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Grace E, Heaney B, France A, Bruckel T, Oldham MA. Psychiatric Explanations of Poor Oral Intake: A Clinically Focused Review. J Acad Consult Liaison Psychiatry 2024:S2667-2960(24)00088-0. [PMID: 39222846 DOI: 10.1016/j.jaclp.2024.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 08/06/2024] [Accepted: 08/26/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Poor oral intake (POI) among medical-surgical inpatients can cause malnutrition and delay recovery due to medical consequences and the need for more invasive nutritional support. Many psychiatric conditions can cause POI; however, the role that psychiatric conditions play in POI has received limited attention to date. OBJECTIVE This review aggregates available information on POI due to psychiatric conditions and provides a framework for the clinical approach to these conditions in hospitalized adult patients. METHODS We searched PubMed and EMBASE for reviews of POI due to psychiatric causes, but no relevant publications were identified. Diagnostic criteria for relevant conditions in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision and Rome IV were reviewed, as were C-L psychiatry textbooks and relevant society websites. This review was further supplemented by a case conference at the authors' institution. RESULTS We have divided results into five sections for clinical utility: (1) the need to rule out medical causes of POI; (2) unpleasant somatic experiences, including psychotropic causes; (3) mood, psychotic, catatonic, and neurocognitive disorders that can present with POI; (4) eating and feeding disorders; and (5) personal and interpersonal explanations of POI. Within each section, we review how to identify and manage each condition, specifically considering the effects of treatment on oral intake. CONCLUSIONS The clinical management of POI varies based on cause. For instance, psychostimulants can cause POI due to inappetence; however, they can treat POI due to abulia by improving motivation. The fact that such a broad range of psychiatric conditions can cause POI calls for a systematic clinical approach that considers the categories of potential causes. We also identified a need for prospective studies focused on the management of POI due to psychiatric conditions, as the literature on this topic is limited to case reports, case series, and retrospective cohort studies.
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Affiliation(s)
- Eliane Grace
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Beth Heaney
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY
| | - Alexandra France
- Department of Medicine, Gastroenterology/Hepatology, University of Rochester Medical Center, Rochester, NY
| | - Tanya Bruckel
- Department of Medicine, Gastroenterology/Hepatology, University of Rochester Medical Center, Rochester, NY
| | - Mark A Oldham
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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Coltman A, Ojeda T, Ashafa M, Pertel D, McCauley S. The Global Malnutrition Composite Score: Impacting malnutrition care. Nutr Clin Pract 2024. [PMID: 38824274 DOI: 10.1002/ncp.11162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/03/2024] [Accepted: 05/10/2024] [Indexed: 06/03/2024] Open
Abstract
The presence and impact of malnutrition in adult hospitalized patients has been well documented by a significant body of literature. However, current malnutrition care practices often vary widely and frequently lack standardization. The Global Malnutrition Composite Score (GMCS), the first nutrition-related electronic clinical quality measure, is intended to evaluate the quality of malnutrition care provided to inpatient adults. This measure aims to aid in standardizing malnutrition care through performance measurement. The four components of the measure (nutrition screening, nutrition assessment, malnutrition diagnosis, and nutrition care plans) follow the well-established Nutrition Care Process and encourage the use of standardized terminology. Facilities with high-performance scores on the GMCS are likely to experience improved outcomes associated with high-quality malnutrition care.
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Affiliation(s)
- Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois, USA
| | - Tamaire Ojeda
- Commission on Dietetic Registration, Chicago, Illinois, USA
| | | | - Donna Pertel
- Commission on Dietetic Registration, Chicago, Illinois, USA
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Ojeda T, Ashafa M, Pertel D, McCauley S, Coltman A. The Updated Global Malnutrition Composite Score Clinical Quality Measure: Its Relevance to Improving Inpatient Clinical Outcomes and Health Equity. J Acad Nutr Diet 2024; 124:249-256. [PMID: 37939845 DOI: 10.1016/j.jand.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 11/03/2023] [Indexed: 11/10/2023]
Abstract
Quality improvement has existed in health care for centuries with a dramatic transformation over time, largely motivated by the academic health quality movement. Throughout this evolution, the Centers for Medicare and Medicaid Services have been at the forefront of the development and provision of quality measures for health care in a variety of settings, including acute care. Quality initiatives aid in the evaluation of patient care to encourage quality improvement efforts, determine pay-for-performance rates, and help patients and consumers evaluate their care providers. The addition of the Global Malnutrition Composite Score as an electronic Clinical Quality Measure in 2022 highlights the key role nutrition plays in outcomes and quality of hospitalized patients. With this, credentialed nutrition and dietetics practitioners lie front and center for the development of quality improvement processes to help promote high quality standards of nutrition care, improve length of stay, and reduce health care costs and readmissions while addressing malnutrition, health equity, and nutrition care as a human right. As the Global Malnutrition Composite Score steward, it is the obligation of the Academy of Nutrition and Dietetics and the Commission on Dietetic Registration to promote the measure and support credentialed nutrition and dietetics practitioners in advocating for the implementation of this measure. Therefore, the purpose of this practice update is to provide necessary information to credentialed nutrition and dietetics practitioners and other health care leaders related to the history and implementation of the Global Malnutrition Composite Score, along with relevant updates to the measure and practice implications.
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Affiliation(s)
- Tamaire Ojeda
- Commission on Dietetic Registration, Chicago, Illinois
| | | | - Donna Pertel
- Commission on Dietetic Registration, Chicago, Illinois
| | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
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Chan HCN, Fei X, Leung ELY, Langston K, Marshall S, van der Meij BS. Post-discharge consequences of protein-energy malnutrition, sarcopenia, and frailty in older adults admitted to rehabilitation: A systematic review. Clin Nutr ESPEN 2023; 54:382-397. [PMID: 36963884 DOI: 10.1016/j.clnesp.2023.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 02/09/2023]
Abstract
BACKGROUND & AIMS Malnutrition, sarcopenia, and frailty are three prevalent wasting conditions among older rehabilitation patients that lead to multiple health-related negative outcomes. This systematic review and meta-analysis aimed to determine the post-discharge consequences of malnutrition, sarcopenia, and frailty in older adults admitted to inpatient rehabilitation. METHODS MEDLINE, Embase, Web of Science, and CINAHL databases were searched on 20 April, 2021 for longitudinal studies in older adults (≥65 years) admitted for inpatient rehabilitation. This systematic review included and synthesised studies that 1) measured malnutrition, sarcopenia, and/or frailty using a validated assessment tool or guideline; and 2) reported the association with post-discharge mortality, physical function, quality of life, or discharge location. The Academy of Nutrition & Dietetics Quality Criteria Checklist and GRADE criteria were used to assess risk of bias and evidence certainty. Where possible, data were pooled using Revman. RESULTS Twenty-six observational studies (n = 9709 participants in total) with similarly aged populations were included. Eight, seven, and eleven studies assessed malnutrition, sarcopenia, and frailty, respectively. Follow-up periods ranged from immediate to 7 years post-rehabilitation. Malnutrition was associated with discharge to a higher level of care (GRADE: very low), and worse quality of life (GRADE: very low) and physical function (GRADE: very low). Sarcopenia was associated with worse physical function (GRADE: very low) and lower rate of home discharge (OR: 0.14; 95%CI: 0.09-0.20; I2:30%; GRADE: low). Frailty was associated with increased mortality (GRADE: very low), hospital readmission (GRADE: very low), and decreased home discharge (GRADE: very low). CONCLUSION Wasting conditions in older adults during rehabilitation admission may be associated with poorer quality of life, lower rates of home discharge, and higher rates of health service use, physical dysfunction, and mortality following discharge. Further research is needed to investigate the comparative and combined impacts, as well as the overlap of malnutrition, sarcopenia, and frailty during and after rehabilitation to guide priority screening and intervention.
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Affiliation(s)
- Hei Chun Nicholas Chan
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Xinzhu Fei
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Eden Long Yin Leung
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Keanne Langston
- Department of Nutrition and Dietetics, Robina Hospital, Gold Coast, Queensland, Australia
| | - Skye Marshall
- Research Institute for Future Health, Gold Coast, Queensland, Australia
| | - Barbara Suzanne van der Meij
- Dietetics and Foodservices, Mater Health, Brisbane, Queensland, Australia; Mater Research Institute - University of Queensland, Brisbane, Queensland, Australia; Department of Nutrition, Dietetics and Lifestyle, School of Allied Health, HAN University of Applied Sciences, Nijmegen, the Netherlands; Department of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands.
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5
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Botero L, Young AM, Banks MD, Bauer J. Incidence and criteria used in the diagnosis of hospital-acquired malnutrition in adults: a systematic review and pooled incidence analysis. Eur J Clin Nutr 2023; 77:23-35. [PMID: 35501387 PMCID: PMC9876784 DOI: 10.1038/s41430-022-01141-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/20/2022] [Accepted: 03/31/2022] [Indexed: 01/29/2023]
Abstract
Despite advances in identifying malnutrition at hospital admission, decline in nutritional status of well-nourished patients can be overlooked. The aim of this systematic review was to investigate the incidence of hospital-acquired malnutrition (HAM), diagnostic criteria and health-related outcomes. PubMed, CINAHL, Embase and Cochrane Library were searched up to July 2021. Studies were included if changes in nutritional status was assessed with a validated nutrition assessment tool in acute and subacute adult (≥18 yrs) hospitalised patients. A random-effects method was used to pool the incidence proportion of HAM in prospective studies. The certainty of evidence was appraised using the Grading of Recommendation Assessment, Development and Evaluation system. We identified 12 observational cohort studies (10 prospective and 2 retrospective), involving 35,324 participants from acute (9 studies) and subacute settings (3 studies). Retrospective studies reported a lower incidence of HAM (<1.4%) than prospective studies (acute: 9-38%; subacute: 0-7%). The pooled incidence of HAM in acute care was 25.9% (95% confidence interval (CI): 17.3-34.6). Diagnostic criteria varied, with use of different nutrition assessment tools and timeframes for assessment (retrospective studies: >14 days; prospective studies: ≥7 days). Nutritional decline is probably associated with longer length of stay and higher 6-month readmission (moderate certainty of evidence) and may be association with higher complications and infections (low certainty of evidence). The higher incidence of HAM in the acute setting, where nutritional assessments are conducted prospectively, highlights the need for consensus regarding diagnostic criteria and further studies to understand the impact of HAM.
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Affiliation(s)
- Liliana Botero
- School of Human Movement and Nutrition Science, The University of Queensland, Brisbane, QLD, Australia.
| | - Adrienne M Young
- Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia
| | - Merrilyn D Banks
- Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
| | - Judy Bauer
- School of Human Movement and Nutrition Science, The University of Queensland, Brisbane, QLD, Australia
- Department of Nutrition and Dietetics, The Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia
- School of Nutrition, Dietetics & Food, Monash University, Melbourne, VIC, Australia
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Nosewicz J, Sparks A, Hart PA, Roberts KM, Kaffenberger JA, Korman A, Trinidad JC, Spaccarelli N, Kaffenberger BH. The Evaluation and Management of Macronutrient Deficiency Dermatoses. J Am Acad Dermatol 2022; 87:640-647. [PMID: 35427683 DOI: 10.1016/j.jaad.2022.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 03/31/2022] [Accepted: 04/03/2022] [Indexed: 10/18/2022]
Abstract
In industrialized countries, nutritional dermatoses are likely underdiagnosed and result in increased disease morbidity and utilization of hospital resources. These findings underscore the need for physicians to be able to correctly identify these deficiencies. Nutritional dermatoses may be split into micronutrient deficiencies and macronutrient deficiencies. This article is intended to serve as a supplement to a two-part review of micronutrient deficiency dermatoses and highlights cutaneous findings in patients with protein-energy malnutrition and essential fatty acid deficiency. This article reviews the evaluation, cutaneous manifestations, and management of macronutrient deficiencies.
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Affiliation(s)
- Jacob Nosewicz
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Alexander Sparks
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Phil A Hart
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kristen M Roberts
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Jessica A Kaffenberger
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Abraham Korman
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - John C Trinidad
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Natalie Spaccarelli
- Division of Dermatology, The Ohio State University Wexner Medical Center, Columbus, Ohio
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Brglez M, Plazar N, Poklar Vatovec T, Meulenberg CJW. Health concerns regarding malnutrition among the older populations: considerations from a Slovenian perspective. Health Promot Int 2021; 37:6310297. [PMID: 34179974 DOI: 10.1093/heapro/daab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Diet is an important factor in a healthy lifestyle for all age groups. However, with aging it is important to be aware that the diet, due to changed physiology, needs an accordingly adjusted and balanced daily regime. This article reviews the field of older population's nutrition and presents: the most common nutritional disorders, causes, demographics and malnutrition measurement tools. Relevant scientific literature as well as professional Slovenian papers were identified through specific searches with topic-related keywords in EBSCO, PubMed, Web of Science and COBISS databases. The results of the identified papers are subsequently discussed in a descriptive narrative. The reviewed literature shows noticeable trends of high proportions of malnutrition among older persons, both globally and in Slovenia: predominantly observed are overnutrition like overweight and obese, but as well, and often unnoticed, undernutrition. The latter is more worrying, as inadequate knowledge in health care institutions regarding nutritional screening tools and measures to prevent drastic forms of undernutrition, seem to facilitate these trends. Though there are many reasons for insufficient food intake in older people, the article formulates considerations that can feed appropriate education and awareness programs, and through correct screening point to timely identification of malnourished individuals and those with risk of malnutrition. The promotion and implementation of such considerations could prevent malnutrition among the older population, reduce the frequency of nutritional disorders and co-morbidities, and generally improve the nutritional status of the older population, thus, provide better quality of health later in life.
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Affiliation(s)
- Monika Brglez
- Alma Mater Europaea, European Centre, Maribor, Slovenia
| | - Nadja Plazar
- Alma Mater Europaea, European Centre, Maribor, Slovenia
| | | | - Cécil J W Meulenberg
- Institute for Kinesiology Research, Science and Research Centre, Koper, Slovenia
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8
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Abstract
The aim of this article is to emphasize that starvation is an important potential consequence of psychosis and to provide recommendations for management of this condition. A review of the literature on food refusal and starvation in patients with psychotic illnesses was performed. Our search strategy returned 54 articles with one article meeting inclusion criteria. Additional independent research returned an additional four cases of patients with psychosis engaging in self-starvation. The cases of several patients from our institution who engaged in self-starvation behaviors as a result of psychosis are also presented. The management and outcomes of each of these 10 patients are discussed. Starvation secondary to psychosis is an important but underappreciated consequence of psychosis that can lead to serious adverse outcomes in these patients. Few cases have been reported in the literature. More study is warranted to develop evidence-based management guidelines.
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9
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Roberts S, Chaboyer W, Marshall AP. Hospital patients' perceptions of using a technology-based intervention to participate in their nutrition care: A qualitative descriptive study. Clin Nutr ESPEN 2020; 39:79-86. [PMID: 32859333 DOI: 10.1016/j.clnesp.2020.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND & AIMS Promoting patient participation in health care is a worldwide health care priority. When patients participate in their nutrition care during hospitalisation, they are more likely to meet their dietary needs. Patient participation is a potential solution to hospital malnutrition, for which inadequate dietary intake is the major modifiable risk factor. Our team developed a health information technology (HIT) intervention aiming to improve patients' dietary intakes during hospitalisation by engaging them in their nutrition care. The aim of this study was to explore patient perceptions and acceptability of the intervention. METHODS This qualitative descriptive study was conducted at a tertiary teaching hospital in Australia. Participants were a subset of patients from a larger feasibility study, selected using maximum variation purposive sampling to include a broad representation of patients in terms of age, gender and experience with technology. All patients had used the HIT intervention to participate in their nutrition care in hospital, through nutritional goal setting and dietary intake monitoring. A semi-structured interview guide was used to collect qualitative data on patients' perceptions of the intervention, focusing on acceptability. Data were analysed thematically. FINDINGS 11 patients participated in interviews, from which two main themes emerged. The first captured patients' experiences and perceptions of using technology to participate in their nutrition care. Patients found it easy to use, useful and valuable, but still valued interaction with researchers and hospital staff. The second theme portrayed the spectrum of participation, from simply learning about nutrition, to self-monitoring and evaluating, to changing behaviour. Participants enjoyed gaining new knowledge and awareness around nutrition. Most self-monitored their food intake and evaluated their goals, and some changed what foods they ordered based on what they had learned. CONCLUSIONS Patients responded positively to the intervention, likely because they found it valuable and easy to use. These findings are promising for potential future use of HIT to engage hospital patients in care. Future research should investigate the effects of HIT interventions on patient-centred outcomes in hospital.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Griffith University, Australia; Gold Coast Hospital and Health Service, Australia; Menzies Health Institute Queensland, Australia.
| | - Wendy Chaboyer
- Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, Australia; Menzies Health Institute Queensland, Australia; School of Nursing and Midwifery, Griffith University, Australia
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Kemp A, Walton K, Rosario V, Charlton K, McMahon A. Audit of the national meal guidelines for home‐delivered and centre‐based meal programs. Australas J Ageing 2020; 39:e375-e381. [DOI: 10.1111/ajag.12806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 04/19/2020] [Accepted: 04/20/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Alice Kemp
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
| | - Karen Walton
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
- Illawarra Health & Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Vinicius Rosario
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
| | - Karen Charlton
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
- Illawarra Health & Medical Research Institute University of Wollongong Wollongong NSW Australia
| | - Anne McMahon
- Faculty of Science, Medicine and Health School of Medicine University of Wollongong Wollongong NSW Australia
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Crichton M, Marshall S, Marx W, McCarthy AL, Isenring E. Efficacy of Ginger (Zingiber officinale) in Ameliorating Chemotherapy-Induced Nausea and Vomiting and Chemotherapy-Related Outcomes: A Systematic Review Update and Meta-Analysis. J Acad Nutr Diet 2019; 119:2055-2068. [PMID: 31519467 DOI: 10.1016/j.jand.2019.06.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 06/03/2019] [Accepted: 06/12/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Ginger has been proposed as an adjuvant treatment for chemotherapy-induced nausea and vomiting. OBJECTIVE The aim of this systematic review with meta-analyses is to evaluate, in adult cancer patients receiving chemotherapy, the effects of ginger supplementation dose and duration on the incidence, duration, and severity of chemotherapy-induced nausea and vomiting and outcomes related to chemotherapy-induced nausea and vomiting (eg, quality of life and fatigue), compared with placebo or standard antiemetic medication. METHOD Five electronic databases were searched from database inception to April 2018. The quality of evidence was appraised with the Cochrane Risk of Bias tool and Grading of Recommendations, Assessment, Development, and Evaluation level. Data were pooled using Revman software. RESULTS Eighteen articles were analyzed. The likelihood of acute vomiting was reduced by 60% with ginger supplementation ≤1 g/day for duration >3 days, compared with control groups (odds ratio 0.4, 95% CI 0.17 to 0.81; P=0.01; n=3 studies; n=3 interventions; n=301 participants; I2=20%; Grading of Recommendations, Assessment, Development, and Evaluation level: Moderate). The likelihood of fatigue was reduced by 80% with ginger supplementation of any dose for duration <3 days (odds ratio 0.2, 95% CI, 0.03 to 0.87; P=0.03; n=1 studies; n=2 interventions; n=219 participants; I2=0%; Grading of Recommendations, Assessment, Development, and Evaluation level: Low). No statistically significant association was found between ginger and likelihood of overall or delayed vomiting, likelihood or severity of nausea, or other outcomes related to chemotherapy-induced nausea and vomiting. CONCLUSIONS Ginger supplementation might benefit chemotherapy-induced vomiting as well as fatigue. Due to clinical heterogeneity, this systematic review update found no association between ginger and chemotherapy-induced nausea and other chemotherapy-induced nausea and vomiting-related outcomes. The results of this systematic review and meta-analysis provide a rationale for further research with stronger study designs, adequate sample sizes, standardized ginger products, and validated outcome measures to confirm efficacy of ginger supplementation and optimal dosing regimens.
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Anker MS, Anker SD, Coats AJ, von Haehling S. The Journal of Cachexia, Sarcopenia and Muscle stays the front-runner in geriatrics and gerontology. J Cachexia Sarcopenia Muscle 2019; 10:1151-1164. [PMID: 31821753 PMCID: PMC6903443 DOI: 10.1002/jcsm.12518] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Markus S. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of CardiologyCharité Campus Benjamin FranklinBerlinGermany
| | - Stefan D. Anker
- Division of Cardiology and Metabolism, Department of CardiologyCharité Universitätsmedizin BerlinBerlinGermany
- Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- German Centre for Cardiovascular Research (DZHK) partner site BerlinBerlinGermany
- Department of Cardiology (CVK)Charité Universitätsmedizin BerlinBerlinGermany
- Charité Universitätsmedizin BerlinBerlinGermany
| | | | - Stephan von Haehling
- Department of Cardiology and Pneumology, Heart Center GöttingenUniversity of Göttingen Medical Center, Georg‐August‐UniversityGöttingenGermany
- German Center for Cardiovascular Medicine (DZHK), partner site GöttingenGöttingenGermany
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Kaya E, Bakir A, Koseoglu YK, Velidedeoglu M, Trabulus S, Seyahi N. Association of Nutritional Assessment by Phase Angle With Mortality in Kidney Transplant Patients in an 8-Year Follow-Up. Prog Transplant 2019; 29:321-326. [PMID: 31476959 DOI: 10.1177/1526924819873906] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Phase angle is a bioimpedance analysis parameter that indirectly shows body cell mass. Its association with mortality has been shown in patients receiving dialysis treatment. However, assessment with mortality in kidney transplant recipients has not been studied previously. METHODS We examined 158 kidney transplant recipients who underwent bioimpedance analysis 8 years ago in a cross-sectional study. We contacted them again and investigated the presence of cardiovascular events, cancer, angina pectoris, and claudication. Data regarding mortality, graft failure, and creatinine values were collected from recipients' files. FINDINGS During the follow-up period, 15 recipients died, 26 lost graft function, 36 experienced cardiovascular events, and 4 developed cancer. Phase angle was significantly associated with mortality during the 8-year follow-up period of kidney transplant recipients (P < .001). The cutoff value for phase angle as a predictor of mortality was ≤5.85. Moreover, a phase angle value lower than 5.85 indicated 5.33 times higher risk of mortality. DISCUSSION Phase angle was a predictor of mortality in kidney transplant recipients. Since phase angle is an inexpensive, easy-to-perform, and noninvasive method, it might be considered as an additional tool to assess survival in kidney transplant recipients.
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Affiliation(s)
- Eda Kaya
- Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Fatih, Turkey
| | - Alev Bakir
- Faculty of Medicine, Department of Biostatistics and Medical Informatics, Halic University, Istanbul, Turkey
| | - Yusuf Kenan Koseoglu
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Mehmet Velidedeoglu
- Department of General Surgery, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Sinan Trabulus
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Nurhan Seyahi
- Division of Nephrology, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University-Cerrahpasa, Istanbul, Turkey
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Roberts S, Grealish L, Williams LT, Hopper Z, Jenkins J, Spencer A, Marshall AP. Development and Process Evaluation of a Complex Intervention for Improving Nutrition among Hospitalised Patients: A Mixed Methods Study. Healthcare (Basel) 2019; 7:E79. [PMID: 31238528 PMCID: PMC6628331 DOI: 10.3390/healthcare7020079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/20/2019] [Indexed: 11/23/2022] Open
Abstract
Hospital-acquired malnutrition is a significant issue with complex aetiology, hence nutrition interventions must be multifaceted and context-specific. This paper describes the development, implementation and process evaluation of a complex intervention for improving nutrition among medical patients in an Australian hospital. An integrated knowledge translation (iKT) approach was used for intervention development, informed by previous research. Intervention strategies targeted patients (via a nutrition intake monitoring system); staff (discipline-specific training targeting identified barriers); and the organisation (foodservice system changes). A process evaluation was conducted parallel to implementation assessing reach, dose, fidelity and staff responses to the intervention using a mixed-methods design (quantitative and qualitative approaches). Staff-level interventions had high fidelity and broad reach (61% nurses, 93% foodservice staff and all medical staff received training). Patient and organisation interventions were implemented effectively, but due to staffing issues, only reached around 60% of patients. Staff found all intervention strategies acceptable with benefits to practice. This study found an iKT approach useful for designing a nutrition intervention that was context-specific, feasible and acceptable to staff. This was likely due to engagement of multiple disciplines, identifying and targeting specific areas in need of improvement, and giving staff frequent opportunities to contribute to intervention development/implementation.
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Affiliation(s)
- Shelley Roberts
- School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Laurie Grealish
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Lauren T Williams
- School of Allied Health Sciences, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
| | - Zane Hopper
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Julie Jenkins
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Alan Spencer
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
| | - Andrea P Marshall
- Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, QLD 4215, Australia.
- Menzies Health Institute Queensland, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
- School of Nursing and Midwifery, Gold Coast Campus, Griffith University, Southport, QLD 4222, Australia.
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15
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Marshall S, van der Meij BS, Milte R, Collins CE, de van der Schueren MA, Banbury M, Warner MM, Isenring E. Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study. JMIR Res Protoc 2019; 8:e12647. [PMID: 31038466 PMCID: PMC6658316 DOI: 10.2196/12647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/28/2018] [Accepted: 11/29/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. OBJECTIVE The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. METHODS This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. RESULTS Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. CONCLUSIONS This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry Number (ACTRN) 12618000338268; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374608&isReview=true (Archived by WebCite at http://www.webcitation.org/74gtZplU2). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/12647.
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Affiliation(s)
- Skye Marshall
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Barbara S van der Meij
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Dietetics and Foodservices, Mater Health, Brisbane, Australia.,Mater Research Institute, University of Queensland, Brisbane, Australia
| | - Rachel Milte
- Institute for Choice, University of South Australia, Adelaide, Australia
| | - Clare E Collins
- Faculty of Health and Medicine, University of Newcastle, Callaghan, Australia.,Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle, Callaghan, Australia
| | - Marian Ae de van der Schueren
- Department of Nutrition and Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, Netherlands.,Department of Nutrition and Dietetics, HAN University of Applied Sciences, Amsterdam, Netherlands
| | - Mark Banbury
- Northern NSW Local Health District, NSW Health, Tweed Heads, Australia.,Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Molly M Warner
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
| | - Elizabeth Isenring
- Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences and Medicine, Bond University, Robina, Australia
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16
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Crichton M, Craven D, Mackay H, Marx W, de van der Schueren M, Marshall S. A systematic review, meta-analysis and meta-regression of the prevalence of protein-energy malnutrition: associations with geographical region and sex. Age Ageing 2019; 48:38-48. [PMID: 30188972 DOI: 10.1093/ageing/afy144] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 08/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background protein-energy malnutrition is a major health concern in home-dwelling older adults, particularly in the context of an ageing population. Therefore, a systematic review and meta-analysis was undertaken to determine the prevalence of malnutrition among older adults living independently in the community according to geographical region, sampling frame, rurality and sex. Methods six electronic databases were searched until September 2016. Original research studies which used the Mini Nutritional Assessment, Patient-Generated Subjective Global Assessment or Subjective Global Assessment to determine nutrition status in community samples with a mean age of ≥65 years were critically appraised and pooled using meta-analysis. Meta-regression was used to explore predictors of malnutrition prevalence in pooled statistics with high heterogeneity. Results 111 studies from 38 countries (n = 69,702 participants) were included. The pooled prevalence of malnutrition in the older community setting ranged from 0.8% (95% CI: 0.2-1.7%) in Northern Europe to 24.6% (95% CI: 0.0-67.9%) in South-East Asia. Of all sampling frames, participants receiving homecare services had the highest prevalence at 14.6% (95% CI: 9.9-20.0%). Malnutrition prevalence in rural communities (9.9%; 95% CI: 4.5-16.8%) was double that in urban communities (5.7%; 95% CI: 4.2-7.3%) and higher among females than males (odds ratio = 1.45 [95% CI: 1.27-1.66]; P < 0.00001). Conclusions the results of this review provide strategic insight to develop public and community health priorities for preventing malnutrition and associated poor health outcomes.
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Affiliation(s)
- Megan Crichton
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - Dana Craven
- School of Health and Sport Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Hannah Mackay
- Mater Health Services, South Brisbane, Queensland, Australia
| | - Wolfgang Marx
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
- School of Allied Health, La Trobe University, Victoria, Australia
- Food & Mood Centre, IMPACT SRC, School of Medicine, Deakin University, Geelong, Australia
| | - Marian de van der Schueren
- Faculty of Health and Social Studies, HAN University of Applied Sciences, Nijmegen, the Netherlands
- Department of Nutrition and Dietetics, Amsterdam University Medical Centres, VUmc, Amsterdam, the Netherlands
| | - Skye Marshall
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
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17
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Morley JE. Editorial: Screening for Malnutrition (Undernutrition) in Primary Care. J Nutr Health Aging 2019; 23:1-3. [PMID: 30569060 DOI: 10.1007/s12603-018-1142-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- J E Morley
- John E. Morley, MB,BCh, Division of Geriatric Medicine, Saint Louis University School of Medicine, 1402 S. Grand Blvd., M238, St. Louis, MO 63104,
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18
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Grammatikopoulou MG, Gkiouras K, Theodoridis X, Tsisimiri M, Markaki AG, Chourdakis M, Goulis DG. Food insecurity increases the risk of malnutrition among community-dwelling older adults. Maturitas 2019; 119:8-13. [DOI: 10.1016/j.maturitas.2018.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 12/22/2022]
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19
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Is telehealth effective in managing malnutrition in community-dwelling older adults? A systematic review and meta-analysis. Maturitas 2018; 111:31-46. [PMID: 29673830 DOI: 10.1016/j.maturitas.2018.02.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 02/13/2018] [Accepted: 02/14/2018] [Indexed: 01/22/2023]
Abstract
Telehealth offers a feasible method to provide nutrition support to malnourished older adults. This systematic review and meta-analysis aims to determine the efficacy of telehealth methods in delivering malnutrition-related interventions to community-dwelling older adults. Studies in any language were searched in five electronic databases from inception to 2nd November 2017. Quality of the evidence was assessed using the Cochrane Risk of Bias tool and the GRADE approach. Nine studies were identified, with results published across 13 included publications, which had mostly low to unclear risk of bias. There were two interventions delivered to disease-specific groups, one with kidney disease and one with cancer; the remaining seven interventions were delivered to patients with mixed morbidities following discharge from an inpatient facility. Seven studies delivered telehealth via telephone consultations and two used internet-enabled telemedicine devices. Ten meta-analyses were performed. Malnutrition-focused telehealth interventions were found to improve protein intake in older adults by 0.13 g/kg body weight per day ([95%CI: 0.01-0.25]; P = .03; n = 2 studies; n = 200 participants; I2 = 41%; GRADE level: low) and to improve quality of life (standardised mean difference: 0.55 [95%CI: 0.11-0.99]; P = .01; n = 4 studies with n = 9 quality-of-life tools; n = 248 participants; I2 = 84%: GRADE level: very low). There were also trends towards improved nutrition status, physical function, energy intake, hospital readmission rates and mortality in the intervention groups. Overall, this review found telehealth is an effective method to deliver malnutrition-related interventions to older adults living at home, and is likely to result in clinical improvements compared with usual care or no intervention. However, further research with larger samples and stronger study designs are required to strengthen the body of evidence.
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20
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Dahl C, Crichton M, Jenkins J, Nucera R, Mahoney S, Marx W, Marshall S. Evidence for Dietary Fibre Modification in the Recovery and Prevention of Reoccurrence of Acute, Uncomplicated Diverticulitis: A Systematic Literature Review. Nutrients 2018; 10:nu10020137. [PMID: 29382074 PMCID: PMC5852713 DOI: 10.3390/nu10020137] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2018] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/21/2022] Open
Abstract
In practice, nutrition recommendations vary widely for inpatient and discharge management of acute, uncomplicated diverticulitis. This systematic review aims to review the evidence and develop recommendations for dietary fibre modifications, either alone or alongside probiotics or antibiotics, versus any comparator in adults in any setting with or recently recovered from acute, uncomplicated diverticulitis. Intervention and observational studies in any language were located using four databases until March 2017. The Cochrane Risk of Bias tool and GRADE were used to evaluate the overall quality of the evidence and to develop recommendations. Eight studies were included. There was "very low" quality evidence for comparing a liberalised and restricted fibre diet for inpatient management to improve hospital length of stay, recovery, gastrointestinal symptoms and reoccurrence. There was "very low" quality of evidence for using a high dietary fibre diet as opposed to a standard or low dietary fibre diet following resolution of an acute episode, to improve reoccurrence and gastrointestinal symptoms. The results of this systematic review and GRADE assessment conditionally recommend the use of liberalised diets as opposed to dietary restrictions for adults with acute, uncomplicated diverticulitis. It also strongly recommends a high dietary fibre diet aligning with dietary guidelines, with or without dietary fibre supplementation, after the acute episode has resolved.
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Affiliation(s)
- Camilla Dahl
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia.
| | - Megan Crichton
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia.
| | - Julie Jenkins
- Department of Nutrition and Dietetics, Robina Hospital, Robina, QLD 4226, Australia.
| | - Romina Nucera
- Department of Nutrition and Dietetics, Robina Hospital, Robina, QLD 4226, Australia.
| | - Sophie Mahoney
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia.
| | - Wolfgang Marx
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia.
- School of Allied Health, La Trobe University, Melbourne, VIC 3086, Australia.
| | - Skye Marshall
- Faculty of Health Sciences & Medicine, Bond University, Robina, QLD 4226, Australia.
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