Perceptions, Experiences, Barriers and Facilitators Regarding Nutritional Intake of Patients with Chronic Limb Threatening Ischemia: A Qualitative Study.

Aniek M Kolen, Harriët Jager-Wittenaar, Jean-Paul P M de Vries, Martijn L Dijkstra, Pieter U Dijkstra, Rienk Dekker, Leonie A Krops, Jan H B Geertzen

Journal: Annals of vascular surgery 2024;99():166-174

PMID: 37924865

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Abstract

BACKGROUND

Patients with chronic limb threatening ischemia (CLTI) are at high risk for amputation and other cardiovascular adverse events. Nutrition-related symptoms and malnutrition are common in the CLTI population, and lead to worse clinical outcomes. Understanding of the factors influencing nutritional intake is required to determine whether optimization of nutritional intake in this population requires interventions. Therefore, this study aimed to describe perceptions and experiences on nutrition of patients with CLTI, and to identify perceived barriers and facilitators influencing their nutritional intake.

METHODS

In this phenomenological qualitative study, individual semi-structured, face-to-face interviews were conducted with patients with CLTI who lived independently. Interviews were transcribed verbatim, and reflexive thematic analysis was performed.

RESULTS

Twelve participants were interviewed. Five themes were generated: (1) lack of nutritional risk perception, (2) role of nutrition for health, functioning, and surviving, (3) multiple factors influencing nutritional intake, (4) limited nutritional advice, and (5) no intention to change current nutritional intake.

CONCLUSIONS

Patients with CLTI perceive nutritional intake as a necessity to survive and function. Patients express limited risk perception regarding adequate nutritional intake and undernutrition. Nutritional intake is mainly based on non-health-related factors, as habits and taste, and multiple barriers hinder nutritional intake. Patients received no or only limited nutritional advice. Together this leads to an expressed lack of intention to change nutritional intake. Findings of this study stress the urgency for patient-centered nutritional support, to increase nutrition-related knowledge and motivation, to prevent or treat undernutrition, and may improve clinical outcomes in patients with CLTI.

Address: Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: [email protected].; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Physical Education and Physiotherapy, Research Unit Experimental Anatomy, Department Physiotherapy and Human Anatomy, Vrije Universiteit Brussel, Brussels, Belgium.; Division of Vascular Surgery, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Faculty of Medicine Siriraj Hospital, Sirindhorn School of Prosthetics and Orthotics, Mahidol University, Bangkok, Thailand.; Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

DOI: 10.1016/j.avsg.2023.09.096

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MeSH Terms: Humans, Chronic Limb-Threatening Ischemia, Ischemia, Treatment Outcome, Malnutrition, Nutritional Status, Risk Factors, Limb Salvage, Peripheral Arterial Disease, Retrospective Studies