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The purpose of value-based healthcare is to effectively control medical costs on the basis of comprehensively improved healthcare quality, which is the key focus of medical system reform in China. Improving information system framework, establishing scientific evaluation methods and transforming medical insurance payment methods are the impetus for value-based healthcare practice in China. "Screening, assessment and intervention" is the critical step in standardized medical nutrition management. In line with the connotation of value-based healthcare, nutritional risk screening aims to improve clinical outcomes. The diagnosis of malnutrition per the Global Leadership Initiative on Malnutrition (GLIM) criteria enables the inclusion into Diagnosis Related Groups (DRGs). Oral nutritional supplement is the preferred medical nutrition treatment for patients at nutritional risk or with malnutrition and insufficient food intake. Standardized application can reduce weight loss, improve clinical outcomes, save medical costs and improve the health and survival of malnourished elderly patients at a lower cost, exemplifying the value-based healthcare model.
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@#The worldwide population is ageing rapidly, and the number of people aged ≥65 years is expected to double by 2050. Prevalence of risk of malnutrition is high among community-dwelling older adults and is associated with adverse health outcomes and higher costs of care. Anorexia of ageing is a major cause, characterized by unintentional loss of appetite and reduced oral intake. Achieving energy, protein and micronutrient requirements is important to maintaining health and functional independence. Older adults require a minimum of 1.0 to 1.2 g/kg body weight/day of protein to maintain muscle health. The only exception to this recommendation is older adults with advanced kidney disease and not on dialysis. Nutritional supplementation, in addition to diet, is often required. Several international guidelines recommend oral nutritional supplements (ONS) and dietary advice for older people with malnutrition. ONS containing β-hydroxy-β-methylbutyrate (HMB) has been shown to improve nutritional and functional outcomes in community-dwelling older adults with or at risk of malnutrition. As such, early screening for malnutrition risk in older adults is an important public health strategy. Such screening enables early identification, intervention and best clinical outcomes. Raising awareness on the importance of nutritional health in older people is key, in order to maintain physical function and independent living for as long as possible, preserve quality of life and reduce burdens of unhealthy ageing on healthcare systems.
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Objective To investigate the effect of oral nutritional supplements (ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. ResultsThe body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge. (2 months after discharge: 1. 65±2. 11vs. 2. 70±1. 90 kg, t = -2. 3853, P = 0. 0193; 3 months after discharge: 1. 95±2. 75vs. 3. 67±2. 29 kg, t = -3. 1347, P = 0. 0024), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score (56. 82±13. 65％vs. 51. 71± 9. 72％, t = 2. 0148, P = 0. 0472) and QOL score (41. 91±6. 92 vs. 38. 39±8. 77, t = 2. 0597, P = 0. 0426) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective@#To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer.@*Methods@#All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge.@*Results@#The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients.@*Conclusion@#ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Objective@#To survey the nutritional status of maintenance hemodialysis (MHD) patients and explore the role of oral nutritional supplement (ONS) in improving nutritional status among MHD patients.@*Methods@#From January 2016 to December 2017, one hundred and sixty-two MHD patients were selected randomly from hemodialysis centre of No. 2 peoples’ Hospital and assessed malnutrition incidence by objective score of nutrition on dialysis (OSND). Patients with malnutrition were divided into control group and ONS group randomly, patients in control group were conducted with traditional nutritional education, while patients in ONS group were conducted with ONS as a substitution of diet on the basis of control group. Finally, nutrition-related indexes were observed after 6 months.@*Results@#The malnutrition incidence of MHD patients was 66.7% (108/162) screening by OSND, the malnutrition incidence of patients over 60 years old was 82.8% (72/87), significantly higher than below 60 years old, 49.3%(37/75)(P<0.05). After 6-month intervention, the differences of nutrition-related physical and laboratory indexes between control group and ONS group was observed [BW:(53.2±6.5)kg vs. (50.7±6.0)kg, t=2.08, P=0.04; TSF:(10.3±3.1)mm vs. (9.0±3.0)mm, t=2.21, P=0.03; ALB:(39.6±5.6)g/L vs. (35.6±5.5)g/L, t=3.74, P<0.01; HB:(104.5±10.8)g/L vs. (99.7±12.6)g/L, t=2.13, P=0.04; TF:(2.0±0.5)g/L vs. (1.5±0.4)g/L, t=5.74, P<0.01], while opposite before intervention (P>0.05). There was no significant difference of OSND, GNRI and MIS scores between control group and ONS group before intervention [OSND:(24.1±1.9) vs. (25.3±1.7), t=3.46, P<0.01; GRNI:(90.4±5.4) vs. (92.4±4.5), t=2.09, P=0.04; MIS:(9.2±3.2) vs. (10.9±3.3), t=2.72, P=0.01], while opposite after intervention (P<0.05). Subjective feeling score of patients in ONS group was significantly higher than control group after intervention [(10.7±3.5)vs(8.9±4.0), t=2.49, P=0.01]. The extra cost in control group and ONS group was (688.8±254.6) RMB and (749.2±44.9) RMB respectively with no significance (t=1.72, P=0.09).@*Conclusion@#The malnutrition incidence is high among MHD patients, traditional nutrition education takes poor patients compliance, while ONS could improve patients′ compliance and nutritional status because of scientific formula and good taste, which provide another diet selection for MHD patients.
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Objective To survey the nutritional status of maintenance hemodialysis (MHD) patients and explore the role of oral nutritional supplement (ONS) in improving nutritional status among MHD patients. Methods From January 2016 to December 2017, one hundred and sixty-two MHD patients were selected randomly from hemodialysis centre of No. 2 peoples’Hospital and assessed malnutrition incidence by objective score of nutrition on dialysis (OSND). Patients with malnutrition were divided into control group and ONS group randomly, patients in control group were conducted with traditional nutritional education, while patients in ONS group were conducted with ONS as a substitution of diet on the basis of control group. Finally, nutrition-related indexes were observed after 6 months. Results The malnutrition incidence of MHD patients was 66.7% (108/162) screening by OSND, the malnutrition incidence of patients over 60 years old was 82.8% (72/87), significantly higher than below 60 years old, 49.3%(37/75)(P<0.05). After 6-month intervention, the differences of nutrition-related physical and laboratory indexes between control group and ONS group was observed [BW:(53.2±6.5)kg vs. (50.7± 6.0)kg, t=2.08, P=0.04; TSF:(10.3±3.1)mm vs. (9.0±3.0)mm, t=2.21, P=0.03; ALB:(39.6±5.6)g/L vs. (35.6± 5.5)g/L, t=3.74, P<0.01; HB:(104.5±10.8)g/L vs. (99.7±12.6)g/L, t=2.13, P=0.04; TF:(2.0±0.5)g/L vs. (1.5± 0.4)g/L, t=5.74, P<0.01], while opposite before intervention (P>0.05). There was no significant difference of OSND, GNRI and MIS scores between control group and ONS group before intervention [OSND:(24.1± 1.9) vs. (25.3 ± 1.7), t=3.46, P<0.01; GRNI:(90.4 ± 5.4) vs. (92.4 ± 4.5), t=2.09, P=0.04; MIS:(9.2 ± 3.2) vs. (10.9±3.3), t=2.72, P=0.01], while opposite after intervention (P<0.05). Subjective feeling score of patients in ONS group was significantly higher than control group after intervention [(10.7±3.5)vs(8.9±4.0), t=2.49, P=0.01]. The extra cost in control group and ONS group was (688.8±254.6) RMB and (749.2±44.9) RMB respectively with no significance (t=1.72, P=0.09). Conclusion The malnutrition incidence is high among MHD patients, traditional nutrition education takes poor patients compliance, while ONS could improve patients′ compliance and nutritional status because of scientific formula and good taste, which provide another diet selection for MHD patients.
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@#Compliance rate towards consumption of oral nutritional supplement (ONS) is low among geriatric patients. Thus, this study aimed to examine factors affecting low compliance of ONS intake among a sample of geriatric patients. A cross-sectional survey was carried out involving 30 geriatric patients being prescribed with ONS during their stay in Hospital Kuala Lumpur. Information on compliance rate and influencing factors were collected through interview and observation. Nutritional status was assessed using anthropometry and Patient Generated Subjective Global Assessment (PG-SGA). 50.0% subjects were underweight and 70.0% and 30.0% were moderate and severely malnourished, respectively. A total of 43.3% were categorised as low, 53.4% medium and 3.3% high compliance towards consumption of ONS. Most of the subjects with low compliance agreed expressed that they need more nursing support (53.8%). Less than half perceived they had been given the needed nursing support (44.4%), and with respect to ONS: knowledgeable (38.5%), timely given (37.5%), understood the importance (35.7%), were able to finish it (35.0%), well-aware of the reasons of prescription (33.3%), satisfied with its taste (33.3%), received suitable volume (33.3%), satisfied with the texture (31.6%), and received suitable frequency (28.6%). In conclusion, approximately 40% of subjects had low compliance towards ONS. Awareness and nursing support were important factors associated with low compliance. There is a need to ensure adequate nursing support and education been given to patients prescribed with ONS in order to increase the compliance rate.
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Objective To investigate the effect of nutritional intervention upon the clinical efficacy of chemoradiotherapy in patients diagnosed with esophageal carcinoma. Methods A total of 46 patients who were diagnosed with esophageal cancer in Anhui Cancer Hospital from November 2016 to August 2017 were enrolled in this prospective study. All patients were randomly and evenly divided into the nutritional intervention (NI) and routine treatment (RT) groups. The changes in body mass index (BMI),PG-SGA, serum albumin ( ALB), hemoglobin ( HB), white blood cell ( WBC) and other objective nutritional parameters and the incidence of chemoradiotherapy-induced complications were recorded before and after chemoradiotherapy. Results Prior to chemoradiotherapy,age,sex,BMI,ALB,PLT and clinical staging did not significantly differ between two groups (all P>0. 05).In the NI group,the BMI was (21.52±2. 67) after chemoradiotherapy,significantly higher than (21.13±2. 73) before radiotherapy (P= 0. 000).Moreover,the PG-SGA score after chemoradiotherapy was significantly lower compared with that before chemoradiotherapy (P= 0. 000).In the RT group,the BMI,Hb,ALB,PLT and WBC after chemoradiotherapy were significantly lower than those before radiotherapy, and thePG-SGA score was worse after chemoradiotherapy ( all P<0. 05).In the NI group, the incidence of grade 3 myelosuppression was 4. 34％, significantly lower than 8. 68％ in the RT group ( P= 0. 000 ). Conclusions Patients with esophageal cancer treated with chemoradiotherapy have a high nutritional risk. Nutritional intervention can improve the nutritional status, reduce the incidence of chemoradiotherapy-induced complications,and probably improve the quality of life and clinical prognosis.
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Objective To investigate the effect of nutritional counseling combined with oral high-fat, high-protein nutritional supplement (Ensource) on nutritional status and clinical outcomes of esophageal cancer patients under radiotherapy treatment.Methods Totally 80 esophageal cancer patients under radiotherapy treat-ment who were able to take oral feeding and with Nutritional Risk Screening 2002 (NRS 2002) score≥3 were se-lected and divided into a study group (n=41, nutritional counseling combined with oral nutritional supplements) and a control group ( n=39, nutritional counseling) with a random number table.Energy intake, nutritional sta-tus, and incidences of radiotherapy complications of the two groups before and after radiotherapy were compared. Results Energy intakes in the study group increased significantly during radiotherapy compared with the control group [ (2 445 ±686) kJ vs.(1 747 ±456) kJ, P=0.003];and the level of prealbumin and transferrin were increased significantly compared with before radiotherapy [ (17.35 ±5.83) mg/L vs.(20.15 ±6.02) mg/L, P=0.008;(213.74 ±52.66) mg/L vs.(264.19 ±43.78) mg/L, P=0.002].Besides, compared with the control group, incidence of radiation esophagitis ( GradeⅢ) and radiation skin injury ( GradeⅢ) in the study group decreased significantly (24%vs.38%, P=0.000;27%vs.41%, P=0.000).Conclusion Nutritional counseling combined with oral nutritional supplements in esophageal cancer patients could help improve the patients'nutritional profile and decrease the incidence of complications related with radiotherapy.
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Recently, it is reported that intervention of oral nutritional supplement improves the nutritional status of cancer patients, and the effectiveness is affected by the sensory preference of cancer patients on the oral nutritional supplement. However, the variety of oral nutritional supplement is extremely limited and the number of patient's benefits from using the products are restricted mostly due to sensory dislikes. The objective of this study was to provide sensory preference score of trial manufactured products with different accessory ingredients to maximize the use of oral nutritional supplements. Cancer patients (n = 30) and age, sex-matched healthy volunteers (n = 30) participated in the sensory assessments (taste, flavor, viscosity, color and overall preference) of three types of oral supplements (cereal base, cereal base+herb and cereal base+fruit) and a control supplement product with scorched cereal flavor, a top seller in current Korean market. Results indicate that the cancer patients' overall preference was significantly higher for the control supplement, and fruit added supplement was preferred over plain cereal and herb added products, although the difference was insignificant. However, there was no significant preference difference for the supplements among the control group for all sensory factors. These results suggest that cancer patients are more sensitive to sensory preferences compared to the control group, and the patients prefer the flavor of cooked cereal which is a staple food in Korea.
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Humanos , Grano Comestible , Frutas , Voluntarios Sanos , Corea (Geográfico) , Estado Nutricional , ViscosidadRESUMEN
Protein-calorie malnutrition is common in CAPD patients and is associated with increased morbidity and mortality. To evaluate the effect of an oral nutritional supplement(Greenbia RDplus, DR. CHUNG'S FOOD CO., LTD, Seoul, Korea) providing 800Cal and 24g of protein daily in addition to their usual diet on the nutritional status, we conducted a prospective study in malnourished CAPD patients (N=26). Subjects were randomised into 2 groups: group I(N=15) taking Greenbia RDplus for 3 months, group II(N=11) as control. In group I, the data of 12 patients who completed the 3-months study period were analyzed. There were no statistically significant changes in biochemical parameters including total protein, serum albumin, prealbumin, transferrin during the study period in both groups, but IGF-I increased significantly in group I(129.2+/-88.8 vs. 174.1+/-109.3ng/mL, P<0.05). Total calorie (1349+/-272 vs. 1720+/-251Cal/day, P<0.05) and protein intake(1.05+/-0.29 vs. 1.24+/-0.25g/kg/day, P<0.05) assessed by 72-hours dietary recall method increased significantly in group I with oral supplement. Body weight(52.4+/-8.3 vs. 54.2+/-8.8kg, P<0.05), body mass index(18.7+/-1.8 vs. 19.5+/-2.0kg/m2, P<0.05), % body fat(13.2+/-4.2 vs. 15.4+/-3.9%, P<0.05), total body muscle(16.8+/-3.7 vs. 18.2+/-3.3kg, P<0.05), midarm circumference(22.8+/-2.1 vs. 23.7+/-2.2cm, P<0.05) and calculated arm muscle area(25.9+/-7.1 vs. 28.9+/-6.1 cm2, P<0.05) increased significantly in group I after 3 months. Biceps and triceps skinfold thickness tended to increase following oral nutritional supplement but there was no statistical significance. Anthropometric parameters remained unchanged in group II. Kt/Vurea, normalized protein catabolic rate and standardized creatinine clearance did not change in both groups. In conclusion, oral nutritional supplement in malnourished CAPD patients well tolerated and was effective in improving the anthropometric parameters.