Lead Researchers:
Nazy Zarshenas & Maria Chan
Current research includes collaborative multi-centre observational studies through the Australian society for Parenteral and Enteral Nutrition. Studies include:
An observational study of nutrition support practice in Australasian hospitals
A prospective, multi-centre, observational study investigating nutritional support practice patients in Australia and New Zealand hospitals. This study demonstrated that nutritional support is utilised in a minority of hospitalised patients, but when indicated it is usually successfully delivered. The majority of patients are administered enteral nutrition, however parenteral nutrition is not uncommonly required. The barriers to feeding are identified and addressed early to optimise nutrition provision.
A Retrospective Review of the Nutritional Management of Severe Acute Pancreatitis (SAP) in an Australian Hospital
The aim of this study was to investigate the nutritional management of SAP patients and to recommend improvements based on the current scientific literature. We found that Current practice varies from the recommendations, and thus changes are necessary to optimise nutritional support of SAP patients. Early dietetic referral for routine nutrition assessment and implementation of appropriate nutrition support is recommended. Early implementation of appropriate nutrition support may assist in preventing malnutrition and optimizing nutrition status in this patients group.
Following this study we are now collaborating with Australian society for Parenteral and Enteral Nutrition (AuSPEN) and re involved in a multicentre study:
A prospective observational multicentre study of nutritional therapy in severe acute pancreatitis patients in Australasia.
A prospective study investigating current nutritional practices of patients with severe acute pancreatitis over a six-month period. This study will identify how we feed our patients who are admitted with Severe Acure Pancreatitis, what we feed our patients and how appropriate our nutrition management is for this group.
Nutrition and quality of life assessment following different weight loss operations
The aim of this study was to determine which of these bariatric procedures produces adequate weight loss without compromising nutritional status or gastrointestinal quality of life (GIQOL). We found that Gastric Bypass surgery was the most effective in treating obesity, without compromising GIQOL or nutritional status. Gastric banding produced inadequate weight loss and led to the poorest GIQOL outcomes. Low intakes of several micronutrients and food groups reiterate the need for multivitamin supplementation and the development of specific recommendations for use in the bariatric population
Prevalence of nutrition deficiencies in morbidly obese and bariatric surgical patients
This aim of this study was to determine the prevalence of nutrient deficiencies in patients who present for bariatric surgery, assess nutritional parameters post-surgery and compare these to preoperative levels, and finally make supplementation recommendations.
We identified that vitamin D deficiency is common among morbidly obese patients seeking bariatric surgery. As prevalence of deficiencies persist or worsen post-op, it is important that routine nutrition screening is performed, supplements are recommended and reinforced, and compliancy monitored.
CURRENT NUTRITION MANAGEMENT OF PATIENTS UNDERGOING BARIATRIC SURGERY.
Obesity is emerging as the most challenging chronic health problem facing our society, surpassing smoking-related illnesses, with a prevalence rate in Australian adults of 20%. Medical treatments have poor results with a 1-2% long-term success rate. Weight loss surgery is the most effective treatment for morbid obesity, as it resolves the consequences of obesity as well as decreasing the mortality rate in this population.
There are no evidence-based guidelines for nutrition management of patients’ pre and post bariatric surgery. An interest group was developed for the dieticians working in this area and a survey was subsequently undertaken to determine the current nutrition management in this growing field and identify the shortfalls.
The survey results indicate that most bariatric surgery centres use a weight loss program pre operatively. The duration and intensity of this depends on the severity of the patient’s obesity as well as their tolerance for the intervention.
Post operatively nutrition counselling is provided at the hospital level and the diet is progressed according to patients’ tolerance and the clinicians’ experience. Recommendations for energy, protein and multivitamin supplementations are inconsistent and not evidence based. Micronutrients such as Calcium, Vitamin D, and Iron are not routinely supplemented. Long-term food intolerances were identified as these may contribute to nutritional inadequacy in this population.
Ongoing counselling and education is essential to change eating habits, reinforce a healthy balanced diet and ensure compliancy with micronutrient supplementation. Further research is warranted in this growing field.
Recent Publications
NH&MRC guidelines. Clinical Practice Guidelines for the Management of Overweight and Obesity in Adults. www.obesityguidelines.gov.au
Pories W. et al. Who would have thought it? An operation proves to be the most effective therapy for adult onset diabetes mellitus. Annals of Surgery 1995; 222(3): 339-352.
Christou NV, Sampalis JS, Liberman M, Look D, Auger S, McLean APH, MacLean LD. Surgery Decreases Long-term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Ann Surg 2004; 240: 416–424.
Marcason W. What are the dietary guidelines following bariatric surgery. JADA. 2004; Mar; 104 (3). 487-8
