Nutrition Therapy Research Articles

A cross-sectional survey of prehabilitation among surgeons and anesthesiologists

BackgroundPrehabilitation, which includes nutritional and exercise therapies, is recommended for patients before surgery to improve physical and cognitive functions. This study aimed to identify the awareness, understanding, and issues among surgeons and anesthesiologists regarding the implementation of prehabilitation.MethodsWe conducted a survey on prehabilitation targeting surgeons and anesthesiologists working at a university hospital and two private hospitals. The survey collection period was set for 1 month, commencing on February 5, 2024. Descriptive statistics were employed to summarize the characteristics of the participants.ResultsA total of 254 surgeons and 49 anesthesiologists from three hospitals participated, with a response rate of 61.7%. Regarding the understanding of prehabilitation, 16.7% of anesthesiologists and only 2% of surgeons had a good grasp of its content. When enquired about the necessity of prehabilitation, 100% of anesthesiologists indicated it as necessary or somewhat necessary, whereas 98.7% of surgeons responded similarly. Several barriers to the implementation of prehabilitation were identified, with the most common reason being the busy schedule of outpatient services.ConclusionThis study highlights that while both surgeons and anesthesiologists recognize the importance of prehabilitation, significant challenges exist in its practical implementation. This underscores the need for simple explanatory tools for patients, the introduction of remote care options, and simple orders to relevant departments, which are essential and require multidisciplinary collaboration.

Navigating Chronic Kidney Disease: Through Culturally Sensitive Medical Nutrition Therapy

Navigating Chronic Kidney Disease: Through Culturally Sensitive Medical Nutrition Therapy

Perioperative use of enteral nutrition with ω-3 polyunsaturated fatty acid in patients with gastric cancer: a meta-analysis.

To systematically evaluate the efficacy and safety of enteral nutrition with ω-3 polyunsaturated fatty acid preparations or standard enteral nutrition preparations used in patients with gastric cancer during perioperative period, and to provide reference for clinical rational drug use. Pubmed, EMbase, The Cochrane Library, CNKI and Wanfang Medical databases were searched by computer to collect relevant literature. The search period was from the establishment of the database to August 1, 2024. Meta-analysis was performed using Revman5.4 software after two researchers independently screened literature, extracted data, and evaluated the risk of bias in included studies. A total of 20 randomized controlled studies were included. The Meta results showed that there was no statistical difference in mortality between the enteral nutrition with ω-3 polyunsaturated fatty acid group and the control group (RR = 0.46, P = 0.17). However, the IEN group demonstrated superior advantages in reducing infection complications (RR = 0.81, P = 0.05) and wound infection (RR = 0.61, P = 0.04) among gastric cancer patients, as well as improving immune-related indicators (including IgG, IgA, IgM, CD4, and CD4/CD8), inflammation-related markers (including CRP, IL-1β, and IL-6), and nutritional indicators (including Total protein, Albumin, and Transferrin). enteral nutrition with ω-3 polyunsaturated fatty acid preparation has advantages in the efficacy and safety of perioperative nutritional therapy in patients with gastric cancer, and can be used as a clinical choice. Due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Protein supplementation preserves muscle mass in persons against sleeve gastrectomy.

Sleeve gastrectomy surgery can lead to deficiencies in both macro and micronutrients, with protein being particularly crucial due to its role in muscle mass, physiological, and metabolic functions. Inadequate protein intake due to physiological, psychological, or financial reasons may prevent achieving the recommended intake levels. The significance of this issue is often underappreciated. This study evaluates the impact of protein supplementation on muscle mass in individuals undergoing sleeve gastrectomy and emphasizes the need for more comprehensive dietary training by expert dietitians. Data were collected from 60 participants (15 male, 45 female, aged 20-54) who visited the surgery clinic. Participants were divided into two groups: those receiving the recommended protein supplement (15 g/day) with post-bariatric surgery diet training (BSD + PS), and those receiving only the post-bariatric surgery diet (BSD). A pre-surgery questionnaire gathered health and general information. Daily energy and nutrient intakes were recorded using 24-h food consumption logs on the day before surgery and at 7 days, 1 month, and 3 months postoperatively. Anthropometric measurements, including muscle and fat mass, and International Physical Activity Questionnaire (IPAQ) data were also collected. The characteristics of participants in both groups were similar, although there were more females in the BSD + PS group (86.7%) compared to the BSD group (63.3%). Despite an increase in energy and nutrient intake over time, levels remained below the recommended amounts in both groups. A significant difference was found in protein supplement consumption between the groups (p = 0.000). Repeated measures showed significant differences in body muscle mass percentage over time (F = 202.784; p = 0.000). In individuals who underwent sleeve gastrectomy surgery, deficiencies in macro and micronutrient intake were observed below reference levels. For this reason, the first approach in the treatment of obesity should always be medical nutrition therapy accompanied by a dietician. When designing post-bariatric surgery nutrition programs, it should be taken into consideration that nutrition protocols and trainings should be followed more closely and given in more detail under the supervision of a specialist before supplements are considered.

An intensified trans-sectoral nutritional intervention in malnourished patients with chronic pancreatitis improves diseases prognosis and identifies potential biomarkers of nutritional status.

Malnutrition is a common complication in chronic pancreatitis and associated with reduced quality of life and life expectancy. Nutritional support is considered mandatory in malnourished patients with chronic pancreatitis but there is only scarce evidence on optimal treatment modalities and the efficacy of nutrition therapy. Here, we investigated the feasibility and efficacy of an intensified nutritional intervention in malnourished patients with chronic pancreatitis and aimed to identify suitable indicators for monitoring nutritional status. We performed a single-arm feasibility study, in which malnourished patients with chronic pancreatitis received an intensified trans-sectoral nutritional intervention for 6 months. Multimodal treatment comprised face-to-face dietary counseling, oral nutritional supplementation, and a complementary telephone-based nutrition and exercise coaching. Patients underwent follow-up examinations after 28, 90, and 180 days, when we assessed changes in anthropometric and body composition measures, muscle function, Chronic Pancreatitis Prognosis Score (COPPS), as well as blood parameters and intestinal microbiota composition. Eleven out of 73 patients initially screened for study participation were enrolled in the trial of which 9 subjects (age (mean ± SD): 56.2 (±14.8) years; male: 67%; alcoholic etiology: 44%) underwent the complete intervention. Patients gained a median of 5.3 kg (8.6%) body weight, including 1.6 kg skeletal muscle mass, and significantly increased gait speed (p < 0.001). Ameliorated nutritional status and muscle function were associated with increased blood levels of IGF-1 and cholinesterase as well as altered gut microbiota composition on the phyla and genera level. Moreover, significant improvements in COPPS indicated reduced disease severity after 90 and 180 days. Malnourished patients with chronic pancreatitis benefit from intensified nutritional therapy. Besides ameliorated nutritional status, a multimodal intervention can improve muscle function as well disease prognosis. Future studies are needed to prove superiority to standard-of-care and to validate potential biomarkers for prospective monitoring of nutritional status. https://clinicaltrials.gov/study/NCT04476056, NCT04476056.

Parenteral nutrition customization in pediatrics: A descriptive cohort study.

The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital. We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels. A total of 264 patients, with a median age of 2.2 years (IQR: 0.3-9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = -0.222; P = 0.002). Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.

Evaluation of the Effect of Diet Adherence on Nutritional Status and Metabolic Control in Children with Phenylketonuria Consuming a Phenylalanine-Restricted Diet: A Single-Center Study

Objective: The aim of this study was to determine the dietary habits of patients with phenylketonuria (PKU) in different age groups, to assess energy, protein and phenylalanine intakes, and to evaluate dietary compliance and its effect on metabolic control. Material and Methods: The study, conducted between 1 March 2022 and 30 September 2022, the study involved 20 children aged 2-18 diagnosed with PKU at the Department of Pediatric Metabolism Outpatient Clinic of Ankara Bilkent City Hospital. Participants were evaluated for diet compliance and had their blood phenylalanine and tyrosine levels were measured. Results: Among the 20 patients, 42.9% (n=9) were female and 57.1% (n=11) were male, with a mean age of 4.7±3.22 years. Age distribution was 70% (n=14) aged 2-6, 20% (n=4) aged 6-10, and 10% (n=2) aged 10-13. Patients attended four follow-ups over six months. A moderate negative correlation was found between daily dietary phenylalanine and blood phenylalanine levels in the first and last controls, and a high negative correlation in the 2nd and 3rd controls (p=0.006, p&amp;lt;0.001, p&amp;lt;0.001, p=0.013). A positive moderate correlation was found between the frequency of daily amino acid mixture consumption and diet compliance (p=0.025). Increased meal frequency improved diet compliance. No significant relationship was found between blood phenylalanine levels and amino acid mixture consumption, diet compliance, or daily amino acid mixture consumption frequency. Conclusion: In PKU, nutritional habits, daily phenylalanine intake and amino acid mixture consumption frequency impact dietary compliance and metabolic control. Lifelong medical nutrition therapy requires multidisciplinary team support, frequent follow-ups and adherence to the recommended diet.

8469 Endocrinologists Underutilize Virtual Care Services Resulting in Suboptimal Clinical and Financial Outcomes

Abstract Disclosure: D. Terry: Employee; Self; Valendo Health. Less than 150,000 Medicare patients with diabetes (PWD) receive billable telehealth and remote monitoring services, even though over 12 million PWDs are eligible for these services. This is a missed quality opportunity, as studies show that PWDs who receive these services experience reductions in A1C levels and improvements in TIR. It is also a missed financial opportunity for Endocrinologists, who are among the lowest paid specialists in the US. The economics of Endocrinology are important, because inadequate compensation is leading to access constraints when the diabetes population is growing, and care complexity is increasing. We analyzed billed virtual health claims for every Medicare PWD in 2022. The types of services we examined included: Chronic Care Management (CCM &amp; PCM), Continuous Glucose Monitoring (CGM &amp; RPM), Medical Nutrition Therapy (MNT), and Diabetes Self-Management Training (DSMT). When we looked by Endocrinologist by virtual care service type, we found the following levels of service delivery for Endocrinologists at the median levels of utilization:4.8% of eligible PWDs received remote Continuous Glucose Monitoring support.4.2% received virtual Chronic Care Management services.6.2% received virtual Diabetes Self-Management Support.&amp;lt;1% received Medical Nutrition Therapy This is clearly a missed clinical quality opportunity as a study published in JAMA in October 2023, Comprehensive Telehealth Model to Support Diabetes Self-Management, reported the following improvements for PWDs who received virtual care for 6 months:Mean change in A1C levels: Type 1: -0.6%; Type 2: -1.0%Mean TIR Improvement: Type 1: 16%; Type 2: 18% It is also a missed financial opportunity for Endocrinology practices. Each patient with diabetes is potentially eligible for $100 or more of virtual care services per month. We’ve looked at every Endocrinology practice in the US and many are missing out on over a million dollars of annual revenue opportunity. This is important as Endocrinology organizations everywhere, independent and hospital based, are struggling to retain the doctors &amp; staff necessary to provide adequate access to care - leading to months of wait time to see an Endocrinologist. The prevalence of diabetes is growing significantly, while Endocrinologist capacity is shrinking. Value added and billable virtual care services create new opportunities for Endocrinologist to generate the revenue necessary to increase clinical capacity and improve access by creating diverse clinical teams led by Endocrinologists and supported by Diabetes Educators, Dietitians, and others with expertise in diabetes who can care for many more PWDs. Creating virtual care capabilities is also an early step in moving Endocrinology into Value-Based Care arrangements that reward providers for improving care and reducing costs rather than for generating more visits. Presentation: 6/1/2024

Illustrated eating plan as a strategy for adherence to carbohydrate counting in patients with diabetes mellitus

The carbohydrate counting method is an effective meal planning tool used in diabetes mellitus (DM) patients that focuses on carbohydrates as the main nutrient that affects the glycemic response. Therefore, this study aims to develop a nutritional therapy with carbohydrate counting, providing the inclusion of patients with DM on insulin therapy. This is a clinical-longitudinal and descriptive study, carried out on patients diagnosed with insulin-dependent type 1 or 2 DM, treated at a reference university hospital, in Belém/Pará. It was found that there was a reduction in weight and BMI until the fourth consultation, with an increase in the fifth. Average fasting glucose and total cholesterol decreased significantly throughout the consultations. However, systolic blood pressure and TGO levels showed variations, highlighting the need for continuous monitoring. This study demonstrated the benefits of technology in helping glycemic control in insulin-dependent patients.

8077 Use of Lovaza for Management of Hypertriglyceridemia in Pregnancy

Abstract Disclosure: J. Segarra-Villafane: None. L.R. Sepulveda-Garcia: None. L. El Musa Penna: None. I.C. Arroyo: None. Z. Maisonet -Feliciano: None. W. Medina-Torres: None. M. Alvarado: None. M. Ramirez: None. L.A. Gonzalez-Rodriguez: None. Severe hypertriglyceridemia in pregnancy increases the risk of health complications to both mother and fetus, including preeclampsia, hyperviscosity syndrome and life-threatening pancreatitis. Several case reports include management of hypertriglyceridemia in pregnancy with medical nutrition therapy, omega fatty acids and gemfibrozil but is controversial. There are no formal clinical guidelines for management of severe hypertriglyceridemia in pregnancy which presents a challenge for physicians. Lovaza is a combination of ethyl esters of omega 3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) indicated as an adjunct to diet to reduce triglycerides (TG) levels in adult patients with severe hypertriglyceridemia. Lovaza is Category C (risk cannot be ruled out) and should be used in pregnancy only if the potential benefit justifies the potential risk to the fetus. Case of a 40 years old female G3P1A1 with IUP 25 WGA with history of hypothyroidism, dyslipidemia and episode of acute pancreatitis in 2016 due to hypertriglyceridemia, who was referred to clinics due to uncontrolled lipids and thyroid disease. Laboratories included fasting serum triglycerides (TG) 4357mg/dL (40-150mg/dL), total cholesterol 525mg/dL (120-200), HDL 56mg/dL, LDL invalid due to elevated TG. Thyroid function test revealed TSH of 161uIU/mL (0.43-2.91) and FT4 of 0.24ng/dL (0.8-1.8). HbA1c, lipase and amylase within range. Vital signs were normal. Patient was asymptomatic, no abdominal complaints or hypothyroidism-related symptoms, but hospital admission was recommended due to high risk of pancreatitis and uncontrolled hypothyroidism. She was started on Synthroid 220 mcg IV daily for hypothyroidism and was placed NPO until nutritionist evaluation. Triglycerides levels improved with conservative interventions and low-fat diet. However, TG persisted above 2000mg/dL and, after discussing risks and benefits with patient, pharmacological therapy with Lovaza was started to reach goal of TG less than 1000 mg/dL and reduce potential risk of pancreatitis. Patient agreed to start Lovaza 2gm AM and 2gm PM. After initiation of Lovaza, in addition to dietary modifications and hypothyroidism management, laboratories showed significant improvement in TG levels from 3569 down to 1778 mg/dL. Patient was discharged on Lovaza 2gm oral BID and Synthroid 200mcg oral daily. One month later, TG had decreased to 557mg/dL (0-150) and thyroid tests showed TSH at 0.305mIU/mL and FT4 at 1.71ng/dL. Patient tolerated medications well without side effects and had an uncomplicated pregnancy and delivery. This case demonstrates that severe hypertriglyceridemia during pregnancy can be managed effectively and, more importantly, in a safe manner with Lovaza, in addition to dietary fat restriction. However, additional research is needed if its use is to be included in future pregnancy management guidelines. Presentation: 6/2/2024

Rapid advancement of enteral nutrition and in-hospital mortality in critically ill adults: A retrospective cohort study.

Early enteral nutrition (EN) initiation is recommended for intensive care unit (ICU) patients; however, the optimal rate of EN advancement remains unclear. We aimed to assess the association between EN advancement and in-hospital mortality, as well as length of hospital stay. We performed a retrospective cohort study on 341 critically ill adults receiving EN between January 2021 and December 2023. The exposure of interest was rapid EN advancement, defined as an EN change exceeding the median value calculated between the first and seventh days after EN initiation. The comparator group included patients without rapid EN advancement. Factors related to in-hospital mortality and length of hospital stay were assessed using multivariable logistic and linear regression analyses. Subgroup analyses were performed for EN initiation within 48 h of ICU admission. Rapid EN advancement reduced in-hospital mortality (adjusted odds ratio [OR] = 0.64, 95% CI 0.38-1.07, P = 0.092), although this was not statistically significant. However, rapid EN advancement significantly shortened hospital stay by 25 days (95% CI -25 to -9.2, P = 0.002). In the early EN initiation subgroup, rapid EN advancement significantly reduced in-hospital mortality (adjusted OR = 0.42, P = 0.039) and shortened hospital stay by 48 days (95% CI -77 to -19, P = 0.001). Rapid EN advancement reduced in-hospital mortality and length of hospital stay in critically ill patients, especially with early EN initiation. These findings could inform clinical practices that enhance timely and adequate nutrition therapy in ICUs. Further randomized controlled trials can help establish clinical guidelines.

Does Insulin Treatment Affect Umbilical Artery Doppler Indices in Pregnancies Complicated by Gestational Diabetes?

Background/Objectives: Gestational diabetes mellitus (GDM) is one of the most common morbidities of pregnancy. The impact of increased maternal blood glucose on fetoplacental hemodynamics is not fully elucidated, especially in patients with uncontrolled GDM necessitating insulin therapy. The objective of this study was to assess the impact of insulin therapy on the umbilical artery dopplers in GDM pregnancies adequate for gestational-age fetuses. Methods: Retrospective observational study among 447 GDM pregnant women, divided according to their treatment (nutritional therapy (NT), long acting (LA) insulin, combined insulin) and 100 healthy controls with the same gestational age. The umbilical artery pulsatility index (UA-PI) was recorded at 28, 32 and 36 weeks. Results: UA-PI values declined in both GDM and healthy controls at all three time intervals. The combined insulin group showed reduced UA-PI values in comparison to the LA insulin group, but the difference never reached statistical significance. The combined insulin group exhibited significantly reduced UA-PI values at 32- and 36-weeks' gestation compared to the NT groups. Conclusions: A decreased impedance to blood flow in the umbilical artery of diabetic mothers on insulin therapy was observed. This was more pronounced during the last trimester. The extent to which umbilical artery PI can predict unfavorable outcomes has yet to be determined. Further additional studies are necessary to confirm the precise impact of glucose levels and medical interventions on the circulation of both the fetus and the mother.

A lifespan perspective on fetal alcohol syndrome: Developmental challenges and outcomes

Fetal alcohol syndrome (FAS) and fetal alcohol spectrum disorder (FASD) result from alcohol exposure during the intrauterine life of the fetus and are the most common nonheritable, avoidable causes of intellectual disability and a wide range of neurobehavioral outcomes. Alcohol causes neurotoxicity in the developing brain. Children with FASD experience behavioral issues from an early age and progress to adulthood. The prevalence of alcohol consumption among women is increasing. Clinically, symptoms in children with FAS manifest in a wide range of ways, probably as a result of the quantity and timing of alcohol exposure, as well as maternal and genetic effects. All of these elements contribute to the mechanisms through which alcohol harms a growing brain, the specifics of which are still largely unknown. Neuroimaging reveals alterations in the structure of the brain, white matter structure, cortical development, and functional connections. However, recent advancements and ongoing research have yielded encouraging findings that could result in the use of FAS screening tools and therapy for individuals. Intervention aims to enhance development, address behavioural challenges, and ensure suitable educational programming. Prioritizing early childhood intervention is crucial to prevent secondary disabilities that may arise from delays in obtaining a definitive diagnosis of Fetal Alcohol Syndrome. Effective nutritional therapies as well as cognitive rehabilitation are now being tested. This disorder represents the intersection of complicated societal, community, family, and biological circumstances that increase the risk for intergenerational suffering, health disparity, and social injustice. This paper aims to guide healthcare professionals and policymaker in enhancing the quality of life for individuals with FAS through effective strategies.

Ketogenic diet - A gateway to optimize aerobic and anaerobic athletic performance

This narrative review aims to highlight the effect of the Ketogenic diet on aerobic and anaerobic athletic performance. This paper adopts a narrative approach exposing the results of approximately 40 earlier studies to define the scope of applying the ketogenic diet as a nutritional therapy, aiming to aid recovery from fatigue or muscle damage caused by exercise and to increase aerobic and anaerobic performance. A ketogenic diet appears better suited for lower-intensity physical activities conducted in a balanced or moderate state of energy demand. However, there is a lack of consensus on its compatibility with strength exercises that require maximal bursts of energy. These investigations should explore its effects on performance, health, and body composition compared to other dietary approaches. Ultimately, a better understanding of the ketogenic diet's benefits and limitations will help athletes and individuals make informed decisions about its adoption for optimizing their health and athletic goals. Keywords: Injuries, ketogenic, ketosis, aerobic exercises, anaerobic exercises, muscle damage

A-348 Portable aptamer-based home monitoring system for blood phenylalanine measurement

Abstract Background Aptatek BioSciences, Inc. has developed a home monitoring tool for blood phenylalanine (phe) levels. The Aptatek system integrates a proprietary aptamer assay approach with a user-friendly handheld, smartphone-enabled test platform. PKU (phenylketonuria), is an inborn error of phenylalanine (Phe) metabolism If undiagnosed or untreated, phe accumulates in all body tissues, including the blood and brain, where it is especially neurotoxic and when untreated it can cause significant cognitive impairment and neurological defects. PKU management targets maintaining blood Phe concentration within the therapeutic range (120-360uM) to avoid severe neurological sequelae, mainly through nutritional therapy. Methods PheCheck™ includes a portable hand-held reader, software accessible as a mobile phone application, and a disposable single-use lateral flow cassette, blood collection, cap, and buffer chamber. PheCheck™ detects phe by binding of the phe in a small blood sample using small molecule-specific DNA aptamers. A patient (or caregiver) collects 5μl of capillary blood using a lancet to lance the fingertip and use the collection cap to collect the specimen. Once collected, the specimen is placed into the buffer chamber where the blood is diluted and processed in preparation for a lateral flow assay. The buffer chamber is placed on top of a lateral flow cassette to release the solution into the cassette. The lateral flow cassette is inserted into a small electronic reader after specimen incubation. The reader will detect a fluorescent signal from the strip and report the quantitative Phe concentration present in the specimen to the integrated mobile phone application. The reader has a simple design with a single operating push button, USB data connection port, and replaceable battery compartment. The reader reads the output of the lateral flow cassette and reports the result to a Smartphone app. The app is designed to either display the quantitative results or store the results without displaying the quantitative value. Results Twelve patients were trained on the PheCheck system and observed using the system for self-testing. Patients also prepared dried blood spot cards for comparative testing using LC-mass spectrometry. Patients were asked to return to the clinic within two weeks to retest. The blood phenylalanine levels measured by the PheCheck system were within targeted standard deviation of the dried blood spots demonstrating the feasibility of portable home-based testing for routine monitoring of blood phenylalanine levels in phenylketonuria patients. Such a portable system would enable real time monitoring and adjustment of diet or therapy for chronic diseases such as PKU. Conclusions Aptatek has developed a DNA aptamer based portable monitor for measuring blood phenylalanine levels. The system quantitatively measures phenylalanine from a 5-microliter finger stick blood sampler. Aptamer-based detection of phenylalanine provides reliable quantitation across a wide clinical concentration range and encouraging performance relative to gold standard testing of venous blood draw or dried blood spots. Analysis of samples from patients on Palynziq indicate that the PheCheck system could provide more reliable testing than venous blood draws. The system shows strong promise for routine home monitoring of blood phe levels by patients.

Nutrition Rehabilitation in Oncopathology: Opportunities and Prospects

Nutritional corrective support is an integral component of rehabilitation programs in the perioperative period for oncological pathology. The aim of this study was to evaluate the effectiveness of including remaxol in the rehabilitation treatment regimen for gastroenterological cancer patients. Material and methods. The treatment results of 42 patients with gastric outlet tumors and small intestine tumors were retrospectively analyzed. Remaxol was included in the adjuvant therapy for patients in the main (I, N=22) group: intravenously 400 ml at a rate of 40–80 drops/min (2–4 ml/min) once a day for 10 days. Patients in the comparison group (II, N= 20) received traditional nutritional therapy. The study used both traditional clinical diagnostic methods and methods for assessing the risks of nutritional deficiency and the rehabilitation potential of the body, its adaptive capabilities, and disease prognosis. Results. All patients showed signs of severe nutritional deficiency, endotoxemia, intoxication, and hepatotoxicity. Liver detoxification parameters were better in patients who received remaxol as an adjuvant therapy than in the comparison group. Conclusions. Cancer patients with a high nutritional risk and moderate to high nutritional deficiency are at a higher risk of developing toxic complications requiring adjuvant therapy. The inclusion of remaxol in adjuvant therapy reduced the severity of hepatotoxic reactions in these patients. The data obtained made it possible to recommend its inclusion in treatment regimens for patients with this pathology.

Evaluation of Body Composition and Biochemical Parameters in Adult Phenylketonuria

Background/Objectives: Phenylketonuria is a hereditary metabolic disorder characterized by a deficiency of phenylalanine hydroxylase. The main treatment for PKU is a phenylalanine-restricted diet. The exclusion of protein rich natural foods and inclusion of low-Phe substitutes may give rise to an imbalanced diet, and the increased risk of overweight and obesity in PKU is a cause for concern. We aimed to evaluate the body composition and nutritional biochemical biomarkers in adult PKU patients who are on Phe-restricted and essential amino acid-supplemented nutrition therapy and to investigate the relationships between these parameters and patient gender, adherence to dietary therapy, and disease type, defined as mild or classic PKU. Methods: The study group comprised 37 PKU patients and 26 healthy siblings as controls. The participants were assessed based on an analysis of anthropometric parameters, body composition, and biochemical test results. Results: PKU patients do not have a higher incidence of overweight and obesity than healthy controls, the proportion of energy derived from carbohydrates in their diets was below the recommended level, and their total energy intake was below the recommended daily allowance. It was remarkable that patients with a treatment adherence ratio of &lt;50% displayed a higher prevalence of overweight and abdominal obesity in comparison to those with a more favorable treatment adherence ratio. Conclusions: In view of the growing prevalence of overweight in the general population, PKU patients should be kept under close long-term follow-up. Particularly in the group with low treatment compliance, more caution should be taken in terms of adverse outcomes.

Clinical evidence of low-calorie and ketogenic nutrological therapy before, during and after bariatric surgery: a systematic review

Introduction: Obesity is a multifactorial disease that causes serious comorbidities. There are more than 2.2 billion overweight and obese people in the world. Obese patients tend to be predisposed to micronutrient deficiency even before bariatric surgery, therefore, it is imperative to supplement nutrients orally, enterally, or parenterally, according to the indications of each patient. Objective: It was highlighted the importance of low-calorie and ketogenic nutritional therapy before, during, and after bariatric surgery through the systematic analysis of clinical studies. Methods: The systematic review rules of the PRISMA Platform were followed. The search was conducted from June to July 2024 in the Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 119 articles were found. A total of 40 articles were fully evaluated and 34 were included and developed in the present systematic review study. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 23 studies with a high risk of bias and 27 that did not meet GRADE and AMSTAR-2. Most studies presented homogeneity in their results, with X2=76.5%&gt;50%. It was concluded that nutrological therapy strategies could represent a possible alternative to other methodologies, especially when it is recommended to improve patient adherence to following the prescribed diet before bariatric surgery. Weight loss induced by the ketogenic diet before bariatric surgery has beneficial effects on reducing liver volume, metabolic profile, and intra- and postoperative complications. Knowledge of the type of bariatric surgery performed and an understanding of its anatomy and physiology are useful to provide optimal care to patients, especially in nutritional complications. Nutritional deficiencies and metabolic disorders result from “malabsorption” procedures such as RYGB. Immediate administration of thiamine is essential. Dextrose should be avoided in intravenous hydration until thiamine is adequately replaced. For all bariatric patients, a protein intake of 60-70 g/d and a multivitamin with iron and vitamin B12 supplementation is recommended. Daily calcium and vitamin D supplementation is also encouraged. In addition, serum micronutrient levels should be monitored regularly and additional supplementation should be prescribed as indicated.

Protocolo terapéutico y seguimiento del paciente con diabetes mellitus tipo 1 y obesidad

Treatment protocol and follow-up of patients with type 1 diabetes and obesity This protocol focuses on the management of obesity in patients with type 1 diabetes mellitus (DM1), a growing problem due to factors such as lifestyle, insulin treatment, and hypoglycemia. The approach includes four key pillars: nutrition therapy, drug therapy, physical activity, and management of insulin therapy. Nutrition therapy is the first line of treatment and is based on calorie reduction and a diet rich in fiber. In addition, there are pharmacological options for the management of overweight in patients with DM1, although they have specific challenges, such as euglycemic diabetic ketoacidosis. Physical activity and the adjustment of insulin therapy also play an essential role in weight and glycemic control. In severe cases, bariatric surgery is a viable option for patients with severe obesity.

The usefulness of a new indirect calorimeter in critically ill adult patients and its impact on nutritional therapy

The usefulness of a new indirect calorimeter in critically ill adult patients and its impact on nutritional therapy