Dr Barry Laird
Barry Laird graduated in medicine from the University of Glasgow in 1997 and completed higher specialist training in palliative medicine in 2009. During his training in palliative medicine he was awarded a National Cancer Research Institute Fellowship and joined the academic palliative medicine department at the University of Edinburgh with Professor Marie Fallon. He completed his MD in cancer induced bone pain and neuropathic cancer pain in 2009 and was then awarded a fellowship from the European Palliative Care Research Centre (PRC) working with Professor Stein Kaasa. His interest in cachexia was nurtured by the late Professor Kenneth Fearon.
He currently holds positions as a Senior Lecturer in Palliative Medicine at the University of Edinburgh and a consultant in palliative medicine in St Columba’s Hospice.
His research interests are focussed around symptoms in life-limiting illness and the role of palliative care in optimising the care of malignant (lung and pancreatic cancer) and non-malignant disease. He leads a research programme examining the systemic inflammatory response in cachexia, symptom genesis and prognosis in cancer. He has published over 70 papers and is the CI and PI of clinical trials in symptomatology and treatment.
Treating cancer cachexia: past, present and future
Cancer cachexia remains a devastating condition causing reduced quality of life and physical function, and it is detrimental to improve the pathophysiology behind the condition and develop new treatment options. To date there are no licensed treatments and no standard of care. However there are grounds for optimism as newer agents such as anamorelin, enobosarm and bermekimab have been examined with varying degrees of success. Further phase 2 and 3 trials have highlighted the need for combination therapy which tackles the genesis of cancer cachexia and provide a basic cachexia therapeutic foundation on which targeted agents may be most efficacious. The role of the systemic inflammatory response in cachexia classification, prognosis and treatment stratification is likely to be key to improving outcomes in cancer cachexia.
Barry J A Laird, Senior Lecturer in Palliative Medicine, IGMM, University of Edinburgh
Michael EJ Lean, MA, MB, BChir, MD, FRCP (Edinburgh), FRCPS (Glasgow), FRSE
Mike Lean is Professor of Human Nutrition at Glasgow University, and a consultant physician in General Medicine and Diabetes at the Glasgow Royal Infirmary. He holds visiting professorships at the Universities of Otago and Sydney.
Professor Lean has successfully established the only academic department of Human Nutrition in a Scottish Medical School. He leads with a ‘broad-focus’ strategy toward translational research and teaching, integrating the full range of scientific disciplines within Human Nutrition: basic sciences, clinical and public health.
Professor Lean is currently the primary investigator on one of the largest research grants provided by Diabetes UK, for the Diabetes Remission Clinical Trial (DiRECT). In 2018 he was awarded Fellowship of the Royal Society of Edinburgh, and has previously been awarded Tenovus Medal (2017) and the Diabetes UK-Rank Prize Lecture (2014). Professor Lean frequently writes and broadcasts for Public Understanding of Science, and whenever possible plays his fiddle and climbs mountains.
Title: Remission of type 2 diabetes –knife or plate?
Type 2 diabetes has usually been considered a chronic progressive disorder that requires lifelong treatment. Bariatric surgeons have claimed remissions by weight loss for many years, now proven by RCT evidence for weight losses over 10-15kg, but with frequent complications and need for lifelong medical support. The Diabetes Remission Clinical Trial (DiRECT) trial was designed assess remissions over two years using a non-surgical weight-management programme, delivered within routine primary care so potentially acceptable and accessible to the large numbers of people with type 2 diabetes, which currently continues to deteriorate despite modern drug treatments.
DiRECT provided either a weight management programme (n=149, intervention) or usual best-practice care (n=149, control) for people aged 20–65 years, diagnosed with type 2 diabetes for up to 6 years, BMI 27–45 kg/m2, and not receiving insulin. The integrated intervention comprised Total Diet replacement (825–853 kcal/day formula diet) for 3–5 months, stepped food reintroduction (2–8 weeks), and structured support for weight loss maintenance, with 20-30 minute appointments with a trained local dietitian or nurse. All anti-diabetes drugs and antihypertensive drugs were stopped at the start, and reintroduced in necessary later.
Remission of diabetes
At 12 months, with a mean weight loss of about 10kg, 46% of patients in the intervention group were in remission (HbA1c <6·5%, <48 mmol/mol on no anti-diabetes medications). Overall, 86% of participants who lost >15kg, and 73% of those who lost >10kg, no longer had diabetes. The cost of providing the intervention programme is under half the average healthcare cost of continuing to treat the diabetes conventionally. Cardiovascular risk factors and quality of life all improved. Results at 24 months, to be announced 8th March 2019, will be presented.
Conclusion: Type 2 diabetes is a disease of ectopic fat accumulation and not necessarily permanent. Remission of type 2 diabetes is a practical and important treatment target. A structured weight management can sustain remission to a non-diabetic state, with great personal benefits.
Dr. Arthur R. H. van Zanten, MD Ph.D. Department of Intensive Care, Gelderse Vallei Hospital, Ede, The Netherlands
Dr Arthur van Zanten is internist-intensivist and chair of the Department of Intensive Care and ICU Research at Gelderse Vallei Hospital, The Netherlands. He is also Medical Advisor to the Executive Hospital Board, with involvement in nutrition, sports and exercise programmes.
After graduating from Medical School at the Erasmus University Rotterdam and training in Internal Medicine, he completed a fellowship in Intensive Care Medicine at the University of Amsterdam. He later defended his Ph.D. thesis on Infectious Complications in Critically Ill Patients.
Dr van Zanten has been involved in the organisation of Dutch Intensive Care for many years, was Board Secretary of the Netherlands Society of Intensive Care Medicine (NVIC) and Council member of the European Society of Intensive Care Medicine (ESICM). He chaired Fundamental Critical Care Support (FCCS), was president of the NVIC Committee on Intensive Care Quality and co-chair of guideline programs on ICU, leading the Surviving Sepsis Campaign in The Netherlands.
He was Managing Editor of the Netherlands Journal of Critical Care for ten years. He is now a reviewer for several high impact journals including the Lancet, Am J Resp Crit Care Med and JPen and has organised over 150 medical congresses.
In recent years, his interests have moved to Critical Care Nutrition, specifically immune-modulating nutrition, protein needs and timing, mitochondrial dysfunction and refeeding syndrome. He is a lecturer at the Wageningen University for Medical Physiology and Clinical Nutrition Research. He is a member of the Working Group on Gastrointestinal Failure of the ESICM, the Practice Guideline Committee of ESPEN for Critical Care Nutrition and board member of NESPEN.
Dr. van Zanten was the coordinating investigator of the MetaPlus immune-nutrient enteral nutrition trial, since published in JAMA. He authored the Chapter on Critical Care Nutrition in the newest standard Textbook of Critical Care Medicine. Widely published on nutrition and metabolism in peer-reviewed journals, he is (co)promotor and scientific coach for many (inter)national medical and nutrition students, nurses and doctors from several leading Universities.
Since 2011, Dr van Zanten has given over 300 lectures in 29 countries. Among these, he was an invited keynote speaker at meetings of ESPEN, ASPEN, ISICEM, ESICM, BRASPEN, DAPEN, CSPEN, CSCCM and the Middle-East ICU Nutrition Summit.
ESPEN adult ICU guideline highlights: towards a more personalized nutrition strategy
Based on the recent published ESPEN guidelines the latest insights on nutrition therapy in adult ICU patients will be addressed. Among the topics, targets, progressive energy and protein delivery, refeeding syndrome, and indirect calorimetry will be further explored. Based on the guideline practical guidance will be provided.
Prof Carel Le Roux
Professor Carel le Roux graduated from medical school in Pretoria South Africa, completed his specialist training in metabolic medicine at St Bartholomew’s Hospitals and the Hammersmith Hospitals, his PhD at Imperial College London and was later promoted to Reader. He moved to University College Dublin for the Chair in Pathology and he is now the Co-Director of the Metabolic Medicine Group. He previously received a President of Ireland Young Researcher Award, Clinician Scientist Award from the National Institute Health Research in the UK, a Wellcome Trust Clinical Research Fellowship for his work on how the gut talks to the brain.
Defining remission of diabetes after bariatric surgery
Professor Carel le Roux, Chemical Pathology, University College Dublin, Ireland
Type 2 diabetes is considered a chronic and progressive disease. Despite the mission statement of the American Diabetes Association (ADA) for many years of aiming to cure diabetes, they didn’t have a definition for “cure” until 2009. Bariatric surgery precipitated this rethink, but even though surgery was predominantly used for the treatment of obesity, in 1995 Walter Pories published a paper with the provocative title: “Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus”. The observation was made that patients with type 2 diabetes developed normoglycaemia within days after bariatric surgery. It took more than a decade for this observation to be acknowledged by the diabetes community, but in 2009 the ADA established a working group who defined cure of type 2 diabetes because of the mounting evidence after bariatric surgery suggesting that type 2 diabetes could be placed into remission. The consensus were that Partial remission should be defined as 1. hyperglycemia below diagnostic thresholds for diabetes, 2. at least 1 year’s duration and 3. no active pharmacologic therapy or ongoing procedures. Complete remission was defined as 1. normal glycemic measures, 2. at least 1 year’s duration and 3. no active pharmacologic therapy or ongoing procedures. Cure or prolonged remission was defined as 1. complete remission of at least 5 years’ duration.
Clinicians in the field have struggled to agree which of these definitions are most appropriate and the 12 randomized controlled trials comparing best medical care with bariatric surgery have used very different criteria for their endpoints. This talk will review the advantages and disadvantages of using the various diagnostic cut-offs to define remission of diabetes and what the clinical implications may be.
Professor Giuseppe De Vito
Professor Giuseppe De Vito was born in 1958 in Blantyre (Malawi). He then grew up in Italy where he graduated in Medicine and Surgery in 1986 at the medical school of the University of Rome la Sapienza. At the same university he completed firstly a clinical specialization in Sports Medicine (1989) and then a PhD in Human and Exercise physiology (1994) presenting a thesis on exercise training adaptations in the older individual. Before joining UCD in July 2007 he previously held academic positions in Glasgow (1996-2005; University of Strathclyde) and in Rome at the University Institute of Movement Science (2005-2007). As specialist in Sports Medicine he has acted as Team Physician to the Italian Olympic Committee, being from 1994 to 1996 the physician/physiologist of the Italian Olympic Sailing team. In the past, he represented Italy in the World Championships as a Modern Pentathlete.
At present is Head of the UCD School of Public Health, Physiotherapy and Sports Science. He is a member of both British and Italian Physiological Societies, Fellow of the European College of Sport science and of the Faculty of Sport and Exercise Medicine of the Royal college of Physicians of Ireland. He was associate Editor of the Journal of Aging and Physical Activity and at present is member of the editorial board of the Journal of Electromyography and Kinesiology, the Journal of Sports Science for Health and associate editor of the Journal of Science in Sport and Exercise. He has published widely on aspects of muscle function and cardiovascular control across the lifespan.
From performance research in athletes to healthy ageing: the essential role of exercise and nutrition”
Giuseppe De Vito1,2
1UCD School of Public Health, Physiotherapy and Sports Science, 2UCD Institute for Sport and Health.
The skeletal muscle represents about 40-50% of the human body mass. Its role is not limited to locomotion, posture and breathing but involves a myriad of essential additional functions: endocrine, thermoregulatory and as energy storage, for instance. Aging is associated to a decline in muscle mass and function (1) which could be mitigated by the regular practice of physical activity, particularly resistance exercise but also by an adequate nutritional intake. It is in fact, nowadays accepted that older individuals, particularly if undergoing to energy demanding activities, require an adequate daily intake of proteins and that these must be of optimal amino acids composition (i.e. leucine). There are other important nutrients as Vit D, and Omega-3 polyunsaturated fatty acids which should be considered. In other words, it is essential for the success of a rehabilitation or of a training programme to pay attention not only to the quality of the actual exercise intervention but also to the nutritional aspects. Obviously, aging is a variegate phenomenon and therefore an attempt should be made in individualising the approach tailoring the interventions on the specific characteristics of the individual. In frail, sarcopenic individuals, especially if “malnourished”, a proper supplementation alone can partially reverse the muscle mass lost (2). In more functioning healthy older, however, it is necessary that this supplementation would be associated to a proper training programme. Recently (3) we demonstrated that 12 weeks of bodyweight and elastic bands-based resistance training, induced, in healthy young older (63.5 ± 4.4 y) participants, improvements in body composition and muscle function. When protein supplementation was added to the diet of the people engaged in the resistance training, additional improvements in fat mass (↓) and changes in skeletal muscle signaling, favoring protein synthesis pathways were also detected.
1) Kemp GJ, et al. Developing a toolkit for the assessment and monitoring of musculoskeletal ageing. Age Ageing. 2018 Sep 1;47(suppl_4):iv1-iv19.
2) Bauer JM, et al. Effects of a vitamin D and leucine-enriched whey protein nutritional supplement on measures of sarcopenia in older adults, the PROVIDE study: a randomized, double-blind, placebo-controlled trial. J Am Med Dir Assoc. 2015 Sep 1;16(9):740-7.
3) Krause M, et al. The effects of a combined bodyweight-based and elastic bands resistance training, with or without protein supplementation, on muscle mass, signaling and heat shock response in healthy older people. Exp Gerontol. 2019 Jan;115:104-113.
Professor John V. Reynolds
Professor Reynolds is Professor of Clinical Surgery at St. James’s Hospital and Trinity College Dublin. He is the National Lead for oesophageal and gastric cancer. He is Cancer Lead at St. James’s Hospital and the Trinity School of Medicine, and a Principal Investigator in the Trinity Translational Medicine Institute. He has formerly held Fellowship positions with the University of Pennsylvania and Wistar Institute in Philadelphia and at the Memorial Sloan-Kettering Cancer Centre in New York. He was a Senior Lecturer at St. James’s University Hospital in Leeds (1994-6).
Professor Reynolds has obtained numerous research awards and has published widely in cancer research, with over 320 publications and approximately €5m research grant income. His clinical interest is in diseases of the oesophagus and stomach. His research interest is in five areas: (1) pathogenesis of Barrett’s oesophagus and progression; (2) prediction of response and resistance to chemotherapy and radiation therapy; (3) obesity, altered metabolism, and cancer; (4) malnutrition and peri-operative nutrition. (5) exercise and cancer.
Nutrition in cancer care in Ireland: what will it take to translate expert guidelines into practice?
In 2017, our affiliate organisation the European Society for Clinical Nutrition and Metabolism (ESPEN), published evidence-based clinical guidelines for nutritional care in cancer patients. The guidelines provide clear recommendations for the effective identification and treatment of nutritional issues in patients across the trajectory of the disease. However, to be translated into practice in Ireland, several issues must be addressed. Based on the results obtained from several work streams set up by IRSPEN over the last 3 years, it has become clear that many patients with cancer receive inadequate, late or no nutritional care for problems that have the potential to impede treatment and undermine the effectiveness of medical care, potentially reducing survival. Access to dietetic services is extremely limited and uneven. Nutritional screening of patients is not routinely conducted in cancer centres or hospitals, let alone daycare units and outpatient clinics which potentially offer the best opportunity for early identification and assessment of those found to be at risk. Without sufficient specialist dietitians to whom patients can be referred, screening programmes cannot work, highlighting the urgent need to address the lack of specialist oncology dietitians in Ireland. Beyond the need to improve access to dietitians for patients with signs of malnutrition, there is a broader need to improve communication around nutrition for all cancer patients, which are not being consistently addressed. Whether the current gaps in care reflect a lack of engagement between nutrition experts and policy makers, uncertainties amongst fellow clinicians about the role and benefits of nutrition support or the absence of dietetic services to which patients can be referred, is unclear. What is important is that we now work together to make nutritional care an integral part of cancer care within the life of the current cancer strategy.
Dr Jerome Coffey
Dr Jerome Coffey is the Director of the National Cancer Control Programme (NCCP).
A graduate of TCD he completed internal medicine and radiation oncology training in Ireland. Following higher training in major academic oncology centres in Canada and the UK he was appointed as a Consultant Radiation Oncologist to the staff of the St Luke’s Radiation Oncology Network and the Mater Misericordiae University Hospital in 2006. Before taking up his current role he was Clinical Director of the St Luke’s Radiation Oncology Network, Chairman of the Radiation Oncology Committee in the Faculty of Radiologists (RCSI) and Radiation Oncology Advisor to the NCCP.
Dr Coffey was appointed Chairperson of the Board of the National Cancer Registry in May 2017.
Aoife Ryan PhD RD
Dr Aoife Ryan graduated from Trinity College Dublin/Dublin Institute of Technology with a BSc (1H) Human Nutrition and Dietetics in 2000 and was the recipient of a Trinity College gold medal. She initially worked as a dietitian at St. James’s Hospital for 7 years during which time she completed her PhD (2007) at the Department of Surgery, under the supervision of Prof John Reynolds. She then moved to New York and took up a faculty position as Assistant Professor of Nutrition & Dietetics at New York University. In 2011 she returned to Ireland and took up the position of Lecturer in Nutritional Sciences at UCC. Aoife is a CORU Registered Dietitian and also holds a Postgraduate Diploma in Teaching & Learning in Higher Education.
Aoife’s main area of research is the effect of cancer on nutritional status. Her current research programme focuses on: (1) Computed tomography (CT) diagnosed cancer cachexia and sarcopenia and the impact on quality of life, toxicity to chemotherapy treatment and survival (2) the development of functional foods to treat anorexia of aging and disease (3) role of nutrition in the prevention and treatment of cancer. She was awarded INDI Research Dietitian of the Year in 2009 and received the Julie Wallace Award from the Nutrition Society in 2015. Aoife has published many scientific journal articles and four cookbooks for cancer patients which have all been professionally endorsed and have received a number of awards.
Prevalence and impact of cancer related malnutrition in Ireland
The prevalence of malnutrition in patients with cancer has frequently been shown to be one of the highest of all hospital patient groups. Weight loss is a frequent manifestation of malnutrition and several large scale studies over the last 40 years have reported that involuntary weight loss affects 50-80% of patients with cancer with the degree of weight loss dependent on tumour site, type and stage of disease. The prognostic impact of weight loss on overall survival has long been recognised with recent data suggesting a weight loss as little as 2.4% predicts survival independent of disease, site, stage or performance score. In addition to the adverse impact on survival, weight loss has historically been associated with severe chemotherapy-related toxicity; is a predictor of postoperative complications and higher health care costs and leads to a significant deterioration in a patients’ performance status, psychological well-being and overall quality of life. The scientific literature describing the prevalence and impact of cancer-related weight loss will be reviewed in this presentation with particular emphasis on the Irish context.
Pancreatic Dietitian & HRB Research Fellow
Trinity College Dublin and St Vincent’s University Hospital, Dublin
Oonagh has worked as Senior Pancreatic Dietitian at the National Surgical Centre for Pancreatic Cancer at St Vincent’s University Hospital, since 2011, establishing a specialist dietetic service for people with pancreatic cancer. A graduate of Dublin Institute of Technology/Trinity College Dublin, she initially worked at the Mater Misericordiae University Hospital Hospital in Dublin before moving to the UK to gain experience in oncology. She spent over 7 years working in the NHS from 2003 to 2010, including Addenbrooke’s Hospital in Cambridge, St Bartholomew’s in London. Her final role in the NHS was as Dietetic Team Leader at the Royal Marsden Hospital where she was selected for the National Cancer Leadership Programme.
Oonagh is vice-chair of the Nutrition Interest Group of the Pancreatic Society of Great Britain and Ireland (PSGBI), co-ordinating educational activities and representing the group at PSGBI Council. A former practice educator/tutor on the British Dietetic Association Parenteral and Enteral Nutrition Group’s annual Clinical Update Course, she now delivers the nutritional education component at the annual Surgical Bootcamp at the National Surgical Training Centre, RCSI.
In 2015 she received a Health Research Board Research Training Fellowship, allowing her to commence her PhD at Trinity College Dublin. Her research interests include cancer cachexia, pancreatic exocrine insufficiency, and body composition assessment.
Nutrition in cancer: can it make a difference?
Cancer-induced weight loss and cancer cachexia are established negative prognostic indicators for many cancers. They significantly increase the symptom burden endured by people living with the disease, and may limit their treatment options. Both frequently have multi-factorial aetiologies, requiring multi-modal strategies as treatment. This talk will review recent nutrition- focused interventions targeting cancer-induced weight loss, and include considerations for future research study design.
Veronica qualified as a Dietitian from Leeds Beckett University, UK in 2010, having initially obtained an honours degree in Physiology, Sport Science and Nutrition from the University of Glasgow. She also went on to achieve a Masters in Clinical Nutrition at Leeds Beckett University in 2015.
Veronica initially worked as a Macmillan Oncology Dietitian in Mount Vernon Cancer Centre in Middlesex, UK where she worked in the Head and Neck and Upper Gastrointestinal Medical and Clinical Oncology teams. During this time, she established a weight management service for overweight and obese breast cancer survivors. In 2014, she moved to a Specialist Macmillan Oncology Dietitian post at Imperial College Healthcare NHS Trust in the Upper Gastrointestinal Cancer and Lung Oncology Teams. She also worked part time as an outpatient Oncology Dietitian at The Harley Street Clinic, London. Veronica has worked at the Mater Misericordiae University Hospital since 2016. She set up the medical haematology oncology outpatient dietitian service which secured permanent funding in 2018.
Veronica has a keen interest in the impact of nutrition in patient focused care, throughout the cancer journey. She is contributing to nutrition work and research being undertaken by the Mater Hospital, Our Ladies Hospice Research Group, Irish Nutrition and Dietitian Institute and the National Cancer Care Programme.
Nutritional care in practice: how dietitians make a difference
By 2020 one in two people will be affected by a diagnosis of cancer in their lifetime. A goal of the National Cancer Strategy 2017-2026 is to improve outcomes for patients by ensuring effective treatment throughout the cancer pathway. Malnutrition is commonly seen in cancer patients. Research shows up to 80% of patients experience weight loss, and/or muscle wasting, influenced by tumour location and the treatments provided. Malnutrition reduces tolerance to anti-cancer therapy; increases risk of post-surgical complications; reduces quality of life and increases mortality. It impacts on length of hospital stay, admission rates and overall hospitalisation costs.
Fad diets and diets lacking a credible evidence base are common in patients undergoing cancer treatment. Cancer patients often seek information on diet, and yet evidence suggests few healthcare professionals discuss dietary information with patients. Dietitians specialising in Oncology are able to provide evidence based, expert advice on the diet needed to help optimise a patients nutritional and emotional wellbeing, body composition and quality of life. They can provide nutritional counselling to patients and their families at every stage of their cancer treatment. This talk will focus on the clinical impact a new outpatient service delivered by a dietitian experienced in oncology, had for chemotherapy patients. It will explore how the service was evaluated and address gaps that remain in service provision.
Niamh Rice is a director and founding member of the Irish Society for Clinical Nutrition and Metabolism Board and Management Committee (IrSPEN) in Ireland, established in 2010. She is also a Consultant in Nutrition and Medical Affairs since 2008, and Managing Partner of consultancy company Previs Healthcare Ltd, specialising in nutrition marketing, insights and strategic affairs. A qualified Dietitian and Nutritionist, having graduated from Trinity College / Dublin Institute of Technology, Niamh has over 25 years’ experience working in senior scientific, general management and global director positions within nutrition companies in Ireland, UK and Netherlands. In her earlier career as an independent consultant, Niamh was a member of two UK Nutrition Task Force working groups aimed at improving public health and nutrition policies within hospitals, schools and the workplace. Within her role in IrSPEN, Niamh has actively campaigned for improved standards of nutritional care and she has applied her knowledge of business strategy and health economics to underpin IrSPEN’s advocacy and campaigning efforts. Her work on developing a national costing for malnutrition was published in 2012, and she has also authored or contributed to several expert reports, government submissions, reviews and business case submissions on behalf of non-governmental agencies and professional groups, including IrSPEN. In the last four years, Niamh has served on national advisory committees on nutrition and hydration for both HIQA and the HSE and as chair of IrSPEN’s programmes and communication committee, is actively involved in key initiatives aimed at improving outcomes through better nutritional care.
Nutritional care in practice: the patient’s perspective
In 2018, IrSPEN collaborated with Dr. Aoife Ryan in developing a National Survey (IrSPEN National ‘Nutrition and Cancer’ Survey, 2018), results of which will be presented. Patients who had received cancer care in the last three years were invited to participate online or by completing a paper survey. The survey was distributed to 25 hospitals and palliative care hospice settings, with all designated cancer centres included. The survey was also hosted on the websites and Facebook pages of Breakthrough Cancer Research and the Irish Cancer Society. Ethics approval was granted by the Clinical Research Ethics Committee of the Cork teaching hospitals.
The aim of the survey, which was completed by 1085 patients who met eligibility criteria, was to examine patient attitudes to nutrition as part of their cancer journey and to gain an insight into their experiences around nutritional issues. The survey was designed to answer the following key questions:
- What nutritional problems and concerns patients experienced and how it affected them?
- What are the major gaps in nutritional information, care or support during or after treatment?
- Which patients have been seen by a dietitian and how helpful did they find it?
- What role have the media, friends, family, alternative practitioners played in shaping their views about what foods they should eat or avoid and have they tried any special ‘cancer’ diets since diagnosis?
Increasingly in healthcare research, a combination of research methods are used to gain true insight into the ‘lived experiences’ of patients. Thus, to contextualise findings from survey data and to give us a greater insight into the experiences of patients with serious nutritional problems, 90 minute in–depth interviews were conducted with selected patients and family members of those receiving nutritional care, all of whom had recently been under the care of an oncology dietitian. Their experiences and thoughts have been invaluable in providing context to our survey findings and where possible within this presentation, their words are used to communicate the impact of malnutrition on their daily lives and their experiences of nutrition support and advice.
Acknowledgements: Special thanks to Dr. Aoife Ryan, UCC, Erin O Sullivan, UCC (survey input/data analysis), Dr. Robert O Connor of the Irish Cancer Society, Orla Dolan of Breakthrough Cancer Research, Arun Fenton, Senior Dietitian, Dietitians / INDI who distributed/coordinated return of the survey. Patients and family members: Sheila, Paul, Grace, Helen, Fiona, Peter, Marie, Breda and Larry.
Dr Eileen Gibney
Associate Prof Eileen Gibney (BSc, PhD, MSc) graduated with a degree in human nutrition from the University of Ulster at Coleraine, and then obtained her PhD from University of Cambridge in 2001. She went on to complete an MSc in Molecular Medicine (TCD) in 2003. Eileen held post-doctoral positions at the University of Newcastle and Trinity College Dublin, before joining UCD as Lecturer in Nutrition in 2005. She is now Associate Professor in Nutrition Her current research interests lie in the area of personalised nutrition, where she develops strategies and innovative technologies for personalised dietary and lifestyle feedback based on dietary, phenotypic and genetic information of the individual. Her research also encompasses human intervention studies examining the metabolic impact of foods and novel food ingredients. She is a Deputy Director of the UCD Institute of Food and Health and a member of the academic staff for BSc Human Nutrition and several other degrees. She is Associate Dean of Teaching and Learning within the School of Agriculture and Food Science. Eileen is a Director of the Irish Association for Clinical Nutrition and Metabolism (IrSPEN).
Personalised Nutrition: where are we, where next?
Personalised Nutrition allows individual differences in dietary, lifestyle, anthropometric, phenotypic and/or genomic information to be considered when giving dietary advice. Compared to general dietary advice, personalised dietary advice has been shown more likely to result in healthy dietary change. Food4me project conducted one of largest studies to date examining the impact of provision of personalised nutrition on behavioural change. Recruiting individuals across 7 European countries, food4me examined whether providing personalized nutrition (PN) advice based on information on individual diet, lifestyle, phenotype and/or genotype would promote larger, more appropriate, and sustained changes in dietary behaviour than general healthy eating advice. Results demonstrated that the provision of personalized advice resulted in greater improvements in dietary intake in the personalized groups, compared to the control (general healthy eating guidelines) group, but that the level of personalization (diet, diet + phenotype, diet + phenotype + genotype), had no effect. In essence to the participant, or the consumer, personalization of advice was important, but not how that advice was derived. In a clinical setting personalised advice can help patients, by taking into account influences on behavioural change, motives for food choice and social and lifestyle factors affecting their eating context. Whilst this can offer an advantage to the patient, before this approach becomes routine, it needs to consider differences associated with the process from the collecting of information and taking of biological samples through to how the results are interpreted and delivered in a systematic manner. Evidence to date shows that the delivery of personalised nutrition from health professionals such as doctors, nutritionists and dietitians is preferred over commercial agents. Nutritionists and dieticians, therefore, will play a key role in making personalised nutrition happen in the future.
Pete Turner qualified as dietitian in 1990 and worked in Liverpool for over 20 years specialising on parenteral nutrition and ICU before taking up his current post as nutrition support lead at the Ulster Hospital in May 2016. He is a member of BAPEN Council and chairs the committee that organises their annual conference.
IF on the ICU – When to Start Parenteral Nutrition?
Parenteral nutrition (PN) has had a bad reputation on the intensive care unit (ICU) for a number of years, probably due to some meta-analyses and review papers published in the late 1990s which were recently compounded by the EPANIC1 Study. There is a great deal of pressure to use enteral nutrition and a common perception that resorting to PN is a failure. However it is easy to explain the reasons for poor outcomes with PN in these studies and why appropriate use of PN is safe. This session will use an intestinal failure (IF) case based approach to demonstrate the physiological reasons why PN should be considered and at what stage.
- Casaer et al, Early versus Late Parenteral Nutrition in Critically Ill Adults. N Engl J Med 2011; 365:506-517
Ms Helen Heneghan
Ms Helen Heneghan is a Consultant Bariatric Surgeon at St. Vincent’s University Hospital, Dublin. She is a graduate of NUI Galway, and completed basic surgical training in Galway University Hospital. In 2012 she was awarded a PhD in the molecular expression of breast cancer and obesity from NUI Galway. She then completed the RCSI Higher Surgical Training scheme in General Surgery in 2016. During her training, she spent two years in the Bariatric Metabolic Institute in Cleveland Clinic, Ohio. She then completed her training with a Bariatric Fellowship in the UK (Chester, Liverpool).
She has co-authored 60 publications in peer-reviewed journals and has written 5 book chapters on the topics of bariatric and endocrine surgery.
Qualifications: MB BCh BAO, PhD, FRCS
Speciality: Bariatric Surgery
Subspeciality Expertise: Bariatric Surgery, Gastrointestinal Malignancies, General Surgery
Niamh Maher, Senior Dietitian, HSE Dublin North City & County Area
Niamh has worked as a Senior Dietitian for Home Enteral Feeding since 2008. Based in Community Nutrition & Dietetic Service in HSE Dublin North City & County, her primary role is to co-ordinate the nutritional care of adults discharged into the area on enteral feeding, and in an extended role she also performs gastrostomy tube reinsertions.
Prior to taking up this role, she worked as a Senior Dietitian in Oncology and ENT at Beaumont Hospital for 10 years, during which time she coordinated the discharge and follow-up of oncology & surgery patients on home enteral feeding. She was also a member of the INDI/IASLT working group which developed the ‘National descriptors for terminology for modified foods and fluids’ in 2009.
Niamh sits on the management committee of IrSPEN (Irish Society of Clinical Nutrition & Metabolism) and is jointly co-ordinating the development of IrSPENs National Standards & Guidelines for Home Enteral Nutrition.
In addition, Niamh is a working with the HSE Community Funded Schemes Service Improvement Programme Nutrition Group, in reviewing the delivery of Home Enteral Feeding in Ireland.
Dr. Karen Boland
Dr. Karen Boland graduated from Royal College of Surgeons in Ireland in 2007. Awared a Higher Specialist Training in gastroenterology by RCPI in 2016. Karen was also awarded a PhD from RCSI in 2016, studying novel proteasomal targets in colorectal cancer. Subsequently, at Mount Sinai Hospital, Toronto, Karen was the Ogden-Goldstein Advanced IBD Fellowship recipient in 2016, and the Irving-Gerstein Research Fellowship recipient in 2017. She is currently a gastroenterology consultant in Beaumont Hospital, Dublin with special expertise in Inflammatory Bowel Disease, gut microbiome, clinical nutrition, colorectal cancer and general gastroenterology.