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La nutrition artificielle à domicile, entérale ou parentérale, s'adresse à des malades chroniques fragiles. La situation actuelle de pandémie COVID-19 peut compromettre leur prise en charge à plusieurs niveaux : difficultés d'accès aux établissements de santé largement réorientés vers la prise en charge des malades COVID-19, possible pénurie d'infirmières à domicile, forte réduction des visites des prestataires de service à domicile, tensions sur les solutions hydro-alcooliques, les masques et les régulateurs de débit. Le but de ces recommandations établies par le Comité de nutrition à domicile de la Société Francophone de Nutrition Clinique et Métabolisme (SFNCM) est, d'une part, de préciser la prise en charge minimale de ces patients, tant en termes de suivi que de matériels, mais surtout de s'adapter aux tensions actuelles relatives aux personnes et aux matériels, afin de poursuivre une prise en charge de qualité et de ne pas compromettre l'état de santé des patients en nutrition artificielle à domicile pendant la crise. Home artificial nutrition, whether enteral or parenteral, is provided to chronic and fragile patients. The current COVID-19 epidemics may compromise their care at several levels: difficulties to access to hospitals mainly focused on treating COVID-19 patients, possible lack of nurses at home, strong reduction of visits by homecare providers, tended flow or lack of hand sanitizers, surgical masks and pumps. The aim of these recommendations put together by the French-speaking Society for Clinical Nutrition and Metabolism (SFNCM)'s Home Artificial Nutrition Committee is to define in terms of healthcare resources the minimum care to provide to these patients. We also aim to help cope with the possible tensions, in order to secure the care we must provide to home artificial nutrition patients during this crisis. [ABSTRACT FROM AUTHOR]

Background and objective: to evaluate the impact of a solid nutritional supplement on the weight gain of institutionalised older adults >70 years with protein-energy malnutrition. The innovation of these high-protein and high-energy cookies was the texture adapted to edentulous patients (Protibis®, Solidages, France).Design: an open, multicentre, randomised controlled trial.Setting: seven nursing homes.Participants: one hundred and seventy-five malnourished older adults, aged 86 ± 8 years.Intervention: all participants received the standard institutional diet. In addition, Intervention group participants received eight cookies daily (11.5 g protein; 244 kcal) for 6 weeks (w0–w6).Measurements: five visits (w−4, w0, w6, w10 and w18). Main outcome: percentage of weight gain from w0 to w6 (body mass in kg). Secondary outcomes: appetite, rated using a numerical scale (0: no appetite to 10: extremely good appetite); current episodes of pressure ulcers and diarrhea.Results: average weight increased in Intervention group (n = 88) compared with Control group (n = 87) without cookies supplementation (+1.6 versus −0.7%, P = 0.038). Weight gain persisted 1 month (+3.0 versus −0.2%, P = 0.025) and 3 months after the end of cookies consumption (+3.9 versus −0.9%, P = 0.003), with diarrhea reduction (P = 0.027). There was a synergistic effect with liquid/creamy dietary supplements. Subgroup analysis confirmed the positive impact of cookies supplementation alone on weight increase (P = 0.024), appetite increase (P = 0.009) and pressure ulcers reduction (P = 0.031).Conclusion: the trial suggested that, to fight against anorexia, the stimulation of touch (finger food; chewing, even on edentulous gums) and hearing (intra-oral sounds) could be valuable alternatives to sight, smell and taste alterations. [ABSTRACT FROM PUBLISHER]

The viral epidemic caused by the new Coronavirus SARS-CoV-2 is responsible for the new Coronavirus disease-2019 (Covid-19). Fifteen percent of the Covid-19 patients will require hospital stay, and 10% of them will need urgent respiratory and hemodynamic support in the intensive care unit (ICU). Covid-19 is an infectious disease characterized by inflammatory syndrome, itself leading to reduced food intake and increased muscle catabolism. Therefore Covid-19 patients are at high risk of being malnourished, making the prevention of malnutrition and the nutritional management key aspects of care. Urgent, brutal and massive arrivals of patients needing urgent respiratory care and artificial ventilation lead to the necessity to reorganize hospital care, wards and staff. In that context, nutritional screening and care may not be considered a priority. Moreover, at the start of the epidemic, due to mask and other protecting material shortage, the risk of healthcare givers contamination have led to not using enteral nutrition, although indicated, because nasogastric tube insertion is an aerosol-generating procedure. Clinical nutrition practice based on the international guidelines should therefore adapt and the use of degraded procedures could unfortunately be the only way. Based on the experience from the first weeks of the epidemic in France, we emphasize ten challenges for clinical nutrition practice. The objective is to bring objective answers to the most frequently met issues to help the clinical nutrition caregivers to promote nutritional care in the hospitalized Covid-19 patient. We propose a flow chart for optimizing the nutrition management of the Covid-19 patients in the non-ICU wards.

Background & Aims: Assessment of dietary intake using a 3-day dietary record may delay the management of undernutrition. Methods allowing a quick estimation of dietary intake are needed. We aimed to determine the feasibility of assessing dietary intake using two 10-point verbal (AVeS) and visual (AViS) analogue scales, to assess the correlations of both scales with energy intake, and to determine the accuracy of AVeS for assessing undernutrition., Methods: We prospectively recruited 114 patients undernourished or nutritionally at-risk in two French University Hospitals. Undernutrition was defined as a Nutritional Risk Index <97.5. AVeS and AViS were performed by one interviewer and mean daily energy intake was calculated from 3-day dietary records by one dietician., Results: The feasibility of AVeS and AViS was 98% and 96%, respectively. Both verbal and visual scales were statistically correlated with calculated energy intake (rho=0.66 and rho=0.74, P<0.0001), especially in undernourished patients (rho=0.82, P<0.0001, for AVeS). Sensitivity, specificity, positive and negative predictive values of an AVeS score less than 7 for assessing undernutrition were 57%, 81%, 86% and 46%, respectively., Conclusion: AVeS and AViS could be used for a quick assessment of dietary intake in clinical practice, particularly in undernourished in-patients. Thus, both verbal and visual analogue scales could be particularly useful for the management of hospital undernutrition.

Background & Aims: Weight loss in Alzheimer's disease (AD) may be either progressive or rapid, with different consequences. The aim of this study was to characterize massive weight loss (>or= 5 kg over 6 months) during a 6.5-year follow-up., Methods: 395 patients with AD (mean age 75.4 years) were included in a prospective single-centre cohort study (mean follow-up 2.5 years). A standardized gerontologic assessment was performed every six months, including nutritional, neuropsychological, functional, and caregiver burden evaluations, along with recording all intercurrent events before weight loss., Results: Among the 127 cases of weight loss (in 110 subjects, 27.8% of the population), we identified 60 cases of intercurrent illnesses and 88 cases of behavioral and psychological symptoms of dementia (BPSD) during the six months before weight loss. Three factors were independently associated with rapid weight loss: higher initial weight (HR=1.06, 95% CI [1.02, 1.08]), higher Prognosis Inflammatory and Nutritional Index (HR=2.16, 95% CI [1.26, 3.72]) and a higher Cohen-Mansfield agitation inventory score, reflecting BPSD (HR=1.05, 95% CI [1.01, 1.10]). Cholinesterase inhibitors appeared as protective (HR=0.33, 95% CI [0.15, 0.73]). Rapid weight loss was predictive of death at 6 months (HR=3.01, 95% CI [1.73, 5.22])., Conclusion: BPSD play an important role in rapid weight loss and should be managed effectively. Biological assessment of malnutrition may be warranted.

The aim of the present prospective study was to determine if malnutrition, measured using a simple validated score, is an independent risk factor for nosocomial infections (NI) in non-selected hospital in-patients. Between 29 and 31 May 2001, a survey on the prevalence of NI was conducted on all 1637 in-patients (61 (SD 25) years old) in a French university hospital as part of a national survey. Actual and usual body weights were recorded in all in-patients, and serum albumin levels were measured on all blood samples taken during the week before the study. Nutritional status was evaluated by using the nutritional risk index (NRI). Albumin values were obtained in 1084 patients, and complete weight information was obtained in 911. Therefore, NRI was calculated in 630 patients (61 (SD 20) years old): 427 (67.8 %) were malnourished. NI prevalence was 8.7 %: 4.4 % in non-malnourished patients, 7.6 % in moderately malnourished patients and 14.6 % in severely malnourished patients. In univariate analysis, the odds ratios for NI were 1.46 (95 % CI 1.2, 2.1) in moderately malnourished patients and 4.98 (95 % CI 4.6, 6.4) in severely malnourished patients. In multivariate analysis, age, immunodeficiency and NRI class influenced NI risk. Vascular and urinary catheters, and surgical intervention, were the extrinsic factors associated with NI, with odds ratios ranging from 2.0 (95 % CI 1.8, 2.6) for vascular catheters to 10.8 (95 % CI 8.8, 12.6) for association of the three factors. In conclusion, in non-selected hospitalized patients, malnutrition assessed with a simple and objective marker is an independent risk factor for NI. An early screening for malnutrition may therefore be helpful to reduce the high prevalence of NI.