Background and Objectives: The placement of a peripherally inserted central venous catheter (PICC) is an es- sential procedure in neonatal intensive care units (NICU). The aim of this study was to determine the risk of PICC complications in NICU, and further identify the effects of PICC complications on body weight gain in premature infants. Methods and Study Design: A total of 304 premature infants who had a PICC inserted in NICU were enrolled in this study. The weight-for-age z-score (WAZ) at the time of PICC insertion and removal were calculated, and changes of WAZ in different groups were compared using a t-test. Risk factors for PICC complications were assessed using the chi-squared test and multiple logistic regression analysis. Results: Thirty (9.97%) PICCs were removed due to complications. Of them, 14 PICCs were removed because of non-infectious complications and 16 PICCs were removed for central-line-associated bloodstream infections (CLABSIs). Multi- ple logistic regression analysis showed that premature infants with birth weight >1,500 g were less likely to have PICC complications than infants with birth weight ≤1,500 g (OR, 0.29; 95% CI: 0.10-0.82; p=0.020). In addition, the changes in WAZ between PICC insertion and removal were significantly different in both infectious (-0.144±0.122, p<0.005) and non-infectious (-0.65±0.528, p<0.001) complications groups, compared with the no complications group (0.291±0.552). Conclusions: Findings from this study suggest that birth weight is a risk fac- tor for PICC-associated complications in the NICU, and both infectious and non-infectious PICC complications are associated with poor body weight gain in premature infants.
Background and Objectives: This study aimed to investigate the effects of tomato juice consumption on semi- nal plasma lycopene levels and sperm parameters in infertile men. Methods and Study Design: Subjects were male infertility patients with poor sperm concentration (<20×106/mL) and/or motility (<50%). Following a four- week observation period, subjects were randomly assigned among three groups: a tomato juice group, an antioxi- dant group, and a control group. The subjects in the tomato juice group and the antioxidant group daily consumed one can of tomato juice (containing 30 mg of lycopene) or one antioxidant capsule (containing vitamin C 600 mg, vitamin E 200 mg, and glutathione 300 mg), respectively, for 12 weeks (feeding period). Seminal plasma lyco- pene levels and sperm parameters were measured every 6 weeks during the feeding period. Results: Forty-four patients completed the study (control group: 12, antioxidant group: 15, tomato juice group: 17). In the tomato juice group, plasma lycopene level was significantly increased at the 12th week of the feeding period. Moreover, a decrease in seminal plasma white blood cells and an increase in sperm motility in the tomato juice group were statistically significant at the 12th and 6th weeks, respectively, compared to the control group. In the antioxidant capsule group, no significant improvement was observed in semen parameters. Conclusions: In conclusion, regu- lar consumption of tomato juice seems to improve sperm motility in infertile patients. This is the first report to show that commercially available food, such as tomato juice, might be beneficial for male infertility.
To demonstrate the gastrointestinal survival of Lactobacillus casei strain Shirota (LcS) in healthy Vietnamese adults, a fermented milk drink containing LcS was administered daily for 14 days. Twenty-six healthy Vietnam- ese adults took part in the study. Each participant consumed 65 mL of a fermented milk drink containing LcS dai- ly for 14 days. The drink contained a dose of 108 CFU/mL LcS. Fecal samples were collected before, during and after consuming the fermented milk drink. LcS was confirmed by culture and ELISA. After 7 and 14 days of in- gesting fermented milk drink, LcS was recovered from fecal samples at average of 5.0×107 CFU/g feces (n=26) and 5.4×107 CFU/g feces (n=26), respectively. LcS persisted in 8 voluteers until day 42 (after 14 days stopping fermented milk drink) at 0.0033×107 CFU/g feces (n=8). We confirmed survival of LcS after passage through the gastrointestinal tract of Vietnamese adults.
Background and Objectives: Alanine aminotransferase (ALT) is generally used for evaluating liver function, and its concentrations are closely associated with sex and nutritional status. This study investigates the relation- ships between dietary components and serum ALT activity in Taiwanese adolescents. Methods and Study De- sign: Data were collected from 1,941 adolescents aged 13-18 years who participated in the fourth National Nutri- tion and Health Survey in Taiwan (2010-2011, adolescents). Results: The mean age was 15.3±0.1 y (15.3±0.1 y for boys and 15.2±0.1 y for girls). Mean serum ALT was 14.8±13.3 U/L (17.7±16.3 U/L for boys and 12.1±8.7 U/L for girls; p<0.001). Multivariate analysis revealed that, among girls, a single-unit increase in dietary zinc was associated with 1.12- and 1.11-fold increases in risk for increased serum ALT tertile 2 (T2) and T3, respectively, compared with T1; and a single-unit increase in vitamin B-2 intake increased risk by 1.71- and 1.54-fold, respec- tively. Further analysis revealed that the risk increase for boys and girls who consumed the highest amounts of dietary zinc and vitamin B-2 (T3) was 1.97- and 2.62-fold, respectively; they were also more likely to have high- er serum ALT (>11 U/L for boys and >9 U/L for girls) than those of the reference (presented as zinc T1 and vit- amin B-1 T1). Conclusions: Increased dietary zinc and vitamin B-2 intake is associated with higher serum ALT in adolescents.
Background and Objectives: The objective of this study was to explore the association between 25- hydroxyvitamin D (25(OH)D) and muscle strength/architecture. Methods and study Design: Thirty patients (27 women, 3 men) were allocated into Group I (n=15, mean age; 44.4±9.4 years) and Group II (n=15, mean age; 39.0±9.9 years) according to the median of 25(OH)D (<13.7 ng/mL vs >13.7 ng/mL, respectively). Peak torque/body weight of the knee flexor/extensor muscles at 60°/sec and 180°/sec and those of ankle flex- or/extensor muscles at 30°/sec and 90°/sec were evaluated by using a Biodex System 3 Pro Multijoint System isokinetic dynamometer. A 7-12 MHz linear array probe was used to evaluate thickness (MT), pennation angle (PA) and fascicle length (FL) of medial gastrocnemius and vastus lateralis muscles. Results: Mean of 25(OH)D was 9.4±2.5 ng/mL and 20.7±8.3 ng/mL in Groups I and II, respectively. Although all isokinetic strength parame- ters were lower in Group I, significant differences were found in knee flexion at 180°/sec (p=0.007), knee exten- sion at 30°/sec (p=0.038) and 180°/sec (p=0.001), and ankle extension at 30°/sec (p=0.002) and 90°/sec (p=0.007). On the other hand, no significant difference was found between the groups regarding MT, PA and FL values (all p>0.05). Conclusion: In light of our results, we can argue that 25(OH)D is associated with muscle strength but not with muscle architecture. Further studies concerning the long-term follow-up effects of 25(OH)D treatment on muscle strength are awaited.
Background and Objectives: The association between fiber intake and pancreatic cancer risk is conflicting and poorly explored. The aim of study was to investigate the association between dietary fiber intake and the risk of pancreatic cancer by conducting a meta-analysis of epidemiological studies. Methods and Study Design: Sys- tematic search of PubMed and Embase databases up to April 2015 were conducted to identify relevant studies. Adjusted odds ratios (ORs) were combined using random-effects models to assess the risk of pancreatic cancer when comparing extreme categories of fiber intake. Dose-response meta-analysis was performed for studies re- porting categorical risk estimates for at least 3 exposure levels. Results: One cohort and thirteen case-control studies were identified. The overall analysis revealed a strong inverse association between risk of pancreatic can- cer and high fiber intake (OR 0.52; 95% CI 0.44-0.61). No publication bias was detected by Egger’s or Begg’s test. The dose-response analyses showed that the summary OR for an increment of 10 g daily intake of fiber was 0.88 (0.84 to 0.92). Conclusion: A high intake of dietary fiber was associated with a reduced risk of pancreatic cancer. Further well-designed prospective studies are warranted to confirm the inverse association and to identify the dietary fiber types involved.
Background and Objectives: To evaluate the effect of culturally-relevant food supplementation and psychoso- cial stimulation on infant growth and development. Methods and Study Design: A community-based random- ized controlled trial was conducted in 40 clusters from 5 selected villages in Tanah Datar District of West Su- matera, Indonesia. We assessed 355 infants aged 6 to 9 months at the beginning of the study. The infants were di- vided into 4 groups: 1) Food Supplementation (FS); 2) Psychosocial Stimulation (PS); 3) Food Supplementation and Psychosocial Stimulation (FS+PS); and 4) Control Group (CG). The formula food supplement was comprised of a variety of local food sources (local MP-ASI) and adjusted for the local habits. The quality of psychosocial stimulation was assessed with the Infant HOME inventory method. Progress at 6 months was assessed by anthro- pometry and the Bayley scores of cognition, language and motor function. Results: There were improvements in linear growth, cognitive and motor development of children in the FS (p<0.05) and the FS+PS (p<0.01) groups compared to the CG. After six months of intervention, mean length increased to 6.862.08 cm and 6.662.41 cm for FS and FS+PS respectively (p<0.05). With the combination of food supplementation and psychosocial stimu- lation (FS+PS), cognitive development increased to 21.412.2 points (effect size 0.56) (p<0.01) and motor devel- opment increased to 20.718.4 points (effect size 0.50) (p<0.001). Conclusion: Combined intervention with local food supplementation and psychosocial stimulation improved infant growth, cognitive and motor development.
Background and Objectives: Picky eating behaviours are common in young children and may adversely affect dietary intake. This study examined the adequacy of dietary patterns and nutrient intake in preschool-aged chil- dren in China and Hong Kong with picky eating behaviours and weight-for-height in the lowest quartile of the WHO Growth Standards. Methods and Study Design: Dietary intake was assessed using baseline 3-day food records from a multicenter, randomized trial in Chinese children (N=151) ages 2.5-5 years characterized as picky eaters by their parents and with weight-for-height ≤25th percentile of the WHO Growth Standards. Nutrient in- takes were calculated using validated dietary analysis software and compared with age-appropriate Chinese Rec- ommended Nutrient Intakes (RNIs). Dietary patterns were compared with Hong Kong Food Pyramid recommen- dations. Results: Median daily energy intake was 25% lower than the age-appropriate RNI, while median intakes of calcium, iron, zinc, and vitamins C and E ranged from 52%-73% of the RNI. Vitamin D intake was only 37% of the RNI. Total fat and sodium intakes exceeded recommendations by 10% and 56%, respectively, while >16% of daily energy was derived from foods in the sweets/beverages/snack and the fats/oils groups. Almost 75% of the children met the recommended daily servings of meat/meat substitutes and nearly half met the recommendation for daily servings of fruit. Fewer met the recommendations for daily servings of vegetables (14.7%), milk/milk products (6.3%), and grains and cereals (6.3%). Conclusions: Young children with picky eating behaviours and low weight-for-height had suboptimal dietary patterns and were at risk for significant dietary and nutrient insuffi- ciencies.
Background and Objective: Little is known about purchasing micronutrient powders (MNP) for children 2-5 years. We describe acceptability for purchasing and price points for MNP for children 2-5 years among caregivers living in districts where free MNP are distributed for children 6-23 months. Methods and Study Design: Cross- sectional surveys conducted 3 months after MNP program implementation in 2 districts; 15 months after imple- mentation in 2 different districts. Chi square tests and logistic regression describe associations among socio- demographics and program exposure factors and acceptability of purchasing MNP among 1,261 mothers of chil- dren 6-23 months who had heard of MNP. Results: Overall, 77.5% and 86.1% of mothers reported acceptability for purchasing MNP in the 3 and 15 month surveys, respectively. Positive pricing attitude (PPA) about paying 150 Nepali rupees for 60 sachets of MNP was reported by 66.3% and 73.4% of mothers. Acceptability for pur- chasing MNP in both time periods increased with higher wealth quintile and higher maternal education; PPA in- creased with higher maternal education. Controlling for socio-demographics, program exposure factors associated with acceptability for purchasing MNP included: lack of perceived barriers to MNP intake and health worker counselling (3 month surveys); knowledge of benefits of MNP intake and lack of perceived barriers to MNP in- take (15 month surveys). Conclusions: Mothers reported acceptability for purchasing MNP and PPA for older children in Nepal. Differences in acceptability were found across socio-demographics and program exposures. Use of these results and further exploration into actual purchasing behaviour can inform future MNP distribution methods in Nepal.
Background and Objectives: Constipation is a common complaint in children, which is not fatal but can affect quality of life. Several lifestyle-related risk factors for constipation have been reported, particularly dietary fac- tors, but results have been inconsistent. Here, we examined the relationship of dietary and lifestyle factors with constipation in Japanese preschool children using data of a nationwide study. Methods and Study Design: Sub- jects were 5,309 children aged 5 to 6 years at 380 nursery schools in 44 of 47 prefectures in Japan. Children hav- ing three or fewer bowel movements per week were considered constipated. Dietary intake data was collected us- ing a validated brief-type self-administered diet history questionnaire for Japanese preschool children, and infor- mation about general lifestyle was collected using a 4-page questionnaire designed for this study. Multivariate- adjusted odds ratios for constipation were calculated by logistic regression. Results: Higher dietary fiber intake was significantly associated with a lower prevalence of constipation (adjusted odds ratio: 0.62, p for trend: 0.005), but higher carbohydrate intake was marginally associated with a higher prevalence of constipation. Intake of po- tatoes, pulses, vegetables, and fruits intake decreased constipation prevalence, whereas higher rice intake was significantly and independently associated with higher prevalence of constipation. Regarding lifestyle factors, high physical activity and sufficient preparation time for breakfast and dinner for guardians were significantly as- sociated with lower prevalence. Prevalence tended to be negatively associated with a higher educational back- ground of the mother. Conclusions: Several lifestyle factors were associated with a lower prevalence of constipa- tion among Japanese preschool children, including dietary fiber intake.
Background and Objectives: The purpose of the present study was to determine whether depression was associ- ated with metabolic syndrome and unhealthy behaviours in community residents. Methods and Study Design: Using the 2009-2010 baseline data of the Saku Cohort Study, 1,225 men and women who participated in a com- munity health screening were included in the cross-sectional analyses. Depression was assessed using the Zung Self-Rating Depression Scale. Consistent with the Japanese Society of Internal Medicine’s definition, we defined metabolic syndrome as abdominal obesity plus two or more of the following: high blood pressure, hyperglycae- mia, and dyslipidaemia. We defined ‘pre- and metabolic syndrome’ as the presence of one or more of the three criteria in addition to abdominal obesity. Results: There was no significant association between depression and metabolic syndrome. In women, the prevalence of pre- and metabolic syndrome was significantly higher in the depression group than that in the non-depression group (17.5% vs 9.5%, p=0.046), whereas no such significant association was observed in men. Logistic regression analysis showed that depression was associated with un- healthy behavioural factors differently in men and women. Conclusions: This study revealed that depression was associated with several unhealthy behavioural factors in both men and women, but depression was associated with pre- and metabolic syndrome only in women. These findings suggest that depression may be a warning sign of metabolic syndrome in women with unhealthy behavioural factors. Psychological factors should be considered in addition to the assessment of physical status.
Background and Objectives: The aim of the present study was to retrospectively analyze the relationship be- tween the Geriatric Nutritional Risk Index (GNRI) at baseline and healthcare costs of three-month as well as the risk of quality-of-life score at the 6-month follow-up for Chinese hemodialysis patients. Methods and Study De- sign: One hundred patients who had been on maintenance hemodialysis were enrolled in this study. The general characteristics, laboratory test results and GNRI of the patients at baseline were recorded. The healthcare costs and quality-of-life scores were determined at the follow-up examination. Results: Patients were divided into two groups according to their median GNRI at baseline: a lower GNRI group (GNRI <86.4) and a higher GNRI group (GNRI >86.4). The patients in the lower GNRI group exhibited reduced hemoglobin (74.7±13.1 g/dL vs 82.3±15.2 g/dL, p<0.05) and albumin (27.4±3.3 g/L vs 34.5±4.0 g/L, p<0.05) as well as reduced body weight (62.7±9.5 kg vs 68.0±9.2 kg, p<0.05) at baseline. The medication cost at follow-up was higher in the lower GNRI group (RMB 3,238±1,534 vs RMB 2,378±1,048, p<0.05). And a lower GNRI at baseline was associated with in- creased future medication costs and worse health in hemodialysis patients. Conclusions: The present study sug- gests that a lower GNRI in hemodialysis patients may be associated with an increased risk of higher future healthcare costs as well as worse health.
Background and Objectives: The aim was to investigate the association between peripheral circulating white blood cell count (WBC) and the metabolic syndrome among populations in central China. Methods and Study Design: In the present study, 5,278 subjects (2,412 women, 2,866 men) aged 18-75 years were recruited through a health check program in Wuhan, China. Biochemical and haematological parameters were measured by stand- ard methods and the metabolic syndrome diagnosed as defined by the Chinese Diabetes Society criteria for Chi- nese. Results: Both WBC counts and prevalence of metabolic syndrome were significantly higher in men than in women (p<0.01). Participants in the highest quartile of white blood cell count had significantly higher odds ratio of metabolic syndrome (3.79, 95% CI: 2.64, 5.44), compared with subjects in the lowest quartile. The trend re- mained significant after adjustment for confounding factors and in further subgroup-analyses. Conclusions: Met- abolic syndrome prevalence was significantly and positively correlated with the total white blood cell count in this Chinese population.
Background and Objectives: The principal objective was to explore in greater detail safety issues with regard to the use of the Lucky Iron Fish® (fish) as a treatment for iron deficiency and iron deficiency anaemia in women in rural Cambodia. Methods and Study Design: Experiments were done to determine: (1) purity of the iron in the fish by mass spectroscopy; (2) release of iron and contaminants released during boiling in water using inductive- ly-coupled plasma optical emission spectroscopy; (3) the impact of cooking time, acidity and number of fish in acidified water and two types of Khmer soups; and (4) drinkability of the water after boiling with different num- bers of fish. Results: The fish is composed primarily of ferrous iron with less than 12% non-ferrous iron. Con- taminants were either not detectable or levels were below the acceptable standards set by the World Health Or- ganization. The length of time boiling the fish and the acidity of the water increased iron release but even with 5 fish boiled for 60 minutes, iron levels only approached levels where side effects are observed. Boiling one fish in water did not affect the perception of colour, smell or taste of the water but boiling in water with two or more fish resulted in the water being unpalatable which further limits the potential for iron toxicity from using the fish. Conclusions: The results suggest that the Lucky Iron FishTM may be a safe treatment for iron deficiency.
This study examines the relationship between of food group intake and household income in a representative Jap- anese population. A total of 11,015 subjects (5,127 men and 5,888 women) aged 20 to 79 years, in 5,475 house- holds who were part of the National Health and Nutrition Survey, Japan, in 2010 and 2011 were analyzed. Die- tary intake was recorded for one day in November for those aged one year and older, from 300 randomly selected survey districts. Household income per year was recorded in the questionnaire in three categories: low (<2 mil- lion yen), middle (2-6 million yen) and high (≥6 million yen). Multilevel regression modelling was applied to take into account the hierarchical data structure of subjects nested within households, and households nested within survey districts. Dichotomous variables divided at the median intake of each food group were used. In a model where sex, age, household size and population size of municipalities to which survey districts belonged were adjusted, the total energy intake was found to be highest in individuals from middle income households, and lowest for those from low income households. In models where a total energy intake was additionally adjusted, household members with low and middle incomes had a significantly higher intake of cereals, and a lower intake of potatoes and starches, pulses, vegetables, fruits, mushrooms, fish and shellfish, milk and seasonings and spices compared with those with high incomes. In conclusion, household members with lower incomes in Japan con- sumed more staple foods, but less vegetable, fruit and fish.
Nutritional standards are important guidelines for providing students with nutritionally-balanced school meals. This study compared nutrient-based school lunch standards regulated by South Korea, Japan, and Taiwan. The data were collected from relevant literature and websites of each country during September 2014. The number of classification groups of target students was 8, 5, and 5 for South Korea, Japan, and Taiwan, respectively. Gender was considered across all age groups in South Korea but only for high school students in Taiwan. Gender was not considered in Japan. Along with energy, the number of nutrients included in the standards for South Korea, Japan and Taiwan was 9, 12, and 4, respectively. The standards for all three countries included protein and fat among macronutrients. The standards for South Korea and Japan included vitamin A, B-1, B-2, and C, while the stand- ards for Taiwan did not include any vitamins. Calcium was the only mineral commonly included in the three standards. The proportions of recommended daily intakes as reference values for each nutrient differed among the countries. Japan differentiated the proportions among 33%, 40%, or 50%, reflecting the target students’ intake status of the respective nutrients. Taiwan differentiated either two-fifths or one-third of the recommended daily intakes. South Korea applied the proportion of recommended daily intake as one-third for all selected nutrients. This study could be valuable information for countries in developing nutrient-based standards for school lunches and for South Korea, Japan, and Taiwan in the process of reforming nutrient-based standards.
Background and Objectives: This study explored attitudes toward two food guides currently being widely used in Australia: the Healthy Eating Pyramid and the Australian Guide to Healthy Eating Plate. Methods and Study Design: Ten focus groups were conducted with adults (aged 18+ years) and children (aged 10-17 years) across various locations in Perth, Western Australia. The discussions focused on liked and disliked aspects of each food guide and the implications for participants’ perceptions of their relative usefulness. Results: When asked to state their preference, a large majority of participants nominated the plate as their preferred nutrition guide. The style of presentation used for the plate was reportedly clearer and more aesthetically pleasing. The plate was also per- ceived to be more complex while the pyramid was considered by adults to be more child-friendly. Conclusions: This study provides information on consumers’ reactions to different food guides and the implications for per- ceived relevance and utility.
Background and Objectives: To investigate the association between demographic characteristics and eating competence (EC), “the behaviour and attitudinal conceptualization of eating”, among elderly Taiwanese. Meth- ods and Study Design: Random questionnaire survey. Overall, 564 questionnaires were analyzed, and independ- ent t-tests, analysis of variance, chi-square tests, were used to compare the differences in the EC scores when stratified by various demographic variables. Results: The mean score of both EC and non-EC (NEC) for all re- spondents was 29.3. Younger respondents (65-70 years old) reported significantly higher EC scores than did old- er respondents (71-76 years old) (p<0.05). Similarly, respondents with high school or a higher education level re- ported higher scores than did respondents with elementary or a lower education level (p<0.001), and respondents with partners had higher scores than did those with no partners (p<0.001). Respondents who lived in urban areas reported higher EC scores than those living in rural areas (p<0.001). No significant gender differences were found in both EC and NEC scores. Conclusions and Implications: Thirty-seven percent of elderly Taiwanese were not eating competent. Older respondents with higher education levels, those with partners, and those residing in urban areas showed significantly higher EC scores. Nutritional practitioners should therefore develop nutrition educa- tion programs tailored for those with low EC scores.
Background: The leading cause of death in children in developing countries is protein-energy malnutrition. In Viet Nam, 25.9% of children under 5 experience stunted growth and 6.6% are moderately wasted. Iron deficiency anaemia and vitamin A deficiency contribute to these and other malnutrition conditions. Objectives: Given these factors, more evidence based approaches are required to improve understanding of current attitudes, opinions and behaviours of mothers with young children, in order to operationalise social marketing of nutrition commodities in Viet Nam. Methods and Study Design: A literature review supported a rapid assessment and response method involving semi-structured interviews with 77 stakeholders and focus group discussions with 80 program benefi- ciaries from four geographic locations in the north and south of Viet Nam. Discussion agendas were developed to address key program issues with grounded theory utilized for data analysis. Results: Data analysis highlighted challenges and opportunities within the six Ps of social marketing: Supply and demand side issues included: cost and the quality of products, the limited scale of interventions and promotional activities. Policy issues identified related to current policies that inhibited the broader promotion and distribution of micronutrient products, and op- portunities for improved dialogue with policy partners. Partnerships further emphasized the need for public pri- vate partnerships to support the social change process. Conclusion: Implications for theory, policy, and practice indicates that rapid assessment and response is a cost-effective, pragmatic method of public health research, in re- source constrained settings, to explore policies and behaviours amenable to change and build stakeholder en- gagement in the program.
Background and Objectives: Here we systematically reviewed and quantitatively analyzed randomized con- trolled trials (RCTs) to compare the important initial outcomes of critically ill adults receiving low- and high- energy enteral nutrition. Methods and Study Design: RCTs comparing low- and high-energy supplementation in critically ill adults receiving enteral nutrition admitted to the intensive care unit for an expected stay of >48 h were included. Abstracts submitted to major scientific meetings were included and the primary endpoint was mortality. The risk ratio (RR) and weighted mean difference (WMD) with 95% confidence intervals (CIs) were the effect measures. Results: Eleven RCTs (3,212 patients) were included. The groups did not differ significantly in mortality (RR, 0.94; 95% CI, 0.80-1.11; p=0.47), infections morbidity (RR 1.09; 95% CI 0.95-1.26; p=0.23), pneumonia morbidity (RR 1.04; 95% CI 0.88-1.23; p=0.68), hospital length of stay (WMD -0.27; 95% CI -3.21 to 3.76; p=0.88), intensive care unit length of stay (WMD -0.32; 95% CI, -1.81 to 1.16; p=0.46), mechanical ven- tilation days (WMD -0.30; 95% CI-1.42 to 0.82; p=0.60). The incidence of gastrointestinal intolerance was sig- nificantly lower in the low-energy group (RR 0.79; 95% CI 0.65-0.97; p<0.05). Conclusions: The initial admin- istration of low- versus high-energy supplements did not impact clinical outcomes except for gastrointestinal in- tolerance in non-malnourished critically ill patients receiving enteral nutrition. The initial administration of high- rather than low-energy may benefit these patients by reducing infections, but this effect might actually be at- tributable to the concomitant high protein intake.
Background and Objectives: Following major upper gastrointestinal surgical procedures, early enteral nutrition to the jejunum is strongly recommended, either through a nasoenteric tube or a percutaneous transperitoneal jeju- nal feeding tube (jejunostomy). However, to date there has been no consensus as to the best enteral feeding strat- egy. Our aim was to determine the safest and most efficacious early enteral nutrition supplement strategy follow- ing major upper gastrointestinal operations. Methods and Study Design: PubMed, Embase and Cochrane Li- brary databases were systematically searched for comparison of trials. The primary outcome analyzed was length of postoperative hospital stay, and secondary outcomes were: duration of enteral nutrition, time to resumption of normal oral intake, and tube dislodgement, tube leakage and tube obstruction complications. Weighted mean dif- ferences (WMDs) and risk ratios (RRs) were calculated with 95% confidence intervals (CI). Results: A total of 5 studies were included with 420 patients in all. The length of hospital stay, duration of enteral nutrition and the time to resumption of normal oral intake were all significantly shorter in the nasoenteric group (p<0.05). There was no increase or reduction in the RR of tube obstruction between the nasoenteric and jejunostomy groups (p=0.5). The RR of tube dislodgement was increased in the nasoenteric group (p<0.05) while the RR of tube leakage was increased in the jejunostomy group (p<0.05). Conclusions: A nasoenteric tube is more likely to be effective in early postoperative enteral feeding following major upper gastrointestinal operations.
Background and Objectives: The optimal delivery of enteral nutrition (EN) may improve clinical outcomes in critically ill patients; thus, optimal EN protocols should be developed. The purpose of this study was to evaluate the impact of implementing an EN protocol on the improvement of EN practices and on the clinical outcomes of critically ill patients. Methods and Study Design: This was a retrospective study with prospectively collected data. Multidisciplinary working group developed an evidence-based EN protocol based on an extensive review of literature and existing guidelines. Subjects included patients consecutively admitted to the ICU who received EN for more than 24 hours. EN practices and clinical outcomes were compared before and after implementation of the protocol. Results: A total of 270 patients were included, 134 patients before implementation and 136 after implementation of the protocol. EN was initiated earlier (35.8 vs 87.1 hours, p=0.001) and more patients received EN within 24 hours (59.6% vs 41.0%, p=0.002) after implementation of the protocol. The interval between start- ing EN and reaching the caloric goal was not different, but more patients reached the caloric goal after implemen- tation (52.2% vs 38.3%, p=0.037). The post-implementation group was given more prokinetics and less parenter- al nutrition. The incidences of diarrhea and gastrointestinal bleeding significantly decreased following implemen- tation of the protocol. There was no difference in clinical outcomes including in-hospital mortality and length of hospital and ICU stay. Conclusion: The implementation of the EN protocol significantly improved the practices of EN and decreased complications in critically ill patients. Clinical outcomes were not different before and after implementation.
Background and Objectives: Aging and malnutrition are known to influence immune functions. The aim of this study was to investigate the relationship of aging and malnutrition to innate immune functions in tube-fed bedrid- den patients. Methods and Study Design: A cross-sectional survey was performed in 71 tube-fed bedridden pa- tients aged 50-95 years (mean age±SD, 80.2±8.5 years) with serum albumin concentrations between 2.5 and 3.5 g/dL. We evaluated associations of age and nutritional variables with natural-killer cell activity, neutrophil- phagocytic activity, and neutrophil-sterilizing activity. Nutritional variables included body mass index, weight- adjusted energy intake, total lymphocyte count, and serum concentrations of albumin, transferrin, prealbumin, to- tal cholesterol, C-reactive protein, and zinc. Results: Natural-killer cell activity, neutrophil-phagocytic activity, and neutrophil-sterilizing activity were normal or increased in 67 (94%), 63 (89%), and 69 (97%) patients, re- spectively. Multiple linear regression analysis with a backward elimination method showed that natural-killer cell activity correlated negatively with aging and lymphocyte counts (p<0.01 for both) but positively with body mass index and transferrin (p<0.01 for both). Neutrophil-phagocytic and neutrophil-sterilizing activities were not asso- ciated with any variables. Conclusions: In tube-fed bedridden patients with hypo-albuminemia, natural-killer cell activity may be associated with aging, body mass index, transferrin, and lymphocyte counts.
Background and Objectives: Patients undergoing chemotherapy often develop distressing adverse effects such as oral mucositis and diarrhea. Nutritional support with elemental diet is effective against various gastrointestinal complications and may exert protective effects against adverse effects induced by chemotherapy. To evaluate the influence of elemental diet on chemotherapy-induced oral mucositis and diarrhea, we conducted a randomized control trial in patients with esophageal cancer undergoing chemotherapy. Methods and Study Design: Twenty esophageal cancer patients receiving chemotherapy with 5-fluorouracil plus cisplatin were assigned randomly to one of the following two groups: (1) receiving elemental diet with Elental (one pack per day) for 14 days and (2) not receiving Elental during chemotherapy. The severity of oral mucositis and diarrhea was graded using clinical examination by doctors and a standard questionnaireon days 1-14. Results: Based on the analysis of the standard questionnaire, the distribution of the maximum severity of oral mucositis showed a statistically significant reduc- tion in the Elental group (p=0.020), while clinical examination showed insignificant reduction but shift toward lower grade. In the Elental group, the incidence of oral mucositis (grade ≥2) reduced consistently and the median grade was lower at all-time points. Regarding diarrhea, no difference was observed between the two groups based on the analysis of the standard questionnaire and clinical examination results. Conclusions: This study illustrates the effectiveness of oral elemental diet in preventing oral mucositis during chemotherapy. This is a preliminary report and further study with larger patients groups should be devoted to optimization of efficacy.
Background and Objectives: To determine the nutritional status of patients with esophageal cancer, and to investigate its relationship with performance status and prognosis. Methods and Study Design: This clinical, cross-sectional study was conducted from August 2014 to February 2015 at National Cancer Hospital, Hanoi, Vietnam. Stage III/IV esophageal cancer patients were assessed for their nutritional status (patient-generated subjective global assessment (PG-SGA) and SGA scores, BMI, mid-arm circumference (MAC), energy and protein intakes, weight changes, Karnofsky and Eastern cooperative oncology group performance scores (KPS/ECOG), and Glasgow prognostic score (GPS). Results: Sixty-four male patients were enrolled. The mean ± standard deviation of PG-SGA score was 9.88±4.41. SGA revealed 44% as class B and 6.2% as class C. The BMI revealed 43.8% of patients were underweight. MAC measurement revealed 29.7% of undernourished patients. Patients with an energy intake <25 kcal/kg/d comprised 54.7%, and 48.4% with <1 g/kg/day of protein. Totally, 68.8%, 84.4% and 92.2% patients exhibited weight loss past 2-weeks, one-month and six-months, respectively. The PG-SGA and SGA strongly correlated with the KPS (r=-0.717 and 0.632, both p<0.001) and ECOG (r=0.672 and 0.626, both p<0.001), but were weakly correlated with the GPS (r=0.332 and 0.278, p<0.01 and 0.05). The KPS, ECOG, BMI, MAC, energy and protein intakes, and weight change were not correlated with the GPS. Conclusions: Malnutrition, weight change, and insufficient intake were noteworthy in esophageal cancer patients. The PG-SGA and SGA were strongly correlated with the performance status, but weakly correlated with prognostic indices.
Background and Objectives: Postprandial glycemic control is important for prevention of diabetes. Black tea consumption may improve postprandial glycemic control. The major bioactive compounds are polyphenols, black tea polymerized polyphenol (BTPP).This study examined the effect of black tea consumption on postprandial blood glucose and insulin response following sucrose loading in normal and pre-diabetes subjects. Methods and Study Design: This study was a randomized, double-blind, placebo-controlled crossover study. Twenty-four sub- jects, male and female aged 20-60 years, normal and pre-diabetic, randomly ingested a sucrose solution with a low dose (110 mg BTPP), a high dose (220 mg BTPP) of black tea drink or a placebo drink (0 mg BTPP). Blood samples were collected at 0, 30, 60, 90, and 120 min from commencement of drink ingestion to measure blood glucose and insulin levels. Results: The drink containing low dose and high dose BTPP significantly decreased incremental blood glucose area under the curve (AUC) after sucrose intake compared with placebo in the normal (T0-60 min 3,232±356 vs 3,295±312 vs 3,652±454 mg.min/dL; p=0.016) and pre-diabetic subjects (T0-60 min 2,554±395 vs 2,472±280 vs 2,888±502 mg.min/dL; p=0.048). There was no statistically significant difference of changes in insulin levels between the placebo and black tea groups (p>0.05). No significant differences in adverse effects were observed with the placebo, low dose and high dose of BTPP groups. Conclusion: Black tea con- sumption can decrease postprandial blood glucose after sucrose intake.