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Objective This study aimed to analyze the practice of nurturing stunting toddlers in the coastal community of Balang Lompo, Pangkep Regency. The study was conducted in the Balang Lompo Island, Pangkep Regency. Methods This research design was qualitative research with a case study approach with in-depth interview techniques and uninvolved observation. The research subjects consisted of 12 key informants who had children aged 1–3 years and 6 supporting informants. The data were analyzed using content analysis. Results The results of the analysis showed the feeding of the child, the time of administration, the place of feeding, the rules of feeding, the frequency of eating fish, the role of family members, the atmosphere of stunting toddler feeding were still not optimal. It was concluded that the practice of child nutrition care on the Balang Lompo Island coast was still less than optimal due to low food access due to lack of transportation facilities on the Balang Lompo Island coastline, economic inequality, poor eating behavior and habits in the community, low knowledge and also low community participation at the Posyandu. Conclusion Stunting childcare practices on Coastal Island of Balang Lompo are less than optimal.

Cases of chronic kidney disease (CKD), including CKD in pregnant women, have increased globally in recent years. CKD during pregnancy is associated with a higher risk of adverse outcomes, including gestational hypertension, preeclampsia, intrauterine growth restriction, and preterm birth, among others. Nutrition plays a significant role in many metabolic and physiological changes during pregnancy. Women with CKD are at increased risk of nutrition deficiencies and metabolic issues than women without CKD. Currently, we lack evidence regarding metabolic and nutritional adaptations during pregnancy in women with CKD and how these adaptations relate to perinatal outcomes. In this review, dietary and supplementation recommendations for CKD in adults and pregnant women are summarized from current clinical guidelines. We present the main nutrition care practices that have been studied in CKD pregnancies. This review will be helpful to health professionals as a preliminary reference for nutrition assessment and therapy in pregnant women with CKD.

Objective The number of liver cancer patients in China accounts for more than half of the world. However, China currently lacks national, multicenter economic burden data, and meanwhile, measuring the differences among different subgroups will be informative to formulate corresponding policies in liver cancer control. Thus, the aim of the study was to measure the economic burden of liver cancer by various subgroups. Methods A hospital-based, multicenter and cross-sectional survey was conducted during 2012-2014, covering 39 hospitals and 21 project sites in 13 provinces across China. The questionnaire covers clinical information, sociology, expenditure, and related variables. All expenditure data were reported in Chinese Yuan (CNY) using 2014 values. Results A total of 2,223 liver cancer patients were enrolled, of whom 59.61% were late-stage cases (III-IV), and 53.8% were hepatocellular carcinoma. The average total expenditure per liver cancer patient was estimated as 53,220 CNY, including 48,612 CNY of medical expenditures (91.3%) and 4,608 CNY of non-medical expenditures (8.7%). The average total expenditures in stage I, II, III and stage IV were 52,817 CNY, 50,877 CNY, 50,678 CNY and 54,089 CNY (P>0.05), respectively. Non-medical expenditures including additional meals, additional nutrition care, transportation, accommodation and hired informal nursing were 1,453 CNY, 839 CNY, 946 CNY, 679 CNY and 200 CNY, respectively. The one-year out-of-pocket expenditure of a newly diagnosed patient was 24,953 CNY, and 77.2% of the patients suffered an unmanageable financial burden. Multivariate analysis showed that overall expenditure differed in almost all subgroups (P

Justificación: La brecha entre la educación nutricional proporcionada a los estudiantes de medicina y las competencias y actitudes nutricionales necesarias para que los médicos brinden una atención nutricional eficaz es una preocupación mundial. El objetivo de este estudio fue investigar el contenido curricular sobre educación nutricional en las facultades de medicina de América Latina y evaluar los conocimientos, las actitudes y las barreras autopercibidas para la práctica de la nutrición de los estudiantes de último año de medicina. Métodos: Se invitó a participar en el estudio a 85 facultades de medicina públicas y privadas de 17 países de América Latina. Se enviaron dos cuestionarios en línea cerrados que constaban de 25 y 43 preguntas a los directores de las facultades de medicina. Las variables cuantitativas se expresaron como frecuencias, porcentajes, media ± desviación estándar, medianas y rangos. Resultados: Respondieron un total de 22 (26%) directores de escuelas de medicina, de los cuales 11 escuelas (50%) ofrecían cursos de nutrición obligatorios independientes en años preclínicos y 8 (36%) en años clínicos. La media de horas dedicadas a la educación nutricional fue de 47 (rango: 0-150). Respondieron un total de 1530 de 1630 (94%) estudiantes de 12 países. La edad promedio de los estudiantes fue de 25 ± 3 años y el 59% eran mujeres. La mayoría de los estudiantes estuvo de acuerdo en que mejorar la salud de los pacientes a través de la nutrición (91 %) es importante y que el asesoramiento y la evaluación nutricional deben ser parte de la atención de rutina brindada por todos los médicos (89 %), pero carecen del nivel de educación y capacitación necesarios para abordar la nutrición. -asuntos relacionados. Conclusiones: La actitud positiva y el interés por la nutrición entre los estudiantes de último año de medicina es alto, pero la educación en nutrición no se percibe como suficiente para preparar adecuadamente a los médicos en el campo de la nutrición. Rationale: The gap between the nutrition education provided to medical students and the nutrition competences and attitudes needed for doctors to provide effective nutrition care is a global concern. The goal of this study was to investigate the curricular content on nutrition education in Latin American medical schools and to evaluate the self-perceived knowledge, attitudes, and barriers to nutrition practice of final-year medical students. Methods: Eighty-five public and private medical schools from 17 Latin American countries were invited to participate in the study. Two close-ended online questionnaires consisting of 25 and 43 questions were sent to medical school directors. Quantitative variables were expressed as frequencies, percentages, mean ± standard deviation, medians, and ranges. Results: A total of 22 (26%) medical school directors responded, of which 11 schools (50%) offered stand-alone mandatory nutrition courses in preclinical and 8 (36%) in clinical years. The mean hours dedicated to nutrition education was 47 (range: 0–150). A total of 1530 of 1630 (94%) students from 12 countries responded. Students’ average age was 25 ± 3 years, and 59% were female. Most students agreed that improving patients’ health through nutrition (91%) is important and that nutrition counseling and assessment should be part of routine care provided by all physicians (89%), but they lack the level of education and training required to address nutrition-related issues. Conclusions: Positive attitude and interest in nutrition among final-year medical students is high, but nutrition education is not perceived as sufficient to adequately prepare doctors in the field of nutrition.

The obesity epidemic, mainly due to lifestyle changes in recent decades, leads to serious comorbidities that reduce life expectancy. This situation is affecting the health policies of many nations around the world. Traditional measures such as diet, physical activity, and drugs are often not enough to achieve weight loss goals and to maintain the results over time. Bariatric surgery (BS) includes various techniques, which favor rapid and sustained weight loss. BS is a useful and, in most cases, the best treatment in severe and complicated obesity. In addition, it has a greater benefit/risk ratio than non-surgical traditional therapies. BS can allow the obese patient to lose weight quickly compared with traditional lifestyle changes, and with a greater probability of maintaining the results. Moreover, BS promotes improvements in metabolic parameters, even diabetes remission, and in the quality of life. These changes can lead to an increase of life expectancy by over 6 years on average. The nutrition of people before and after BS must be the subject of indications from a trained staff, and patients must be followed in the subsequent years to reduce the risk of malnutrition and the associated problems. In particular, it is still debated whether it is necessary to lose weight prior to surgery, a procedure that can facilitate the surgeon’s work reducing the surgical risk, but at the same time, lengthens preparation times increasing the risks associated with concomitant pathologies. Furthermore, preventing nutritional deficiencies prior to the intervention can improve the results and reduce short- and long-term mortality.

Background Malnutrition is common in hospitalized patients and strategies to improve energy and protein intake have a positive impact on outcome. Despite early evidence suggesting the usefulness of peripheral parenteral nutrition (PPN), its adoption has been hampered by concerns regarding safety and efficacy. This study addresses this issue. Methods This prospective observational study was performed in medical and surgical inpatients in who were screened for nutrition risk and assessed using Subjective Global Assessment (SGA). Data captured included nutrition status, energy and protein requirements, intravenous access, indications for PPN, use of supplemental micronutrients, and disposition of patients on PPN. Results Ninety-eight patients were recruited from two centers over 8 months. The average age was 61.5 years, the mean Charlson Comorbidity Index was 4.21 (±3.09), 52% were male, and 48% were admitted to medicine, whereas 52% were admitted to surgery. Thirty-three percent of patients were SGA C, 44% were SGA B, and 19% were SGA A. Twenty-seven percent of patients had cancer. The average length of hospital stay was 22 days. The main indications for PPN were gastrointestinal tract dysfunction (72%) and postsurgical status (16%). PPN provided an average of 1296 kcal (±191) and 46 g of protein (±7). Intravenous access complications in patients receiving PPN did not occur in excess of expected. Almost 40% of patients required transition to central PN. Conclusions PPN is a safe, effective way to deliver supplemental protein, energy, and micronutrients to malnourished patients and supports transition to other modes of nutrition care.

Background: Midwives and nurses are in an opportune position to provide nutrition care to pregnant women and lactating mothers during routine antenatal and postnatal care. However, midwives and nurses may not have adequate competencies and confidence to provide effective nutrition care. We evaluated the adequacy of nutrition education received in nursing and midwifery school; nutrition care competencies; self – efficacy and the nutrition care practice of midwives and nurses during routine antenatal and postnatal care in Ghana. We also evaluated determinants of nutrition care practice among these participants.Methods: This was a multi-site cross- sectional study conducted among midwives and nurses working at antenatal and postnatal contact points in Sunyani Municipality, Ghana. Data was collected using a self-administered questionnaire. Descriptive statistics of mean, standard deviation and frequencies were used to describe the data. Results: Almost 90% (n=267) of the participants received nutrition education during training. More than half of the participants were either unsatisfied or uncertain with: the amount of time allocated for nutrition education during training in school (77.5%); the integration of nutrition content into the curriculum (82.6%); and how nutrition course content was presented (77.4%). Almost 40% of the participants felt inadequately prepared from school to provide nutrition care during routine antenatal and postnatal care. The mean (±SD) knowledge of the participants was 57.46 (8.12) %. Participants attitude towards nutrition care was positive. Self-efficacy level ranged from moderate to low. Factors that had a positive association with nutrition care practice were age of respondents (B = 0.04; p = 0.002), nutrition-related knowledge (B = 0.05; p = 0.016), adequacy of nutrition education in school (0.14; p = 0.006), receipt of nutrition training after school (B = 0.38; p = 0.010) and nutrition care self-efficacy (B = 0.03; p = 0.048). Conclusion: Nutrition education received during nursing/midwifery training was unsatisfying and inadequate, resulting in participants inadequate knowledge in basic nutrition issues, feeling ill prepared, less confident and lacking the key skills to provide nutrition care. Although participants recognised nutrition care to be important and as their responsibility to provide it, they could not provide nutrition care as may be needed by mothers during routine antenatal and postnatal care.

BACKGROUND AND OBJECTIVES: Fat-based energy-dense nutritional supplements may offer benefits over protein- or carbohydrate-dense supplements for patients receiving dialysis because of the adverse metabolic consequences of the latter. We conducted a randomized controlled trial to assess the effects of the short-term use of a fat-based nutritional supplement on various measures of nutritional status in patients receiving maintenance hemodialysis who have low dietary energy intake. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We enrolled nondiabetic patients receiving hemodialysis for >3 months who had inadequate dietary energy intake (

To evaluate the effect of a nutrition care bundle in improving growth in premature infants during neonatal hospitalization.This study was a retrospective analysis of prospectively collected data for 584 surviving infants with birth weight ≤1000 g and gestational age 24-29 weeks admitted to a single-center neonatal intensive care unit between July 3, 2005, and June 6, 2016. Participants were divided into 3 discrete epochs based on evolving nutrition practices during the study period: epoch 1, baseline, open-bay setting; epoch 2, improved lactation staffing, introduction of high-protein formula, single-family room setting; epoch 3, complete nutrition care bundle. Infants in each epoch were evaluated for the primary outcome of change in weight z-score between postnatal day 7 and 36 weeks postmenstrual age (PMA) or discharge if sooner. Univariate and multivariable regression analyses were conducted to evaluate the effect of clinical variables on outcome.Significant increases in weight z-score between day of life 7 and 36 weeks PMA were observed across the 3 epochs, which accounted for 31% (P .0001) of the variance. Variables that were positive predictors of weight z-score change included birth weight z-score, cesarean delivery, and later epochs of nutritional support. Variables that were negative predictors of weight change included gestational age, postnatal steroids, and days on parenteral nutrition.Implementation of a nutrition care bundle was associated with improved weight gain in extremely low birth weight infants.

Malnutrition, frailty and sarcopenia are becoming increasingly prevalent among community-dwelling older adults; yet are often unidentified and untreated in community settings. There is an urgent need for community-based healthcare professionals (HCPs) from all disciplines, including medicine, nursing and allied health, to be aware of, and to be able to recognise and appropriately manage these conditions. This paper provides a comprehensive overview of malnutrition, frailty and sarcopenia in the community, including their definitions, prevalence, impacts and causes/risk factors; and guidance on how these conditions may be identified and managed by HCPs in the community. A detailed description of the care process, including screening and referral, assessment and diagnosis, intervention, and monitoring and evaluation, relevant to the community context, is also provided. Further research exploring the barriers/enablers to delivering high-quality nutrition care to older community-dwelling adults who are malnourished, frail or sarcopenic is recommended, to inform the development of specific guidance for HCPs in identifying and managing these conditions in the community.

This special issue showcases the fundamental importance of nutrition care and weight management in family practice. In doing so, these articles highlight numerous opportunities to improve standard care. But, it is worth recognizing the history that has led us to this place. Inadequate nutrition education during medical training is widely recognized as a fundamental problem for clinicians, especially given the centrality of diet to the management of lifestyle-related diseases. As general practice constitutes the largest group of specialist training doctors (1,2), understanding the history of nutrition in medical education is important to ensure that meaningful improvements can take place in the future. So, why has not nutrition found a more prominent position in contemporary medical education and practice?

In severe dysphagia, risk of aspiration or choking can make it unsafe to swallow food and drink. Nutrition can instead be delivered via tube feeding with a gastrostomy, but this can be contraindicated and denies patients the pleasure and social connection of eating and drinking. Therefore, patients may prefer to continue unsafe oral intake, known as risk feeding. Patients should undergo assessment of dysphagia and be asked about their preferences before deciding how to proceed. According to the Mental Capacity Act 2005, if patients are not competent to provide valid informed consent, a person with power of attorney or treating clinician must make the decision in their best interests and in respect to their previously expressed or implied wishes. Decision-making should be shared between members of the multidisciplinary team and the patient's family. Huntington's disease is a progressive neurological condition that, in its later stages, is associated with dysphagia and cognitive or communication impairments that can hinder capacity to consent. A case study is presented of a patient with Huntington's and dysphagia, which illustrates the importance of a collaborative, structured approach to advanced care planning for managing nutrition in a progressive neurological disease in an inpatient setting.

Background Prediabetes increases the risk of developing type 2 diabetes (T2D). Improving diet quality is key in preventing this progression, yet little is known about the characteristics of individuals with prediabetes or the nutrition care they receive. Objectives This study aims to identify characteristics and experiences associated with receiving a prediabetes diagnosis prior to developing T2D. Methods A mixed methods study encompassed a quantitative subanalysis of participants with newly diagnosed T2D from The 3D Study, and semi-structured telephone interviews with a subsample of participants who were previously diagnosed with prediabetes. Interviews were thematically analysed and survey data synthesized using SPSS statistical software. Results Of the 225 study participants, 100 individuals were previously diagnosed with prediabetes and 120 participants were not. Those with prediabetes were less likely to be smokers (P = 0.022) and more likely to be satisfied with seeing a dietitian (P = 0.031) than those without a previous prediabetes diagnosis. A total of 20 participants completed semi-structured interviews. Thematic analysis revealed three themes: (i) experiencing a prediabetes diagnosis; (ii) receiving nutrition care during prediabetes and (iii) reflecting on the experience of receiving care for prediabetes versus T2D. Conclusions There are gaps in the current management of prediabetes in Australia. Low rates of prediabetes diagnosis and an ambiguous experience of receiving this diagnosis suggest an area of health service improvement. With no difference in diet quality between individuals with and without a previous prediabetes diagnosis, the nutrition care during prediabetes may be more important than the diagnosis itself in delaying the onset of T2D.

The accurate diagnosis and subsequent treatment of malnutrition is an essential component of nutrition care because of the known negative impacts of malnutrition on patient outcomes. The detection of malnutrition is influenced by disease-specific characteristics, practice settings, and the availability of resources. This article explores how malnutrition diagnosis through the application of the Global Leadership Initiative on Malnutrition global consensus on malnutrition diagnostic criteria is impacted by the unique characteristics of the heart failure, oncology, and trauma populations.

Poor growth has long been a characteristic feature of cystic fibrosis (CF) and is significantly linked to lung function and overall health status. Improvements in pulmonary and nutrition care for patients with cystic fibrosis (CF) have resulted in better growth outcomes; however, height gains have not paralleled the improvements in weight in children with CF, and patients with more severe CF mutations remain significantly more affected. Many factors affect the growth hormone-IGF-1 axis and the growth plate of the long bones, including the chronic inflammatory state associated with CF. There are also increasing data on the direct effects of CFTR on bone and implications for CFTR modulators in attaining optimal growth. Treatments aimed at improving growth in CF are also reviewed here.

Hospital malnutrition and pediatric nutrition care in Hasan Sadikin Hospital Bandung Background: Malnutrition during hospitalization delays the recovery of children with acute or chronic illnesses. The Pediatric Nutrition Care (PNC) can improve nutritional support and reduce the prevalence of hospital malnutrition. Objectives: This study was done to find evidence of hospital malnutrition and to evaluate the nutrition care in the pediatric ward of Dr. Hasan Sadikin Hospital, Bandung. Methods: We evaluated malnutrition by comparing body weight change between the first day of admission and at hospital discharge to the length of hospitalization. Screening for malnutrition risk was done using modified Pediatric Yorkhill Malnutrition Screening (mPYMS). Score≥2 was determined as high risk. The PNC process was evaluated by a focused group discussion with PNC-associated pediatric ward personnel. Results: From February-March 2016, 760 patients were admitted to the pediatric ward, of which 111(14.6%) were included in the study. An mPYMS score of ≥2 was found in 69(62.2%) of the patients. During hospitalization, body weight decreased in 23(20.7%) patients, 10(9.0%) of whom were defined as hospital malnutrition. Among these, seven had an mPYMS score≥2. PNC was performed in patients with an mPYMS score≥2 by dietitians who also provided a standardized nutrition care process following American Dietetic Association recommendation. However, a dedicated multidisciplinary PNC team was absent and the nutrition and metabolic disease division was consulted only in a few cases. Performing consistent monitoring and evaluation of PNC was also found to be difficult. Conclusions: Hospital malnutrition may be prevalent among pediatric patients in Dr. Hasan Sadikin Hospital, Bandung. Improving PNC services may reduce this prevalence.

Purpose The purpose of this paper is to investigate registered dietitians’ (RDs) experiences in consulting to adults with intellectual disabilities (ID) in Sweden. Design/methodology/approach A descriptive study using a study-specific web-based questionnaire was administered, comprising both multiple-choice questions with a space for comments and open-ended questions. The open-ended answers and comments from 53 respondents were analysed with systematic text condensation. Findings Four categories were identified: RDs’ experiences from the first meeting; explanations for late initial contact; the actions taken by RDs; and necessary measures for more sustainable nutrition care. Ten sub-categories described the challenges that RDs experience in more detail. Practical implications It is necessary to provide adults with ID and their supporting staff with individually tailored nutritional information. Individuals with ID must be actively involved in lifestyle changes that affect their everyday life. The RD must be included in the interdisciplinary team supporting adults with ID. If a new practice is to be implemented, it should be compatible with the existing values of adults with ID and their staff and must be feasible to implement in the everyday life of the individual. Originality/value This paper identified several barriers that should be overcome in relation to the preparation of RDs for consultation with adults with ID about nutritional health issues. A systematic structure, knowledge about nutrition and knowledge about adults with ID and their living situations are needed. An assessment instrument may meet health promotion needs and facilitate longitudinal follow-ups of nutritional problems.

As Registered Dietitian Nutritionists play an important role in providing nutrition care plans for successful aging, it is important to identify factors influencing nutrition students' intention to work with older adults. A cross-sectional study was conducted to identify significant predictors of nutrition students' intention to work with older adults by utilizing the Theory of Planned Behavior (TPB). A total of 183 students, majoring in Nutrition at a large Southern University, completed a questionnaire examining validated TPB constructs. Structural Equation Modeling with maximum likelihood was used to analyze the data. The structural model provided a good fit to the data (

The process of standardized nutrition care is an activity carried out on patients who are at risk of malnutrition, already experiencing malnutrition and special conditions with certain diseases. As for the steps of nutrition care process is namely nutrition assessment, diagnosis and intervention. Based on medical records at Ende Regional Hospital the number of inpatient hypertension patients was 442 in 2018. Nutrition services especially nutrition care process in hospital have been done well, but the implementation is still not optimal due to luck of nutritionists. This research was conducted to determine the process of standardized nutrition care in hypertensive patients in RSUD Ende. This research is a descriptive study with a qualitative approach. Informants key in this study are nutritionist and supporting informants is nutrition workers and hypertensive patients. The results of the study had been carried out well in Ende Regional Hospital,but the implementation was not optimal due to lack of nutritionists and nurses’ knowledge about nutrition. Standarduzed nutrition care can provide a good change for hypertensive patients, giving the right diet can reduce the hypertensive patient’s blood pressure. The results of this study are expected to further improve well-standarduzed nutrition care services to patients in accordance with the steps of nutrition care process so that it can help the healing process of disease.

The aim of this project was to evaluate the current practice and implement best practice related to Enhanced Recovery After Surgery (ERAS) nutrition care protocols amongst elective colorectal surgery patients at Calvary North Adelaide Hospital. A second aim was to improve outcomes regarding length of hospital stay and rate of unplanned readmissions within 28-days in patients undergoing elective colorectal surgery.The rate of postoperative morbidity remains high after elective colorectal surgery. Enhanced Recovery After Surgery is an evidence-based program incorporating multimodal interventions (including nutrition interventions) in the perioperative period to reduce postoperative morbidity and expedite recovery.This evidence implementation project used the JBI Practical Application of Clinical Evidence System (JBI PACES) and Getting Research into Practice (GRiP) audit and feedback tool. This project was conducted across the preadmission clinic, intensive care unit and surgical wards of a 153-bed, private, acute care hospital in Australia, along with five private surgical clinics. The sample size included 20 patients undergoing elective colorectal surgery and five colorectal surgeons. Seven audit criteria based on the ERAS Society nutrition care protocols for elective colorectal surgery were used, and patient outcomes were length of stay and rate of unplanned readmission within 28 days. A pre-implementation audit was conducted, which informed the development of an implementation plan for ERAS nutrition care protocols using the GRiP analysis. A follow-up audit was conducted to measure change in practice and patient outcomes.Improvement in compliance was observed in four audit criteria: preoperative fasting is minimized (from 0% to 15%), early feeding is implemented postoperatively (from 10% to 65%), preoperative carbohydrate drinks are given (from 20% to 25%) and oral supplements are given postoperatively (from 0% to 20%). Compliance for one audit criterion remained constant: patients are screened for malnutrition risk in preadmission clinic (100% for both audits). Two audit criteria saw a drop in compliance: nutrition support is provided preoperatively to malnourished patients (from 60% to 15%) and nutrition education is provided preoperatively (from 60% to 20%). There was a 2.5-day reduction in length of stay (average 10.8 days length of stay pre-implementation versus 8.3 days post-implementation) and an increase from 0% to 20% in the rate of unplanned readmissions within 28 days post-implementation; however, these were not statistically significant (p = 0.7 and p = 0.11, respectively).Changes in patient outcomes could not be attributed to the implementation of ERAS nutrition care protocols, given the mixed compliance with audit criteria in the post-implementation audit. This project has, however, raised awareness of the importance of having operational definitions for audit criteria, systems to ensure adherence to protocols, and audits of calendar year data for reliability and validity of results. It has also increased knowledge of ERAS nutrition care protocols amongst those involved in the care of patients undergoing elective colorectal surgery and strengthened relationships within the multidisciplinary team. This project represents the first step toward the development of an effective ERAS nutrition care program for patients underoing elective colorectal surgery at Calvary North Adelaide Hospital and informs future audits and feedback cycles.

Background Malnutrition remains an important yet under-recognised problem among hospitalised adults. Although interventions exist aiming to improve nutritional status beyond hospitalisation, few studies examine how often and what type of nutrition care instructions are given at discharge. The present study sought to review nutrition-focused discharge care provided to malnourished adults. Methods We reviewed the electronic medical record for discharge nutrition care instructions provided to adult patients identified by dietitians as malnourished over a 4-month period. Results Seventy-six eligible patients were identified during the study period. More than half of malnutrition cases (64.5%) were attributed to chronic illness. According to electronic medical record documentation, 6.6% received discharge instructions to consume oral nutrition supplements and 30.3% received new or changed prescriptions for vitamins/noncaloric supplements. Almost half of patients (47.4%) received general diet instructions that did not address malnutrition and 44.8% received inappropriate instructions to limit caloric intake. Conclusions A majority of malnourished adult patients receive inappropriate or inadequate nutrition care instructions at the time of discharge. Clinician education and redesign of nutrition care options in the electronic medical record may improve the provision of post-discharge nutrition care instructions.

Aim: This study aimed to determine satisfaction with dietetic services, identify barriers and enablers to engaging with dietetic services and acceptable methods of delivering nutrition care to patients on haemodialysis. Methods: A questionnaire was developed based on existing satisfaction surveys and key constructs from the Theoretical Domains Framework to understand patient behaviours around accessing dietetic services. Constructs were grouped according to the COM-B model (Capability, Opportunity and Motivation) of the Behaviour Change Wheel to inform future interventions. Patients at three Brisbane haemodialysis units participated, with questionnaire administered via laptop (by dietetic assistants) or paper-based version (by nurses). Results: Sixty-six patients completed the questionnaire (response rate 40%, 62 ± 14 years, 58% male). Most respondents (n = 63, 95%) reported seeing a dietitian since commencing haemodialysis. A quarter of respondents reported declining or not wanting to see the dietitian. Despite this, questions pertaining to service satisfaction were largely positive. Questions related to enablers and barriers to engaging with the dietitian revealed the domain of motivation as the main barrier with 41% (n = 26) participants not wanting to make dietary changes. The domains of capability and opportunity were not barriers. Patients preferred receiving nutrition information from dietitians, when they had a question or concern, rather than at predefined intervals. Telehealth was not acceptable to the majority of participants. Conclusions: While patients were satisfied with dietetic care, their preferences for dietetic service delivery were not aligned with current evidence-based guidelines, highlighting need for alternative models of care. Dietetic interventions need to be delivered in a way that addresses motivation.

Obesity continues to be a major public health crisis, both nationally and globally. Metabolic and bariatric surgery has been proven to be a safe and effective treatment for this multifactorial chronic disease. However, inconsistent and varied results in bariatric nutrition literature have prevented the implementation of standardized guidelines. The purpose of this Evidence Analysis Library systematic review is to provide an evidence-based summary of nutrition-related practices in bariatric surgery. The systematic review methodology of the Academy of Nutrition and Dietetics was applied. A total of 27 research studies were included, analyzed, and assessed for risk of bias by trained evidence analysts. The literature included in the systematic review was published from 2003 to 2015. Evaluation of the literature resulted in the development of five graded conclusion statements. Limited research demonstrates that registered dietitian nutritionists play a role in improving weight loss outcomes after bariatric surgery; further research is needed to understand the role of registered dietitian nutritionists in changing behaviors after bariatric surgery. Bariatric surgery results in significant reductions in resting metabolic rate and postoperative energy intake. There is no significant relationship between macronutrient distribution and postoperative weight loss. The graded conclusion statements provide registered dietitian nutritionists who practice in the field of bariatric nutrition with more insight and evidence that can guide and support their recommendations.

本研究では、病棟における栄養ケアに必要な要因の検討を行うために山口県内の38医療施設を対象とし、栄養管理において中心的な役割を担う看護師と管理栄養士に対して、病棟で行われている栄養管理の実態把握と、職種間連携の現状についてアンケート調査を実施した。病棟での栄養ケアは、異なる専門性を持った職種の集まりにより実施されているため、情報共有や職種間の調整が必要であり、栄養状態の改善という共通の課題を達成するために、各専門職種が専門分野を超えて横断的に役割を共有していく必要があることが示唆された。, In this study, surveys were conducted in 38 medical facilities in Yamaguchi Prefecture to examine factors that are necessary for nutritional care in wards. Furthermore, surveys were conducted among nurses and registered dietitians who play a central role in nutrition management in the wards. Questionnaires were also conducted on grasping the actual condition of nutrition management and the current state of interdisciplinary collaboration. Since nutrition care in wards is implemented by a group of professionals with different expertise, information sharing and interdisciplinary collaboration is necessary. In order to achieve a common goal of improving nutritional care, it is a requirement for each professional to share roles equally by going beyond individual professional frameworks.

Aim: Neurosurgical patients often transition from enteral nutrition (EN) to oral nutrition (ON) as they recover. Implementing a nurse-led feeding protocol to guide this transition may improve consistency of nutrition care and dietitian workload efficiency. This pragmatic study aimed to evaluate the effect of such a protocol on these outcomes and on nurses’ nutrition care attitudes, practices and knowledge. Methods: Data were collected retrospectively for 1 year pre- and prospectively for 1 year post-implementation of the transition feeding protocol (TFP). Participants who transitioned from EN to ON were included in the study. Post-implementation nurses in the neurosurgery ward were invited to complete a self-administered questionnaire to investigate attitudes, practices and knowledge. Results: One hundred and thirteen participants, 55 pre- and 58 post-implementation, took part in the study. Significantly more patients received transition feeding (TF) post-implementation (58% vs 93%, P < 0.001), there was a statistically significant improvement in the commencement of TF (0 vs 1 day after ON clearance; P = 0.029), and all patients consumed adequate oral intake 1-week post-EN cessation (92.3% vs 100%, P = 0.078). There was no difference in dietetic occasions of service post-implementation (2 vs 1.5; P = 0.204). A 38% survey response rate from nursing staff (n = 15) was achieved. More nurses were found to be initiating TF (P < 0.001) and a majority reported a perceived increase in knowledge and confidence in providing nutrition support. Conclusions: A TFP can optimise the transition from EN to ON by improving consistency and commencement of TF and nurses’ confidence and knowledge in overall nutrition care.

Objective The purpose of the study was to ascertain pediatric-focused and adult-focused renal dietitians' perspectives on need for pediatric specific training and education materials. Design This study has a descriptive, survey research design using a cross-sectional electronic survey. Subjects included North American dietitians of all ages and experience levels in either pediatric or adult-focused renal nutrition care per self-report. Inclusion criteria were access to renal listservs and/or membership within a Council on Renal Nutrition (CRN) group. Methods Individuals were recruited to participate in the survey via email correspondence disseminated through the pediatric renal listserv hosted by the University of Alberta, Canada, and through the NKF online list of CRN contacts. Surveys were conducted between April 14 and May 2, 2016, and between December 5, 2016 and January 9, 2017. A quantitative and qualitative survey/questionnaire was used to gather information. The main outcome measure of this study was to determine the need for pediatric specific renal nutrition training and education. Results The majority of both pediatric-focused and adult-focused renal dietitians indicated that more pediatric renal nutrition training and education materials (100% and 87.8%, respectively) than what is currently available would be at least somewhat beneficial. In addition, the survey results showed that 22.1% of adult-focused practitioners work with pediatric individuals (≤21 years) at least monthly. Those practitioners also indicated a need for pediatric training resources and education materials. Conclusion More pediatric training and education resources need to be made available to meet the needs of both adult-focused and pediatric-focused dietitians to ensure optimal care of children with renal disease.

Editor's Note: This article is adapted from the address Ms. Boucher delivered as the recipient of the American Diabetes Association’s (ADA’s) Outstanding Educator in Diabetes Award for 2018. She delivered the address in June 2018 at the association’s 78th Scientific Sessions in Orlando, Fla. A webcast of this speech is available for viewing at the ADA website (professional.diabetes.org/webcast/outstanding-educator-diabetes-award-lecture%E2%80%95connectedness%E2%80%94how-technology-and-social-networks).

Background and objectives Guidelines recommend people with prediabetes receive diet and lifestyle support to avoid type 2 diabetes, yet it is unclear whether this care is provided in practice. The aim of this article is to explore the perspectives and nutrition care practices of healthcare providers (HCPs) for patients with prediabetes. Method This was a mixed-methods case study of an urban practice comprising a retrospective chart review and semi-structured interviews. Charts of adult patients with prediabetes were reviewed and informed a protocol used to interview HCPs. Interviews were thematically analysed. Results Charts of 47 patients, representing 1096 consultations, were reviewed. The majority (74.5%) of patients had 'diet' noted in their chart, yet this accounted for only 8.1% of consultations. Only 19.1% of patients were referred to a dietitian. Interviews provided HCP explanations of the quantitative findings. Discussion HCPs value nutrition care, yet are limited by the healthcare system to provide comprehensive care to people with prediabetes.

The nutrition care process is a standardized and systematic method used by nutrition professionals to assess, diagnose, treat, and monitor patients. Using the nutrition care process model, we demonstrate how nutrition prehabilitation can be applied to the pre-surgical oncology patient.

BACKGROUND Accurate dietary intake data are critical to nutrition care planning. Commonly used food record charts (FRC) are paper-based, time consuming, require nutrient analysis estimations, and may provide limited accuracy. The present study aimed to validate Mobile Intake® (MI) (an electronic food intake tool incorporating the five-point visual scale and providing automatic nutrient analysis) for usability and efficacy in quantifying dietary intake in the healthcare setting. METHODS Two research stages within two tertiary hospitals included: (1) examining criterion validity and efficiency of dietary intake quantification using FRC and MI compared to the gold standard weighed food record (WFR) in a controlled environment and (2) comparing efficiency and effectiveness of FRC and MI in usual care conditions. RESULTS In Stage 1, dietary intake was calculated (n = 90) with a significant difference across all methods (FRC, MI and WFR) for energy (p = 0.04), but not between MI and WFR (p = 1.00). The time taken for MI (40 s) was significantly less than FRC (174 s) and WFR (371 s) (p

Many children with type 1 diabetes (T1D) do not meet nutritional guidelines. Little is known about how caregivers perceive the necessity of appointments with a dietitian (RD) or how satisfied they are with their nutrition care. To better understand caregiver nutrition experiences and perceptions, we surveyed 838 families of children 3 years, respectively. Among children in the analysis, 55% were ≥ 13 years old and 51% had T1D for ≤ 3 years. Over half (56.6%) of respondents considered it necessary to see a RD every year. Older age (aOR=2.06, 95% CI [1.01, 4.20]) and shorter disease duration (aOR=2.50, 95% CI [1.22, 5.12]) were associated with this perception. Less than half (47.8%) reported satisfaction with their nutrition care, with shorter disease duration associated with a higher likelihood of satisfaction (aOR=2.24, 95% CI [1.13, 4.42]). Only 61.4% of respondents reported encouragement from a nurse or doctor to meet with a RD. No demographic or clinical characteristics were associated with this finding. Our findings suggest that caregiver satisfaction with nutrition care and its perceived need for children with T1D may wane with longer disease duration. However, the perceived need for nutrition services is also higher in parents of teens. Future work should delineate strategies for engaging families in nutrition education that is more tailored to later stages of the T1D journey. In addition, there is a need for teen-focused T1D nutrition care curricula. Disclosure E. N. Gordon: None. B. S. Dykeman: None. K. Greco: None. E. Rhodes: Other Relationship; Self; AstraZeneca. K. Garvey: None.

There is scarce evidence regarding the risk of weight loss and the effect of having registered dietitians (RDs) on staff in rehabilitation wards on weight loss. We aimed to examine the effects of RDs in Kaifukuki (convalescent) rehabilitation wards (KRWs) on the prevention of weight loss in adult patients. Data from 2-year nationwide annual surveys on KRWs in Japan were retrospectively analysed. Weight loss was defined as loss of ≥5% weight during the KRW stay. Risk of weight loss in class 1 KRWs (obligated to provide nutrition care) was compared with that in class 2–6 KRWs (not obligated). Risk of weight loss in class 2–6 KRWs with RDs was compared to those without. Overall, 17.7% of 39,417 patients lost weight. Class 1 KRWs showed a lower risk of weight loss than class 2–6 KRWs (17.3% vs. 18.5%, p = 0.003). KRWs with RDs showed a significantly lower incidence of weight loss than those without RDs (16.1% vs. 18.8%, p = 0.015). Class 1 KRWs and exclusively staffed RDs were independently associated with lower odds of weight loss (odds ratio = 0.915 and 0.810, respectively). Approximately 18% of KRW patients lost weight, and having RDs on staff can lower the risk of weight loss.

BACKGROUND The nutrition care process (NCP) and its associated standardised terminology (NCPT, referred to collectively as NCP/T) forms a problem-solving framework fundamental to dietetic practice. Global implementation would assist in confirming outcomes from dietetic care, but implementation rates have varied between countries. We investigated which factors predict NCP/T knowledge and use among dietetic professionals in an international cohort, aiming to understand how implementation can be strengthened. METHODS The validated International NCP Implementation Survey was disseminated to dietitians in 10 countries via professional networks. Implementation, attitudes and knowledge of the NCP/T along with workplace and educational data were assessed. Independent predictive factors associated with higher NCP/T knowledge and use were identified using backward stepwise logistic regression. RESULTS Data from 6149 respondents was used for this analysis. Enablers that were independent predictors of both high knowledge and frequent use of NCP/T were peer support, recommendation from national dietetic association and workplace requirements (all p

Background and Objectives: Over 25% of United States (US) community-dwelling, older adults are at nutritional risk. Health and cost burdens of poor nutrition can be lowered by nutrition programs for hospital inpatients, but few studies have looked at the impact on outpatients. The objective of our study was to assess outcomes of a nutrition focused quality improvement program (QIP) on healthcare resource use and costs in poorly nourished outpatients. Methods: This pre-post QIP study was implemented at 3 US healthcare system clinics. Included patients (n = 600) were ≥45 years old, had ≥2 chronic conditions, and were enrolled over a 15-month interval. For comparison, historical (n = 600) and concurrent control (n = 600) groups were used. Assessment of poor nutritional status was performed during each patient’s baseline visit. Healthcare resource use (hospitalizations, emergency department visits, and outpatient clinic visits), medication use, and costs were determined for a 90-day interval. Results: QIP patients (mean age 61.6 years) were predominantly female (62.5%) and overweight/obese (81.7%). The proportion of QIP outpatients presenting for healthcare services was significantly reduced compared to both historical and concurrent controls—relative risk reduction (RRR) versus historical (11.6%, P Conclusions: Nutrition QIPs in outpatient clinics are feasible and can reduce healthcare resource use and cut costs. Such findings underscore benefits of nutritional interventions for community-dwelling outpatients with poor nutritional status.

The objective of the Hormones, Oxidative stress, Methylation, Inflammation and Gene expression (HOMING) trial was to assess the efficacy of personalized bio identical hormone, dietary supplement and nutritional care plans on dry and wet Age-related Macular Degeneration (AMD) outcomes. We evaluated 220 Age-related Macular Degeneration (AMD) patients that followed a personalized clinical care plan for up to 9 months. The care plans consisted of bio identical hormones, dietary supplements and nutrition recommendations with the objective to improve lab and clinical measurements linked to oxidative stress, inflammation and gene expression. Serum concentrations of CRP, HbA1c and homocysteine responded favorably to the HOMING protocol with full program compliance. Sixty percent (42/70) of wet AMD patients reported improvement in visual acuity and/or a reduction in the frequency of anti-VEGF injections during the study period. Forty eight percent (44/92) of dry AMD patients reported improvement in visual acuity during the study period. Nine percent (4/45) patients reported improvement in visual acuity in the dry AMD control group and no (0/13) wet AMD patients in the control group reported improvement. Six percent (4/70) of wet AMD patients reported that their vision declined and/or that their F frequency increased during the study period. Five percent (4/92) of dry AMD patients reported that their vision was worse. Keywords: Bio identical Hormones, Oxidative stress, Methylation, Inflammation, Gene Expression, Nutrition and AMD.