Enteral Nutrition Treatment Research Articles

Near-term prognostic impact of integrated muscle mass and function in upper gastrointestinal cancer

Despite the known association between muscle mass/function and malnutrition-related mortality in upper gastrointestinal (UGI) cancer, no comprehensive study to determine the impact of muscle mass-dominant nutritional status on cancer prognosis has been conducted. The present study aimed to investigate the prognostic significance of integrated muscle mass and function in UGI cancer. Between July 2013 and March 2018, we enrolled 2546 cancer patients with risks of malnutrition (Nutrition Risk Screening 2002, ≥3 points) from a multicenter cohort study and split 527 patients with primary UGI cancer into an internal validation group. We prospectively performed instant nutritional assessment and recorded all general clinical characteristics of the participants, such as weight loss, body mass index, anthropometric measurements of muscle mass and function, dietary intake conditions, and disease burden and/or inflammation status based on the validated tools. Prognostic analyses were performed with post-assessment overall survival (OS). According to the entire set, UGI cancer was identified as the dominant risk factor for disease burden and inflammation criteria (hazard ratio (HR), 2.08, 95% confidence interval (Cl), 1.81-2.39, P<0.001). Integrated muscle mass/function analysis with validated cutoff values showed that hand grip strength/weight followed by triceps skinfold thickness and maximum calf circumference are the most potent predictors. Univariate and multivariate analyses revealed that reduced muscle mass/function (74.8%) and dietary intake (66.2%) independently affect OS of patients with UGI cancer. Significant associations were found between the reduced muscle mass/reduced dietary intake and the shortest OS (HR, 4.48; 95% Cl, 3.07-6.53; P<0.001). Appending subgroups of muscle mass/function and dietary intake to the pre-existing risk model increased the efficiency of the time-dependent receiver operating characteristic curve analysis for OS in UGI cancer, particularly within 2 years of instant nutritional assessment. Impaired muscle mass/function adversely affects the near-term prognosis in patients with UGI cancer. Along with a comprehensive evaluation of dietary intake conditions, the timely nutritional assessment might be useful for risk stratification of UGI cancers with potential for enteral and parenteral nutrition interventions. ChiCTR1800020329.

Early Total Versus Gradually Advanced Enteral Nutrition in Stable Very-Low-Birth-Weight Preterm Neonates: A Randomized, Controlled Trial.

To assess whether early total enteral nutrition (80mL/kg/d) started on day 1 of life in hemodynamically stable preterm very-low-birth-weight (VLBW) neonates with the rapid advancement of feeds (20mL/kg/d) help in the earlier achievement of full feeds (180mL/kg/d). Early total enteral nutrition (intervention) group feeding was started with 80mL/kg/d on the first day in all hemodynamically stable neonates admitted with birth weight of 1000-1499grams, born at 29-33 wk of gestation as determined by first-trimester ultrasonography (USG) or expanded New Ballard Score (NBS) and was advanced by 20mL/kg/d until maximum feeds of 180mL/kg/d were achieved; while in control group feeding was started with 30mL/kg/d on the first day and was advanced by 20mL/kg/d until maximum feeds were achieved. Primary outcome measure was time taken to achieve full feeds; secondary outcomes were duration of hospital stay, necrotizing enterocolitis (NEC), time to regain birth weight, duration of antibiotics, and death. Sixty VLBW neonates (1000-1499g) with comparable baseline demographics were randomized within 24h of admission to two groups. Early total enteral nutrition intervention group (group I, n= 31) achieved the target of full enteral nutrition at median 6 d; IQR: 0 to 7.8 d, a significantly shorter time compared to the controls (n= 29) (median 10 d; IQR: 9 to 11.0 d; p= < 0.05). Early total enteral nutrition started from the first day of life results in significantly less time to achieve full feeds in hemodynamically stable preterm and VLBW infants.

A European Survey on Digestive Perianastomotic Ulcerations, a Rare Crohn-like Disorder Occurring in Children and Young Adults.

Digestive perianastomotic ulcerations (DPAU) resembling Crohn disease lesions are long-term complications of intestinal resections, occurring in children and young adults. They are known to be uncommon, severe and difficult to treat. In the absence of recommendations, we performed a large European survey among the members of the ESPGHAN working group on inflammatory bowel disease (IBD) in order to collect the experience of expert pediatric gastroenterologists on DPAU. Fifty-one patients (29 boys and 22 girls) were identified from 19 centers in 8 countries. Most patients were followed after necrotizing enterocolitis (n = 20) or Hirschsprung disease (n = 11). The anastomosis was performed at a median age (interquartile range) of 6 [1-23] months, and first symptoms occurred 39 [22-106] months after surgery. Anemia was the most prevalent symptom followed by diarrhea, abdominal pain, bloating, and failure to thrive. Hypoalbuminemia, elevated CRP, and fecal calprotectin were common. Deep ulcerations were found in 59% of patients usually proximally to the anastomosis (68%). During a median follow-up of 40 [19-67] months, treatments reported to be the most effective included exclusive enteral nutrition (31/35, 88%), redo anastomosis (18/22, 82%), and alternate antibiotic treatment (37/64, 58%). Unfortunately, persistence of symptoms, failure to thrive, and abnormal laboratory tests at last follow-up in most of patients show the burden of DPAU lacking optimal therapy and incomplete understanding of the pathophysiology.

Impact of Enteral Nutrition Formulations Containing Dietary Fiber on Diarrhea Outcomes in Hospitalized Critical Care Patients: A Systematic Review and Meta-Analysis

ObjectivesThe objective is to conduct a systematic review on the safety of using enteral nutrition formulations containing dietary fiber in hospitalized critical care patients. MethodsThis systematic review was conducted in accordance with the Cochrane Handbook for Systematic Reviews of Interventions (Version 6.1,2020). Searches were implemented in four databases on 4/20/20. Results were limited to English language studies conducted in humans. Any clinical study design or case study measuring adverse events (e.g., diarrhea and mortality) or health outcomes (as defined in each study) associated with enteral nutrition interventions containing dietary fiber in adult critically ill patients was considered. Random effects meta-analyses were conducted on outcomes assessed by three or more included studies. ResultsAltogether, 18 articles were included, and 11 randomized controlled trials assessed diarrhea outcomes (i.e., diarrhea score and number or frequency of events). Six studies used the Hart and Dobb (1988) diarrhea score, and random effects meta-analyses showed the mean diarrhea scores were lower for fiber compared to non-fiber groups (n = 4, pooled mean difference: –2.78, 95% confidence interval: –4.10, –1.47). Five of seven reported group comparisons showed fewer diarrhea events for fiber compared with non-fiber groups, although the overall difference was not statistically significant (n = 7, pooled risk ratio: 0.68, 95% CI: 0.45, 1.02). For three studies using other or unspecified scoring methods, pooled results showed significantly fewer diarrhea events in the fiber groups compared to non-fiber groups (n = 3, pooled RR: 0.42, 95% CI: 0.20, 0.89). Studies reported no difference in incidence of mortality due to fiber interventions (n = 7, pooled RR: 0.99, 95% CI: 0.66, 1.48). Risk of bias for diarrhea outcomes was high due to missing outcome data, and there was some concern for bias due to randomization, measurement of the outcome, and selection of reported results. ConclusionsEnteral nutrition formulas with fiber may help reduce incidence and severity of diarrhea in critically ill patients without increasing incidence of mortality. As these results are subject to bias, more high-quality studies are needed to verify this conclusion. Funding SourcesThis study was supported by funding from an unrestricted educational grant from Nestle Health Sciences.

A Case of Necrotizing Fasciitis due to Group G Streptococcus with Amputation Avoided of the Affected Limb

Group G Streptococcus (GGS) causes toxic shock syndrome. Its incidence has been increasing in the elderly in recent years. The case is a female patient in her 60s, with rheumatoid arthritis, who developed necrotizing fasciitis in her right thigh. We administered antibacterial agents and debridement frequently at an early stage, followed by aggressive high-protein enteral nutrition and multidisciplinary treatment. During the course of treatment, the patient’s general condition temporarily deteriorated because of fecal contamination. We considered amputation of the lower limb and implantation of a stoma, but finally succeeded in preserving the limb by performing two skin grafts. The patient was able to walk and was discharged on day 66. GGS infection is a risk factor for elderly patients with underlying diseases such as malignancy or immunocompromised states. When necrotizing fasciitis due to fulminant streptococcal infection develops in a proximal limb, amputation of the limb is often necessary to save the patient’s life. In this case, a fulminant GGS infection developed in an immunocompromised patient with active rheumatoid arthritis. Although the risk of limb amputation was high, multidisciplinary treatment enabled functional preservation of the affected limb.

Effect of electroacupuncture at Zusanli (ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis

To observe the effect of electroacupuncture (EA) of Zusanli(ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis (SAP). A total of 68 SAP patients (hospitalized from January of 2018 to December of 2019 in Cangzhou Hospital of Integrated Medicine) were randomly divided into control and EA groups (n=34 cases in each group). All patients of the two groups received the same early enteral nutrition treatment through nasojejunal tube. EA (5-15 Hz, 1-5 mA) was applied to bilateral ST36 and CV12 for 20 min, twice a day for 7 days. The incidence of feeding intolerance (abdominal distension, vomiting, diarrhea, constipation, gastrointestinal bleeding), time to reach energy target, intraperitoneal pressure and the number of borborygmus in 1 min were recorded. The contents of plasma high sensitivity -C reactive protein (hs-CRP), IL-6 and endotoxin were measured using Latex immunoturbidimetric method, chemiluminescence and Tachypiens Amebocyte Lysate Azo substrate color development method, respectively, and the contents of urinary lactulose and mannitol detected using high-performance liquid chromatography. The total protein and albumin levels in the blood were measured for assessing the patients' nutrition status, and acute physiology and chronic health evaluation scoring system (APACHE-Ⅱ) score was determined for assessing the severity of disease. Compared with the control group, the incidence of abdominal distension, vomiting and constipation, intolerance rate to feeding, time to reach the energy target, intraperitoneal pressure on day 7, inflammatory indexes, hs-CRP, IL-6, endotoxin, urine L/M on day 4 and 7, and the APACHE Ⅱ score on day 7 were significantly lower (P<0.01), and the number of borborygmus in 1 min on day 4 and 7 after the treatment was significantly higher in the EA group (P<0.01). In comparison with pretreatment, the abdominal pressure and plasma endotoxin level on day 4 and 7, hs-CRP, IL-6 and L/M ratio on day 1, 4 and 7, as well as APACHE Ⅱ score on day 7 after the treatment were significantly decreased in the two groups (P<0.01), and the number of borborygmus on day 4 and 7, and the total protein and albumin on day 7 significantly increased in both the control and EA groups (P<0.01). EA of ST36 and CV12 can shorten the time to reach the energy target, reduce inflammatory response, improve the intestinal mucosal barrier function, and thus reduce the incidence of feeding intolerance in SAP patients.

Changes of intestinal flora and miR-10a expression after radical resection of colorectal cancer: Effect of microecological enteral nutrition intervention

Changes of intestinal flora and miR-10a expression after radical resection of colorectal cancer: Effect of microecological enteral nutrition intervention

Very Low Birthweight Preterm Infants: A 2020 Evidence Analysis Center Evidence-Based Nutrition Practice Guideline.

The National Institutes for Health and the Academy of Nutrition and Dietetics initiated the “Pre-B Project” to address the lack of very low birth weight (VLBW) preterm infant evidence-based nutrition practice guidelines. A scoping review and nine systematic reviews on enteral nutrition interventions were conducted by a multidisciplinary Preterm Panel. Recommendations were developed using the Academy’s Evidence Analysis Center Process and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence-to-Decision framework.

Clinical observation of individualized nutritional formula on inflammation index, immune status and gastrointestinal tolerance in patients with severe head injury.

Objectives:To evaluate the clinical significance of individualized nutritional formulas on inflammatory factors, immune status and gastrointestinal tolerance in patients with severe head injury.Methods:A total of 80 patients with severe head injury who were hospitalized in Baoding No.1 Central Hospital from March 2017 to March 2020 were randomly divided into two groups with 40 cases in each group. Patients in both groups were given enteral nutrition (EN), the control group was given conventional enteral nutrition formula through nasointestinal tube, and the experimental group was given individualized nutrition formula. All patients were tested for tumor necrosis factor(TNF-α), C-reactive protein(CRP), interleukin 6(IL-6), IgA, IgM, IgG, serum intestinal fatty acid binding protein(I-FABP) and D-lactic acid concentration before and after enteral nutrition treatment. The incidence of adverse reactions such as abdominal distension, diarrhea, constipation, and gastric retention within seven days after treatment of two groups were compared and analyzed.Results:There was no significant difference in inflammatory factors such as TNF-a, CRP, IL-6, immunoglobulin levels, I-FABP and D-lactic acid concentration between the two groups before treatment (p>0.05). After treatment, the above indicators of the two groups of patients were better than before treatment, the difference was statistically significant (p<0.05), and the experimental group was significantly better than the control group (p<0.05). The experimental group had a gastrointestinal adverse reaction rate of 10%, and the control group had 27.5%, the difference was statistically significant (p=0.04).Conclusions:Individualized nutritional formula has more significant advantages than conventional nutritional formula for patients with severe head injury, which can reduce inflammatory response, increase the patient’s immune level, improve the intestinal mucosal barrier function, have good gastrointestinal tolerance, and have a low incidence of adverse reactions.

Reporting of Randomized Controlled Trials Investigating an Enteral or Parenteral Nutrition Intervention in Critical Illness According to the CONSORT Statement: A Systematic Review and Recommendation of Minimum Standard Reporting Criteria

Lack of reporting consistency is common in randomized controlled trials (RCTs) in critical care nutrition. This impacts synthesis and interpretation and may misinform clinical practice. The objective was to evaluate reporting of parallel-group RCTs of enteral or parenteral nutrition interventions in critically ill adults against the recommendations in the Consolidated Standards of Reporting Trials (CONSORT) 2010 guidelines and a priori-defined nutrition criteria. A systematic search of CENTRAL, MEDLINE, EMBASE, and CINAHL was conducted to identify RCTs published from January 2011 to February 14, 2020. The primary outcome was the percentage of CONSORT criteria "completely met" (a score of 1) from all included studies (out of a total possible score of 37). Secondary outcomes included the percentage of CONSORT criteria that were "partially" or "not met" and the percentage of a priori-defined nutrition criteria that were "completely," "partially," or "not met" (adjusted to reflect criteria applicable to the paper). Data are presented as mean (standard deviation). Comparisons of normally distributed continuous data were made using a t-test (P < .05). Of 18,969 articles identified, 56 studies met inclusion criteria. Of these, 60% (19%) of the eligible CONSORT criteria were "completely met," 20% (9%) "partially met," and 20% (15%) "not met." For the nutrition criteria, 41% (20%) of the eligible criteria were "completely met," 25% (14%) "partially met," and 34% (17%) "not met." Reporting against CONSORT guidelines was variable and often incomplete in relation to important a priori-defined nutrition variables.

Results of a Randomized, Open Label, Multicenter Trial Assessing the Safety, Dose and Schedule of RRx-001 (R001) in Reducing Severe Oral Mucositis (SOM) in Patients Receiving Chemoradiation (CRT) for Oral Cavity/oropharynx Squamous Cell Carcinoma (OSCC)

Severe oral mucositis (SOM, assessed WHO grade 3 or 4) occurs in up to 70% of patients receiving CRT for OSCC, many of whom require enteral nutrition or experience treatment interruption. Pharmacological targeting of nuclear factor erythroid related factor (Nrf2) represents an opportunity to mitigate radiation-associated toxicities mediated by oxidative species (OS). Preclinical studies demonstrate R001 activates Nrf2, a key regulator of gene expression encoding antioxidant, phase II detoxifying enzymes, and downstream Antioxidant Response Element signaling pathways. Activation of Nrf2 increases the threshold and buffering capacity of OS generated by CRT, and its multi-target activity provides a counterbalance to oxidative stress resulting in focal and systemic radioprotection. This proof of concept Phase 2a randomized clinical trial examined the safety, efficacy and schedule-dependent effects of R001 in reducing the incidence, severity and duration of SOM. Patients with OSCC treated with definitive or postoperative CRT were randomized to one of 4 treatment arms: 2 doses/week for 2 weeks before (pre) CRT (Arm 1); pre-CRT plus 2 doses or pre-CRT plus 6 weekly doses during CRT (Arm 2, 3 respectively); or standard of care (SOC) (Arm 4). The primary endpoint was duration of SOM through resolution < grade 2. Secondary endpoints included safety, time to onset, incidence, and duration of SOM and grade 4 mucositis through 60 and 70 Gy. Between June 2018 and July 2019 across 11 institutions, 53 patients were randomized, with 45 evaluable. Short 15-minute infusions of R001 were well tolerated with no associated serious adverse events (SAE). Side effects were comparable to SOC. Trends in treatment benefits for all endpoints were consistent across the 3 treatment arms, with the greatest effect size in Arm 1. R001 delayed time to onset (38 vs. 26 days) and duration of SOM (22 vs. 40 days), with 83% having resolution vs 60% with SOC, respectively. No patients developed grade 4 mucositis vs 30% SOC arm. A 95% decrease in duration of SOM (1 vs 17 days) through 60 Gy was also observed. Gastrostomy requirement was reduced by 45% (33% vs 60%). In this small open-label trial, R001 demonstrated a favorable benefit-risk profile with a markedly decreased incidence and duration of SOM through 60 Gy, 70 Gy and follow-up post CRT. Treatment effect was greatest in Arm 1 suggesting short periods of Nrf2 activation prior to generation of OS by CRT may be sufficient to increase the threshold and buffering capacity of antioxidants. Larger, blinded trials, confirming the observed dose, schedule and treatment effect are planned.

Talking about Prevention and Control Nursing of Ventilator-Associated Pneumonia

Ventilator-associated pneumonia (VAP) refers to the infection of lung parenchyma in patients undergoing endotracheal intubation or tracheotomy after receiving mechanical ventilation for 48 h, which is the most common complication of patients undergoing mechanical ventilation and has a high mortality rate (21.2%-43.2%). At present, the main measures to prevent and control VAP are to strictly implement hand hygiene, strengthen oral care, raise the bedside, effectively remove secretions from the airbag, implement airbag management and ventilator circuit management, carry out enteral nutrition and cluster intervention strategies according to the actual situation of hospitals. This article reviews the characteristics, diagnosis, prevention and control of VAP, aiming to provide reference for better prevention and control of VAP.

Effects of enteral nutrition intervention on immune and nutritional indexes of patients with gastric malignant cancer during postoperative chemotherapy

Abstract Objective The aim of this study was to investigate changes in nutritional status and related indexes in patients with Nutritional Risk Score (NRS) ≥ 3 gastric cancer after nutritional support treatment. Methods A total of 50 patients with gastric cancer were divided into two groups according to the different nutritional support treatment they received during postoperative chemotherapy: immune-enhanced enteral nutrition group (n = 25) and conventional enteral nutrition group (n = 25). Changes in patient’ body mass index (BMI), hemoglobin (HB), serum total protein (TP), serum albumin (ALB), and immune indexes (CD3+, CD4+/CD8+, CD3+/CD8+) were monitored before and after chemotherapy. At the same time, the incidence and classification of gastrointestinal adverse reactions after chemotherapy were assessed. Results Compared with the conventional enteral nutrition group, the nutritional and immune indexes in the immune-enhanced enteral nutrition group were significantly improved. After chemotherapy, the incidence of adverse reactions in the digestive tract was relatively lower and the grade was reduced. Conclusion Immune-enhanced enteral nutrition support can significantly improve the nutritional status of patients, improve immune function, increase the susceptibility of cancer patients to chemotherapy, reduce toxicity and adverse effects, and improve the quality of life of tumor patients compared with conventional enteral nutrition support.

Intensive care nurses' knowledge of enteral nutrition at public hospitals in Sana'a, Yemen: a cross-sectional survey

Background: Nurses have a pivotal role in initiating and managing enteral nutrition (EN) and monitoring any potential complications. Yet, it is unclear whether Yemeni nurses have adequate knowledge to deliver and manage enteral nutrition safely. Therefore, the aim of this study was to assess the level of ICU nurses’ knowledge regarding the management of EN. Methods: A descriptive cross-sectional study was conducted from February 2019 to March 2019. A probability sampling method was used to recruit 174 nurses from four public hospitals in the capital city of Yemen. A self-administered 17-item questionnaire related to ICU nurses' knowledge regarding EN intervention was used to collect the data. Results: Out of the 174 respondents, 60.9% were females, 48.9% were aged between 20 and 25 years and 66.1% had a 3-year nursing diploma. Most respondents (79.3%) had one to five years of working experience as nurses, while almost two-thirds (70.7%) had one to five years of working experience as an ICU nurse. Above half (59.2%) of the respondents had never attended training courses on EN management and 65.5% specified that the college or institute of nursing was the source for their knowledge about EN management. Only 10.9% of the respondents had an adequate level of knowledge, while (43.1%) of them had a moderate level of knowledge and 46.0% of them had an inadequate level of knowledge regarding the EN management. Significant associations between the level of ICU nurses' knowledge of EN management and their level of education and the sources of knowledge were detected. Conclusions: The significant gap in ICU nurses’ knowledge regarding EN management identified implies the need to upgrade and refresh of the ICU nurses' knowledge by implementing a regular training program concerning EN management.

Integrated strategy based on microecological therapy in the treatment of inflammatory bowel disease

Inflammatory bowel disease (IBD) is a group of chronic, recurrent, and inflammatory intestinal diseases. At present, it is believed that the destruction of intestinal homeostasis may be the cause of the onset and progression of IBD. Under normal circumstances, the maintenance of intestinal homeostasis depends on the balance among the intestinal microbes, the intestinal mucosal barrier, and the immune system. Accordingly, the treatment strategy for IBD must take into account micro-ecological reconstruction, immune regulation and intestinal barrier function recovery. Because different patients have different responses to incentives, different treatments, or those at different stages of the disease course show different disease behaviors, multidisciplinary collaboration seems quite necessary. This article aims to introduce a five-in-one integrated treatment strategy, including microecological treatment, immunotherapy, enteral nutrition, interventional therapy, and surgical treatment.

Effect of Exclusive Enteral Nutrition on the Disease Process, Nutrition Status, and Gastrointestinal Microbiota for Chinese Children With Crohn's Disease.

The aim of this study was to prospectively study the effect of exclusive enteral nutrition (EEN) treatment on Chinese pediatric Crohn's disease (CD) patients. Thirty-one newly diagnosed CD patients were enrolled in this study and treated with EEN for 8 weeks. Twelve healthy controls (HCs) donated their fecal samples. Statistical methods were used to compare the differences. According to the Simple Endoscopic Score for CD (SES-CD) at the end of the EEN treatment, 21 patients with SES-CD ≤4 were classified into the remission group (CD-RE), and 10 patients with SES-CD >4 were classified into the nonremission group (CD-NRE). After EEN therapy, there was a significant decrease in the SES-CD, the weighted Pediatric Crohn's Disease Activity Index (wPCDAI), and fecal calprotectin (FCP) in the CD-RE group (all P < .001). The wPCDAI and FCP also decreased in the CD-NRE group (both P < .05). In terms of nutrition improvement, the CD-RE group patients showed more improvement in weight gain, hemoglobin, and serum albumin level than the CD-NRE group patients (all P < .05). For the microbiota, the CD patients had a lower bacterial diversity and different bacterial community compared with HCs. EEN increased overall diversity and was able to shift the dysbiosis in CD patients toward a healthier state. Absence of improvement in wPCDAI and Shannon index at 2 weeks predicts poor response at the end of EEN. EEN can be used in most Chinese pediatric CD patients to induce remission and improve nutrition.

Effects of nutritional interventions on nutritional status in patients with gastric cancer: A systematic review and meta-analysis of randomized controlled trials.

Nutritional interventions may improve quality of life, morbidity and mortality in gastric cancer (GC) patients. A growing number of randomized controlled trials (RCTs) evaluated different nutritional strategies - oral nutritional supplements (ONS), enteral nutrition (EN), enteral immunonutrition (EIN), parenteral nutrition (PN) and nutritional counselling - in GC patients. This systematic review and meta-analysis aims to assess the effects of these nutritional interventions on nutritional status of GC patients undergoing gastrectomy and/or chemotherapy. A systematic literature search was performed in Pubmed, Web of Science and Scopus databases from inception to March 2020, based on fixed inclusion and exclusion criteria. Effect sizes were estimated with mean difference (MD) or standard mean difference (SMD) with 95% confidence interval (CI) and heterogeneity was assessed by measuring inconsistency (I2) based on chi-squared test. Pooled analyses and quality assessment were performed with Review Manager 5.3. A total of 25 RCTs were identified, including ONS (n=7), EN (n=6), PN (n=4), EIN (n=5) and nutrition counselling (n=3) interventions. Ten RCTs with 1838 patients were deemed eligible for pooled analyses. Body weight loss was found lower in ONS group versus control group (MD 0.77; 95% CI-0.02-1.56; p=0.05). PN and EIN studies did not assess body weight, while all nutrition counselling studies did not show significant differences (p>0.05). Twenty-three out of 25 studies evaluated serum protein levels - albumin (ALB) and/or prealbumin (PA) and/or transferrin (TF). ALB levels did not significantly differ (p>0.05) in 4 ONS studies. Significant improvements of PA levels from baseline to postoperative day (POD)≥7 were shown in EN compared with PN groups (MD 19.90; 95% CI 10.09-29.70; p<0.0001). Compared with EN, EIN interventions showed no significant improvements of ALB, PA and TF levels (p > 0.05) from baseline to POD≥7. Amino-acid enriched PN showed no significant improvements of ALB, PA and TF levels (p>0.05) while the effect of omega-3 enriched PN was debated. Only three studies out of 25 evaluated total fat mass and skeletal muscle mass and no significant differences (p>0.05) were found between ONS versus control groups. Whereas our meta-analysis showed promising results from ONS and EN interventions the optimal delivery of GC nutritional support and nutritional status assessment are still unclear. Moreover, the majority of studies did not consider muscle mass and strength as nutritional parameters. This review highlights the crucial need to close this research gap, with high-quality, large RCTs, adopting effective nutritional assessment tools to evaluate the appropriateness of nutrition strategies.

Comparison of Perioperative Standard and Immunomodulating Enteral Nutrition in Patients Received Major Abdominal Cancer Surgery: a Prospective, Randomized, Controlled Clinical Trial

The aim of this study was to compare the effects of standard and immunomodulating enteral nutrition on the clinical outcomes of the patients undergoing major abdominal cancer surgery. Patients who underwent a major elective abdominal cancer surgery in our clinic were randomly assigned preoperatively to two groups according to enteral nutritional intervention; Standard (ST) or Immunomodulating (IM) group. The patients who were randomized to ST and IM groups received Resource® 2.0 fiber and OraI Impact® RTD 7 days prior to surgery and 30 days after surgery, respectively. The outcome variables were as follows; infections (surgical site infection, pneumonia, abdominal abscess or septicemia), non-infectious complications (wound dehiscence, anastomotic leak, adult respiratory distress syndrome (ARDS), multi-organ failure), need for intensive care unit admission, need for re-operation, length of hospital stay, and hospital mortality. A total of 78 patients were randomized (n = 39 in each group). Forty-five (58%) of patients were male and mean age was 62.9 ± 13.4 (25–85). The mean pre-operative Body Mass Index (BMI) and Nutritional Risk Screening (NRS-2002) scores were 26.5 ± 5.4 and 2.3 ± 1.1, respectively. There were no significant differences in gender, age, BMI, and NRS-2002 scores between groups (p ≥ 0.05). ASA scores, surgical interventions also were similar in two groups. Rate of surgical site infection in groups ST and IM was 72% (n = 28) and 15% (n = 6), (p < 0.001). Rate of pneumonia in groups ST and IM was 25% (n = 10) and 0% (n = 0), (p < 0.001). Rate of urinary tract infection in groups ST and IM was 33.3% (n = 13) and 5.1% (n = 2), (p < 0.03). Length of hospital stay in groups ST and IM was 8.4 ± 4.8 and 6.1 ± 1.4, respectively (p < 0,003). There were no significant differences in other outcome variables between groups (p ≥ 0.05, for all comparisons). Perioperative immunomodulating enteral nutrition may reduce the incidence of surgical site infection, pneumonia, urinary tract infection and length of hospital stays in patients who received abdominal cancer surgery.

Economic value of nutritional support methods in gastrointestinal cancer: A quantitative meta-analysis.

Multiple studies of the relative economic value of different nutritional support methods for patients with gastrointestinal cancer have provided inconsistent results. The PUBMED and EMBASE databases were systematically searched through September 30, 2018to identify latent studies of the benefits of parenteral nutrition (PN), enteral nutrition (EN) or conventional intervention (CI) in gastrointestinal cancer patients. A fixed-effects model or random-effects model was applied depending on the heterogeneity of the studies. Statistical analysis was conducted using R software. A total of 728 studies were reviewed, and 21 studies published from 1998 to 2018 were included in the final analysis. The results showed that the hospitalization expenditure of the EN group was 3938 RMB less than that of the PN group. Similarly, the EN group had a shorter length of hospitalization than the PN and CI groups. The infection rate was lower in the EN group (12%) than in the PN group (16%) and CI group (20%). Subgroup analysis showed that gastrointestinal cancer patients who received oral nutritional supplements had the lowest infection rate (11%) after surgery. EN, especially oral nutritional supplements, has a positive economic impact on patients with gastrointestinal cancer, based on reductions in the post-operative infection rate, length of hospitalization, and hospitalization expenditure.

P091 Dietary triggers of colonic inflammation following treatment with exclusive enteral nutrition in children with Crohn’s disease

Abstract Background Exclusive enteral nutrition (EEN) ameliorates gut inflammation in children with Crohn’s disease (CD). We have previously described the rapid rise in faecal calprotectin levels (FC) when children with CD return to their habitual diet after EEN treatment (1). We performed dietary assessment and measured biomarkers of food consumption in faeces of children with CD during early food reintroduction. Methods A composite outcome of clinical remission post EEN (weighted Paediatric Crohn’s Disease Activity Index &amp;lt;12.5) and a significant drop in FC (FC decrease: &amp;gt;500 mg/kg / &amp;gt;35%) was used to define the patient group. All patients completed 3-day estimated weight food diaries and provided a faecal sample. Patients were divided equally for statistical analysis purposes in two groups; above (Group 1) and below (Group 2) the median FC concentration at food reintroduction. Nutrient analysis was performed with WinDiets. Short-chain fatty acids, the gluten immunogenic peptide (GIP) and starch were measured in stool, as proxy of fibre, gluten and malabsorbed starch, respectively. Food groups were assigned using the National Diet and Nutrition Survey approach and statistics employing taxonomy were utilised in the food group analysis. All data are displayed using medians (Q1, Q3). Results Fourteen children provided an FC sample within 21 (15, 51) days post EEN. Patients were of similar age, weight and height (p = 0.4, p = 0.37, p = 0.79). Total energy intake did not differ between the groups (p = 0.37). Patients in Group 1 consumed more fibre than Group 2 [12.1 g (11.3, 19.9) vs. 9.9 g (7.6, 12.1), p = 0.04]. Protein and phosphorus intakes, expressed as a percentage of reference nutrient intakes, were also higher in Group 1 than Group 2 [protein (%): 262 (195, 291) vs. 211 (88, 215), p = 0.02], [phosphorus (%): 241 (171, 290) vs. 177 (131, 1901), p = 0.04]. Butyrate and valerate levels were higher in Group 1 than Group 2 [butyrate: 62.5 (41.8, 114) vs. 34.1 (29.2, 49.6), p = 0.02; valerate: 13.7 (9.3, 17.9) vs. 4.5 (2.3, 8.1), p &amp;lt; 0.01. There were no differences in GIP and faecal starch levels between the two groups. Red and processed meat intake was higher in Group 1 than Group 2 [151 g (66.7, 190) vs. 63.3 g (21.7, 67), p = 0.02)]. Cereals intake was non-significantly higher in Group 1 [389 (207, 405) vs. 231 (141, 279), p = 0.08]. Overall diet diversity did not differ between the two groups (p = 0.47). Conclusion The current analysis suggests that fibre, protein, phosphorus and red and processed meat may be associated with recurrence of colonic inflammation in children with CD during early food reintroduction. These findings should be confirmed in larger studies. Reference