首页 > 最新文献

Journal of Parenteral and Enteral Nutrition最新文献

英文 中文
Hunger and the transition from parenteral nutrition in hospitalized adults: A descriptive cohort study 住院成人的饥饿和肠外营养的转变:一项描述性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-16 DOI: 10.1002/jpen.2710
Sergio Henrique Loss MD, PhD, Klara Muller Alves RD, Aline Camargo Nunes RN, Joel Stefani MD, Giovanna Peres Loureiro RD, Adriana Píscopo MD, Luciana Verçoza Viana MD, PhD

Background

Parenteral nutrition (PN) provides nutrition to patients who cannot use the digestive tract. Some patients experience delayed appetite recovery after PN, but the factors contributing to this remain unclear. This study aimed to investigate whether hospitalized patients receiving PN experience reduced hunger or appetite.

Methods

A descriptive cohort study was conducted on adults who underwent PN between April 2022 and July 2023. Data on patient characteristics and nutritional support were collected from medical records. Hunger and satiety were assessed using a validated tool during three phases: clinical stability with calorie-protein targets on PN, transition to oral/enteral feeding, and PN withdrawal. The primary outcome was the absence of hunger assessed by the tool.

Results

Of 231 screened patients, 102 were included. Among these, 62.7% reported hunger during PN. Lipid doses and energy reduction strategies did not affect hunger or satiety. Transition success to oral/enteral nutrition was 2.38 times higher in patients who experienced hunger compared to those who did not (95% CI: 1.59–3.54). Poisson regression identified higher age, inflammation, and metastatic cancer as independent factors associated with the absence of hunger.

Conclusion

This study suggests that PN does not suppress hunger and that factors other than nutritional therapy (age, inflammation, and cancer) could explain the absence of appetite. Considering individual conditions and needs, these findings could guide decision-making strategies regarding the transition from PN to oral/enteral feeding.

背景:肠外营养(PN)为不能使用消化道的患者提供营养。一些患者在PN后经历延迟的食欲恢复,但导致这种情况的因素尚不清楚。本研究旨在调查住院患者接受PN治疗是否会减少饥饿感或食欲。方法:对2022年4月至2023年7月期间接受PN治疗的成年人进行描述性队列研究。从医疗记录中收集患者特征和营养支持的数据。饥饿感和饱腹感是通过一种经过验证的工具在三个阶段进行评估的:临床稳定,以卡路里-蛋白质为目标的PN,过渡到口服/肠内喂养,PN戒断。该工具评估的主要结果是饥饿的消失。结果:231例筛查患者中,102例纳入。其中,62.7%的人在PN期间报告饥饿。脂质剂量和能量减少策略对饥饿感和饱腹感没有影响。经历过饥饿的患者过渡到口服/肠内营养的成功率是没有经历过饥饿的患者的2.38倍(95% CI: 1.59-3.54)。泊松回归发现,年龄增大、炎症和转移性癌症是与饥饿缺失相关的独立因素。结论:本研究提示PN不能抑制饥饿感,营养治疗以外的因素(年龄、炎症和癌症)可以解释食欲不振。考虑到个体情况和需求,这些发现可以指导从PN过渡到口服/肠内喂养的决策策略。
{"title":"Hunger and the transition from parenteral nutrition in hospitalized adults: A descriptive cohort study","authors":"Sergio Henrique Loss MD, PhD,&nbsp;Klara Muller Alves RD,&nbsp;Aline Camargo Nunes RN,&nbsp;Joel Stefani MD,&nbsp;Giovanna Peres Loureiro RD,&nbsp;Adriana Píscopo MD,&nbsp;Luciana Verçoza Viana MD, PhD","doi":"10.1002/jpen.2710","DOIUrl":"10.1002/jpen.2710","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parenteral nutrition (PN) provides nutrition to patients who cannot use the digestive tract. Some patients experience delayed appetite recovery after PN, but the factors contributing to this remain unclear. This study aimed to investigate whether hospitalized patients receiving PN experience reduced hunger or appetite.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive cohort study was conducted on adults who underwent PN between April 2022 and July 2023. Data on patient characteristics and nutritional support were collected from medical records. Hunger and satiety were assessed using a validated tool during three phases: clinical stability with calorie-protein targets on PN, transition to oral/enteral feeding, and PN withdrawal. The primary outcome was the absence of hunger assessed by the tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 231 screened patients, 102 were included. Among these, 62.7% reported hunger during PN. Lipid doses and energy reduction strategies did not affect hunger or satiety. Transition success to oral/enteral nutrition was 2.38 times higher in patients who experienced hunger compared to those who did not (95% CI: 1.59–3.54). Poisson regression identified higher age, inflammation, and metastatic cancer as independent factors associated with the absence of hunger.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests that PN does not suppress hunger and that factors other than nutritional therapy (age, inflammation, and cancer) could explain the absence of appetite. Considering individual conditions and needs, these findings could guide decision-making strategies regarding the transition from PN to oral/enteral feeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"256-266"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
JPEN Journal Club 89. Signal-finding studies. 日本笔会杂志俱乐部Signal-finding研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-10 DOI: 10.1002/jpen.2709
Ronald L Koretz
{"title":"JPEN Journal Club 89. Signal-finding studies.","authors":"Ronald L Koretz","doi":"10.1002/jpen.2709","DOIUrl":"https://doi.org/10.1002/jpen.2709","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Associations between the Dietary Inflammatory Index and fractional exhaled nitric oxide among United States adults: A cross-sectional study 美国成年人饮食炎症指数与呼出一氧化氮分数之间的关系:一项横断面研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-05 DOI: 10.1002/jpen.2708
Yinghong Wang MD, Xiaolian Song MD, PhD, Min Tan MD, PhD

Background

Fractional exhaled nitric oxide (FeNo) is a convenient and noninvasive test that measures the concentration of nitric oxide in exhalation as a surrogate biomarker of airway inflammation. This cross-sectional study aimed to determine the associations between Dietary Inflammatory Index (DII) and FeNo in US adults.

Methods

Adults participating in the 2007–2012 cycles of the US National Health and Nutrition Examination Survey with complete information and available measurement data of DII and FeNo were included. Associations between DII and FeNo were assessed using univariable and multivariable logistic regression models, restricted cubic spline analysis, stratified analysis, and sensitivity analysis.

Results

A total of 7677 participants (mean age 45.68 years, 53.03% men) with a mean DII of 1.28 and FeNo of 17.33 ppb were included. The multivariable-adjusted linear regression analysis showed that a one-unit increase in DII was associated with a 0.283-ppb reduction in FeNo level. The beta and 95% CI for the second, third, and fourth DII quartile groups were −1.19 (−2.04 to −0.35), −1.07 (−2.26 to 0.12), and −1.60 (−2.85 to −0.36), respectively (P for trend = 0.04), with the lowest quartile group as the reference. The restricted cubic spline curve showed an inversely linear relationship between DII and FeNo. The study result is robust and did not appear to be affected by the participant's age, sex, race, body mass index, physical activity, diabetes status, or white blood cell or eosinophil counts.

Conclusion

A proinflammatory diet, as indicated by a higher DII, is cross-sectionally associated with lower FeNo levels in US adults.

背景:呼气一氧化氮分数(FeNo)是一种方便且无创的检测方法,可测量呼气中一氧化氮的浓度,作为气道炎症的替代生物标志物。本横断面研究旨在确定美国成年人饮食炎症指数(DII)和FeNo之间的关系。方法:纳入2007-2012年美国国家健康与营养调查周期中具有完整信息和可获得的DII和FeNo测量数据的成年人。采用单变量和多变量logistic回归模型、受限三次样条分析、分层分析和敏感性分析评估DII和FeNo之间的相关性。结果:共纳入7677名参与者(平均年龄45.68岁,男性53.03%),平均DII为1.28,FeNo为17.33 ppb。多变量调整线性回归分析显示,DII增加1个单位与FeNo水平降低0.283 ppb相关。第二、第三、第四个DII四分位数组的beta和95% CI分别为-1.19(-2.04 ~ -0.35)、-1.07(-2.26 ~ 0.12)和-1.60 (-2.85 ~ -0.36)(P为趋势= 0.04),以最低四分位数组为参考。限制三次样条曲线显示DII与FeNo呈反线性关系。研究结果是可靠的,似乎不受参与者的年龄、性别、种族、体重指数、身体活动、糖尿病状况、白细胞或嗜酸性粒细胞计数的影响。结论:促炎饮食,如较高的DII所示,与美国成年人较低的FeNo水平横断面相关。
{"title":"Associations between the Dietary Inflammatory Index and fractional exhaled nitric oxide among United States adults: A cross-sectional study","authors":"Yinghong Wang MD,&nbsp;Xiaolian Song MD, PhD,&nbsp;Min Tan MD, PhD","doi":"10.1002/jpen.2708","DOIUrl":"10.1002/jpen.2708","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fractional exhaled nitric oxide (FeNo) is a convenient and noninvasive test that measures the concentration of nitric oxide in exhalation as a surrogate biomarker of airway inflammation. This cross-sectional study aimed to determine the associations between Dietary Inflammatory Index (DII) and FeNo in US adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults participating in the 2007–2012 cycles of the US National Health and Nutrition Examination Survey with complete information and available measurement data of DII and FeNo were included. Associations between DII and FeNo were assessed using univariable and multivariable logistic regression models, restricted cubic spline analysis, stratified analysis, and sensitivity analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7677 participants (mean age 45.68 years, 53.03% men) with a mean DII of 1.28 and FeNo of 17.33 ppb were included. The multivariable-adjusted linear regression analysis showed that a one-unit increase in DII was associated with a 0.283-ppb reduction in FeNo level. The beta and 95% CI for the second, third, and fourth DII quartile groups were −1.19 (−2.04 to −0.35), −1.07 (−2.26 to 0.12), and −1.60 (−2.85 to −0.36), respectively (<i>P</i> for trend = 0.04), with the lowest quartile group as the reference. The restricted cubic spline curve showed an inversely linear relationship between DII and FeNo. The study result is robust and did not appear to be affected by the participant's age, sex, race, body mass index, physical activity, diabetes status, or white blood cell or eosinophil counts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A proinflammatory diet, as indicated by a higher DII, is cross-sectionally associated with lower FeNo levels in US adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"249-255"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The ASPEN Rhoads Research Foundation: Supporting and advancing clinical nutrition research 阿斯彭路德斯研究基金会:支持和推进临床营养研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-05 DOI: 10.1002/jpen.2707
Marion Winkler PhD, RD, Kelly A. Tappenden PhD, RD, M. Molly McMahon MD, Michelle Spangenburg MS, RD, Charlene Compher PhD, RD

The vision of the ASPEN Rhoads Research Foundation is to promote innovation and research discovery to improve nutrition care and health. The Foundation was launched in 1993, incorporated in 2002, and established as a nonprofit 501(c)(3) organization in 2007. On the occasion of American Society for Parenteral and Enteral Nutrition (ASPEN)'s 50th anniversary, this article examines the creation of the Foundation, the state of clinical nutrition research funding, the Foundation's philanthropic mission, and the return on investment of Foundation grant support. To date, 114 investigators have received 2.78 million dollars in funding. The article examines the success of ASPEN research programs and Foundation grant support in career development, leadership, and mentorship. It is important to document a historical account of the ASPEN Rhoads Research Foundation and encourage innovation and discovery and ongoing financial support.

阿斯彭路德斯研究基金会的愿景是促进创新和研究发现,以改善营养保健和健康。基金会成立于1993年,成立于2002年,并于2007年成为一个非营利性的501(c)(3)组织。在美国肠外营养学会(ASPEN)成立50周年之际,本文考察了基金会的创建、临床营养研究经费的状况、基金会的慈善使命以及基金会赠款支持的投资回报。到目前为止,114名调查人员已经获得了278万美元的资助。本文考察了ASPEN研究项目的成功以及基金会在职业发展、领导力和指导方面的资助支持。重要的是要记录ASPEN路德斯研究基金会的历史记录,鼓励创新和发现以及持续的财政支持。
{"title":"The ASPEN Rhoads Research Foundation: Supporting and advancing clinical nutrition research","authors":"Marion Winkler PhD, RD,&nbsp;Kelly A. Tappenden PhD, RD,&nbsp;M. Molly McMahon MD,&nbsp;Michelle Spangenburg MS, RD,&nbsp;Charlene Compher PhD, RD","doi":"10.1002/jpen.2707","DOIUrl":"10.1002/jpen.2707","url":null,"abstract":"<p>The vision of the ASPEN Rhoads Research Foundation is to promote innovation and research discovery to improve nutrition care and health. The Foundation was launched in 1993, incorporated in 2002, and established as a nonprofit 501(c)(3) organization in 2007. On the occasion of American Society for Parenteral and Enteral Nutrition (ASPEN)'s 50th anniversary, this article examines the creation of the Foundation, the state of clinical nutrition research funding, the Foundation's philanthropic mission, and the return on investment of Foundation grant support. To date, 114 investigators have received 2.78 million dollars in funding. The article examines the success of ASPEN research programs and Foundation grant support in career development, leadership, and mentorship. It is important to document a historical account of the ASPEN Rhoads Research Foundation and encourage innovation and discovery and ongoing financial support.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"10-17"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Dietetic-led interventions in critically ill adults that influence outcome: A scoping review 影响预后的危重成人饮食主导干预:范围综述
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-04 DOI: 10.1002/jpen.2705
Ella Terblanche PGDip Dietetics, MSc, Judith Merriweather PhD, Mina Bharal MRes, Rhiannon Lewis PGDip Dietetics, Liesl Wandrag PhD

Background

Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes.

Methods

A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions.

Results

Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral).

Conclusion

Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.

背景:危重患者面临营养不良风险,使营养管理具有挑战性。营养师通过运用他们的专业知识来解决这些挑战,在重症监护病房(ICU)中发挥着至关重要的作用。本综述探讨了以营养师为主导的干预措施及其对患者预后的影响。方法:对1995年1月至2023年7月的MEDLINE、Embase、CINAHL、EBSCO、Web of Science和ProQuest数据库进行回顾性分析。包括在成人重症监护中以营养师为主导的干预研究。数据提取遵循乔安娜布里格斯研究所的方法,重点关注研究设计、人口和干预措施。结果:751项研究中,39项符合纳入标准。大多数研究是观察性的,只有三个干预性试验。营养师主导的干预措施包括(1)指南的制定和实施,(2)个体化营养治疗,(3)肠内营养管的插入。结果分为(1)患者临床结果(ICU住院时间、机械通气、感染、成本节约、再入院、死亡率、不良反应和血糖控制)和(2)营养相关结果(营养开始、能量和蛋白质输送、胃肠道耐受性、肠外营养使用和适当的饮食转诊)。结论:营养师主导的干预改善了营养结果,可能有助于更好的临床结果。未来的研究应优先报告核心结果,包括营养状况和身体功能,以进一步量化营养师在ICU护理中的有效性,并提高他们在多专业团队中的认可度。
{"title":"Dietetic-led interventions in critically ill adults that influence outcome: A scoping review","authors":"Ella Terblanche PGDip Dietetics, MSc,&nbsp;Judith Merriweather PhD,&nbsp;Mina Bharal MRes,&nbsp;Rhiannon Lewis PGDip Dietetics,&nbsp;Liesl Wandrag PhD","doi":"10.1002/jpen.2705","DOIUrl":"10.1002/jpen.2705","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"165-179"},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Least significant change with repeat bioelectrical impedance analysis measurements in children with metabolic dysfunction–associated steatotic liver disease: A descriptive cohort study 重复生物电阻抗分析测量在代谢功能障碍相关脂肪变性肝病儿童中最不显著的变化:一项描述性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-12-03 DOI: 10.1002/jpen.2706
Alexandria Speakman DO, Kathryn Hitchcock MS, RD, Emily Romantic RD, Venancio Quiambao RD, Abigail Lepolt RD, CSP, Ana Catalina Arce-Clachar MD, Kristin Bramlage MD, Lin Fei PhD, Qin Sun MS, Stavra Xanthakos MD, MS, Marialena Mouzaki MD, MSc

Background

Bioelectrical impedance is used clinically to assess body composition. To determine true (rather than chance/measurement error) change in bioelectrical impedance analysis measurements over time, it is necessary to know their least significant change. Least significant change represents values exceeding the 95% prediction interval of the precision error of repeat measurements. The least significant change of repeat bioelectrical impedance analysis measurements in children with obesity and metabolic dysfunction–associated steatotic liver disease is currently unknown.

Methods

This is a prospective, single-center, descriptive cohort study in youth 6–20 years of age with obesity and metabolic dysfunction–associated steatotic liver disease. Two same-day bioelectrical impedance analysis measurements were performed on a multifrequency, octopolar device (InBody 370). Fat mass and fat-free mass were adjusted for age using respective indices (dividing by height squared). Fasting status was determined by patient report. Descriptive statistics (medians with interquartile ranges and means with standard deviations and proportions) were used; the least significant change between repeat measurements with precision interval was calculated.

Results

We recruited 43 patients (81% male; 33% Hispanic; median age: 14 years [interquartile range: 11–16]; median body mass index z score: 2.31 [interquartile range: 2.84–2.65]). A total of 60% were fasting, for a median of 12 h. The least significant change of fat mass index was 0.5 (precision interval: −0.4 to 0.5) kg/m2, fat-free mass index was 0.3 (precision interval: −0.3 to 0.3) kg/m2, and body fat percent was 1.5% (precision interval: −1.3 to 1.50). Fasting status affected least significant change measurements.

Conclusion

In youth with obesity and metabolic dysfunction–associated steatotic liver disease, repeat bioelectrical impedance analysis measurements beyond least significant change and precision interval determined in this study likely represent true changes in body composition over time, vs measurement error.

背景:生物电阻抗在临床上用于评估身体成分。为了确定生物电阻抗分析测量随时间的真实(而不是偶然/测量误差)变化,有必要知道它们的最不显著变化。最不显著变化表示超过重复测量精度误差95%预测区间的值。在肥胖和代谢功能障碍相关的脂肪变性肝病儿童中,重复生物电阻抗分析测量的最不显著变化目前尚不清楚。方法:这是一项前瞻性、单中心、描述性队列研究,研究对象为6-20岁的肥胖和代谢功能障碍相关的脂肪变性肝病青年。在多频八爪形装置(InBody 370)上进行了两次同日生物电阻抗分析测量。使用相应的指数(除以身高的平方)调整脂肪质量和无脂肪质量。空腹状态由患者报告确定。采用描述性统计(中位数为四分位数范围,平均值为标准差和比例);以精度区间计算重复测量之间的最小显著变化。结果:我们招募了43例患者(81%为男性;33%的西班牙裔;中位年龄:14岁[四分位数范围:11-16];身体质量指数z得分中位数:2.31[四分位数范围:2.84-2.65])。60%的患者禁食,平均时间为12小时。脂肪质量指数变化最不显著的是0.5(精确区间:-0.4 ~ 0.5)kg/m2,无脂质量指数变化最不显著的是0.3(精确区间:-0.3 ~ 0.3)kg/m2,体脂率变化最不显著的是1.5%(精确区间:-1.3 ~ 1.50)。禁食状态对测量结果影响最小。结论:在患有肥胖和代谢功能障碍相关脂肪变性肝病的青少年中,重复生物电阻抗分析测量超过本研究确定的最不显著变化和精度区间可能代表身体成分随时间的真实变化,而不是测量误差。
{"title":"Least significant change with repeat bioelectrical impedance analysis measurements in children with metabolic dysfunction–associated steatotic liver disease: A descriptive cohort study","authors":"Alexandria Speakman DO,&nbsp;Kathryn Hitchcock MS, RD,&nbsp;Emily Romantic RD,&nbsp;Venancio Quiambao RD,&nbsp;Abigail Lepolt RD, CSP,&nbsp;Ana Catalina Arce-Clachar MD,&nbsp;Kristin Bramlage MD,&nbsp;Lin Fei PhD,&nbsp;Qin Sun MS,&nbsp;Stavra Xanthakos MD, MS,&nbsp;Marialena Mouzaki MD, MSc","doi":"10.1002/jpen.2706","DOIUrl":"10.1002/jpen.2706","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bioelectrical impedance is used clinically to assess body composition. To determine true (rather than chance/measurement error) change in bioelectrical impedance analysis measurements over time, it is necessary to know their least significant change. Least significant change represents values exceeding the 95% prediction interval of the precision error of repeat measurements. The least significant change of repeat bioelectrical impedance analysis measurements in children with obesity and metabolic dysfunction–associated steatotic liver disease is currently unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective, single-center, descriptive cohort study in youth 6–20 years of age with obesity and metabolic dysfunction–associated steatotic liver disease. Two same-day bioelectrical impedance analysis measurements were performed on a multifrequency, octopolar device (InBody 370). Fat mass and fat-free mass were adjusted for age using respective indices (dividing by height squared). Fasting status was determined by patient report. Descriptive statistics (medians with interquartile ranges and means with standard deviations and proportions) were used; the least significant change between repeat measurements with precision interval was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 43 patients (81% male; 33% Hispanic; median age: 14 years [interquartile range: 11–16]; median body mass index <i>z</i> score: 2.31 [interquartile range: 2.84–2.65]). A total of 60% were fasting, for a median of 12 h. The least significant change of fat mass index was 0.5 (precision interval: −0.4 to 0.5) kg/m<sup>2</sup>, fat-free mass index was 0.3 (precision interval: −0.3 to 0.3) kg/m<sup>2</sup>, and body fat percent was 1.5% (precision interval: −1.3 to 1.50). Fasting status affected least significant change measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In youth with obesity and metabolic dysfunction–associated steatotic liver disease, repeat bioelectrical impedance analysis measurements beyond least significant change and precision interval determined in this study likely represent true changes in body composition over time, vs measurement error.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"200-206"},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770017","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Association between early enteral nutrition and length of stay in neonates with congenital bowel obstruction: A retrospective cohort study 先天性肠梗阻新生儿早期肠内营养与住院时间的关系:一项回顾性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-11-28 DOI: 10.1002/jpen.2702
Manisha B. Bhatia MD, MPH, Sai Nelanuthala MD, Tasha Sparks Joplin MD, MPH, Cassandra Anderson MD, MPH, Michael Sobolic MD, Brian W. Gray MD

Background

The optimal feeding strategy for postoperative neonatal patients with congenital bowel obstruction is widely debated. This study aims to evaluate perioperative characteristics and postoperative nutrition practices for patients with congenital bowel obstruction. We hypothesized that earlier introduction of enteral nutrition (EN) is associated with shorter hospital stays and increased weight gain velocities.

Methods

We performed a retrospective cohort study on neonatal patients (<30 days old) admitted to a pediatric referral hospital who underwent an operation for bowel obstruction between 2010 and 2020. Demographic information, clinical characteristics, and feeding characteristics were collected. Associations between early EN (EEN), defined as commencement of enteral feeding within 5 days of surgery, and perioperative characteristics were analyzed with SAS 9.4.

Results

Of the 97 neonates with congenital bowel obstruction, 36 patients received EEN. Sex, gestational age, and ethnicity were similar between groups. Patients receiving EEN were more likely to have a diagnosis of malrotation, anorectal malformation, or annular pancreas (P = 0.04). Patients receiving EEN weaned from parenteral nutrition earlier (9 vs 17 days, P = 0.005). Receiving EEN was associated with shorter median hospital stay (16 vs 29 days, P < 0.0001). Weight gain velocities at the 2-month follow-up were greater for patients receiving EEN (8.02 vs 7.00 g/kg/day, P = 0.04) with the difference dissipating at 6 months.

Conclusion

EEN was more likely provided in patients with certain operative diagnoses and was associated with improved outcomes. Creating and implementing an EEN protocol in congenitally obstructed neonates may lead to shorter hospital stays and improved outcomes.

背景:先天性肠梗阻新生儿患者术后的最佳喂养策略广受争议。本研究旨在评估先天性肠梗阻患者的围手术期特征和术后营养措施。我们假设,较早引入肠内营养(EN)与缩短住院时间和提高体重增长速度有关:我们对新生儿患者进行了一项回顾性队列研究:在 97 名患有先天性肠梗阻的新生儿中,有 36 名患者接受了 EEN。各组间的性别、胎龄和种族相似。接受 EEN 的患者更有可能被诊断为旋转不良、肛门直肠畸形或环状胰腺(P = 0.04)。接受 EEN 的患者较早脱离肠外营养(9 天 vs 17 天,P = 0.005)。接受 EEN 与缩短中位住院时间有关(16 天 vs 29 天,P = 0.005):某些手术诊断的患者更有可能接受肠外营养,并与改善预后有关。为先天性梗阻新生儿制定并实施 EEN 方案可缩短住院时间并改善预后。
{"title":"Association between early enteral nutrition and length of stay in neonates with congenital bowel obstruction: A retrospective cohort study","authors":"Manisha B. Bhatia MD, MPH,&nbsp;Sai Nelanuthala MD,&nbsp;Tasha Sparks Joplin MD, MPH,&nbsp;Cassandra Anderson MD, MPH,&nbsp;Michael Sobolic MD,&nbsp;Brian W. Gray MD","doi":"10.1002/jpen.2702","DOIUrl":"10.1002/jpen.2702","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal feeding strategy for postoperative neonatal patients with congenital bowel obstruction is widely debated. This study aims to evaluate perioperative characteristics and postoperative nutrition practices for patients with congenital bowel obstruction. We hypothesized that earlier introduction of enteral nutrition (EN) is associated with shorter hospital stays and increased weight gain velocities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study on neonatal patients (&lt;30 days old) admitted to a pediatric referral hospital who underwent an operation for bowel obstruction between 2010 and 2020. Demographic information, clinical characteristics, and feeding characteristics were collected. Associations between early EN (EEN), defined as commencement of enteral feeding within 5 days of surgery, and perioperative characteristics were analyzed with SAS 9.4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 97 neonates with congenital bowel obstruction, 36 patients received EEN. Sex, gestational age, and ethnicity were similar between groups. Patients receiving EEN were more likely to have a diagnosis of malrotation, anorectal malformation, or annular pancreas (<i>P</i> = 0.04). Patients receiving EEN weaned from parenteral nutrition earlier (9 vs 17 days, <i>P</i> = 0.005). Receiving EEN was associated with shorter median hospital stay (16 vs 29 days, <i>P</i> &lt; 0.0001). Weight gain velocities at the 2-month follow-up were greater for patients receiving EEN (8.02 vs 7.00 g/kg/day, <i>P</i> = 0.04) with the difference dissipating at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EEN was more likely provided in patients with certain operative diagnoses and was associated with improved outcomes. Creating and implementing an EEN protocol in congenitally obstructed neonates may lead to shorter hospital stays and improved outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"69-76"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739770","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What do we know about micronutrients in critically ill patients? A narrative review 我们对重症患者的微量营养素了解多少?叙述性综述。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-11-18 DOI: 10.1002/jpen.2700
Angelique M.E. de Man MD, PhD, Christian Stoppe MD, Kristine W.A.C. Koekkoek MD, George Briassoulis MD, PhD, Lilanthi S.D.P. Subasinghe MD, Cristian Cobilinschi MD, Adam M. Deane MD, PhD, William Manzanares MD, PhD, Ioana Grințescu MD, PhD, Liliana Mirea MD, PhD, Ashraf Roshdy MD, PhD, Antonella Cotoia MD, PhD, Danielle E. Bear PhD, Sabrina Boraso MD, PhD, Vincent Fraipont MD, Kenneth B. Christopher MD, SM, Michael P. Casaer MD, PhD, Jan Gunst MD, PhD, Olivier Pantet MD, Muhammed Elhadi MD, Giuliano Bolondi MD, MSc, Xavier Forceville MD, PhD, Matthias W.A. Angstwurm MD, PhD, Mohan Gurjar MD, Rodrigo Biondi MD, MSc, Arthur R.H. van Zanten MD, PhD, Mette M. Berger MD, PhD, ESICM/FREM MN group

Micronutrient (MN) status alterations (both depletion and deficiency) are associated with several complications and worse outcomes in critically ill patients. On the other side of the spectrum, improving MN status has been shown to be a potential co-adjuvant therapy. This review aims to collect existing data to better guide research in the critical care setting. This narrative review was conducted by the European Society of Intensive Care Medicine Feeding, Rehabilitation, Endocrinology, and Metabolism MN group. The primary objective was to identify studies focusing on individual MNs in critically ill patients, selecting the MNs that appear to be most relevant and most frequently investigated in the last decade: A, B1, B2, B3, B6, folate, C, D, E, copper, iron, selenium, zinc, and carnitine. Given the limited number of interventional studies for most MNs, observational studies were included. For each selected MN, the review summarizes the main form and functions, special needs and risk factors, optimal treatment strategies, pharmacological dosing, and clinical implications all specific to critically ill patients. A rigorous rebalancing of research strategies and priorities is needed to improve clinical practice. An important finding is that high-dose monotherapy of MNs is not recommended. Basal daily needs must be provided, with higher doses in diseases with known higher needs, and identified deficiencies treated. Finally, the review provides a list of ongoing trials on MNs in critically ill patients and identifies a priority list of future research topics.

微量营养素(MN)状态的改变(包括消耗和缺乏)与危重病人的多种并发症和更差的预后有关。另一方面,改善微量营养素状态已被证明是一种潜在的辅助疗法。本综述旨在收集现有数据,以更好地指导危重症护理领域的研究。这篇叙述性综述由欧洲重症医学会喂养、康复、内分泌和代谢 MN 小组完成。其主要目的是确定针对危重病人中个别 MN 的研究,选择过去十年中似乎最相关和最常被研究的 MN:A、B1、B2、B3、B6、叶酸、C、D、E、铜、铁、硒、锌和肉碱。鉴于大多数营养素的干预性研究数量有限,因此纳入了观察性研究。对于每种选定的 MN,综述都总结了其主要形式和功能、特殊需求和风险因素、最佳治疗策略、药物剂量以及对危重病人的临床影响。为了改善临床实践,需要对研究策略和优先事项进行严格的重新平衡。一个重要的发现是,不推荐对 MNs 进行大剂量的单一治疗。必须提供每日基本需要量,在已知需要量较高的疾病中增加剂量,并治疗已发现的缺乏症。最后,综述提供了一份正在进行的重症患者 MNs 试验清单,并确定了未来研究课题的优先列表。
{"title":"What do we know about micronutrients in critically ill patients? A narrative review","authors":"Angelique M.E. de Man MD, PhD,&nbsp;Christian Stoppe MD,&nbsp;Kristine W.A.C. Koekkoek MD,&nbsp;George Briassoulis MD, PhD,&nbsp;Lilanthi S.D.P. Subasinghe MD,&nbsp;Cristian Cobilinschi MD,&nbsp;Adam M. Deane MD, PhD,&nbsp;William Manzanares MD, PhD,&nbsp;Ioana Grințescu MD, PhD,&nbsp;Liliana Mirea MD, PhD,&nbsp;Ashraf Roshdy MD, PhD,&nbsp;Antonella Cotoia MD, PhD,&nbsp;Danielle E. Bear PhD,&nbsp;Sabrina Boraso MD, PhD,&nbsp;Vincent Fraipont MD,&nbsp;Kenneth B. Christopher MD, SM,&nbsp;Michael P. Casaer MD, PhD,&nbsp;Jan Gunst MD, PhD,&nbsp;Olivier Pantet MD,&nbsp;Muhammed Elhadi MD,&nbsp;Giuliano Bolondi MD, MSc,&nbsp;Xavier Forceville MD, PhD,&nbsp;Matthias W.A. Angstwurm MD, PhD,&nbsp;Mohan Gurjar MD,&nbsp;Rodrigo Biondi MD, MSc,&nbsp;Arthur R.H. van Zanten MD, PhD,&nbsp;Mette M. Berger MD, PhD,&nbsp;ESICM/FREM MN group","doi":"10.1002/jpen.2700","DOIUrl":"10.1002/jpen.2700","url":null,"abstract":"<p>Micronutrient (MN) status alterations (both depletion and deficiency) are associated with several complications and worse outcomes in critically ill patients. On the other side of the spectrum, improving MN status has been shown to be a potential co-adjuvant therapy. This review aims to collect existing data to better guide research in the critical care setting. This narrative review was conducted by the European Society of Intensive Care Medicine Feeding, Rehabilitation, Endocrinology, and Metabolism MN group. The primary objective was to identify studies focusing on individual MNs in critically ill patients, selecting the MNs that appear to be most relevant and most frequently investigated in the last decade: A, B<sub>1</sub>, B<sub>2</sub>, B<sub>3</sub>, B<sub>6</sub>, folate, C, D, E, copper, iron, selenium, zinc, and carnitine. Given the limited number of interventional studies for most MNs, observational studies were included. For each selected MN, the review summarizes the main form and functions, special needs and risk factors, optimal treatment strategies, pharmacological dosing, and clinical implications all specific to critically ill patients. A rigorous rebalancing of research strategies and priorities is needed to improve clinical practice. An important finding is that high-dose monotherapy of MNs is not recommended. Basal daily needs must be provided, with higher doses in diseases with known higher needs, and identified deficiencies treated. Finally, the review provides a list of ongoing trials on MNs in critically ill patients and identifies a priority list of future research topics.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"33-58"},"PeriodicalIF":3.2,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647509","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 segmental phase angles and functional independence measure scores in hospitalized adults following stroke: A retrospective cohort study 预测中风后患者功能恢复和日常生活活动的节段相位角。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-11-09 DOI: 10.1002/jpen.2703
Yoshihiro Yoshimura MD, PhD, Hidetaka Wakabayashi MD, PhD, Fumihiko Nagano, Ayaka Matsumoto, Sayuri Shimazu, Ai Shiraishi, Yoshifumi Kido, Takahiro Bise, Aomi Kuzuhara, Takenori Hamada, Kouki Yoneda

Background

This study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status.

Methods

A retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations.

Results

Phase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge.

Conclusion

Segmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living.

背景:本研究调查了脑卒中患者的节段相位角与功能预后之间的关系:本研究调查了脑卒中患者的节段相位角与功能预后之间的关系,假设节段相位角的增加与功能状态的改善相关:方法:对 1012 名中风后患者进行了回顾性队列研究。方法:对 1012 名脑卒中患者进行了回顾性队列研究,在入院 3 天内使用生物电阻抗分析测量了全身和节段相位角。我们关注的暴露是通过多频生物电阻抗分析仪测量的节段相位角,计算公式为相位角 = 正切 (Xc/R) × (180/π),其中 R 是右半身的电阻,Xc 是在 50 kHz 频率下测量的电抗。主要结果是出院时的功能独立性测量(FIM)运动分量表以及入院和出院之间的 FIM 变化。次要结果包括特定活动的 FIM 分数。进行了多元线性回归分析以评估相关性:与全身或瘫痪肢体的相位角相比,健康上肢和下肢的相位角与出院时的 FIM 运动评分(分别为 β = 0.175 和 β = 0.105)和 FIM 运动增益(分别为 β = 0.242 和 β = 0.092)有更强的相关性。上肢相位角与梳理和如厕能力的关系更为密切,而下肢相位角则与出院时的如厕和运动能力有关:结论:节段相位角,尤其是非瘫痪肢体的节段相位角,是预测中风后患者功能预后的有效指标。评估节段相位角可指导有针对性的干预和康复策略,以改善特定的日常生活活动。
{"title":"Association between segmental phase angles and functional independence measure scores in hospitalized adults following stroke: A retrospective cohort study","authors":"Yoshihiro Yoshimura MD, PhD,&nbsp;Hidetaka Wakabayashi MD, PhD,&nbsp;Fumihiko Nagano,&nbsp;Ayaka Matsumoto,&nbsp;Sayuri Shimazu,&nbsp;Ai Shiraishi,&nbsp;Yoshifumi Kido,&nbsp;Takahiro Bise,&nbsp;Aomi Kuzuhara,&nbsp;Takenori Hamada,&nbsp;Kouki Yoneda","doi":"10.1002/jpen.2703","DOIUrl":"10.1002/jpen.2703","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Phase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Segmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"239-248"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Chyme reinfusion therapy in adults with severe acute intestinal failure: A descriptive cohort study 严重急性肠功能衰竭成人的食糜再灌注疗法:一项描述性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-11-09 DOI: 10.1002/jpen.2704
Kirstine Farrer MPhil, Maja Kopczynska MBBCh, Maria Barrett MSc, Simon Harrison MPharm, Antje Teubner MD, Arun Abraham MD, Derek McWhirter MD, Jonathan Epstein MD, Simon Lal PhD, Gordon L. Carlson CBE, MD

Background

Chyme reinfusion therapy treats patients with high-output fistulas or stomas by returning chyme to the distal gut. The role of this treatment in severe acute intestinal failure is currently unclear. The primary outcome of this study was a successful establishment of chyme reinfusion therapy, defined by the ability to replace parenteral nutrition for nutrition support.

Methods

A descriptive cohort study of adult patients with severe acute intestinal failure due to a high-output stoma and distal mucus fistula or a high-output small intestinal fistula receiving chyme reinfusion therapy was undertaken. The effect of chyme reinfusion therapy on parenteral nutrition requirements, medication, nutrition status, liver function, and treatment cost were studied.

Results

Twenty-four patients commenced treatment for a median of 44 (range, 3–571; total, 2263) days. Fifteen (62.5%) were successfully established for 1208 days, and nine continued treatment at home. Parenteral requirements, including volume, energy and nitrogen content, and frequency, were significantly reduced (P = 0.002), whereas anthropometric measurements remained stable. However, chyme therapy was not tolerated in nine patients (37.5%), and only two (8.3%) weaned fully from parenteral nutrition. Chyme reinfusion therapy was associated with a 47.6% reduction in parenteral energy requirements, 42.8% reduction in nitrogen, and 33.3% reduction in volume of parenteral nutrition requirements. Treatment was associated with a net cost of £30.05 ($40.27) per patient per day.

Conclusion

Chyme reinfusion therapy was associated with reductions in the need for parenteral therapy and medication but did not replace parenteral nutrition or result in a significant cost saving.

背景:食糜再灌注疗法通过向远端肠道回输食糜来治疗高输出量瘘管或造口患者。这种疗法在严重急性肠功能衰竭中的作用目前尚不清楚。本研究的主要结果是成功建立食糜再灌注疗法,其定义是能够替代肠外营养进行营养支持:方法:对因高输出造口和远端粘液瘘或高输出小肠瘘导致严重急性肠功能衰竭并接受食糜再灌注治疗的成年患者进行了一项描述性队列研究。研究了食糜再灌注疗法对肠外营养需求、用药、营养状况、肝功能和治疗费用的影响:24 名患者开始接受治疗,中位数为 44 天(范围为 3-571 天,总计 2263 天)。15名患者(62.5%)成功接受了1208天的治疗,9名患者继续在家接受治疗。肠外治疗的需求量(包括容量、能量和氮含量以及频率)显著减少(P = 0.002),而人体测量值保持稳定。然而,有九名患者(37.5%)不能耐受食糜疗法,只有两名患者(8.3%)完全断绝了肠外营养。采用食糜再灌注疗法后,肠外营养所需的能量减少了 47.6%,氮减少了 42.8%,肠外营养所需的量减少了 33.3%。每位患者每天的治疗净成本为 30.05 英镑(40.27 美元):食糜再灌注疗法可减少肠外治疗和药物的需求,但不能取代肠外营养,也不能显著节约成本。
{"title":"Chyme reinfusion therapy in adults with severe acute intestinal failure: A descriptive cohort study","authors":"Kirstine Farrer MPhil,&nbsp;Maja Kopczynska MBBCh,&nbsp;Maria Barrett MSc,&nbsp;Simon Harrison MPharm,&nbsp;Antje Teubner MD,&nbsp;Arun Abraham MD,&nbsp;Derek McWhirter MD,&nbsp;Jonathan Epstein MD,&nbsp;Simon Lal PhD,&nbsp;Gordon L. Carlson CBE, MD","doi":"10.1002/jpen.2704","DOIUrl":"10.1002/jpen.2704","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chyme reinfusion therapy treats patients with high-output fistulas or stomas by returning chyme to the distal gut. The role of this treatment in severe acute intestinal failure is currently unclear. The primary outcome of this study was a successful establishment of chyme reinfusion therapy, defined by the ability to replace parenteral nutrition for nutrition support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive cohort study of adult patients with severe acute intestinal failure due to a high-output stoma and distal mucus fistula or a high-output small intestinal fistula receiving chyme reinfusion therapy was undertaken. The effect of chyme reinfusion therapy on parenteral nutrition requirements, medication, nutrition status, liver function, and treatment cost were studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four patients commenced treatment for a median of 44 (range, 3–571; total, 2263) days. Fifteen (62.5%) were successfully established for 1208 days, and nine continued treatment at home. Parenteral requirements, including volume, energy and nitrogen content, and frequency, were significantly reduced (<i>P</i> = 0.002), whereas anthropometric measurements remained stable. However, chyme therapy was not tolerated in nine patients (37.5%), and only two (8.3%) weaned fully from parenteral nutrition. Chyme reinfusion therapy was associated with a 47.6% reduction in parenteral energy requirements, 42.8% reduction in nitrogen, and 33.3% reduction in volume of parenteral nutrition requirements. Treatment was associated with a net cost of £30.05 ($40.27) per patient per day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Chyme reinfusion therapy was associated with reductions in the need for parenteral therapy and medication but did not replace parenteral nutrition or result in a significant cost saving.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"85-93"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Journal of Parenteral and Enteral Nutrition
全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1