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Dietetic Intervention (dietetic + intervention)
Selected AbstractsCan dietetic intervention for obesity ever succeed in real life?JOURNAL OF GASTROENTEROLOGY AND HEPATOLOGY, Issue 4 2007Henry L-Y Chan [source] Improving clinical outcome in patients with intestinal failure using individualised nutritional adviceJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2009A. Culkin Abstract Background: Patients with intestinal failure are required to adhere to a complex regimen. Written information may increase knowledge leading to improvements in clinical outcomes. The present study aimed to evaluate the effectiveness of nutrition advice incorporating the use of a booklet. Methods: Each patient completed a questionnaire evaluating their knowledge of the regime and quality of life and kept a diet and gastrointestinal output diary. The diary was assessed and they were given the booklet with a verbal explanation tailored to individual requirements. The booklet explained the causes of intestinal failure, diet and fluid recommendations in relation to intestinal anatomy, information on medications and long-term monitoring. Patients were reassessed at their next appointment using the same tools. The primary endpoint was an improvement in knowledge. Secondary endpoints were an improvement in oral nutritional intake, nutritional status, quality of life and the content of home parenteral nutrition. Results: Forty-eight patients completed the study. Knowledge improved significantly after dietetic intervention in association with the provision of the booklet (P < 0.001). Oral energy (P = 0.04) and fat (P = 0.003) intake increased with an improvement in body mass index (P = 0.02). Patients on home parenteral nutrition showed a reduction in parenteral energy (P = 0.02), nitrogen (P = 0.003), volume (P = 0.02) and frequency (P = 0.003). Conclusions: A booklet for patients with intestinal failure in conjunction with personalised dietary counselling improves knowledge and clinical outcomes. [source] Identification of ,hot spots' of obesity and being underweight in early pregnancy in LiverpoolJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 3 2009J. C. Abayomi Abstract Background: Obesity and being underweight in pregnancy are related to an increased risk of maternal and foetal morbidity, yet their prevalence is often unknown. The present study aimed to identify neighbourhoods with a higher than average prevalence or ,hot spots' of obesity and/or being underweight among first trimester pregnant women. Methods: A database was compiled consisting of postcode, height and weight for 7981 women who had booked-in for antenatal care between July 2004 and June 2005 at Liverpool Women's Hospital. Body mass index (BMI) was calculated and women were categorised accordingly. Postcodes for 6865 cases across Merseyside were converted to geolocations (pin-points on a map) using conversion software (http://www.census.ac.uk/cdu/). Results: There was a very high prevalence of being overweight (27%) and obesity (17%); 3.8% of women were underweight and probably malnourished (BMI < 18.5 kg m,2); and a further 10.7% of women were possibly malnourished (BMI < 20.0 kg m,2. Deriving case density from the geolocations allowed visualisation and identification of six neighbourhoods with above average levels of obesity and three neighbourhoods had marked concentrations of both being underweight and obesity. Conclusions: These neighbourhoods, particularly those identified as ,hot spots' for both being underweight and obesity, include some of the most deprived wards in the UK. As dietetic intervention may help to promote optimal weight gain during pregnancy and improve dietary intake for pregnant women and their families, primary health care providers should target these localities with a high prevalence of low and high BMI as a priority. [source] The efficacy of dietetic intervention in patients with chronic obstructive pulmonary diseaseJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008L. Bottle Background:, Clinical trials have shown that pulmonary rehabilitation can improve the functional status and quality of life of chronic obstructive pulmonary disease (COPD) patients (Lacasse, 2006) but there is no research examining the efficacy of group dietetic intervention during standard 8 week rehabilitation courses. Current input is usually limited to a 1 h nutrition education session. This pilot study aimed to investigate whether patients receiving additional dietetic intervention during pulmonary rehabilitation significantly increased their general nutritional knowledge, thereby facilitating improvements in dietary intake and nutritional status. Methods:, Patients were recruited from two courses of pulmonary rehabilitation and randomly allocated to a control group or an intervention group. Anthropometry (height, weight, body mass index, mid arm circumference and triceps skinfold), 3 day food diaries and nutritional knowledge questionnaires covered guidelines, food groups, choosing healthy options and diet and COPD were completed at baseline and at the end of 8 weeks. In week 2 both groups received the same nutrition education session which covered healthy eating during periods of stability as well as advice on coping with loss of appetite and reduced intake during illness and exacerbations. The intervention group was followed up during weeks 4, 6 and 7 when further anthropometric measurements were taken and additional dietary advice was provided, which addressed issues raised by individual patients. Information from food diaries was converted to nutrients using Windiets dietary analysis software. Statistical analyses were carried out using SPSS (v14) and included Mann,Whitney U non parametric tests, paired t -tests and Spearman correlations used for comparisons over time and between groups. For analysis purposes patients were classified as normal weight (NW) and overweight (OW). Approval was obtained from the appropriate Ethics Committee. Results:, Changes reported were not statistically significant (P > 0.05). Complete data sets were obtained for six control (NW = 2, OW = 4) and five intervention (NW = 1, OW = 4) patients. Nutritional knowledge increased in the control group by 5% compared to 3% in the intervention group. Control NW patients increased their energy intake resulting in a mean weight gain of 0.5 kg (SD 3.3). OW control group patients increased their energy intake by 12.4% (16.9) with a mean weight gain of 0.2 kg (2.5). All control patients increased their intake of in total fat, saturated fatty acids (SFA), sugars and sodium. Conversely there was a decrease in energy intake in the intervention group of 14.4% (17.8) and a mean weight loss of 1.5 kg (1.2) (three out of four overweight patients lost weight). Improvements in diet were shown with reduced intakes of total fat, SFA, sugars and sodium. The NW patient in the intervention group regained weight that had previously been lost. These changes did not correlate with changes in nutritional knowledge. Discussion:, An increase in nutritional knowledge was expected to facilitate appropriate changes in dietary intake and nutritional status. Despite the lack of correlation between dietary knowledge and intake, beneficial outcomes were none-the-less observed in the intervention group. The trend for weight gain in OW control group patients, and weight loss in OW intervention group patients contrasted with results seen by Slinde et al. (2002) where the control OW patients lost weight, and OW intervention patients gained weight. It is possible that in the current study, patients in the intervention group were motivated to lose weight with repeated exposure to the dietitian, rather than an increase in nutritional knowledge. Significant anthropometrical changes were unlikely to be observed in 8 weeks, and further follow up may be necessary to establish sufficient evidence for the most efficacious level of dietetic intervention. The small sample sizes, especially with regard to weight sub groups, limits the conclusions which can be drawn. Further research is recommended, using a larger sample size, in order to make recommendations for dietetic best practice. Conclusion:, The results of this study did not show statistical significance and the association between nutritional knowledge and improved nutritional outcomes remains unclear. However, the findings may have clinical significance since they appear to show that additional dietetic intervention may benefit the nutritional status of patients with COPD attending pulmonary rehabilitation. References, Lacasse, Y., Goldstein, R., et al. (2006) Pulmonary rehabilitation for chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 4, CD003793. Slinde, F., Gronberg, A.M., et al. (2002) Individual dietary intervention in patients with COPD during multidisciplinary rehabilitation. Respir. Med. 96, 330,336. [source] A service evaluation to determine the effectiveness of current dietary advice in treating human immunodeficiency virus-associated weight loss and to highlight potential service improvementsJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 4 2008C.A. Hunt Background:, Weight loss and muscle wasting are experienced by many patients with human immunodeficiency virus (HIV) (Grinspoon et al., 2003). Malnutrition is an important predicator of morbidity and mortality; people who are malnourished who received antiretroviral treatment are six times more likely to die than those who are adequately nourished (Paton et al., 2006). The physical manifestations of muscle wasting can have significant psychosocial implications for HIV patients (Power et al., 2003; Sattler, 2003). The aim of this study to evaluate provision of dietetic care to patients referred for acute weight loss advice and identify areas for potential service improvement. Methods:, The data were gathered from the departmental dietetic activity statistics in 2007, diagnosis code ,HIV , acute weight loss'. Fifty-nine cards were located and baseline weight, height and body mass index (BMI) were recorded (two female, 57 male). Qualitative data on dietetic intervention were extracted from record cards , little and often eating approach, food fortification (FF), high energy high protein oral nutritional supplement (ONS) prescribed. Data were collected on body image, exercise and weight at follow-up visits during 2007. Results:, Forty-three percent of the patients referred for ,HIV-acute weight loss' were lost to follow-up. Forty-seven percent of the remaining patients had a BMI <20 kg m,2. Following their initial dietetic intervention, 81% of these patients had gained weight at the first follow-up. All had received nutritional counselling on little and often eating approach and FF; 75% had ONS prescribed. Average weight gain with nutritional counselling alone was 1.3 kg (2.1 kg) and for nutritional counselling plus supplementation was 2.1 kg (1.8 kg). This represented 2.5% (4.1%) and 3.9% (3.4%) weight gain, respectively. Discussion:, This evaluation has highlighted that patient follow-up frequency is an area for service improvement. Fifty-three per cent of patients (excluding those lost to follow up) had a BMI ,20 kg m,2 and were inaccurately recorded in the statistics as being referred for ,HIV-acute weight loss'. Fifty-two percent of these patients reported lipodystrophy and body image concerns, similar to findings of other studies. Fifty-six percent reported weight improvements following dietetic consultation. Body image is a frequent referral trigger, therefore improvements should be made to identify and treat patients with body shape issues. Conclusions:, Dietitians are effective at achieving weight gain in HIV positive patients with a BMI <20 kg m,2 using nutritional counselling methods with or without oral nutritional supplementation; these patients experienced a 3.3% weight gain. Strategies need to be implemented to reduce the number of patients lost to follow-up, as weight loss is a key morbidity and mortality indicator in HIV. References, Grinspoon, S. & Mulligan, K. (2003) Weight loss and wasting in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 69,78. Nerad, J., Romeyn, M., Silverman, E., Allen-Reid, J., Dieterich, D., Merchant, J., Pelletier, V., Tinnerello, D. & Fenton, M. (2003) General nutritional management in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 52,62. Ockenga, J., Grimble, R., Jonkers-Schuitema, C., Macallan, D., Melchior, J.C., Sauerwein, H.P., Schwenk, A. & Suttmann, U. (2006) ESPEN guidelines on enteral nutrition: wasting in HIV and other chronic infectious diseases. Clin. Nutr.25, 319,329. Paton, N.I., Sangeetha, S., Earnest, A. & Bellamy, R. (2006) The impact of malnutrition on survival and the CD4 count response in HIV-infected patients starting antiretroviral therapy. HIV Med.7, 232,330. Power, R., Tate, H.L., McGill, S.M. & Taylor, C. (2003) A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals. Sex. Transm. Infect.79, 137,141. Sattler, F. (2003) Body habitus changes related to lipodystrophy. Clin. Infect. Dis36 (Suppl. 2): 84,90. [source] Palliative management of cancer of the oesophagus , opportunities for dietetic interventionJOURNAL OF HUMAN NUTRITION & DIETETICS, Issue 5 2003A. Holdoway Introduction: Cancer of the oesophagus develops insidiously and when patients present with symptoms such as dysphagia to solids/semi-solids and in some cases liquids, the disease is often advanced and patients are frequently poorly nourished and cachectic (Angorn, 1981; Larrea, 1992). In our own unit we were aware that patients were only referred to the dietitian once an oesophageal stent was inserted or radiotherapy commenced, thereby possibly missing opportunities to treat or prevent malnutrition earlier. We therefore evaluated the nutritional status and care pathways of patients diagnosed with cancer of the oesophagus in whom palliative treatment was the only option, with the aim of assessing the extent of malnutrition and identifying opportunities for earlier dietetic intervention to prevent or slow the development of malnutrition. Method: Data were collated on all patients referred to the hospital's dysphagia clinic and diagnosed with inoperable cancer of the oesophagus. Height, weight, body mass index, degree of dysphagia, period of dysphagia, percentage weight loss (data collected as standard practice in the dysphagia clinic) and time to stent insertion/radiotherapy and survival time was collected from the medical notes. Results: Data were available on 58 patients, 33 male, 25 female, mean age 75 years (range 49,92 years). The mean length of survival was 10.2 months (0,24 months). At diagnosis, 47% experienced dysphagia with solids, 33% with semi-solids and 16% experienced a degree of dysphagia with liquids. The period of dysphagia was 1 month to 2 years. Eighty-three per cent of patients had lost weight at diagnosis. Mean percentage weight loss per individual was 13% (range 0,45%). Thirty-five per cent had a BMI <20 kg/m2. Median time from diagnosis to radiotherapy (n = 8) was 2 months with range, 1,6 months. Median time from diagnosis to the placement of the oesophageal stent (n = 12) was 1 month with range, 0,7 months. Discussion: These data illustrate that malnutrition remains a significant problem in this patient group. These results demonstrate that dysphagia and malnutrition, as indicated by weight loss, is developing in the community before diagnosis. Opportunities for earlier dietetic intervention exist between diagnosis and date at which other treatments commence, i.e. stent insertion. Further opportunities exist to educate community health professionals on treating and preventing malnutrition when dysphagia presents. Survival times support the need for dietetic follow-up. In our unit the results of this audit helped to improve care pathways for patients with cancer of the oesophagus. In response to the above findings, a nutritional screening tool is now completed by a nurse specialist at the first clinic attended. This has enabled appropriate and timely advice to be given on modified texture and fortification of food to optimize nutritional intake at diagnosis. [source] Anti-tissue transglutaminase antibodies in the follow-up of adult coeliac diseaseALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 3 2009C. R. DIPPER Summary Background, The detection of auto antibodies directed against tissue transglutaminase (anti-tTG antibodies) has a well-established role in the diagnosis of coeliac disease, but the value of these antibodies in long-term follow-up is controversial. Aims, To determine if serial anti-tTG antibody measurements could confirm adherence to a gluten-free diet (GFD) and identify patients at risk of disease complications. Methods, In a 54-month cohort follow-up study, 182 adult patients were assessed. Data recorded included self-assessment of GFD adherence; anti-tTG antibody concentration and serum ferritin, vitamin B12 and folate. Where available, bone mineral density (BMD) and duodenal histology data were retrieved. Results, Persistently elevated anti-tTG antibody levels were significantly associated with abnormal duodenal histology (P < 0.001), low ferritin (P < 0.01) and poor adherence to the GFD (P < 0.001). The specificity was >85% while the sensitivity was 39,60%. Anti-tTG antibody concentrations fell rapidly following successful initiation of a GFD, and maintenance of normalization identified those who continued to be adherent to the diet. Conclusions, This study supports a strategy of using anti-tTG antibody concentrations to monitor newly diagnosed and established patients with coeliac disease, and to target dietetic intervention to reduce the risk of complication. [source] Effect of diet and fenofibrate on lipid and glycaemic control in type 2 diabetesPRACTICAL DIABETES INTERNATIONAL (INCORPORATING CARDIABETES), Issue 8 2001MRCP, Ravi Sinha MB Abstract The effect of dietetic advice on hyperlipidaemia in type 2 diabetic patients is uncertain. We have investigated this modality of treatment in 50 type 2 diabetic patients (24 female), mean (±SD) age 54±4 years and diabetes duration 5±4 years. All had a random plasma total cholesterol concentration of >6.5,mmol/L (mean 7.5±0.7,mmol/L). Three months after dietetic intervention, cholesterol fell to 7.1±1.1 (p=0.049), but triglycerides, LDL-cholesterol and HDL-cholesterol were unchanged, as were HbA1c and body mass index (BMI). Thirteen (26%) patients reduced total cholesterol levels to <6.5,mmol/L on dietary treatment (,diet responders'). In this group there were significant improvements in total cholesterol (6.9±0.3 versus 5.9±0.6, p=0.03) and LDL-cholesterol (4.8±0.5 versus 4.1±0.5, p=0.003). This group had lower baseline total cholesterol levels than ,diet non-responders'. Multiple regression analysis revealed no association between diet response and baseline levels of HbA1c, BMI, age, sex, diabetes duration or compliance with dietetic advice. After two years of follow-up only four of these 13 ,diet responders' had cholesterol levels<6.5,mmol/L without drug treatment. ,Diet non-responders' at 3 months were treated with fenofibrate, which resulted in significant improvements in total cholesterol (7.6±0.9 before versus 6.8±1.1 after, p=0.012), LDL-cholesterol (5.2±0.8 before versus 4.6±0.8 after, p=0.019) and triglycerides (3.7±2.7 before versus 2.7±1.4 after, p=0.008). HDL cholesterol rose (1.0±0.3 before versus 1.1±0.3 after, p=0.048), and HbA1c also fell from 7.5±1.9 to 6.9±1.8 (p=0.024) on fenofibrate treatment. We conclude that dietary treatment of dyslipidaemia in type 2 diabetes is effective only in a minority of patients, who are characterised by milder degrees of hypercholesterolaemia. Fenofibrate however was effective in improving dyslipidaemia, and was also associated with a reduction in HbA1c. Copyright © 2001 John Wiley & Sons, Ltd. [source] In Silico Modeling and Simulation of Bone Biology: A ProposalJOURNAL OF BONE AND MINERAL RESEARCH, Issue 7 2005Nadine A Defranoux Abstract Contemporary, computer-based mathematical modeling techniques make it possible to represent complex biological mechanisms in a manner that permits hypothesis testing in silico. This perspective shows how such approaches might be applied to bone remodeling and therapeutic research. Currently, the dominant conceptual model applied in bone research involves the dynamic balance between the continual build-up and breakdown of bone matrix by two cell types, the osteoblasts and osteoclasts, acting together as a coordinated, remodeling unit. This conceptualization has served extraordinarily well as a focal point for understanding how mutations, chemical mediators, and mechanical force, as well as external influences (e.g., drugs, diet) affect bone structure and function. However, the need remains to better understand and predict the consequences of manipulating any single factor, or combination of factors, within the context of this complex system's multiple interacting pathways. Mathematical models are a natural extension of conceptual models, providing dynamic, quantitative descriptions of the relationships among interacting components. This formalization creates the ability to simulate the natural behavior of a system, as well as its modulation by therapeutic or dietetic interventions. A number of mathematical models have been developed to study complex bone functions, but most include only a limited set of biological components needed to address a few specific questions. However, it is possible to develop larger, multiscale models that capture the dynamic interactions of many biological components and relate them to important physiological or pathological outcomes that allow broader study. Examples of such models include Entelos' PhysioLab platforms. These models simulate the dynamic, quantitative interactions among a biological system's biochemicals, cells, tissues, and organs and how they give rise to key physiologic and pathophysiologic outcomes. We propose that a similar predictive, dynamical, multiscale mathematical model of bone remodeling and metabolism would provide a better understanding of the mechanisms governing these phenomena as well as serve as an in silico platform for testing pharmaceutical and clinical interventions on metabolic bone disease. [source] | ||||||||||