Nutritional Status Of Malnourished Patients Research Articles

Nutritional disorders and nutrition-related conditions: an underestimated clinical problem in systemic sclerosis

Nutritional disorders are significant but often underestimated complications in patients with systemic sclerosis (SSc). The most prevalent nutritional disorders in SSc are malnutrition, affecting up to 62.5% of patients, and sarcopenia, with a frequency of up to 42%. Thus, clinical vigilance is recommended for the detection of eating disorders in SSc patients, particularly those with gastrointestinal involvement, cardiopulmonary complications, an advanced disease stage, and high disease activity. Nutritional treatment should be carefully tailored to the patients’ clinical condition to ensure that it effectively addresses their specific needs. Studies focusing on enteral nutrition in SSc patients demonstrate its effectiveness in stabilizing or improving nutritional status in malnourished patients. In severe cases, parenteral nutrition offers viable options to support patient health. The findings highlight the importance of early nutritional assessment and intervention in improving patient outcomes and suggest that individualized nutritional therapy can be a critical component of comprehensive care for SSc patients.

High-Protein Nutritional Supplements Improve Nutritional Status in Malnourished Patients with Systemic Sclerosis.

(1) Background: Impaired nutritional status in systemic sclerosis (SSc) is prevalent. (2) Objective: This study aimed to identify pre-cachexia and malnutrition in SSc patients and to estimate the effectiveness of a high-protein oral nutritional supplement (ONS) in improving their nutritional status. (3) Materials and methods: The SSc population comprised 56 patients and a control group of 49 healthy persons. After a baseline clinical evaluation, bioelectrical impedance analysis (BIA), and laboratory tests, SSc patients were divided into well-nourished, pre-cachectic, and malnourished categories. SSc patients with a nutritional disbalance received a high-protein ONS once daily for 3 months. Patients were reassessed at 3 and 12 months after inclusion in the study. (4) Results: SSc patients, in comparison to the control group, had a significantly lower seven-point SGA value [6(0) vs. 7(1), p < 0.001)], lean tissue mass [LTM, 35.1 (10.5) vs. 40.1 (10.10), p = 0.008], and lean tissue index [LTI, 13.5 (3) vs. 14.9 (4), p = 0.009]. Of the 56 SSc patients, 40 (71.4%) were well nourished, 5 (8.9%) had pre-cachexia, and 11 (19.7%) were malnourished. A high-protein ONS in the pre-cachexia group stabilized the SGA value, anthropometric measurements, and BIA after 3 and 12 months. In malnourished patients, it significantly improved the SGA value [5(0) vs. 6(0), p = 0.002], LTI [12.1 (2.1) vs. 12.7 (3.2), p = 0.021] and LTM [31.1 (7.7) vs. 35.1 (9.1), p = 0.021], and that effect remained stable at 12 months. (5) Conclusion: Malnutrition is a common complication of SSc that can be improved with nutritional intervention.

Evaluation of improved nutritional status in patients over 60 years with 6-month follow-up by a nutritionist in a hospital setting in Almería. The MOR-NUT study

Background: non-institutionalized elderly patients who are prescribed an oral nutritional supplement (ONS) often have difficulties with compliance, which leads to physical deterioration and increases the risk of malnutrition. Objective: to assess improvement in the nutritional status of patients over 60 years of age, using the Mini Nutritional Assessment (MNA) score after the intervention of a nutritionist during a 6-month follow-up of malnourished patients with an indication for ONS. To demonstrate that the intervention of a nutritionist provides long-term improvements in the nutritional status of malnourished patients who are taking an ONS. Results: the nutritional intervention significantly improved BMI (from 22.9 ± 4.5 to 24.0 ± 4.1; p = 0.001) and the MNA score (from 14.7 ± 4.4 to 20.4 ± 5.8; p < 0.001) of the patients, as well as their perception of health (measured by VAS). Conclusions: the nutritional advice provided by a nutritionist to patients who were taking an ONS provided a high rate of adherence to treatment, which resulted in improvement in the nutritional status of patients.

The Effectiveness of a High-Protein Liquid Dietary Supplementation in Improving Nutritional Status of Malnourished Patients in Hospital Care: a Preliminary Study

Background: Malnutrition is a very common problem in hospitalized patients. Based on studies conducted in various countries, the prevalence of hospital malnutrition ranges from 20-45%. Hospital malnutrition can occur as a result of insufficient nutrient intake, impaired absorption of nutrients in the gastrointestinal (GI) tract, loss of nutrients due to disease, or increased metabolic requirement during illness. Nutrition is the basis for the healing process as it requires good nutrients through various enzymatic reactions. Some studies have shown that hospital malnutrition increases morbidity, mortality, prolongs the duration of hospitalization, and delays recovery. To improve nutritional status, a high-protein diet can be given. Liquid diet is one of the alternative forms of nutrition because it is easier to swallow.Method: This study was a double-blind randomized controlled trial conducted to assess the effectiveness of high protein liquid dietary supplementation in malnourished hospitalized patients. The patients were assessed for their nutritional status based on ESPEN 2015 criteria. Patients who experienced malnutrition will be divided into 2 groups, namely the control group which was given normal protein liquid diet, while the intervention group was given high protein liquid diet supplementation as much as 2 bottles (200 mL) per day for 7-10 days. Furthermore, the nutritional status of the patient was assessed.Results: By administering high-protein liquid diet supplementation, there was a tendency to increase the strength of the right handgrip in 3 subjects (50%), the tendency to increase body mass index (BMI) in 3 subjects (50%), Subjective Global Assessment (SGA) score improved in 2 subjects with mild/moderate malnutrition (33.3%) and 1 subject with normal nutrition (16.7%), and the tendency to increase the fat-free mass in 3 subjects (50%).Conclusion: The administration of high protein liquid dietary supplementation tended to increase the strength of the right handgrip, BMI, SGA score, and body fat-free mass index.

The importance of proper use of oral nutritional supplements in oncological patients undergoing surgery.

&lt;b&gt;Introduction:&lt;/b&gt; There are many natural approaches that may improve the nutritional status in malnourished patients. Increased consumption of natural food is a more physiological, attractive, and available form of nutritional therapy of patients than medical nutrition. However, in specific clinical situations, oral nutritional supplements (ONS) may constitute a good support of nutritional management in malnourished cancer patients. Selecting proper ONS and their appropriate use may reduce the risk and progression of malnutrition and significantly affect oncological patient's treatment as well as decrease the rate of postoperative complications. Oral nutritional supplements should be the first nutritional choice to prevent and correct nutritional disorders in oncological surgery patients, especially during the pandemic, with the connected inability to visit patients. Despite this, many specialists recommend improperly adjusted preparations, and they do not consider all ailments and diseases of the patient. If ONS are overused or used inappropriately, they can cause many clinical disorders. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Aim:&lt;/b&gt; This paper aimed to help explain and understand the general recommendations on the proper administration of ONS, their benefits, and difficulties connected with their use in clinical practice.

MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP41)1 Sep 2021MP41-06 THE ROLE OF MALNUTRITION UNIVERSAL SCREENING TOOL IN PREDICTING OUTCOMES AFTER RADICAL CYSTECTOMY Ziv Savin, Aviv Kupershmidt, Snir Dekalo, Dorel Poulin, Ofer Yossepowitch, Alon Lazarovich, Barak Rosenzwieg, Reut Shashar, Azik Hoffman, Jonathan Gal, Miki Haifler, and Roy Mano Ziv SavinZiv Savin More articles by this author , Aviv KupershmidtAviv Kupershmidt More articles by this author , Snir DekaloSnir Dekalo More articles by this author , Dorel PoulinDorel Poulin More articles by this author , Ofer YossepowitchOfer Yossepowitch More articles by this author , Alon LazarovichAlon Lazarovich More articles by this author , Barak RosenzwiegBarak Rosenzwieg More articles by this author , Reut ShasharReut Shashar More articles by this author , Azik HoffmanAzik Hoffman More articles by this author , Jonathan GalJonathan Gal More articles by this author , Miki HaiflerMiki Haifler More articles by this author , and Roy ManoRoy Mano More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002062.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The Malnutrition Universal Screening Tool (MUST) integrates body mass index and unplanned weight loss to assess the nutritional status of patients, and was previously associated with adverse outcomes after gastrointestinal operations. The predictive role of MUST among patients undergoing radical cystectomy is unknown. METHODS: We conducted a multi-center retrospective analysis of 227 patients who underwent radical cystectomy for bladder cancer in 4 medical centers between 2015-2019. Patients were stratified according to the MUST score [MUST=0 (n=188) vs. MUST ≥1 (n=39)]. Baseline clinical, pathological and functional characteristics were compared between groups. Endpoints were 30-day postoperative morbidity, cancer-specific-survival (CSS) and overall survival (OS). Kaplan-Meier curves and cox regression analyses were used to evaluate survival and identify predictors of outcome. RESULTS: Median age of the study cohort was 69 years (IQR 63-74). Median duration of follow up was 23 months (IQR 14-35). Thirty-day major postoperative complication rate (Clavien-Dindo grade 3-5) was 17%. Estimated 2-year OS and CSS rates were 73% and 75%, respectively. Baseline characteristics were not different between the MUST groups. OS and CSS were significantly lower (p <0.001) in the malnourished group (MUST ≥1) with medians of 32 months (95%CI 20-44) and 33 months (95%CI 27-46), respectively, compared to the MUST=0 group (medians were not reached, Figure 1). There was no difference in post-operative complication rates between the groups. On multivariable analysis, MUST ≥1 was found to be an independent risk factor for overall-mortality (HR=2.4, 95%CI 1.4-4.2) and cancer-specific-death (HR=2.5, 95% CI 1.4-4.4). CONCLUSIONS: High MUST scores are associated with decreased survival in patients after radical cystectomy. Therefore, the MUST score may assist in perioperative evaluation and patient selection. Future studies should focus on whether improving the nutritional status of malnourished patients will result in improved ontological outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e762-e762 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ziv Savin More articles by this author Aviv Kupershmidt More articles by this author Snir Dekalo More articles by this author Dorel Poulin More articles by this author Ofer Yossepowitch More articles by this author Alon Lazarovich More articles by this author Barak Rosenzwieg More articles by this author Reut Shashar More articles by this author Azik Hoffman More articles by this author Jonathan Gal More articles by this author Miki Haifler More articles by this author Roy Mano More articles by this author Expand All Advertisement Loading ...

Cookies Prepared using Peanuts, Pregerminated Soybean, and Moringa Leaf Flour Improve Food Intake and Nutritional Status in Malnourished Patients

Meals provided to patients in hospitals is an essential part of their treatment. The meals of malnourished patients have been observed to be devoid of basic nutrients that support patient recuperation. This study examined the effect of consumption of a energy-rich and high-protein cookie, called Pronisi, prepared using peanuts, pregerminated soybean, and Moringa leaf flour, on patients’ food acceptance, food intake, and nutritional status. This was a quasi-experiment study with pretest-posttest with a control group design conducted. The subjects were malnourished-at-risk adult inpatients, divided into intervention group and the control group. The Independent T-test analyses were used to analyze the differences between two groups. Patients’ acceptance of Pronisi is significantly higher in comparison to green bean porridge (p < 0.001). Energy and protein intake from in-between meals in the intervention group was significantly higher (100.68±9.79 kcal; 35.41 ± 0.71 g, respectively) compared to the control group (3.75±0.21 kcal; 2.83±0.22, respectively). There was significantly high reduction in body muscle mass percentage in the control group in comparison to the intervention group (-0.51;-0.43, respectively, p< 0.001). There was a significant difference in SNST (Simple Nutrition Screening Tool) scores in the intervention group in comparison to the control group (0.68 ; 0.63, respectively; p<0.001). Food acceptance, nutritional intake, and nutritional status of malnourished-at-risk patients was high with the provision of Pronisi.

How sweetness intensity and thickness of an oral nutritional supplement affects intake and satiety

Oral nutritional supplements (ONS) can be used to improve the nutritional status of malnourished patients, but their effectiveness depends on adequate intake. This is not always achieved due to the disliked flavour and satiating properties of ONS. The aim of this study was to investigate the effect of sweetness intensity and thickness on intake and sensory sequential profile of an ONS. It was hypothesized that lower sweetness intensity and thickness would decrease oro-sensory stimulation and satiety, improve the sensory profile, and thus, improve ONS intake.The effect of sweetness intensity and thickness on intake and satiety was investigated using a 2 × 2 design (low-high-sweetness and thin/thick). Participants (n = 36) consumed each ONS to satiation. Each ONS was identical in macronutrient and calorie content. Appetite and thirst were measured throughout the morning of the test. Additionally, an expert sensory panel (n = 11), performed a sensory sequential profile of each ONS.No effect of sweetness intensity was found. Results showed that 33% more of the thin, compared to thick, ONS was consumed, without affecting satiety. Furthermore, mouth-drying first increased, up to a consumption volume of 300 ml, and then decreased, independent of sweetness intensity and thickness.In conclusion, this study showed that an ONS with lower thickness increased intake in healthy adults, without affecting satiety. This implies that, for ONS, attention should not be solely focused on nutritional content. Instead, a sensory-nutrition approach is recommended that balances nutritional content with oro-sensory cues. This proof of concept should be further investigated with malnourished older adults.

Oral nutritional supplementation in patients undergoing peritoneal dialysis: a randomised, crossover pilot study.

Malnutrition is a significant problem in those undergoing peritoneal dialysis (PD). Factors such as gastrointestinal (GI) symptoms and the need for a fluid reduced diet can limit tolerance and thereby the efficacy of oral nutritional supplements to treat malnutrition. To evaluate the acceptability and impact of two different forms of oral nutrition supplementation for 16 weeks on nutritional markers and quality of life of malnourished patients undergoing PD. A randomised, within-subject cross-over study. Patients assessed as malnourished or with serum albumin <35 g/l were recruited. Participants were randomised to receive either 200 ml of a 1.25 kcal/ml nutrition supplement or a high protein nutrition supplement bar, for eight weeks. Each group then crossed over to receive the alternative supplement for eight weeks. Total intervention time was 16 weeks. Serum albumin, serum transthyretin and food intake were evaluated at baseline, at 8 and 16 weeks. Subjective Global Assessment, the presence of GI symptoms and quality of life were evaluated at baseline and 16 weeks. Sixteen weeks of nutritional support was associated with statistically significant improvements in weight and a reduction in the proportion of patients who were malnourished. There was no difference in the impact of bars compared with liquid oral nutrition supplementation. Patients preferred the fluid supplement to the bars. Sixteen weeks of nutritional support improved nutritional status in malnourished patients on PD.

Energy- and protein intake of surgical patients after the implementation of energy dense hospital menus

Malnutrition is common among hospitalized patients and is associated with negative health consequences. Oral nutrition supplements (ONS) have been used to improve nutritional status of malnourished patients. Considering the costs and the sometimes poor acceptance of ONS, the present study investigated the effects of changing hospital food composition on patients' energy- and protein intake. One-hundred-and-six patients admitted to the Department of Cardio Thoracic Surgery at University Hospital in Iceland in 2013 were recruited. Inclusion criteria were age ≥18 years, hospital stay of ≥five days and ability to eat. In 2012 a new hospital menu was implemented and the meals contain more energy dense foods in comparison to earlier. Energy- and protein intake from the five meals provided daily were estimated using a validated plate diagram sheet on days 3-5 after surgery and compared to similar data retrieved in 2011. In 2013 92 participants finished the study, data from 69 patients were available from 2011. Energy- and protein requirements were similar between years. Energy provided by meals was higher in 2013 (1711±199 vs. 1946±65kcal, P<0.001), accordingly energy intake from meals was higher in 2013 (1096±340 vs. 1293±386kcal/d; P=0.001). Protein intake from meals was not different. However, the total energy- and protein intake of patients was unchanged between 2011 (1374±394kcal; 62.1±17.8g) and 2013 (1452±389kcal; 60.2±17.2g) because the consumption of in-between meals (ONS or food brought from home) was less in the 2013 (170±171 vs. 282±207kcal, P<0.001 and 13.2±10.3 vs. 6.9±6.5g, P<0.001, respectively). Our study shows that an increase in energy density increases energy consumed from hospital meals, however, they did not increase total energy intake due to a decrease in use of ONS and home brought food.

How can screening for malnutrition among hospitalized patients be improved? An automatic e-mail alert system when admitting previously malnourished patients

Screening for malnutrition is not often done in the management of hospitalized patients. An original computer tool was developed at the Dunkerque hospital to detect readmissions of patients with malnutrition during a previous stay and generate e-mail alerts to the nutrition department. The aim of the study was to describe and evaluate this tool and the activity of the nutrition department in connection with the alerts sent. The number of alerts sent, dietary consultations conducted, assessments of the nutritional status and the number of malnourished patients diagnosed were collected from September 1st to November 30th 2012. The positive predictive value (PPV) of the malnutrition screening tool was estimated. The evolution of the nutritional status between the last and the current hospitalization was also evaluated. A total of 531 e-mail alerts were sent (mean of 8.2 per working day), leading to 205 dietary consultations but only 144 recorded assessments of the nutritional status (lack of information in medical records). Of the latter, 128 diagnoses of malnutrition were made, i.e. a PPV of 88.9%, 95% Confidence Interval = [83.8%, 94%]. Overall, only one quarter of readmitted patients had improved nutritional status. The automatic e-mail alert system is operational and useful to effectively detect patients at risk of malnutrition and make follow up possible. In addition, an unfavorable evolution of the nutritional status of malnourished patients was observed.

Albumin concentration determined by the modified bromocresol purple method is superior to that by the bromocresol green method for assessing nutritional status in malnourished patients with inflammation

The controlling nutritional status (CONUT) score (CS), a simple score for assessing nutritional status, is calculated using laboratory data, including serum albumin concentration. Although dye-binding assays such as the bromocresol green (BCG) and modified bromocresol purple (mBCP) methods are widely used for albumin measurement, acute-phase proteins interfere with the BCG method. We aimed to determine whether the choice of albumin assay affects assessment of nutritional status using CONUT scores (CSs). We measured serum albumin concentrations by the BCG (ALBBCG) and mBCP (ALBmBCP) methods in 44 malnourished inpatients, 27 of whom underwent nutritional intervention, and compared them to 30 age-matched healthy volunteers. In treated patients, CSs were calculated by ALBBCG (CS-BCG) and ALBmBCP (CS-mBCP). C-reactive protein (CRP) concentrations were positively correlated with the difference between ALBBCG and ALBmBCP in malnourished inpatients (r = 0.59, p < 0.001). CS-BCG was always lower than CS-mBCP (lower CS indicates superior nutritional status) in treated patients with persistently high CRP levels. However, in patients whose CRP decreased gradually, this difference diminished over the clinical course. CS-BCG and CS-mBCP were similar throughout their courses in patients with normal CRP concentrations. Adding haptoglobin to the human albumin solutions increased ALBBCG in a dose-dependent manner. The choice of albumin assay affected the assessment of nutritional status using CSs in patients with inflammation. We recommend that the modified BCP assay be used to assess nutritional status, particularly in patients with inflammation.

Higher dextrose delivery via TPN related to the development of hyperglycemia in non-diabetic critically ill patients

The beneficial effects of total parenteral nutrition (TPN) in improving the nutritional status of malnourished patients during hospital stays have been well established. However, recent randomized trials and meta-analyses have reported an increased rate of TPN-associated complications and mortality in critically ill patients. The increased risk of complications during TPN therapy has been linked to the development of hyperglycemia, especially during the first few days of TPN therapy. This retrospective study was conducted to determine whether the amount of dextrose from TPN in the 1st week in the intensive care unit (ICU) was related to the development of hyperglycemia and the clinical outcome. We included 88 non-diabetic critically ill patients who stayed in the medical ICU for more than two days. The subjects were 65 ± 16 years old, and the mean APACHE (Acute Physiology and Chronic Health Evaluation) II score upon admission was 20.9 ± 7.1. The subjects received 2.3 ± 1.4 g/kg/day of dextrose intravenously. We divided the subjects into two groups according to the mean blood glucose (BG) level during the 1st week of ICU stay: < 140 mg/dl vs ≥ 140 mg/dl. Baseline BG and the amount of dextrose delivered via TPN were significantly higher in the hyperglycemia group than those in the normoglycemia group. Mortality was higher in the hyperglycemia group than in the normoglycemia group (42.4% vs 12.8%, P = 0.008). The amount of dextrose from TPN was the only significant variable in the multiple linear regression analysis, which included age, APACHE II score, baseline blood glucose concentration and dextrose delivery via TPN as independent variables. We concluded that the amount of dextrose delivered via TPN might be associated with the development of hyperglycemia in critically ill patients without a history of diabetes mellitus. The amount of dextrose in TPN should be decided and adapted carefully to maintain blood glucose within the target range.

Dietary Counseling Versus Dietary Supplements for Malnutrition in Chronic Pancreatitis: A Randomized Controlled Trial

Up to 50% of patients with chronic pancreatitis (CP) are malnourished. There are limited data on the role of dietary intervention in improving the nutritional status of such patients. The aim was to compare the efficacy of medium chain triglyceride (MCT)-enriched commercial dietary supplements with dietary counseling for homemade food in the management of malnutrition in patients with CP. In a randomized controlled trial, consecutive undernourished patients with CP (body mass index [BMI] <18.5 kg/m(2)) at a tertiary care hospital were randomized to receive either dietary counseling for regular homemade food or commercial MCT-enriched dietary supplements for a period of 3 months to compensate for the dietary calorie deficit. All patients received standard management for CP including pancreatic enzyme supplements. Primary outcome measure was improvement in BMI. Sixty malnourished patients with CP were randomized to counseling group (n = 29; mean age, 32 +/- 10 years; male, 83%) and supplementation group (n = 31; mean age, 28 +/- 10 years; male, 84%). BMI increased in both the counseling group and supplementation group (17.2 +/- 1.7 vs 18.1 +/- 1.8 kg/m(2), P = .001; 16.7 +/- 1.6 vs 18.2 +/- 1.6 kg/m(2), P = .001). There were similar improvements in triceps skinfold thickness, dietary intake, fecal fat, and pain score during a period of 3 months in both groups. There was, however, no significant difference between the counseling and supplementation groups with regard to any of the outcome measures. Dietary counseling for a balanced homemade diet is as good as commercial food supplements in improving malnutrition in patients with CP.

Nutritional support

Malnutrition in surgical practice is common and often undetected. It is associated with increased morbidity and mortality. Identification of patients with or at risk of malnutrition is important, and consideration of nutritional requirements should be part of the assessment of every patient on surgical ward rounds. Artificial nutritional support improves nutritional status in malnourished patients and facilitates improved clinical outcomes and potentially shorter length of hospital stay. All patients should undergo nutrition screening as a part of the admission process and expert help is available from your dietician or nutritional support team. Enteral feeding is always preferable to parenteral nutrition if the gastrointestinal tract is available and functional. It is more physiological, safer and maintains gut barrier function. The simplest form of enteral nutrition is oral nutritional support by sip supplements. These should be used liberally. If this fails, enteral tube feeding is indicated. Enteral feeding tubes can be placed endoscopically, radiologically or surgically, although the nasal route is simplest and can be used for up to four weeks. Parenteral nutritional support can be achieved via a peripheral cannula or by central venous access depending on the available peripheral venous access and duration of planned nutritional support. Parenteral nutrition via central venous access is the most invasive and the infective complications can have serious implications. Multidisciplinary nutritional support teams are essential for safe and effective nutritional support.

Nutritional support

Malnutrition in surgical practice is common and often undetected. It is associated with increased morbidity and mortality. Identification of patients with or at risk of malnutrition is important, and consideration of nutritional requirements should be part of the assessment of every patient on surgical ward rounds. Artificial nutritional support improves nutritional status in malnourished patients and facilitates improved clinical outcomes and potentially shorter length of hospital stay. All patients should undergo nutrition screening as a part of the admission process and expert help is available from your dietician or nutritional support team. Enteral feeding is always preferable to parenteral nutrition if the gastrointestinal tract is available and functional. It is more physiological, safer and maintains gut barrier function. The simplest form of enteral nutrition is oral nutritional support by sip supplements. These should be used liberally. If this fails, enteral tube feeding is indicated. Enteral feeding tubes can be placed endoscopically, radiologically or surgically, although the nasal route is simplest and can be used for up to four weeks. Parenteral nutritional support can be achieved via a peripheral cannula or by central venous access depending on the available peripheral venous access and duration of planned nutritional support. Parenteral nutrition via central venous access is the most invasive and the infective complications can have serious implications. Multidisciplinary nutritional support teams are essential for safe and effective nutritional support.

Ornithine α-ketoglutarate supplementation influences motor activity in healthy rats

Background: Ornithine α-ketoglutarate (OKG) improves nutritional status in malnourished patients. Published and unpublished data suggest OKG may have effects on the central nervous system that may contribute to its action. Objective: We investigated the effect of an OKG-enriched diet on behaviour in healthy rats. Design: Thirty male Wistar rats were randomised in three groups: the OKG group was fed for 5 days (D0–D5) at 90% of spontaneous food intake with an OKG-enriched diet (5 g/kg/d). The non-essential amino acids (NEAA) group was fed similarly with a regimen enriched with NEAA (glycine, alanine, histidine and serine) to be isonitrogenous to OKG group. The ad libitum (AL) group had no treatment and was fed ad libitum with a standard regimen throughout. Rats were tested at D4 for motor activity by actimetry, and at D5 first for spontaneous alternation behaviour measured in the Y-maze, and then for exploratory behaviour measured using the open-field test (stressful environment). Results: We found that OKG supplementation enhanced global motricity by actimetry (AL 772±55, NEAA 811±54 vs. OKG 966±24 arbitrary units, P<0.05) and total numbers of arms visited in the Y-maze (AL 26±2, NEAA 30±3 vs. OKG 38±3, P<0.05). The lack of any effect of the OKG-enriched diet in the open-field test shows that the enhancement of locomotion activity was most probably not due to an increase in anxiety or fear in the rats. Conclusion: An OKG-enriched diet can induce beneficial stimulant effects that may be involved in the mechanism of action of OKG.

Safety, acceptability and efficacy of a high-energy, fibre-containing oral nutritional supplement in malnourished patients: an observational study

We describe an open, uncontrolled, observational study to evaluate the safety, acceptability and efficacy of a high-energy, fibre-containing oral nutritional supplement in patients who were either malnourished or who had experienced recent, acute weight loss and therefore needed a high-energy and/or fibre supplement. Assessments For assessment of safety and tolerance, occurrence of adverse events and oedema were to be documented during the 2-week trial and routine blood biochemistry was measured. The acceptability of the oral nutritional supplement was rated by the patients. In order to assess efficacy, patients’ body mass index (BMI) was calculated at baseline and following 2 weeks of nutritional intervention. Results A daily intake of 400–600 mL of a high-energy, fibre-containing liquid nutritional supplement was well accepted and no adverse events or problems with compliance were recorded. The high acceptability was underlined by favourable ratings of taste, smell, texture and overall acceptability. The patients’ median (interquartile range) BMI increased from 18 kg m–2 (18–19 kg m–2) to 20 kg m–2 (19–20 kg m–2); this increase was highly significant (P < 0.001). Conclusion We conclude that a high-energy, fibre-containing nutritional supplement is safe, well tolerated and associated with improved nutritional status in malnourished patients.

A comparison between oral and nasogastric nutritional supplements in malnourished patients

There is a common perception that malnutrition is an inevitable manifestation of illness, that oral nutritional supplements are not taken or reduce the consumption of oral diet, and that nasogastric feeding is poorly tolerated. This study assessed the efficacy of supplemental enteral feeding on the nutritional status of malnourished patients, to compare oral supplements (OS) with overnight supplemental nasogastric feeding (NG) on nutritional status and to determine the effect of nutritional supplements on oral diet. Malnourished hospital patients were randomized to one of three groups: control (C), OS, or NG. All patients had access to hospital diet. Supplements were prescribed to meet estimated nutritional needs. Nutritional status was recorded at the start and the end of the feeding period. The total nutritional intake was recorded. Weight gain occurred in 64% of the supplemented patients, whereas 73% of the controls lost weight with mean weight changes of +2.9% OS, +3.3% NG, and −2.5% C. There was no difference in the mean energy intake from food in the three groups. There were no documented complications of OS and three minor complications of NG. Both methods of supplementation allow weight gain without significantly affecting spontaneous oral intake.

Elemental diets—Facts and fantasies

Sherlock Holmes was recently hospitalized for Crohn’s disease by his friend and personal physician Dr. Watson. When the famous detective asked what he was having for.lunch, Watson replied, “It’s elemental, my dear Holmes!” The elemental diet (ED) has been introduced into clinical practice as one approach to improve the nutritional status of malnourished patients. It is an almost ancient observation that starved and malnourished individuals are less able to cope with the ravages of illness than are their well-fed counterparts. Many sufferers of both acute and chronic diseases may develop protein-calorie malnutrition as an outcome of their disease.’ Although these patients differ from those with starvation in that their premorbid nutritional status was usually adequate, it is often assumed that this disease-acquired malnutrition-will be associated with additional adverse effects. By this reasoning, correction of nutritional deficiency might benefit the patient. Based on these assumptions, an entire technology has arisen to support catabolic patients nutritionally. These techniques employ both parenteral (not to be further considered) and enteral routes. Enteral nutrition can be supplied through a variety of means, most commonly natural food. In the past three decades, a different type of diet has been developed, in which the nutritional elements are individually added to produce a predefined mixture. The first planned human application of these diets was for the use of. astronauts on prolonged space voyages, where the problems of storage, ingestion, and waste disposal were considerably more pressing than they are on the earth’s surface.’ For this reason, they came to be called “space diets.” With their application to the nutritional support of terrestrials, however, these diets became known as “elemental” or “chemically defined.”