Measures of nutrition status and health for weight-inclusive patient care: A narrative review.

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

A comparative analysis of outpatient nutrition clinic scheduling outcomes based on in-person and telehealth patient care delivery modalities.

During the start of the global COVID-19 pandemic in March 2020, patient care modalities changed from in-person to telehealth to comply with physical distancing guidelines. Our study uniquely examines operations data from three distinct periods: before the transition to telehealth, early transition from in-person care to telehealth, and the eventual adoption of telehealth. We present a comparative analysis of outpatient nutrition clinic scheduling outcomes based on care delivery modality. We used descriptive statistics to report means and variance and frequencies. We used inferential statistics to make comparisons: categorical data were compared using chi-square analysis with post-hoc comparisons using a z-test with alpha at 0.05. Means of continuous variables were compared using ANOVA with Tukey HSD post-hoc analysis. We found patient demographics remained widely unchanged across the three distinct periods as the demand for telehealth visits increased, with a notable rise in return patient visits, signaling both adaptability across the patient population and acceptance of the telehealth modality. These analyses along with evidence from the included literature review point to many the benefits of telehealth, thus telehealth as a healthcare delivery modality is here to stay. Our work serves as a foundation for future studies in this field, provides information for decision-makers in telehealth-related strategic planning, and can be utilized in advocacy for the extension of telehealth coverage.

Physical activity and sleep quality correlations with anthropometric measurements in young adults.

OBJECTIVE: This cross-sectional study examined correlations between physical activity and anthropometrics as well as sleep quality and anthropometrics. PARTICIPANTS: College students (n = 85) with average age 25.6 ± 5.4 years. METHODS: Participants received full-body dual-energy x-ray absorptiometry scans and completed validated surveys: Habitual Physical Activity questionnaire, Pittsburgh Sleep Quality Index (PSQI), and Epworth Sleepiness Scale. RESULTS: Males reported more sports-related physical activity than females (p = 0.041). Physical activity indices and percent body fat were inversely correlated (total ⍴ = -0.320, p < 0.001; sport ß = -0.378, p = 0.003). Participants had poor overall sleep quality (PSQI = 6.19 ± 2.99). The PSQI sleep quality index: disturbance was directly correlated with body mass index (BMI) (ß = 0.328, p = 0.007). CONCLUSION: Health interventions on college campuses should promote more physical activity and better quality sleep as these factors were related to improved body anthropometrics and potentially reduced chronic disease risk.

The consequences of a weight-centric approach to healthcare: A case for a paradigm shift in how clinicians address body weight.

Current healthcare is weight-centric, equating weight and health. This approach to healthcare has negative consequences on patient well-being. The aim of this article is to make a case for a paradigm shift in how clinicians view and address body weight. In this review, we (1) address common flawed assumptions in the weight-centric approach to healthcare, (2) review the weight science literature and provide evidence for the negative consequences of promoting dieting and weight loss, and (3) provide practice recommendations for weight-inclusive care.

Conservative Clothing Effects on Body Composition Assessment by Air Displacement Plethysmography.

Form-fitting spandex swimsuits or single-layer compression shorts are recommended during BOD POD® testing to ensure accurate results. The purpose of this study was to evaluate the effects of various outfit types on body composition measurements using the BOD POD®, and self-reported comfort level wearing each outfit. Twenty-one participants, 8 females and 13 males, (age 31.6 ± 9.8 years) wore a spandex swim cap and three different outfits during BOD POD® testing (manufacturer-recommended form-fitting spandex swimsuit, short sleeve spandex, long sleeve spandex). Measured variables include body mass, body fat percentage, body volume, and self-reported comfort level wearing each outfit. Calculated variables include BMI and body density. Mean body density when wearing the control outfit was 0.004 g/cm3 lower than both short (p < 0.001) and long sleeve (p = 0.001) alternatives. Short and long sleeve outfits resulted in body fat percentage underestimations of 2.0% and 2.1%, respectively (p < 0.001). The short sleeve outfit had the highest mean comfort rating followed by the long sleeve outfit, and the lowest was the control swimsuits. The short sleeve outfit and control outfit had the largest differences in reported comfort levels (p < 0.05). Wearing short and long sleeve spandex outfits instead of recommended form-fitting swimsuits resulted in body density increases and body fat percentage underestimations. Participants should follow manufacturer recommendations by wearing spandex swimsuits. Participants had higher self-reported comfort levels when wearing short or long sleeve outfits.

Performing nutrition assessment remotely via telehealth.

Performing nutrition assessment remotely via telehealth is a topic of significant interest given the global pandemic in 2020 that has necessitated physical distancing and virtual communications. This review presents an evidence-based approach to conducting nutrition assessments remotely. The authors present suggestions for adaptations that can be used to perform a remote nutrition-focused physical exam. Direct-to-consumer technologies that can be used in remote nutrition assessment are discussed and compared. Practice tips for conducting a telehealth visit are also presented. The aim of this publication is to provide interdisciplinary clinicians a set of guidelines and best practices for performing nutrition assessments in the era of telehealth.

The Age of Artificial Intelligence: Use of Digital Technology in Clinical Nutrition.

PURPOSE OF REVIEW: Computing advances over the decades have catalyzed the pervasive integration of digital technology in the medical industry, now followed by similar applications for clinical nutrition. This review discusses the implementation of such technologies for nutrition, ranging from the use of mobile apps and wearable technologies to the development of decision support tools for parenteral nutrition and use of telehealth for remote assessment of nutrition. RECENT FINDINGS: Mobile applications and wearable technologies have provided opportunities for real-time collection of granular nutrition-related data. Machine learning has allowed for more complex analyses of the increasing volume of data collected. The combination of these tools has also translated into practical clinical applications, such as decision support tools, risk prediction, and diet optimization. SUMMARY: The state of digital technology for clinical nutrition is still young, although there is much promise for growth and disruption in the future.

A Quality Improvement Study: Comparison of Volume-Based and Rate-Based Tube Feeding Efficacy and Clinical Outcomes in Critically Ill Patients.

BACKGROUND: Adequate nutrition (receiving ≥80% of estimated energy requirements [EER]) is important in preventing and treating malnutrition and improving clinical outcomes. In conventional rate-based tube feeding (RBTF), patients are prescribed a constant infusion rate. Per volume-based tube feeding (VBTF), the hourly infusion rate can be increased (max 150 mL/h) to make up for feeding deficits, ensuring patients receive the targeted 24-hour volume. This study compared clinical outcomes between patients on VBTF vs RBTF. METHODS: Data were collected from medical charts of patients within a 5-month period. Inclusion criteria included patients ≥18 years of age who were admitted to an intensive care unit and receiving enteral nutrition for at least 24 hours. RESULTS: More patients on VBTF (n = 77; 55.8% females, age 59.9 ± 18.1 years, body mass index [BMI] 29.7 ± 17.7 kg/m2 ) received adequate nutrition (VBTF: 88.3%, 93.1 ± 11.3% EER; RBTF: 36.4%, 71.3 ± 35.8% EER) than those on RBTF (n = 206; 35.9% females, age 61 ± 15 years, BMI 28.3 ± 6.5 kg/m2 ) during the first crucial 7 days of nutrition support. No significant differences in adverse outcomes (hyperglycemia P = 0.052, hypoglycemia P = 0.168, emesis P = 0.084, diarrhea P = 0.470, and high gastric output P = 0.096) were found between the groups. CONCLUSION: VBTF can help promote nutrition adequacy. This study provides evidence for clinicians to be more proactive and aggressive in providing tube feeding in the critical care setting when patients are deemed appropriate for VBTF.

The Type of Dietary Fat in an Isocaloric Breakfast Meal Does Not Modify Postprandial Metabolism in Overweight/Obese Pregnant Women.

Almonds provide a satiating, healthy source of fat and fiber. The postprandial metabolic and satiety response to 2 ounces of nuts or dairy was assessed in 18 overweight/obese women during late pregnancy. Serum glucose, triglycerides, insulin, c-peptide, leptin, ghrelin, and lipoprotein particles were measured prior to and during a 5-h postprandial period following the consumption of an isocaloric breakfast meal with equivalent amounts of fat from either nuts or dairy on two separate mornings. Satiety was assessed by visual analogue scale (VAS) questionnaires and ad libitum food intake at the end of the study. At 33 weeks gestation, the women had gained an average of 7.0 ± 4.4 kg during gestation. Body fat averaged 41.9 ± 5.5% and hemoglobin A1c levels were elevated, (7.2 ± 0.6%). Fasting glucose levels were normal, but hyperinsulinemia was evident. The two test meals did not affect the postprandial metabolic response, but glucose, triglyceride, and ghrelin concentrations changed with time during the postprandial period (p < 0.001, p = 0.0008, p = 0.006). Satiety measures did not differ between the two test meals. Consuming an isocaloric breakfast meal with equivalent amounts of fat from nuts or dairy did not alter postprandial levels of blood lipids, glucose, hormones, or measures of satiety in overweight/obese, pregnant women.

New Guidelines for Assessment of Malnutrition in Adults: Obese Critically Ill Patients.

Recently released recommendations for detection and documentation of malnutrition in adults in clinical practice define 3 types of malnutrition: starvation related, acute disease or injury related, and chronic disease related. The first 2 are more easily recognized, but the third may be more often unnoticed, particularly in obese patients. Critical care patients tend to be at high risk for malnutrition and thus require a thorough nutritional assessment. Compared with patients of earlier times, intensive care unit patients today tend to be older, have more complex medical and comorbid conditions, and often are obese. Missed or delayed detection of malnutrition in these patients may contribute to increases in hospital morbidity and longer hospital stays. Critical care nurses are in a prime position to screen patients at risk for malnutrition and to work with members of the interprofessional team in implementing nutritional intervention plans.

Higher calorie diets increase rate of weight gain and shorten hospital stay in hospitalized adolescents with anorexia nervosa.

PURPOSE: Current recommendations for refeeding in anorexia nervosa (AN) are conservative, beginning around 1,200 calories to avoid refeeding syndrome. We previously showed poor weight gain and long hospital stay using this approach and hypothesized that a higher calorie approach would improve outcomes. METHODS: Adolescents hospitalized for malnutrition due to AN were included in this quasi-experimental study comparing lower and higher calories during refeeding. Participants enrolled between 2002 and 2012; higher calories were prescribed starting around 2008. Daily prospective measures included weight, heart rate, temperature, hydration markers and serum phosphorus. Participants received formula only to replace refused food. Percent Median Body Mass Index (%MBMI) was calculated using 50th percentile body mass index for age and sex. Unpaired t-tests compared two groups split at 1,200 calories. RESULTS: Fifty-six adolescents with mean (±SEM) age 16.2 (±.3) years and admit %MBMI 79.2% (±1.5%) were hospitalized for 14.9 (±.9) days. The only significant difference between groups (N = 28 each) at baseline was starting calories (1,764 [±60] vs. 1,093 [±28], p < .001). Participants on higher calories had faster weight gain (.46 [±.04] vs. .26 [±.03] %MBMI/day, p < .001), greater daily calorie advances (122 [±8] vs. 98 [±6], p = .024), shorter hospital stay (11.9 [±1.0] vs. 17.6 [±1.2] days, p < .001), and a greater tendency to receive phosphate supplementation (12 vs. 8 participants, p = .273). CONCLUSIONS: Higher calorie diets produced faster weight gain in hospitalized adolescents with AN as compared with the currently recommended lower calorie diets. No cases of the refeeding syndrome were seen using phosphate supplementation. These findings lend further support to the move toward more aggressive refeeding in AN.

The carboxyl-terminal segment of apolipoprotein A-V undergoes a lipid-induced conformational change.

Apolipoprotein (apo) A-V is a 343-residue, multidomain protein that plays an important role in regulation of plasma triglyceride homeostasis. Primary sequence analysis revealed a unique tetraproline sequence (Pro293-Pro296) near the carboxyl terminus of the protein. A peptide corresponding to the 48-residue segment beyond the tetraproline motif was generated from a recombinant apoA-V precursor wherein Pro295 was replaced by Met. Cyanogen bromide cleavage of the precursor protein, followed by negative affinity chromatography, yielded a purified peptide. Nondenaturing polyacrylamide gel electrophoresis verified that apoA-V(296-343) solubilizes phospholipid vesicles, forming a relatively heterogeneous population of reconstituted high-density lipoprotein with Stokes' diameters >17 nm. At the same time, apoA-V(296-343) failed to bind a spherical lipoprotein substrate in vitro. Far-UV circular dichroism spectroscopy revealed the peptide is unstructured in buffer yet adopts significant alpha-helical secondary structure in the presence of the lipid mimetic solvent trifluoroethanol (TFE; 50% v/v). Heteronuclear multidemensional NMR spectroscopy experiments were conducted with uniformly (15)N- and (15)N/(13)C-labeled peptide in 50% TFE. Peptide backbone assignment and secondary structure prediction using TALOS+ reveal the peptide adopts alpha-helix secondary structure from residues 309 to 334. In TFE, apoA-V(296-343) adopts an extended amphipathic alpha-helix, consistent with a role in lipoprotein binding as a component of full-length apoA-V.

Apolipoprotein A-V N-terminal domain lipid interaction properties in vitro explain the hypertriglyceridemic phenotype associated with natural truncation mutants.

The N-terminal 146 residues of apolipoprotein (apo) A-V adopt a helix bundle conformation in the absence of lipid. Because similarly sized truncation mutants in human subjects correlate with severe hypertriglyceridemia, the lipid binding properties of apoA-V(1-146) were studied. Upon incubation with phospholipid in vitro, apoA-V(1-146) forms reconstituted high density lipoproteins 15-17 nm in diameter. Far UV circular dichroism spectroscopy analyses of lipid-bound apoA-V(1-146) yielded an alpha-helix secondary structure content of 60%. Fourier transformed infrared spectroscopy analysis revealed that apoA-V(1-146) alpha-helix segments align perpendicular with respect to particle phospholipid fatty acyl chains. Fluorescence spectroscopy of single Trp variant apoA-V(1-146) indicates that lipid interaction is accompanied by a conformational change. The data are consistent with a model wherein apoA-V(1-146) alpha-helices circumscribe the perimeter of a disk-shaped bilayer. The ability of apoA-V(1-146) to solubilize dimyristoylphosphatidylcholine vesicles at a rate faster than full-length apoA-V suggests that N- and C-terminal interactions in the full-length protein modulate its lipid binding properties. Preferential association of apoA-V(1-146) with murine plasma HDL, but not with VLDL, suggests that particle size is a determinant of its lipoprotein binding specificity. It may be concluded that defective lipoprotein binding of truncated apoA-V contributes to the hypertriglyceridemia phenotype associated with truncation mutations in human subjects.