Browsing by Author "Meij, B.S. van der"

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Mapping ongoing nutrition intervention trials in muscle, sarcopenia, and cachexia: a scoping review of future research.
Orsso, C.E. ; Montes-Ibarra, M. ; Findlay, M ; Meij, B.S. van der ; Schueren, M.A.E. de van der ; Landi, F. ; Laviano, A. ; Prado, C.M.
2022, Article / Letter to editor (Journal of Cachexia Sarcopenia and Muscle, vol. 13, iss. 3, (2022), pp. 1442-1459)Muscle loss alone, or in the context of sarcopenia or cachexia, is a prevalent condition and a predictor of negative outcomes in aging and disease. As adequate nutrition is essential for muscle maintenance, a growing number of studies has been conducted to explore the role of specific nutrients on muscle mass or function. Nonetheless, more research is needed to guide evidence-based recommendations. This scoping review aimed to compile and document ongoing clinical trials investigating nutrition interventions as a strategy to prevent or treat low muscle mass or function (strength and physical performance), sarcopenia, or cachexia. ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform were searched up to 21 April 2021 for planned and ongoing trials. Randomized controlled trials with ≥20 participants per arm were included based on intent to explore the effects of nutrition interventions on muscle-related outcomes (i.e. muscle mass or strength, physical performance, or muscle synthesis rate) in both clinical and non-clinical conditions (i.e. aging). Two reviewers independently screened records for eligibility, and a descriptive synthesis of trials characteristics was conducted. A total of 113 trials were included in the review. Most trials (69.0%) enroll adults with clinical conditions, such as cancer (19.5%), obesity and metabolic diseases (16.8%), and musculoskeletal diseases (10.7%). The effects of nutrition interventions on age-related muscle loss are explored in 31% of trials. Although nutrition interventions of varied types were identified, food supplements alone (48.7%) or combined with dietary advice (11.5%) are most frequently reported. Protein (17.7%), amino acids (10.6%), and β-hydroxy-β-methylbutyrate (HMB, 6.2%) are the top three food supplements' nutrients under investigation. Primary outcome of most trials (54.9%) consists of measures of muscle mass alone or in combination with muscle strength and/or performance (as either primary or secondary outcomes). Muscle strength and physical performance are primary outcomes of 38% and 31.9% of the trials, respectively. These measurements were obtained using a variety of techniques. Only a few trials evaluate muscle synthesis rate either as a primary or secondary outcome (5.3%). Several nutrition studies focusing on muscle, sarcopenia, and cachexia are underway and can inform future research in this area. Although many trials have similar type of interventions, methodological heterogeneity may challenge study comparisons, and future meta-analyses aiming to provide evidence-based recommendations. Upcoming research in this area may benefit from guidelines for the assessment of therapeutic effects of nutrition interventions.
The incorporation of body composition assessments as part of routine clinical care in a tertiary hospital's dietetic department: a best practice implementation project
Wilkinson, SA ; Jobber, CJD ; Nave, F ; Meij, B.S. van der
2022, Article / Letter to editor (JBI EVIDENCE IMPLEMENTATION, vol. 20, iss. 1, (2022), pp. 21-32)Objectives: Our aim was to incorporate body composition assessment (BCA) into dietetic department procedures using interventions tailored to previously identified barriers and enablers. Introduction: BCA is recommended as part of routine malnutrition assessment and follow-up but is not yet part of usual care. Methods: Evidence-informed strategies to overcome barriers and enablers were operationalized and delivered as three overarching interventions: upskilling (professional development strategy), modelling and reducing fear of change (Clinical Champion project), and embedding as usual practice (departmental integration). Process evaluation assessed intervention fidelity. A survey assessed utilization of BCA devices, (perceived) competency, and attitudes of clinical dietitians towards BCA before and after interventions. Results: Two of the three elements were incorporated as planned (upskilling and embedding as usual practice), with one element (modelling and reducing fear of change) modified through iterative processes. The Clinical Champion project ran for 12 rather than 6 months, and resulted in the majority of champions confident with their skills, completing BCA within their daily clinical workload and feeling BCA was useful. Pre-surveys and post-surveys within the department of 26 dietitians showed a marked reduction in most perceived barriers and improved recognition of enablers across all theoretical framework domains; with a large proportion of 'not applicable' responses given for many barriers at follow-up. Conclusion: This evidence-informed implementation strategy successfully integrated BCA into dietitians' practice and departmental processes highlighting direction for future service changes. Continual assessment of barriers and success of integration into routine workloads is required to facilitate this.
Experts reageren op Voedingsnormen voor eiwitten voor Ouderen
Meij, B.S. van der ; Grootswagers, P. ; Groot, L.C.P.G.M. de ; Schueren, M.A.E. de van der
2021, Article / Letter to editor (Nederlands Tijdschrift voor Voeding & Diëtetiek, vol. 76, (2021), pp. 39-41)
Malnutrition in patients with COVID-19: assessment and consequences
Meij, B.S. van der ; Ligthart-Melis, GC ; Schueren, M.A.E. de van der
2021, Article / Letter to editor (Current Opinion in Clinical Nutrition and Metabolic Care, vol. 24, iss. 6, (2021), pp. 543-554)Purpose of review COVID-19 disease often presents with malnutrition and nutrition impact symptoms, such as reduced appetite, nausea and loss of taste. This review summarizes the most up-to-date research on nutritional assessment in relation to mortality and morbidity risk in patients with COVID-19. Recent findings Numerous studies have been published on malnutrition, muscle wasting, obesity, and nutrition impact symptoms associated with COVID-19, mostly observational and in hospitalized patients. These studies have shown a high prevalence of symptoms (loss of appetite, nausea, vomiting, diarrhea, dysphagia, fatigue, and loss of smell and taste), malnutrition, micronutrient deficiencies and obesity in patients with COVID-19, all of which were associated with increased mortality and morbidity risks. Early screening and assessment of malnutrition, muscle wasting, obesity, nutrition impact symptoms and micronutrient status in patients with COVID-19, followed by pro-active nutrition support is warranted, and expected to contribute to improved recovery. There is limited research on nutritional status or nutrition impact symptoms in patients living at home or in residential care. RCTs studying the effects of nutrition intervention on clinical outcomes are lacking. Future research should focus on these evidence gaps.
State of the art: the role of citrulline as biomarker in patients with chemotherapy- or graft-versus-host-disease-induced mucositis
Dekker, I.M. ; Bruggink, H ; Meij, B.S. van der ; Wierdsma, N.
2021, Article / Letter to editor (Current Opinion in Clinical Nutrition and Metabolic Care, vol. 24, iss. 5, (2021), pp. 416-427)Purpose of review Serum or plasma citrulline levels are used as biomarker for a broad spectrum of intestinal functions. During high-dose chemotherapy, citrulline levels are decreased due to mucositis, a common side effect of chemotherapy. This may decrease intestinal function and result in diarrhea. In this review, most recent studies investigating citrulline as biomarker for intestinal function are discussed, with focus on patients with oncological diseases, specifically hematological malignancies with chemotherapy- or Graft-versus-Host-disease (GVHD)-induced mucositis. Recent findings Citrulline has recently been widely studied in relation to intestinal function and various clinical conditions. It seems therefore a promising noninvasive biomarker in clinical practice for more than intestinal function alone. The association between citrulline levels and intestinal function in patients with hematological malignancies, with or without mucositis remains unclear, as no other parameters of intestinal function for this purpose were assessed. In conclusion, citrulline seems to be a promising noninvasive biomarker for various intestinal conditions in general, and potentially for intestinal function in patients with chemotherapy- or GVHD-induced mucositis. It is unclear from recent literature whether high fecal volume or diarrhea as side effect, results in impaired intestinal function and severe malabsorption and if citrulline biomarkers can be useful to detect this.
The effect of oral omega-3 polyunsaturated fatty acid supplementation on muscle maintenance and quality of life in patients with cancer: A systematic review and meta-analysis
Lam, CN ; Watt, AE ; Isenring, EA ; Schueren, M.A.E. de van der ; Meij, B.S. van der
2021, Article / Letter to editor (Clinical Nutrition, vol. 40, iss. 6, (2021), pp. 3815-3826)Background & aims: Omega-3 polyunsaturated fatty acid (PUFA) supplementation has been proposed as a potential therapy for cancer-related malnutrition, which affects up to 70% of patients with cancer. The aim of this systematic review and meta-analysis was to examine the effects of oral omega-3 PUFA supplementation on muscle maintenance, quality of life, body weight and treatment-related toxicities in patients with cancer. Methods: Randomised controlled trials in patients with cancer aged 18 years were retrieved from 5 electronic databases: MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL (via EBSCOhost), and Web of Science, from database inception until 31st of December 2019. The quality of included studies was assessed using the Cochrane risk of bias tool. Trials supplementing >600 mg/d omega-3 PUFA (oral capsules, pure fish oil or oral nutritional supplements) compared with a control intervention for >3 weeks were included. Meta-analyses were performed in RevMan to determine the mean differences (MD) in muscle mass, quality of life and body weight, and odds ratio (OR) for the incidence of treatmentrelated toxicities between omega-3 PUFA and control groups with 95% confidence intervals (CI) and I2 for heterogeneity. Results: We included 31 publications in patients with various types of cancers and degrees of malnutrition. The Cochrane risk of bias tool graded most trials as 'unclear' or 'high' risk of bias. Meta-analyses showed no significant difference between omega-3 PUFA supplements and control intervention on muscle mass, quality of life and body weight. Oral omega-3 PUFA supplements reduced the likelihood of developing chemotherapy-induced peripheral neuropathy (OR: 0.20; 95% CI: 0.10-0.40; p < 0.001; I2 1/4 0%). Conclusion: This systematic review and meta-analysis indicates that oral omega-3 PUFA supplementation does not improve muscle maintenance, quality of life or body weight in patients with cancer, but may reduce the incidence of chemotherapy-induced peripheral neuropathy. Well-designed large-scale randomised controlled trials in homogenous patient cohorts are required to confirm these findings. (c) 2021 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
Using the theoretical domains framework to inform strategies to support dietitians undertaking body composition assessments in routine clinical care
Jobber, CJD ; Wilkinson, SA ; Hughes, EK ; Nave, F ; Meij, B.S. van der
2021, Article / Letter to editor (BMC Health Services Research, vol. 21, iss. 1, (2021))BackgroundMalnutrition, sarcopenia and cachexia are clinical wasting syndromes characterised by muscle loss. Systematic monitoring by body composition assessment (BCA) is recommended for the diagnosis, treatment and monitoring of the syndrome(s). This study investigated practices, competency, and attitudes of Australian dietitians regarding BCA, to inform a local implementation process.MethodsApplying the Action cycle in the Knowledge to Action framework, surveys were distributed to the 26 dietitians of an 800-bed tertiary hospital. The survey assessed barriers and enablers to performing routine BCA in clinical care. Results were categorised using the Theoretical Domains Framework (TDF) and suitable interventions mapped using the Behaviour Change Wheel.ResultsTwenty-two dietitians (84.6%) completed the survey. Barriers to BCA were identified in all TDF domains, particularly in Knowledge, Skills, Social/professional role and identity, Beliefs about capabilities, and Environmental context and resources. Enablers existed in domains of: Skills; Beliefs about consequences; Goals; Environmental context and resources; Social influences; Intentions; Optimism; Reinforcement.ConclusionsThis study showed that hospital dietitians experience individual, team, and organisational barriers to adopt BCAs in clinical practice. We were able to formulate targeted implementation strategies to overcome these barriers to assist BCA adoption into routine practice.
Cancer cachexia: an overview of diagnostic criteria and therapeutic approaches for the accredited practicing dietitian
Meij, B.S. van der ; Teleni, L ; McCarthy, AL ; Isenring, EA
2021, Article / Letter to editor (Journal of Human Nutrition and Dietetics, vol. 34, iss. 1, (2021), pp. 243-254)Background: Cancer cachexia (CC) is a multifactorial syndrome characterised by ongoing skeletal muscle loss that leads to progressive functional impairment driven by reduced food intake and abnormal metabolism. Despite the traditional use of non-volitional weight loss as the primary marker of CC, there is no consensus on how to diagnose and manage CC. Methods: The aim of this narrative review was to describe and discuss diagnostic criteria and therapeutic approaches for the accredited practicing dietitian with respect to identifying and managing CC. Results: Available diagnostic criteria for cachexia include the cancer-specific (Fearon and Cachexia Score) and general criteria (Evans and Global Leadership Initiative on Malnutrition). These include phenotypic criteria [weight loss, body mass index, (objective) muscle mass assessments, quality of life] and aetiological criteria (disease burden, inflammation, energy expenditure, anorexia and inadequate food intake) and can be incorporated into the nutrition care process (NCP). This informs the nutrition diagnosis of 'chronic disease- or condition-related malnutrition (undernutrition) as related to increased nutrient needs, anorexia or diminished intake due to CC'. Optimal nutrition care and management of CC is multidisciplinary, corrects for increased energy expenditure (via immunonutrition/eicosapentaenoic acid), suboptimal protein/energy intake and poor nutrition quality of life, and includes a physical exercise intervention. Monitoring of intervention efficacy should focus on maintaining or slowing the loss of muscle mass, with weight change as an alternative gross indicator. Conclusions: Dietitians and the NCP can play an essential role with respect to identifying and managing CC, focusing on aspects of nutrition screening, assessment and intervention.
Pasteurised donor human milk audit: What is happening in the neonatal critical care unit?
Page, D. van der ; Gilroy, M. ; Joseph, R. ; Meij, B.S. van der
2021, Article / Letter to editor (Journal of Paediatrics and Child Health, (2021))Aim: Human milk with fortification, providing additional energy, protein and micronutrients, is considered the optimal form of nutrition for preterm infants as it provides protection against infections and improves outcomes. Mothers' own milk (MOM) is the preferred choice, however in situations where MOM is insufficient or contraindicated; Pasteurised donor human milk (PDHM) is the preferred alternative. This study aimed to identify whether PDHM during neonatal critical care unit (NCCU) admission is associated with discharge nutrition in preterm infants. Methods: A retrospective observational cohort study was conducted over a 12-month period in 2017. This included all inborn infants admitted to the NCCU with gestational age ≤ 28 weeks or ≤ 1000 g birthweight, who survived until discharge. Multivariate logistic models were used to detect the association between study groups (PDHM vs. No PDHM) and discharge nutrition. Results: Seventy-seven infants were included; 35 infants received PDHM during admission. At discharge, infants who received PDHM were significantly more likely to be on infant formula (IF) (86%) than infants who did not receive PDHM (26%). In contrast, infants who did not receive PDHM (No PDHM) were significantly more likely to be receiving MOM exclusively at discharge (74%), than those who did receive PDHM (14%). The odds of an infant being discharged on IF were 16.91 times higher if they received PDHM. Conclusion: In this study, infants born at ≤28 weeks or ≤ 1000 g who received PDHM were more likely to receive IF at NCCU discharge than infants who did not receive PDHM.
Presence or Absence of Skeletal Muscle Dysfunction in Chronic Obstructive Pulmonary Disease is Associated With Distinct Phenotypes
Cruthirds, C.L. ; Meij, B.S. van der ; Wierzchowska-McNew, A. ; Deutz, N.E.P. ; Engelen, M.P.K.J.
2021, Article / Letter to editor (Archivos de Bronconeumología, vol. 57, iss. 4, (2021), pp. 264-272)
Early Signs of Impaired Gut Function Affect Daily Functioning in Patients With Advanced Cancer Undergoing Chemotherapy
Meij, B.S. van der ; Deutz, N.E.P. ; Rodriguez, RE ; Engelen, M.M.
2021, Article / Letter to editor (Jpen, Journal of Parenteral and Enteral Nutrition, vol. 45, iss. 4, (2021), pp. 752-760)Background Gastrointestinal symptoms are common during chemotherapy, but underlying disturbances in gut function and their impact on daily life are unclear. This study investigates gut function in a heterogenous group of cancer patients with gastrointestinal symptoms during chemotherapy and its relation to anabolic response, muscle health, and daily functioning. Methods In 16 patients with solid tumors (mostly stage III+IV) undergoing chemotherapy (T) and 16 healthy (H) matched controls, small-intestinal membrane integrity was measured by urine sugar tests. Protein digestion, absorption, and anabolic response to a conventional protein supplement were analyzed by stable-tracer methods. Muscle mass and strength and daily functioning were assessed. Results Eighty-one percent of T patients reported gastrointestinal symptoms. Small-intestinal membrane permeability was similar, but active glucose transport was lower in the T group (T, 35.5% +/- 3.4% vs H, 48.4% +/- 4.7%; P = .03). Protein digestion and absorption tended to be lower in the T group (0.67 +/- 0.02 vs 0.80 +/- 0.04; P = .08). Net protein anabolic response to feeding was comparable, although lower in cancer patients with recent weight loss. Gut permeability negatively correlated to hand grip strength, global health, and physical functioning, and active-transport capacity positively correlated to global health in the T group. Conclusion Advanced cancer patients with gastrointestinal symptoms during chemotherapy, particularly those with recent weight loss, show signs of impaired gut function negatively affecting muscle health, daily functioning, and anabolic response to feeding.
Malnutrition Screening and Assessment in the Cancer Care Ambulatory Setting: Mortality Predictability and Validity of the Patient-Generated Subjective Global Assessment Short form (PG-SGA SF) and the GLIM Criteria
Groot, L.M. De ; Lee, G. ; Ackerie, A. ; Meij, B.S. van der
2020, Article / Letter to editor (Nutrients, vol. 12, iss. 8, (2020), pp. 2287)Background: A valid malnutrition screening tool (MST) is essential to provide timely nutrition support in ambulatory cancer care settings. The aim of this study is to investigate the validity of the Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF) and the new Global Leadership Initiative on Malnutrition (GLIM) criteria as compared to the reference standard, the Patient-Generated Subjective Global Assessment (PG-SGA). Methods: Cross-sectional observational study including 246 adult ambulatory patients with cancer receiving in-chair intravenous treatment at a cancer care centre in Australia. Anthropometrics, handgrip strength and patient descriptive data were assessed. Nutritional risk was identified using MST and PG-SGA SF, nutritional status using PG-SGA and GLIM. Sensitivity (Se), specificity (Sp), positive and negative predictive values and kappa (k) were analysed. Associations between malnutrition and 1-year mortality were investigated by Cox survival analyses. Results: A PG-SGA SF cut-off score ≥5 had the highest agreement when compared with the PG-SGA (Se: 89%, Sp: 80%, k = 0.49, moderate agreement). Malnutrition risk (PG-SGA SF ≥ 5) was 31% vs. 24% (MST). For malnutrition according to GLIM, the Se was 76% and Sp was 73% (k = 0.32, fair agreement) when compared to PG-SGA. The addition of handgrip strength to PG-SGA SF or GLIM did not improve Se, Sp or agreement. Of 100 patients who provided feedback, 97% of patients found the PG-SGA SF questions easy to understand, and 81% reported that it did not take too long to complete. PG-SGA SF ≥ 5 and severe malnutrition by GLIM were associated with 1-year mortality risk. Conclusions: The PG-SGA SF and GLIM criteria are accurate, sensitive and specific malnutrition screening and assessment tools in the ambulatory cancer care setting. The addition of handgrip strength tests did not improve the recognition of malnutrition or mortality risk.
The effect of oral omega-3 polyunsaturated fatty acid supplementation on muscle maintenance and quality of life in patients with cancer: A systematic review and meta-analysis
Nga Lam, C. van der ; Isenring, E. ; Schueren, M.A.E. de van der ; Meij, B.S. van der
2020, Article in monograph or in proceedings (42nd ESPEN Virtual Congress - Online, pp. 667)Rationale: Omega-3 polyunsaturated fatty acid (PUFA) supplementation is a promising therapy for cancer-relatedmalnutrition, which affects 20-70% of patients with cancer1,2. This systematic review aimed to examine the effects of oralomega-3 PUFA supplementation on muscle maintenance and quality of life in patients with cancer. Methods: Randomised controlled trials in cancer patients aged >18 years were retrieved from 5 electronic databases;MEDLINE (via PubMed), EMBASE, CENTRAL, CINAHL (via EBSCOhost), and Web of Science, from database inceptionuntil 31st of December 2019. Trials supplementing ≥600 mg/d omega-3 PUFA (oral capsules, pure fish oil or oralnutritional supplements) or a control intervention for ≥3 weeks were included. Meta-analyses were performed in RevManto determine the mean differences (MD) in muscle mass and quality of life between omega-3 PUFA and control groupswith 95% confidence intervals (CI) and I2 for heterogeneity. Results: We included 33 studies in patients with various types of cancers and degrees of malnutrition. The Cochrane riskof bias tool graded most trials as ‘unclear’ or ‘high’ risk of bias. Meta-analyses showed oral omega-3 PUFA supplementsimproved physical functioning (MD: 6.33; 95% CI: 0.32, 12.34, p=0.04; I2=0%) and potentially reduced fatigue (MD: -6.21;95% CI: -13.473, 1.05, p=0.09; I2=14%). However, there was no significant effect of omega-3 PUFA supplements on muscle mass, global health status, emotional functioning and symptoms (nausea and vomiting, loss of appetite anddiarrhoea). Conclusion: This review provides evidence for the benefits of oral omega-3 PUFA supplementation on quality of life butnot on muscle maintenance in patients with cancer. Well-designed large-scale randomised controlled trials inhomogenous patient cohorts are required to confirm these findings.
Clinical Oncology Society of Australia: Position statement oncancer-relatedmalnutrition and sarcopenia
Kiss, N ; Loeliger, J ; Findlay, M ; Isenring, EA ; Baguley, BJ ; Boltong, A ; Butler, A ; Deftereos, I ; Eisenhuth, M ; Fraser, SF ; Fichera, R ; Griffin, H ; Hayes, S ; Jeffery, E ; Johnson, C ; Lomma, C ; Meij, B.S. van der ; McIntyre, C ; Nicholls, T ; Pugliano, L ; Skinner, T ; Stewart, J ; Bauer, J. et al. sine al.
2020, Article / Letter to editor (Nutrition & Dietetics: Journal of Dietitians Australia, vol. 77, iss. 4, (2020), pp. 416-425)This position statement describes the recommendations of the Clinical Oncology Society of Australia (COSA) regarding management of cancer-related malnutrition and sarcopenia. A multidisciplinary working group completed a review of the literature, focused on evidence-based guidelines, systematic reviews and meta-analyses, to develop recommendations for the position statement. National consultation of the position statement content was undertaken through COSA members. All people with cancer should be screened for malnutrition and sarcopenia in all health settings at diagnosis and as the clinical situation changes throughout treatment and recovery. People identified as "at risk" of malnutrition or with a high-risk cancer diagnosis or treatment plan should have a comprehensive nutrition assessment; people identified as "at risk" of sarcopenia should have a comprehensive evaluation of muscle status using a combination of assessments for muscle mass, muscle strength and function. All people with cancer-related malnutrition and sarcopenia should have access to the core components of treatment, including medical nutrition therapy, targeted exercise prescription and physical and psychological symptom management. Treatment for cancer-related malnutrition and sarcopenia should be individualised, in collaboration with the multidisciplinary team (MDT), and tailored to meet needs at each stage of cancer treatment. Health services should ensure a broad range of health care professionals across the MDT have the skills and confidence to recognise malnutrition and sarcopenia to facilitate timely referrals and treatment. The position statement is expected to provide guidance at a national level to improve the multidisciplinary management of cancer-related malnutrition and sarcopenia.
Fish oil supplementation and maintaining muscle mass in chronic disease: state of the evidence
Meij, B.S. van der ; Mazurak, V.
2020, Article / Letter to editor (Current Opinion in Clinical Nutrition and Metabolic Care, vol. 23, iss. 3, (2020), pp. 164-173)Purpose of review Providing eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), in the form of fish oils, to benefit muscle is an emerging area of interest. The aim of this work was to evaluate the current literature that has assessed muscle mass as an outcome during a fish oil intervention in any chronic disease. Recent findings The vast majority of studies published in the last 3 years (12 of 15) have been conducted in the oncological setting, in patients undergoing treatment for cancers of the gastrointestinal tract, breast, head and neck, lung, cervix, and hematological cancers. Three studies were conducted in patients with chronic obstructive pulmonary disease (COPD). Fish oil was provided as part of nutrient mixtures in 12 studies and as capsules in three studies. Overall, the evidence for an effect of fish oil supplementation on muscle mass in patients with cancer undergoing treatment and in COPD remains unequivocal and reveals limited new knowledge in the area of fish oil supplementation in the cancer setting. Recent literature continues to provide mixed evidence on the efficacy of fish oil on muscle mass and function. The present review highlights challenges in comparing and interpreting current studies aimed at testing fish oil supplementation for muscle health.
Family in Rehabilitation, Empowering Carers for Improved Malnutrition Outcomes: Protocol for the FREER Pilot Study.
Marshall, S. ; Meij, B.S. van der ; Milte, R. ; Collins, C.E. ; Schueren, M.A.E. de van der ; Banbury, M. ; Warner, M.M. ; Isenring, E.
2019, Article / Letter to editor (JMIR Research Protocols, vol. 8, iss. 4, (2019))Background: Interventions to improve the nutritional status of older adults and the integration of formal and family care systems are critical research areas to improve the independence and health of aging communities and are particularly relevant in the rehabilitation setting. Objective: The primary outcome aimed to determine if the FREER (Family in Rehabilitation: EmpowERing Carers for improved malnutrition outcomes) intervention in malnourished older adults during and postrehabilitation improve nutritional status, physical function, quality of life, service satisfaction, and hospital and aged care admission rates up to 3 months postdischarge, compared with usual care. Secondary outcomes evaluated include family carer burden, carer services satisfaction, and patient and carer experiences. This pilot study will also assess feasibility and intervention fidelity to inform a larger randomized controlled trial. Methods: This protocol is for a mixed-methods two-arm historically-controlled prospective pilot study intervention. The historical control group has 30 participants, and the pilot intervention group aims to recruit 30 patient-carer pairs. The FREER intervention delivers nutrition counseling during rehabilitation, 3 months of postdischarge telehealth follow-up, and provides supportive resources using a novel model of patient-centered and carer-centered nutrition care. The primary outcome is nutritional status measured by the Scored Patient-Generated Subjective Global Assessment Score. Qualitative outcomes such as experiences and perceptions of value will be measured using semistructured interviews followed by thematic analysis. The process evaluation addresses intervention fidelity and feasibility. Results: Recruitment commenced on July 4, 2018, and is ongoing with eight patient-carer pairs recruited at the time of manuscript submission. Conclusions: This research will inform a larger randomized controlled trial, with potential for translation to health service policies and new models of dietetic care to support the optimization of nutritional status across a continuum of nutrition care from rehabilitation to home.

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