Showing papers on "Clinical nutrition published in 2015"
TL;DR: A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high-quality, cost-effective nutritional care.
Abstract: The Academy of Nutrition and Dietetics (the Academy) and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.), utilizing an evidence-informed, consensus-derived process, recommend that a standardized set of diagnostic indicators be used to identify and document pediatric malnutrition (undernutrition) in routine clinical practice. The recommended indicators include z scores for weight-for-height/length, body mass index-for-age, or length/height-for-age or mid-upper arm circumference when a single data point is available. When 2 or more data points are available, indicators may also include weight gain velocity (<2 years of age), weight loss (2-20 years of age), deceleration in weight for length/height z score, and inadequate nutrient intake. The purpose of this consensus statement is to identify a basic set of indicators that can be used to diagnose and document undernutrition in the pediatric population ages 1 month to 18 years. The indicators are intended for use in multiple settings (eg, acute, ambulatory care/outpatient, residential care). Several screening tools have been developed for use in hospitalized children. However, identifying criteria for use in screening for nutritional risk is not the purpose of this paper. Clinicians should use as many data points as available to identify and document the presence of malnutrition. The universal use of a single set of diagnostic parameters will expedite the recognition of pediatric undernutrition, lead to the development of more accurate estimates of its prevalence and incidence, direct interventions, and promote improved outcomes. A standardized diagnostic approach will also inform the prediction of the human and financial responsibilities and costs associated with the prevention and treatment of undernutrition in this vulnerable population and help to further ensure the provision of high-quality, cost-effective nutritional care.
287 citations
TL;DR: Intolerance occurs frequently during EN in critically ill patients and is associated with poorer nutrition and clinical outcomes, and the sensitivity analysis demonstrated that intolerance remained associated with negative outcomes.
Abstract: Background: We aimed to determine the incidence of enteral feed intolerance and factors associated with intolerance and to assess the influence of intolerance on nutrition and clinical outcomes Methods: We conducted a retrospective analysis of data from an international observational cohort study of nutrition practices among 167 intensive care units (ICUs) Data were collected on nutrition adequacy, ventilator-free days (VFDs), ICU stay, and 60-day mortality Intolerance was defined as interruption of enteral nutrition (EN) due to gastrointestinal (GI) reasons (large gastric residuals, abdominal distension, emesis, diarrhea, or subjective discomfort) Logistic regression was used to determine risk factors for intolerance and their clinical significance A sensitivity analysis restricted to sites specifying a gastric residual volume ≥200 mL to identify intolerance was also conducted Results: Data from 1,888 ICU patients were included The incidence of intolerance was 305% and occurred after a median 3 d
167 citations
TL;DR: There was observed a high prevalence of moderate/severe malnutrition in cancer patients, with the increased risk of malnutrition associated with the presence of factors that can be assessed during hospital admission suggesting a higher alert of the medical and health care staff about the need for nutritional assessment and intervention.
Abstract: The incidence of cancer is increasing worldwide and with it the prevalence of malnutrition, which is responsible for the death of almost 20 % of cancer patients. The objective of this study was to identify the factors associated with malnutrition in hospitalized cancer patients. Cross-sectional study conducted with 277 hospitalized patients in the Institute of Integrative Medicine Prof. Fernando Figueira from March to November 2013. The nutritional status was classified as well-nourished and moderate/severe malnutrition, according to the Patient-Generated Subjective Global Assessment. The association between moderate/severe malnutrition and demographic, behavioral, socioeconomic, clinical, therapeutic and nutritional variables was investigated through univariate regression and hierarchical Poisson models, with a 5 % significance level. The prevalence of malnutrition was 71.1 %, being classified as moderate in 35.4 % and severe in 35.7 %. After multivariate analysis, smokers/ex-smokers low socioeconomic status, performance status ≥2 and age ≥60 years were associated with increased risk of malnutrition. There was observed a high prevalence of moderate/severe malnutrition in cancer patients, with the increased risk of malnutrition associated with the presence of factors that can be assessed during hospital admission suggesting a higher alert of the medical and health care staff about the need for nutritional assessment and intervention.
92 citations
TL;DR: Children in Nairobi had moderate nutrition knowledge and poor dietary practices, associated with negative dietary attitude, and this study recommends activities to raise awareness on the effect ofpoor dietary practices on obesity and related health risks.
Abstract: Kenya is undergoing rapid urbanization resulting in changing lifestyles. Childhood dietary habits are changing and might result in childhood obesity and related health risks. Dietary habits learnt in early life are likely to be carried to adulthood. Nutrition knowledge and positive attitude are known to influence dietary practices. There is paucity of information on nutrition knowledge, attitude and practices of school-children in cities. This study established nutrition knowledge, attitude and practices among urban school children in Nairobi. A cross-sectional study was conducted among 202 school-children aged 8–11 years, systematically sampled from four randomly selected schools. Structured questionnaire, key informant interviews and focus group discussions were used to collect data. A nutrition knowledge score was determined (correct response: 1, incorrect: 0). Overall knowledge level was the total of correct responses in percentages. Scores of ≤40 %, 41–69 % and ≥70 % were categorized as low, moderate and high knowledge respectively. Dietary practices were determined from frequency of food consumption, habitual patterns and attitude on what they ate. Data were analyzed using SPSS. P-value of p < 0.05 was considered significant. Pupils had moderate nutrition knowledge (mean score 5.16 ± 1.6, 51.6 %). 65 % did not care what they ate. About 82 % ate food in front of TV unsupervised. Over 70 % had consumed sweetened beverages and 73 % junk foods in previous 7 days. Only 9 % consumed fruits 4–7 times a week. Almost all study children carried money to school and made decision on foods to buy. Chips, candies, sausages and smokies, doughnuts and chocolate were preferred snacks. Nutrition knowledge had no significant relationship with dietary practices, but attitude had. Children had moderate nutrition knowledge and poor dietary practices, associated with negative dietary attitude. This study recommends activities to raise awareness on the effect of poor dietary practices on obesity and related health risks.
82 citations
TL;DR: Traditional screening and assessment tools did not uniformly identify patients as malnourished or at nutrition risk in the ICU and therefore may be inappropriate for use in this population.
Abstract: Background: Identifying patients at nutrition risk proves difficult in the intensive care unit (ICU) due to the nature of critical illness. No consensus exists on the most appropriate method to identify these patients. Traditional screens and assessments are often limited due to their subjective nature. The purpose of the quality improvement project was to compare proportions of ICU patients deemed at nutrition risk using 3 different tools. Material and Methods: A convenience sample of 294 patients admitted to the ICU was used. Patients were assessed using the institution’s routine nutrition screening method, the Subjective Global Assessment (SGA), and the NUTrition Risk in Critically ill (NUTRIC) score. Information was collected on demographics, severity of illness, hospital and ICU length of stay (LOS), and disposition. Descriptive statistics were used to examine counts/proportions of risk categories; means ± SD were used to summarize demographic and clinical variables. Results: A total of 139 patients ...
79 citations
TL;DR: Nutritional assessment is a comprehensive assessment of dietary intake, anthropometrics, and physical examination often conducted by dietitians or geriatricians after simple screening has identified at-risk patients.
72 citations
TL;DR: Focusing attention on improving nutrition early in the lives of children with CP affords families and care providers with a unique opportunity for intervention, which may result in better outcomes for the children.
64 citations
TL;DR: Young children, and particularly boys, accumulate more MVPA in care compared to at home and future research should identify factors accounting for this difference and consider targeting non-care time in intervention efforts to increase higher-intensity activity and decrease sedentary time in preschoolers.
Abstract: Young children are thought to be inactive in childcare, but little is known about location-specific activity levels. This observational study sought to describe the in-care and out-of-care activity patterns of preschool-aged children and explore differences in physical activity level by childcare attendance. Three to four-year-old children were recruited from 30 preschool and nursery ‘settings’ in Cambridgeshire, UK. Average minutes per hour (min/h) spent sedentary (SED), in light physical activity (LPA) and in moderate-to-vigorous PA (MVPA) were measured by accelerometry for up to 7 days (mean: 6.7 ± 1.1). Weekly childcare attendance patterns were reported by parents. The within-child association between childcare attendance and outcomes was assessed using two- and three-level hierarchical regression; sex by care (in/out) interactions were considered. Two hundred and two children (51 % female) had valid activity data for ≥2 days. Children, and particularly boys, were less sedentary and more active when in care compared to at home (SED: Boys: β (SE): −6.4 (0.5) min/h, Girls: −4.8 (0.5); LPA: Boys: 0.6 (0.4), Girls: 1.8 (0.4); MVPA: Boys: 5.7 (0.5); Girls: 3.0 (0.4)). Differences between in-care and at-home activity were largest in the (early) mornings and early evenings for boys; no compensation in at-home activity occurred later in the day. On days when children were in care part-time (1–5 h) or full-time (>5 h), they were significantly less sedentary and more active compared with non-care days. Young children, and particularly boys, accumulate more MVPA in care compared to at home. Future research should identify factors accounting for this difference and consider targeting non-care time in intervention efforts to increase higher-intensity activity and decrease sedentary time in preschoolers.
62 citations
TL;DR: It is the position of the Academy of Nutrition and Dietetics that nutrition services provided by registered dietitian nutritionists (RDNs) and nutrition and dietetics technicians, registered (NDTRs), who work under RDN supervision, are essential components of comprehensive care for adults with intellectual and developmental disabilities (IDD) and children and youth with special health care needs (CYSHCN).
54 citations
TL;DR: The GRS confirmed that the high genetic risk group showed greater values of adiposity than the low risk group and demonstrated that macronutrient intake modifies the GRS association with adiposity traits.
Abstract: There is little evidence about genetic risk score (GRS)–diet interactions in order to provide personalized nutrition based on the genotype. The aim of the study was to assess the value of a GRS on obesity prediction and to further evaluate the interactions between the GRS and dietary intake on obesity. A total of 711 seekers of a Nutrigenetic Service were examined for anthropometric and body composition measurements and also for dietary habits and physical activity. Oral epithelial cells were collected for the identification of 16 SNPs (related with obesity or lipid metabolism) using DNA zip-coded beads. Genotypes were coded as 0, 1 or 2 according to the number of risk alleles, and the GRS was calculated by adding risk alleles with such a criterion. After being adjusted for gender, age, physical activity and energy intake, the GRS demonstrated that individuals carrying >7 risk alleles had in average 0.93 kg/m2 of BMI, 1.69 % of body fat mass, 1.94 cm of waist circumference and 0.01 waist-to-height ratio more than the individuals with ≤7 risk alleles. Significant interactions for GRS and the consumption of energy, total protein, animal protein, vegetable protein, total fat, saturated fatty acids, polyunsaturated fatty acids, total carbohydrates, complex carbohydrates and fiber intake on adiposity traits were found after adjusted for confounders variables. The GRS confirmed that the high genetic risk group showed greater values of adiposity than the low risk group and demonstrated that macronutrient intake modifies the GRS association with adiposity traits.
50 citations
TL;DR: In patients unable to tolerate oral intake, multiple options of nutrient delivery are available to the clinician, and the registered dietitian is a key resource in enteral formula selection and method of administration.
Abstract: In patients unable to tolerate oral intake, multiple options of nutrient delivery are available to the clinician. Administration of enteral nutrition (EN) has long been considered the standard of care for nutrition support among patients unable to meet energy and protein requirements orally. Healthcare practitioners must make careful decisions related to ordering, administering, and monitoring EN therapy. In the hospital setting, the registered dietitian is a key resource in enteral formula selection and method of administration, monitoring for and troubleshooting EN-related complications, and transitioning to oral feeding. The hospital setting also presents many unique challenges in providing optimal nutrition to the enterally fed patient.
TL;DR: Prolonged time to nutrition initiation and interruptions in delivery caused pediatric patients to spend a high proportion of admission without nutrition support, preventing most from meeting energy requirements.
Abstract: Background: Nutrition support is often delayed or interrupted. The aim of this study is to identify reasons for and quantify time spent without nutrition in a mixed medical-surgical-cardiac pediatric intensive care unit (PICU). Methods: Data were prospectively collected to describe the patient cohort (anthropometrics and diagnostic category) and nutrition practices (time to nutrition initiation; frequency, duration, and causes of interruptions; and overall caloric intake). Descriptive statistics were used; comparisons of groups were performed using an independent t test and P 24 hours. Nutrition was interrupted 1.2 (2.0) times per patient. Time spent without nutrition due to interruptions was 11.6 (23.0) hours, up to 102 hours. Patients spent 42.4% (28.2%) of their median (range) PICU admission of 2.9 days (0.25–39 days) without any for...
TL;DR: The results show a relatively high prevalence of malnutrition among elderly patients in the general surgery department, especially in patients with digestive disease, and MNA-SF may be a more suitable tool for the nutrition assessment of surgical elderly inpatients.
Abstract: Nutrition assessment enables early identification of malnourished patients and those at risk of malnutrition. To determine the prevalence of malnutrition, to analyze the correlation between short-form Mini Nutritional Assessment (MNA-SF) and Nutritional Risk Screening 2002 (NRS2002) with classical nutritional markers among elderly hospitalized patients in surgery departments, with a view to improving nutrition advice for these patients. A total of 142 elderly patients admitted for surgery were enrolled in the study. Within 48 hours of admission, MNA-SF and NRS2002 scale, anthropometric measures and biochemical tests were carried out to assess the nutritional status of each patient. The prevalence of malnutrition classified by MNA-SF, NRS2002, BMI, serum albumin, hemoglobin, total lymphocyte count, handgrip strength, calf circumference and mid-arm circumference were 45 %, 38 %, 17 %, 22 %, 24 %, 71 %, 36 %, 12 % and 15 %, respectively. As the nutritional status classified by both MNA-SF and NRS2002 deteriorated, BMI, serum albumin, hemoglobin, handgrip strength, mid-arm circumference and calf circumference of patients with malnutrition were lower (P 0.05). MNA-SF results showed a moderate agreement (P < 0.001) with NRS2002. Malnourished patients were older than well-nourished patients with NRS2002 (P < 0.05). Digestive disease patients tend to suffer from malnutrition, evaluated by MNA-SF (P < 0.05). The results show a relatively high prevalence of malnutrition among elderly patients in our general surgery department, especially in patients with digestive disease. NRS2002 and MNA-SF on elderly patients showed great consistency but significant difference in elderly patients with digestive disease. Both MNA-SF and NRS2002 correlated with each other and with BMI, serum albumin, hemoglobin, handgrip strength, calf circumference and mid-arm circumference. MNA-SF may be a more suitable tool for the nutrition assessment of surgical elderly inpatients.
TL;DR: Interventions involving nutrition care provided by primary health professionals have the potential to improve patients' dietary behaviours, however, the consistency and clinical significance of intervention outcomes are unclear.
Abstract: Background. 'Nutrition care' refers to any practice conducted by a health professional to support a patient to improve their dietary behaviours. Better understanding about the effectiveness of nutrition care is required to identify ways to enhance success of future interventions.
TL;DR: SRER is effective in improving children’s food and nutrient intakes at a critical time point when dietary habits and preferences are established and can inform future public health nutrition interventions in this setting.
Abstract: Objective Early childhood settings are promising avenues to intervene to improve children’s nutrition. Previous research has shown that a nutrition award scheme, Start Right – Eat Right (SRER), improves long day care centre policies, menus and eating environments. Whether this translates into improvements in children’s dietary intake is unknown. The present study aimed to determine whether SRER improves children’s food and nutrient intakes. Design Pre–post cohort study. Setting Twenty long day care centres in metropolitan Adelaide, South Australia, Australia. Subjects Children aged 2–4 years (n 236 at baseline, n 232 at follow-up). Methods Dietary intake (morning tea, lunch, afternoon tea) was assessed pre- and post-SRER implementation using the plate wastage method. Centre nutrition policies, menus and environments were evaluated as measures of intervention fidelity. Comparisons between baseline and follow-up were made using t tests. Results At follow-up, 80 % of centres were fully compliant with the SRER award criteria, indicating high scheme implementation and adoption. Intake increased for all core food groups (range: 0·2–0·4 servings/d, P<0·001) except for vegetable intake. Energy intake increased and improvements in intakes of eleven out of the nineteen nutrients evaluated were observed. Conclusions SRER is effective in improving children’s food and nutrient intakes at a critical time point when dietary habits and preferences are established and can inform future public health nutrition interventions in this setting.
TL;DR: The average contribution of protein and total energy of each patient increased after imparting the nutritional education to them, indicating nutritional education is an effective measure to bring about a favorable and significant change in oncology patients’ nutrient intake.
Abstract: Four hundred and forty-four high-risk oncology patients with malnutrition participated in this study aimed at assessing the effectiveness of nutrition education on improving an oncology patient's dietary intake. We used a nutritional risk screening to select oncology patients in need of nutritional care. Team Nutrition provides technical assistance for foodservice, nutrition education for patients and their caregivers, and support for healthy eating and physical activity to improve their diets and their lives. The average contribution of protein and total energy of each patient increased after imparting the nutritional education to them. Thus, nutritional education is an effective measure to bring about a favorable and significant change in oncology patients' nutrient intake.
TL;DR: A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture and the key finding was that a multi-level approach is needed to address this complex issue.
TL;DR: Low-FODMAP EN may improve diarrhea, leading to improved nutritional status and facilitating prompt recovery from illness, and BMI significantly increased in all groups except the unimproved.
Abstract: Background
Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are poorly absorbed, short-chain carbohydrates that play an important role in inducing functional gut symptoms. A low-FODMAP diet improves abdominal symptoms in patients with inflammatory bowel disease and irritable bowel syndrome. However, there were no study for the effect of FODMAP content on gastrointestinal intolerance and nutritional status in patients receiving enteral nutrition (EN).
TL;DR: This narrative review aims to provide an overview of the major evidence base on nutrition therapy in critically ill patients and provide practical suggestions.
TL;DR: This review describes several different approaches to enteral nutrition-total parenteral, oral supplementation and enteral tube feeding-in terms of results, patients compliance, risks and and benefits, and focuses on the homeEnteral nutrition strategy as the future goal for treating IBD while focusing on patient wellness.
Abstract: Malnutrition is a common consequence of inflammatory bowel disease (IBD) Diet has an important role in the management of IBD, as it prevents and corrects malnutrition It is well known that diet may be implicated in the aetiology of IBD and that it plays a central role in the pathogenesis of gastrointestinal-tract disease Often oral nutrition alone is not sufficient in the management of IBD patients, especially in children or the elderly, and must be combined with oral supplementation or replaced with tube enteral nutrition In this review, we describe several different approaches to enteral nutrition—total parenteral, oral supplementation and enteral tube feeding—in terms of results, patients compliance, risks and and benefits We also focus on the home entaral nutrition strategy as the future goal for treating IBD while focusing on patient wellness
TL;DR: The physical examination component of the nutrition assessment is more critical in pediatric patients because pediatric patients can become malnourished more quickly than adults and because prolonged malnutrition can negatively affect growth and development.
Abstract: A complete nutrition assessment includes several components: medical record review, anthropometric measurements, diet/nutrition intake, interview, and physical examination. The nutrition-focused physical examination (NFPE) can identify or confirm muscle wasting, subcutaneous fat loss, and edema and clarify information gathered during the medical record review. The physical examination component of the nutrition assessment is more critical in pediatric patients because pediatric patients can become malnourished more quickly than adults and because prolonged malnutrition can negatively affect growth and development. In addition, case studies of micronutrient deficiencies, essential fatty acid deficiency, and protein-calorie malnutrition with skin manifestations have been reported in developed countries. The etiologies of the deficiencies are chronic disease, long-term tube feedings, or long-term parenteral nutrition. An NFPE involves an in-depth examination of the patient from head to toe by a trained nutrition professional. Nutrition professionals recognize the importance and value of an NFPE, yet it is seldom completed, particularly in pediatrics, most likely due to lack of training and lack of pediatric-specific information or training opportunities. Although there are similarities between NFPE in pediatric and adult patients such as the techniques used (inspection, palpation, percussion, and auscultation), there are important differences related to growth and development. This review provides an overview of nutrition assessment with focus on the NFPE and aspects unique to the pediatric patient.
TL;DR: African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years are explored.
Abstract: Background : Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders’ views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years.
Methods : Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa.
Results : Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries.
Conclusion : Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists.
TL;DR: The PANDORA score is a simple, robust scoring system for a general population of hospitalised patients to be used for risk stratification and benchmarking.
Abstract: Three-compartment bags are safe, economic and ergonomic. It is important, however, to keep the knowledge of pharmacies to compound total parenteral nutrition for children and (adult) patients with specific pathologies. Research is ongoing in the development of bags with more than three compartments, to include for instance vitamins. This necessitates improvements in bag materials and wrapping. Progress can be made regarding total parenteral nutrition prescription and delivery, as well as in the incidence of related infections by promoting training in clinical nutrition and the implementation of a multidisciplinary nutritional support team.
TL;DR: The high percentage of children aged 0-14 years who were overfed emphasizes the need to measure energy needs by using indirect calorimetry.
Abstract: Background: Monitoring nutrition therapy is essential in the care of critically ill children, but the risk of nutrition failure seems to remain. The aims of the present study were to examine the prevalence of underfeeding, adequate feeding, and overfeeding in mechanically ventilated children and to identify barriers to the delivery of nutrition support. Materials and Methods: Children aged 0–14 years who fulfilled the criteria for indirect calorimetry were enrolled in this prospective, observational study and were studied for up to 5 consecutive days. Actual energy intake was recorded and compared with the required energy intake (measured energy expenditure plus 10%); energy intake was classified as underfeeding ( 110%). The reasons for interruptions to enteral and parenteral nutrition were recorded. Results: In total, 104 calorimetric measurements for 140 total days were recorded for 30 mechanically ventilated children. Underfe...
TL;DR: There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China, by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition and the European Society for Clinical Nutrition and Metabolism.
Abstract: The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when critically ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, reduced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chinese Medical Association's Group of Geriatric Nutrition Support has developed guidelines by researching the present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).
Journal Article•
TL;DR: Prawidlowe postepowanie zywieniowe warunkuje skutecznośc i powodzenie leczenia u tych chorych prawidlowa identyfikacja niedozywionych pacjentow onkologicznych.
Abstract: Malnutrition affects a large part of patients with malignant neoplasm. Proper nutritional treatment determines the effectiveness and success of therapy in these patients. Given the importance of this issue, thanks to the collaboration of scientific societies: Polish Society of Surgical Oncology (PTChO), Polish Society of Oncology (PTO), Polish Society of Clinical Oncology (PTOK) and Polish Society for Parenteral, Enteral Nutrition and Metabolism (POLSPEN) standards for nutritional therapy in oncology have been set. An introduction to nutritional therapy is the correct identification of malnourished patients. In Poland, hospitalized patients are subject to screening towards malnutrition. Nutrition intervention should be tailored to the clinical situation. It involves the use of dietary advice, use of oral diet products (oral nutritional support), enteral or parenteral nutrition, in hospital or in home, in consideration of special situations.
TL;DR: The result of this study confirmed the interaction between APOA2 −256T>C polymorphism and SFAs intake with BMI in type 2 diabetic patients, and homozygous patients for the C allele with high saturated fatty acids intake had higher BMI.
Abstract: Recent studies have established the interaction between APOA2 −256T>C polymorphism and dietary saturated fatty acids intake in relation to obesity on healthy individuals. In the current study, we investigate the effects of this interaction on anthropometric variables and serum levels of leptin and ghrelin in patients with type 2 diabetes. In this cross-sectional study, 737 patients with type 2 diabetes mellitus (290 males and 447 females) were recruited from diabetes clinics in Tehran. The usual dietary intake of all participants during the last year was obtained by validated semiquantitative food frequency questionnaire. APOA2 genotyping was performed by real-time PCR on genomic DNA. No significant relation was obtained by univariate analysis between anthropometric variables and APOA2 genotypes. However, after adjusting for age, gender, physical activity and total energy intake, we identified a significant interaction between APOA2-saturated fatty acids intake and body mass index (BMI). After adjusting for potential confounders, serum levels of ghrelin in CC genotype patients were significantly higher than T allele carriers (p = 0.03), whereas the case with leptin did not reveal a significant difference. The result of this study confirmed the interaction between APOA2 −256T>C polymorphism and SFAs intake with BMI in type 2 diabetic patients. In fact, homozygous patients for the C allele with high saturated fatty acids intake had higher BMI. The APOA2 −256T>C polymorphism was associated with elevated levels of serum ghrelin.
TL;DR: Despite the wide range of quality in the current clinical outcomes evidence, early enteral nutrition within the first week of ICU admission, delivered to the appropriate patient, promotes gut-mediated immunity, lowers metabolic response to stress, maintains microbial diversity, and improves clinical outcomes versus standard of care or parenteral nutrition therapy.
Abstract: Purpose of review To review the mechanistic evidence for early enteral nutrition in critically ill patients within the first week of ICU admission. Recent findings There is a lack of recent large randomized controlled trials showing clinically important outcome benefits related to early enteral nutrition. Most supporting studies are based on the animal models, and explore mechanisms of benefit related to gut immunity and oxidative stress. In addition, the impact of nutrient deprivation on the microbiome recently shown in a human trial is compelling. Large randomized controlled clinical trials have emerged in the last 2 years, however, comparing minimal enteral nutrition therapy and enteral nutrition versus parenteral nutrition. They call into question the low quality of clinical evidence and the widespread support for early enteral nutrition as a primary recommendation. As a result, the questions of whether or not enteral nutrition should be initiated in the first week versus standard of care or parenteral nutrition and how clinicians justify this recommendation are raised. Summary Despite the wide range of quality in the current clinical outcomes evidence, early enteral nutrition within the first week of ICU admission, delivered to the appropriate patient, promotes gut-mediated immunity, lowers metabolic response to stress, maintains microbial diversity, and improves clinical outcomes versus standard of care or parenteral nutrition therapy.
TL;DR: Celiac patients treated with GFD presented inadequacy of dietary folate intake and low-serum concentrations of folate, suggesting that more attention should be given to the quality of the nutrients offered by the GFD, as it constitutes a lifelong treatment.
Abstract: The only treatment for celiac disease is the gluten-free diet. Few studies have assessed the nutritional adequacy of this diet, especially of B vitamins related to homocysteine metabolism. The aim of this study was to assess the nutritional status and serum concentrations of B vitamins involved in homocysteine metabolism, and to determine whether the dietary intake of these vitamins are meeting Dietary Reference Intakes in celiac patients. A cross-sectional study enrolled a total of 20 celiac patients (36.3 ± 13.7 years old; 65 % women), following strict gluten-free diet (GFD) and 39 healthy controls matched by sex and age. The dietary intake was assessed by 3-day food records, and serum concentrations of homocysteine and vitamins B6, B12, and folate were determined after overnight fasting. Comparisons between the two groups were performed by Student’s t test or Mann–Whitney U-test, for continuous variables. Pearson’s chi-square test or Fisher’s exact test was used for categorical variables. An alpha level of 5 % were considered significant. Celiac patients had lower serum folate concentrations (7.7 ± 3.5 ng/mL, P < 0.05) than controls. All celiac patients had folate intake below the Estimated Average Requirement (EAR) (130.8 ± 53.6 μg/d). However, only a small proportion of celiac patients had hyperhomocysteinemia. Celiac patients treated with GFD presented inadequacy of dietary folate intake and low-serum concentrations of folate, suggesting that more attention should be given to the quality of the nutrients offered by the GFD, as it constitutes a lifelong treatment.