Nutrition & Dietetics最新文献

Aims: Delayed gastric emptying is a common complication of a pancreaticoduodenectomy and can adversely impact nutritional status, and potentially clinical outcomes due to delays in nutrition initiation post-operatively. The aim of this study was to explore associations between delayed gastric emptying and patient baseline characteristics, early post-operative nutritional status, post-operative nutritional practices and clinical outcomes in a tertiary Australian hospital.

Methods: This was a retrospective, observational study of 80 consecutive patients who underwent a pancreaticoduodenectomy between January 2019 and June 2022. Delayed gastric emptying was classified according to the International Study Group of Pancreatic Surgery definition. Continuous variables were compared using the independent t test, and categorical variables were compared using chi-squared or Fisher's exact test. Significant variables were included in a multivariable model.

Results: The incidence of delayed gastric emptying within this cohort was 45% (36/80) and was higher in males compared to females (p = 0.025). Early post-operative nutritional status was not significantly associated with delayed gastric emptying (p = 0.124). Patients with delayed gastric emptying had a higher incidence of post-operative pancreatic fistula (p = 0.03) and Clavien-Dindo complications ≥3 (p = 0.011). Delayed gastric emptying was associated with greater usage of enteral (p < 0.001) and parenteral nutrition (p < 0.001), a longer length of stay (p < 0.001) and increased re-admissions (p = 0.014). Male sex remained significantly associated with delayed gastric emptying following regression analysis.

Conclusions: Delayed gastric emptying rates were high, associated with greater use of artificial nutrition and worse outcomes in our patient population post-operatively. Early post-operative malnutrition was not significantly associated with delayed gastric emptying.

Aim: Nutritional status is a factor that impacts the clinical outcomes of various medical conditions, including cardiovascular disease and surgical procedures; however, little is known about its role in percutaneous procedures. This study aimed to assess the association between nutritional status and risk in patients undergoing coronary angiography and in-hospital mortality and length of stay to improve risk stratification and peri-procedural care.

Methods: Patients who underwent coronary angiography between January 2022 and August 2023. Nutritional status was assessed with body mass index, and nutritional risk was assessed with the Nutritional Risk Screening 2002 score. Multivariate regression models assessed independent predictors of in-hospital mortality, adjusting for age, sex, coronary event, Canadian Cardiovascular Society class, and cardiac arrest at admission. Subgroup analyses were performed based on coronary event type to evaluate whether the associations differed across clinical presentations.

Results: Patients who underwent angiography (n = 1343) were aged 69.2 ± 11.1 years, 51% male, and 49% had acute coronary syndrome. The mean length of stay at the hospital was 4.5 ± 4.8 days; 38% of patients stayed ≥5 days. The in-hospital mortality rate was 1.3%. Regression analyses revealed that the Nutritional Risk Screening 2002 score independently predicted the length of stay (β = 0.63, p = 0.002), and this relationship was strongest in the non-ST segment elevation myocardial infarction subgroup (β = 1.26, p = 0.02). Body mass index did not predict the length of stay. There was no significant relationship between in-hospital mortality and body mass index or the Nutritional Risk Screening 2002 score.

Conclusion: Nutritional risk significantly predicts the length of stay after coronary angiography, independent of age, sex, and coronary event type. Clinicians should consider routine nutritional risk assessment preceding coronary angiography to help individualise post-procedure, in-hospital care.

Aims: Hospital food provision/intake dashboards may improve malnutrition screening. The aim of this study was to use Nutrition Dashboard data to determine the optimal threshold for screening for malnutrition risk, and compare the accuracy of this method with estimated dietary requirements.

Methods: Observational data were extracted from medical files and food service records of 267 patients for a 4-month period in a 99-bed hospital. Energy (2500-8000 kJ) and protein (30-90 g) thresholds were applied for Nutrition Dashboard categorisation by supply and intake of food. Deficits in estimated requirements (105 kJ/kg/day and 0.75 g/kg/day) were also applied as a comparative method. The association between Nutrition Dashboard categories and the Malnutrition Screening Tool was explored using generalised estimating equations.

Results: A total of 267 patients and 1908 days of data were analysed. The use of estimated requirements for Nutrition Dashboard categorisation was not a statistically significant predictor of malnutrition risk. Application of energy (≤6000 kJ) and protein (≤65 g) thresholds for categorisation was significant (χ² = 9.50, df = 3, p = 0.023). When 5000 kJ and 55 g of protein were used for categorisation, patients were more likely to be at malnutrition risk when within low supply (odds ratio = 2.11, p = 0.002) and low intake (odds ratio 2.23, p < 0.001) categories.

Conclusions: Nutrition Dashboard categories are associated with an increased risk of malnutrition when categorised using thresholds of up to 6000 kJ and 65 g protein. Technologies like the Nutrition Dashboard present innovative opportunities for dietitians to utilise nutrition informatics to enhance and optimise nutrition care.

Aims: This study aimed to test the feasibility and acceptability of mental health clinicians using a multifaceted nutrition-risk screening tool in Australian mental health settings.

Methods: A mixed-methods cross-sectional design was used. Mental health clinicians implemented the multifaceted NutriMental screener at seven sites across Australia and provided feedback via a standardised form. Primary outcomes were the feasibility, acceptability and appropriateness domains of the feedback questionnaire. Additional outcomes included association/agreement between the consumer's desire for dietetic support, clinicians' impression of need for dietetic support, and total nutrition risks reported. Directed content analysis was employed to analyse open-ended sections of the clinician feedback questionnaire.

Results: Fifty-four clinicians participated, completing the NutriMental screener with a total of 256 mental health consumers. Mean total nutrition risks reported were 6.4 ± 1.8 (out of nine). Mean implementation outcomes (out of five) were 3.1 ± 0.8 for acceptability, 3.7 ± 0.5 for appropriateness, and 4.3 ± 1.7 for feasibility. There was moderate agreement between consumer's desire for dietetic support and clinicians' impression of need for dietetic support κ = 0.32 (95% CI: 0.21-0.43), p < 0.001, and positive correlations between the number of nutrition risks reported and consumer's desire for dietetic support (r = 0.29, p < 0.001) and clinicians' impression of need for dietetic support (r = 0.29, p < 0.001). Six themes and 17 subthemes related to barriers and facilitators to the screener's implementation were identified.

Conclusion: The multifaceted risk screening tool appears to be feasible, acceptable and appropriate for use within Australian mental health services. Refinements of the NutriMental screener based on clinician feedback may further improve its implementation.

Aims: To describe (1) dietary intake, food avoidance and adequacy, and (2) physical activity levels and barriers among New Zealand adults with inflammatory bowel disease.

Methods: A cross-sectional online survey comprising four questionnaires collecting data on demographics, disease activity index, dietary intake and physical activity levels was distributed. Exclusion criteria applied to those who were pregnant/lactating, with a stoma or pouch, or on enteral/parenteral nutrition. Descriptive analyses were performed, and dietary intakes were compared to established references. T-tests, equality-of-medians tests and two-sample proportion tests investigated differences between disease types.

Results: Two hundred and thirteen adults with mostly quiescent or mildly active inflammatory bowel disease (53% Crohn's disease) completed at least one questionnaire. Participants were predominantly female (70%), New Zealand European (89%) with a median age of 37 years. Discretionary food intake was high, while fruit and vegetable consumption was generally suboptimal. Food avoidances were reported by 69% of participants, primarily dairy and vegetables. A higher proportion of participants with ulcerative colitis or inflammatory bowel disease-unspecified avoided gluten and unprocessed red meat. Inadequate intakes of calcium (69%), selenium (40%) and magnesium (26%) were common. Most participants limited vigorous physical activity, but 67% met the physical activity guidelines. Barriers to physical activity were reported by 63% of participants, where fatigue (54%) and abdominal cramps (26%) were common barriers.

Conclusion: Our findings demonstrate that New Zealand adults with inflammatory bowel disease had inadequate dietary intake and faced several barriers to physical activity, even when in remission.

Aims: Adherence to any dietary approach is crucial for achieving long-term benefits. This qualitative study aims to explore the facilitators and barriers to adherence, and how individuals in community settings navigate time-restricted eating in their daily lives.

Methods: Semi-structured, in-depth interviews were conducted with 21 participants who had practised time-restricted eating (confining the daily eating window to <10h a day; and excluding periodic fasting methods like the 5:2 approach or alternate day fasting) for periods ranging from 3 months to more than 5 years. A qualitative content analysis, underpinned by the Capability-Opportunity-Motivation-Behaviour Model, identified multiple facilitators, barriers, and strategies that evolved over the practice.

Results: Key facilitators included the simplicity and versatility of time-restricted eating, maintaining a non-obsessive and non-dieting mindset, and having a supportive environment. Barriers included hunger and food cravings, an obsessive mindset during the initial stages, and conflicting schedules with social eating occasions, including holidays. Participants employed several coping strategies to successfully navigate adherence and reported confidence in maintaining time-restricted eating as a lifestyle that contributes to better health and weight management.

Conclusion: Our findings suggest that successful implementation of time-restricted eating in community settings requires flexibility and viewing it as more than a short-term weight loss tool. Guidelines are needed to help individuals and practitioners implement better practices and promote healthier behaviours.

Aim: To quantify, describe, and compare production waste and food packaging waste in two healthcare centres with different foodservice models.

Methods: In this observational study, all food wasted during production and all food packaging was measured by weight and cost over a 7-day period for two hospitals: Hospital A (800 beds, cook-on demand fresh, a la carte menu room service model) and Hospital B (60 beds, traditional cook chill retherm model with weekly cyclical menu and set meal times). Comparisons between sites were made per patient overnight bed day, as an indicator of hospital activity. The average daily waste was calculated, and costed by multiplying cost (AU$) food item/ kilogram by measured weight; to derive the cost of food waste per kilogram. Food waste by weight and cost per overnight bed day was used as a measure to compare the hospitals.

Results: Over 7 days, Hospital A wasted 916.4 kg (AU$6937.22) and Hospital B wasted 69.7 kg (AU$417.10) of food. Most food wasted at both hospitals was edible (78.6% Hospital A and 93.5% Hospital B) and trayline contributed more food waste than bulk production. At both hospitals, plant-based foods comprised the greatest proportion of edible food waste by weight, but not by cost. When accounting for hospital activity, food waste was lower at Hospital A than at Hospital B (0.15 kg of food per overnight bed day and 0.30 kg, respectively). Hospital A generated 199.5 kg (0.03 kg per overnight bed day) of packaging waste compared to 32.2 kg (0.14 kg per overnight bed day) at Hospital B.

Conclusion: Findings suggest that food waste is costly, that food waste differs between hospitals with different foodservice models, and that overnight bed days is a useful metric for making comparisons. A cook-fresh, on-demand room service foodservice model resulted in less food and packaging waste.

Aim: This study aimed to evaluate the variation in food intake during dialysis and non-dialysis days and to assess the nutritional status of elderly haemodialysis patients.

Methods: An observational multicentre cross-sectional study was conducted. A total of 311 patients aged ≥18 years were recruited. Multiple 24-h recalls were collected, appetite levels were assessed through self-reporting, and biochemical and anthropometric data were obtained. Data were collected via a face-to-face interview during haemodialysis sessions at four major dialysis centres.

Results: The findings of this study revealed higher consumption of sodium (2570.25 ± 74.15 vs. 2106.25 ± 77.39, p-value < 0.001) and potassium (1456.59 ± 47.42 vs. 1137.41 ± 35.40, p-value < 0.001) on dialysis days compared to non-dialysis days. Superior appetite levels were significantly associated with higher protein and energy intake and better serum albumin levels on days with versus without dialysis. Patients who reported a better understanding of the importance of their dietary recommendations had lower consumption of sodium, phosphorus, and potassium. Further, patients aged ≥60 years had significantly lower albumin levels and consumed considerably lower levels of protein and sodium but had higher body mass index and waist circumference compared to young patients.

Conclusions: Dialysis treatment schedules could affect nutrient intake and compliance rates with renal guidelines; thus, nutritional education must be performed individually to eliminate barriers to adherence. Elderly haemodialysis patients might be prone to a high risk of nutritional deficiencies and require special continuous and in-depth dietary provisions.