Nutrition in Clinical Practice 

About: Nutrition in Clinical Practice is an academic journal published by SAGE Publishing. The journal publishes majorly in the area(s): Parenteral nutrition & Medicine. It has an ISSN identifier of 0884-5336. Over the lifetime, 3018 publications have been published receiving 62431 citations. The journal is also known as: NCP.

Effects of Gut Microbes on Nutrient Absorption and Energy Regulation

Abstract: Malnutrition may manifest as either obesity or undernutrition. Accumulating evidence suggests that the gut microbiota plays an important role in the harvest, storage, and expenditure of energy obtained from the diet. The composition of the gut microbiota has been shown to differ between lean and obese humans and mice; however, the specific roles that individual gut microbes play in energy harvest remain uncertain. The gut microbiota may also influence the development of conditions characterized by chronic low-level inflammation, such as obesity, through systemic exposure to bacterial lipopolysaccharide derived from the gut microbiota. In this review, the role of the gut microbiota in energy harvest and fat storage is explored, as well as differences in the microbiota in obesity and undernutrition.

Diet and Inflammation

Abstract: The emerging role of chronic inflammation in the major degenerative diseases of modern society has stimulated research into the influence of nutrition and dietary patterns on inflammatory indices. Most human studies have correlated analyses of habitual dietary intake as determined by a food frequency questionnaire or 24-hour recall with systemic markers of inflammation like high-sensitivity C-reactive protein (HS-CRP), interleukin-6 (IL-6), and tumor necrosis factor alpha (TNF-α). An occasional study also includes nutrition analysis of blood components. There have been several controlled interventions which evaluated the effect of a change in dietary pattern or of single foods on inflammatory markers in defined populations. Most studies reveal a modest effect of dietary composition on some inflammatory markers in free-living adults, although different markers do not vary in unison. Significant dietary influences have been established for glycemic index (GI) and load (GL), fiber, fatty acid composition, magnesium, carotenoids, and flavonoids. A traditional Mediterranean dietary pattern, which typically has a high ratio of monounsaturated (MUFA) to saturated (SFA) fats and ω-3 to ω-6 polyunsaturated fatty acid (PUFAs) and supplies an abundance of fruits, vegetables, legumes, and grains, has shown anti-inflammatory effects when compared with typical North American and Northern European dietary patterns in most observational and interventional studies and may become the diet of choice for diminishing chronic inflammation in clinical practice.

Probiotic Prophylaxis in Predicted Severe Acute Pancreatitis: A Randomised, Double-Blind, Placebo-Controlled Trial

Abstract: Background: Infectious complications and associated mortality are a major concern in acute pancreatitis. Enteral administration of probiotics could prevent infectious complications, but convincing evidence is scarce. Our aim was to assess the effects of probiotic prophylaxis in patients with predicted severe acute pancreatitis. Methods: In this multicenter randomized, double-blind, placebo-controlled trial, 298 patients with predicted severe acute pancreatitis (Acute Physiology and Chronic Health Evaluation [APACHE II] score ≥8, Imrie score ≥3, or C-reactive protein> 150 mg/L) were randomly assigned within 72 h of onset of symptoms to receive a multispecies probiotic preparation (n = 153) or placebo (n = 145), administered enterally twice daily for 28 days. The primary endpoint was the composite of infectious complications—i.e., infected pancreatic necrosis, bacteremia, pneumonia, urosepsis, or infected ascites—during admission and 90-day follow-up. Analyses were by intention to treat. This study is regis...

Short-chain fatty acids: ready for prime time?

Abstract: The concept of colonic health has become a major target for the development of functional foods such as probiotics, prebiotics, and synbiotics. These bioactive agents have a profound effect on the composition of the microflora, as well as on the physiology of the colon, and display distinct health benefits. Dietary carbohydrates escaping digestion/absorption in the small bowel and prebiotics undergo fermentation in the colon and give rise to short-chain fatty acids (SCFA). As the main anions of the colon and the major source of energy for colonocytes, SCFA are rapidly absorbed by nonionic diffusion mostly but also by active transport mediated by a sodium-coupled transporter, thereby fostering the absorption of sodium and water. SCFA in general and butyrate in particular enhance the growth of lactobacilli and bifidobacteria and play a central role on the physiology and metabolism of the colon. The effect of prebiotics on cell proliferation, differentiation, apoptosis, mucin production, immune function, mineral absorption, lipid metabolism, and gastrointestinal (GI) peptides has been well documented experimentally. These effects seem to be largely mediated by SCFA, but evidence from human studies remains inconsistent. The food industry is making a leap of faith in their efforts to commercialize prebiotics and exploit potential health benefits. The future lies with the design of studies to further explore basic mechanisms, and gene expression in particular, but emphasis should be placed on human intervention trials.

Guidelines for the prevention of intravascular catheter-related infections: Centers for Disease Control and Prevention.

Abstract: MMWR 51:1–30, 2002 Debra S. Kovacevich, RN, MPH*; and Lorelei F. Papke, RN, MSN, CRNI† *Department of Home Care Services, College of Pharmacy, and †Vascular Access Service, Department of Pharmacy, College of Pharmacy, University of Michigan, Ann Arbor Since 1983, the Centers for Disease Control and Prevention have been providing healthcare practitioners with guidelines based on evidence for the prevention of catheter-related infection. This latest report was developed by a working group representing various organizations and disciplines from the fields of infection control, critical care medicine, infectious disease, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. As per the previous guidelines published in 1983 and 1996, each recommendation is categorized based on existing scientific data, theoretical rationale, applicability, and economic impact. The categories are listed as follows: Category IA—strongly recommended for implementation and strongly supported by well-designed experimental, clinical, or epidemiologic studies; Category IB—strongly recommended for implementation and supported by some experimental, clinical, or epidemiologic studies, and a strong theoretical rationale; Category IC—required by state or federal regulations, rules, or standards; Category II—suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical rationale; and Unresolved Issue—an unresolved issue for which evidence is insufficient or no consensus regarding efficacy exists. In the past, the guidelines were intended for use in hospitals and acute care with the recommendation of adapting them for use in home care and outpatient areas. They are now recommended to be used across the health continuum. Overall, the guidelines are much easier to read. The working group placed catheter types into their respective categories instead of listing them separately. For instance, peripheral venous catheter recommendations incorporate midline catheter information, and central venous catheter recommendations include peripherally inserted central catheters (PICC), hemodialysis, and pulmonary artery catheters. The paper also has two appendices for reference purposes. One contains examples of clinical and surveillance definitions for primary bloodstream infection (BSI), and the second is a summary of the recommended frequency for the replacement of catheters, dressings, administration sets, and fluids. There are major areas that have been included into the paper. These include the following: (1) suggestions for performance indicators that organizations can monitor to reduce the incidence of catheter-related bloodstream infection (Category IA); (2) the use of maximal sterile barrier precautions inclusive of mask, cap, sterile gown, sterile gloves, and large sterile sheet for the insertion and guidewire changes of central venous catheters (CVCs), including PICCs (Category IA); (3) preference of a 2% chlorhexidinebased preparation for insertion and catheter site care, although tincture of iodine and iodophor or 70% alcohol may be used (Category IA); (4) the use of antimicrobialor antiseptic-impregnated catheters should be used in adults whose catheters are to remain in place for 5 days if the institution’s BSI rate is greater than benchmark rates and if other infection control measures have failed (Category IB); (5) central catheters and midline catheters should not be routinely replaced to decrease the risk of infection (Category IB); and (6) the importance of educational programs and competency testing for clinicians responsible for the insertion and care of venous catheters (Category IA). Evidence-based documentation in refereed journals and clinical competencies has demonstrated that specially trained personnel decrease the potential for catheter-related bloodstream infections (CRBSI). In the guidelines there is a lengthy discussion concerning the morbidity and mortality of patients requiring central venous access and the substantial financial burden CRBSI places on the healthcare system. Numerous studies have demonCorrespondence: Debra S. Kovacevich, RN, MPH, University of Michigan, Homemed, 2850 S. Industrial Hwy Ste 50, Ann Arbor, MI 48104-9821. Electronic mail may be sent to debbiek@ umich.edu.