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Assessment – Anthropometrics and Functional Status
Published in Jennifer Doley, Mary J. Marian, Adult Malnutrition, 2023
Anthropometric measurements and functional exams are useful to assess and reassess nutrition status, sarcopenia, and frailty, to provide evidence of a PEM diagnosis, direct appropriate interventions, and monitor patient progress and outcomes. Muscle quality, which changes with age due to myosteatosis and connective tissue changes, as well as other factors in aging and disease, underlies impaired muscle performance that affects the individual’s ability to be independent, recover from illness, and their quality of life. Discovery of functional deficits related to PEM can prompt the clinician to promote activities to improve nutrition intake and physical activity, to slow the rate of deficit, maintain, or ideally improve, skeletal muscle mass, muscle quality, strength, and performance.79 Conversely, early discovery of nutrition deficits can trigger awareness of potential functional deficits, especially in less active patients, older adults, and those with complex diagnoses. Nutrition therapy and physical activity can often help improve functional ability, patient independence, and quality of life. Inclusion and analysis of these measures adds to the importance, depth, and strength of a thorough nutrition assessment of the malnourished patient as well as early identification of functional conditions of those at risk of PEM, sarcopenia, and frailty so that early and prompt intervention can be implemented to maintain or improve declines in health and clinical outcomes.
Diabetes Mellitus Type 1 (DM1)/Juvenile Diabetes/Insulin Dependent Diabetes Mellitus (IDDM)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Medical nutrition therapy is recommended for all patients to achieve and maintain healthy body weight. A well-balanced, nutritious diet remains a fundamental element of therapy. The meal plan should be moderate in carbohydrates and low in saturated fat, with a focus on balanced meals.1
Care of the Hospitalized Child
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Anushree Algotar, Anna Tuttle, Mark R. Corkins
The most appropriate mode of nutrition intervention is based on multiple factors including but not limited to age of the patient, anatomical and functional gastrointestinal integrity, safety, and ability to take oral feeding and disease pathology. Nutrition therapy has a significant role in hospitalized malnourished patients, especially those undergoing surgery. Surgical processes can add to the physiological stress in already sick and malnourished patients. In addition, suboptimal nutrition in the perioperative period is associated with poorer surgical outcomes with regard to wound healing, infection, fluid-electrolyte imbalances, and increase duration of hospitalization. Initial nutrition assessment is important to delineate the degree of malnutrition and identify patients that require nutrition therapy pre- and postoperatively.
Barriers and Facilitators to Adherence to a Mediterranean Diet Intervention during Chemotherapy Treatment: A Qualitative Analysis
Published in Nutrition and Cancer, 2023
Brianna I. Harvey, Shari M. Youngblood, Amber S. Kleckner
The incidence of cancer is about 1.9 million cases per year in the U.S. (1). Patients undergoing curative or palliative chemotherapy for their cancer experience a host of side effects including fatigue, nausea, vomiting, loss of appetite, hair loss, and mouth sores (2). These side effects reduce the ability to consume food and reduce quality of life (3). The physical and mental stress of a cancer diagnosis and its treatments can be compounded by malnutrition, with malnutrition affecting more than half of patients with cancer (2, 4). Malnutrition increases the risk of morbidity (5) and mortality (6), highlighting the importance of nutrition counseling in patients with cancer. On the other hand, and not mutually exclusively, chemotherapy can contribute to accumulation of fat mass, especially among some cancer types such as breast, prostate, and ovarian cancers (7). However, despite growing evidence-based nutrition recommendations to prevent cancer (8), there is currently a paucity of specific nutritional recommendations, clinical guidelines, and interventions that can be delivered during treatment to mitigate side effects, prevent malnutrition and weight gain, and potentially increase the efficacy of chemotherapy. Current guidelines (9) recommend that a registered dietitian should be part of the care team and provide individualized medical nutrition therapy throughout treatment, though specific dietary patterns have not yet been established.
To Feed or Not to Feed – Nutritional Risk Assessment and Support in Elective Colorectal Surgery. A Prospective Study on the Effect of Screening
Published in Nutrition and Cancer, 2022
Dániel Kollár, Zoltán Benedek-Tóth, András Drozgyik, Tamás F. Molnár, Attila Oláh
A second, inpatient dietitian follow-up was carried out after the planned surgery. The patients reported their compliance with the prescribed supplemental treatment and counsel for future nutrition therapy was also provided. The patients were allocated into study groups based on this inpatient follow-up.Group I: NRS 2002 < 3, nutrition therapy was not indicated before the surgeryGroup II-: NRS 2002 ≥ 3, nutrition therapy was offered before the surgery but the patient did not receive the adequate regimen (possible reasons: unsuccessful phone call attempts, the patient refused ONS, the prescription was not utilized, the patient did not like/tolerate ONS or consumed lower than the prescribed doses, or the treatment lasted <7 days)Group II+: NRS 2002 ≥ 3, nutrition therapy was offered before the surgery and the patient received ONS treatment with the recommended dosage for at least 7 days
The Effect of Nutritional Support on the Disease Progression and Survival in Pediatric Patients with Solid Tumors
Published in Nutrition and Cancer, 2022
Nora Gallo, Krisztina Czuppon, Erika Tomsits, Miklos Garami, Peter Hauser, Zsuzsanna Jakab, Krisztina Nagy, Gabor T. Kovacs
In this single center study we investigated two similar periods. The only difference was regular malnutrition risk screening and intensified nutrition support, which was provided by a professional team in Period 2. The focus of our study was on disease progression and survival in pediatric patients with solid tumors undergoing chemotherapy. In Period 1 dietetic counsel was given only to the very severely malnourished patients based on the subjective judgment of the pediatric physician, since no nutrition risk screening tools were applied. In this period, the physician decided on the nutrition therapy – when to start it and how it should be provided. In Period 1 parenteral nutrition was preferred during hospital stay since it was easier to administer through the central vein catheter.