Enteral Nutrients Research Articles

SP2.10 - Early outcomes with the Insides Chyme Reinfusor (ICR) device in the management of parenteral nutrition dependent high output stomas (PN-HOS)

Abstract Aims PN-HOS represent a complex challenge, requiring input from surgical, gastroenterology and nutritional teams. Length of stay (LOS) is prolonged with difficulties in achieving output control and adequate nutrition with other associated risks. ICR is a modified stoma bag/mechanical pump and catheter device, reinfusing chyme into the distal limb, maintaining gut continuity, preserving enteral nutrient absorption and preventing distal limb atrophy. ICR may accelerate establishment of nutritional autonomy and reduce costs associated with PN/LOS. We report the largest study of ICR outcomes Methods Prospective study of ICR outcomes in patients with PN-HOS. Analysis included LOS, duration of PN, establishment of nutritional autonomy, nutritional markers, adverse ICR effects. Results Sixteen patients were trained to use the ICR (6M:10F). Median age 60yr. 75% achieved independent use (median 5.6 days). Overall usage was 395 days (median 32 days). Nutritional autonomy achieved in nine patients (pre-reversal). ICR increased median albumin 10.5 g/l. Adverse events included changing difficulties, spillage, noise, and discomfort. Two patients discontinued ICR because of pain/reflux. One patient died from unrelated post-operative complications. One patient with multiple loop stomas was successfully established on dual ICR. Nursing experience with ICR demonstrated ease of use and straightforward patient education. Cost analysis PN £5000/mth v ICR 1800/mth. Anecdotally at the time of reversal, surgical opinion was of much favourable bowel for anastomosis and return to function. Conclusions The ICR device is safe and contributes to restoration of nutritional autonomy. It reduces PN dependence with cost-benefits and acceptable adverse effects. At time of initial surgery distal limb should be fashioned to allow potential use of ICR.

Our experience in repairs using the native esophagus such as the Foker and Gazi methods in the management of patients with long-gap esophageal atresia.

This study aimed to share our experience with infants with repaired long-gap esophageal atresia (LGEA) using the native esophagus and Foker and Gazi methods. We retrospectively analyzed the medical records of 10 patients with LGEA (six with pure esophageal atresia [EA], and four with distal trachea-esophageal fistula [TEF] + EA). The mean length between the esophageal pouches was 5.9 cm (4-9 cm). Five Foker methods, three Gazi methods, and two delayed primary repairs after a daily bougie were performed an average of 19.3 days after the first surgery and 26.4 days after the final esophageal anastomosis. For the Foker technique, it was 36.1 days. Their first oral intake was 10.2 days, and their transition to full enteral food was 26.2 days. An esophageal leak was detected in six patients. Fundoplication and dilatations were performed for three and four patients, respectively. For good results, LGEA patients should be operated on at least under the supervision of an experienced surgeon in specialized centers, and the team should be familiar with the techniques for using the native esophagus.

Clinical Analysis of Feeding Jejunostomy and Optimal Selection of Enteral Nutrients (Report of 238 Cases)

The objectives of this study is to summarize and analyze the clinical and pathological data of patients with feeding jejunostomy, evaluate its clinical application value and risk, and study the optimal selection of enteral nutrients. The clinical data of 238 patients who underwent feeding jejunostomy in Beijing Shijitan Hospital, Capital Medical University, from September 1, 2017 to July 31, 2021 were retrospectively studied. The serious complications and treatment of patients were summarized and analyzed. Serious complications included anastomotic fistula, postoperative bleeding, and so on. Complications related to jejunal feeding stoma included: tube folded, intestinal stenosis at the stoma, and others. The symptoms of some enteral nutrition patients with abdominal pain, abdominal distension and diarrhea were improved by changing the type of enteral nutrients and increasing dietary fiber. Feeding jejunostomy can effectively solve the enteral nutrition problems of upper gastrointestinal anastomotic leakage, perforation, obstruction and functional eating disorder, can also be used as a separate means of enhance enteral nutrition support, but also can cause severe complications, and even death. Compliance with surgical indications is as important as mastery of surgical technical details. Reasonable use of enteral nutrients can achieve better nutritional support effect.

Pengukuran Tekanan Intra Abdominal Sebagai Penanda Toleransi Nutrisi Enteral pada Pasien ICU

This aim of this study is to determine the effectiveness of intra-abdominal pressure measurement as a marker of enteral nutrient tolerance in ICU patients. The method of this study used systematic review searched several eligible research articles from October 2013 to October 2023 using Scopus, ProQuest, Science Direct, and PubMed databases with the keywords critical ill patient, intra abdominal pressure measurement, gastric residual volume, and enteral nutrition.The result of this study show that based on six eligible research articles from 5 different countries that had been identified, show that intra-abdominal pressure measurements can predict enteral nutrient tolerance, although there was one study that had low sensitivity and significance. This systematic review concluded that intra-abdominal pressure measurements is one of the effective strategies that can be used to predict enteral nutrient tolerance in adult ICU patients. Keywords: Critical Ill Patient, Intra Abdominal Pressure Measurement, Gastric Residual Volume, Enteral Nutrition

Measurements of enteral feeding intolerance in critically ill children: a scoping review.

To examine the measurements on enteral feeding intolerance (EFI) in critically ill children. The Joanna Briggs Institute methods for conducting a scoping review were followed. Articles published since 2004 which assessed EFI in critically ill children were identified. A full search strategy was executed in seven English databases (MEDLINE, EMBASE, PubMed, Web of Science, Cochrane Central Register of Controlled Trials, JBI EBP, CINAHL) and four Chinese databases (CNKI, VIP, Wanfang, Sinomed). Two reviewers screened records according to our inclusion and exclusion criteria, and conducted a full-text review of selected articles. The reference lists of all studied selected were screened for additional sources. Relevant data was extracted using a researcher-developed tool. Of the 627 articles identified, 32 were included in this scoping review. Most articles focused on the measurement of high gastric residual volume (n = 22), followed by diarrhea (n = 20), and vomiting (n = 9). Most of the studies were of observational-analytic design (13/32) and experimental design (8/32). This scoping review addressed the complexity and diversity of EFI measurements. Given the importance of adequacy of enteral nutrient intake, we highlighted the necessary to develop individual measurements of EFI, taking the age of children and disease condition into consideration. Further studies can also investigate accurate and objective physiological measurements of EFI to advance EN and improve outcomes in critically ill children.

The potential of catfish (Clarias gariepinus) and yellow pumpkin (Cucurbita moschata) as enteral formulas for diabetes mellitus

Diabetes Mellitus is a non-communicable disease whose incidence rate is still quite high in Indonesia. Currently, the availability of enteral diabetes mellitus formulas derived from local food is still small. Meanwhile, the price of commercial enteral formula is quite expensive. Whereas local food has the potential as anti-diabetic and anti-hyperglycemia. Pumpkin and catfish are local food ingredients that have the potential to be alternative enteral formulas for people with diabetes mellitus. Yellow pumpkin contains antioxidants that play a role in reducing blood sugar. Catfish as a source of energy and protein needed by diabetes mellitus patients. The purpose of this study was to determine the acceptability of enteral diabetes mellitus formula based on pumpkin flour and catfish meal. This study used a quasi-experimental, with a non-factorial Completely Randomized Design (CRD) trial design by making 3 diabetes mellitus formulas. The acceptability of the three formulations obtained an average ranking score in Formula 1 of 2.32, Formula 2 of 1.73, and Formula 3 of 1.93. The results of the proximate analysis of Formula 1 had carbohydrate content of 64.85%, protein of 16.50%, dietary fiber of 4.69%, ash of 4.32%, water 4.53%, total energy 413.60 kcal/100g, energy from fat 88.20 kcal/100g and total fat content 9.80%. Enteral formula based on pumpkin and catfish flour has the potential as enteral food for Diabetes Mellitus patient.

Administration of Free Amino Acids Improves Exogenous Amino Acid Availability when Compared with Intact Protein in Critically Ill Patients: A Randomized Controlled Study

BackgroundProtein digestion and amino acid absorption appear compromised in critical illness. The provision of enteral feeds with free amino acids rather than intact protein may improve postprandial amino acid availability. ObjectiveOur objective was to quantify the uptake of diet-derived phenylalanine after the enteral administration of intact protein compared with an equivalent amount of free amino acids in critically ill patients. MethodsSixteen patients who were mechanically ventilated in intensive care unit (ICU) at risk of malabsorption received a primed continuous infusion of L-[ring-2H5]-phenylalanine and L-[ring-3,5-2H2]-tyrosine after an overnight fast. Patients were randomly allocated to receive 20 g intrinsically L-[1-13C]-phenylalanine-labeled milk protein or an equivalent amount of amino acids labeled with free L-[1-13C]-phenylalanine via a nasogastric tube over a 2-h period. Protein digestion and amino acid absorption kinetics and whole-body protein net balance were assessed throughout a 6-h period. ResultsAfter enteral nutrient infusion, both plasma phenylalanine and leucine concentrations increased (P-time < 0.001), with a more rapid and greater rise after free amino acid compared with intact protein administration (P-time × treatment = 0.003). Diet-derived phenylalanine released into the circulation was 25% greater after free amino acids compared with intact protein administration [68.7% (confidence interval {CI}: 62.3, 75.1%) compared with 43.8% (CI: 32.4, 55.2%), respectively; P < 0.001]. Whole-body protein net balance became positive after nutrient administration (P-time < 0.001) and tended to be more positive after free amino acid in provision (P-time × treatment = 0.07). ConclusionsThe administration of free amino acids as opposed to intact protein further increases postprandial plasma amino acid availability in critically ill patients, allowing more diet-derived phenylalanine to become available to peripheral tissues.This trial was registered at clinicaltrials.gov as NCT04791774.

Oral Drug Absorption and Drug Disposition in Critically Ill Cardiac Patients.

(1) Background: In critically ill cardiac patients, parenteral and enteral food and drug administration routes may be used. However, it is not well known how drug absorption and metabolism are altered in this group of adult patients. Here, we analyze drug absorption and metabolism in patients after cardiogenic shock using the pharmacokinetics of therapeutically indicated esomeprazole. (2) Methods: The pharmacokinetics of esomeprazole were analyzed in a consecutive series of patients with cardiogenic shock and controls before and after elective cardiac surgery. Esomeprazole was administered orally or with a nasogastric tube and once as an intravenous infusion. (3) Results: The maximum plasma concentration and AUC of esomeprazole were, on average, only half in critically ill patients compared with controls (p < 0.005) and remained lower even seven days later. Interestingly, esomeprazole absorption was also markedly compromised on day 1 after elective surgery. The metabolites of esomeprazole showed a high variability between patients. The esomeprazole sulfone/esomeprazole ratio reflecting CYP3A4 activity was significantly lower in critically ill patients even up to day 7, and this ratio was negatively correlated with CRP values (p = 0.002). The 5'-OH-esomeprazole and 5-O-desmethyl-esomeprazol ratios reflecting CYP2C19 activity did not differ significantly between critically ill and control patients. (4) Conclusions: Gastrointestinal drug absorption can be significantly reduced in critically ill cardiac patients compared with elective patients with stable cardiovascular disease. The decrease in bioavailability indicates that, under these conditions, any vital medication should be administered intravenously to maintain high levels of medications. After shock, hepatic metabolism via the CYP3A4 enzyme may be reduced.

Differences in the growth of microorganisms depends on the type of semi-solid enteral nutritional supplements

BackgroundEnteral nutritional supplements are used in many medical facilities and home care, but require appropriate management because they are nutrient-rich products. Recently, infection control methods for Ready To Hang (RTH) preparations, which are widely used and are expected to reduce the risk of infection, have not been established in Japan and are dependent on caregivers. Therefore, we evaluated the difference in the growth of microorganisms depending on the type of enteral nutrients following contamination with microorganisms.MethodsNine types of enteral nutrition were used. Escherichia coli (E. coli) W3110, Serratia marcescens (S. marcescens) NBRC3046, and Candida albicans (C. albicans) IFM61197 were used as test bacteria. The bacterial solution was added to the enteral nutritional supplement, adjusted, and the number of bacteria was measured at 0, 4, 8, and 24 h after the addition of the bacterial solution at 25 °C and in the dark.ResultsE. coli and S. marcescens grew in RACOL®-NF SemiSolid for Enteral Use, Hine® Jerry AQUA, and Mermed Plus® over a 24-h period; however, a decrease was observed for other enteral nutrition products. In contrast, C. albicans grew in all enteral nutrition products.ConclusionBecause the viscosity and calorie content vary among enteral nutrition preparations in which growth was observed, we found that pH had the greatest effect on the differences in bacterial growth. Nonetheless, C. albicans growth occurred in all nine types of enteral nutrients, indicating that unlike bacteria, its growth was independent of pH. If semi-solid enteral nutrients are contaminated with microorganisms for any reason, microorganisms will grow, so appropriate infection control is necessary to prevent infection.

Nutritional Approach of Neonatal with High Output Stoma Due to Long Segment Hirschsprung Disease: A Case Report

Background: High Output Stoma (HOS) continues to be one of the most challenging problems for pediatrician especially in neonates. One of the most common causes in neonatal HOS is post resection long segment Hirschsprung disease.&#x0D; Case: We reported a case of three-day-old baby boy diagnosed as Hirschsprung diseases with peritonitis possibility and did laparotomy with ileal resection, double barrel ileostomy and biopsy. Nutritional management is a major subject on taking care of this type of neonatal patient. We share our experience in limited facilities with all the patient uniqueness&#x0D; Discussion: Loss of a significant length of the small bowel results in interrelated physiologic events as a result of decreased small intestinal mucosal absorptive cell. This leads to a lesser fraction of ingested food and intestinal secretion thus causing an excessive volume loss. The introduction of early enteral feeds promotes intestinal adaptation, with subsequent weaning off parenteral nutrition. Most off patient with high output stoma will require parenteral nutrition which is associated with acute and long-term complications. In our case, we did early nutritional intervention using parenteral and enteral nutrition, counting ongoing fluid loss trough stoma and adjust it to total daily fluid requirement. We found weight loss during hospitalized due to HOS, and we do catch up at the end. We found difficulties to adjust comparation between enteral and parenteral intake to maintain the weight gain.&#x0D; Conclusion: Although parenteral nutrition is often necessary, at least initially, the therapeutic goal should be to enhance intestinal adaptation and enteral nutrient assimilation, and thereby reduce parenteral nutrition requirements. Daily monitoring for ongoing fluid loss very crucial for adjusting nutrition.

Evaluation of Nutritional Care for HIV (Human Immunodeficiency Virus) Patients with Pulmonary Tuberkulosis

Introduction: Indonesia is one of the countries with the fastest HIV development in Asia. The cumulative number of cases from 2003 to 2013 was 108,600 cases. The national accumulation is estimated at 186,000 people living with HIV in 2010. Papua is an area with an expanding HIV prevalence of 2.4%. HIV (Human Immunodeficiency Virus) is a virus that attacks the body's immune system. Tuberculosis (TB) is a bacterial infection that is spread through droplets inhaled from the coughs or sneezes of an infected person. Nutritional status is an important factor of disease immunity and plays a role in the frequency and severity of infection by inhibiting immune function for HIV patients with pulmonary TB. Vulnerability in HIV patients with a nutritional status below normal is more easily infected with Mycobacterium tuberculosis. Based on cases of TB HIV coinfection during 2010-2017, there was an increase from 2,393 to 7,796. This study aimed to determine the enhancement of nutritional needs of patients during hospitalization.Method: This research method uses a descriptive case study. This research was conducted in July 2021 at the Rumah Sakit Umum Tangerang with a saturated sample.Result: The outcome of observations and interviews with nutritional care for five days, there was an improvement in appetite disorders with an initial fulfillment of 70% to achieve a nutritional intake of 100%, the feeding route with the NGT gradually became oral, as well as the texture of enteral food, then the texture of the combination of soft and enteral, thus regular enteral meals. The finding is that monitoring the compliance of nutrients gradually increase the need for daily intake, eating routes, and evolved eating texture.

Semisolid Enteral Nutrients Alter the Pharmacokinetics of Orally Administered Levetiracetam in Rats.

Enteral nutrients (ENs) affect the plasma drug concentration of orally co-administered drugs, particularly those of antiepileptic drugs, such as phenytoin and carbamazepine. However, few studies have reported the interactions of levetiracetam (LEV), an upcoming antiepileptic drug, with ENs. In this study we aimed to investigate the pharmacokinetics of LEV in 55 rats after oral co-administration of LEV with liquid or semisolid ENs. Compared with the control group, co-administration with Terumeal ® Soft significantly decreased the plasma LEV concentration at 0.5, 1, and 2 h and area under the plasma concentration-time curve from 0 to 3 h (AUC0→3h) (P < 0.01). However, the AUC0→3h of LEV remained unchanged following the administration of Terumeal ® Soft 2 h after the initial LEV administration. Moreover, co-administration with semisolid Racol® NF delayed the absorption of LEV without decreasing the AUC0→3h, whereas liquid Racol ® NF did not alter LEV pharmacokinetics. Thus, co-administration of LEV with Terumeal® Soft reduced the absorption of LEV from the gastrointestinal tract, which was prevented by administering Terumeal ® Soft 2 h after LEV administration. Semisolid Racol ® NF altered LEV pharmacokinetics without decreasing its gastrointestinal absorption. Our findings suggested that careful monitoring of the plasma LEV levels is necessary when co-administering LEV with Terumeal ® Soft, semisolid Racol ® NF, or any other semisolid ENs, to prevent the inadvertent effects of the interaction between LEV and ENs.

Study on enteral nutrient components causing decreased gastric phenytoin absorption.

Previously, we revealed that coadministration of particular enteral nutrients (ENs) decreases plasma concentrations and gastric absorption of phenytoin (PHT), an antiepileptic drug, in rats; however, the mechanism has not been clarified. We measured the permeability rate of PHT using a Caco-2 cell monolayer as a human intestinal absorption model with casein, soy protein, simulated gastrointestinal digested casein protein (G-casein or P-casein) or simulated gastrointestinal digested soy protein (G-soy or P-soy), dextrin, sucrose, degraded guar gum, indigestible dextrin, calcium, and magnesium, which are abundant in the ENs, and measured the solution's properties. We demonstrated that casein (40 mg/ml), G-soy or P-soy (10 mg/ml), and dextrin (100 mg/ml) significantly decreased the permeability rate of PHT compared with the control. By contrast, G-casein or P-casein significantly increased the permeability rate of PHT. We also found that the PHT binding rate to casein 40 mg/ml was 90%. Furthermore, casein 40 mg/ml and dextrin 100 mg/ml have high viscosity. Moreover, G-casein and P-casein significantly decreased the transepithelial electrical resistance of Caco-2 cell monolayers compared with casein and the control. Casein, digested soy protein, and dextrin decreased the gastric absorption of PHT. However, digested casein decreased PHT absorption by reducing the strength of tight junctions. The composition of ENs may affect the absorption of PHT differently, and these findings would aid in the selection of ENs for orally administered PHT.

Decreased Expression of KLF4 Leading to Functional Deficit in Pediatric Patients with Intestinal Failure and Potential Therapeutic Strategy Using Decanoic Acid.

Pediatric intestinal failure (IF) is the reduction in gut function to below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth. The overall goal in treating IF is to achieve intestinal adaptation; however, the underlying mechanisms have not been fully understood. In this study, by performing single-cell RNA sequencing in pediatric IF patients, we found that decreased Kruppel-Like Factor 4 (KLF4) may serve as the hub gene responsible for the functional deficit in mature enterocytes in IF patients, leading to the downregulation of solute carrier (SLC) family transporters (e.g., SLC7A9) and, consequently, nutrient malabsorption. We also found that inducible KLF4 was highly sensitive to the loss of certain enteral nutrients: in a rodent model of total parenteral nutrition mimicking the deprivation of enteral nutrition, the expression of KLF4 dramatically decreased only at the tip of the villus and not at the bottom of crypts. By using IF patient-derived intestinal organoids and Caco-2 cells as in vitro models, we demonstrated that the supplementation of decanoic acid (DA) could significantly induce the expression of KLF4 along with SLC6A4 and SLC7A9, suggesting that DA may function as a potential therapeutic strategy to promote cell maturation and functional improvement. In summary, this study provides new insights into the mechanism of intestinal adaptation depending on KLF4, and proposed potential strategies for nutritional management using DA.

Recent Advances in the Nutritional Screening, Assessment, and Treatment of Japanese Patients on Hemodialysis

Patients on hemodialysis (HD) have a higher rate of protein-energy wasting (PEW) due to lower dietary intake of energy and protein (particularly on dialysis days) and greater loss of many nutrients in the dialysate effluent than other patients. The most well-known method of nutritional screening is the subjective global assessment. Moreover, the Global Leadership Initiative on MalnutIrition has developed the first internationally standardized method for diagnosing malnutrition; however, its use in patients on HD has not been established. In contrast, the nutritional risk index for Japanese patients on HD has recently been developed as a screening tool for malnutrition in patients on HD, based on the modified PEW criteria. These tools are beneficial for screening nutritional disorders, enabling registered dietitians to assess patients' dietary intake on dialysis and non-dialysis days and provide advice on dietary intake, especially immediately after dialysis cessation. Oral supplementation with enteral nutrients containing whey protein may also be administered when needed. In patients that experience adverse effects from oral supplementation, intradialytic parenteral nutrition (IDPN) should be combined with moderate dietary intake because IDPN alone cannot provide sufficient nutrition.

Self‐Assembled Integrative Nutrient Carrier Platform Containing Green Tea Catechin for Short Bowel Syndrome Treatment (Adv. Healthcare Mater. 3/2023)

Enteral Nutrition In article 2201933 by Wen Hu, Junling Guo, and co-workers, an integrative nutrient carrier platform is constructed based on green tea catechin and ferrous ions. A series of nutrients are self-assembled to form phenolic-based integrative nutrient complexes, prolonging nutrients residence and absorption in the intestine. This enteral phenolic-based nutrient delivery strategy offers a new and promising nutritional support and treatment for short bowel syndrome.

Effect of ethanolamine utilization on the pathogenicity and metabolic profile of enterotoxigenic Escherichia coli.

Bacterial pathogenicity is greatly affected by nutrient recognition and utilization in the host microenvironment. The characterization of enteral nutrients that promote intestinal pathogen virulence is helpful for developing new adjuvant therapies and inhibiting host damage. Ethanolamine (EA), as a major component of intestinal epithelial cells and bacterial membranes, is abundant in the intestine. Here, we provide the first demonstration that the critical human and porcine pathogen enterotoxigenic Escherichia coli (ETEC) can utilize EA as a nitrogen source, which affects its virulence phenotype. We found that compared with that in M9 medium (containing NH4Cl), EA inhibited ETEC growth to a certain extent; however, the relative expression levels of virulence-related genes, such as ltA (3.0-fold), fimH (2.9-fold), CfaD (2.6-fold), gspD (3.6-fold), and qesE (1.3-fold), increased significantly with 15mM EA as a nitrogen source (P < 0.05), and the adhesion efficiency of ETEC to Caco-2 cells increased approximately 4.2-fold. In Caco-2 cells, the relative cell viability decreased from 74.8 to 63.4%, and the transepithelial electrical resistance (TEER) cells decreased to 74.8% with intestinal EA (4mM). In addition, the relative expression levels of proinflammatory factors, such as TNF-α (3.2-fold), INF-γ (2.9-fold), and IL-1β (1.98-fold), in ETEC-infected Caco-2 cells were significantly upregulated (P < 0.05) under EA exposure; however, the above virulence changes were not found in ΔeutR and ΔeutB ETEC. A gas chromatography-mass spectrometry (GC-MS)-based untargeted metabolomics approach was then employed to reveal EA-induced metabolic reprogramming related to ETEC virulence. The data showed that most metabolites related to carbohydrate, aspartate and glutamate metabolism, shikimic acid metabolism, and serine metabolism in ETEC exhibited a decreasing trend with increases in the EA concentration from 0 to 15mM, but the branched-chain amino acid (BCAA) levels in ETEC increased in a dose-dependent manner under EA exposure. Our data suggest that the intestinal EA concentration can significantly affect the virulence phenotype, metabolic profile, and pathogenicity of ETEC. KEY POINTS: • ETEC growth and virulence gene expression could be regulated by ethanolamine. • The intestinal concentration of EA promoted the damaging effect of ETEC on the host epithelial barrier. • The promoting effect of EA on ETEC toxicity may be related to BCAA metabolism.

EFEKTIFITAS FORMULA “SUPROMIN” (MAKANAN ENTERAL DARI TEMPE) TERHADAP PERBAIKAN KADAR ALBUMIN DAN KOLESTEROL PASIEN STROK

Stroke has been a leading cause of death in Indonesia based on Riskesdas data in 2018, it is known that Sroke's prevalence increased from 7 per million to 10.9 per million. Patients with acute stroke were found to be lacking in protein energy by 16.3 percent - 35 percent. "Supromin" is a modified enteral food made from tempeh, skim milk, and egg white which is expected to increase food intake and improve the lipid profile of stroke patients. This study aims to analyze the effect of "supromin" and commercial formulas on albumin and cholesterol levels in stroke patients. This experimental study employed the pre-test and post-test control group design. Respondents were selected using consecutive random sampling. Data were analyzed using paired – t-tests. After 10 days of treatment, there was an increase in albumin levels of 0.17+0.29 mg/dL (p=0.069) in the group receiving the supromin formula and a decrease in albumin levels of 0.08+0.08 mg/dL (p=0.006) in the group receiving the commercial formula. Supromin formula is effective in reducing cholesterol level 16.58+18.31 mg/dL (p = 0.009). Giving supromin formula increases albumin levels and significantly lowers cholesterol levels in stroke patients. It is necessary to consider the provision of the supromin formula for a longer period.

Response of multiple hormones to glucose and arginine challenge in T2DM after gastric bypass.

PurposeIn patients with type 2 diabetes mellitus (T2DM), Roux-en-Y gastric bypass (RYGB) leads to beneficial metabolic adaptations, including enhanced incretin secretion, beta-cell function, and systemic insulin sensitivity. We explored the impact of RYGB on pituitary, pancreatic, gut hormones, and cortisol responses to parenteral and enteral nutrient stimulation in patients with obesity and T2DM with repeated sampling up to 2 years after intervention.MethodsWe performed exploratory post hoc analyses in a previously reported randomized trial. Levels of adrenocorticotropic hormone (ACTH), cortisol, growth hormone (GH), glucagon-like peptide 1 (GLP-1), glucose-dependent insulinotropic peptide (GIP), peptide YY (PYY), ACTH, insulin, and glucagon were measured in 13 patients with T2DM and obesity at four different visits: before and 4, 24, and 104 weeks after RYGB; and in three sequential conditions on the same day: fasting, intravenous arginine challenge, and OGTT.ResultsRYGB surprisingly induced a rise in ACTH, cortisol, and GH levels upon an oral glucose load, together with enhanced GLP-1 and PYY responses. Fasting and post-arginine GH levels were higher after RYGB, whereas insulin, glucagon, GLP-1, GIP, and cortisol were lower. These endocrine adaptations were seen as early as 4 weeks after surgery and were maintained for up to 2 years.ConclusionThese findings indicate adaptations of glucose sensing mechanisms and responses in multiple endocrine organs after RYGB, involving the gut, pancreatic islets, the pituitary gland, the adrenals, and the brain.

Efficacy of semi-solidification of enteral nutrients for postoperative nutritional management with a nasogastric tube.

ABSTRACTPostoperative nutritional management with a nasogastric tube is often used to prevent malnutrition after oral and maxillofacial surgery. However, enteral nutrients (EN) may cause various complications due to their liquid formulation. In this study, we retrospectively evaluated the efficacy of semi-solid EN with a xanthan gum thickener through a nasogastric tube and examined patients’ complications, nutritional status, and quality of life. We established two groups: an L group (n=20) to which we administered liquid EN, and an SS group (n=20) to which we administered semi-solidified EN. The primary outcome was the occurrence of gastrointestinal complications. The secondary outcome was a change in nutritional status based on body weight and controlling nutritional status. The other outcome was the improvement in the patients’ quality of life, assessed by the administration time. During nutritional management with a nasogastric tube, the median daily administration time in the L group was 9.0 hours, and 9 patients experienced diarrhea. In the SS group, the median daily feeding time was 2.3 hours, and only 2 patients experienced diarrhea. Both groups exhibited a decrease in body weight while controlling nutritional status scores were maintained. Semi-solidification of EN may be useful for postoperative nutritional management after oral and maxillofacial surgery by reducing complications, maintaining nutritional status, and shortening administration time.