Sue Green

A satiety quotient : A formulation to assess the satiating effect of food

This paper introduces a satiety quotient (SQ) to assess the satiating effect of an eating episode. This procedure constitutes an improvement on previous measures by considering the satiating effects of the eating episode over time. A satiety quotient was calculated from data obtained from several studies involving the presentation of a preload/meal to young lean male and female subjects. Subjects were presented with preloads/meals of varying composition, and motivation to eat immediately prior to, and periodically following, the eating episode were measured. Food and fluids were not consumed whilst motivation to eat was measured in the post preload/meal period. The SQ was calculated by dividing the difference between ratings of motivation to eat before and after the eating episode (pre minus post) by the weight or energy content of intake during the episode. This quotient relates intake to the rate of return of motivation to eat in the post-ingestive period, a relationship which is not apparent on separate examination of the amount consumed or ratings of motivation to eat. Development of this satiety quotient is a further contribution to the evolution of the concept of quantifying satiating effects of foods, and provides additional information on the effects of food attributes on short-term appetite control.

Carbohydrates and human appetite

Experiments indicate that exposure to high-carbohydrate foods can give rise to a clear modulation of the expression of human appetite. The potency and time course of the effects of various carbohydrates on satiety vary with the amount consumed and the chemical structure. There is evidence that this biological effect can modulate the temporal profile of hunger and the eating pattern of meals and snacks. One important issue is the action of carbohydrate foods on satiation (within meals) and satiety (after meals). These effects can be compared with the effects of high-fat foods. The physiological mechanisms through which carbohydrates exert an action on appetite are not completely identified, although plasma glucose values are likely to play a role. The experimental evidence suggests that it is possible to design high-carbohydrate diets that provide good nutrition with adequate control over appetite and a beneficial effect on body weight.

Feeding and dementia: a systematic literature review

Aim.  This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. Background.  Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. Method.  A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms ‘feeding’, ‘eating’ and ‘dementia’ combined as follows: ‘(feeding or eating) and (dementia)’. A second search was carried out combining the search terms ‘mealtimes’ and ‘dementia’ as follows: ‘mealtimes and dementia’. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. Results.  Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. Conclusions.  Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis.

Barriers and facilitators to undertaking nutritional screening of patients: a systematic review

BACKGROUND Recent reports have suggested that registered nurses may not screen patients admitted to their care for malnutrition. The objective of this integrative review was to locate and review published research investigating barriers and facilitators to nutritional screening by nurses. METHODS A systematic search for relevant English language publications was conducted through CINAHL®, Web of Science, MEDLINE® and EMBASE and an Internet search engine (completed November 2011). Reference lists of relevant publications were also searched. Search terms included nursing, dietetics, nutrition disorders and screening, as well as associated MeSH® terms and Subject Headings. Six hundred and sixteen publications were identified and 605 were excluded. Publications reporting research concerning barriers and facilitators to nutritional screening by nurses were selected using exclusion and inclusion criteria. These were reviewed and the key findings described, categorised, combined, reviewed and refined to create themes. RESULTS Eleven publications were reviewed. Publications primarily reported hospital-based studies undertaken in three continents and considered barriers rather than facilitators. Five themes emerged: organisational culture, competing priorities, the value of clinical judgement, training and education, and discrepancy between attitudes and practice. CONCLUSIONS Studies primarily involved acute care and indicated that routine screening for malnutrition will not take place unless it is considered an integral part of nursing assessment that is required by policy and resourced appropriately. Qualitative studies investigating barriers and facilitators to screening for malnutrition in community settings are needed and research is required to test interventions designed to modify or remove barriers and facilitate screening.

Evaluating the use of streaming video to support student learning in a first-year life sciences course for student nurses

Streaming video was used to support the learning of first year student nurses on a Life Sciences module, as one of many innovations designed to increase the range of resources and support available to students. This paper describes the background to this innovation, the procedures adopted and the results of extensive evaluation. The use of streaming video was evaluated in three applications in the module. A total of 656 students used online directed-learning sessions that incorporated streamed video. Just over half of these students actually viewed the video streams. Their feedback showed that 32% found access easy, 59% enjoyed using the resources, and 25% were very confident that they learned from them. Different types of video were used, and embedded in diverse ways, but the results were consistent across the three applications. They suggest that streamed video can contribute to useful resources to support learning by student nurses but, for a variety of reasons, it may not appeal or be adequately accessible to all students at present.

Comparison of high-fat and high-carbohydrate foods in a meal or snack on short-term fat and energy intakes in obese women.

The present study aimed to compare the action of high-fat and high-carbohydrate (CHO) foods on meal size (satiation) and post-meal satiety in obese women. A within-subjects design was used; each participant received all four nutritional challenges. Fifteen healthy obese women (age 21-56 years, BMI 35-48 kg/m2) participated; thirteen completed all four test days. On two test days, participants were exposed to a nutritional challenge comprising an ad libitum high-fat or high-CHO lunch. On the other two test days they were exposed to a challenge comprising an ad libitum sweet high-fat or high-CHO mid-afternoon snack. Energy and macronutrient intakes were measured at each eating episode. Visual analogue rating scales were completed periodically to record subjective feelings of appetite. When offered a high-CHO selection of foods at lunch and mid-afternoon participants consumed less energy than when offered a high-fat selection. However, post-meal satiety was similar. Total test-day energy intake was significantly higher when high-fat foods were consumed at lunch, but not as a snack. Consumption of high-fat foods at a lunch and snack increased the amount of fat consumed over the whole test day. In conclusion, energy intake of an eating episode was influenced by nutrient composition in this group of obese women. Consumption of high-fat foods at lunch or as a snack led to overconsumption relative to high-CHO foods. However, high-fat foods at meals may have greater potential to influence daily intake than at snacks, probably because meals are larger eating episodes and therefore give greater opportunity to overconsume.

A systematic review of the use of volunteers to improve mealtime care of adult patients or residents in institutional settings

AIMS AND OBJECTIVES The objective of this review was to locate and assess the evidence obtained from articles reporting empirical research that volunteers improve mealtime care of adults in institutional settings. BACKGROUND Malnutrition in adult patients or residents in institutional care settings is common. Poor standards of mealtime care have been suggested to contribute to the development of malnutrition. DESIGN A systematic review of the literature was undertaken. METHOD Key words were identified and used separately and in combination to search the electronic databases MEDLINE, CINHAL, BNI and EMBASE and the internet for relevant articles. Searches were undertaken in August 2008, April 2009 and July 1010. RESULTS Ten studies fulfilled the criteria for inclusion. The methodologies of five of the 10 studies were unclear due to the brevity of the reports. The validity of the design of the other five studies varied. Generally the results suggested the use of volunteers in mealtime care increased satisfaction of patients, relatives, volunteers and staff concerning meal-time assistance (assessed using methods such as questionnaires and focus groups) and three studies found increased nutritional intake in groups assisted by volunteers. However, few well designed and reported studies were identified. CONCLUSIONS There is some evidence that volunteers can improve mealtime care of adult patients or residents in institutional settings, however few well designed studies are reported. Relevance to clinical practice.  This review demonstrates that there is limited evidence that the use of volunteers improves mealtime care of adult patients or relatives in institutional settings.

The effect of caffeinated versus decaffeinated drinks on overactive bladder: a double-blind, randomized, crossover study

PURPOSE: The primary aims of this study were to test the methodology for use in a future randomized control trial and to investigate the effect of drinking caffeinated versus decaffeinated fluids on symptoms of overactive bladder (OAB) in women. DESIGN: A double-blind, randomized, crossover study was conducted. METHODS: Fourteen community-dwelling women newly diagnosed with OAB and a history of caffeine consumption were randomly allocated to group A (14-day caffeinated drink period followed by 14-day decaffeinated drink period) or group B (14-day decaffeinated drink period followed by 14-day caffeinated drink period). The periods were preceded by a 14-day run-in period and interspersed with a 14-day washout period. Primary outcomes were episodes of urgency, frequency, volume per void, and incontinence obtained each period on 3-day bladder diaries. Secondary outcome measures were OAB symptom severity and health-related quality of life (QOL) recorded each period using International Consultation on Incontinence–Overactive Bladder Module (ICIQ-OAB) and ICIQ-OAB–Quality of Life (ICIQ-OABqol) tools. Effects of caffeine reduction were measured each day using visual analogue scales. RESULTS: Eleven participants completed the study. A significant reduction in urgency (P < .01) and frequency (P < .05) of urinary voids on day 3 of the diary, total ICIQ-OAB score (P < .01), and a non-significant directional change for the total ICIQ-OABqol score (P = .065) was found using sign tests for the period of decaffeinated compared to caffeinated drink intake. No significant differences were found for any caffeine withdrawal measures. CONCLUSIONS: Despite the small sample size, this pilot study demonstrated that reducing caffeine intake may alleviate the severity of some symptoms and health-related QOL factors associated with OAB. Furthermore, caffeine substitutes were well tolerated.

Development and evaluation of a home enteral nutrition team.

The organisation of services to support the increasing number of people receiving enteral tube feeding (ETF) at home varies across regions. There is evidence that multi-disciplinary primary care teams focussed on home enteral nutrition (HEN) can provide cost-effective care. This paper describes the development and evaluation of a HEN Team in one UK city. A HEN Team comprising dietetians, nurses and a speech and language therapist was developed with the aim of delivering a quality service for people with gastrostomy tubes living at home. Team objectives were set and an underpinning framework of organisation developed including a care pathway and a schedule of training. Impact on patient outcomes was assessed in a pre-post test evaluation design. Patients and carers reported improved support in managing their ETF. Cost savings were realised through: (1) prevention of hospital admission and related transport for ETF related issues; (2) effective management and reduction of waste of feed and thickener; (3) balloon gastrostomy tube replacement by the HEN Team in the patient’s home, and optimisation of nutritional status. This service evaluation demonstrated that the establishment of a dedicated multi-professional HEN Team focussed on achievement of key objectives improved patient experience and, although calculation of cost savings were estimates, provided evidence of cost-effectiveness.

Feeding and dementia

Aim.  This paper reports a systematic review of the literature on interventions to promote oral nutritional intake of older people with dementia and feeding difficulty between 1993 and 2003. Background.  Older people with dementia commonly experience difficulty with feeding, especially in the later stages of the condition. This topic and related nursing care was reviewed in 1993 and the conclusion was that there was little research into interventions that nurses could use to alleviate feeding difficulty. Method.  A systematic review of the literature was carried out using the CINAHL, Medline, EMBASE and Cochrane databases and the search terms ‘feeding’, ‘eating’ and ‘dementia’ combined as follows: ‘(feeding or eating) and (dementia)’. A second search was carried out combining the search terms ‘mealtimes’ and ‘dementia’ as follows: ‘mealtimes and dementia’. The literature search was carried out on 1 December 2003 and papers were included in the review if retrieved by 31 December 2003. English language papers only were retrieved. Results.  Sixty-seven papers were retrieved, of which 13 addressed interventions aimed at helping older people with dementia to feed. All studies reported positive outcomes but only one randomized controlled trial was reported. Music was the most common intervention but there were no standardized interventions or outcomes across the studies and none reported the use of power analysis to decide on sample size. There were problems in some studies with confounding variables. Conclusions.  Further research is needed into interventions aimed at how nurses can help older people with dementia to feed. There are some promising lines of enquiry, with music being one of these, but future studies need to use adequate samples and to use power calculations and account adequately for confounding variables. There is also a need to standardize interventions and outcomes across such studies to facilitate meta-analysis.