Servizio di Dietetica e Nutrizione Clinica

Como, Italy

Servizio di Dietetica e Nutrizione Clinica

Como, Italy

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PubMed | Nutricia Italia, SCDO Dietetica e Nutrizione Clinica, Servizio di Dietetica e Nutrizione Clinica, Servizio di Biometria e Statistica and 2 more.
Type: | Journal: Clinical nutrition (Edinburgh, Scotland) | Year: 2015

The Oligo Element Sore Trial has shown that supplementation with a disease-specific nutritional formula enriched with arginine, zinc, and antioxidants improves pressure ulcer (PU) healing in malnourished patients compared to an isocaloric-isonitrogenous support. However, the use of such a nutritional formula needs to be supported also by a cost-effectiveness evaluation.This economic evaluation - from a local healthcare system perspective - was conducted alongside a multicenter, randomized, controlled trial following a piggy-back approach. The primary efficacy endpoint was the percentage of change in PU area at 8 weeks. The cost analysis focused on: the difference in direct medical costs of local PU care between groups and incremental cost-effectiveness ratio (ICER) of nutritional therapy related to significant study endpoints (percentage of change in PU area and 40% reduction in PU area at 8 weeks).Although the experimental formula was more expensive (mean difference: 39.4 Euros; P<0.001), its use resulted in money saving with respect to both non-nutritional PU care activities (difference,-113.7 Euros; P=0.001) and costs of local PU care (difference,-74.3 Euros; P=0.013). Therefore, given its efficacy it proved to be a cost-effective intervention. The robustness of these results was confirmed by the sensitivity analyses.The use of a disease-specific oral nutritional formula not only results in better healing of PUs, but also reduces the costs of local PU care from a local healthcare system perspective.


PubMed | University of Turin, University of Tours, MedSciHealth Consultants, Baxter Healthcare Corporation and Servizio di Dietetica e Nutrizione Clinica
Type: | Journal: JPEN. Journal of parenteral and enteral nutrition | Year: 2016

Subcutaneous infusion, or hypodermoclysis, is a technique whereby fluids are infused into the subcutaneous space via small-gauge needles that are typically inserted into the thighs, abdomen, back, or arms. In this review, we provide an overview of the technique, summarize findings from studies that have examined the use of subcutaneous infusion of fluids for hydration or nutrition, and describe the indications, advantages, and disadvantages of subcutaneous infusion. Taken together, the available evidence suggests that, when indicated, subcutaneous infusion can be effective for administering fluids for hydration or nutrition, with minimal complications, and has similar effectiveness and safety to the intravenous route. Of note, subcutaneous infusion offers several advantages over intravenous infusion, including ease of application, low cost, and the lack of potential serious complications, particularly infections. Subcutaneous infusion may be particularly suited for patients with mild to moderate dehydration or malnutrition when oral/enteral intake is insufficient; when placement of an intravenous catheter is not possible, tolerated, or desirable; at risk of dehydration when oral intake is not tolerated; as a bridging technique in case of difficult intravenous access or catheter-related bloodstream infection while infection control treatment is being attempted; and in multiple settings (eg, emergency department, hospital, outpatient clinic, nursing home, long-term care, hospice, and home).


Cereda E.,Servizio di Dietetica e Nutrizione Clinica | Neyens J.C.L.,Maastricht University | Caccialanza R.,Servizio di Dietetica e Nutrizione Clinica | Rondanelli M.,University of Pavia | Schols J.M.G.A.,Maastricht University
Journal of Nutrition, Health and Aging | Year: 2016

Objectives: The aim of this systematic review was to summarize the evidence on the efficacy of high-calorie, high-protein nutritional formula enriched with arginine, zinc, and antioxidants (disease-specific support) in patients with pressure ulcers (PUs). Methods: Randomized controlled trials in English published from January 1997 until October 2015 were searched for in electronic databases (EMBASE, Medline, PubMed, and CINAHL). Studies comparing a disease-specific nutritional support (oral supplements or tube feeding) to a control nutritional intervention enabling the satisfaction of energy requirements regardless of the use of high-calorie formula or placebo or no support for at least 4 weeks were considered eligible. Study outcomes were the percentage of change in PU area, complete healing and reduction in the PU area ≥40% at 8 weeks, and the percentage of change in area at 4 weeks. Results: A total of 3 studies could be included in the metaanalysis. Compared with control interventions, formulas enriched with arginine, zinc and antioxidants resulted in significantly higher reduction in ulcer area (−15.7% [95%CI, −29.9, −1.5]; P=0.030; I2=58.6%) and a higher proportion of participants having a 40% or greater reduction in PU size (OR=1.72 [95%CI, 1.04, 2.84]; P=0.033; I2=0.0%) at 8 weeks. A nearly significant difference in complete healing at 8 weeks (OR=1.72 [95%CI, 0.86, 3.45]; P=0.127; I2=0.0%) and the percentage of change in the area at 4 weeks (−7.1% [95%CI, −17.4, 3.3]; P=0.180; I2=0.0%) was also observed. Conclusion: This systematic review shows that the use of formulas enriched with arginine, zinc and antioxidants as oral supplements and tube feeds for at least 8 weeks are associated with improved PU healing compared with standard formulas. © 2016 Serdi and Springer-Verlag France


Cereda E.,Nutrition and Dietetics Service | Pedrolli C.,Unita Operativa di Dietetica e Nutrizione Clinica | Zagami A.,Fondazione Bellaria Onlus | Vanotti A.,Servizio di Dietetica e Nutrizione Clinica | And 4 more authors.
British Journal of Nutrition | Year: 2013

Previous studies have reported a close relationship between nutritional and functional domains, but evidence in long-term care residents is still limited. We evaluated the relationship between nutritional risk and functional status and the association of these two domains with mortality in newly institutionalised elderly. In the present multi-centric prospective cohort study, involving 346 long-term care resident elderly, nutritional risk and functional status were determined upon admission by the Geriatric Nutritional Risk Index (GNRI) and the Barthel Index (BI), respectively. The prevalence of high (GNRI <Â 92) and low (GNRI 92-98) nutritional risk were 36·1 and 30·6Â %, respectively. At multivariable linear regression, functional status was independently associated with age (P=Â 0·045), arm muscle area (P=Â 0·048), the number of co-morbidities (P=Â 0·027) and mainly with the GNRI (P<Â 0·001). During a median follow-up of 4·7 years (25th-75th percentile 3·7-6·2), 230 (66·5Â %) subjects died. In the risk analysis, based on the variables collected at baseline, both high (hazard ratio (HR) 1·86, 95Â % CI 1·32, 2·63; P<Â 0·001) and low nutritional risk (HR 1·52, 95Â % CI 1·08, 2·14; P=Â 0·016) were associated with all-cause mortality. Participants at high nutritional risk (GNRI <Â 92) also showed an increased rate of cardiovascular mortality (HR 1·93, 95Â % CI 1·28, 2·91; P<Â 0·001). No association with outcome was found for the BI. Upon admission, nutritional risk was an independent predictor of functional status and mortality in institutionalised elderly. Present data support the concept that the nutritional domain is more relevant than functional status to the outcome of newly institutionalised elderly. Copyright © The Authors 2013.


Cereda E.,Nutrition and Dietetics Service | Pedrolli C.,Unita Operativa di Dietetica e Nutrizione Clinica | Zagami A.,Fondazione Bellaria Onlus | Vanotti A.,Servizio di Dietetica e Nutrizione Clinica | And 4 more authors.
Clinical Nutrition | Year: 2011

Background & aims: Several tools are available for nutritional screening. We evaluated the risk of mortality associated with the Geriatric Nutritional Risk Index (GNRI) and the Mini Nutritional Assessment (MNA) in newly institutionalised elderly. Methods: A prospective observational study involving 358 elderly newly admitted to a long-term care setting. Hazard ratios (HR) for mortality among GNRI categories and MNA classes were estimated by multivariable Cox's model. Results: At baseline, 32.4% and 37.4% of the patients were classified as being malnourished (MNA <17) and at severe nutritional risk (GNRI <92), respectively, whereas 57.5% and 35.2%, respectively, were classified as being at risk for malnutrition (MNA 17-23.5) and having low nutritional risk (GNRI 92-98). During a median follow-up of 6.5 years [25th-75th percentile, 5.9-8.6], 297 elderly died. Risk for all-cause mortality was significantly associated with nutritional risk by the GNRI tool (GNRI<92 HR = 1.99 [95%CI, 1.38-2.88]; GNRI 92-98 HR = 1.51 [95%CI, 1.04-2.18]) but not with nutritional status by the MNA. A significant association was also found with cardiovascular mortality (GNRI <92 HR = 1.79 [95%CI, 1.23-2.61]). Conclusions: Nutritional risk by GNRI but not nutritional status by MNA was associated with higher mortality risk. Present data suggest that in the nutritional screening of newly institutionalised elderly the use of the GNRI should be preferred to that of the MNA. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Cereda E.,Nutrition and Dietetics Service | Pedrolli C.,Unita Operativa di Dietetica e Nutrizione Clinica | Zagami A.,Fondazione Belluria Onlus | Vanotti A.,Servizio di Dietetica e Nutrizione Clinica | And 4 more authors.
Journal of the American Medical Directors Association | Year: 2011

Objective: Malnutrition and sarcopenia in institutions are very common and significantly affect the prognosis. Aging is characterized by weight and lean body mass losses. Accordingly, in elderly patients, body mass index (BMI) is considered a marker of protein stores rather than of adiposity. Current guidelines suggest a BMI 21 kg/m 2 or lower as major trigger for nutritional support. We evaluated the association between BMI and mortality in institutionalized elderly. Methods: This was a multicentric prospective cohort study involving 519 long-term care resident elderly individuals. Risk for mortality across BMI tertiles was estimated by the Cox hazards regression model adjusted for potential confounders recorded at inclusion and collected during the follow-up. Results: During a median follow-up of 5.7 years (25th to 75th percentile, 5.2-8.2], 409 (78.8%) elderly patients died. In primary analyses, based on variables collected at inclusion, patients in the first tertile of BMI (≤21 kg/m 2) were at higher risk for all-cause (hazard ratio [HR] 1.38; 95% confidence interval [CI] 1.04-1.84; P = .025) and cardiovascular mortality (HR = 1.49; 95% CI, 1.00-2.08; P = .045). Increased risk was confirmed even after adjusting for nutritional support during the follow-up (all-cause HR = 1.53; 95% CI, 1.13-2.06; P = .006; cardiovascular HR = 1.62; 95% CI, 1.09-2.40; P = .018), which in turn was associated with a reduced risk (all-cause HR = 0.74; 95% CI, 0.55-0.97; P = .035; cardiovascular HR = 0.62; 95% CI, 0.42-0.91; P = .016). Conclusion: BMI is significantly associated with all-cause and cardiovascular mortality in institutionalized elderly patients. A value of 21 kg/m 2 or lower can be considered a useful trigger for nutritional support. These results support intending BMI as nutritional reserve in institutionalized elderly patients. © 2011 American Medical Directors Association.


Cereda E.,Nutrition and Dietetics Service | Malavazos A.E.,U.O. di Diabetologia e Malattie Metaboliche | Caccialanza R.,Nutrition and Dietetics Service | Rondanelli M.,University of Pavia | And 2 more authors.
Clinical Nutrition | Year: 2011

Background & aims: To investigate the association between history of multiple weight loss diets followed by weight regain, namely weight cycling (WCy), and both body weight excess and abdominal fat accumulation. Methods: A one-day cross-sectional survey (" Obesity-Day" ) including 914 participants (605F:309M). Anthropometric variables (body mass index [BMI], waist circumference [WC] and waist-to-height ratio [WtHR]), covariates and WCy (≥5 intentional weight loss episodes of ≥5 kg followed by rapid return to pre-diet or higher body weight) were assessed by a self-administered questionnaire, interview and physical examination. Results: Data on central fat accumulation (by WC and WtHR) were available in a representative sub-group (n = 600). WCy was reported by 119 participants (13.0%) of total population and by 79 (13.2%) of those with available data on central fat accumulation. At multivariable linear regressions WCy was independently associated with higher BMI (P = .004), WC (P = .011) and WtHR (P = .008). Sensitivity analyses, performed after excluding those being on a diet at the time of assessment, confirmed these findings. Conclusions: A history of WCy appears related to body weight excess and abdominal fat accumulation. These findings support the importance of designing adequate weight loss programs to achieve long-term weight maintenance and to prevent undesirable and unhealthy weight accumulation. © 2011 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism.


Barichella M.,Servizio di Dietetica e Nutrizione Clinica | Malavazos A.E.,U.O. di Diabetologia e Malattie Metaboliche | Fatati G.,U.O. di Dietetica e Nutrizione Clinica | Cereda E.,University of Milan
Public Health Nutrition | Year: 2011

Objective To evaluate the awareness and knowledge about weight status and its management. Design A 1 d cross-sectional survey. Basic anthropometric assessments (weight, height, BMI and waist circumference) and a self-administered questionnaire were considered.Setting Nineteen Clinical Nutrition or Endocrinology and Metabolic Disorders Units or Dietetics Services in the Italian region of Lombardy.Subjects All adults attending the 'Obesity Day' initiative.Results A total of 914 participants (605 female and 309 male) were recruited. Although most of the participants (83.5 %) considered obesity to be a disease, 38.5 % were likely to misperceive their weight status. In particular, 38.8 % of normal-weight adults believed themselves to be overweight, whereas 71.1 % and 37.5 % of classes I and II/III obese adults classified themselves as being overweight and mildly obese, respectively. However, most of the overweight (90.2 %), mildly (96.8 %) and moderately/severely obese adults (99.1 %) recognized the need to lose weight. In all, 37.8 % of the sample underestimated the role of physical activity in weight management. Interestingly, only 17.2 % of dieters (previous or current) declared being advised by their doctor to lose weight. Multivariate models revealed that higher age, low education and higher BMI were important determinants of poor weight control and management. In addition, previous dieting appeared not to provide better knowledge, whereas the role of physical activity was recognized mainly by those practising it.Conclusions The present study suggests that in Italy knowledge about weight management should be improved not only in the general population but also among health-care professionals. To confirm this finding, there is now the rationale for a nationally representative survey. New educational programmes can be designed on the basis of the information collected. Copyright © The Authors 2011.


Caccialanza R.,Servizio di Dietetica e Nutrizione Clinica | Klersy C.,Instituto Of Ricovero E Cura A Carattere Scientifico | Cereda E.,Servizio di Dietetica e Nutrizione Clinica | Cameletti B.,Servizio di Dietetica e Nutrizione Clinica | And 5 more authors.
CMAJ | Year: 2010

Background: Comprehensive evaluations of the nutritional parameters associated with length of hospital stay are lacking. We investigated the association between malnutrition and length of hospital stay in a cohort of ambulatory adult patients. Methods: From September 2006 to June 2009, we systematically evaluated 1274 ambulatory adult patients ad - mitted to hospital for medical or surgical treatment. We evaluated the associations between malnutrition and pro - longed hospital stay (> 17 days [> 75th percentile of distribution]) using multivariable log-linear models adjusted for several potential nutritional and clinical confounders re - corded at admission and collected during and at the end of the hospital stay. Results: Nutritional factors associated with a prolonged hospital stay were a Nutritional Risk Index score of less than 97.5 (relative risk [RR] 1.64, 95% confidence interval [CI] 1.31-2.06) and an in-hospital weight loss of 5% or greater (RR 1.60, 95% CI 1.30-1.97). Sensitivity analysis of data for patients discharged alive and who had a length of stay of at least three days (n = 1073) produced similar findings (adjusted RR 1.51, 95% CI 1.20-1.89, for Nutritional Risk Index score < 97.5). A significant association was also found with in-hospital starvation of three or more days (RR 1.14, 95% CI 1.01-1.28). Interpretation: Nutritional risk at admission was strongly associated with a prolonged hospital stay among ambulatory adult patients. Another factor associated with length of stay was worsening nutritional status during the hospital stay, whose cause-effect relationship with length of stay should be clarified in intervention trials. Clinicians need to be aware of the impact of malnutrition and of the potential role of worsening nutritional status in prolonging hospital stay. © 2010 Canadian Medical Association or its licensors.


Cereda E.,Servizio di Dietetica e Nutrizione Clinica | Klersy C.,Servizio di Dietetica e Nutrizione Clinica | Rondanelli M.,Servizio di Dietetica e Nutrizione Clinica | Caccialanza R.,Servizio di Dietetica e Nutrizione Clinica
Journal of the American Dietetic Association | Year: 2011

Medical nutrition therapy is reported to contribute to wound healing. However, effective intervention requires an accurate estimation of individual energy needs, which, in turn, relies on accurate methods of assessment. The primary aims of this systematic review and meta-analysis were to evaluate the resting energy expenditure (REE) of patients with pressure ulcers (PUs) compared to matched control groups and the potential estimation bias of REE predictive equations. The recommended daily energy requirements of patients with PUs were also assessed, along with their energy balance (daily energy requirement vs intake). All language, original, full-text research articles published between January 1, 1950, and July 31, 2010, were searched through electronic databases. Relevant studies were also identified by reviewing citations. Observational (case-control and case-series) studies providing data on measured REE were initially included. Data extracted were measured REE, predicted REE, and daily energy intake. Five studies were included in the meta-analysis. Compared to controls (n=101), patients with PUs (n=92) presented higher measured REE (weighted mean 20.7±0.8 vs 23.7±2.2 kcal/kg/day; P<0.0001). In these patients, measured REE was also higher than predicted REE (calculated using the Harris-Benedict formula in all studies; 21.0±1.0 kcal/kg/day; P<0.0001), whereas energy intake (n=78; 21.7±3.1 kcal/kg/day) was significantly lower (P<0.0001) than total daily requirement, which was calculated as 29.4±2.7 kcal/kg/day. Patients with PUs are characterized by increased REE and reduced energy intake. In the estimation of REE using the Harris-Benedict formula, a correction factor (×1.1) should be considered to accurately assess energy needs. Moreover, an energy intake of 30 kcal/kg/day seems appropriate to cover the daily requirements of patients with PUs. © 2011 American Dietetic Association.

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