Perspective: Key Considerations When Developing and Publishing Dietary Interventions for Human Clinical Trials.

A key guiding principle in the 2020-2025 Dietary Guidelines for Americans emphasizes the need for individuals to choose eating habits that allows for personal, cultural, and traditional preferences while establishing a high-quality diet. This concept becomes a daunting task given the need to reduce the consumption of foods higher in saturated fat, sodium, and/or added sugar-which are typically found in familiar, highly palatable foods most-often liked and consumed in the United States. Similarly, in nutrition intervention studies, adherence to healthier dietary patterns is typically low because of many factors, including reduced taste, flavor, and familiarity to the study foods. Increasing evidence illustrates the promising role of herbs and spices to maintain acceptability of healthier food options for nutrition interventions. This perspective article was informed by a Satellite Session presented at the American Society for Nutrition's annual meeting, Nutrition 2023, entitled, "Developing Culturally Appropriate Recipes for Human Clinical Trials," which explored several proposed best practice guidelines when developing nutrition interventions to improve dietary adherence and acceptability within clinical trials. The session also highlighted a need to include sufficient detail concerning the types and amounts of specific foods included within nutrition interventions in combination with preparation methods and study recipes, including herbs and spices, to improve intervention reproducibility and translatability for future research, dietary guidelines, and clinical practice.

Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review.

BACKGROUND: Evidence-based practice (EBP) promotes shared decision-making between clinicians and patients. OBJECTIVE: The aim was to determine EBP competencies among nutrition professionals and students reported in the literature. METHODS: We conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. RESULTS: We identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. CONCLUSIONS: The overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners. This study was registered at PROSPERO as CRD42022311916.

Behavioural strategies to reduce obesity among lower socio-economic adults living in high-income countries: a Grades of Recommendation, Assessment, Development and Evaluation-assessed systematic review and meta-analysis of randomised controlled trials.

Adult obesity disproportionately affects lower socio-economic groups in high-income countries and perpetuates health inequalities, imposing health and socio-economic burden. This review evaluates the effectiveness of behavioural strategies in reducing weight and cardiovascular disease (CVD) risks among low-income groups based in high-income countries. We searched major databases for randomised controlled trials published between 1 November 2011 and 1 May 2023. Meta-analyses and subgroup analyses were undertaken to analyse the pooled and individual effects of behavioural strategies. Cochrane Risk of bias (RoB 2·0) tool and Grades of Recommendation, Assessment, Development and Evaluation (GRADE) criteria were used to assess the quality and certainty of evidence. Fourteen trials (3618 adults, aged 40·2 ± 9·7 years with BMI 33·6 ± 2·8 kg/m2) and nine unique interventions were identified. Three trials with high RoB were omitted. Meta-analysis favoured interventions, demonstrating significant reductions in body weight (MD: -1·56 kg, (95 % CI -2·09, -1·03)) and HbA1c (MD: -0·05 %, (95 % CI - 0·10, -0·001)) at intervention end. Sub-group analysis showed no differences in waist circumference, blood pressure or serum lipids. Financial incentives and interactive feedback produced greatest amounts of weight losses ≥ 2 kg (GRADE: moderate). Behavioural strategies are effective weight loss interventions among lower socio-economic groups living in high-income nations. However, the impact on CVD risk remains unclear.

Survey of international pediatric nutritional supportive care practices: a report from the Pediatric Study Group of the Multinational Association of Supportive Care in Cancer (MASCC).

PURPOSE: Malnutrition is common in children with cancer. While multiple validated malnutrition screens exist, there is no universal, standardized approach to screen or diagnose malnutrition. The Multinational Association of Supportive Care in Cancer (MASCC) Pediatric Study Group is focused on oncologic supportive care for children and young adults. This subgroup designed and administered a pilot study to characterize global malnutrition screening, diagnosis, and treatment practices for pediatric patients with cancer after identifying variations in malnutrition practice patterns within its members. METHODS: A novel, exploratory survey was iteratively developed and distributed in early 2020 to 45 MASCC Pediatric Study Group members. The survey included multiple questions with standard patient presentations and nutritional scenarios, and the respondents selected the answer that best reflected the care patients would receive at their institution. RESULTS: A validated screening tool to assess for malnutrition was routinely used by 15 of 26 respondents (58%). No single validated screen was used by more than 24% of responders, and 11 of 26 (42%) reported not having a standard malnutrition treatment screen. When the same patient was presented with the survey using different malnutrition indicators, patient care plans varied greatly. This was particularly true for z-scores compared to weight percentiles. CONCLUSIONS: Development of consensus recommendations for screening practices, preferred malnutrition indicators, and treatment guidelines could help reduce the underdiagnosis of malnutrition and subsequent variation in its management and ought to be a focus of the global pediatric cancer supportive care community.

Evaluation of the nutrition care process documentation in the patients' records using the Diet-NCP-Audit: experience in a medium-sized multi-site Swiss hospital.

BACKGROUND: The nutrition care process (NCP) is a four-step systematic approach to guide dietitians in providing high-quality nutrition care. It fosters critical thinking and enhances the consistency of dietitians' documentation. Following international recommendations, University Training Hospital of Fribourg (HFR) implemented it in 2013. This study aimed to evaluate the quality of NCP documentation in electronic patient records (EPRs) and to determine the nutrition problems dietitians most often identified while documenting their actions. METHODS: The audit was performed on 92 EPRs using the Diet-NCP-Audit, which was translated into French for this study. RESULTS: The documentation quality was assessed as high in 62% of the EPRs, and nutrition diagnoses were mostly documented. In half of the EPRs, nutrition assessment (step 1 of the NCP) was inconsistent with nutrition diagnosis (step 2). Dietitians often used the same nutrition problems: out of the 73 nutrition problems defined in NCP terminology, only 4 (5%) represented 58% of the 189 problems identified in the EPR audit. CONCLUSION: EPRs were mostly assessed as high quality. However, the entire process requires improved consistency. The poorly documented link between the NCP steps and the restricted choices of nutrition problems dietitians identified should be addressed because they could reveal that dietitians have not fully adopted critical thinking, which the NCP stresses.

Wernicke's Encephalopathy in Acute and Chronic Kidney Disease: A Systematic Review.

Thiamine (vitamin B1) deficiency is relatively common in patients with kidney disease. Wernicke's encephalopathy (WE) is caused by vitamin B1 deficiency. Our aim was to systematically review the signs and symptoms of WE in patients with kidney disease. We conducted a systematic literature review on WE in kidney disease and recorded clinical and radiographic characteristics, treatment and outcome. In total 323 manuscripts were reviewed, which yielded 46 cases diagnosed with acute and chronic kidney disease and WE published in 37 reports. Prodromal characteristics of WE were loss of appetite, vomiting, weight loss, abdominal pain, and diarrhea. Parenteral thiamine 500 mg 3 times per day often led to full recovery, while Korsakoff's syndrome was found in those receiving low doses. To prevent WE in kidney failure, we suggest administering high doses of parenteral thiamine in patients with kidney disease who present with severe malnutrition and (prodromal) signs of thiamine deficiency.

Nutritional status and risk of malnutrition.

Malnutrition is a global health problem that is not limited to developing countries. So far, it is one of the underdiagnosed and curative medical problems. THE AIM of our observation was to evaluate the nutritional status of patients at risk of malnutrition. METHODS AND PATIENTS: We retrospectively evaluated 140 patients from the Gastroenterology Clinic and the Center for Home Parenteral Nutrition (HPN) at the University Hospital Bratislava, Slovakia. Patients were indicated for examination as part of the entry screening for malnutrition or consultation examination in patients presenting with signs of malnutrition. Based on the determination of the body mass index (BMI), the completed questionnaire of nutritional risk screening (NRS) and the determination of the state of performance, we evaluated the nutritional status of the patient and subsequently started enteral, or parenteral nutrition. RESULTS: We recorded a statistically significant negative correlation between BMI and malnutrition risk (p<0.001), ie. the lower the BMI, the higher the risk of malnutrition. We did not observe a relationship between age, diagnoses and the incidence of BMI-related malnutrition in the study group of patients. CONCLUSION: Properly applied clinical nutrition, whether enteral, parenteral, or a combination thereof, can significantly affect morbidity and mortality in patients with malnutrition or the risk of its development. Unfortunately, Slovakia is still lagging behind developed countries in its implementation as part of a comprehensive treatment of patients (Tab. 2, Fig. 4, Ref. 28).

In-depth health surveillance and clinical nutrition in farmed Atlantic salmon: a strategic attempt to detect and mitigate an HSMI outbreak.

Fish health personnel have limited tools in combatting viral diseases such as heart and skeletal muscle inflammation (HSMI) in open net-pen farmed Atlantic salmon. In this study, we aimed to predict HSMI by intensified health monitoring and apply clinical nutrition to mitigate the condition. We followed a commercial cohort (G1) of Atlantic salmon that was PRV-1 naïve when transferred to a sea cage at a location where HSMI outbreaks commonly occur. The fish in the other cages (G2-G6) at the location had a different origin than G1 and were PRV-1 positive prior to sea transfer. By continuous analysis of production data and sequentially (approximately every fourth week) performing autopsy, RT-qPCR (for PRV-1 and selected immune genes), blood and histological analysis of 10 fish from G1 and G2, we identified the time of PRV-1 infection in G1 and predicted the onset of HSMI prior to any clinical signs of disease. Identical sequences across partial genomes of PRV-1 isolates from G1 and G2 suggest the likely transfer from infected cages to G1. The isolates were grouped into a genogroup known to be of high virulence. A commercial health diet was applied during the HSMI outbreak, and the fish had low mortality and an unaffected appetite. In conclusion, we show that fish health and welfare can benefit from in-depth health monitoring. We also discuss the potential health value of clinical nutrition as a mean to mitigate HSMI.

Association between early nutrition support and 28-day mortality in critically ill patients: the FRANS prospective nutrition cohort study.

BACKGROUND: Current guidelines suggest the introduction of early nutrition support within the first 48 h of admission to the intensive care unit (ICU) for patients who cannot eat. In that context, we aimed to describe nutrition practices in the ICU and study the association between the introduction of early nutrition support (< 48 h) in the ICU and patient mortality at day 28 (D28) using data from a multicentre prospective cohort. METHODS: The 'French-Speaking ICU Nutritional Survey' (FRANS) study was conducted in 26 ICUs in France and Belgium over 3 months in 2015. Adult patients with a predicted ICU length of stay > 3 days were consecutively included and followed for 10 days. Their mortality was assessed at D28. We investigated the association between early nutrition (< 48 h) and mortality at D28 using univariate and multivariate propensity-score-weighted logistic regression analyses. RESULTS: During the study period, 1206 patients were included. Early nutrition support was administered to 718 patients (59.5%), with 504 patients receiving enteral nutrition and 214 parenteral nutrition. Early nutrition was more frequently prescribed in the presence of multiple organ failure and less frequently in overweight and obese patients. Early nutrition was significantly associated with D28 mortality in the univariate analysis (crude odds ratio (OR) 1.69, 95% confidence interval (CI) 1.23-2.34) and propensity-weighted multivariate analysis (adjusted OR (aOR) 1.05, 95% CI 1.00-1.10). In subgroup analyses, this association was stronger in patients ≤ 65 years and with SOFA scores ≤ 8. Compared with no early nutrition, a significant association was found of D28 mortality with early enteral (aOR 1.06, 95% CI 1.01-1.11) but not early parenteral nutrition (aOR 1.04, 95% CI 0.98-1.11). CONCLUSIONS: In this prospective cohort study, early nutrition support in the ICU was significantly associated with increased mortality at D28, particularly in younger patients with less severe disease. Compared to no early nutrition, only early enteral nutrition appeared to be associated with increased mortality. Such findings are in contrast with current guidelines on the provision of early nutrition support in the ICU and may challenge our current practices, particularly concerning patients at low nutrition risk. Trial registration ClinicalTrials.gov Identifier: NCT02599948. Retrospectively registered on November 5th 2015.

Undervalued professionals: placement of nutritionist in the Ecuadorian health system.

BACKGROUND: Currently, many public health issues are directly related to malnutrition, and are made worse by social inequities. Nutrition professionals must be a key player in improving epidemiological aspects of nutrition-related diseases and must be part of clinical teams to control nutritional concerns. OBJECTIVE: To identify and analyze the nutritionists´ employment situation in Ecuador and areas of work covered and determine if type of university has an impact over work situation. METHODOLOGY: A cross-sectional study was conducted, approved by the ethics committee of Universidad San Francisco de Quito. It included 442 nutritionists in Ecuador who graduated in 13 universities (5 private (PR) and 8 public (PU)) between 2008 and 2019. It implied an online survey that questioned their satisfaction with their education and current work situation. All the statistical analyses were performed using R version 4.0.3, two-sided weighted chi-square test was performed to estimate the difference between public and private university graduates, IC 95%, p between 0.01 and 0.05. RESULTS: 38,6% of participants are unemployed, 68,28% private university graduates (PR) are currently employed and 58.87% work as nutritionists, compared to 56,86% from a public university (PU) currently working and 44.69% working in the field. 76% have reported being unemployed at some point in their careers, being difficulty finding jobs the main reason. Regarding the professional field, most professionals have their own business, and the less common area of work was public and community nutrition. One third of the participants had another paid activity. The main salary is 800USD per month and graduated from PR perceived better salaries than from PU. CONCLUSION: There is a lack of job opportunities for Ecuadorian nutritionists despite the high demand in every level of the health system. Most have been unemployed at some point in their careers due to difficulties finding jobs. There is a minimum nutrition staff working in community and public health nutrition.

Sources of nutrition advice and desired nutrition guidance in oncology care: Patient's perspectives.

BACKGROUND: The present study aimed to describe the proportion of cancer patients and survivors who receive nutrition advice, the sources of that advice and to explore the nutrition advice this cohort would like to have received. METHODS: A descriptive cross-sectional survey was completed by 211 cancer patients and survivors recruited through two hospitals in the North-West of Ireland. The survey consisted of open-ended and closed questions that aimed to explore the provision of and sources of nutrition advice and desired guidance in this cohort. Descriptive analysis was conducted using SPPS, while open-ended questions underwent thematic analysis. RESULTS: Respondents were mainly female (n = 133; 63%), aged 50-69 years old (n = 118; 56%), attending the outpatient department (n = 128; 60.7%) and < 5 years since diagnosis (n = 150; 71.7%). Breast (n = 69; 32.7%) was the most common cancer type. Respondents experienced a mean ± SD of 5 ± 3.1 nutrition impact symptoms. The most common was changes in taste/smell (n = 122; 57.8%). Although 53.6% (n = 113) reported being given advice, only 34.1% (n = 72) received this advice from a dietitian. The main sources of nutritional advice were friends and family. Respondents expressed their desire for nutrition advice from a dietitian and that this should be individualised, clear and practical. There was also a desire to avoid misinformation and uncertainty. CONCLUSIONS: The results of the present study can be used to help tailor nutrition support for this group. There is a need to ensure that patients and survivors consistently receive evidence-based advice tailored to their needs, cancer type and treatment stage.

Association of breakfast skipping with cardiovascular outcomes and cardiometabolic risk factors: an updated review of clinical evidence.

"Eat breakfast like a king, lunch like a prince and dinner like a pauper" (Adelle Davis, 1904-1974) is a concept that appears to align with some contemporary evidence concerning the appropriate proportioning of daily meals. At the same time, with the popular and scientific dissemination of the concepts of intermittent fasting and time-restricted feeding, well-controlled clinical trials have emerged showing the safety or even possible benefits of skipping breakfast. In this comprehensive literature review, we discuss recent evidence regarding breakfast intake, cardiovascular outcomes and cardiovascular risk markers. Overall, breakfast omission appears to be associated with a higher risk for atherosclerotic and adverse cardiovascular outcomes. However, caution should be employed when deciphering these data as many complex, unmeasured confounders may have contributed. Unfortunately, long-term randomized, clinical trials with detailed dietary control that have assessed clinical outcomes are sparse. Notwithstanding the observational findings, current trials conducted so far-albeit apparently smaller number-have shown that breakfast addition in subjects who do not habitually consume this meal may increase body weight, particularly fat mass, through caloric excess, whereas skipping breakfast may be a feasible strategy for some people aiming for calorie restriction. To date, definitive benefits of breakfast omission or consumption are not supported by the best evidence-based research, and the question of whether skipping breakfast per se is causally associated with cardiovascular outcomes remains unresolved.

A prospective epidemiological analysis of controlling nutritional status score with the poor functional outcomes in Chinese patients with haemorrhagic stroke.

Nutritional Risk Screening index is a standard tool to assess nutritional risk, but epidemiological data are scarce on controlling nutritional status (CONUT) as a prognostic marker in acute haemorrhagic stroke (AHS). We aimed to explore whether the CONUT may predict a 3-month functional outcome in AHS. In total, 349 Chinese patients with incident AHS were consecutively recruited, and their malnutrition risks were determined using a high CONUT score of ≥ 2. The cohort patients were divided into high-CONUT (≥ 2) and low-CONUT (< 2) groups, and primary outcomes were a poor functional prognosis defined as the modified Rankin Scale (mRS) score of ≥ 3 at post-discharge for 3 months. Odds ratios (OR) with 95 % confidence intervals (CI) for the poor functional prognosis at post-discharge were estimated by using a logistic analysis with additional adjustments for unbalanced variables between the high-CONUT and low-CONUT groups. A total of 328 patients (60·38 ± 12·83 years; 66·77 % male) completed the mRS assessment at post-discharge for 3 months, with 172 patients at malnutrition risk at admission and 104 patients with a poor prognosis. The levels of total cholesterol and total lymphocyte counts were significantly lower in high-CONUT patients than low-CONUT patients (P = 0·012 and < 0·001, respectively). At 3-month post discharge, there was a greater risk for the poor outcome in the high-CONUT compared with the low-CONUT patients at admission (OR: 2·32, 95 % CI: 1·28, 4·17). High-CONUT scores independently predict a 3-month poor prognosis in AHS, which helps to identify those who need additional nutritional managements.

Clinical nutrition issues in 2022: What is missing to trust supplemental parenteral nutrition (SPN) in ICU patients?

A multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefits, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufficient. The experts agreed on actions needed to increase evidence quality on SPN use in specific patients at a given time point during acute critical illness or recovery.

Effects of liberal oral intake on postoperative outcomes after elective laparoscopic gynaecological surgery: A randomised controlled clinical trial.

BACKGROUND: Women are at risk of postoperative nausea and vomiting (PONV) after laparoscopic gynaecological surgery. Traditionally, patients who undergo laparoscopic gynaecological surgery are only allowed to initiate oral intake after return of bowel function, including bowel sounds or passage of flatus or stool. The present study was designed to assess the effect of liberal oral intake immediately after discharge from the post-anaesthesia care unit (PACU) on PONV incidence in patients who underwent elective laparoscopic gynaecological surgery. METHODS: In total, 174 patients (aged 20-64 years) were randomly assigned to the traditional and liberal groups. In the traditional group, patients were allowed to initiate oral intake 6 h after discharge from the PACU. In the liberal group, patients were allowed oral intake immediately after discharge from the PACU. The primary outcome was the incidence of PONV 48 h after surgery. Secondary outcomes included ileus incidence, total dose of postoperative opiate (sufentanil) use, time to postoperative first flatus (FFL), first out-of-bed mobilisation and the duration of postoperative hospitalisation stay. RESULTS: Incidence of PONV was not significantly different between both groups (32.18% vs. 33.33%, p = 0.872). Time to FFL in the liberal group was significantly shorter than that in the traditional group (14.82 ± 0.91 h vs. 17.50 ± 0.96 h, p = 0.024). The postoperative pain score at 48 h after surgery was significantly lower in the liberal group than that in the traditional group (2.48 ± 0.17 vs. 3.20 ± 0.19, p = 0.008) without an increase in sufentanil use (89.32 ± 1.02 µg vs. 89.92 ± 1.16 µg, p = 0.702). No ileus occurred in either group. When considering the time of actually return to regular diet, initiating regular diet no more than 6 h after discharge from PACU significantly shortened the time to first out-of-bed mobilisation (11.18 ± 1.01 h vs. 15.05 ± 0.70 h, p = 0.003). CONCLUSIONS: Our results indicate that liberal oral intake after discharge from the PACU in patients aged 20-64 years who underwent gynaecological surgery is safe and beneficial and supports the rationale for a more liberal diet regime postoperatively.

An evaluation of plasma vitamin C concentrations in individuals requiring home parenteral nutrition.

BACKGROUND: Ascorbic acid (VitC) is an essential coenzyme to maintain health, but there are minimal data on the adequacy of VitC supply in patients requiring home parenteral nutrition (HPN). METHODS: A prospective pilot study was carried out measuring plasma VitC, serum vitamins A, D and E, and the minerals zinc, copper, selenium and magnesium in 28 adult HPN-dependent (≥6 months) patients. RESULTS: Fifty-seven percent of patients had insufficient VitC status. There was a strong, positive correlation between HPN provision of VitC and plasma VitC concentrations (rs = 0.663, p = 0.00) with an 83% insufficiency rate below a provision of 800 mg week-1 . There was no association seen between plasma VitC and number of HPN days week-1 (p = 0.539), number of months on HPN (p = 0.773) or dependency on HPN (86% ± 31% of energy requirements met via HPN (77% ± 23%, p = 0.39). CONCLUSIONS: VitC insufficiency is prevalent in HPN-dependent patients. Our data highlight the need for regular monitoring of VitC in those living with type III intestinal failure.

Group education on the low FODMAP diet improves gastrointestinal symptoms but neither anxiety or depression in irritable bowel syndrome.

BACKGROUND: The low fermentable oligosaccharides, disaccharides, monosaccharides and polyols (FODMAP) diet is an effective dietitian-led treatment for irritable bowel syndrome (IBS). An increasing demand of IBS patient referrals has warranted group FODMAP education led by specialist dietitians. Psychological co-morbidities are common in IBS, although how the low FODMAP diet influences psychological outcomes is not understood. The present study aimed to evaluate symptom related outcomes of the diet following group education and assess its effect on psychological profiles. METHODS: An observational, prospective study was conducted in 55 IBS patients who attended FODMAP Restriction and FODMAP Reintroduction group sessions. Data were collected at baseline and follow-up after FODMAP Restriction and analysed using descriptive and McNemar's tests. Primary outcome was evaluated by IBS Symptom Severity Score (IBS-SSS). Secondary psychological outcomes included anxiety and depression using the Hospital Anxiety and Depression Scale (HADS) and risk of eating disorder questionnaire (SCOFF). RESULTS: After FODMAP Restriction, 27 of 55 (54%) patients reported clinically relevant symptom improvement, as defined by a reduction in the IBS-SSS ≥50 points, whereas no differences were recorded in the proportion of patients identified with clinical anxiety (p = 1.000) or clinical depression (p = 0.375). Positively, no increased risk of an eating disorder was observed. CONCLUSIONS: The present study provides data supporting the efficacy of the low FODMAP diet in IBS patients who attended dietitian led group education settings in tertiary care. Clinically significant improvements in gastrointestinal symptoms were observed, although with no impact on clinical levels of anxiety, depression or the risk of an eating disorder.

Is the frequency of dietitian support associated with greater clinical improvements in adults with Crohn's disease undertaking exclusive enteral nutrition?

BACKGROUND: Exclusive enteral nutrition (EEN) is considered to be an effective, low-risk therapy in the treatment of Crohn's disease (CD). Frequent dietetic support may assist adults to succeed. The present observational study aimed to compare whether the frequency of dietetic support during EEN therapy was associated with differences in clinical and nutritional outcomes across two gastroenterology inflammatory bowel disease services. Site A provided ≥3 visits plus more if clinically indicated and Site B provided weekly support. METHODS: Eligible patients were adults with active CD recommended to be treated with oral EEN for ≥6 weeks between February 2018 and December 2019. Demographic, anthropometric, clinical, medications, pathology and EEN treatment descriptors were sourced from the medical chart. Descriptive statistics, as well as chi-squared and t tests, were used to compare data between sites. RESULTS: Eighty-four CD patients were eligible (44 ± 14 years, 54% female, baseline Crohn's disease activity index [CDAI] 259.5 ± 113.1, n = 51 Site A) and completed EEN for median (range) 6.1 (1-12) weeks. Most patients (82%, n = 69/84) completed ≥6 weeks of EEN treatment. CDAI score and calprotectin improved across the total sample from pre- to post-EEN by -109.8 ± 92.1 (p < 0.001) and -65 µg g-1 (-65,230 to 4370) (p = 0.002), respectively. Dietitian occasions of service were more frequent at Site B (7 [4-12] occasions vs. 3 [1-8], p < 0.001). However, changes in clinical and biomarker data were similar between sites (p < 0.05). CONCLUSIONS: EEN with regular dietetic input resulted in clinical and biochemical improvements for patients with active CD. Tailoring dietetic support based on the client's needs and preference may achieve clinical improvements similar to providing weekly dietetic support to adults on EEN.

Investigating the patient food experience: Understanding hospital staffs' perspectives on what leads to quality food provision in Ontario hospitals.

BACKGROUND: Food quality influences patient food satisfaction, which may subsequently affect food intake and recovery, influencing hospital costs. The present qualitative study aimed to gain an understanding of hospital staff/volunteers experiences of serving food in Ontario hospitals, perceptions of food quality and challenges to quality food provision. METHODS: Sixteen Ontario hospitals participated. Semi-structured interviews (n = 64 participants) and focus groups (n = 24; 150 participants) were conducted. Transcripts were analysed using inductive thematic analysis. RESULTS: Four themes emerged: (1) Providing Good Quality Food (e.g., attributes that comprise the construct of meal quality, patients' expectations and desires from meals); (2) Individualising the Food and Mealtime Experience (e.g., processes to identify and cater to patients' needs and preferences); (3) Acknowledging Organisational Constraints (e.g., staffing, budget, etc.); and (4) Innovating Beyond Constraints (e.g., identifying innovation within potential modifiable and unmodifiable organisational constraints). CONCLUSIONS: Serving meals in hospital is complex because of organisational and patient factors; however, current efforts to serve quality food despite these complexities were uncovered in our investigation. Discussions highlighted current practices that promote food quality and strategies for improvement. Improving food quality and the hospital meal experience can support food intake and patient outcomes, as well as reduce waste and hospital associated costs. The findings can be used to support quality improvement measures aiming to serve high quality food that meets patients' expectations and nutritional needs.

Clinical nutrition approach in medical management of COVID-19 hospitalized patients: A narrative review.

BACKGROUND: Malnutrition in COVID-19 hospitalized patients is associated with a high-risk condition to increase disease severity and prolonging the recovery period. Therefore, nutritional therapy, including supplements plays a critical role to reduce disease-related complications and the length of hospital stay. AIM: To review the latest evidence on nutritional management options in COVID-19 hospitalized patients, as well as possibly prescribed supplements. Methods: This review was conducted by considering the latest recommendations, using the guidelines of the American Society of Enteral and Parenteral (ASPEN) and the European Society of Enteral and Parenteral (ESPEN), and searching Web of Science, PubMed/Medline, ISI, and Medline databases. The relevant articles were found using a mix of related mesh terms and keywords. We attempted to cover all elements of COVID-19 hospitalized patients' dietary management. Results: Energy demand in COVID-19 patients is a vital issue. Indirect Calorimetry (IC) is the recommended method to measure resting energy expenditure. However, in the absence of IC, predictive equations may be used. The ratio of administered diet for the macronutrients could be based on the phase and severity of Covid-19 disease. Moreover, there are recommendations for taking micronutrient supplements with known effects on improving the immune system or reducing inflammation. Conclusions: Nutritional treatment of COVID-19 patients in hospitals seems to be an important element of their medical care. Enteral nutrition would be the recommended feeding method for early nutrition support. However, data in the COVID-19 nutritional domain relating to micronutrient supplementation are still fragmentary and disputed, and further study is required.