Improvement In Nutritional Parameters Research Articles

High β-Glucans Oats for Healthy Wheat Breads: Physicochemical Properties of Dough and Breads

Bread is a highly consumed food whose nutritional value can be improved by adding an oat flour (Avena sativa L.-variety Bonaerense INTA Calen-Argentina) to a high-industrial quality wheat flour (Triticum aestivum L.). This cultivar of oat contains high amounts of β-glucans, which act as a prebiotic fiber. Wheat flour was complemented with different amounts of oat flour (5, 15, and 25%). A contribution of hydrophilic components from oat flour was evident in the oat-wheat mixtures. At the same time, the high content of total dietary fiber led to changes in the rheological properties of the dough. Mixtures with a higher proportion of oats showed an increase in alveographic tenacity (stiffer dough), higher stability, and a lower softening degree in farinographic assays. The dough showed significant increases in hardness and gumminess, without significant changes in cohesiveness, i.e., no disruption to the gluten network was observed. Relaxation tests showed that the blends with a higher oat content yielded 10 times higher stress values compared to wheat dough. Analysis of the oat-wheat breads showed improvements in nutritional parameters, with slight decreases in the volume and crust color. The crumb showed significant increases in firmness and chewing strength as the amount of oats added increased. Nutritional parameters showed that lipids, dietary fiber, and β-glucans were significantly increased by the addition of oats. Sensory analysis achieved high response rates with good-to-very good ratings on the hedonic scale set. Thus, the addition of oats did not generate rejection by the consumer and could be accepted by them. Breads with wheat and oats showed nutritional improvements with respect to wheat bread, since they have higher dietary fiber content, especially in β-glucans, so they could be considered functional breads.

Optimizing nutrition in chronic pancreatitis

This review aims to discuss recent developments in the nutritional management in chronic pancreatitis. Nutritional assessment should be comprehensive and include dietary history, anthropometry, and biochemical nutritional parameters. Micronutrients should be evaluated at least yearly and dual-energy X-ray absorptiometry (DEXA) at every 2-yearly intervals. Studies on pancreatic enzyme replacement therapy (PERT) have primarily evaluated coefficient of fat excretion (CFA), coefficient of nitrogen excretion (CNA), and stool weight. Two RCTs, in which patients were treated with PERT for 7 days in a blinded manner and subsequently extended for 6-12 months in an open-label manner, showed improvement in nutritional parameters. However, two subsequent RCTs failed to show any benefit, and the most recent observational study demonstrated persistence of malnutrition even after PERT. The reason for the latter findings were nonadherence to PERT and poor oral intake of calories. Therefore, it is essential to educate the patients on adherence, counsel on taking high-protein, high-calorie diet, and supplement nutrients in those with inadequate oral intake. Other associated manifestations, such as diabetes and related complications, and anxiety/depression could also contribute to malnutrition directly or indirectly, and should, therefore, be adequately managed. Nutritional assessment should be performed meticulously. Nutritional therapy should not be restricted to only PERT and nutritional supplementation, but should also include dietary counselling and disease related education.

P064 Association Between Crohn's Disease (CD) and Transient IgM and IgG Immunodeficiency-Diagnostic and Management Challenges.

Background: CD is an inflammatory disease that predominantly affects the gastrointestinal tract and has a progressive course. Immunodeficiencies can occur by altering different components of innate or adaptive immune responses. Such changes put the patient at greater risk for infectious diseases or non-infectious complications. Among the non-infectious complications are cancer, autoimmune diseases and gastrointestinal diseases, which should be suspected in patients with recurrent infections, with clinical, radiological or histological features of the disease are atypical or in the occurrence of an unsatisfactory response to conventional therapy. To describe a case report of a CD patient complicated with enteric alterations related to immunodeficiency. A 31-year-old male patient started presenting abdominal pain, diarrhea, and weight loss in October 2020. He underwent a colonoscopy that showed diffuse involvement of the colon suggestive of CD. He didn`t respond to therapy with prednisone and azathioprine and lost 40kg until January 2021, when he was referred to an IBD center. He had signs of malnutrition (eg, BMI = 15.4, Albumin = 1.8g/dL). The MRI showed diffuse thickening of the walls of the entire length of the ileum, colon and rectum, associated with submucosal edema and more intense enhancement in the inner layer. Findings compatible with nonspecific diffuse ileocolitis. After negative infectious screening, hydrocortisone, azathioprine and infliximab were prescribed, but the patient remained clinical worsening. During the 6 weeks of therapy use, the patient presented oral candidiasis, septic pyoarthritis, DNA testing for Clostridium difficile and PCR for Cytomegalovius were positive. Despite the treatment of infectious diseases, the patient continued to worsen and was considered a primary non-response to anti-TNF, opting for the initiation of Ustekinumab. There was improvement in endoscopic and fecal calprotectin, but continued progression of ileal disease and diarrhea, with no response to enteral or parenteral nutritional therapies. An investigation for immunodeficiencies was carried out and IgM/IgG deficiency was noted, and parenteral immunoglobulin was started. He presented an intestinal subocclusion, requiring a loop ileostomy. In this surgery, it was decided to send a sample of ileal tissue for diagnostic differentiation, where ileitis was observed with intense plasma cell reaction and lymphoid nodular hyperplasia, uncharacteristic of DC, which may correspond to enteropathy secondary to immunodeficiency. Despite the treatment, the patient presented fungal endocarditis, esophageal moniliasis and septic condition of undetermined origin. He remained in hospital for 120 days until complete improvement of the infectious complications. With the slow improvement in nutritional parameters, there was a reduction in the incidence of infections as well as an increase in immunoglobulins. After five months of combined nutrition and anti-interleukin therapy, the patient presented clinical improvement, weight gain and complete normalization of IgG and IgM. Ileal disease is in regression and in the colon, in endoscopic remission. We present a case report of the initial presentation of DC complicated with severe malnutrition where there was depletion of part of immunoglobulins, resulting in infectious and non-infectious complications, where ileal involvement intensified the manifestation of colonic DC.

Exclusive Enteral Nutrition Plus Immediate vs. Delayed Washed Microbiota Transplantation in Crohn's Disease With Malnutrition: A Randomized Pilot Study.

Background: The potential of washed microbiota transplantation (WMT) in Crohn's disease (CD) has been reported. This study aimed to explore the suitable timing of WMT in patients with CD complicated with malnutrition.Methods: This is a randomized, open-label study. Patients with active CD complicated with malnutrition were included and 1:1 randomized to undergo WMT at day 1 (group WMT-DAY1) or day 8 (group WMT-DAY8). The observation duration was 15 days. Exclusive enteral nutrition (EEN) was administered in both groups. The primary outcome was the improvement in nutritional parameters at day 8 and day 15 in two groups. The secondary outcome was the rate of clinical remission at day 15 in two groups.Results: Totally 19 patients completed the trial. At day 8, the lymphocyte count, albumin and prealbumin increased significantly compared to those at day 1 in group WMT-DAY1 (p = 0.018, p = 0.028, p = 0.028, respectively), while no significant increase in any nutritional parameter was shown in group WMT-DAY8. At day 15, albumin increased significantly compared to that at day 1 in both groups (p < 0.05), while significant increase in prealbumin was only shown in group WMT-DAY1 (p = 0.004) compared to that at day 1. The rate of clinical remission at day 15 in group WMT-DAY1 and group WMT-DAY8 was 87.5% (7/8) and 72.7% (8/11), respectively (p = 0.603).Conclusion: EEN combined with immediate WMT intervention could rapidly improve the nutritional status and induce clinical remission in malnourished patients with CD.Clinical Trial Registration: www.ClinicalTrials.gov, identifier: NCT02897661.

Rodeando al enemigo: Colectomía derecha laparoscópica por enfermedad de Crohn estenosante y fistulizante.

Nicolás Avellaneda (1) (ORCID 0000-0002-6802-7125), Augusto Carrie (1) (ORCID 0000-0003-4226-7240), Federico Veracierto (1) (ORCID 0000-0003-3363-8935).&#x0D; &#x0D; Centro de Educación Médica e Investigaciones Clínicas “Norberto Quirno” (CEMIC). Galván 4102, C1431 CABA, Argentina.&#x0D; &#x0D; &#x0D; &#x0D; Introducción.&#x0D; &#x0D; &#x0D; La enfermedad de Crohn presenta una incidencia aumenta en los últimos años en los países industrializados, y la afectación ileocecal es la mas frecuente en esta patología.&#x0D; En una primera instancia los pacientes puede recibir tratamiento médico, pero un porcentaje significativo de estos pueden evolucionar hacia complicaciones de la enfermedad como estenosis o fístulas. Cuando estas se presentan, deben ser tratadas quirúrgicamente, representando un desafío para el equipo quirúrgico porque se trata de pacientes en mal estado general y con gran compromiso inflamatorio a nivel abdominal que dificulta la correcta identificación de los planos anatómicos.&#x0D; &#x0D; 2) Descripción.&#x0D; Se presenta el caso de un paciente de 84 años que ingresa por guardia en nuestra institución por presentar diagnóstico de enfermedad de Crohn de 10 años de evolución, mal estado general y deterioro nutricional severo. Al examen físico se palpa tumor a nivel de flanco derecho y fosa ilíaca derecha.&#x0D; Entero-RMN: Ileon terminal con fístula hacia colon derecho y transverso y cavidad intermedia con colección de 3 cm.&#x0D; Laboratorio: Glóbulos blancos: 12.000x10-9/L, Albúmina: 1,3 gr/dl.&#x0D; Se decide internar al paciente, se instaura tratamiento antibiótico, medidas de sostén y nutrición parenteral total.&#x0D; A las 3 semanas, el paciente presenta mejora en los parámetros nutricionales y en el estado general, por lo cual se programa tratamiento quirúrgico de la patología.&#x0D; Se realiza una laparoscopía exploradora donde se evidencia gran tumor inflamatorio que involucra ileon terminal, colon derecho y transverso. Se logra logra la movilización completa de las estructuras mencionadas, las cuales se exteriorizan por una mini laparotomía mediana supraumbilical, y se hace la resección en bloc del tumor inflamatorio, confeccionando una ileostomía terminal y abocando el colon transverso en tejido celular subcutáneo.&#x0D; Paciente presenta buena evolución postoperatoria, recibiendo el alta senatorial al séptimo día postoperatorio sin complicaciones.&#x0D; &#x0D; 3) Conclusiones.&#x0D; &#x0D; El tratamiento quirúrgico de la enfermedad de Crohn representa un desafío para el cirujano. Realizado por vía laparoscópica y luego de optimizar al paciente desde el punto de vista clínico y nutricional, se pueden obtener buenos resultados postoperatorios.

Rodeando al enemigo: colectomía derecha laparoscópica por enfermedad de Crohn estenosante y fistulizante

1) Introduction. Crohn's disease has an increasing incidence in recent years in industrialized countries, and ileocecal involvement is the most frequent in this pathology. Firstly, patients can receive medical treatment, but many of them can present complications of the disease such as stenosis or fistulas. When these appear, they must be treated surgically, representing a challenge for the surgical team because this are patients in poor general condition and with a large abdominal inflammatory compromise that makes it difficult to correctly identify the anatomical planes. 2) Description. We present the case of an 84-year-old patient who is admitted to our institution in Emergency Service for presenting a diagnosis of Crohn's disease of 10 years of evolution, poor general condition and severe nutritional deterioration. Physical examination revealed a palpable tumor at the level of the right flank and right iliac fossa. Entero-MRI: Terminal ileum with fistula towards the right and transverse colon and intermediate cavity with a 3 cm collection. Laboratory: White blood cells: 12,000x10-9 / L, Albumin: 1.3 gr / dl. Decission is made to admit the patient, antibiotic treatment, support measures and total parenteral nutrition were instituted. At 3 weeks, the patient shows improvement in nutritional parameters and general condition, for which surgical treatment of the pathology is scheduled. An exploratory laparoscopy is performed where a large inflammatory tumor involving the terminal ileum, right and transverse colon is evidenced. Complete mobilization of the aforementioned structures is achieved, which are externalized by a supraumbilical median mini laparotomy, and enbloc resection of the inflammatory tumor is made, performing a terminal ileostomy and leaving the transverse colon in subcutaneous cellular tissue. Patient presented good postoperative evolution, receiving sanatorial discharge on the seventh postoperative day without complications. 3) Conclusions. Surgical treatment of Crohn's disease represents a challenge for the surgeon. Performed laparoscopically and after optimizing the patient from a clinical and nutritional point of view, good postoperative results can be obtained.

Chemical-nutritional quality and oxidative stability of milk and dairy products obtained from Friesian cows fed with a dietary supplementation of dried grape pomace.

The aim of the study was to evaluate the nutritional properties of milk and cheese obtained from Friesian cows fed with a diet supplemented with dried grape pomace, a by-product of the oenological industry, which is very rich in polyphenols. This approach is inspired by the increasing interest in foods containing functional ingredients that may have beneficial effects on human health. During the testing period, analyses of the chemical and nutritional properties of milk and dairy products derived from it were performed; particular attention was given to the effect of cheese ripening on the oxidative stability and fermentation process, evaluating respectively the presence of malondialdehyde and γ-aminobutyric acid. Dietary enrichment with grape pomace did not affect the milk composition but induced modifications in the fatty acid profiles in both milk and cheese with an increase in concentration of linoleic acid, trans-vaccenic acid, rumenic acid and total n-6 fatty acids. Moreover, after 30 days of cheese ripening, an increased oxidative stability and an increased concentration of γ-aminobutyric acid were found. Our results indicated a general improvement in nutritional parameters of milk and related cheese obtained from Friesian cows that received the feeding enrichment with dried grape pomace. Further analysis should be performed to improve knowledge of the chemical and microbiological mechanisms at the source of these findings. © 2019 Society of Chemical Industry.

Effects of Carnitine on Nutritional Parameters in Patients with Chronic Kidney Disease: An Updated Systematic Review and Meta-Analysis.

Protein energy malnutrition is a common problem in patients with chronic kidney disease (CKD). Scattered reports indicate that supplementation of Carnitine may improve patients' clinical symptoms, with significant improvement in nutritional parameters. This systematic review was done to document the evidences of Carnitine effects in nutritional status of CKD patients. Peer-reviewed RCTs on Carnitine administration at any dose in CKD patients with at least four weeks of follow-up were including in the meta-analysis. Online databases (PubMed/Medline, ISI Web of Science, Embase, and Scopus) were searched to October 2017 using selected MeSH terms related to the study topic. Data was extracted independently by two reviewers using a standard form and then cross-checked. Statistical analyses were carried out with Comprehensive Meta-analysis software. Data are presented as standard mean difference (SMD) and 95% confidence interval (CI). According to the predefined criteria, a total of 14 randomized controlled clinical trials were included and screened for data extraction by two reviewers, separately. The preliminary results extracted from meta-analysis have shown that Carnitine can significantly increase the levels of albumin (SMD: -0.861; 95% CI: -1.321, -0.402), total protein (SMD: -0.418; 95% CI: -0.695, -0.141), total cholesterol (SMD: -0.350; 95% CI: -0.564, -0.135), LDL cholesterol (SMD: -0.362; 95% CI: -0.551, -0.173), transferrin (SMD: -1.465; 95% CI: -1.822, -1.108), and hemoglobin (SMD: -0.525; 95% CI: -0.732, -0.318); however there were no conclusive effects of Carnitine on body weight (SMD: -0.057; 95% CI: -0.404, 0.291) and BMI (SMD: -0.567; 95% CI: -1.548, 0.415), in pooled analyses. The results of this meta-analysis showed that there are considerable useful pieces of evidence so far about the effect of Carnitine on nutritional factors; however, there is still doubt about some evidences with this regard. It seems necessary to carry out clinical trials with stronger designs to evaluate the impact of these primary outcomes on the patients' clinical conditions. Having this evidences, the potential role of Carnitine in improving malnutrition consequences in CKD patients would be clearly defined.

Alfapump® system vs. large volume paracentesis for refractory ascites: A multicenter randomized controlled study

Patients with refractory ascites (RA) require repeated large volume paracenteses (LVP), which involves frequent hospital visits and is associated with a poor quality-of-life. This study assessed safety and efficacy of an automated, low-flow pump (alfapump® [AP]) compared with LVP standard of care [SoC]. A randomized controlled trial, in seven centers, with six month patient observation was conducted. Primary outcome was time to first LVP. Secondary outcomes included paracentesis requirement, safety, health-related quality-of-life (HRQoL), and survival. Nutrition, hemodynamics, and renal injury biomarkers were assessed in a sub-study at three months. Sixty patients were randomized and 58 were analyzed (27 AP, 31 SoC, mean age 61.9years, mean MELD 11.7). Eighteen patients were included in the sub-study. Compared with SoC, median time to first LVP was not reached after six months in the AP group, meaning a significant reduction in LVP requirement for the AP patients (AP, median not reached; SoC, 15.0days (HR 0.13; 95%CI 13.0-22.0; p<0.001), and AP patients also showed significantly improved Chronic Liver Disease Questionnaire (CLDQ) scores compared with SoC patients (p<0.05 between treatment arms). Improvements in nutritional parameters were observed for hand-grip strength (p=0.044) and body mass index (p<0.001) in the sub-study. Compared with SoC, more AP patients reported adverse events (AEs; 96.3% vs. 77.4%, p=0.057) and serious AEs (85.2 vs. 45.2%, p=0.002). AEs consisted predominantly of acute kidney injury in the immediate post-operative period, and re-intervention for pump related issues, and were treatable in most cases. Survival was similar in AP and SoC. The AP system is effective for reducing the need for paracentesis and improving quality of life in cirrhotic patients with RA. Although the frequency of SAEs (and by inference hospitalizations) was significantly higher in the AP group, they were generally limited and did not impact survival. Lay summary: The alfapump® moves abdominal fluid into the bladder from where it is then removed by urination. Compared with standard treatment, the alfapump reduces the need for large volume paracentesis (manual fluid removal by needle) in patients with medically untreatable ascites. This can improve life quality for these patients. www.clinicaltrials.gov#NCT01528410.

Very Low Calorie Diets for Weight Loss in Obese Older Adults—A Randomized Trial

Obesity contributes to disability in older adults, and this is offset by weight loss and exercise. Very Low Calorie Diets (VLCDs) achieve rapid weight loss; however, these have not been rigorously evaluated in older people. A randomized trial was conducted from August 2012 through December 2015. The intervention was 12 weeks of thrice weekly exercise combined with either healthy eating advice (Ex/HE), hypocaloric diet (Ex/Diet), or VLCD (Ex/VLCD). Outcomes were physical function, measured by 6-minute walk test (6MWT) and De Morton Mobility Index (DEMMI). Other measures were body composition measured by Dual Energy X-Ray Absorptiometry, and nutritional parameters (albumin, vitamins B12 and D, ferritin and folate). 36, 40, and 41 participants were randomized to Ex/HE, Ex/Diet, and Ex/VLCD, respectively. At 12 weeks, weight was reduced by 3.7, 5.1, and 11.1% (p < .01), respectively. Ex/VLCD had significant reduction in fat (16.8%), lean mass (4.8%), and bone mineral density (1.2%), but increased relative lean mass (3.8%). DEMMI improved by 14.25, 14.25, and 13.75 points in Ex/HE, Ex/Diet, and Ex/VLCD, respectively; however, there was no between-group difference (p = .30). 6MWT improved by 53.1, 64.7, and 84.4 meters in Ex/HE, Ex/Diet, and Ex/VLCD (p = .18). Post hoc stratification for gender and adjustment for initial physical function and type 2 diabetes only revealed significant between-group differences for men in the 6MWT, with improvement by 57.8, 77.8, and 140.3 meters in Ex/HE, Ex/Diet, and Ex/VLCD, respectively (p = .01). Improvements in nutritional parameters were seen in Ex/VLCD, but not in Ex/HE and Ex/Diet. The VLCD was well tolerated. VLCDs have potential in the treatment of obesity in older persons; of particular benefit is improvement in nutritional status. The gait speed improvement observed in men warrants further investigation.

Up date nutritional support for patients with COPD

Chronic Obstructive Pulmonary disease (COPD) is associated with multiple comorbid conditions including ischemic heart disease, peripheral muscular dysfunction, osteoporosis, osteopenia, glaucoma, anemia, anxiety , depression, caquexia and malnutrition. A number of individuals with COPD experience involuntary weight loss as the condition progresses and weight loss, muscle wasting and tissue depletion are commonly seen. Malnutrition has a negative impact on the clinical course of COPD. The negative impact of malnutrition has led to interest in nutritional assessment and supplementation, alone or in combination with anabolic substances or appetite stimulants, in an effort to improve disease outcome. The effects of nutritional supplementation on weigh gain and anthropometric parameters were small suggesting that oral supplementation alone is of limited efficacy. The studies with anabolic steroids or growth hormone showed improvement in nutritional parameters but no improvement in exercise capacity. Large randomized trials that include measure of lean body mass, exercise capacity and quality of life should be stimulated.

Depression in End-Stage Renal Disease Patients: A Critical Review

Depression is the most common psychological disorder in end-stage renal disease (ESRD) patients with a prevalence rate as high as 20% to 25% by some contemporary estimates. There are several studies linking depression with mortality in ESRD, making early diagnosis and treatment essential. The mechanisms linking depression with survival in ESRD patients are unclear but may be related to treatment compliance, improvement in nutritional parameters, increased perception of social support, and modulation of the immune system. Although the best methods for depression screening remain controversial, recent research has validated cutoff values for some of the more common depression screening questionnaires for evaluation in ESRD hemodialysis (HD) patients. A cutoff score of 14 to 16 for the Beck Depression Inventory is believed to have the most sensitivity and specificity at making the psychiatric diagnosis of depression in ESRD HD patients. There are limited data regarding the treatment of depression in ESRD patients. Selective serotonin reuptake inhibitors, at initial low starting doses, may be used in close consultation with mental health providers if no active contraindication to their use exists. Data on the mechanisms linking depression and mortality and the optimal treatment of depression in ESRD patients await the performance of randomized controlled clinical trials.

New insight of amino acid-based dialysis solutions

Malnutrition is a major complication of peritoneal dialysis (PD) and is associated with increased morbidity and mortality. Daily losses of proteins and amino acids (AAs) into dialysate contribute to this problem. Previous metabolic balance study demonstrated that treatment with 1.1% AA-based dialysis solution is safe and may improve protein malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients ingesting low protein intake. Other prospective studies also showed that AA solution can provide nutritional benefit for malnourished PD patients resulting in a significant improvement in some biochemical and/or anthropometric nutritional parameters. However, there are other studies showing no particular improvement in nutritional parameters after long-term use of AA solution. This may be related to the differences in the study design, sample size, methods used to assess nutritional status, and other factors such as dietary intake and comorbidities of study subjects. Published data will be reviewed to further emphasize the nutritional benefit of long-term use of AA solution in malnourished PD patients along with a brief discussion on the various reasons that may partly explain the different study results. We will also present the results of a longitudinal observational study evaluating changes in nutritional parameters following use of one exchange of 1.1% AA solution in malnourished Korean PD patients. A significant improvement of somatic protein status such as lean body mass (LBM) and hand grip strength was observed. No significant change in serum albumin level was noted. Patients with a positive estimated coefficient for LBM in the fitted regression model to the repeated observations over 1 year were classified as responders and patients with neutral or negative coefficient were considered as non-responders. Thirty-one out of 43 malnourished patients (72%) showed nutritional benefit based on the change of LBM. Hand grip strength and back lift strength were significantly higher in responders at baseline. Other baseline parameters did not differ between the two groups.

Undernutrition is predictive of early mortality after palliative self-expanding metal stent insertion in patients with inoperable or recurrent esophageal cancer

Self-expanding metallic stents (SEMS) are a first-line therapeutic procedure in the palliative treatment of dysphagia in patients with esophageal cancer. However, the impact of SEMS insertion on patient nutritional status has never been assessed. To evaluate the nutritional status of patients after insertion of a SEMS and the impact of a preexisting undernutrition status on survival. Retrospective observational study. A total of 120 patients treated in a single center by insertion of a SEMS for relief of dysphagia in the palliative treatment of esophageal cancer were retrospectively included. Efficacy of SEMS was assessed by the Ogilvie's dysphagia score. Patient nutritional and clinical statuses were evaluated at SEMS insertion, and patients were regularly followed until death. Independent predictive factors of early 30-day mortality were researched. Dysphagia scores decreased after SEMS insertion in 89.1% of patients, with median scores decreasing from 3.0 to 1.0 (P < .05). There was a significant decrease in body mass index (BMI) (P < .04), serum albumin level (P < .01), and World Health Organization (WHO) performance index (P < .02) at a 1-month evaluation. Serum albumin level, BMI <18 kg/m(2), and WHO performance index >2 at SEMS insertion were independent predictive factors of 30-day mortality. This study suggested that palliative stent placement in esophageal cancer was effective to relieve dysphagia but was not followed by an improvement of nutritional parameters. Moreover, it underlined the key role played by undernutrition on survival.

Clinical profile and natural history of children with HIV infection

As the HIV infection spreads in India, increasing number of children are affected. We report the clinical manifestations, the laboratory parameters and follow up of these children. We reviewed case records of all children diagnosed as pediatric HIV infection since 1995 in our department at a tertiary care hospital in north India. Since September 1999, all children with HIV infection registered in our clinic were prospectively followed up. Complete clinical and laboratory evaluation was performed at baseline and thereafter children were followed up. The children were managed according to standard treatment guidelines. 109 children (82 boys, 27 girls) were diagnosed to have HIV infection. The median (range) age at presentation was 48 months (range: 0.75 months-180 months). Eighty one (74.3%) children acquired the infection vertically. Ninety-one (83.5%) children were symptomatic at time of presentation. The common symptoms in the former were failure to thrive (81.3%), recurrent fever (73.6%), diarrhea (50.5%) and recurrent or persistent pneumonia (44%). All children had poor nutritional status at baseline. Of the 67 children who followed up, 36 were receiving antiretroviral drugs (32 received 3 drugs), while families of 31 children did not opt for antiretroviral therapy. Children receiving antiretroviral therapy showed improvement in nutritional parameters. Majority of children with HIV infection presented with various clinical manifestations, poor nutritional status and immunosuppression. Administration of nevirapine based antiretroviral therapy leads to improvement in growth and immune restoration.

Clinical course of prenatally detected primary vesicoureteral reflux

The purpose of this study was to report the clinical course of medium-long-term follow-up of children with prenatally detected vesicoureteral reflux (VUR). Between 1986 and 2004, 53 (41 males) children with VUR detected by investigation of prenatal hydronephrosis were followed up for a mean time of 66 months (range: 6-200 months). Newborns were investigated by ultrasound, voiding cystourethrogram (VCUG) and DMSA scan. Follow-up clinical visits were performed at 6-month intervals. After 24 months patients were investigated by conventional VCUG or direct isotope cystogram. Survival analysis was performed in order to evaluate the resolution of the reflux. Differences between subgroups (mild vs moderate/severe reflux) were assessed by the two-sided log rank test. Thirty (58%) infants presented bilateral VUR, for a total of 83 renal units. There was a predominance of severe reflux (54%). Renal damage was detected in 33.7% of the units on first renal scan. There was a significant correlation between severe reflux and renal damage scars (RR=3.4, 95% confidence interval [CI], 1.4-8, p=0.002). Forty-seven patients were treated with continuous prophylaxis. One patient developed systolic hypertension. Urinary tract infection occurred in 12 (25%) children conservatively managed. VUR resolution was evaluated in 56 renal units. Spontaneous resolution was observed in 25 units (45%). At 48 months after diagnosis, 75% of the cases of mild reflux (I-III) and 37% of severe reflux (IV-V) had resolved (log-rank, 5.6, p=0.017). There was an improvement of nutritional parameters between admission and the end of follow-up. In conclusion, the clinical course of prenatally detected VUR followed up on a medium-long-term basis is relatively benign. Our study corroborates the results obtained in other series of infants with reflux that emphasized the heterogeneity of this disorder.

Oral Glutamine Supplementation Decreases Resting Energy Expenditure in Children and Adolescents With Sickle Cell Anemia.

To determine the effects of orally administered glutamine on the resting energy expenditure (REE) and nutritional status of children and adolescents with sickle cell anemia. Twenty-seven children and adolescents (13 boys, 14 girls), 5.2 to 17.9 years old (median 11.0 years), received orally administered glutamine (600 mg/kg per day) for 24 weeks. Measures of REE and other nutritional parameters were compared at baseline and 24 weeks. After 24 weeks, the patients' median REE (kcal/d) decreased by 6% (P = 0.053) as indicated by the Harris Benedict equations and by 5% (P = 0.049) as indicated by the modified equations. Patients with less than 90% ideal body weight had even greater declines in REE after 24 weeks (P < 0.03 and 0.02, respectively). Improvements in nutrition parameters and in two amino acids in the plasma were observed. After 24 weeks of orally administered glutamine, children and adolescents with sickle cell anemia had a decrease in REE and improvement in nutritional parameters. Those who were underweight had a greater decrease in REE than those of normal body weight. Lowering REE may be an effective way to improve the growth of these children and adolescents.

Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long-term follow-up.

Nutritional depletion, either macronutrient- or micronutrient-related, is common in patients with drug-refractory gastroparesis (GP) for which there is often no effective treatment. We studied a group of 12 patients (4 men, 8 women; mean age, 35.7 years) who had symptoms of GP and were a subset of the Gastric ElectroMechanical Stimulation trial of gastric electrical stimulation. Patients' symptoms were of long duration (7.3 years) and associated with diabetes mellitus (3 patients) or were idiopathic (9 patients) as etiology. The patients had permanent gastric electrical stimulation devices surgically implanted after a positive trial of temporary stimulation. Patients had baseline measures of gastrointestinal total symptom score (TSS), laboratory (albumin and related) measures, weight (kg), body mass index, and route of nutrition: oral feeding, enteral tubes, or hyperalimentation, repeated at 3, 6, and 12 months. Intermediate-term follow-up was done at 1 to 2 years, and long-term follow-up was done at 5 years and included gastrointestinal TSS, weekly vomiting frequency score, and nutrition and overall health-related quality-of-life measures. Gastric electrical stimulation was associated with rapid improvement over the short-term in TSS (35.6 at baseline to 16.6 at month 12; p < .05), body weight, body mass index, and serum albumin over the short term with most parameters improving by 3 to 6 months. Intermediate (1 to 2 years) and long-term (5 year) data showed continued improvement in TSS, vomiting frequency (weekly vomiting frequency score 3.9 at baseline to 1.7 at 5 years; p < .01), quality-of-life measures, and maintenance of weight gain. Gastric electrical stimulation implantation resulted in improvement of nutritional parameters throughout the first 12 months, as nausea and vomiting decreased and oral intake increased. This improvement in nutritional measures is maintained long-term and is associated with improvements in quality of life. Gastric electrical stimulation should be considered as a therapeutic option for any patients with refractory GP and nutritional compromise.

Improvement in Nutritional Parameters After Initiation of Chronic Hemodialysis

Protein‐calorie malnutrition is highly preventable in patients with chronic renal failure and on chronic dialysis therapy. Longitudinal studies evaluating nutritional outcomes after the initiation of chronic dialysis therapy in incident dialysis patients are limited. Methods: This prospective cohort study evaluated time‐dependent changes in several well‐defined markers of nutritional status before and after initiation of chronic hemodialysis therapy. Fifty incident hemodialysis (HD) patients (60% men, 38% white, 32% with insulin‐dependent diabetes mellitus) were studied. Multiple nutritional markers, including biochemical parameters and analysis of body composition, were assessed before the initial outpatient chronic HD treatment and every 3 months thereafter for 12 months. Results: At baseline, nutritional markers correlated well with each other. After the initiation of HD therapy, there were marked improvements in most nutritional parameters, including serum albumin, serum prealbumin, normalized protein catabolic rate, fat mass, reactance, and phase angle (P &lt; 0.05 for all). Improvements in nutritional parameters were influenced by baseline nutritional status, ie, baseline nutritional parameters were predictors of their end‐of‐study value. Conclusion: Initiation of chronic HD therapy is associated with improvements in most nutritional markers. Nutritional benefits of increased solute clearance provided by the initiation of chronic dialysis therapy prevail over its potential catabolic effects. However, the extent of improvement was dependent on nutritional status at the time of initiation of dialysis therapy, which remained an important determinant of subsequent nutritional improvements during the first year of treatment.

The nutritional status of chronic renal failure patients following the initiation of hemodialysis treatment

The nutritional status of chronic renal failure patients following the initiation of hemodialysis treatment