Nutrition Clinique et Metabolisme最新文献

Background

One of the key aspects to enhance the suitability for surgery in elective arthroplasty is the optimization of hemoglobin concentration. In this randomized controlled trial, we investigated the efficacy of an oral iron supplement and its impact on blood management practices.

Materials and methods

A total of 60 older adults undergoing elective hip or knee surgery were randomized to follow a month and a half of supplementation with a water-soluble powder containing iron and vitamins. We monitored iron homeostasis and the use of blood resources.

Results

The trial was completed by 58 subjects. We observed a significant inter-group change in hemoglobin and its mean corpuscular concentration (P < 0.05), vitamin B6, B9 (P < 0.001), and B12 (P < 0.05). Albeit not statistically significant, fewer patients in the intervention group had hemoglobin over the threshold for blood unit request before (11 vs. 14) or transfusion evaluation after surgery (1 vs. 6), or actually received a blood transfusion (1 vs. 3). The extent of preoperative iron deficiency and hematocrit were predictive for postoperative blood units (AUC = 0.9).

Conclusion

Iron homeostasis improved in the intervention group, while the changes in the control group were consistent with the depletion of iron reserves. The iron-based formulation enriched with vitamins was safe but showed a slight impact on blood management practices. The potential of optimizing patient blood management encourages the planning of large-scale studies, possibly combining a diet therapy to promote the consumption of foods rich in iron long before the operation.

Objective

French epidemiological data regarding home parenteral nutrition (HPN) are not well known and give rise to imprecise estimates. This study targets the adult population to obtain accurate data especially by trying to determine the pathologies associated with the HPN.

Methods

A retrospective and observational study covering the year 2017 (from 01/01 to 31/12/2017) has been carried out, with the data of the adult population aged over 15 years, by defining three age groups: 15–39 years, 40–64 years, 65 years and over. The databases of the health insurance allowed to obtain on the one hand, the number of patients who started HPN and on the other hand, the number of patients followed in HPN. The target population (health insurance beneficiary population) being known, these data allowed to calculate incidence and prevalence, respectively. The data were also crossed with the thirty long-term diseases file of health national insurance (ALD 30), allowing patients to be classified into six categories: cancer, neurology, chronic intestinal inflammatory diseases, organ deficiency, others pathologies, and undetermined pathologies.

Results

Data from 92.1% of adult national population were obtained, totaling 50.8 millions adults. The average incidence and prevalence of HPN were estimated at 20.8/100,000 inhabitants/yr and 26.0/100,000 inhabitants, respectively. Prevalence of long-term HPN (> 12 weeks) was 6.0/100,000 inhabitants. The main pathology was cancer. Inflammatory bowel diseases were the second cause of HPN in the age range 15–39 years.

Conclusion

This is the first national study on the epidemiology of HPN in adults in France, based on data from health insurance. The projection of these figures to the entire French adult population leads to an estimate of around 14,300 patients per year benefiting from national health insurance for HPN, mainly for cancer diseases.

Health prevention includes an adequate dietary intake of macronutrients (carbohydrates, lipids, proteins) and micronutrients (vitamins, trace elements). Micronutrients play an essential role as co-factors or reducing agents in almost all of the biochemical reactions of cellular metabolism. The objective of this review is to provide an update of knowledge of the metabolism of the main micronutrients such as water-soluble (B1, B6, B9, B12, C) and fat-soluble (A, E, D) vitamins and trace elements (iron, zinc, copper, selenium) with a particular attention to their impact of inflammation. The aim of the review is also to define the status of micronutrients in groups at risk of emerging deficiency (inflammation bowel disease, bariatric surgery, bowel resection, COVID) and to draw out the main messages for putting them into practice. Biomarkers of micronutrient excess are generally less well characterized than those of deficiency, particularly in terms of links to functional or clinical symptoms of toxicity. The prevention of deficiencies in the absence of pathology, is based on a diet varied and balanced that easily covers all needs. Prevention by micronutritional supplements may be justified on a temporary or prolonged basis in particular pathophysiological situations (special diets, drug interactions, pathologies).

Introduction and objective

The finger-food (FF) technique is intended to allow people with neuropsychiatric, visual or motor disabilities to eat by taking food by hand. Data from the use of this technique are scarce. The objective of the study was to specify the modes of use of FF in medico-social establishments in the New-Aquitaine region.

Method

A simple secure questionnaire was sent electronically to the 2625 medico-social establishments. Data were collected automatically and answers were presented descriptively.

Results

In all, 3% of establishments contacted responded (n = 80, 82% from nursing homes, 15% from establishments for disabled adults and 2% from establishments for disabled children). FF concerned 24 establishments and 2% of residents. The presentation of food in FF was in 42% of cases in the form of bites, 30% of toasts and 20% of hydration cubes. The basic materials for FF were scarce. The FF diet was mainly offered at lunch and dinner. The perceived advantages of FF were the maintenance of the residents’ autonomy and pleasure of eating and the fight against undernutrition. On the side of the disadvantages felt, the main ones were the increase in working time, the excessively technical nature of the method and possible hygiene problems.

Conclusion

The FF technique seemed to have advantages, but raised problems which could probably be improved, thanks to an increase in the available staff time, the training of professionals, the acquisition of basic materials and the more frequent application of FF during breakfast and snacks. The interest of FF in terms of costs deserved to be explored.

Introduction

The new diagnostic criteria of the french health authority (HAS) for undernutrition suggest assessing patients’ muscle strength and/or mass. The methods are less available in practice. Albumin levels are now considered as a criterion for the severity of undernutrition. Our aim was to assess the impact of these changes in recommendations on the practices of professionals involved in screening for and diagnosing undernutrition.

Materials and methods

The Scientific Advisory Board of the french speaking society for clinical nutrition and metabolism (SFNCM) used google forms® to conduct an e-mail survey of the society's members.

Results

We obtained 363 responses. Eighty-seven percent and 77% of respondents respectively stated that they rarely or never assess muscle mass or strength. A minority of professionals said they were equipped to carry out these assessments (38% had a dynamometer, 23% an impedancemeter). However, even those had access to them did not use them regularly. With regard to albuminemia, almost half of those questioned said they used it to diagnose malnutrition.

Conclusion

Few of the professionals responsible for diagnosing undernutrition are able to assess muscle mass and strength, due to a lack of muscle mass and strength due to a lack of access to techniques. The use of albumin levels as a marker of the severity of undernutrition seems ambiguous to some. The training of teams and funding for equipment would therefore seem to be prerequisites for the successful implementation of these recommendations.

Diet is suspected to play a key role in IBD natural history. IBD patients often believe that diet is associated with symptoms and flares, leading to restrictive diets avoiding dietary components considered as potentially harmful. The risk factors of this restrictive eating disorder are now reported and result from disease activity, from patients’ psychological health and from confusing dietary advice. These restrictive diets are at risk of undernutrition, nutritional deficiencies and of mixed anxiety-depressive disorders. Epidemiological studies have highlighted the role of dietary factors in IBD risk. Mediterranean diets tend to reduce the risk of developing IBD. Conversely, the “Western” diet (high intakes of fat, sugar, salt, animal protein and ultra-processed foods) increases the risk of developing IBD. Experimental studies demonstrate the ability of nutrients to modulate the intestinal inflammatory response by influencing the composition of the intestinal microbiota, the function of the intestinal barrier or various actors of immunity. The level of scientific evidence is currently insufficient to propose an anti-inflammatory diet for IBD patients. Nevertheless, promising avenues of clinical research deserve to be investigated in the future through randomised interventional studies. As recommended by ESPEN statements with a strong consensus, every patient should benefit from dietary follow-up by a health professional as part of a multidisciplinary approach.

Objective

Parkinson's disease (PD) is associated with inflammation and lipid profile abnormalities. Considering the effects of omega-3 polyunsaturated fatty acids (ω-3 PUFAs) on inflammation and lipid metabolism, the present study aimed to investigate the effects of ω-3 PUFAs supplementation on the pro- and anti-inflammatory cytokines and lipid profile in PD.

Material and methods

In this study, 44 patients with PD were selected and divided into two groups. The intervention group received two capsules of ω-3 PUFAs daily, each capsule containing 120 mg eicosapentaenoic acid and 180 mg docosahexaenoic acid, and the placebo group received two soft capsules of soybean oil daily for eight weeks. Weight, height, lipid profile (TG, HDL-c, LDL-c, total cholesterol [TC]), and pro- and anti-inflammatory cytokines (IL-6, TNF-α, and IL-10) were assessed at the beginning and at the end of the study.

Results

Body mass index (P = 0.02), weight (P = 0.04), HDL-c (P = 0.01), LDL-c (P = 0.03), and IL-6 (P = 0.02) levels increased, while TG (P = 0.01), TNF-α (P = 0.01), and IL-10 (P = 0.01) decreased significantly in the ω-3 PUFAs group. Between-group comparisons revealed the changes not to be significant after adjustments for baseline values and confounders. Moreover, the changes in TC were not significant in either within- or between-group comparisons.

Conclusion

Based on the results of the study, 600 mg ω-3 PUFAs supplementation for eight weeks has no significant effect on the assessed pro- and anti-inflammatory cytokines and lipid profiles in patients with PD. Further studies with higher doses are needed to better clarify the role of ω-3 PUFAs in the biochemical and clinical outcomes of PD patients.