Nestlé Nutrition workshop series. Clinical & performance programme

Publisher: Nestlé Nutrition S.A; Nestlé Nutrition Services, Karger

Journal description

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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Website Nestlé Nutrition Workshop Series: Clinical and Performance Program website
Other titles Clinical & performance programme, Nestlé Nutrition workshop series., Nestlé Nutrition workshop series
ISSN 1422-7584
OCLC 47597563
Material type Conference publication, Series
Document type Journal / Magazine / Newspaper

Publisher details


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Publications in this journal

  • [Show abstract] [Hide abstract]
    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 08/2009; 12:71-8. DOI:10.1159/000235669
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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 08/2009; 12:79-93. DOI:10.1159/000235670
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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 08/2009; 12:137-58. DOI:10.1159/000235676
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    M Elia ·
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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 08/2009; 12:29-40. DOI:10.1159/000235666
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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 08/2009; 12:105-11. DOI:10.1159/000235672
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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. DOI:10.1159/000235664
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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. DOI:10.1159/000235671
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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. DOI:10.1159/000235673
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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. DOI:10.1159/000235668
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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. DOI:10.1159/000235665
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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. DOI:10.1159/000094429
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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. DOI:10.1159/000094407
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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. DOI:10.1159/000094404
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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. DOI:10.1159/000094453
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    ABSTRACT: Fructose is a monosaccharide which is abundant in nature. It is the sweetest naturally occurring carbohydrate. The availability of fructose increased substantially when it became possible in the 1960s to economically produce high fructose syrups from corn starch and other starches. Such high fructose syrups are now used to sweeten soft drinks, fruit drinks, baked goods, jams, syrups and candies. The most recent data available suggest that fructose consumption is increasing worldwide. Fructose presently accounts for about 10% of average total energy intake in the United States. Studies in both healthy and diabetic subjects demonstrated that fructose produced a smaller postprandial rise in plasma glucose and serum insulin than other common carbohydrates. Substitution of dietary fructose for other carbohydrates produced a 13% reduction in mean plasma glucose in a study of type-1 and type-2 diabetic subjects. However, there is concern that fructose may aggravate lipemia, particularly in men. In one study, daylong plasma triglycerides (estimated by determining the area under response curves) in healthy men was 32% greater during a high fructose diet than during a high glucose diet. There is also concern that fructose may be a factor contributing to the growing worldwide prevalence of obesity. Increasing fructose consumption is temporally associated with the increase in obesity. Moreover, on theoretical grounds, dietary fructose might increase energy intake. Fructose stimulates insulin secretion less than does glucose and glucose-containing carbohydrates. Since insulin increases leptin release, lower circulating insulin and leptin after fructose ingestion might inhibit appetite less than consumption of other carbohydrates and lead to increased energy intake. However, there is not yet any convincing experimental evidence that dietary fructose does increase energy intake. Although evidence that fructose has adverse effects is limited, adding fructose in large amounts to the diet may be undesirable, particularly for men. Fructose that occurs naturally in fruits and vegetables is a modest component of energy intake and should not be of concern.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:83-91; discussion 92-5. DOI:10.1159/000094427
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    ABSTRACT: The glycemic index concept owes much to the dietary fiber hypothesis that fiber would reduce the rate of nutrient absorption and increase the value of carbohydrate foods in the maintenance of health and treatment of disease. However, properties and components of food other than its fiber content contribute to the glycemic and endocrine responses postprandially. The aim of the glycemic index classification of foods was therefore to assist in the physiological classification of carbohydrate foods which, it was hoped, would be of relevance in the prevention and treatment of chronic diseases such as diabetes. Over the past two decades low glycemic index diets have been reported to improve glycemic control in diabetic subjects, to reduce serum lipids in hyperlipidemic subjects and possibly to aid in weight control. In large cohort studies, low glycemic index or glycemic load diets (glycemic index multiplied by total carbohydrate) have also been associated with higher levels of high-density lipoprotein cholesterol, reduced C-reactive protein concentrations and with a decreased risk of developing diabetes and cardiovascular disease. More recently, some case-control and cohort studies have also found positive associations between the dietary glycemic index and the risk of colon, breast and other cancers. While the glycemic index concept continues to be debated and there remain inconsistencies in the data, sufficient positive findings have emerged to suggest that the glycemic index is an aspect of diet of potential importance in the treatment and prevention of chronic diseases.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:43-53; discussion 53-6. DOI:10.1159/000094405
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    ABSTRACT: This review focuses on the efficacy and safety of Chinese medicine in the treatment of type-2 diabetes. Included were 84 controlled clinical studies of type-2 diabetes treated with Chinese medicine for at least 1 month. Reported outcomes were: symptom relief; improvement in glycemia, insulin resistance and secondary failure, and adverse events. Symptom relief was achieved in most (>80%) of the patients receiving Chinese medicine. Compared with orthodox drugs, Chinese medicine had a 1.2-fold (95% CI 1.2-1.3) increase in symptom relief. The relative risk of achieving a fasting blood glucose of <7.3 mmol/l or a postprandial blood glucose of <8.2 mmol/l was: 3.0 (95% CI 1.4-6.5) for Chinese medicine plus diet versus diet; 2.0 (95% CI 1.4-3.0) for Chinese medicine versus placebo; 1.8 (95% CI 1.4-2.3) for combined Chinese medicine and orthodox drugs versus Yuquan Wan (a classic Chinese herbal formula for diabetes), 1.5 (95% CI 1.4-1.7) for combined Chinese medicine and orthodox drugs vs. orthodox drugs, and 1.3 (95% CI 1.2-1.5) for Chinese medicine versus orthodox drugs. A fasting blood glucose of <8.2 mmol/l plus symptom relief was observed in 71-100% of the patients with secondary failure to oral anti-diabetic drugs. Serious adverse events including hypoglycemic coma and death were caused by adulteration with orthodox drugs, erroneous substitution, self-meditation, overdoses, and improper preparation. Chinese herbal medicine should be used cautiously with doctors' prescription and follow-up. Long-term clinical studies may disclose the effectiveness of Chinese medicine in reducing the mortality and morbidity of diabetic complications.
    Nestlé Nutrition workshop series. Clinical & performance programme 02/2006; 11:15-25; discussion 25-9. DOI:10.1159/000094399