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En svårt sjuk patient som vårdas på en intensivvårdsavdelning, med svikt i ett eller flera organsystem, löper betydande risk att drabbas av malnutrition med ökad risk för infektioner och längre vårdtider. När en väl utarbetad riktlinje inom nutrition följs ökar patientens möjligheter att nå upp till sitt kalorimål med minskad malnutrition och förkortade vårdtider som följd. Syftet med studien var att undersöka följsamheten till en befintlig riktlinje om nutrition på en intensivvårdsavdelning i västra Sverige med hjälp av journalgranskning. Ett konsekutivt urval gjordes och 31 uppfyllde inklusionskriterierna. Journalerna granskades enligt deskriptiv analys. Resultatet visade en varierande följsamhet till riktlinjen med högst följsamhet mot slutet av vårdtiden och lägst följsamhet i början av vårdtiden. Med hjälp av resultatet i denna studie kan följsamheten till riktlinjen förbättras och på så sätt kan bedömning och behandling av nutrition för intensivvårdspatienten optimeras. / A critically ill patient within the intensive care unit, with failure in one or more organ systems, has an increased risk of malnutrition with infections and extended hospital stay as a result. When a wellestablished guideline of nutrition is used, the patients possibility of reaching the caloric goal increases which lead to decreased malnutrition and shortened hospital stay. The aim of the study was to investigate the compliance of an enteral and parenteral guideline in an intensive care unit in a hospital in the west of Sweden with a review of medical records. A consecutive sample was made and 31 patients met the criteria. The medical records were reviewed according to descriptive analysis. The results showed a varying compliance to the guideline, with the highest compliance in the end of hospital stay and the lowest compliance in the beginning of hospital stay. Using the results in this study, the compliance of the nutritional guideline can be improved, and nutritional assessment and treatment for the intensive care patient can be optimized.

The primary purpose of this study was to determine the effect of ingesting an 8% carbohydrate (CHO) beverage during a moderate intensity exercise trial on performance outcomes, fuel utilization and blood glucose levels of wheelchair athletes (spinal cord injury (SC I) or cerebral palsy (CP)). The secondary purpose was to analyze the dietary intake of the eight participants and to determine if they were meeting current sport nutrition guidelines for macronutrients and fluids recommended in the joint position statement developed by the American Dietetic Association (ADA), the American College of Sports Medicine (ACSM) and Dietitians of Canada (DC).<p> Under random, double blind conditions eight athletes (6 males, 2 females); mean age 36 ± 8.5 y with a SCI (n = 7) or CP (n = 1) completed two exercise trials on an adapted stationary hand cycle; each trial was 60 minutes in duration at 65 % VO2peak followed immediately by a 30-minute performance trial. During the first 60-minutes the participants were given four 200 ml dosages (15, 30, 45, 60-min) of an 8% CHO beverage or a taste-matched placebo beverage. Blood lactate and glucose levels were sampled during the 60-minute exercise trial (pre, 20, 40, 60-min) and immediately after the 30-minute performance trial (post, 2, 5, 10-min). Heart rate was monitored continuously during the exercise and performance trial. Expired gas samples were also taken for 5-min periods during the exercise trial and then continuously during the performance trial. These values were used to calculate respiratory exchange ratio (RER) and carbohydrate oxidation. Dietary intake was assessed with a three day food record.<p> No significant differences were apparent between beverage trials for total distance (km), average speed (kmhr-1) or maximum speed achieved (kmhr-1). Significant differences were evident for blood glucose values, RER and CHO oxidation between the two beverage trials (p< .05). At the end of the 30-minute performance trial blood glucose values were significantly higher in the CHO trial (4.8 ± 1.3 mmol.l-1 vs. 4.0 ± 0.5 mmol.l-1 for placebo trial; p< .05). The CHO beverage resulted in higher CHO oxidation during the last 5 minutes of the performance trial, 2.1 ± 1.0 gmin-1 vs. the placebo beverage 1.9 ± 1.0 gmin-1 (p< .05). The CHO beverage trial resulted in significantly higher RER values during the final 5 minutes of the exercise trial and during the final 10 minutes of the performance trial. At the 20-25 minute mark RER values were significantly higher with the CHO beverage trial (1.04 ± 0.10) vs. the placebo trial (1.01 ± 0.11) (p< .05). During the final 5 minutes of the performance trial RER values were also significantly higher with the CHO beverage trial (1.06 ± 0.11) vs. the placebo trial (1.01 ± 0.10) (p< .05). The results indicated the participants were not meeting the current dietary guidelines for able-bodied athletes and active adults. Only 25% of the participants met the daily caloric requirements for active adults. Carbohydrate recommendations of 6 to 10 gkg-1 body weightd -1 were not met by any of the wheelchair athletes Seven participants were within the acceptable macronutrient range (AMDR) for CHO. For protein intake, 63% of the participants were meeting the protein recommendations active adults and all of them were within the AMDR. Average caloric intake from fat exceeded current recommendations of 20 to 25%; two participants were above the AMDR. The results demonstrate that the 8% CHO beverage consumed during exercise resulted in higher CHO oxidation rates and elevated blood glucose values, but it did not result in a performance gain.

The primary purpose of this study was to determine the effect of ingesting an 8% carbohydrate (CHO) beverage during a moderate intensity exercise trial on performance outcomes, fuel utilization and blood glucose levels of wheelchair athletes (spinal cord injury (SC I) or cerebral palsy (CP)). The secondary purpose was to analyze the dietary intake of the eight participants and to determine if they were meeting current sport nutrition guidelines for macronutrients and fluids recommended in the joint position statement developed by the American Dietetic Association (ADA), the American College of Sports Medicine (ACSM) and Dietitians of Canada (DC).<p> Under random, double blind conditions eight athletes (6 males, 2 females); mean age 36 ± 8.5 y with a SCI (n = 7) or CP (n = 1) completed two exercise trials on an adapted stationary hand cycle; each trial was 60 minutes in duration at 65 % VO2peak followed immediately by a 30-minute performance trial. During the first 60-minutes the participants were given four 200 ml dosages (15, 30, 45, 60-min) of an 8% CHO beverage or a taste-matched placebo beverage. Blood lactate and glucose levels were sampled during the 60-minute exercise trial (pre, 20, 40, 60-min) and immediately after the 30-minute performance trial (post, 2, 5, 10-min). Heart rate was monitored continuously during the exercise and performance trial. Expired gas samples were also taken for 5-min periods during the exercise trial and then continuously during the performance trial. These values were used to calculate respiratory exchange ratio (RER) and carbohydrate oxidation. Dietary intake was assessed with a three day food record.<p> No significant differences were apparent between beverage trials for total distance (km), average speed (kmhr-1) or maximum speed achieved (kmhr-1). Significant differences were evident for blood glucose values, RER and CHO oxidation between the two beverage trials (p< .05). At the end of the 30-minute performance trial blood glucose values were significantly higher in the CHO trial (4.8 ± 1.3 mmol.l-1 vs. 4.0 ± 0.5 mmol.l-1 for placebo trial; p< .05). The CHO beverage resulted in higher CHO oxidation during the last 5 minutes of the performance trial, 2.1 ± 1.0 gmin-1 vs. the placebo beverage 1.9 ± 1.0 gmin-1 (p< .05). The CHO beverage trial resulted in significantly higher RER values during the final 5 minutes of the exercise trial and during the final 10 minutes of the performance trial. At the 20-25 minute mark RER values were significantly higher with the CHO beverage trial (1.04 ± 0.10) vs. the placebo trial (1.01 ± 0.11) (p< .05). During the final 5 minutes of the performance trial RER values were also significantly higher with the CHO beverage trial (1.06 ± 0.11) vs. the placebo trial (1.01 ± 0.10) (p< .05). The results indicated the participants were not meeting the current dietary guidelines for able-bodied athletes and active adults. Only 25% of the participants met the daily caloric requirements for active adults. Carbohydrate recommendations of 6 to 10 gkg-1 body weightd -1 were not met by any of the wheelchair athletes Seven participants were within the acceptable macronutrient range (AMDR) for CHO. For protein intake, 63% of the participants were meeting the protein recommendations active adults and all of them were within the AMDR. Average caloric intake from fat exceeded current recommendations of 20 to 25%; two participants were above the AMDR. The results demonstrate that the 8% CHO beverage consumed during exercise resulted in higher CHO oxidation rates and elevated blood glucose values, but it did not result in a performance gain.

D. Tech. (Department of Tourism and Hospitality Management, Faculty of Human Sciences) Vaal University of Technology. / The elderly in Nigeria are used to consuming foods that are inadequate in providing the required amount of nutrients for a healthy living due to uninformed food choices and dietary food intake habits. The main objective of this study was to determine the impact of the developed food and nutrition guidelines on the dietary behaviour of the elderly in Ondo West city Ondo, Nigeria. The developed food and nutrition guidelines were used to generate a training manual for the caregivers’ in order to apply and disseminate the correct information about food nutrients and food choices to the elderly through the knowledge acquired in the nutrition education training programme by the caregivers. A baseline study was conducted making use of the measuring instruments namely, socio-demographic questionnaire, 24-hour recall, food frequency questionnaire completed by the elderly attending the old people’s home and a nutrition knowledge questionnaire to test the nutrition knowledge of the caregivers. The methodology for the study was in six phases: Phase 1: is about the baseline survey, involving the training of fieldworkers, administering and completing questionnaires: Socio-demographic, 24-hour recall, food frequency questionnaire (FFQ), by the elderly and the nutrition knowledge questionnaire (NKQ) by the caregivers. Phase 2: It involved the planning and development of food and nutrition guidelines for the caregivers of the elderly. Phase 3: This phase is about the training of the caregivers by the researcher, making use of the developed training manual with information sourced from the developed food and nutrition guidelines. Phase 4 was about the intervention programme in the study, i.e. the nutrition education programme (NEP) using information from guidelines of USA, Europe, New Zealand, South Africa, Nigeria and adapted FAO framework. Phase 5 was about the evaluation of the study, involving the completion of the nutrition knowledge questionnaire (NKQ), by the caregivers on post-test assessment after intervention, conducting observation and group interview. Phase 6 involved determining the impact of the food and nutrition guidelines and conducting a post-test making use of the research instruments, 24-hour recall, and food frequency questionnaires (FFQ) with the main objective drawn and followed up by the conclusion and recommendations in the study. A content analysis of both the observation and focus group discussion resulted in compliance with the food and nutrition guideline specifications and a remarkable improvement on food preparation skills and performance of the old people’s homes’ personnel. The main findings in the study revealed that consistent and, full compliance, with effective implementation of the food and nutrition guidelines would improve the older people’s dietary behaviour and food consumption patterns. The NEP did not improve the knowledge of the caregivers at the expected rate and level because of the low-level basic scientific background of the caregivers. The socio-demographic questionnaire revealed that 61.7% of those researched were females and 38.3% males with an average age between 60 and 65 years; 54% were married with a household income between N20001- N50000 and majority of them spending between N10001-N15000 on two meals (40%) and three meals (30%). The result from 24-hour recall and the food frequency (FFQ) questionnaires indicated that, the intake of energy, calcium and fiber were below the recommended daily allowance (RDA), while protein and carbohydrate were higher, with an emphasis on starchy foods. The nutrition knowledge questionnaire (NKQ) identified the need for higher level of food and nutrients by the caregivers in their responsibility to the elderly, for improvement in their healthy dietary habits as indicated in the four sections of NKQ results (A, B, C and D). The consumption of fruits and vegetables were impressively high, after the intervention compared to before. Moreover, there was a drastic reduction in the consumption of carbohydrate-sourced food items, fat, sugar and salt as informed by the developed guidelines. Conclusively, the study was able to establish a reliable basis on the improvement of nutrient based dietary intake with the effective utilisation of available information in the guidelines. Also, awareness was created for the elderly to improve their eating habits through the exposure of the caregivers to training on nutrition knowledge. The researcher recommended an in-house organized refresher programme which should take place periodically and consistently on the information in the developed nutrition guidelines along with encouraging the personnel in the handling of foods (caregivers, chefs, cooks) for effective implementation.