Effect of oral supplements on the nutritional status of nasopharyngeal carcinoma patients undergoing concurrent chemotherapy: A randomized controlled Phase II trial.

OBJECTIVES: The objectives of this study were to prospectively compare individualized dietary counseling with or without oral nutritional supplements (ONSs) in nasopharyngeal carcinoma (NPC) patients undergoing concurrent chemoradiotherapy (CCRT) in a Phase II, randomized trial. MATERIALS AND METHODS: Between June 2014 and August 2016, Stage II-IVb NPC patients were randomly enrolled. The primary endpoint was change in body weight between during CCRT, and the secondary endpoints were change in body mass index (BMI) and fat-free mass index (FFMI). RESULTS: Fifty-two patients were randomized; 19 patients in the control group and 23 in the ONS group were eligible for analysis. Weight, BMI, and body composition parameters significantly decreased from baseline to week 6. FFMI was significantly better in patients with ONS intake >2/3 planed than the control group (P = 0.028). Weight and BMI maintenance was slightly better in patients with total intake >2/3 planed (P = 0.170 and P= 0.229, respectively). The mean Patient-Generated Subjective Global Assessment score was also better in the ONS group at the end of CCRT (P = 0.053). CONCLUSIONS: ONSs with individualized dietary counseling may be beneficial in patients with enough intake, and further prospective studies with large groups of patients are warranted.

Position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior: Food and Nutrition Programs for Community-Residing Older Adults.

Given the increasing number and diversity of older adults and the transformation of health care services in the United States, it is the position of the Academy of Nutrition and Dietetics and the Society for Nutrition Education and Behavior that all older adults should have access to evidence-based food and nutrition programs that ensure the availability of safe and adequate food to promote optimal nutrition, health, functionality, and quality of life. Registered dietitian nutritionists and nutrition and dietetics technicians, registered, in partnership with other practitioners and nutrition educators, should be actively involved in programs that provide coordinated services between the community and health care systems that include regular monitoring and evaluation of programming outcomes. The rapidly growing older population, increased demand for integrated continuous support systems, and rising cost of health care underscore the need for these programs. Programs must include food assistance and meal programs, nutritional screening and assessment, nutrition education, medical nutrition therapy, monitoring, evaluation, and documentation of evidence-based outcomes. Coordination with long-term care services and support systems is necessary to allow older adults to remain in their homes; improve or maintain their health and manage chronic disease; better navigate transitions of care; and reduce avoidable hospital, acute, or long-term care facility admissions. Funding of these programs requires evidence of their effectiveness, especially regarding health, functionality, and health care-related outcomes of interest to individuals, caregivers, payers, and policy makers. Targeting of food and nutrition programs involves addressing unmet needs for services, particularly among those at high risk for poor nutrition. Registered dietitian nutritionists and nutrition and dietetics technicians, registered must increase programmatic efforts to measure outcomes to evaluate community-based food and nutrition services.

Encouraging appropriate, evidence-based use of oral nutritional supplements.

With the considerable cost of disease-related malnutrition to individuals and to society (estimated to be >£13×109 for the UK, 2007 prices), there is a need for effective and evidence-based ways of preventing and treating this condition. The wide range of oral nutritional supplements that may be prescribed for the dietary management of malnutrition and other conditions account for only about 1% (about £99×106, 2007 data) of the prescribing budget in England. Systematic reviews and meta-analyses consistently suggest that ready-made, multi-nutrient liquids which may be prescribed can improve energy and nutritional intake, body weight and have a variety of clinical and functional benefits in a number of patient groups. Meta-analyses have repeatedly shown that oral nutritional supplements produce significant reductions in complications (e.g. infections) and mortality, and a recent meta-analysis shows a reduction in hospital admissions (OR 0·56 (95% CI 0·41, 0·77), six randomised controlled trials). Such benefits suggest that the appropriate use of oral nutritional supplements should form an integral part of the management of malnutrition, particularly as there is currently a lack of evidence for alternative oral nutrition strategies (e.g. food fortification and counselling). As with all therapies, compliance to oral nutritional supplements needs to be maximised and the use monitored. To make sure that those at risk of malnutrition are identified and treated appropriately, there is a need to embed national and local policies into routine clinical practice. In doing so, the economic burden of this costly condition can be curtailed. As recently suggested by the National Institute for Health and Clinical Excellence, substantial cost savings could be made if screening and treatment of malnourished patients was undertaken.

Oral nutritional supplementation increases caloric and protein intake in peritoneal dialysis patients.

BACKGROUND: Malnutrition is highly prevalent in peritoneal dialysis (PD) patients and is associated with a poor prognosis. Attempts to improve nutritional status with enteral supplements have yielded poor results. METHODS: We performed a crossover-design trial on 13 PD patients to investigate whether these patients reduce their food intake after drinking oral nutritional supplements. Patients attended three visits in which they were administered a standard oral nutritional supplement either 2 hours or 30 minutes before lunch or a placebo drink 30 minutes before lunch. Lunch was provided as a self-select buffet-style meal, and food intake was measured. Total intake was calculated by adding the nutritional content of the oral supplement. RESULTS: Patients showed poor food intake, with mean values equaling only 18% of the recommended daily intake for calories and 34% for protein. Drinking the supplement 2 hours before lunch resulted in a significant increase compared with the placebo visit in total caloric (430 to 843 kcal; P < 0.001) and protein intake (27.6 to 41.3 g; P = 0.006). No significant difference in total intake was detected between drinking the supplement 2 hours versus 30 minutes before lunch. CONCLUSION: These results indicate that oral nutritional supplements administered before a meal may significantly increase caloric and protein intakes of PD patients.

Patient nutrition acuity as a predictor of the time required to perform medical nutrition therapy.

OBJECTIVE: To determine if patient nutrition acuity accurately predicts the time required to perform medical nutrition therapy (MNT). DESIGN: Data detailing demographic characteristics, patient nutrition acuity, and time spent performing MNT were collected for 12 consecutive days. Random systematic sampling was used to select 25%, or a minimum of 20 patients, from daily admissions to the hospital. Nutrition acuity was categorized using a 27-item patient acuity tool. SUBJECTS/SETTING: Analysis included data from 92 acute-care hospitals nationwide; the median census was 271 patients. Of the 7,289 patients in the survey, 3,321 were included in this data analysis. All subjects were assigned an acuity rating and received MNT. Mean age (+/- standard deviation [SD]), was 55 +/- 24 years, and the sample was 48% male and 52% female. Time spent delivering MNT ranged from 5 to 285 minutes (mean +/- SD = 43.3 +/- 34.2 minutes). STATISTICAL ANALYSES PERFORMED: Stepwise multiple regression analysis (P < .05), with independent variables of age, gender, and 27 acuity descriptors, determined time required to perform MNT. RESULTS: The number of acuity descriptors assigned to patients ranged from zero (53 patients) to 20 (1 patient); the mean (+/- SD) for all patients was 5.6 +/- 3.1. Gender and 21 of the 27 acuity descriptors were statistically significant in predicting the time required to perform MNT. APPLICATIONS/CONCLUSIONS: A formula was developed to determine medical nutrition therapy time (MNTT) as minutes per patient sampled. When extrapolated to a facility's patient census, MNTT is the basis for predicting staffing requirements. The MNTT formula is crucial in the present environment of managed care where fiscal accountability challenges staffing rationales.

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS.

Dietitians have the opportunity to be leaders in providing medical nutrition therapy and home-delivered meals for people with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in the community setting. Four community agencies developed the Visiting Nurse Service HIV/Home Delivered Meals Program. Fifty clients with the diagnosis of HIV and/or AIDS were served for a 6-month period. The program provided convenient, energy-enhanced nutritious meals. Participants received daily hot and cold, energy- and protein-enhanced home-delivered meals; weekly high-energy, high-protein, shelf-stable Snack Packs; a Medical Nutritional Supplement Sampler Pack; and two home visits from dietitians. Different diet options were available. Dietitians completed 47 initial nutrition assessment and food safety education visits 1 to 2 weeks after meal delivery began, and 35 participants received follow-up nutrition counseling visits 4 to 8 weeks later. Participant data (including weights) were self-reported. Dietitians reported that 13 of 35 participants gained weight (mean = 6 lb), 11 of 35 remained the same weight, and 11 of 35 lost weight (mean = 5 lb). Initially, 14 of 35 participants were considered to be "doing well"; this improved to 19 of 35 participants 1 to 2 months later. Snack Packs were effective means to help participants meet some of their increased nutrient needs. The Medical Nutritional Supplement Sampler Pack was effective in familiarizing each participant with available products. Medical nutrition therapy by registered dietitians helped most participants improve their food consumption.