Diet modification reduces pain and improves function in adults with osteoarthritis: a systematic review.

BACKGROUND: The effect of dietary modifications on pain and joint function in adults with osteoarthritis (OA) is an emerging area of study. This systematic review aimed to evaluate if adults with OA who consume diets with a higher proportion of plant phenols and omega-3 fatty acids would have less pain and improved joint function than those with a higher proportion of saturated fatty acids, omega-6 fatty acids and refined carbohydrates. METHODS: Database searches of CINAHL (EBSCO), Clinical Trials (NIH-NLM), Cochrane Library (Wiley), Dissertation & Thesis Global (ProQuest), Embase (Elsevier), Medline (OVID), PubMed (NLM), Scopus (Elsevier), Web of Sciences (Clarivate) for clinical trials identified 7763 articles published between January 2015 and May 2023. After an independent review of the articles, seven randomised clinical trials and one nonrandomised clinical trial were included in the analysis. Because of the heterogeneity of the outcome measures, a meta-analysis was not possible. RESULTS: Participants who were instructed to consume high-phenol/high-omega-3 fatty acid diets reported significant improvements in pain and physical function scores. The greatest improvement was reported by those who consumed a diet that had the most omega-3 fatty acids. CONCLUSION: Because of the high risk of bias, the strength of the evidence is limited. However, there is evidence that counselling adults with OA to replace refined grains and processed foods with whole plant foods, fish and plant oils may have a favourable effect on pain and physical function. Routine follow-up care regarding these diet modifications may be necessary to ensure adherence to this therapy.

Potential Determinants of Subjective Global Assessment Among Patients on Maintenance Hemodialysis.

OBJECTIVE: The Subjective Global Assessment (SGA) is a validated tool for identifying nutritional status in patients receiving maintenance dialysis (MHD), but it is not without limitations. Current research identifies additional clinical characteristics such as phase angle (PhA) associated with SGA. This study aimed to assess the overall correlation between PhA and SGA; associations between PhA and SGA by body mass index (BMI), and to identify clinical characteristics associated with SGA. DESIGN AND METHODS: This is a secondary analysis of the Rutgers Nutrition & Kidney Database, which enrolled participants from four primary studies that included adults diagnosed with chronic kidney disease who were receiving MHD. Multivariable binary logistic regression analyses were conducted to estimate odds ratio (OR) and corresponding 95% confidence intervals. RESULTS: The study sample included 60.0% males with 81.1% of the sample identifying as African American. Additionally, 38.9% were obese according to the BMI classification, and 57.0% were moderately malnourished. Patients with obesity had 44% lower odds of being moderately malnourished (OR=0.56, 95% CI= 0.37, 0.85). In the model adjusted for age and ethnicity and other clinical characteristics, increasing PhA values by one unit was associated with 28% lower odds (OR= 0.72, 95% CI= 0.53, 0.97) of being moderately malnourished while increasing waist circumference (WC) values by one unit was associated with 12% higher odds (OR= 1.12; 95% CI= 1.06, 1.19) of being moderately malnourished than well-nourished. In this fully adjusted model, increasing FFM (OR= 0.95, 95% CI=0.91, 0.99) and FM (OR = 0.92, 95% CI= 0.87, 0.97) by 1 kg was also associated with a 5% and 8% lower odds of being moderately malnourished, respectively. CONCLUSION: PhA and SGA were significantly associated only among patients classified as obese. PhA, WC, FM, and FFM were identified as potential clinical determinants of SGA. Patients receiving MHD and who have obesity may benefit from utilizing SGA along with WC, PhA, FM, and FFM to assess nutritional status.

Predictors of Skeletal Muscle Index for Patients Treated With Hemodialysis.

OBJECTIVE: There is an increased risk of skeletal muscle mass (SMM) loss among patients with stage 5 chronic kidney disease treated with maintenance hemodialysis (MHD). The reduced SMM considerably influences the development of protein-energy wasting (PEW). Patients who develop PEW have higher hospitalization and mortality rates than those without PEW. This study determined if key variables could predict SMM Index (SMM adjusted for height) in patients receiving MHD. METHODS: We conducted a secondary analysis of cross-sectional data obtained from the Rutgers Nutrition and Kidney Database (n = 178). Data were used to calculate both SMM and SMM Index. Univariate and multiple linear regression models explored the relationship between SMM Index and the following variables: serum albumin, urea clearance normalized treatment ratio, normalized protein catabolic rate, serum creatinine, and urea reduction ratio (URR). RESULTS: Most participants were Black/African American (82.9%), male (59.1%), and obese (39%), with a mean age of 55.9 ± 11.9 years. The median Subjective Global Assessment score was 5, indicating a lower risk of malnutrition. Participants had a mean SMM of 26.4 kg and a median SMM Index of 8.9 kg/m2. Univariate regression modeling found URR to be a significant predictor of SMM Index, with increases in the percentage of URR predicting lower SMM Index values. The adjusted regression modeling found similar results, with increases in URR percentage predicting declines in SMM Index. CONCLUSION: This study found that URR was a predictor of SMM Index in patients receiving MHD. Further research is required to explore these relationships and provide clinicians with a more extensive array of tools to recognize early signs of SMM loss to prevent the progression of PEW.

The Role of Dietary Acid Load on Progression of Estimated Glomerular Filtration Rate Among Individuals Diagnosed With Chronic Kidney Disease.

OBJECTIVE: Individuals with chronic kidney disease (CKD) are at an increased risk for developing metabolic acidosis. Metabolic acidosis has been shown to worsen kidney function and exacerbate systemic inflammation. Diets high in protein foods can exacerbate metabolic acidosis as protein foods tend to be more acidic, while fruits and vegetables are more alkalotic. The main objective of this systematic review was to determine if higher consumption of fruits and vegetables in adults with CKD stages 1-5 reduces the rate of decline of estimated glomerular filtration rate. METHODS: Searches of Cumulated Index to Nursing and Allied Health Literature (CINAHL -Elton B. Stephens Company [EBSCO]), Cochrane Library (Wiley), Dissertation & Thesis Global (ProQuest), Embase (Elsevier), Medline (OVID), PubMed (National Library of Medicine), Scopus (Elsevier), and Web of Sciences (Clarivate) identified 1,451 articles published between January 2015 and June 2023. RESULTS: After independent review, 7 total studies were included. Six of the studies found an association between dietary acid load and progression of CKD. CONCLUSIONS: Dietary counseling focusing on decreasing dietary acid load may be beneficial for individuals with CKD.

Reproducibility and Relative Validity of a Dietary Screener Adapted for Use among Pregnant Women in Dhulikhel, Nepal.

OBJECTIVES: Here we examined the reproducibility and validity of a dietary screener which was translated and adapted to assess diet quality among pregnant Nepalese women. METHODS: A pilot cohort of singleton pregnant women (N = 101; age 25.9 ± 4.1 years) was recruited from a tertiary, periurban hospital in Nepal. An adapted Nepali version of the PrimeScreen questionnaire, a brief 21-item dietary screener that assesses weekly consumption of 12 healthy and 9 unhealthy food groups, was administered twice, and a month apart, in both the 2nd and 3rd trimesters. Up to four inconsecutive 24-h dietary recalls (24-HDRs) were completed each trimester and utilized as the reference method for validation. For each trimester, data from multiple 24-HDRs were averaged across days, and items were grouped to match the classification and three weekly consumption categories (0-1, 2-3, or 4 + servings/week) of the 21 food groups represented on the PrimeScreen. RESULTS: Gwet's agreement coefficients (AC1) were used to evaluate the reproducibility and validity of the adapted PrimeScreen against the 24-HDRs in both the 2nd and 3rd trimester. AC1 indicated good to excellent (≥ 0.6) reproducibility for the majority (85%) of food groups across trimesters. There was moderate to excellent validity (AC1 ≥ 0.4) for all food groups except for fruits and vegetables in the 2nd trimester, and green leafy vegetables and eggs in both the 2nd and 3rd trimesters. CONCLUSIONS: The modified PrimeScreen questionnaire appears to be a reasonably valid and reliable instrument for assessing the dietary intake of most food groups among pregnant women in Nepal.

Dietary Intake Correlated to Waist-To-Hip Ratio in Patients on Maintenance Hemodialysis.

OBJECTIVE: Individuals with end-stage kidney disease (ESKD) receiving maintenance hemodialysis (MHD) are at risk for protein-energy wasting (PEW). Inadequate dietary intake and altered anthropometrics are two criteria of the PEW diagnosis. This study explored whether individuals with ESKD on MHD meet the National Kidney Foundation Kidney Disease Outcome Quality Initiative (NKF-KDOQI) 2020 guidelines for nutritional adequacy on a dialysis treatment day (DD) and explored the relationship between dietary energy [DEI] and protein [DPI] intake and anthropometrics. METHODS: This was a secondary analysis of clinical and demographic data for 142 adults from the Rutgers Nutrition and Kidney Disease database. The study assessed the relationships between DEI, DPI, and anthropometrics, including body mass index (BMI), BMI category, waist circumference, and waist-to-hip ratio (WHR) using Pearson's or Spearman's correlation and one-way ANOVA. RESULTS: The sample had a median age of 55.7 years; 58% were male, 83.8% were Black/African American, with a median dialysis vintage of 42.0 months (e.g., 3.5 years). Seventy-five percent of the data sample were overweight or obese. The WHR was 1.0 ± 0.8 cm for males and 0.9 ± 0.1 for females. DEI and DPI on a DD did not meet the NKF-KDOQI 2020 guidelines. Median DEI was 17.6 ± 8.4 kcal/kg and DPI was 0.7 ± 0.4 g/kg. In the total sample, significant positive correlations were found between DEI (r = 0.74, P = 0.03) and DPI (r = 0.18, P = 0.037) and WHR. In females, a significant positive correlation was identified between DPI and WHR (r = 0.26, P = 0.046). CONCLUSIONS: These findings suggest that the nutritional intake of individuals with ESKD receiving MHD is inadequate to meet NKF-KDOQI 2020 guidelines on a DD. WHR may be a useful tool to assess alterations in anthropometrics related to DEI or DPI in this population, but more research is warranted.

A user-centered approach to the development of a diet education tool for older adults with tooth loss.

BACKGROUND: Tooth loss is associated with suboptimal nutrient intake and greater risk of malnutrition. OBJECTIVE: To develop and field-test a stakeholder-informed diet education tool that addresses the unique needs of older adults with tooth loss who do not wear dentures. METHODS: An iterative user-centered approach was used. Initial content was developed based on findings from previous research. Stakeholder panels of older adults with 20 or fewer teeth, and dentists, were conducted at two time points to obtain feedback on the tool, which was revised following each panel. The tool was field-tested in a dental school clinic and evaluated using the Patient Education Materials Assessment Tool; it was further revised based on feedback. RESULTS: A diet education tool entitled "Eating Healthier With Tooth Loss" was developed. Sections for fruits and vegetables, grains, and proteins food groups, and one addressing socioemotional aspects of eating with missing teeth were included. Panel members provided constructive, positive feedback; recommendations for editing text, images, design, and content were integrated. Field-testing in the dental clinic with 27 pairs of student dentists and their patients resulted in scores of 95.7% for understandability and 96.6% for actionability, with over 85% agreement with each item. The tool was revised based on field-testing feedback. CONCLUSION: A diet education tool for older adults with tooth loss was developed using a user-centered approach, integrating the 'patient voice' and patient experiences with US dietary guidelines. Use of this tool is feasible in a dental clinic setting. Future research should explore usage in larger settings.

Transitioning the eating experience in survivors of head and neck cancer.

PURPOSE: Applying the Social Cognitive Transition (SCT) Model of Adjustment as an interpretive framework, this mixed-methods case series explored how head and neck cancer (HNC) survivors participate in the dimensions of the eating experience (described as physiological, psychological, social, cultural). METHODS: This was a sub-study of a primary study, "The Natural History and Impact of Taste Change in Oncology Care." Qualitative interviews and quantitative data (questionnaires and exams) were intersected to examine and describe the complexities of transitioning the eating experience after treatment for HNC. Triangulation of qualitative and quantitative data within and across cases was examined to produce rich descriptions of the changes and transitions in the eating experience. RESULTS: Four case studies were detailed. All reported some taste and/or smell changes. Each case described worry about weight loss and the decreased ability to engage and finding meaning in the eating experience. Each expressed coping strategies that drew upon the social and cultural dimensions of their prior eating experience that brought meaning and purpose to the post-treatment eating experience. CONCLUSIONS: This case series explored the impact of taste and oral function and the participant's pre- and post-treatment mental model of the eating experience. Application of the SCT Model of Adjustment to the eating experience in adults with HNC provided a deeper insight into how cognitive adaptation and coping strategies supported transition in identity related to the eating experience following cancer therapy.

Characterizing the Parental Perspective of Food-Related Quality of Life in Families After Pediatric Inflammatory Bowel Disease Diagnosis.

Food-related quality of life is defined as achieving adequate nutrition, deriving pleasure, and maintaining social activities through eating and drinking. The objective of this qualitative study was to characterize the parental perspective about eating experiences and family functioning after diagnosis of inflammatory bowel disease in their child in order to describe how these experiences may impact food-related quality of life. Semistructured interviews were completed with 10 parents of a child with inflammatory bowel disease. Conventional content analysis was conducted with steps to ensure trustworthiness. Family Systems Theory was the interpretive framework. Ambiguous nutrition information emerged as the main theme. Families experienced various and conflicting viewpoints regarding the role of diet, which presented a challenge after diagnosis. Parents reported frustration regarding the lack of uniform and personalized nutrition guidance. Our results support that families desire shared decision-making in regard to medication and diet, which is an important clinical practice implication for the entire gastroenterology medical team. Understanding the challenges faced by families after a major medical diagnosis in a child provides insight into designing medical interventions that maintain optimal quality of life in families.

KDOQI Clinical Practice Guideline for Nutrition in CKD: 2020 Update.

The National Kidney Foundation's Kidney Disease Outcomes Quality Initiative (KDOQI) has provided evidence-based guidelines for nutrition in kidney diseases since 1999. Since the publication of the first KDOQI nutrition guideline, there has been a great accumulation of new evidence regarding the management of nutritional aspects of kidney disease and sophistication in the guidelines process. The 2020 update to the KDOQI Clinical Practice Guideline for Nutrition in CKD was developed as a joint effort with the Academy of Nutrition and Dietetics (Academy). It provides comprehensive up-to-date information on the understanding and care of patients with chronic kidney disease (CKD), especially in terms of their metabolic and nutritional milieu for the practicing clinician and allied health care workers. The guideline was expanded to include not only patients with end-stage kidney disease or advanced CKD, but also patients with stages 1-5 CKD who are not receiving dialysis and patients with a functional kidney transplant. The updated guideline statements focus on 6 primary areas: nutritional assessment, medical nutrition therapy (MNT), dietary protein and energy intake, nutritional supplementation, micronutrients, and electrolytes. The guidelines primarily cover dietary management rather than all possible nutritional interventions. The evidence data and guideline statements were evaluated using Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria. As applicable, each guideline statement is accompanied by rationale/background information, a detailed justification, monitoring and evaluation guidance, implementation considerations, special discussions, and recommendations for future research.

Test-Retest Reliability and Validity of the Nutrition-Specific Quality of Life Questionnaire.

OBJECTIVE: The purpose of this study is to test the Nutrition-Specific Quality of Life (NSQOL) questionnaire for test-retest reliability and validity in a sample of patients on maintenance hemodialysis (MHD). DESIGN AND METHODS: Test-retest reliability of the NSQOL questionnaire via two patient interviews and comparison of the NSQOL questionnaire to a comprehensive nutrition assessment performed by a registered dietitian nutritionist for validity testing. This study was conducted in one outpatient MHD center in Chicago, IL. Adults, aged 18 years or older, treated with MHD for at least six months prior to start of the study. A Spearman's correlation coefficient was used to determine test-retest reliability and a Cronbach's alpha was used to determine the internal consistency of the 2 NSQOL questionnaires. Validity testing was done by comparing the NSQOL questionnaire to the most recent comprehensive nutrition assessment. RESULTS: The sample consisted of 17 men (63%) and 10 women (37%), with a mean age of 60 ± 13, who were mostly African American (63%) and Caucasian (26%). There was a significant correlation (P = .001) between the initial NSQOL interview and repeat NSQOL interview in all questions except for question 14 (P = .100). The NSQOL questionnaire was found to have excellent internal consistency with an α = 0.900. No significant relationship was found among total NSQOL score and age, dialysis vintage, albumin, or normalized protein catabolic rate; however, older participants had lower total NSQOL questionnaire scores. Although not statistically significant, there was variability between NSQOL questionnaire score and nutritional status. CONCLUSIONS: The NSQOL questionnaire was found to be reliable and had high internal consistency in this sample of patients receiving MHD. The NSQOL questionnaire may be beneficial for monitoring nutrition quality of life changes in-between nutrition assessment intervals.

Patient-Centered Model for Protein-Energy Wasting: Stakeholder Deliberative Panels.

OBJECTIVE: Integrating the patient's voice into research prioritization is essential for solving problems that patients care the most about in terms of health, symptom management, and survival. We used deliberative processes for adapting the existing model of protein-energy wasting (PEW) to one that includes stakeholder priorities, addressing gaps from the initial concept. DESIGN AND METHODS: From September 2015- to December 2017, two diverse, deliberative panels of stakeholders (one for patients and one for clinicians) were recruited from local communities and national networks and met four times to provide an insight into developing a patient-centered model for PEW. After each stakeholder meeting, the research team added the factors and outcomes that reached consensus, using a content analysis. The stakeholder members were then able to confirm what had been collected from an earlier panel discussion and offer additional feedback. The final model was approved by stakeholders. RESULTS: There were eight patient and twelve clinician stakeholders who participated in the panels. Factors and outcomes were only added or modified to the existing model, but none were deleted from the original PEW model. Critical factors identified by the stakeholders were ones related to lifestyle, treatment, and psychosocial aspects. The most important outcomes selected by stakeholders were living longer, staying out of the hospital, and being able to do more. CONCLUSIONS: The approved patient-centered model for PEW represents a testable model for researchers which incorporates the patient's voice. Garnering this insight should assist in the prioritization of projects for a maximal value to patients and their families by future investigators.

Managing Hyperkalemia: Another Benefit of Exercise in People With Chronic Kidney Disease?

People with chronic kidney disease (CKD) are at increased risk of hyperkalemia, an electrolyte abnormality that can cause serious, sometimes fatal, cardiac arrhythmias. Muscle contraction causes potassium to be released from cells, increasing serum potassium concentrations. However, these effects are transient, and the long-term impact of exercise training on hyperkalemia risk in CKD patients is largely unknown. In this review, we examine the effects of exercise on factors affecting potassium balance in people with CKD, highlighting the potential benefits of regular exercise on hyperkalemia risk in this population. Although regular exercise is already recommended for people with CKD, research examining this hypothesis may lead to novel therapeutic treatments for this life-threatening condition.

Is Nutrition Specific Quality of Life Associated With Nutritional Status?

OBJECTIVE: The study purpose was to explore the relationship between nutritional status, as measured by Subjective Global Assessment (SGA), and Health Related Quality of Life measured using the Nutrition Specific Quality of Life (NS-QoL), tool among participants on maintenance hemodialysis (MHD). The study aim was to determine if NS-QoL may be an adjuvant tool for detecting changes in nutritional status among patients on MHD. DESIGN, SETTING, AND SUBJECTS: This is a cross-sectional, secondary analysis of data from a multi-center study. Participants were adult (>18) men and women on MHD (n = 145) recruited from 3 institutions in the Northeastern United States. METHODS: Statistical tests were conducted to determine the relationship between key demographic characteristics (age, sex, dialysis vintage, gender, and ethnicity) and SGA and NS-QoL. Spearman's correlation examined the relationship between the independent variable, SGA and the dependent variable, NS-QoL. A univariate general linear model was conducted to adjust for confounding variables. MAIN OUTCOME MEASURE: The relationship between overall SGA score and composite NS-QoL score. RESULTS: The sample consisted of 85 men (58.6%), with a mean age of 55.3 ± 11.9 years, who were largely African-American (84.1%) and non-Hispanic (77.2%). Mean SGA score was 5.5 ± 1.0, and the mean NS-QoL composite score was 9.51 ± 3.77. No key demographic characteristics had a statistically significant relationship with SGA, whereas sex (P < .001) and race (P = .015) both had statistically significant relationships with NSQoL. After adjusting for the variables of race and sex, NS-QoL score was positively correlated with SGA composite score (P = .042); as NS-QoL score increased so did the SGA score. CONCLUSION: The present study found a positive linear correlation between NS-QoL composite score and SGA, as well as 5 SGA subcomponent scores and NS-QoL. These findings indicate that NS-QoL can complement the SGA to provide information about a patient's nutritional status.

Comparison of a Handheld Indirect Calorimetry Device and Predictive Energy Equations Among Individuals on Maintenance Hemodialysis.

OBJECTIVES: Practical methods for determining resting energy expenditure (REE) among individuals on maintenance hemodialysis (MHD) are needed because of the limitations of indirect calorimetry. Two disease-specific predictive energy equations (PEEs) have been developed for this metabolically complex population. The aim of this study was to compare estimated REE (eREE) by PEEs to measured REE (mREE) with a handheld indirect calorimetry device (HICD). METHODS: A prospective pilot study of adults on MHD (N = 40) was conducted at 2 dialysis clinics in Houston and Texas City, Texas. mREE by an HICD was compared with eREE determined by 6 PEEs using Bland-Altman analysis with a band of acceptable agreement of ±10% of the group mean mREE. Paired t-test and the intraclass correlation coefficient were also used to compare the alternate methods of measuring REE. A priori alpha was set at P < .05. RESULTS: The mean (±standard deviation) age was 56.7 ± 12.9 years, 52.5% (n = 21) were female, and 85% (n = 34) were African American. Body mass index (BMI) ranged from 18.1 to 47.1 kg/m2, 67.5% were overweight (BMI ≥25 kg/m2) and 50% were obese (BMI ≥30 kg/m2). The Maintenance Hemodialysis Equation-Creatinine version (MHCD-CR) was the most accurate PEE with 52.5% of values within the band of acceptable agreement, followed by the Mifflin-St. Jeor Equation and the Vilar et al. Equation at 45.0% and 42.5%, respectively. CONCLUSION: When compared with mREE by the HICD, the MHDE-CR was more accurate and precise than other PEEs evaluated; however, this must be interpreted with caution as mREE was consistently lower than eREE from all PEEs. Further research is needed to validate the MHDE-CR and other practical methods for determining REE among individuals on MHD.

Comparison of Subjective Global Assessment and Protein Energy Wasting Score to Nutrition Evaluations Conducted by Registered Dietitian Nutritionists in Identifying Protein Energy Wasting Risk in Maintenance Hemodialysis Patients.

OBJECTIVE: To compare the 7-point subjective global assessment (SGA) and the protein energy wasting (PEW) score with nutrition evaluations conducted by registered dietitian nutritionists in identifying PEW risk in stage 5 chronic kidney disease patients on maintenance hemodialysis. DESIGN AND METHODS: This study is a secondary analysis of a cross-sectional study entitled "Development and Validation of a Predictive energy Equation in Hemodialysis". PEW risk identified by the 7-point SGA and the PEW score was compared against the nutrition evaluations conducted by registered dietitian nutritionists through data examination from the original study (reference standard). SUBJECTS: A total of 133 patients were included for the analysis. MAIN OUTCOME MEASURES: The sensitivity, specificity, positive and negative predictive value (PPV and NPV), positive and negative likelihood ratio (PLR and NLR) of both scoring tools were calculated when compared against the reference standard. RESULTS: The patients were predominately African American (n = 112, 84.2%), non-Hispanic (n = 101, 75.9%), and male (n = 80, 60.2%). Both the 7-point SGA (sensitivity = 78.6%, specificity = 59.1%, PPV = 33.9%, NPV = 91.2%, PLR = 1.9, and NLR = 0.4) and the PEW score (sensitivity = 100%, specificity = 28.6%, PPV = 27.2%, NPV = 100%, PLR = 1.4, and NLR = 0) were more sensitive than specific in identifying PEW risk. The 7-point SGA may miss 21.4% patients having PEW and falsely identify 40.9% of patients who do not have PEW. The PEW score can identify PEW risk in all patients, but 71.4% of patients identified may not have PEW risk. CONCLUSIONS: Both the 7-point SGA and the PEW score could identify PEW risk. The 7-point SGA was more specific, and the PEW score was more sensitive. Both scoring tools were found to be clinically confident in identifying patients who were actually not at PEW risk.

Early Oral Feeding as Compared With Traditional Timing of Oral Feeding After Upper Gastrointestinal Surgery: A Systematic Review and Meta-analysis.

OBJECTIVE: To compare the effects of early oral feeding to traditional (or late) timing of oral feeding after upper gastrointestinal surgery on clinical outcomes. BACKGROUND: Early postoperative oral feeding is becoming more common, particularly as part of multimodal or fast-track protocols. However, concerns remain about the safety of early oral feeding after upper gastrointestinal surgery. METHODS: Comprehensive literature searches were conducted across 5 databases from January 1980 until June 2015 without language restriction. Risk of bias of included studies was appraised and random-effects model meta-analyses were performed to synthesize outcomes of anastomotic leaks, pneumonia, nasogastric tube reinsertion, reoperation, readmissions, and mortality. RESULTS: Fifteen studies comprising 2112 adult patients met all the inclusion criteria. Mean hospital stay was significantly shorter in the early-fed group than in the late-fed group [weighted mean difference = -1.72 d, 95% confidence interval (CI) -1.25 to -2.20, P < 0.01). Postoperative length of stay was also significantly shorter (weighted mean difference = -1.44 d, 95% CI -0.68 to -2.20, P < 0.01). There was no significant difference in risk of anastomotic leak, pneumonia, nasogastric tube reinsertion, reoperation, readmission, or mortality in the randomized controlled trials (RCTs). The pooled RCT and non-RCT results, however, showed a significantly lower risk of pneumonia in early-fed as compared with late-fed group (odds ratio = 0.6, 95% CI 0.41-0.89, P = 0.01). CONCLUSIONS: Early postoperative oral feeding as compared with traditional (or late) timing is associated with shorter hospital length of stay and is not associated with an increase in clinically relevant complications.

Nutritional Status Based on Body Mass Index Is Associated With Morbidity and Mortality in Mechanically Ventilated Critically Ill Children in the PICU.

OBJECTIVE: To determine the influence of admission anthropometry on clinical outcomes in mechanically ventilated children in the PICU. DESIGN: Data from two multicenter cohort studies were compiled to examine the unique contribution of nutritional status, defined by body mass index z score, to 60-day mortality, hospital-acquired infections, length of hospital stay, and ventilator-free days, using multivariate analysis. SETTING: Ninety PICUs from 16 countries with eight or more beds. PATIENTS: Children aged 1 month to 18 years, admitted to each participating PICU and requiring mechanical ventilation for more than 48 hours. MEASUREMENTS AND MAIN RESULTS: Data from 1,622 eligible patients, 54.8% men and mean (SD) age 4.5 years (5.1), were analyzed. Subjects were classified as underweight (17.9%), normal weight (54.2%), overweight (14.5%), and obese (13.4%) based on body mass index z score at admission. After adjusting for severity of illness and site, the odds of 60-day mortality were higher in underweight (odds ratio, 1.53; p < 0.001) children. The odds of hospital-acquired infections were higher in underweight (odds ratio, 1.88; p = 0.008) and obese (odds ratio, 1.64; p < 0.001) children. Hazard ratios for hospital discharge were lower among underweight (hazard ratio, 0.71; p < 0.001) and obese (hazard ratio, 0.82; p = 0.04) children. Underweight was associated with 1.3 (p = 0.001) and 1.6 (p < 0.001) fewer ventilator-free days than normal weight and overweight, respectively. CONCLUSIONS: Malnutrition is prevalent in mechanically ventilated children on admission to PICUs worldwide. Classification as underweight or obese was associated with higher risk of hospital-acquired infections and lower likelihood of hospital discharge. Underweight children had a higher risk of mortality and fewer ventilator-free days.

The eating experience in long-term survivors of head and neck cancer: a mixed-methods study.

PURPOSE: This study explored the eating experience in long-term survivors of head and neck cancer (HNC) ≥3 years post concurrent chemoradiation. Quality of life (QOL) and the meanings and perceptions survivors had as it related to the eating experience were explored. METHODS: Purposive sampling was utilized; 10 long-term survivors of HNC participated in the study. A mixed-methods approach was used; exploratory qualitative research using content analysis and summary statistics was used to describe demographic and clinical characteristics and the Vanderbilt Head and Neck Symptom Survey version 2.0 scores (VHNSS 2.0). RESULTS: Four categories (psychological, social impact, functional status, and the current eating experience) containing 15 subthemes and 1 overarching theme (adaptation) emerged. Current health status, QOL, and QOL related to eating were viewed favorably despite the impact of treatment late effects on participants' daily lives. Adaptation and maladaptation in regard to food choice and downplaying of symptoms were recognized. Interviews as well as the VHNSS 2.0 scores indicated that xerostomia, mucosal sensitivity, swallowing difficulty, length of time required to eat, and dysgeusia remained problematic. CONCLUSION: Psychological, functional, and social losses associated with eating were identified. Participants modify or avoid foods that are challenging yet report enjoyment with eating. Challenges with eating were downplayed. Due to the potential negative nutritional and social implications of avoiding specific food/food groups, standard of care in long-term survivors of HNC should include assessment of the eating experience and functional challenges. Nutrition professional can help patients optimize dietary intake and the eating experience.

A Review of Dietary Intake Studies in Maintenance Dialysis Patients.

Protein-energy wasting affects many maintenance dialysis patients (MDPs) and decreases survival. Suboptimal dietary energy intake (DEI) and dietary protein intake (DPI), secondary to reduced dietary intake (DI), are important risk factors in the development of protein-energy wasting. Multiple investigations of DEI and DPI in MDPs have occurred but few authors have synthesized these data. A comprehensive review of DI studies in MDPs was completed with the purpose of providing timely data on DI in MDPs until updated clinical practice guidelines for nutrition in nephrology care are published. A majority of DI investigations in MDPs confirm that DEI and DPI are below current nutrition guidelines. MDPs also have significantly lower DEI and DPI when compared with healthy controls. These findings inform the direction of further guidelines for nutrition in nephrology care as well as spark future research interests.