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首页> 外文期刊>Journal of human nutrition and dietetics >A service evaluation to determine the effectiveness of current dietary advice in treating human immunodeficiency virus-associated weight loss and to highlight potential service improvements.
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A service evaluation to determine the effectiveness of current dietary advice in treating human immunodeficiency virus-associated weight loss and to highlight potential service improvements.

机译：服务评估，以确定当前饮食建议在治疗与人类免疫缺陷病毒相关的体重减轻中的有效性，并着重指出潜在的服务改进。

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Background: Weight loss and muscle wasting are experienced by many patients with human immunodeficiency virus (HIV) (Grinspoon et al., 2003). Malnutrition is an important predicator of morbidity and mortality; people who are malnourished who received antiretroviral treatment are six times more likely to die than those who are adequately nourished (Paton et al., 2006). The physical manifestations of muscle wasting can have significant psychosocial implications for HIV patients (Power et al., 2003; Sattler, 2003). The aim of this study to evaluate provision of dietetic care to patients referred for acute weight loss advice and identify areas for potential service improvement. Methods: The data were gathered from the departmental dietetic activity statistics in 2007, diagnosis code 'HIV - acute weight loss'. Fifty-nine cards were located and baseline weight, height and body mass index (BMI) were recorded (two female, 57 male). Qualitative data on dietetic intervention were extracted from record cards - little and often eating approach, food fortification (FF), high energy high protein oral nutritional supplement (ONS) prescribed. Data were collected on body image, exercise and weight at follow-up visits during 2007. Results: Forty-three percent of the patients referred for 'HIV-acute weight loss' were lost to follow-up. Forty-seven percent of the remaining patients had a BMI <20 kg m(-2). Following their initial dietetic intervention, 81% of these patients had gained weight at the first follow-up. All had received nutritional counselling on little and often eating approach and FF; 75% had ONS prescribed. Average weight gain with nutritional counselling alone was 1.3 kg (2.1 kg) and for nutritional counselling plus supplementation was 2.1 kg (1.8 kg). This represented 2.5% (4.1%) and 3.9% (3.4%) weight gain, respectively. Discussion: This evaluation has highlighted that patient follow-up frequency is an area for service improvement. Fifty-three per cent of patients (excluding those lost to follow up) had a BMI >/=20 kg m(-2) and were inaccurately recorded in the statistics as being referred for 'HIV-acute weight loss'. Fifty-two percent of these patients reported lipodystrophy and body image concerns, similar to findings of other studies. Fifty-six percent reported weight improvements following dietetic consultation. Body image is a frequent referral trigger, therefore improvements should be made to identify and treat patients with body shape issues. Conclusions: Dietitians are effective at achieving weight gain in HIV positive patients with a BMI <20 kg m(-2) using nutritional counselling methods with or without oral nutritional supplementation; these patients experienced a 3.3% weight gain. Strategies need to be implemented to reduce the number of patients lost to follow-up, as weight loss is a key morbidity and mortality indicator in HIV. References Grinspoon, S. & Mulligan, K. (2003) Weight loss and wasting in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 69-78. Nerad, J., Romeyn, M., Silverman, E., Allen-Reid, J., Dieterich, D., Merchant, J., Pelletier, V., Tinnerello, D. & Fenton, M. (2003) General nutritional management in patients infected with HIV. Clin. Infect. Dis.36 (Suppl. 2): 52-62. Ockenga, J., Grimble, R., Jonkers-Schuitema, C., Macallan, D., Melchior, J.C., Sauerwein, H.P., Schwenk, A. & Suttmann, U. (2006) ESPEN guidelines on enteral nutrition: wasting in HIV and other chronic infectious diseases. Clin. Nutr.25, 319-329. Paton, N.I., Sangeetha, S., Earnest, A. & Bellamy, R. (2006) The impact of malnutrition on survival and the CD4 count response in HIV-infected patients starting antiretroviral therapy. HIV Med.7, 232-330. Power, R., Tate, H.L., McGill, S.M. & Taylor, C. (2003) A qualitative study of the psychosocial implications of lipodystrophy syndrome on HIV positive individuals. Sex. Transm. Infect.79, 137-141. Sattler, F. (2003) Body habitus changes related to lipodystrophy. Clin. Infect. Dis3
机译：背景：许多人免疫缺陷病毒（HIV）患者经历了体重减轻和肌肉消瘦（Grinspoon等，2003）。营养不良是发病率和死亡率的重要预测因素。营养不良的人接受抗逆转录病毒治疗的人死亡的可能性是营养充足的人的六倍（Paton等，2006）。肌肉消瘦的物理表现可能会对HIV患者产生重大的社会心理影响（Power等，2003; Sattler，2003）。这项研究的目的是评估为急诊减肥建议转诊的患者提供饮食护理，并确定可能改善服务的领域。方法：数据来源于2007年部门饮食活动统计数据，诊断代码为“ HIV-急性体重减轻”。找到59张卡片，记录基线体重，身高和体重指数（BMI）（两名女性，男性57位）。有关饮食干预的定性数据是从记录卡中提取的-很少进食且经常进食的方法，食品强化（FF），高能量高蛋白口服营养补充剂（ONS）。在2007年的随访期间收集了有关身体图像，运动和体重的数据。结果：因“ HIV急性体重减轻”而被转诊的患者中有43％失去了随访。其余患者中有47％的BMI <20 kg m（-2）。在最初的饮食干预之后，这些患者中有81％的患者在首次随访时体重有所增加。所有人都很少和经常进食和FF接受了营养咨询; 75％的人指定了ONS。仅营养咨询的平均体重增加为1.3千克（2.1千克），营养咨询加补充的平均体重增加为2.1千克（1.8千克）。这分别代表了2.5％（4.1％）和3.9％（3.4％）的体重增加。讨论：该评估强调了患者的随访频率是服务改善的领域。 53％的患者（不包括失去随访的患者）的BMI> / = 20 kg m（-2），并且在统计中被错误地记录为“ HIV急性体重减轻”。这些患者中有52％的患者报告了脂肪营养不良和对身体图像的担忧，与其他研究的结果相似。有56％的人在饮食咨询后称体重有所改善。身体图像经常是转诊的触发因素，因此应进行改进以识别和治疗患有身体形状问题的患者。结论：营养师可以有效地通过营养咨询方法（有或没有口服营养补充剂）使BMI <20 kg m（-2）的HIV阳性患者实现体重增加;这些患者体重增加了3.3％。由于体重减轻是艾滋病毒的关键发病率和死亡率指标，因此需要采取减少患者流失的策略。参考文献Grinspoon，S.和Mulligan，K.（2003）感染HIV的患者的体重减轻和消瘦。临床感染。 Dis.36（Suppl.2）：69-78。 Nerad，J.，Romeyn，M.，Silverman，E.，Allen-Reid，J.，Dieterich，D.，Merchant，J.，Pelletier，V.，Tinnerello，D.＆Fenton，M.（2003）General艾滋病毒感染者的营养管理。临床感染。 Dis.36（Suppl.2）：52-62。 Ockenga，J.，Grimble，R.，Jonkers-Schuitema，C.，Macallan，D.，Melchior，JC，Sauerwein，HP，Schwenk，A.＆Suttmann，U.（2006）ESPEN肠内营养指南：浪费艾滋病毒和其他慢性传染病。临床食品25，319-329。 Paton，N.I.，Sangeetha，S.，Earnest，A.＆Bellamy，R.（2006）营养不良对开始抗逆转录病毒治疗的HIV感染患者的存活率和CD4计数反应的影响。 HIV Med.7，232-330。 Power，R.，Tate，H.L.，McGill，S.M. ＆Taylor，C.（2003）对lipodystrophy综合征对HIV阳性个体的社会心理影响的定性研究。性别。传输感染79，137-141。 Sattler，F.（2003）与脂肪营养不良有关的身体习性变化。临床感染。 Dis3

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