Nutrition in Pregnancy: A Comparative Review of Major Guidelines.

IMPORTANCE: Nutrition patterns in pregnancy play a decisive role in the well-being of the mother and the fetus. OBJECTIVE: The aim of this review was to summarize and compare guidelines and recommendations on nutrition in pregnancy. EVIDENCE ACQUISITION: A descriptive review of major guidelines on antenatal nutrition was conducted, including the most recently published guidelines, namely, by the Australian Government Department of Health (2018); the Canadian Nutrition Working Group and Society of Obstetricians and Gynaecologists of Canada (2016); the World Health Organization (2016); the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland (2016); the International Federation of Gynecology and Obstetrics (2015); the Academy of Nutrition and Dietetics (2014); and the National Institute for Health and Care Excellence (2008). RESULTS: There is almost universal agreement regarding macronutrient requirements during pregnancy. The WHO, FIGO, and the NICE guidelines make no recommendation on fluid intake. Almost all guidelines state that weight gain during pregnancy should be closely monitored. Folic acid supplementation is universally recommended from the preconception period, but there are controversies regarding other vitamins' supplementation. Multiple micronutrient supplementation could be an option in specific settings according only to the FIGO. Probiotics are not routinely recommended in pregnancy. CONCLUSIONS: There is wide agreement among the reviewed guidelines regarding nutrition in pregnancy, but still there are controversies. Evaluation and classification of influential guidelines can be beneficial for establishing a universal consensus on nutrition during pregnancy, in order to achieve more favorable perinatal outcomes.

Is continuing medical education sufficient? Assessing the clinical nutrition knowledge of medical doctors.

OBJECTIVES: Provision of nutritional support (NS) can improve disease outcome and shorten hospital length of stay. NS, often prescribed by medical doctors, requires adequate clinical nutrition (CN) expertise. The aim of this study was to investigate self-perceived and actual CN knowledge among medical doctors in Greece. METHODS: Internal medicine physicians and surgical specialties (residents and specialized) were asked to self-evaluate their CN expertise, via a seven-item questionnaire and to complete a 20-question multiple-choice test on CN topics, with the aim of evaluating their actual CN knowledge. Participants were discouraged from accessing literature/information during the completion of either questionnaire. RESULTS: Of 182 invited medical doctors, 115 (50.4% surgical specialties) participated in the study (63.2% response rate). The majority of participants (65.2%) demonstrated inadequate CN knowledge, with 30.4% of those scoring low having a high self-perception of their CN expertise. Comparison of perceived and actual CN knowledge revealed that only 56.5% of the participants estimated their knowledge correctly. Those who had participated in CN continuous medical education courses demonstrated increased related expertise (P = 0.002). CONCLUSIONS: Medical doctors in Greece demonstrate low knowledge of fundamental CN principles, jeopardizing the provision of high-quality and efficient NS. Most importantly, the majority of participants overestimated their CN knowledge and prescribe artificial nutrition or participate in related decision making. Physicians' CN knowledge should be enhanced accordingly, either by attending CN modules during their studies, by participating in basic and advanced courses or CN-specific continuous medical education, or both.

Screening for Malnutrition Among People Accessing Health Services at Greek Public Hospitals: Results From an Observational Multicenter Study.

BACKGROUND: Malnutrition is associated with increased hospital stay and subsequently higher healthcare costs. Early detection of malnutrition among people accessing health services at public hospitals is vital to identify and treat malnutrition effectively and in a timewise and cost-effective manner. The aim of this study was to evaluate the nutrition risk of this population. MATERIALS AND METHODS: Nutrition screening was performed for 2970 patients (52% male; 55.3 ± 20.1 years old) at 34 hospitals. Nutrition risk was evaluated through 3 nutrition screening tools-Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Universal Screening Tool (MUST), and Mini Nutritional Assessment-Screening Form (MNA-SF). RESULTS: Malnutrition risk was found: 25.3% with NRS-2002, 22.9% with MUST, and 60.5% with MNA-SF. Nutrition risk among patients accessing health services at public hospitals increases with age (high-risk patients among those ≥80 years old: NRS-2002, 9.8%; MUST, 16.9%; MNA-SF, 43.9%). The highest prevalence of nutrition risk was found at the oncology departments (16.7%, NRS-2002; 23.4%, MUST). According to the NRS-2002 and MUST, surgical patients have a greater risk for malnutrition vs internal medicine patients (adjusted odds ratio [OR] = 1.0, P < .001; adjusted OR = 1.17, P < .001, respectively), whereas according to MNA-SF, surgical patients have 30% lower probability for malnutrition risk against internal medicine patients (adjusted OR = 0.7, P < .001). CONCLUSIONS: A high prevalence of malnutrition risk was reported among patients accessing health services at public hospitals. Early detection of malnutrition is vital to allow the allocation of the needed workforce to manage it effectively.