Mediterranean Diet (MD) is an eating pattern associated with multiple healthy benefits, including the conservation of skeletal muscle. Frailty is a major geriatric syndrome characterized by low ...muscle strength. The Hand Grip Strength (HGS) is the most frequently used indicator of muscle functional capacity for clinical purposes. The association between the adherence to the MD and HGS in elderly has not yet fully investigated. The goal of this study was to examine the association between the adherence to the MD and HGS in a not hospitalized elderly who participated in the project PERsonalised ict Supported Services for Independent Living and Active Ageing (PERSSILAA).
Eighty-four elderly women were consecutively enrolled (aged 60–85 years) in this cross-sectional observational study. Anthropometric measures were evaluated. A validated 14-item questionnaire PREDIMED (PREvención con DIeta MEDiterránea) was used for the assessment of adherence to the MD. Dietary data were collected by a 7-day food records. Muscle strength was measured by HGS using a grip strength dynamometer (KERN & SOHN GmbH).
The majority of participants were overweight (46.4%). An average adherence to the MD was found in 52.4% of participants, while the minority of them showed a low adherence (21.4%). HGS > cut-point of 20 kg were found in 43 subjects (51.2%). According to the adherence to MD, 39% participants with HGS values higher than cut-point presented a high adherence score compared with 14% of those with lower values of HGS (p = 0.018). The participants with HGS > cut-point presented significantly higher PREDIMED score than those with HGS < cut-point (p < 0.001). Based on ROC curves, the most sensitive and specific cut-point for the PREDIMED score to predict HGS categories was ≥8. No evident correlations were observed between HGS and age, while HGS was negatively correlated with hip circumference (r = −0.233, p = 0.033) and BMI (r = −0.219, p = 0.045), and positively correlated with PREDIMED score (r = 0.598, p < 0.001). At binomial logistic regression analysis almost all 14-items of PREDIMED questionnaire were significantly associated with HGS adjusted for BMI. At multinomial logistic regression analysis to assess the association of the three classes of adherence to the MD with the HGS, after adjusting for BMI the lowest adherence to MD was associated with the lowest Odds Ratio of HGS (p < 0.001).
This study evidenced a positive association between the adherence to the MD and muscle strength in a sample of active elderly women, stratified according to the HGS > cut-point of 20 kg. Our study highlights the usefulness of the developing health services to detect and prevent age-associated decline in physical performance in elderly subjects by addressing nutritional and physical intervention.
Understanding the knowledge, attitudes, and practices pertaining to food insecurity among oncology registered dietitian nutritionists (RDNs) is critical to ensuring that cancer survivors have ...adequate nutrition—a fundamental component of successful treatment and recovery.
To qualitatively assess oncology RDNs’ knowledge, attitudes, and practices regarding the food access needs of their patients using a qualitative semantic approach to thematic analysis.
The qualitative cross-sectional study was conducted from September 2018 to January 2019.
Forty-one oncology RDNs working with cancer survivors in various clinical settings across the United States participated.
Participants completed a semistructured, in-depth interview via telephone, lasting an average of 49 minutes.
Two coders (primary and secondary) trained in qualitative thematic data analysis methods used a semantic approach to thematic analysis to analyze transcripts. A qualitative and mixed methods online coding program Dedoose was used to organize and analyze the data.
Participants defined food insecurity (FI) as a lack of access to nutritious foods and a lack of resources to purchase nutritious foods. RDNs stated they believe FI is a serious problem in the United Staes, has a greater influence on cancer survivors than healthy individuals and they have specific concerns about FI among their own patients. Despite their concerns, most expressed that they do not use a validated tool to identify FI, nor were they aware that any exists. Only a small proportion of the RDNs stated that they regularly ask patients about their food access needs.
Although Oncology RDNs have heard of FI, they do not routinely assess patients’ food security status with a validated tool, nor do they consistently ask patients directly about their food access needs. These findings suggest there is a need for developing education and training opportunities for oncology RDNs to enhance their ability to screen for and address FI with their patients.
The epidemic of obesity is growing steadily across the whole world. Obesity is not only a merely aesthetic disease but is the "mother" of most chronic diseases such as associated with a range of type ...2 diabetes, cardiovascular disease, obstructive sleep apnea, and cancer. However, although there is a need to find a strategy to stop this epidemic disease, most of the times the current nutritional strategies are not effective in weight loss and in long term weight maintenance. Very low-calorie ketogenic diets (VLCKD) is increasingly establishing as a successful nutritional pattern to manage obesity; this is due to rapid weight loss that gives rise to a positive psychological cycle which in turn increases the compliance to diet. Another important key point of VLCKD is the ability to preserve fatty free mass which is known to play a role of paramount importance in glucose metabolism. Despite the clinical evidence of VLCKD there are paucity of data regarding to its management. Therefore, we will provide a useful guide to be used by nutrition experts taking care of subjects with obesity. In particular, we will report recommendations on the correct use of this therapeutic approach for weight loss and management of side effects.
Cancer cells (CCs) predominantly use aerobic glycolysis (Warburg effect) for their metabolism. This important characteristic of CCs represents a potential metabolic pathway to be targeted in the ...context of tumor treatment. Being this mechanism related to nutrient oxidation, dietary manipulation has been hypothesized as an important strategy during tumor treatment. Ketogenic diet (KD) is a dietary pattern characterized by high fat intake, moderate-to-low protein consumption, and very-low-carbohydrate intake (<50 g), which in cancer setting may target CCs metabolism, potentially influencing both tumor treatment and prognosis. Several mechanisms, far beyond the originally proposed inhibition of glucose/insulin signaling, can underpin the effectiveness of KD in cancer management, ranging from oxidative stress, mitochondrial metabolism, and inflammation. The role of a qualified Nutritionist is essential to reduce and manage the short and long-term complications of this dietary therapy, which must be personalized to the individual patient for the planning of tailored KD protocol in cancer patients. In the present review, we summarize the proposed antitumor mechanisms of KD, the application of KD in cancer patients with obesity and cachexia, and the preclinical and clinical evidence on KD therapy in cancer.
In 2014 and 2017, the Centers for Medicare and Medicaid Services authorized nutrition-related ordering privileges for registered dietitian nutritionists (RDNs) in hospital and long-term care ...settings, respectively. Despite this practice advancement, information describing current parenteral nutrition (PN) and enteral nutrition (EN) ordering practices is lacking. Dietitians in Nutrition Support, a dietetic practice group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society of Parenteral and Enteral Nutrition (ASPEN) utilized a survey to describe PN and EN ordering practices among RDNs in the United States.
A cross-sectional study design was utilized to describe RDN PN and EN ordering privileges. Respondents were asked to describe PN and EN ordering privileges, primary practice setting, primary patient population served, nutrition specialty certification, highest degree earned, career length, and, if applicable, the nature of prior denials for ordering privileges or reasons for not applying for ordering privileges.
Seven hundred two RDNs completed the survey (12% response rate), with 664 RDNs providing complete data. The majority of respondents (n=558) cared for adult/geriatric patients. Among this subset, 47% had no PN ordering privileges; 14% could order and sign PN; 28% could order PN with provider cosignature; and 10% could order partial PN with provider cosignature. Nineteen percent of RDNs had no EN ordering privileges; 37% could order and sign EN; and 44% could order EN with provider cosignature. RDNs with ordering privileges were more likely to have a nutrition specialty certification and work in an academic or community hospital setting.
PN and EN ordering privileges are varied because of institution and state requirements. Future research describing the outcomes associated with RDN ordering privileges is needed. This article has been approved by the Academy’s Research, International, and Scientific Affairs team and Council on Research and the ASPEN Board of Directors. This article has been co-published with permission in Nutrition in Clinical Practice. The articles are identical except for minor stylistic and spelling differences in keeping with each journal's style. Either citation can be used when citing this article.
Nutrition, inflammation and liver-spleen axis Barrea, Luigi; Di Somma, Carolina; Muscogiuri, Giovanna ...
Critical reviews in food science and nutrition,
12/2018, Volume:
58, Issue:
18
Journal Article
Peer reviewed
Chronic low-grade systemic inflammation represents a mechanism common to many diseases linked to atherosclerosis-related pathways. There is a growing body of evidence indicating that the combination ...of food quantity and quality along with genetic susceptibility are able to induce the aberrant activation of innate immune signalling, which initially contributes to chronic low-grade inflammation. Liver represents the central player to inflammatory response. Dietary/metabolic factors contribute to the pathogenesis of Non-alcoholic Fatty Liver Disease (NAFLD), the main causes of liver disease in the Western world. Enlargement of the spleen, central organ in regulating the inflammation-related immune response, is commonly seen in patients with of NAFLD, depicting the so called "liver-spleen axis." The aim of this review was to provide an at-a-glance overview of the possible bi-directional mechanisms linking nutrition and inflammation, particularly pinpointing the inflammatory effects stemmed by nutrition on "liver-spleen axis." In particular, the role of unhealthy diet, healthy dietary patterns, such as the Mediterranean diet style, dietary vitamins and micronutrients, such as vitamin D or Magnesium, and Glucagon-Like Peptide-1, a well-known incretin released in response to meal intake, will be discussed. The highly variability of the inflammatory response highlights the role of expert nutritionists in refining methodologies apt to assess nutritional epidemiology and to apply appropriate dietary intervention to counteract diet-induced inflammation mechanisms.
There is growing recognition of the human health co-benefits of some dietary patterns considered more sustainable. Nutrition and dietetics professionals (NDPs) are well positioned to facilitate ...dietary change but their role in supporting sustainable food systems and diets is ambiguous. Researchers used Delphi Inquiry methods to explore how NDPs in 30 nations envision sustainable food systems, their perceived roles, barriers, and supports needed. Results indicate not all agree it is within their scope of practice, and highlight barriers across several system levels and scales, including an unsupportive professional culture, societal and ecological barriers. Strong leadership, learning, and collaboration are needed.
Nutrition plays a critical role in preventing, managing, and treating noncommunicable diseases; thus it is essential physicians be able to appropriately refer to and collaborate with ...interprofessional (IP) care team members, like registered dietitian nutritionists (RDNs). This study evaluated the effectiveness of the Nutrition Clinical Experience (NCE) to increase first-year medical students' (M1s′) understanding of RDNs’ roles on the IP healthcare team, common reasons to consult a RDN, and interventions RDNs implement.
M1s participated in a 1.5 or 2-h IP clinical observation experience with an outpatient or inpatient RDN. Due to the COVID-19 pandemic, virtual, in-person, and hybrid experiences were offered. Before the experience, students were provided a handout with an overview of a RDN's role, description of medical nutrition therapy, and example cases. During the NCE students shadowed a RDN as they conducted outpatient encounters or inpatient rounds, and were encouraged to discuss real or sample patient cases. Students and RDNs answered post-experience 5-point Likert surveys and free-response questions to evaluate experience effectiveness. Of responding students, 96% agreed or strongly agreed the experience helped them learn about RDNs' roles and 99% agreed or strongly agreed they were more likely to involve a RDN in patient care following the experience. Additionally, after the experience, 78% of participating students identified at least one common reason to consult a RDN and 70% described at least three interventions that RDNs implement. All responding RDNs agreed or strongly agreed the experience is valuable to students and 85% agreed or strongly agreed the NCE allowed them to communicate their roles to students. The ability to deliver the experience virtually makes it a useful curricular program for schools without on-site RDNs to engage preclinical students in IP experiences. This report includes materials required for the experience.
Introducción. En el año 2009 se realizó la primera declaración de postura sobre la incorporación del colectivo de Dietistas-Nutricionistas en el Sistema Nacional de Salud, actualizado en 2020. En ...2023, el Colegio Oficial de Dietistas-Nutricionistas de la Comunitat Valenciana plantea una actualización basándose en este, incluyendo una previsión de los recursos humanos necesarios para cumplir estos criterios, destacando que harían falta 770 plazas en toda la Comunitat Valenciana. Este estudio complementa este informe, estableciendo la prioridad de integración en las unidades en base al criterio de expertos. Metodología. Se planteó un estudio exploratorio utilizando metodología Delphi, como proceso de consenso prospectivo, participando un grupo de expertos (n= 12) que respondieron de forma anónima a dos cuestionarios sucesivos por vía electrónica; en primer lugar, con una preselección de 6 de las 28 unidades sanitarias presentadas, y en segundo lugar ordenando de más a menos prioritario las 28 unidades indicadas. Resultados. Los resultados de ambos métodos indican que es más prioritario la integración de los y las DN en las unidades de Dietética y Nutrición, Oncología, Aparato Digestivo, Endocrinología y Diálisis. Otras unidades sanitarias con prioridad variable son Cirugía General, Medicina Interna, Nefrología y Cardiología. Ambos métodos reflejan que las unidades de Urología, Hospitalización a Domicilio, Anestesia y Reanimación, Psiquiatría o las unidades de cirugía no general (torácica, cardíaca, neurológicas) serían las menos prioritarias para la integración de estos profesionales. Conclusión. Estudios exploratorios como el presentado anteriormente pueden ayudar a la administración pública a establecer prioridades asistenciales. La integración de estas plazas debe atender a los criterios expertos como los planteados en el presente trabajo.
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