Nestle Nutrition workshop series. Clinical & performance programme最新文献_第4页

Efficacy of enteral and parenteral nutrition in cancer patients. 肿瘤患者肠内和肠外营养的疗效。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083302

Federico Bozzetti, Valentina Bozzetti

Before attempting to analyze the potential efficacy of the two different routes of administering nutrients to cancer patients, enteral nutrition (EN) versus total parenteral nutrition (TPN), it should be appreciated that patients who are usually fed via a vein are not the same as those who receive EN. If fact, nowadays, the option for TPN only emerges if a patient is not suitable for EN because his/her gut is not working. Consequently the different effects of EN and TPN cannot be attributed only to the administration route of nutrients, but also to the different basic conditions of these 2 groups of patients. There are, however, some exceptions: at the beginning of the era of artificial nutrition, TPN was more developed than EN probably because the impetus of this new approach relied on an urgent need to solve the problems of patients with intestinal failure. In fact, initially TPN was developed in surgical departments to meet the nutritional requirements of patients with short-bowel syndrome or abdominal catastrophes. This translated into the use of TPN also in patients with a working gut, and finally rendered a comparison between TPN and EN not only possible, but even scientifically rational and ethically acceptable. At this point we were roughly in the 1980s. Another field where TPN and EN are frequently compared is the perioperative setting. Nutritional support in the perioperative period is not nutrition in the traditional meaning of the word: it is the attempt to control the metabolic reaction to surgical trauma and to potentiate the defenses of the patient through the administration of nutrients. The indication for nutritional support in this patient population was questioned for a long time and the simple provision of a saline solution for a few days was usually accepted in many institutions. Consequently in the literature there are studies comparing not only different nutritional regimens and Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 127–142, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 16

Malnutrition in the developing world: the lack of food scenario. 发展中国家的营养不良:缺乏食物的情景。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083257

D Labadarios

The current literature concurs that the prevalence of malnutrition, and stunting among children in particular, is a reasonably accurate reflection on the prevailing socioeconomic status in a given environment. In this regard, malnutrition is known to adversely impact on mental development, scholastic achievement, productivity, child and woman morbidity and mortality as well as the risk for infection. As such, it is hardly surprising that nutritional status is one of the key Millennium Development Goals [1]. Poverty and food insecurity are almost universally accepted to be very significant contributory factors. Although slow, but welcome improvements are being achieved in many developing countries, child malnutrition, poverty and household food insecurity appear to be actually increasing (fig. 1) in India and Sub-Saharan Africa [2]. In South Africa for instance and at the national level, three of four households have been reported to be either ‘hungry’ or at ‘risk of hunger’ (table 1), the extent of hunger being related to adverse growth patterns (fig. 2), lower energy intake (fig. 3), lower income as well as a lower intake of a number of nutrients among children 1–9 years of age [3]. In this regard, the World Bank and the International Monetary Fund have recently predicted [4] that although the income poverty goal is likely to be achieved at the global level, Africa will fall well short. The predicted shortfalls appear especially serious for the health and environmental goals, namely child and maternal mortality, and access to safe drinking water and basic sanitation. The likely increasing number of malnourished people in these regions assumes even greater importance against the background of the HIV/AIDS pandemic in such developing countries, since HIV/AIDS exacerbates food insecurity by decreasing the available agricultural labor force and food production [2]. Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 1–13, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 2

Home enteral nutrition. Epidemiology and legislation in Europe. 家庭肠内营养。欧洲的流行病学和立法。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083275

A van Gossum

Enteral nutrition is the preferred way of feeding patients who cannot maintain sufficient oral intake but have a functioning gastrointestinal tract. Enteral feeding has been used for several decades for hospitalized patients, but for the last 20 years home enteral nutrition (HEN) has been expanding in home care in many industrialized countries throughout the world. Despite the fact that the number of patients on HEN is now much higher than patients on home parenteral nutrition (HPN), scientific interest and medical concern were initially much higher for HPN [1–3]. The number of scientific publications on the use of HEN is quite weak. In many European countries, legislation on HEN has only quite recently come into effect or is lacking. There are no real guidelines on the correct use of HEN while guidelines for enteral nutrition in hospitalized patients have recently been published [4]. In this chapter, we have tried to collect data on epidemiology, legislation and the current use of HEN throughout Europe.

引用次数: 6

When does malnutrition become a risk? 营养不良何时成为一种风险?

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083276

L Genton, W G van Gemert, C H Dejong, P L Cox-Reijven, P B Soeters

Malnutrition has been defined as a deficiency of energy, protein or other types of nutrients, which produces alterations in body function, is associated with worse outcome from illness and is reversible by nutritional support [1]. Global malnutrition generally results from simple starvation or stress starvation and has to be distinguished from deficiency of one micronutrient or vitamin [2]. Starvation results from a pure deficit of all macroand micronutrients and occurs for instance in hunger strikers, persons with anorexia, or patients with intestinal diseases leading to malabsorption. Stress starvation, or cachexia, represents the accelerated loss of muscle mass in response to metabolic stress and generally affects patients with inflammatory or neoplastic diseases. Some authors report a third type of malnutrition, sarcopenia [3], which reflects loss of skeletal muscle in the elderly as well as in persons who repeatedly try to lose weight by dieting and in people with growth hormone deficiency, immobilization or arthritis. However, it is questionable whether cachexia and sarcopenia are totally different entities because they may share one or more common pathophysiologic causes including metabolic stress. Whatever the specific etiology is, global malnutrition results in decreased body cell mass (BCM) and fat-free mass (FFM) and leads to diminished body function. FFM can routinely be assessed by several methods, including measurements of skinfold thickness, arm circumference, bioelectrical impedance analysis (BIA) or dual energy X-ray absorptiometry (DXA). In many studies, parallel decreases in BCM and quality of life have been demonstrated [4–7] Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 73–88, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 6

Home enteral nutrition. Demographics and utilization in the United States. 家庭肠内营养。美国的人口统计和使用情况。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083274

Mark H DeLegge

Enteral nutrition is the act of receiving nutrients through the gut, either orally or through an enteral access device. It has long been used in the hospital and nursing home setting. The number of patients receiving home enteral nutrition (HEN) in the United States has progressively increased, yet the absolute numbers remain difficult to determine. The use of enteral nutrition has a long history. In 1790, Hunter was first reported to use a mixture of jellies, milk, eggs, sugar and wine through a whale bone covered with eel skin attached to a bladder pump [1]. Einhorn [2] in 1910 provided medical practitioners with guidelines for gastric and intestinal enteral feedings. In the 1950s, attention was placed on the development of enteral formulas. Pareira et al. [3] and Meade Johnson (Evansville, Ind., USA) developed an early enteral formula consisting of milk, milk solids, calcium caseinate, dextrose, maltodextrose, vitamins and minerals. At the same time at Henry Ford Hospital, Barron et al. [4] reported on the use of tube feedings made in the kitchen by blenderizing and straining table food. In the late 1950s and early 1960s a large study on the use of an elemental-based diet was conducted by the Vivonex Corporation (Mountain View, Calif., USA) and the National Institutes of Health. These diets were shown to provide adequate nutrition and maintain a patient’s well-being [5]. The last 3 decades have shown an explosion in the enteral formula industry with the development of many enteral products, some disease-specific. This has provided some specificity in a clinician’s ability to use enteral nutrition as a disease-specific tool, but has complicated the home care industry by the sheer volume of enteral formula choices available to patients and their providers. HEN has become a growing segment of the total home care arena in the United States. In 1992 it was estimated that there were approximately 73,000 HEN patients with an average yearly expenditure of USD 136 million [6]. Today’s expenditure estimates are very difficult to obtain, not only from the Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 45–58, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 1

Ethics and economics in nutritional support. 营养支持的伦理和经济学。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083303

Alan L Buchman

Enteral and parenteral nutritional support was developed to provide sustenance to patients who ordinarily were unable to meet their nutritional needs either because of an inability to eat or an inability to digest and absorb food. Undernutrition has been associated with increased infection risk, poor wound healing, increased postoperative complications, prolonged hospital stay, respiratory, cardiac, and hepatic dysfunction, as well as increased mortality. A clinical decision must be made about the provision of both nutrition as well as hydration fluids for patients otherwise able to eat in the usual fashion. Patients who had intestinal failure from either short bowel syndrome (congenital or acquired) or severe dysmotility disorders were doomed in the absence of parenteral nutrition. Soon after the advent of total parenteral nutrition (TPN) in the late 1960s and early 1970s, it was thought that TPN was the cure-all for many ills and it became integral to the management of the chemotherapy patient, bone marrow transplant patient, preoperative patient, burn patient, and trauma patient, among other patient subsets. It was once hypothesized that, because patients who received TPN had a significantly decreased serum cholesterol concentration, TPN might be a reasonable therapy for atherosclerotic heart disease [1]. As this therapy came under increasingly more widespread use, evidencebased medicine with regard to TPN began to evolve. It was found TPN did not increase the effectiveness of chemotherapy, improve bone marrow engraftment, result in decreased postoperative infections in only mildly or non-malnourished patients, and did not improve outcome in trauma (other than head trauma) or burn patients, and in fact was associated with significant treatment-related complications in some patients [2]. The survival rate Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 143–166, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 4

How can we improve functional outcomes? 我们如何改善功能结果?

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083309

Marinos Elia

Health has multiple dimensions. In a broad sense, health can be considered in terms of physical, mental and social well-being, but this may be difficult to measure, particularly in whole populations. The earliest population indices of health were based on readily available and unambiguous indicators, such as mortality; and these were applied to particular age groups, such as the first year of life (infant mortality). The legal requirement in many societies to record mortality meant that generally complete data could be obtained. However, although such information has been of considerable value, this may change over time as societies evolve. Health indicators are often specifically chosen to reflect current problems within societies, especially those requiring improvement. Mortality statistics may reveal new layers of concerns, which may lead to the development of new indicators of health outcome to reflect these new concerns. For example, in low income countries, where infant mortality is high (or mortality from specific treatable diseases are high) appropriate policies may produce improvements in outcome relatively easily. In developed countries, where this mortality has already been reduced to very low levels, the cost of reducing it to an even lower level may be disproportionately high and unacceptable to policy makers. Therefore, new policies are established so that resources can be redirected to address other more important health problems in the general population. For example, as survival from a particular condition or groups of conditions improves, a range of persisting disabilities may develop, e.g. increasing life expectancy in countries with well-developed economies is associated with greater disability and dependency in older life, and a poorer quality of life. As a consequence, indicators of these health outcomes have become increasingly more prominent in Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 233–247, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 1

Oral protein and energy supplementation in older people: a systematic review of randomized trials. 老年人口服蛋白质和能量补充:随机试验的系统回顾。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083301

Anne C Milne, Alison Avenell, Jan Potter

A report of the UK Royal College of Physicians entitled ‘Nutrition and Patients: A Doctor’s Responsibility’, published in July 2002 [1], highlighted again the importance of nutritional care for vulnerable groups such as undernourished elderly people, particularly those who are hospitalized or institutionalized. Older people have longer periods of illness and longer hospital stays [2], and data show that up to 55% of elderly hospitalized patients are undernourished on admission [3, 4]. Malnutrition is associated with poorer recovery in a broad range of patients and conditions [5, 6], and furthermore, nutritional status has been shown to decline during hospitalization [3, 7]. This has led to the hypothesis that providing nutritional support to those at risk of malnutrition will have beneficial effects on outcome. The best way to establish this is to demonstrate it in a randomized controlled trial (RCT). A systematic review of RCTs by Potter et al. [8] in 1998 examined the effects of oral and enteral protein and energy supplementation in trials involving adults of all ages with any medical or surgical condition. Supplementation seemed to improve the nutritional indices of adult patients, but there were insufficient data in trials which met strict methodological criteria to be certain if mortality was reduced. A Cochrane Review of dietary advice for illness-related malnutrition in adults of all ages was also carried out by Baldwin et al. [9]. There was insufficient evidence to establish whether dietary advice alone improves the outcomes, however the limited information available suggested that weight gain was greater in people who also received supplements, with or without advice. Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 103–125, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 25

Interaction between nutrition, intestinal flora and the gastrointestinal immune system. 营养、肠道菌群和胃肠道免疫系统之间的相互作用。

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083305

H Lochs

The intestinal mucosa is the biggest surface of the body, which is constantly in close contact with a high number of different bacteria and food antigens. Furthermore it has to absorb nutrients and in this process to differentiate between those molecules which have to pass the mucosal barrier and be taken up as nutrition and those molecules and organisms which have to be kept out to maintain the sterile condition in the organism. This is a complex function which is regulated by different layers of the intestinal barrier as well as specific transport systems.

引用次数: 2

Are older people starving to death in a world of plenty? 在一个丰饶的世界里，老年人会饿死吗?

Nestle Nutrition workshop series. Clinical & performance programme

Pub Date : 2005-01-01 DOI: 10.1159/000083261

David R Thomas

The indictment by Nightingale has persisted for over a century, aided by the inadequate attention paid by physicians to nutritional status. Dietary restrictions, improper dietary prescriptions, and keeping patients non per ora for considerable lengths of time have contributed to nutritional problems in the healthcare system [1, 2]. The nutritional status of older adults living at home is poor. On average, persons over the age of 70 years consume one third less calories compared to younger persons. Energy intakes of older men (40–74 years old) range from 2,100 to 2,300 cal/day compared to younger men (24–34 years old) who consume 2,700 cal/day [3]. Ten percent of older men and 20% of older women have intakes of protein below the US recommended daily allowance (RDA), and one third consume fewer calories than the RDA. Fifty percent of older adults have intakes of minerals and vitamins less than the RDA and 10–30% have subnormal levels of minerals and vitamins [4]. Sixteen to eighteen percent of community-dwelling elderly persons consume less than 1,000 kcal daily [5]. The drive to find food, designated by the term ‘hunger’, is essential in all species. Hunger is controlled by chemical mediators, signaling when to stop eating (‘satiation’), and when to resume searching for food (‘satiety’) which Lochs H, Thomas DR (eds): Home Care Enteral Feeding. Nestlé Nutrition Workshop Series Clinical & Performance Program, vol 10, pp 15–29, Nestec Ltd., Vevey/S. Karger AG, Basel, © 2005.

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引用次数: 2