Parenteral Nutrition Support Research Articles

Effect of nutrition support on quality adjusted life year in elderly patients with nutritional risk

Objective To summarize the progress of research on the influence of nutrition support on quality adjusted life year (QALY) in elderly patients with nutritional risk, and to evaluate the feasibility of QALY as an outcome indicator. Methods Literature in Chinese, English and Japanese relating tothe feasibility of QALY and cost-utility in evaluating the influence of nutrition support on the outcomes of patients with nutritional riskpublished from 1980 to 2013 were searched in Wanfang, China National Knowledge Infrastructure, PubMed, Nature databases.The methodological quality of randomized controlled trials was assessed using Jadad scale combined with Schulz allocation concealment, and the quality of cohort studies with Newcastle-Ottawa scale. Results Totally 10 articles were found, in which 8 were selected, including 6 randomized controlled trial and 2 cohort studies, covering 1 130 patients; the other 2 were excluded for not conforming to inclusion criteria.Four of the 6 randomized controlled trial indicate that QALY is higher and all-cost is lower in the treatment group compared with the control group (or cost-utility is higher in the treatment group). The 2 cohort studies indicate that total parenteral nutrition support at home could improve the QALY of malnourished patients and could save cost compared with nutrition support at hospital when necessary. Conclusions Nutrition support for patients with nutritional risk can improve prognosis, reduce cost, and increase QALY. More large-scale, high-quality randomized controlled trials are needed to evaluate the effect of nutrition support on the QALY of elderly patients with nutritional risk. Key words: Quality adjusted life year; Nutrition support; Nutritional risk

Diferencias en estándares de calidad a la hora de pautar un soporte nutricional: diferencias entre médicos especialistas y no especialistas

Adequate nutritional support includes many different aspects, but poor understanding of clinical nutrition by health care professionales often results in an inadequate prescription. Material and methodsA study was conducted to compare enteral and parenteral nutritional support plans prescribed by specialist and non-specialist physicians. ResultsNon-specialist physicians recorded anthropometric data from only 13.3% of patients, and none of them performed nutritional assessments. Protein amounts provided by non-specialist physicians were lower than estimated based on ESPEN (10.29g of nitrogen vs 14.62; P<.001). Differences were not statistically significant in the specialist group (14.88g of nitrogen; P=.072). Calorie and glutamine provision and laboratory controls prescribed by specialists were significantly closer to those recommended by clinical guidelines. ConclusionNutritional support prescribed by specialists in endocrinology and nutrition at San Pedro de Alcántara Hospital was closer to clinical practice guideline standards and of higher quality as compared to that prescribed by non-specialists.

The effect of three-lumen gastrojejunal tube on the enteral nutritional support for patients with severe acute pancreatitis(SAP)

Objective To explore the effect of three-lumen gastrojejunal tube on the enteral nutritional support for patients with severe acute pancreatitis(SAP). Methods A total of 32 patients with SAP were divided into two groups for comparative analysis. The treatment group,14 patients, were provided with enteral nutritional support using three-lumen gastrojejunal tube, while the control group,18 patients,were provided with parenteral nutritional support. Results Length, cost and complications of hospitalization of the treatment group were less than those of the control group,P< 0.05. Conclusions Three-lumen gastrojejunal tube has a significant advantage in enteral nutritional support and nursing for SAP, with fewer complications, smaller risks and easier nursing, and it is worth using in clinical practice. Key words: Three-Lumen Gastrojejunal Tube; Severe acute pancreatitis; Enteral Nutrition; Nursing

MON-PP191: Costs of Enteral and Parenteral Nutrition Support at Tertiary Hospital: Single Hospital Experience

MON-PP191: Costs of Enteral and Parenteral Nutrition Support at Tertiary Hospital: Single Hospital Experience

Nutritional support in children and young people with cancer undergoing chemotherapy.

It is well documented that malnutrition is a common complication of paediatric malignancy and its treatment. Malnutrition can often be a consequence of cancer itself or a result of chemotherapy. Nutritional support aims to reverse malnutrition seen at diagnosis, prevent malnutrition associated with treatment and promote weight gain and growth. The most effective and safe forms of nutritional support in children and young people with cancer are not known. To determine the effects of any form of parenteral (PN) or enteral (EN) nutritional support,excluding vitamin supplementation and micronutrient supplementation, in children and young people with cancer undergoing chemotherapy and to determine the effect of the nutritional content of PN and EN. This is an update of a previous Cochrane review. We searched the following databases for the initial review: CENTRAL (The Cochrane Library, Issue 2, 2009), MEDLINE (1950 to 2006), EMBASE (1974 to 2006), CINAHL (1982 to 2006), the National Research Register (2007) and Dissertations & Theses (2007). Experts in the field were also contacted for information on relevant trials. For this update, we searched the same electronic databases from 2006 to September 2013. We also scrutinised the reference lists of included articles to identify additional trials. Randomised or quasi-randomised controlled trials comparing any form of nutritional support with another, or control, in children or young people with cancer undergoing chemotherapy. Two authors independently selected trials. At least two authors independently assessed quality and extracted data. We contacted trialists for missing information. The current review included the eight trials from the initial review and six new trials which randomised 595participants (< 21 years of age) with leukaemias or solid tumours undergoing chemotherapy. The trials were all of low quality with the exception of two of the trials looking at glutamine supplementation. One small trial found that compared to EN, PN significantly increased weight (mean difference (MD) 4.12, 95% CI 1.91 to 6.33), serum albumin levels (MD 0.70, 95% CI 0.14 to 1.26), calorie intake (MD 22.00, 95% CI 5.12 to 38.88) and protein intake (MD 0.80, 95% CI 0.45 to 1.15). One trial comparing peripheral PN and EN with central PN found that mean daily weight gain (MD -27.00, 95% CI -43.32 to -10.68) and energy intake (MD -15.00, 95% CI -26.81 to -3.19) were significantly less for the peripheral PN and EN group, whereas mean change in serum albumin was significantly greater for that group (MD 0.47, 95% CI 0.13 to 0.81, P = 0.008).Another trial with few participants found an increase in mean energy intake (% recommended daily amount) in children fed an energy dense feed compared to a standard calorie feed (MD +28%, 95% CI 17% to 39%). Three studies looked at glutamine supplementation. The evidence suggesting that glutamine reduces severity of mucositis was not statistically significant in two studies (RR 0.64, 95% CI 0.19 to 2.2 and RR 0.85, 95% CI 0.66 to 1.1) and differences in reduction of infection rates were also not significant in two studies (RR 1.0, 95% CI 0.72 to 1.4 and RR 0.98, 95% CI 0.63 to 1.51). Only one study compared olive oil based PN to standard lipid containing PN. Despite similar calorie contents in both feeds, the standard lipid formula lead to greater weight gain (MD -0.34 z-scores, 95% CI -0.68 to 0.00). A single study compared standard EN with fructooligosaccharide containing EN. There was no difference in weight gain between groups (mean difference -0.12, 95% CI -0.57 to 0.33), with adverse effects (nausea) occurring equally between the groups (RR 0.92, 95% CI 0.48 to 1.74). There is limited evidence from individual trials to suggest that PN is more effective than EN in well-nourished children and young people with cancer undergoing chemotherapy. The evidence for other methods of nutritional support remains unclear. Limited evidence suggests an energy dense feed increases mean daily energy intake and has a positive effect on weight gain. Evidence suggesting glutamine supplementation reduces incidence and severity of mucositis, infection rates and length of hospital stay is not statistically significant.Further research, incorporating larger sample sizes and rigorous methodology utilising valid and reliable outcome measures, is essential.

Computational modeling to predict nitrogen balance during acute metabolic decompensation in patients with urea cycle disorders.

Nutritional management of acute metabolic decompensation in amino acid inborn errors of metabolism (AA IEM) aims to restore nitrogen balance. While nutritional recommendations have been published, they have never been rigorously evaluated. Furthermore, despite these recommendations, there is a wide variation in the nutritional strategies employed amongst providers, particularly regarding the inclusion of parenteral lipids for protein-free caloric support. Since randomized clinical trials during acute metabolic decompensation are difficult and potentially dangerous, mathematical modeling of metabolism can serve as a surrogate for the preclinical evaluation of nutritional interventions aimed at restoring nitrogen balance during acute decompensation in AA IEM. A validated computational model of human macronutrient metabolism was adapted to predict nitrogen balance in response to various nutritional interventions in a simulated patient with a urea cycle disorder (UCD) during acute metabolic decompensation due to dietary non-adherence or infection. The nutritional interventions were constructed from published recommendations as well as clinical anecdotes. Overall, dextrose alone (DEX) was predicted to be better at restoring nitrogen balance and limiting nitrogen excretion during dietary non-adherence and infection scenarios, suggesting that the published recommended nutritional strategy involving dextrose and parenteral lipids (ISO) may be suboptimal. The implications for patients with AA IEM are that the medical course during acute metabolic decompensation may be influenced by the choice of protein-free caloric support. These results are also applicable to intensive care patients undergoing catabolism (postoperative phase or sepsis), where parenteral nutritional support aimed at restoring nitrogen balance may be more tailored regarding metabolic fuel selection.

Parenteral and enteral nutritional support (excluding immunonutrition)

The surgeon plays a key role in the perioperative nutritional care in patients undergoing elective major digestive surgery; therefore, he has to be able to anticipate needs and to implement corrective measures according to recommendations. Pre- and postoperative enteral feeding is preferred. In patients without obvious undernutrition, postoperative nutritional support has to be initiated if patients cannot maintain oral intake above 60% of recommended intake for more than 7 days, and it has to be programmed if it is anticipated that the patient will be unable to eat for more than 7 days. Preoperative and postoperative nutritional support has to be offer in malnourished patients (grades 3 and 4).

Risk factors for nosocomial infections in children who had open-heart surgery

Nosocomial infections at pediatric intensive care units ( PICUs) often lead to substantial morbidity, mortality, and prolonged hospital stays in children who have open-heart surgery. Little is known about the risk factors in this populat ion. Our aim was to identify the incidence and clinical factors associated with infections at the PICU in children with congenital heart disease after surgery. Clinical records of patients 6 3-year-old with congenital heart disease, admitted for surgery, were evaluated for clinical, nutritional, and other risk factors. Infecti on was determined during the patient's stay at the PICU. Two h undred eighty-nine patients were included in the study. Factors re lated to overall infection were: higher risk adjustment for congenital heart surgery, age > 1-year-old, cyanotic cardiac anomaly, parenteral or mixed nutrition support, more than 5 days of fasting, and mechanical ventilation > 48 h. Factors related to pneumonia were higher risk adjustment for congenital heart surgery, cyanotic cardiac anomaly more than three inotropics infused during surgery, parenteral or mixed nutritional support, more than 5 days of fasting, and mechanical ventilation > 48 h. Factors related to mediastinitis and sepsis were: age > 1-year-old, aortic clamp > 120 min, parenteral or mixed nutritional support, more than 5 days of fasting, and mechanical ventilation > 48 h. In the multivariate survival analysis, parenteral or mixed nutri tion and mechanical ventilation > 48 h increased the risk for overall infection (relative risk 1.949, 95% confidence interval 1.1 08-3.43, P = 0.021 and relative risk 25, 95% confidence interval 2.53-246.19, P = 0.006 respectively). Early enteral nutrition after surger y and early weaning from mechanical ventilation (less than 48 h) will reduce infection incidence.

Bishop Koop Technique is Preferred than Primary Anastomosis in Managing Jejunoileal Atresia in a Setup without Neonatal Intensive Care Unit - Our Initial Experience

Background: Neonatal intestinal obstruction due to jejunoileal atresia is not uncommon. Recommended treatment is resection with end to back anastomosis and post operative care in Neonatal Intensive Care Unit (NICU) with Total Parenteral Nutrition (TPN) support. In a setup without NICU and TPN, mortality of primary anastomosis is very high due to unusual delay in starting enteral feeding. Bishop Koop technique seems to allow early oral feeding and rapid establishment of normal gastrointestinal function and thus reduce mortality and morbidity.Objective: To find out the outcome of Bishop Koop procedure in patients with Jejunoileal atresia.Methods: This is an ongoing study started from March, 2011 in the Department of Pediatric Surgery, Chittagong Medical College Hospital. Here we are presenting our initial experience till June, 2012 (duration of 16 months). During this period total 13 patients of uncomplicated Jejunoileal atresia was treated surgically. Four patients were treated by classical end to oblique anastomosis and all died. Rest of the 9 patients were treated by Bishop Koop technique. Overall outcome of this technique was assessed considering time to establish oral feeding and normal bowel movement, ceasation of coming distal stoma’s effluent, weight gain, death etc.Result: Out of 9 patients, 6 patients weighing less than 2.5 Kg. Type- III A was the commonest variant. Two patients died following surgery due to sepsis. Oral feeding was possible within 4-7 postoperative day in all survived patients except one. In follow up satisfactory weight gain was observed in all those patients.Conclusion: Bishop Koop technique could be considered as preferred surgical option in a set up without NICU and TPN.J. Paediatr. Surg. Bangladesh 3(1): 5-11, 2012 (January)

The Current Role of Parenteral Nutrition in the Hospitalized Patient

The role of early versus late initiation of total parenteral nutrition in critically ill patients is a topic of debate among nutrition experts. The European Society of Parenteral and Enteral Nutrition (ESPEN) recommends that all patients who are not expected to be on normal nutrition within 3 days of ICU admission should receive parenteral nutrition (PN) within 24–48 h if enteral nutrition (EN) is contraindicated or if they cannot tolerate EN. The American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines recommend that if early EN is not feasible or available the first 7 days following admission to the ICU, no supplemental PN support therapy should be provided. Since the release of these guidelines, several large multi-center trials have been published that may alter the previously published recommendations. With the anticipated release of the new ASPEN guidelines, a number of recent studies will not be evaluated since the cut-off for the inclusion of new studies was December 31, 2013. The current article reviews both the ESPEN and ASPEN guidelines for the recommendation of PN support in critically ill adult patients and reviews large multi-center studies that were performed since these guidelines were published.

Clinical analysis of colon cancer combined with abdominal abscess

Objective To summarize the clinical characteristics, preoperative examinations and therapeutic method of colon cancer combined with abdominal abscess. Methods The clinical data of 41 patients with colon cancer combined with abdominal abscess who were admitted to the First Hospital of Longyan between January 2008 and August 2014 were retrospectively analyzed. All the patients underwent laboratory tests and imaging examinations before operation. According to the principles of operative safety and radical resection of tumor, 41 patients underwent open operation and then received the fluid infusion, antibiotic treatment, parenteral nutrition support and symptomatic treatment after operation. Patients were followed up via telephone interview and outpatient examination till August 2014. Results All the 41 patients had different levels of obstruction and infection at admission, and concomitant diabetes mellitus were detected in 26 patients, essential hypertension in 21 patients, heart diseases in 19 patients and chronic obstructive pulmonary disease in 9 patients. The results of laboratory tests showed that there were 4 patients with hemoglobin (Hb) 90 g/L, 36 patients with albumin (Alb) <30 g/L, 18 patients with increased glycosylated hemoglobin (GHb) , 41 patients with increased serum procalcitonin and 10 patients with increased blood carcinoembryonic antigen (CEA) . Abdominal tumors and intestinal obstructions were detected in 41 patients by thoracic and abdominal enhanced CT, intraluminal tumors in 23 patients by colonoscopy because of unsuccessful placement of colonoscopy in 19 patients, the metal stent endoprosthesis was placed in 2 patients to relieve obstruction. Fifty-nine strains of bacteria were cultured from 41 copies of the pus (28 copies obtained from diagnosistic peritoneocentesis and 13 copies obtained from operation) , and most of them were escherichia coli with a percentage of 61.0% (36/59) and were sensitive to imipenem. All patients underwent open surgery including 33 patients combined wtih enterostomy. The operation time was 150-272 minutes with a median time of 221 minutes. The volume of intraoperative blood loss was 100-800 mL with a median volume of 370 mL. The tumor located at the ileocecal valve was detected in 6 patients and ascending colon in 9 patients, and then palliative or radical right hemicolectomy was performed. The tumor located at the hepatic flexure of colon was detected in 2 patients and then radical extended right hemicolectomy was performed. The tumor located at the splenic flexure was detected in 4 patients and descending colon in 7 patients, and then the radical resection and terminal ileostomy were performed. Among 13 patients with tumor located at the sigmoid colon, 12 patients received radical resection and 1 patient received palliative resection. Eleven patients were complicated with pulmonary infection, 6 patients with infection or dehiscence of incision, 5 patients with anastomotic leakage, 4 patients with ureteral injury, 4 patients with heart failure, 3 patients with paralytic intestinal obstruction, 2 patients with septicemia, 1 patient with renal failure, 1 patient with cerebral infarction and 1 patient with pulmonary embolism. Nine patients died after operation. The diameter of resected tumor was 4.5-15.0 cm with a median diameter of 9.4 cm. High-differentiated tumors were detected in 25 patients, moderate-differentiated tumors in 12 patients and low-differentiated tumors in 4 patients (signet-ring cell carcinoma in 1 patient) . There were 4 patients in the T3 stage of tumor and 37 patients in the T4 or T4b stage. The number of lymph node dissection was 23 (range, 15-35 ) with 18 positive lymph nodes. Six patients had lymph node metastasis. Twenty-eight patients were followed up for a median time of 27 months (range, 3-80 months) . During the follow-up, 16 patients died and 12 patients survived, 10 patients died of tumor recurrence and metastasis, 6 patients died of other diseases, 4 patients had tumor recurrence and metastasis and 8 patients had no recurrence and metastasis. Conclusions Patients with colon cancer combined with abdominal abscess are usually complicated with internal diseases, with a high mortality. Surgical treatment is the only curative treatment option, but an accurate preoperative evaluation is essential and the opportunity of operation should be evaluated before operation, the injury of ureteral , vascular and other surrounding important structures should be avoided during operation, meanwhile, intraoperative application of enterostomy could reduce anastomosis-related complications. After operation, routine peritoneal lavage and antibiotics according to the drug sensitive test are conducted for reducing the postoperative complications and mortality. Key words: Colonic neoplasms; Abdominal abscess; Surgical procedure, operative

Perioperative Alanyl-Glutamine-Supplemented Parenteral Nutrition in Chronic Radiation Enteritis Patients With Surgical Intestinal Obstruction: A Prospective, Randomized, Controlled Study.

A prospective, randomized, controlled study was performed to evaluate the effects of perioperative alanyl-glutamine-supplemented parenteral nutrition (PN) support on the immunologic function, intestinal permeability, and nutrition status of surgical patients with chronic radiation enteritis (CRE)-induced intestinal obstruction. Patients who received 0.4 g/kg/d alanyl-glutamine and isonitrogenous PN were assigned to an alanyl-glutamine-supplemented PN (Gln-PN) group and a control group, respectively. Serum levels of alanine aminotransferase and glutamine, body fat mass (FM), immunologic function, and intestinal permeability were measured before and after surgery. Serum glutamine levels of the Gln-PN group significantly exceeded that of the control group (P < .001; Gln-PN, baseline 460.7 ± 42.5 vs 523.3 ± 48.6 µmol/L on postoperative day 14 [POD14], P < .001; control, baseline 451.9 ± 44.0 vs 453.8 ± 42.3 µmol/L on POD14, P = .708). Lactulose/mannitol ratios of both groups decreased over time (Gln-PN, baseline 0.129 ± 0.0403 vs 0.024 ± 0.0107 on POD1 4; control, baseline 0.125 ± 0.0378 vs 0.044 ± 0.0126 on POD14, P < .001 in both groups). CD4/CD8-positive T-lymphocyte ratios significantly rose in both groups, with significant intergroup difference (P < .001; Gln-PN, baseline 1.36 ± 0.32 vs 1.82 ± 0.30 on POD14, P < .001; control, baseline 1.37 ± 0.25 vs 1.63 ± 0.31 on POD14, P < .001). In the Gln-PN group, FM increased from 3.68 ± 1.68 kg at baseline to 5.22 ± 1.42 kg on POD14 (P < .001). FM of control group increased from 3.84 ± 1.57 kg at baseline to 5.40 ± 1.54 kg on POD14 (P < .001). However, there were no significant intergroup differences (P = .614). Gln-PN significantly boosted the immune state and decreased the intestinal permeability of CRE patients. However, Gln-PN was not superior to standard PN in improving the nutrition state and intestinal motility of surgical patients with CRE-induced intestinal obstruction.

Short bowel syndrome in infants: modern views on problem according to literature and own experience

Summary. Short bowel syndrome (SBS) in infants refers to the condition of nutritional malabsorption because of anatomical or /and functional loss of a significant length of the small intestine. The problem of SBS is actual up till now because of high quantity of surgical operations in full-term and premature newborns. The main clinical manifestations of SBS are pronounced malabsorption and maldigestion. Patients with SBS need long-term parenteral nutrition support until intestinal adaptation occurs. Therefore, children need long-term regular monitoring to prevent various complications. SBS treatment is aimed at achievement of adequate enteral nutrition of infants.

A randomised controlled comparison of enteral versus parenteral nutritional support post allogeneic haematopoietic cell transplantation

Nutritional support during allogeneic haematopoietic progenitor cell transplantation (HPCT) is imperative to prevent malnutrition and poorer patient outcomes. However, there is little literature on the most efficacious approach, leading to wide variation in the use of enteral (EN) and parenteral (PN) feeding across HPCT units. This study aimed to determine the tolerability and efficacy of EN versus PN in patients undertaking allogeneic HPCT. A randomised controlled trial was conducted from September 2011 to January 2013. Patients were randomized to receive either EN (nasogastric) or PN if nutrition support was required, however those with severe gastro-intestinal toxicity, including severe mucositis, were excluded from randomisation. If patients did not tolerate the type of feeding given they were swapped to the alternate route. Nine patients were able to be randomized between EN (n=5) and PN (n=4). The patients randomized to EN all required changing to PN due to gastro-intestinal intolerance (p≤0.01). None of the patients receiving PN required changing to EN. This study demonstrates that due to the significant gastrointestinal toxicity, EN was not feasible to commence when oral intake became inadequate. This study was registered with the Australian New Zealand Clinical Trials Registry (ANZCTR), Trial Number ACTRN12611001084976.

Effects of different types of triglycerides on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis: a prospective study

Objective To investigate the effects of structured triglyceride (STG) and physical mixed medium chain/ long chain triglycerides (MCT/ LCT) on hepatic and renal function and lipometabolism of patients with acute necrotizing pancreatitis (ANP) . Methods The clinical data of 30 patients with ANP who were admitted to the PLA General Hospital between January 2012 and June 2014 were prospectively analyzed. A double-blind, randomized, controlled study was performed in 30 patients who were allocated into the experimental group (15 patients received STG) and the control group (15 patients received physical mixed MCT/ LCT) . All the patients received isometrical nitrogen and isocaloric parenteral nutrition more than 5 days. The levels of alanine transaminase (ALT) , aspartate transaminase (AST) , glutamyl-transpeptidase (GGT) , alkaline phosphatase (ALP) , creatinine (Cr) , blood urea nitrogen (BUN) , triglyceride (TG) and total cholesterol (TC) were assayed before nutritional support treatment and at day 1 , 3 and 5 after nutritional support therapy. The measurement data with normal distribution was presented as ±s. The skew distribution data were described as M (range) . The comparison between groups were evaluated with an independent sample t test or one-way ANOVA. The count data were analyzed using the chi-square test. Results A total of 30 patients were screened for eligibility. The levels of ALT, AST, GGT, ALP, Cr, BUN, TG and TC were changed within a certain range at day 1, 3 and 5 after nutritional support treatment. The levels of ALT, AST, GGT, ALP, Cr, BUN and TC before treatment and at day 5 after treatment were changed from 29. 0 U/ L, 25. 4 U/ L, 83.2 U/ L, (193 ± 115) U/ L, (124 ± 97) μmol/ L, (8 ±6) mmol/ L and (2.4 ± 1.1) mmol/ L to 29.4 U/ L, 33.0 U/ L, 77.7 U/ L, (172 ± 74) U/ L, (117 ± 103) μmol/ L, (8 ± 5) mmol/ L and (2.3 ± 1.0) mmol/ L in the experimental group, and from 23.8 U/ L, 22. 9 U/ L, 96. 2 U/ L, (148 ± 108) U/ L, (82 ± 57) μmol/ L, (9 ± 7) mmol/ L and (2.5 ± 0.7) mmol/ L to 21. 3 U/ L, 24. 5 U/ L, 127.4 U/ L, (179 ± 126) U/ L, (80 ± 54) μmol/ L, (10 ± 6) mmol/ L and (2.4 ± 0. 8 ) mmol/ L in the control group, respectively. There were no significant differences in the changing trends of the levels of ALT, AST, GGT, ALP, Cr, BUN and TC between the 2 groups (F =0.647, 1.186, 0.282, 0.553, 0.862, 0.182, 0.369, P >0.05) . The level of TG in the experimental group from pre-treatment to day 5 after treatment was changed from (1. 5 ± 0.6) mmol/ L to (1. 5 ± 0.7) mmol/ L, with increasing trend from pre-treatment to day 1 after treatment and reaching the normal level at day 3 and 5 after treatment. The level of TG in the control group from pre-treatment to day 5 after treatment was changed from (1.5 ± 0.6) mmol/ L to (2.4 ± 0. 6) mmol/ L, with increasing trend from pre-treatment to day 1 , 3 and 5 after treatments. There were significant differences in the changing trends of TG before and after nutritional support therapy between the 2 groups (F = 7.940, P <0.05) . Conclusion STG and physical mixed MCT/ LCT don't influence the hepatic and renal function of patients with ANP undergoing parenteral nutritional support therapy, while STG has a better effect of lipometabolism compared with physical mixed MCT/ LCT. Registry This study was registered with the UMIN Clinical Trial Registry with the registry number of UMI16958 Key words: Acute necrotizing pancreatitis; Nutritional support therapy; Structured triglyceride; Lipometabolism

Application of Early Nutrition Support in Neurosurgical Coma Patients.

The present study was conducted to investigate the clinical efficacy of early parenteral and enteral nutrition (PN + EN) support in neurosurgical coma patients. Eighty cases of neurosurgical coma patients were randomly divided into intervention group and control group. The intervention group received early PN + EN support, and the control group received only total enteral nutritional (TEN) support. The levels of hemoglobin (HGB), serum albumin (ALB), prealbumin (PA), and retinol-binding protein (RBP) in two groups on days 1, 10, and 20 were observed. The incidences of pneumonia, stress ulcer, abnormal liver function, abdominal distension, and diarrhea between two groups were also compared. Results found that, on day 10, compared with the control group, the levels of HGB, PA, and RBP in the intervention group were significantly increased (P < 0.05). On day 20, ALB in the intervention group significantly increased (P < 0.05), and the incidences of pneumonia, abdominal distension, and diarrhea in the intervention group were significantly lower than those in the control group (P < 0.05). Compared with only TEN support, early PN + EN support can obviously improve the nutritional status of neurosurgical coma patients and reduce the occurrence of complications.

Early enteral and parenteral nutritional support after hepatectomy in patients with hepatic carcinoma: a systematic review and meta-analysis.

BackgroundThis study sought to conduct a systematic review providing a comparative analysis of enteral nutrition (EN) and parenteral nutrition (PN) after hepatectomy.MethodsPubMed, Embase, and the China National Knowledge Infrastructure databases were searched for publications describing randomized controlled trials that compared early EN and PN after hepatectomy. The time period for this search was from January 1990 to December 2013. In accordance with the inclusion criteria of this study, two researchers independently screened the retrieved literature, extracted data, and assessed methodological quality. A meta-analysis of the included publications was then performed using RevMan 5.2 software.ResultsThe meta-analysis results indicated statistically significant differences between the group that received EN and the group that received PN during the early stages after hepatectomy with respect to average total bilirubin and alanine aminotransferase levels after nutrition, pre-albumin levels, incidence of diarrhea and abdominal bloating, time to flatus, and average cost of nutrition. To varying degrees, better results were observed in the EN group than in the PN group for these metrics.ConclusionDuring the early stages after hepatectomy, EN has obvious advantages relative to PN; thus, EN merits more widespread promotion and application in this clinical context.

Parenteral Fish Oil–Containing Lipid Emulsions May Reverse Parenteral Nutrition–Associated Cholestasis in Neonates: A Systematic Review and Meta-Analysis ,

Growing evidence indicates that fish oil-containing lipid emulsions have a beneficial effect on parenteral nutrition-associated cholestasis (PNAC) in adults; however, data are limited in neonates regarding the effect of fish oil on PNAC. We conducted a meta-analysis of studies that addressed the effect of fish oil-containing lipid emulsions on reversing and preventing PNAC. We searched PubMed, the EMBASE database, and the Cochrane Library for this systematic review and meta-analysis. The methodologic assessment of studies was performed with the Jadad scale and the Newcastle-Ottawa Scale. Comprehensive Met-Analysis version 2.0 was used for the statistical analysis. We performed a meta-analysis with the primary outcomes of reversal of PNAC and the occurrence of PNAC in newborn infants, including preterm infants, after parenteral administration of fish oil-containing lipid emulsions. Of the 36 studies identified, 7 fulfilled the inclusion criteria and were used in this meta-analysis, including 3 studies with 93 participants in which reversal of PNAC was an outcome and 4 studies with 1012 participants on preventing PNAC. The use of fish oil-containing lipid emulsions was more likely to reverse PNAC (OR: 6.14; 95% CI: 2.27, 16.6; P < 0.01), but the use of fish oil-containing lipid emulsions did not have a significant effect on the development of PNAC (OR: 0.56; 95% CI: 0.28, 1.10; P = 0.09) compared with soybean-based or olive oil-based lipid emulsions. The pooled data suggest that the use of fish oil-containing lipid emulsions is effective for reversing PNAC but cannot prevent PNAC in neonates who require prolonged parenteral nutritional support.

Clinical value of helical nasointestinal tube placement in the enhanced recovery of patients with the radical gastrectomy for gastric cancer

Objective To investigate the clinical value of helical nasointestinal tube placement in the enhanced recovery of patients with the radical gastrectomy for gastric cancer. Methods The clinical data of 74 patients who received radical gastrectomy at the Ruijin Hospital of Shanghai Jiaotong University from June 2012 to June 2014 were retrospectively analyzed. Thirty-six patients who received parenteral nutrition via helical nasointestinal tube were in the nasointestinal tube group, 15 patients who received nutritional support from the sinus tract after jejunostomy were in the jejunostomy group, 23 patients who received postoperative traditional parenteral nutrition duo to early treatment were in the parenteral nutrition group. The levels of albumin, prealbumin, number of lymph nodes, immunoglobin A (IgA), immunoglobin G (IgG) and immunoglobin M (IgM), the postoperative flatus time, incidence of postoperative complications (wound infection, peritoneal infection, intestinal obstruction, digestive tract leakage and delayed healing of incision) and duration of postoperative stay in the 3 groups were compared. Patients were followed up via out-patient examination and telephone interview till September 2014. The normal distribution measurement data were presented as ±s.The comparison among groups and pairwise comparison were evaluated with the analysis of variance and the LSD-t test. The count data were analyzed using the chi-square test or Fisher exact probability. Results All the patients in the 3 groups were cured and discharged without perioperative death. No peritoneal infection, intestinal obstruction or delayed healing of incision occurred. The levels of albumin, number of lymph nodes, IgA, IgG and IgM at postoperative day 3 were (34±4) g/L, (0.9±0.3) ×109/L, (1.9±0.8) g/L, (9.5±2.1) g/L, (1.00±0.29) g/L in the nasointestinal tube group, (34±4) g/L, (0.8±0.7) ×109/L, (1.6±1.2) g/L, (8.2±1.4) g/L, (0.91±0.15) g/L in the jejunostomy group, and (31±5) g/L, (0.9±0.3) ×109/L, (1.7±1.0) g/L, (9.3±1.8) g/L, (0.97±0.33) g/L in the parenteral nutrition group, with no significant difference among the 3 groups (F =2. 168, 1. 745, 2. 115, 2. 189, 2. 124, P >0.05). The levels of albumin, number of lymph nodes, IgA, IgG and IgM at postoperative day 7 were (36±5) g/L, (1.7±0.5) ×109/L, (2.3±1.2) g/L, (10.5±1.9) g/L, (1.40±0.40) g/L in the nasointestinal tube group, (35±5) g/L, (1.5±0.7) ×109/L, (2.1±0.9) g/L, (10.4±2.1) g/L, (0.80±0.60) g/L in the jejunostomy group, and (32±5) g/L, (1.3±0.5) ×109/L, (1.8±0.7) g/L, (8.2±2.1) g/L, (1.20±0.60) g/L in the parenteral nutrition group, with no significant difference among the 3 groups (F =2. 225, 1. 785, 2. 756, 2. 882, 2. 278, P >0.05). The incidence of postoperative wound infection, digestive tract leakage and duration of postoperative stay were 1, 0, (7.2±1.8) days in the nasointestinal tube group, 0, 0, (8.1±2.2) days in the jejunostomy group, and 0, 1, (7.8±2.6) days in the parenteral nutrition group, with no significant difference among the 3 groups (F =1. 688, P >0.05). The levels of prealbumin at postoperative day 3 and 7 and the postoperative flatus time were (168±34) mg/L, (167±32) mg/L, (3.1±1.6) days in the nasointestinal tube group, (162±36) mg/L, (166±34) mg/L, (3.3±2.1) days in the jejunostomy group, and (127±38) mg/L, (118±26) mg/L, (4.2±2.1) days in the parenteral nutrition group, with a significant difference among the 3 groups (F =4. 109, 4. 438, 3. 425, P 0.05). All the patients were followed up for 2-24 months, with the median time of 12 months. No patient was re-admitted to the hospital due to postoperative complications. Conclusions Early enternal nutrition support via the helical nasointestinal tube after radical gastrectomy for gastric cancer is more effective than parenteral nutrition support, and with the advantages of easy manipulation, little trauma and obvious efficacy. The nutritional condition and the intestinal function of the patients could be improved and thus the recovery is speeded up. Key words: Gastric neoplasms; Gastrectomy; Helical nasointestinal tube; Enteral nutrition; Enhanced recovery after surgery

Guidelines for parenteral and enteral nutrition support in geriatric patients in China.

The mortality and morbidity of geriatric patients is much higher than for younger patients, especially when critically ill. This may be attributed to a lower reserve capacity in most organs and systems, reduced ability to deal with physical stress and the presence of acute or chronic co-mobidities. Parenteral and enteral nutrition support can improve the clinical condition of the elderly patient and result in better outcomes, such as lower mortality, reduced hospital stay and reduced medical costs. There is a need to standardize nutrition screening and assessment, and the implementation of appropriate evidence based nutritional support of geriatric patients in China. The Chinese Medical Association's Group of Geriatric Nutrition Support has developed guidelines by researching the present situation in Chinese hospitals and by referring to the guidelines from both American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN).