Dietetic protocols for management of haemodialysis patients on low phosphorus diets.

Effect of stage-based education provided by dedicated dietitians on hyperphosphataemic haemodialysis patients: results from the Nutrition Education for Management of Osteodystrophy randomised controlled trial

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Background

The Nutrition Education for Management of Osteodystrophy trial showed that stage-based nutrition education by dedicated dietitians surpasses existing practices in Lebanon with respect to lowering serum phosphorus among general haemodialysis patients. The present study explores the effect of nutrition education specifically on hyperphosphataemic patients from this trial.

Methods

Hyperphosphataemic haemodialysis patients were allocated to a dedicated dietitian (DD), a trained hospital dietitian (THD) and existing practice (EP) protocols. From time-point (t)-0 until t-1 (6 months), the DD group (n = 47) received 15 min of biweekly nutrition education by dedicated dietitians trained on renal nutrition; the THD group (n = 89) received the usual care from trained hospital dietitians; and the EP group (n = 42) received the usual care from untrained hospital dietitians. Patients were followed-up from t-1 until t-2 (6 months). Analyses used two-way repeated measures analysis of variance and Cohen’s effect sizes (d).

Results

At t-1, phosphataemia significantly decreased in all groups (DD:−0.27 mmol L−1; EP:−0.15 mmol L−1; THD:−0.12 mmol L−1P < 0.05); the DD protocol had the greatest effect relative to EP (d = −0.35) and THD (d = −0.50). Only the DD group showed more readiness to adhere to a low phosphorus diet at t-1; although, at t-2, this regressed to baseline levels. The malnutrition inflammation score remained stable only in the DD group, whereas the EP and THD groups exhibited a significant increase (DD: 6.74, 6.97 and 7.91; EP: 5.82, 8.69 and 8.13; THD: 5.33, 7.92 and 9.42, at t-0, t-1 and t-2, respectively).

Conclusions

The results of the present study suggest that the DD protocol decreases serum phosphorus compared to EP and THD, at the same time as maintaining the nutritional status of hyperphosphataemic haemodialysis patients. Assessing the cost-effectiveness of the DD protocol is recommended.

Nutritional screening to determine malnutrition and cardiometabolic risk in haemodialysis.

Comparison between direct and indirect methods to diagnosis of malnutrition and cardiometabolic risk in haemodialysis patients

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Background

The present study aimed to evaluate the nutritional status of patients undergoing haemodialysis (HD) by comparing nutritional risk scores with biochemical, anthropometric and body composition variables.

Methods

Eighty-five individuals [65.9% male, mean (SD) age 62 (14) years] participated in a cross-sectional study. Global Objective Assessment (GOA) and Modified Global Subjective Assessment (mGSA) scores, as well as biochemical, anthropometric and body composition data, were collected using standardised procedures.

Results

The prevalence of malnutrition ranged from 20.0% (% body fat by electrical bioimpedance) to 95.3% (by GOA), depending on the indicator or score used. According to the waist circumference, 61.2% of the individuals presented abdominal obesity and visceral adipose tissue was excessive in 20% of them. Malnutrition diagnosis by GOA showed the relationship between the anthropometric and body composition indicators, as assessed by the extent that the ratings of risk nutritional/mild malnutrition and mainly moderate malnutrition were accompanied by a significant decrease in nutritional status and body composition variables. However, with respect to categories of mGSA, no statistically significant differences were observed for nutritional status and body composition variables. In the receiver operator characteristic curve analyses, mGSA and GOA were good indicators for diagnosing malnutrition because both achieved an AUC > 0.5.

Conclusions

mGSA and GOA were more sensitive with respect to identifying individuals at nutritional risk compared to the isolated anthropometric indicators, thus indicating their utility in diagnostic malnutrition. However, individuals at high nutritional risk also presented cardiometabolic risk, as diagnosed mainly by central fat indicators, suggesting the application of both malnutrition and cardiometabolic risk markers in HD patients.

A protein-free module improve nutritional intake and biochemistry for children with organic acidaemias.

The challenge of nutritional profiling of a protein-free feed module for children on low protein tube feeds with organic acidaemias

Daly et al., JHND Early View unknown-2

Background

Enteral tube feeding for children with organic acidaemias (OA) is recommended. Protein restriction, providing minimum safe levels of protein intake, is advocated. Standard paediatric tube feeding formulae provide more than the minimum safe protein requirements and are unsuitable in OA without modification. Modified paediatric enteral feeds consist of several modular ingredients. The aim of this prospective longitudinal interventional study was to assess the efficacy of a premeasured novel protein-free module developed for children aged over 12 months compared to conventional practice.

Methods

In total, 15 children with OA (11.6–31 kg) needing enteral feeding were recruited. The protein-free module, from either a protein-free infant feed or modular ingredients, was replaced by the study feed. To ensure metabolic stability, energy and protein intake were unchanged. Dietary intake, anthropometry and nutritional biochemistry were recorded at baseline and week 26.

Results

Dietary intakes of magnesium (P = 0.02), sodium (P = 0.005), vitamin D (P = 0.04), docosahexaenoic acid (P = 0.01) and arachidonic acid (P = 0.001) significantly improved; plasma selenium (P = 0.002) and whole blood glutathione peroxidase (P = 0.02) significantly increased. Feed preparation accuracy as measured by composition analysis showed consistent errors both in pre- and study feeds.

Conclusions

A protein-free module improved nutritional intake and biochemistry, although feed preparation errors remained a common finding

Dietary epigallocatechin 3-gallate supplements improve outcomes of gestational diabetes

Dietary epigallocatechin 3-gallate supplement improves maternal and neonatal treatment outcome of gestational diabetes mellitus: a double-blind randomised controlled trial

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Background

Gestational diabetes mellits (GDM) is an increasing prevalent health risk in pregnant women. Epigallocatechin 3-gallate (EGCG) is known to benefit the insulin secretory machinery. We aimed to investigate the effect of daily dietary EGCG supplementation on both the maternal and neonatal treatment outcomes in GDM-affected pregnancies.

Methods

In total, 472 pregnant women during their third trimester of pregnancy were diagnosed with GDM and subsequently enrolled into this trial. After exclusion, 404 patients were randomly assigned into EGCG and placebo study groups and subsequently administered either 500 mg of EGCG or placebo, respectively, on a daily basis until full term. The daily nutritional intake of all patients was monitored throughout the study. Maternal diabetic parameters at baseline and full term, including metabolism of glucose and insulin, as well as neonatal symptoms at birth, including birth weight, macrosomia, hypoglycaemia, respiratory distress and Apgar scores, were analysed.

Results

In total, 176 and 150 patients from the EGCG and placebo study groups, respectively, completed the trial. Patients from the EGCG group displayed significantly improved maternal diabetic parameters, and fewer cases of neonatal complications, compared to the placebo group.

Conclusions

Daily dietary EGCG supplement improves both maternal and neonatal treatment outcomes of GDM.