Effect Of Early Nutrition Support Research Articles

A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting

To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician's assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.

The use of prophylactic percutaneous endoscopic gastrostomy and early enteral feeding in patients with advanced head and neck cancer-A prospective longitudinal study

Summary Background&aims This descriptive study aimed to explore the effect of early nutritional support and enteral feeding using percutaneous endoscopic gastrostomy (PEG) in preventing malnutrition in patients with locally advanced head-neck cancer. Method Sixty-four patients received a prophylactic PEG before treatment. Weight, body mass index (BMI), body composition, fat free mass index (FFMI), dysphagia and use of tube feeding were followed during two years. Results The patients started to use their PEGs on average 30 days after treatment start and used enteral feeding for 180 days. PEG was well tolerated with few side-effects. After one-year 89% had returned to almost normal diet. At the time of inclusion in the study, 42% had lost weight, on average 6% of their normal weight. Despite nutritional advice and early tube feeding the patients continued to lose weight. The largest weight loss was found after six months (average 11.2%). At that follow-up 62% of the patients were malnourished (loss of >10% of their weight at inclusion), however BMI, and more importantly, the fat free-mass remained normal, probably due to the rather slow weight loss progression. Conclusion Patients required nutritional support and enteral feeding for an extended time-period, however a normal body composition was maintained despite weight loss.

Schwere Brandverletzungen - Frühe künstliche Ernährung reduziert die Komplikationsrate

Quelle: Tancheva D, Hadjilski O. Effect of early nutritional support on clinical course and septic complications in patients with severe burns. Annals of Burns and Fire Disasters 2005; XVIII: 74-78

Régime sans sel : le retour !

Guidelines recommend the use of nutritional support during hospital stays for medical patients (patients not critically ill and not undergoing surgical procedures) at risk of malnutrition. However, the supporting evidence for this recommendation is insufficient, and there is growing concern about the possible negative effects of nutritional therapy during acute illness on recovery and clinical outcomes. Our aim was thus to test the hypothesis that protocol-guided individualised nutritional support to reach protein and caloric goals reduces the risk of adverse clinical outcomes in medical inpatients at nutritional risk.The Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) is a pragmatic, investigator-initiated, open-label, multicentre study. We recruited medical patients at nutritional risk (nutritional risk screening 2002 [NRS 2002] score ≥3 points) and with an expected length of hospital stay of more than 4 days from eight Swiss hospitals. These participants were randomly assigned (1:1) to receive either protocol-guided individualised nutritional support to reach protein and caloric goals (intervention group) or standard hospital food (control group). Randomisation was done with variable block sizes and stratification according to study site and severity of malnutrition using an interactive web-response system. In the intervention group, individualised nutritional support goals were defined by specialist dietitians and nutritional support was initiated no later than 48 h after admission. Patients in the control group received no dietary consultation. The composite primary endpoint was any adverse clinical outcome defined as all-cause mortality, admission to intensive care, non-elective hospital readmission, major complications, and decline in functional status at 30 days, and it was measured in all randomised patients who completed the trial. This trial is registered with ClinicalTrials.gov, number NCT02517476.5015 patients were screened, and 2088 were recruited and monitored between April 1, 2014, and Feb 28, 2018. 1050 patients were assigned to the intervention group and 1038 to the control group. 60 patients withdrew consent during the course of the trial (35 in the intervention group and 25 in the control group). During the hospital stay, caloric goals were reached in 800 (79%) and protein goals in 770 (76%) of 1015 patients in the intervention group. By 30 days, 232 (23%) patients in the intervention group experienced an adverse clinical outcome, compared with 272 (27%) of 1013 patients in the control group (adjusted odds ratio [OR] 0·79 [95% CI 0·64–0·97], p=0·023). By day 30, 73 [7%] patients had died in the intervention group compared with 100 [10%] patients in the control group (adjusted OR 0·65 [0·47–0·91], p=0·011). There was no difference in the proportion of patients who experienced side-effects from nutritional support between the intervention and the control group (162 [16%] vs 145 [14%], adjusted OR 1·16 [0·90–1·51], p=0·26).In medical inpatients at nutritional risk, the use of individualised nutritional support during the hospital stay improved important clinical outcomes, including survival, compared with standard hospital food. These findings strongly support the concept of systematically screening medical inpatients on hospital admission regarding nutritional risk, independent of their medical condition, followed by a nutritional assessment and introduction of individualised nutritional support in patients at risk.The Swiss National Science Foundation and the Research Council of the Kantonsspital Aarau, Switzerland.

Nitrogen balance, 3-methylhistidine excretion, and plasma amino acid profile in infants after cardiac operations for congenital heart defects: The effect of early nutritional support

Objective: The objective of this study was to evaluate the effect of nutritional support on proteolysis and plasma amino acid profile in infants early after cardiac operations for congenital heart defects. Methods: Thirty-seven patients, 2 to 12 months old, were randomized on postoperative day 1 for 24-hour isocaloric metabolic study. Group STANDARD (18 patients) received glucose as the maintenance fluid, and group PN (19 patients) received glucose and crystalloid amino acid solution at a dosage of 0.8 ± 0.1 gm/kg per day. The nonprotein caloric intake in the two groups was 25 ± 15 and 33 ± 9 kcal/kg, respectively ( p = not significant). Results: The nitrogen balance was markedly less negative in group PN than in group STANDARD (–114 ± 81 vs –244 ± 86 mg/kg, respectively, p = 0.001). There was a highly significant inverse correlation between the nitrogen balance and urinary 3-methylhistidine excretion in both groups, but the muscle proteolysis was blunted more effectively in patients receiving amino acids. Concentrations of the plasmatic branched-chain amino acids, alanine, glycine, and proline, decreased significantly in group STANDARD but not in group PN on postoperative day 2. Glutamine and threonine levels declined significantly on postoperative day 2 in both groups. Low levels of arginine were observed in our patients before operation and in the early postoperative period. The amino acid concentrations normalized on postoperative day 7 in all patients. Conclusion: Significant proteolysis and hypoaminoacidemia were observed in infants early after cardiac operations. This hypercatabolic response was blunted by parenteral nutritional support. (J Thorac Cardiovasc Surg 1997;114:1053-60)

ENTERAL FEEDING IN INFANTS WITH LOW TRACT RESPIRATORY INFECTIONS

To evaluate the effect of early nutritional support on infants hospitalized because of low respiratory infections, we studied 60 infants (2 to 12 months) for seven days. On admission they were randomly all ocated to 4 groups: A, fed powdered whole cow's milk formula (CM) reconstituted to 7.5% with 5% sucrose and 5% maltodextrin (77 Kcal/dl) via nasogastric tube as a bolus; B, same as group A but given by continuous drip; C, 10% CM plus 5% sucrose and 2% vegetable oil (87 Kcal/dl) via nasogastric tube as a bolus; and D, same as C but given as a continuous drip. Infants of group B, had the shortest hospital stay (7.2 vs 8.7, 8.4 and 7.7 days; p < 0.01), and faster improvement of parameters of respiratory faiiure (2.7 vs 4.1, 3.8 and 3.5 days; p < 0.0003). The maximal decrease in cardiac rate was observed in group D (169 to 126 beats/min). No differences were observed in blood glucose levels, ESR, C-reactive protein, and anthropometric measurements. We conclude that early nutritional support with hypercaloric and high lipid formulas, administered via a nasogastric tube by continuous drip is associated to an early decrease of the severity of infections of the low respiratory tract in infants.