specific needs is essential in optimizing nutritional care and improving quality of life.

BackgroundOne previous study examined implementation of evidence-based nutrition practice guidelines (EBNPG).ObjectivesTo describe alignment of registered dietitian nutritionists' (RDNs) documented nutrition care with the Academy of Nutrition and Dietetics' EBNPG for Type 1 and Type 2 diabetes and examine impact of a midpoint training on care alignment with the guideline.MethodsIn this 2-year, quasi-experimental study, 19 RDNs providing outpatient medical nutrition therapy to adults with diabetes (n = 562) documented 787 initial and follow-up encounters. At study midpoint, RDNs received a guideline content training. A validated, automated tool was used to match standardized nutrition care process terminology (NCPT) in the documentation to NCPT expected to represent guideline implementation. A congruence score ranging from 0 (recommendation not identified) to 4 (recommendation fully implemented) was generated based on matching. Multilevel linear regression was used to examine pre-to-post training changes in congruence scores.ResultsMost patients (~75%) had only one documented RDN encounter. At least one guideline recommendation was fully implemented in 67% of encounters. The recommendations “individualize macronutrient composition” and “education on glucose monitoring” (partially or fully implemented in 85 and 79% of encounters, respectively) were most frequently implemented. The mean encounter congruence scores were not different from pre-to-post guideline training (n = 19 RDNs, 519 encounters pre-training; n = 14 RDNs, 204 encounters post-training; β = −0.06, SE = 0.04; 95% CI: −0.14, 0.03).ConclusionsMost RDN encounters had documented evidence that at least one recommendation from the EBNPG was implemented. The most frequently implemented recommendations were related to improving glycemic control. A midpoint guideline training had no impact on alignment of care with the guideline.

Nutrition-Focused Physical Exam (NFPE) feasibility is not well-studied. We describe registered dietitian nutritionist (RDN)-reported NFPE completion for hospitalized adult and pediatric patients overall and by assessment parameters. Trained RDNs systematically conducted NFPEs for hospitalized adult and pediatric patients during the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition Indicators to diagnose Malnutrition multisite cohort study (ClinicalTrials.gov: NCT03928548). RDNs reported their ability to evaluate assessment sites for subcutaneous fat and muscle loss, fluid accumulation, and micronutrient status and to complete handgrip strength (adults and children ≥6 years) and mid-upper arm circumference measurements (children). RDNs noted if they could complete the full NFPE; if not, they noted challenges. We descriptively summarized results and used multilevel logistic regression models to examine relationships between patient characteristics and NFPE completion. RDNs from 39 adult and 29 pediatric US hospitals conducted NFPEs for 327 adults and 214 children aged 1 month to 17.9 years. RDNs reported completing the examination for 44% (n = 145) of adults and 15% (n = 33) of children. They successfully evaluated 25 of 27 and 19 of 26 unique NFPE components in >80% of adults and children, respectively. Common reasons the full NFPE was not completed were limited mobility in adults and patient refusal in children. RDNs had lower odds of completing NFPEs in adults with lower vs higher education levels or higher vs lower nutrition complexity and in younger vs older children. RDNs evaluated NFPE components for a high proportion (>80%) of hospitalized patients.

Impaired growth, accompanied by low lean mass and poor bone mineralization in undernourished children, is linked to adverse short- and long-term health outcomes. Oral nutritional supplements (ONS) promote catch-up growth, but their efficacy in improving lean mass and bone mineralization remains uninvestigated. This study aims to compare the efficacy of long-term ONS with dietary counseling (DC) versus DC alone on growth, body composition, bone mineralization, and health outcomes in children with or at risk of undernutrition. Children (n = 330) aged 24-60months with WHO Growth Standard z-scores of weight-for-age < - 1, height-for-age < - 1, and weight-for-height < 0 were randomized in a multisite controlled trial to receive two servings of a complete and balanced ONS formula with DC, or DC-only, for 240days. Anthropometric measurements, dietary intake, and parent-reported measures of illness-related and other health outcomes were assessed at baseline and days 30, 120, and 240. Dual X-ray absorptiometry-assessed body composition and bone mineralization, and nutritional blood biomarkers were measured at baseline and day 240. ONS supplementation augmented growth in height and weight through day 240, with increasing between-group differences over visits (P < 0.01 for treatment-by-visit interaction in height, weight, height-for-age and weight-for-age z-scores). Energy and protein intake levels were 26% and 22% higher, respectively, in the ONS + DC compared to the DC-group at day 240 (both P < 0.001). The ONS + DC group also had a higher lean mass index of 11.06 (0.05) versus 10.92 (0.05) kg/m2 (P = 0.048) and total body less head bone mineral density of 0.407 (0.003) versus 0.399 (0.003) g/cm2 (P = 0.03) at day 240, with no differences in fat mass index compared to DC. The ONS + DC group also had better serum vitamin D and K status, fewer sick and missed school days, better parent-reported sleep habits, appetite, energy, and physical activity levels versus DC-group (all P < 0.05). Adding ONS to DC for 8months improved linear catch-up growth and supported quality growth, as evidenced by greater lean mass and bone mineral accretion. These findings, alongside parent-reported improvements in child health, suggest that improved nutrient intake with ONS improves multiple domains of child health and well-being. This clinical trial was registered on ClinicalTrials.gov (registration number: NCT05239208) on 14 February 2022. Video Abstract.

Oral Nutritional Supplements Containing (n-3) Polyunsaturated Fatty Acids Affect the Nutritional Status of Patients with Stage III Non-Small Cell Lung Cancer during Multimodality Treatment1–3