Showing papers in "Clinical nutrition ESPEN in 2018"
TL;DR: Validation results differed significantly between tools, and also between studies using the same tool in different settings, leaving the true validity of some tools unclear.
Abstract: Summary Background Older adults are at increased risk of malnutrition compared to their younger counterparts. Malnutrition screening should be conducted using a valid malnutrition screening tool. An aim of the Healthy Diet for a Healthy Life (HDHL) Joint Programming Initiative (JPI) 'Malnutrition in the Elderly Knowledge Hub' (MaNuEL) was to review the reported validity of existing malnutrition screening tools used in older adults. Methods A literature search was conducted to identify validation studies of malnutrition screening tools in older populations in community, rehabilitation, residential care and hospital settings. A database of screening tools was created containing information on how each tool was validated. Results Seventy-four articles containing 119 validation studies of 34 malnutrition screening tools used in older adults were identified across the settings. Twenty-three of these tools were designed for older adults. Sensitivity and specificity ranged from 6 to 100% and 12–100% respectively. Seventeen different reference standards were used in criterion validation studies. Acceptable reference standards were used in 68 studies; 38 compared the tool against the Mini Nutritional Assessment-Full Form (MNA-FF), 16 used clinical assessment by a nutrition-trained professional and 14 used the Subjective Global Assessment (SGA). Twenty-five studies used inappropriate reference standards. Predictive validity was measured in 14 studies and was weak across all settings. Conclusions Validation results differed significantly between tools, and also between studies using the same tool in different settings. Many studies have not been appropriately conducted, leaving the true validity of some tools unclear. Certain tools appear to be more valid for use in specific settings.
121 citations
TL;DR: In obese and overweight subjects weight loss is a determinant factor for reducing the level of pro-inflammatory markers and Hypocaloric diet has an anti-inflammatory effect independent of the diet composition which can play an important role in the prevention of chronic diseases.
Abstract: Summary Background Chronic inflammation is a process sustained by the augmentation of circulating cytokines level and C-reactive protein (CRP) Adipocytes and adipose tissue infiltration with inflammatory cells, are an important source of adipokines production, and their expansion due to overnutrition is responsible for increased in inflammation The reduction of body fat following both controlled diets or gastric surgery can be favorable in the reduction of pro-inflammatory cytokines Methods A systematic literature search performed using PubMed, Google Scholar and Cochrane Library database screened for clinical and randomized controlled trials (RCTs) using the combination of the following keywords: “weight loss, inflammation,” “restricted diet, anti-inflammatory effect” Studies including diet intervention, weight loss after gastric surgery have been included Multidisciplinary program with the addition of food supplements, exercise, or drugs have been excluded to avoid their interference with the regulation inflammatory markers Results Out of 967 articles found, 76 were selected, including a total of 6742 patients with a mean age of 440 ± 3,3 years and a BMI of 33 ± 66 The observation period ranged from 3 weeks up to two years with an average weight loss per month of 11 kg In most of the studies, it was found that weight loss caused a significant reduction of plasma level of inflammatory cytokines although three studies did not see any effect Conclusions In obese and overweight subjects weight loss, induced both by energy-restricted diet or surgery, is a determinant factor for reducing the level of pro-inflammatory markers Hypocaloric diet has an anti-inflammatory effect independent of the diet composition which can play an important role in the prevention of chronic diseases
76 citations
TL;DR: The majority of studies that analyze the intermittent fasting impacts on the lipid profile and body weight loss are observational based on Ramadan fasting, which lacks large sample and detailed information about diet.
Abstract: Intermittent fasting, whose proposed benefits include the improvement of lipid profile and the body weight loss, has gained considerable scientific and popular repercussion. This review aimed to consolidate studies that analyzed the lipid profile in humans before and after intermittent fasting period through a detailed review; and to propose the physiological mechanism, considering the diet and the body weight loss. Normocaloric and hypocaloric intermittent fasting may be a dietary method to aid in the improvement of the lipid profile in healthy, obese and dyslipidemic men and women by reducing total cholesterol, LDL, triglycerides and increasing HDL levels. However, the majority of studies that analyze the intermittent fasting impacts on the lipid profile and body weight loss are observational based on Ramadan fasting, which lacks large sample and detailed information about diet. Randomized clinical trials with a larger sample size are needed to evaluate the IF effects mainly in patients with dyslipidemia.
70 citations
TL;DR: Six weeks of AGE consumption modulated immune cell distribution, prevented the increase of serum TNF-α and IL-6 concentrations and reduced blood LDL concentration in adults with obesity.
Abstract: Summary Background Obesity is a serious global health issue and often results in low-grade systemic inflammation, increasing the risk for several chronic diseases. If obesity-induced inflammation could be reduced, fewer complications and co-morbidities might occur. Objective To investigate whether daily supplementation with aged garlic extract (AGE) could reduce chronic inflammation and improve immune function in adults with obesity. Methods Fifty-one healthy adults with obesity (mean age 45.6 ± 1.6 years, mean BMI 36.1 ± 0.9 kg/m2) were recruited to participate in a parallel, double-blind, placebo-controlled, randomized study. After being matched by BMI, participants were randomized into the AGE supplementation or placebo group. Participants were asked to take a divided daily dose of 3.6 g AGE or placebo, with food for 6 weeks. Blood lipid and inflammatory markers were assessed at baseline and after 6 weeks of supplementation. Additionally, peripheral blood mononuclear cells (PBMC) were isolated from whole blood and used to detect changes in immune cell populations and levels of cytokine secretion. A one-way ANCOVA was performed to evaluate differences between the two groups, controlling for respective baseline values. Results At the end of study, serum IL-6 (p = 0.04) and TNF-α (p = 0.05) of participants consuming AGE were significantly lower than those consuming the placebo capsules. PBMC flow cytometry results showed that participants from the AGE group had a higher proportion of γδ-T cells (p = 0.03) and a lower proportion of NKT cells (p = 0.02) in the total population of lymphocytes. There was no difference in percentage of NK cells between the two groups. A significant difference in blood LDL concentration was also observed (p = 0.05). Total cholesterol and non-HDL cholesterol tended to differ between participants from the AGE group and those from the placebo group, although values did not achieve statistical significance. Conclusion Six weeks of AGE consumption modulated immune cell distribution, prevented the increase of serum TNF-α and IL-6 concentrations and reduced blood LDL concentration in adults with obesity. AGE, taken consistently, may be beneficial in preventing the development of chronic diseases associated with low-grade inflammation in adults with obesity. Registered under ClinicalTrials.gov with the identifier code NCT01959646 .
66 citations
TL;DR: It is postulated that thiamine and magnesium deficiency are under-recognized in obesity and may be important in the progress of obesity and obesity related chronic disease states.
Abstract: The WHO 2016 report indicates that worldwide obesity is rising, with over 600 million people in the obese range (BMI>30). The recommended daily calorie intake for adults is 2000 kcal and 2500 kcal for women and men respectively. The average American consumes 3770 kcal/day and the average person in the UK consumes 3400 kcal/day. With such increased caloric intake, there is an increased load on metabolic pathways, in particular glucose metabolism. Such metabolism requires micronutrients as enzyme co-factors. The recommended daily allowance (RDA) for thiamine is 1.3 mg/day and 0.5 mg thiamine is required to process 1000 kilocalories (kcal). Therefore, despite the appearance of being overfed, there is now increasing evidence that the obese population may nutritionally depleted of essential micronutrients. Thiamine deficiency has been reported to be in the region of 16-47% among patients undergoing bariatric surgery for obesity. Thiamine, in turn, requires magnesium to be in its active form thiamine diphosphate, (TDP). TDP also requires magnesium to achieve activation of TDP dependent enzymes, including transketolase (TK), pyruvate dehydrogenase (PDH) and alpha-keto glutaric acid dehydrogenase (AKGDH), during metabolism of glucose. Thiamine and magnesium therefore play a critical role in glucose metabolism and their deficiency may result in the accumulation of anaerobic metabolites including lactate due to a mismatch between caloric burden and function of thiamine dependent enzymes. It may therefore be postulated that thiamine and magnesium deficiency are under-recognized in obesity and may be important in the progress of obesity and obesity related chronic disease states. The aim of the present systematic review was to examine the role of thiamine dependent enzymes in obesity and obesity related chronic disease states.
44 citations
TL;DR: BCAA supplementation may be beneficial in improving muscle strength, ascites and edema with potential clinically significant improvements in HE in adult liver patients and longitudinal studies examining the efficacy of BCAA supplementation as a therapeutic treatment of malnutrition in chronic liver disease is warranted.
Abstract: Summary Background & Aims Malnutrition is highly prevalent in chronic liver disease (CLD) due to alterations in nutrient utilization, malabsorption and poor intake. Low serum concentrations of branched chain amino acids (BCAA) in the presence of elevated aromatic acid concentrations is commonly observed in adult and children with liver cirrhosis and is associated with malnutrition and other adverse patient outcomes. The efficacy of BCAA supplementation has not been well established in adults and children with CLD. The purpose of this review was to critically evaluate the literature regarding the impact of BCAA supplementation related to changes in body composition, muscle strength, liver biomarkers, medical and hepatic complications (hepatic encephalopathy (HE), ascites, edema) and patient care outcomes (event free survival, health related quality of life, length of hospitalization). Methods A total of 40 articles retrieved from PubMed or Web of Science databases (1989–2017) were included. Results BCAA supplementation may be beneficial in improving muscle strength, ascites and edema with potential clinically significant improvements in HE in adult liver patients. In children, limited data have shown that BCAA supplementation may exert favourable effects on weight, fat mass, fat free mass and serum albumin level. Conclusions Heterogeneity of study findings attributed to variability in BCAA dose (total, relative proportions), duration, disease severity and lack of uniformity in tools used for assessing patient outcomes limit overall conclusions. Longitudinal studies examining the efficacy of BCAA supplementation as a therapeutic treatment of malnutrition in chronic liver disease is warranted.
40 citations
TL;DR: About 1-6 g of these cinnamon species mainly in powder seems to be an adjunct drug treatment for type 2 diabetes mellitus and other conditions of glycemic impairment, but more controlled clinical trials are needed.
Abstract: Summary Background & aims Cinnamon is a condiment used in cooking and by some in large quantities as a supplement with purported hypoglycemic and lipid-lowering potential. The current literature review aims to discuss the evidence of cinnamon administration regarding its hypoglycemic and lipid-lowering effects, summarizing clinical recommendations. Methods Electronic databases including PubMed, Cochrane library, Science Direct and Web of Science were searched with the scientific name of the plant as well as the common name. The search for articles was based on following keywords: “cinnamon diabetes”, “cinnamon diabetes type 2”, “cinnamon and diabetes type 2”, “Cinnamomum aromaticum”, “Cinnamomum cassia”, “Cinnamomum verum”, “Cinnamomum zeylanicum”. We carried out inclusion criteria between 2003 and 2018 focusing on human studies. Results Concerning glycemic profile, in individuals with type II diabetes mellitus the fasting blood glucose reduced from 12.9 to 52.2 mg/dL and HbA1c from 0.27 to 0.83%, whereas serum insulin decreased in few studies. Research papers ranged from 6 to 17 weeks in duration. The lipid lowering potential, in turn, is most controversial compared to anti-hyperglycemic potential. Also cinnamon administration has been claimed to reduce fat mass and raise serum antioxidants, but the studies used inaccurate methods. Two species are most investigated, C. cassia/aromaticum, and C. zeylanicum/verum. Conclusions About 1–6 g of these cinnamon species mainly in powder seems to be an adjunct drug treatment for type 2 diabetes mellitus and other conditions of glycemic impairment. However, more controlled clinical trials are needed.
39 citations
TL;DR: The DASH diet may have beneficial effects on the alterations of BP, overweight and obesity in adolescence, however, adherence to this dietary pattern is still low.
Abstract: Summary Background & aims The high prevalence of overweight/obesity, and arterial hypertension (AH) in adolescence is a public health problem worldwide. The aim of the article is to perform a systematic review looking to verify the effects of DASH diet on overweight/obesity and blood pressure (BP) in adolescents. Methods Systematic search of the literature conducted until March 2018. Five databases were investigated. We follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) Statement. The systematic review protocol was recorded in PROSPERO (CRD42016046968). Two reviewers examined 1005 abstracts. The risk of bias was assessed using STROBE or CONSORT. Results Seven studies were eligible, three cross-sectional, two cohort and two randomized clinical trials (RCTs). Cross-sectional study found that a higher DASH score was associated with decreased body composition measurements; the other two did not find associations between DASH scores, body weight, and BP. Cohort studies found that the DASH diet resulted in lower levels of diastolic BP and lower body mass index gain over 10 years. One RCT showed that the DASH diet proved to be effective in improving systolic BP and another RCT observed a decrease in the prevalence of AH. Conclusions The DASH diet may have beneficial effects on the alterations of BP, overweight and obesity in adolescence. However, adherence to this dietary pattern is still low. It is believed that, in the future, dietary interventions based on DASH may be part of public policies to combat AH and overweight/obesity, since all age groups of the population can adopt this dietary pattern.
39 citations
TL;DR: It is suggested that sarcopenia is highly prevalent in patients living in long-term care institutions, especially in female patients, and the muscle mass was negatively associated with poor nutritional status and poor capacity to develop basic activities of daily living.
Abstract: Summary Background & aims Sarcopenia is a syndrome characterised by a progressive and generalised loss of skeletal muscle mass and strength with a risk of adverse outcomes such as physical disability, poor quality of life and death. The main aim of the present study was to establish the prevalence of sarcopenia using EWGSOP-defined criteria in institutionalised older adult patients in long-term care institutions. A secondary purpose was to identify the risk factors that develop Sarcopenia in this population. Methods A Multicentre cross-sectional study was conducted in 334 institutionalised older adult patients, where the prevalence of sarcopenia and its relation with certain risk factors were measured. Physical performance was measured by gait speed, muscle strength measured by a handheld dynamometer and skeletal muscle mass measured using bioimpedance analysis. Different variables were collected: body mass index (BMI), diseases documented in the clinical record, the numbers of falls, the level of activity and functional ability. Results Two hundred eighty five individuals were included. According the EWGSOP algorithm and the cut-off points proposed by Masanes et al. for the Spanish population, 118 (41.4%) participants presented sarcopenia, of which 32 patients (27%) suffered from moderate sarcopenia, 78 patients (66%) were identified as severe sarcopenia patients and only 8 (7%) were classified as sarcopenic obesity. More female residents (96 females (81.4%) vs. 22 males (18.6%), p Conclusion The present study suggests that sarcopenia is highly prevalent in patients living in long-term care institutions, especially in female patients. Our findings support that the muscle mass was negatively associated with poor nutritional status and poor capacity to develop basic activities of daily living that indicates high dependency of these patients and high necessity of care.
38 citations
TL;DR: Further research is needed to refine BIA methods for segmental composition estimates in heterogeneous samples and disease-specific populations before this methods can be used reliably in a clinical setting.
Abstract: Summary Background & aims Segmental body composition may be an important indicator of health and nutritional status in conditions where variations in fat and lean mass are frequently isolated to a particular body segment (e.g. paralysis, sarcopenia). Until recently, segment-specific body composition could only be assessed using invasive and expensive methods such as dual-energy x-ray absorptiometry (DXA), magnetic resonance imaging (MRI), or computed tomography (CT). Bioelectrical impedance analysis (BIA) may be a rapid, inexpensive alternative for assessing segmental composition, but it has not been fully validated for this purpose. The purpose of this study was to compare segmental estimates of lean and fat mass using BIA versus a criterion standard of DXA. Methods A cross-sectional pilot study was conducted in n = 30 healthy adults. Outcome measures included total mass, fat mass and lean mass of arm, leg and trunk. Pearson correlation coefficients (r) and paired-samples t-tests (t) were used to assess relationships between each outcome as measured by BIA and DXA. Results Although the methods were strongly correlated for all measures, (r > .87 for all segments) BIA routinely overestimated lean mass for arm and trunk (mean difference arm: 0.97 kg, p = .008; trunk: 5.58 kg, p Conclusions Significant discrepancies were noted between DXA and BIA in all body segments. Further research is needed to refine BIA methods for segmental composition estimates in heterogeneous samples and disease-specific populations before this methods can be used reliably in a clinical setting.
38 citations
TL;DR: It is shown that 8-week supplementation with 3 g MO can decrease depression, anxiety, stress, and sleep disorder in patients with CSA.
Abstract: Summary Background Despite advances in the treatment of cardiovascular diseases in recent decades, patients experience high levels of depression, anxiety, stress, and insomnia. Since the calming effect of Melissa officinalis (MO) has been known, this study aimed to determine the effects of MO supplementation on depression, anxiety, stress, and sleep disturbances in patients with chronic stable angina (CSA). Methods In this double-blind placebo-controlled clinical trial, 80 patients with CSA were divided randomly into two groups (taking 3 g MO supplement or placebo daily for 8 weeks). The shortened 21-item version of the depression, anxiety and stress scale (DASS-21) test and Pittsburgh sleep quality index were done before and after the intervention. Results At the end of the study, the intervention group receiving MO capsules had a significant reduction in scores of depression, anxiety, stress, and total sleep disturbance, compared with the placebo group (P Conclusions The results showed that 8-week supplementation with 3 g MO can decrease depression, anxiety, stress, and sleep disorder in patients with CSA.
TL;DR: Using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery, which underlines the importance of currently implemented easy-to-use nutritional screening tools (MUST).
Abstract: Summary Background Computed tomography (CT) can be used for accurate estimation of whole-body muscle mass and muscle density and for detection of sarcopenia. The goal of this study was to evaluate the additional value of CT measured sarcopenia and muscle attenuation alongside the Malnutrition Universal Screening Tool (MUST) for the prediction of post-operative morbidity after oncological colorectal resection, whilst correcting for known risk factors. Methods A prospective cohort study of 80 patients undergoing elective colorectal surgery in the Netherlands. Patients were screened for nutritional risk upon admission using the MUST. Additionally, preoperative CT scans were used to determine skeletal muscle mass for the detection of sarcopenia and muscle attenuation. Univariate and multivariable analyses were performed to evaluate associations between the MUST, muscle attenuation and sarcopenia on the one hand and post-operative complications measured by the Clavien-Dindo score on the other hand. Results American Society of Anesthesiology-classification (ASA) ≥3, age ≥70, MUST ≥2 and lower than median muscle attenuation were significantly associated with a higher risk for postoperative complications (Clavien-Dindo score ≥2) (p ≤ 0.05), whereas sarcopenia was not (p = 0.59). Multivariate analyses showed that only MUST ≥2 remained significantly associated with postoperative complications when corrected for age (p = 0.03, OR 5.8, 95%CI 1.1–29.6), but not when corrected for age ≥70 and ASA ≥3. Muscle attenuation and sarcopenia were not significantly associated with postoperative complications. Conclusion Our results suggest that using CT measured sarcopenia may have only little additional value over the MUST for the prediction of increased short-term post-operative morbidity after oncological colorectal surgery. It also underlines the importance of currently implemented easy-to-use nutritional screening tools (MUST) and raises the question of the evaluation of muscle quality versus quantity in body composition imaging. However, further research is needed to investigate the role of sarcopenia for predicting outcome after colorectal surgery, and investigate the role of muscle attenuation measurements for the prediction of muscle function. Category of submission observational study.
TL;DR: This retrospective study confirms that estimations of energy expenditure in critically ill children are inaccurate leading to unintended under and overfeeding, and under feeding seems to be associated with fewer mechanical ventilation days and PICU LOS.
Abstract: Summary Background & aims Energy is essential for the treatment and recovery of children admitted to Pediatric Intensive Care Units (PICU). There are significant immediate and long-term health consequences of both under- and over-feeding in this population. Energy requirements of critically ill children vary depending on age, nutritional status, sepsis, fever, pharmacotherapy, and duration and stage of critical illness. This study aimed to determine the incidence of over- and under-feeding and to compare hospital outcomes between these feeding categories. Secondary outcomes were collected to describe the association between feeding categories and biochemistries (serum lactate, triglycerides, C-reactive protein). Methods An ethics approved retrospective study of children admitted to PICU was performed. All intubated patients admitted to PICU (2008–2013) were included, except those in which an IC test was not feasible. Data collection included demographics, the primary outcome variable reported as under feeding ( 110% MREE) determined through comparison of measured resting energy expenditure (MREE) using indirect calorimetry (IC) to actual energy intake based on predicted basal metabolic rate (PBMR) and clinical outcomes mechanical ventilation and PICU length of stay (LOS). Data were analysed with descriptive methods, ANOVA and linear regression models. Results A total of 139 patients aged 10 (range 0.03–204) months were included. Sixty (43%) were female and 77 (55%) were admitted after a surgical procedure. A total of 210 IC tests were conducted showing a statistically significant difference between MREE measurements and PBMR (p = 0.019). Of the 210 measurements, only 26 measures (12.4%) demonstrated appropriate feeding, while 72 (34.3) were underfed and 112 (53.3%) were overfed. Children who were overfed had significantly longer PICU LOS (median 45.5, IQR 47.8 days) compared to those children in the appropriately fed (median 21.0, IQR 54.5 days), and underfed groups (median 16.5, IQR 21.3 days). There was a mean difference between the over and under feeding category and ventilation days after adjusting for age and PRISM score (p = 0.026), suggesting decreased mechanical ventilation days for underfed. Children who were underfed had significantly higher CRP (median 75.5, IQR 152.8 mg/L) compared to those children in the appropriately fed (median 57.8, IQR 90.9 mg/L) and overfed groups (median 22.4, IQR 56.2 mg/L). Conclusions This retrospective study confirms that estimations of energy expenditure in critically ill children are inaccurate leading to unintended under and overfeeding. Importantly under feeding seems to be associated with fewer mechanical ventilation days and PICU LOS. Further research is required to elucidate the role of optimal nutrition in altering clinical variables in this population.
TL;DR: This large-scale survey provided valuable data regarding nutritional assessment practice and malnutrition prevalence among children with CP in Turkey, which may be utilized for future proactive strategies in the prevention and treatment of malnutrition in this population.
Abstract: Summary Background & aims This study was designed to assess clinical characteristics and nutritional status of pediatric outpatients with cerebral palsy (CP) and to determine prevalence of malnutrition based on physicians' clinical judgment and on anthropometric data in relation to percentile reference values. Methods A total of 1108 pediatric neurology outpatients (mean ± SEM age: 7.2 ± 0.1 years, 59.3% were males) diagnosed with CP were included in this cross-sectional, non-interventional multicenter single-visit study conducted between October 2015 and July 2016 at 20 centers across Turkey. Data on patient and CP characteristics, concomitant nonneuromotor impairments and gastrointestinal disorders as well as anthropometrics, outcome of nutritional status assessment (via physicians' clinical judgment and Gomez classification and Waterlow classification of anthropometric data) and physician's view on nutritional care in CP patients were collected at a single visit. Results The most common CP etiology was asphyxia (62.5%). The most common clinical category was spastic CP (87.5%) with quadriplegic (54.0%) topography and level V gross motor dysfunction (45.4%) in most of patients. The prevalence of malnutrition was considered to be 57.2% based on physicians' clinical judgment, while shown to be 94.3% (3rd degree in 86.7%) according to Gomez classification of Neyzi weight for age (WFA) percentiles and to be 91.3% (severe in 88.3%) according to Waterlow classification of Neyzi height for age (HFA) percentiles. Conclusions In conclusion, our findings revealed high prevalence of malnutrition, while also emphasize the likelihood of overestimation of malnutrition in children with CP when anthropometric assessment was based on use of growth charts for general pediatric population. This large-scale survey provided valuable data regarding nutritional assessment practice and malnutrition prevalence among children with CP in Turkey, which may be utilized for future proactive strategies in the prevention and treatment of malnutrition in this population.
TL;DR: Although a small number of studies and a relatively small sample size, a suggestion is that provision of multidisciplinary nutritional support may have a positive effect on mortality and improves quality of life in older patients.
Abstract: Malnutrition is common in older hospitalised patients. As the aetiology is multifactorial, nutritional care should involve a multidisciplinary team. However, the knowledge of the effectiveness of t ...
TL;DR: Sarcopenia assessed by abdominal CT demonstrated low correlation with BMI and was a risk factor for lower 30-day survival, higher hospital mortality and higher complications in critically ill patients.
Abstract: Summary Background & aims In the intensive care unit (ICU) setting, body composition is typically estimated through anthropometry, which does not specifically quantify skeletal muscle (SM). Recent findings have shown that computed tomography (CT) is a useful tool to identify low SM in critically ill patients, which in turn is associated with poor clinical outcomes. So, the present study aims at comparing low SM assessed by CT to BMI anthropometric data and its association with outcomes in critically ill patients. Methods Observational study was used, which included >18 year-old patients, with over 72 h of ICU length of stay, who had an abdominal CT at ICU admission. Demographic, body mass index (BMI), hospital outcomes and abdominal CT data (SM and adipose tissue at the 3rd lumbar vertebrae) were collected for analysis. ROC curve optimal stratification analysis for hospital mortality was applied to classify people into low SM (sarcopenic) versus normal SM (non-sarcopenic). A Cox regression was applied to find independent associations between sarcopenia and 30-day survival. Results The study involved 99 patients, 56% male, mean-age of 61.6 years old, BMI 24.19 ± 4.49 kg/m2; hospital mortality was 26%. According to BMI, 19.4% of the patients were underweight. However, a poor correlation was observed between BMI and SM index by CT: R2 = 0.39, P Conclusion Sarcopenia assessed by abdominal CT demonstrated low correlation with BMI and was a risk factor for lower 30-day survival, higher hospital mortality and higher complications in critically ill patients.
TL;DR: Evidence is found indicating consumption of honey can decrease total cholesterol, TG and LDL and increase HDL in healthy young subjects, but intake of sucrose increase totalolesterol, TG, LDL and HDL and decreased HDL.
Abstract: Summary Background and aims Several studies have demonstrated that honey consumption has beneficial effects on cardiovascular disease indicators. The current study aimed to investigate the effect of honey consumption compared with sucrose on lipid profile among young healthy subjects. Methods Sixty healthy subjects, aged 18–30 years, were randomly recruited into this double blind randomized trial and assigned into two groups: honey (received 70 g honey per day) and sucrose (received 70 g sucrose per day) groups. Total cholesterol, TG, LDL and HDL were measured in the control and intervention groups at the beginning and end of study. Results In this trial, the baseline FBS, SBP and DBP were not different between honey and sucrose groups (P > 0.3). We found evidence indicating consumption of honey can decrease total cholesterol, TG and LDL and increase HDL in healthy young subjects, but intake of sucrose increase total cholesterol, TG and LDL and decreased HDL. In all of these analyses, confounding variable including age, physical activity and some nutrient intake were adjusted. Conclusions Honey consumption can improve the lipid profile such as; total cholesterol, TG and LDL and increase HDL, but consumption of sucrose increases total cholesterol, TG and LDL and decreases HDL. Further clinical trial studies are required to confirm our findings.
TL;DR: It is demonstrated that probiotics could be a promising target in hemodialysis patients with the capability of decreasing serum phenolic uremic toxins in this population.
Abstract: Summary Background Uremic toxins such as p-cresol and phenol are suggested to be associated with higher mortality in hemodialysis patients. The aim of this study was to investigate the effects of probiotics on some serum uremic toxin levels in hemodialysis patients. Methods Patients undergoing hemodialysis in a university dialysis center were enrolled in this randomized controlled double blind clinical trial. The patients received probiotic (Lactobacillus Rhamnosus) for duration of 4 weeks. All data were presented as the mean ± SD. Statistical analyses were performed by SPSS statistical software. Paired t-test was used to compare pre- and post-treatment p-cresol levels. P values less than .05 were considered statistically significant. Results A total of 42 hemodialysis patients (32 male and 10 female) were enrolled in this study. The mean ± SD age of the patients in Lactobacillus Rhamnosus and placebo groups were 57.05 ± 13.96 and 59.67 ± 15.04 years, respectively. Values of uremic toxins before treatment did not differ statistically between groups but they were significantly lower in Lactobacillus Rhamnosus group compared with placebo group (P Conclusions This study demonstrated that probiotics could be a promising target in hemodialysis patients with the capability of decreasing serum phenolic uremic toxins in this population. Trial registration IRCT20154182017N21 Date:09/12/2016.
TL;DR: Future cachexia trials would likely benefit from studying a single tumour type with earlier stage disease, with probably different dosage depending on the cancer type and its inflammatory profile.
Abstract: SUMMARY Objectives Cancer cachexia is characterised by a progressive loss of muscle, resulting in functional impairment and shorter survival. Therefore, omega-3 has been studied for its role as an anti-cachectic therapy. This systematic review identified studies published on use of omega-3 in cancer cachexia in order to examine the potential benefit. Methods A systematic review of the literature using PubMed and B-on databases was conducted to identify clinical trials published between 2000 and 2015, to evaluate the effect of n-3 PUFAs on nutritional features and Quality of Life in cancer cachexia. Of 140 publications, 7 were selected on the basis of their methodological quality, according to the Delphi List. The collected data was summarized and written in text format and in tables. Results Only one study, made in pre-cachectic population, show statistically and clinically positive intervention. No benefits were observed with the 4 g EPA/day, but a potentially clinically relevant treatment effect with 2 g EPA/day. Lung tumours showed the highest CRP levels and while the weight of patients with gastrointestinal cancer increased significantly, patients with lung cancer showed no significant response. Conclusions Future cachexia trials would likely benefit from studying a single tumour type with earlier stage disease, with probably different dosage depending on the cancer type and its inflammatory profile.
TL;DR: Multi-faceted system-level approach to nutrition care, including changes to dietary and mealtime care processes, was associated with measureable and sustained improvements in nutritional intake of older inpatients over a seven year period.
Abstract: Background & aims Interventions such as oral nutritional supplements (ONS), fortified meals and mid-meals, feeding assistants and Protected Mealtimes have shown some impact on nutritional intake in research studies, but embedding them in practise remains challenging. This study monitored nutritional intake of older medical inpatients as dietary and mealtime interventions were progressively implemented into routine practise. Methods Series of three prospectively evaluated patient cohorts allowed comparison of nutritional intake of 320 consented medical inpatients aged 65 + years: cohort 1 (2007-8), cohort 2 (2009) and cohort 3 (2013-14) as nutrition care interventions were progressively introduced and embedded. Interventions focused on 'assisted mealtimes', fortified meals and mid-meals, and ONS. Energy and protein intake were calculated from visual plate waste of individual meal and mid-meal components on day 5 of admission. Nutrition care processes were evaluated by mealtime audits of diet type, assistance and interruptions on the same day. One-way ANOVA and chi square tests were used for comparison between cohorts. Results Significant, progressive improvements in energy and protein intake were seen between cohorts (energy: cohort 1: 5073 kJ/d; cohort 2: 5403 kJ/d; cohort 3: 5989 kJ/d, p = 0.04; protein: cohort 1: 48 g/d, cohort 2: 50 g/d, cohort 3: 57 g/d, p = 0.02). Greater use of fortified meals and mid-meals and sustained improvements in mealtime assistance likely contributed to these improvements. Conclusions Multi-faceted system-level approach to nutrition care, including changes to dietary and mealtime care processes, was associated with measureable and sustained improvements in nutritional intake of older inpatients over a seven year period.
TL;DR: The Asia-Pacific and Middle East Working Group on Nutrition in the ICU has identified major areas of uncertainty in clinical practice for healthcare professionals providing nutrition therapy in Asia- Pacific and the Middle East and developed a series of consensus statements to guide nutrition therapy on managing the nutritional requirements of critically ill patients in the intensive care unit (ICU).
Abstract: Summary Background & aims Guidance on managing the nutritional requirements of critically ill patients in the intensive care unit (ICU) has been issued by several international bodies. While these guidelines are consulted in ICUs across the Asia–Pacific and Middle East regions, there is little guidance available that is tailored to the unique healthcare environments and demographics across these regions. Furthermore, the lack of consistent data from randomized controlled clinical trials, reliance on expert consensus, and differing recommendations in international guidelines necessitate further expert guidance on regional best practice when providing nutrition therapy for critically ill patients in ICUs in Asia–Pacific and the Middle East. Methods The Asia–Pacific and Middle East Working Group on Nutrition in the ICU has identified major areas of uncertainty in clinical practice for healthcare professionals providing nutrition therapy in Asia–Pacific and the Middle East and developed a series of consensus statements to guide nutrition therapy in the ICU in these regions. Results Accordingly, consensus statements have been provided on nutrition risk assessment and parenteral and enteral feeding strategies in the ICU, monitoring adequacy of, and tolerance to, nutrition in the ICU and institutional processes for nutrition therapy in the ICU. Furthermore, the Working Group has noted areas requiring additional research, including the most appropriate use of hypocaloric feeding in the ICU. Conclusions The objective of the Working Group in formulating these statements is to guide healthcare professionals in practicing appropriate clinical nutrition in the ICU, with a focus on improving quality of care, which will translate into improved patient outcomes.
TL;DR: Use of EFPC compared to SEF was associated with significantly higher total energy, carbohydrate, protein, lipid, enteral volume and fluid intake, and the importance of avoiding protein debt in provision of nutrition therapy and the likelihood of deterioration of nutritional status in elderly neurocritical care patients.
Abstract: Summary Objective To compare use of standard enteral formula versus enteric formula with prebiotic content in terms of nutrition therapy related outcomes among neurocritical care patients. Methods A total of 46 adult neurocritical care patients who received nutrition therapy with standard enteral formula (SEF group; n = 23) or enteral formula with prebiotic content (EFPC group; n = 23) during their hospitalization in intensive care unit (ICU) were included in this prospective randomized controlled study. Data on patient demographics (age, gender), diagnosis, co-morbid diseases, anthropometrics, length of stay (LOS) in hospital and ICU, Nutritional Risk Screening (NRS-2002) score, and Acute Physiology and Chronic Health (APACHE-II) score were recorded at enrollment. Data on daily nutritional intake [total energy (kcal/day), carbohydrate (g/day), protein (g/day), lipid (g/day), FOS (g/day), enteral volume (ml/day), fluid in enteral product (ml/day) and fluid intake (ml/day)], achievement of target dose [total fluid intake in enteral product (ml)/20 h], laboratory findings (blood biochemistry and complete blood count), complications and drug treatments were recorded on Day 1, Day 4, Day 7, Day 14 and Day 21 of nutrition therapy in SEF and EFPC groups. Results Use of EFPC compared to SEF was associated with significantly higher total energy, carbohydrate, protein, lipid, enteral volume and fluid intake (p values ranged from Conclusions In conclusion, our findings revealed achievement of target nutritional intake in majority of neurocritical care patients via nutrition therapy, whereas EFPC was associated with a non-significant tendency for more frequent and earlier achievement of target dose along with significantly lower rate and faster amelioration of diarrhea as compared with SEF group. Prealbumin and albumin levels remained below the normal range, whereas C reactive protein (CRP) and white blood cell (WBC) were over the normal range throughout the nutrition period in both groups, while creatinine and urea levels were higher in EFPC than in SEF group. Hence, our findings seem to emphasize the importance of avoiding protein debt in provision of nutrition therapy and the likelihood of deterioration of nutritional status in elderly neurocritical care patients despite provision of early enteral nutrition support due to complex and deleterious inflammatory and metabolic changes during critical illness.
TL;DR: In PICU patients with acute respiratory failure, EEN is associated with shorter PICu and overall length of stay and delivery of higher percentage of goal Kcal and protein by tube feeds.
Abstract: Summary Background and aims Children who are critically ill undergo metabolic stress and it is important that they receive adequate calories and protein in order to recover. Our objective was to investigate the impact of early enteral nutrition (EEN) on pediatric intensive care (PICU) patients with acute respiratory failure. Methods A retrospective cohort study was performed on all patients admitted to a 20 bed PICU at a tertiary children's hospital over a 30 month period. Inclusion criteria were: intubation on admission or within 24 h of admission, ventilation over 48 h and enteral nutrition initiated on ventilatory support. Baseline patient characteristics and nutritional, ventilatory and overall outcome data were collected. Subgroup analysis was performed comparing those that received EEN (goal in 72 h) and those that did not. Results Patients that received EEN had a shorter PICU and overall length of stay 8.7 vs 10.7 and 17.5 vs 22; p Conclusions In PICU patients with acute respiratory failure, EEN is associated with shorter PICU and overall length of stay and delivery of higher percentage of goal Kcal and protein by tube feeds. Feeds are commonly interrupted despite efforts to achieve EEN and patients receiving vasoactive agents have feeds held more commonly for perceived intolerance.
TL;DR: The Parenteral Nutrition Impact Questionnaire (PNIQ), a patient-centric measure of quality of life specific to people using HPN, was produced to illustrate how patients' lives are affected by HPN.
Abstract: Summary Background & Aims Several studies have been published reporting on the impact of Home Parenteral Nutrition (HPN) on the lives of people with Type 3 Intestinal Failure. These studies focused on symptoms and functional limitations resulting from the treatment. The aim of this study was to determine how dependence on HPN affects individuals' ability to fulfil their human needs. Methods Unstructured qualitative interviews were conducted with people dependent on HPN, who were asked to explain how their lives were affected by the treatment. Theoretical thematic analysis was conducted on the interview transcripts to identify statements describing aspects of human needs that were left unfulfilled. Care was taken to separate the impact of HPN from that of the underlying disease. Results Interviews were conducted with 30 patients (53% female; mean age, 55.9 (range 35–76) years). Most of the sample (87%) had short bowel syndrome. Major aspects of need affected by HPN were related to: autonomy, cognition, relationships, role fulfilment, socialisation, appearance and self-esteem, appetite and perceived vulnerability. Conclusions The study illustrates how patients' lives are affected by HPN. Statements generated from this qualitative study were used to produce the Parenteral Nutrition Impact Questionnaire (PNIQ), a patient-centric measure of quality of life specific to people using HPN.
TL;DR: Flavour and sensory-based ranking of in-between-meals opens the possibility to design new in- Between-Meals to old adults with dysphagia, by choosing the most liked in-ones to offer the target group.
Abstract: Summary Background and aims Old adults suffering from dysphagia have difficulties swallowing, chewing and/or eating, and are therefore at high risk of undernutrition. In-between-meals that are texture modified are of particular importance for people suffering from dysphagia. To meet their adequate daily amount of food intake they are recommended to eat 3–5 in-between-meals daily. The aim of the current pilot study was to identify the most liked in-between-meals for old adults based on flavour and describe the basic sensory properties of these in-between-meals. Following, the equality between flavour and appearance-based preferences was investigated. Methods From three nursing homes 30 old adults aged 70 years or older suffering from dysphagia were recruited. They were assessing 20 texture modified in-between-meals based on their flavour and appearance on a 3 point hedonic scale. Results When participants were asked to assign liking based on flavour, the most liked in-between-meals were frozen, cold and sweet (vanilla ice cream, strawberry parfait and panna cotta). These meals were among the in-between-meals richest in fat and energy. Liking based on flavour and appearance was equal in 18 out of 20 samples. Furthermore, nutritional and sensory characteristics of the preferred meals were described. Conclusion Flavour and sensory-based ranking of in-between-meals opens the possibility to design new in-between-meals to old adults with dysphagia, by choosing the most liked in-between-meals to offer the target group.
TL;DR: Neonates and Infants tolerate feeds immediately following congenital heart repairs, and feeds appear to decrease duration of mechanical ventilation and duration of ICU stay.
Abstract: Summary Objective To assess the feasibility of initiating enteral nutrition support with first 24 h of congenital heart repairs in neonates and Infants and its impact on outcomes following surgery. Design It is a prospective randomized control single blind study. Setting It is a single centre prospective study carried out in a tertiary care centre at Pediatric cardiac intensive care unit. Patients All patients with the cyanotic congenital heart disease with increase pulmonary blood flow, weighing less than 5 kg and undergoing congenital heart repair during the study period were included in the study. Patients with single ventricle status, those undergoing palliative procedures (PA band), open chest, requiring ECMO before leaving operating room, having any other contraindication for starting enteral feeding or those who refuse for consent were excluded from study. Interventions The patients were randomized into two groups. Group 1 received trophic feeds (10–20 ml/kg/day) starting 4–6 h after surgery while feeds children in group 2 were kept NPO and received feeds after 48 h after surgery. Measurements and main results 15 children enrolled in both the groups. Both pre-operative and intraoperative variables were comparable in both the groups. There was no complication (vomiting, diarrhea, NEC, bowel necrosis) noted in the children who received feeds after surgery. Mean duration of mechanical ventilation in the feeds group was 58.2 ± 4.71 h, which was less then significantly less than those in the NPO group (P value 0.05). Similarly, duration of ICU stay was only 179.04 ± 41.28 h in feeds group as compared to 228.72 ± 85.44 h in the NPO group. Conclusions Neonates and Infants tolerate feeds immediately following congenital heart repairs. Moreover, feeds appear to decrease duration of mechanical ventilation and duration of ICU stay.
TL;DR: Long-term high consumption of potato (each serving a day increase) may be strongly associated with increased risk of diabetes, and the findings suggest that diet-health policy may be of importance in the prevention of diabetes.
Abstract: Summary Background & aims High potato intake has been suggested as a risk factor for the development of type 2 diabetes. We aimed to investigate the association between potato consumption and risk of type 2 diabetes. Methods A systematic review was conducted on PubMed and Embase from the database commencement until September 2017 (updated by June 2018) following the MOOSE guidelines. The random effect model dose–response meta-analysis method of Greenland and Longneck was used to estimate the maximally adjusted log hazard ratio (HR) for a unit (serving per day) increment of potato consumption. A restricted cubic spline model with three knots was used to evaluate the potential non-linear relationship. Results A total of 3544 citations were retrieved from the databases, of which six prospective cohort studies including 4545230 person-year of follow-up and 17,758 diabetes cases met the inclusion criteria. The pooled dose–response HR per an increment of 1 serving/day of total potato consumption was 1.20 (95% CI 1.13 to 1.127, P Conclusion Long-term high consumption of potato (each serving a day increase) may be strongly associated with increased risk of diabetes. These findings suggest that diet–health policy may be of importance in the prevention of diabetes.
TL;DR: Low adherence to nutritional treatment in the community is shown, with patients who were edentulous, with more depression symptoms, or lower BMI were significantly more likely to adhere to ONS than patients with full dentition, fewer depression Symptoms, and higher BMI.
Abstract: Summary Background & aims Data on the continuity of nutritional care in the transition from the hospital to the community is scarce although its impact on medical complications is highly significant. The aim of the current study is to determine level of adherence to dietary recommendations after hospitalization and identify barriers for adherence. Methods A prospective study among patients age ≥65 who were treated with oral nutritional supplements (ONS) during their hospitalization and discharged with dietary recommendations. Data was obtained in the hospital and at a 3-month home-visit. Adherence was assessed monthly and barriers for non-adherence were determined. Adherence levels were summed for 3 months and then divided into: 1. Full adherence: complete consumption as prescribed; 2. Partial adherence: partial consumption of the prescription [at least half]; or 3. No adherence: not consumed or less than half. Health-status was obtained from medical records; nutritional-status using anthropometric measurements, depressive symptoms using GDS [Geriatric Depression Scale], and functional abilities using FIM [Functional Independence Measure] were determined. Dietary intake was assessed by 24-h recall. Results Eighty-six patients were recruited (56 women) and followed for 3-months after discharge; 47.7% were advised in their discharge letter to consume at least one liquid ONS daily, 29% daily powder ONS, and 23.3% were advised to consume both. Adherence with liquid ONS was significantly higher among both groups, p Conclusions Our results show low adherence to nutritional treatment in the community. Improving hospital-community communication is required.
TL;DR: Omega-3 capsule as a safe over-the-counter supplement might be helpful in reducing the signs of depression and also body weight in patients with co-morbidity of depressed and obesity.
Abstract: Summary Purpose We aimed to evaluate the effects of the omega-3 supplementation on body weight and depression among women with co-morbidity of depression and obesity seeking weight reduction compared with the placebo. Methods Sixty five patients with co-morbidity of depression and overweight/obesity (BMI ≥ 25) signed the informed consent form and enrolled into this 12-week double-blind, placebo-controlled randomized clinical Trial. Subsequently, participants randomly assigned into one of the two groups receiving daily 6 capsules of omega-3 (each capsule containing 180 mg EPA, and 120 mg DHA) or 6 capsules of placebo (two with each meal). We performed body composition assessments and Beck depression inventory at the baseline, and weeks 2, 4, 8, and 12 after the start of the study. One month after stopping the capsules at the follow-up visit, weight was measured to compare weight relapse between the two groups. Results Forty five patients finished the study. No significant differences were seen between groups regarding demographic and clinical variables at baseline. Using repeated measures ANOVA, omega-3 significantly reduced depression compared with the placebo (P = 0.05). Mean ± SD weight reduction in omega-3 group 3.07 ± 3.4 kg and in the placebo group was 1.16 ± 2.7 kg and the difference between groups was significant using independent sample t-test (p = 0.049). Patients in the omega-3 group did not show significantly more side effects compared to the placebo but they were not successful in preventing weight regain one month after the end of the study. Conclusion Based on our findings omega-3 capsule as a safe over-the-counter supplement might be helpful in reducing the signs of depression and also body weight in patients with co-morbidity of depression and obesity.
TL;DR: Normalization of gut permeability was observed in 13% of patients during probiotic treatment, however, none of the previously described effects could be confirmed.
Abstract: Summary Background A potential positive effect of probiotics in cystic fibrosis (CF) on fecal calprotectin (FCP), pulmonary exacerbations and weight has been described in small controlled trials. Methods A double-blind multicenter cross-over study (2 × 4 m) was performed looking at abdominal pain, nutritional status, pulmonary function, pulmonary exacerbation, FCP and lactulose/mannitol gut permeability test. Patients kept a diary with daily scoring of abdominal pain, stool frequency and consistency as well as treatment changes. Results 31 CF patients entered the study of which 25 finished it. At start patients aged 9.3yrs (6.9–12.2), had a median BMI z-score of −0.5 (−1.5–0.08), height z-score of −0.4 (−1.1–0.05) and FEV1% of 100% (87.2–106.6). Median FCP at start was 61 μg/g (17–108) and gut permeability 0.079 (0.051–0.122). No significant changes were observed in the clinical parameters (BMI, FEV1%, abdominal pain, exacerbations). Despite being frequently abnormal (17/28 (61%) >50 mg/kg), FCP did not change significantly with probiotics. The proportion of patients with normal permeability was 8% during placebo and 32% during probiotic treatment (p = 0.031). FCP correlated to BMI z-score (p = 0.043) and gut permeability to abdominal pain (p = 0.015). The microbiome revealed a high predominance of Actinobacteria and Proteobacteriae. Probiotic supplementation did not result in a shift at the phylum nor at phylogenetic level. Conclusion Normalization of gut permeability was observed in 13% of patients during probiotic treatment. However, none of the previously described effects could be confirmed.