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Delsoglio M, Griffen C, Syed R, Cookson T, Saliba H, Vowles A, Davies S, Willey N, Thomas J, Millen N, Odeh N, Longstaff J, Westran N, Allan L, Offer H, Howell C, Sanders M, Gaffigan K, Garrett K, Foster S, Salt A, Carter E, Moore S, Bergin N, Roper J, Alvarez J, Voss C, Connolly T, MacDonald C, Thrower T, Sills D, Baxter J, Manning R, Gray L, Voas K, Richardson S, Hurren AM, Murphy D, Blake S, McArdle P, Walsh S, Booth L, Albrich L, Ashley-Maguire S, Allison J, Brook S, Capener R, Hubbard GP, Stratton RJ. A multi-center prospective study of plant-based nutritional support in adult community-based patients at risk of disease-related malnutrition. Front Nutr 2023; 10:1297624. [PMID: 38024371 PMCID: PMC10667471 DOI: 10.3389/fnut.2023.1297624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction There is an emerging need for plant-based, vegan options for patients requiring nutritional support. Methods Twenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed. Results Patients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition ('MUST' score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p < 0.0001) and protein intake (+14 g/day (SD 39), p = 0.03), and the number of micronutrients meeting the UK reference nutrient intake (RNI) (7 vs. 14, p = 0.008) significantly increased. Appetite (Simplified Nutritional Appetite Questionnaire (SNAQ) score; p = 0.13) was maintained. Most GI symptoms were stable throughout the study (p > 0.06) with no serious adverse events related. Discussion This study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.
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Affiliation(s)
- Marta Delsoglio
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Corbin Griffen
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | | | | | | | - Amanda Vowles
- Trowbridge Health Centre, Trowbridge, United Kingdom
| | | | | | | | - Nicola Millen
- Cowplain Family Practice, Waterlooville, United Kingdom
| | - Nour Odeh
- Cowplain Family Practice, Waterlooville, United Kingdom
| | | | - Naomi Westran
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Lindsey Allan
- Department of Nutrition and Dietetics, Royal Surrey NHS Foundation Trust, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Hannah Offer
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Chloe Howell
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Meg Sanders
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Kirsty Gaffigan
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Kirby Garrett
- Dietetic Department, Thorpe Health Centre, Norfolk Community Health and Care NHS Trust, Norwich, United Kingdom
| | - Sally Foster
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Agnes Salt
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Emily Carter
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Sarah Moore
- Nutrition and Dietetic Department, North Tyneside District General Hospital, Tyne and Wear, United Kingdom
| | - Nick Bergin
- Department of Nutrition and Dietetics, Airedale General Hospital, Keighley, West Yorkshire, United Kingdom
| | - Jane Roper
- Warden Lodge Medical Practice, Cheshunt, United Kingdom
| | - Joe Alvarez
- Warden Lodge Medical Practice, Cheshunt, United Kingdom
| | | | | | | | | | - Darren Sills
- Nutrition and Dietetics, Nottingham University Hospitals NHS Trust, City Hospital Campus, Nottingham, United Kingdom
| | - Janet Baxter
- Department Nutrition and Dietetics, Kings Cross Hospital, Dundee, United Kingdom
| | - Rhonda Manning
- Department Nutrition and Dietetics, Kings Cross Hospital, Dundee, United Kingdom
| | - Lynsey Gray
- Dietetics, Victoria Integrated Care Centre, Helensburgh, United Kingdom
| | - Karen Voas
- Dietetic Department, Betsi Cadwaladr University Health Board, Denbighshire, United Kingdom
| | - Scot Richardson
- James Alexander Family Practice, Bransholme South Health Centre, Hull, United Kingdom
| | - Anne-Marie Hurren
- James Alexander Family Practice, Bransholme South Health Centre, Hull, United Kingdom
| | | | | | - Paul McArdle
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | - Sinead Walsh
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | - Lucy Booth
- Birmingham Community Nutrition, Birmingham, United Kingdom
| | | | | | | | - Sarah Brook
- Dietetics, Princess Royal Health Centre, Huddersfield, United Kingdom
| | - Rebecca Capener
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Gary P. Hubbard
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
| | - Rebecca J. Stratton
- Research & Innovation, Nutricia Ltd., Trowbridge, United Kingdom
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom
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Wang QC, Yuan H, Chen ZM, Wang J, Xue H, Zhang XY. Barriers and Facilitators of Adherence to Oral Nutritional Supplements Among People Living With Cancer: A Systematic Review. Clin Nurs Res 2023; 32:209-220. [PMID: 35707872 DOI: 10.1177/10547738221104216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
This study aims to synthesize the barriers and facilitators of oral nutritional supplement adherence in people with cancer and assess levels of adherence. Databases including Embase, PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, and Chinese Scientific Journal Database, were used to search articles before January 4, 2021. Eighteen studies with 1,267 participants met the inclusion criteria. All studies reported rates of adherence, ranging from 6.0% to 96.9%. Gastrointestinal intolerances and disliked tastes were considered common barriers to cancer patients' adherence, whereas the ONS management strategy was considered the most crucial facilitator of adherence. Health professionals can improve adherence through regular monitoring and guidance and incentive strategies, and paying attention to the management and prevention of adverse reactions when prescribing nutritional products.
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Affiliation(s)
| | - Hua Yuan
- Jilin University, Changchun, P.R. China
| | | | - Jia Wang
- Jilin University, Changchun, P.R. China
| | - Hui Xue
- Jilin University, Changchun, P.R. China
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Wang Q, Chen Y, Peng Y, Yuan H, Chen Z, Wang J, Xue H, Zhang X. Preferences of oral nutritional supplement therapy among postoperative patients with gastric cancer: Attributes development for a discrete choice experiment. PLoS One 2022; 17:e0275209. [PMID: 36174091 PMCID: PMC9522277 DOI: 10.1371/journal.pone.0275209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 09/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Adherence to oral nutritional supplement therapy among postoperative patients with gastric cancer is low. There is little knowledge about patients’ priorities and needs regarding oral nutritional supplement therapy. The discrete choice experiment is an innovative method used to elicit patients’ preferences. Good practice guidelines emphasize that the development of attributes and levels is a fundamentally important process. Objective To comprehensively describe the identification, refinement, and selection of attributes and levels for a discrete choice experiment. Methods A mixed-methods approach, consisting of three consecutive steps: a literature review, in-depth interviews, and focus groups. First, the literature review allowed quick identification of attributes and levels. Then, 15 in-depth interviews were conducted to gather a rich description of the experience of patients taking oral nutritional supplements after gastrectomy and to verify and enrich the attributes and levels list. Finally, four focus group participants discussed the wording of the attributes and levels and reduced the number of attributes to manageable numbers through voting ranking methods. Results Following the literature review and qualitative data collection, eight attributes were finally generated, each with two to three levels. The following attributes were included: 1) information provider; 2) health guidance approach; 3) adverse reactions; 4) flavor; 5) follow-up method; 6) follow-up frequency; 7) psychological support; 8) cost. These attributes covered the important attributes of nutritional preparations and health guidance included in ONS therapy that were relevant to patients. Conclusions This study’s mixed-methods approach has been found highly suitable to identify, refine and select attributes and levels for a discrete choice experiment. The three methods have pros and cons, and they complement each other, especially the analysis of qualitative data led to a deeper and broader understanding of attributes and levels.
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Affiliation(s)
- Qiuchen Wang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, PR China
| | - Yahong Chen
- Interventional Operating Room, China-Japan Union Hospital of Jilin University, Changchun, Jilin Province, PR China
| | - Yi Peng
- Department of Hematology, First Hospital of Jilin University, Changchun, Jilin Province, PR China
| | - Hua Yuan
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, PR China
| | - Zhiming Chen
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, PR China
| | - Jia Wang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, PR China
| | - Hui Xue
- Department of Histology and Embryology, College of Basic Medical Sciences, Jilin University, Changchun, Jilin Province, PR China
- * E-mail: (HX); (XZ)
| | - Xiuying Zhang
- Department of Fundamental Nursing, School of Nursing, Jilin University, Changchun, Jilin Province, PR China
- * E-mail: (HX); (XZ)
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The role of saliva in taste dysfunction among cancer patients: Mechanisms and potential treatment. Oral Oncol 2022; 133:106030. [PMID: 35868097 DOI: 10.1016/j.oraloncology.2022.106030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 06/21/2022] [Accepted: 07/15/2022] [Indexed: 01/17/2023]
Abstract
Two of the highest prevalent symptoms reported by cancer patients are taste dysfunction (17.6-93%) and dry mouth/xerostomia (40.4-93%). While it has been hypothesized that reduced saliva may impair taste function, few studies investigate the co-occurrence of taste and dry mouth symptoms in cancer patients. This review provides a summary of the physiological relationship between saliva and taste, focusing on taste transduction mechanism, regulation of the taste sensitivity, and protection of taste receptor cells, including the impact of cancer treatments and malignancy on saliva function, salivary components, and the mechanisms in which it can negatively impact the taste function. Here, the authors present a scoping review of the recent literature reporting on the association between taste dysfunction and dry mouth in cancer patients, including reports of non-pharmaceutical liposomal agents or drugs taken to improve dry mouth symptoms that also assess taste dysfunction. Considering the complexities of cancer and cancer treatment, understanding the physiological relationship between saliva and taste function may provide important insight into identifying treatments for alleviating taste dysfunction and dry mouth symptoms. There are substantial research gaps given the limited studies assessing the co-occurrence of taste loss and dry mouth and inconsistencies in the assessment of these symptoms. Clinical studies examining taste dysfunction will provide a foundational groundwork that will help understand the relationship between taste and saliva. Considering the increased rates in survivorship and the significant negative impact of taste dysfunction on quality of life, more research is needed to reduce the suffering of cancer patients.
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Fan Y, Yao Q, Liu Y, Jia T, Zhang J, Jiang E. Underlying Causes and Co-existence of Malnutrition and Infections: An Exceedingly Common Death Risk in Cancer. Front Nutr 2022; 9:814095. [PMID: 35284454 PMCID: PMC8906403 DOI: 10.3389/fnut.2022.814095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/24/2022] [Indexed: 12/16/2022] Open
Abstract
In nutrition science, malnutrition is a state of imbalance between intake and the needs of the organism, leading to metabolic changes, impaired physiological functions, and weight loss. Regardless of the countless efforts being taken and researched for years, the burden of malnutrition is still alarming and considered a significant agent of mortality across the globe. Around 45% of 12 million children deaths (0–5 years old) annually are due to malnutrition, mostly from developing countries. Malnutrition develops associations with other infections and leads to substantial clinical outcomes, such as mortality, more visits to hospitals, poor quality of life and physical frailty, and socioeconomic issues. Here, in this review, we intend to provide an overview of the current burden, underlying risk factors, and co-existence of malnutrition and other infections, such as cancer. Following the rising concern of the vicious interplay of malnutrition and other medical illnesses, we believed that this narrative review would highlight the need to re-make and re-define the future strategies by giving comprehensive and sustainable programs to alleviate poverty and combat the rampant infectious diseases and those nutrition-related health problems. Furthermore, the study also raises the concern for hospitalized malnourished cancer patients as it is crucially important to knowledge the caregiver healthcare staff for early interventions of providing nutritional support to delay or prevent the onset of malnutrition.
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Affiliation(s)
- Yuanyuan Fan
- School of Life Sciences, Henan University, Kaifeng, China
| | - Qianqian Yao
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Yufeng Liu
- Institute of Nursing and Health, Henan University, Kaifeng, China
| | - Tiantian Jia
- Institute of Nursing and Health, Henan University, Kaifeng, China
- DeDepartment of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, China
| | - Junjuan Zhang
- DeDepartment of Orthopedics, Henan Provincial People's Hospital, Zhengzhou, China
- Junjuan Zhang
| | - Enshe Jiang
- Institute of Nursing and Health, Henan University, Kaifeng, China
- Henan International Joint Laboratory for Nuclear Protein Regulation, Henan University, Kaifeng, China
- *Correspondence: Enshe Jiang
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Identification of aroma compounds in a commonly prescribed oral nutritional supplement and associated changes in olfactory abilities with human ageing. Sci Rep 2021; 11:16518. [PMID: 34389768 PMCID: PMC8363706 DOI: 10.1038/s41598-021-95915-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/13/2021] [Indexed: 01/13/2023] Open
Abstract
Undernutrition is prevalent in the older adult population. Oral nutritional supplements (ONS) are a clinically effective nutritional intervention, however, patient acceptance of ONS can be limited by their palatability. While sensory attributes such as sweetness and mouthfeel have been investigated, the contribution made by aroma to the perceived flavour of ONS has not been studied. Firstly, this research aimed to identify the aroma active compounds within a commonly prescribed ONS using estimated odour activity values (OAV) and gas chromatography olfactometry mass spectrometry (GC-O-MS). Secondly, age related differences in olfactory detection were explored. Eight aroma active compounds were identified within the ONS, including diacetyl (sweet), isoamyl acetate (banana), dimethyl trisulfide (sulfur) and methanethiol (sulfur). When compared with younger adults (n = 24, 18–44 years), older adults (n = 24, 62–80 years) had higher detection thresholds for all aroma compounds and this was significant for isoamyl acetate (sweet, fruity) and methanethiol (sulfur) (p = 0.01 and p = 0.03, respectively). Thus, a decline in olfactory sensitivity was present in the older subjects included in the study, and this reduced detection sensitivity was aroma specific. Thus, older adults’ flavour perception of ONS likely depends on the combined effect of product factors (the aroma profile) along with age related consumer factors (the degree of impairment in perception). This is a fundamental study which will aid future research into how the aroma profile, and associated age related impairments in perception, shape the global perception of ONS for nutritionally at risk older individuals.
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Enriquez Fernandez BE, Klassen P, Mazurak V, Chen L, Prado CM, Wismer WV. Acceptance of oat-based beverages tailored for patients with cancer. J Food Sci 2021; 86:2671-2683. [PMID: 34096063 DOI: 10.1111/1750-3841.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 03/11/2021] [Accepted: 04/19/2021] [Indexed: 12/12/2022]
Abstract
Oat-based beverages are a nutritious product with the potential to support increased nutrient intake of patients with cancer. The aim of this research was to evaluate the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer as future vehicles for nutrient delivery. In study 1, three flavors of oat-beverages were well accepted without significant difference in liking among flavors or serving temperature, or between patients with cancer and healthy participants. Patients with cancer more frequently rated the beverages as too sweet compared to healthy participants; flavor intensity was just about right for all participants. In the second study, one of two formulations fortified with protein and fish oil was not different in liking compared to the unfortified chocolate product. Patients associated oat food products with specific oat-based food products and oat health benefits in a free-word association task in the third study. Together, sensory acceptance and the perceived health benefits of oats indicate the potential for oats to be incorporated in fortified and unfortified products tailored for patients with cancer. PRACTICAL APPLICATION: The three studies presented here to assess the sensory acceptance of oat-based beverages and perceptions of oats among patients with cancer demonstrate that oats can be incorporated in fortified and unfortified products tailored for patients with cancer. Inadequate nutrition is highly prevalent among oncology patients and there is a lack of available products targeted to improve their nutritional intake. These findings can support product developers and sensory scientists in the development and evaluation of food products acceptable to this population.
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Affiliation(s)
| | - Pamela Klassen
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Vera Mazurak
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Lingyun Chen
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy V Wismer
- Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
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Wang C, Chen X, Nakamura Y, Yu C, Qi H. Fucoxanthin activities motivate its nano/micro-encapsulation for food or nutraceutical application: a review. Food Funct 2020; 11:9338-9358. [PMID: 33151231 DOI: 10.1039/d0fo02176h] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Fucoxanthin is a xanthophyll carotenoid abundant in marine brown algae. The potential therapeutic effects of fucoxanthin on tumor intervention have been well documented, which have aroused great interests in utilizing fucoxanthin in functional foods and nutraceuticals. However, the utilization of fucoxanthin as a nutraceutical in food and nutrient supplements is currently limited due to its low water solubility, poor stability, and limited bioaccessibility. Nano/micro-encapsulation is a technology that can overcome these challenges. A systematic review on the recent progresses in nano/micro-delivery systems to encapsulate fucoxanthin in foods or nutraceuticals is warranted. This article starts with a brief introduction of fucoxanthin and the challenges of oral delivery of fucoxanthin. Nano/micro-encapsulation technology is then covered, including materials and strategies for constructing the delivery system. Finally, future prospective has been discussed on properly designed oral delivery systems of fucoxanthin for managing cancer. Natural edible materials such as whey protein, casein, zein, gelatin, and starch have been successfully utilized to fabricate lipid-based, gel-based, or emulsion-based delivery systems, molecular nanocomplexes, and biopolymer nanoparticles with the aid of advanced processing techniques, such as freeze-drying, high pressure homogenization, sonication, anti-solvent precipitation, coacervation, ion crosslinking, ionic gelation, emulsification, and enzymatic conjugation. These formulated nano/micro-capsules have proven to be effective in stabilizing and enhancing the bioaccessibility of fucoxanthin. This review will inspire a surge of multidisciplinary research in a broader community of foods and motivate material scientists and researchers to focus on nano/micro-encapsulated fucoxanthin in order to facilitate the commercialization of orally-deliverable tumor intervention products.
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Affiliation(s)
- Chunyan Wang
- School of Food Science and Technology, Dalian Polytechnic University, National Engineering Research Center of Seafood, Dalian 116034, P. R. China.
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