Showing papers on "Clinical nutrition published in 1997"

Nutrition Support in Clinical Practice: Review of Published Data and Recommendations for Future Research Directions

Abstract: In the last 30 years, marked advances in enteral feeding techniques, venous access, and enteral and parenteral nutrient formulations have made it possible to provide nutrition support to almost all patients. Despite the abundant medical literature and widespread use of nutritional therapy, many areas of nutrition support remain controversial. Therefore, the leadership at the National Institutes of Health, The American Society for Parenteral and Enteral Nutrition, and The American Society for Clinical Nutrition convened an advisory committee to perform a critical review of the current medical literature evaluating the clinical use of nutrition support; the goal was to assess our current body of knowledge and to identify the issues that deserve further investigation. The panel was divided into five groups to evaluate the following areas: nutrition assessment, nutrition support in patients with gastrointestinal diseases, nutrition support in wasting diseases, nutrition support in critically ill patients, and perioperative nutrition support. The findings from each group are summarized in this report. This document is not meant to establish practice guidelines for nutrition support. The use of nutritional therapy requires a careful integration of data from pertinent clinical trials, clinical expertise in the illness or injury being treated, clinical expertise in nutritional therapy, and input from the patient and his/her family.

Home parenteral nutrition: a systematic review.

Abstract: Objectives The objective of this Review was to locate, appraise and summarise evidence from scientific studies on home parenteral nutrition (HPN) in order to answer specific research questions on the effectiveness of this technology. The following questions were asked. What patients have received HPN? What has been the experience of patients on HPN programmes? How have HPN programmes been organised, and what techniques and equipment have been used, and to what effect? What comparative information is available on effectiveness? What evidence exists for the cost-effectiveness of HPN? What questions about the provision of HPN could be answered with additional research, and what studies would be most suitable? Data sources A comprehensive list of studies was provided by an extensive search of electronic databases (including MEDLINE, Embase, Science Citation Index, Uncover, Cinahl, Caredata, Food Science and Technology Abstracts, NTIS, Pascal, Psychlit, and Economic Literature Index), relevant journals (including Journal of Parenteral and Enteral Nutrition, Clinical Nutrition, American Journal of Clinical Nutrition, Nutrition, Clinical Gastroenterology, Nutrition Reviews, Annals of Nutrition and Metabolism, Nutrition and Cancer, Nutrition and Health, and Journal of Paediatric Nutrition and Metabolism), and scanning of reference lists, as well as other search strategies outlined in the protocol. Study selection Studies relevant to the questions were selected. The inclusion criteria were fairly broad because of the quality of the studies located. Data extraction Data extraction forms were used to collect data from studies included in the review. The data was checked by a second researcher to reduce error. Data synthesis Quantitative analysis was difficult owing to the type of studies located. The data is discussed in a qualitative manner. Where complication rates have been given, we have attempted to combine the results in a quantitative manner. Results The age and sex of patients on HPN varies according to the underlying disease but, on the whole, patients are young (see Tables 4a and 4b). There are trends showing an increased use of the technology at the extremes of the age range. There are marked differences between countries on the underlying diseases for which HPN is indicated. For example, many more patients with an underlying malignancy are treated in Italy and the USA than in the UK (40-67% versus 8%). Morbidity rates for the majority of patients are acceptable (see Table 8), the complications tend to be related to the central venous catheter. It is fairly clear that a minority of patients are susceptible to recurrent problems and that many patients have very few complications. The mortality rate for HPN patients (see Table 10) was good for those patients with benign underlying disease (for example, 5% of Crohn's HPN patients die per year), and there are very few reports of patients dying from complications of the technology. The survival of those with malignant disease and AIDS is poor, almost all having died from the underlying disease at one year; despite this, most programme growth worldwide is due to an increase in the numbers of patients with these diagnoses (see Table 5). Quality of life is reasonable for patients with benign disease (see Table 9); no studies were found that examined the quality of life of HPN patients with malignant disease. Economic analysis shows that the cost of HPN treatment is cheaper than the alternative of in-patient care (see Table 18). There is a paucity of comparative studies examining different aspects of the technology, and this accounted for the majority of gaps in the evidence. Conclusions The use of HPN for benign intestinal failure is supported by evidence from the scientific studies located. There are, however, large gaps in the evidence, particularly relating to the use of HPN in malignant disease and AIDS. A programme of research is suggested at the end of this review.

Clinical Nutrition in Pancreatitis

Abstract: In patients with acute pancreatitis or an acute flare of chronic pancreatitis, a discrepancy exists between increased protein/calorie requirements induced by a hypermetabolic stress state and reduced ingestion/assimilation of exogenous nutrients, which promotes progressive nutritional deterioration. Patients with severe pancreatitis (defined by > or =3 Ranson criteria, an APACHE II score of > or =10, development of major organ failure, and/or presence of pancreatic necrosis) are more likely to require aggressive nutritional support than patients with mild disease. The type of formula and level of the gastrointestinal tract into which nutrients are infused determine the degree to which pancreatic exocrine secretion is stimulated. Animal studies and early prospective randomized controlled trials in humans suggest that total enteral nutrition via jejunal feeding may be the preferred route to parenteral alimentation in this disease setting.

Handbook Of Clinical Nutrition

Abstract: Health promotion and disease prevention nutrients - metabolism, requirements and sources childhood and adolescence ageing hospital-associated malnutrition nutritional assessment nutritional support - general approach and complications the nutrition support team therapeutic diets enteral nutrition parental nutrition drug-nutrient interactions obesity diabetes hypertension cardiovascular disease cancer gastrointestinal and liver diseases critical illness pulmonary disease renal failure nutritional anemias eating disorders metabolic bone disease nutrition, immunity, and AIDS nutrition in organ transplantation.

Pediatric Nutrition Assessment: Identifying Children at Risk

Abstract: Nutrition services are important in the prevention of disabilities as well as in the treatment and/or habilitation of children with chronic illness. Level 1 nutrition care requires some basic knowledge of nutrition to screen for nutritional risk factors, knowledge of and access to referral systems for children identified to be at risk, and ability to use general nutrition education materials. Level 2 involves individualized nutrition assessment and intervention for problems such as anemia, chronic constipation, low- or high-calorie diets, feeding problems, and growth monitoring. Level 3 nutrition services are for children with identified disabilities such as cystic fibrosis, diabetes, and metabolic disorders that require specific complex nutrition interventions. The five major components of assessment of nutritional status in children are: anthropometric, clinical, biochemical, dietary, and feeding skill development. J Am Diet Assoc. 1997; 97(suppl 2):S107–S115.

Nutrition Across the Life Span

Abstract: I: Foundations: Introduction to Nutrition Across the Life Span. Application 1: Assessing and Interpreting Nutrition. Nutrition Assessment. Application 2: A Case for Nutrition Assessment. Nutrition: Communication and Counselling. Application 3: A Case for Nutrition Counselling. II: Growth and Development: Nutrition During Infancy. Application 4: Food for Infants: the Supermarket. The High Risk Infant. Application 5: Inborn Errors of Metabolism. Nutrition During Growth: Preschool and School Years. Application 6: Lunch at School. Nutrition During Adolescence. Application 7: Substance Use During Adolescence. III: Reproduction: Reproduction: Pregnancy. Application 8: Nutrition Care for Pregnant Women. High Risk Pregnancy. Application 9: Health Care and Nutrition Resources for Pregnant Women and Their Offspring. Lactation and Breast-Feeding. Application 10: Counselling for Breast-Feeding Success. IV: The Adult Years: Adulthood. Application 11: Foods, Supplements, Herbs. Aging and Older Adults. Application 12: Program for Older Adults. V: Special Concerns Across the Lifespan. Eating Disturbances: Dietary Restraint, Binging, Purging, And Excessive Consumption. Application 13: Is It Weight, Fat or Health? Nutrition and Physical Activity. Application 14: Are Ergogenic Aids Enhancers of Sports Performance? Nutrition of Persons with Developmental Delays and Disabilities. Application 15: A Case for Nutrition Intervention.

Complications and Costs of Early Postoperative Parenteral Versus Enteral Nutrition in Trauma Patients

Abstract: The objective of this paper is to compare the complications and costs of early postoperative parenteral and enteral nutrition in trauma patients. The research plan was to review the relevant prospective, randomized, clinical trials comparing parenteral with enteral nutrition in trauma patients. Data were pooled and analyzed for infectious and gastrointestinal complications reported in the trials. Economic costs were used to evaluate the therapeutic expense associated with each route of nutrition support. The results indicated that parenteral nutrition has greater infectious complications and greater associated therapeutic costs than enteral nutrition and thus should be used only in cases in which it is truly indicated.

Medical nutrition therapy for patients with osteoporosis.

Abstract: Osteoporosis is a disease of bone fragility that afflicts more than 25 million Americans and costs the economy of the United States approximately $13.8 billion per year. In addition to direct economic costs, osteoporosis frequently costs patients their independence and a decrease in quality of life. Patients with osteoporosis, particularly those with hip fractures, are often older, malnourished persons in need of nutrition assessment and intervention. Such intervention in persons with hip fractures has been shown to be effective in reducing medical costs by decreasing hospital stays and morbidity. We review here a working practice of care at our osteoporosis research center for the medical nutrition therapy of patients with osteoporosis. Medical nutrition therapy includes an evaluation of the patient's health history, social status, and nutrient intake. On the basis of the assessment, a nutrition care plan can be developed and implemented with the goals of improving clinical outcomes and the quality of life for patients and saving health care dollars. J Am Diet Assoc. 1997:97:414–417 .

Clinical nutrition protocols for continuous quality improvements in the outcomes of patients with burns.

Abstract: Multiple guidelines for nutrition services in the postburn period exist Given that nutrition intervention after burn injury affects outcome, it is appropriate to routinely consider methods for improving current practices Effective nutrition therapies for the thermally injured individual are outlined in this article Support for benchmarking these protocols is presented, and the completion of outcomes research in nutrition services for patients with burn injuries is encouraged

Home parenteral nutrition: a systematic review.

Abstract: Objectives The objective of this Review was to locate, appraise and summarise evidence from scientific studies on home parenteral nutrition (HPN) in order to answer specific research questions on the effectiveness of this technology. The following questions were asked. What patients have received HPN? What has been the experience of patients on HPN programmes? How have HPN programmes been organised, and what techniques and equipment have been used, and to what effect? What comparative information is available on effectiveness? What evidence exists for the cost-effectiveness of HPN? What questions about the provision of HPN could be answered with additional research, and what studies would be most suitable? Data sources A comprehensive list of studies was provided by an extensive search of electronic databases (including MEDLINE, Embase, Science Citation Index, Uncover, Cinahl, Caredata, Food Science and Technology Abstracts, NTIS, Pascal, Psychlit, and Economic Literature Index), relevant journals (including Journal of Parenteral and Enteral Nutrition, Clinical Nutrition, American Journal of Clinical Nutrition, Nutrition, Clinical Gastroenterology, Nutrition Reviews, Annals of Nutrition and Metabolism, Nutrition and Cancer, Nutrition and Health, and Journal of Paediatric Nutrition and Metabolism), and scanning of reference lists, as well as other search strategies outlined in the protocol. Study selection Studies relevant to the questions were selected. The inclusion criteria were fairly broad because of the quality of the studies located. Data extraction Data extraction forms were used to collect data from studies included in the review. The data was checked by a second researcher to reduce error. Data synthesis Quantitative analysis was difficult owing to the type of studies located. The data is discussed in a qualitative manner. Where complication rates have been given, we have attempted to combine the results in a quantitative manner. Results The age and sex of patients on HPN varies according to the underlying disease but, on the whole, patients are young (see Tables 4a and 4b). There are trends showing an increased use of the technology at the extremes of the age range. There are marked differences between countries on the underlying diseases for which HPN is indicated. For example, many more patients with an underlying malignancy are treated in Italy and the USA than in the UK (40-67% versus 8%). Morbidity rates for the majority of patients are acceptable (see Table 8), the complications tend to be related to the central venous catheter. It is fairly clear that a minority of patients are susceptible to recurrent problems and that many patients have very few complications. The mortality rate for HPN patients (see Table 10) was good for those patients with benign underlying disease (for example, 5% of Crohn's HPN patients die per year), and there are very few reports of patients dying from complications of the technology. The survival of those with malignant disease and AIDS is poor, almost all having died from the underlying disease at one year; despite this, most programme growth worldwide is due to an increase in the numbers of patients with these diagnoses (see Table 5). Quality of life is reasonable for patients with benign disease (see Table 9); no studies were found that examined the quality of life of HPN patients with malignant disease. Economic analysis shows that the cost of HPN treatment is cheaper than the alternative of in-patient care (see Table 18). There is a paucity of comparative studies examining different aspects of the technology, and this accounted for the majority of gaps in the evidence. Conclusions The use of HPN for benign intestinal failure is supported by evidence from the scientific studies located. There are, however, large gaps in the evidence, particularly relating to the use of HPN in malignant disease and AIDS. A programme of research is suggested at the end of this review.

Clinical pathways in home nutrition support

Abstract: In home-care settings, physicians with various medical specialties may order home enteral and/or parenteral nutrition support. Clinical pathways may be used to provide a clear, concise, standardized method for ordering and monitoring home nutrition support. The clinical pathways should be appropriate for 80% of the patients placed on the pathways, allowing for a 20% variance, or deviation, from the pathway. In one home-care facility, disease-specific clinical pathways have been used for longer than 1 year for patients with a variety of diseases requiring home nutrition support. To determine the usefulness of the home nutrition support clinical pathways, data obtained from 20 patients were analyzed. Patients were followed up while being treated using home nutrition support clinical pathways designed for oncology (9 patients), human immunodeficiency virus/acquired immunodeficiency syndrome (2 patients), short bowel syndrome (6 patients), and hyperemesis (3 patients) for 191 weeks. Overall, an average variance (deviation from the pathway) of 22% (the number of variances divided by the total weeks of therapy) was observed. The use of the pathways to provide enteral or parenteral nutrition facilitated more cost-effective care by following pathway guidelines for obtaining laboratory values and patient visits. Communication between the home-care staff and the physician was also improved. Clinical pathways can enable standardization of care for patients receiving nutrition support at home.

School-Based Health Clinics: The Role for Nutrition

Abstract: There are three primary areas for nutrition intervention in schools: direct nutrition care in a school-based health clinic, school meals, and nutrition education in the classroom and of school staff. Dietitians can positively affect students' nutrition health by providing nutrition guidance in the clinic and by creating a positive nutrition environment in the school through increased nutrition education in the classroom and healthful, tasty meals in the cafeteria. J Am Diet Assoc. 1997;97(suppl 2):S117–S119.

Nutrition Counseling Skills for Medical Nutrition Therapy

Abstract: The Basics of Interviewing and Counseling Skills for Nutrition Counseling Overview of Nutrition Counseling Interviewing Skills Counseling Skills Designing Instructional Plans Application of Interviewing and Counseling Skills Nutrition Counseling in Treatment of Obesity Nutrition Counseling In Prevention and Treatment of Coronary Heart Disease Nutrition Counseling in Treatment of Diabetes Nutrition Counseling in Treatment of Renal Disease Nutrition Counseling in Treatment of Hypertension Nutrition Counseling for Cancer Risk Prevention Nutrition Counseling in Treatment of Anorexia Nervosa and Bulimia Nutrition Counseling in Management of Pregnancy Ending Counseling Sessions Evaluation and Follow-Up

Nutrition and the hospitalized patient: implications for nurses

Abstract: This article, in response to the recent report by the Association of Community Health Councils (CHCs) England and Wales ‘Hungry in Hospital’, explores nutrition in the hospitalized patient. Nutrition is instrumental to health and perhaps, more importantly, ill health. CHCs have a statutory responsibility to monitor the delivery of health care on behalf of the general public. It Is suggested that the issue of nutrition in hospitals is of concern and that there are numerous factors which contribute to this. However, this aspect of patient care is not identified as the specific responsibility of hospital staff. Nurses should play a pivotal role in preventing malnutrition in hospital but, in most cases, they do not. The article concludes with a set of recommendations to improve the nutritional status of patients and stresses the importance of health professionals listening to patients' views.

Paediatric nutrition as a new subspecialty: is the time right?

Abstract: Scientific interest in nutrition in early life preceded the formal development of paediatrics. Building on biochemical studies of the 18th century,1 Franz Simon underpinned a rational, scientific basis for infant feeding with his landmark work in 1838,2 when the word ‘paediatrics’ had not even entered the English language.3 This was 20 years before the first chair of paediatrics in the US and a century before paediatric chairs were created in Britain (1930s). By then, the field of paediatric nutrition had already passed many major milestones,4 for instance the scientific understanding that led to prevention and treatment of infantile scurvy and rickets.5 6 In 1940 the editors of Holt’s Diseases of Infancy and Childhood (11th edition) stated ‘Nutrition in its broadest sense is the most important branch of paediatrics’.7 Given the extraordinary scientific effort and interest over the past two centuries, it is paradoxical that nutrition has never emerged as an independent paediatric specialty, when other areas of much more recent focus have done so. Why should this be so? Firstly, the intensive interest in nutrition largely solved the earlier concerns. With the exception of iron deficiency anaemia, primary nutritional deficiency diseases are now uncommon in the West. Secondly, other specialties have evolved partly from the need to master specialised techniques (for example cardiac catheterisation); yet, until recently there have been few such techniques in clinical nutrition. Thirdly, medical specialties have been based traditionally on organ systems, a categorisation into which a broad, multidisciplinary subject like nutrition does not fit. Consequently, nutrition has been fragmented and subsumed piecemeal into other fields—enteral nutrition into gastroenterology, intravenous feeding into surgery, growth into endocrinology and so forth. However, there has now been a significant shift in thinking about nutrition from a preoccupation with meeting nutrient needs to a …

Clinical Nutrition of Companion Birds

Abstract: Nutritional problems encountered in avian practice include poor feeding management, faulty diets, and birds suffering from disease or trauma and in need of nutritional support. Energy intakes may be inadequate or excessive. Diets may be lacking in vitamins A and D3, calcium, iodine, or essential amino acids. Other problems, such as zinc or iron toxicoses, myopathies, feather loss or depigmentation, and generalized poor doing, may be linked to nutrition. The challenge of nutritional intervention in companion birds is met by using principles of comparative nutrition, with knowledge from studies in psittacine and passerine birds, melded with clinical judgement and ex- perience.

Infant nutrition: implication for somatic growth, adult onset diseases, and oral health.

Abstract: The gold standard for assessing the adequacy of nutrient intake in pediatrics is that diet which promotes optimal growth and development. Thus, it is crucial that our methods for measuring these outcomes be valid, reliable, and widely accepted. A review of the recent medical literature in the field of clinical nutrition indicates that both growth data and dietary standards continue to evolve as more data accrue concerning their applicability in both health and disease. In addition, oral nutrition is clearly a determinant of perhaps the most prevalent infectious disease in pediatrics: dental caries. Research in this field stresses the importance of oral fluoride intake in the prevention of caries, as well as the fact that current efforts at reducing milk-bottle tooth decay are inadequate.

Total parenteral nutrition for patients receiving antineoplastic therapy at a regional oncology unit: a two‐year study

Abstract: The aim of this prospective study was to establish the exact role parenteral nutrition has in the provision of nutritional support to patients receiving antineoplastic therapy. The diagnosis, reasons for implementation, method of delivery and duration of nutritional support were determined. The outcome of nutritional support was established by the percentage change in weight and alteration in body mass index during the period of nutritional support. The results indicate that parenteral nutrition can successfully maintain the body weight of patients who are unable to receive enteral nutrition whilst receiving antineoplastic treatment. However, it is recommended that the provision of parenteral nutrition is evaluated at regular intervals and alternative feeding methods via the enteral feeding route are accessed as soon as possible.