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Nutrition in Clinical Practice

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https://www.readbyqxmd.com/read/28445108/manganese-provision-in-parenteral-nutrition-an-update
#1
Callum Livingstone
Manganese (Mn) is an essential micronutrient required for the activity of metalloenzymes. It is an essential component of parenteral nutrition (PN), but requirements are low. Mn status is difficult to assess, with the commonest method being measurement of its concentration in whole blood. This method has limitations, including artifactually high concentrations resulting from contamination of specimen tubes. Mn toxicity is a well-recognized complication of PN, the risk of which increases if there is cholestasis or if the patient has received high doses...
April 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28437132/home-enteral-nutrition-updates-trends-and-challenges
#2
Karen Martin, Gabriela Gardner
The true prevalence of home enteral nutrition (HEN) utilization is unclear and requires further study. HEN therapy has remained virtually unchanged for several decades. However, new trends in HEN are evolving; enteral nutrition is undergoing changes ranging from enteral feeding devices, ingredients used, practice innovations, and challenges with reimbursement. A 2006 Joint Commission call to action that reported 2 sentinel events related to misconnections set things into motion for the transition of enteral device connectors to become specific for enteral nutrition use, which will affect patients who receive HEN...
April 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28426396/current-status-of-and-recommendations-for-nutrition-education-in-gastroenterology-fellowship-training-in-canada
#3
Jing Hu, Maitreyi Raman, Leah Gramlich
PURPOSE: Knowledge and skill in the area of nutrition are a key competency for the gastroenterologist. However, standards for nutrition education for gastroenterology fellows in Canada do not exist, and gastroenterologists in training and in practice do not feel confident in their knowledge or skill as it relates to nutrition. This study was undertaken to identify the current status of nutrition education in gastroenterology (GI) fellowship training programs in Canada and to provide insight into the development of nutrition educational goals, processes, and evaluation...
April 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28358595/treatment-of-enterocutaneous-fistulas-then-and-now
#4
Luis Alfonso Ortiz, Bin Zhang, Maureen Walsh McCarthy, Haytham M A Kaafarani, Peter Fagenholz, David R King, Marc De Moya, George Velmahos, Daniel Dante Yeh
BACKGROUND: An enterocutaneous fistula (ECF) is an aberrant connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]). Multimodal treatment includes surgical procedures, nutrition support, and wound care. We evaluated our practice and compared our outcomes with previous results published from our institution. MATERIALS AND METHODS: We performed a retrospective analysis of hospitalized ECF/EAF patients admitted between January 2011 and November 2015...
March 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28350525/hang-height-of-enteral-nutrition-influences-the-delivery-of-enteral-nutrition
#5
Renee Walker, Lauren Probstfeld, Anne Tucker
PURPOSE: Adequate enteral nutrition (EN) delivery to critically ill patients is difficult to achieve. Given the large number of unpreventable influences affecting adequate caloric intake, further research on preventable influences of adequate EN administration is warranted. The purpose of this study was to evaluate whether hang height of EN formula, formula viscosity, or flow rate influences pump accuracy and formula delivery. METHODS: Formulas of varying viscosities (1...
March 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28350517/anti-inflammatory-diet-in-clinical-practice
#6
Mari Anoushka Ricker, William Christian Haas
Recently, there has been an increase in the research regarding the impact of acute and chronic inflammation on health and disease. Specific foods are now known to exert strong effects on inflammatory pathways within the body. Carefully selecting foods that are anti-inflammatory in nature while avoiding foods that are proinflammatory is central to an anti-inflammatory diet plan. Ultimately, the plan models a pattern of eating that (1) focuses on eating whole, plant-based foods that are rich in healthy fats and phytonutrients and (2) maintains a stable glycemic response...
March 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28350508/role-of-nutrition-support-in-inflammatory-conditions
#7
Olivier Lheureux, Jean-Charles Preiser
This review intends to summarize recent development on the potential nutrition implications of acute inflammation encountered during critical illness. Different aspects of the inflammatory response and their impact on nutrition management during critical illness will be discussed: the timing of the postinjury metabolic response, the integration of regulatory mechanisms involved in the metabolic response to stress, the oxidative stress, the metabolic and clinical consequences in terms of energy expenditure, use of energy, changes in body composition, and behavior...
March 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28199797/nutritional-risk-screening-2002-short-nutritional-assessment-questionnaire-malnutrition-screening-tool-and-malnutrition-universal-screening-tool-are-good-predictors-of-nutrition-risk-in-an-emergency-service
#8
Estela Iraci Rabito, Aline Marcadenti, Jaqueline da Silva Fink, Luciane Figueira, Flávia Moraes Silva
BACKGROUND: There is an international consensus that nutrition screening be performed at the hospital; however, there is no "best tool" for screening of malnutrition risk in hospitalized patients. OBJECTIVE: To evaluate (1) the accuracy of the MUST (Malnutrition Universal Screening Tool), MST (Malnutrition Screening Tool), and SNAQ (Short Nutritional Assessment Questionnaire) in comparison with the NRS-2002 (Nutritional Risk Screening 2002) to identify patients at risk of malnutrition and (2) the ability of these nutrition screening tools to predict morbidity and mortality...
February 1, 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388381/protein-requirements-of-the-critically-ill-pediatric-patient
#9
Jorge A Coss-Bu, Jill Hamilton-Reeves, Jayshil J Patel, Claudia R Morris, Ryan T Hurt
This article includes a review of protein needs in children during health and illness, as well as a detailed discussion of protein metabolism, including nitrogen balance during critical illness, and assessment and prescription/delivery of protein to critically ill children. The determination of protein requirements in children has been difficult and challenging. The protein needs in healthy children should be based on the amount needed to ensure adequate growth during infancy and childhood. Compared with adults, children require a continuous supply of nutrients to maintain growth...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388380/acquired-amino-acid-deficiencies-a-focus-on-arginine-and-glutamine
#10
Claudia R Morris, Jill Hamilton-Reeves, Robert G Martindale, Menaka Sarav, Juan B Ochoa Gautier
Nonessential amino acids are synthesized de novo and therefore not diet dependent. In contrast, essential amino acids must be obtained through nutrition since they cannot be synthesized internally. Several nonessential amino acids may become essential under conditions of stress and catabolic states when the capacity of endogenous amino acid synthesis is exceeded. Arginine and glutamine are 2 such conditionally essential amino acids and are the focus of this review. Low arginine bioavailability plays a pivotal role in the pathogenesis of a growing number of varied diseases, including sickle cell disease, thalassemia, malaria, acute asthma, cystic fibrosis, pulmonary hypertension, cardiovascular disease, certain cancers, and trauma, among others...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388379/variation-in-protein-origin-and-utilization-research-and-clinical-application
#11
Douglas Paddon-Jones, Jorge A Coss-Bu, Claudia R Morris, Stuart M Phillips, Jan Wernerman
Muscle health can be rapidly compromised in clinical environments. Modifiable strategies to preserve metabolic homeostasis in adult patient populations include physical activity and pharmacologic support; however, optimizing dietary practices, or more specifically protein intake, is a necessary prerequisite for any other treatment strategy to be fully effective. Simply increasing protein intake is a well-intentioned but often unfocused strategy to protect muscle health in an intensive care setting. Protein quality is a frequently overlooked factor with the potential to differentially influence health outcomes...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388378/protein-turnover-and-metabolism-in-the-elderly-intensive-care-unit-patient
#12
Stuart M Phillips, Roland N Dickerson, Frederick A Moore, Douglas Paddon-Jones, Peter J M Weijs
Many intensive care unit (ICU) patients do not achieve target protein intakes particularly in the early days following admittance. This period of iatrogenic protein undernutrition contributes to a rapid loss of lean, in particular muscle, mass in the ICU. The loss of muscle in older (aged >60 years) patients in the ICU may be particularly rapid due to a perfect storm of increased catabolic factors, including systemic inflammation, disuse, protein malnutrition, and reduced anabolic stimuli. This loss of muscle mass has marked consequences...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388377/how-many-nonprotein-calories-does-a-critically-ill-patient-require-a-case-for-hypocaloric-nutrition-in-the-critically-ill-patient
#13
Saúl J Rugeles, Juan B Ochoa Gautier, Roland N Dickerson, Jorge A Coss-Bu, Jan Wernerman, Douglas Paddon-Jones
Calculation of energy and protein doses for critically ill patients is still a matter of controversy. For more than 40 years of nutrition support, the total amount of nutrients to be delivered to these patients has been calculated based on expert recommendations, and this calculation is based on the administration of nonprotein calories in one attempt to ameliorate catabolic response and avoid the weight loss. New evidence suggests protein delivery is the most important intervention to improve clinical and metabolic outcomes...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388376/how-much-and-what-type-of-protein-should-a-critically-ill-patient-receive
#14
Juan B Ochoa Gautier, Robert G Martindale, Saúl J Rugeles, Ryan T Hurt, Beth Taylor, Daren K Heyland, Stephen A McClave
Protein loss, manifested as loss of muscle mass, is observed universally in all critically ill patients. Depletion of muscle mass is associated with impaired function and poor outcomes. In extreme cases, protein malnutrition is manifested by respiratory failure, lack of wound healing, and immune dysfunction. Protecting muscle loss focused initially on meeting energy requirements. The assumption was that protein was being used (through oxidation) as an energy source. In healthy individuals, small amounts of glucose (approximately 400 calories) protect muscle loss and decrease amino acid oxidation (protein-sparing effect of glucose)...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388375/assessment-of-protein-turnover-in-health-and-disease
#15
Jan Wernerman, Claudia R Morris, Douglas Paddon-Jones, Menaka Sarav
To identify protein requirements, it is necessary to be familiar with basic physiology, practical methods, and dose response of protein delivery. This review evaluates available methodology, with emphasis on the limitations of existing techniques most often related to the underlying assumption. Historically, nitrogen balance has been the dominating technique. It is still the gold standard, although there are considerable problems related to the underlying assumptions to have reliable readings. When minimal requirements needed to be defined, the indicator amino acid oxidation technique came into practice...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388374/summary-points-and-consensus-recommendations-from-the-international-protein-summit
#16
Ryan T Hurt, Stephen A McClave, Robert G Martindale, Juan B Ochoa Gautier, Jorge A Coss-Bu, Roland N Dickerson, Daren K Heyland, L John Hoffer, Frederick A Moore, Claudia R Morris, Douglas Paddon-Jones, Jayshil J Patel, Stuart M Phillips, Saúl J Rugeles, Menaka Sarav Md, Peter J M Weijs, Jan Wernerman, Jill Hamilton-Reeves, Craig J McClain, Beth Taylor
The International Protein Summit in 2016 brought experts in clinical nutrition and protein metabolism together from around the globe to determine the impact of high-dose protein administration on clinical outcomes and address barriers to its delivery in the critically ill patient. It has been suggested that high doses of protein in the range of 1.2-2.5 g/kg/d may be required in the setting of the intensive care unit (ICU) to optimize nutrition therapy and reduce mortality. While incapable of blunting the catabolic response, protein doses in this range may be needed to best stimulate new protein synthesis and preserve muscle mass...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388373/protein-kinetics-and-metabolic-effects-related-to-disease-states-in-the-intensive-care-unit
#17
Robert G Martindale, Daren K Heyland, Saúl J Rugeles, Jan Wernerman, Peter J M Weijs, Jayshil J Patel, Stephen A McClave
Evaluating protein kinetics in the critically ill population remains a very difficult task. Heterogeneity in the intensive care unit (ICU) population and wide spectrum of disease processes creates complexity in assessing protein kinetics. Traditionally, protein has been delivered in the context of total energy. Focus on energy delivery has recently come into question, as the importance of supplemental protein in patient outcomes has been shown in several recent trials. The ICU patient is prone to catabolism, immobilization, and impaired immunity, which is a perfect storm for massive loss of lean body tissue with a unidirectional flow of amino acids from muscle to immune tissue for immunoglobulin production, as well as liver for gluconeogenesis and acute phase protein synthesis...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388372/protein-delivery-in-the-intensive-care-unit-optimal-or-suboptimal
#18
Daren K Heyland, Peter J M Weijs, Jorge A Coss-Bu, Beth Taylor, Arnold S Kristof, Grant E O'Keefe, Robert G Martindale
Emerging evidence suggests that exogenous protein/amino acid supplementation has the potential to improve the recovery of critically ill patients. After a careful review of the published evidence, experts have concluded that critically ill patients should receive up to 2.0-2.5 g/kg/d of protein. Despite this, however, recent review of current International Nutrition Survey data suggests that protein in critically ill patients is underprescribed and grossly underdelivered. Furthermore, the survey suggests that most of protein administration comes from enteral nutrition (EN) despite the availability of products and protocols that enhance the delivery of protein/amino acids in the intensive care unit (ICU) setting...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388371/experimental-and-outcome-based-approaches-to-protein-requirements-in-the-intensive-care-unit
#19
Peter J M Weijs, Roland N Dickerson, Daren K Heyland, Frederick A Moore, Saúl J Rugeles, Stephen A McClave
Insight into protein requirements of intensive care unit (ICU) patients is urgently needed, but at present, it is unrealistic to define protein requirements for different diagnostic groups of critical illness or at different stages of illness. No large randomized controlled trials have randomized protein delivery, adequately addressed energy intake, and evaluated relevant clinical outcomes. As a pragmatic approach, experimental studies have focused on protein requirements of heterogeneous ICU patients. Data are scarce and the absolute value of protein requirements therefore is an approximation...
April 2017: Nutrition in Clinical Practice
https://www.readbyqxmd.com/read/28388370/will-we-ever-agree-on-protein-requirements-in-the-intensive-care-unit
#20
L John Hoffer, Roland N Dickerson, Robert G Martindale, Stephen A McClave, Juan B Ochoa Gautier
The precise value of the normal adult protein requirement has long been debated. For many reasons-one of them being the difficulty of carrying out long-term nutrition experiments in free-living people-uncertainty is likely to persist indefinitely. By contrast, the controlled environment of the intensive care unit and relatively short trajectory of many critical illnesses make it feasible to use hard clinical outcome trials to determine protein requirements for critically ill patients in well-defined clinical situations...
April 2017: Nutrition in Clinical Practice
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