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The role of high-quality systematic reviews in the nutrition literature: Creatine, a promising nutrition intervention to optimize physical function in patients at risk of functional disability 高质量系统综述在营养文献中的作用:肌酸,一种有望优化有功能性残疾风险的患者身体功能的营养干预措施。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-29 DOI: 10.1002/jpen.2625
Bruno Adler Maccagnan Pinheiro Besen MD, PhD
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引用次数: 0
Microbiome changes under enteral deprivation are dynamic and dependent on intestinal location 肠道剥夺下的微生物组变化是动态的,并取决于肠道位置。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-24 DOI: 10.1002/jpen.2624
Haggai Bar-Yoseph MD, Avril Metcalfe-Roach MsC, Mihai Cirstea PhD, B. Brett Finlay PhD

Background

The microbiome has a pivotal role in intestinal health, and nutrition has a major role shaping its structure. Enteral deprivation, in which no oral/enteral nutrition is administered, is common in hospitalized/gastrointestinal patients. The dynamics that enteral deprivation exerts on the microbial community, specifically in the small intestine, are not well understood.

Methods

Enteral deprivation was modeled with exclusive parenteral nutrition (EPN) mice. Mice were allocated to receive either EPN or saline and chow (control) and euthanized after 0, 2, 4, or 6 days. DNA was extracted from jejunum, ileum, and colon content. 16S sequencing was used to compare changes in microbial communities between groups. Functional pathways were predicted using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States.

Results

EPN-treated mice showed community changes throughout the intestine. Beta diversity in colon showed clear separation between the groups (Bray-Curtis, P < 0.001). Time-dependent dynamics were seen in ileal but not jejunal samples. Alpha diversity was lower in the colon of EPN mice compared with control/baseline mice (Chao1, P < 0.01) but not in ileum/jejunum. Progressive loss of single-taxon domination was seen, most notably in the small intestine. This was accompanied by increases/decreases in specific taxa. A clear separation was seen in the functional capacity of the community between fed and enterally deprived mice at the ileum and colon, which was observed early on.

Conclusions

Enteral deprivation disturbs the microbial community in a spatial and dynamic manner. There should be further focus on studying the effect of these changes on the host.

背景:微生物组在肠道健康中起着关键作用,而营养对其结构的形成起着重要作用。在住院/胃肠道病人中,肠道剥夺(即不提供口服/肠道营养)很常见。人们对肠内缺氧对微生物群落(尤其是小肠内的微生物群落)所产生的影响还不甚了解:方法:用纯肠外营养(EPN)小鼠模拟肠内剥夺。小鼠被分配接受 EPN 或生理盐水和饲料(对照组),并在 0、2、4 或 6 天后安乐死。从空肠、回肠和结肠内容物中提取 DNA。16S 测序用于比较不同组间微生物群落的变化。通过重建未观察到的状态对群落进行系统发育调查,预测功能途径:结果:经 EPN 处理的小鼠整个肠道的微生物群落都发生了变化。结肠中的 Beta 多样性在各组之间显示出明显的差异(Bray-Curtis, P 结论:肠道剥夺会扰乱肠道中的生物群落:肠道剥夺以空间和动态的方式扰乱了微生物群落。应进一步关注研究这些变化对宿主的影响。
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引用次数: 0
Plasma beta-hydroxy-beta-methylbutyrate availability after enteral administration during critical illness after trauma: An exploratory study 创伤后危重病人肠内给药后血浆中 beta-羟基-beta-甲基丁酸的可用性:一项探索性研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-24 DOI: 10.1002/jpen.2622
Kym Wittholz MDiets, Amy J. Bongetti BSc (Hons), Kate Fetterplace PhD, Marissa K. Caldow PhD, Amalia Karahalios PhD, David P. De Souza BSc (Hons), Sheik Nadeem Elahee Doomun PhD, Olav Rooyackers PhD, René Koopman PhD, Gordon S. Lynch PhD, Yasmine Ali Abdelhamid PhD, Adam M. Deane PhD

Background

During critical illness skeletal muscle wasting occurs rapidly. Although beta-hydroxy-beta-methylbutyrate (HMB) is a potential treatment to attenuate this process, the plasma appearance and muscle concentration is uncertain.

Methods

This was an exploratory study nested within a blinded, parallel group, randomized clinical trial in which critically ill patients after trauma received enteral HMB (3 g daily) or placebo. Plasma samples were collected at 0, 60, and 180 min after study supplement administration on day 1. Needle biopsies of the vastus lateralis muscle were collected (baseline and day 7 of the HMB treatment intervention period). An external standard curve was used to calculate HMB concentrations in plasma and muscle.

Results

Data were available for 16 participants (male n = 12 (75%), median [interquartile range] age 50 [29–58] years) who received placebo and 18 participants (male n = 14 (78%), age 49 [34–55] years) who received HMB. Plasma HMB concentrations were similar at baseline but increased after HMB (T = 60 min: placebo 0.60 [0.44–1.31]  µM; intervention 51.65 [22.76–64.72]  µM). Paired muscle biopsies were collected from 11 participants (placebo n = 7, HMB n = 4). Muscle HMB concentrations were similar at baseline between groups (2.35 [2.17–2.95]; 2.07 [1.78–2.31] µM). For participants in the intervention group who had the repeat biopsy within 4 h of HMB administration, concentrations were greater (7.2 and 12.3 µM) than those who had the repeat biopsy >4 h after HMB (2.7 and 2.1 µM).

Conclusion

In this exploratory study, enteral HMB administration increased plasma HMB availability. The small sample size limits interpretation of the muscle HMB findings.

背景:危重病人骨骼肌迅速萎缩。虽然β-羟基-β-甲基丁酸盐(HMB)是一种可减轻这一过程的潜在治疗药物,但其血浆外观和肌肉浓度尚不确定:这是一项探索性研究,嵌套在一项盲法、平行组、随机临床试验中,创伤后的重症患者接受肠内 HMB(每天 3 克)或安慰剂。在第 1 天服用研究补充剂后的 0、60 和 180 分钟采集血浆样本。收集侧阔肌的针刺活检样本(基线和 HMB 治疗干预期的第 7 天)。使用外部标准曲线计算血浆和肌肉中的 HMB 浓度:16名接受安慰剂治疗的参与者(男性12人(75%),中位数[四分位数间距]年龄50[29-58]岁)和18名接受HMB治疗的参与者(男性14人(78%),年龄49[34-55]岁)的数据。血浆中的 HMB 浓度在基线时相似,但在服用 HMB 后有所增加(T = 60 分钟:安慰剂 0.60 [0.44-1.31] µM;干预疗法 51.65 [22.76-64.72] µM)。从 11 名参与者(安慰剂 n = 7,HMB n = 4)中收集了配对肌肉活检样本。各组的肌肉 HMB 基线浓度相似(2.35 [2.17-2.95]; 2.07 [1.78-2.31] µM)。干预组参与者在服用 HMB 后 4 小时内重复活检的浓度(7.2 µM 和 12.3 µM)高于在服用 HMB 超过 4 小时后重复活检的浓度(2.7 µM 和 2.1 µM):在这项探索性研究中,肠内给药可增加血浆中HMB的可用性。由于样本量较小,对肌肉 HMB 研究结果的解释受到限制。
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引用次数: 0
Nutrition considerations for patients with persistent critical illness: A narrative review 持续危重症患者的营养注意事项:叙述性综述。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-23 DOI: 10.1002/jpen.2623
Elizabeth Viner Smith BND, Hons, Kate Lambell PhD, Oana A. Tatucu-Babet PhD, Emma Ridley PhD, Lee-anne Chapple PhD

Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support.

重症患者在入住重症监护病房(ICU)期间营养不良和肌肉严重流失的发生率很高,影响了患者的康复。营养很可能在缓解重症监护病房营养不良和肌肉流失的发展和恶化方面发挥重要作用,但重症监护病房营养干预的明确临床试验却未能显示出其益处。随着医疗质量的提高,病情较重的患者能够挺过最初的伤害,再加上人口老龄化和合并症日益增多,预计重症监护室的住院时间将继续延长。本综述旨在讨论重症监护病房住院时间超过 10 天的持续危重症患者所特有的营养问题。与持续危重症患者相关的营养概念将包括能量和蛋白质代谢、处方和输送;床旁营养监测;以及医疗团队在优化营养支持中的作用。
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引用次数: 0
JPEN Journal Club 83. Selecting trials to include in a systematic review JPEN 期刊俱乐部 83。选择纳入系统综述的试验。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-16 DOI: 10.1002/jpen.2621
Ronald L. Koretz MD
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引用次数: 0
Association between protocol change to a higher-protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID-19: A retrospective cohort study COVID-19 重症患者改用高蛋白、低能量目标配方与营养输送之间的关系:一项回顾性队列研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-13 DOI: 10.1002/jpen.2620
Kym Wittholz MDietS, Chloe Hinckfus BSc (Hons), Amalia Karahalios PhD, Haustine Panganiban BNS, Nadine Phillips MBiostat, Hannah Rotherham MBBS, Thomas Rechnitzer MBBS, Yasmine Ali Abdelhamid PhD, Adam M. Deane PhD, Kate Fetterplace PhD

Background

Guidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID-19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a “higher-protein formula protocol” on protein, energy, and volume delivery when compared with standard nutrition protocol.

Methods

This was a retrospective cohort study of adult patients with COVID-19 who received mechanical ventilation for >72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher-protein formula protocol for patients with COVID-19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered.

Results

There were 114 participants (standard protocol, 48; higher-protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (−0.02 to 0.18 g/kg/day), −1.71 kcal/kg/day (−3.64 to 0.21 kcal/kg/day) and −1.5 ml/kg/day (−2.9 to −0.1 ml/kg/day). Thirty-three patients (standard protocol, 7; higher-protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [−0.89 to 1.88 kcal/kg/day]).

Conclusion

Implementation of a higher-protein formula protocol to patients with COVID-19 modestly reduced volume administration without impacting protein and energy delivery.

背景:指南建议优先为 2019 年冠状病毒病(COVID-19)重症患者提供蛋白质,同时避免提供过多能量,但目前还没有前瞻性研究对这一群体的针对性方法进行评估。我们旨在评估与标准营养方案相比,"高蛋白配方方案 "对蛋白质、能量和容量供给的影响:这是一项回顾性队列研究,研究对象为接受机械通气超过 72 小时并接受肠内营养的 COVID-19 成年患者。2021 年 10 月之前,患者的标准营养方案为每小时 0.7 毫升/千克理想体重(IBW)、63 克/升蛋白质和 1250 千卡/升热量的配方。自 2021 年 10 月起,我们对 COVID-19 患者实施了高蛋白配方方案。初始处方为 0.5 毫升/千克/小时 IBW 的 100 克/升蛋白质和 1260 千卡/升配方,并在可能的情况下通过间接热量测定法更加强调能量目标。测量结果包括蛋白质、能量和输送量:共有 114 名参与者(标准方案 48 人;高蛋白方案 66 人)接受了 1324 天的营养支持。目标方案和标准方案期间蛋白质、能量和容量输送的中位数(95% CI)差异分别为 0.08 克/千克/天(-0.02 至 0.18 克/千克/天)、-1.71 千卡/千克/天(-3.64 至 0.21 千卡/千克/天)和-1.5 毫升/千克/天(-2.9 至-0.1 毫升/千克/天)。33 名患者(标准方案,7 人;高蛋白方案,26 人)进行了 44 次间接热量测定评估。随着时间的推移,测得的能量消耗没有差异(增加了 0.49 千卡/千克/天 [-0.89 至 1.88 千卡/千克/天]):结论:对 COVID-19 患者实施高蛋白配方方案可适度减少给药量,但不会影响蛋白质和能量的输送。
{"title":"Association between protocol change to a higher-protein formula with lower energy targets and nutrient delivery in critically ill patients with COVID-19: A retrospective cohort study","authors":"Kym Wittholz MDietS,&nbsp;Chloe Hinckfus BSc (Hons),&nbsp;Amalia Karahalios PhD,&nbsp;Haustine Panganiban BNS,&nbsp;Nadine Phillips MBiostat,&nbsp;Hannah Rotherham MBBS,&nbsp;Thomas Rechnitzer MBBS,&nbsp;Yasmine Ali Abdelhamid PhD,&nbsp;Adam M. Deane PhD,&nbsp;Kate Fetterplace PhD","doi":"10.1002/jpen.2620","DOIUrl":"10.1002/jpen.2620","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Guidelines recommend prioritizing protein provision while avoiding excessive energy delivery to critically ill patients with coronavirus disease 2019 (COVID-19), but there are no prospective studies evaluating such a targeted approach in this group. We aimed to evaluate the effect of a “higher-protein formula protocol” on protein, energy, and volume delivery when compared with standard nutrition protocol.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a retrospective cohort study of adult patients with COVID-19 who received mechanical ventilation for &gt;72 h and enteral nutrition. Before October 2021, the standard nutrition protocol for patients was 0.7 ml/kg/h ideal body weight (IBW) of a 63 g/L protein and 1250 kcal/L formula. From October 2021, we implemented a higher-protein formula protocol for patients with COVID-19. The initial prescription was 0.5 ml/kg/h IBW of a 100 g/L protein and 1260 kcal/L formula with greater emphasis on energy targets being directed by indirect calorimetry when possible. Measured outcomes included protein, energy, and volume delivered.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There were 114 participants (standard protocol, 48; higher-protein protocol, 66) with 1324 days of nutrition support. The median (95% CI) differences in protein, energy, and volume delivery between targeted and standard protocol periods were 0.08 g/kg/day (−0.02 to 0.18 g/kg/day), −1.71 kcal/kg/day (−3.64 to 0.21 kcal/kg/day) and −1.5 ml/kg/day (−2.9 to −0.1 ml/kg/day). Thirty-three patients (standard protocol, 7; higher-protein protocol, 26) had 44 indirect calorimetry assessments. There was no difference in measured energy expenditure over time (increased by 0.49 kcal/kg/day [−0.89 to 1.88 kcal/kg/day]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Implementation of a higher-protein formula protocol to patients with COVID-19 modestly reduced volume administration without impacting protein and energy delivery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 4","pages":"429-439"},"PeriodicalIF":3.4,"publicationDate":"2024-03-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2620","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140110446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Malnutrition as a prognostic factor for 2-year mortality in hospitalized patients in Norway: A matched cohort study 营养不良是挪威住院病人 2 年死亡率的预后因素:一项匹配队列研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-13 DOI: 10.1002/jpen.2619
Marte A. Trollebø MSc, Randi J. Tangvik PhD, Eli Skeie PhD, Martin K. Grønning MSc, Ottar Nygård PhD, Tomas M. L. Eagan PhD, Jutta Dierkes PhD

Background

Risk of malnutrition and malnutrition have been previously associated with increased risk of mortality. It remains unclear, however, whether the severity of malnutrition differentiates in association with all-cause mortality. The aim was to assess the association between being at risk of malnutrition or being diagnosed with malnutrition according to the diagnostic assessment of the Global Leadership Initiative on Malnutrition (GLIM) with all-cause mortality during a 2-year follow-up in hospitalized patients.

Methods

A matched cohort study was conducted in hospitalized patients (excluding cancer, intensive care, and transmissible infections) at a university hospital in Bergen, Norway. All patients underwent nutrition screening with the Nutritional Risk Screening 2002 and a further nutrition assessment using the GLIM criteria. All-cause mortality was estimated from the Norwegian death registry after 2 years, and risk factors were calculated by Cox regression analysis.

Results

Among 326 patients included, 55 patients died within 2 years (17% mortality rate). Risk of malnutrition was associated with increased all-cause mortality, which disappeared after adjustment for age and sex. Malnutrition was associated with an increased risk of all-cause mortality at 2 years also after adjustment for age and sex and, additionally, for further comorbidities (hazard ratio = 2.50; 95% CI, 1.41–4.42). When analyzed separately only severe malnutrition was associated with mortality (hazard ratio = 2.73; 95% CI, 1.44–5.15).

Conclusion

The findings highlight a strong association between inpatients with severe malnutrition, defined by the GLIM criteria, and an increased risk of all-cause mortality within a 2-year follow-up.

背景:营养不良风险和营养不良曾与死亡风险增加有关。但是,营养不良的严重程度是否与全因死亡率相关仍不清楚。我们的目的是评估住院患者中存在营养不良风险或根据全球营养不良领导倡议(GLIM)的诊断评估被诊断为营养不良与两年随访期间全因死亡率之间的关系:对挪威卑尔根一所大学医院的住院患者(不包括癌症、重症监护和传染性感染患者)进行了一项匹配队列研究。所有患者都接受了《2002 年营养风险筛查》的营养筛查,并根据 GLIM 标准进行了进一步的营养评估。根据挪威死亡登记册估算了2年后的全因死亡率,并通过Cox回归分析计算了风险因素:结果:在纳入的 326 名患者中,有 55 名患者在 2 年内死亡(死亡率为 17%)。营养不良的风险与全因死亡率的增加有关,但在对年龄和性别进行调整后,这种风险消失了。在对年龄和性别以及其他合并症进行调整后,营养不良与 2 年内全因死亡风险的增加也有关联(危险比 = 2.50;95% CI,1.41-4.42)。单独分析时,只有严重营养不良与死亡率相关(危险比=2.73;95% CI,1.44-5.15):研究结果表明,根据 GLIM 标准定义的严重营养不良住院患者与 2 年随访期内全因死亡风险增加之间存在密切联系。
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引用次数: 0
A clinical consensus paper on jejunal tube feeding in children 关于儿童空肠管喂养的临床共识文件。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-03-02 DOI: 10.1002/jpen.2615
Kathleen H. McGrath MBBS (Hons), Tanya Collins BSc, Annabel Comerford BNutDiet (Hons), Zoe McCallum MBBS, Michaela Comito BNutDiet (Hons), Kim Herbison BHSc, Olivia Rose Cochrane MDiet, Deirdre Mary Burgess BSc, Sarah Kane BHSc (Nut&Diet) (Hons), Keryn Coster BND, Michele Cooper BNurs, Kathryn Jesson BNurs

Background

Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support.

Methods

A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus.

Results

A total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment.

Conclusion

Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.

背景:患复杂内科疾病或急性危重症的儿童普遍存在喂养问题,可能需要肠内营养。在某些情况下,胃管喂养的耐受性较差或不可行。在适当调整口服和胃肠道治疗方案后仍出现喂养不耐受的情况下,可考虑将空肠管喂养作为营养支持的一种选择:方法:澳大利亚肠外和肠内营养学会(Australasian Society of Parental and Enteral Nutrition)召集了一个多学科专家工作组。他们确定了儿童空肠管喂养的主题问题和五个关键领域。在 Pubmed、Embase 和 Medline 上对 2000 年 1 月至 2022 年 9 月期间的所有相关研究进行了文献检索(n = 103)。根据国家健康与医学研究委员会的指导方针对研究进行评估,以形成声明,并在小组内进行讨论,然后采用改良的德尔菲程序对声明进行投票,以确定共识:结果:针对患者选择、喂食管的类型和选择、并发症、空肠管的临床使用、随访和重新评估这五个关键领域,共制定了 24 项共识声明:空肠管喂养是一种安全有效的方法,可为部分有复杂医疗需求、无法使用胃管喂养的儿科患者提供营养。适当选择患者非常重要,因为空肠管喂养相关的并发症并不少见,虽然大多是轻微并发症,但也可能是严重并发症或需要重新插管。所有接受空肠管喂养的儿童都应接受多学科团队的评估和随访。
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引用次数: 0
Comparison of energy intake in critical illness survivors, general medical patients, and healthy volunteers: A descriptive cohort study 危重病幸存者、普通内科病人和健康志愿者的能量摄入比较:一项描述性队列研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-02-29 DOI: 10.1002/jpen.2612
Elizabeth Viner Smith BND, Imre W. K. Kouw PhD, Matthew J. Summers MDiet, Rhea Louis BMedSc, Laurence Trahair PhD, Stephanie N. O'Connor MNSc, Karen L. Jones PhD, Michael Horowitz PhD, Marianne J. Chapman PhD, Lee-anne S. Chapple PhD

Background

Intensive care unit (ICU) survivors have reduced oral intake; it is unknown whether intake and associated barriers are unique to this group.

Objective

To quantify energy intake and potential barriers in ICU survivors compared with general medical (GM) patients and healthy volunteers.

Design

A descriptive cohort study in ICU survivors, GM patients, and healthy volunteers. Following an overnight fast, participants consumed a 200 ml test-meal (213 kcal) and 180 min later an ad libitum meal to measure energy intake (primary outcome). Secondary outcomes; taste recognition, nutrition-impacting symptoms, malnutrition, and quality of life (QoL). Data are mean ± SD, median (interquartile range [IQR]) or number [percentage]).

Results

Twelve ICU survivors (57 ± 17 years, BMI: 30 ± 6), eight GM patients (69 ± 19 years, BMI: 30 ± 6), and 25 healthy volunteers (58 ± 27 years, BMI: 25 ± 4) were included. Recruitment ceased early because of slow recruitment and SARS-CoV-2. Energy intake was lower in both patient groups than in health (ICU: 289 [288, 809], GM: 426 [336, 592], health: 815 [654, 1165] kcal). Loss of appetite was most common (ICU: 78%, GM: 67%). For ICU survivors, GM patients and healthy volunteers, respectively, severe malnutrition prevalence; 40%, 14%, and 0%; taste identification; 8.5 [7.0, 11.0], 8.5 [7.0, 9.5], and 8.0 [6.0, 11.0]; and QoL; 60 [40–65], 50 [31–55], and 90 [81–95] out of 100.

Conclusions

Energy intake at a buffet meal is lower in hospital patients than in healthy volunteers but similar between ICU survivors and GM patients. Appetite loss potentially contributes to reduced energy intake.

背景:重症监护室(ICU)幸存者的口腔摄入量减少;目前尚不清楚这一群体的摄入量和相关障碍是否独特:与普通内科(GM)患者和健康志愿者相比,量化重症监护室幸存者的能量摄入量和潜在障碍:设计:对重症监护室幸存者、普通内科患者和健康志愿者进行描述性队列研究。参与者在一夜禁食后进食 200 毫升测试餐(213 千卡),180 分钟后进食自由餐,以测量能量摄入量(主要结果)。次要结果;味觉识别、营养影响症状、营养不良和生活质量(QoL)。数据为平均值±标准差、中位数(四分位数间距[IQR])或人数[百分比]):结果:共纳入 12 名重症监护室幸存者(57 ± 17 岁,体重指数:30 ± 6)、8 名 GM 患者(69 ± 19 岁,体重指数:30 ± 6)和 25 名健康志愿者(58 ± 27 岁,体重指数:25 ± 4)。由于招募工作进展缓慢和 SARS-CoV-2 的影响,招募工作提前结束。两组患者的能量摄入量均低于健康人(重症监护室:289 [288, 809];普通病房:426 [336, 592];健康人:815 [654, 1165]千卡)。食欲不振最为常见(ICU:78%;GM:67%)。对于 ICU 幸存者、GM 患者和健康志愿者,严重营养不良发生率分别为 40%、14% 和 0%;味觉识别率分别为 8.5 [7.0,11.0]、8.5 [7.0,9.5] 和 8.0 [6.0,11.0];生活质量分别为 60 [40-65]、50 [31-55]和 90 [81-95](满分 100 分):医院患者在自助餐中摄入的能量低于健康志愿者,但重症监护室幸存者与转基因患者的摄入量相似。食欲不振可能是导致能量摄入减少的原因之一。
{"title":"Comparison of energy intake in critical illness survivors, general medical patients, and healthy volunteers: A descriptive cohort study","authors":"Elizabeth Viner Smith BND,&nbsp;Imre W. K. Kouw PhD,&nbsp;Matthew J. Summers MDiet,&nbsp;Rhea Louis BMedSc,&nbsp;Laurence Trahair PhD,&nbsp;Stephanie N. O'Connor MNSc,&nbsp;Karen L. Jones PhD,&nbsp;Michael Horowitz PhD,&nbsp;Marianne J. Chapman PhD,&nbsp;Lee-anne S. Chapple PhD","doi":"10.1002/jpen.2612","DOIUrl":"10.1002/jpen.2612","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Intensive care unit (ICU) survivors have reduced oral intake; it is unknown whether intake and associated barriers are unique to this group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To quantify energy intake and potential barriers in ICU survivors compared with general medical (GM) patients and healthy volunteers.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Design</h3>\u0000 \u0000 <p>A descriptive cohort study in ICU survivors, GM patients, and healthy volunteers. Following an overnight fast, participants consumed a 200 ml test-meal (213 kcal) and 180 min later an ad libitum meal to measure energy intake (primary outcome). Secondary outcomes; taste recognition, nutrition-impacting symptoms, malnutrition, and quality of life (QoL). Data are mean ± SD, median (interquartile range [IQR]) or number [percentage]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twelve ICU survivors (57 ± 17 years, BMI: 30 ± 6), eight GM patients (69 ± 19 years, BMI: 30 ± 6), and 25 healthy volunteers (58 ± 27 years, BMI: 25 ± 4) were included. Recruitment ceased early because of slow recruitment and SARS-CoV-2. Energy intake was lower in both patient groups than in health (ICU: 289 [288, 809], GM: 426 [336, 592], health: 815 [654, 1165] kcal). Loss of appetite was most common (ICU: 78%, GM: 67%). For ICU survivors, GM patients and healthy volunteers, respectively, severe malnutrition prevalence; 40%, 14%, and 0%; taste identification; 8.5 [7.0, 11.0], 8.5 [7.0, 9.5], and 8.0 [6.0, 11.0]; and QoL; 60 [40–65], 50 [31–55], and 90 [81–95] out of 100.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Energy intake at a buffet meal is lower in hospital patients than in healthy volunteers but similar between ICU survivors and GM patients. Appetite loss potentially contributes to reduced energy intake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 3","pages":"275-283"},"PeriodicalIF":3.4,"publicationDate":"2024-02-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2612","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139996537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between nutrition intake and muscle mass in adult inpatients receiving nutrition support: A prospective cohort study 接受营养支持的成年住院患者的营养摄入量与肌肉质量之间的关系:前瞻性队列研究。
IF 3.4 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-02-28 DOI: 10.1002/jpen.2611
Luciana de Abreu Silva MSc, RD, Simone de Vasconcelos Generoso PhD, RD, Vanessa Moreira da Rocha RD, Lincoln Antinossi Cordeiro da Mata MD, Carolina Fernandes Castro RD, Mariana Vassallo Ribeiro RD, Bruna Guerra Campolina RD, Camila Kümmel Duarte PhD, RD

Objective

The present study aimed to evaluate the association between muscle mass variation, estimated by different equations, during hospitalization with the energy and protein intake and clinical and nutrition outcomes of patients using nutrition support.

Methods

A prospective observational study with patients older than 18 years in use of enteral and/or parenteral nutrition therapy and monitored by the Nutritional Therapy Committee between December 14, 2021, and December 14, 2022. Data were collected from the electronic records and were applied in 11 equations to estimate the four different portions of muscle mass of patients receiving nutrition support at the beginning and the end of hospitalization.

Results

A total of 261 patients were evaluated, with a median age of 61.0 (49.0–69.75) years, and 106 were women (40.6%). According to the nutrition diagnosis, several participants had severe malnutrition (39.5%). The most muscle mass estimation equations indicated a reduction of muscle mass during hospitalization. All patients presented negative energy and protein balances during hospitalization, but greater protein intake increased the lean soft tissue. Also, the greater the number of infections, metabolic complications, and scheduled diet interruption, the greater was the chance of losing muscle mass.

Conclusion

There can be an association between the variation in muscle mass and energy and protein intake during hospitalization of patients using nutrition support. In addition, variation in muscle mass was associated with complications from nutrition support. The results emphasize the importance of anthropometric measurements to estimate muscle mass when other methods are not available.

目的:本研究旨在评估使用营养支持的患者在住院期间肌肉质量变化与能量和蛋白质摄入以及临床和营养结果之间的关系:本研究旨在评估使用营养支持的患者在住院期间通过不同公式估算的肌肉质量变化与能量和蛋白质摄入以及临床和营养结果之间的关联:一项前瞻性观察研究,研究对象为2021年12月14日至2022年12月14日期间使用肠内和/或肠外营养疗法并接受营养治疗委员会监测的18岁以上患者。研究人员从电子记录中收集数据,并通过 11 个方程估算出接受营养支持的患者在住院开始和结束时肌肉质量的四个不同部分:共有 261 名患者接受了评估,中位年龄为 61.0(49.0-69.75)岁,其中 106 人为女性(40.6%)。根据营养诊断结果,多名参与者患有严重营养不良(39.5%)。大多数肌肉质量估算方程显示,住院期间肌肉质量有所下降。所有患者在住院期间都出现了能量和蛋白质负平衡,但蛋白质摄入越多,瘦软组织就越多。此外,感染、代谢并发症和计划饮食中断的次数越多,肌肉量减少的几率就越大:结论:使用营养支持的患者在住院期间,肌肉质量的变化与能量和蛋白质的摄入量之间可能存在关联。此外,肌肉质量的变化还与营养支持引起的并发症有关。研究结果强调了在没有其他方法的情况下,通过人体测量来估算肌肉质量的重要性。
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引用次数: 0
期刊
Journal of Parenteral and Enteral Nutrition
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