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Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure.
Zhou, C, Wang, S, Sun, X, Han, Y, Zhang, L, Liu, M
BMC cardiovascular disorders. 2023;23(1):80
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Chronic heart failure (CHF) is the terminal stage of heart disease and in recent years, the prevalence of CHF has been increasing among the elderly. Studies have demonstrated that the incidence rate of malnutrition among elderly patients with stable CHF is relatively high. Thus, how to help elderly CHF patients based at home to effectively carry out nutritional self-management and prevent the occurrence of malnutrition, has become a major focus of medical research. The aim of this study was to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF. This study is a randomised controlled trial that enrolled a total of 90 elderly patients with stable CHF. The patients were randomly divided into the experimental group and the control group. Results show that home-based food exchange nutritional interventions can effectively improve the malnutrition status as well as the cardiopulmonary function and exercise tolerance of elderly patients with CHF. Furthermore, after two months of intervention, the protein content and skeletal muscle mass were significantly higher in the experimental group than in the control group, while the reduction in body fat and body fat rate was also significantly higher in the former than in the latter. Authors conclude that the food exchange method is easy to grasp, operate and master, and is highly suitable for home-based elderly CHF patients.
Abstract
BACKGROUND The home treatment of elderly patients with chronic heart failure (CHF) is often accompanied by malnutrition, which increases the risk of re-hospitalisation and affects the prognosis. Therefore, how to effectively improve the nutritional self-management of patients is a current focus of medical research. This study aims to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF. METHODS A total of 90 hospitalised elderly patients with CHF were randomly divided into the experimental group (n = 45) and the control group (n = 45). The patients in both groups were given standardised drug therapy and their nutritional status was evaluated using a body composition analyser prior to discharge (protein, body fat percentage, visceral fat area, skeletal muscle, upper arm muscle circumference, left lower limb and right lower limb muscle mass), with the cardiopulmonary function evaluated using a six-minute walk test and the metabolic equivalents method. The control group was given general nutrition education and routine dietary guidance from cardiac rehabilitation nurses, while the experimental group was given an individualised nutrition prescription by dietitians based on the evaluation results, according to which one-to-one food exchange dietary intervention training was given until the patients mastered the process. RESULTS The nutritional indexes at the end of the study were significantly higher in the experimental group than in the control group and were higher than those before the intervention (P < 0.05). The muscle circumference of the upper arm, the muscle mass of the left lower limb and the right lower limb had no statistical significance following the intervention compared to the control group and before the intervention (P > 0.05). The cardiopulmonary function indexes were significantly better in the experimental group at the end of the study than before the intervention and were better than those in the control group, with statistically significant differences (P < 0.05), while no significant changes were observed in the control group before and after the intervention (P > 0.05). CONCLUSION The home-based nutritional intervention method of food exchange portions can effectively improve the nutritional status of elderly patients with CHF, with the distribution of visceral fat more reasonable and the cardiopulmonary function and exercise endurance improved.
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The roles of the dietitian in an 18-week telephone and mobile application nutrition intervention for upper gastrointestinal cancer: a qualitative analysis.
Testa, S, Furness, K, Choi, T, Haines, T, Huggins, CE
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. 2023;31(4):245
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Patients with upper gastrointestinal (UGI) cancer (oesophagus, gastric, and pancreas) are vulnerable to malnutrition. Symptoms of the cancer and its treatment are barriers to usual eating patterns that contribute to unintentional weight loss. The aim of this study was to explore the patient-dietitian experience of an 18-week nutrition intervention (the TEND study) delivered using the telephone and a mobile application to people newly diagnosed with UGI cancer to elucidate the roles of the dietitian. This study was an analysis set within the TEND study (a three-arm randomised controlled trial exploring the impact of delivering an 18-week intensive nutrition intervention to patients newly diagnosed with UGI cancer). Participants were allocated to receive the intervention using either the telephone or a mobile application, myPace. Results showed that: - rapport can be built within the patient-dietitian relationship without face-to-face communication. - the roles of the dietitian were characterised by regular collaborative problem-solving to encourage empowerment, a reassuring care navigator (including anticipatory guidance), and rapport building via reliable psychosocial support. - that role limitations led to unmet needs as the dietitian was constrained by poorly managed cancer symptoms that negatively impacted oral intake and subsequently weight stability. Authors concluded that more research is needed to examine an advanced care role for dietitians in the management of nutrition impact symptoms.
Abstract
PURPOSE This study aimed to explore the patient-dietitian experience during an 18-week nutrition counselling intervention delivered using the telephone and a mobile application to people newly diagnosed with upper gastrointestinal (UGI) cancer to (1) elucidate the roles of the dietitian during intervention delivery and (2) explore unmet needs impacting nutritional intake. METHODS Qualitative case study methodology was followed, whereby the case was the 18-week nutrition counselling intervention. Dietary counselling conversations and post-intervention interviews were inductively coded from six case participants which included fifty-one telephone conversations (17 h), 244 written messages, and four interviews. Data were coded inductively, and themes constructed. The coding framework was subsequently applied to all post-study interviews (n = 20) to explore unmet needs. RESULTS Themes describing the roles of the dietitian were as follows: regular collaborative problem-solving to encourage empowerment, a reassuring care navigator including anticipatory guidance, and rapport building via psychosocial support. Psychosocial support included provision of empathy, reliable care provision, and delivery of positive perspective. Despite intensive counselling from the dietitian, nutrition impact symptom management was a core unmet need as it required intervention beyond the scope of practice for the dietitian. CONCLUSION Delivery of nutrition care via the telephone or an asynchronous mobile application to people with newly diagnosed UGI cancer required the dietitian to adopt a range of roles to influence nutritional intake: they empower people, act as care navigators, and provide psychosocial support. Limitations in dietitians' scope of practice identified unmet patient's needs in nutrition impact symptom management, which requires medication management. TRIAL REGISTRATION 27th January 2017 Australian and New Zealand Clinical Trial Registry (ACTRN12617000152325).
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Prevalence and outcomes of malnutrition among hospitalized COVID-19 patients: A systematic review and meta-analysis.
Abate, SM, Chekole, YA, Estifanos, MB, Abate, KH, Kabthymer, RH
Clinical nutrition ESPEN. 2021;43:174-183
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Malnutrition during Coronavirus Disease 2019 (COVID-19) is a ‘two-edged sword’ particularly in low-income countries where chronic malnutrition is very high. The disease is still very high, and it is relapsing to the worst in some countries. The aim of this study was to investigate the prevalence and outcome of malnutrition among patients with COVID-19. This study is a systemic review and meta-analysis of 14 studies with 4187 participants. Results indicate that the prevalence of malnutrition was very high among hospitalized patients with COVID-19, and that mortality among hospitalized patients with COVID-19 was more than 10 times more likely as compared to those who were well-nourished. Authors conclude that a mitigating strategy by different stakeholders is needed to prevent and manage malnutrition and its outcomes.
Abstract
BACKGROUND Malnutrition is inevitable in patients with Coronavirus Disease 2019 (COVID-19) due to its effect on the gastrointestinal system, immune system, and high metabolic activity. However, the prevalence of malnutrition and its outcomes is uncertain. This study aimed to investigate the prevalence and outcome of malnutrition among patients with COVID-19. METHOD A comprehensive search was conducted in PubMed/Medline; Science direct and LILACS from December 29, 2019 to September, 2020 without language restriction. All observational studies reporting the prevalence of malnutrition were included while case reports and reviews were excluded. The data were extracted with two independent authors with a customized format and the disagreements were resolved by the other authors. The methodological quality of included studies was evaluated using a standardized critical appraisal tool. RESULTS A total of 511 articles were identified from different databases and 27 articles were selected for evaluation after the successive screening. Fourteen articles with 4187 participants were included. The pooled prevalence of malnutrition among hospitalized patients with COVID-19 was 49.11% (95% CI: 31.67 to 66.54). The odd of mortality among patients COVID-19 with malnutrition was 10 times more likely as compared to those who were well-nourished. CONCLUSION The prevalence of malnutrition and mortality associated with malnutrition among COVID-19 hospitalized patients was very high which entails a mitigating strategy by different stakeholders to prevent and manage malnutrition and its outcomes. REGISTRATION This systematic review was registered in Prospero's international prospective register of systematic reviews (CRD42020215396).
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Enhancing immunity in viral infections, with special emphasis on COVID-19: A review.
Jayawardena, R, Sooriyaarachchi, P, Chourdakis, M, Jeewandara, C, Ranasinghe, P
Diabetes & metabolic syndrome. 2020;14(4):367-382
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A healthy immune system is one of the most important weapons in relation to the current pandemic of COVID-19 where no effective preventive and curative medicine is available. The main aim of this study was to evaluate the evidence on enhancing immunity in viral infections. This review focuses on influenza-like viral infections; however, other studies on viral infections have also been included. It included 43 articles of which 13 were on vitamins, 8 on minerals, 18 on nutraceuticals and 4 on probiotics. Results indicate that: - vitamin supplementation, especially vitamin D may be beneficial in people who are either deficient or insufficient. - adverse effects of vitamin E supplementation on the immune response have been reported. - there are several beneficial nutraceuticals, however their efficacy and safety depend on their ingredients, as well as various other factors including, methods of extraction. - in addition to basic hygienic practices, proper dietary and lifestyle behaviours are essential for prevention and treatment of respiratory viral diseases. Authors conclude that achieving recommended amounts of calories and micronutrient will be a challenge and elective micronutrient supplementations may be beneficial especially for vulnerable populations such as the elderly.
Abstract
BACKGROUND AND AIMS Balanced nutrition which can help in maintaining immunity is essential for prevention and management of viral infections. While data regarding nutrition in coronavirus infection (COVID-19) are not available, in this review, we aimed to evaluate evidence from previous clinical trials that studied nutrition-based interventions for viral diseases (with special emphasis on respiratory infections), and summarise our observations. METHODS A systematic search strategy was employed using keywords to search the literature in 3 key medical databases: PubMed®, Web of Science® and SciVerse Scopus®. Studies were considered eligible if they were controlled trials in humans, measuring immunological parameters, on viral and respiratory infections. Clinical trials on vitamins, minerals, nutraceuticals and probiotics were included. RESULTS A total of 640 records were identified initially and 22 studies were included from other sources. After excluding duplicates and articles that did not meet the inclusion criteria, 43 studies were obtained (vitamins: 13; minerals: 8; nutraceuticals: 18 and probiotics: 4). Among vitamins, A and D showed a potential benefit, especially in deficient populations. Among trace elements, selenium and zinc have also shown favourable immune-modulatory effects in viral respiratory infections. Several nutraceuticals and probiotics may also have some role in enhancing immune functions. Micronutrients may be beneficial in nutritionally depleted elderly population. CONCLUSIONS We summaries possible benefits of some vitamins, trace elements, nutraceuticals and probiotics in viral infections. Nutrition principles based on these data could be useful in possible prevention and management of COVID-19.
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The Malnutritional Status of the Host as a Virulence Factor for New Coronavirus SARS-CoV-2.
Briguglio, M, Pregliasco, FE, Lombardi, G, Perazzo, P, Banfi, G
Frontiers in medicine. 2020;7:146
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This opinion article explores the role of an individual’s nutrition status when subjected to infection by viruses, in particular Covid-19. Distinction is made between the susceptibility to infection in the first instance and the ability to persist in fighting infection once it is established. For Covid-19, it is argued that a healthier nutritional status, in particular Vitamins A, B, C, D and E, iron selenium and zinc, will lower susceptibility to infection, lower the severity of the virus and therefore reduce the length of time an individual has to find reserves to fight the virus. More severe cases of Covid-19 infection also often include gastro-intestinal symptoms which further exacerbate nutritional status with lowered appetite. The authors conclude that malnourished individuals may be more susceptible to Covid-19 infection and that nutritional support is vital in severe cases. The article includes a useful diagram of both hyponutrition and hypernutrition and possible impacts of Covid-19.
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Nutrition support in the time of SARS-CoV-2 (COVID-19).
Laviano, A, Koverech, A, Zanetti, M
Nutrition (Burbank, Los Angeles County, Calif.). 2020;74:110834
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Nutrition is part of the treatment regimen for acute and chronic diseases and applies particularly to ailments for which an etiologic treatment has not yet been discovered and validated. Furthermore, the timing of nutritional intervention is also important as patients rapidly progress from cough to shortness of breath, and then to respiratory failure and admission to an intensive care unit (ICU) for mechanical ventilation. Literature shows that COVID-19 is associated with negative outcomes in older, comorbid, and hypoalbuminemic (low albumin – protein made by the liver - blood levels) patients. In fact, international nutrition scientific societies are developing updated guidelines that are specific to the needs of patients who are critically ill with COVID-19. While waiting for specific recommendations on the nutritional management of patients with COVID-19 in the ICU, current available guidelines on the clinical nutrition for patients in the ICU are likely to fit the needs of patients with COVID-19.
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Nutritional Interventions to Improve Clinical Outcomes in Ovarian Cancer: A Systematic Review of Randomized Controlled Trials.
Rinninella, E, Fagotti, A, Cintoni, M, Raoul, P, Scaletta, G, Quagliozzi, L, Miggiano, GAD, Scambia, G, Gasbarrini, A, Mele, MC
Nutrients. 2019;11(6)
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Ovarian cancer is one of the most common cancers worldwide and it has the highest mortality rate of all gynaecologic cancers. The aim of the study was to examine the impact of several types of nutrition interventions on clinical outcomes in ovarian cancer patients. The study is a systemic review of fourteen randomised controlled trials (RCTs) focusing on nutritional interventions during chemotherapy or during the perioperative period. The majority of RCTs reported improved clinical outcomes after nutritional interventions. Most RCTs show a reduction in length of hospital stay and ameliorated intestinal recovery after surgery. Authors conclude that it is important to find nutritional interventions in order to improve patient’s survival since the ovarian mortality rate is one of the highest among malignancies.
Abstract
Among all gynaecological neoplasms, ovarian cancer has the highest rate of disease-related malnutrition, representing an important risk factor of postoperative mortality and morbidity. Hence, the importance of finding effective nutritional interventions is crucial to improve ovarian cancer patient's well-being and survival. This systematic review of randomized controlled trials (RCTs) aims at assessing the effects of nutritional interventions on clinical outcomes such as overall survival, progression-free survival, length of hospital stay (LOS), complications following surgery and/or chemotherapy in ovarian cancer patients. Three electronic bibliographic databases (MEDLINE, Web of Science, and Cochrane Central Register of Controlled Trials) were used to conduct a systematic literature search based on fixed inclusion and exclusion criteria, until December 2018. A total of 14 studies were identified. Several early postoperative feeding interventions studies (n = 8) were retrieved mainly demonstrating a reduction in LOS and an ameliorated intestinal recovery after surgery. Moreover, innovative nutritional approaches such as chewing gum intervention (n = 1), coffee consumption (n = 1), ketogenic diet intervention (n = 2) or fruit and vegetable juice concentrate supplementation diet (n = 1) and short-term fasting (n = 1) have been shown as valid and well-tolerated nutritional strategies improving clinical outcomes. However, despite an acceptable number of prospective trials, there is still a lack of homogeneous and robust endpoints. In particular, there is an urgent need of RCTs evaluating overall survival and progression-free survival during ovarian oncology treatments. Further high-quality studies are warranted, especially prospective studies and large RCTs, with more homogeneous types of intervention and clinical outcomes, including a more specific sampling of ovarian cancer women, to identify appropriate and effective nutritional strategies for this cancer, which is at high risk of malnutrition.
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Reversing the immune ageing clock: lifestyle modifications and pharmacological interventions.
Duggal, NA
Biogerontology. 2018;19(6):481-496
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Advancing age is accompanied by a compromised ability of older adults to combat bacterial and viral infections, increased risk of autoimmunity, poor vaccination responses and the re-emergence of latent infections. This review discusses current understanding of immunesenescence [the gradual deterioration of our immune system as we get older] and also focuses on lifestyle interventions and therapeutic strategies that have been shown to restore immune functioning in aged individuals. Findings show that: - changes in nutrition and lifestyle can be an effective approach towards improving immune outcome in older adults but may be hard to achieve at a population level. - improving immune responses, such as the developments of vaccines, may be used as an early biomarker for anti-ageing effects. Authors conclude that immunomodulation represents a promising therapeutic approach to improve the health of older adults.
Abstract
It is widely accepted that ageing is accompanied by remodelling of the immune system, including reduced numbers of naïve T cells, increased senescent or exhausted T cells, compromise to monocyte, neutrophil and natural killer cell function and an increase in systemic inflammation. In combination these changes result in increased risk of infection, reduced immune memory, reduced immune tolerance and immune surveillance, with significant impacts upon health in old age. More recently it has become clear that the rate of decline in the immune system is malleable and can be influenced by environmental factors such as physical activity as well as pharmacological interventions. This review discusses briefly our current understanding of immunesenescence and then focuses on lifestyle interventions and therapeutic strategies that have been shown to restore immune functioning in aged individuals.