[Consensus approach: Prior to the construction of an evaluation scale of risk constipation patients hospitalized for nursing practice]. / Approche par recherche de consensus : un préalable à la construction d'une échelle d'évaluation du risque de constipation des patients hospitalisés destinée à la pratique infirmière.

BACKGROUND: Constipation is a frequent issue during hospitalization. Multiple causes such as the existence of irregular habits, lack of exercise as well as medical history have been identified. Drugs such as strong painkillers, central nervous system therapies and treatments of the digestive tract are a major cause of constipation. Additionally, unbalanced diet, fluid deficiency, and anxiety may aggravate constipation. The consideration of all these risk factors being under the responsibility of nurses. The difficulty to take into account such a multifactorial aetiology in nursing practice and the fact that there is no easy to use and validated tool to assess the risk of constipation in current nurse practice has led us to consider the development of a Risk Assessment scale of Constipation in Patient Hospitalized (ERCoPH) to facilitate preventive management of this trouble. We present here the first step of the elaboration of this scale, the identification of risk factors through a consensus approach after a systematic literature review. METHODS: The key informants consensus-based approach proposed by Pineault and Daveluy is based on five steps: (1) a literature review to identify risk factors for constipation; (2) the elaboration of a questionnaire containing the factors identified in the first step; (3) pre-select a panel of experts; (4) submission the questionnaire to the panel; (5) analysis the results of the consensus survey. Only factors that received a rating>6 by at least 80 % of the experts were retained. RESULTS: The systematic literature review identified 69 risk factors submitted to the 23 experts of the panel. Fifteen risk factors were retained after analyzing the answers of the experts. The Scientific Committee added eight risk factors because of their importance in the literature and decided to group together some factors of the same domain. CONCLUSION: A total of 19 risk factors were selected and grouped by major class (age, physical activity, medication, social data, food/hydration, medical and surgical history and environmental data). These factors have been tested among 300 patients enrolled in different clinical settings as part of the construction and validation of ERCoPH.

[Is nutritional intervention influencing lipid allowances beneficial?]. / L'intervention nutritionnelle portant sur les apports lipidiques est-elle bénéfique?

An earlier study (consumption study) has shown that in subjects eating normally: 1) the amount of fat consumed per day corresponds to 4/5 of the fat contained in the portions served; 2) the distribution of the fatty acids (FA) consumed is unfavorable because of the use of saturated FA for food preparation and cooking and because of the elimination of mono- and polyunsaturated FA in the unconsumed food. In order to determine whether a simple nutritional intervention might favorably modify the distribution of FA consumed, a computer simulation of a decrease in allowances of saturated FA in exchange for an increase in mono- and polyunsaturated FA was tested. The laboratory results were compared to those of the computer program. Comparison of the intervention study with the consumption study revealed that: 1) the fat content was identical; 2) there were the same number of total calories, but there were more lipidic calories consumed during the intervention (38% instead of 35%); 3) the distribution of FA more nearly approached the recommended amounts: 40% saturated FA (-25%), 39% monounsaturated FA (+8%), 21% polyunsaturated FA (+91%) and a P/S ratio of .60 (instead of .21); 4) these proportions can be explained by a decrease in palmitic (-30%) and stearic (-20%) acids and by an increase in linoleic (+100%) and linolenic (+40%) acids; 5) the allowances of elaidic acid was on the average 4.3 g per day and had little influence on the P/S ratio; 6) the omega 6/omega 3 ratio (ratio of 7) was higher than that of the consumption study (ratio of 5); 7) there was a 16% decrease in cholesterol intake (260 mg instead of 310 mg). The laboratory findings corresponded on the whole to those of the computer program that only faulted by overestimating lipid and cholesterol allowances.

[Qualitative and quantitative assessment of lipid consumption in the intake of a community]. / Evaluation qualitative et quantitative de la consommation lipidique dans la ration d'une collectivité.

Most nutritional studies assess the nutriment allowance of a selected population from inquiries and tables of food components. Very few of them use biochemical analysis of lipid extraction, which is a more reliable process. In other respects, the investigations on the real consumption of the population are scarce. Our study aims to assess the lipid consumption of subjects submitted to normal feeding in hospital food service, from biochemical analysis of allowances and of non-consumed food. The allowances of 10 dietary days and the whole of the non-consumed food a 10 subjects by dietary day have been assessed. The results show that: 1) the ratio of fat in the non-consumed food (7.5% in wet weight) exceeds that of the proposed intake (6.6%); 2) the consumed food (1,900 KCal/d) represents 80% of the initial total calorie allowance and includes 37.5% lipid calories (71% of initial lipid allowance); 3) the distribution of the consumed fatty acids (FA) is identical to that of the fatty acids of the initial intake and not in conformity with the recommendations of the FAO/WHO Board: 53% saturated FA, 34% mononunsaturated FA, 13% polyunsaturated FA and P/S ratio: 0.23; 4) mono and polyunsaturated FA are eliminated in the non-consumed food, more particularly in unclean plates where the distribution is very near the recommended one: 48% monounsaturated FA, 21% polyunsaturated FA, 31% saturated FA and P/S ratio: 0.8; 5) in spite of these data, the consumption of essential FA remains satisfactory: 7 g of linoleic acid, and 1.5 g of linolenic acid; 6) the consumption of cholesterol (215 mg/d), corresponding to 3/4 of the initial allowance, is satisfactory. The whole of these results are correlated with the Table of Food Components and two dietary softwares.