Psychosocial Support and Nutrition Counselling Among Patients with Cancer Receiving Chemotherapy: A Mixed-Methods Study

Purpose Cancer chemotherapy causes nutrition impact symptoms (NIS) that affect patient diet and nutrition. Such patients, therefore, require nutrition counselling. In this study, we aimed to 1) identify the psychosocial factors of patients who require nutrition counselling and 2) articulate the specific details of the issues for which patients desire advice. Methods We conducted anthropometric measurements, surveys using questionnaires, and interviews with patients receiving outpatient chemotherapy for head and neck, oesophageal, gastric, colorectal, and lung cancers. The questionnaire included items on NIS, patients’ experience of eating-related distress (ERD), and quality of life (QOL). Interviews were conducted with patients who required nutrition counselling regarding specific issues. We provided nutrition counselling in two sessions. Results Of the 151 patients, 42 required nutrition counselling. The psychosocial factors affecting the required nutrition counselling were the number of people in the household, employment status, QOL, and ERD. The contexts of the specific issues patients wanted to discuss included self-management, distress, understanding and sympathy, anxiety, and confusion. Conclusion Nutrition counselling for patients receiving cancer chemotherapy needs to involve multidisciplinary support that considers psychological (anxiety, confusion) and social (family structure, employment situation) aspects as additional means to address NIS.

Effects of artificial intelligence-SsupporTed Automated NutRiTional Intervention on LDL cholesterol Control in Patients with Familial Hypercholesterolaemia (iSTART-FH): protocol for a randomised controlled trial

IntroductionFamilial hypercholesterolaemia (FH) is an autosomal dominant inherited genetic disease that has an extremely elevated cardiovascular risk because of their significantly elevated low-density lipoprotein (LDL) cholesterol. Nutritional intervention is needed in improving LDL cholesterol control in patients with FH but requires a considerable burden in manpower. Artificial intelligence (AI)-supported and mobile-supported nutritional intervention using this technique may be an alternative approach to traditional nutritional counselling in person. This study aims to test the hypothesis that AI-supported nutritional counselling is more effective in reducing LDL cholesterol than the in-person, face-to-face method in terms of improving LDL cholesterol control in patients with FH.Methods and analysisThis is a single-centre, unblinded, cross-over, randomised controlled study comparing the efficacy of AI-supported automated nutrition therapy with that of conventional human nutrition counselling in patients with FH. Patients with FH are recruited and randomly assigned to AI-supported nutrition counselling (n=30) and to face-to face nutrition counselling (n=30). We are using an Asken, a mobile application that has been specially modified for this study so that it follows the recommendations by the Japan Atherosclerosis Society. We started patient recruitment on 1 September 2020, and is scheduled to continue until 31 December 2022.Ethics and disseminationThis study is being conducted in compliance with the Declaration of Helsinki, the Ethical Guidelines for Medical and Health Research Involving Human Subjects, and all other applicable laws and guidelines in Japan. The study protocol was approved by the Institutional Review Board of Kanazawa University on 13 April 2020 (IRB no. 2623-3); all recruited patients are required to provide written informed consent. We will disseminate the final results at international conferences and in a peer-reviewed journal.Trial registration numberUMIN000040198.

PROVISION OF VITAMIN C AND VITAMIN D FOOD INGREDIENTS AGAINST THE REDUCTION OF BLOOD GLUCOSE LEVELS IN DIABETES MELLITUS TYPE II INDICATED RESPONDENTS

This community service was carried out to improve the knowledge of Kutisari residents who identified had diabetes mellitus. The preliminary study was conducted regarding residents who identified with diabetes mellitus with deficiency of vitamin C and vitamin D intake. This community service program lasts for one year. The activity in this community service was collecting the data of respondents with diabetes mellitus, gave nutrition counselling, and directly provided food sources of vitamin C and vitamin D. Besides provided leaflets of vitamin C and vitamin D food sources, the nutrition counselling also measured the respondent’s blood sugar levels. Checking blood glucose levels was carried out to determine the glucose levels of residents who were identified as having diabetes mellitus. Intake of food sources of vitamin C and vitamin D was expected to lower blood glucose levels. The respondent received guava and chicken eggs as the food source of vitamin C and vitamin D. The purpose of this community service is to improve the respondent's knowledge about the food sources of vitamin C and vitamin D. Those foods will reduce the high blood glucose levels close to the normal values. The output of this community service activity is an online-published report.

Assessing the impact of a combined nutrition counselling and cash transfer intervention on women’s empowerment in rural Bangladesh: a randomised control trial protocol

IntroductionThere is growing interest in assessing the impact of health interventions, particularly when women are the focus of the intervention, on women’s empowerment. Globally, research has shown that interventions targeting nutrition, health and economic development can affect women’s empowerment. Evidence suggests that women’s empowerment is also an underlying determinant of nutrition outcomes. Depending on the focus of the intervention, different domains of women’s empowerment will be influenced, for example, an increase in nutritional knowledge, or greater control over income and access to resources.ObjectiveThis study evaluates the impact of the Shonjibon Cash and Counselling (SCC) Trial that combines nutrition counselling and an unconditional cash transfer, delivered on a mobile platform, on women’s empowerment in rural Bangladesh.Methods and analysisWe will use a mixed-methods approach, combining statistical analysis of quantitative data from 2840 women in a cluster randomised controlled trial examining the impact of nutrition behaviour change communications (BCCs) and cash transfers on child undernutrition. Pregnant participants will be given a smartphone with a customised app, delivering nutrition BCC messages, and will receive nutrition counselling via a call centre and an unconditional cash transfer. This study is a component of the SCC Trial and will measure women’s empowerment using a composite indicator based on the Project-Level Women’s Empowerment in Agriculture Index, with quantitative data collection at baseline and endline. Thematic analysis of qualitative data, collected through longitudinal interviews with women, husbands and mothers-in-law, will elicit a local understanding of women’s empowerment and the linkages between the intervention and women’s empowerment outcomes. This paper describes the study protocol to evaluate women’s empowerment in a nutrition-specific and sensitive intervention using internationally validated, innovative tools and will help fill the evidence gap on pathways of impact, highlighting areas to target for future programming.Ethics and disseminationEthical approval has been obtained from the International Centre for Diarrhoeal Disease Research (Ref. PR 17106) and The University of Sydney (Ref: 2019/840). Findings from this study will be shared in Bangladesh with dissemination sessions in-country and internationally at conferences, and will be published in peer-reviewed journals.

Evaluation of telehealth based nutrition counselling to improve dietary compliance and nutritional status of cancer patients.

e13619 Background: According to published literature, regardless of the cancer type, the overall prevalence of malnutrition in cancer is about 40% (range 30%-70%). Malnutrition is known to adversely affect the treatment compliance, quality of life and survival outcomes for cancer patients. Onco.com provides telehealth based nutrition care support (NCS) as a part of cancer care management program. We sought to evaluate impact of telehealth based nutrition counselling on diet compliance and overall nutritional status of patients. Methods: NCS includes virtual nutrition screening, nutrition diagnosis and nutrition intervention. Virtual nutrition screening was done using modified patient generated subjective global assessment (PG-SGA) tool developed by Ottery. An initial nutrition screening was initially performed for 165 patients. After nutrition screening, patients were divided as malnourished (category 1- 47%), nutritionally at risk (category 2- 34%) and well nourished (category 3- 19%). Patients in category 1 & 2 were analysed for the purpose of study. Diet counselling and customized diet plans were provided to the patients between the age group of 12 to 83 years for a period of 3 months from October to December 2020. On follow up, 24 hour diet recall method and food frequency method were used to assess the compliance to the diet plan. One day prior 24 hour diet recall and food frequency method for two weeks was used to analyse the adherence to the plan. If the patient consumed ≥75% of the recommended diet for a minimum of 5 days in a week, he/she was considered a ‘compliant’, while those who consumed < 75% of the recommended diet were considered to be ‘non-compliant’. Data on body weight and performance status (PS) was documented during follow up to track changes. Results: Of 134 study participants, 35.1% were in the early (I & II) stage, 38.7 % were in the locally advanced (III) stage, 21.2 % were in the metastatic stage, and 4.8 % were in the recurrent stage of disease. After 3 months of initiation of the nutrition counselling, 40% of the patients had gained weight, whereas 38% could maintain the body weight and 22 % had lost weight. Change in physical activity, appetite, management of side effects after diet plan initiation were also assessed during the reassessment calls. Overall, 67% patients showed improvement in diet compliance across all stages of disease. Majority of dietary non-compliance was noted in patients with head and neck, upper GI cancers or those with poor PS. Conclusions: Telehealth based nutritional counselling is an effective tool to help cancer patients achieve better diet compliance and nutrition outcomes across all stages of disease. Dietary non-compliance in head and neck cancers and upper gastrointestinal cancers or poos PS could correlate with difficulty in oral intake. Getting accurate information could be one of the challenges in virtual mode of counselling.

Nutrition Management of Gestational Diabetes Mellitus

Medical nutrition therapy (MNT) is the bedrock for the management of gestational diabetes mellitus (GDM). Several different types of dietary approaches are used globally, and there is no consensus among the various professional groups as to what constitutes an ideal approach. The conventional approach of limiting carbohydrates at the cost of increasing energy from the fat source may not be most optimal. Instead, allowing higher levels of complex, low-to-medium glycaemic index carbohydrates and adequate fibre through higher consumption of vegetables and fruits seems more beneficial. No particular diet or dietary protocol is superior to another as shown in several comparative studies. However, in each of these studies, one thing was common – the intervention arm included more intensive diet counselling and more frequent visits to the dieticians. For MNT to work, it is imperative that diet advice and nutrition counselling is provided by a dietician, which is easy to understand and use and includes healthy food options, cooking methods, and practical guidance that empower and motivate to make changes towards a healthy eating pattern. Various simple tools to achieve these objectives are available, and in the absence of qualified dieticians, they can be used to train other health care professionals to provide nutrition counselling to women with GDM. Given the impact of GDM on the future health of the mother and offspring, dietary and lifestyle behaviour changes during pregnancy in women with GDM are not only relevant for immediate pregnancy outcomes, but continued adherence is also important for future health.