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Nutrition in Clinical Practice

Nishanth Vallumsetla, Lisa Epp, Ryan T Hurt, Manpreet S Mundi
BACKGROUND: Diabetes mellitus (DM) is estimated to affect 9% of Americans and is associated with significant morbidity, mortality, and increased healthcare costs. METHODS: A retrospective review of a home enteral nutrition (HEN) database of patients seen between March 1, 2004, and April 31, 2014, at our institution was conducted to identify HEN patients who had a diagnosis of DM or were diagnosed within the acute period (4 months) of starting HEN therapy. RESULTS: 174 (3...
July 13, 2018: Nutrition in Clinical Practice
Heidi J Murphy, Carolyn W Finch, Sarah N Taylor
Critically ill neonates who require extracorporeal life support have particular nutrition needs. These infants require prescription of aggressive, early nutrition support by knowledge providers. Understanding the unique metabolic demands and nutrition requirements of these fragile patients is paramount, particularly if additional therapies such as aggressive diuretic regimens or continuous renal replacement therapy are used concurrently. Although the American Society for Parenteral and Enteral Nutrition has published guidelines for this population, a review of each nutrition component is warranted because few studies exist specific to this population...
July 13, 2018: Nutrition in Clinical Practice
Tim Torsy, Renée Saman, Kurt Boeykens, Ivo Duysburgh, Nele Van Damme, Dimitri Beeckman
BACKGROUND: Several studies have shown that the nose-earlobe-xiphoid distance (NEX) is inadequate to estimate the insertion length of nasogastric tubes. An alternative approach tested in these studies, which leads to > 90% well-placed nasogastric tubes, used a corrected calculation of the NEX: (NEX × 0.38696) + 30.37. The primary aim of this study was to determine whether using the corrected NEX was more successful than the NEX in determining the insertion length. The secondary aim was to investigate the likelihood to successfully obtain gastric aspirate...
June 30, 2018: Nutrition in Clinical Practice
Vikram J Christian, Elizabeth Polzin, Scott Welak
Necrotizing enterocolitis (NEC) is one of the most significant causes of morbidity and mortality among premature infants. The exact cause is considered multifactorial and related to gastrointestinal immaturity, inflammation and enteral feeding. The role of nutrition is vitally important in NEC. The main modifiable risk factor is the introduction and advancement of enteral feedings. After an infant has recovered from NEC, enteral feeds should be cautiously resumed to prevent injury from prolonged use of parenteral nutrition...
June 25, 2018: Nutrition in Clinical Practice
Lisa Mostafavifar, David C Evans
No abstract text is available yet for this article.
June 25, 2018: Nutrition in Clinical Practice
Erika Johnson, Long Vu, Laura E Matarese
Short bowel syndrome (SBS) occurs in patients who have had extensive resection. The primary physiologic consequence is malabsorption, resulting in fluid and electrolyte abnormalities and malnutrition. Nutrient digestion, absorption, and assimilation may also be diminished by disturbances in the production of bile acids and digestive enzymes. Small bowel dilation, dysmotility, loss of ileocecal valve, and anatomical changes combined with acid suppression and antimotility drugs increase the risk of small intestinal bacterial overgrowth, further contributing to malabsorption...
June 21, 2018: Nutrition in Clinical Practice
Satomi Ichimaru
There are several methods of enteral nutrition (EN) administration, including continuous, cyclic, intermittent, and bolus techniques, which can be used either alone or in combination. Continuous feeding involves hourly administration of EN over 24 hours assisted by a feeding pump; cyclic feeding involves administration of EN over a time period of <24 hours generally assisted by a feeding pump; intermittent feeding involves administration of EN over 20-60 minutes every 4-6 hours via pump assist or gravity assist; and bolus feeding involves administration of EN over a 4- to 10-minute period using a syringe or gravity drip...
June 20, 2018: Nutrition in Clinical Practice
Megan Rattray, Andrea Marshall, Ben Desbrow, Shelley Roberts
BACKGROUND: Evidence-based guidelines (EBG) recommend recommencing oral feeding (liquids and solids) ≤24 hours after surgery. The aims of this study were to determine time to first diet (any) and solid-diet prescriptions, delivery, and intakes among adult, non-critically ill, postoperative patients. METHODS: This prospective cross-sectional study included 100 postsurgical patients. Demographic and perioperative dietary-related data were collected from patients' medical records or via direct observation...
June 7, 2018: Nutrition in Clinical Practice
Natália F Pena, Sílvia F Mauricio, Ana M S Rodrigues, Ariene S Carmo, Nayara C Coury, Maria I T D Correia, Simone V Generoso
BACKGROUND: Different nutrition assessment tools in surgical cancer patients are used in clinical practice, which results in different prevalence rates of malnutrition. This may impact the interpretation of the association between nutrition status and clinical outcomes. Reduced standardized phase angle (SPA) values are associated with adverse outcomes in patients with cancer. Thus, it is important to assess the association of SPA with nutrition status and relate it to postoperative clinical outcomes...
June 5, 2018: Nutrition in Clinical Practice
Marianne Boulé, Sophie Lachapelle, Laurence Collin-Lévesque, Émile Demers, Christina Nguyen, Marylou Fournier-Tondreau, Maxime Thibault, Denis Lebel, Jean-François Bussières
BACKGROUND: The parenteral nutrition (PN) process is complex and involves multiple steps and substeps, especially in pediatrics and neonatology, given the particular needs of these patients. The objective of this study was to perform a critical analysis of the PN process at the Centre Hospitalier Universitaire Sainte-Justine to determine which potential pitfalls are related to this process and which should be prioritized when implementing corrective measures. METHODS: This is a Failure Mode, Effect, and Criticality Analysis (FMECA) study...
May 30, 2018: Nutrition in Clinical Practice
Jeong Shin Lee, Ji Eun Kang, So Hyun Park, Hye Kyung Jin, Soo Min Jang, Sun Ah Kim, Sandy Jeong Rhie
BACKGROUND: To examine the outcomes of the implementation of a multidisciplinary nutrition support team (NST) that included a pharmacist for critically ill patients in the intensive care unit (ICU). METHODS: Data were retrospectively collected from electronic medical records and compared between the pre-NST group (n = 73) and post-NST group (n = 75). Patients were included if they received enteral or parenteral nutrition support for at least 72 hours in the ICU of an approximately 900-bed, top-tier university medical center...
May 26, 2018: Nutrition in Clinical Practice
Angela Teodósio da Silva, Daniela Barbieri Hauschild, Yara Maria Franco Moreno, João Luiz Dornelles Bastos, Elisabeth Wazlawik
BACKGROUND: In the absence of a gold standard technique for assessing nutrition status in patients receiving hemodialysis (HD), we aimed to determine the diagnostic accuracy of single-frequency (50 kHz) bioelectrical impedance analysis parameters, resistance/height (R/H), reactance/height (Xc/H), and impedance/height (Z/H), and their cutoff points for malnutrition. METHODS: The reference standards, Subjective Global Assessment (SGA), Malnutrition Inflammation Score, and Nutritional Risk Screening 2002, were performed at baseline and then once a year for 2 years...
May 22, 2018: Nutrition in Clinical Practice
Mayane Marinho Esteves Pereira, Mariana Dos Santos Campello Queiroz, Nathália Masiero Cavalcanti de Albuquerque, Juliana Rodrigues, Emanuelly Varea Maria Wiegert, Larissa Calixto-Lima, Livia Costa de Oliveira
Phase angle (PA) is a ratio between the reactance and resistance obtained by bioelectric impedance analysis and has been interpreted as a cell membrane integrity indicator and a predictor of total body cell mass. A low PA may suggest deterioration of the cell membrane, which in advanced cancer patients may result in a reduced overall survival (OS). This systematic review sought to investigate the current evidence regarding whether there is an association between PA and OS in patients with advanced cancer (ie, metastatic disease)...
May 22, 2018: Nutrition in Clinical Practice
Meredith Linley Harvie, Margaret Alyssa Tucker Norris, Wednesday Marie A Sevilla
BACKGROUND: In pediatric short bowel syndrome (SBS), adding fiber to enteral feedings is 1 treatment method to manage increased stool output. However, there are no standardized recommendations on the use of fiber in this setting, including type, dosage, titration strategies, etc. OBJECTIVE: The aim of this study is to determine current prevailing practices on the use of fiber in the treatment of chronic high stool output in the pediatric SBS population. METHODS: An anonymous electronic survey with 13 questions was sent through health professional electronic mailing lists...
May 16, 2018: Nutrition in Clinical Practice
Douglas L Seidner, Ken Fujioka, Joseph I Boullata, Kishore Iyer, Hak-Myung Lee, Thomas R Ziegler
BACKGROUND: Patients with intestinal failure associated with short bowel syndrome (SBS-IF) require parenteral support (PS) to maintain fluid balance or nutrition. Teduglutide (TED) reduced PS requirements in patients with SBS-IF in the randomized, placebo (PBO)-controlled STEPS study (NCT00798967) and its 2-year, open-label extension, STEPS-2 (NCT00930644). METHODS: STEPS-3 (NCT01560403), a 1-year, open-label extension study in patients with SBS-IF who completed STEPS-2, further monitored the safety and efficacy of TED (0...
May 15, 2018: Nutrition in Clinical Practice
Rachel Chambers, Joanna Bryan, Deanna Jannat-Khah, Emily Russo, Louise Merriman, Renuka Gupta
BACKGROUND: As described in detail in the literature, patients identified with malnutrition are at increased risk for poor clinical outcomes. Despite this knowledge, malnourished patients do not always receive optimal nutrition management while admitted into a hospital because of what we describe as gaps in care throughout their admission. We hypothesized that the 3 main gaps in care were poor dietitian-doctor communication, excessive time spent nil per os (NPO) for procedures and testing, and/or inaccurate or incomplete dietary discharge instructions...
April 27, 2018: Nutrition in Clinical Practice
Caitlin Curtis
Technology is constantly being used in novel ways, and its use in the practice of medicine is no exception. Examples of this include computer physician order entry, barcode-medication scanning, electronic health records (EHRs), and bedside patient charts, to name a few. Compounding parenteral nutrition has been included in this technological revolution, with improvements such as barcode-assisted medication preparation systems and EHR-to-compounder interfaces. Along with some of these electronic advancements come the inevitable improvements and challenges, which are explored in this article...
April 17, 2018: Nutrition in Clinical Practice
Jeanette M Hasse
No abstract text is available yet for this article.
August 2018: Nutrition in Clinical Practice
Nimish Vakil
FODMAP is an acronym for fermentable oligosaccharides, disaccharides, monosaccharides, and polyols. Dietary modification of FODMAPs has been shown to have significant effects on the physiology of the gastrointestinal tract and improves symptoms of abdominal pain, distention, and bloating in patients with irritable bowel syndrome. Structured withdrawal and reintroduction of FODMAPs supervised by a dietitian is the optimal practice for dietary FODMAP modification in irritable bowel syndrome. FODMAPs are present in enteral feeding formulas and may have a role in diarrhea and bloating in tube-fed patients...
August 2018: Nutrition in Clinical Practice
Jeanette M Hasse
No abstract text is available yet for this article.
June 2018: Nutrition in Clinical Practice
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