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Summary: Nutritional care has recently been recognized as a human right to promote access to optimal and timely nutritional care and help reduce disease related malnutrition. The patient who is endangered or suffering from malnutrition is highly vulnerable and at risk of having their human dignity affected. International declarations (of Vienna and Cartagena) have proposed and recognized nutritional care as an emerging human right, and the ethical duty of the nutrition support professional is to ensure access to it through care, responsibility, and justice. The purpose of this paper is to reflect the ethical implications of care, responsibility, and justice as foundations of ethical duty, the ethical implications of lack of access to nutritional care, and the possible solution in generating ethical awareness and education about nutritional care, based on the Vienna and Cartagena Declaration.

Background: Although previous research has attempted to understand the barriers and enablers of oral intake in hospitalized patients, these studies have mainly focused on short-stay inpatients and lacked a theory-driven examination of the determinants that influence dietary behavior in the hospital., Objective: To explore and compare the factors influencing adequate and poor oral intake in long-stay acute patients (admitted >14 days)., Design: A qualitative descriptive study with semistructured interviews., Participants/setting: Twenty-one adult inpatients (13 men, 8 women) admitted to 2 medical and 2 surgical wards at a tertiary hospital in Brisbane, Australia, during 2022, stratified by the Subjective Global Assessment. Analysis performed Transcripts were initially deductively analyzed against the Theoretical Domains Framework, and a reflexive thematic approach was used to create overall themes., Results: Of the 21 included patients (median age = 68.0 years, IQR 34 years), 11 had adequate/improved intake and 10 poor/decreased intake. Six themes were identified to have influenced oral intake in long-stay patients: self-determination to eat; nutrition impact symptoms; foodservice characteristics and processes; nutrition-related knowledge and skills; social support; and optimism, emotions, and emotion regulation. Patients with adequate/improved oral intake were characterized by an autonomous motivation to eat. They had increased awareness about their nutritional status, knowledge, and skills about food for recovery, were more optimistic, and social support was an important enabler to eating. In contrast, patients with poor/decreased oral intake perceived nutrition impact symptoms and dislike of meals as the main barriers to eating in the hospital; however, they also expressed more negative emotions, reduced coping strategies, and decreased knowledge, skills, intrinsic motivation, and capabilities to eat. Social support was present but did not enable oral intake in this patient group., Conclusions: This study provides novel insights into the factors that influenced oral intake in long-stay acute patients, highlighting the importance of patient-centered nutrition care, encompassing motivational interviewing techniques and collaboration from the multidisciplinary team to create a supportive environment that fosters autonomy and empowers patients to actively participate in their own nutrition and recovery., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Background: Organization of food services within hospitals has been identified as a determinant of hospitalized patients' nutritional intake and associated food waste. Whereas hospital food service systems in the Netherlands traditionally consist of 3 fixed mealtimes each day, we recently implemented a new 3-channel concept that provides patients the opportunity to order extra meals or snacks in-between their 3 main mealtimes or even have dinner with their visitors in a bistro located on their ward., Aim: This study investigates the impact of transitioning from a traditional paper-based to a patient-centered, digital hospital food service system on food waste production patterns and its associated financial implications., Methods: Plate waste (served but uneaten food) measurements were performed at baseline for all served meals during a one-week period within the traditional system and follow-up measurements were conducted annually after implementation of the new system during 3 consecutive years. Measurements were conducted at two hospital floors, each comprising four wards. Average grams of plate waste per served meal, daily meal frequency per patient and the associated production and disposal costs of the collected waste were calculated and compared between the two systems., Results: A total of 4361 meals served within the traditional system were compared with 7815 meals served within the new digital system. Meal frequency increased from an average of 2.5 meals per patient per day in the old system to an average varying between 3 and 3.3 meals per patient per day in the consecutive years. Within the traditional system, average plate waste was 81 grams per served meal, whilst it ranged between 33 and 49 grams per served meal during the following years, with the 3-channel concept in place (p < 0.001, p = 0.010). Dinner demonstrated the largest reduction in plate waste at all measurement points. Following this reduction of plate waste, estimated associated costs of plate waste production and disposal decreased in a similar pattern., Conclusion: Transitioning from a traditional, paper based to a patient-centered and digital hospital catering system results in significantly higher daily meal frequency and less food waste per served meal., Competing Interests: Conflict of interest Author H. Mertens is the CEO of Maastricht University Medical Centre+., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Poor food and fluid intake and subsequent malnutrition and dehydration of residents are common, longstanding challenges in long-term care (LTC; eg, nursing homes, care homes, skilled nursing facilities). Institutional factors like inadequate nutrition care processes, food quality, eating assistance, and mealtime experiences, such as staff and resident interactions (ie, relationship-centered care) are partially responsible and are all modifiable. Evidence-based guidelines on nutrition and hydration for older adults, including those living with dementia, outline best practices. However, these guidelines are not sector-specific, and implementation in LTC requires consideration of feasibility in this setting, including the impact of government, LTC home characteristics, and other systems and structures that affect how care is delivered. It is increasingly acknowledged that interconnected relationships among residents, family members, and staff influence care activities and can offer opportunities for improving resident nutrition. In this special article, we reimagine LTC nutrition by reframing the evidence-based recommendations into relationship-centered care practices for nutrition care processes, food and menus, eating assistance, and mealtime experience. We then expand this evidence into actions for implementation, rating these on their feasibility and identifying the entities that are accountable. A few of the recommended activities were rated as highly feasible (6 of 27), whereas almost half were rated moderate (12/27) and the remainder low (9/27) owing to the need for additional staff and/or expert staff (including funding), or infrastructure or material (eg, food ingredients) investment. Government funding, policy, and standards are needed to improve nutrition care. LTC home leadership needs to designate roles, initiate training, and support best practices. Accountability will result from enforcement of policies through auditing of practice. Further evidence on these desirable nutrition care and mealtime actions and their benefit to residents' nutrition and well-being is required., (Copyright © 2021 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.)

Bariatric surgery is currently the most effective treatment for morbid obesity and its associated metabolic complications. To ensure long-term postoperative success, patients must be prepared to adopt comprehensive lifestyle changes. This review summarizes the current evidence and expert opinions with regard to nutritional care in the perioperative and long-term postoperative periods. A literature search was performed with the use of different lines of searches for narrative reviews. Nutritional recommendations are divided into 3 main sections: 1 ) presurgery nutritional evaluation and presurgery diet and supplementation; 2 ) postsurgery diet progression, eating-related behaviors, and nutritional therapy for common gastrointestinal symptoms; and 3 ) recommendations for lifelong supplementation and advice for nutritional follow-up. We recognize the need for uniform, evidence-based nutritional guidelines for bariatric patients and summarize recommendations with the aim of optimizing long-term success and preventing complications., (© 2017 American Society for Nutrition.)

Background: Nutrition is recognized as a strong factor influencing the health outcomes of patients with chronic disease. General practitioners (GPs) require nutrition knowledge and skills to support patients to have healthy dietary behaviours., Objective: To investigate New Zealand GP registrars' provision of nutrition advice using patient scenarios., Study Design: A cross-sectional study design targeted GP registrars to investigate the nutrition care they provided to patients., Methods: Fourty-seven GP registrars completed a survey at a training event. The survey included patient scenarios. Respondents were asked to provide nutrition advice for each scenario, in line with best practice guidelines. Responses to each scenario were scored based on a panel of nutrition experts. Regression analysis was used to compare the scores to participants' previously reported confidence to provide nutrition care., Results: Seventeen male (36.2%) and thirty female (63.8%) GP registrars completed the survey, giving a response rate of 92.2%. GP registrars scored a mean of 7.9 ± 0.2 out of 15 for recall of dietary strategies with the scenarios. There was no association between GP registrars' scenario scores and their confidence to provide nutrition care., Conclusions: An evidence-practice gap exists for New Zealand GP registrars' confidence to provide nutrition care, and their knowledge of evidence-based nutritional guidelines to support patients to have healthy dietary behaviours. A better understanding of the determinants of this disparity is required in order to support optimal nutrition care by GPs., (Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: The prevalence of chronic disease is considerable, and dietary behaviours influence the progression of many chronic diseases. Practice guidelines recommend that general practitioners (GPs) promote healthy dietary behaviours in relevant consultations with patients in order to improve health outcomes at a population level., Objective: To describe GPs' perceived interest, confidence and barriers to support patients to have a healthy diet., Method: A 24-item online and written survey was distributed in a national weekly newsletter to GPs in Australia. Results were descriptively analysed and investigated for associations with GPs' demographic characteristics., Results: A total of 322 GPs responded to the survey. Nearly all (n = 295, 91.6%) were interested in supporting patients to eat well, and most (n = 231, 71.7%) reported moderately high confidence for providing nutrition care with clear public health messages for conditions, such as cardiovascular disease. Many GPs (n = 170, 52.8%) cited lack of time as the biggest barrier to providing nutrition care, and the overwhelming majority (n = 289, 89.8%) were interested in receiving additional education and training to enhance their nutrition knowledge and skills., Discussion: Many GPs are interested in nutrition and would benefit from educational programmes that improve their competence to provide nutrition care. Professional development opportunities should focus on the identification of nutritional risk and the promotion of healthy dietary behaviours within the time constraints of a standard consultation., (Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.)