Nutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in medical ICUs in Turkiye and to investigate their compliance with current international guidelines.
Methods
This multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status.
Results
A total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24hours of admission. On the study day, the median energy intake of the patients during the last 24hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28th day of the study, of them 23 (21.1% of all patients) were still in the ICU.
Conclusion
Nutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.
{"title":"Nutritional practices in medical intensive care units: Multicenter, one-day point prevalence study","authors":"Leyla Ferlicolak , Neriman Defne Altintas , Burcin Halacli , Sahin Temel , Ozlem Cakin , Melda Turkoglu , Bilgin Comert , Gurhan Taskin , Avsar Zerman , Turkay Akbas , Emre Karakoc , Kamil Gonderen , Ismail Hakkı Akbudak , Kursat Gundogan , Arzu Topeli","doi":"10.1016/j.nupar.2023.06.002","DOIUrl":"10.1016/j.nupar.2023.06.002","url":null,"abstract":"<div><h3>Background/Aim</h3><p><span>Nutritional planning is an important aspect of Intensive Care Unit (ICU) care. The present study aimed to evaluate the nutritional practices adopted in </span>medical ICUs in Turkiye and to investigate their compliance with current international guidelines.</p></div><div><h3>Methods</h3><p>This multicenter, cross-sectional study was performed on a predetermined study date. Centers were required to fill three groups of questionnaires: One on ICU characteristics and facilities, one on patients included, and one on outcomes of patients. Forms on patients had questions on demographics and their nutritional status.</p></div><div><h3>Results</h3><p><span>A total of 12 sites participated and 132 patients were recorded in the study and 109 patients were included in analyses. The median age was 72 [57–83] years and 55 (50%) of them was female. The median APACHE II score was 23 [18–29], median SOFA score was 6 [4–9] and median BMI was 25.32 [21.22–29.38]. More than 50% of patients were fed enterally; for most, it was started within the first 24</span> <span>hours of admission. On the study day, the median energy intake of the patients during the last 24</span> <span>hours was 21.62 [15.9–27.3] kcal/kg and the median amount of protein intake was 1.02 [0.7–1.3] g/kg, representing 83.1% and 78.9% of the targets, respectively. A total of 64 (58.7%) patients were alive on the 28</span><sup>th</sup> day of the study, of them 23 (21.1% of all patients) were still in the ICU.</p></div><div><h3>Conclusion</h3><p>Nutrition therapy in medical ICUs was initiated early after ICU admission, the enteral route was preferred and target calories<span> were calculated using weight-based formulas. These results suggest that multi-dimensional planning of critical care management of patients by intensivists may provide better nutritional care for the critically ill.</span></p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 221-226"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135111386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nupar.2023.08.001
Frédéric V. Valla , Guillaume Ulmann , Najate Achamrah , Dorothée Bedock , Véronique Douard , Evelyne Eyraud , Nicolas Flori , Vincent Fraipont , Emilie I. Guerriero , Adam Jirka , Maude Le Gall , Sébastien Le Garf , Emilie Lecoq , Caroline Martineau , Cindy Neuzillet , Aurore Pierson , Pierre Poinsot , Florian Poullenot , Thierry Quessada , Claire Rives-Lange , Christelle Guillet
<div><h3>But et objectif</h3><p>La Haute Autorité de santé et la Fédération Française de Nutrition ont publié en 2019 et 2021 de nouvelles recommandations cliniques relatives à la dénutrition chez l’enfant, l’adulte et la personne âgée. De nouvelles définitions sont ainsi proposées, basée sur une mise à jour des critères diagnostiques et de leurs valeurs seuil. Le défi est désormais la diffusion de ces recommandations et leur mise en pratique au quotidien par les professionnels de santé concernés.</p></div><div><h3>Matériel et méthodes</h3><p>Le conseil scientifique et le comité éducationnel et de pratique clinique de la société francophone de nutrition clinique et métabolisme ont appliqué à ces recommandations nouvelles la méthode Pronovost, validée comme un des outils d’aide à la transposition/implémentation des recommandations à la pratique clinique.</p></div><div><h3>Résultats</h3><p>Le modèle Pronovost a permis de proposer un cadre servant de guide à l’implémentation des recommandations sur la dénutrition dans la pratique, avec l’aide de document et d’outils adaptés. Les quatre étapes-clé de transposition clinique des recommandations sont suivies : résumer les recommandations ; identifier les freins locaux à l’implémentation ; mesurer la performance ; s’assurer que l’ensemble des patients bénéficie de ces recommandations. Des checklists pertinentes sont proposées pour l’implémentation et l’évaluation de la compliance aux recommandations, ainsi que des tableaux détaillant les missions respectives de chaque professionnel.</p></div><div><h3>Conclusion</h3><p>La méthode Pronovost fournit un cadre et des outils aux professionnels de santé, afin de faciliter la transposition des récentes recommandations du diagnostic et dépistage de la dénutrition.</p></div><div><h3>Objectives</h3><p>The French ministry of health and the French federation of nutrition published in 2019 and 2021 updated clinical recommendations around nutritional status assessment in children, adults and elderly people. New definitions of undernutrition were produced based on new criteria and/or new thresholds. The challenge now is to engage with healthcare professionals to implement these into their daily practice.</p></div><div><h3>Material and methods</h3><p>This practical implementation guide uses the established implementation model Pronovost to help implementing these evidence-based clinical recommendations into clinical practice.</p></div><div><h3>Results</h3><p>The Pronovost implementation model of evidence into practice allowed us to provide a practical framework with associated documents and tools to facilitate implementation of these clinical recommendations into healthcare professional practice. The paper is structured around the four steps of the Pronovost model: summary of the evidence; identification of local barriers to implementation; measurement of performance; ensuring all patients receive the intervention. Relevant checklists for implementation and compliance mo
2019年和2021年，高级卫生当局和法国营养联合会发布了关于儿童、成人和老年人营养不良的新临床建议。因此，根据最新的诊断标准及其阈值，提出了新的定义。现在的挑战是传播这些建议，并由有关保健专业人员在日常基础上实施这些建议。教育装备和méthodesLe科学技术咨询小组和临床实践临床营养与代谢的法语社会新方法采用了这些建议Pronovost验证过的,作为一个辅助工具调换tro /临床实践提出建议。结果Pronovost模型提出了一个框架，在适当的文件和工具的帮助下，作为在实践中实施营养不良建议的指南。遵循临床转换建议的四个关键步骤:总结建议;识别实施中的本地障碍;衡量绩效;确保所有患者都能从这些建议中受益。提出了执行和评估遵守建议情况的相关清单，以及详细说明每个专业人员各自任务的表格。结论Pronovost方法为卫生专业人员提供了一个框架和工具，以促进最近关于营养不良诊断和筛查的建议的转换。法国卫生部和法国营养联合会于2019年和2021年发表了关于儿童、成人和老年人营养状况评估的最新临床建议。根据新的标准和/或新的阈值，对营养不良作出了新的定义。现在的挑战是与保健专业人员接触，将这些措施落实到日常实践中。实际实施指南的材料和方法利用Pronovost的既定实施模式，帮助将这些循证临床建议落实到临床实践中。Pronovost实施循证实践模式的结果使我们能够提供一个具有相关文件和工具的实用框架，以促进将这些临床建议落实到医疗专业实践中。本文是根据代词模型的四个步骤构建的:证据摘要;确定实施的地方障碍;绩效测量;确保所有患者接受干预。除了列出专业人员各自职责和任务的表外，还提出了执行和遵守情况监测的相关清单。ConclusionImplementation models like the help Pronovost model)实施临床科学建议融入临床实践。
{"title":"Transposition dans les unités de soin des recommandations de bonne pratique de la Haute Autorité de santé sur le diagnostic de la dénutrition de l’enfant, de l’adulte et de la personne âgée","authors":"Frédéric V. Valla , Guillaume Ulmann , Najate Achamrah , Dorothée Bedock , Véronique Douard , Evelyne Eyraud , Nicolas Flori , Vincent Fraipont , Emilie I. Guerriero , Adam Jirka , Maude Le Gall , Sébastien Le Garf , Emilie Lecoq , Caroline Martineau , Cindy Neuzillet , Aurore Pierson , Pierre Poinsot , Florian Poullenot , Thierry Quessada , Claire Rives-Lange , Christelle Guillet","doi":"10.1016/j.nupar.2023.08.001","DOIUrl":"10.1016/j.nupar.2023.08.001","url":null,"abstract":"<div><h3>But et objectif</h3><p>La Haute Autorité de santé et la Fédération Française de Nutrition ont publié en 2019 et 2021 de nouvelles recommandations cliniques relatives à la dénutrition chez l’enfant, l’adulte et la personne âgée. De nouvelles définitions sont ainsi proposées, basée sur une mise à jour des critères diagnostiques et de leurs valeurs seuil. Le défi est désormais la diffusion de ces recommandations et leur mise en pratique au quotidien par les professionnels de santé concernés.</p></div><div><h3>Matériel et méthodes</h3><p>Le conseil scientifique et le comité éducationnel et de pratique clinique de la société francophone de nutrition clinique et métabolisme ont appliqué à ces recommandations nouvelles la méthode Pronovost, validée comme un des outils d’aide à la transposition/implémentation des recommandations à la pratique clinique.</p></div><div><h3>Résultats</h3><p>Le modèle Pronovost a permis de proposer un cadre servant de guide à l’implémentation des recommandations sur la dénutrition dans la pratique, avec l’aide de document et d’outils adaptés. Les quatre étapes-clé de transposition clinique des recommandations sont suivies : résumer les recommandations ; identifier les freins locaux à l’implémentation ; mesurer la performance ; s’assurer que l’ensemble des patients bénéficie de ces recommandations. Des checklists pertinentes sont proposées pour l’implémentation et l’évaluation de la compliance aux recommandations, ainsi que des tableaux détaillant les missions respectives de chaque professionnel.</p></div><div><h3>Conclusion</h3><p>La méthode Pronovost fournit un cadre et des outils aux professionnels de santé, afin de faciliter la transposition des récentes recommandations du diagnostic et dépistage de la dénutrition.</p></div><div><h3>Objectives</h3><p>The French ministry of health and the French federation of nutrition published in 2019 and 2021 updated clinical recommendations around nutritional status assessment in children, adults and elderly people. New definitions of undernutrition were produced based on new criteria and/or new thresholds. The challenge now is to engage with healthcare professionals to implement these into their daily practice.</p></div><div><h3>Material and methods</h3><p>This practical implementation guide uses the established implementation model Pronovost to help implementing these evidence-based clinical recommendations into clinical practice.</p></div><div><h3>Results</h3><p>The Pronovost implementation model of evidence into practice allowed us to provide a practical framework with associated documents and tools to facilitate implementation of these clinical recommendations into healthcare professional practice. The paper is structured around the four steps of the Pronovost model: summary of the evidence; identification of local barriers to implementation; measurement of performance; ensuring all patients receive the intervention. Relevant checklists for implementation and compliance mo","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 233-240"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136159988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nupar.2023.09.002
Bertrand Dufils , Marie Galmiche , Pierre Déchelotte
Eating disorders (EDs) affect around 14% of the French population, and represent a major public health issue due to their high morbidity and mortality. Insufficient and often late screening of ED leads to treatment at an advanced stage, with reduced efficacy, a prolonged course and negative medicosocial and financial consequences. Pharmacists can play a useful role in the screening and care of EDs. Indeed, patients with ED often have a high level of health care consumption due to the high frequency of their multiple symptoms and associated comorbidities, and a high propensity for self-medication, which frequently brings them to the pharmacy. The aim of this review is to highlight the role of the pharmacist in the screening for EDs and in the support of patients in the pharmacy, by proposing: key elements of semiology and pathophysiology; alerts for identifying at-risk patients; advice on language and attitude for the pharmaceutical interview in order to create a therapeutic alliance and facilitate acceptance of screening, notably with the help of validated digital tools, whether or not the patient initially requests it; advice on symptom care and orientation towards a care pathway. In this way, the dispensary pharmacist can play a very useful role in the earlier screening and support of patients with ED, as part of a multidisciplinary team providing comprehensive ED care.
{"title":"Rôle du pharmacien d’officine dans le dépistage et l’orientation des patients atteints de troubles du comportement alimentaire","authors":"Bertrand Dufils , Marie Galmiche , Pierre Déchelotte","doi":"10.1016/j.nupar.2023.09.002","DOIUrl":"10.1016/j.nupar.2023.09.002","url":null,"abstract":"<div><p>Eating disorders (EDs) affect around 14% of the French population, and represent a major public health issue due to their high morbidity and mortality. Insufficient and often late screening of ED leads to treatment at an advanced stage, with reduced efficacy, a prolonged course and negative medicosocial and financial consequences. Pharmacists can play a useful role in the screening and care of EDs. Indeed, patients with ED often have a high level of health care consumption due to the high frequency of their multiple symptoms and associated comorbidities, and a high propensity for self-medication, which frequently brings them to the pharmacy. The aim of this review is to highlight the role of the pharmacist in the screening for EDs and in the support of patients in the pharmacy, by proposing: key elements of semiology and pathophysiology; alerts for identifying at-risk patients; advice on language and attitude for the pharmaceutical interview in order to create a therapeutic alliance and facilitate acceptance of screening, notably with the help of validated digital tools, whether or not the patient initially requests it; advice on symptom care and orientation towards a care pathway. In this way, the dispensary pharmacist can play a very useful role in the earlier screening and support of patients with ED, as part of a multidisciplinary team providing comprehensive ED care.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 201-213"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136167036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nupar.2023.09.003
Emeline Cuvilliez , Jean Claude Desport , Stéphane Meyer , Géraldine Lautrette , Carole Villemonteix , Sandra Guérin , Corentin Varrier , Aurélie Lavaud , Philippe Fayemendy , Pierre Jésus , Jean Louis Fraysse
A patient in a nursing home suffered from primary lateral sclerosis (PLS), which is a slowly progressive neuromuscular disease, in her case, very disabling. She gradually developed obesity. The possibility of an underlying sarcopenia was eliminated, and the weight gain was explained by very low physical activity and especially uncontrolled snacking. In the absence of treatment for PLS, the patient was considered to be in a palliative situation. Invoking respect for her quality of life, she refused to moderate her snacking. The only recourse was to provide dietary advice to the patient, the teams and her family. This clinical case highlights the difficulty of nutritional assessment and management of people with neurological and neuromuscular diseases.
{"title":"Prise en charge nutritionnelle d’une patiente âgée obèse atteinte de sclérose latérale primitive","authors":"Emeline Cuvilliez , Jean Claude Desport , Stéphane Meyer , Géraldine Lautrette , Carole Villemonteix , Sandra Guérin , Corentin Varrier , Aurélie Lavaud , Philippe Fayemendy , Pierre Jésus , Jean Louis Fraysse","doi":"10.1016/j.nupar.2023.09.003","DOIUrl":"https://doi.org/10.1016/j.nupar.2023.09.003","url":null,"abstract":"<div><p>A patient in a nursing home suffered from primary lateral sclerosis (PLS), which is a slowly progressive neuromuscular disease, in her case, very disabling. She gradually developed obesity. The possibility of an underlying sarcopenia was eliminated, and the weight gain was explained by very low physical activity and especially uncontrolled snacking. In the absence of treatment for PLS, the patient was considered to be in a palliative situation. Invoking respect for her quality of life, she refused to moderate her snacking. The only recourse was to provide dietary advice to the patient, the teams and her family. This clinical case highlights the difficulty of nutritional assessment and management of people with neurological and neuromuscular diseases.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 247-250"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"92173038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Diarrhea is relatively common in critically-ill mechanically-ventilated patients. This study investigated the effect of bovine colostrum supplement in the prevention of diarrhea.
Methods
Mechanically-ventilated patients expected to require enteral nutrition for at least five days were randomly assigned to the intervention or placebo groups. The intervention group received enteral diet providing 30 g of bovine colostrum daily, and the control group received a similar diet except for whey protein as a placebo. The duration of the intervention was ten days. Serum levels of IGF-1 were measured at baseline and the end of the intervention. Patients were followed up for the occurrence of diarrhea.
Results
Out of 136 participants, 45 patients in the colostrum group and 45 patients in the control group were included in the final analysis of the outcomes. Plasma IGF-1 concentration increased significantly in the colostrum group after the intervention (P = 0.02). In the between-group comparison, the increase in IGF-1 was significantly higher in the colostrum group compared with the placebo group (P = 0.04). Furthermore, the incidence of diarrhea was significantly lower in the colostrum group compared to the control group.
Conclusion
Bovine colostrum supplementation increased serum levels of IGF-1 and may reduce the incidence of diarrhea in critically-ill mechanically-ventilated patients.
{"title":"Colostrum supplement, IGF-1, and diarrhea in mechanically-ventilated patients: A double-blind, randomized, placebo-controlled study","authors":"Elham Roohelhami , Zahra Vahdat Shariatpanahi , Seyed Hossein Ardehali","doi":"10.1016/j.nupar.2023.09.004","DOIUrl":"10.1016/j.nupar.2023.09.004","url":null,"abstract":"<div><h3>Background</h3><p>Diarrhea is relatively common in critically-ill mechanically-ventilated patients. This study investigated the effect of bovine colostrum supplement in the prevention of diarrhea.</p></div><div><h3>Methods</h3><p><span>Mechanically-ventilated patients expected to require enteral nutrition for at least five days were randomly assigned to the intervention or placebo groups. The intervention group received enteral diet providing 30</span> <!-->g of bovine colostrum daily, and the control group received a similar diet except for whey protein as a placebo. The duration of the intervention was ten days. Serum levels of IGF-1 were measured at baseline and the end of the intervention. Patients were followed up for the occurrence of diarrhea.</p></div><div><h3>Results</h3><p>Out of 136 participants, 45 patients in the colostrum group and 45 patients in the control group were included in the final analysis of the outcomes. Plasma IGF-1 concentration increased significantly in the colostrum group after the intervention (<em>P</em> <!-->=<!--> <!-->0.02). In the between-group comparison, the increase in IGF-1 was significantly higher in the colostrum group compared with the placebo group (<em>P</em> <!-->=<!--> <!-->0.04). Furthermore, the incidence of diarrhea was significantly lower in the colostrum group compared to the control group.</p></div><div><h3>Conclusion</h3><p>Bovine colostrum supplementation increased serum levels of IGF-1 and may reduce the incidence of diarrhea in critically-ill mechanically-ventilated patients.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 227-232"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135011670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nupar.2023.09.001
Maxime Thobois, Cécile Gomercic, Thierry Piche, Geoffroy Vanbiervliet
Obesity and overweight are proving to be pandemic public health problems that significantly reduce the life expectancy of those affected. Obesity has a significant medico-economic impact, in relation to the treatments it requires and its comorbidities. In France, the therapeutic management of this pathology is limited to a lifestyle modification or a surgical approach. Endoscopy has allowed the development of therapeutic alternatives in the management of obesity in recent years, although not all of these methods are currently recommended in France, even though convincing results have been shown. With the advent of organ-sparing interventional endoscopy, innovative minimally invasive therapeutic procedures have emerged and will tend to develop in order to take a full place in the treatment of this chronic disease. More ambitious endoscopic procedures could also be combined, thus combining the different modes of action of each of them. Finally, with the availability of new effective drug treatments, combined “endoscopy-drug” approaches could be newly defined to achieve unprecedented clinical effectiveness. The objective of this review will be to present the current endoscopic techniques available for the management of obesity, to discuss the innovative procedures under development and to outline the future of bariatric endoscopy, either by combining procedures or by combining them with medical therapies.
{"title":"L’endoscopie bariatrique et métabolique. États des lieux et futur","authors":"Maxime Thobois, Cécile Gomercic, Thierry Piche, Geoffroy Vanbiervliet","doi":"10.1016/j.nupar.2023.09.001","DOIUrl":"10.1016/j.nupar.2023.09.001","url":null,"abstract":"<div><p>Obesity and overweight are proving to be pandemic public health problems that significantly reduce the life expectancy of those affected. Obesity has a significant medico-economic impact, in relation to the treatments it requires and its comorbidities. In France, the therapeutic management of this pathology is limited to a lifestyle modification or a surgical approach. Endoscopy has allowed the development of therapeutic alternatives in the management of obesity in recent years, although not all of these methods are currently recommended in France, even though convincing results have been shown. With the advent of organ-sparing interventional endoscopy, innovative minimally invasive therapeutic procedures have emerged and will tend to develop in order to take a full place in the treatment of this chronic disease. More ambitious endoscopic procedures could also be combined, thus combining the different modes of action of each of them. Finally, with the availability of new effective drug treatments, combined “endoscopy-drug” approaches could be newly defined to achieve unprecedented clinical effectiveness. The objective of this review will be to present the current endoscopic techniques available for the management of obesity, to discuss the innovative procedures under development and to outline the future of bariatric endoscopy, either by combining procedures or by combining them with medical therapies.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 190-200"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136371854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 10.1016/j.nupar.2023.11.001
Francisca Joly
{"title":"L’éditorial de la présidente de la SFNCM","authors":"Francisca Joly","doi":"10.1016/j.nupar.2023.11.001","DOIUrl":"10.1016/j.nupar.2023.11.001","url":null,"abstract":"","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Page 189"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135614527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-11-01DOI: 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.
{"title":"Oral iron powder for prehabilitation in hip and knee arthroplasty: A randomized controlled trial to optimize hemoglobin concentration","authors":"Matteo Briguglio , Tiziano Crespi , Marco Mazzocchi , Stefano Petrillo , Cristina Turco , Elena De Vecchi , Patrizia Riso , Marisa Porrini , Giuseppe Banfi , Sergio Romagnoli , Paolo Perazzo","doi":"10.1016/j.nupar.2023.08.002","DOIUrl":"10.1016/j.nupar.2023.08.002","url":null,"abstract":"<div><h3>Background</h3><p>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.</p></div><div><h3>Materials and methods</h3><p>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.</p></div><div><h3>Results</h3><p>The trial was completed by 58 subjects. We observed a significant inter-group change in hemoglobin and its mean corpuscular concentration (<em>P</em> <!--><<!--> <!-->0.05), vitamin B6, B9 (<em>P</em> <!--><<!--> <span>0.001), and B12 (</span><em>P</em> <!--><<!--> <!-->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).</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 4","pages":"Pages 241-246"},"PeriodicalIF":0.6,"publicationDate":"2023-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136093570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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.
{"title":"Épidémiologie de la nutrition parentérale à domicile chez l’adulte en France","authors":"Dominique Lescut , Nicolas Danel Buhl , Luc Dauchet , Marie-France Vaillant , Stéphane Schneider","doi":"10.1016/j.nupar.2023.05.004","DOIUrl":"https://doi.org/10.1016/j.nupar.2023.05.004","url":null,"abstract":"<div><h3>Objective</h3><p>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.</p></div><div><h3>Methods</h3><p>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.</p></div><div><h3>Results</h3><p>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.</p></div><div><h3>Conclusion</h3><p>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.</p></div>","PeriodicalId":54702,"journal":{"name":"Nutrition Clinique et Metabolisme","volume":"37 3","pages":"Pages 149-154"},"PeriodicalIF":0.6,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49841981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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