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Background: Low skeletal muscle mass (MM) is known to be associated with poor morbidity and mortality outcomes in cancer, but evidence of its impact on health related quality of life (HRQOL) is less established. This systematic review and meta-analysis examines the relationship between skeletal MM and HRQOL in adults with cancer. Methods : Five databases (Ovid MEDLINE, Embase via Ovid, CINAHL plus, Scopus, PsycInfo) were systematically searched to identify studies reporting on the association between computed tomography (CT) derived skeletal MM, and a validated measure of HRQOL in adults with cancer. Studies classifying skeletal MM as a categorical variable (low or normal) were combined in a meta-analysis to investigate cross-sectional association with HRQOL. Studies reporting skeletal muscle as a continuous variable were qualitatively synthesised. Results : 14 studies involving 2,776 participants were eligible for inclusion. Participants were dichotomised according to low or normal skeletal MM in ten studies (n = 1,375); 58% had low MM. Low MM was associated with poorer global HRQOL scores (n = 985 from seven studies, standardised mean difference -0.27, 95% CI -0.40 to -0.14, P < 0.0001), and poorer physical functioning domain HRQOL scores (n = 507 from five studies, standardised mean difference -0.40, 95% CI -0.74 to -0.05, P = 0.02), but not social, role, emotional or cognitive functioning domain scores. Five studies examined the cross-sectional relationship between HRQOL and skeletal muscle mass as a continuous variable, and found little evidence of an association unless non-linear analysis was used. Two studies investigated the relationship between longitudinal changes in both skeletal muscle and HRQOL, reporting that an association exists across several HRQOL domains.

Background: Increased accessibility to the internet and mobile devices has seen a rapid expansion in electronic health (eHealth) behavior change interventions delivered to patients with cancer and survivors using synchronous, asynchronous, and combined delivery methods. Characterizing effective delivery methods of eHealth interventions is required to enable improved design and implementation of evidence-based health behavior change interventions. Objective(s): This study aims to systematically review the literature and synthesize evidence on the success of eHealth behavior change interventions in patients with cancer and survivors delivered by synchronous, asynchronous, or combined methods compared with a control group. Engagement with the intervention, behavior change, and health outcomes, including quality of life, fatigue, depression, and anxiety, were examined. Method(s): A search of Scopus, Ovid MEDLINE, Excerpta Medica dataBASE, Cumulative Index to Nursing and Allied Health Literature Plus, PsycINFO, Cochrane CENTRAL, and PubMed was conducted for studies published between March 2007 and March 2019. We looked for randomized controlled trials (RCTs) examining interventions delivered to adult cancer survivors via eHealth methods with a measure of health behavior change. Random-effects meta-analysis was performed to examine whether the method of eHealth delivery impacted the level of engagement, behavior change, and health outcomes. Result(s): A total of 24 RCTs were included predominantly examining dietary and physical activity behavior change interventions. There were 11 studies that used a synchronous approach and 11 studies that used an asynchronous approach, whereas 2 studies used a combined delivery method. Use of eHealth interventions improved exercise behavior (standardized mean difference [SMD] 0.34, 95% CI 0.21-0.48), diet behavior (SMD 0.44, 95% CI 0.18-0.70), fatigue (SMD 0.21, 95% CI -0.08 to 0.50; SMD change 0.22, 95% CI 0.09-0.35), anxiety (SMD 1.21

Gut appetite hormone responses may be influenced by meal macronutrients and obesity. The primary aim of this study was to examine in adolescents with obesity and of healthy weight the effect of a high-protein and a high-carbohydrate meal on postprandial gut appetite hormones. A postprandial cross-over study with adolescents 11-19 years old was undertaken. Participants consumed, in random order, a high 79% carbohydrate (HCHO) and a high 55% protein (HP) meal. Ghrelin, glucagon-like peptide 1 (GLP-1), peptide YY (PYY), and self-reported appetite were assessed for four hours postprandial. Total energy intake from an ad libitum lunch and remaining 24 h was assessed. Eight adolescents with obesity (OB) and 12 with healthy weight (HW) participated. Compared with HW, OB adolescents displayed a smaller ghrelin iAUC (-25,896.5 +/- 7943 pg/mL/4 h vs. -60,863.5 +/- 13104 pg/mL/4 h) (p = 0.008) with no effect of meal (p > 0.05). The suppression of ghrelin relative to baseline was similar between OB and HW. Ghrelin suppression was greater following the HP vs. HCHO meal (effect of meal, p = 0.018). Glucose and insulin response were greater following HCHO vs. HP, with responses more marked in OB (time x weight x meal interaction, p = 0.003 and p = 0.018, respectively). There were no effects of weight or macronutrient on GLP-1 or PYY, appetite or subsequent energy intake. The present study demonstrates that dietary protein can modulate postprandial ghrelin responses; however, this did not translate to subsequent changes in subjective appetite or energy intake.Copyright © 2019 by the authors. Licensee MDPI, Basel, Switzerland.

AIM: To compare standing height, estimated current height and demi-span estimated height and examine their impact on body mass index (BMI) classification. METHOD(S): Cross-sectional data was collected on 104 patients admitted to an adult rehabilitation ward and seen by the dietitian. Patient's standing, estimated current height and demi-span estimated height were collected and grouped by age: 19-64 and >=65 years. RESULT(S): The limits of agreement (95% confidence interval) for estimated current height compared with standing height were +9.9 cm and -7.9 cm, in contrast to +8.7 cm and -14.3 cm for demi-span estimated height. Demi-span underestimated height when compared with standing height in both age groups, 19-64 years: (mean +/- SD) 3.0 +/- 6.5 cm (P = 0.001, n = 68) and >= 65 year age group 4.0 +/- 6.0 cm (P < 0.001, n = 36), resulting in a significantly greater mean BMI (analysis of variance P < 0.001, P = 0.02). In the 19-64 and >=65 year age groups, 3% (2/68) and 10% (4/36) of patients, respectively, had a different BMI classification using demi-span estimated height compared with standing height. CONCLUSION(S): Estimated current height is a simple and practical alternative if standing height is unable to be obtained when performing a nutrition assessment. Demi-span estimated height should be used with caution when calculating BMI to assess nutritional status, particularly in the elderly.Copyright © 2017 Dietitians Association of Australia.

Purpose: Manipulation of meal macronutrient may be a useful way to modulate meal-induced thermogenesis (MIT) to induce increases in energy expenditure. The objective of this study was to examine in adolescents with obesity and of healthy weight and the effect of a high protein and high carbohydrate meal on MIT. Method(s): An acute cross-over study with adolescents aged 11-19 years was undertaken. Participants consumed in random order, a high 79% carbohydrate (HCHO), and a high 55% protein (HP) meal (adjusted to 25% of energy requirements). MIT and subjective appetite were assessed for 4 h postprandial and an ad libitum lunch served. Data calculated as total AUC and expressed as mean +/- SEM. Result(s): Thirteen adolescents with obesity (mean BMI z score 2.3 +/- 0.1) and 13 healthy weight (BMI z score 0.0 +/- 0.2) participated. Mean MIT (% of energy intake) was greater after the HP (8.19 +/- 0.709%) compared with the HCHO meal (4.36 +/- 0.480%) (p < 0.001). The HP compared with the HCHO meal promoted greater fullness (12,994 +/- 1208 vs 11,186 +/- 1220 mm/4 h) (p = 0.016) and decreased hunger (8868 +/- 1315 vs 10984 mm +/- 1438 mm/4 h) (p = 0.007). These effects observed were independent of body weight. Conclusion(s): High protein meals can increase MIT and fullness and reduce hunger compared with high carbohydrate meals in adolescents with obesity. Future research is warranted to determine if MIT can be targeted through manipulation of dietary choices to support weight management strategies. Trial registration: This study is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR). Trial ID: ACTRN12612001066875.Copyright © 2018, Springer-Verlag GmbH Germany, part of Springer Nature.

Background: A major challenge for those living with cancers of the upper gastrointestinal tract (oesophagus, stomach and pancreas), is the impact of the disease and treatment on nutritional status and quality of life. People with cancer and malnutrition have a greater risk of morbidity and mortality. Nutrition intervention is recommended to commence immediately in those who are malnourished or at risk of malnutrition. Novel cost-effective approaches that can deliver early, pre-hospital nutrition intervention before usual hospital dietetic service is commenced are needed. Linking clinicians and patients via mobile health (mHealth) and wireless technologies is a contemporary solution not yet tested for delivery of nutrition therapy to people with cancer. The aim of this study is to commence nutrition intervention earlier than usual care and evaluate the effects of using the telephone or mHealth for intervention delivery. It is hypothesised that participants allocated to receive the early and intensive pre-hospital dietetic service will have more quality-adjusted life years lived compared with control participants. This study will also demonstrate the feasibility and effectiveness of mHealth for the nutrition management of patients at home undergoing cancer treatment. Method(s): This study is a prospective three-group randomised controlled trial, with a concurrent economic evaluation. The 18 week intervention is provided in addition to usual care and is delivered by two different modes, via telephone (group 1) or via mHealth (group 2), The control group receives usual care alone (group 3). The intervention is an individually tailored, symptom-directed nutritional behavioural management program led by a dietitian. Participants will have at least fortnightly reviews. The primary outcome is quality adjusted life years lived and secondary outcomes include markers of nutritional status. Outcomes will be measured at three, six and 12 months follow up. Discussion(s): The find

Background: Cancers of the upper gastrointestinal tract commonly result in malnutrition, which increases morbidity and mortality. Current nutrition best practice lacks a mechanism to provide early and intensive nutrition support to these patients. A 3-arm parallel randomised controlled trial is testing the provision of a tailored, nutritional counselling intervention delivered using a synchronous, telephone-based approach or an asynchronous, mobile application-based approach to address this problem. This protocol outlines the design and methods that will be used to undertake an evaluation of the implementation process, which is imperative for successful replication and dissemination. Method(s): A concurrent triangulation mixed methods comparative analysis will be undertaken. The nutrition intervention will be provided using best practice behaviour change techniques and communicated either via telephone or via mHealth. The implementation outcomes that will be measured are: fidelity to the nutrition intervention protocol and to the delivery approach; engagement; acceptability and contextual factors. Qualitative data from recorded telephone consultations and written messages will be analysed through a coding matrix against the behaviour change techniques outlined in the standard operating procedure, and also thematically to determine barriers and enablers. Negative binomial regression will be used to test for predictive relationships between intervention components with health-related quality of life and nutrition outcomes. Post-intervention interviews with participants and health professionals will be thematically analysed to determine the acceptability of delivery approaches. NVivo 11 Pro software will be used to code for thematic analysis. STATA version 15 will be used to perform quantitative analysis. Discussion(s): The findings of this process evaluation will provide evidence of the core active ingredients that enable the implementation of best practice nutrition

Purpose: This study aimed to evaluate the long-term survival of all patients who participated in a pilot randomised trial of an early nutritional intervention for adults with upper gastrointestinal cancer. It also sought to identify factors that predicted patient mortality. Method(s): All participants (n = 21) who were randomised into the original study were followed for a maximum of 5 years and 2 months (final follow-up April 2016). The primary outcome measure was time from date of recruitment until date of death, ascertained by the Victorian Cancer Registry and/or Monash Health Scanned Medical Records. Secondary analyses were conducted to identify factors that adversely affected survival. Result(s): At the end of the follow-up period, three patients were alive in the nutrition intervention group whilst only two patients were living from the standard care group. Visual evaluation of the Kaplan-Meier survival curves demonstrated a possible survival benefit from being exposed to the intervention between 6 months and 1.4 years post-recruitment, though this benefit dissipated soon after. The intervention was not associated with increased survival in univariate analyses, but was after adjustment for other factors found to adversely impact on survival (adjusted hazard ratio 0.12 (95% CI 0.02-0.72) p = 0.02). These factors were being a smoker (14.2 (1.43 to 140.67), p = 0.02); low baseline physical functioning (1.11 (1.01 to 1.21), p = 0.03); high baseline fatigue (1.09 (1.02-1.16), p = 0.007); and high baseline dyspnoea (1.08 (1.02-1.13), p = 0.003). Conclusion(s): Early and intensive nutrition intervention may increase the survival of people with upper gastrointestinal cancer.Copyright © 2017, Springer-Verlag GmbH Germany.

Objectives: The prevalence of malnutrition in subacute inpatient settings has been reported to be 30-50%. While there are a number of nutrition evaluation tools which have been validated to diagnose malnutrition, the use of a validated nutrition evaluation tool to measure changes in nutritional status during an average length of stay for a subacute inpatient has not yet been tested. This study aims to determine the potential of the full MNA (full Mini Nutritional Assessment) and MNA (Mini Nutritional Assessment Short Form) scores to measure change in nutritional status over an average subacute inpatient stay (21 days). Design(s): A prospective observational study. Setting(s): The study was performed in three Rehabilitation and Geriatric Evaluation and Management (GEM) wards of the Kingston Centre, Monash Health, Melbourne, Australia. Participant(s): All patients >=65 years admitted to these wards with an expected length of stay of at least 14 days were considered for inclusion in this study. Measurements: Nutritional status was assessed on admission using the full MNA as part of usual dietetic care and patients were provided with nutrition intervention/diet therapy based on full MNA classification. Full MNA score (0-30), MNA score (0-14), anthropometry (weight and height) and nutritional biochemistry (serum albumin, transthyretin and C-reactive protein) were compared between admission and day 20.5 +/- 2.4. Result(s): Mean age (+/- SD) of 83 +/- 7 years, n=114. For those patients diagnosed at risk of malnutrition or malnourished (n=103), there were significant increases in full MNA score (1.8 +/- 2.4, p<0.001), MNA score (0.9 +/- 1.7, p<0.001), weight (0.6 +/- 2.5kg, p=0.017) and serum albumin (1.4 +/- 4.4g/L, p=0.003) over the study period. All four of the full MNA domain sub-scores, also increased significantly in those patients diagnosed at risk of malnutrition or malnourished (n=103): anthropometric assessment (p<0.001), dietary assessment (p<0.001), general stat

Objective: The prevalence of malnutrition in subacute inpatient settings has been reported to be 30-50%. While there are a number of nutrition evaluation tools which have been validated to diagnose malnutrition, the use of a validated nutrition evaluation tool to measure changes in nutritional status during an average length of stay for a subacute inpatient has not yet been tested. This study aims to determine the potential of the full MNA (full Mini Nutritional Assessment) and MNA (Mini Nutritional Assessment Short Form) scores to measure change in nutritional status over an average subacute inpatient stay (21 days). Design(s): A prospective observational study. Setting(s): The study was performed in three Rehabilitation and Geriatric Evaluation and Management (GEM) wards of the Kingston Centre, Monash Health, Melbourne, Australia. Participant(s): All patients >=65 years admitted to these wards with an expected length of stay of at least 14 days were considered for inclusion in this study. Measurements: Nutritional status was assessed on admission using the full MNA as part of usual dietetic care and patients were provided with nutrition intervention/diet therapy based on full MNA classification. Full MNA score (0-30), MNA score (0-14), anthropometry (weight and height) and nutritional biochemistry (serum albumin, transthyretin and C-reactive protein) were compared between admission and day 20.5 +/- 2.4. Result(s): Mean age (+/- SD) of 83 +/- 7 years, n>=114. For those patients diagnosed at risk of malnutrition or malnourished (n>=103), there were significant increases in full MNA score (1.8 +/- 2.4, p<0.001), MNA score (0.9 +/- 1.7, p<0.001), weight (0.6 +/- 2.5kg, p>=0.017) and serum albumin (1.4 +/- 4.4g/L, p>=0.003) over the study period. All four of the full MNA domain sub-scores, also increased significantly in those patients diagnosed at risk of malnutrition or malnourished (n>=103): anthropometric assessment (p<0.001), dietary assessment (p<0.001), general

Purpose: This study aimed to test whether a very early nutrition intervention delivered over the telephone was feasible and could improve outcomes amongst patients with upper gastrointestinal cancer. Methods: Participants with a histologically proven new diagnosis of primary oesophageal or stomach cancer and who were to undergo surgery and/or chemotherapy were randomised to receive either standard nutrition care (SC) or early and intensive nutrition intervention (NI) over the telephone/face-to-face. Participants were followed for 6 months. The primary outcome was quality of life (QoL), assessed using the European Organization for Research and Treatment of Cancer Global Quality of Life questionnaire C30 (EORTC QLQ-C30) and the European Quality of Life Instrument (EQ-5D) tool; secondary outcomes were nutritional status and survival. Results: Twenty-one participants were recruited (11 SC and 10 NI). At baseline, the prevalence of malnutrition was 90 %. Compared with SC, the NI group had a significantly higher EORTC global QoL score at the first mid-study follow-up (coefficient (95 % CI) 21.0 (12.1, 29.9) adjusted for baseline, p < 0.001) and at 26 weeks (28.4 (21.3, 35.4) adjusted for baseline, p < 0.001). Nutritional risk score was lower (p < 0.001), and loss of body weight attenuated (p < 0.001) in the NI group compared with SC. Six deaths occurred during the study, five in the SC group and one in the NI group (p = 0.06). The mean time spent with a dietitian per contact was significantly less for the NI group compared with SC (16(3) vs 40(6) min per dietetic contact, p < 0.001). Conclusions: This pilot study has shown the potential of a novel telephone-based early and intensive dietetic model of care for newly diagnosed upper gastrointestinal cancer patients.Copyright © 2014, Springer-Verlag Berlin Heidelberg.

Despite evidence of nutritional deficiency, specific nutritional interventions are often not sought until severe malnutrition is evident in the upper gastrointestinal cancer population. This may limit patient response to therapy, and diminish their Quality of Life (QOL) and overall survival. This study evaluated the efficacy of early and intensive nutrition intervention (INI), compared to standard nutrition care (SNC) for improving health outcomes amongst patients with primary oesophageal or stomach cancer. Patients were randomised and stratified by diagnosis to receive early and intensive nutrition intervention or standard nutrition care. SNC involved no dietetic intervention until the patient was admitted for treatment. INI were consulted weekly for 18 weeks, which covered time of diagnosis and the patient's treatment journey, and then at week 26. Behaviour change techniques were categorised (Abraham & Michie's Taxonomy of Behaviour Change Techniques). Outcome measures were collected at several time points.The primary outcome measure was Health-Related Quality of Life (HR-QOL) using the global EQ-5D, and the cancer specific EORTC QLQ-C30. Scores were linearly transformed to obtain quantified scores. Nutritional status was the secondary outcome measure and evaluated using the PG-SGA. Dietetic interaction time and participants' perceptions of nutrition counselling were measured. The effect of the intervention on outcomes was examined using linear mixed model analysis. At baseline (diagnosis) the prevalence of malnutrition was similar between the groups (90%). Six deaths occurred, five in the SNC group and one in the INI group (p = 0.06). At week 26, HR-QOL scores were significantly higher in the INI group (n = 10) compared with SNC group (n = 11) (EQ-5D p < 0.001; EORTC QLQ-C30 p < 0.001). Weight on average was 6 kilograms greater (p < 0.001) and nutritional risk lower (PG-SGA score 10 points lower, p < 0.001) in the INI group compared to the SNC group. This study d

Aim Continuous subcutaneous insulin infusion (CSII) can improve glycaemic control and dietary flexibility compared with conventional insulin therapies. There is little information on whether users are utilising this increased dietary flexibility, and whether dietary quality is affected. Methods A pre-post observational study was undertaken in 28 children and adolescents with type 1 diabetes commencing CSII. Meal pattern and dietary composition was examined from 3-day food diaries completed before and 3-6 months after CSII commencement. Participants completed the Diabetes-Specific Quality of Life for Youth Short Form, and body mass index z-score, and glycated haemoglobin were measured. A second posttest was undertaken at 18 months with those who were still on CSII and contactable (n = 18). Results Energy and macronutrient intake before and 18 months after CSII commencement were unchanged. Mean snacking events decreased significantly by 1.2 snacks per day (P = 0.009), as did the percentage energy derived from snacks (28.8%, 95% confidence interval (CI) 21.5-36.1 vs. 19.3%, 95% CI 13.2-25.4; P = 0.045). Diabetes-Specific Quality of Life for Youth Short Form score was not significantly affected by pump commencement (25.9 95% CI 18.2-33.6), and body mass index z-score remained similar before and after CSII. Glycated haemoglobin decreased by 0.5% in the 3-6 months following CSII commencement, but was similar to baseline at 18 months. Conclusions This study demonstrates that the commencement of CSII did not lead to an abandonment of healthy eating principles, and that patients utilised the increased dietary flexibility to make changes to their snacking pattern. © 2013 The Authors. Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

A medical record audit of upper gastrointestinal cancer patients admitted to Southern Health between 1 January and 31 March 2008 was undertaken to identify existing referral pathways to dietetic services, at what steps during the patients journey were dietetic services accessed, the risk of malnutrition and service gaps. The audit revealed that screening, assessment and intervention predominately occurred at the time of surgery, with little evidence of dietetic intervention at other stages of the care continuum. Furthermore, there was a high incidence of documented risk of malnutrition. The results of this audit led to the development of an early and intensive nutrition intervention model. The aim of the study is to evaluate the efficiency of this model of care with usual care, for improving health outcomes amongst patients with oesophageal or stomach cancer. Newly diagnosed stomach or oesophageal cancer patients undergoing treatment at Southern Health are being randomised into two groups; 'usual nutrition practice' offering nutritional advice at time of treatment whilst 'early intervention' offers frequent, short consultation multi modal dietetic service delivery from the time of diagnosis for 18 weeks and at week 26. Outcome measures include quality-of-life and nutritional status determined using the subjective global assessment (SGA),which will be measured at the time of diagnosis, prior to chemotherapy or surgery, at the completion of the intervention (18 weeks) and two months after the cessation of the intervention. The best practice model for dietetic services for patients undergoing upper gastrointestinal cancer treatment includes screening, assessment, and proactive individualised and timely intervention. Supportive nutritional care is an integral component of a comprehensive medical and surgical treatment package for upper gastrointestinal cancers. This pilot study tests a predetermined dietetic model of best practice for improving patient nutritional care