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  • 1.
    Bosaeus, Ingvar
    et al.
    Sahlgrenska University Hospital, Gothenburg.
    Wilcox, Gisela
    Monash University, Clayton, Victoria, Australia.
    Rothenberg, Elisabet
    Högskolan Kristianstad, Sektionen för lärande och miljö, Avdelningen för Praktisk-estetiska ämnen.
    Strauss, Boyd
    Monash University, Clayton, Victoria, Australia.
    Reply to Thibault & Genton2014Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, nr 6, s. 1158-1159Artikkel i tidsskrift (Annet vitenskapelig)
  • 2.
    Bosaeus, Ingvar
    et al.
    Sahlgrenska University Hospital.
    Wilcox, Gisela
    Monash University.
    Rothenberg, Elisabet
    Sahlgrenska University Hospital.
    Strauss, Boyd J
    Monash University.
    Skeletal muscle mass in hospitalized elderly patients: comparison of measurements by single-frequency BIA and DXA2014Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 33, nr 3, s. 426-431Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND & AIMS: There is increasing interest in estimating skeletal muscle mass (SMM) in clinical practice. We aimed to validate a bioelectrical impedance analysis (BIA) prediction equation for SMM, developed in a different healthy elderly population, in a population of hospital patients aged 70 and over, by comparison with dual-energy X-ray absorptiometry (DXA) SMM estimates. Comparison was also made with two other previously published BIA muscle prediction equations.

    METHODS: Muscle measurements by BIA and DXA were compared in 117 patients with a range of clinical conditions (45 female, 72 male, mean age 75 years).

    RESULTS: The BIA equation used yielded an accurate estimate of DXA-derived SMM. Mean (SD) difference was 0.26(1.79) kg (ns). The two other BIA equations over-estimated SMM compared to DXA (both p < 0.001), but all equations were highly correlated.

    CONCLUSIONS: The BIA equation used, developed in a different healthy elderly population, gave an accurate estimate of DXA-derived SMM in a population with various clinical disorders. BIA appears potentially capable to estimate SMM in clinical disorders, but the optimal approach to its use for this purpose requires further investigation.

  • 3.
    Cederholm, Tommy
    et al.
    Uppsala universitet.
    Barazzoni, R.
    Italien.
    Austin, Peter
    Storbritannien.
    Ballmer, Peter
    Schweiz.
    Biolo, G.
    Italien .
    Bischoff, Stephan C.
    Tyskland.
    Compher, C.
    USA.
    Correia, Isabel
    Brasilien.
    Higashiguchi, T.
    Japan.
    Hoist, Mette
    Danmark.
    Jensen, Gordon L.
    USA.
    Malone, Ainsley
    USA.
    Muscaritoli, Maurizio
    Italien.
    Nyulasi, I.
    Australien.
    Pirlich, Matthias
    Tyskland.
    Rothenberg, Elisabet
    Högskolan Kristianstad, Forskningsmiljön Food and Meals in Everyday Life (MEAL). Högskolan Kristianstad, Sektionen för lärande och miljö, Avdelningen för Mat- och måltidsvetenskap.
    Schindler, Karin
    Österrike.
    Schneider, Stephane M.
    Frankrike.
    de van der Schueren, M. A. E.
    Nederländerna.
    Sieber, Cornel
    Tyskland.
    Valentini, L.
    Tyskland.
    Yu, J. C.
    Kina.
    Van Gossum, André
    Belgien.
    Singer, Pierre
    Israel.
    ESPEN guidelines on definitions and terminology of clinical nutrition2017Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 36, nr 1, s. 49-64Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background

    A lack of agreement on definitions and terminology used for nutrition-related concepts and procedures limits the development of clinical nutrition practice and research.

    Objective

    This initiative aimed to reach a consensus for terminology for core nutritional concepts and procedures.

    Methods

    The European Society of Clinical Nutrition and Metabolism (ESPEN) appointed a consensus group of clinical scientists to perform a modified Delphi process that encompassed e-mail communication, face-to-face meetings, in-group ballots and an electronic ESPEN membership Delphi round.

    Results

    Five key areas related to clinical nutrition were identified: concepts; procedures; organisation; delivery; and products. One core concept of clinical nutrition is malnutrition/undernutrition, which includes disease-related malnutrition (DRM) with (eq. cachexia) and without inflammation, and malnutrition/undernutrition without disease, e.g. hunger-related malnutrition. Over-nutrition (overweight and obesity) is another core concept. Sarcopenia and frailty were agreed to be separate conditions often associated with malnutrition. Examples of nutritional procedures identified include screening for subjects at nutritional risk followed by a complete nutritional assessment. Hospital and care facility catering are the basic organizational forms for providing nutrition. Oral nutritional supplementation is the preferred way of nutrition therapy but if inadequate then other forms of medical nutrition therapy, i.e. enteral tube feeding and parenteral (intravenous) nutrition, becomes the major way of nutrient delivery.

    Conclusion

    An agreement of basic nutritional terminology to be used in clinical practice, research, and the ESPEN guideline developments has been established. This terminology consensus may help to support future global consensus efforts and updates of classification systems such as the International Classification of Disease (ICD). The continuous growth of knowledge in all areas addressed in this statement will provide the foundation for future revisions.

  • 4. Copland, Lotta
    et al.
    Liedman, Bengt
    Rothenberg, Elisabet
    Sahlgrenska University Hospital, Gothenburg.
    Bosaeus, Ingvar
    Effects of nutritional support long time after total gastrectomy2007Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 26, nr 5, s. 605-613Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background & aims

    Long-term effects of total gastrectomy on nutritional status are not well known, neither is the role of nutritional support. Dietary counselling is usually individualized, but generally not well defined. We aimed to evaluate effects of individualized oral nutritional support long time after total gastrectomy.

    Methods

    Dietary advice was given, aiming for an energy and protein rich diet, using ordinary food and liquid supplements tailored to individual needs and preferences. Counselling was repeated monthly. Body weight and a 4-day food record were obtained at baseline, and thereafter—at month 1, 3, 6 and 12. Body composition, resting and total energy expenditure were measured at baseline and at 12 months.

    Results

    Thirteen of 15 included patients completed the study. Though a trend of weight gain was seen after 1 month, there was no significant weight change at 12 months as weight development was quite heterogeneous. Six patients who remained healthy during the study (all with BMI<25) gained weight (p<0.05), while five patients with intercurrent co-morbidity and two with initial BMI>25 lost weight or remained stable.

    Conclusions

    Nutritional intervention long time after total gastrectomy did not change body weight, body composition or energy metabolism. Intercurrent co-morbidity appeared to have a major impact on outcome, as the nutritional support was more effective in patients who remained healthy and had a BMI<25.

  • 5. Copland, Lotta
    et al.
    Liedman, Bengt
    Rothenberg, Elisabet
    Sahlgrenska University Hospital, Gothenburg.
    Ellegård, Lars
    Hustvedt, Bo-Egil
    Bosaeus, Ingvar
    Validity of the ActiReg system and a physical activity interview in assessing total energy expenditure in long-term survivors after total gastrectomy2008Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 27, nr 6, s. 842-848Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND & AIMS: Malnutrition is common after total gastrectomy. There is a need for clinically useful methods to assess energy requirements. We aimed to validate measurements of energy expenditure by an activity monitor (ActiReg) and a physical activity interview (HPAQ(modified)), in long-term survivors after gastrectomy for gastric carcinoma, using doubly labelled water as reference method.

    METHODS: Total energy expenditure (TEE) was estimated by DLW (14 days), ActiReg (3 days) and HPAQ(modified) (7 days) in 15 patients. Measurements were repeated after 12 months. Basal metabolic rate was measured with indirect calorimetry.

    RESULTS: ActiReg and HPAQ(modified) both underestimated TEE by 180 (+/-254 SD) and 130 (+/-326 SD)kcalday(-1), i.e. 14% vs. 12%, respectively. However, this was evident only at higher levels of physical activity (PAL(DLW)> or =1.65), whereas at lower levels (PAL<1.65) no difference was found. There were no changes in TEE over time independent of the method used. DLW and ActiReg had approximately the same width of the 95% confidence interval of this estimate, while it was 2.4 times larger by HPAQ(modified).

    CONCLUSION: Both simple methods underestimated total energy expenditure at higher, but not at lower physical activity levels. The ActiReg method appears useful to estimate changes in TEE over time.

  • 6. Hausner, Helene
    et al.
    Hartvig, Ditte L.
    Reinbach, Helene C.
    Wendin, Karin
    Department of Food Science, Faculty of Life Sciences, University of Copenhagen.
    Bredie, Wender L. P.
    Effects of repeated exposure on acceptance of initially disliked and liked Nordic snack bars in 9-11 year-old children2012Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 31, nr 1, s. 137-143Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background & aims: Children's food choices are guided by their preferences. It is established, however, that repeated exposure to a novel food increases children's acceptance. This study investigated how acceptance of an initially liked and disliked snack bar develops in 9-11 year-old children. Methods: 315 children were randomised into three groups: A control group (n = 111) and two groups exposed to an initially liked kamut bar (n = 94) and an initially disliked sea buckthorn bar (n = 110). Acceptance of both bars was tested before and after the exposure period, and on the 9th exposure. Results: Intake of both bars increased significantly in the exposure groups. There was no difference in the control groups' intake or liking of the bars between pre and post-testing. Liking rose significantly for children exposed to the disliked sea buckthorn bar, while this was not observed in children exposed to the liked kamut bar. In a post-test children exposed to kamut bars had higher intake of that bar than non-exposed children. This was also observed for the sea buckthorn bar that was also given significantly higher liking scores by the exposure group. Conclusions: The majority of children exposed to an initially disliked bar increase acceptance after nine exposures to the same level as an initially liked bar. Children repeatedly exposed to a liked bar show stable acceptance.

  • 7.
    Hommel, Ami
    et al.
    Department of Health Sciences, Lund University.
    Bjorkelund, Karin B.
    Department of Health Sciences, Lund University.
    Thorngren, Karl-Göran
    Department of Orthopedics, Lund University Hospital.
    Ulander, Kerstin
    Högskolan Kristianstad, Institutionen för hälsovetenskaper.
    Nutritional status among patients with hip fracture in relation to pressure ulcers2007Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 26, nr 5, s. 589-596Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background & aims

    Patients with a hip fracture often have a poor nutritional status that is associated with increased risk of complications, morbidity and mortality. The aim of this study was to investigate the effects of an improved care intervention in relation to nutritional status and pressure ulcers. An intervention of best practices for patients with hip fracture was introduced, using the available resources effectively and efficiently with a not too complicated or expensive intervention.

    Methods

    A quasi-experimental study of 478 patients consecutively included between April 1, 2003 and March 31, 2004. A new evidence-based clinical pathway was introduced on October 1, 2003. The results from the first 210 patients in the control group and the last 210 patients in the intervention group are presented in this article.

    Results

    The total number of patients with a hospital-acquired pressure ulcer was in the intervention group, 19 patients, and in the control group, 39 patients (p=0.007). No patient younger than 65 years developed a pressure ulcer. There were no statistical significant differences between the groups with respect to blood biochemical variables at inclusion. Patients in the control group had higher arm muscle circumference (AMC) (p=0.05), calf circumference (CC) (p=0.038) and body mass index (BMI) (p=0.043) values. Abnormal anthropometrical tests of BMI, triceps skin fold (TSF) <10th percentile and AMC <10th percentile were found in 12 patients in the control group and in 4 patients in the intervention group. None of the 4 patients in the intervention group developed pressure ulcers. However, 2 of the 12 patients in the control group were affected.

    Conclusions

    It is possible to reduce the development of hospital-acquired pressure ulcers among elderly patients with a hip fracture even though they have poor prefracture nutritional status. Results in this study indicate the value of the new clinical pathway, as number of patients who have developed pressure ulcers during their stay in hospital has been reduced by 50%.

  • 8.
    Khalaf, Atika
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Westergren, Albert
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Berggren, Vanja
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap.
    Nurses’ views and experiences of caring for malnourished patients in surgical settings in South Western Saudi Arabia (KSA)2012Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 7, nr Suppl. 1, s. 264-265Artikkel i tidsskrift (Fagfellevurdert)
  • 9. Mowe, Morten
    et al.
    Bosaeus, Ingvar
    Rasmussen, Henrik Højgaard
    Kondrup, Jens
    Unosson, Mitra
    Rothenberg, Elisabet
    Sahlgrenska University Hospital, Gothenburg.
    Irtun, Øivind
    Insufficient nutritional knowledge among health care workers?2008Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 27, nr 2, s. 196-202Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND & AIMS: Though a great interest and willingness to nutrition therapy, there is an insufficient practice compared to the proposed ESPEN guidelines for nutrition therapy. The aim of this questionnaire was to study doctors and nurses' self-reported knowledge in nutritional practice, with focus on ESPEN's guidelines in nutritional screening, assessment and treatment.

    METHODS: A questionnaire about different aspects of nutritional practice was answered by 4512 doctors and nurses in Denmark, Sweden and Norway.

    RESULTS: The most common cause for insufficient nutritional practice was lack of nutritional knowledge. Twenty-five percent found it difficult to identify patient in need of nutritional therapy, 39% lacked techniques for identifying malnourished patients, and 53% found it difficult to calculate the patients' energy requirement and 66% lacked national guidelines for clinical nutrition. Twenty-eight percent answered that insufficient nutrition practice could lead to complications and prolonged hospital stay. Those that answered that their nutritional knowledge was good had also a better nutritional practice.

    CONCLUSION: The self-reported nutritional knowledge was inadequate among Scandinavian doctors and nurses. Increased nutritional knowledge seems to improve the nutritional practice. A combination of an integrated nutrition curriculum during the education, together with post-graduated education for both physicians and nurses should be established.

  • 10.
    ter Beek, Lies
    et al.
    Nederländerna.
    Vanhauwaert, Erika
    Belgien.
    Slinde, Frode
    University of Gothenburg.
    Orrevall, Ylva
    Karolinska University Hospital.
    Henriksen, Christine
    Norge.
    Johansson, Madelene
    University of Gothenburg.
    Vereecken, Carine
    Berlgien.
    Rothenberg, Elisabet
    Högskolan Kristianstad, Sektionen för lärande och miljö, Avdelningen för Humanvetenskap. Högskolan Kristianstad, Forskningsmiljön Food and Meals in Everyday Life (MEAL).
    Jager-Wittenaar, Harriët
    Nederländerna.
    Unsatisfactory knowledge and use of terminology regarding malnutrition, starvation, cachexia and sarcopenia among dietitians2016Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 35, nr 6, s. 1450-1456Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background & Aims

    Clinical signs of malnutrition, starvation, cachexia and sarcopenia overlap, as they all imply muscle wasting to a various extent. However, the underlying mechanisms differ fundamentally and therefore distinction between these phenomena has therapeutic and prognostic implications. We aimed to determine whether dietitians in selected European countries have 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia, and use these terms in their daily clinical work.

    Methods

    An anonymous online survey was performed among dietitians in Belgium, the Netherlands, Norway and Sweden. 'Sufficient knowledge' was defined as having mentioned at least two of the three common domains of malnutrition according to ESPEN definition of malnutrition (2011): 'nutritional balance', 'body composition' and 'functionality and clinical outcome', and a correct answer to three cases on starvation, cachexia and sarcopenia. Chi-square test was used to analyse differences in experience, work place and number of malnourished patients treated between dietitians with 'sufficient knowledge' vs. 'less sufficient knowledge'.

    Results

    712/7186 responded to the questionnaire, of which data of 369 dietitians were included in the analysis (5%). The term 'malnutrition' is being used in clinical practice by 88% of the respondents. Starvation, cachexia and sarcopenia is being used by 3%, 30% and 12% respectively. The cases on starvation, cachexia and sarcopenia were correctly identified by 58%, 43% and 74% respectively. 13% of the respondents had 'sufficient knowledge'. 31% of the respondents identified all cases correctly. The proportion of respondents with 'sufficient knowledge' was significantly higher in those working in a hospital or in municipality (16%, P&lt;0.041), as compared to those working in other settings (7%).

    Conclusions

    The results of our survey among dietitians in four European countries show that the percentage of dietitians with 'sufficient knowledge' regarding malnutrition, starvation, cachexia and sarcopenia is unsatisfactory (13%). The terms starvation, cachexia and sarcopenia are not often used by dietitians in daily clinical work. As only one-third (31%) of dietitians identified all cases correctly, the results of this study seem to indicate that nutrition-related disorders are suboptimally recognized in clinical practice, which might have a negative impact on nutritional treatment. The results of our study require confirmation in a larger sample of dietitians.

  • 11.
    Westergren, Albert
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Hagell, Peter
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Screening for nutritional risk among home dwelling elderly people without service from the municipality2011Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 6, nr Suppl. 1, s. 87-Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Risk factors for malnutrition were frequent mamong elderly persons and calls for preventive actions through information about how to eat healthy. This information can be provided during preventive home visits.

  • 12.
    Westergren, Albert
    et al.
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Hagell, Peter
    Högskolan Kristianstad, Sektionen för hälsa och samhälle, Avdelningen för Hälsovetenskap. Högskolan Kristianstad, Forskningsmiljön PRO-CARE.
    Undernutrition, mental and physical factors form a triad of coexisting problems2012Inngår i: Clinical Nutrition, ISSN 0261-5614, E-ISSN 1532-1983, Vol. 7, nr Suppl.1, s. 117-Artikkel i tidsskrift (Fagfellevurdert)
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