Nutricion hospitalaria最新文献

Background: Malnutrition and dehydration are widespread in older people, and obesity is an increasing problem. In clinical practice, it is often unclear which strategies are suitable and effective in counteracting these key health threats.

Aim: To provide evidence-based recommendations for clinical nutrition and hydration in older persons in order to prevent and/or treat malnutrition and dehydration. Further, to address whether weight-reducing interventions are appropriate for overweight or obese older persons.

Methods: This guideline was developed according to the standard operating procedure for ESPEN guidelines and consensus papers. A systematic literature search for systematic reviews and primary studies was performed based on 33 clinical questions in PICO format. Existing evidence was graded according to the SIGN grading system. Recommendations were developed and agreed in a multistage consensus process.

Results: We provide eighty-two evidence-based recommendations for nutritional care in older persons, covering four main topics: Basic questions and general principles, recommendations for older persons with malnutrition or at risk of malnutrition, recommendations for older patients with specific diseases, and recommendations to prevent, identify and treat dehydration. Overall, we recommend that all older persons shall routinely be screened for malnutrition in order to identify an existing risk early. Oral nutrition can be supported by nursing interventions, education, nutritional counselling, food modification and oral nutritional supplements. Enteral nutrition should be initiated if oral, and parenteral if enteral nutrition is insufficient or impossible and the general prognosis is altogether favorable. Dietary restrictions should generally be avoided, and weight-reducing diets shall only be considered in obese older persons with weight-related health problems and combined with physical exercise. All older persons should be considered to be at risk of low-intake dehydration and encouraged to consume adequate amounts of drinks. Generally, interventions shall be individualized, comprehensive and part of a multimodal and multidisciplinary team approach.

Conclusion: A range of effective interventions is available to support adequate nutrition and hydration in older persons in order to maintain or improve nutritional status and improve clinical course and quality of life. These interventions should be implemented in clinical practice and routinely used.

Introduction:

Introduction: Background: parenteral nutrition-associated liver disease (PNALD) is a common complication in patients receiving total parenteral nutrition (TPN). Our study aimed to establish a nomogram to predict short-term occurrence of PNALD patients and implement intervention early as far as possible. Methods: 187 patients who met the eligibility criteria were retrospectively screened May 2020 to May 2022. They were further divided into the training cohort and validation cohort. The univariate and multivariate analysis were used to select risk factors for the predictive model which was presented with a nomogram. Model building and validation were done using R version 4.4.0. The discrimination and calibration of the nomogram were evaluated using receiver operating characteristic (ROC) curve analysis and calibration plots. The net benefits of the nomogram at different threshold probabilities were quantified using decision curve analysis (DCA). Results: the incidence of PNALD in patients who received TPN was 22.99 %. The logistic regression model equation was constructed based on the three factors of fasting time, glycolipid ratio and ALT by the univariate and multivariate analysis: Logit (p) = 0.056 x fasting time - 3.721 x glycolipid ratio + 0.044 x ALT + 0.518. The AUC value (0.695) indicated satisfactory discriminative ability of the nomogram. The calibration plots showed favorable consistency between the prediction of the nomogram and actual observations in both the training and validation cohorts. Furthermore, DCA showed that the nomogram was clinically useful and had discriminative ability to recognize patients at high PNALD risk. Conclusions: a nomogram was developed and validated to assist clinicians in predicting possibility of PNALD patients in short term.

Introduction: Objective: fatigue is one of the key symptoms of many health disorders. This prospective observational study aims to evaluate effect of a nutritional supplement on fatigue improvement in individuals older than 50 years. Methods: persons diagnosed by their general practitioners with fatigue, and agreeing to participate were advised to take a nutritional supplement (ApportAL®, Pharmanutra Spa, Pisa, IT) for 35 consecutive days: two sachets per day for the first 7 days, and one sachet per day thereafter. At recruitment (T0), as well as after 7 (T1) and 35 days (T2) of supplementation, all individuals completed 2 questionnaires to assess fatigue and quality of life. Results: four-hundred-fifty-eight individuals were recruited (63.5 % women), with an average age of 69 ± 10 years. An improvement of 46 % of the worst fatigue experienced and of 47.5 % in the interference score of fatigue was reported. Quality of life improved both for the physical (+29 %) and mental component (+77.4 %). A significant improvement was observed as early as after the first week of supplementation, increasing further over the remaining 4 weeks. Self-reported adverse events were mild, and the percentage of affected individuals decreased from 10.3 % at T1 to 8.5 % at T2. Conclusions: These findings showed the daily intake of a specially formulated supplement resulting in a progressive improvement of both fatigue and in individuals' quality of life. ApportAL® can be considered a valuable and safe support for adult/elderly individual with chronic fatigue, allowing them to carry out the desired activities, cultivate their social relationships and thus live more satisfactorily.

Introduction:

Introduction: Objectives: this cross-sectional study investigated the association between the Cardiometabolic Index (CMI) and heart failure (HF) prevalence in hypertensive individuals. Methods: this cross-sectional study analyzed dataset from the National Health and Nutrition Examination Survey (NHANES) 2009-2018, focusing on hypertensive adults with complete information on CMI and HF prevalence, employed CMI based on the following formula: [waist circumference (cm)/height (cm)] × [TG (mmol/L)/HDL-C (mmol/L)]. The relationships between CMI and HF prevalence were assessed using weighted multivariable logistic regression and subgroup analysis. Additionally, the threshold effect was determined by applying a two-piece linear regression model. Results: a total of 3,706 subjects with hypertension were enrolled, with heart failure being reported in 6.77 % of cases. A positive relationship was observed between CMI and HF prevalence. In the fully adjusted model, a one-unit rise in CMI corresponded to a 14 % increased likelihood of HF (OR = 1.14, 95 % CI: 1.03-1.26). Subjects in the top CMI tertile were 49 % more likely to progress to HF than those in the bottom tertile (OR = 1.49, 95 % CI: 1.01-2.21). We did not detect statistically significant interactions across subgroups. An inverted U-shaped correlation was identified between CMI and HF prevalence. The breakpoint was identified at 6.00. On the left of the breakpoint, a positive relationship between CMI and HF prevalence (OR = 1.56, 95 % CI: 1.35-1.79) was observed. Conclusions: these findings suggest a positive association between elevated CMI levels and a higher prevalence of HF in hypertensive adults.

Introduction: Background: nightmares are a common sleep disorder characterized by distressing dreams, leading to sleep disruption and psychological distress. Emerging evidence suggests a potential link between lipid metabolism and nightmare occurrence, but the causal relationship is poorly understood. Objective: to investigate the causal relationship between blood lipid metabolism characteristics and the risk of nightmares using Mendelian randomization (MR) analysis. Methods: a two-sample Mendelian randomization (MR) analysis was conducted using data from genome-wide association studies (GWAS). The analysis focused on specific lipid metabolism traits, including triglyceride levels in HDL and LDL, the triglycerides to total lipids ratio in medium HDL, and the free cholesterol to total lipids ratio in medium LDL. The inverse variance weighting (IVW) method was used as the primary analytical approach, with supplementary analyses conducted using MR-Egger, weighted median, and weighted mode methods. Results: the study identified that higher triglyceride levels in HDL (OR = 0.40, 95 % CI: 0.16-0.98, p = 0.04) and LDL (OR = 0.24, 95 % CI: 0.10-0.57, p = 0.001), as well as a higher triglycerides to total lipids ratio in medium HDL (OR = 0.38, 95 % CI: 0.15-0.95, p = 0.04), were protective against the occurrence of nightmares. In contrast, a higher free cholesterol to total lipids ratio in medium LDL was associated with an increased risk of nightmares (OR = 3.14, 95 % CI: 1.29-7.67, p = 0.01). Conclusion: lipid metabolism characteristics have a causal relationship with nightmare risk. Proper regulation of lipid metabolism may help reduce nightmare prevalence, particularly in vulnerable populations. Further studies are needed to validate these findings and explore underlying mechanisms.

Introduction: Objective: the Ramadan fast (RF) is practiced by millions of adult Muslims globally for a whole lunar month every year. Fasting is a common practice in different religious disciplines, including Islam, Christianity, Judaism and Hinduism. In Islam, the practice entails abstinence from eating and drinking between dawn and sunset. This study aimed to characterize food intake of undergraduate students (male and female) from M'Hamed Bougara University, Boumerdes, Algeria, observed before and during Ramadan. Methods: during a month before Ramadan and during the month of Ramadan, 120 undergraduate students (male and female) from M'Hamed Bougara University, Boumerdes, Algeria, completed 24-h dietary recalls. Dietary intake was studied using food groups as well as macro and micronutrients consumption. Results: significant differences in dietary intakes were observed before and during Ramadan in both sexes, with a significantly higher intake of cereals, milk, milk products and eggs in women compared to men before Ramadan, while men consume more vegetables, fish and oils during this period. During Ramadan in women there is a significant increase in cereals, vegetables and fruits and a significant decrease in milk and dairy products and eggs, while in men there is a significant increase in fruits, meat and oils, and a decrease in milk and eggs. Such differences in food groups intake were reflected in macro and micronutrients intakes including carbohydrates, saturated fats, calcium, vitamin A, vitamin C and sodium. Conclusion: In summary, the findings of this study are that gender-specific variations persist, influencing dietary habits and micronutrient intake, suggesting diversity in Ramadan diets to address imbalances and promote healthier eating behavior among students.

Introduction: Introduction: the study aims to train and standardize novice healthcare professionals (NHPs) in the use of point-of-care ultrasound (POCUS) for quadriceps femoris thickness measurement (QFT) and evaluate the reliability of measurements performed by NHPs. Methods: this study was conducted in a pediatric center in Mexico City between May and July 2024, where the NHPs were trained in ultrasound (US). The training included 12 hours of theory and practice. Measurements were evaluated through an intra- and inter-rater reliability analysis using triplicate measurements from 11 healthy adult volunteers. Results: excellent agreement was observed between the NHPs and the expert instructor's measurements, with an intraclass correlation coefficient (ICC) of 0.91. Furthermore, inter-rater reliability was very good, with an ICC of 0.997 for the instructor and 0.992 for the NHPs. The Bland-Altman analysis showed a small bias error, indicating high precision in the novice measurements. The results suggest that NHPs can make reliable measurements after appropriate training. These findings are consistent with previous studies and highlight the importance of protocolizing the measurements and structured training to guarantee their reliability. Conclusions: ultrasound is a reliable tool for Quadriceps Femoris Thickness Measurement (QFTM) that NHPs can use. Theoretical-practical training and standardization reduce biases in the precision of measurements made by the US.

Introduction: Introduction: constipation is common in children with neurological disability. There is scarce evidence on the response to dietary treatment and factors that modulate it. Objective: to describe the frequency of constipation and associated factors in children with neurological disability and to evaluate the response to dietary treatment in those with constipation. Patients and methods: retrospective study of children with neurological disability admitted to a long stay hospital. We evaluated the presence of constipation and its association with age, sex, diagnosis, nutritional status, motor function, diet (route, type and method) and anticonvulsant treatment. In those with constipation, we studied the response to increased fluids and fiber, recording the frequency and characteristics of bowel movements, use, and doses of laxatives. STATA was used, considering p < 0.05 as significative. Results: of 146 patients with median age 11 months (7; 20), 54 % were male, 69 % had constipation, 82 % a very diminished motor function and 88 % gastrostomy. Older patients and those who were overweight/obese were at increased risk of having constipation. Of the 101 (69 %) with constipation, 58.4 % had a positive response after increasing fiber intake from 36.4 to 95 % and water intake from 127 to 136 % of the recommendations. The modulating factor of the response to the diet was feeding by bolus (p = 0.03) and could contribute to have mixed diet (p = 0.08). Conclusion: the frequency of constipation was high and most of the children with it had a favorable response to dietary management, which can decrease the cost of treatment and improve their quality of life.