Application Of Nutritional Support Research Articles

Nutritional support in the perioperative period of treatment of cancer patients: Retrospective cohort study

Background. The most important component of multimodality treatment of cancer is nutritional support. The management of the correct full nutritional support in the perioperative period will help to maintain body weight and muscle function, to reduce the frequency of development of postoperative complication severity and to reduce hospital length of stay. To provide full nutritional support is necessary to cover all energy requirements in patients (30 kcal/kg body weight per day), protein requirements (1.5 g of protein/kg of body weight per day) and eicosapentaenoic acid requirements (2 g/day), applying clinical nutrition through the appropriate routes of administration (oral, enteral, parenteral or combined).
 Materials and methods. The trial studied the dynamics of the nutritional status of 400 oncological patients who underwent surgical treatment at the Hertsen Moscow Oncology Research Institute the branch of the National Medical Research Radiology Centre from 2019 to 2021. The patients were divided into 2 groups: the main (n=200) and the control (n=200). The patients of the main group received full nutritional support. The control group consisted of the patients, according to retrospective analysis of the patients, with the traditional approach to nutritional support. The study included patients with nutritional deficiency confirmed by clinical criteria, as well as patients with malignant neoplasms of the upper gastrointestinal tract the gastrointestinal tract (esophagus and stomach), colon and rectum, as well as head and neck.
 Results. The application of nutritional therapy in the perioperative period can improve the nutritional status of the patients with head and neck and upper gastrointestinal tract cancer (the statistically significant increase in body weight by 1 kgs and 0.5 kgs, respectively). In patients with colorectal cancer, body weight during the treatment was stable with the tendency to increase by 0.4 kg. Perioperative nutritional support for patients with head and neck and upper gastrointestinal tract cancer showed statistically significant increase of the level of both complete protein by 2.8 and 4.1 g/l, respectively, as well as serum albumin by 5.2 and 3.3 g/l, respectively. The absolute lymphocyte count increased at the trend level. No statistically significant difference was obtained during treatment in patients with colorectal cancer. Nutritional support in cancer patients during the surgical treatment allowed to reduce the total number of surgical complications by 36%, including the incidence of anastomotic failure by 3 times (p=0.014), infectious complications by 1.5 times (p=0.074), to reduce the duration of stay in the intensive care unit, as well as inpatient stay in hospital to 0.3 and 1.08 bed days, respectively (p0.05).
 Conclusion. The application of nutritional support can help to reach more favorable perioperative course in cancer patients and also can lead to a decrease in the number of complications and early rehabilitation for patients, and on the other hand, will help to reduce the duration of stay in the intensive care unit as well as inpatient stay in hospital, reducing the cost of treating patients.

Application of Nutritional Support in the Comprehensive Treatment of Gastric Cancer: A Case Report

Objective To relieve long-term malnutrition caused by a malignant tumor affecting the pylorus and to prolong the patient survival. Methods A patient presented with complete pyloric obstruction due to pyloric tumors, and achieved good therapeutic effects through nutritional support and effective chemotherapy. Results After about 40 days of treatment, all physiological indicators were improving. After chemotherapy, the pyloric tumor shrank and the complete obstruction was relieved. The patient was able to eat and drink normally. Conclusion Nutritional support, combined with chemotherapy, may effectively treat complete pyloric obstruction caused by advanced tumors.

Comparative Survey on Nutrition Risk and Nutrition Support Among Hospitalized General Surgery Patients Over a 7-Year Period.

BackgroundIn China, the trend of the prevalence of nutrition risk and malnutrition among the patients in hospitals has changed dramatically in the past few years. The aim of this study was to compare the prevalence of nutrition risk, undernutrition, and the application of nutrition support among hospitalized general surgery patients over a 7‐year period from 2010 to 2017.MethodsA total of 810 consecutive inpatients who met the inclusion criteria upon admission and provided informed consent were recruited from March to December 2017. Nutrition risk was screened using the Nutritional Risk Screening 2002 tool. All the data collected in 2017 were compared with the data collected in 2010.ResultsThe prevalence of undernutrition among the surgical patients in 2017 (12.8%) was lower than that in 2011 (15.5%) (P < .05), whereas the prevalence of nutrition risk in 2017 (42.6%) was higher than that in 2011 (30.4%) (P < .01). The application of nutrition support, including parenteral nutrition and enteral nutrition, among the patients in 2017 was higher than that in 2010 (P < .05). In 2017, 70.7% of the patients who were at nutrition risk received nutrition support, whereas only 48.9% of patients at nutrition risk did in 2010 (P < .05). Moreover, 26.9% of patients without nutrition risk received nutrition support in 2017 compared with 18.0% of patients in 2010.ConclusionsThe nutrition statuses among surgical inpatients changed from 2010 to 2017. The prevalence of undernutrition was reduced, whereas the prevalence of nutrition risk increased. The application of nutrition support increased significantly, whereas inappropriate application of nutrition support still existed in our hospital. More attention should be paid to the nutrition‐related issues of general surgery inpatients in the future.

Retrospective analysis of nutritional status of 68 patients with malignant tumors before primary radiotherapy

Objective To retrospectively analyze the nutritional status of patients with malignant tumors prior to the primary radiotherapy, aiming to to provide clinical evidence for the rational application of nutritional support during radiotherapy. Methods The nutritional status of 68 patients with malignant tumors admitted our department from August 2016 to May 2017 was investigated. All patients received primary radiotherapy. The Nutrition Risk Screening 2002 was utilized to assess the nutrition risk. The body mass index (BMI), hemoglobin, total protein, albumin, pre-albumin and C-reactive protein levels were detected and statistically analyzed. Results The incidence of nutritional risk of 68 patients with primary radiotherapy was 6%, and the incidence of malnutrition was 5.9%.All patients presenting with nutritional risk and malnutrition were diagnosed with head and neck and gynecological malignant tumors. Twenty-four patients had elevated levels of C-reactive protein, 16 had decreased levels of hemoglobin, 17 developed decreased levels of prealbumin, 1 had a decline in the level of albumin and 5 presented with a decrease in the levels of total protein. The nutritional status and clinical parameters were evaluated between patients who had/had not received chemotherapy before radiotherapy. The BMI, C-reactive protein, hemoglobin and prealbumin levels significantly differed between two groups (all P<0.01), whereas the remaining parameters did not significantly differ. The BMI, C-reactive protein, hemoglobin and prealbumin levels significantly differed between patients who had/had not underwent surgery prior to radiotherapy (all P<0.01). Conclusions Analysis of the nutritional status of patients receiving primary radiotherapy demonstrates that patients with head and neck, and gynecological malignant tumors are more likely to suffer from nutritional risk and malnutrition compared with those with other types of malignant tumors. Compared with patients who have not received chemotherapy/surgery before radiotherapy, those who have underwent chemotherapy/surgery have worse nutritional status. Besides, more significant changes are observed in the levels of C-reactive protein, hemoglobin and prealbumin than the levels of albumin and total protein. Key words: Nutrition status; Nutritional support; Neoplasms/radiotherapy

Role of nutrition support in the enhanced recovery after surgery for gastrointestinal surgery patients

Nutrition support therapy can improve the general condition of the patient and is one of the main factors to ensure the success of the operation. Enhanced recovery after surgery (ERAS) improves the recovery following gastrointestinal surgery by reducing postoperative stress response. The application of nutrition support in ERAS includes nutrition risk assessment before surgery and preoperative nutrition treatment for malnutrition. The time to fasting and clear liquid was shortened to 6 h and 2 h before anesthesia induction. Early postoperative recovery of oral feeding can improve the patient's clinical outcome. The application of ERAS enables the development and improvement of clinical nutrition concepts, and deepens the role of nutrition support therapy, which is conducive to the recovery of patients.

The application of nutrition support in conservative treatment of chylous ascites after abdominal surgery.

BackgroundChylous ascites is the pathologic leakage of triglycerides-rich lymphatic fluid into the peritoneal cavity. Chylous ascites is a rare complication in abdominal surgery. This study aimed to find a relatively better method for nutrition support in the treatment of chylous ascites after abdominal surgery.MethodsThis study was a retrospective study. This study retrospectively reviewed patients who underwent abdominal surgery and developed chylous ascites, from the year 2010 to 2014, at the West China Hospital of Sichuan University and the Affiliated Hospital of Zunyi Medical College. Fifty-eight patients who developed chylous ascites after abdominal surgery were included in the study. The clinical effect of somatostatin was evaluated. The differences in the curative efficacy among a daily diet, a low-fat diet supplemented with medium-chain triglyceride (MCT), and total parenteral nutrition (TPN) were also analyzed in this study.ResultsComplete clinical success was reached earlier in patients treated with somatostatin (P<0.001). The tube removal time, the time to resumption of an oral diet, and the length of hospital stay after chylous leakage were significantly different between patients treated with and without somatostatin. The curative efficacies of the enteral nutrition (EN) + MCT plan and the TPN plan were quite similar, with no significant difference, however, were significantly different from the MCT regime, which was the worst. However, using the EN + MCT plan was more cost-effective (P=0.038).ConclusionIn treating chylous ascites, EN + MCT instead of TPN was the best nutrition support. Moreover, somatostatin or its analog octreotide should be used immediately. The treatment with somatostatin in combination with EN + MCT is recommended in the conservative treatment of postoperative chylous ascites.

Current status of parenteral nutrition and enteral nutrition application: an assessment of nutritional prescriptions from 59 hospitals in the People's Republic of China.

PurposeThe aim of the study reported here was to assess the use of parenteral nutrition (PN) and enteral nutrition (EN), and the prevalence of PN and EN formulas, in the People’s Republic of China.MethodsFifty-nine hospitals in the People’s Republic of China participated in a nutrition survey. The resulting information on nutritional support was analyzed.ResultsWe received 379,584 nutritional-support prescriptions over 40 days in 2013. PN provided approximately 63.2% and EN provided approximately 36.8% of nitrogen intake. PN provided 63.5% and EN provided 36.5% of lipid intake. There were obvious differences in nitrogen and lipid intake between PN and EN in different regions, departments, and diseases. The percentage of nourishment provided by PN in different regions was highest in Chengdu, followed by the Beijing, Guangzhou, and Hangzhou areas. The percentage of nourishment provided by PN in different departments was highest in general surgery, followed by gastroenterology and the intensive care unit. The percentage of nourishment provided by PN in different diseases/conditions was highest in acute pancreatitis, followed by cancer, and burns. The main source of nitrogen in PN was balanced amino-acid preparations, and in EN, it was protein. The main source of lipids in PN was long- and medium-chain triglyceride lipid emulsion injection.ConclusionDespite recent improvements in the application of nutritional support in the People’s Republic of China, a much higher percentage of nitrogen and lipids is delivered through PN than through EN. Furthermore, there are marked regional, departmental, and disease-based differences in the selection of PN versus EN. The rationale for use of nutritional support needs to be improved.

Application of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients

To investigate the guidance role of preoperative nutritional risk screening in perioperative nutrition support for colorectal cancer patients in order to provide evidence for the rational clinical application of nutrition support. Nutritional risk screening was carried out in 290 hospitalized colorectal cancer patients from The Fourth People's Hospital of Wuxi City, Tongji Hospital of Tongji University and The Second Hospital of Soochow University with the nutritional risk screening(NSR) 2002 score summary table. Postoperative bowel function recovery and associated nutritional indices were compared between patients who received preoperative nutrition support according to the risk screening results and those who did not. Among 110 patients at nutritional risk, 65 received perioperative nutrition support and had faster recovery of intestinal function [time to first flatus (2.3±0.5) d vs. (3.3±0.5) d, time to first defecation (3.5±0.5) d vs. (4.6±0.6) d, semi-fluid intake (10.1±1.2) d vs. (12.4±2.2) d], shorter postoperative stay [(15.7±1.1) d vs. (18.8±1.4) d], and higher albumin, prealbumin and transferrin [(33.2±4.5) g/L vs. (26.0±4.0) g/L, (0.28±0.05) g/L vs. (0.16±0.04) g/L, (1.92±0.33) g/L vs. (1.75±0.45) g/L] at 7-day postoperatively (all P<0.05) as compared to those without perioperative nutrition support(n=45). While among 180 cases without nutritional risk, there were no significant differences in the above indices between patients who received preoperative nutrition support and those who did not (all P>0.05). It is important to evaluate the nutritional risk in hospitalized patients with colorectal cancer, and to carry out nutrition support actively for those at nutritional risk.

A multicentre study to implement nutritional risk screening and evaluate clinical outcome and quality of life in patients with cancer

To implement nutritional risk screening and evaluate the relationship of nutritional risk to complication rate and quality of life in patients with cancer. A total of 687 patients with cancer from two teaching hospitals in China were consecutively enrolled. Data were collected on the nutritional risk screening, application of nutritional support, complication and quality of life. The prevalence of nutritional risk at admission among the total, younger and elderly patients was 45.6%, 38.7% and 58.0%, respectively. There was a significant increase in the prevalence from admission to 2 weeks after admission in all patients (P=0.011). The prevalence in those patients ≥70 years was significantly higher than that in the younger ones (P<0.001). The highest prevalence of nutritional risk was in pancreas cancer (81.8%). Only 46.7% of at-risk patients received nutritional support and the average PN:EN ratio was 7.0:1. Complications were noted in 29.0% of all patients and were significantly more frequent in 'at-risk' patients (P<0.001). Among the scales of quality of life (SF-36), the scores of physical functioning (P<0.001), role-physical (P<0.001), bodily pain (P=0.012), energy/fatigue (P<0.001) and general health (P<0.001) were significant lower in the patients at risk. A large proportion of cancer inpatients were at nutritional risk and tended to worsen during the course of admission, which has been associated with increased complication rate and lower scores of quality of life. The application of PN and EN was inappropriate in patients with cancer in China.

A multicentre assessment of malnutrition, nutritional risk, and application of nutritional support among hospitalized patients in Guangzhou hospitals.

To assess nutritional status, the prevalence of nutritional risk, and nutritional support in hospitalized patients in Guangzhou, to determine gender or age associated differences in the prevalence of nutritional risk. A total of 2550 patients admitted during April to December 2008 from six departments (Gastroenterology, Pulmonology, Neurology, Nephrology, General Surgery and Thoracic Surgery) of four teaching hospitals were screened using the Nutritional Risk Screening 2002 tool. Overall prevalence of undernutrition and nutritional risk was 17.8% and 41.5%, respectively. The department of Pulmonology had the highest prevalence of undernutrition (28.2%) and nutritional risk (55.9%). The prevalence of nutritional risk was significantly higher in patients >=70 years of age than patients <70 years (64.2% vs 32.6%, p<0.001). No gender difference in the prevalence of nutritional risk was observed in general. In total, 47.6% of "at risk" and 19.4% of "not at risk" patients received nutritional support. Parenteral nutrition accounted for 88.8% of the nutritional support. The present study documented the prevalence of nutritional risk defined by NRS2002 and inappropriate assignment of nutritional interventions in Guangzhou hospitals.

Prevalence of nutritional risks, malnutrition and application of nutritional support rates at one Chongqing teaching hospital

To prospectively explore the prevalence of nutritional risks and undernutrition, obesity and the application of nutritional support in First Affiliated Hospital of Chongqing Medical University and compare the data with those of big hospitals in Beijing. A total of 2255 inpatients from the department of gastroenterology, gastrointestinal surgery, neurology and respiratory medicine at our hospital were consecutively recruited from June to October 2011. Nutritional Risk Screening 2002 (NRS2002) was performed at 24 h post-admission. And nutritional support was examined during the period of hospitalization. Among them, 2166 patients (96.1%) received NRS2002. The overall prevalence of nutritional risk was 29.5% (638/2166), undernutrition 12.2% (265/2166) and the incidence of obesity 2.4% (52/2166). For the patients at nutritional risks, only 9.2% (59/638) of them received nutrition support. The nutrition support of gastrointestinal surgery department was higher than Beijing, and that of neurology department was lower than Beijing. For those not at nutritional risks, 1.0% (16/1528) received nutritional support. And that of 4 department were all lower than Beijing (all P < 0.01). The nutritional risk patients on nutritional support rates is lower at First Affiliated Hospital of Chongqing Medical University and excessive use of parenteral nutrition support seems routine. The Chinese Society for Parenteral and Enteral Nutrition (CSPEN) guidelines of rational nutrition support should be vigorously promoted.

Application of nutrition support in patients with severe craniocerebral injury

Objective To discuss the rational application and clinical significance of nutrition support in patients with severe craniocerebral injury.Methods 402 cases of severe craniocerebral traumawere randomly divided into control group and experimental group.The experimental group was supported with nutrison fibre(208 cases)and the control group with ordinary nutrients homogenate products(194 cases).The seralbumin,TSF,AMC and body weight were detected.The degree of consciousness recovery was investigated.The incidence rate of complication was observed.Results The nutritional indications (e.g.seralbumin,TSF,AMC and body weight,etc) of the experimental group were better than those of the control group and the GCS score was significantly improved in the experimental group,while the incidence rate of complication was markedly decreased in the experimental group (P ＜ 0.05).Conclusions Early enteral nutrition support could improve metabolic status,reduce the incidence rate of complication and improve the GCS score as a whole for severe craniocercbral injury patient. Key words: Craniocerebral injury; Enteral nutrition; Early stage

Application of nutrition support using half solid diet in the oldest patients with tube feeding

Application of nutrition support using half solid diet in the oldest patients with tube feeding