scholarly journals Trajectories of Nutritional Parameters Before and After Prescribed Oral Nutritional Supplements: A Longitudinal Cohort Study of Patients With Chronic Kidney Disease Not Requiring Dialysis

2022 ◽  
Vol 9 ◽  
pp. 205435812110690
Author(s):  
Michelle M. Y. Wong ◽  
Yuyan Zheng ◽  
Dani Renouf ◽  
Zainab Sheriff ◽  
Adeera Levin
Keyword(s):  
Chronic Kidney Disease ◽  
Cluster Analysis ◽  
Cohort Study ◽  
Nutritional Supplements ◽  
Nutritional Supplement ◽  
Nutritional Parameters ◽  
Oral Nutritional Supplement ◽  
Oral Nutritional Supplements ◽  
Before And After ◽  
Inflammation Parameters

Background: The association between oral nutritional supplement use and nutritional parameters among patients with nondialysis chronic kidney disease (CKD-ND) with or at high risk of undernutrition/protein-energy wasting has not been previously studied. The definition of patient subgroups most likely to benefit from oral nutritional supplementation (ONS) is also an area where more research is needed. Objective: To assess nutritional parameter trajectories among patients with CKD-ND prescribed oral nutritional supplements in British Columbia, and to compare trajectories by nutritional phenotype. Design: Longitudinal cohort study, pre-post design. Setting: Multidisciplinary CKD clinics across British Columbia. Patients: A total of 3957 adult patients with CKD-ND, who entered multidisciplinary CKD clinics during 2010 to 2019, met criteria for oral nutritional supplement prescription based on dietitian assessment, and received ≥1 oral nutritional supplement prescription. Measurements: Longitudinal nutritional parameters, including body mass index (BMI), serum albumin, serum bicarbonate, serum phosphate, and neutrophil-to-lymphocyte ratio (NLR). Methods: Using linear mixed models, slopes for nutritional and inflammation parameters were assessed in the 2-year periods before and after the first oral nutritional supplement prescription. Hierarchical cluster analysis was applied to identify nutritional phenotypes using baseline data, and slope analysis was repeated by cluster. Results: In the pre-oral-nutritional-supplement period, declines in BMI (−0.87 kg/m2/year, 95% confidence interval [CI]: −0.99 to −0.75), albumin (−1.11 g/L/year, 95% CI: −1.27 to −0.95), and bicarbonate (−0.49 mmol/L/year; 95% CI: −0.59 to −0.39), and increases in NLR (+0.79/year; 95% CI: 0.60 to 0.98) and phosphate (+0.05 mmol/L/year; 95% CI: 0.04 to 0.06) were observed. Following oral nutritional supplement prescription, there were statistically significant increases in BMI slope (+0.91 kg/m2/year, P < .0001), albumin slope (+0.82 g/L/year, P < .0001), and phosphate slope (+0.02 mmol/L/year, P = .005), as well as a decline in NLR slope of −0.55/year ( P < .0001). There was no significant change in bicarbonate slope. Cluster analysis identified 5 distinct phenotypes. The cluster with the highest mean baseline NLR and lowest mean BMI demonstrated the greatest number of improvements in nutritional parameter slopes in the post-oral-nutritional-supplement period. Limitations: Possibility of residual confounding. Data on dietary intake, muscle mass, and nutritional scoring systems were not available in the registry. Conclusions: Among patients with CKD-ND prescribed oral nutritional supplements, there were improvements in nutrition/inflammation parameters over time following the first ONS prescription. The heterogeneity in response to ONS by cluster subgroup suggests an individualized approach to nutritional management may be beneficial.

scholarly journals ORAL NUTRITIONAL SUPPLEMENTS AND TASTE ADHERENCE IN MALNOURISHED ELDERLY ADULT’S OUTPATIENTS

2017 ◽  
pp. 1-5
Author(s):  
D.A. de Luis ◽  
O. Izaola ◽  
A Castro ◽  
J.J. Lopez ◽  
B. Torres ◽  
...  
Keyword(s):  
Weight Loss ◽  
Daily Intake ◽  
Nutritional Supplements ◽  
Nutritional Supplement ◽  
Taste Preferences ◽  
Oral Nutrition ◽  
Oral Nutritional Supplement ◽  
Nutrition Supplement ◽  
Significant Difference ◽  
Oral Nutritional Supplements

Abstract: The aim of our study was to evaluate a hypercaloric sweet milkbased oral nutrition supplement in a prospective 3 day-study designed to assess the taste preferences of this oral nutritional supplement (ONS) in elderly malnourished out-patients and the influence on adherence in daily intake during two months.A total of 28 out-patients with recent weight loss were included in this study. One flavour (chocolate, vanilla or strawberry) was administered each day in a random way during three consecutive days. In the first three days, patients were asked to fulfill two questionnaires in order to reflect ONS tolerance and acceptance. Sweet and aftertaste were better for chocolate flavour than for vanilla or strawberry flavours. Patients who chose vainilla took a total of 96.3+7.4 average bricks during outpatient followup (1.60+0.3 per day), patients who chose chocolate took 76.8+15.0 bricks (1.28+0.8 per day) and patients who chose strawberry bricks taken 60.3+19.5 bricks (1.10+0.7 per day), with a significant difference with vainilla flavour (p <0.01). The improvement of weight (vanilla +1.0+0.8 kg vs chocolate +0.5+0.8 kg vs 0.6+1.0 kg:p=0.03), tricipital skinfols (vanilla +1.5+0.3 mm vs chocolate +1.1+0.4 mm vs 0.7+0.3 mm:p=0.03), prealbumin levels (vanilla +4.2+0.8 mg/dl vs chocolate +3.9+0.7 mg/dl vs +3.6+1.0 mg/dl:p=0.01) and transferrin levels (vanilla +100.0+21.8 mg/dl vs chocolate +75.5+18.8 mg/dl vs 63.8+14.1 mg/dl:p=0.03) was higher in patients treated with vanilla ONS than chocolate or strawberry ONS. The three flavoured ONS taste preferences are similar although the consumption is high in vanilla flavoured ONS.

Oral Nutritional Supplements and Taste Adherence in Malnourished Adults Inpatients, Effect on Adhesion during Hospital Stance

2015 ◽  
Vol 67 (4) ◽  
pp. 205-209 ◽  
Author(s):  
Daniel Antonio de Luis ◽  
Olatz Izaola ◽  
Juan Jose Lopez ◽  
Beatriz Torres ◽  
Emilia Gomez Hoyos
Keyword(s):  
Weight Loss ◽  
Daily Intake ◽  
Nutritional Supplements ◽  
Nutritional Supplement ◽  
Taste Preferences ◽  
Oral Nutrition ◽  
Oral Nutritional Supplement ◽  
Nutrition Supplement ◽  
Oral Nutritional Supplements ◽  
Strawberry Flavor

Aim: The aim of our study was to evaluate a hypercaloric sweet milk-based oral nutrition supplement in a prospective 3-day study designed to assess the taste preferences of this oral nutritional supplement (ONS) in malnourished inpatients and the influence on adherence in daily intake. Methods: A total of 46 in patients with recent weight loss were included in this study. One flavor (chocolate, vanilla or strawberry) was administered each day in a random way to each patient during 3 consecutive days. In the first 3 days, patients were asked to fill 2 questionnaires intended for reflecting ONS tolerance and acceptance. Results: Sweet was better for chocolate flavor (3.9 ± 2.4 points) than for vanilla flavor (2.7 ± 2.3 points; p < 0.02) and strawberry flavor (3.1 ± 2.3 points; p < 0.01). Chocolate flavored ONSs were rated as having more aftertaste (3.4 ± 2.1 points) than vanilla (2.4 ± 2.1 points; p < 0.01) and strawberry (2.6 ± 1.5 points; p < 0.03). Patients who chose chocolate took a total of 20.7 ± 20.9 average bricks during hospitalization (1.95 ± 0.2 per day), patients who chose vanilla took 18.6 ± 21.0 bricks (1.90 ± 0.7 per day) and finally patients who chose strawberry took 14.5 ± 13.5 bricks during admission (1.78 ± 0.1 per day; p < 0.01). Conclusions: The taste preferences of all the ONSs are similar although the consumption is high in chocolate flavored ONS during hospitalization. Sweetness may have influenced this finding.

Appropriate use of oral nutritional supplements in stages 4–5 chronic kidney disease

2015 ◽  
Vol 7 (3) ◽  
pp. 115-117 ◽  
Author(s):  
Helen MacLaughlin ◽  
Harriet Williams ◽  
Jan Flint ◽  
Karen Magee ◽  
Kevin Jesty ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Nutritional Supplements ◽  
Appropriate Use ◽  
Oral Nutritional Supplements

scholarly journals TOLERABILITY, COMPLIANCE, AND PRODUCT EVALUATION OF A PRE-THICKENED ORAL NUTRITIONAL SUPPLEMENT FOR DISEASE RELATED MALNUTRITION IN PATIENTS WITH DYSPHAGIA

2019 ◽  
pp. 1-6
Author(s):  
T. Dennehy ◽  
F. Veldkamp ◽  
M. Lansink ◽  
R.J. Schulz
Keyword(s):  
Nutritional Support ◽  
Oropharyngeal Dysphagia ◽  
Gastrointestinal Symptoms ◽  
Test Group ◽  
Product Evaluation ◽  
Nutritional Supplement ◽  
Stool Frequency ◽  
Control Group ◽  
Oral Nutritional Supplement ◽  
Oral Nutritional Supplements

Background: Oropharyngeal dysphagia is a prevalent risk factor for malnutrition in older patients and both conditions are related to poor outcome. For the management of (risk of) malnutrition in patients with oropharyngeal dysphagia pre-thickened oral nutritional supplements are available. Objective: The objective of the study is to describe tolerance parameters (stool frequency and incidence and intensity of gastrointestinal symptoms), study product intake (compliance), product appreciation and product properties of a pre-thickened oral nutritional supplement compared to a manually-thickened standard oral nutritional supplement. Design: A randomized, open label, controlled, parallel group study. Setting: participants were recruited through nine general practices in Ireland, one nursing home in The Netherlands, and one hospital in Germany. Participants: Fifty patients requiring oral nutritional support (twenty-four of fifty cases (48%) with dysphagia) were divided into two groups: test group (N = 27) and control group (N = 23). Intervention: During four weeks the test group received a ready-to-use, low volume (125 mL), and energy dense pre-thickened oral nutritional supplement, and the control group a manually-thickened iso-caloric oral nutritional supplement (200 mL) with a similar viscosity. Measurements: Compliance and stool frequency were recorded daily, evaluation of the product appreciation and properties and gastrointestinal tolerability were assessed with questionnaires. Results: Incidence and intensity of gastrointestinal symptoms was not statistically different between groups. Pre-thickened oral nutritional supplement scored significantly better on compliance in week 4 (p = 0.019), on thickness appreciation by patients (day 14, p = 0.035) and on product properties evaluation by carers (appearance, preparation time, ease of preparation and change in thickness, all p < 0.001) compared to the manually-thickened ONS. Conclusion: These results substantiate the use of pre-thickened oral nutritional supplement for the dietary management of patients in need of nutritional support and with oropharyngeal dysphagia.

scholarly journals Associations of Chronic Kidney Disease With Dementia Before and After Transient Ischemic Attack and Stroke: Population-Based Cohort Study

Neurology ◽  
2022 ◽  
pp. 10.1212/WNL.0000000000013205
Author(s):  
Dearbhla M. Kelly ◽  
Sarah T. Pendlebury ◽  
peter M. rothwell
Keyword(s):  
Chronic Kidney Disease ◽  
Cohort Study ◽  
Kidney Disease ◽  
Sex Education ◽  
Population Based ◽  
Competing Risk ◽  
Minor Stroke ◽  
Stroke Severity ◽  
Increased Risk ◽  
Before And After

Objective:Individuals with chronic kidney disease (CKD) appear to be at increased risk of cognitive impairment, with both vascular and neurodegenerative mechanisms postulated. To explore the vascular hypothesis, we studied the association between CKD and dementia before and after transient ischaemic attack (TIA) and stroke.Methods:In a prospective, population-based cohort study of TIA and stroke (Oxford Vascular Study; 2002-2012), pre-event and new post-event dementia were ascertained through direct patient assessment and follow-up for 5 years, supplemented by review of hospital/primary care records. Associations between pre-event dementia and CKD (defined as an estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73m2) were examined using logistic regression, and between post-event dementia and CKD using Cox and competing risk regression models, adjusted for age, sex, education, stroke severity, prior stroke, white matter disease, diabetes mellitus, and dysphasia.Results:Among 2305 TIA/stroke patients (median [IQR] age, 77 [67-84] years, 1133 [49%] male, 688 [30%] TIA), 1174 (50.9%) had CKD. CKD was associated with both pre-event (odds ratio [OR], 2.04 [95% CI, 1.52–2.72]; P<0.001) and post-event dementia (hazard ratio [HR], 2.01 [95% CI, 1.65–2.44]; P<0.001), but these associations attenuated after adjustment for covariates (OR=0.92 [0.65-1.31]; p=0.65 and HR=1.09 [0.85-1.39]; p=0.50). The results were similar when a competing risk model was used (subdistribution HR [SHR] =1.74 [1.43-2.12; p<0.001, attenuating to 1.01 [0.78-1.33]; p=0.92 with adjustment). CKD was more strongly associated with late (>1 year) post-event dementia (SHR=2.32, 1.70-3.17; p<0.001), particularly after TIA and minor stroke (SHR=3.08, 2.05-4.64; p<0.001), but not significantly so after adjustment (SHR=1.53, 0.90-2.60; p=0.12).Conclusions:In patients with TIA and stroke, CKD was not independently associated with either pre- or post-event dementia, suggesting that renal-specific mechanisms are unlikely to play an important role in aetiology.

Oral nutritional supplement prescribing in primary care: a new dietitian-led medicines management team model of practice

2020 ◽  
Vol 2 (11) ◽  
pp. 574-581
Author(s):  
Emily Rose ◽  
Wenda Avey ◽  
Kulsuma Begum ◽  
Nikki Brooks ◽  
Gareth Davies ◽  
...  
Keyword(s):  
Primary Care ◽  
Nutritional Supplements ◽  
Cost Effective ◽  
Nutritional Supplement ◽  
Management Team ◽  
Screening Tools ◽  
Medicines Management ◽  
Clinical Support ◽  
Oral Nutritional Supplements ◽  
Model Of Practice

Oral nutritional supplements may be prescribed for the management of disease-related malnutrition, but there is a large variety of nutritionally differing products available. ONS prescribing in primary care is an area of uncertainty for GPs and prescribing of ONS on the NHS in England and Wales in 2018/2019 was over £150000000. Clinically appropriate prescribing of oral nutritional supplements is supported by the use of validated malnutrition screening tools to assess the patient's risk of malnutrition. Local prescribing formularies promote the use of cost-effective oral nutritional supplements products in primary care which are often not available for use in secondary care. A new medicines management model of practice which uses pharmacy technicians, with clinical support from a dietitian, to address inappropriate oral nutritional supplements prescribing in primary care is described here. The model maximises the skills within the medicines management team and promotes a food first, aging-well approach to managing malnutrition in primary care.

Sign in / Sign up

Export Citation Format

Share Document