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Malnutrition is common in stroke patients, as it is associated with neurological and cognitive impairment as well as clinical outcomes. Nutritional screening is a process with which to categorize the risk of malnutrition (i.e., nutritional risk) based on validated tools/procedures, which need to be rapid, simple, cost-effective, and reliable in the clinical setting. This review focuses on the tools/procedures used in stroke patients to assess nutritional risk, with a particular focus on their relationships with patients’ clinical characteristics and outcomes. Different screening tools/procedures have been used in stroke patients, which have shown varying prevalence in terms of nutritional risk (higher in rehabilitation units) and significant relationships with clinical outcomes in the short- and long term, such as infection, disability, and mortality. Indeed, there have been few attempts to compare the usefulness and reliability of the different tools/procedures. More evidence is needed to identify appropriate approaches to assessing nutritional risk among stroke patients in the acute and sub-acute phase of disease or during rehabilitation; to evaluate the impact of nutritional treatment on the risk of malnutrition during hospital stay or rehabilitation unit; and to include nutritional screening in well-defined nutritional care protocols.

Background In cardiovascular prevention and rehabilitation, care activities are carried out by different professionals in coordination, each with their own specific competence. This GICR–IACPR position paper has analysed the interventions performed by the nurse, physiotherapist, dietician and psychologist in order to identify what constitutes minimal care, and it lists the activities that are fundamental and indispensable for each team member to perform in clinical practice. Results In analysing each type of intervention, the following dimensions were considered: the level of clinical care complexity, determined both by the disease and by environmental factors; the ‘area’ complexity, i.e. the specific level of competence required of the professional in each professional section; organisational factors, i.e. whether the care is performed in an inpatient or outpatient setting; duration of the rehabilitation intervention. The specific contents of minimal care have been identified for each professional area together with the specific goals, the assessment tools and the main essential interventions. For the assessments, only a few validated tools have been indicated, leaving the choice of which instrument to use to the individual professional based on experience and usual practice. Conclusion For the interventions, attention has been focused on conditions of major complexity requiring special care, taking into account the different care settings, the clinical conditions secondary to the disease event, and the distinct tasks of each area according to the operator's specific role. The final report performed by each professional has also been included.

Dietary habits are widely reported to play a primary role in the occurrence of coronary artery disease (CAD). Cardiac rehabilitation is a multidisciplinary intervention that includes nutritional education. Proper nutrition plays an important role in cardiovascular health outcomes and in decreasing morbidity and mortality of cardiovascular diseases (CVD) as highlighted in the literature. The aim of this study was to assess the efficacy of an educational program to improve the diet of cardiac rehabilitation patients compared to usual treatment. 160 patients with CAD, (124 M, 36 F) were randomized into two groups. Data analysis was conducted on 133 patients (11 % dropped out). All enrolled patients attended two educational seminars about proper nutrition and cardiovascular prevention, and completed a questionnaire about dietary habits (before CAD). The Body Mass Index (BMI) was calculated, and basal glycaemia and plasma lipids were assessed at the beginning and at the end of the study (12 months after hospital discharge). The intervention group patients underwent a mid-term evaluation of nutrient intakes, BMI, and received a personalized educational reinforcement by a dietitian. At the end of the study, the intervention group was shown to have significantly reduced their daily caloric intake (reduction of total proteins, total fat, carbohydrate, alcohol), and showed a significant reduction of weight and BMI compared to the control group. Individual nutritional counseling session as a reinforcement of a standard educational program is effective in reducing caloric intake and BMI, which may reduce cardiovascular risk factors in cardiovascular patients.

We aimed to evaluate the effect an adequate nutritional intervention, carried out by an experienced Nutritional Team, has on the risk and degree of bedsores (BS) in patients with severe brain injuries (SBI). The study was conducted on 50 patients (mean age 59 years, 34% females) admitted in the SBI ward of our hospital. Patients were screened at admission and discharge for the risk of malnutrition (MUST) and of Braden Scale; number and degree of BS (EDUAP Guidelines) and biochemical markers of malnutrition were also registered. A significant decrease in patients’ artificial nutrition, MUST score and number and degree of bedsores was observed at discharge. At the same time, after hospitalization, patients showed higher levels of albumin, transferrin and lymphocytes and higher energy and proteins intake per day (Table 1). Although the development of BS is a multifactorial process, influenced by many more factors other than nutrition, we suggest that a correct nutritional intervention could improve the healing process, hence the outcome, in patients with SBI. These preliminary results are consistent with the most recent ESPEN Neurological Guidelines, which recommend the presence in the neurological rehabilitation team of a dietitian or nutritionist with experience in SBI, who can provide a personalized nutritional plan and monitor it over time in order to maximize the rehabilitation potential of the patient.

Rehabilitative and preventive cardiology (CRP) is configured as intervention prevention to “gain health” through a process of multifactorial care that reduces disability and the risk of subsequent cardiovascular events. It makes use of an interdisciplinary team in which every professional needs to have multiple intervention paths because of the different levels of clinical and functional complexity of cardiac patients who currently have access to the rehabilitation. The document refers to the use of interventions by nurses, physiotherapists, dietitians and psychologists that are part of the rehabilitation team of CRP. Interventions of which have been documented, on scientific bases and clinical practice, empirical effectiveness and organizational efficiency. The methodological approach of this paper is a first attempt to define, through the model of consensus, the minimum standards for a CRP evidence based characterized by clearly defined criteria that can be used by operators of CRP. The document describes the activities to be carried out in each of the phases included in the pathways of care by nurses, physiotherapists, dietitians and psychologists. The routes identified were divided, according to the type of patients who have access to the CRP and to the phases of care, including the initial assessment, intervention, evaluation and final reporting, in high medium and low complexity. Examples of models of reporting, used by the operators of the team according to the principles of good clinical practice, are provided. This is made to allow traceability of operations, encourage communication inside the working group and within the patient and the caregiver. Also to give any possible indication for the post-rehabilitation.

Rehabilitation and secondary prevention programs are recognized as an essential part of the overall care of patients with cardiovascular disease. They consist of multidisciplinary strategies aiming at the reduction of modifiable risk factors for cardiovascular disease. There are some evidence of the efficacy of nutritional care in modifying eating habits and behavior in patients undergoing cardiac rehabilitation. In 2007, the Italian Association of Dietitians (ANDID) appointed a working group of dietitians, skilled in nutrition applied in cardiovascular disease, with the aim to make an overview of the available scientific literature and to develop a Professional Position Paper on the role of Dietitian in cardiac rehabilitation and secondary prevention. The first Position Paper, developed in 2008, covered the available evidence about the dietitian professional role and contribution in the management of the topic. The working group has recently updated the contents by introducing, in agreement with the work done by ANDID, the methodology of the Nutrition Care Process and Model (NCP), a systematic problem-solving method intended to stimulate critical thinking, decision-making and address issues related to food and nutritional assistance, in order to provide a safe, effective and high quality care.

Background: In previous pilot studies we have demonstrated that the Treatment Motivation and Readiness Test (TRE-MORE) is capable of predicting the outcome of obesity therapy and that a higher muscle mass (MM) is associated with a greater weight loss. Purposes of the present study were: to confirm the predictive value of TRE-MORE scores and MM, using a standardized non-pharmacologic intervention for weight loss; to explore the relationship between TRE-MORE and MM; to discriminate predictors of attendance from predictors of final therapeutic success. Methods: A consecutive series of 331 patients was enrolled and addressed to a standardized treatment protocol. Results: Mean weight loss at 6 months was -5.03%. Among participants, 48.7% lost at least 5% initial body weight after 6 months and had significantly higher TRE-MORE total scores and MM. Weight loss was significantly associated with baseline MM, TRE-MORE-3, and a lower number of previous diets. Significantly lower TRE-MORE-3 scores were associated with drop-out. Conclusion: The present study confirms that therapeutic success is predicted by TRE-MORE scores and, independently from these, by estimated MM (after adjustment for BMI). TRE-MORE total score is a predictor of failure, but not of attendance, whereas drop-out patients showed a lower score only in TREMORE-3 subscale which investigates lifestyle habits.

Patient education is a key component of diabetes care. Limits in resources often prevent the participation of many patients with type 2 diabetes to structured education programs. The identification of predictors of response to group education could help in selecting those patients in whom the intervention is more cost-effective. A structured interactive group program was proposed to a consecutive series of 150 type 2 diabetes patients, who were then followed prospectively in 24 months, with measurements of HbA1c, BMI, quality of life, eating habits. For comparison, another consecutive series of 113 patients who had received no intervention was also observed for 12 months. A significant reduction in HbA1c was observed in the intervention group at 12 and 24 months (from 7.5 ± 1.4 to 6.9 ± 1.2 and 6.6 ± 1.1% at 12 and 24 months, respectively, both P0.01), with no variation in BMI and quality of life. A sustained reduction in total energy, protein, and fat intake was observed after education. The proportion of success (HbA1c7% and/or HbA1c reduction from baseline1%) in the intervention group was 60.7% (vs. 38.1% in controls) and 63.3% at 12 and 24 months, respectively. In the intervention group, patients with success at 12 months showed lower baseline HbA1c, BMI, duration of diabetes, protein, and cholesterol intake. Patients with a lower duration of diabetes appear to have a greater response to structured group education, whereas age is not a predictor of response. Therefore, educational intervention should be planned in the earlier phases of the disease.

The role of healthy diet as an effective tool to prevent chronic diseases is well established. Recently, most of the attention has been paid to food education since childhood. Aim of the present study was to evaluate generational and gender differences in perceiving the importance of healthy diet in a sample of subjects ranging from children to their grandparents. We studied 226 subjects, 74 children attending a primary school, 82 parents and 70 grandparents. Children received the Food Frequency Questionnaire and two “ad hoc” questionnaires, the former about general principles of food education and the latter about perception of the importance of healthy diet and the personal engagement to pursue it, while parents and grandparents received only this latter questionnaire. Both boys and girls reported to have little information on the different types of fats and which fats are harmful for their health. With regard to females, mothers’ engagement to pursue a healthy diet was significantly higher than that of grandmothers, while girls’ engagement did not exceed the already high engagement of their mothers. Regarding males, the engagement followed a similar increase across generations, without significant differences. However, despite different courses, no significant gender difference was detected within the new generation. This finding seems to be of extreme importance for all the professionals involved in food educational programs for childhood.