Nutrition in Clinical Practice最新文献

{"title":"Preimplementation of malnutrition screening in the context of outpatient memory care: A quality improvement project.","authors":"Austin M Sullivan, Jeffrey M Burns, Debra K Sullivan, Matthew K Taylor, Diego R Mazzotti, Heather D Gibbs","doi":"10.1002/ncp.70050","DOIUrl":"https://doi.org/10.1002/ncp.70050","url":null,"abstract":"<p><strong>Background: </strong>Older adults with dementia are at heightened risk of malnutrition, but nutrition screening is an uncommon practice in this population. This study aimed to determine the feasibility of malnutrition screening and to determine nutrition risk prevalence in an outpatient memory care clinic.</p><p><strong>Methods: </strong>This quality improvement project used the eight-item Seniors in the Community: Risk Evaluation for Eating and Nutrition screener to determine nutrition risk. The Organizational Readiness to Change Assessment (ORCA) determined providers' views on readiness for change.</p><p><strong>Results: </strong>During the 12-week trial, 15.3% of eligible memory care clinic patients were screened. Of these, 58.3% (n = 123) had high nutrition risk. Lack of staffing was the most significant barrier to completion of nutrition screening. Clinic staff responses on the ORCA indicated moderate agreement that screening among persons with dementia is evidence based (mean = 3.7 of 5; SD = 0.26) and strong agreement for evidence of organizational support (mean = 4.12 of 5; SD = 0.38). A majority of patients and/or caregivers reported nutrition screening was easy (n = 79 of 211) or extremely easy (n = 44 of 211). A total of 69 patients (33.7%) who completed the screener indicated interest in a nutrition consultation. The most common barriers to nutrition services reported by caregivers and/or patients were difficulty accessing the clinic and unwillingness to use nutrition services.</p><p><strong>Conclusions: </strong>This study detected barriers and facilitators to administering nutrition screening in a memory care clinic. These preliminary findings suggest further efforts to implement nutrition screening in outpatient memory care clinics are warranted.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145275304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Calf circumference as a screening tool for muscle mass in older adults of mixed ethnicities: Cutoff points based on dual-energy x-ray absorptiometry.","authors":"Guilherme Fonseca Graciano, Ann Kristine Jansen, Rodrigo Ribeiro Dos Santos, Thayana Oliveira Soares, Olivio Brito Malheiro, Camila Dias Nascimento Rocha, Marco Túlio Gualberto Cintra, Maria Aparecida Camargos Bicalho","doi":"10.1002/ncp.70051","DOIUrl":"https://doi.org/10.1002/ncp.70051","url":null,"abstract":"<p><strong>Background: </strong>Calf circumference (CC) is a recognized proxy for muscle mass, yet few studies have established specific cutoff points across diverse populations. This study aimed to define CC cutoffs for detecting low muscle mass in older adults, using appendicular lean mass (ALM) from dual-energy x-ray absorptiometry (DXA) as the reference, stratified by sex and age.</p><p><strong>Methods: </strong>A total of 254 adults ≥60 years of age were recruited from two outpatient clinics at the Reference Center for Older Adults of the Federal University of Minas Gerais. Participants underwent comprehensive geriatric assessments and DXA scans. CC was measured on the left leg. Low muscle mass was defined using the ALM index, and cutoff points were determined through receiver operating characteristic (ROC) curves. The participants were categorized through self-reported ethnicity.</p><p><strong>Results: </strong>Most participants were female (63.0%), with a mean age of 81.4 ± 8.2 years. The most commonly identified race was White (49.4%), followed by mixed race (43.8%) and Black (6.8%). For men, the CC cutoff was 35.0 cm (AUC = 0.90; sensitivity = 90.2%, specificity = 72.6%), with no differences across age groups. For women aged 60-84, the cutoff was 34.0 cm (AUC = 0.74; sensitivity = 77.1%, specificity = 60.8%), and for those ≥85 years of age, the cutoff was 32.0 cm (AUC = 0.74; sensitivity = 86.8%, specificity = 58.3%). Ethnicity did not influence the results.</p><p><strong>Conclusion: </strong>The proposed CC cutoffs provide a practical and low-cost method for identifying low muscle mass and supporting sarcopenia screening among ethnically diverse older adults.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effects of a dietitian-supported multidisciplinary nutrition intervention on optimizing nutrition care in older patients with hip fracture and at nutrition risk-A quality improvement study.","authors":"Tina Munk, Anne Marie Beck, Cecilie M Møller, Frederikke E Pudselykke, Guro Ø H Mikkelsen, Heidrun T Filtenborg, Trine S Pedersen, Jens Peter Alva-Jørgensen, Anne W Knudsen","doi":"10.1002/ncp.70049","DOIUrl":"https://doi.org/10.1002/ncp.70049","url":null,"abstract":"<p><strong>Introduction: </strong>A 1-day cross-sectional study at our hospital found that only 22% of patients with hip fractures at nutrition risk met their energy and protein requirements during hospitalization. This study aimed to test whether closer collaboration between a clinical dietitian and ward staff, guided by the Model for Improvement, could optimize nutrition care for hospitalized older patients with hip fractures at nutrition risk.</p><p><strong>Method: </strong>A dietitian was embedded to facilitate staff-led enhancements in nutrition care at an orthopedic ward in from September to December 2024. Two Plan-Do-Study-Act cycles were implemented. Cycle 1 focused on nutrition documentation. Cycle 2 targeted nutrition intake. The primary outcome was the proportion of patients meeting individual energy and protein requirements (≥80%). Secondary process indicators were (1) ≥80% of patients screened using Nutrition Risk Screening 2002, and (2) ≥80% of at-risk patients with intake documented in the medical record. Preintervention data served as the baseline.</p><p><strong>Results: </strong>The primary outcome was achieved, with 80% (8 of 10) of patients meeting both energy and protein requirements, a significant improvement from 22% (2 of 9) at baseline (P < 0.05). Documentation of nutrition risk increased from 10% (1 of 10) to 80% (8 of 10) (P < 0.01), and intake documentation improved from 30% (3 of 10) to 100% (10 of 10) (P < 0.01).</p><p><strong>Conclusion: </strong>This quality improvement study demonstrates that applying the Model for Improvement to integrate a clinical dietitian into ward practice strengthened interdisciplinary nutrition care and led to measurable gains in screening, documentation, and nutrition intake among older patients with hip fractures at nutrition risk.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative analysis of the relationship of sarcopenia or sarcopenic obesity with functional impairment: A cross-sectional study.","authors":"Flavia Alves Gomes, Stephany Beatriz do Nascimento, Letícia Sabino Santos, Taynara de Sousa Rego Mendes, Roana Carolina Bezerra Dos Santos, Maria Conceição Chaves de Lemos, Cláudia Porto Sabino Pinho","doi":"10.1002/ncp.70046","DOIUrl":"https://doi.org/10.1002/ncp.70046","url":null,"abstract":"<p><p>Growing evidence suggests that sarcopenic obesity (SO) may have a more pronounced effect on functionality compared with isolated sarcopenia, but research in this crucial area remains scarce. Therefore, this study aimed to evaluate whether the combination of sarcopenia and obesity is associated with increased functional impairment in hospitalized older adults. This is a cross-sectional study involving hospitalized older patients. SO was defined as the simultaneous presence of obesity and sarcopenia. Obesity was determined based on a high body fat percentage obtained through bioelectrical impedance analysis, whereas both reduced muscle strength and mass identified sarcopenia. Functionality was evaluated using the Barthel Index and the gait speed test. Additional sociodemographic, clinical, nutrition, and behavioral data were assessed. A total of 176 patients were included in our study. The mean age was 69.8 ± 7.8 years. The frequency of sarcopenia was 37.5%, whereas SO was found in 17.6%. Barthel Index indicated that 64.2% of patients exhibited functional dependency, whereas 87.5% had a slow gait speed. Logistic regression analysis revealed that SO was independently associated with poor functionality by the Barthel Index (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.1-8.5) and slow gait speed (OR, 3.3; 95% CI, 1.1-9.8). Patients with SO showed poorer functional capacity compared with those with obesity alone (P < 0.05), but not compared with those with sarcopenia alone (P > 0.05). In conclusion, we observe that SO was associated with diminished functionality but did not elevate the risk compared with sarcopenia alone.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145233026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of clinical practice guidelines using the Plan-Do-Study-Act framework: The methodology and experiences of the Academy of Nutrition and Dietetics Health Informatics Infrastructure Registry Study on gestational diabetes mellitus.","authors":"Kerri Lynn Knippen, Lindsay Woodcock, Constantina Papoutsakis, Diana M Gonzales-Pacheco","doi":"10.1002/ncp.70043","DOIUrl":"https://doi.org/10.1002/ncp.70043","url":null,"abstract":"<p><strong>Background: </strong>Registered dietitian nutritionists (RDNs) use clinical practice guidelines (CPGs) to inform evidence-based practice. Despite the availability of CPGs, guidelines are not always translated into practice. This challenge is central to implementation science (IS), which seeks to understand how evidence can be adopted and sustained.</p><p><strong>Methods: </strong>The Gestational Diabetes Mellitus (GDM) Registry Study was a multiphase, multisite hybrid implementation study that explored guideline implementation using quality improvement (QI) methods grounded in the Model of Improvement and guided by Plan-Do-Study-Act (PDSA) cycles. Following a baseline period, RDNs completed training, conducted a gap analysis, and identified 2 CPG implementation aims. Sites completed iterative PDSA cycles. Deidentified nutrition care data were entered into the GDM Study Registry and manually audited to evaluate process outcomes. RDNs participated in a closing interview. Qualitative data were analyzed using a constructivist approach and reflexive thematic analysis, supported by artificial intelligence (AI)-assisted qualitative software.</p><p><strong>Results: </strong>Six themes were identified, highlighting the value of assessing current practices and the flexibility of PDSA as an implementation strategy. Themes were mapped against the Normalization Process Theory and Consolidated Framework for Implementation Research and showed alignment between PDSA and implementation principles. The registry audit demonstrated improved process measures. The median normalization score across RDNs (9.00) and sites (9.42) was high, suggesting normalization.</p><p><strong>Conclusion: </strong>PDSA facilitated the work of normalization and enabled practice changes. This study contributes to IS by demonstrating how QI strategies, such as PDSA can help RDNs translate evidence into everyday nutrition care.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145213288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of octreotide in pediatric patients: Practical applications for gastrointestinal disorders and beyond: A narrative review.","authors":"Bailey Dunn, Megan Foxe, Kathy Hunter Sprott, Jessica E Hook, Candi Jump","doi":"10.1002/ncp.11348","DOIUrl":"10.1002/ncp.11348","url":null,"abstract":"<p><p>Somatostatin is a naturally occurring polypeptide hormone that exerts its effect on the gastrointestinal tract by reducing exocrine and endocrine secretion, resulting in decreased motility, gastric emptying, splanchnic blood flow, fat absorption, lymphatic flow, and gallbladder contraction. Octreotide is a synthetic somatostatin analogue that has a variety of clinical applications in the gastrointestinal tract, including in the treatment of gastrointestinal bleeding, motility disorders, lymphatic disorders, pancreatic disorders, and high-output states. Clinicians may hesitate to use octreotide because of its potential side effects and the lack of robust pediatric data. Here we describe potential side effects of the drug and review the use of octreotide in the above pediatric indications.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1040-1052"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diet, nutraceuticals, and lifestyle interventions for the treatment and management of irritable bowel syndrome.","authors":"Zoe N Memel, Neha D Shah, Kendall R Beck","doi":"10.1002/ncp.11307","DOIUrl":"10.1002/ncp.11307","url":null,"abstract":"<p><p>Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) disorder of the gut-brain interaction and causes significant GI distress. The etiology of IBS is multifactorial, with food intolerances being a frequent contributing factor to IBS symptoms. Diet and lifestyle interventions are key components in comprehensive IBS care. In this review, we examine the current evidence-based dietary approaches for treating IBS. The low-FODMAP diet has the most robust data for improving overall symptom burden. In conjunction with guidance from a registered dietitian, certain patients may benefit from targeted dietary elimination of specific carbohydrates such as lactose or fructose or gluten. Among the nutraceuticals used to treat IBS, peppermint oil has sufficient evidence and appropriate safety data to recommend adjunctive use to reduce IBS symptoms. Although prebiotic and probiotic food sources may be beneficial to the microbiome, there is not enough evidence to support the routine use of prebiotic or probiotic supplements. Given the complexity of IBS, a holistic approach in which clinicians address a patients' diet, culture, sleep hygiene, exercise habits, and mental health may improve patients' overall quality of life.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1013-1030"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to the Letter to the Editor titled \"Fish oil intravenous lipid emulsion monotherapy and essential fatty acids. Comment on Essential fatty acid deficiency in parenteral nutrition: Historical perspective and modern solutions, a narrative review\".","authors":"Jodi Wolff, Mary Petrea Cober, Katie A Huff","doi":"10.1002/ncp.70012","DOIUrl":"10.1002/ncp.70012","url":null,"abstract":"","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1241-1243"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complementarity of nutrition risk screening tools with malnutrition diagnosis in patients with cancer: A 12-month follow-up study assessing accuracy metrics and mortality.","authors":"Bruna Luisa Gomes de Miranda, Flavia Moraes Silva, Iasmin Matias de Sousa, Liliane Nunes Bertuleza, Jadson Gomes Xavier, Rodrigo Albert Baracho Rüegg, Maria Cristina Gonzalez, Ana Paula Trussardi Fayh","doi":"10.1002/ncp.11295","DOIUrl":"10.1002/ncp.11295","url":null,"abstract":"<p><strong>Background: </strong>The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition were established to provide a standardized approach for diagnosing malnutrition in clinical practice using a nutrition screening tool (NST) as the first step for this process. This study aimed to compare the complementarity of NSTs with the GLIM criteria for malnutrition diagnosis in patients with cancer.</p><p><strong>Methods: </strong>Hospitalized patients with different cancer types were evaluated in a prospective cohort study in which they were initially screened using the Patient-Generated Subjective Global Assessment (PG-SGA), Protocol for Nutritional Risk in Oncology (PRONTO), Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, Malnutrition Screening Tool, and NutriScore for nutrition risk. Malnutrition diagnosis involved phenotypic and etiological criteria as proposed by the GLIM. Complementarity of NST to GLIM criteria was evaluated by calculating accuracy metrics and investigating association with 12-month mortality.</p><p><strong>Results: </strong>Nutrition risk ranged from 14.8% (NutriScore) to 82.8% (PRONTO) and frequency of malnutrition from 13.8% (with NutriScore) to 88.9% (with PG-SGA). NutriScore presented the lowest negative predictive value (25.1%) whereas PG-SGA presented the highest (58.32%). Regardless of the NST applied, the risk of malnutrition and diagnosis of malnutrition according to the GLIM criteria, combined or isolated, increased the risk of 12-month mortality.</p><p><strong>Conclusion: </strong>All NSTs presented low negative predictive value when their complementarity to GLIM criteria for malnutrition diagnosis was tested. Indeed, patients \"at risk\" presented similar increased risk of 12-month after discharge mortality in comparison with those at risk and malnourished by the GLIM criteria when all NSTs were applied.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1166-1177"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143983716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Development of dietetic staffing requirements for adult intestinal failure services using a best-practice model.","authors":"Sharon Carey, Brooke Chapman, Emma Osland","doi":"10.1002/ncp.11308","DOIUrl":"10.1002/ncp.11308","url":null,"abstract":"<p><strong>Background: </strong>The number of people diagnosed with chronic intestinal failure (CIF) worldwide is low. The condition is clinically complex to manage and resource intense. Guidance on best-practice staffing levels is lacking. This paper proposes a methodology for determining dietetic staffing levels for adult CIF to estimate dietetic staffing levels allowing patients access to best-practice care.</p><p><strong>Methods: </strong>After undertaking a literature search, a novel method for developing recommended adequate dietetic staffing within adult CIF services was utilized. This included (1) mapping the current patient journey and best-practice dietetic care throughout the journey, (2) allocating clinical and nonclinical hours at each phase of the patient journey, and (3) calculating percentage clinical time, and (4) finalizing estimated dietetic staffing requirements per patient.</p><p><strong>Results: </strong>Current literature informed mapping the patient journey and dietetic best practice for CIF. Australian data were included where possible to reflect patient care locally. Direct and indirect clinical hours were allocated to each activity. Allowing for nonclinical activity of 40% for a senior clinician, total hours required to provide best-practice care per patient was calculated as 0.028 of a full-time dietitian per adult with CIF. This equates to the management of 36 people with CIF per full-time dietitian.</p><p><strong>Conclusion: </strong>Use of a bottom-up methodology allows calculation of staffing to meet best practice. Proposed dietetic staffing levels obtained from this study are far greater than current allocated staffing within the Australian adult CIF setting. Adequate dietetic resourcing may reduce patient complications and improve quality of life, resulting in enhanced patient and clinical outcomes.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1146-1157"},"PeriodicalIF":2.2,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12450335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}