Tuesday, April 29, 2014

New Trends in nutritional status assessment in cancer patients

This study is from the European review for Medical and Pharmacological Sciences. Cancer is currently the most frequent cause of morbidity and mortality in Europe. Often in cancer patients weight loss and nutritional status are a large concern for those on the team that takes care of a patient. The definition of malnutrition is stated as, " a subacute or chronic state of nutrition in which varying degrees of over or undernutrition and inflammation activity have lead to a change in the body composition and function." In cancer patients if there is severe malnutrition there are associated complications to treatment that are often seen. Cancer patients have also been noted to suffer from cachexia, " a complex metabolic syndrome associated with underlying illness and characterized by muscle loss with or without loss of fat." These two forms of malnutrition in general are the same thing with very similar effects on the patient. If the patient is suffering from a poor nutrition status the prognosis and treatment methods can be compromised. That is why assessing the patient for nutritional status along with the oncology team is very important in treating the patient.  The dietitian should be looking for the following:

  • Dietary Assessment- or food recall of daily diet that is being consumed
  • Physical Examination- muscle mass/ strength, evidence of liver disease, vitamin or mineral deficiency, to give classification of a well nourished to severely malnourished patient
  • Nutrition Index or Lab Values: protein protein undernutrition or protein-energy-undernutrition, found through serum albumin levels, anthropometrics 
  • Cancer Assessment: impact of tumor, nutrition status and anti-cancer treatments
The dietitians responsibility is to monitor and evaluate the patient based on these parameters to help maintain optimal nutritional status in the patient.This assessment should be used in ever anti-cancer treatment plan to reduce hospital stays along with increasing nutritional status. 
This article can be used as a guide for dietitians that need more advancement on assessing a cancer patient. 


Statins Users have Increased the Amount of Calories and Fat in 10 years

Researchers have found that Americans that are taking statin have increased the amount of calories and fat during the 2009-2010 year than in the past ten years. Statins are cholesterol lowering drugs that inhibits the HMG-CoA reductase enzyme, which plays a role in producing cholesterol in the liver. Researchers found that the increase of fat and calories were only among those that are taking satins. According to National Center for Global Health and Medicine in Japan, "We may need to re-emphasize the importance of dietary modification for those who are taking these medications, now that obesity and diabetes are important problems in society". Patients are usually put on statins when obesity and high cholesterol are already an issue for the patient.

Does the use of statins entitle patients not to change their lifestyle and behavior modifications since the drug will work to lower the amount of cholesterol even though they are receiving large amounts through diet?




Monday, April 28, 2014

New Hospital Malnutrition Standardized Guidelines

Hospital Malnutrition Standardized Guidelines

Malnutrition remains a serious problem in hospitals today. It is estimated that one in three patients enter the hospital malnourished and if left untreated will experience significant decline in their condition. It is also estimated that one in three patients becomes malnourished during their hospital stay which severely compromises their short and long term outcomes. Malnutrition contributes to pressure ulcers, poor wound healing, infection, longer hospital stays, and readmissions which all create higher health care costs.
These serious consequences of malnutrition have led dietitians to improve nutritional assessments and allot more time to spend monitoring malnourished or at-risk patients. With current policy changes in our healthcare system promoting affordable care, there is a need to emphasize the role that nutrition therapy plays in patient care. Five organizations have launched a partnership to improve patient outcomes through nutrition intervention in hospital settings. These organizations include the Academy of Medical-Surgical Nurses, The Academy of Nutrition and Dietetics, the American Society for Parenteral and Enteral Nutrition, The Society of Hospital Medicine, and Abbott Nutrition.
These parties have worked together to establish a more standardized guideline for diagnosing malnutrition in order to deliver quality, time-sensitive care. It has been proposed that malnutrition be diagnosed from six characteristics including: insufficient energy intake, weight loss, body fat loss, muscle mass loss, fluid accumulation, and reduced grip strength. When two or more of these criteria are met, malnutrition may be diagnosed.
The alliance has also formed six key principles for clinicians to use in providing optimal nutrition care. These involve collaboration with the entire health care team to provide well-rounded and complete care. The alliance draws attention at the clinician’s responsibility to create an hospital culture in which nutrition care is a top priority. Other key principles include continues monitoring of nutrition interventions, communicating care plans effectively and developing solid nutrition plans for patients after they are discharged.
To both prevent and treat malnutrition appropriately, dietitians can take several action steps. These include working with nursing to ensure nutrition screening is properly performed, implementing nutrition-focused physical assessment into the facility, using the new standardized malnutrition guidelines to diagnose malnutrition, and being an active and visible member of the healthcare team.

Corrigan ML. Hospital malnutrition – standardized guidelines take center stage. Today’s Dietitian. 2014:16(1);40.

Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition. J Parenter Enteral Nutr. 2013;37(4):482-497.

View article at: http://www.todaysdietitian.com/newarchives/010614p40.shtml


New Cholesterol Guidelines Released

New Cholesterol Guidelines Released

The American Heart Association released new clinical practice guidelines for managing cholesterol. The focus for lowering LDL cholesterol has moved away from focusing on achieving target numbers and instead has moved toward assessing risk and implementing cholesterol-lowering statin medications as appropriate.
            This new recommendation is based on recent research that found that lifestyle changes as combined with a statin have shown the most significant improvements in cholesterol levels. They establish risk categories to determine the need for statin use. “High risk” include those who have already suffered a heart attack or stroke or suffer from cardiovascular disease, or who have abnormally high LDL levels. It is recommended that these patients use statins. For others, the American Heart Association has created a risk calculator to determine if statin use is appropriate. According to the guidelines, anyone with a risk of 7.5% or above on this calculator could benefit from statin use. Some factors analyzed in this new tool include sex, age, blood pressure, LDL and HDL cholesterol levels, smoking status, diabetes, and race.
            So why is there such controversy with these new guidelines? To many, it seems that this tool promotes simply using medication to cure cholesterol instead of implementing appropriate lifestyle changes. Dietitians working in the field of cardiovascular health see this new recommendation as positive. They emphasized that anytime there is focus on cardiovascular health, people are becoming more educated and aware of changes they need to make. They are also helpful that there will be more dialogue between doctors and patients seeing that the statins are recommended along with lifestyle changes.
            Dietitians firmly believe that doctors should begin with emphasizing lifestyle changes before implementing statins and even should provide guidance to those who are on statins. As physicians become familiar with the recommendations, dietitians have the chance to help in emphasizing the importance of lifestyle changes for this population and helping patients make sustainable, lifelong changes to maintain optimal heart health.

Thalheimer JC. New cholesterol guidelines released – lifestyle changes and statin use said to make the most impact on cutting risk. Today’s Dietitian. 2014:16(3);14.

View article at: http://www.todaysdietitian.com/newarchives/030314p14.shtml


Diabetes and Heart Disease

Diabetes and Heart Disease
            According to the American Heart Association, at least 68% of people 65 and older die from heart disease and 16% die of stroke. Heart disease rates are two to four times higher in adults with diabetes than among adults without diabetes. What is the link between heart disease and diabetes? How should dietitians counsel patients who are at risk?
It is estimated that about 97% of people with diabetes have dyslipidemia. Dyslipidemia causes disturbances in endothelial function which promotes atherosclerosis is these individuals. Some changes that result include increased constriction of the  coronary artery, increased thrombosis, and increased local inflammatory response.
There is a strong relationship between hyperglycemia, hypertension, dyslipidemia, and heart disease. It has been shown that managing proper blood glucose levels can reduce heart disease risk. Keeping blood pressure in a healthy range can reduce overall cardiovascular mortality. Treatments to lower LDL cholesterol and increase HDL cholesterol have been proven to correct dyslipidemia and reduce heart disease risk in these patients.
So what is the job of the clinical dietitian? It is our job to work with the healthcare team to identify at-risk patients. Dietitians should pay close attention to blood glucose levels, A1c, and BMI of patients. It is then the job of the dietitian to provide appropriate medical nutrition therapy and educate them about the risk. Find out which heart-healthy foods the patient enjoys and brainstorm some healthy meal and snack ideas the patient can eat at home. The dietitian has the expertise needed to develop an individualized eating pattern directed toward lowering blood glucose, blood pressure, and altering blood lipid profiles.

Brown-Riggs C. The diabetes and heart disease link. Today’s Dietitian. 2014:16(4);12.

Early signs of heart disease in preadolescent children with type 1 diabetes. Science Daily Web site. http://www.sciencedaily.com/releases/2011/02/110214155501.htm. February 11, 2011. Accessed February 6, 2014.

View article at: http://www.todaysdietitian.com/newarchives/040114p12.shtml

Vitamin D and Fall Risk in Seniors

Vitamin D and Fall Risk

Along with the majority of people in the north during the winter months, many seniors in retirement centers are also vitamin D deficient. Many older individuals experience a loss of muscle mass and muscle strength that is directly related to loss of bone. Elderly with low intake of vitamin D may have decreased renal production of calcitrol and may be more at risk for falls due to resulting proximal myopathy.
Some studies have suggested that supplemental vitamin D may decrease seniors’ fall risk. This may be due to the decreased psychomotor functioning and increased sway that occurs with vitamin D deficiency that increases fall risk.
            Such studies that have proven that vitamin D supplements are beneficial for improving fall risk include meta-analysis was conducted by Bischoff-Ferrari, Dawson-Hughes, and Staehelin et al. This study reviewed eight randomized control trials of supplemental vitamin D. This review found that vitamin D in a dose of 700-1000 IU per day reduced the risk of falls in older individuals by 19%. Doses less than 700 IU did not reduce the risk of falls.
However, a recent meta-analysis has suggested the opposite.  This study was a meta-analysis of 20 studies that looked at the connection between supplemental vitamin D and fall risk. This review showed that supplemental vitamin D did not improve seniors’ fall risk more than 15 percent so the effect of vitamin D supplementation was not seen as significant.
Even though the effects of vitamin D supplementation on fall risk in the elderly is still unclear, it is important to look at the importance of vitamin D in the diet. Supplementation has been shown to improve muscle function, walking distance, and functional ability. Whether or not these effects directly relate to improving fall risk may still be debatable, but it is clear that seniors need to avoid Vitamin D deficiency through diet and supplementation for optimal health.

Janssen HC, Samson MM, Verhaar HJ. Vitamin D deficiency, muscle function, and falls in elderly people. Am J Clin Nutr. 2002:75(4):611-615.

Preidt R. Vitamin D may not lower seniors’ fall risk. HealthDay Web Site.


Is Animal Protein Intake Linked to Diabetes Risk?

The Academy of Nutrition and Dietetics posted a link to an article about a recent study that found that high animal protein consumption may increase ones risk for type 2 diabetes. According to their diet records those with diabetes tended to consume most of their protein from red meat and processed meats. They found those with a normal protein intake or getting higher protein from plant sources had a lower risk. Although this specific study focused only on the protein, it is important to also look at the overall big picture. Those consuming large quantities of meat were also consuming high saturated fat levels and lower fiber than those consuming lower amounts.

 This can be beneficial in clinical dietetics when counseling those with a family history of diabetes, If their 24 hour recall shows that they are getting a majority of their protein from animal sources, it may be beneficial to educate them on plant sources of protein as well. Having recipes and ways for them to learn how to incorporate these into their diet could help encourage them to increase plant protein.

 For more information visit the link below: