Parental Nutrition Research Articles

S2290 Complete Esophageal Obstruction: A Rare Complication of Zollinger-Ellison Syndrome (ZES)

Introduction: Patients diagnosed with ZES typically have minimal esophageal morbidity given advancements in anti-secretory medications. This case presents a rarely documented sequala of modern-day patients with ZES. Case Description/Methods: A 73-year-old man with history of HIV on HAART and ZES presented with worsening dysphagia to both solids and liquids. In the 2 year interval since his original presentation, his medical therapy was quickly maximized to omeprazole 180 mg/day and famotidine 80 mg/day. He also underwent tumor resection with distal gastrectomy, resection of D1, roux-en-Y hepaticojejunostomy, and truncal vagotomy. During that time his gastrin levels normalized from 1941 to 87. Despite these measures, he had undergone 21 EGDs and 7 esophageal stents for dysphagia secondary to refractory esophageal strictures. He lost 48 lbs over 2 years despite extensive attempts at both enteral and total parental nutrition. In January 2022, he presented with inability to swallow his own secretions and profound weakness from malnutrition. An esophagram was performed (figure 1a) revealing complete esophageal obstruction. An EGD with esophageal lumen restoration was attempted using combined retrograde and anterograde recanalization with 2 operators, 2 EGD scopes, and an EUS needle (figure 1c). Unfortunately, the 2 blind loops appeared to be approximately 6 cm apart in different alignments making lumen restoration unfeasible. The patient was most recently evaluated for esophageal reconstruction by jejunal interposition but was not a candidate due to poor nutritional status. Discussion: ZES is characterized by severe ulcerative disease due to gastric acid hypersecretion via neuroendocrine tumors. Our case is unique because this patient developed complete esophageal obstruction (CEO) despite management with maximal acid suppressive therapy, surgical resection, multiple EGDs with dilations, and numerous esophageal stents. CEO is a rare occurrence characterized by lumen obliteration leading to the inability to tolerate own secretions and most recorded cases are due to radiation-therapy for treatment of head and neck cancers. Given the low incidence, there is no single established method for endoscopic lumen restoration. However recombined retrograde and anterograde recanalization and dilation (CARD) has been shown to be successful for strictures less than 3 cm.Figure 1.: (A) Barium swallow study revealing a high-grade stricture in mid thoracic esophagus followed by another high-grade stricture with complete lumen obstruction. (B) EGD showing blind pouch approximately 35 cm from incisors. (C) Fluoroscopic imaging displaying attempt at combined anterograde and retrograde decannulation and dilation.

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute.

Chylothorax is an uncommon cause of pleural effusion in children. This study aimed to determine the characteristics, treatment strategies, and outcomes of chylothorax in children from a single institute. The 65 episodes of chylothorax in patients aged 0-15 years who were diagnosed and received treatment in Songklanagarind Hospital between January 2001 and December 2020 were retrospectively review and analyzed. Of the 65 episodes, 80% were postoperative chylothorax, and were mostly related to cardiac surgery. The most common treatment strategy employed was dietary modification (64.6%). Octreotide was used as adjunctive therapy in 33.8%. Most cases of chylothorax were successfully treated by conservative treatment, while 10.7% required surgical therapy. The median time to resolution of chylothorax was 21 days [interquartile range (IQR): 8-33 days]. Young children aged <1 year were more likely to require mechanical ventilation and develop ventilator-associated pneumonia and catheter-related complications. The factors associated with death or prolonged hospitalization (>28 days) were non-postoperative chylothorax, use of total parental nutrition (TPN) >14 days, hypoalbuminemia, and ventilator-associated pneumonia. Most (89.2%) cases of chylothorax were successfully treated conservatively using dietary modification and octreotide therapy. The modifiable risk factors for death or prolonged hospitalization were use of TPN >14 days and hypoalbuminemia.

S3365 Autoimmune Enteropathy: A Rare Cause of Small Intestinal Villous Atrophy in Adults

Introduction: Autoimmune enteropathy (AIE) is a rare cause of small intestinal villous atrophy. This condition is more frequently diagnosed in children, with only a handful of case series describing its presentation in adults. We present a case of adult-onset AIE in which diagnosis was made based on its unique endoscopic and histologic findings. Case Description/Methods: A 54 year-old previously healthy woman was hospitalized with profuse watery diarrhea, abdominal pain, and weight loss of six months duration. Stool testing was negative for infection. Inflammatory markers were mildly elevated. Computer tomography imaging showed hyperenhancement of the small bowel consistent with enteritis, without evidence of stricture or abscess. She underwent esophagogastroduodenoscopy which revealed diffuse edema of the duodenal mucosa with villous blunting and cracked-earth appearance (Figure A, B). She had normal appearing mucosa of the distal small bowel and colon on video capsule endoscopy and colonoscopy, respectively. Pathology from duodenal biopsies showed chronic active duodenitis characterized by marked villous blunting, reduced goblet and Paneth cells, neutrophilic and lymphocytic infiltration of deep crypts, and basal layer apoptosis (Figure C). Similar findings were seen in random ileal biopsies, while random colon biopsies were normal. Anti-enterocyte antibodies and anti-transglutaminase antibodies were negative. Patient was treated for AIE with intravenous methylprednisolone and she required supplemental parental nutrition. Within days of initiating steroids, her diarrhea had improved and she was transitioned to oral prednisone. Several days later she was weaned off parenteral nutrition and stable for discharge with plans to introduce a thiopurine at follow-up. Discussion: AIE should be suspected in a patient with chronic diarrhea, signs of severe malabsorption, and characteristic histologic features in absence of other causes of villous atrophy such as Celiac disease. Specific histologic features of AIE include absence of goblet cells and Paneth cells and presence of crypt apoptotic bodies in intestinal biopsies. Development of autoantibodies against enterocytes are associated with this condition, but not required for diagnosis. Steroids are the mainstay of therapy and have variable effect. We aim to raise awareness of AIE, as the rarity of this condition can make its diagnosis elusive.Figure 1.: 1A. EGD shows villous blunting and edema of duodenal mucosa. Figure 1B. EGD shows cracked-earth appearance of duodenal mucosa. Figure 1C. Duodenal biopsy reveals chronic active duodenitis characterized by marked villous blunting, reduced goblet and Paneth cells, neutrophilic and lymphocytic infiltration of deep crypts, and basal layer apoptosis.

507. ENHANCED RECOVERY AFTER SURGERY FOR VIDEO-ASSISTED THORACOSCOPIC (VATS) ESOPHAGECTOMY- A PROPENSITY SCORE MATCHING ANALYSIS IN A LOCAL INSTITUTE

Abstract Enhanced recovery after surgery (ERAS) has been implemented in esophagectomy. In our center, a specific and structured ERAS program for esophagectomy was initiated since 2017. In this study, we reviewed the feasibility and value of ERAS program in patients undergoing VATS esophagectomy when compared to a historical cohort. Total 81 Patients who underwent VATS esophagectomy from 2014-2021 were recruited and divided into “ERAS” and “non-ERAS” groups. Propensity score matching (PSM) analysis was performed with patient baseline dermographics, tumour characteristics, and operation details. After PSM, 21 patients on each arm were identified. The primary outcome was hospital stay. The secondary outcomes included various perioperative outcome measures, complications, short-term mortality and overall survival. ERAS group had shorter hospital stay (10 days vs. 23 days, p=0.026), while the readmission rate remained low (4.8%). There were statistically significant improvement in perioperative outcomes including less total parental nutrition use, faster resumption of oral feeding, earlier removal of foley and chest drain, and earlier mobilization. There was no difference in anastomotic leakage rate. Less chest complications was observed in ERAS group. Overall there was less significant morbidities in ERAS group (≥Grade III, 9.5% vs. 43%, p=0.009). While short-term mortality was similar, ERAS group had a trend towards better overall survival rate. (37.7 months vs. 15.6 months, p=0.287). The implementation of ERAS protocol in esophagectomy was feasible. It resulted in a shorter hospital stay with improving perioperative outcomes. Its impact on long term overall survival necessitated further ongoing study. ERAS table.xlsx (could not be inserted).

P367 Candida sepsis in neonates a neglected pathogen: study from neonatal intensive care unit tertiary care hospital

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM IntroductionSignificance of Candida species in neonatal intensive care units (NICU) is increasingly being recognized. It is the third most common cause of late-onset sepsis in NICU patients and accounts for 9 to 13% of bloodstream infections (BSI) in neonates. Although Candida albicans has historically been the most frequently isolated species, recently non-albicans Candida (NAC) have emerged as an important opportunistic pathogen, notably Candida tropicalis, C. parapsilosis, C. krusei, C. glabrata, and C auris. This changing trend and the increasing use of azoles agents is now a matter of concern due to the emerging resistance of the non-albicans species to azoles.AimTo evaluate the Candida sepsis in neonates from neonatal intensive care units from a tertiary care hospital.Material and MethodsA cross-sectional study was conducted in the Department of Microbiology, University College of Medical Sciences and Guru Teg Bahadur Hospital, East Delhi, India, during the period of July 2021 to December 2021. Overall, 30 suspected Candida sepsis patients from neonatal intensive care units were enrolled in the present study. The Candida spp. Isolated was identified as per standard mycological techniques. Preliminary identification was done by colony morphology on SDA, chromogenic media (Hichrome, Himedia Pvt. Ltd.), grown at 45°C, germ tube test, chlamydospore formation, and was confirmed by carbohydrate fermentation and assimilation tests. Antifungal susceptibility testing (AFST) was performed for Fluconazole (25 μg), and amphotericin B (AMB, 100 units) using the disc diffusion method on Muller-Hinton agar supplemented with 2% glucose and methylene blue (5 mg/ml). Zone diameters were interpreted as per the approved Clinical Laboratory Standards (CLSI-M44-A) guidelines. Quality control for AFST was performed using C. albicans-ATCC 90028 and C. parapsilosis-ATCC 22019.Statistical analysisThe statistical analysis was done using Statistical Package for Social Sciences (SPSS) version. The P-value ˂0.05 were considered as statistically significant.ResultOut of 30 Candida species from suspected septicemia neonates, non-albicans Candida (NAC) species accounted for (87%) compared to C. albicans (13.4%). Candida tropicalis was predominant at 9 (30%) followed by C. glabrata 8 (27%), C.parapsilosis 4 (13.3%), and C. krusei 3(10%), Pichia species (4.2%), and C.auris (3.4%). Antifungal sensitivity of the NAC isolates demonstrated >85% resistance to fluconazole amongst C. glabrata, C. parapsilosis, though amphotericin B had 100% sensitivity in all Candida species. The risk factor for candidemia as observed in our study were low birth weight 26(87%), use of broad-spectrum antibiotics 25 (83.4%), presence of an orogastric tube 18 (60%), and total parental nutrition 9 (30%) were significantly associated statistically (P <.05, paired t-test). The overall mortality amongst these neonates was 16.6%.ConclusionFungal BSI has emerged as an important cause of morbidity and mortality in neonates. Reporting of fungal bloodstream infections and the spectrum of species involved are essential measures in neonatal intensive care units in order to implement appropriate preventive and therapeutic strategies.

A participatory approach to redesign a tube connecting system for home parental nutrition

Abstract Patients receiving parenteral nutrition at home suffer from a lower quality of life as they receive continuous therapy for up to 16 hours a day. It is not possible to interrupt nutriton therapy for everyday activities, as any interruption poses a health risk to the patient. Therefore, a ambulatory care services comes twice a day to connect and disconnect. The aim of this project is to develop a system that makes it manageable for patients to interrupt their feeding therapy in a self-determined way. In order to achieve this, enginners and social scientists collaborated to conduct an ergonomics study using the Design of Experiments(DoE) method to compare three commonly used connection systems. Analysis of variance(ANOVA) was used to secure the tests. In parallel, the probands were asked about their subiective feelings during the closure process. The results provided indications for the redesign of a home parenteral nutrition system. As safety is a crucial issue, the opening and closing process of the system was virtually simulated with the min. and max. finger force of the test persons in order to ensure a safe connection and disconnection with the system at all times. Overall, this participatory approach enable the design of the closure system to take account patients'fears wishes.

Transluminal stenting: An intraoperative adjunct for preserving bowel length in the surgical management of necrotizing enterocolitis

Surgical management of necrotizing enterocolitis (NEC) presents a morbid dilemma: it requires maximal preservation of the small bowel length to prevent complications such as short bowel syndrome while ensuring the resection of all necrotic and non-viable bowel segments. We performed a retrospective review of four single institution cases that underwent multiple small bowel resections and anastomoses for NEC. Transluminal stenting was used prior to restoring continuity to preserve small bowel length. All four infants had >40% of predicted bowel length after their procedure, and none of the infants in the first three cases required repeat surgery after the stent removal and returned and restored small bowel continuity. The stent in the fourth case is the most recent and will remain in place for six weeks. The mean time to stent removal was 58 days for the first three cases. All four infants are alive with only mild developmental delays and are tolerating oral feeds without any parental nutrition dependency. Our experience shows that transluminal stenting is an adequate bowel lengthening procedure to lessen the risk of short bowel syndrome without increasing mortality.

Use of Antibiotics in Preterm Newborns.

Due to complex maturational and physiological changes that characterize neonates and affect their response to pharmacological treatments, neonatal pharmacology is different from children and adults and deserves particular attention. Although preterms are usually considered part of the neonatal population, they have physiological and pharmacological hallmarks different from full-terms and, therefore, need specific considerations. Antibiotics are widely used among preterms. In fact, during their stay in neonatal intensive care units (NICUs), invasive procedures, including central catheters for parental nutrition and ventilators for respiratory support, are often sources of microbes and require antimicrobial treatments. Unfortunately, the majority of drugs administered to neonates are off-label due to the lack of clinical studies conducted on this special population. In fact, physiological and ethical concerns represent a huge limit in performing pharmacokinetic (PK) studies on these subjects, since they limit the number and volume of blood sampling. Therapeutic drug monitoring (TDM) is a useful tool that allows dose adjustments aiming to fit plasma concentrations within the therapeutic range and to reach specific drug target attainment. In this review of the last ten years’ literature, we performed Pubmed research aiming to summarize the PK aspects for the most used antibiotics in preterms.

Safety of biliopancreatic diversion with duodenal switch in patients with body mass index less than 50kg/m2.

Biliopancreatic diversion with duodenal switch (BPD-DS) has often been reserved for patients with BMI > 50kg/m2. We aim to assess the safety of BPD-DS in patients with morbid obesity (BMI 335kg/m2 and < 50kg/m2) using a 150-cm common channel (CC), 150-cm Roux limb, and 60-fr bougie. A retrospective review was performed on patients with a BMI < 50mg/k2 who underwent a BPD-DS in 2016-2019 at a single institution. Limb lengths were measured with a laparoscopic instrument with minimal tension. Sleeve gastrectomy was created with 60-fr bougie. Variables were compared using paired t test, Chi-square analysis or repeated measures ANOVA where appropriate. Forty-five patients underwent BPD-DS. CC lengths and Roux limb lengths were 158 ± 20cm and 154 ± 18cm, respectively. Preoperative BMI was 44.9 ± 2.3kg/m2 and follow-up was 2.7 ± 1.4years. One patient required reoperation for bleeding and died from multiorgan failure and delayed sleeve leak. There was 1 (2.2%) readmission for contained anastomotic leak and 2 ED visits (4.5%) within 30days. There were no marginal ulcers, limb length revisions, or need for parental nutrition. Percent excess weight loss was 67.2 ± 19.7%. 88.9% (N = 8), 86.6% (N = 13), and 55.5% (N = 5) of patients had resolution or improvement of their diabetes mellitus type II, hypertension, and hyperlipidemia, respectively. 40% (N = 4) of patients had resolution of their gastroesophageal reflux disease (GERD) and 11.4% (N = 5) developed de novo GERD. 32% (N = 14) of patients had vitamin D deficiency and 25% (N = 11) experienced zinc deficiency. BPD-DS may be considered in patients with BMI < 50kg/m2 with 150-cm CC, 150-cm Roux limb, and a 60-fr bougie sleeve gastrectomy. There was sustained weight loss and no protein calorie malnutrition, but Vitamin D and zinc deficiency remained a challenge. Careful patient selection and proper counseling of the risks and benefits are necessary.

Young Child Nutrition: Knowledge and Surveillance Gaps across the Spectrum of Feeding.

The first 1000 days is a critical window to optimize nutrition. Young children, particularly 12–24 month-olds, are an understudied population. Young children have unique nutrient needs and reach important developmental milestones when those needs are met. Intriguingly, there are differences in the dietary patterns and recommendations for young children in the US vs. globally, notably for breastfeeding practices, nutrient and food guidelines, and young child formulas (YCFs)/toddler drinks. This perspective paper compares these differences in young child nutrition and identifies both knowledge gaps and surveillance gaps to be filled. Parental perceptions, feeding challenges, and nutrition challenges are also discussed. Ultimately, collaboration among academia and clinicians, the private sector, and the government will help close young child nutrition gaps in both the US and globally.

Is the age at surgery in Crohn’s disease clinically relevant? Differences and peculiarities: a wide single centre experience after long-term follow-up

PurposeThe Montreal classification for Crohn’s disease includes “age at diagnosis” as a parameter but few is reported about the age at surgery. The aim of this study is to evaluate the short- and long-term differences in the postoperative surgical outcome and disease behaviour, according to the age at the first surgery.MethodsPatients consecutively operated for abdominal Crohn’s disease during the period 1986–2012 at our centre were systematically analysed according to their age at first surgery. In our retrospective cohort, the age at first surgery ranged from 13 to 83 years, and patients were arbitrarily divided into four groups: ≤ 19 (G1), 20–39 (G2), 40–59 (G3) and ≥ 60 (G4) years old.ResultsIn total, 1051 patients were included with a median follow-up time of 232 months. The four groups exhibited statistically significant differences in age at diagnosis, smoke habit, time between diagnosis and surgery, disease location and behaviour, history of perianal fistula or abscess, severe malnutrition requiring total parental nutrition before surgery, type of surgery, total length of resected bowel, median duration of hospitalization, incidence of abdominal recurrences and number of surgical recurrences. G1 displays an inverse linear trend with time in the severity of clinical characteristics when compared to G4 groups. On the contrary, the incidence of short-term complications, types of abdominal recurrence and presence of concomitant perianal disease did not vary among groups. In addition, at multivariate analysis, the age at surgery and the disease location were the only independent risk factors for abdominal surgical recurrence.ConclusionDespite first surgery is extremely more frequent between 20 and 59 years, patients from G1 and G4 groups showed clinical differences and peculiarities when compared to the other age groups. The most indolent CD behaviour and occurrence of surgical recurrence was observed in patients having their first abdominal surgery in the elderly, while patients operated before the age of 19 experienced a more aggressive disease course.

Nutritional Interventions to Improve Cachexia Outcomes in Cancer-A Systematic Review.

Background and Objectives: The prevalence of cachexia has increased across all of the cancer types and accounts for up to 20% of cancer-related deaths. This paper is a systematic review of nutritional interventions aiming to improve cachexia outcomes in cancer, focusing on weight gain. Materials and Methods: A search in Medline and Elsevier databases for articles up until the 23 January 2022, was conducted. Results: Out of 5732 screened records, 26 publications were included in the final analysis. Four randomized clinical trials showed a significant body weight (BW) increase in patients treated with eicosapentaenoic acid (EPA), β-hydroxy-beta-methyl butyrate (β-HMB), arginine, and glutamine or marine phospholipids (MPL). An upward BW trend was observed in patients treated with L-carnitine, an Ethanwell/Ethanzyme (EE) regimen enriched with ω-3 fatty acids, micronutrients, probiotics, fish oil, a leucine-rich supplement, or total parental nutrition (TPN) with a high dose of a branched-chain amino acid (BCAA). Conclusions: Although clinical trials relating to large numbers of nutritional supplements present promising data, many trials provided negative results. Further studies investigating the underlying mechanisms of action of these nutritional supplements in cancer cachexia are needed. Early screening for cancer cachexia risk and nutritional intervention in cancer patients before aggravating weight loss may stabilize their weight, preventing cachexia syndrome. According to the GRADE methodology, no positive recommendation for these nutritional supplements may be expressed.

Clinical implications of chyle leakage following esophagectomy.

The clinical consequences of chyle leakage following esophagectomy are underexposed. The aim of this study was to investigate the clinical implications of chyle leakage following esophagectomy. This retrospective study of prospectively collected data included patients who underwent transthoracic esophagectomy in 2017-2020. Routinely, the thoracic duct was resected en bloc as part of the mediastinal lymphadenectomy. Chyle leakage was defined as milky drain fluid for which specific treatment was initiated and/or a triglyceride level in drain fluid of ≥1.13mmol/L, according to the Esophagectomy Complications Consensus Group (ECCG) classification. Primary endpoints were the clinical characteristics of chyle leakage (type, severity and treatment). Secondary endpoints were the impact of chyle leakage on duration of thoracic drainage and hospital stay. Chyle leakage was present in 43/314 patients (14%), of whom 24 (56%) were classified as severity A and 19 (44%) as severity B. All patients were successfully treated with either medium chain triglyceride diet (98%) or total parental nutrition (2%). There were no re-interventions for chyle leakage during initial admission, although one patient needed additional pleural drainage during readmission. Patients with chyle leakage had 3days longer duration of thoracic drainage (bias corrected accelerated (BCa) 95%CI:0.46-0.76) and 3days longer hospital stay (BCa 95%CI:0.07-0.36), independently of the presence of other complications. Chyle leakage is a relatively frequent complication following esophagectomy. Postoperative chyle leakage was associated with a significant longer duration of thoracic drainage and hospital admission. Nonsurgical treatment was successful in all patients with chyle leakage.

Failure to Thrive and Severe Malnutrition due to a Jest of Nature: Dysphagia Lusoria

Dysphagia Lusoria is a rare condition in which dysphagia results from external vascular compression of the esophagus. We describe a 69-year-old man with longstanding intermittent solid-food dysphagia with failure to thrive who was found to have an aberrant right subclavian artery resulting in dysphagia lusoria. This caused a mass effect upon the posterior esophagus resulting in dilatation of the mid and upper esophagus. A diagnosis of dysphia lusoria was made and surgery was consulted for surgical correction and total parental nutrition started. Definitive diagnosis of dysphagia lusoria involves imaging modalities such as barium esophagram or a CT/MRI. Upper endoscopy is often normal though a pulsatile extrinsic mass can sometimes be seen. There are no pathognomonic manometric findings. Given the rarity of the condition, a high index of suspicion is often required for diagnosis. Definitive management of patients with dysphagia lusoria often involves surgical correction of the anatomical aberrancy. In patients who decline to undergo surgical correction, have mild-moderate symptoms, or are poor surgical candidates, eating slower, chewing well, taking smaller bites, and taking PPIs could be effective therapy options.

Parental High-Fat High-Sugar Diet Intake Programming Inflammatory and Oxidative Parameters of Reproductive Health in Male Offspring.

Parental nutrition can impact the health of future generations, programming the offspring for the development of diseases. The developing germ cells of the offspring could be damaged by the maternal or the paternal environment. The germ cells in development and their function could be affected by nutritional adversity and therefore, harm the health of subsequent generations. The paternal or maternal intake of high-fat diets has been shown to affect the reproductive health of male offspring, leading to imbalance in hypothalamic-pituitary-gonadal axis, testicular oxidative stress, low testosterone production, and changes in sperm count, viability, motility, and morphology. There is a need for studies that address the combined effects of diets with a high-fat and high-sugar (H) content by both progenitors on male reproduction. In this context, our study evaluated epigenetic parameters and the inflammatory response that could be associated to oxidative stress in testis and epididymis of adult offspring. 90 days-old male rats were divided according to the combination of the parental diet: CD (control paternal and maternal diet), HP (H paternal diet and control maternal diet), HM (H maternal diet and control paternal diet) and HPM (H paternal and maternal diet).We evaluated serum levels of testosterone and FSH; testicular gene expression of steroidogenic enzymes Star and Hsd17b3 and epigenetic markers Dnmt1, Dnmt3a, Dnmt3b, and Mecp2; testicular and epididymal levels of TNF-α, IL-6, IL-10, and IL-1β; testicular and epididymal activity of SOD, CAT, and GST; the oxidative markers MDA and CP; the daily sperm production, sperm transit time, and sperm morphology. Testicular epigenetic parameter, inflammatory response, oxidative balance, and daily sperm production of the offspring were affected by the maternal diet; paternal diet influenced serum testosterone levels, and lower daily sperm production was exacerbated by the interaction effect of both parental intake of high-fat high-sugar diet in the testis. There was isolated maternal and paternal effect in the antioxidant enzyme activity in the cauda epididymis, and an interaction effect of both parents in protein oxidative marker. Maternal effect could also be observed in cytokine production of cauda epididymis, and no morphological effects were observed in the sperm. The potential programming effects of isolated or combined intake of a high-fat high-sugar diet by the progenitors could be observed at a molecular level in the reproductive health of male offspring in early adulthood.

The Impact of School-Based Nutrition Interventions on Parents and Other Family Members: A Systematic Literature Review.

Little is known about the impact of school-based nutrition interventions on parents and other family members. This systematic review aims to explore the impact of school-based nutrition interventions on different parental/family outcomes, mainly dietary intake, nutrition knowledge, and health outcomes. PubMed, Web of Science, PsycINFO, EconLit, Cochrane Reviews, and Google Scholar were systematically searched for controlled trials or natural experiments measuring the impact of school-based nutrition interventions, with or without parental involvement, on parents/families of school children. Twenty-two studies met the inclusion criteria. Of which, 15 studies assessed the impact of school-based nutrition interventions on parental/family dietary intake, 10 on parental/family nutrition knowledge, and 2 on parental/family health outcomes. Inconsistent results were found for parental dietary intake with six studies reporting favorable effects. Most studies found improved parental nutrition knowledge. Positive impacts were seen by both studies that assessed the impact on a parental health outcome. Overall, we found that there is potential for school-based nutrition interventions to result in positive effects for parents, in particular for nutrition knowledge. More research is needed to assess the impacts of school-based nutrition interventions on parents and other family members and to assess important intervention characteristics in creating a positive impact.

Feeding in Preterm Neonates With Antenatal Doppler Abnormalities: A Systematic Review and Meta-Analysis.

In this systematic review and meta-analysis, we attempted to determine the most appropriate feed initiation and advancement practices in preterm neonates with antenatal Doppler abnormalities. We included randomized controlled trials comparing different feed initiation and advancement practices in neonates with antenatal Doppler abnormalities. The databases of PubMed, Embase, Cochrane, CINAHL, Scopus, and Google Scholar were searched on February 25, 2022. The risk of bias was assessed using the Risk of Bias tool, version 2. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development, and Evaluation approach. RevMan 5.4 was used for data analysis. Of the 1499 unique records identified, 7 studies were eligible for inclusion (6 on feed initiation, 1 on feed advancement). Early enteral feeding did not increase NEC stage 2 or more [risk ratio (RR) 1.12, 95% confidence interval (CI) 0.71-1.78; 6 studies, 775 participants] and mortality (RR 0.83, 95% CI 0.47-1.48; 5 studies, 642 participants). A trend was noted towards an increase in feeding intolerance (RR 1.23, 95% CI 0.98-1.56; 5 studies, 715 participants). There was a significant reduction in age at full enteral feeds, duration of total parental nutrition, and rates of hospital-acquired infections. Rapid feed advancement decreased the age at full enteral feeds without affecting other outcomes. The overall certainty of the evidence was rated low. Heterogeneity was not significant. There is low-certainty evidence that early feed initiation in preterm neonates with antenatal Doppler abnormalities does not increase rates of NEC and mortality. There is insufficient data on the speed of feed advancement.

The prevalence of hypophosphatemia and refeeding-related hypophosphatemia in hospitalized patients requiring parental nutrition: a retrospective study.

Hypophosphatemia might cause respiratory and heart failure and even death. We aimed to evaluate risk factors for hypophosphatemia and refeeding-related hypophosphatemia in patients requiring parental nutrition (PN). This was a single-center, retrospective study. Clinical parameters were obtained from medical records. Serum phosphate (inorganic phosphorus) was measured by photometric analysis. Hypophosphatemia was confirmed when serum phosphate level was less than 0.8mmol/L (≈2.5mg/dl). Refeeding related hypophosphatemia was confirmed if serum phosphate level had a decrease of 0.16mmol/L or more from baseline and if the final assessment was below 0.65mmol/L. A total number of 655 (426 men and 229 women, aged 62.8 ± 14.8years) hospitalized patients requiring PN were included in the study, and 60.6% of them were patients with cancer. The average body mass index (BMI) was 21.1 ± 4.1kg/m2 and the median of serum phosphate was 0.9mmol/L (quartile range: 0.68mmol/L, 1.11mmol/L). The prevalence of hypophosphatemia was 37.6% (246/655). Older age (≥ 65years vs. < 65years), lower serum level of pre-albumin (< 160mg/L vs. ≥ 160mg/L), calcium (< 2.11mmol/L vs. ≥ 2.11mmol/L), and magnesium (< 0.75mmol/L vs. ≥ 0.75mmol/L) were associated with high risk of hypophosphatemia by multivariate logistic regression (OR ranged from 1.43 to 3.06, all p < 0.05). Refeeding related hypophosphatemia was 9.5% (16/168). Serum level of calcium at baseline was significantly lower in participants with refeeding related hypophosphatemia than those without it. Total calorie and nitrogen delivered during first week of PN period showed no obvious difference between patients with and without refeeding related hypophosphatemia. Hypophosphatemia is common (37.6%) in hospitalized patients requiring PN. Monitoring of serum level of phosphorus is necessary to facilitate early treatment of hypophosphatemia.

Acute Abdominal Distention in a Premature Low-birthweight Infant.

Acute Abdominal Distention in a Premature Low-birthweight Infant.

Exploration of the consequences of a high carbohydrate and low protein diet in female broodstock trout

Adequate parental nutrition is essential to maintain high reproductive performances and to produce high quality gametes. Concerning teleost fish belonging to higher trophic level, broodstock have a high protein requirement but no specific requirement for dietary carbohydrates. Nevertheless, in farming practice, the protein‐rich fishmeal traditionally used in aquafeed formulation needs to be replaced, and plant‐derived carbohydrates appear as a possible substitute. In trout (Oncorhynchus mykiss), two previous studies have found some contradictory results. While a first study had demonstrated that the lowering of the protein‐to‐carbohydrate ratio in female broodstock ratio had surprisingly improved relative fecundity, hatchability and survival of their progeny at the eye‐up stage [1], a more recent study calls into question part of these results as they have not been confirmed [2]. Therefore, it is essential to deepen the exploration of the consequences of a maternal high carbohydrate and low protein nutrition on their reproductive performances, before increasing the fishmeal replacement by plant‐derived carbohydrates.To do so, two‐year old female trout were fed either a control diet formulated with no carbohydrate and a high protein content (65.7 %) or a diet containing 32.5 % carbohydrate but with a lower protein content (42.9 %) for an entire reproductive cycle. The reproductive performances, the quality of the unfertilized eggs and the development of the progeny (at the embryo and at the yolk‐sac fry stages) were carefully monitored.On the one hand, the spawn were of high quality (i.e. more than 90% of unfertilized eggs were viable) and, in average, the egg proximate composition was not affected. The relative fecundity (number of eggs produced per unit of weight) was also increased by the high carbohydrate – low protein nutrition, confirming the first results obtained in trout. On the other hand, the egg fatty acid profile was altered, and in particular, a decrease in EPA (20:5 n‐3) content was triggered by the maternal high carbohydrate/low protein nutrition in trout. Because this particular fatty acid is known to play an essential role during fish development, its diminution could be a cause for the lower survival observed at eyed stage. Moreover, females fed the high carbohydrate/low protein nutrition produced spawns whose eggs size were more variable.Altogether, even though the relative fecundity was significantly increased, the high carbohydrate and low protein nutrition in female broodstock could have deleterious consequences on their progeny development.[1] Washburn, B. S., Frye, D. J., Hung, S. S., Doroshov, S. I., &amp; Conte, F. S. (1990). Dietary effects on tissue composition, oogenesis and the reproductive performance of female rainbow trout (Oncorhynchus mykiss). Aquaculture, 90(2), 179‐195.[2] Callet, T., Hu, H., Larroquet, L., Surget, A., Liu, J., Plagnes‐Juan, E., … &amp; Marandel, L. (2020). Exploring the impact of a low‐protein high‐carbohydrate diet in mature broodstock of a glucose‐intolerant teleost, the rainbow trout. Frontiers in physiology, 11, 303.