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Nutrition Clinique et Metabolisme最新文献

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L’éditorial de la présidente de la SFNCM SFNCM主席的社论
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-11-01 DOI: 10.1016/j.nupar.2023.11.001
Francisca Joly
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引用次数: 0
Oral iron powder for prehabilitation in hip and knee arthroplasty: A randomized controlled trial to optimize hemoglobin concentration 口服铁粉用于髋关节和膝关节置换术中的康复:优化血红蛋白浓度的随机对照试验
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-11-01 DOI: 10.1016/j.nupar.2023.08.002
Matteo Briguglio , Tiziano Crespi , Marco Mazzocchi , Stefano Petrillo , Cristina Turco , Elena De Vecchi , Patrizia Riso , Marisa Porrini , Giuseppe Banfi , Sergio Romagnoli , Paolo Perazzo

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.

背景:提高选择性关节置换术手术适宜性的关键因素之一是优化血红蛋白浓度。在这个随机对照试验中,我们调查了口服铁补充剂的功效及其对血液管理实践的影响。材料和方法共60名接受择期髋关节或膝关节手术的老年人被随机分组,接受为期一个半月的含铁和维生素的水溶性粉末补充剂。我们监测铁稳态和血液资源的使用。结果共完成试验58例。我们观察到血红蛋白及其平均红细胞浓度在组间有显著变化(P <0.05),维生素B6, B9 (P <0.001), B12 (P <0.05)。虽然没有统计学意义,但干预组患者血红蛋白在术前(11比14)或术后输血评估(1比6)或实际接受输血(1比3)前超过血单位要求阈值的患者较少(1比6)。术前缺铁和红细胞压积的程度可预测术后血单位(AUC = 0.9)。结论干预组铁稳态改善,而对照组的改变与铁储备的耗竭一致。富含维生素的铁基配方是安全的,但对血液管理实践的影响很小。优化患者血液管理的潜力鼓励了大规模研究的规划,可能结合饮食疗法,在手术前很久就促进富含铁的食物的摄入。
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引用次数: 0
Épidémiologie de la nutrition parentérale à domicile chez l’adulte en France 法国成人家庭肠外营养流行病学
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.05.004
Dominique Lescut , Nicolas Danel Buhl , Luc Dauchet , Marie-France Vaillant , Stéphane Schneider

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.

目的法国关于家庭肠外营养(HPN)的流行病学数据不为人所知,并导致不精确的估计。本研究针对成年人群,特别是通过尝试确定与HPN相关的病理来获得准确的数据。方法对2017年(2017年1月1日至12月31日)的15岁以上成年人群的数据进行了回顾性和观察性研究,定义了三个年龄组:15-39岁、40-64岁、65岁及以上。健康保险数据库一方面可以获得开始HPN的患者人数,另一方面可以获取HPN随访的患者人数。目标人群(健康保险受益人群)是已知的,这些数据可以分别计算发病率和患病率。数据还与健康国家保险(ALD 30)的30种长期疾病档案交叉,将患者分为六类:癌症、神经病学、慢性肠道炎症性疾病、器官缺乏、其他病理学和未确定病理学。结果获得的数据来自全国92.1%的成年人口,共计5080万成年人。HPN的平均发病率和患病率估计分别为20.8/10万居民/年和26./10万居民。长期HPN(>12周)的患病率为6.0/10万居民。主要病理为癌症。炎症性肠病是15-39岁人群中HPN的第二大病因。结论这是法国首次基于健康保险数据对成人HPN流行病学进行全国性研究。根据这些数字对整个法国成年人口的预测,估计每年约有14300名患者受益于HPN国家医疗保险,主要是癌症疾病。
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引用次数: 0
Carences et excès en micronutriments 微量营养素缺乏和过量
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.05.002
David Metsu , Sylvie Caspar-Bauguil , Anne Galinier

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).

健康预防包括充足的膳食摄入大量营养素(碳水化合物、脂质、蛋白质)和微量营养素(维生素、微量元素)。微量营养素在细胞代谢的几乎所有生化反应中都作为辅助因子或还原剂发挥着重要作用。这篇综述的目的是提供主要微量营养素代谢的最新知识,如水溶性(B1、B6、B9、B12、C)和脂溶性(A、E、D)维生素和微量元素(铁、锌、铜、硒),并特别注意它们对炎症的影响。该综述的目的还在于确定有新出现的微量营养素缺乏风险的人群(炎症性肠病、减肥手术、肠道切除术、新冠肺炎)中微量营养素的状况,并提出将其付诸实践的主要信息。微量营养素过量的生物标志物通常不如缺乏的生物标志器具有良好的特征,特别是在与功能或临床毒性症状的联系方面。在没有病理的情况下预防缺陷,是基于多样化和均衡的饮食,可以轻松满足所有需求。在特定的病理生理情况下(特殊饮食、药物相互作用、病理学),微营养补充剂的预防可能是暂时的或长期的。
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引用次数: 0
Étude de l’utilisation de la technique du manger-mains dans les établissements médico-sociaux de la région française de Nouvelle-Aquitaine 法国新阿基坦地区医疗社会机构使用手食技术的研究
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.05.003
Emeline Cuvilliez , Jean Claude Desport , Carole Villemonteix , Sandra Guérin , Bastian Coulon , Corentin Varrier , Aurélie Lavaud , Jean Louis Fraysse

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.

引言和目的手指食物(FF)技术旨在让有神经精神、视觉或运动障碍的人通过手拿食物来进食。使用这种技术的数据很少。本研究的目的是明确新阿基坦地区医疗社会机构中FF的使用模式。方法以电子方式向2625家医疗社会机构发送一份简单、安全的问卷。数据是自动收集的,答案是描述性的。结果总的来说,3%的联系机构做出了回应(n=80,82%来自养老院,15%来自残疾成年人机构,2%来自残疾儿童机构)。FF涉及24家机构和2%的居民。在FF中,42%的病例以咬伤、30%的烤面包和20%的水合立方体的形式出现食物。FF的基本材料匮乏。FF饮食主要在午餐和晚餐时提供。FF的优势在于保持居民的自主性和饮食乐趣,并与营养不良作斗争。从感觉到的缺点来看,主要是工作时间增加、方法过于技术化以及可能存在的卫生问题。结论FF技术看似有优势,但由于增加了可用的工作人员时间、培训了专业人员、获得了基本材料以及在早餐和零食期间更频繁地使用FF,因此提出了可能需要改进的问题。FF在成本方面的利益值得探讨。
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引用次数: 0
L’éditorial de la présidente de la SFNCM SFNCM主席的社论
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.08.003
Francisca Joly
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引用次数: 0
Quel est le rôle de l’alimentation dans les maladies inflammatoires chroniques de l’intestin ? 饮食在慢性炎症性肠病中的作用是什么?
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.02.001
Nicolas Richard , Mathilde Leboutte , Marie-France Vaillant , Xavier Hébuterne , Guillaume Savoye , Rachel Marion-Letellier PhD

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.

饮食被怀疑在IBD自然史中起着关键作用。IBD患者通常认为饮食与症状和发作有关,导致限制性饮食避免摄入被认为可能有害的饮食成分。目前已有报道称,这种限制性饮食障碍的风险因素来自疾病活动、患者的心理健康和令人困惑的饮食建议。这些限制性饮食有营养不良、营养缺乏和混合性焦虑抑郁障碍的风险。流行病学研究强调了饮食因素在IBD风险中的作用。地中海饮食往往可以降低患IBD的风险。相反,“西方”饮食(高摄入脂肪、糖、盐、动物蛋白和超加工食品)会增加患IBD的风险。实验研究表明,营养物质能够通过影响肠道微生物群的组成、肠道屏障的功能或各种免疫因子来调节肠道炎症反应。目前,科学证据水平不足以为IBD患者提供抗炎饮食。然而,有希望的临床研究途径值得在未来通过随机介入研究进行研究。根据ESPEN声明的建议,作为多学科方法的一部分,每个患者都应该从健康专业人员的饮食随访中受益。
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引用次数: 0
Modifications des recommandations de la Haute Autorité de santé concernant le diagnostic de la dénutrition : application par les professionnels de la nutrition en pratique clinique 高等卫生局关于营养不良诊断的建议修正案:营养专业人员在临床实践中的应用
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.05.005
Guillaume Ulmann , Claire Cherbuy , Emilie Guerriero , Adam Jirka , Maude Le Gall , Cindy Neuzillet , Aurore Pierson , Didier Quilliot , Manuel Sanchez , Frédéric Valla , Thierry Van Der Linden , Christelle Guillet

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.

引言法国卫生当局(HAS)针对营养不良的新诊断标准建议评估患者的肌肉力量和/或质量。这些方法在实践中不太可用。白蛋白水平现在被认为是营养不良严重程度的一个标准。我们的目的是评估这些建议变化对参与营养不良筛查和诊断的专业人员做法的影响。材料和方法法语临床营养与代谢学会(SFNCM)的科学咨询委员会使用谷歌表格®对该学会的成员进行了电子邮件调查。结果获得363份回复。87%和77%的受访者表示,他们很少或从未评估过肌肉质量或力量。少数专业人士表示,他们有能力进行这些评估(38%有测功机,23%有阻抗计)。然而,即使是那些能够接触到它们的人也没有经常使用它们。关于白蛋白血症,几乎一半的受访者表示他们用它来诊断营养不良。结论由于缺乏技术,导致肌肉质量和力量不足,负责诊断营养不良的专业人员很少能够评估肌肉质量和强度。使用白蛋白水平作为营养不良严重程度的标志对一些人来说似乎不明确。因此,培训小组和为设备提供资金似乎是成功执行这些建议的先决条件。
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引用次数: 0
Issue contents 发布内容
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/S0985-0562(23)00255-8
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引用次数: 0
Effects of omega-3 polyunsaturated fatty acids on the levels of pro- and anti-inflammatory cytokines and lipid profile in patients with Parkinson's disease ω-3多不饱和脂肪酸对帕金森病患者促炎和抗炎细胞因子水平及脂质状况的影响
IF 0.6 4区 医学 Q4 Medicine Pub Date : 2023-09-01 DOI: 10.1016/j.nupar.2023.06.001
Sara Mohammadi , Mirmohsen Sharifi Bonab , Mahdyieh Hamed Behzad , Bahram Pourghassem Gargari

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.

目的帕金森病(PD)与炎症和血脂异常有关。考虑到ω-3多不饱和脂肪酸(ω-3 PUFA)对炎症和脂质代谢的影响,本研究旨在研究补充ω-3 PUFAs对PD的促炎、抗炎细胞因子和脂质代谢谱的影响。材料和方法本研究选择44例PD患者,分为两组。干预组每天服用两粒ω-3 PUFA胶囊,每粒含有120 mg二十碳五烯酸和180 mg二十二碳六烯酸,安慰剂组每天服用2粒大豆油软胶囊,持续8周。在研究开始和结束时评估了体重、身高、脂质状况(TG、HDL-c、LDL-c、总胆固醇[TC])以及促炎和抗炎细胞因子(IL-6、TNF-α和IL-10)。结果ω-3 PUFAs组的体重指数(P=0.02)、体重(P=0.04)、HDL-c(P=0.01)、LDL-c(P=0.03)和IL-6(P=0.02。组间比较显示,在调整基线值和混杂因素后,变化并不显著。此外,TC的变化在组内或组间比较中均不显著。结论根据研究结果,连续8周补充600 mgω-3 PUFA对PD患者的促炎和抗炎细胞因子及脂质水平没有显著影响。需要进一步进行更高剂量的研究,以更好地阐明ω-3 PUFAs在PD患者生化和临床结果中的作用。
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引用次数: 0
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Nutrition Clinique et Metabolisme
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