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Contains fulltext : 232480.pdf (Publisher’s version ) (Open Access) OBJECTIVE: Observational instruments are preferred for assessment of cultural competence. The aim of the current study is to identify observational instruments to assess cultural competence in healthcare providers and dieticians specifically and assess their psychometric properties. METHODS: A systematic review was conducted in Cinahl, Cochrane, EMBASE, PsycInfo, Pubmed, and Web of Science using search terms related to cultural competency and measurement properties. Methodological quality of the selected studies of observational cultural competence instruments in dieticians, other healthcare professionals and psychological counsellors and the measurement properties of instruments were assessed using the COSMIN checklist. RESULTS: From 11,913 articles, six articles on five instruments were selected. Instruments were targeted at health professionals and counsellors only, and designed for face-to-face communication (n = 4) or verbal responses to videotaped simulated interactions (n = 1). The instruments' content varied largely, with main focus on attitude, and little on knowledge and skills. The measurement properties were suboptimal. CONCLUSION: No observational instrument are available to evaluate cultural competence of dieticians. Studies on psychometric properties of instruments targeted at other health professionals lack methodological rigour. PRACTICE IMPLICATIONS: Future work should focus on developing an instrument that encompasses both 'general' cultural competences necessary for all healthcare professionals and dietetic specific competences.

Background Whether decreased physical functioning of patients with mitochondrial disease (MD) is related to altered body composition or low protein intake needs clarification at the background of the nutrition state. Methods In this 2‐site cross‐sectional study, MD patients were age‐, body mass index (BMI)–, and gender‐matched to controls. Body composition was assessed by dual‐energy x‐ray absorptiometry. Physical functioning was measured by handgrip strength, 6‐minute walking test, 30‐second sit‐to‐stand test (30SCT), and 6‐minute mastication test. Total daily protein intake was calculated by 3‐day food records. Malnutrition was assessed by Patient‐Generated Subjective Global Assessment and the Global Leadership Initiative on Malnutrition (GLIM) criteria and sarcopenia by the 2018 consensus. Data were analyzed using independent samples t‐tests, Fisher exact test, and Spearman and Pearson correlation coefficients. Results Thirty‐seven MD patients (42 ± 12 years, BMI: 23 ± 4 kg/m2, 59% females) and 37 matched controls were included. Handgrip strength was moderate, inversely related to fat mass index in both MD patients and controls, whereas it correlated with fat‐free mass index in controls solely. Protein intake was associated with muscle strength (handgrip strength and 30SCT) in MD patients but not in controls. Twenty‐seven MD patients (73%) were malnourished, and 5 (14%) were classified as sarcopenic. Conclusions Muscle strength is related to body composition and protein intake in MD patients. This, in combination with the high incidence of both malnutrition and sarcopenia, warrants individual nutrition assessment in MD patients., Journal of Parenteral and Enteral Nutrition, 45 (1), ISSN:0148-6071, ISSN:1941-2444

This systematic review and meta-analysis assesses the prevalence of protein-energy malnutrition risk across different health-care settings in European older adults, using 22 malnutrition screening tools recently validated for use in older adults. Systematic searches were performed in six electronic databases (2006 through 2017). Included were studies which reported malnutrition risk in adults aged ≥65y in Europe. Frequency of high and moderate malnutrition risk for each malnutrition screening tool was collated. Meta-analyses of malnutrition risk using a random-effects model were performed where data from at least 10 study samples were available. Of 21,465 studies, 196 studies were available for data extraction, representing 223 study samples from 24 European countries and 583,972 older adults. Pooled prevalence rates of high malnutrition risk across all countries and malnutrition screening tools were 28.0% (n = 127 study samples), 17.5% (n = 30), and 8.5% (n = 32), for the hospital, residential care and community settings respectively. Using meta-regression, prevalence rates were higher in adults aged >80y (p < 0.0001), in women (p = 0.03)and in patients with one or multiple comorbidities (p < 0.0001). Prevalence rates differed by country, from 15.2% in Spain to 37.7% in Switzerland, and by screening tool, from 14.9% using MNA-SF to 40.6% using NRS-2002. In conclusion, the prevalence of high malnutrition risk in European older adults varies widely between countries and across health-care settings. Malnutrition risk is associated with older age, gender and presence of disease. As prevalence rates differ depending on the screening tool used, the use of one preferred malnutrition screening tool per setting is strongly recommended.

This systematic review and meta-analysis assesses the prevalence of protein-energy malnutrition risk across different health-care settings in European older adults, using 22 malnutrition screening tools recently validated for use in older adults. Systematic searches were performed in six electronic databases (2006 through 2017). Included were studies which reported malnutrition risk in adults aged ≥65y in Europe. Frequency of high and moderate malnutrition risk for each malnutrition screening tool was collated. Meta-analyses of malnutrition risk using a random-effects model were performed where data from at least 10 study samples were available. Of 21,465 studies, 196 studies were available for data extraction, representing 223 study samples from 24 European countries and 583,972 older adults. Pooled prevalence rates of high malnutrition risk across all countries and malnutrition screening tools were 28.0% (n = 127 study samples), 17.5% (n = 30), and 8.5% (n = 32), for the hospital, residential care and community settings respectively. Using meta-regression, prevalence rates were higher in adults aged >80y (p < 0.0001), in women (p = 0.03)and in patients with one or multiple comorbidities (p < 0.0001). Prevalence rates differed by country, from 15.2% in Spain to 37.7% in Switzerland, and by screening tool, from 14.9% using MNA-SF to 40.6% using NRS-2002. In conclusion, the prevalence of high malnutrition risk in European older adults varies widely between countries and across health-care settings. Malnutrition risk is associated with older age, gender and presence of disease. As prevalence rates differ depending on the screening tool used, the use of one preferred malnutrition screening tool per setting is strongly recommended.

Summary Rationale Many malnutrition screening tools are used to screen for risk of malnutrition in older adults. An aim of the Joint Programming Initiative (JPI) ‘A Healthy Diet for a Healthy Life’ (HDHL) MalNutrition in the ELderly Knowledge hub (MaNuEL) is to devise recommendations on the best tools to screen for risk of malnutrition in older adults in community and healthcare settings across Europe. The aim of this paper was to develop and apply a scoring system to rate malnutrition screening tools. Methods Using a targeted literature search strategy, 48 malnutrition screening tools used to screen for risk of malnutrition in older adults were identified across community, rehabilitation, residential care and hospital settings. Criteria to rate each tool were developed; these were based on published evidence and expert opinion. These criteria were translated into a scoring system. Results The scoring system had three equally weighted sections; validation, parameters and practicability, and was applied to all 48 tools. Overall, the highest scoring tools per setting for screening for risk of malnutrition in older adults were i) DETERMINE your health checklist for the community setting; ii) the Nutritional Form for the Elderly (NUFFE) for the rehabilitation setting; iii) the Short Nutritional Assessment Questionnaire-Residential Care (SNAQRC) for residential care and iv) both the Malnutrition Screening Tool (MST) and the Mini Nutritional Assessment Short Form Version 1 (MNA-SF-V1) for the hospital setting. Conclusion Setting-specific tools are more appropriate for use with older adults. These findings will inform recommendations for the optimal screening of geriatric malnutrition across Europe.

This review provides an overview of the current state of the art of magnetic resonance spectroscopy (MRS) in in vivo investigations of diffuse liver disease. So far, MRS of the human liver in vivo has mainly been used as a research tool rather than a clinical tool. The liver is particularly suitable for static and dynamic metabolic studies due to its high metabolic activity. Furthermore, its relatively superficial position allows excellent MRS localization, while its large volume allows detection of signals with relatively low intensity. This review describes the application of MRS to study the metabolic consequences of different conditions including diffuse and chronic liver diseases, congenital diseases, diabetes, and the presence of a distant malignancy on hepatic metabolism. In addition, future prospects of MRS are discussed. It is anticipated that future technical developments such as clinical MRS magnets with higher field strength (3 T) and improved delineation of multi-component signals such as phosphomonoester and phosphodiester using proton decoupling, especially if combined with price reductions for stable isotope tracers, will lead to intensified research into metabolic syndrome, cardiovascular disease, hepato-biliary diseases, as well as non-metastatic liver metabolism in patients with a distant malignant tumor.

We recently observed inhibition of weight loss in patients with advanced nonsmall-cell lung cancer after intravenous infusion of ATP. Because liver ATP levels were found to be decreased in lung cancer patients with weight loss, the present 31P magnetic resonance spectroscopy (MRS) study was aimed at investigating whether ATP infusion restores liver energy status in these patients. Nine patients with advanced nonsmall-cell lung cancer (stage IIIB/IV) were studied 1 week before (baseline) and at 22 to 24 hours of continuous ATP infusion (37-75 microg/kg/min). Localized hepatic 31P MR spectra (repetition time 15 seconds), obtained in the overnight-fasted state, were analyzed for ATP and P(i) content. Ten healthy subjects (without ATP infusion) served as control. Liver ATP levels in lung cancer patients increased from 8.8 +/- 0.7% (relative to total MR-detectable phosphate; mean +/- SE) at baseline to 12.2 +/- 0.9% during ATP infusion (P or = 5% weight loss (baseline: 7.9 +/- 0.7%, during ATP infusion: 12.8 +/- 1.0%, P < 0.01). In conclusion, ATP infusion restores hepatic energy levels in patients with advanced lung cancer, especially in weight-losing patients. These changes may contribute to the previously reported beneficial effects of ATP infusion on the nutritional status of lung cancer patients.

Altered energy status has been reported in the liver of tumour-bearing animals, but data on energy status in humans are scarce. Therefore, bioenergetics in tumour-free liver of lung cancer patients were monitored using 31P magnetic resonance spectroscopy (MRS) with infusion of L-alanine as a gluconeogenic challenge.Twenty-one overnight-fasted lung cancer patients without liver metastases, with (CaWL) or without weight loss (CaWS), and 12 healthy control subjects (C) were studied. Hepatic energy status was monitored before and during an i.v. L-alanine infusion of 1.4-2.8 mmol/kg + 2.8 mmol x kg(-1) x h(-1) for 90 min by 31p MR spectroscopy.Baseline levels of ATP in WL lung cancer patients, expressed relative to total MR-detectable phosphate, were reduced (CaWL, 9.5+/-0.9% vs. CaWS, 12.6+/-0.8% and C, 12.4+/-0.8%; p0.05) and inversely correlated with the degree of weight loss in lung cancer patients (r=-0.46, p=0.03). Pi/ATP ratios were increased (p0.05), indicating reduced liver phosphorylation status. During L-alanine infusion, ATP levels decreased in all groups (p0.05); in CaWL, ATP levels were lower at all time-points between 0-90 min as compared to both CaWS and C (p0.05). Pi/ATP ratios were significantly higher after 70-90 min of L-alanine infusion in CaWL compared to CaWS and C (p0.05).Hepatic ATP and phosphorylation status are reduced in WL lung cancer patients, in contrast to WS patients and healthy subjects, and continue to decrease during infusion of a gluconeogenic substrate, suggesting impaired energy regenerating capacity in these patients.

We recently observed inhibition of weight loss in patients with advanced nonsmall-cell lung cancer after intravenous infusion of ATP. Because liver ATP levels were found to be decreased in lung cancer patients with weight loss, the present 31P magnetic resonance spectroscopy (MRS) study was aimed at investigating whether ATP infusion restores liver energy status in these patients. Nine patients with advanced nonsmall-cell lung cancer (stage IIIB/IV) were studied 1 week before (baseline) and at 22 to 24 hours of continuous ATP infusion (37-75 microg/kg/min). Localized hepatic 31P MR spectra (repetition time 15 seconds), obtained in the overnight-fasted state, were analyzed for ATP and P(i) content. Ten healthy subjects (without ATP infusion) served as control. Liver ATP levels in lung cancer patients increased from 8.8 +/- 0.7% (relative to total MR-detectable phosphate; mean +/- SE) at baseline to 12.2 +/- 0.9% during ATP infusion (P.05), i.e., a level similar to that in healthy subjects (11.9 +/- 0.9%). The increase in ATP level during ATP infusion was most prominent in patients withor = 5% weight loss (baseline: 7.9 +/- 0.7%, during ATP infusion: 12.8 +/- 1.0%, P0.01). In conclusion, ATP infusion restores hepatic energy levels in patients with advanced lung cancer, especially in weight-losing patients. These changes may contribute to the previously reported beneficial effects of ATP infusion on the nutritional status of lung cancer patients.

Stable-isotope tracers were used to assess whether levels of phosphomonoesters (PME) and phosphodiesters (PDE) in the livers of lung cancer patients, as observed by P-31 magnetic resonance (MR) spectroscopy, reflect elevated whole-body glucose turnover and gluconeogenesis from alanine. Patients with advanced non-small-cell lung cancer without liver metastases (n = 24;weight loss 0-24%) and healthy control subjects (n = 13) were stud led after an overnight fast. P-31 MR spectra of the liver in vivo were obtained, and glucose turnover and gluconeogenesis from alanine were determined simultaneously using primed-constant infusions of [6,6-H-2(2)]glucose and [3-C-13]alanine. Liver PME concentrations were 6% higher in lung cancer patients compared with controls (not significant); PME levels in patients with greater than or equal to 5% weight loss were significantly higher than in patients with