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Patients with advanced or metastatic gastric cancer often suffer from malnutrition, which can have an impact on quality of life, increase the toxicity of chemotherapy and reduce overall survival. Options available to the clinician to manage a patient's nutritional status include screening and assessment of malnutrition at diagnosis, monitoring during the 'cancer journey', early detection of precachexia and the ongoing use of a multidisciplinary team (oncologists, other medical specialists and nutritionists). Because malnutrition is frequently overlooked and under treated in patients with advanced or metastatic gastric cancer, this narrative review focuses on the clinical meaning of nutritional status in gastric cancer and provides general guidance regarding nutritional care management for patients with advanced or metastatic gastric cancer.Lay abstract Patients with gastric cancer that has spread to other parts of the body often suffer from malnutrition. This can impact patients’ lives, increase side effects from cancer treatment and reduce life expectancy. This article provides guidance for healthcare providers on nutritional care for patients with gastric cancer. Key ways healthcare providers can contribute to nutritional care include: looking for malnutrition when a patient is diagnosed with gastric cancer; watching carefully for malnutrition during cancer treatment; keeping a lookout for early signs of extreme weight loss and muscle wasting; and involving a team of healthcare providers with a broad range of expertise in patients’ nutritional care.

Background: Malnutrition in older people in hospitals leads to negative patient outcomes. Nurses often underestimate the problem, showing negative attitudes.Aims: To compare nurses' attitudes towar...

Cancer patients often have inappropriately low energy intake, exhibit an increased loss of muscle proteins and generalized inflammatory status. Nutritional support aims to reverse these processes. Covering energy requirements is necessary for safety of anti-cancer treatments: radiotherapy, chemotherapy, surgery. Nutritional support and nutritional status monitoring should be managed at every stage of the disease. Nutritional intervention is most important in malnourished patients. Comprehensive, individualized nutritional care improves the results of treatment in cancer patients. Nutritional therapy is essential in obtaining the best results from anti-cancer treatment; however, it will be effective, if should completely cover nutrient requirements.

The present paper outlines current issues in the nutritional care of women during pregnancy and potential resources to address them. Globally, overnutrition, undernutrition and nutritional imbalances are widespread among women of reproductive age; increasing the risk of pregnancy complications and non-communicable diseases in both mothers and their children. Most women do not meet dietary guidelines for pregnancy. The World Health Organisation (WHO) recommends nutrition and weight counselling during pregnancy for all women. However, clinical practices focusing on nutrition vary and there is no consensus on which outcomes are most important for pregnancy nutrition interventions, with little consideration for the ‘patient voice’. The International Federation of Gynaecology and Obstetrics (FIGO) nutrition checklist is a clinical practice tool that is available for healthcare professionals that will address this issue. The pregnancy nutrition core outcome set will also support advancement of antenatal nutrition by identifying the most critical nutrition-related outcomes from the perspective of healthcare professionals, researchers and women with experience of pregnancy. While poor nutrition can result in adverse outcomes across women of all weight categories, those with obesity may require specialist care to reduce their risk. Obesity is a chronic, progressive, relapsing disease that has high individual variability in its prognosis. The use of obesity staging systems, which consider mental, physical and functional health, can stratify individuals into risk categories and aid in treatment prioritisation in pregnancy. As the prevalence of obesity continues to rise, an obesity staging approach may support clinicians, especially those in limited resource settings.

Within South Africa, approximately 1.5 million children suffer from malnutrition and stunting with dire effects on their early development and thriving potential. Nutritional care within the first ...

AIM Evidence-based guidelines provide recommendations on how dietitians should work with patients with head and neck cancer for best outcomes. Research with healthcare professionals from head and neck cancer teams would provide insight into how these recommendations are implemented in practice. Therefore, the aim of this study was to explore how the role of the dietitian is perceived and enacted in different head and neck cancer teams from the perspective of healthcare professionals. METHODS This qualitative study recruited radiation oncologists, nurses, dietitians and speech pathologists from four different head and neck cancer teams in Australia and the United States. Data were collected via semi-structured interviews and analysed using a grounded-theory approach. RESULTS Seventeen radiation oncologists, 12 nurses, 11 dietitians and six speech pathologists participated. Perceptions on the role of dietitians were summarised by the category: "Providing expertise in nutritional care: A core role in head and neck cancer." Five categories summarised perceptions of factors that can influence how the role of the dietitian is enacted in practice: "having experience in head and neck cancer"; "initiating nutritional care plans and the role of doctors and nurses"; "clinic structuring"; "an evolving culture in healthcare services" and "the presence of evidence-based guidelines." CONCLUSIONS While dietitians can be perceived to be the experts in nutritional care, several factors influence how their role is enacted in head and neck cancer teams. Further research on patient nutritional outcomes and on clinic structures that best use dietetic expertise is required to strengthen recommendations on how dietitians should work with head and neck cancer patients internationally.

To enhance prevention and treatment of malnutrition in older adults before, during and after hospitalization, deeper understanding of older adults' and informal caregivers' perspective on nutritional care is important. One-time in-depth interviews were conducted with 15 older adults who had been discharged from hospital, and seven informal caregivers. We explored their experiences and needs regarding nutritional care provided in the periods before, during and after hospitalization. Five themes emerged from the data: (1) dietary intake, (2) food service during hospitalization, (3) nutrition-related activities, (4) whose job it is to give nutritional care, and (5) competing care priorities. Further, several opinions about nutritional issues were identified. Older adults and informal caregivers did not always experience optimal nutritional care. When discussing nutritional care, they mainly focused on the in-hospital period. When providing nutritional care and developing guidelines, older adults' and informal caregivers' perspective on nutritional care should be incorporated. Here, the periods before, during and after hospitalization should be taken into account equally.

Los firmantes, coordinadores de los Capítulos nacionales integrantes del Comité Internacional para la Elaboración de Consensos y Estandarización en Nutriología (CIENUT), después de un proceso profundo de discusión y análisis que involucró a la totalidad de nuestros miembros, declaramos lo siguiente: La anemia por deficiencia de hierro es un problema de Nutrición Pública que afecta en grados variables, pero significativos, a la población de todos los países latinoamericanos y presenta algunos factores que vienen contribuyendo a esta situación. La prevalencia de lactancia materna exclusiva, por ejemplo, ha caído sostenidamente en el último quinquenio; la introducción de alimentos diferentes a la leche humana se produce en promedio a partir de los 4 meses y es la leche de vaca uno de los alimentos más empleados como sustituto de la leche humana. Dada las características bioquímico-moleculares de la proteína de la leche de vaca su consumo antes del año de vida contribuye significativamente a agudizar el problema de anemia en poblaciones de riesgo. En este contexto, hemos elaborado la Declaración de Lima sobre el consumo de leche entera de vaca en menores de un año; esta declaración busca generar conciencia entre las autoridades de salud sobre lo siguiente: Difundir que las características bioquímicas de la proteína de la leche entera de vaca pueden generar microsangrados a nivel intestinal cuando es administrada en niños de 0 a 1 año. Promover la lactancia materna exclusiva los primeros 6 meses de vida y la alimentación complementaria a partir de los 6 meses. Promover la lactancia materna hasta los 2 años. Invocamos, además, a todas las instituciones que brindan atención nutricional suscriban este consenso y hagan todo lo necesario para que pueda implementarse en la forma más rápida posible. Firmado el 14 de setiembre de 2019 en Lima, Perú.

Nutritional care after bariatric surgery is an issue of major importance, especially insofar as risk of deficiency has been extensively described in the literature. Subsequent to the deliberations carried out by a multidisciplinary working group, we are proposing a series of recommendations elaborated using the Delphi-HAS (official French health authority) method, which facilitates the drawing up of best practice and consensus recommendations based on the data of the literature and on expert opinion. The recommendations in this paper pertain to dietary management and physical activity, multivitamin and trace element supplementation and the prevention and treatment of specific deficiencies in vitamins B1, B9, B12, D and calcium, iron, zinc, vitamins A, E and K, dumping syndrome and reactive hypoglycemia.

Diet therapy can make a significant contribution to the comprehensive treatment of neurological disorders. The high frequency of malnutrition among patients with neurological profile requires timely and adequate organization of nutritional care in order to preserve somatic health, improve the quality of life and the effectiveness of treatment and rehabilitation measures. The article represents the problems of nutrition organization in neurological patients, the peculiarities of their nutritional status and ways of its optimization. Nutritional possibilities in neurological practice, including both, the organization of nutritional support and alternative approaches to the treatment of certain pathological conditions, and, in particular, the use of a ketogenic diet in the treatment of drug-resistant epilepsy, are considered.

Many older patients with pneumonia cannot intake orally after admission and may need nutritional care such as nasogastric tube feeding or total parenteral nutrition. This study sought to compare in-hospital outcomes between patients receiving nasogastric tube feeding and total parenteral nutrition. This is a retrospective cohort study. A hospital-based database constructed by the Diagnosis Procedure Combination survey data comprising more than 100 acute-care hospitals. The study included consecutive older inpatients aged >65 years admitted to participating hospitals with a diagnosis of pneumonia from 2014 through 2017. We compared patients who received total parenteral nutrition and those who received nasogastric tube feeding in terms of characteristics and outcomes. Among the included inpatients, a total of 336 (73.2%) patients received total parenteral nutrition and 123 (26.8%) patients received nasogastric tube feeding. Patients with nasogastric tube feeding had less in-hospital mortality (13.8% vs 27.1%, p = 0.003) and a smaller number of complications (mean; 0.71 vs 1.44, p

Objective This study aims to evaluate the implementation of standardized nutrition care process through nutrition screening, assessment, and nutritional diagnosis on inpatients with tuberculosis. Method This research was a descriptive observational study. Convenient sampling was conducted, with 40 tuberculosis cases. The data were obtained both from medical record and interview of dieticians. There are two main steps in the nutritional care process assessed in this research, namely, nutritional assessment and nutritional diagnosed. Results Majority of the patients (97.5%) had completed nutritional screening according to the standard. In contrast, most of patients did not have a standardized and complete documents of nutritional history (90%), anthropometric assessment (77.5%) and clinical result assessment (97.5%). Conclusion The standardized nutritional care process on hospitalization of tuberculosis patients was not performed accordingly due to heavy workload of dieticians.

Purpose of review There is ongoing interest in nutritional screening tools in pediatrics to facilitate the identification of children at risk for malnutrition who need further assessment and possible nutritional intervention. The choice for a specific tool depends on various factors. This review aims to provide an overview of recent progress in pediatric nutritional screening methods. Recent findings We present recent studies about newly developed or adjusted tools, the applicability of nutritional screening tools in specific populations, and how to implement screening in the overall process of improving nutritional care in the pediatric hospital setting. Summary Three new screening tools have been developed for use on admission to hospital: two for the mixed pediatric hospitalized population and one for infants. A simple weekly rescreening tool to identify hospital-acquired nutritional deterioration was developed for use in children with prolonged hospital stay. Different from most previous studies that only assessed the relationship between the nutritional risk score and anthropometric parameters of malnutrition, new studies in children with cancer, burns, and biliary atresia show significant associations between high nutritional risk and short-term outcome measures such as increased complication rate and weight loss. For implementation of a nutritional care process incorporating nutritional screening in daily practice, simplicity seems to be of great importance.

Summary Background & Aims The risk of malnutrition in people with COVID-19 is high; prevalence is reported as 37% in general medical inpatients, 53% in elderly inpatients and 67% in ICU. Thus, nutrition is a crucial element of assessment and treatment. This rapid review aimed to evaluate what evidence is available to inform evidence-based decision making on the nutritional care of patients hospitalised with COVID-19 infection. Methods Cochrane Rapid Reviews guidance was followed; the protocol was registered (CRD42020208448). Studies were selected that included patients with COVID-19, pneumonia, respiratory distress syndrome and acute respiratory failure, in hospital or the community, and which examined nutritional support. All types of studies were eligible for inclusion except non-systematic reviews, commentaries, editorials and single case studies. Six electronic databases were searched: MEDLINE, Embase, Cochrane Central Register of Controlled Trials, PubMed, CINAHL and MedRxiv. Results Twenty-six articles on COVID-19 were retrieved, including 11 observational studies, five guidelines and 10 opinion articles. Seven further articles on pneumonia included three RCTs, one unblinded trial, three observational studies, and one systematic review on rehabilitation post-ICU admission for respiratory illness. The evidence from these articles is presented narratively and used to guide the nutritional and dietetic care process. Conclusions Older patients with COVID-19 infection are at risk of malnutrition and addressing this may be important in recovery. The use of nutritional management strategies applicable to other acute conditions are recommended. However, traditional screening and implementation techniques need to be modified to ensure infection control measures can be maintained. The most effective nutritional interventions require further research and more detailed guidance on nutritional management post-discharge to support long-term recovery is needed.

Summary Anorexia nervosa (AN) in its two major types (restricting type and binge-eating/purging type) is one of the most frequent and serious eating disorder. Severe undernutrition due to intake restriction and pathological associated behaviors such as potomania and vomiting can cause serious somatic complications such as cardiac and/or hepatic disturbances. Nutritional rehabilitation of undernourished AN patients should be very causes to avoid refeeding syndrome. Managing AN need a multidisciplinary approach including psychiatric and nutritional care.

El sobrepeso y la obesidad presentan causas multifactoriales y su control y/o adhesión al tratamiento nutri- cional pueden estar relacionados con las estrategias de afrontamiento y la autoeficacia. Objetivo: El objetivo de este estudio fue investigar la relación entre estrategias de afrontamiento y autoefi- cacia entre mujeres que estaban en atención nutricional en un servicio-escuela interdisciplinario. Método: Se trata de una investigación descriptiva y correlacional, de abordaje cuantitativo y corte trans- versal, de la cual participaron 24 mujeres adultas con sobrepeso y obesidad, que respondieron al Cuestio- nario en Datos Sociodemográficos y Clínicos; Weigth Efficacy Lifestyle Questionnarie (WEL- Bellace, 2005; Clark et al., 1991); y Escala Modos de Enfrentamiento de problemas (Seidl, Trócolli, & Zannon, 2001). Resultados: Los análisis descriptivos indicaron mayores medias en el afrontamiento enfocado en el problema, mayor autoeficacia frente a actividades positivas y menor autoeficacia en resistir al alimento frente a emociones negativas. También hubo asociación negativa entre focalización en la emoción y emociones negativas, incomodidad física y presión social. Discusión y Conclusión: Se destaca la importancia de la promoción de estrategias de afrontamiento que propicien mayor percepción de autoeficacia, con el objetivo de promover mayor adhesión al tratamiento y mantenimiento de ganancias.

In the context of the right to life - and particularly to the life of children and their fundamental well-being – the national and international legislation enshrines this right. Since anemia is one of the factors that most influences both infant morbidity and the development of their faculties, it is essential to validate strategies that lead to its reduction / elimination. The research was founded on the conceptual framework of the National Plan for the Reduction and Control of Childhood and Maternal Anemia in Peru, 2017-2021. In this senseand from the opinion of experts, doctors, nutritionists, leading mothers, among others, the proposal was to demonstrate the scope of an educational intervention that allows the reduction of anemia in children between 6 and less than 36 months old from October 2018and February 2019 in Flor de Amancaes shanty town. It is concluded that the control and effect of anemia in inner city areas in Peru will depend on the level of education, training with accompaniment of parents and the legal commitment of the State to ensure the right to life through the nutritional care of our children.

Background: Accurate identification of malnutrition and preoperative nutritional care in Inflammatory Bowel Disease (IBD) surgery is mandatory. There is no validated nutritional screening tool for IBD patients. We developed a novel nutritional screening tool for IBD patients requiring surgery and compared it with other tools. Methods: we included 62 consecutive patients scheduled for elective surgery. The IBD Nutritional Screening tool (NS-IBD) was developed to screen patients for further comprehensive assessment. NRS-2002, MUST, MST, MIRT, SaskIBD-NR are compared with the new test. All screening tests were subsequently related to new GLIM criteria. Results: according to GLIM criteria, 25 (40%) IBD patients were malnourished (15 CD and 10 UC, 33% vs. 63%, p = 0.036). Stage 1 malnutrition was reported in ten patients, while stage 2 was detected in 15 patients. The comparison of each nutritional risk tool with GLIM criteria showed sensitivity of 0.52, 0.6, 0.6, 0.84, 0.84 and 0.92 for SASKIBD-NR, MUST, MST, NRS-2002, MIRT, and the new NS-IBD, respectively. Conclusions: in IBD, currently adopted nutritional screening tools are characterized by a low sensitivity when malnutrition diagnosis is performed with recent GLIM criteria. Our proposed tool to detect malnutrition performed the best in detecting patients that may require nutritional assessment and preoperative intervention.

Cancer is making patients vulnerable to diseases by impairing immunity directly or by anticancer therapy. In COVID-19 era, it is mandatory to face cancer with more organized & prompter response. Nutrition plays an important role in prevention & management of cancer patients. The objective of this study is to understand the role of nutrition in cancer patients during Corvid 19 era. We conducted literature searches till May 2020, electronic databases, evidence-based collections, relevant websites and trial registries about SARS-CoV2/COVID-19 and nutrition in cancer patients. Search generated 836 sources; 83/836 sources were relevant. This review summarized role of nutrition in predisposition, prevention and management of COVID-19 in cancer patient and role of vitamins, mineral supplements and microbiota in era of COVID-19. In this review, implementing appropriate nutritional care with vitamins or mineral supplementation & their effect on outcome remain largely unknown. COVID co-infection with cancer whether under chemotherapy or not have worse outcome especially in male adults. Findings may help in creating recommendations on nutritional protocol of management & prevention of complications during ongoing COVID-19 pandemic for all cancer patients.

The increased risk of mortality and treatment-related toxicities among children with cancer who are also malnourished has prompted several efforts aimed at improving access to clinical care and promoting high-quality research in nutrition and pediatric oncology. The presence of strong nutrition programs in pediatric cancer units located in low- and middle-income countries where endemic rates of malnutrition, nutrient deficiencies and food insecurity are high makes this an even more crucial component of pediatric cancer care. This is especially true in Southeast Asia where nearly 30% of children in the region experience severe acute malnutrition at some point in childhood. Several global initiatives have been put forth to support pediatric cancer units in closing this disparity in nutritional care by increasing the availability of nutritionists knowledgeable in the provision of nutrition care to children with cancer. This report provides highlights of several collaborative, global initiatives aimed at further improving the quality of care, increasing education opportunities, and fostering multi-disciplinary collaborations in nutrition and research in pediatric oncology. Keywords: Pediatric oncology, Childhood cancer, Nutrition, Supportive care

Objectives Few studies have captured the experiences of family carers who manage the nutritional needs of family members living with dementia at home. The identification and management of symptoms that may affect nutritional status is often reliant upon the family carer. This interpretative phenomenological study aimed to explore the experiences and perceptions of the nutritional care of people living with dementia at home from the perspectives of the family members who support them. Method Semi-structured interviews were conducted between October 2017 and February 2018. Participants were also asked to keep a diary of experiences for two weeks before the interview. An Interpretative Phenomenological Analysis approach was used throughout. Findings: Eight participants, with a mean age of 69.6 years residing in South West England were recruited and represented a range of familial roles. Following analysis, three superordinate themes were identified: ‘becoming carer and cook’, ‘changing role and relationships’ and ‘emotional eating’. Conclusion Family carers make food and drink decisions daily, and feel a duty to take on the responsibility for food shopping and cooking. They are conscious about ‘doing the right thing’ when it comes to providing nutritional care, and some feel uncertain about the food choices they are making, particularly regarding a reliance on convenience foods. Changes in appetite, food preferences and mealtime habits related to dementia can lead to disruption affecting the dyad. It is important that family carers and people living at home with dementia are provided with adequate support regarding identifying nutritional risks, making appropriate food and drink choices and preventing the risk of malnutrition in the dyad.

Information on disease-related malnutrition and related outcomes in pediatric patients with chronic diseases in different settings of care is not available.Consecutive eligible patients attending the out-patient clinic (n = 177) or admitted to the day-hospital clinic (n = 163) or to hospital (n = 201) were screened for the presence of malnutrition (BMI and/or height/length for age z-scores -2). We recorded data on emergency care admissions to hospital that occurred during the 3 years before screening and related total days of stay, as well as data on emergency care admissions to hospital occurring within 6 months after screening.Prevalence of malnutrition was 2-fold higher (P 0.001) in in-patients (56.7% [95% CI, 49.6-63.7]) than in patients assessed at the out-patient (33.3% [95% CI, 26.4-40.8]) and day-hospital (28.3% [95% CI, 21.5-35.8]) clinics. Estimates were heterogeneous across diagnostic groups with higher rates in patients with neurologic (61%) and cardiac (56%) diseases. Stunting was more frequent among in-patients, who also had more evident nutritional derangements. Multivariate logistic regression (covariates: age, gender, healthcare setting and disease group), showed that malnutrition (OR = 1.86 [95% CI, 1.21-2.88]; P = 0.005) was significantly associated with prolonged hospitalization (≥15 days) in the 3 years before screening. In-patients were also more likely to have been hospitalized ≥15 days (using out-patients as reference category, OR = 2.24 [95% CI, 1.39-3.63], P = 0.001), but we did not find any modifying effect (interaction) of the setting of care on the association between malnutrition and prolonged hospitalization.The rates of malnutrition in children with chronic diseases are very high and increase hospital care needs, especially when they are admitted to hospital. Nutritional care in this patient population is recommended.

This article gives an outline of the key groups at risk of malnutrition in the community and the effects and clinical consequences of not identifying and managing these groups. It outlines the potential health and social costs of not identifying and treating malnutrition in the community and advises how malnutrition arises in these ‘at-risk’ groups. As 93% of those affected by malnutrition are living in our communities, advice is given on how community nurses can play a pivotal role in identifying malnutrition by initiating conversations about dietary intake with patients and integrating screening and nutritional care into pathways of care.

Background Bowel necrosis is a commonly observed condition in elderly patients with longstanding diabetes. In such condition, intestinal resection is usually performed for the removal of the gangrenous part. Post-surgical dietary management after bowel resection poses several challenges for the health care team. Case presentation The case presented in this study is that of an elderly diabetic male who developed acute renal failure as a result of neglect in post-surgical feeding after intestinal resection. After the intervention by a trained dietitian, a transitional diet was planned and successfully executed, resulting in reversal of acute renal failure, dehydration, and post-surgical stress. Several complications including hepatic dysfunction and mouth ulcers were resolved through well-planned transitional diet. The patient was finally discharged in a stable health condition and was regularly followed up for any nutritional or medical issues. Conclusion Neglects in nutritional care of patients can have severe implications including development of medical complications, resulting in increased length of hospital stay, augmenting the disease stress of the patient and family, and finally the preventable drainage of several human and monetary resources. Therefore, recognition of nutritional intervention as an important part of in-hospital health care may have social as well as economic impacts.

The term malnutrition is used to describe a deficiency, excess or imbalance of a wide range of nutrients, resulting in measurable adverse effects on body composition, function and clinical outcome.1 As such it can refer to individuals who are either over- or under-nourished although it is frequently used synonymously with undernutrition, as is the case in this article. Although it is well known that malnutrition is common in the developing world, the fact that significant malnourishment occurs in UK society and health settings is not widely appreciated. Malnutrition occurs for psychosocial reasons and as a consequence of disease. It has direct effects on clinical outcomes and is associated with massive healthcare expenditure. Recognition and treatment can have a significant impact on patient care and can reduce costs. Failure to diagnose and manage carries medico-legal risks. It is the responsibility of all doctors to recognize the fundamental importance of proper nutritional care to good clinical practice.2 The focus of this article is predominantly concerned with malnutrition and its consequences in the UK.

In the last years, different societies published clinical guidelines to provide evidence into practical recommendations in a consensual manner that promote and raise awareness of the importance of nutritional care in cancer patients.

Considering the high prevalence of malnutrition associated with disease and the need to advance education and research in clinical nutrition, the Cartagena Declaration was signed in May 2019. This is the International Declaration on the right to nutritional care which is addressed to societies, colleges and associations affiliated with FELANPE, and to any organization or institution that promotes the fight against malnutrition. The Declaration provides a coherent framework of 13 Principles which can serve as a guide in the development of action plans. In addition, it will serve as an instrument for states to formulate policies and legislate in the field of clinical nutrition. We believe that the general framework of principles proposed by the Declaration can contribute to raising awareness about the magnitude of this problem and forging cooperation networks between the countries of the region, and why not, the world. It will be, then, contributing to achieving the United Nations Sustainable Development Goals that seek, by 2030, to end all forms of malnutrition.

Malnutrition and muscle wasting are frequently reported in cancer patients, either linked to the tumor itself or caused by oncologic therapies. Understanding the value of nutritional care during cancer treatment remains crucial. In fact, cancer-associated sarcopenia plays a key role in determining higher rates of morbidity, mortality, treatment-induced toxicities, prolonged hospitalizations and reduced adherence to anticancer treatment, worsening quality of life and survival. Planning baseline screening to intercept nutritional troubles earlier, organizing timely reassessments, and providing adequate counselling and dietary support, healthcare professional may positively interfere with this process and improve patients’ overall outcomes during the whole disease course. Several screening tools have been proposed for this purpose. Nutritional Risk Screening (NRS), Mini Nutritional Assessment (MNA), Patient Generated Subjective Global Assessment (PG-SGA) are the most common studied. Interestingly, second-level tools including skeletal muscle index (SMI) and bioelectric impedance analysis (BIA) provide a more precise assessment of body composition, even if they are more complex. However, nutritional assessment is not currently used in clinical practice and procedures must be standardized in order to improve the efficacy of standard chemotherapy, targeted agents or even checkpoint inhibitors that is potentially linked with the patients’ nutritional status. In the present review, we will discuss about malnutrition and the importance of an early nutritional assessment during chemotherapy and treatment with novel checkpoint inhibitors, in order to prevent treatment-induced toxicities and to improve survival outcomes.

Evidence-based guidelines (EBGs) for patients with head and neck cancer (HNC) recommend that nutritional care is delivered by an interprofessional team inclusive of dietitians, doctors, nurses, and speech pathologists. Barriers to collaboration exist within interprofessional teams. However, research on this is currently lacking in the HNC setting, particularly with regard to the provision of nutritional care. This study aimed to explore what facilitates collaborative nutritional care for patients with HNC from the perspectives of different healthcare professionals. This qualitative study used a grounded theory approach. Healthcare professionals from two radiotherapy departments in the United States and two in Australia were interviewed. Forty-six interviews were completed with 17 radiation-oncologists, 12 nurses, eleven dietitians, and 6 speech-pathologists. Collaborative nutritional care for patients with HNC was underpinned by three categories and six sub-categories: access to dietitians (facilitated by funding for dietitians and the strength of evidence), communication (facilitated by team meetings, communication systems, and multidisciplinary clinics), and role-clarity (facilitated by non-clinical activities and respect). This study highlights opportunities for enhancing collaborative nutritional care within HNC teams. Further studies on the impact of the dietitian, interprofessional education, team meetings, and multidisciplinary clinics are required to promote collaborative nutritional care for HNC patients.

BACKGROUND Little is known about the nutritional care provided to patients who develop hospital acquired malnutrition (HAM). The present study aimed to describe the quality of nutritional care provided to patients who developed HAM and determine whether this differed by length of stay (LOS). METHODS A retrospective medical records audit was conducted on adults with LOS > 14 days across five Australian public hospitals from July 2015 to January 2019 who were clinically assessed to have HAM. Descriptors and nutrition-related care data were sourced. Descriptive statistics were conducted. Chi-squared and t-tests were used to compare patient data by LOS ≤ or > 50 days. RESULTS Eligible patients (n = 208) were 64% male, with median (range) LOS of 51 (15-354) days, body mass index = 26.8 ± 6.2 kg m-2 and mean ± SD age of 65 ± 17 years. Malnutrition screening was first completed a median (range) of 0 (0-31) days after admission, with weekly screening conducted on 29% of patients. Mean (range) time to initial dietitian assessment was 9 (0-87) days and 27 (2-173) days until malnutrition diagnosis. Thirty-seven percent of patients were weighed within 24 h of a dietitian requesting it, and 51% had fluid retention that may have masked further weight loss. Most (91%) patients consumed 2 weeks. However, 54% did not receive additional nutrition support (e.g., enteral nutrition), which was not considered by the dietitian in 28% (n = 31/112) of these patients. Only 40% consumed adequate intake prior to discharge. Those with LOS > 50 days (50%, n = 104/208) took 24 days longer to be diagnosed with malnutrition and lost 2.4 kg more body weight during admission (p

Intestinal failure is a debilitating, complex disorder associated with loss of portions of intestine or loss of intestinal function. Short bowel syndrome is the most common form of intestinal failure and results in inability to maintain nutritional, fluid, and electrolyte status while consuming a regular diet. Nutrition interventions to treat short bowel syndrome include enteral and parenteral nutrition, intestinal rehabilitation techniques to enhance absorptive capacity of remnant bowel, and surgical reconstruction designed to provide more surface area for absorption. These therapies are interrelated services to restore nutritional status through the safest most effective therapy consistent with patient lifestyle and wishes.

NutritionDay (nDay) is a project established by the Medical University of Vienna and the European Society for Clinical Nutrition and Metabolism (ESPEN) to audit the nutritional status of hospitalized patients and nursing home residents. This study aimed to evaluate nDay data describing the prevalence of hospital malnutrition, nutritional risk factors, and elements of the nutritional care process implemented in hospital wards in 25 European countries and to compare the data derived from Poland with the data collected in all the European countries participating in the study. In total, 10,863 patients (European reference group: 10,863 participants including Poland: 498 participants) were involved in the study. The prevalence of malnutrition was identified on the basis of the ESPEN diagnostic criteria established in 2015, while the prevalence of nutritional risk factors was assessed by analyzing the following parameters: body mass index (BMI), score of Malnutrition Screening Tool (MST), recent weight loss, insufficient food intake, decreased appetite, increased number of drugs intake, reduced mobility, and poor self-reported health status. Malnutrition prevalence was 12.9% in patients from the European reference group and 9.4% in patients from Polish hospital wards (p &lt, 0.05). However, the prevalence of some nutritional risk factors, i.e., recent weight loss, history of decreased food intake, and low actual food intake, were approximately four times more prevalent than diagnosed malnutrition (referring to approximately 40–50% of all participants). In comparison to the European reference group, the significant differences observed in Polish hospital wards concerned mainly dietitian’s involvement in the process of treating malnutrition (16% vs. 57.2%, p &lt, 0.001), supply of special diets (8% vs. 16.1%, 0.0001), provision of oral nutritional support (ONS) (3.8% vs. 12.2%, prescription of enteral/parenteral nutrition therapy to hospitalized patients (8.2% vs. 11.7%, as well as recording patient weight performed at hospital admission (100% vs. 72.9%, 0.0001), weekly (20% vs. 41.4%, 0.05), and occasionally (0% vs. 9.2%). These results indicate that the prevalence of malnutrition and malnutrition risk factors in hospitalized patients in Poland was slightly lower than in the European reference group. However, some elements of the nutritional care process in Polish hospitals were found insufficient and demand more attention.

Item does not contain fulltext AIMS AND OBJECTIVES: To gain insight into the experiences and perceptions of hospital and home care nurses regarding nutritional care for older adults to prevent and treat malnutrition. BACKGROUND: In-depth knowledge about hospital and home care nurses' experiences and perceptions can contribute to optimise nutritional care for older adults across the care continuum between hospital and home to prevent and treat malnutrition. DESIGN: Multicentre cross-sectional descriptive study. METHOD: A validated questionnaire addressing malnutrition was used. A total of 1,135 questionnaires were sent to hospital and home care nurses. The STROBE statement was followed for reporting. RESULTS: The response rate was 49% (n = 556). Of all the nurses, 37% perceived the prevalence of malnutrition among their care recipients between 10% and 25%. Almost 22% of the nurses neither agreed nor disagreed or disagreed with the statement that prevention of malnutrition is possible. More than 28% of the nurses reported that malnutrition is a small or no problem. Over 95% of the hospital nurses and 52.5% of the home care nurses stated they screened routinely for malnutrition. The nurses considered several interventions for treating malnutrition important. Over 81% of the nurses indicated they wanted to follow further training. CONCLUSION: Most hospital and home care nurses perceived that nutritional care for older adults to prevent and treat malnutrition was important. A fair group of nurses, however, had the opposite perception. RELEVANCE TO CLINICAL PRACTICE: Raising the awareness of all hospital and home care nurses about the importance of nutritional care for older adults is pivotal to increase the chance of successfully providing nursing nutritional care. Nurses should follow training for consolidation of nutritional care. Nurses are well-positioned to take a leadership role to improve continuity and quality of nutritional care across the care continuum between hospital and home.

The obesity in children and adolescent (2–19 years old) is measured by growth charts to determine age- and sex-specific body mass index (BMI). Having a BMI ≥ 95th percentile is defined as obesity. Approximately 18.5% of youth in the U.S. are obese, while 8.5% of those are categorized as severely obese (BMI ≥ 120% of the 95th percentile); representing approximately 4.5 million children. Children with obesity have a significantly higher risk of diabetes mellitus, hypertension, and coronary artery disease when they become obese adults. The risk decreases significantly if the child is non-obese by adulthood. Bariatric surgery (BS), has proven its effectiveness in treating obese children. Recently, the American Society for Metabolic and Bariatric Surgery (ASMBS) has issued the paediatric metabolic and bariatric surgery guidelines which recommended sleeve gastrectomy (SG) as the best option for this population. In this chapter we will discus the eligibility, procedure steps, nutritional care, psychological concerns, and outcomes following sleeve gastrectomy in adolescents.

Nutrition is fundamental to health and the provision of adequate nutrition to hospitalized patients should be a priority for healthcare providers. For children in the intensive care setting, nutritional support can be difficult given the multitude of their medical needs. This chapter aims to provide an overview of the basic tenets of nutritional care of the PICU patient.

Nutrition is an important aspect of care in the management of cancer at all stages from diagnosis to survivorship. There is currently little data available on the views of those with cancer regarding the importance of nutrition throughout the cancer journey. To identify the views of those with cancer regarding the importance of nutrition in ten different situations or cancer stages. A questionnaire containing demographic information and one question utilising a 5-point Likert scale around the importance of nutrition in relation to ten different cancer stages or patient types was circulated through the oncology day wards and outpatient departments in two hospitals in the North West of Ireland. We received 197 complete responses. Nutritional care was viewed positively with 88.8 to 98.5% agreeing or strongly agreeing that nutritional care is important for everyone independent of their weight or cancer treatment; when you are receiving any form of active treatment for cancer; when you require surgery for cancer; when you require chemotherapy for cancer; when you require radiotherapy for cancer; when you are in the advanced stages of cancer; when you are a cancer survivor; when you have a low body weight; when you have a normal body weight; and when you are overweight. Irish cancer patients and survivors have a positive view of the role of nutritional care in cancer from diagnosis through cancer survivorship. It is important that services are put in place to provide this nutritional care at all stages of cancer.

ObjectivesThe prevalence of malnutrition after hospitalisation is reported to be 20%–45%, which may lead to adverse outcomes, as malnutrition increases the risk of complications, morbidity, mortality and loss of function. Improving the quality of nutritional treatment in hospitals and post-discharge is necessary, as hospital stays tend to be short. We aimed to identify and map studies that assess the effectiveness of individualised nutritional care plans to reduce malnutrition during hospitalisation and for the first 3 months post-discharge.DesignThis was a systematic scoping review.MethodsWe systematically searched for all types of studies in the following databases: EMBASE, MEDLINE via PubMed, and the Cumulative Index to Nursing and Allied Health Literature, with no restriction on data or publication language. We also reviewed the reference lists of the included studies. The abstracts and full articles were simultaneously screened by two independent reviewers. Differences of opinion were discussed among the two investigators, and a third reviewer assisted with the discussion until consensus was reached. Studies in which the patients received an individual nutritional care plan related to their hospital stay and were followed up post-discharge were included. We then conducted a thematic content analysis of the extracted literature.ResultsNine randomised controlled trial studies met the inclusion criteria: six were conducted in Scandinavian countries. All studies were mainly conducted among elderly patients (mean ages varied from 75 to 88 years). The review studies measured 10 different outcomes; the most common outcomes were nutritional status and readmission. Six studies reported one or more significant positive intervention effect. Inconsistent results were identified for four outcome variables.ConclusionsIndividualised nutritional care plans and follow-up home visits might improve patients’ nutritional status. However, there is need for a systematic review that assesses study quality and extends the time to 6 months post-discharge.

The study aimed to investigate the impact of physical intervention and the amount of nutritional intake on the increase in tongue strength and swallowing function in older adults with sarcopenia. From November 2018 and May 2019, older patients with sarcopenia who were admitted for rehabilitation were analyzed. The intervention employed in the study was the usual physical and occupational therapy for two months. Tongue strength was measured before and after two months of treatment. Data on tongue strength, the amount of energy and protein intake, intervention time, and swallowing function were examined. A total of 95 sarcopenic older patients were included (mean age 83.4 &plusmn, 6.5 years). The mean tongue strength after the intervention was significantly increased from 25.4 &plusmn, 8.9 kPa to 30.5 &plusmn, 7.6 kPa as a result of the treatment (p &lt, 0.001). After adjusting the confounding factors in the multivariable models, an energy intake of &ge, 30 kcal/kg/day and a protein intake of &ge, 1.2 g/kg/day based on the ideal body weight had a significant impact on the increase in tongue strength after the treatment (p = 0.011 and p = 0.020, respectively). Swallowing function assessed using the Mann Assessment of Swallowing Ability was significantly increased after the treatment (mean difference between pairs: 1.12 [0.53&ndash, 1.70], p &lt, 0.001). Physical intervention and strict nutritional management for older inpatients with sarcopenia could be effective to improve tongue strength and swallowing function.

The National Academies of Sciences, Engineering, and Medicine last reviewed the state of the science on nutrition during pregnancy and lactation 30 years ago with the publication of Nutrition During Pregnancy (IOM, 1990) and Nutrition During Lactation (IOM, 1991). In the intervening period, there have been advancements in evidence on nutrients, dietary patterns, nutritional supplements, and other nutrition-based topics relevant to pregnancy and lactation. On January 29–30, 2020, the Food and Nutrition Board of the National Academies convened a workshop in Washington, DC, to explore where new evidence has emerged. The workshop included, but was not limited to, discussion of the current state of the science on requirements for specific nutrients, relationships between intake during pregnancy and outcomes for the mother and child, alignment of dietary and supplement intake with existing recommendations, factors that affect lactation and human milk composition, and equity in access to nutritional care. This Proceedings of a Workshop-in Brief highlights key points made by participants.

Purpose of review Any intensive therapy requires individual adaptation, despite the standardization of the concepts that support them. Among these therapies, nutritional care has repeatedly been shown to influence clinical outcome. In order to evaluate the risk of malnutrition among critically ill patients and to identify those patients who may benefit from medical nutrition therapy is imperative to have a validated screening tool to optimize nutritional care.The scope of this review is to analyze the recent literature on the management of nutritional scores for patients admitted to the ICU. Recent findings Critically ill patient staying for more than 24-48 h in the ICU, if unable to eat, should be considered at risk for malnutrition. Several nutritional tools have been proposed but not all are validated to screening those patients. The limitations of existing screening tools are described. Summary Nutritional scores should be routinely performed at ICU admission according to recommended guidelines. An approach to incorporate these tools into everyday clinical practice is suggested.

The COVID-19 outbreak has drastically changed practices inside hospitals, which include oncology routines. In oncology, malnutrition was and certainly still is a frequent problem associated with an increase in treatment-related toxicity, a reduced response to cancer treatment, an impaired quality of life, and a worse overall prognosis. Even in this situation of healthcare crisis, nutritional support in cancer care is an essential element. During the current COVID-19 pandemic, there is a concrete high risk to see a dramatic worsening of cancer patients' nutritional status, who are left without adequate clinical and nutritional support. The consequences are already reasonably foreseeable and will have a severe negative impact after the emergency. Therefore, we believe that it is essential to try to continue, as far as possible, the activity of clinical nutrition in oncology, by revolutionizing the setting and the approach to patients. For this purpose, the Clinical Nutrition and Dietetics Unit and the Medical Oncology Unit of our hospital, one of the largest community hospital in Lombardy that has been involved in the COVID-19 outbreak management since its inception, have reorganized the clinical routine activity in strict collaboration since the very beginning of the emergency, to better face up to the challenge, while preserving cancer patients' needs.

We describe a retrospective cohort study of patients with malignant bowel obstruction to examine their nutritional care pathways between 1.1.16 and 31.12.16 with readmissions until 31.12.17. Data were analyzed by comparing patients who were referred (R) and not referred (NR) for PN. We identified 72 patients with 117 MBO admissions (mean ± SD age:63.1 ± 13.1yrs, 79% female). 24/72 patients were in R group. Predominant primary malignancies were gynaecological and lower-gastrointestinal cancers (76%). 83% patients had metastases (61% sub-diaphragmatically). All patients were at high-risk of malnutrition and baseline mean weight loss was 7%. Discussion of PN at multidisciplinary team meeting (MDT) (22% vs.5%, P = 0.02) and dietetic contact (94% vs. 41%, P < 0.0001) were more likely to occur in the R group. In 13/69 MBO admissions in NR group, reasons for non-referral were unclear. Median baseline and follow-up weight was similar (55-55.8 kg). Overall survival was 4.7 (1.4-15.2)months, with no differences by referral groups. We compared a sub-sample of patients who 'may have' required PN (n = 10) vs. those discharged on home PN (n = 10) and found greater survival in the HPN group (323vs.91 day, P < 0.01). Our findings highlight disparity in care pathways suggesting that nutritional care should be integrated into clinical management discussion(s) at MDT to ensure equal access to nutritional services.

Trata – se de um estudo bibliográfico realizado entre abril e maio de 2017 a outubro de 2019, em artigos científicos e livros revistos referentes a consulta de enfermagem. O estudo tem por objetivo identificar de que forma o enfermeiro pode atuar na nutrição infantil da criança obesa com vistas à prevenir situações agravantes na saúde da criança obesa, estabelecendo junto com o familiar ou responsável os benefícios para um crescimento e desenvolvimento completo. Os estudos selecionados, mostram que com a consulta de enfermagem trazendo informações sobre o peso e outros índices antropométricos, traz para a família, mãe/ cuidador a importância da assistência na hora da alimentação, criando assim um vínculo de confiança e respeito entre o enfermeiro e o responsável. Devido ao crescimento da obesidade infantil, deve – se repensar certos parâmetros e procurar a estimular a sociedade para que a próxima geração venha a ter um pouco mais de qualidade de vida.

This article reports the implementation of a new procedure for screening and treatment of malnutrition in a community NHS trust in England. The barriers and facilitators to implementation were assessed with staff from Integrated Community and Older People's Mental Health teams. Data from interviews and surveys were collected at baseline, 2 months after initial training and 16 months after initial training as well as following deployment of a nutrition lead to embed new developments for nutritional care. The adoption of the procedure made screening and treatment of malnutrition simpler and more likely to be actioned. The benefit of a nutrition lead and local nutrition champions to support and empower staff (avoiding reliance on training alone) was shown to drive change for nutritional care across the community. Prioritisation and commitment of leadership at the organisational level are needed to embed and sustain malnutrition screening and treatment in routine practice.

The purpose of this paper is to update the oncologist on the correct approach to the nutritional care of the head and neck cancer patient. Recent scientific contributions on this issue, with a special emphasis on international guidelines and randomised clinical trials (RCTs), are reviewed. The following points are noteworthy: 1. Despite the advances in early diagnosis and modern treatment of head and neck cancer, this tumour still ranks first regarding frequency and severity of weight loss, both at the clinical presentation and during the therapy. 2. This is due to the combination of poor alimentation because of the tumour mass localization, as well as of the presence of an inflammatory response which furtherly drives catabolism. 3. Several studies have shown a very limited role for a dietary counselling unless it includes oral nutritional supplements which are protein or omega-3 fatty acid enriched. 4. A parental nutritional supplementation could represent an acceptable short-term alternative. 5. Long-term nutritional support relies on the use of percutaneous endoscopic gastrostomy (PEG), whereas the role of a prophylactic or “a la demande” PEG is still unsettled and requires further investigations. In conclusion, the nutritional approach using specific formulas and the appropriate route of administration should be part of the therapeutic armamentarium of the modern oncologist.

Ten years ago, European health care professional societies, health associations and members of the European Parliament convened in Brussels to discuss the necessary and urgent actions needed to improve access, initiation and follow up nutritional care for European citizens. As a response to this, in 2014 the Optimal Nutritional Care for All (ONCA) campaign was launched under the leadership of the European Nutritional for Health Alliance and its members. As of today this campaign has been rolled out in 18 European countries, whereby national multi-disciplinary platforms including patient groups work together to implement national nutritional care programs and develop good practices in care, research, education in order to increase awareness on malnutrition and improve nutritional care. This article describes the making of and evolution of the ONCA campaign, the outcomes and impact created, as well as opportunities to accelerate implementation of personalized nutritional care for all European citizens.