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Oral supplement palatability study in an outpatient radiotherapy clinic
THURSDAY, OCTOBER 28 |
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DEVELOPMENT OF MEDFICTS -A DIETARY ASSESSMENT INSTRUMENT FOR EVALUATING FAT, SATURATED FAT, AND CHOLESTEROL INTAKE. U Srinath, MS*, F Shacklock, MS, RD*, LW Scott, MA, RD+, S Jaax, MS, RD+, and PM Kris-Etherton, PhD, RD*, Department of Nutrition, The Pennsylvania State University, University Park, PA* and Baylor College of Medicine, Houston, TX+ MEDFICTS (Meat, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks) is a dietary assessment questionnaire designed to assess adherence to Step-One and Step-Two diets in a clinical setting. It focuses on foods that are prime contributors of fat, saturated fat, and cholesterol and provides a tool to quickly record food selection, frequency of intake, and portion sizes. MEDFICTS was developed after reviewing several dietary assessment instruments in use that have been either pilot tested or validated. A pilot test validation of MEDFICTS was carried out using 16 computer analyzed sets of four food records randomly selected from 7-day food records collected in the Diet Modification Clinic, Baylor College of Medicine, Houston, TX. The average 'MEDFICTS score for 11 patients on a Step-One Diet, 2 patients on a Step-Two Diet, and 3 patients on an average American Diet were 53, 38, and 102, respectively. The MEDFICTS score was significantly correlated with % Calories from fat (R*=0.8, p<0.0002), % Calories from saturated fat (R=0.8, p<0.0003) and dietary cholesterol (R=0.5, p<0.05) as analyzed in the diet records. Studies are in progress to validate the MEDFICTS Dietary Assessment Instrument on participants in two major dietary intervention studies. MEDFICTS, besides being a quick and efficient tool for dietary assessment of Step-One and StepTwo Diets, is useful for monitoring dietary changes over time. This instrument can be self-administered. It can also play an important role in nutrition education.
AN EARLY MULTIDISCIPLINARY TEAM APPROACH TO NUTRITIONAL MANAGEMENT PROMOTES GROWTH IN INFANTS POST EXTRACORPOREAL MEMBRANE OXYGENATION. C J. Valentine, MS, RD, LD; S.M. Phillips, MS, RD, LD and A. Elizondo, MSN, RN Baylor College of Medicine Division of Neonatology and Texas Children's Hospital, Houston, Texas. The advent of Extracorporeal Membrane Oxygenation (ECMO) to treat infants who have failed conventional respiratory management has historically created a challenge to provide adequate nutrition for growth. Our objective was to focus on the nutritional management by having a standard protocol and to achieve appropriate growth in these infants. The Baylor ECMO protocol includes standing orders for parenteral nutrition (PN) to begin on ECMO day # 1, a Neonatal Nutrition consult on ECMO day # 2, and nonnutritive nipple feeds to begin on ECMO day #2. Four days post ECMO infants are scheduled to begin enteral feeds with 25 cc/kg/day milk and a pacifier is introduced. The first nutritive nipple feed begins on post ECMO day # 6. The Suck - Swallow' Team intervenes if the nipple feed is inadequate ( greater than 20 minutes duration or with aspiration, apnea). Enteral feeds progress by 25 cc/kg/day and nipple feeds progress as tolerated, with a goal intake of 150 cc/kg/day of 24 kcalorie per ounce breast milk or formula by post-ECMO day # 21. We retrospectively reviewed the nutrition intervention provided to 6 infants treated with ECMO for an average of 5 days (1-5 day range) to assess the outcome of feeding and growth. Fluid and energy intake during ECMO was limited but PN began by ECMO day # 3 (2-5 days), with full PN achieved by 1-2 days post ECMO. Enteral feeds began on post ECMO day #6 (2-14 days), with full enteral feeds by postECMO day #14 (4-28 days). Nipple feeding began by post ECMO day # 12 (2-28 days) and complete nipple feeding by post ECMO day #17 (4-30). Infants regained birth weight by day 6 of life and weight gain for the duration of hospitalization was 24 grams per day (18-34 days). At discharge, mean intake was 210 cc/kg/day and 140 kcal/kg/day of breast milk for formula. All infants demonstrated growth parameters comparable to the NCHS percentiles for appropriate growth. In conclusion, a multidisciplinary team approach focused on nutrition management and nipple feeding results in adequate feeding and growth for infants post ECMO.
ORAL SUPPLEMENT PALATABILITY STUDY IN AN OUTPATIENT RADIOTHERAPY CLINIC. J. Vanderzyl, MS, RD, LD, L. Gastorf, MS, RD, LD, M. Bivins, RD, LD, H. Smith, and D. Johnston, PhD', Department of Nutrition and Food Service, Department of Biomathematics*, The University of Texas M. D. Anderson Cancer Center, Houston, TX Patients undergoing cancer treatment often rely on the use of oral nutritional supplements (ONS) to maintain adequate calorie and protein intake to prevent weight loss. Despite the variety available, it can be challenging to find a supplement that patients are willing to consume on a regular basis. Taste acuity and preference can be affected by the cancer process, nutrition-related side effects of treatment modalities, and other factors. A single blinded palatability test of ONS was conducted with 40 radiotherapy outpatients representing various treatment fields (Head and Neck, Breast, Lung, Mantle, Upper Gastrointestinal Tract, Lower Gastrointestinal Tract, Pelvic, and Prostate). Ensure, Nutren 1.0, Resource, and Newtrition were included by meeting the following criteria: oral liquid; nutritionally complete; lactose-free; 1.0-1.4 calories/mi; caloric distribution: 13-15.9% protein, 45-56% carbohydrate, no more than 37% fat; provides 100% USRDA for vitamins and minerals in 2000 calories or less; assorted flavors; 8 oz. container. To reduce result bias, ONS were offered in random order and both vanilla and chocolate were sampled. Queries about diagnosis, treatment modalities, treatment week, previous supplement usage, nutrition-related therapy side-effects, smoking habits, packaging preference, and food aversions were obtained via questionnaire. ONS were evaluated for appearance, odor, flavor, and overall acceptability. Results showed the study group to be equally distributed in terms of sex, age, and cancer site. Most were in their 2nd to 4th week of treatment. Three were receiving chemotherapy or antibiotics in addition to radiotherapy. Participants reporting side effects were as follows: taste changes (8), nausea (6), diarrhea (4), vomiting (3), and sore mouth (2). Forty percent expressed a packaging preference for a can, 20% a carton, and 40% either one. None of the factors screened for had a statistically significant effect on overall ONS acceptability. ONS ranked from least to most acceptable overall in the following order: Nutren 1.0, Resource, Ensure, and Newtrition, with a statistically significant difference between Nutren 1.0 and Newtrition, but none between other supplements. Overall acceptability was most closely correlated with flavor score. Results of this study and a previous inpatient palatability study of 1.5 calorie/mi formulas will be incorporated into the Enteral Formulary selection process that occurs every two years at our institution.
RISK OF DRUG-INDUCED MALNUTRITION GOES UNCHECKED IN ELDERLY NURSING HOME PATIENTS. R.N. Varma, Ph.D., R.D., L.D., Home Economics Department, Youngstown State University, Youngstown, Ohio. A retrospective study of 390 randomly selected medical records of patients aged 65 years and older living in 10 nursing homes in the Youngstown area revealed that a total of 276 prescription and non-prescription drugs were used in patients during a period of one year, the number of drugs per patients ranging from 2 to 21 per day with an average of 6.6 drugs per day. Further examination revealed that 23 of the 62 more frequently drugs were those that were known to cause reduced food intake and 15 were those that were known to cause specific nutrient deficiencies in geriatric patients. Of the 112 patients who received one or more of the drugs known to cause reduced food intake, 46 were found to have < 90% of their admission weights, although 32 of these patients were receiving some form of calorie and protein supplement. Specific nutrient deficiencies known to be caused by the 15 drugs included those of folate, vitamin B12, vitamin B6, vitamin C, vitamin D, vitamin K, phosphate, potassium, calcium, magnesium and zinc. The only laboratory tests performed frequently for the detection of these deficiencies were serum potassium, calcium and phosphate. The only nutrient supplement that the patients received frequently for the prevention of drug-induced nutrient deficiencies was that of potassium. This study shows that the current monitoring of geriatric patients is inadequate for the prevention of drug-induced nutrient deficiencies and emphasizes the need for Integrating nutrition and pharmacy in geriatric care.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-105
~ ~~~~~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ POSTER SESSION: CLINICAL NUTRITION i
i
i
i l
Ill
,
DEVELOPMENT OF MEDFICTS -A DIETARY ASSESSMENT INSTRUMENT FOR EVALUATING FAT, SATURATED FAT, AND CHOLESTEROL INTAKE. U Srinath, MS*, F Shacklock, MS, RD*, LW Scott, MA, RD+, S Jaax, MS, RD+, and PM Kris-Etherton, PhD, RD*, Department of Nutrition, The Pennsylvania State University, University Park, PA* and Baylor College of Medicine, Houston, TX+ MEDFICTS (Meat, Eggs, Dairy, Fried foods, In baked goods, Convenience foods, Table fats, Snacks) is a dietary assessment questionnaire designed to assess adherence to Step-One and Step-Two diets in a clinical setting. It focuses on foods that are prime contributors of fat, saturated fat, and cholesterol and provides a tool to quickly record food selection, frequency of intake, and portion sizes. MEDFICTS was developed after reviewing several dietary assessment instruments in use that have been either pilot tested or validated. A pilot test validation of MEDFICTS was carried out using 16 computer analyzed sets of four food records randomly selected from 7-day food records collected in the Diet Modification Clinic, Baylor College of Medicine, Houston, TX. The average 'MEDFICTS score for 11 patients on a Step-One Diet, 2 patients on a Step-Two Diet, and 3 patients on an average American Diet were 53, 38, and 102, respectively. The MEDFICTS score was significantly correlated with % Calories from fat (R*=0.8, p<0.0002), % Calories from saturated fat (R=0.8, p<0.0003) and dietary cholesterol (R=0.5, p<0.05) as analyzed in the diet records. Studies are in progress to validate the MEDFICTS Dietary Assessment Instrument on participants in two major dietary intervention studies. MEDFICTS, besides being a quick and efficient tool for dietary assessment of Step-One and StepTwo Diets, is useful for monitoring dietary changes over time. This instrument can be self-administered. It can also play an important role in nutrition education.
AN EARLY MULTIDISCIPLINARY TEAM APPROACH TO NUTRITIONAL MANAGEMENT PROMOTES GROWTH IN INFANTS POST EXTRACORPOREAL MEMBRANE OXYGENATION. C J. Valentine, MS, RD, LD; S.M. Phillips, MS, RD, LD and A. Elizondo, MSN, RN Baylor College of Medicine Division of Neonatology and Texas Children's Hospital, Houston, Texas. The advent of Extracorporeal Membrane Oxygenation (ECMO) to treat infants who have failed conventional respiratory management has historically created a challenge to provide adequate nutrition for growth. Our objective was to focus on the nutritional management by having a standard protocol and to achieve appropriate growth in these infants. The Baylor ECMO protocol includes standing orders for parenteral nutrition (PN) to begin on ECMO day # 1, a Neonatal Nutrition consult on ECMO day # 2, and nonnutritive nipple feeds to begin on ECMO day #2. Four days post ECMO infants are scheduled to begin enteral feeds with 25 cc/kg/day milk and a pacifier is introduced. The first nutritive nipple feed begins on post ECMO day # 6. The Suck - Swallow' Team intervenes if the nipple feed is inadequate ( greater than 20 minutes duration or with aspiration, apnea). Enteral feeds progress by 25 cc/kg/day and nipple feeds progress as tolerated, with a goal intake of 150 cc/kg/day of 24 kcalorie per ounce breast milk or formula by post-ECMO day # 21. We retrospectively reviewed the nutrition intervention provided to 6 infants treated with ECMO for an average of 5 days (1-5 day range) to assess the outcome of feeding and growth. Fluid and energy intake during ECMO was limited but PN began by ECMO day # 3 (2-5 days), with full PN achieved by 1-2 days post ECMO. Enteral feeds began on post ECMO day #6 (2-14 days), with full enteral feeds by postECMO day #14 (4-28 days). Nipple feeding began by post ECMO day # 12 (2-28 days) and complete nipple feeding by post ECMO day #17 (4-30). Infants regained birth weight by day 6 of life and weight gain for the duration of hospitalization was 24 grams per day (18-34 days). At discharge, mean intake was 210 cc/kg/day and 140 kcal/kg/day of breast milk for formula. All infants demonstrated growth parameters comparable to the NCHS percentiles for appropriate growth. In conclusion, a multidisciplinary team approach focused on nutrition management and nipple feeding results in adequate feeding and growth for infants post ECMO.
ORAL SUPPLEMENT PALATABILITY STUDY IN AN OUTPATIENT RADIOTHERAPY CLINIC. J. Vanderzyl, MS, RD, LD, L. Gastorf, MS, RD, LD, M. Bivins, RD, LD, H. Smith, and D. Johnston, PhD', Department of Nutrition and Food Service, Department of Biomathematics*, The University of Texas M. D. Anderson Cancer Center, Houston, TX Patients undergoing cancer treatment often rely on the use of oral nutritional supplements (ONS) to maintain adequate calorie and protein intake to prevent weight loss. Despite the variety available, it can be challenging to find a supplement that patients are willing to consume on a regular basis. Taste acuity and preference can be affected by the cancer process, nutrition-related side effects of treatment modalities, and other factors. A single blinded palatability test of ONS was conducted with 40 radiotherapy outpatients representing various treatment fields (Head and Neck, Breast, Lung, Mantle, Upper Gastrointestinal Tract, Lower Gastrointestinal Tract, Pelvic, and Prostate). Ensure, Nutren 1.0, Resource, and Newtrition were included by meeting the following criteria: oral liquid; nutritionally complete; lactose-free; 1.0-1.4 calories/mi; caloric distribution: 13-15.9% protein, 45-56% carbohydrate, no more than 37% fat; provides 100% USRDA for vitamins and minerals in 2000 calories or less; assorted flavors; 8 oz. container. To reduce result bias, ONS were offered in random order and both vanilla and chocolate were sampled. Queries about diagnosis, treatment modalities, treatment week, previous supplement usage, nutrition-related therapy side-effects, smoking habits, packaging preference, and food aversions were obtained via questionnaire. ONS were evaluated for appearance, odor, flavor, and overall acceptability. Results showed the study group to be equally distributed in terms of sex, age, and cancer site. Most were in their 2nd to 4th week of treatment. Three were receiving chemotherapy or antibiotics in addition to radiotherapy. Participants reporting side effects were as follows: taste changes (8), nausea (6), diarrhea (4), vomiting (3), and sore mouth (2). Forty percent expressed a packaging preference for a can, 20% a carton, and 40% either one. None of the factors screened for had a statistically significant effect on overall ONS acceptability. ONS ranked from least to most acceptable overall in the following order: Nutren 1.0, Resource, Ensure, and Newtrition, with a statistically significant difference between Nutren 1.0 and Newtrition, but none between other supplements. Overall acceptability was most closely correlated with flavor score. Results of this study and a previous inpatient palatability study of 1.5 calorie/mi formulas will be incorporated into the Enteral Formulary selection process that occurs every two years at our institution.
RISK OF DRUG-INDUCED MALNUTRITION GOES UNCHECKED IN ELDERLY NURSING HOME PATIENTS. R.N. Varma, Ph.D., R.D., L.D., Home Economics Department, Youngstown State University, Youngstown, Ohio. A retrospective study of 390 randomly selected medical records of patients aged 65 years and older living in 10 nursing homes in the Youngstown area revealed that a total of 276 prescription and non-prescription drugs were used in patients during a period of one year, the number of drugs per patients ranging from 2 to 21 per day with an average of 6.6 drugs per day. Further examination revealed that 23 of the 62 more frequently drugs were those that were known to cause reduced food intake and 15 were those that were known to cause specific nutrient deficiencies in geriatric patients. Of the 112 patients who received one or more of the drugs known to cause reduced food intake, 46 were found to have < 90% of their admission weights, although 32 of these patients were receiving some form of calorie and protein supplement. Specific nutrient deficiencies known to be caused by the 15 drugs included those of folate, vitamin B12, vitamin B6, vitamin C, vitamin D, vitamin K, phosphate, potassium, calcium, magnesium and zinc. The only laboratory tests performed frequently for the detection of these deficiencies were serum potassium, calcium and phosphate. The only nutrient supplement that the patients received frequently for the prevention of drug-induced nutrient deficiencies was that of potassium. This study shows that the current monitoring of geriatric patients is inadequate for the prevention of drug-induced nutrient deficiencies and emphasizes the need for Integrating nutrition and pharmacy in geriatric care.
JOURNAL OF THE AMERICAN DIETETIC ASSOCIATION / A-105