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Improving clinical outcome in patients with intestinal failure using individualised nutritional advice

Authors

  • A. Culkin,

    1. Department of Nutrition and Dietetics, St Mark’s Hospital, Harrow, UK
    2. Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow, UK
    3. Department of Health and Human Sciences, London Metropolitan University, London, UK
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  • S. M. Gabe,

    1. Lennard-Jones Intestinal Failure Unit, St Mark’s Hospital, Harrow, UK
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  • A. M. Madden

    1. Department of Health and Human Sciences, London Metropolitan University, London, UK
    2. School of Health and Emergency Professions, University of Hertfordshire, Hatfield, UK
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Alison Culkin, Department of Nutrition and Dietetics, Northwick Park and St Mark’s Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK.
Tel.: +44 (0)208 8692666
Fax: +44 (0)208 8692659
E-mail alison.culkin@nwlh.nhs.uk

Abstract

Background:  Patients with intestinal failure are required to adhere to a complex regimen. Written information may increase knowledge leading to improvements in clinical outcomes. The present study aimed to evaluate the effectiveness of nutrition advice incorporating the use of a booklet.

Methods:  Each patient completed a questionnaire evaluating their knowledge of the regime and quality of life and kept a diet and gastrointestinal output diary. The diary was assessed and they were given the booklet with a verbal explanation tailored to individual requirements. The booklet explained the causes of intestinal failure, diet and fluid recommendations in relation to intestinal anatomy, information on medications and long-term monitoring. Patients were reassessed at their next appointment using the same tools. The primary endpoint was an improvement in knowledge. Secondary endpoints were an improvement in oral nutritional intake, nutritional status, quality of life and the content of home parenteral nutrition.

Results:  Forty-eight patients completed the study. Knowledge improved significantly after dietetic intervention in association with the provision of the booklet (P < 0.001). Oral energy (P = 0.04) and fat (P = 0.003) intake increased with an improvement in body mass index (P = 0.02). Patients on home parenteral nutrition showed a reduction in parenteral energy (P = 0.02), nitrogen (P = 0.003), volume (P = 0.02) and frequency (P = 0.003).

Conclusions:  A booklet for patients with intestinal failure in conjunction with personalised dietary counselling improves knowledge and clinical outcomes.

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