Nestlé Nutrition workshop series. Clinical & performance programme

Publisher: Nestlé Nutrition S.A; Nestlé Nutrition Services, Blackwell Publishing


In 1981, Nestlé created a program called 'Nestlé Nutrition Services', with the aim of improving and diffusing knowledge on health and nutrition, as well as providing scientific information to the medical profession. Since 1997, the program has been extended, and the 'Nestlé Nutrition Workshop Series: Clinical & Performance Program' will address topics related to clinical nutrition or performance nutrition. One of the components of the Nestlé Nutrition Services Program is the organization of workshops and the publication of the proceedings. Each workshop focuses on the latest facts, the controversies and further need for research concerning topics in nutrition.

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    Nestlé Nutrition Workshop Series: Clinical and Performance Program website
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    Clinical & performance programme, Nestlé Nutrition workshop series., Nestlé Nutrition workshop series
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    Conference publication, Series
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    Journal / Magazine / Newspaper

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Blackwell Publishing

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Publications in this journal

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    ABSTRACT: Malnutrition was first highlighted as a prevalent concern in hospital care more than 30 years ago. In response the nutrition support field grew precipitously but changes in the healthcare environment have culminated in a period of accountability and consolidation in nutrition support practice over the past decade. Evolving regulatory environment and reimbursement policies have had a profound impact upon nutrition support and these trends are likely to continue. Both undernutrition and overnutrition (obesity) remain prevalent concerns in North America. In particular the growing prevalence of overweight/obesity will have far-reaching implications for nutrition support practitioners and will require the development, testing, and validation of new standards of assessment, intervention, and monitoring. Adoption of common language and definitions by practitioners will facilitate standardized interventions, outcome measures, and high quality research. The future remains bright with tailored nutrition interventions poised to become a part of the individual medical treatment plan for specific patient conditions and genotypes. Future research priorities should include studies of nutritional modulation of inflammatory conditions with specific nutrients and functional foods and the testing of individualized nutritional interventions tailored to gene polymorphisms.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:15-28.
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    ABSTRACT: Despite extensive information on the adverse physical and psychological consequences of malnutrition, there is little information on its economic consequences. International studies suggest that disease-related malnutrition increases hospital costs by 30-70%. In the United Kingdom the Malnutrition Universal Screening Tool (MUST) was used as the basis for identifying the prevalence of malnutrition in various care settings. Malnutrition increased both the frequency of admissions and length of stay in hospitals, as well as the frequency of visits to a general practitioner and hospital outpatient visits, and residency in care homes. After assigning nationally representative costs to the utilization of these services, the public expenditure on disease-related malnutrition in the UK in 2003 was estimated to be more than GBP 7.3 billion. The large cost of disease-related malnutrition means that small fractional cost savings from intervention can result in substantial absolute cost savings. A summary of nutritional intervention studies with cost analyses (including meta-analyses) and cost-effectiveness analyses are presented, and some of the clinical and ethical implications discussed.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:29-40.
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    ABSTRACT: In the United Kingdom, 5% of the population are underweight or have features of malnutrition. The prevalence of malnutrition rises with age and is more common in the north of England than in the south, but comparable data are not available for Scotland. In 2003, the National Health Service Quality Improvement Scotland (NHS QIS) developed a standard for food, fluid and nutritional care in hospitals (FFNCH). In 2006, a peer review of Scottish health boards was published. The reviewers reported that all Scottish health boards had started to implement the standards, but not across all clinical areas. Every health board had set up a nutritional care group to oversee and advise on the implementation of the standards, but none had produced a financial framework to support the work of the groups. Most health boards had not fully developed a policy or strategic plan to improve nutritional care as required, and there was a shortage of specialist nutrition nurses and clinical and nutrition support teams to supervise the treatment of patients with complex nutritional needs. The Scottish experience emphasizes the size of the task that health services face to bring about change.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:105-11.
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    ABSTRACT: Enteral nutrition (EN) is generally defined by third party payers as tube feeding for patients who cannot take food orally. EN is widely accepted in the United States as an effective, often life-sustaining therapy. Coverage and payment policies for EN differ among payers and settings. These differences often may depend on whether EN is reimbursed as a discrete therapy or subsumed into a larger benefit. In the US, the Medicare and Medicaid programs are the major public payers for EN. EN may be susceptible to overuse, especially in the long-term care setting. The trends in coverage and payment for EN suggest tighter reimbursement; competitive bidding between suppliers and data-driven performance measurement and payments may be in the future for EN reimbursement.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:53-70.
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    ABSTRACT: Both the German statutory and private health insurances cover enteral nutrition (EN) products. Approximately 100,000 patients receive reimbursed EN; 70% are tube fed for an average 9 months. 70% of the tube-fed patients are cared for in institutions (i.e. for the elderly) and 30% at home. The prescription and reimbursement of EN is covered by Volume Five of the Social Legislation Code (Social Code Book No. 5). Reimbursement for EN depends on medical prescription and is in principle guaranteed whenever normal food intake is impaired and modification of normal nutrition and other measurements do not improve nutritional status. It is unclear what effect the reform laws will have on EN but they may impact the prices for medical devices and negotiations between health insurance funds and product manufacturers.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:71-8.
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    ABSTRACT: When President Lyndon Johnson signed the Medicare and Medicaid bill into law in 1965, it ended the 46-year campaign to enact a healthcare program for senior citizens and started what is now a 42-year effort by the American Dietetic Association (ADA) and its members to expand its coverage to 'nutrition services' for all appropriate diseases, disorders and conditions. In December 2000, Congress passed a Medicare Part B Medical Nutrition Therapy (MNT) provision, limited to patients with diabetes and/or renal disease, effective January 2002. In December 2003, the Medicare Modernization Act expanded access to MNT benefit and ADA continues to focus on the role of the registered dietician in MNT. Successful expansion of MNT benefits will require that ADA continues to demonstrate the cost-effectiveness and efficacy of nutrition counseling, as performed by the registered dietitian.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:137-58.
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    ABSTRACT: In 2005, the European Nutrition for Health Alliance (ENHA, the Alliance) was established to raise awareness of the relevance and urgency of malnutrition and ensure that this important issue is included in policy discussions and appropriate action is taken by policymakers and stakeholders at EU and member state levels. Malnutrition remains under-recognized, under-detected and under-managed across Europe, 4 years after the publication of the Call to Action resolution issued by the Council of Europe in 2003, on food and nutritional care in hospitals. The goal of the ENHA is to implement policy changes in nutrition and health at government and healthcare organizational levels. The value of specific evidence-based medical interventions must be demonstrated.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:121-6.
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    ABSTRACT: By translating the principles of 'disease management' in an insurance environment, health insurance funds play an important role in the management of chronic diseases of their members. The independent health insurance funds in Belgium have developed an obesity disease management approach based on the integration of collective and individual prevention, early detection and immediate action. Incentive monetary prizes are provided if body mass index (BMI) is reduced by at least 5% following participation in the prescribed treatment plan. The independent health insurance funds plan to launch multimedia projects about the program to educate the target audience of lower income, less educated, obese patients.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:113-9.
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    ABSTRACT: A review of the publications on hospital malnutrition in Europe over the last 5 years shows that the incidence and prevalence of malnutrition are still very high: 21 and 37%, respectively. The process of structured nutrition support is still far from being generally implemented, as based on the few studies available. As a result, malnutrition diagnosed on admission to hospital is still associated with adverse clinical outcome (increased length of stay and higher rates of complications).
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:1-14.
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    ABSTRACT: Economists have devised three main techniques to evaluate healthcare treatments: cost-benefit analysis, cost-effectiveness analysis and cost-utility analysis. Many countries have established regulatory authorities to examine the clinical safety, efficacy, and cost-effectiveness of a product. Currently, economic evaluations play a limited role in decision-making but may increase in importance as healthcare costs continue to rise.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:95-104.
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    ABSTRACT: Oral liquid nutrition supplements (ONS) are widely used in community, residential and healthcare settings. ONS are intended for individuals whose nutrient requirements cannot be achieved by conventional diet or food modification, or for the management of distinctive nutrient needs resulting from specific diseases and/or conditions. ONS appear to be most effective in patients with a body mass index of <or=20. Studies are needed to evaluate the clinical and functional efficacy of food-based versus ONS nutrition interventions.
    Nestlé Nutrition workshop series. Clinical & performance programme 01/2009; 12:79-93.
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    ABSTRACT: Overproduction of superoxide by the mitochondrial electron transport chain is the common link between the various pathways of glucotoxicity. The increased oxidative byproducts in diabetes are the result of a glucose-induced increase in the production of reactive oxygen species and decreased antioxidant defense capacity. Several epidemiologic observations indicate an inverse association between vitamin E intake and coronary heart disease (CHD). There are several limitations in such studies including the fact that they rely on food questionnaires and dietary recalls. Large interventional trials have yielded inconsistent results. Of concern is that, in some of these studies there was a greater incidence of lung cancer or CHD. These observations underscore the potential hazards of consuming large amounts of antioxidants. At the present time, given the inconsistencies of the studies available, the widespread supplementation with pharmacological doses of antioxidants should be discouraged. Future studies should focus on identifying reliable markers of oxidation to incorporate these measurements in the clinical interventional trial.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:107-22; discussion 122-5.
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    ABSTRACT: Lifestyle modification should be the primary therapeutic intervention in individuals with the dysmetabolic syndrome, given the fact that obesity, unhealthy diet, and physical inactivity are primary underlying risk factors for its development. Most individuals with the dysmetabolic syndrome need to lose weight through dietary changes and increases in physical activity. Modest weight losses may significantly improve all aspects of the syndrome. Because individuals differ in their lifestyles, tailoring interventions to meet the specific needs of each person will maximize the chances of success. Assessment of the individual with the dysmetabolic syndrome involves quantification of obesity, diets and dietary patterns, physical activity, emotional problems, and motivation. To help individuals make lifestyle changes, a number of behavior modification strategies have shown good efficacy. These strategies include a tailored problem-solving intervention, involving goal-setting, self-monitoring, stimulus control, cognitive restructuring, stress management, relapse prevention, social support, and contracting. The frequency of self-monitoring is an especially important strategy for continued success. Research studies have clearly demonstrated the power of lifestyle modification for long-term behavioral change. Lifestyle modification appears effective in delaying or preventing the development of the dysmetabolic syndrome.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:197-205; discussion 205-6.
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    ABSTRACT: Obesity and type-2 diabetes can be considered diseases of physical inactivity. Physically activity protects against type-2 diabetes through its positive effects on weight management and on the metabolic pathways involved in glycemic control that are not weight-dependent. Increasing physical activity is one of the most effective strategies both for preventing type-2 diabetes and for managing it once it is present. However, we still face an enormous challenge in getting people to achieve sustainable increases in physical activity. A promising strategy is to get people walking more, starting small and increasing gradually over time.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:183-91; discussion 191-6.
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    ABSTRACT: A diet always induces weight loss in the short term. The loss does not depend on the dietary composition but rather on the caloric deficit. However, a drastic diet often induces binge eating disorders and can lead to a weight gain in the long term. A cognitive-behavioral-nutritional approach allows lasting weight loss and best results with low fat diets in the long term. Therapeutic education is a patient-centered humanistic approach which allows patients to be actors in their own treatment and own diet to improve their success in losing weight and their quality of life. Motivational interviewing and cognitive-behavioral approaches are perfect complements to therapeutic education for long-term weight loss maintenance. Finally, the best diet is the one that the patient can follow in the long term.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:127-34; discussion 134-7.
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    ABSTRACT: The nutrition recommendations of 6 major scientific organizations (the American Diabetes Association, the Diabetes and Nutrition Study Group of the European Association for the Study of Diabetes, the Canadian Diabetes Association, the Joslin Diabetes Center and Joslin Clinic, the American Association of Clinical Endocrinologists and Diabetes UK) are reviewed. They all agree that weight loss (with reduction in energy intake and increase in physical activity) is an important therapeutic strategy in all overweight/obese individuals who have or are at risk of type-2 diabetes. Very low carbohydrate diets are not considered appropriate. The recommended proportion varies slightly (from 40 to 65%). The concept of the glycemic index is stressed as important in nearly all guidelines. Fiber intake is advised, up to 50 g/day, if tolerated. Protein intake (for normal kidney function) is advised to range from 10 to 20% of total energy. A low fat diet (<30-35%) is recommended by all. Saturated fat and trans-fatty acids should be restricted to <10% and dietary cholesterol to <300 mg/day. Monounsaturated fatty acids are generally considered beneficial and should replace saturated fat or carbohydrates in low-fat diets. Polyunsaturated fatty acids (PUFAs) should comprise about 10%, with the n-3 PUFAs being more beneficial, especially for high triglyceride levels. Alcohol intake has cardioprotective effects when used in moderation. Routine supplementation of the diet with antioxidants and vitamins is not necessary.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:207-18; discussion 218.
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    ABSTRACT: The increasing prevalence of diabetes is reaching epidemic proportion worldwide. Because of the associated morbidity and mortality, it is exerting major pressure on the healthcare system. With a better understanding of the pathophysiology of type-2 diabetes, the concept of primary prevention has emerged. A number of studies have confirmed that intensive lifestyle modification was very effective in the prevention of diabetes in the impaired glucose tolerance (IGT) population. However, maintaining long-term lifestyle modification is a major challenge. It is, therefore, important to have other strategies, either pharmacological or surgical, that can be used as an adjunct or alternative to lifestyle modification. The Chinese study showed that metformin and acarbose could reduce the risk of diabetes by 65 and 83%, respectively, in IGT subjects. The efficacy of metformin was confirmed by the Diabetes Prevention Program (31% risk reduction) and that of acarbose by the STOP-NIDDM trial (36% risk reduction) in a similar high-risk population. The TRIPOD study showed that troglitazone could reduce the risk of diabetes by 55% in Hispanic women with a history of gestational diabetes. And more recently, the XENDOS study showed that orlistat could reduced the risk of diabetes by 37% in obese subjects when used as an adjunct to an intensive lifestyle program. Three studies have suggested that bariatric surgery in morbidly obese subjects could reduce the risk of diabetes to near zero. Furthermore, a number of studies have examined the effect of a renin angiotensin aldosterone system inhibitor, as well as statin and hormone replacement therapy on the prevention of type-2 diabetes in high-risk subjects as secondary outcomes and have suggested that they could be of potential benefit. The accumulating evidence is now overwhelming. Yes, diabetes can be prevented or delayed in high-risk populations. With this new information, we need to design new strategies to screen high-risk populations and to implement the new treatments that have proven effective in the prevention of type-2 diabetes.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:31-9; discussion 39-42.
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    ABSTRACT: There is a large bulk of evidence that using low glycemic index (GI) foods has a very significant impact on the amelioration of metabolic disturbances observed in diabetic and/or hyperlipidemic patients and in subjects affected by the metabolic syndrome. Studies bringing convincing evidence against this concept are very rare if any. Improvement is observed not only in postprandial blood glucose and insulin variations but also in circulating plasma lipid levels and the morphology and function of adipocytes. Using the concept of low GI foods in diet counseling of diabetic patients is not exclusive of other measures to improve postprandial and overall blood glucose control. On the contrary, the use of low GI foods should be considered as one of other means and tools available to improve diabetes control (such as other dietary modifications, use of specific and nonspecific drug therapy altering postprandial blood glucose). Among these therapies, the most promising ones are alpha-glucosidase inhibitors, glynides, rapid insulin analogues and in the near future the GLP1 analogue. Again, all these classes of drugs could be associated with one another in order to obtain a postprandial delta excursion target of not below 20 and not above 40-50 mg/dl blood glucose.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:73-9; discussion 79-81.

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