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HOMEFOOD randomized trial-beneficial effects of 6-month nutrition therapy on body weight and physical function in older adults at risk for malnutrition after hospital discharge.
Blondal, BS, Geirsdottir, OG, Beck, AM, Halldorsson, TI, Jonsson, PV, Sveinsdottir, K, Ramel, A
European journal of clinical nutrition. 2023;77(1):45-54
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Malnutrition, which is commonly observed among older adults, is strongly associated with altered body composition, diminished physical and mental function as well as other adverse clinical outcomes. The aim of this study was to investigate the effects of intense nutritional therapy, including free access to energy- and protein-dense foods delivered to subjects recently discharged from hospital. This study is a 6-month, randomised controlled, assessor blinded intervention trial conducted in older adults. The participants (n=106) were randomly allocated to either the intervention or the control group. Results show that the nutrition intervention: - had strong beneficial effects on body weight (moderate weight gain in the intervention group compared to weight loss in the control group) and other anthropometric measures; - had favourable effects on physical function (however, there were no changes in muscular strength), and - led to improved nutritional status after being discharged from hospital (whereas the dietary intake decreased dramatically in the control group despite being informed at discharge of the importance of nutrition). Authors conclude that a 6-month nutrition therapy provided by a clinical nutritionist, following the principles of Nutrition Care Process in combination with freely delivered supplemental energy- and protein-dense foods, has beneficial effects on body weight, physical function, dietary intake, and nutritional status.
Abstract
BACKGROUND/OBJECTIVES Malnutrition is common among older adults. Dietary intervention studies in older adults aiming to improve anthropometrics measures and physical function have been inconsistent. We aimed to investigate the effects of nutrition therapy in combination with home delivered meals and oral nutritional supplements (ONS) in community-dwelling older adults discharged from hospital. METHODS A total of 106 participants (>65 years) were randomized into the intervention group (n = 53) and into the control group (n = 53). The intervention group received individual nutrition therapy (five in person visits and three phone calls) and freely delivered energy- and protein- rich foods, while the control group received standard care. Dietary intake, anthropometrics, and short physical performance battery (SPPB) were assessed at baseline and at endpoint. RESULTS Energy intake at baseline was similar in both groups (~1500 kcal at the hospital) but there was a significant increase in energy intake and body weight in the intervention group (+919 kcal/day and 1.7 kg, P < 0.001 in both cases) during the study period, compared to a significant decrease in both measures among controls (-815 kcal/day and -3.5 kg, P < 0.001 in both cases). SPPB score increased significantly in the intervention group while no changes were observed among controls. CONCLUSIONS Most Icelandic older adults experience substantial weight loss after hospital discharge when receiving current standard care. However, a 6-month multi-component nutrition therapy, provided by a clinical nutritionist in combination with freely delivered supplemental energy- and protein-dense foods has beneficial effects on body weight, physical function, and nutritional status. STUDY REGISTRATION This study was registered at ClinicalTrials.gov ( NCT03995303 ).
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HOMEFOOD randomised trial - Six-month nutrition therapy improves quality of life, self-rated health, cognitive function, and depression in older adults after hospital discharge.
Blondal, BS, Geirsdottir, OG, Halldorsson, TI, Beck, AM, Jonsson, PV, Ramel, A
Clinical nutrition ESPEN. 2022;48:74-81
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It is well known that older people are at a higher risk for nutritional inadequacy which is accompanied by depression, impaired cognitive function, and poor overall health. In this secondary analysis of a randomised controlled assessor-blinded dietary intervention trial, the authors examined the effects of six months of nutritional therapy on quality of life, self-rated health, cognitive function, and depression in elderly patients aged 65 years and over. The participants in the intervention group received nutritional therapy (HOMEFOOD) education to overcome malnutrition, which included dietary recommendations to ensure an adequate nutritional intake of energy and protein through diet and additional supplemental protein and energy-rich foods. After six months of nutritional therapy, the intervention group showed improvement in cognitive function, self-rated health, depression score, and quality of life scores, as well as improvements in measures related to weight gain. Further studies need to be conducted in order to determine if nutritional therapy provides additional benefits to older people. However, healthcare professionals can use the results of this study to better understand how nutritional therapy can improve the quality of life and health of older people in comparison to standard care, so they can better advise their patients.
Abstract
BACKGROUND AND AIMS Malnutrition is common among older adults and is related to quality of life, cognitive function, and depression. To what extent nutrition interventions can improve these outcomes remains unclear. The aim of this study was to investigate the effect of nutrition therapy on health-related quality of life (EQ-5D), self-rated health, cognitive function, and depression in community dwelling older adults recently discharged from hospital. METHODS Participants (>65 years) were randomised into an intervention (n = 53) and a control group (n = 53). The intervention group received individualised nutrition therapy based on the nutrition care process including 5 home visits and 3 phone calls, in combination with freely delivered energy- and protein-rich foods and oral nutrition supplements for six months after hospital discharge. EQ-5D, self-rated health, Mini-Mental-State-Examination (MMSE), and the Centre for Epidemiologic Studies Depression - IOWA (CES-D) scale were measured at baseline and at endpoint. RESULTS Two subjects dropped out, one from each arm. The control group experienced an increase in depressive symptoms and a decrease in self-rated health during the study period, while the intervention group experienced increases in cognitive function, self-rated health, and EQ-5D resulting in significant endpoint differences between the groups: EQ-5D (0.102, P = 0.001); self-rated health: 15.876 (P < 0.001); MMSE 1.701 (P < 0.001); depressive symptoms: - 3.072 (P < 0.001); all in favour of the intervention group. Improvements during the intervention in MMSE, self-rated health, and CES-D were significantly related to body weight gain in a linear way. CONCLUSION Cognitive function and mental well-being worsen or stagnate in older adults who receive standard care after hospital discharge. However, a six-month nutrition therapy improves these outcomes leading to statistically and clinically significant endpoint differences between the groups. As improvements were related to body weight gain after hospital discharge, we conclude that the increase in dietary intake, with focus on energy and protein density, and changes in body weight might have contributed to better cognitive function and mental well-being in older adults after the intervention.
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Evaluating the Effectiveness of Nutritional Therapy in the McClelland Teaching Clinic at the University of Worcester
Iris Publishers strives to expose the valuable research work of science and technology to the international scientific community. As an Open Access publisher, it provides services in diversified academic disciplines with a mission to publish innovative research in the fields of science, medicine and technology.
2021
Abstract
This pilot study by Harris and Benbow (University of Worcester) published in April 2021, highlights the effectiveness of Nutritional Therapy (NT) as an evidence-based complementary therapy for health and lifestyle improvements. The study used a symptom-specific outcome measure, Measure Yourself Medical Outcome Profile (MYMOP2) to evaluate client symptoms, activity and wellbeing, and the Working Alliance Inventory-Short Revised (WAI-SR) to evaluate therapist and client working relationship. Fifty-five clients and twenty-two students participated and preliminary results suggest that NT practice is effective in reducing symptoms and improving health and lifestyle, especially when facilitated by a strong therapist and client working relationship. Although further larger-scaled research is needed, these results are proof of the satisfactory outcomes that can be achieved through personalised nutritional therapy and lifestyle medicine.
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Precision Nutrition and Cancer Relapse Prevention: A Systematic Literature Review.
Reglero, C, Reglero, G
Nutrients. 2019;11(11)
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This article looks at the role food plays in precision medicine and nutrition therapies targeting cancers, specifically the mechanistic role of bioactive phytochemicals and their interaction with tumour progression, metastasis, and chemo-resistance. The term precision medicine represents the advances in genomics, metabolomics, and proteomics which have made cancer treatments more targeted and ‘precise’. Lung, breast, prostate and colon cancers account for a 49.2% mortality rate amongst cancers. Relapses worsen the prognosis of patients. This review aims to provide a better understanding of metabolic variation between nutrients, metabolism, microbiota, and related genes, which may help to develop adjuvant cancer therapies for the above cancers. 35 studies from 2017-2019 were selected: 20 on polyphenols, 3 on lipids (omega 3) and 12 on bioactive plant extracts. Epigallocatechin-gallate (EGCG), a flavonoid present in green tea, is shown to inhibit tumour cell growth. Curcumin modulates gene expression and critical anti-apoptotic effectors and enhances the effect of some targeted drugs used in cancer treatment. Bioactive lipid docosahexaenoic acid (DHA) induces apoptosis and has inhibitory effects on breast cancer cells growth. Ginger is shown to have an antiproliferative impact on cancer cell growth. Grape seed extract was associated with antitumor effect in colon cancer in combination with curcumin. Bioavailability of these extracts is discussed as a barrier to clinical use. Precision nutritional therapies are seen as a new era in the treatment of cancer and precision medicine but the review concludes that more research is necessary.
Abstract
Cancer mortality rates are undergoing a global downward trend; however, metastasis and relapse after surgery and adjuvant treatments still correlate with poor prognosis and represent the most significant challenges in the treatment of this disease. Advances in genomics, metabolomics, and proteomics are improving our understanding regarding cancer metabolic diversity, resulting in detailed classifications of tumors and raising the effectiveness of precision medicine. Likewise, the growing knowledge of interactions between nutrients and the expression of certain genes could lead to cancer therapies based on precision nutrition strategies. This review aims to identify the recent advances in the knowledge of the mechanistic role of bioactive phytochemicals in foodstuffs in tumor progression, metastasis, and chemo-resistance in order to assess their potential use in precision nutrition therapies targeting relapse in lung, breast, colon, and prostate cancer, and leukemia. A considerable number of bioactive phytochemicals in foodstuffs were identified in the literature with proven effects modulating tumor growth, progression, and metastasis. In addition, the use of foodstuffs in cancer, and specifically in relapse therapies, is being reinforced by the development of different formulations that significantly increase the therapeutic efficiency of these products. This can open the possibility for testing combinations of bioactive phytochemicals with cancer relapse treatments as a potential prevention strategy.
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Therapists' experiences with a new treatment combining physical exercise and dietary therapy (the PED-t) for eating disorders: an interview study in a randomised controlled trial at the Norwegian School of Sport Sciences.
Bakland, M, Sundgot-Borgen, J, Wynn, R, Rosenvinge, JH, Stornæs, AV, Pettersen, G
BMJ open. 2018;8(1):e019386
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Research has found that physical exercise and diet therapy (PED-t) can significantly reduce the symptoms experienced by patients with eating disorders. While many studies exist on overall knowledge about treating eating disorders, there is a gap around the therapist’s perspective in delivering a treatment programme. The aim of this study is to explore the therapists’ experiences while delivering PED-t treatments for patients with eating disorders. Interviews from ten therapists delivering the PED-t program were transcribed and analysed. Overall these therapists felt their professional knowledge and ability to maintain a good group dynamic was an important source of patients’ trust in the program. Based on these results, the authors conclude that professionals of various clinical backgrounds may have a significant role in treating patients with eating disorders.
Abstract
OBJECTIVES The aim of the current study is to explore how therapists running a guided physical exercise and dietary therapy programme (PED-t) experience their contribution to the treatment of patients with bulimia nervosa and binge eating disorder. METHODS Ten therapists running the PED-t were semistructurally interviewed and the transcribed interviews were analysed using a systematic text condensation approach. SETTING The study was run within the context of a randomised controlled trial at the Norwegian School of Sport Sciences. RESULTS The therapists experienced their knowledge about physical exercise and nutrition as important and useful, and that they could share their knowledge with the patients in different ways and with confidence in their own role. They also believed that their knowledge could serve as tools for the patients' post-treatment recovery and management of their daily lives. Moreover, the therapists put much effort in adjusting their teaching to fit each individual participant. Finally, they reported their personal qualities as important to build trust and therapeutic alliance. CONCLUSIONS The terms 'clinical confidence' and 'alliance' may stand out as the overarching 'metacategories' covering the experiences revealed in this study. The clinical implication is that new groups of professionals may have an important role in the treatment of eating disorders. TRIAL REGISTRATION NUMBER NCTO2079935; Results.