Caloric Requirements Research Articles

Conceptos actuales sobre el soporte nutricional preoperatorio: ¿cómo, cuándo y por qué?

Malnutrition is associated with several complications during hospital stay, including patients who will undergo major surgery. Therefore, it is important to optimize nutritional status in the preoperative period being the main objective restoring metabolic and immunological abnormalities. Preoperative fasting is a common practice in clinical settings, although it has been shown to induce insulin resistance. One intervention to avoid this practice is the implementation of the ERAS (Enhanced Recovery After Surgery) protocol. Proper nutritional assessment in hospitalized patients is the cornerstone to identify patients at nutritional risk, or those in malnutrition who may benefit from early nutritional interventions. The feeding route should be chosen according to the patient's condition, either orally with the use of nutritional supplements and in those where calorie requirements cannot be achieved by oral, enteral nutrition is the next logical step, reserving parenteral nutritional support in patients with non-functional gastrointestinal tracts in order to improve postoperative morbidity and mortality.

Evaluation of a pet-separating automatic feeder and high-frequency meal feeding for weight loss in multi-cat households.

The objectives of this study were two-fold: (1) to determine if a feeder system providing individualized food access and automatic dispensing of meals makes weight-loss programs in multi-cat homes easier for cat owners; and (2) to assess if feeding six meals daily reduces food-seeking behavior and increases calorie requirements vs two meals per day. Adult cats with body condition scores (BCSs) of 7/9 or greater underwent a weight-loss plan for up to 6 months using a traditional feeding bowl with two meals per day (B2) or an automatic feeder with two meals (A2) or six meals (A6) per day. Cats were weighed at weeks 0, 2, 4, 6, 10, 14, 18, 22 and 26 and food intake was adjusted to maintain weight-loss rates between 0.5% and 1.5% body weight per week. Owner questionnaires were completed at each study visit. Twenty-three cats were included in the study. Cats fed from the automatic feeders were more likely to reach ideal body condition (P = 0.006), with 83.2% of cats in A6, 40% of cats in A2 and no cats in B2 achieving a BCS of ⩽6/9. Owners of cats fed from automatic feeders reported the weight-loss plan was easier vs owners of cats fed from bowls (P = 0.01). Owners using the automatic feeders also reported fewer incidences of certain food-seeking behaviors. Neither percent body weight lost per week nor calorie intake per kg differed between groups. Feeding six instead of two meals daily did not result in faster rates of weight loss or the need to increase calorie intake to maintain appropriate rates of weight loss. However, use of an automatic feeder that provided separated, portioned meal feeding made the weight-loss program easier, reduced food-seeking behaviors and improved the overall success of the weight-loss plan.

The role of food and land use systems in achieving India’s sustainability targets

The food and land use sector is a major contributor to India’s total greenhouse gas (GHG) emissions. On one hand, India is committed to sustainability targets in the Agriculture, Forestry and Other Land Use (AFOLU) sectors, on the other, there is little clarity whether these objectives can align with national developmental priorities of food security and environmental protection. This study fills the gap by reviewing multiple corridors to sustain the AFOLU systems through an integrated assessment framework using partial equilibrium modeling. We create three pathways that combine the shared socio-economic pathways with alternative assumptions on diets and mitigation strategies. We analyze our results of the pathways on key indicators of land-use change, GHG emissions, food security, water withdrawals in agriculture, agricultural trade and production diversity. Our findings indicate that dietary shift, improved efficiency in livestock production systems, lower fertilizer use, and higher yield through sustainable intensification can reduce GHG emissions from the AFOLU sectors up to 80% by 2050. Dietary shifts could help meet EAT-Lancet recommended minimum calorie requirements alongside meeting mitigation ambitions. Further, water withdrawals in agriculture would reduce by half by 2050 in the presence of environmental flow protection and mitigation strategies. We conclude by pointing towards specific strategic policy design changes that would be essential to embark on such a sustainable pathway.

Fuzzy Utility Matrix-Based Intelligent Decision-Making Model and Its Application to Diet Recommendation System for Metabolic Disorder Patients

In the present article an effort has been made to design and develop a diet recommendation system for Metabolic Disorders patients. The key feature of this system is to recommend a menu for dinner to maintain nutritional micros as per daily requirements.The proposed intelligent decision-making system is designed as per the following phases:Under the 1st Phase, we compute the requirement of calories as per the Patient's personal information (like sex, age, height, weight), physical activity, environmental situations, and food habits on a daily basis. Under the 2nd Phase, development of knowledge base as per Patient's foods habits information. 3rd Phase is based on designing the recommendation system for a dinner menu to maintain nutritional micros as per daily requirements. The results of the system have been validated by using the Degree of match algorithm and comments of Nutritional experts. This intelligent decision making system will help the ordinary people living in urban and rural areas, especially those not aware of the nutritional value concerned with their daily food items.

Diet Related Taboos During Pregnancy – A Narrative Review

Maternal nutrition has a huge impact on the health of the mother and the fetus. Pregnancy imposes the need for considerable extra calorie and nutrient requirements. A food taboo is a prohibition against consuming certain foods are embedded into the cultural and religious threads. The restrictions imposed on people forces them to abstain from certain food and drinking items as these things. Food taboos in this community are deep rooted. Avoidance of nutritive food was common in both the religion. Many misconceptions are prevalent which do not have scientific basis. Maternal nutrition needs to be prioritized at community level among family members and front line workers. Anganwadi workers need to be sensitized regarding different beliefs about food consumption during pregnancy and lactation.
 Keywords: Pregnancy, dietary deficiency

Calorie estimation model for Indian elderly persons using image processing and convnets techniques

Nutrition is a basic human necessity as well as a requirement for a healthy lifestyle. Especially in elderly people, nutrition is an essential modulator of health and well-being. Nutritional intake in older people is sometimes hampered by a variety of circumstances like isolation depression, weak muscles etc. which increases the risk of various diseases. An effective Food Assessment system that classifies and estimates calorie requirements from a cooked food image is highly recommended, allowing a person to discover what foods contain and how healthy it can be. In this paper a dietary assessment system is developed which classifies the given Indian cooked food image and further estimates its Calories and nutrients by obtaining food region. The proposed method was tested on certain fruits and cooked foods, yielding an average error rate of 8.31, which is highly acceptable.

Effectiveness and tolerability of standardized milk based, standardized non-milk based and hospital-based formulations in the management of moderate acute malnutrition in under-five children: A randomized clinical trial

Introduction : Moderate acute malnutrition (MAM) is a leading cause of under-five morbidity and mortality globally. Supplementary feeding is a strategy recommended by WHO for managing the condition.Objective: To evaluate the effectiveness and tolerability of standardized milk-based formulation (SMBF), standardized non-milk based formulation (SNMBF) and hospital-based formulation (HBF) in under-fives with MAM.Method: This was an open label randomized clinical trial in which eligible children aged 6 – 59 months with MAM were assigned to receive the SMBF, SNMBF or HBF at 50% of their daily caloric requirement with their regular family diet for four months. Their baseline characteristics and anthropometric indices were noted. They were followed up on two weekly basis during which further assessments were performed. The analysis for effectiveness and tolerability of the formulations were based on “per protocol”.Results: A total of 687 children were screened and 188 enrolled. Seventy children received SMBF, 63 received SNMBF while 55 received HBF. There were 54/70 (77.1%), 57/64 (89.1%) and 46/55 (83.6%) evaluable participants in the SMBF, SNMBF and HBF group respectively. Recovery from MAM was 43/54 (79.6%), 40/57 (70.2%) and 32/46 (69.6%) in the SMBF, SNMBF and HBF group respectively. Normal nutritional status was attained by 13 (24.0%), 10 (17.6%) and 5 (10.9%) children in the SMBF, SNMBF and HBF group respectively. Diarrhea and skin rashes were the main features of poor tolerability.Conclusions: The formulations were effective in managing MAM in childhood but the SMBF was the most effective. Diarrhea and skin rashes were the main features of poor tolerability.

Oral Nutritional Supplements – Nutritionally Replete or Incomplete?

This is a case study of severe hypokalemia in a 59-year-old lady who was reliant on a fruit based nutritional supplement to meet the majority of her caloric and protein requirements. Through this case study, we aim to highlight the importance of identifying red flags for patients at risk of dietary complications, understanding the contents of oral nutritional supplements, and working closely with dietitians in a multidisciplinary team to provide holistic patient care.

Clinical Nutrition for the Medical Patient: From Screening to Diagnosis and Start of Nutritional Therapy

Clinical Nutrition for the Medical Patient: From Screening to Diagnosis and Start of Nutritional Therapy Abstract. With the demographic increase of elderly, multimorbid patients, the number of those with disease-related malnutrition is also steadily increasing. We now know that malnutrition is a strong and independent risk factor for morbidity, mortality, and poor quality of life. Fortunately, however, several studies have shown that malnutrition screening followed by physiological nutritional therapy to meet individual nutritional goals has a positive impact on the clinical course of medical patients. In this context, Nutritional Risk Screening is suitable as a tool for assessing nutritive risk in hospitalized and ambulatory patients in family practice. Patients at risk for malnutrition should undergo an in-depth clinical assessment in an interdisciplinary team of nutritionists, nurses, and physicians to clarify the etiology of malnutrition and risk factors, and to examine the indication for nutritional therapy. Such nutrition therapy should be individually tailored to the patient's nutritional needs (calorie, protein, and micronutrient requirements), the underlying disease and the patient's preferences. Patients should be closely monitored, and the therapy should be adapted during the disease.

Feeding Coconut Oil Reduces Fatty Acid Oxidation and Exacerbates Steatosis in the Liver of Neonatal Pigs

Coconut oil is commonly used to enhance the energy content of infant formulas due to its high medium‐chain fatty acid (MCFA) content. Using neonatal pigs as model for the human infant, we previously reported that feeding a formula rich in MCFA led to hepatic fat accumulation compared to an isocaloric long‐chain fatty acid formula (LCFA). In addition, isolated hepatocytes from MCFA fed pigs oxidized more glutamate than LCFA fed pigs, suggesting a shift in liver metabolism. Thus, the objectives of this study were to investigate whether MCFA and LCFA feeding affect hepatic laurate (C12:0), and palmitate (C16:0) oxidation, and determine whether fat type influences the expression of genes related to fatty acid metabolism in the liver. Twenty‐six, 3‐day‐old pigs were allotted one of three sow milk replacer formulas: a control (CONT) formula that provided 80% of caloric requirements, and two isocaloric formulas that provided 120% of caloric requirements with fat either as LCFA or MCFA. Pigs were fed 250 ml∙kg‐1∙day‐1 for 22 days, weights were determined every other day, and formula allowance adjusted accordingly. Body composition was determined using DXA at day ‐1 and 21. On day 22, pigs were euthanized. Muscle and organs were excised, weighed, and sampled. Liver samples were homogenized and incubated with [2‐C14]palmitate or [2‐C14]laurate. Following a 60 min incubation, radio‐labelled enrichment of CO2 and acid‐soluble metabolites were determined. Fat was extracted from liver samples using a modified Bligh and Dyer method, fatty acids were methylated to fatty acid methyl esters, and their concentrations determined by gas chromatography/mass spectrometry. Expression of genes related to fatty acid metabolism was determined using Real‐Time PCR. In addition, citrate synthase (CS) activity was measured in liver homogenates using spectrophotometry. Body weight of pigs fed the LCFA formula was greater (8.3%) than those fed the MCFA and CONT formulas (P< 0.05). In addition, LCFA lean tissue mass was greater (29%) when compared with CONT while MCFA was intermediate (P< 0.05). Liver weight of MCFA pigs was 25 and 77% greater than LCFA and CONT groups (P< 0.05). Liver fat was greater (142%) for MCFA pigs compared with LCFA and CONT counterparts (P< 0.05). Palmitate and laurate oxidation to CO2 was greater (49%) for pigs fed the LCFA and CONT formulas compared with those fed MCFA (P< 0.05). In addition, complete oxidation of palmitate and laurate was greater (112%) for LCFA and CONT pigs (P< 0.05). MCFA fed pigs had greater proportions of laurate, myristate and palmitate in their livers compared with LCFA and CONT groups (P< 0.05). Expression of fatty acid synthase 3 (FASN‐3), fatty acid binding protein 1(FABP‐1), and acetyl CoA carboxylase 1 (ACACA‐1) were 8, 6, and 2‐fold greater for the MCFA pigs than LCFA and CONT pigs (P< 0.05). However, apolipoprotein‐B (APO‐B) expression was not affected by treatment. These data suggest that feeding a formula rich in MCFA led to hepatic steatosis, and that fatty acid composition in liver did not reflect that of fed formulas. In addition, liver steatosis in pigs fed the MCFA rich formula is correlated with a reduction in the liver’s ability to oxidize fatty acids when compared with pigs fed an isocaloric LCFA based formula.

Crop harvests for direct food use insufficient to meet the UN’s food security goal

Rising competition for crop usage presents policy challenges exacerbated by poor understanding of where crops are harvested for various uses. Here we create high-resolution global maps showing where crops are harvested for seven broad use categories—food, feed, processing, export, industrial, seed and losses. Yields for food crops are low relative to other crop-use categories. It is unlikely, given current trends, that the minimum calorie requirement to eliminate projected food undernourishment by 2030 will be met through crops harvested for direct food consumption, although enough calories will be harvested across all usages. Sub-Saharan African nations will probably fall short of feeding their increased population and eliminating undernourishment in 2030, even if all harvested calories are used directly as food.

Relationships between livestock grazing intensity and mammal predator-prey: A study case in Copo National Park in the dry Chaco forests

Extensive livestock ranching is one of the main drivers of habitat degradation in terrestrial communities in the dry Chaco forest (Argentina). Grazing intensity could differentially affect native mammals and their interactions, which could impact both, native mammal communities and livestock production systems. Here, we determined how the activity index of grey foxes Lycalopex gymnocercus and capture abundance and richness of small mammals vary along a grazing intensity gradient in a particular region of the dry Chaco forest (Copo National Park, Argentina). Track plots were used to estimate the activity index of foxes and cattle, and Sherman traps for small mammals. Fresh scats were collected to analyse the diet of foxes and to assess possible changes in predator-prey dynamics. Fruit availability and shrub density were measured in 6 plots of 2 m × 50 m. We used generalized linear mixed models, Spearman’s nonparametric rank correlation, Chi-squared test, and Spearman’s partial correlation coefficient to analyse the potential effects of grazing intensity. We found that the activity index of foxes increased (0.06 ± 0.018) while small mammal abundance (-0.08 ± 0.024) and species richness decreased (rs = -0.94) with increasing grazing intensity. However, the proportion of scats with mammalian remains decreased with increasing grazing intensity. Also, we did not find a strong partial correlation between foxes and small mammals when we controlled for grazing intensity. This suggests that the abundance and diversity of small mammals in the study area are determined more by grazing intensity than by predator-prey interactions. Grazing intensity could negatively affect small mammals, but not through changes in fruit availability or shrub density, but possibly by affecting grass cover. Consequently, foxes’ activity could increase to meet caloric intake requirements. Our results suggest that specific cattle management recommendations depend on the wildlife species that serves as a conservation target. We recommend testing whether reducing cattle load can make this productive activity compatible with wildlife conservation in dry Chaco forests.

The Formation of the Criteria, Rules and Regulations of the Sufficient and High-Quality Food According to the European Standards

Abstract. Introduction. Modern food systems face the challenge of supporting food choices that are consistent with a healthy and adequate diet. The vast majority of consumers of food products do not choose the principle of quality � the choice is made in favor of lower cost (low nutrient content), readiness of the product for consumption (high processing and trans fat content) or taste (high sugar, salt, etc.). At the same time, poor nutrition around the world is the number one risk factor for death and disability. Purpose. To study the criteria of the sufficient and high-quality food based on the norms and standards according to the European standards at different levels. Results. The article examines the indicators of calorie consumption per capita, daily calorie reserve per person, the minimum daily calorie requirement, inequality in calorie consumption per capita in the world. The key drivers of the impact of the level of nutrition on the quality of life have been identified: a healthy diet; unhealthy diet and lack of physical activity are the main global health risks, especially obesity; breastfeeding; balanced energy consumption; restriction of sugar consumption (up to 10%) and salt (up to 5 g per day). The WHO data and recommendations on ensuring a healthy diet for adults and children are summarized. The effective actions of politicians to create a healthy food environment have been identified, which should include three interrelated areas: building coherence in national policies and investment plans, including trade, food and agricultural policies; encouraging consumer demand for healthy food; promoting appropriate feeding practices for infants and young children; and tools for their implementation at the national level were systematized. WHO�s healthy eating policies and programs for national governments and related healthy eating policies and programs in Ukraine were described. Conclusions. A healthy diet from birth and throughout life prevents malnutrition in all its forms, as well as a number of non-communicable diseases. However, increased production and consumption of processed foods, rapid urbanization and lifestyle changes have led to changes in diets. People now consume significantly more foods high in energy, fat, sugar and salt / sodium. At the same time many people do not consume enough fruits, vegetables and whole grains, which contain the necessary fiber, vitamins and minerals for the human body. The required content of a varied, balanced and healthy diet varies depending on individual characteristics (age, gender, lifestyle and level of physical activity), cultural context, local products and eating habits. Along with this the basic principles of healthy nutrition remain unchanged.

Mediterranean Dietary Treatment in Hyperlipidemic Children: Should It Be an Option?

Background: Diet is considered the cornerstone of lipid management in hyperlipidemic children but evidence to demonstrate the effects of nutrient benefits on the lipid profile is limited. Aim: The aim of this study is to evaluate the impact of the Mediterranean diet on low-density lipoprotein (LDL-C) and non-high density lipoprotein (HDL-C) decrease in primary hyperlipidemia affected children and in the achievement of therapeutical target levels. Methods: A retrospective cohort study was used, recruiting n = 223 children (10.05 ± 3.26 mean age years) with familial hypercholesterolemia (FH) (n = 61, 27%) and polygenic hypercholesterolemia (PH) (n =162, 73%). Secondary hyperlipidemias were excluded. Based on LDL-C and non-HDL-C decrease, participants were divided into two groups, named the Responder Group and Non-Responder Group. Participants and their families underwent dietary education by an expert nutritionist and were asked to fill in a weekly diary to be delivered at visits. Dietary indications were in line with daily caloric requirement, daily food quality and quantity intakes typical of the Mediterranean diet. These include carbohydrates, extra virgin olive oil, yoghurt and milk derivatives, fish and vegetable proteins, fresh seasonal vegetables and fresh fruits. Nuts or almonds were also recommended. The advice to limit intakes of meat, in particular red meat, and caution against junk food and sugar added food and beverages was provided. At medical visits, carried out at baseline (T0) and 6 months later (T1), children underwent anthropometric measurements and blood collection. Standard kits and methods were applied for lipid analysis. Statistical methods were performed by SAS version 9.4 (SAS Institute, Cary, NC, USA). Signed informed consent was given by parents according to the Declaration of Helsinki and the study was approved by the Local Committee. Results: The Responder Group (n = 156/223, 70%) included 45 FH and 111 PH children, while the Non-Responder Group (n = 67/223, 30%) included 16 FH and 51 PH children. The Responder Group showed total cholesterol (TC), LDL-C and non-HDL-C median percentage decreases of 9.45, 13.51 and 10.90, respectively. These statistically significant changes (p ≤ 0.0001) were similar in the FH and PH subgroups but just PH subjects reached the LDL-C and non-HDL-C target, which fell below 130 mg/dL and 145 mg/dL, respectively. Saturated fatty acids (SFAs) were the main dietary parameter that distinguished between the Responder Group and the Non-Responder Group (p = 0.014). Positive correlations were found at T1 between dietary total lipids, SFAs and cholesterol with serum LDL-C, non-HDL-C and TC variations. These latter serum parameters had an inverse correlation with dietary carbohydrate at T1. Among macronutrients, SFAs were finally demonstrated to be the predictor of serum lipids variation at T1. Conclusions: The dietary intervention with a Mediterranean diet in children with primary hyperlipidemia significantly improves the lipid profile both in FH and PH subgroups and allows target levels of LDL-C and non-HDL-C in PH subjects to be reached. Responsiveness benefits should be primarily attributed to the reduction in SFAs, but changes in dietary lipids, cholesterol and carbohydrate intake may also play a role. In contrast, the Non-Responder Group showed a worsening of lipid profile regarding the unchanged diet.

Spatio-Temporal Patterns of the Land Carrying Capacity of Tibet Based on Grain Demand and Calorie Requirement

Tibet constitutes a major part of the Qinghai–Tibet Plateau (QTP) and is a typical ethnic minority (e.g., Tibetan) and ecologically fragile area in the world. Land resources are one of the most important foundations of food production, and Tibet’s increasingly multi-type food demands are putting new pressure on land resources. However, there is still debate on how many people can be supported with the food production in Tibet. Investigating the land carrying capacity (LCC) in Tibet is very important for maintaining food security and formulating sustainable land management and utilization. Based on an analysis of the unique characteristics of the local farming, pastoral production, and dietary consumption, the spatio-temporal patterns of theLCC in Tibet in 2000–2019 were quantitatively assessed against the grain demands and calorie requirements at three different standards of living (i.e., basic prosperity, comprehensive moderate prosperity, and affluence). The dietary consumption was characterized by the high consumption of grains and meat products, and the low consumption of fruits and vegetables. The LCC in Tibet has continued to increase. The LCC in approximately 60% of the counties increased, with the high-LCC counties concentrated mainly in the Yarlung Zangbo River—Nyangqu River—Lhasa River area, and municipal districts and pastoral counties generally experiencing a low LCC. The load on land resources (LoL) in Tibet exhibited the characteristic of overall balance with local overloads and increasing tensions. More than 50% of the counties experienced population overload, mainly in municipal districts and pastoral counties. Food surplus was mainly found in farming counties, while the food production in pastoral counties was generally unable to meet the calorie demand. Considering the important role of land use in maintaining regional food security and ecological security, the conversion of grassland to cultivated land, the occupation of cultivated land, and the phenomenon of cultivated land was used to non grain should be avoided. Trans-regional transport of food should be strengthened to meet the calorie needs in population overload areas in the future. Our study provides a perspective for evaluating the pressure of land resources. The result can provide a reference for realizing the balance of grain and calorie supply–demand and lay a foundation for formulating sustainable land use policies in the QPT.

Safety and efficacy of three enteral feeding strategies in patients with severe stroke in China (OPENS): a multicentre, prospective, randomised, open-label, blinded-endpoint trial

Early enteral nutrition is crucial for preventing malnutrition and improving outcomes in patients with severe stroke, but previous trials have provided conflicting results regarding the optimal nutritional strategy. We aimed to compare the efficacy and safety of three enteral feeding strategies in patients with severe stroke. The Optimizing Early Enteral Nutrition in Severe Stroke (OPENS) study was a multicentre, investigator-initiated, prospective, open-label, randomised controlled trial, with blinded outcome assessment, in 16 tertiary and district general hospitals in the west of China. Adult patients with acute severe ischaemic or haemorrhagic stroke (Glasgow Coma Scale score ≤12 or National Institutes of Health Stroke Scale score ≥11 on admission) who were expected to receive enteral nutrition for more than 7 days were randomly assigned (1:1:1) to full enteral nutrition (70-100% of estimated caloric requirements), modified full enteral nutrition (full enteral nutrition plus prokinetic agents), or hypocaloric enteral nutrition (40-60% of estimated caloric requirements) via a centralised web-based randomisation system. The assigned nutrition was initiated within 24 h after enrolment and continued for 7 days. The computer-generated randomisation sequence was prepared by a statistician not involved with the rest of the study. Randomisation was done with an automated permuted block size of six. The allocation was unblinded to participants and investigators. The primary efficacy outcome was the proportion of participants with poor outcome (modified Rankin Scale score ≥3) at day 90 and the prespecified primary safety outcome was mortality at day 90, assessed in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, NCT02982668. Between Jan 15, 2017, and Sept 23, 2020, 321 patients were randomly assigned (107 in each group) and 315 patients (175 [56%] men, median age 71 years, IQR 60-78) were included in the final analysis. The study was terminated ahead of schedule on Sept 23, 2020, because a significant difference between groups was detected in mortality. The proportion of participants with poor outcomes at 90 days did not differ (modified full enteral nutrition 86 [82%] of 105 patients vs full enteral nutrition 85 [80%] of 106 patients, adjusted odds ratio [OR] 0·87, 95% CI 0·41-1·86, p=0·721; hypocaloric enteral nutrition 76 [73%] of 104 patients vs full enteral nutrition 0·61, 0·30-1·27, p=0·186; hypocaloric enteral nutrition vs modified full enteral nutrition 0·70, 0·34-1·46, p=0·340). Hypocaloric enteral nutrition showed significantly higher 90-day mortality than did modified full enteral nutrition (35 [34%] of 104 patients vs 18 [17%] of 105 patients, adjusted OR 2·89, 95% CI 1·46-5·72; p=0·0023), whereas the difference was not significant between hypocaloric enteral nutrition and full enteral nutrition (24 [23%] of 106 patients; adjusted OR 1·92, 95% CI 1·00-3·69; p=0·049), and between modified full enteral nutrition and full enteral nutrition (adjusted OR 0·61, 0·29-1·28; p=0·187). The most common adverse event was pneumonia, the incidence of which showed no significant difference among groups (full enteral nutrition 82 [78%] of 105 patients, modified full enteral nutrition 83 [81%] of 103 patients, hypocaloric enteral nutrition 78 [75%] of 104 patients; p=0·625). In the early phase of severe stroke, modified full enteral nutrition or hypocaloric enteral nutrition did not significantly reduce the risk of a poor outcomes compared with full enteral nutrition over a 90-day period. Hypocaloric enteral nutrition might be associated with increased mortality compared with modified full enteral nutrition. Further studies are needed to investigate whether modified full enteral nutrition might be the optimal strategy. Shaanxi province Key Research and Development Project.

Sustainable Diets as Tools to Harmonize the Health of Individuals, Communities and the Planet: A Systematic Review.

Background. Climate change and global health are inextricably linked. Thus, health systems and their professionals must adapt and evolve without losing quality of care. Aim(s). To identify health and environmental co-benefits derived from a sustainable diet and promotion strategies that favor its implementation. Methods. A systematic search for articles published on sustainable diets and human/planetary health published between 2013 and 2020 was conducted on the databases PubMed, Cinahl, Scopus and Trip from 4 to 7 May 2020 in accordance with the PRISMA guideline. Results. A total of 201 articles was retrieved, but only 21 were included. A calorie-balanced diet mainly based on food of plant origin that would allow the attainment of 60% of daily caloric requirements and a low protein intake from animal foods (focusing in fish and poultry) could significantly reduce global morbi-mortality and the dietary environmental impact maintaining a framework of sustainability conditioned by the consumption of fresh, seasonal, locally produced and minimally packaged products. Discussion. The implementation of sustainable diets requires working on the triangulation of concepts of food–health–environment from schools and that is permanently reinforced during all stages of the life by healthcare workers, who should establish the appropriate modifications according to the age, gender and health situation.

Homemade blenderized Ryles tube formula is equally efficient as commercial formula in terms of anthropometric and biochemical measurements in tertiary care neurologic intensive care unit: A single center study

Objectives: In Indian intensive care units (ICUs), malnutrition is a leading cause of death and morbidity. There is a scarcity of information on the state of malnutrition in India and the efficacy of homemade Ryle’s tube formula in neurologic cases as compared to commercial formula feed. The goals of the present study were to evaluate the nutritional status of neurological disorder patients, to prepare a home-based feed using locally available cereal and pulse combinations, and to investigate the impact of two different Ryes tube formulas on nutritional status. Material and Methods: A prospective, randomized comparative study was conducted in the neurological ICU of a tertiary care medical college hospital located in rural Telangana. Group A was given commercial formula, while Group B was given homemade Ryle’s tube formula, which was calorically equivalent to commercial formula. The Harris-Benedict equation was used to determine the patients’ caloric requirements. During hospital stay, both groups received a comparable amount of Ryle’s tube feeding. The impact of two different formulations was evaluated using quantitative indices including weight, body mass index, triceps skinfold thickness, and serum albumin over a period of 2 weeks. The standard deviation and mean were determined. The researchers used a paired t-test with a two-tailed distribution. If the P < 0.05, it was considered significant. For data processing, open-source software open Epi 2007 was used. Results: In both classes, thirty patients were enrolled. On admission, the demographic profiles of both groups were identical, as evidenced by non-significant P-values. According to the sample parameters, there was no substantial difference between the two formulas at the end of the study period. Both formulas were equally efficacious for the nutritional assessment parameters during the study period. Conclusion: On initial admission, malnutrition was uncommon in the neurologic ICU. In terms of study parameters, both formulas were equally efficient. The homemade blenderized formula was 50% less expensive than commercial formula, making it an important nutritional supplementation option for the deprived strata of the population.

Homemade blenderized Ryles tube formula is equally efficient as commercial formula in terms of anthropometric and biochemical measurements in tertiary care neurologic intensive care unit: A single center study

OBJECTIVES:In Indian intensive care units (ICUs), malnutrition is a leading cause of death and morbidity. There is a scarcity of information on the state of malnutrition in India and the efficacy of homemade Ryle’s tube formula in neurologic cases as compared to commercial formula feed. The goals of the present study were to evaluate the nutritional status of neurological disorder patients, to prepare a home-based feed using locally available cereal and pulse combinations, and to investigate the impact of two different Ryes tube formulas on nutritional status.MATERIAL AND METHODS:A prospective, randomized comparative study was conducted in the neurological ICU of a tertiary care medical college hospital located in rural Telangana. Group A was given commercial formula, while Group B was given homemade Ryle’s tube formula, which was calorically equivalent to commercial formula. The Harris-Benedict equation was used to determine the patients’ caloric requirements. During hospital stay, both groups received a comparable amount of Ryle’s tube feeding. The impact of two different formulations was evaluated using quantitative indices including weight, body mass index, triceps skinfold thickness, and serum albumin over a period of 2 weeks. The standard deviation and mean were determined. The researchers used a paired t-test with a two-tailed distribution. If the P < 0.05, it was considered significant. For data processing, open-source software open Epi 2007 was used.RESULTS:In both classes, thirty patients were enrolled. On admission, the demographic profiles of both groups were identical, as evidenced by non-significant P-values. According to the sample parameters, there was no substantial difference between the two formulas at the end of the study period. Both formulas were equally efficacious for the nutritional assessment parameters during the study period.CONCLUSION:On initial admission, malnutrition was uncommon in the neurologic ICU. In terms of study parameters, both formulas were equally efficient. The homemade blenderized formula was 50% less expensive than commercial formula, making it an important nutritional supplementation option for the deprived strata of the population.

Vitamin K Deficiency in the Setting of Blenderized Tube Feeding Regimen in a Teenager: A Case Report

Vitamin K acts a cofactor for the gamma-carboxylation of several proteins in the coagulation cascade. The clinical spectrum of vitamin K deficiency (VKD) can be asymptomatic to a significant bleeding. VKD is classically seen in newborns. However, this can manifest later in patients with risks such as sub-optimal nutrition, fat malabsorption, medications including antibiotics. A 17-year-old male with spinal muscular atrophy (SMA) Type 1, tracheostomy with ventilator dependent, gastrostomy tube feeding was seen by the gastroenterologist following treatment for small intestinal bacterial overgrowth (SIBO). Investigations showed coagulopathy following which he was transferred to the Pediatric ICU. Labs revealed prothrombin time (PT) 114 s [Normal 9.4–12.5 s], INR (International normalized ratio) 12.6 [Normal < 1.1] and partial thromboplastin time (PTT) 90 s [Normal 25.1–36.5 s]. Mixing studies and coagulation assays were consistent with VKD (low Factor VII and Factor IX with normal Factor V). His home blenderized feeding regimen met the caloric requirement but not the adequate intake (AI) values for vitamin K and other minerals. He received intravenous vitamin K (phytonadione) for five consecutive days with resolution of the coagulopathy (PT 13.2 s, PTT 37.1 s, INR 1.2). The patient was discharged on enteral vitamin K and additional supplements following dietary review by a nutritionist. Clinicians should be cognizant of VKD in patients on blenderized tube feeds which may not meet the adequate intake (AI) goals. In patients who are not receiving nutritionally complete formulas or receiving inadequate volumes, it is important to monitor macro and micronutrients.