RESUMEN
Background: Nutrition and exercise are the mainstay of therapy for the prevention and treatment of frailty in cirrhosis. This pilot study assessed feasibility of the online delivery of an app-based semi-supervised nutrition and exercise intervention in this population. Methods: The 11-week pilot recruited adults with cirrhosis who owned internet-connected devices. Patients were encouraged to participate in exercise sessions 3× per week including a combination of online group exercise (weekly) and home-based follow-along exercise (biweekly). They also participated in group nutrition classes (five sessions) and one-to-one exercise and nutrition check-ins delivered through the app. Primary outcome measures pertained to program feasibility: recruitment, retention, adherence, and satisfaction. Exploratory measures included physical performance (liver frailty index [LFI], 6-minute walk test [6MWT]), health behaviour domains, and quality of life. Results: Twenty three patients completed baseline measures. Of these, 18 (72%) completed end of study measures (mean MELD-Na, 9.2; female, 44.4%). Over 70% of participants fulfilled 75% or more of the feasibility criteria. Satisfaction with the program was high (mean, 89%). Exercise program modifications were required for 17 patients to accommodate health events or abilities. Exploratory evaluation showed improvement in the LFI and the 6MWT by -0.58-units (95% CI: -0.91 to -0.25) and 46.0 m (95% CI: 22.7-69.3) respectively without changes in quality of life or health behaviour domains. Conclusions: Outcomes demonstrate feasibility of the app-based delivery of programming with promising exploratory impact on efficacy for physical performance. Findings can guide the design of a large-scale app-based randomized controlled trials in cirrhosis.
RESUMEN
ABSTRACT Background: Body composition assessment in breast cancer survivors (BCSs) is essential to plan feasible dietary strategies for sarcopenic obesity prevention. Objective: Studying the effect of an individualized nutrition intervention according to socioeconomic status and grocery shopping behavior on BCSs relative fat mass (RFM). Methods: BCSs attending an academic medical center were studied; participants saved all 1-week supermarket tickets and answered a grocery shopping consumer preference survey. RFM was assessed at baseline and after the 3-month nutrition intervention. Nutrition plans were based on the dynamic macronutrient meal-equivalent menu method (MEM) and dietary guidelines for BCSs. Results: Thirty-three BCSs completed the study and 91% of them presented obesity or overweight at baseline. After the intervention, BCSs lost 1.6 kg (p < 0.01) of body weight, 1.8 kg (p < 0.01) of RFM, 3 cm (p < 0.01) of waist circumference, and 2.4 cm (p < 0.01) of hip circumference, while no changes were observed in fat-free mass (p = 0.6) and arm bone-free muscle area (p = 0.7). Conclusions: RFM and body weight in breast cancer survivors decreased after an individualized nutrition intervention according to socioeconomic status and grocery shopping consumer behavior. Based on the participants food preferences and consumer behavior, plant-based protein diet plans cost less than the animal-based protein diet plans.