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Uhlmann K, Reber E, Schonenberger KA, Stanga Z, Kurmann S. Should handgrip strength be considered when choosing the administration mode of oral nutritional supplements in geriatric patients? A secondary analysis of the MEDPass Trial. Nutrition 2024; 124:112429. [PMID: 38631270 DOI: 10.1016/j.nut.2024.112429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 11/09/2023] [Accepted: 03/17/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE It is important to individualize nutrition therapy and to identify whether certain patient groups benefit from a specific intervention such as oral nutritional supplements (ONS). This study investigated whether patients with weak handgrip strength (HGS) benefit better from ONS administration in the Medication Pass Nutritional Supplement Program (MEDPass) mode regarding the individual coverage of energy and protein requirements throughout their hospitalization. METHODS A secondary analysis of the intention-to-treat data set of the randomized controlled MEDPass trial was conducted. Weak HGS was defined as <27 kg for men and <16 kg for women. Linear mixed-effect models adjusted for the stratification factors energy density of ONS and nutritional risk screening 2002 score were used to address the aim of the study. RESULTS We included 188 participants. Energy and protein coverage did not differ between the patients with weak or normal HGS depending on ONS administration mode (P = 0.084, P = 0.108). Patients with weak HGS and MEDPass administration mode tended to have the lowest energy and protein coverage (estimated mean, 77.2%; 95% confidence interval [CI], 69.3%-85% and estimated mean, 95.1%; 95% CI, 85.3%-105%, respectively). Patients with weak HGS and conventional ONS administration had the highest energy and protein coverage (estimated mean, 90%; 95% CI, 82.8%-97.2% and estimated mean, 110.2%; 95% CI, 101.3%-119%, respectively). CONCLUSION No clear recommendations regarding the mode of ONS administration depending on HGS can be made. In clinical practice, appetite and satiety in patients with weak HGS should be monitored, and the ONS administration mode should be adjusted accordingly.
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Affiliation(s)
- Katja Uhlmann
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland.
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Katja A Schonenberger
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland; Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Silvia Kurmann
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
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Riddle E, Munoz N, Clark K, Collins N, Coltman A, Nasrallah L, Nishioka S, Scollard T, Simon JR, Moloney L. Prevention and Treatment of Malnutrition in Older Adults Living in Long-Term Care or the Community: An Evidence-Based Nutrition Practice Guideline. J Acad Nutr Diet 2024; 124:896-916.e24. [PMID: 38583584 DOI: 10.1016/j.jand.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 03/27/2024] [Indexed: 04/09/2024]
Abstract
Malnutrition in older adults can decrease quality of life and increase risk of morbidities and mortality. Accurate and timely identification of malnutrition, as well as subsequent implementation of effective interventions, are essential to decrease poor outcomes associated with malnutrition in older adults. The Academy of Nutrition and Dietetics Evidence Analysis Center conducted a systematic review of the literature to develop an evidence-based nutrition practice guideline for the prevention and treatment of malnutrition in older adults. The objective of this guideline was to provide evidence-based recommendations to identify, prevent, or treat protein-energy malnutrition in older adults (mean age ≥65 years) living in long-term care and community settings. This guideline provides 11 nutrition recommendations to inform shared decision making among dietitians, members of the health care team, family members or caregivers, and older adults living in long-term care or the community to prevent or treat malnutrition. Topics include dietitian effectiveness, nutrition assessment tools, oral nutrition supplements, food fortification, and home-delivered and congregate meals. Guideline implementation should include consideration of the importance of comprehensive individualized nutrition care for older adults. Future research is needed to address gaps that were identified related to the validity, reliability, and feasibility of nutrition assessment tools, as well as the effectiveness of dietitian interventions on outcomes of interest in older adults living in long-term care and the community.
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Affiliation(s)
- Emily Riddle
- State University of New York at Oneonta, Oneonta, New York
| | - Nancy Munoz
- Veterans Affairs Southern Nevada Healthcare System, Las Vegas, Nevada
| | | | | | - Anne Coltman
- Commission on Dietetic Registration, Chicago, Illinois
| | - Lamia Nasrallah
- Outpatient Nutrition Services, University of North Carolina Hospitals, Chapel Hill, North Carolina
| | - Shinta Nishioka
- Department of Clinical Nutrition and Food Services, Nagasaki Rehabilitation Hospital, Nagasaki, Japan
| | | | - Judy R Simon
- Nutrition and Health Promotion Consultant, Easton, Maryland
| | - Lisa Moloney
- Academy of Nutrition and Dietetics, Chicago, Illinois.
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Su L, Zhang J, Jia L, Dou W, Li M, Zhang Y, Chang J. Compliance with oral nutritional supplements and its influencing factors in postoperative patients with digestive tract tumors: a cross-sectional study. BMC Nurs 2024; 23:380. [PMID: 38840132 PMCID: PMC11151578 DOI: 10.1186/s12912-024-02010-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 05/13/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Oral nutritional supplements are one of the preferred methods of nutritional support for postoperative patients. This study aims to investigate the current status of oral nutritional supplements compliance in postoperative patients with digestive tract tumors and its influencing factors. METHODS Convenience sampling was employed to select 242 patients who underwent surgery for digestive tract tumors at a tertiary hospital in Shanghai from October 2022 to July 2023 as the study subjects. Data following a normal distribution were analyzed using independent sample t-tests, ANOVA single-factor analysis, Pearson correlation analysis, and multiple linear regression analysis to determine the factors influencing compliance with oral nutritional supplements. RESULTS A total of 252 questionnaires were distributed, with 10 invalid questionnaires excluded, resulting in an effective questionnaire rate of 96.03%. The compliance score for oral nutritional supplements in postoperative patients with digestive tract tumors was (2.40 ± 1.45), General Self-efficacy Scale (GSES) score was (24.72 ± 4.86), Multidimensional Scale of Perceived Social Support Scale (MSPSS) score was (58.67 ± 11.09), and Belief about Medicines Questionnaire Scale (BMQ) score was (0.17 ± 2.78). Multiple linear regression analysis revealed that age, adverse reactions, educational level, self-efficacy, medication beliefs, and social support were factors influencing compliance with oral nutritional supplements in postoperative patients with digestive tract tumors (P < 0.05). CONCLUSION Our study revealed that the compliance to oral nutritional supplements among postoperative patients with digestive tract tumors was at a moderate level and was closely associated with age, educational level, adverse reactions to oral nutritional supplements, medication beliefs, social support, and self-efficacy. Nursing staff should conduct nursing assessments based on the specific circumstances of patients and their families, provide personalized health education management plans based on the patients' educational level, enhance patients' nutrition knowledge, improve patient self-efficacy, and enhance social support for patients, while further improving patient nutrition management.
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Affiliation(s)
- Liqing Su
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jie Zhang
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Lei Jia
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Wenyue Dou
- Department of Nursing, Shanghai General Hospital, Shanghai, China
| | - Mengxue Li
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Yumeng Zhang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Jian Chang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China.
- Department of Nursing, Shanghai General Hospital, Shanghai, China.
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Verstraeten LM, Mashni A, van Wijngaarden JP, Meskers CG, Maier AB. Sarcopenia knowledge of geriatric rehabilitation patients is low while they are willing to start sarcopenia treatment: EMPOWER-GR. J Cachexia Sarcopenia Muscle 2024; 15:352-360. [PMID: 38124340 PMCID: PMC10834324 DOI: 10.1002/jcsm.13372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 09/08/2023] [Accepted: 10/18/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND Sarcopenia is prevalent in 20-50% of geriatric rehabilitation inpatients and is associated with functional dependence and mortality. The aim is to assess knowledge of geriatric rehabilitation inpatients on sarcopenia and their willingness and perceived barriers to start treatment. METHODS Enhancing Muscle POWER in Geriatric Rehabilitation (EMPOWER-GR) is an observational cohort of geriatric rehabilitation inpatients in Amsterdam, the Netherlands. Knowledge of sarcopenia, willingness and perceived barriers to treatment were assessed with a survey among inpatients. Importance of and self-perceived muscle health were rated using a visual analogue scale from 0 to 10. Descriptive statistics were used. RESULTS Inpatients' (n = 157, 59.9% female) mean age was 80.5 years (SD 7.3). Sarcopenia (European Working Group on Sarcopenia in Older People 2) prevalence was 21.7%. Five inpatients (3.2%) had heard of sarcopenia and had knowledge of its definition. Median muscle health was rated as 6 (interquartile range: 4-7). After explanation of treatment options, 67.1% were willing to start resistance exercise training (RET), 61.1% a high-protein diet and 55.7% oral nutritional supplements (ONS). Inpatients with sarcopenia were less willing (51.6%) to start a high-protein diet compared with inpatients without sarcopenia (77.8%) (P = 0.002); there was no difference for RET and ONS. Most reported barriers to treatment were ONS dislike (17.0%), too many other health issues (13.6%), doubts about treatment effectiveness/importance (12.9%) and RET intensity/difficulty (10.2%). CONCLUSIONS Knowledge of sarcopenia was low, while the majority of inpatients showed willingness to start treatment. A dislike of ONS, RET difficulty and too many other health issues may reduce willingness to start treatment. Education is important to increase sarcopenia-related health issues in geriatric rehabilitation inpatients.
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Affiliation(s)
- Laure M.G. Verstraeten
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
| | - Amir Mashni
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
| | | | - Carel G.M. Meskers
- Department of Rehabilitation MedicineAmsterdam University Medical Centre, Amsterdam Movement SciencesAmsterdamThe Netherlands
| | - Andrea B. Maier
- Department of Human Movement Sciences@AgeAmsterdam, Vrije Universiteit Amsterdam, Amsterdam Movement Sciencesvan der Boechorststraat 7Amsterdam1081 BTThe Netherlands
- Department of Medicine and Aged Care@AgeMelbourne, The Royal Melbourne Hospital, The University of MelbourneParkvilleVictoriaAustralia
- Healthy Longevity Translational Research Program, Yong Loo Lin School of MedicineNational University of SingaporeSingapore
- Centre for Healthy Longevity@AgeSingapore, National University Health SystemSingapore
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Kielb EI, Moding KJ, Kimiecik C, Klenosky DB. Parents' food choice for their preschool-aged children: A means-end investigation. Child Care Health Dev 2024; 50:e13172. [PMID: 37699702 DOI: 10.1111/cch.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/26/2023] [Accepted: 08/22/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND Despite the growing literature on the importance of parental feeding practices, the factors that influence how parents make decisions regarding the foods they offer to their young children are not fully understood. Means-end theory and its associated methodology known as laddering provide a useful framework for characterizing the relationships between the attributes of a choice option (e.g., a food item), the consequences (i.e., the benefits or costs/risks) associated with those attributes and the personal values (i.e., enduring beliefs) those consequences help reinforce. The present research uses this means-end perspective to enrich our understanding of how parents make food choices for their preschool-aged children. METHODS Interviews were conducted with parents (N = 33) of 3- to 5-year-old children to explore the factors underlying parents' decisions regarding the foods they recently offered, prefer to offer and avoid offering to their preschooler. The resulting data were transcribed, content analysed and summarized in a series of summary diagrams known as hierarchical value maps (HVMs). RESULTS Study results indicate that although most parents reported trying to make food decisions because they want their child to be healthy, factors such as avoiding fights/battles and low perceived likelihood their child would eat a food may be barriers to offering certain foods. CONCLUSIONS Taken together, these study findings enhance our understanding of the range of meanings underlying parents' food choice decisions and suggest opportunities for interventions to improve the quality of foods that parents offer to their children at home.
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Szklarzewska S, Mottale R, Engelman E, De Breucker S, Preiser JC. Nutritional rehabilitation after acute illness among older patients: A systematic review and meta-analysis. Clin Nutr 2023; 42:309-336. [PMID: 36731161 DOI: 10.1016/j.clnu.2023.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/18/2022] [Accepted: 01/13/2023] [Indexed: 01/22/2023]
Abstract
BACKGROUND & AIMS Acute illness can lead to disability and reduced quality of life in older patients. The aim of this systematic review was to evaluate the effect of nutritional rehabilitation provided during and after hospitalisation for an acute event on functional status, muscle mass, discharge destination and quality of life of older patients. METHODS The protocol for this systematic review was registered in PROSPERO (CRD42021264971). Articles were searched using Scopus, Medline, Google Scholar and Clinical. TRIALS gov. For studies included in the meta-analysis, Hedges'g standardized mean difference effect size was calculated and transformed in odds ratios. RESULTS We identified 7383 articles, of which 45 publications (41 trials, n = 8538 participants, mean age 80.35 ± 7.01 years.) were eligible for the systematic review. Patients were hospitalized for acute medical diseases (n = 6925) and fractures (n = 1063). The interventions included supplementation with a fixed amount of oral nutritional supplements (ONS, n = 17 trials), individualized diet plan (n = 3), combination of physical exercise with nutrition therapy (n = 14 trials), combination of anabolic agents with nutrition therapy (n = 5 trials). Overall nutritional rehabilitation improved functional status (Odds ratio 1.63 [1.15; 2.3], p = 0.003) and muscle mass (Odds ratio 2.61 [1.22; 5.5], p = 0.01), but not the quality of life or the discharge destination. CONCLUSION Nutritional rehabilitation was found to improve functional status and muscle mass. There is a need for larger studies involving older hospitalized patients.
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Affiliation(s)
- Sylwia Szklarzewska
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
| | - Raphael Mottale
- Department of Internal Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Sandra De Breucker
- Department of Geriatric Medicine, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Jean-Charles Preiser
- Medical Direction, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Venkatraman K, Manoharan A. Public Engagement as the Fifth Dimension of Outbreak Communication: Public's Perceptions of Public Health Communication during COVID-19 in India. HEALTH COMMUNICATION 2023; 38:285-297. [PMID: 34294016 DOI: 10.1080/10410236.2021.1950294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Public health/risk communication is the foremost responsibility of a government during a pandemic. Risk communication aims to educate people, enhance their risk perceptions to help them engage and understand the benefits of compliance with recommendations. The existing legal enforcement of recommendations in India is criticized for failing to influence the public's compliance. While existing research provides conceptual and empirical support in explaining compliance during COVID-19, we note a lack of studies that might bring out country-specific areas of improvement. We argue that value-aligned risk communication is more likely to influence the public's behavioral intentions to adopt the government's recommendations. We employed a triangulation mixed-method study to link risk communication attributes to the public's end goals and values. We triangulate these findings using the COVID score survey. We found that timeliness and transparency constitute risk communication's functional component, and empathy and trust constitute risk communication's emotional component. We found a difference in the preference of functional and emotional components among the public and health partners. Irrespective of this divide in perception, the study found that both groups unanimously noted engagement as the crucial aspect for empowerment and involvement to aid the public in teaming with the government to combat the pandemic effectively.
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Affiliation(s)
- Krithika Venkatraman
- Faculty of Management Science, Sri Ramachandra Institute of Higher Education and Research (SRIHER)
| | - Anand Manoharan
- Department of Clinical Research, Kanchi Kamakoti CHILDS Trust Hospital
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MEDPass versus conventional administration of oral nutritional supplements - A randomized controlled trial comparing coverage of energy and protein requirements. Clin Nutr 2023; 42:108-115. [PMID: 36525797 DOI: 10.1016/j.clnu.2022.11.015] [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: 06/07/2022] [Revised: 10/20/2022] [Accepted: 11/21/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND & AIMS The use of oral nutritional supplements (ONS) in the hospital setting is important to reach individual protein and energy goals in patients at risk for malnutrition. Compliance with ONS can be challenging but may be improved by prescribing ONS in smaller portions with medication rounds (MEDPass). We compared the likelihood of meeting energy and protein requirements in patients receiving ONS with MEDPass versus conventional ONS administration. METHODS The MEDPass Trial is a randomized, controlled, open-label superiority trial conducted on medical and geriatric wards in a University Hospital in Switzerland. The MEDPass group was allocated to receive 50 ml of ONS four times per day with the medication rounds. The control group received ONS per conventional care between the meals. The primary outcome was the percentage of energy in relation to the individual requirement. Secondary outcomes included the coverage of protein intake in relation to the individual requirement, the amount of daily consumed ONS, the course of handgrip strength (HGS), body weight appetite and nausea. Furthermore, we compared 30-day mortality and hospital length of stay (LOS) was studied in medical patients. RESULTS From November 22nd, 2018 until November 30th, 2021, 204 patients were included in the trial (MEDPass group n = 100, control group n = 104). A total of 203 patients at nutritional risk were analyzed in the intention-to-treat analysis (ITT). Regarding the primary endpoint, there was no difference in the coverage of energy requirement between the MEDPass and control group (82 vs. 85% (Δ -3%, 95%CI -11 to 4%), p = 0.38). Similarly, no differences were found for the secondary outcomes including coverage of protein requirement (101 vs. 104% (Δ -3%, 95% CI -12 -7%), p = 0.57, average daily intake of ONS (170 vs 173 ml (Δ - 3 ml, 95% CI -14 to 8 ml), p = 0.58) and 30-day mortality (3 vs. 8 patients, OR 0.4 (95% CI 0.1-1.4), p = 0.15). The course of HGS, body weight, appetite and nausea did not differ between the groups (p = 0.29, p = 0.14, p = 0.65 and p = 0.94, respectively). The per protocol analysis including 178 patients showed similar results. CONCLUSION Within this controlled trial setting, we found a high compliance for ONS intake and high coverage of protein requirements but no further improvement when ONS was administered using MEDPass compared to conventional care. MEDPass administration may provide an alternative that is easy to integrate into nursing routines, which may lead to lower workload with cost benefits and reduction of food waste. TRIAL REGISTRATION ClinicalTrials.gov: NCT03761680.
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Thomson K, Rice S, Arisa O, Johnson E, Tanner L, Marshall C, Sotire T, Richmond C, O'Keefe H, Mohammed W, Gosney M, Raffle A, Hanratty B, McEvoy CT, Craig D, Ramsay SE. Oral nutritional interventions in frail older people who are malnourished or at risk of malnutrition: a systematic review. Health Technol Assess 2022; 26:1-112. [PMID: 36541454 PMCID: PMC9791461 DOI: 10.3310/ccqf1608] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Malnutrition worsens the health of frail older adults. Current treatments for malnutrition may include prescribed oral nutritional supplements, which are multinutrient products containing macronutrients and micronutrients. OBJECTIVE To assess the effectiveness and cost-effectiveness of oral nutritional supplements (with or without other dietary interventions) in frail older people who are malnourished or at risk of malnutrition. DATA SOURCES MEDLINE, EMBASE, Cochrane Library, Scopus, CINAHL (Cumulative Index to Nursing and Allied Health Literature) and grey literature were searched from inception to 13 September 2021. REVIEW METHODS A systematic review and meta-analysis was conducted to evaluate the effectiveness and cost-effectiveness of oral nutritional supplements in frail older people (aged ≥ 65 years) who are malnourished or at risk of malnutrition (defined as undernutrition as per National Institute for Health and Care Excellence guidelines). Meta-analysis and network meta-analysis were undertaken, where feasible, along with a narrative synthesis. A cost-effectiveness review was reported narratively. A de novo model was developed using effectiveness evidence identified in the systematic review to estimate the cost-effectiveness of oral nutritional supplements. RESULTS Eleven studies (n = 822 participants) were included in the effectiveness review, six of which were fully or partly funded by industry. Meta-analyses suggested positive effects of oral nutritional supplements compared with standard care for energy intake (kcal) (standardised mean difference 1.02, 95% confidence interval 0.15 to 1.88; very low quality evidence) and poor mobility (mean difference 0.03, p < 0.00001, 95% confidence interval 0.02 to 0.04; very low quality evidence) but no evidence of an effect for body weight (mean difference 1.31, 95% confidence interval -0.05 to 2.66; very low quality evidence) and body mass index (mean difference 0.54, 95% confidence interval -0.03 to 1.11; very low quality evidence). Pooled results for other outcomes were statistically non-significant. There was mixed narrative evidence regarding the effect of oral nutritional supplements on quality of life. Network meta-analysis could be conducted only for body weight and grip strength; there was evidence of an effect for oral nutritional supplements compared with standard care for body weight only. Study quality was mixed; the randomisation method was typically poorly reported. One economic evaluation, in a care home setting, was included. This was a well-conducted study showing that oral nutritional supplements could be cost-effective. Cost-effectiveness analysis suggested that oral nutritional supplements may only be cost-effective for people with lower body mass index (< 21 kg/m2) using cheaper oral nutritional supplements products that require minimal staff time to administer. LIMITATIONS The review scope was narrow in focus as few primary studies used frailty measures (or our proxy criteria). This resulted in only 11 included studies. The small evidence base and varied quality of evidence meant that it was not possible to determine accurate estimates of the effectiveness or cost-effectiveness of oral nutritional supplements. Furthermore, only English-language publications were considered. CONCLUSIONS Overall, the review found little evidence of oral nutritional supplements having significant effects on reducing malnutrition or its adverse outcomes in frail older adults. FUTURE WORK Future research should focus on independent, high-quality, adequately powered studies to investigate oral nutritional supplements alongside other nutritional interventions, with longer-term follow-up and detailed analysis of determinants, intervention components and cost-effectiveness. STUDY REGISTRATION This study is registered as PROSPERO CRD42020170906. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 51. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Katie Thomson
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Stephen Rice
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eugenie Johnson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Louise Tanner
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Christopher Marshall
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Tumi Sotire
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Catherine Richmond
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Hannah O'Keefe
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Wael Mohammed
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | | | - Anne Raffle
- Elders Council of Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Claire T McEvoy
- Centre for Public Health, Queen's University Belfast, Belfast, UK
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | - Dawn Craig
- Evidence Synthesis Group, Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Sheena E Ramsay
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Liljeberg E, Nydahl M, Lövestam E, Andersson A. 'Between foods and medicines': A qualitative interview study of patient experiences of the meaning and usage of oral nutritional supplements. Appetite 2022; 178:106163. [PMID: 35863507 DOI: 10.1016/j.appet.2022.106163] [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: 04/16/2022] [Revised: 07/03/2022] [Accepted: 07/08/2022] [Indexed: 11/02/2022]
Abstract
The aim of this study was to deepen the understanding of what oral nutritional supplements mean to patients and how this meaning connects to supplement usage, by exploring patient experiences of such supplements. Qualitative interviews were conducted in June 2019-March 2020 with ten patients with malnutrition or at nutritional risk, prescribed oral nutritional supplements by dietitians. Data were thematically analysed using systematic text condensation. Two final categories were identified: 'Oral nutritional supplements are a one-dimensional remedy' and 'Everyday oral nutritional supplement usage is regulated autonomously'. The patients described the meaning of oral nutritional supplements as nutrition. While the supplements could compensate for nutrients not eaten or be part of a helpful compensation strategy, they could not lessen the burden of altered eating. Supplement usage was described as dependent on the acceptance of taste and the priority given to nutrition in everyday life. Usage was greater when nutrients were perceived as needed, such as when striving for higher bodyweight or disease recovery. Usage was lower when a patient's own goals were not increased nutrient intake or bodyweight or when other activities were perceived as more important. Patient experiences indicated that oral nutritional supplements could serve as a remedy for malnutrition, but not for a situation of altered eating. Supplement usage was described as being regulated autonomously based on patient views on the importance of nutrition. Those views were diverse, highlighting the importance of supplement prescribers discussing treatment goals with each patient. A deeper understanding of the meaning of oral nutritional supplements and reasons for their usage from a patient perspective is crucial in order for healthcare to provide appropriate, effective nutrition therapy for malnutrition.
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Affiliation(s)
- Evelina Liljeberg
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden; Medical Unit Clinical Nutrition, Women's Health and Allied Health Professionals Theme, Karolinska University Hospital, Norrbacka S1:04, S-171 76, Stockholm, Sweden.
| | - Margaretha Nydahl
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
| | - Elin Lövestam
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
| | - Agneta Andersson
- Department of Food Studies, Nutrition and Dietetics, Uppsala University, S-752 37, Uppsala, Sweden.
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Lester S, Kleijn M, Cornacchia L, Hewson L, Taylor MA, Fisk I. Factors Affecting Adherence, Intake, and Perceived Palatability of Oral Nutritional Supplements: A Literature Review. J Nutr Health Aging 2022; 26:663-674. [PMID: 35842756 DOI: 10.1007/s12603-022-1819-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Oral nutritional supplements (ONS) are a clinically effective and relatively inexpensive way to supplement the diet of patients with, or at risk of, undernutrition. Good adherence is a primary determinant of the effectiveness of ONS. However adherence can be problematic for those with the greatest clinical need, such as undernourished older adults. This review aimed to appraise the available literature for the factors (contextual, personal and product related) affecting patient adherence and perceived palatability of ONS, identify areas requiring improvement and uncover gaps in the evidence to guide the focus of future research. Contextual factors identified were healthcare staff and the timing of administration. Personal factors included sensory changes and motivation which alter experience of and desire to consume ONS. The product's sensory characteristics determined palatability and intake, but undesirable attributes, such as off-flavours, can stem from nutritional ingredients. The contribution made by aroma to older adults' experience of ONS was a comparatively under-researched area. Further research should address this evidence gap to optimise the flavour, aroma profile and palatability for undernourished older consumers, thereby optimising intake. A combined multidisciplinary effort involving strategic expansion of research, industry development and clinical practice should simultaneously address the factors identified, to provide the best approach to improve adherence.
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Affiliation(s)
- S Lester
- Ian Fisk, University of Nottingham, Nottingham, Nottinghamshire, United Kingdom,
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Krebs F, Uhlmann K, Stanga Z, Kurmann S. Distribution of oral nutritional supplements with medication: Is there a benefit? A systematic review. Nutrition 2021; 96:111569. [PMID: 35074646 DOI: 10.1016/j.nut.2021.111569] [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: 08/09/2021] [Revised: 09/20/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Disease-related malnutrition remains a major burden for patients and health care systems. The Medication Pass Nutritional Supplement Program (MEDPass) involves providing patients with oral nutritional supplements (ONS) in unusually small amounts three to four times per day during medication rounds. This systematic review aims to evaluate the impact of MEDPass ONS administration on compliance, total energy and protein intake, food intake, body weight and handgrip strength in hospitalized adults and nursing-home residents. METHODS We conducted a systematic literature search in the databases MEDLINE, Embase, ScienceDirect, and the Cochrane Library and included randomized controlled trials (RCTs), non-RCTs, and before-after studies. Validated tools specific to the study design were used to assess the included studies. RESULTS Ten studies were identified, including two RCTs, three non-RCTs, and five before-after trials. Compliance increased by 23.4% to 66% with MEDPass administration, resulting in compliance rates of 72.7% to 96%. With MEDPass administration, body weight increased by 1% to 6.8% or remained stable. The assessed evidence on total energy intake is ambiguous for protein, with a trend toward an increased intake. Trials on energy intake from food show mixed results as well. One study suggested a slight increase in handgrip strength. The included studies predominantly raise concerns for bias. CONCLUSIONS We conclude that MEDPass ONS administration increases compliance in hospitalized adults and nursing-home residents. For all other outcomes, robust and well-powered trials are necessary.
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Affiliation(s)
- Fabian Krebs
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Katja Uhlmann
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland
| | - Silvia Kurmann
- Health Division, Nutrition and Dietetics, Bern University of Applied Sciences, Bern, Switzerland.
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Kurmann S, Reber E, Vasiloglou MF, Schuetz P, Schoenenberger AW, Uhlmann K, Sterchi AB, Stanga Z. Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial. Trials 2021; 22:210. [PMID: 33726841 PMCID: PMC7962290 DOI: 10.1186/s13063-021-05145-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 02/22/2021] [Indexed: 11/23/2022] Open
Abstract
Background Disease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization. Discussion To our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question. Trial registration ClinicalTrials.gov NCT03761680. Registered on 3 December 2018. Kofam.ch SNCTP000003191. Registered on 15 October 2018
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Affiliation(s)
- Silvia Kurmann
- Health Division, Department of Nutrition and Dietetics, Research and Development, Bern University of Applied Sciences, Murtenstrasse 10, CH-3010, Bern, Switzerland.
| | - Emilie Reber
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
| | - Maria F Vasiloglou
- AI in Health and Nutrition Laboratory, ARTORG Center for Biomedical Engineering Research, University of Bern, Murtenstrasse 50, CH-3008, Bern, Switzerland
| | - Philipp Schuetz
- Medical University Department, Clinic for Endocrinology, Diabetes and Metabolism, Division of General Internal and Emergency Medicine, Kantonsspital Aarau and Medical Faculty of the University of Basel, Tellstrasse H7, CH-5001, Aarau, Switzerland
| | - Andreas W Schoenenberger
- Department of Geriatrics, Inselspital, Bern University Hospital, and University of Bern, Tiefenaustrasse 112, CH-3004, Bern, Switzerland
| | - Katja Uhlmann
- Health Division, Department of Nutrition and Dietetics, Research and Development, Bern University of Applied Sciences, Murtenstrasse 10, CH-3010, Bern, Switzerland
| | - Anna-Barbara Sterchi
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
| | - Zeno Stanga
- Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, and University of Bern, Freiburgstrasse 15, CH-3010, Bern, Switzerland
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Brindisi MC, Noacco A, Boudaoud Hansal AA, Hugol-Gential C. Delivery of oral nutrition supplement in hospital: Evaluation of professional practices in evaluation of nutritional status and representations of ONS by the caregivers and patients. Clin Nutr ESPEN 2019; 35:85-89. [PMID: 31987126 DOI: 10.1016/j.clnesp.2019.11.005] [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: 03/22/2018] [Revised: 11/15/2019] [Accepted: 11/20/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Nutritional evaluation and detection of malnutrition are based on criteria recommended by French health authorities. In practice, doctors do not always ensure strict implementation of the recommendations. The aim of this study is to evaluate professional practices in France regarding nutritional follow-up on arrival, during and after the hospitalization of inpatients who have oral nutritional supplements (ONS) prescribed and to discuss how ONS are seen by medical staff and patients. METHODS A prospective study including patients consecutively admitted to digestive surgery and endocrinology units of the Dijon university hospital was conducted. Malnutrition risk at hospital admission was identified using anthropometric and biological criteria: Body Mass Index, percentage of weight loss, albumin, prealbumin, C-reactive protein and Mini Nutritional Assessment. Nutritional evaluation and monitoring of inpatients on arrival, during and after hospitalization was analyzed. Interviews were held with caregivers and patients to raise the question of their attitudes toward ONS. RESULTS The sample was composed of 61 patients. At the beginning of hospitalization, nutritional evaluation of patients was satisfactory. Follow-up during hospitalization was not optimal and depends on the degree of malnutrition. Post-hospitalization testing for albumin was rare, whereas ONS were regularly prescribed. ONS was viewed differently by caregivers and inpatients, which makes the status of ONS ambiguous. CONCLUSION Our results show good evaluation of nutritional status of inpatients at the beginning of hospitalization but low follow-up during and after hospitalization. Representation of ONS differed between caregivers and patients leading to a confusion around them. Therefore, interdisciplinary work is necessary to encourage systematic assessment of nutritional status in patients and standardize the message regarding ONS.
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Affiliation(s)
- Marie-Claude Brindisi
- Department of Diabetic Medicine and Endocrinology, Dijon University Hospital, 2 Bd Maréchal de Lattre of Tassigny, 21000 Dijon, France.
| | - Audrey Noacco
- Maison des Sciences de l'Homme, 6 Esplanade Erasme, University of Burgundy and Franche-Comté, 21000 Dijon, France; Laboratory CIMEOS EA 4177, 2 Boulevard Gabriel, University of Burgundy and Franche-Comté, 21000 Dijon, France.
| | - Amel Ait Boudaoud Hansal
- Department of Diabetic Medicine, Nutrition and Endocrinology, Georges-Pompidou European Hospital, 20 Rue Leblanc, 75015 Paris, France
| | - Clémentine Hugol-Gential
- Maison des Sciences de l'Homme, 6 Esplanade Erasme, University of Burgundy and Franche-Comté, 21000 Dijon, France; Laboratory CIMEOS EA 4177, 2 Boulevard Gabriel, University of Burgundy and Franche-Comté, 21000 Dijon, France.
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Regan E, O'Neill GJ, Hutchings SC, O'Riordan D. Exploring how age influences sensory perception, thirst and hunger during the consumption of oral nutritional supplements using the check-all-that-apply methodology. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2019.103736] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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den Boer A, Boesveldt S, Lawlor JB. How sweetness intensity and thickness of an oral nutritional supplement affects intake and satiety. Food Qual Prefer 2019. [DOI: 10.1016/j.foodqual.2018.08.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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den Uijl LC, Jager G, de Graaf C, Kremer S. Exploring the functional mealtime associations of older adults through consumer segmentation and a means-end chain approach. Appetite 2016; 107:613-622. [PMID: 27620646 DOI: 10.1016/j.appet.2016.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 08/11/2016] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Abstract
Senior consumers are a rapidly growing and highly heterogeneous part of the world's population. This group does not always meet its recommended protein intake, which can negatively impact on their physical functioning and quality of life. To date, little is known about their motivations to consume protein-rich meals. In the current study, we therefore aim to identify consumer segments within the group of vital community-dwelling older adults on the basis of mealtime functionality (for example 'I eat because I'm hungry', or 'I eat because it is cosy'). To this end, we first conducted an online survey to identify these functional mealtime expectations of older consumers (study I, n = 398, 158 males, mean age 65.8 (y) ± 5.9 (SD)). To obtain further insights regarding mealtime functionality and proteins/protein enrichment, laddering interviews were conducted with a subgroup of the segmentation study participants (study II, n = 40, 20 males, mean age 66.9 (y) ± 4.8 (SD)). The results of the online survey showed three consumer clusters: cosy socialisers, physical nutritioners, and thoughtless rewarders. Thoughtless rewarders tend to eat without having explicit thoughts about it, they eat for the reward, and score highest on environmental awareness. Both the segmentation and the in-depth interviews showed that, for the cosy socialisers, the cosiness and social function of a meal are important motivators, whereas for the physical nutritioners the focus is more on the health and nutrient aspects of a meal. For cosy socialisers, protein enrichment can best be achieved through addition of protein-rich ingredients, whereas, for physical nutritioners, addition of protein powder is preferred. These results provide practical guidelines for the development of protein-rich meals and communication strategies tailored to the needs of specific vital community-dwelling older subgroups.
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Affiliation(s)
- Louise C den Uijl
- Wageningen Food & Biobased Research, Consumer Science & Health, Bornse Weilanden 9, 6708 WG Wageningen, The Netherlands.
| | - Gerry Jager
- Wageningen University and Research, Department of Human Nutrition, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Cees de Graaf
- Wageningen University and Research, Department of Human Nutrition, Stippeneng 4, 6708 WE Wageningen, The Netherlands
| | - Stefanie Kremer
- Wageningen Food & Biobased Research, Consumer Science & Health, Bornse Weilanden 9, 6708 WG Wageningen, The Netherlands
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Lam IT, Keller HH, Pfisterer K, Duizer L, Stark K, Duncan AM. Micronutrient Food Fortification for Residential Care: A Scoping Review of Current Interventions. J Am Med Dir Assoc 2016; 17:588-95. [DOI: 10.1016/j.jamda.2016.03.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 03/09/2016] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
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