Canadian Nationwide Survey on Pediatric Malnutrition Management in Tertiary Hospitals.

Background: Disease-associated malnutrition (DAM) is common in hospitalized children. This survey aimed to assess current in-hospital practices for clinical care of pediatric DAM in Canada. Methods: An electronic survey was sent to all 15 tertiary pediatric hospitals in Canada and addressed all pillars of malnutrition care: screening, assessment, treatment, monitoring and follow-up. Results: Responses of 120 health care professionals were used from all 15 hospitals; 57.5% were medical doctors (MDs), 26.7% registered dietitians (RDs) and 15.8% nurses (RNs). An overarching protocol for prevention, detection and intervention of pediatric malnutrition was present or "a work in progress", according to 9.6% of respondents. Routine nutritional screening on admission was sometimes or always performed, according to 58.8%, although the modality differed among hospitals and profession. For children with poor nutritional status, lack of nutritional follow-up after discharge was reported by 48.5%. Conclusions: The presence of a standardized protocol for the clinical assessment and management of DAM is uncommon in pediatric tertiary care hospitals in Canada. Routine nutritional screening upon admission has not been widely adopted. Moreover, ongoing nutritional care of malnourished children after discharge seems cumbersome. These findings call for the adoption and implementation of a uniform clinical care pathway for malnutrition among pediatric hospitals.

Diagnosis, symptoms, and calcium intakes of individuals with self-reported lactose intolerance.

OBJECTIVE: To determine methods of diagnosis, symptoms, and calcium intake from food and supplements for individuals with self-reported lactose intolerance. METHODS/DESIGN: Cross-sectional survey using a mailed questionnaire. SUBJECTS/SETTING: A convenience sample of 189 adults with self-reported lactose intolerance living in the metropolitan area of Vancouver Canada responded to posters or advertisements, and 159 returned completed questionnaires. MEASURES OF OUTCOME: Methods of diagnosis, symptoms experienced and their severity were self-reported. Estimated calcium intake from food and supplements was assessed using a food frequency questionnaire. Data were analyzed using descriptive statistics, chi-square, Pearson correlation analysis, t-tests and Analysis of Variance. RESULTS: Participants were 47 +/- 15 years of age; 72% female and 28% male; 67% Caucasian; and 54% had self-diagnosed their lactose intolerance. Of the 42% diagnosed by a physician, only 10% had been diagnosed by valid tests. Mean estimated food calcium intake was 591 +/- 382 mg/d and did not differ between those who were self- or physician-diagnosed. Only 11.5% of participants met their age-appropriate Adequate Intake (AI) from food calcium sources alone. Calcium supplements were used by 65% and provided an average of 746 +/- 703 mg calcium/day to those who used them; mean intakes of this group met the AI. CONCLUSIONS: Calcium intake from food sources alone is inadequate to meet the AI in individuals with self-reported lactose intolerance. Physicians managing lactose intolerance need current information on how the AI can be met through appropriate food choices and possible supplementation.

Enteral nutrition in acute pancreatitis: a survey of practices in canadian intensive care units.

INTRODUCTION: Enteral nutrition (EN) is becoming the standard of care for the artificial nutrition support of the patient with severe acute pancreatitis. This study was designed to describe nutrition support practices for acute pancreatitis in Canadian intensive care units (ICUs) and to identify any barriers to the provision of EN in this patient population. METHODS: After an initial letter of invitation, a survey was sent to all Canadian ICUs with a census of > or = 8 beds. At each center, the critical care dietitian was asked 13 questions about usual practice of providing nutrition support to critically ill patients with acute pancreatitis. RESULTS: Out of 62 ICUs successfully contacted through the initial letter that met entry criteria, responses were obtained from 54 (87%). EN was provided to patients with pancreatitis routinely in 13% (7/54) of units, occasionally in 72% (39/54), and never in 15% (8/54) of the ICUs. Technical difficulty obtaining small bowel access, reported by 38 units (72%), and lack of physician support for EN, as noted in 25 units (47%), were identified as the most common barriers to EN in this population. Enteral access was most commonly obtained via the nasojejunal route. The time frame from ICU admission to initiation of EN (when provided) differed widely between centers, varying from up to 24 hours to 48 hours in 22 units (48% of 46 ICUs), 3 to 5 days in 19 units (41%), and >5 days in 5 units (11%). Supplemental parenteral nutrition (PN) was commonly added to EN, routinely at 8 centers (18% of 45 ICUs) and only occasionally in another 20 units (44%). The duration of supplemental PN when used in conjunction with EN was <7 days in 83% (24/29) of the ICUs. When EN was not initiated, PN was used in all but one ICU. CONCLUSION: Although EN is being commonly provided to patients with acute pancreatitis, PN use remains prominent in many ICUs across Canada. Technical difficulty obtaining small bowel access and lack of physician support seem to be the most common barriers impeding use of EN.