Nutrition in Clinical Practice最新文献

Background: Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD.

Methods: This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons.

Results: There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions.

Conclusion: Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes.

Nutrition plays an integral role in the management of patients with enterocutaneous fistula (ECF), but practice guidelines are often vague because of limited evidence. As a result, clinicians must rely on expert consensus and sound nutrition principles to guide practice. The initial phase of ECF management involves recognition (eg, fistula location and quantifying output) and stabilization (eg, source control and fluid and electrolyte balance). All patients with ECF should be considered at risk of malnutrition because of malabsorption, high gastrointestinal fluid and nutrient losses, and chronic inflammation. Strict bowel rest in conjunction with parenteral nutrition (PN) is typically warranted on initial presentation, but patients can often transition to oral diet or enteral nutrition if ECF output is low (<500 ml/day) and there is good control of ECF drainage at the skin level. Patients with high-output ECF (>500 ml/day) may require PN to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF. Because the healing process can take months, transfer from the inpatient to home setting should be considered when a patient is medically stable. Preparing for discharge home requires stabilization of fluid and electrolyte balance, achievement of glycemic control, containment of ECF output, and patient and/or caregiver training. A long-term PN treatment plan should be developed that incorporates outpatient monitoring, determination of target weight, and desired PN end point. The purpose of this article is to review the optimal use of PN in adult patients with ECF.

Protein-energy wasting is common in people with chronic kidney disease (CKD), especially in those undergoing kidney replacement therapy. Oral nutrition supplements and enteral nutrition are strategies that have been shown to improve nutrition status, and potentially outcomes. However, access to specialized commercial products for people with CKD is limited by factors including cost and regional availability. Homemade formulas represent a potentially cheaper, accessible, and more flexible option than commercial products, but they come with their own unique set of challenges. Furthermore, some aspects of homemade products, including consistency of nutrients, physical properties, and food safety, may pose challenges in the context of physiological changes that occur in CKD. Despite evidence of their use in CKD clinics, there have been few studies using homemade formulas in this population. This narrative review article summarizes the available literature on the potential usage, benefits, and concerns related to homemade formulas, emphasizing the unique challenges in people with CKD. Given the potential usage and limited research on homemade formulas in people with CKD, additional education and research are warranted to optimize the use of these tools in this clinical population.

Background: There are numerous articles, book chapters, and published guidelines on the topic of clinical ethics in the use of artificially administered nutrition and hydration, which often incorporates end-of-life (EOL) nutrition care and support. Components of clinical ethics involve the importance of ethical principles, patient-centered care, and shared decision-making. However, there is sparse information on how to educate patients and caregivers on this subject.

Methods: Initially, PubMed and the Cochrane Library were used to find articles on the subject. Articles were reviewed and new concepts were identified to include.

Results: There is a practice gap with not applying clinical ethics in practice. The application of clinical ethics, which includes the teach-back method of education, soft skills and behavioral skills training, and potential sacred moments, is not well addressed in the literature. Demonstration of the process of incorporating clinical ethics into practice is beneficial in helping educate clinicians so they can then effectively educate the patient and caregiver on EOL nutrition care and support. Reasons for not applying clinical ethics in actual clinical practice may be because of clinicians not receiving training, the lack of opportunity to observe the technique applied in actual clinical practice, or possibly concern for the presumed additional time required in clinical practice to apply clinical ethics.

Conclusion: Educating patients and caregivers on EOL nutrition care and support presupposes engaging, educating, and empowering clinicians about clinical ethics by demonstrating the process and encouraging educators to incorporate the information in an interdisciplinary/interprofessional curriculum.

Background: When exposed to ambient light, parenteral nutrition (PN) contamination with peroxides almost doubles, which increases oxidative stress in preterm infants, contributing to the development of bronchopulmonary dysplasia. The American Society for Parenteral and Enteral Nutrition (ASPEN) recommends complete PN photoprotection to reduce peroxide contamination and optimize its integrity but acknowledges the challenges of its implementation. In this study, a novel photoprotection procedure was tested for its effectiveness in reducing peroxide load and limiting ascorbic acid degradation, and for its feasibility and effectiveness in reducing urinary peroxide levels in preterm infants.

Methods: In vitro evaluation included neonatal lipid injectable emulsion-free PN admixtures prepared and infused according to current practice or the suggested photoprotection procedure through separation and complete shielding of intravenous multivitamin preparation from compounding to administration through photoprotected infusion sets. In vivo evaluation included a single-center randomized controlled pilot study of extremely preterm infants receiving PN according to current practice or the suggested photoprotection procedure.

Results: In vitro, photoprotection allowed a 44% decrease in peroxide generation (P < 0.001) and reduced by half ascorbic acid degradation in PN admixtures (P < 0.001). In vivo, 28 infants completed the study. Baseline urinary peroxide levels were similar in both groups before PN initiation, and the suggested photoprotection procedure resulted in a significant decrease in urinary peroxide levels over the first week of life (P < 0.05).

Conclusion: The suggested procedure appears feasible and effective in reducing peroxide contamination and optimizing PN integrity, representing a step toward integrating complete photoprotection of PN as the standard of care in preterm infants.

Background: This project aimed to develop an evidence-based nursing care bundle after gastrostomy feeding tube insertion and implement it into clinical practice using the Knowledge to Action (KTA) framework.

Methods: This mixed-method design project was conducted in a university hospital between December 2021 and June 2022. The project was carried out in four phases: (1) development of an evidence-based care bundle, (2) education for care bundle training, (3) implementation of the care bundle, (4) evaluation of the care bundle. Nurses' compliance with bundles was measured using All-or-None measurement. The analysis of the qualitative interview conducted was performed using the content analysis method of Graneheim and Lundman.

Results: The developed Sezer gastrostomy care bundle consists of three parameters (peristomal area care, tube feeding, and medication administration through the feeding tube) and a total of 14 elements to be applied by nurses under these parameters. Compliance rates for peristomal area care, tube feeding, and medication administration through feeding tube parameters were 100%, 98.66%, and 98.66%, respectively. Two themes and six subthemes emerged: (1) reflection of using the Sezer gastrostomy care bundle on nursing care and (2) adoption of Sezer gastrostomy care bundle.

Conclusion: The gastrostomy care bundle was developed in accordance with the Institute of Healthcare Improvement's recommendations. The KTA framework provided an appropriate structure to transform evidence into practice, meticulously address barriers, evaluate outcomes, and ensure sustainability. The project found that nurses complied with all its parameters. Studies evaluating the effect of the gastrostomy care bundle on patient outcomes are recommended.

Background: The high prevalence of malnutrition among those of older age and the lack of nutrition knowledge among the elderly and their caregivers underscore the need for a nutrition education intervention (NEI) for caregivers.

Materials and methods: Patients enrolled in the "home care program" who were dependent, were >65 years of age, and had caregivers (n = 94) were included in the study. A nutritionist conducted initial NEI sessions for caregivers and subsequently monitored them monthly at home for 12 months. Mini Nutritional Assessment (MNA) and World Health Organization Quality of Life Elderly Module (WHOQOL-OLD) were used to evaluate the nutrition status and quality of life scores of those of older age, respectively. Additional assessments included dietary intake, anthropometric measurements, and biochemical measurements. Other measures included current medical history and Barthel Index for Activities of Daily Living. All measurements were recorded over 12 months.

Results: The mean age of the participants was 84.4 ± 6.9 years, with 61.7% being women. Significant differences were observed postintervention for MNA (Δ = +1.4; P < 0.001) and WHOQOL-OLD (Δ = +3.0; P < 0.001). The NEI was associated with improved nutrition status and quality of life. Post-intervention, significant improvements were noted in body weight (Δ = +0.4 kg; P < 0.001), waist circumference (Δ = +0.3 cm; P < 0.05), BMI (Δ = +0.2 kg/m²; P < 0.05), energy intake (Δ = +77 kcal/day; P < 0.001), protein intake (Δ = +5.4 g/day; P < 0.001), carbohydrate intake (Δ = +16.2 g/day; P < 0.001), and intakes of vitamin B2 (Δ = +0.3 mg/day; P < 0.001), vitamin C (Δ = +24.0 mg/day; P < 0.05), calcium (Δ = +133 mg/day; P < 0.001), and phosphorus (Δ = +116 mg/day; P < 0.001).

Conclusions: NEI for caregivers may reduce the malnutrition prevalence among those of older age and improve their dietary habits, quality of life, anthropometric measurements, biochemical parameters, and nutritional intake.

This article synthesizes the existing research evidence from Tanzania, a low- to middle-income country, highlighting the persistent issue of growth stunting. Stunting begins early in life, potentially even in utero. It is becoming increasingly clear that infant and childhood environmental enteric dysfunction plays a significant role in perpetuating the observed stunting. The repercussions of this condition include poor growth and detrimental effects on neurodevelopment, preventing affected children from reaching their full potential. The economic implications of this are substantial. The manuscript outlines the trajectory from low birth weight and suboptimal lactation to altered weaning practices and changes in the gut microbiome. It also presents current perspectives on how to mitigate these adverse effects, with a focus on early interventions in lactation and feeding during the crucial first 1000 days of life.

Background: Malnutrition is a highly prevalent condition in patients who are critically ill that has been previously associated with adverse clinical outcomes. The aims of this study are to describe the prevalence of malnutrition using Global Leadership Initiative on Malnutrition (GLIM) criteria and analyze the associations with clinical outcomes using original criteria or the presence of one phenotypic criterion with inflammation measured by C-reactive protein (CRP) in patients with pneumonia and other lung manifestations who are mechanically ventilated.

Methods: This retrospective cohort study included patients who are critically ill. Malnutrition was classified using the original GLIM criteria (reduced muscle mass and the assumption of present inflammation because of critical illness) and one phenotypic criterion with severe inflammation (CRP >5 mg/dl). Associations between both groups with clinical outcomes (duration of invasive mechanical ventilation [IMV], length of stay [LOS] on ICU, hospital LOS, ICU mortality, and prolonged ICU LOS) were assessed.

Results: Two hundred and thirty-four patients who were critically ill were included. The prevalence of malnutrition in the established methods GLIM and phenotypic criterion with severe inflammation was 38.4% and 27.7%, respectively. Patients who survived and were diagnosed with malnutrition using inflammation criterion at baseline had longer hospital LOS (31 vs 25 days, P = 0.04). After adjusting for age, clinical diagnosis at admission, and SOFA and APACHE II scores, phenotypic criterion with severe inflammation was associated with duration of IMV (β: 5.7; 95% confidence interval: 0.7-10.7; P = 0.02) and ICU LOS (β: 6.1; 95% CI: 0.8-11.5; P = 0.02).

Conclusions: Malnutrition considering a phenotypic criterion and CRP >5 mg/dl upon ICU admission was associated with duration of IMV and ICU LOS.