JHND is pleased to have published another important set of guidelines for dietitians in practice. The Royal College of Physicians Intercollegiate Stroke Working Party have produced evidence based guidelines for the nutritional support of stroke patients, which is available to download here. The authors are Gomes, Hookway and Weekes.
Stroke affects 15 million people each year worldwide and is one of the world’s leading causes of death and physical disability. Stroke can result in a decline in nutritional status and this is associated with increased mortality and poor outcomes. The present work aimed to systematically review key aspects of the nutritional support of stroke patients at risk of malnutrition and to provide evidence-based guidelines for use in clinical practice. The work was conducted as part of the process to develop the 4th edition of the Royal College of Physicians’ (RCP) ‘National Clinical Guideline (NCG) for Stroke’.
Questions were generated by the search team, together with contributions from members of the Virtual Stroke Group and the RCP Intercollegiate Stroke Working Party Guideline Development Group. Six questions covering several areas of nutritional support after stroke were defined and searches were conducted through to 31 October 2011 using five electronic databases (Embase, Medline, CINAHL, Cochrane Library and Web of Science). All included studies were assessed for quality and risk of bias using the van Tulder criteria for randomised controlled trials (RCTs) and the Quorum criteria for systematic reviews.
In total, 4215 abstracts were identified, 24 papers were reviewed and 13 systematic reviews and RCTs were included to provide evidence for the nutritional support components of the guidelines. For each question, evidence statements, recommendations and practical considerations were developed.
This systematic review process has resulted in the development of evidence-based guidelines for use in clinical practice and has identified areas for further research.
The Journal has recently made some changes to the senior Editorial team and two of our Associate Editors will be standing down from their positions at the end of December. Gita Sharma and Julie Lovegrove have been committed supporters of JHND for many years. I would like to thank them for their contributions to the editorial process over my first year at the helm. I should also thank two members of Gita’s team in Canada, Fariba Kolahdooz and Mohammadreza Pakseresht, who have both done stirling work without open acknowledgement.
The December issue of the Journal of Human Nutrition and Dietetics is now available online.
These are the top 10 downloaded JHND articles for October 2013. The BDA guidelines on the management of IBS in adults remains the most downloaded paper.
Trial for Reducing Weight Retention in New Mums: a randomised controlled trial evaluating a low intensity, postpartum weight management programme
Wilkinson et al., Journal of Human Nutrition and Dietetics, Early View 2013
Failure to return to pregnancy weight by 6 months postpartum is associated with long-term obesity, as well as adverse health outcomes. This research evaluated a postpartum weight management programme for women with a body mass index (BMI) > 25 kg m–2 that combined behaviour change principles and a low-intensity delivery format with postpartum nutrition information.
Women were randomised at 24–28 weeks to control (supported care; SC) or intervention (enhanced care; EC) groups, stratified by BMI cohort. At 36 weeks of gestation, SC women received a ‘nutrition for breastfeeding’ resource and EC women received a nutrition assessment and goal-setting session about post-natal nutrition, plus a 6-month correspondence intervention requiring return of self-monitoring sheets. Weight change, anthropometry, diet, physical activity, breastfeeding, fasting glucose and insulin measures were assessed at 6 weeks and 6 months postpartum.
Seventy-seven percent (40 EC and 41 SC) of the 105 women approached were recruited; 36 EC and 35 SC women received a programme and 66.7% and 48.6% completed the study, respectively. No significant differences were observed between any outcomes. Median [interquartile range (IQR)] weight change was EC: −1.1 (9.5) kg versus SC: −1.1 (7.5) kg (6 weeks to 6 months) and EC: +1.0 (8.7) kg versus SC: +2.3 (9) kg (prepregnancy to 6 months). Intervention women breastfed for half a month longer than control women (180 versus 164 days; P = 0.10). An average of 2.3 out of six activity sheets per participant was returned.
Despite low intervention engagement, the high retention rate suggests this remains an area of interest to women. Future strategies must facilitate women’s engagement, be individually tailored, and include features that support behaviour change to decrease women’s risk of chronic health issues.