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Caregiver burden and eating-related guilt during dysphagia rehabilitation: A descriptive cross-sectional time series study 吞咽困难康复期间照顾者的负担和与进食有关的内疚感:一项描述性横断面时间序列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-22 DOI: 10.1002/jpen.2679
Hiroko Mori MPH, PhD, Ayako Nakane DDS, Yuri Yokota PhD, Haruka Tohara DDS, PhD, Takeo Nakayama MPH, PhD

Background

Caregivers of patients with chronic dysphasia experience stress and guilt regarding their eating behaviors. Dysphagia rehabilitation, including minimal oral intake with tube feeding, may be vital for caregivers. This study investigated the effects of dysphagia rehabilitation on caregiver well-being and attitudes toward eating assistance.

Methods

This cross-sectional questionnaire study was conducted at two dental university hospitals on caregivers of homebound patients with dysphagia undergoing rehabilitation. Caregivers' experiences, with an emphasis on guilt and psychological status, were assessed using the Apathy Scale and Patient Health Questionnaire-5 Depression Scale. Patients were evaluated at the time of the survey and rehabilitation commencement using the Barthel Index and Functional Oral Intake Scale (FOIS). Changes in FOIS scores and caregiver guilt were assessed using the Wilcoxon signed rank test and McNemar test, respectively. The impact of oral intake changes on caregiving motivation was assessed using the Fisher exact test.

Results

Between August 2019 and January 2021, 55 of 100 targeted caregivers responded (median age=64.5 years). A significant difference in FOIS scores was found (median rehabilitation duration=9.7 months). Despite 25 pneumonia cases, 65% of the caregivers continued to encourage oral intake. Guilt decreased from 48% during peak dysphagia to 22% at survey time (odds ratio=0.2, 95% CI=0.04–0.70; P < 0.01). No association was found between caregiving motivation and improved oral intake.

Conclusion

Severe dysphagia impacted caregiver well-being, indicating preferences for patients' oral intake. To support caregivers, healthcare professionals should explore and integrate new multidisciplinary approaches into dysphagia rehabilitation strategies.

背景:慢性吞咽困难患者的照顾者会因患者的进食行为而感到压力和内疚。吞咽困难康复治疗,包括用管式喂养进行最低限度的口腔摄入,可能对照顾者至关重要。本研究调查了吞咽困难康复对照顾者的幸福感和对饮食协助的态度的影响:这项横断面问卷调查研究在两所牙科大学医院进行,对象是居家接受康复治疗的吞咽困难患者的护理人员。使用冷漠量表和患者健康问卷-5 抑郁量表对护理人员的经历进行评估,重点是内疚感和心理状态。在调查和康复开始时,使用巴特尔指数和功能性口腔摄入量表(FOIS)对患者进行评估。采用 Wilcoxon 符号秩检验和 McNemar 检验分别评估 FOIS 分数和护理人员内疚感的变化。口腔摄入量变化对护理动机的影响采用费雪精确检验进行评估:在 2019 年 8 月至 2021 年 1 月期间,100 名目标护理人员中有 55 人做出了回应(中位年龄=64.5 岁)。发现 FOIS 评分有明显差异(中位数康复时间=9.7 个月)。尽管出现了 25 例肺炎病例,但仍有 65% 的护理人员继续鼓励患者口服药物。内疚感从吞咽困难高峰期的 48% 降至调查时的 22%(几率比=0.2,95% CI=0.04-0.70;P 结论:严重吞咽困难影响了患者的生活质量:严重吞咽困难影响了护理人员的幸福感,表明他们更倾向于患者的口服摄入。为了支持护理人员,医护人员应探索新的多学科方法,并将其融入吞咽困难康复策略中。
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引用次数: 0
Association between new insertion of a long-term enteral feeding tube and mortality in adults admitted to the hospital with aspiration: A retrospective cohort study 新插入长期肠内喂食管与因吸入而入院的成人死亡率之间的关系:一项回顾性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-20 DOI: 10.1002/jpen.2680
Anthony D. Bai MD, MSc, Siddhartha Srivastava MD, MSc, Marie Leung MD, Heather Johnson MD, Amol A. Verma MD, MPhil, Fahad Razak MD, MSc

Background

We aimed to describe the association between insertion of a new long-term enteral feeding tube during admission for aspiration and in-hospital mortality.

Methods

This retrospective cohort study across 28 Canadian hospitals from 2015 to 2022 included consecutive patients who were admitted for aspiration. Patients were categorized based on new long-term enteral feeding tube insertion during hospital stay or not. The primary outcome was the time to death in hospital. Secondary outcomes included time to discharge alive and hospital readmission for aspiration within 90 days. We used propensity score weighting to balance covariates, and a competing risk model to describe in-hospital death and discharge.

Results

Of 12,850 patients admitted for aspiration, 852 (6.6%) patients received a long-term enteral feeding tube. In the hospital, 184 (21.6%) and 2489 (20.8%) patients in the enteral feeding tube group and no enteral feeding tube group died, respectively. Within 90 days of discharge, 127 (14.9%) and 1148 (9.6%) patients in the enteral feeding tube and no enteral feeding tube group were readmitted for aspiration, respectively. After balancing covariates, an enteral feeding tube was associated with a similar in-hospital mortality risk (subdistribution hazard ratio [sHR] = 1.05, 95% CI = 0.89–1.23; P = 0.5800), longer time to discharge alive (sHR = 0.58, 95% CI = 0.54–0.63; P < 0.0001), and a higher risk of readmission (risk difference = 5.0%, 95% CI = 2.4%–7.6%; P = 0.0001).

Conclusion

Initiation of long-term enteral tube feeding was not uncommon after admission for aspiration and was not associated with an improvement in the probability of being discharged alive from the hospital or readmitted for aspiration.

背景我们旨在描述因吸痰入院期间插入新的长期肠内喂养管与院内死亡率之间的关系:这项回顾性队列研究从 2015 年至 2022 年在加拿大 28 家医院进行,纳入了因吸入而入院的连续患者。根据住院期间是否新插入长期肠内喂养管对患者进行分类。主要结果为住院期间死亡时间。次要结果包括出院时存活时间和 90 天内因吸入而再次入院的时间。我们使用倾向评分加权法平衡协变量,并使用竞争风险模型描述院内死亡和出院情况:在因吸入而入院的12850名患者中,852名(6.6%)患者接受了长期肠内喂养管。在住院期间,肠内喂食管组和无肠内喂食管组分别有 184 名(21.6%)和 2489 名(20.8%)患者死亡。出院后 90 天内,肠内喂养管组和无肠内喂养管组分别有 127 名(14.9%)和 1148 名(9.6%)患者因误吸再次入院。在平衡协变量后,肠内喂养管与相似的院内死亡风险(亚分布危险比 [sHR] = 1.05,95% CI = 0.89-1.23;P = 0.5800)、更长的出院存活时间(sHR = 0.58,95% CI = 0.54-0.63;P 结论:肠内喂养管对患者的死亡风险和出院存活时间具有相关性:因吸痰入院后开始长期肠管喂养的情况并不少见,但这与提高出院后存活的概率或因吸痰再次入院的概率无关。
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引用次数: 0
Effect of parenteral lipids on essential fatty acid deficiency in pediatric intestinal failure: A retrospective cohort study 肠外脂质对小儿肠功能衰竭患者必需脂肪酸缺乏症的影响:回顾性队列研究
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-08 DOI: 10.1002/jpen.2678
Parker Johnson PharmD, Victoria L. Phillips PharmD, Nathan Lamb PharmD, Kexin Guo MS, Lihui Zhao PhD, Katherine M. Brennan MSN, Joshua D. Prozialeck MD, Valeria C. Cohran MD

Background

Pediatric patients with intestinal failure require long-term parenteral nutrition owing to impaired enteral nutrition absorption. A potential complication is essential fatty acid deficiency (EFAD), resulting from decreased linoleic and α-linolenic acid concentrations and defined by an increased triene:tetraene ratio (TTR; Mead acid:arachidonic acid). Historically, soybean oil lipid emulsion (SOLE) was the only commercially available parenteral lipid in the United States. Recently, a composite lipid emulsion (CLE) and fish oil lipid emulsion (FOLE) received US Food and Drug Administration approval. This study investigated whether lipid emulsion regimen impacts EFAD incidence in pediatric patients with intestinal failure.

Methods

This study was a 10-year retrospective cohort study of pediatric patients with intestinal failure who received parenteral SOLE, CLE, or FOLE. The primary outcome was EFAD incidence, defined as a TTR ≥ 0.2. Secondary outcomes included TTR ≥ 0.05, cholestasis incidence, lipid dose effect on EFAD incidence, and fatty acid parameter differences.

Results

A total of 144 fatty acid profiles from 47 patients were reviewed. EFAD did not occur in any lipid emulsion group. There were no differences in the incidence of TTR ≥ 0.05 or cholestasis. The effect of dose could not be evaluated because of no EFAD incidence. Lastly, although each group had varied fatty acid parameters, none saw decreased essential fatty acid levels.

Conclusion

This study found that, with close monitoring, the lipid emulsion regimen did not impact EFAD incidence. This suggests that FOLE and CLE do not increase EFAD risk compared with SOLE in pediatric patients with intestinal failure.

背景:肠功能衰竭的小儿患者因肠内营养吸收障碍而需要长期肠外营养。一种潜在的并发症是必需脂肪酸缺乏症(EFAD),其原因是亚油酸和α-亚麻酸浓度降低,三烯:四烯比率(TTR;米德酸:花生四烯酸)升高。一直以来,大豆油脂乳剂(SOLE)是美国唯一的商用肠外脂质。最近,一种复合脂质乳剂(CLE)和鱼油脂质乳剂(FOLE)获得了美国食品药品管理局的批准。本研究调查了脂质乳剂疗法是否会影响肠功能衰竭儿科患者的 EFAD 发生率:该研究是一项为期 10 年的回顾性队列研究,研究对象是接受肠外 SOLE、CLE 或 FOLE 治疗的肠功能衰竭儿科患者。主要结果是 EFAD 发生率,定义为 TTR ≥ 0.2。次要结果包括 TTR ≥ 0.05、胆汁淤积发生率、脂质剂量对 EFAD 发生率的影响以及脂肪酸参数差异:结果:共审查了 47 名患者的 144 份脂肪酸图谱。所有脂质乳剂组均未发生 EFAD。TTR≥0.05或胆汁淤积的发生率没有差异。由于没有发生 EFAD,因此无法评估剂量的影响。最后,虽然每组的脂肪酸参数不同,但都没有发现必需脂肪酸水平下降:本研究发现,在密切监测的情况下,脂质乳剂疗法不会影响 EFAD 的发生率。这表明,在肠功能衰竭的儿科患者中,FOLE 和 CLE 与 SOLE 相比不会增加 EFAD 风险。
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引用次数: 0
Are minor burned patients really hypermetabolic? 轻度烧伤患者真的代谢过高吗?
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-05 DOI: 10.1002/jpen.2676
Gilberto Fabian Hurtado-Torres MD, PhD
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引用次数: 0
Nutritional approach of patients with minor burns: A neglected aspect of burn care? 轻度烧伤患者的营养方法:烧伤护理中被忽视的一个方面?
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-05 DOI: 10.1002/jpen.2677
Anne-Françoise Rousseau MD, PhD, Marjorie Fadeur RD, Benoit Misset MD
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引用次数: 0
Evaluating physiological barriers to oral intake in hospitalized patients: A secondary analysis 评估住院病人口腔摄入的生理障碍:二次分析。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-08-03 DOI: 10.1002/jpen.2675
Elizabeth Viner Smith BND (Hons), Imre W. K. Kouw PhD, Matthew J. Summers MDiet, Rhea Louis BMedSc (Hons), Marianne J. Chapman PhD, Lee-anne S. Chapple PhD

Background

Oral intake in hospitalized patients is frequently below estimated targets. Multiple physiological symptoms are proposed to impact oral intake, yet many have not been quantified objectively.

Aim

To describe the challenges of objectively measuring physiological nutrition-impacting symptoms in hospitalized patients.

Method

A secondary analysis of data from a single-center, descriptive cohort study of physiological nutrition-impacting symptoms in intensive care unit (ICU) survivors and general medical patients was conducted. Demographic and clinical characteristics were extracted for patients who completed the original study and collected retrospectively for those who were screened and recruited but did not complete the original study. Reasons for patient exclusion from the original study were quantified from the screening database. Descriptive data are reported as mean ± SD, median [interquartile range], or number (percentage).

Results

ICU survivors and general medical patients were screened for inclusion in the original study between March 1 and December 23, 2021. Of the 644 patients screened, 97% did not complete the study, with 93% excluded at screening. Of the 266 ICU survivors and 398 general medical patients screened, 89% and 95% were excluded, respectively. Major exclusion criteria included the inability to follow commands or give informed consent (n = 155, 25%), the inability to consume the easy-to-chew and thin-fluid buffet meal, and imminent discharge (both, n = 120, 19%).

Conclusion

Understanding physiological factors that drive reduced oral intake in hospitalized patients is challenging. Exclusion criteria required to objectively quantify physiological nutrition-impacting symptoms significantly preclude participation and likely act as independent barriers to oral intake.

背景:住院病人的口腔摄入量经常低于预期目标。目的:描述客观测量住院患者影响营养的生理症状所面临的挑战:方法:对重症监护室(ICU)幸存者和普通内科病人的生理营养影响症状的单中心描述性队列研究数据进行二次分析。研究提取了完成原始研究的患者的人口统计学和临床特征,并回顾性收集了经过筛选和招募但未完成原始研究的患者的人口统计学和临床特征。从筛查数据库中量化了患者被排除在原始研究之外的原因。描述性数据以均数±标准差、中位数[四分位间]或人数(百分比)表示:结果:2021 年 3 月 1 日至 12 月 23 日期间,对重症监护室幸存者和普通内科患者进行了筛选,以纳入原始研究。在筛选出的 644 名患者中,97% 没有完成研究,93% 在筛选时被排除。在筛选出的 266 名重症监护室幸存者和 398 名普通内科患者中,分别有 89% 和 95% 被排除在外。主要排除标准包括无法听从命令或无法做出知情同意(n = 155,25%)、无法食用易咀嚼且稀薄流质的自助餐,以及即将出院(均为n = 120,19%):结论:了解导致住院患者口腔摄入量减少的生理因素具有挑战性。客观量化生理营养影响症状所需的排除标准极大地阻碍了患者的参与,很可能成为影响口腔摄入量的独立障碍。
{"title":"Evaluating physiological barriers to oral intake in hospitalized patients: A secondary analysis","authors":"Elizabeth Viner Smith BND (Hons),&nbsp;Imre W. K. Kouw PhD,&nbsp;Matthew J. Summers MDiet,&nbsp;Rhea Louis BMedSc (Hons),&nbsp;Marianne J. Chapman PhD,&nbsp;Lee-anne S. Chapple PhD","doi":"10.1002/jpen.2675","DOIUrl":"10.1002/jpen.2675","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Oral intake in hospitalized patients is frequently below estimated targets. Multiple physiological symptoms are proposed to impact oral intake, yet many have not been quantified objectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To describe the challenges of objectively measuring physiological nutrition-impacting symptoms in hospitalized patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>A secondary analysis of data from a single-center, descriptive cohort study of physiological nutrition-impacting symptoms in intensive care unit (ICU) survivors and general medical patients was conducted. Demographic and clinical characteristics were extracted for patients who completed the original study and collected retrospectively for those who were screened and recruited but did not complete the original study. Reasons for patient exclusion from the original study were quantified from the screening database. Descriptive data are reported as mean ± SD, median [interquartile range], or number (percentage).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>ICU survivors and general medical patients were screened for inclusion in the original study between March 1 and December 23, 2021. Of the 644 patients screened, 97% did not complete the study, with 93% excluded at screening. Of the 266 ICU survivors and 398 general medical patients screened, 89% and 95% were excluded, respectively. Major exclusion criteria included the inability to follow commands or give informed consent (<i>n</i> = 155, 25%), the inability to consume the easy-to-chew and thin-fluid buffet meal, and imminent discharge (both, <i>n</i> = 120, 19%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Understanding physiological factors that drive reduced oral intake in hospitalized patients is challenging. Exclusion criteria required to objectively quantify physiological nutrition-impacting symptoms significantly preclude participation and likely act as independent barriers to oral intake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 7","pages":"833-840"},"PeriodicalIF":3.2,"publicationDate":"2024-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2675","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141889550","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
Characteristics of enteral and oral nutrition support among infants and young children in the pediatric intensive care unit: A descriptive cohort study 儿科重症监护室婴幼儿肠内和口服营养支持的特点:一项描述性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-07-22 DOI: 10.1002/jpen.2672
Jacinta Winderlich BNutDietet, MClinRes, Bridget Little BSc, PGDipDiet, Felix Oberender MCPCH, PhD, FCICM, Tessa Bollard BSc, MHSc (Nutr & Diet), Tamara Farrell BSc, PGradDipDiet, Samantha Jenkins BNutDietet, Emma Landorf BNutDietet (Hons), Andrea McCall BSc (Hons), Jessica Menzies BNutrDiet, Katie O'Brien BSc (Hons), MSc, Carla Rowe BNutDietet, MSc (Nutr & Diet), Kirsten Sim BSc, MDiet, Melanie van der Wilk BSc, PGradDipDiet, Jemma Woodgate BHlthSc (Nutr & Diet), Eldho Paul PhD, Andrew A. Udy FCICM, PhD, Emma J. Ridley BNutriDietet, PhD

Background

Children who are critically ill are often reliant on enteral and oral nutrition support. However, there is limited evidence to guide “what” to prescribe, and current practice is unknown. The primary objective of this study was to describe enteral nutrition prescription in children ≤2 years of age in the pediatric intensive care unit (PICU). The secondary objectives were to describe oral nutrition support practices and factors associated with the use of increased energy and protein density nutrition support.

Methods

Children ≤2 years of age admitted to participating PICUs over a 2-week period in June 2021 were enrolled. Data were collected on PICU admission days 1 to 7, 14, 21, and 28 on the mode of nutrition, enteral and oral nutrition support prescription, and dietitian intervention.

Results

Eighty-four children were included (49 [58%] male; 79 [94%] ≤1 year of age). Enteral nutrition was administered to 79 (94%) children (with expressed breast milk in 45 [57%]). Forty-three children received formula as enteral nutrition. Increased energy and protein density formulas were provided to 14 (33%) children enterally, with concentrated standard infant formula powder being the most common (5 [12%]). Among children offered oral intake (22; 26%), three (14%) received oral nutrition support. Children who received increased energy and protein density enteral nutrition were more likely to receive dietitian intervention (P = 0.002).

Conclusion

In children ≤2 years of age admitted to PICU, expressed breast milk was provided to half of those requiring enteral nutrition and oral nutrition support prescription was infrequent. One third of children receiving formula via enteral nutrition received an increased energy and protein density feed, and this was strongly associated with dietitian intervention.

背景:重症儿童通常依赖肠内和口服营养支持。然而,指导开具 "什么 "处方的证据有限,目前的做法也不明朗。本研究的主要目的是描述儿科重症监护室(PICU)中 2 岁以下儿童的肠内营养处方。次要目标是描述口服营养支持的做法以及与使用能量和蛋白质密度增加的营养支持相关的因素:方法:2021 年 6 月,参与研究的 PICU 在两周内收治了≤2 岁的儿童。在 PICU 入院第 1 至 7 天、第 14 天、第 21 天和第 28 天收集有关营养方式、肠道和口服营养支持处方以及营养师干预的数据:共纳入 84 名儿童(49 名[58%] 男性;79 名[94%] 年龄小于 1 岁)。79名儿童(94%)接受了肠内营养(45名儿童[57%]接受了母乳喂养)。43 名儿童接受配方奶作为肠内营养。有 14 名儿童(33%)通过肠内营养获得了能量和蛋白质密度更高的配方奶粉,其中最常见的是浓缩标准婴儿配方粉(5 [12%])。在提供口服营养的儿童中(22 人;26%),有 3 人(14%)接受了口服营养支持。接受能量和蛋白质密度增加的肠内营养的儿童更有可能接受营养师的干预(P = 0.002):结论:在入住 PICU 的 2 岁以下儿童中,半数需要肠内营养的儿童获得了母乳喂养,口服营养支持处方并不常见。三分之一通过肠内营养接受配方奶的儿童接受了能量和蛋白质密度增加的饲料,这与营养师的干预密切相关。
{"title":"Characteristics of enteral and oral nutrition support among infants and young children in the pediatric intensive care unit: A descriptive cohort study","authors":"Jacinta Winderlich BNutDietet, MClinRes,&nbsp;Bridget Little BSc, PGDipDiet,&nbsp;Felix Oberender MCPCH, PhD, FCICM,&nbsp;Tessa Bollard BSc, MHSc (Nutr & Diet),&nbsp;Tamara Farrell BSc, PGradDipDiet,&nbsp;Samantha Jenkins BNutDietet,&nbsp;Emma Landorf BNutDietet (Hons),&nbsp;Andrea McCall BSc (Hons),&nbsp;Jessica Menzies BNutrDiet,&nbsp;Katie O'Brien BSc (Hons), MSc,&nbsp;Carla Rowe BNutDietet, MSc (Nutr & Diet),&nbsp;Kirsten Sim BSc, MDiet,&nbsp;Melanie van der Wilk BSc, PGradDipDiet,&nbsp;Jemma Woodgate BHlthSc (Nutr & Diet),&nbsp;Eldho Paul PhD,&nbsp;Andrew A. Udy FCICM, PhD,&nbsp;Emma J. Ridley BNutriDietet, PhD","doi":"10.1002/jpen.2672","DOIUrl":"10.1002/jpen.2672","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Children who are critically ill are often reliant on enteral and oral nutrition support. However, there is limited evidence to guide “what” to prescribe, and current practice is unknown. The primary objective of this study was to describe enteral nutrition prescription in children ≤2 years of age in the pediatric intensive care unit (PICU). The secondary objectives were to describe oral nutrition support practices and factors associated with the use of increased energy and protein density nutrition support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Children ≤2 years of age admitted to participating PICUs over a 2-week period in June 2021 were enrolled. Data were collected on PICU admission days 1 to 7, 14, 21, and 28 on the mode of nutrition, enteral and oral nutrition support prescription, and dietitian intervention.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-four children were included (49 [58%] male; 79 [94%] ≤1 year of age). Enteral nutrition was administered to 79 (94%) children (with expressed breast milk in 45 [57%]). Forty-three children received formula as enteral nutrition. Increased energy and protein density formulas were provided to 14 (33%) children enterally, with concentrated standard infant formula powder being the most common (5 [12%]). Among children offered oral intake (22; 26%), three (14%) received oral nutrition support. Children who received increased energy and protein density enteral nutrition were more likely to receive dietitian intervention (<i>P</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In children ≤2 years of age admitted to PICU, expressed breast milk was provided to half of those requiring enteral nutrition and oral nutrition support prescription was infrequent. One third of children receiving formula via enteral nutrition received an increased energy and protein density feed, and this was strongly associated with dietitian intervention.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 7","pages":"803-809"},"PeriodicalIF":3.2,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141734358","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 protein intake and functional capacity in critically ill patients: A retrospective cohort study 重症患者蛋白质摄入量与功能能力之间的关系:一项回顾性队列研究。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-07-17 DOI: 10.1002/jpen.2673
Fábio Araújo RD, MHS, Juan G. Posadas-Calleja MD, MSc, Maitreyi Raman MD, MSc, Maureen Tosh PT, Paul Wischmeyer MD, Priscilla Barreto RD, Chelsia Gillis RD, PhD

Background

Intensive care unit (ICU) protein benchmarks are based on mortality and morbidity; whether these targets also support functional recovery is unknown. We assessed whether different protein doses influenced patients' functional capacity, measured by the Chelsea Physical Assessment score (CPAx).

Methods

Single-center retrospective cohort study on ICU survivors with length of stay ≥7 days admitted between October 2014 and September 2020. Eligible patients were divided according to protein intake (g/kg/day): low (<0.8), medium (0.8–1.19), high (1.2–1.5), and very high (>1.5). Protein dose effect on CPAx was assessed at ICU discharge with analysis of covariance adjusting for age, illness severity, hospital length of stay before ICU admission, time to start nutrition support, and mechanical ventilation duration. We also investigated effect modification by energy intake and nutrition status.

Results

Enrolled patients (n = 531) were similar for age, nutrition status, and illness severity across groups. CPAxs were nonlinearly associated with protein doses and similar among low, medium, and very high groups. The CPAx for the high group was statistically different (P = 0.014), indicating that the data of three groups could be pooled. Mean CPAx difference remained statistically significant after adjusting for confounding variables (3.9 ± 1.8, P = 0.029 in the four-group model, and 2.7 ± 0.9, P = 0.003 in the pooled two-group model). Energy intake was equivalent between groups and did not modify CPAx. The high group had superior CPAx in both well-nourished and malnourished patients, indicating nutrition status was not an effect modifier.

Conclusion

Protein dose 1.2–1.5 g/kg/day was associated with superior functional capacity at ICU discharge compared with other doses. Neither energy intake nor nutrition status modified functional capacity across groups; therefore, the results appear to be influenced by 1.2–1.5 g/kg/day.

背景:重症监护病房(ICU)的蛋白质基准以死亡率和发病率为基础,但这些目标是否也有助于功能恢复还不得而知。我们评估了不同的蛋白质剂量是否会影响患者的功能能力(以切尔西体能评估评分(CPAx)来衡量):单中心回顾性队列研究,对象为 2014 年 10 月至 2020 年 9 月期间入住 ICU 且住院时间≥7 天的幸存者。符合条件的患者根据蛋白质摄入量(克/千克/天)分为:低(1.5)。在 ICU 出院时评估蛋白质剂量对 CPAx 的影响,并进行协方差分析,调整年龄、病情严重程度、入 ICU 前的住院时间、开始营养支持的时间和机械通气持续时间。我们还研究了能量摄入和营养状况对效果的影响:各组入选患者(n = 531)的年龄、营养状况和病情严重程度相似。CPAx与蛋白质剂量呈非线性关系,低、中、高组之间相似。高剂量组的 CPAx 有统计学差异(P = 0.014),表明三组的数据可以合并。调整混杂变量后,平均 CPAx 差异仍有统计学意义(四组模型中为 3.9 ± 1.8,P = 0.029;两组集合模型中为 2.7 ± 0.9,P = 0.003)。各组之间的能量摄入量相同,不会改变 CPAx。高剂量组在营养良好和营养不良的患者中都有较好的 CPAx,这表明营养状况不是影响因素:结论:与其他剂量相比,蛋白质剂量为 1.2-1.5 克/公斤/天的患者在重症监护室出院时的功能能力更强。能量摄入和营养状况都不会改变各组的功能能力;因此,结果似乎受到 1.2-1.5 克/公斤/天的影响。
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引用次数: 0
Early nutritional influences on brain regions related to processing speed in children born preterm: A secondary analysis of a randomized trial 早期营养对早产儿大脑处理速度相关区域的影响:随机试验的二次分析。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-07-15 DOI: 10.1002/jpen.2669
Nicole Bando PhD, Julie Sato PhD, Marlee M. Vandewouw MASc, Margot J. Taylor PhD, Christopher Tomlinson MB, ChB, PhD, Sharon Unger MD, Michelle R. Asbury PhD, Nicole Law PhD, CPsych, Helen M. Branson MBBS, Deborah L. O'Connor PhD, RD

Background

Processing speed is a foundational skill supporting intelligence and executive function, areas often delayed in preterm-born children. The impact of early-life nutrition on gray matter facilitating processing speed for this vulnerable population is unknown.

Methods

Magnetic resonance imaging and the Wechsler Preschool and Primary Scale of Intelligence-IV Processing Speed Index were acquired in forty 5-year-old children born preterm with very low birth weight. Macronutrient (grams per kilogram per day) and mother's milk (percentage of feeds) intakes were prospectively collected in the first postnatal month and associations between early-life nutrition and the primary outcome of brain regions supporting processing speed were investigated.

Results

Children had a mean (SD) gestational age of 27.8 (1.8) weeks and 45% were male. Macronutrient intakes were unrelated, but mother's milk was positively related, to greater volumes in brain regions, including total cortical gray matter, cingulate gyri, and occipital gyri.

Conclusion

First postnatal month macronutrient intakes showed no association, but mother's milk was positively associated, with volumetric measures of total and regional cortical gray matter related to processing speed in preterm-born children. This exploratory analysis suggests early-life mother's milk supports processing speed by impacting structural underpinnings. Further research is needed on this potential strategy to improve preterm outcomes.

背景:处理速度是支持智力和执行功能的一项基础技能,而早产儿在这方面往往发育迟缓。早期营养对这一弱势群体处理速度灰质的影响尚不清楚:磁共振成像和韦氏学前和小学智能量表-IV 处理速度指数是针对 40 名 5 岁的超低出生体重早产儿进行的。在出生后的第一个月,对宏量营养素(每天每公斤克数)和母乳(占喂养量的百分比)的摄入量进行了前瞻性收集,并调查了早期营养与支持处理速度的大脑区域这一主要结果之间的关系:儿童的平均(标清)胎龄为27.8(1.8)周,45%为男性。宏量营养素摄入量与大脑区域(包括皮质灰质总量、扣带回和枕叶)的体积增大无关,但与母乳呈正相关:结论:早产儿出生后第一个月的宏量营养素摄入量与大脑皮层灰质总量和区域灰质体积与处理速度无关,但与母乳呈正相关。这一探索性分析表明,早期母乳通过影响结构基础来支持处理速度。我们需要对这一改善早产儿预后的潜在策略进行进一步研究。
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引用次数: 0
JPEN Journal Club 86. Trial registry misinformation JPEN 期刊俱乐部 86.试验登记处的错误信息。
IF 3.2 3区 医学 Q2 NUTRITION & DIETETICS Pub Date : 2024-07-13 DOI: 10.1002/jpen.2674
Ronald L. Koretz MD
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引用次数: 0
期刊
Journal of Parenteral and Enteral Nutrition
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