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Emilie Reber
Department of Diabetes, Endocrinology, Nutritional Medicine and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

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Journal article
Published: 30 July 2021 in JMIR mHealth and uHealth
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Background Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. Objective We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. Methods A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. Results A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). Conclusions This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition.

ACS Style

Maria F Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study. JMIR mHealth and uHealth 2021, 9, e27885 .

AMA Style

Maria F Vasiloglou, Stergios Christodoulidis, Emilie Reber, Thomai Stathopoulou, Ya Lu, Zeno Stanga, Stavroula Mougiakakou. Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study. JMIR mHealth and uHealth. 2021; 9 (7):e27885.

Chicago/Turabian Style

Maria F Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. 2021. "Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study." JMIR mHealth and uHealth 9, no. 7: e27885.

Review article
Published: 07 April 2021 in Frontiers in Nutrition
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Disease-related malnutrition is highly prevalent among cancer patients, with 40–80% suffering from it during the course of their disease. Malnutrition is associated with numerous negative outcomes such as: longer hospital stays, increased morbidity and mortality rates, delayed wound healing, as well as decreased muscle function, autonomy and quality of life. In cancer patients, malnutrition negatively affects treatment tolerance (including anti-cancer drugs, surgery, chemo- and radiotherapy), increases side effects, causes adverse reactions, treatment interruptions, postoperative complications and higher readmission rates. Conversely, anti-cancer treatments are also known to affect body composition and impair nutritional status. Tailoring early nutritional therapy to patients' needs has been shown to prevent, treat and limit the negative consequences of malnutrition and is likely to improve overall prognosis. As the optimisation of treatment outcomes is top priority and evidence for nutritional therapy is growing, it is increasingly recognized as a significant intervention and an autonomous component of multimodal cancer care. The proactive implementation of nutritional screening and assessment is essential for patients suffering from cancer - given the interaction of clinical, metabolic, pharmacological factors with systemic inflammation; and suppressed appetite with accelerated muscle protein catabolism. At the same time, a nutritional care plan must be established, and adequate individualized nutritional intervention started rapidly. Screening tools for nutritional risk should be validated, standardized, non-invasive, quick and easy-to-use in daily clinical practice. Such tools must be able to identify patients who are already malnourished, as well as those at risk for malnutrition, in order to prevent or treat malnutrition and reduce negative outcomes. This review investigates the predictive value of commonly used screening tools, as well as the sensitivity and specificity of their individual components for improving clinical outcomes in oncologic populations. Healthcare professionals' awareness of malnutrition in cancer patients and the pertinence of early nutritional screening must be raised in order to plan the best possible intervention and follow-up during the patients' ordeal with the disease.

ACS Style

Emilie Reber; Katja A. Schönenberger; Maria F. Vasiloglou; Zeno Stanga. Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome. Frontiers in Nutrition 2021, 8, 603936 .

AMA Style

Emilie Reber, Katja A. Schönenberger, Maria F. Vasiloglou, Zeno Stanga. Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome. Frontiers in Nutrition. 2021; 8 ():603936.

Chicago/Turabian Style

Emilie Reber; Katja A. Schönenberger; Maria F. Vasiloglou; Zeno Stanga. 2021. "Nutritional Risk Screening in Cancer Patients: The First Step Toward Better Clinical Outcome." Frontiers in Nutrition 8, no. : 603936.

Study protocol
Published: 16 March 2021 in Trials
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Background Disease-related malnutrition is highly prevalent in hospitalized medical and geriatric inpatients. It is associated with negative outcomes such as muscle wasting, decline of functional status, and increased morbidity and mortality. Oral nutritional supplements (ONS) are frequently used in nutritional therapy to increase intake. However, compliance to ONS is often limited and maybe improved by prescribing ONS in small portions timed with the medication (MEDPass). However, it is unknown whether the MEDPass administration enhances patients’ total energy and protein intake. Methods The MEDPass Trial is a randomized, controlled, open-label superiority trial. Patients in the MEDPass group receive 50 ml of ONS four times per day, distributed with the medication rounds. Patients in the control group receive ONS between meals. The primary outcome is average daily energy intake (% of calculated daily requirement). For our power analysis, we assumed that administration of ONS in the MEDPass administration mode increases energy intake by at least 10% (i.e., by 200 kcal for an average energy requirement of 2200 kcal/day). Thus, with the inclusion of 200 patients, this trial has 80% power to demonstrate that intervention group patients have an average intake of 2200 kcal/day (SD 500 kcal) versus 2000 kcal/day (SD 500 kcal) in control group patients. Energy and protein intakes from ONS and all food consumed are monitored continuously throughout the hospital stay and are statistically compared to the patient’s requirements. Secondary outcomes include average daily protein intake (% of calculated daily requirement), average intake of ONS/day, the course of body weight, handgrip strength, appetite, and nausea. Furthermore, hospital length of stay and 30-day mortality are assessed. The primary statistical analysis will be performed as an intention-to-treat analysis adjusted for the stratification factors used in randomization. Discussion To our knowledge, this is the first randomized controlled trial assessing total energy and protein intake for the entire hospitalization period in patients receiving MEDPass versus conventional ONS administration. Thus, the MEDPass Trial will fill a gap and answer this relevant clinical question. Trial registration ClinicalTrials.gov NCT03761680. Registered on 3 December 2018. Kofam.ch SNCTP000003191. Registered on 15 October 2018

ACS Style

Silvia Kurmann; Emilie Reber; Maria F. Vasiloglou; Philipp Schuetz; Andreas W. Schoenenberger; Katja Uhlmann; Anna-Barbara Sterchi; Zeno Stanga. Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial. Trials 2021, 22, 1 -11.

AMA Style

Silvia Kurmann, Emilie Reber, Maria F. Vasiloglou, Philipp Schuetz, Andreas W. Schoenenberger, Katja Uhlmann, Anna-Barbara Sterchi, Zeno Stanga. Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial. Trials. 2021; 22 (1):1-11.

Chicago/Turabian Style

Silvia Kurmann; Emilie Reber; Maria F. Vasiloglou; Philipp Schuetz; Andreas W. Schoenenberger; Katja Uhlmann; Anna-Barbara Sterchi; Zeno Stanga. 2021. "Energy and protein intake in medical and geriatric inpatients with MEDPass versus conventional administration of oral nutritional supplements: study protocol for the randomized controlled MEDPass Trial." Trials 22, no. 1: 1-11.

Journal article
Published: 03 March 2021 in Clinical Nutrition
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Summary Background and aims The nutritional risk screening (NRS 2002) is a validated screening tool for malnutrition. This study aims to investigate the prognostic value of the NRS 2002 and its individual components regarding long-term mortality and adverse outcomes in a well-characterized cohort of medical inpatients. Methods We performed a 5-year follow-up investigation of patients included in the investigator-initiated, prospective, randomized controlled multicenter EFFORT trial that evaluated the effects of individualized nutritional intervention vs. standard hospital food. We used multivariable cox regression analyses adjusted for randomisation arm, study centre, comorbidities and main admission diagnosis to investigate associations between NRS 2002 total scores at time of hospital admission and several long-term outcomes. Results We had confirmed mortality data over the mean follow-up time of 3.2 years in 1874 from the initial cohort of 2028 EFFORT patients. Mortality showed a step-wise increase in patients with NRS 3 (289/565 [51.2%]) and NRS 4 (355/717 [49.6%]) to 59.5% (353/593) in patient with NRS≥5 corresponding to an adjusted Hazard Ratio (HR) of 1.28 (95%CI 1.15 to 1.42, p ≤ 0.001) for mortality after one year and 1.13 (95%CI 1.05 to 1.23, p = 0.002) for the overall time period. All individual components of NRS including disease severity, food intake, weight loss and BMI provided prognostic information regarding long-term mortality risk. Conclusion Nutritional risk mirrored by a NRS 2002 total score is a strong and independent predictor of long-term mortality and morbidity in polymorbid medical inpatients particularly in patients with high nutritional risk with an NRS ≥5 points.

ACS Style

Andriana Efthymiou; Lara Hersberger; Emilie Reber; Katja A. Schönenberger; Nina Kägi-Braun; Pascal Tribolet; Beat Mueller; Philipp Schuetz; Zeno Stanga; Rebecca Fehr; Valerie Baechli; Martina Geiser; Manuela Deiss; Filomena Gomes; Alexander Kutz; Thomas Bregenzer; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Braendle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé. Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial. Clinical Nutrition 2021, 40, 1546 -1554.

AMA Style

Andriana Efthymiou, Lara Hersberger, Emilie Reber, Katja A. Schönenberger, Nina Kägi-Braun, Pascal Tribolet, Beat Mueller, Philipp Schuetz, Zeno Stanga, Rebecca Fehr, Valerie Baechli, Martina Geiser, Manuela Deiss, Filomena Gomes, Alexander Kutz, Thomas Bregenzer, Claus Hoess, Vojtech Pavlicek, Sarah Schmid, Stefan Bilz, Sarah Sigrist, Michael Braendle, Carmen Benz, Christoph Henzen, Silvia Mattmann, Robert Thomann, Claudia Brand, Jonas Rutishauser, Drahomir Aujesky, Nicolas Rodondi, Jacques Donzé. Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial. Clinical Nutrition. 2021; 40 (4):1546-1554.

Chicago/Turabian Style

Andriana Efthymiou; Lara Hersberger; Emilie Reber; Katja A. Schönenberger; Nina Kägi-Braun; Pascal Tribolet; Beat Mueller; Philipp Schuetz; Zeno Stanga; Rebecca Fehr; Valerie Baechli; Martina Geiser; Manuela Deiss; Filomena Gomes; Alexander Kutz; Thomas Bregenzer; Claus Hoess; Vojtech Pavlicek; Sarah Schmid; Stefan Bilz; Sarah Sigrist; Michael Braendle; Carmen Benz; Christoph Henzen; Silvia Mattmann; Robert Thomann; Claudia Brand; Jonas Rutishauser; Drahomir Aujesky; Nicolas Rodondi; Jacques Donzé. 2021. "Nutritional risk is a predictor for long-term mortality: 5-Year follow-up of the EFFORT trial." Clinical Nutrition 40, no. 4: 1546-1554.

Original article
Published: 23 February 2021 in Obesity
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Objective This study investigated the association between ultraprocessed food consumption and excess body weight in a Swiss nationally representative study. Methods Data stem from the cross‐sectional Swiss National Nutrition Survey menuCH (n = 2,057). Dietary information was collected with 24‐hour dietary recalls, and food items were categorized into non‐ultraprocessed or ultraprocessed using the NOVA food classification system. The following three excess body weight indicators were considered: BMI, waist circumference (WC), and a BMI‐WC composite outcome. Multinomial logistic regression models stratified by sex were fitted. Results Women in the highest quintile of ultraprocessed food weight proportion had significantly higher odds of having obesity (odds ratio [OR] 3.01, 95% CI: 1.48‐6.11), having abdominal obesity (OR 2.69, 95% CI: 1.43‐5.05), and being in the highest category of the BMI‐WC composite outcome (OR 3.28, 95% CI: 1.59‐6.77). No relevant associations were observed in men. Conclusions Ultraprocessed food weight proportion was strongly and dose‐dependently associated with excess body weight in women but not in men. Further studies are required to elucidate potential mechanisms behind this association. Increasing evidence of the detrimental effect of ultraprocessed food consumption on health stresses the need to consider these products in future public health strategies.

ACS Style

Giulia Pestoni; Linda Habib; Emilie Reber; Sabine Rohrmann; Kaspar Staub; Zeno Stanga; David Faeh. Ultraprocessed Food Consumption is Strongly and Dose‐Dependently Associated with Excess Body Weight in Swiss Women. Obesity 2021, 29, 601 -609.

AMA Style

Giulia Pestoni, Linda Habib, Emilie Reber, Sabine Rohrmann, Kaspar Staub, Zeno Stanga, David Faeh. Ultraprocessed Food Consumption is Strongly and Dose‐Dependently Associated with Excess Body Weight in Swiss Women. Obesity. 2021; 29 (3):601-609.

Chicago/Turabian Style

Giulia Pestoni; Linda Habib; Emilie Reber; Sabine Rohrmann; Kaspar Staub; Zeno Stanga; David Faeh. 2021. "Ultraprocessed Food Consumption is Strongly and Dose‐Dependently Associated with Excess Body Weight in Swiss Women." Obesity 29, no. 3: 601-609.

Preprint content
Published: 11 February 2021
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BACKGROUND Digital technologies have evolved dramatically in recent years, finding applications in a variety of aspects of everyday life. Smartphones and mobile apps are being used for a steadily increasing number of tasks, including health monitoring. A large number of nutrition and diet apps are available, and some of them are very popular in terms of user downloads, highlighting a trend toward diet monitoring and assessment. OBJECTIVE We sought to explore the perspectives of end users on the features, current use, and acceptance of nutrition and diet mHealth apps with a survey. We expect that this study can provide user insights to assist researchers and developers in achieving innovative dietary assessments. METHODS A multidisciplinary team designed and compiled the survey. Before its release, it was pilot-tested by 18 end users. A 19-question survey was finally developed and was translated into six languages: English, German, French, Spanish, Italian, and Greek. The participants were mainly recruited via social media platforms and mailing lists of universities, university hospitals, and patient associations. RESULTS A total of 2382 respondents (1891 female, 79.4%; 474 male, 19.9%; and 17 neither, 0.7%) with a mean age of 27.2 years (SD 8.5) completed the survey. Approximately half of the participants (1227/2382, 51.5%) had used a nutrition and diet app. The primary criteria for selecting such an app were ease of use (1570/2382, 65.9%), free cost (1413/2382, 59.3%), and ability to produce automatic readings of caloric content (1231/2382, 51.7%) and macronutrient content (1117/2382, 46.9%) (ie, food type and portion size are estimated by the system without any contribution from the user). An app was less likely to be selected if it incorrectly estimated portion size, calories, or nutrient content (798/2382, 33.5%). Other important limitations included the use of a database that does not include local foods (655/2382, 27.5%) or that may omit major foods (977/2382, 41%). CONCLUSIONS This comprehensive study in a mostly European population assessed the preferences and perspectives of potential nutrition and diet app users. Understanding user needs will benefit researchers who develop tools for innovative dietary assessment as well as those who assist research on behavioral changes related to nutrition.

ACS Style

Maria F Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study (Preprint). 2021, 1 .

AMA Style

Maria F Vasiloglou, Stergios Christodoulidis, Emilie Reber, Thomai Stathopoulou, Ya Lu, Zeno Stanga, Stavroula Mougiakakou. Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study (Preprint). . 2021; ():1.

Chicago/Turabian Style

Maria F Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. 2021. "Perspectives and Preferences of Adult Smartphone Users Regarding Nutrition and Diet Apps: Web-Based Survey Study (Preprint)." , no. : 1.

Journal article
Published: 24 July 2020 in Nutrients
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Accurate dietary assessment is crucial for both the prevention and treatment of nutrition-related diseases. Since mobile-based dietary assessment solutions are promising, we sought to examine the acceptability of ″Nutrition and Diet″ (ND) apps by Healthcare Professionals (HCP), explore their preferences on apps′ features and identify predictors of acceptance. A 23 question survey was developed by an interdisciplinary team and pilot-tested. The survey was completed by 1001 HCP from 73 countries and 6 continents. The HCP (dietitians: 833, doctors: 75, nurses: 62, other: 31/females: 847, males: 150, neither: 4) had a mean age (SD) of 34.4 (10.2) years and mean job experience in years (SD): 7.7 (8.2). There were 45.5% who have recommended ND apps to their clients/patients. Of those who have not yet recommended an app, 22.5% do not know of their existence. Important criteria for selecting an app were ease of use (87.1%), apps being free of charge (72.6%) and validated (69%). Significant barriers were the use of inaccurate food composition database (52%), lack of local food composition database support (48.2%) and tech-savviness (43.3%). Although the adoption of smartphones is growing and mobile health research is advancing, there is room for improvement in the recommendation of ND apps by HCP.

ACS Style

Maria F. Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey. Nutrients 2020, 12, 2214 .

AMA Style

Maria F. Vasiloglou, Stergios Christodoulidis, Emilie Reber, Thomai Stathopoulou, Ya Lu, Zeno Stanga, Stavroula Mougiakakou. What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey. Nutrients. 2020; 12 (8):2214.

Chicago/Turabian Style

Maria F. Vasiloglou; Stergios Christodoulidis; Emilie Reber; Thomai Stathopoulou; Ya Lu; Zeno Stanga; Stavroula Mougiakakou. 2020. "What Healthcare Professionals Think of ″Nutrition & Diet″ Apps: An International Survey." Nutrients 12, no. 8: 2214.

Journal article
Published: 21 April 2020 in Nutrition
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Malnutrition is a challenging issue in hospitals, but mostly reversible. However, despite being associated with increased morbidity and mortality risk, malnutrition is hardly recognized and treated. There is a strong need to raise awareness of treating residents to improve patients’ nutritional management. This study aimed to investigate the impact of an educational intervention on residents’ nutritional knowledge, perception, and prescribed nutritional therapies. This prospective intervention study was conducted at the Department of General Internal Medicine of the Bern University Hospital. Nutritional risk was evaluated in consecutive patients admitted to the wards using the Nutritional Risk Screening 2002 and the number of prescribed nutritional therapies were assessed. The educational intervention included an interactive case discussion headed by nutritional medicine consultants. A pocket card with basic nutritional information was handed out. Each resident’s nutritional knowledge was checked with a multiple choice test before the intervention, immediately after, and after 2 months. In total, 609 patients were included (121 preintervention, 161 postintervention phase I, 327 postintervention phase II). Overall prevalence of malnutrition was 35%. The percentage of prescribed nutritional therapies was 36%. There was no significant difference between the phases (46% preintervention, 52% postintervention phase I, 27% postintervention phase II) or between the test results (mean percentage of correct answers 61 ± 15%; 57 ± 12%, and 60 ± 10%). The multimodal intervention failed to achieve both objectives, as neither residents’ knowledge and awareness nor the number of prescribed therapies could be increased. Nutritional risk remains highly prevalent; thus, innovative and more effective teaching strategies are needed to increase knowledge, abilities, and skills to fight malnutrition.

ACS Style

Emilie Reber; Anna Messmer Ivanova; Patricia Cadisch; Jessica Stirnimann; Martin Perrig; Christine Roten; Zeno Stanga. Does multifaceted nutritional education improve malnutrition management? Nutrition 2020, 78, 110810 .

AMA Style

Emilie Reber, Anna Messmer Ivanova, Patricia Cadisch, Jessica Stirnimann, Martin Perrig, Christine Roten, Zeno Stanga. Does multifaceted nutritional education improve malnutrition management? Nutrition. 2020; 78 ():110810.

Chicago/Turabian Style

Emilie Reber; Anna Messmer Ivanova; Patricia Cadisch; Jessica Stirnimann; Martin Perrig; Christine Roten; Zeno Stanga. 2020. "Does multifaceted nutritional education improve malnutrition management?" Nutrition 78, no. : 110810.

Review
Published: 13 December 2019 in Journal of Clinical Medicine
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Refeeding syndrome (RFS) is the metabolic response to the switch from starvation to a fed state in the initial phase of nutritional therapy in patients who are severely malnourished or metabolically stressed due to severe illness. It is characterized by increased serum glucose, electrolyte disturbances (particularly hypophosphatemia, hypokalemia, and hypomagnesemia), vitamin depletion (especially vitamin B1 thiamine), fluid imbalance, and salt retention, with resulting impaired organ function and cardiac arrhythmias. The awareness of the medical and nursing staff is often too low in clinical practice, leading to under-diagnosis of this complication, which often has an unspecific clinical presentation. This review provides important insights into the RFS, practical recommendations for the management of RFS in the medical inpatient population (excluding eating disorders) based on consensus opinion and on current evidence from clinical studies, including risk stratification, prevention, diagnosis, and management and monitoring of nutritional and fluid therapy.

ACS Style

Emilie Reber; Natalie Friedli; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. Management of Refeeding Syndrome in Medical Inpatients. Journal of Clinical Medicine 2019, 8, 2202 .

AMA Style

Emilie Reber, Natalie Friedli, Maria F. Vasiloglou, Philipp Schuetz, Zeno Stanga. Management of Refeeding Syndrome in Medical Inpatients. Journal of Clinical Medicine. 2019; 8 (12):2202.

Chicago/Turabian Style

Emilie Reber; Natalie Friedli; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. 2019. "Management of Refeeding Syndrome in Medical Inpatients." Journal of Clinical Medicine 8, no. 12: 2202.

Review
Published: 19 November 2019 in Journal of Clinical Medicine
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Artificial nutrition, including enteral (EN) and parenteral (PN) nutrition, is indicated whenever adequate oral nutrition fails to sufficiently supply the necessary nutrients to the body. It is a convenient, efficacious, safe, and well-tolerated form of clinical nutrition in the hospital and home setting. EN is administered via nasogastric tube or ostomies while PN usually requires a central venous access for administration, straight into the blood stream. The infused nutrients can then be taken up directly by the different organs. PN is targeted as a single daily portion formulated as an oil-in-water emulsion providing the necessary substrates for the catabolic and anabolic metabolism including macro- and micronutrients and fluids. PN has a complex pharmaceutical composition—all-in-one admixture—and its compounding or ready-to-use preparation. The use of PN is more challenging and more expensive compare to the use of EN, commercially available as ready-to-use formulations. EN and concomitant medication is highly challenging. Upon incorrect handling and administration, PN is associated with potentially severe or even fatal complications, mostly relating to the central venous access (e.g., catheter-related sepsis) or to a metabolic intolerance (e.g., hyperglycemia, refeeding syndrome) because of inappropriate administration. A correct order of admixing, correct dosing, and administration of the artificial is crucial for safety and efficacy; clinical and biochemical monitoring of the patient and treatment regimen adaption are necessary. The high number of reactive solutes allow only limited stability of a ready-to-use PN admixture. The potential for numerous incompatibilities and interactions renders PN admixtures generally unsuitable as drug vehicle. Laboratory compatibility and stability testing and pharmaceutical expertise are a prerequisite to define the PN composition including nutrients or even drugs admixed to define the appropriate and individualized nutrition and medication regimen. The aim of this narrative review is to present the actual state-of-the-art to deliver best quality artificial nutrition with special regard on pharmaceutical aspects such as instabilities, incompatibilities, and concomitant co-medication.

ACS Style

Emilie Reber; Markus Messerli; Zeno Stanga; Stefan Mühlebach. Pharmaceutical Aspects of Artificial Nutrition. Journal of Clinical Medicine 2019, 8, 2017 .

AMA Style

Emilie Reber, Markus Messerli, Zeno Stanga, Stefan Mühlebach. Pharmaceutical Aspects of Artificial Nutrition. Journal of Clinical Medicine. 2019; 8 (11):2017.

Chicago/Turabian Style

Emilie Reber; Markus Messerli; Zeno Stanga; Stefan Mühlebach. 2019. "Pharmaceutical Aspects of Artificial Nutrition." Journal of Clinical Medicine 8, no. 11: 2017.

Review
Published: 08 November 2019 in Journal of Clinical Medicine
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Swallowing difficulties, also called dysphagia, can have various causes and may occur at many points in the swallowing process. The treatment and rehabilitation of dysphagia represent a major interdisciplinary and multiprofessional challenge. In dysphagic patients, dehydration is frequent and often accelerated as a result of limited fluid intake. This condition results from loss of water from the intracellular space, disturbing the normal levels of electrolytes and fluid interfering with metabolic processes and body functions. Dehydration is associated with increased morbidity and mortality rates. Dysphagic patients at risk of dehydration thus require close monitoring of their hydration state, and existing imbalances should be addressed quickly. This review gives an overview on dehydration, as well as its pathophysiology, risk factors, and clinical signs/symptoms in general. Available management strategies of dehydration are presented for oral, enteral, and parenteral fluid replacement.

ACS Style

Emilie Reber; Filomena Gomes; Ilka A. Dähn; Maria F. Vasiloglou; Zeno Stanga. Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of Clinical Medicine 2019, 8, 1923 .

AMA Style

Emilie Reber, Filomena Gomes, Ilka A. Dähn, Maria F. Vasiloglou, Zeno Stanga. Management of Dehydration in Patients Suffering Swallowing Difficulties. Journal of Clinical Medicine. 2019; 8 (11):1923.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Ilka A. Dähn; Maria F. Vasiloglou; Zeno Stanga. 2019. "Management of Dehydration in Patients Suffering Swallowing Difficulties." Journal of Clinical Medicine 8, no. 11: 1923.

Cme fortbildung
Published: 23 October 2019 in Aktuelle Ernährungsmedizin
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Ernährungsteams sind Einrichtungen in Krankenhäusern, die sowohl für den fachgerechten Einsatz von enteralen und parenteralen stationären Ernährungstherapien als auch für die Beratung zur ambulanten Ernährung zuständig sind. Im vorliegenden Beitrag wird näher auf die Organisation, die Zusammensetzung, die Aufgaben und Herausforderungen eines klinischen Ernährungsteams betreffend Patienten-Outcome und Kosten eingegangen. Many patients are malnourished at hospital admission. This condition further worsens improve during the hospitalisation. Malnutrition itself prolongs the length of hospital stay and the rehabilitation time, increases complication rates, morbidity, and mortality. Prompt reaction is needed to prevent these negative consequences, to maximise the success of therapy and to offer patients a better quality of life and a maintained autonomy. The early recognition of a poor nutritional status is therefore indispensable to initiate an efficient and timely nutritional therapy, according to individual needs. Multidisciplinary knowledge is needed to avoid potential complications as well as clearly defined responsibilities and structured processes. Thus, inter- and multiprofessional efforts clinical nutrition support teams have been created since the 70ies, mainly in the larger hospitals, to manage nutritional therapies. The main task of a clinical nutrition support team is to detect the risk for malnutrition, to prevent malnutrition by targeted measures and, when appropriate, to adequately treat it quickest possible. In the following, we will provide more details about organisation, composition, tasks, challenges of clinical nutrition support teams as wells as efficacy regarding patients’ outcome and briefly about costs.

ACS Style

Emilie Reber; Michèle Leuenberger; Jessica Stirnimann; Anna-Barbara Sterchi; Lia Bally; Zeno Stanga. Herausforderungen und Wirksamkeit eines klinischen Ernährungsteams. Aktuelle Ernährungsmedizin 2019, 44, 336 -354.

AMA Style

Emilie Reber, Michèle Leuenberger, Jessica Stirnimann, Anna-Barbara Sterchi, Lia Bally, Zeno Stanga. Herausforderungen und Wirksamkeit eines klinischen Ernährungsteams. Aktuelle Ernährungsmedizin. 2019; 44 (5):336-354.

Chicago/Turabian Style

Emilie Reber; Michèle Leuenberger; Jessica Stirnimann; Anna-Barbara Sterchi; Lia Bally; Zeno Stanga. 2019. "Herausforderungen und Wirksamkeit eines klinischen Ernährungsteams." Aktuelle Ernährungsmedizin 44, no. 5: 336-354.

Review
Published: 22 August 2019 in Journal of Clinical Medicine
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Malnutrition is frequent in patients during a hospital admission and may further worsen during the hospital stay without appropriate nutritional support. Malnutrition causes greater complication rates, morbidity, and mortality rates, which increases the length of hospital stay and prolongs rehabilitation. Early recognition of individual nutritional risk and timely initiation of a tailored nutritional therapy are crucial. Recent evidence from large-scale trials suggests that efficient nutritional management not only improves the nutritional status, but also prevents negative clinical outcomes and increases patients' quality of life. Multifaceted clinical knowledge is required to ensure optimal nutritional support, according to a patient's individual situation and to avoid potential complications. Furthermore, clear definition of responsibilities and structuring of patient, and work processes are indispensable. Interdisciplinary and multiprofessional nutritional support teams have been built up to ensure and improve the quality and safety of nutritional treatments. These teams continuously check and optimize the quality of procedures in the core areas of nutritional management by implementing nutritional screening processes using a validated tool, nutritional status assessment, an adequate nutritional care plan development, prompt and targeted nutritional treatment delivery, and provision of accurate monitoring to oversee all aspects of care, from catering to artificial nutrition. The foundation of any nutritional care plan is the identification of patients at risk. The aim of this narrative review is to provide an overview about composition, tasks, and challenges of nutritional support teams, and to discuss the current evidence regarding their efficiency and efficacy in terms of clinical outcome and cost effectiveness.

ACS Style

Emilie Reber; Rachel Strahm; Lia Bally; Philipp Schuetz; Zeno Stanga. Efficacy and Efficiency of Nutritional Support Teams. Journal of Clinical Medicine 2019, 8, 1281 .

AMA Style

Emilie Reber, Rachel Strahm, Lia Bally, Philipp Schuetz, Zeno Stanga. Efficacy and Efficiency of Nutritional Support Teams. Journal of Clinical Medicine. 2019; 8 (9):1281.

Chicago/Turabian Style

Emilie Reber; Rachel Strahm; Lia Bally; Philipp Schuetz; Zeno Stanga. 2019. "Efficacy and Efficiency of Nutritional Support Teams." Journal of Clinical Medicine 8, no. 9: 1281.

Review
Published: 30 July 2019 in Journal of Clinical Medicine
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Malnutrition is a common condition in hospitalized patients that is often underdiagnosed and undertreated. Hospital malnutrition has multifactorial causes and is associated with negative clinical and economic outcomes. There is now growing evidence from clinical trials for the efficiency and efficacy of nutritional support in the medical inpatient population. Since many medical inpatients at nutritional risk or malnourished are polymorbid (i.e., suffer from multiple comorbidities), this makes the provision of adequate nutritional support a challenging task, given that most of the clinical nutrition guidelines are dedicated to single diseases. This review summarizes the current level of evidence for nutritional support in not critically ill polymorbid medical inpatients.

ACS Style

Emilie Reber; Filomena Gomes; Lia Bally; Philipp Schuetz; Zeno Stanga. Nutritional Management of Medical Inpatients. Journal of Clinical Medicine 2019, 8, 1130 .

AMA Style

Emilie Reber, Filomena Gomes, Lia Bally, Philipp Schuetz, Zeno Stanga. Nutritional Management of Medical Inpatients. Journal of Clinical Medicine. 2019; 8 (8):1130.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Lia Bally; Philipp Schuetz; Zeno Stanga. 2019. "Nutritional Management of Medical Inpatients." Journal of Clinical Medicine 8, no. 8: 1130.

Review
Published: 20 July 2019 in Journal of Clinical Medicine
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Malnutrition is an independent risk factor that negatively influences patients’ clinical outcomes, quality of life, body function, and autonomy. Early identification of patients at risk of malnutrition or who are malnourished is crucial in order to start a timely and adequate nutritional support. Nutritional risk screening, a simple and rapid first-line tool to detect patients at risk of malnutrition, should be performed systematically in patients at hospital admission. Patients with nutritional risk should subsequently undergo a more detailed nutritional assessment to identify and quantify specific nutritional problems. Such an assessment includes subjective and objective parameters such as medical history, current and past dietary intake (including energy and protein balance), physical examination and anthropometric measurements, functional and mental assessment, quality of life, medications, and laboratory values. Nutritional care plans should be developed in a multidisciplinary approach, and implemented to maintain and improve patients’ nutritional condition. Standardized nutritional management including systematic risk screening and assessment may also contribute to reduced healthcare costs. Adequate and timely implementation of nutritional support has been linked with favorable outcomes such as a decrease in length of hospital stay, reduced mortality, and reductions in the rate of severe complications, as well as improvements in quality of life and functional status. The aim of this review article is to provide a comprehensive overview of nutritional screening and assessment methods that can contribute to an effective and well-structured nutritional management (process cascade) of hospitalized patients.

ACS Style

Emilie Reber; Filomena Gomes; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. Nutritional Risk Screening and Assessment. Journal of Clinical Medicine 2019, 8, 1065 .

AMA Style

Emilie Reber, Filomena Gomes, Maria F. Vasiloglou, Philipp Schuetz, Zeno Stanga. Nutritional Risk Screening and Assessment. Journal of Clinical Medicine. 2019; 8 (7):1065.

Chicago/Turabian Style

Emilie Reber; Filomena Gomes; Maria F. Vasiloglou; Philipp Schuetz; Zeno Stanga. 2019. "Nutritional Risk Screening and Assessment." Journal of Clinical Medicine 8, no. 7: 1065.

Journal article
Published: 10 July 2019 in Journal of Clinical Medicine
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Disease-related malnutrition (DRM) is a highly prevalent independent risk and cost factor with significant influence on mortality, morbidity, length of hospital stay (LOS), functional impairment and quality of life. The aim of our research was to estimate the economic impact of the introduction of routinely performed nutritional screening (NS) in a tertiary hospital, with subsequent nutritional interventions (NI) in patients with potential or manifest DRM. Economic impact analysis of natural detection of inpatients at risk and estimation of the change in economic activity after the implementation of a systematic NS were performed. The reference population for natural detection of DRM is about 20,000 inpatients per year. Based on current data, DRM prevalence is estimated at 20%, so 4000 patients with potential and manifest DRM should be detected. The NI costs were estimated at CHF 0.693 million, with savings of CHF 1.582 million (LOS reduction) and CHF 0.806 million in additional revenue (SwissDRG system). Thus, the introduction of routine NS generates additional costs of CHF 1.181 million that are compensated by additional savings of CHF 2.043 million and an excess in additional revenue of CHF 2.071 million. NS with subsequent adequate nutritional intervention shows an economic potential for hospitals.

ACS Style

Emilie Reber; Kristina Norman; Olga Endrich; Philipp Schuetz; Andreas Frei; Zeno Stanga. Economic Challenges in Nutritional Management. Journal of Clinical Medicine 2019, 8, 1005 .

AMA Style

Emilie Reber, Kristina Norman, Olga Endrich, Philipp Schuetz, Andreas Frei, Zeno Stanga. Economic Challenges in Nutritional Management. Journal of Clinical Medicine. 2019; 8 (7):1005.

Chicago/Turabian Style

Emilie Reber; Kristina Norman; Olga Endrich; Philipp Schuetz; Andreas Frei; Zeno Stanga. 2019. "Economic Challenges in Nutritional Management." Journal of Clinical Medicine 8, no. 7: 1005.

Journal article
Published: 01 July 2019 in Praxis
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Zusammenfassung. Fasten liegt im Trend: sei es zum Gewichtsverlust, zur Steigerung des Wohlbefindens oder zur Behandlung von chronischen und akuten Erkrankungen. Die positiven und/oder negativen Effekte des Fastens sind umstritten. Das Ziel dieser Pilotstudie war es, die Auswirkungen des Fastens auf den Körper und die Psyche zu untersuchen. Dazu wurde eine Fastenwoche durchgeführt. Verschiedene klinische (Gewicht, Blutdruck) und subjektiv empfundene psychische (Hungergefühl, Antriebskraft, Stimmungslage, Kältegefühl und Schlafqualität) Parameter sowie Nebeneffekte wurden untersucht. Insgesamt wurden zwölf Probanden erfasst (zehn Frauen, zwei Männer). Es zeigte sich in dieser Pilotstudie, dass das Fasten unterschiedliche klinische und psychische Auswirkungen hat, die sich individuell sehr unterschiedlich präsentieren.

ACS Style

Rahel Stocker; Emilie Reber; Carla Aeberhard; Lia Bally; Philipp Schütz; Zeno Stanga. Fasten – Auswirkungen auf Körper und Psyche. Praxis 2019, 108, 593 -597.

AMA Style

Rahel Stocker, Emilie Reber, Carla Aeberhard, Lia Bally, Philipp Schütz, Zeno Stanga. Fasten – Auswirkungen auf Körper und Psyche. Praxis. 2019; 108 (9):593-597.

Chicago/Turabian Style

Rahel Stocker; Emilie Reber; Carla Aeberhard; Lia Bally; Philipp Schütz; Zeno Stanga. 2019. "Fasten – Auswirkungen auf Körper und Psyche." Praxis 108, no. 9: 593-597.

Review
Published: 28 June 2019 in Journal of Clinical Medicine
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Hyperglycemia is a common occurrence in hospitalized patients receiving parenteral and/or enteral nutrition. Although there are several approaches to manage hyperglycemia, there is no consensus on the best practice. We systematically searched PubMed, Embase, Cochrane Central, and ClinicalTrials.gov to identify records (published or registered between April 1999 and April 2019) investigating strategies to manage glucose control in adults receiving parenteral and/or enteral nutrition whilst hospitalized in noncritical care units. A total of 15 completed studies comprising 1170 patients were identified, of which 11 were clinical trials and four observational studies. Diabetes management strategies entailed adaptations of nutritional regimens in four studies, while the remainder assessed different insulin regimens and administration routes. Diabetes-specific nutritional regimens that reduced glycemic excursions, as well as algorithm-driven insulin delivery approaches that allowed for flexible glucose-responsive insulin dosing, were both effective in improving glycemic control. However, the assessed studies were, in general, of limited quality, and we see a clear need for future rigorous studies to establish standards of care for patients with hyperglycemia receiving nutrition support.

ACS Style

Céline Isabelle Laesser; Paul Cumming; Emilie Reber; Zeno Stanga; Taulant Muka; Lia Bally. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. Journal of Clinical Medicine 2019, 8, 935 .

AMA Style

Céline Isabelle Laesser, Paul Cumming, Emilie Reber, Zeno Stanga, Taulant Muka, Lia Bally. Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review. Journal of Clinical Medicine. 2019; 8 (7):935.

Chicago/Turabian Style

Céline Isabelle Laesser; Paul Cumming; Emilie Reber; Zeno Stanga; Taulant Muka; Lia Bally. 2019. "Management of Glucose Control in Noncritically Ill, Hospitalized Patients Receiving Parenteral and/or Enteral Nutrition: A Systematic Review." Journal of Clinical Medicine 8, no. 7: 935.

Journal article
Published: 12 June 2019 in Nutrition
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Clinical experience with patients with cystic fibrosis (CF) suggests a nutritional risk in this population. In addition to the lung pathology, a main pathophysiologic concern is the viscous mucus blocking pancreatic ducts, leading to reduced production of pancreatic enzymes. Therefore, maldigestion and consequently malabsorption (particularly fat and fat-soluble vitamins) occur, resulting in steatorrhea, vitamin deficiencies, and subsequently manifest malnutrition. The aim of this study was to investigate the nutritional status and determine the prevalence of malnutrition in an adult Swiss CF cohort. This was an observational cohort study in which the nutritional status and dietary habits of patients with CF and healthy controls were compared. Assessment was based on the nutritional risk screening (NRS-2002), dietary habits (7-d dietary record), body composition (bioelectrical impedance analysis), anthropometrics, resting energy expenditure (REE; indirect calorimetry), and physical or mental function (hand-grip strength, Short Form-36 v2). Nineteen patients (15 men, mean age 32 y) and 15 controls (8 men, mean age 49 y) were included. Eight patients (42%) were at nutritional risk (NRS-2002 ≥3). Patients had higher energy intake/body weight (P = 0.021) with lower body fat percentage (P < .001), body mass index (P = 0.030), and physical/mental health scores (P < 0.001) than controls. Energy intake was higher than REE in patients (P = 0.003), but not in controls (P = 0.373). Prevalence of malnutrition was high in this CF cohort, coinciding with low body fat percentage and low body mass index despite high energy and protein intake. Energy requirements of patients with CF should be estimated as approximately twice the Harris-Benedict REE and 1.7 times indirect calorimetry REE, while ensuring adequate intake of pancreatic enzymes.

ACS Style

Katja A. Schönenberger; Emilie Reber; Lia Bally; Thomas Geiser; Dagmar Lin; Zeno Stanga. Nutritional assessment in adults with cystic fibrosis. Nutrition 2019, 67-68, 110518 .

AMA Style

Katja A. Schönenberger, Emilie Reber, Lia Bally, Thomas Geiser, Dagmar Lin, Zeno Stanga. Nutritional assessment in adults with cystic fibrosis. Nutrition. 2019; 67-68 ():110518.

Chicago/Turabian Style

Katja A. Schönenberger; Emilie Reber; Lia Bally; Thomas Geiser; Dagmar Lin; Zeno Stanga. 2019. "Nutritional assessment in adults with cystic fibrosis." Nutrition 67-68, no. : 110518.

Review
Published: 01 June 2019 in Praxis
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Zusammenfassung. Zusammenfassung: Die ketogene Diät (KD) ist eine sehr fettreiche und stark kohlenhydratreduzierte Ernährungsform, die bisher vor allem bei Kindern mit therapierefraktärer Epilepsie eingesetzt wird. Die Anwendung der KD bei anderen Krankheitsbildern wird zunehmend diskutiert. Diese Übersicht zeigt, dass erste Hinweise für einen klinischen Nutzen der KD beim Diabetes mellitus Typ 2 (T2DM) und beim Polyzystischen Ovarialsyndrom (PCOS) bestehen. In vielen analysierten Studien führte die KD zu einem signifikanten Gewichtsverlust und hatte eine günstige Wirkung auf das Lipoproteinprofil und die Insulinresistenz. Der HbA1c-Wert nahm durch die KD bei der Hälfte der kontrollierten T2DM-Studien signifikant stärker ab (HbA1c-Differenz: –0,5 bis –1,5 %) als durch Vergleichsdiäten (HbA1c-Differenz: +0,2 bis –0,5 %). Insgesamt sind die Studienresultate jedoch für eine allgemeine Empfehlung der KD bei diesem Patientenkollektiv zu heterogen.

ACS Style

Rahel Kristina Stocker; Emilie Reber Aubry; Lilly Bally; Jean-Marc Nuoffer; Zeno Stanga. Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen. Praxis 2019, 108, 541 -553.

AMA Style

Rahel Kristina Stocker, Emilie Reber Aubry, Lilly Bally, Jean-Marc Nuoffer, Zeno Stanga. Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen. Praxis. 2019; 108 (8):541-553.

Chicago/Turabian Style

Rahel Kristina Stocker; Emilie Reber Aubry; Lilly Bally; Jean-Marc Nuoffer; Zeno Stanga. 2019. "Ketogene Diät: evidenzbasierte therapeutische Anwendung bei endokrinologischen Erkrankungen." Praxis 108, no. 8: 541-553.