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Loeliger J, Dewar S, Kiss N, Dumbrell J, Elliott A, Kaegi K, Kelaart A, McIntosh R, Swan W, Stewart J. Co-design of a cancer nutrition care pathway by patients, carers, and health professionals: the CanEAT pathway. Support Care Cancer 2023; 31:99. [PMID: 36609614 PMCID: PMC9825355 DOI: 10.1007/s00520-022-07558-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/21/2022] [Indexed: 01/08/2023]
Abstract
PURPOSE Limited practical resources exist to guide optimal nutrition care for patients, carers, and health professionals (HPs). This study aimed to co-design a cancer nutrition care pathway to guide and improve the provision of consistent, evidence-based care with consumers and HPs. METHODS This study utilised an experienced-based co-design (EBCD) approach over five stages. Stage 1 involved stakeholder engagement and a literature review. Stage 2 included a survey and focus groups with patients/carers. Co-design workshops were conducted within stage 3, key stakeholder consultation within stage 4, and the finalisation and dissemination of the cancer nutrition care pathway formed stage 5. Results of stages 3 to 5 are the focus of this paper. RESULTS Two co-design workshops were held with patients, carers, and HPs (n = 32 workshop 1; n = 32 workshop 2), who collectively agreed on areas of focus and key priorities. Following this, a consultation period was completed with patients, carers, and HPs (n = 45) to refine the pathway. The collective outcome of all study stages was the co-design of a cancer nutrition care pathway (the CanEAT pathway) defining optimal cancer nutrition care that combines evidence-based practice tips into a centralised suite of resources, tools, and clinical guidance. CONCLUSION The CanEAT pathway was co-designed by patients, carers, and HPs. The EBCD approach is a meaningful way to develop targeted improvements in cancer care. The CanEAT pathway is freely available to guide and support patients, carers, and HPs to aid the implementation of optimal nutrition care into clinical practice.
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Affiliation(s)
- Jenelle Loeliger
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
| | - Sarah Dewar
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
- Dietetics Department, Eastern Health, Melbourne, VIC Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC Australia
| | - Jodi Dumbrell
- Australian Cancer Survivorship Centre, Peter MacCallum Cancer Centre, Melbourne, VIC Australia
| | - Andrea Elliott
- Dietetics Department, Eastern Health, Melbourne, VIC Australia
| | - Kate Kaegi
- Nutrition Department, Austin Health, Heidelberg, VIC Australia
| | | | | | - Wendy Swan
- Nutrition & Dietetics, Goulburn Valley Health, Shepparton, VIC Australia
| | - Jane Stewart
- Nutrition & Speech Pathology Department, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC 3000 Australia
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Deftereos I, Hitch D, Butzkueven S, Carter V, Arslan J, Fetterplace K, Fox K, Ottaway A, Pierce K, Steer B, Varghese J, Kiss N, Yeung J. Implementation of a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a multi-site pilot study. J Hum Nutr Diet 2022; 36:479-492. [PMID: 35441757 DOI: 10.1111/jhn.13018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/08/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Perioperative nutrition support is recommended for patients undergoing upper gastrointestinal (UGI) cancer surgery; however, limited evidence exists regarding implementation of a nutrition care pathway in clinical practice. The aims of this pilot study were to determine if implementation of a standardised perioperative nutrition pathway for patients undergoing UGI cancer surgery improves access to dietetics care, and to evaluate study feasibility, fidelity, resource requirements and effect on clinical outcomes. METHODS Patients with newly diagnosed UGI cancer from four major metropolitan hospitals in Melbourne, planned for curative intent surgery, were included in the prospective pilot study (n=35), with historical controls (n=35) as standard care. Outcomes were dietetics care (dietetics contacts) nutritional status; hand grip strength; weight change; preoperative hospital admissions; complications and length of stay; recruitment feasibility; fidelity and adherence; and, resource requirements. Continuous data were analysed using independent samples t-test accounting for unequal variances or Mann-Whitney U test. Dichotomous data were analysed using Fisher's exact test. RESULTS The percentage of participants receiving preoperative dietetic intervention increased from 55% to 100% (p<0.001). Mean and standard deviation (SD) dietetics contacts increased from 2.2 (3.7) to 5.9 (3.9) (p<0.001). Non-statistically significant decreases in preoperative nutrition-related hospital admissions, and surgical complications were demonstrated in patients who underwent neoadjuvant therapy. Recruitment rate was 81%, and adherence to the nutrition pathway was high (>70% for all stages of the pathway). The mean estimated resource requirement for the preoperative period was 3.7 (2.8) hours per patient. CONCLUSION Implementation of this standardised nutrition pathway resulted in improved access to dietetics care. Recruitment feasibility and high fidelity to the intervention suggest that a larger study would be viable. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Danielle Hitch
- Allied Health, Western Health, Melbourne, Australia.,Occupational Therapy, Western Health, Melbourne, Australia
| | - Sally Butzkueven
- Department of Cancer Services, Western Health, Melbourne, Australia
| | - Vanessa Carter
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fox
- Department of Nutrition and Dietetics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Aurora Ottaway
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kathryn Pierce
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jessie Varghese
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Justin Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia.,Department of Colorectal Surgery, Western Health, Melbourne, Australia
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Development and Feasibility of an Inpatient Cancer-Related Sarcopenia Pathway at a Major Cancer Centre. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074038. [PMID: 35409719 PMCID: PMC8997788 DOI: 10.3390/ijerph19074038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 03/26/2022] [Accepted: 03/27/2022] [Indexed: 11/17/2022]
Abstract
Cancer-related sarcopenia is a complex condition; however, no cancer-specific clinical model is available to guide clinical practice. This study aims to (1) develop an evidence-based care pathway for the management of cancer-related sarcopenia (“sarc-pathway”) and (2) pilot test the feasibility (reach, intervention fidelity, patient and clinician acceptability) of the sarc-pathway in an inpatient cancer ward. The sarc-pathway was developed using a care pathway format and informed by the current literature. Patients admitted to a 32-bed inpatient cancer ward were recruited to receive sarc-pathway care and the feasibility outcomes were assessed. Of the 317 participants admitted, 159 were recruited over 3.5-months (median age 61 years; 56.0% males). Participant consent was high (99.4% of those approached) and 30.2% were at risk of/had sarcopenia. The sarc-pathway screening, assessment and treatment components were delivered as intended; however, low completion of clinical assessment measures were observed for muscle mass (bioimpedance spectroscopy, 20.5%) and muscle function (5-times chair stand test, 50.0%). The sarc-pathway was demonstrated to be acceptable to patients and multidisciplinary clinicians. In an inpatient cancer ward, the sarc-pathway is a feasible and acceptable clinical model and method to deliver and adhere to the sarcopenia clinical parameters specified, albeit with further exploration of appropriate clinical assessment measures.
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Deftereos I, Hitch D, Butzkueven S, Carter V, Fetterplace K, Fox K, Ottaway A, Pierce K, Steer B, Varghese J, Kiss N, Yeung JM. Implementing a standardised perioperative nutrition care pathway in upper gastrointestinal cancer surgery: a mixed-methods analysis of implementation using the Consolidated Framework for Implementation Research. BMC Health Serv Res 2022; 22:256. [PMID: 35209897 PMCID: PMC8876395 DOI: 10.1186/s12913-022-07466-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Background Implementation studies of complex interventions such as nutrition care pathways are important to health services research, as they support translation of research into practice. There is limited research regarding implementation of a nutrition care pathway in an upper gastrointestinal (UGI) cancer population. The aim of this study was to comprehensively evaluate the implementation process of a perioperative nutrition care pathway in UGI cancer surgery using The Consolidated Framework for Implementation Research (CFIR). Methods This was a mixed methods implementation study conducted during a pilot study of a standardised nutrition care pathway across four major hospitals between September 2018 to August 2019. Outcome measures included five focus groups among study dietitians (n = 4–8 per group), and quantitative satisfaction surveys from multi-disciplinary team (MDT) members (n = 14) and patients (n = 18). Focus group responses were analysed thematically using the CFIR constructs, which were used as a priori codes. Survey responses were summarised using means and standard deviations. A convergent parallel mixed methods approach according to CFIR domains and constructs was used to integrate qualitative and quantitative data. Results Qualitative data demonstrated that dietitian perceptions primarily aligned with five CFIR constructs (networks and communications, structural characteristics, adaptability, compatibility and patient needs/resources), indicating a complex clinical and implementation environment. Challenges to implementation mostly related to adapting the pathway, and the compatibility of nutrition coordination to existing aspects of care within each setting. Identified benefits from dietitian qualitative data and MDT survey responses included increased engagement between the dietitian and MDT, and a more proactive approach to nutrition care. Patients were highly satisfied with the service, with the majority of survey items being rated highly (≥4 of a possible 5 points). Conclusions The nutrition care pathway was perceived to be beneficial by key stakeholders. Based on the findings, sustainability and compliance to this model of care may be achieved with improved systems level coordination and communication.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia. .,Department of Nutrition and Dietetics, Western Health, Melbourne, Australia.
| | - Danielle Hitch
- Allied Health, Western Health, Melbourne, Australia.,Occupational Therapy, Deakin University, Geelong, Australia
| | | | - Vanessa Carter
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kate Fetterplace
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia.,Department of Medicine and Radiology, Melbourne Medical School, The University of Melbourne, Royal Melbourne Hospital, Melbourne, Australia
| | - Kate Fox
- Department of Nutrition and Dietetics, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - Aurora Ottaway
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Kathryn Pierce
- Department of Nutrition and Dietetics, Western Health, Melbourne, Australia
| | - Belinda Steer
- Nutrition and Speech Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jessie Varghese
- Department of Allied Health (Clinical Nutrition), The Royal Melbourne Hospital, Melbourne, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.,Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Justin M Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, Melbourne, Australia.,Western Health Chronic Disease Alliance, Western Health, Melbourne, Australia.,Department of Colorectal Surgery, Western Health, Melbourne, Australia.,Sunshine Hospital, Level 3, WCHRE Building, 176 Furlong Rd, St Albans, VIC, 3021, Australia
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Deftereos I, Yeung JMC, Arslan J, Carter VM, Isenring E, Kiss N. Preoperative Nutrition Intervention in Patients Undergoing Resection for Upper Gastrointestinal Cancer: Results from the Multi-Centre NOURISH Point Prevalence Study. Nutrients 2021; 13:nu13093205. [PMID: 34579082 PMCID: PMC8467838 DOI: 10.3390/nu13093205] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/09/2021] [Accepted: 09/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background: Preoperative nutrition intervention is recommended prior to upper gastrointestinal (UGI) cancer resection; however, there is limited understanding of interventions received in current clinical practice. This study investigated type and frequency of preoperative dietetics intervention and nutrition support received and clinical and demographic factors associated with receipt of intervention. Associations between intervention and preoperative weight loss, surgical length of stay (LOS), and complications were also investigated. Methods: The NOURISH Point Prevalence Study was conducted between September 2019 and May 2020 across 27 Australian tertiary centres. Subjective global assessment and weight were performed within 7 days of admission. Patients reported on preoperative dietetics and nutrition intervention, and surgical LOS and complications were recorded. Results: Two-hundred patients participated (59% male, mean (standard deviation) age 67 (10)). Sixty percent had seen a dietitian preoperatively, whilst 50% were receiving nutrition support (92% oral nutrition support (ONS)). Patients undergoing pancreatic surgery were less likely to receive dietetics intervention and nutrition support than oesophageal or gastric surgeries (p < 0.001 and p = 0.029, respectively). Neoadjuvant therapy (p = 0.003) and malnutrition (p = 0.046) remained independently associated with receiving dietetics intervention; however, 31.3% of malnourished patients had not seen a dietitian. Patients who received ≥3 dietetics appointments had lower mean (SD) percentage weight loss at the 1-month preoperative timeframe compared with patients who received 0–2 appointments (1.2 (2.0) vs. 3.1 (3.3), p = 0.001). Patients who received ONS for >2 weeks had lower mean (SD) percentage weight loss than those who did not (1.2 (1.8) vs. 2.9 (3.4), p = 0.001). In malnourished patients, total dietetics appointments ≥3 was independently associated with reduced surgical complications (odds ratio 0.2, 95% confidence interval (CI) 0.1, 0.9, p = 0.04), and ONS >2 weeks was associated with reduced LOS (regression coefficient −7.3, 95% CI −14.3, −0.3, p = 0.04). Conclusions: Despite recommendations, there are low rates of preoperative dietetics consultation and nutrition support in this population, which are associated with increased preoperative weight loss and risk of increased LOS and complications in malnourished patients. The results of this study provide insights into evidence–practice gaps for improvement and data to support further research regarding optimal methods of preoperative nutrition support.
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Affiliation(s)
- Irene Deftereos
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia;
- Correspondence: ; Tel.: +61-3-8395-8116
| | - Justin M.-C. Yeung
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
- Department of Colorectal Surgery, Western Health, Footscray, VIC 3011, Australia
- Western Health Chronic Disease Alliance, Western Health, Footscray, VIC 3011, Australia
| | - Janan Arslan
- Department of Surgery, Western Precinct, Melbourne Medical School, The University of Melbourne, St Albans, VIC 3021, Australia; (J.M.-C.Y.); (J.A.)
| | - Vanessa M. Carter
- Department of Nutrition and Dietetics, Western Health, Footscray, VIC 3011, Australia;
| | - Elizabeth Isenring
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226, Australia;
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, QLD 4102, Australia
| | - Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia;
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, VIC 3000, Australia
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Chakravarthy MV, Waddell T, Banerjee R, Guess N. Nutrition and Nonalcoholic Fatty Liver Disease: Current Perspectives. Gastroenterol Clin North Am 2020; 49:63-94. [PMID: 32033765 DOI: 10.1016/j.gtc.2019.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis are diseases in their own right as well as modifiable risk factors for cardiovascular disease and type 2 diabetes. With expanding knowledge on NAFLD pathogenesis, insights have been gleaned into molecular targets for pharmacologic and nonpharmacologic approaches. Lifestyle modifications constitute a cornerstone of NAFLD management. This article reviews roles of key dietary macronutrients and micronutrients in NAFLD pathogenesis and their effects on molecular targets shared with established or emerging pharmacotherapies. Based on current evidence, a recommendation for a dietary framework as part of the comprehensive management strategy for NAFLD is provided.
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Affiliation(s)
| | - Thomas Waddell
- Perspectum Diagnostics, 23-38 Hythe Bridge Street, Oxford OX1 2ET, UK
| | - Rajarshi Banerjee
- Perspectum Diagnostics, 23-38 Hythe Bridge Street, Oxford OX1 2ET, UK; Oxford University Hospitals NHS Foundation Trust, Headley Way, Headington, Oxford OX3 9DU, UK
| | - Nicola Guess
- King's College London, 150 Stamford Street, London SE1 9NH, UK; University of Westminster, 101 New Cavendish St, Fitzrovia, London W1W 6XH, United Kingdom
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HyperFoods: Machine intelligent mapping of cancer-beating molecules in foods. Sci Rep 2019; 9:9237. [PMID: 31270435 PMCID: PMC6610092 DOI: 10.1038/s41598-019-45349-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/03/2019] [Indexed: 01/02/2023] Open
Abstract
Recent data indicate that up-to 30–40% of cancers can be prevented by dietary and lifestyle measures alone. Herein, we introduce a unique network-based machine learning platform to identify putative food-based cancer-beating molecules. These have been identified through their molecular biological network commonality with clinically approved anti-cancer therapies. A machine-learning algorithm of random walks on graphs (operating within the supercomputing DreamLab platform) was used to simulate drug actions on human interactome networks to obtain genome-wide activity profiles of 1962 approved drugs (199 of which were classified as “anti-cancer” with their primary indications). A supervised approach was employed to predict cancer-beating molecules using these ‘learned’ interactome activity profiles. The validated model performance predicted anti-cancer therapeutics with classification accuracy of 84–90%. A comprehensive database of 7962 bioactive molecules within foods was fed into the model, which predicted 110 cancer-beating molecules (defined by anti-cancer drug likeness threshold of >70%) with expected capacity comparable to clinically approved anti-cancer drugs from a variety of chemical classes including flavonoids, terpenoids, and polyphenols. This in turn was used to construct a ‘food map’ with anti-cancer potential of each ingredient defined by the number of cancer-beating molecules found therein. Our analysis underpins the design of next-generation cancer preventative and therapeutic nutrition strategies.
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Liu L, Hong YL, Liu GY. Role of rational diet in postoperative treatment of gastric cancer and application prospect of traditional Chinese medicine diet. Shijie Huaren Xiaohua Zazhi 2018; 26:2057-2063. [DOI: 10.11569/wcjd.v26.i35.2057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The toxic side effects of postoperative radiotherapy and chemotherapy in gastric cancer (GC) often cause patients to have cancer cachexia and poor quality of life. Dietary adjuvant therapy can significantly promote GC patients to recover the body function, alleviate inflammation, improve anticancer treatment tolerance, improve postoperative quality of life and prolong survival. Given the advantages of diet in the postoperative treatment of GC, this paper discusses the role of modern medicine's elemental nutrition diet and traditional Chinese medicine diet in the postoperative treatment of GC, which can help clinicians better understand traditional Chinese medicine treatment in relieving the overall dysfunction of the body. Furthermore, the combination of traditional Chinese medicine diet with the modern medical nutrition diet evaluation system can expand the use of traditional Chinese medicine diet in the clinical treatment of GC.
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Affiliation(s)
- Lei Liu
- School of Pharmaceutical Sciences Xiamen University, Huayan Science and Technology Cancer Prevention and Rehabilitation Research Center, Xiamen 361000, Fujian Province, China
| | - Yu-Ling Hong
- School of Pharmaceutical Sciences Xiamen University, Huayan Science and Technology Cancer Prevention and Rehabilitation Research Center, Xiamen 361000, Fujian Province, China
| | - Guo-Yan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, Xiamen 361000, Fujian Province, China
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