New conference presenter:
• Winner- Megan Whelan: Feasibility of a telephone-based weight loss program delivered in a hospital outpatient setting
• Highly commended- Andrea McDonald: Questioning our practice: Do energy calculations underestimate Resting Metabolic Rate in developing rugby players
New Researcher Award:
• Winner- Alison Yaxley: Development of a field method for the identification of sarcopenia in older adults
• Highly commended- Ekta Agarwal: Medical nutrition therapy and simple interventions can improve intake in patients who eat poorly in hospital
Research in Practice Award:
• Winner- Ekta Agarwal: Shortfalls in malnutrition coding: a mandate for action
• Highly commended-Liz Isenring: Updated evidence based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy
Feasibility of a telephone-based weight loss program delivered in a hospital outpatient setting – Megan Whelan
Obesity is a major public health challenge, and the prevalence of obesity is largely reflected in hospital admissions.Telephone delivery is a novel alternative to face-to-face weight loss services that has the potential to provide greater reach, and the repeated contacts necessary to promote successful behaviour change and weight loss. This study aimed to evaluate the feasibility and effectiveness of a telephone-based weight loss program delivered via a hospital outpatient setting.
Patients referred for weight loss who declined the group-based program (consists of 8 weekly sessions) were offered a telephone-based alternative (16 phone calls over 6-months targeting physical activity, healthy eating and weight loss). Fifty patients (23% of referrals) commenced the group-based program (61% female, 57 ± 14 years, 21% employed), with 66% completion at 2-months. Sixty-one patients (30% of eligible) commenced the telephone program (46% female; 49 ± 12 years, 66% employed), with 66% retention at 2-months and 48% completion at 6-months. Six-month results from those who completed the telephone program show significant weight loss (-4.8 ± 5.1%) and improvements in self-reported vegetable serves (+0.8 ± 1.7), as well as notable improvements in self-reported physical activity (+59 ± 167 minutes walking/week)
The telephone program achieved significantly greater weight loss, and improvements in self-reported physical activity and fruit intake at 2-months compared to the group-based program. These findings indicate that a telephone-based weight loss program was able to reach a greater number and broader demographic of patients referred within a hospital outpatient setting, as well as achieve promising weight loss and lifestyle behaviour outcomes. This study informs that telephone delivery may be a feasible and effective alternative to face-to-face services for overweight and obese patients referred for weight loss in a hospital outpatient setting
Research Team: Megan Whelan APD, Dr Marina Reeves AdvAPD, Dr Ingrid Hickman AdvAPD, Professor Elizabeth Eakin, Dr Ana Goode.
Contact: [email protected]
Acknowledgements: Princess Alexandra Hospital Nutrition and Dietetics Department
Questioning our practice: do energy calculations underestimate Resting Metabolic Rate in Developing Rugby Players? – Andrea McDonald
As dietitians, it is always important to understand the tools you are using in everyday practice and any underlying assumptions that must be considered when they are applied. Energy prediction equations are an integral part of a dietetics practice and are routinely used to estimate the energy requirements of individuals. Many of these equations are derived from the general population; however, there is little research to support the use of these equations in specific groups such as rugby players.
This study was undertaken by Andrea McDonald as part of the research stream in the Nutrition and Dietetic program at the Queensland University of Technology. This project spanned her final year and provided a very complex statistical challenge and insight into the shortcomings of energy equations both for this group; and other groups relevant to dietitians. The study formed part of a large body of work currently being undertaken by Kristen MacKenzie at the QUT Institute of Health and Biomedical Innovation focussing on the nutritional considerations for the physical development of professional Rugby Union players. The study concentrated specifically on the resting metabolic rate of rugby players and found that conventional prediction equations significantly underestimated measured resting metabolic rate by 189-483kcal/day, equivalent to approximately 8-20% of RMR, which has repercussions when using calculated RMR to assess energy requirements.
Contacts: Andrea McDonald [email protected]
Kristen MacKenzie [email protected]
Development of a field method for the identification of sarcopenia in older adults – Alison Yaxley
Alison Yaxley is an APD and an academic in Nutrition and Dietetics at Flinders University in South Australia, and has recently submitted her PhD under the supervision of A/Prof Michelle Miller which investigated unintentional weight loss in older adults. Her research aimed to evaluate the current understanding of categories of unintentional weight loss amongst nutrition professionals, and to provide clinicians with rationale, instruments and guidance for the identification and treatment of sarcopenia and cachexia. This exploratory work found that there is considerable confusion, both in the literature and amongst Australian dietitians, around unintentional weight loss with the term malnutrition dominating the area. The evidence indicates that protein-energy malnutrition, or starvation, sarcopenia and cachexia are the primary aetiologies of unintentional weight loss but there is little clarity around diagnosis or treatment beyond that.
Alison’s research conducted exploratory analyses in an attempt to quantify the prevalence of starvation, sarcopenia and cachexia in a group of older adults, using historical descriptions for these conditions, and found a considerable degree of overlap between categories. The implication of this is inappropriate intervention and potentially poor outcomes, as the literature indicates that each condition responds to a different treatment strategy. This provided strong rationale for the validation of more recent diagnostic criteria, available in consensus definitions which have been published over the past few years but not yet operationalised. This work resulted in the development and validation of a tool for the identification of sarcopenia which was presented at the 30th DAA National Conference in Canberra where Alison won the New Researcher Award. It is anticipated that this work will be published in a peer-reviewed journal in the coming months.
Contact: [email protected]
Can medical nutrition therapy improve dietary intake in hospital patients who eat poorly? – Ekta Agarwal
There is an increasing body of evidence to demonstrate that decreased food intake is common in acute care patients; and that consumption of up to 25% of the offered meals is associated with increased risk of in-hospital mortality. The aim of this study was to evaluate if the implementation of medical nutrition therapy (MNT) improved food intake in patients who eat poorly during hospitalisation and reasons for poor food intake. One-day percentage food intake was observed in 184 acute care patients admitted in the neurology, respiratory and orthopaedic wards of the Princess Alexandra Hospital (Brisbane, Australia). “Poor” intake was defined as consuming up to half the offered meals.
Of the 62 patients with an observed poor food intake, 30 patients reported organisational factors (lack of assistance with feeding and menu completion, inappropriate diets and textures) as barriers to consuming all the offered food. These patients were referred to nursing staff who resolved the issues, following which patients consumed at least 75% of the offered meals and reported a good appetite. Thus, they were excluded from the study. The remaining 32 patients who reported nutrition-impact symptoms (anorexia, early satiety) as reasons for eating poorly were referred to the ward dietitian who implemented MNT (high energy-protein diets, oral nutritional supplements, nutritional counselling). On the seventh day since referral, one-day food intake for these patients was re-evaluated. Due to persistent nutrition-impact symptoms, food intake for a majority of these patients remained poor.
This study highlights the importance of vigilantly observing patients’ food intake during hospitalisation. Decreased food intake could be an outcome of organisational factors, which can be easily resolved without the specialised intervention of a dietitian. Patients with persistent nutrition-impact symptoms may require intensive MNT along with medical management of symptoms to facilitate improved food intake and reduce the risk of adverse health-related outcomes.
Contact: [email protected]
Shortfalls in malnutrition coding: a mandate for action – Ekta Agarwal
Malnutrition, a common problem in acute care patients, has been associated with increased hospital costs (attributable to higher incidence of complications, prolonged length of hospital stay, increased utilisation of healthcare services and resources). Identification of malnutrition is crucial, not only for the implementation of appropriate nutrition support but also because coding for malnutrition can result in increased casemix-related reimbursements for hospitals.
The Australasian Nutrition Care Day Survey (2010) is the largest and most comprehensive evaluation of nutritional status in acute care patients across Australian and New Zealand hospitals. Nutritional status was evaluated using Subjective Global Assessment and BMI during one day of data collection. The study recruited 3122 participants from 370 acute care wards in 56 Australian and New Zealand hospitals and found that malnutrition was prevalent in 32% of the cohort. When malnutrition coding practices were evaluated three months later, results indicated that four-in-five malnourished patients had not been coded for malnutrition. In fact, in 21 hospitals none of the malnourished patients were coded. This shortfall in malnutrition coding could have resulted in a substantial loss of casemix-related reimbursements to participating hospitals (estimated at approximately AU$600000 (range: AU$480000-AU$730000)).
In the current stringent financial, results from this study provide hospital-based dietitians with the opportunity to lead the development and implementation of structured processes to identify, document and code for malnutrition, thereby attracting appropriate financial reimbursements for their hospitals.
Updated evidence based practice guidelines for the nutritional management of patients receiving radiation therapy and/or chemotherapy – Liz Isenring
These guidelines are an update of the evidence-based practice guidelines for the nutritional management of patients receiving radiation therapy published in Nutrition and Dietetics in 2009 and have been expanded to include chemotherapy. There were 12 studies in chemotherapy including five RCTs. While these studies provided strong evidence that simple nutrition intervention improves nutritional outcomes such as dietary intake and weight, they did not find an improvement in quality of life or survival. Several RCTs found no benefits of nutrition support in patients undergoing chemotherapy. In conclusion, the evidence to support nutrition intervention in patients receiving radiation therapy remains strong. However, the benefits of nutrition intervention in chemotherapy are less clear.
Liz would like to acknowledge the hard work of the steering committee members and that they received the support of a DAA Small Grant. She appreciates the recognition of this work at the national level as it takes the dedication of the steering committee to result in these guidelines that can be used to improve the nutritional management of adult patients with cancer receiving radiotherapy and/or chemotherapy treatment.
Contact: [email protected]