OBJECTIVE: Study aim was to determine the levels and barriers of the Nutrition Care Process (NCP), a practical method of individualized nutrition support.
METHODS: Delegate of registered dietitians (RDs) from acute-care hospitals answered our nationwide web-based questionnaire (April-June, 2023) to determine the implementation status of screening, assessment, intervention (including planning), and monitoring (components of the NCP).
RESULTS: Of 5,378 institutions contacted, 905 (16.8%) responded. For Screening, 80.0% screened all inpatients: primary personnel in charge were RDs (57.6%); the most used screening tool was Subjective Global Assessment (SGA) (49.2%). For Assessment, 66.1% assessed all inpatients: food intake (93.3%) was most evaluated whereas muscle mass and strength (13.0%, 8.8%) were least evaluated. For Intervention, 43.9% did so within 48h of hospital admission: oral nutritional supplement (92.9%) was the most common RDs intervention and parenteral nutrition (29.9%) was used less. For Monitoring, 18.5% of institutions had monitoring frequency of ≥ 3 times/week whilst 23.0% had monitoring less than once a week for severely malnourished patients. Energy and protein intake (93.7%, 84.3%) were most monitored and lipid intake (30.1%) was less monitored.
CONCLUSIONS: Barriers of NCP included inefficient staffing systems and unsuitable tools in Screening, inaccurate patient targeting and lack of important evaluation items in Assessment, delayed timing and incomplete contents in Intervention, and inadequate fre-quency and lack of important evaluation items in Monitoring. An increase in RDs staffing in acute-care general wards, widespread NCP instruction manuals, and education about the tools and evaluation items utilized in nutritional management are possible solutions.

Care transitions from hospital to home for older adults with malnutrition present a period of elevated risk; however, minimal data exist describing the existing practice. This study aimed to describe the transition of nutrition care processes provided to older adults in a public tertiary hospital in Australia. A retrospective chart audit conducted between July and October 2022 included older (≥65 years), malnourished adults discharged to independent living. Dietetic care practices (from inpatient to six-months post-discharge) were reported descriptively. Of 3466 consecutive admissions, 345 (10%) had a diagnosis of malnutrition documented by the dietitian and were included in the analysis. The median number of dietetic visits per admission was 2.0 (IQR 1.0-4.0). Nutrition-focused discharge plans were inconsistently developed and documented. Only 10% of patients had nutrition care recommendations documented in the electronic discharge summary. Post-discharge oral nutrition supplementation was offered to 46% and accepted by 34% of the patients, while only 23% attended a follow-up appointment with dietetics within six months of hospital discharge. Most patients who are seen by dietitians and diagnosed with malnutrition appear lost in transition from hospital to home. Ongoing work is required to explore determinants of post-discharge nutrition care in this vulnerable population.

Negative habits persist in contemporary society that can sometimes result in overweight or the deterioration of body image. This study aimed to assess the suitability of a nutritional and psychosocial intervention as part of an interdisciplinary approach to improve the perception of body image and increase the self-esteem of individuals who are overweight or obese. A total of 55 participants (25 men and 30 women) were included in this quasi-experimental intervention study. Measurements were taken as part of an ambulatory treatment to obtain values for weight, self-esteem, and body image perception using the Rosenberg scale and the Body Self-Esteem scale. At the end of the intervention and after one year, the weight reductions reached an average of 13.4 kg, positive self-image perception improved from a mean of 88.73 at pretest to 148.02 at follow-up, and self-esteem improved from a mean of 22.6 to 32.6. These were all statistically significant changes (p < 0.001). The model is effective in terms of weight reduction, together with improved levels of self-esteem and favorable perceptions of body image.

Background: Clinical nutritionists are responsible for nutritional therapy in clinical practice, which significantly enhances patients\' nutritional status. This study aims to develop and validate a competency evaluation scale to effectively assess the abilities of clinical nutritionists. Methods: The competency evaluation scale for clinical nutritionists was developed based on the iceberg model, utilizing literature review, semi-structured interviews, and the Delphi method. The weights of each indicator were calculated using the Analytic Hierarchy Process (AHP), and the validity and reliability of the scale were confirmed through questionnaire surveys. Results: The competency evaluation scale of clinical nutritionists comprised five primary indicators, twelve secondary indicators, and sixty-six tertiary indicators. The primary indicators, including professional theoretical knowledge, professional practical skills, humanistic practice ability, interpersonal communication ability, and professional development capability, have respective weights of 0.2168, 0.2120, 0.2042, 0.2022, and 0.1649. The Cronbach\'s α coefficients of the five dimensions of the scale were 0.970, 0.978, 0.969, 0.962, and 0.947, respectively. The results of the Exploratory Factor Analysis showed that the prerequisites for factor analysis were satisfied. Additionally, Bartlett\'s test of sphericity yielded a significance level of p < 0.001, confirming the scale\'s reliability and validity. Conclusions: The competency evaluation scale for clinical nutritionists developed in this study is of high scientific reliability and validity, which provides assessment criteria for the training and assessment of clinical nutritionists.

This study aims to review existing literature on the effect of oral nutritional supplements (ONSs) during chemotherapy in older cancer patients. Electronic databases were searched for relevant studies up to March 2024. The risk of bias in the included studies was evaluated using the Cochrane tool. Eligible studies included randomized, prospective, and retrospective studies evaluating the effect of ONSs in elderly (median age > 65 years) cancer patients during chemotherapy. Data regarding chemotherapy adherence, toxicity, overall survival, and nutritional status were extracted. A total of ten studies, involving 1123 patients, were included. A meta-analysis of the results was not conducted due to the scarcity and heterogeneity of results. Some ONSs were associated with reduced incidence of chemotherapy side-effects, particularly oral mucositis, and improved nutritional status. There was limited or no evidence regarding the impact of ONSs on chemotherapy adherence or overall survival. Various types of ONS were investigated, including multimodal intervention with tailored nutritional counseling, whey protein supplements, amino acids supplements (including immune nutrition supplements), and fish oil omega-3-enriched supplements. ONSs showed promise in reducing chemotherapy side-effects and improving nutritional status in older cancer patients, but further studies are needed to explore their efficacy on chemotherapy adherence and overall survival. Future research should consider both chronological age and frailty criteria, account for dietary habits, and use specific nutritional assessment like Bioelectrical Impedance Analysis.

BACKGROUND: Adequate nutrition is important for recovery after critical illness. Even so, our knowledge of patients\' nutritional intake after intensive care unit (ICU) discharge is scarce.
OBJECTIVE: We aimed to explore nutritional planning and achieved nutritional intake in ICU patients who transfer from the ICU to general wards.
METHODS: A retrospective quality assurance study.
METHODS: adult ICU patients transferring to a general ward at Copenhagen University Hospital-Herlev from May to August 2021. Primary outcomes were as follows: having a nutritional plan on the day of ICU transfer. A nutritional plan was defined as follows: (i) individual assessment of energy and protein requirement; (ii) intake, documented as achieved percentage of energy and protein requirements; (iii) prescribed type of nutrition. If using enteral or parenteral nutrition; (iv) the prescribed doses; and (v) the prescribed product. Secondary outcomes were as follows: achieved percentage of energy and protein requirements from day -1 before ICU transfer until day +1 and day +3 after ICU transfer.
RESULTS: We included 57 patients; the mean age was 64 years (±11.1); 43 (75%) patients were male; the median ICU stay was 6 days (interquartile range: 3-11). One (2%) patient had a full nutritional plan according to listed criteria. Patients\' median percentage of requirements met declined significantly from the day before to the day after ICU discharge (energy: from 94% to 30.5%; p = 0.0051; protein: from 73% to 27.5%; p = 0.0117). The decline in percentage of requirements met remained unchanged from day 1 to 3 after ICU transfer.
CONCLUSIONS: In conclusion, few patients had a nutritional plan when transferring from the ICU to a general ward. After ICU discharge, percentage of energy and protein requirements met declined significantly and remained insufficient during the first 3 days at the general ward.

OBJECTIVE: Hospitalized patients often have acute kidney disease (AKD) or chronic kidney disease (CKD), with important metabolic and nutritional consequences. Moreover, in case kidney replacement therapy (KRT) is started, the possible impact on nutritional requirements cannot be neglected. On this regard, the present guideline aims to provide evidence-based recommendations for clinical nutrition in hospitalized patients with KD.
METHODS: The standard operating procedure for ESPEN guidelines was used. Clinical questions were defined in both the PICO format, and organized in subtopics when needed, and in non-PICO questions for the more general topics. The literature search was from January 1st, 1999 until January 1st, 2020. Each question led to one or more recommendation/statement and related commentaries. Existing evidence was graded, as well as recommendations and statements were developed and agreed upon in a multistage consensus process.
RESULTS: The present guideline provides 32 evidence-based recommendations and 8 statements, defining how to assess nutritional status, how to define patients at risk, how to choose the route of feeding, and how to integrate nutrition with KRT. In the final online voting, a strong consensus was reached in 84% at least of recommendations and 100% of statements.
CONCLUSIONS: The presence of KD in hospitalized patients identifies a highly heterogeneous group of subjects with widely varying nutrient needs and intakes. Considering the high nutritional risk related with this clinical condition, an individualized approach consisting of nutritional status evaluation and monitoring, frequent evaluation of nutritional requirements, and careful integration with KRT should be planned to avoid both underfeeding and overfeeding. Practical recommendations and statements were developed, aiming at defining suggestions for everyday clinical practice in the individualization of nutritional support in this patient setting. Literature areas with scarce or without evidence were also identified, thus requiring further basic or clinical research.

Stroke patients often face disabilities that significantly interfere with their daily lives. Poor nutritional status is a common issue amongst these patients, and malnutrition can severely impact their functional recovery post-stroke. Therefore, nutritional therapy is crucial in managing stroke outcomes. However, its effects on disability, activities of daily living (ADL), and other critical outcomes have not been fully explored.
To evaluate the effects of nutritional therapy on reducing disability and improving ADL in patients after stroke.
We searched the trial registers of the Cochrane Stroke Group, CENTRAL, MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1982), and AMED (from 1985) to 19 February 2024. We also searched trials and research registries (ClinicalTrials.gov, World Health Organization International Clinical Trials Registry Platform) and reference lists of articles.
We included randomised controlled trials (RCTs) that compared nutritional therapy with placebo, usual care, or one type of nutritional therapy in people after stroke. Nutritional therapy was defined as the administration of supplemental nutrients, including energy, protein, amino acids, fatty acids, vitamins, and minerals, through oral, enteral, or parenteral methods. As a comparator, one type of nutritional therapy refers to all forms of nutritional therapies, excluding the specific nutritional therapy defined for use in the intervention group.
We used Cochrane\'s Screen4Me workflow to assess the initial search results. Two review authors independently screened references that met the inclusion criteria, extracted data, and assessed the risk of bias and the certainty of the evidence using the GRADE approach. We calculated the mean difference (MD) or standardised mean difference (SMD) for continuous data and the odds ratio (OR) for dichotomous data, with 95% confidence intervals (CIs). We assessed heterogeneity using the I2 statistic. The primary outcomes were disability and ADL. We also assessed gait, nutritional status, all-cause mortality, quality of life, hand and leg muscle strength, cognitive function, physical performance, stroke recurrence, swallowing function, neurological impairment, and the development of complications (adverse events) as secondary outcomes.
We identified 52 eligible RCTs involving 11,926 participants. Thirty-six studies were conducted in the acute phase, 10 in the subacute phase, three in the acute and subacute phases, and three in the chronic phase. Twenty-three studies included patients with ischaemic stroke, three included patients with haemorrhagic stroke, three included patients with subarachnoid haemorrhage (SAH), and 23 included patients with ischaemic or haemorrhagic stroke including SAH. There were 25 types of nutritional supplements used as an intervention. The number of studies that assessed disability and ADL as outcomes were nine and 17, respectively. For the intervention using oral energy and protein supplements, which was a primary intervention in this review, six studies were included. The results for the seven outcomes focused on (disability, ADL, body weight change, all-cause mortality, gait speed, quality of life, and incidence of complications (adverse events)) were as follows: There was no evidence of a difference in reducing disability when \'good status\' was defined as an mRS score of 0 to 2 (for \'good status\': OR 0.97, 95% CI 0.86 to 1.10; 1 RCT, 4023 participants; low-certainty evidence). Oral energy and protein supplements may improve ADL as indicated by an increase in the FIM motor score, but the evidence is very uncertain (MD 8.74, 95% CI 5.93 to 11.54; 2 RCTs, 165 participants; very low-certainty evidence). Oral energy and protein supplements may increase body weight, but the evidence is very uncertain (MD 0.90, 95% CI 0.23 to 1.58; 3 RCTs, 205 participants; very low-certainty evidence). There was no evidence of a difference in reducing all-cause mortality (OR 0.57, 95% CI 0.14 to 2.28; 2 RCTs, 4065 participants; low-certainty evidence). For gait speed and quality of life, no study was identified. With regard to incidence of complications (adverse events), there was no evidence of a difference in the incidence of infections, including pneumonia, urinary tract infections, and septicaemia (OR 0.68, 95% CI 0.20 to 2.30; 1 RCT, 42 participants; very low-certainty evidence). The intervention was associated with an increased incidence of diarrhoea compared to usual care (OR 4.29, 95% CI 1.98 to 9.28; 1 RCT, 4023 participants; low-certainty evidence) and the occurrence of hyperglycaemia or hypoglycaemia (OR 15.6, 95% CI 4.84 to 50.23; 1 RCT, 4023 participants; low-certainty evidence).
We are uncertain about the effect of nutritional therapy, including oral energy and protein supplements and other supplements identified in this review, on reducing disability and improving ADL in people after stroke. Various nutritional interventions were assessed for the outcomes in the included studies, and almost all studies had small sample sizes. This led to challenges in conducting meta-analyses and reduced the precision of the evidence. Moreover, most of the studies had issues with the risk of bias, especially in terms of the absence of blinding and unclear information. Regarding adverse events, the intervention with oral energy and protein supplements was associated with a higher number of adverse events, such as diarrhoea, hyperglycaemia, and hypoglycaemia, compared to usual care. However, the quality of the evidence was low. Given the low certainty of most of the evidence in our review, further research is needed. Future research should focus on targeted nutritional interventions to reduce disability and improve ADL based on a theoretical rationale in people after stroke and there is a need for improved methodology and reporting.

Esophageal achalasia is a disease characterized by esophageal motor dysfunction, leading to various symptoms, including vomiting and chest pain. There is no curative treatment for this disease, and the consensus on nutritional therapy or rehabilitation is unclear. Herein, we present the case of a 90-year-old woman with symptoms of esophageal achalasia, exacerbated by secondary sarcopenia and sarcopenic dysphagia after coronavirus disease 2019 (COVID-19) pneumonia. The patient presented with chest pain and vomiting while on a soft diet, and esophagography revealed typical esophageal achalasia. Her esophageal achalasia symptoms resolved, with improvements in nutritional status, skeletal muscle mass, and physical capacity, when a combination of nutritional and comprehensive rehabilitation therapies was adopted. This case highlights that oral dysphagia is associated with worsening esophageal achalasia symptoms and that nutritional and rehabilitative interventions are effective in relieving the symptoms of achalasia in patients with esophageal achalasia and sarcopenia.

BACKGROUND: Type-2 Diabetes Mellitus (T2D) is a growing concern worldwide, and family doctors are called to help diabetic patients manage this chronic disease, also with Medical Nutrition Therapy (MNT). However, MNT for Diabetes is usually standardized, while it would be much more effective if tailored to the patient. There is a gap in patient-tailored MNT which, if addressed, could support family doctors in delivering effective recommendations. In this context, decision support systems (DSSs) are valuable tools for physicians to support MNT for T2D patients - as long as DSSs are transparent to humans in their decision-making process. Indeed, the lack of transparency in data-driven DSS might hinder their adoption in clinical practice, thus leaving family physicians to adopt general nutrition guidelines provided by the national healthcare systems.
METHODS: This work presents a prototypical ontology-based clinical Decision Support System (OnT2D- DSS) aimed at assisting general practice doctors in managing T2D patients, specifically in creating a tailored dietary plan, leveraging clinical expert knowledge. OnT2D-DSS exploits clinical expert knowledge formalized as a domain ontology to identify a patient\'s phenotype and potential comorbidities, providing personalized MNT recommendations for macro- and micro-nutrient intake. The system can be accessed via a prototypical interface.
RESULTS: Two preliminary experiments are conducted to assess both the quality and correctness of the inferences provided by the system and the usability and acceptance of the OnT2D-DSS (conducted with nutrition experts and family doctors, respectively).
CONCLUSIONS: Overall, the system is deemed accurate by the nutrition experts and valuable by the family doctors, with minor suggestions for future improvements collected during the experiments.