Dietary intake distribution patterns in post-intensive care patients.

Stroke is associated with multiple forms of disability, including dysphagia. Post-stroke dysphagia increases the risks of pneumonia and mortality and often results in cessation of oral feeding. However, appropriate rehabilitation methods can eventually lead to resumption of oral food intake. This study tried to clarify that re-initiating oral food intake could modify the composition of oral/gut microbial communities in patients with dysphagia. From 78 patients with sub-acute stage of stroke, 11 complete tube feeding subjects without taking antibiotics were enrolled and received rehabilitation for re-initiation of oral food intake, and 8 subjects were brought back to complete oral feeding. Oral and gut microbiota community profiles were evaluated using 16S rRNA sequencing of the saliva and feces samples before and after re-initiation of oral food intake in patients recovering from enteral nutrition under the same nutrient condition. Standard nutrition in the hospital was 1,840 kcal, including protein = 75 g, fat = 45 g, and carbohydrates = 280 g both for tube and oral feeding subjects. Oral food intake increased oral and gut microbiome diversity and altered the composition of the microbiome. Oral and gut microbiome compositions were drastically different; however, the abundance of family Carnobacteriaceae and genus Granulicatella was increased in both the oral and gut microbiome after re-initiation of oral food intake. Although oral microbiota showed more significant changes than the gut microbiota, metagenome prediction revealed the presence of more differentially enriched pathways in the gut. In addition, simpler co-occurrence networks of oral and gut microbiomes, indicating improved dysbiosis of the microbiome, were observed during oral feeding as compared to that during tube feeding. Oral food intake affects oral and gut microbiomes in patients recovering from enteral nutrition. Rehabilitation for dysphagia can modify systemic health by increasing the diversity and altering the composition and co-occurrence network structure of oral and gut microbial communities.

Customized nutrition intervention and personalized counseling helps achieve nutrition targets in perioperative liver transplant patients

The present study was aimed at (1) the differences between current weight v. ideal weight, (2) total energy intake and comparing it with required energy (Rkeer), (3) absolute protein intake in g/kg per d and g/1000 calories, (4) how energy and protein intake relate to the nutritional status of the subjects in terms of overall overweight (OEW) [overweight + obesity] and conservative overweight (CEW) [obesity] and (5) the contribution (%) of protein to total energy intake based on the acceptable macronutrient distribution range (AMDR). A dietary study was carried out in Colombia with 29 259 subjects between 1 and 64 years of age, based on cross-sectional data collected in 2015 by a 24-h dietary recall (24HR) administered as part of the National Nutrition Survey. Energy and protein intake did not differ by nutritional status. In the general population, energy intake was 2117 kcal/d (95% CI 1969, 2264). The total protein intake was 64⋅3 g/d (95% CI 61⋅4, 67⋅3). Adequate energy intake ranged from 90 to 100%, except for the 1-4-year-old group, which ranged from 144 to 155%. Protein intake was 1⋅64 g/kg per d (95% CI 1⋅53, 1⋅75). The mean AMDR for protein to total energy intake was 13⋅3% (95% CI 12⋅9, 13⋅7). Excess weight began during the first 4 years of age. In conclusion, it is worth reviewing and updating energy and protein intake recommendations and dietary guidelines for the Colombian population and designing and modifying public policy.

Malnutrition is highly prevalent in advanced cancer patients, contributing to reduced quality of life, impaired physical function, and decreased survival. Although parenteral nutrition (PN) is used to supplement oral intake, its effect on oral feeding behaviors and eating pleasure remains unclear. We therefore aimed to evaluate the impact of supplemental PN on oral food intake and eating pleasure in malnourished advanced cancer patients with an intact bowel function. This study presents a sub-analysis of data from a larger, multicenter, randomized controlled trial. In this trial, advanced cancer patients with malnutrition and a functional gastrointestinal tract were assigned (1:1) to receive either supplemental PN plus standard oral feeding or oral feeding alone. Dietary intake was assessed at baseline and one month using a 24 h dietary recall, and eating pleasure was measured with the Self-Evaluation of Food Intake (SEFI) score. Eighty-nine patients were analyzed. In the overall cohort, mean daily energy intake assessed by 24 h recall increased significantly from 986 ± 475 kcal at baseline to 1082 ± 420 kcal at one month (p = 0.02), whereas SEFI score remained stable. At baseline, a significant positive correlation was found between the SEFI score and the ratio of calorie intake to estimated energy requirements (Spearman's ρ = 0.55, P < 0.001). In arm-specific analyses using paired t-test, patients in the oral-feeding arm experienced a significant rise at one month in mean energy intake (1009 ± 476 to 1224 ± 474 kcal; p = 0.045) with no significant change for patients in the PN arm (859 ± 437 to 856 ± 234 kcal, p = 0.71). Using McNemar's test, patients from the oral-feeding arm experienced a significant rise in oral nutritional supplement use ate one month compared with patients from the PN arm (6/19 % to 20/65 %, p = 0.01). Meal frequency, snack consumption, and pleasure to eat did not change in the overall population and in either arm. Supplemental PN does not negatively impact oral food intake or eating pleasure in malnourished advanced cancer patients with intact bowel function. These findings support the use of PN as a nutritional support option without compromising oral feeding behaviors. NCT02151214.

The oral food intake of terminally ill cancer patients is known to gradually decrease, but there are few reports about how oral intake changes around the terminal stage. It is important to clarify changes in oral food intake, as such changes affect the support and care of terminally ill cancer patients. We aimed to clarify changes in oral food intake in terminally ill cancer patients during the last 2 weeks before death. This retrospective cohort study was conducted at a designated cancer center hospital in Japan from January 2013 to June 2013. The subjects were recognized as clinically terminally ill cancer patients who were hospitalized for ≥14 days, and who had death as their reason for hospital discharge. One researcher investigated basic patient information and the food intake status of the subjects using their medical records. The basic information investigated was gender, age, type of cancer, and the presence of gastrointestinal obstruction 14 days prior to death. The Food Intake LEVEL Scale (FILS) was prospectively recorded. After applying the exclusion criteria, 108 subjects were finally included in the analysis (59 males aged 70.3 ± 13.3 years; 49 females aged 70.3 ± 14.5 years). The FILS gradually declined, and half of the subjects were unable to take food orally 6 days before death. In 81 subjects, after excluding subjects with gastrointestinal obstruction, the FILS gradually declined, and half of the subjects were unable to take food orally 4 days prior to death. Many terminally ill cancer patients can take food orally up to a few days prior to their death. Therefore, various specialists should support the oral intake of terminally ill cancer patients until immediately before their death.

Patients with large Stage IV gastric cancer (GC) invading the proximal stomach find it difficult to receive not only bypass surgery but also S-1-based chemotherapy. This study aimed to show our treatment results for those GC patients using elementary diet (ED) tubes, which enabled S-1-based chemotherapy and nutrition support. We evaluated 20 patients (13 men and 7 women; median age 70 years) with large Stage IV GCs (8.7-21.9 cm) invading the proximal stomach, who were admitted due to inability to eat, treated with S-1-based chemotherapy using an ED tube. The duration from the initiation of the chemotherapy to the improvement of oral intake, changes in nutritional status, and disease-specific survival (DSS) were retrospectively investigated. Two of the 20 patients failed to complete even one cycle of chemotherapy due to severe nausea or diarrhea. The other 18 patients improved oral liquid intake after 47.5 ± 18.8 days, and 17 patients improved oral solid food intake after 54.5 ± 19.6 days from the start of chemotherapy. In addition, three patients (16.7%) could receive conversion surgery after improvement of oral intake. The median DSS of those 18 patients was 13.1 months. Serum albumin level and prognostic nutritional index (PNI) were significantly improved after about 1 month of the treatment (both P <0.0001). Improvement of serum albumin level and PNI during the first 1 month of the treatment significantly correlated with better DSS (P = 0.006, 0.01, respectively). Given a high oral intake success rate, S-1-based chemotherapy using an ED tube can be a promising treatment option for large Stage IV GC with poor oral intake.

not effective as observed in this case also, phenytoin may worsen the overall toxicity.Hence, phenobarbitone controls pyrethroid-evoked seizure foci through its dual action such as chloride channel agonist and as a membrane stabilizer. [5] As pyrethroid insecticides have come into prominent use in recent years, the incidence of poisoning has increased.Hence, practitioners may be sensitized on the clinical manifestations, course, selection of anticonvulsants and outcome of pyrethroid poisoning, as well as be informed that these cases shall not be considered as simple or taken lightly.

Integrating nutrients, foods, diets, and appetites with obesity and cardiometabolic health.

Effect of Increasing Energy and Protein Intake on Mammary Development in Heifer Calves

High proportions of older people with normal nutritional status have poor protein intake and low diet quality

AimsOur neonatal unit recently updated their parenteral and enteral feeding guideline and started using a standardised parenteral nutrition regimen (SCAMP).1The aim of this study was to observe the amount of energy and protein that was being delivered to patients using the SCAMP regimen and to evaluate whether it met the recommendations made by ESGPHAN in terms of energy and protein intake.2MethodsA data collection form was designed using Excel. Patients were identified using BadgerNet digital software. All required patient parameters were recorded from Badgernet. Data was anonymised and the Excel spreadsheet was password protected. A single investigator collected data over a 28 day period in October/November 2018. Only patients on the SCAMP regimen were included in the study. Patient data was collected from first day of SCAMP regimen until baby was discharged, or ceased parenteral nutrition.Results22 patients were identified for inclusion in the study. Of these, 17/22 (77%) weighed &lt; 1 kg.Majority of babies (20/22; 91%) were aged &lt; 31 weeks corrected gestational age when SCAMP was initiated.Majority of babies were on the SCAMP regimen due to prematurity; 4/22 (18%) had a surgical condition, that required PN to be initiated.1 patient had a complex congenital cardiac anomaly.Average length of time babies remained on SCAMP was 19 days (range 5–28 days).Majority of babies were enterally fed using breastmilk. Some babies were on alternative formula feeds.Mean amount of energy delivered to each patient was calculated. The amount of energy delivered increased daily over the first week, and by day 10 of life had reached the target range (110–135 kcal/kg/day). Recommended energy intake was then maintained for the rest of the 28–day study period.Target amount of protein intake varied for babies weighing &lt;1 kg and &gt;1 kg. For babies &lt;1 kg, a gradual increase occurred over the first 5 days of life. Recommended protein intake was met between days 5–10 of life, then there was a gradual decline.For babies weighing between 1–1.8 kg, the recommended protein intake was achieved within 24–48 hours. Higher than recommended amounts of protein were being delivered between days 5–10 of life. Mean protein intake remained within ESPGHAN recommendations (3.5–4 g/kg/day) during weeks 3 and 4 of life.The results are encouraging and demonstrate that neonates are managing to achieve the recommended amounts of energy intake from day 10 of life.LimitationsThis study focused solely on energy and protein intake – it did not include observations of growth. Future studies should consider looking at more patient-focused outcomes.ConclusionsSCAMP regimen is delivering the recommended amounts of energy for babies on the neonatal unit – target levels are achieved by day 10 of life.Future work should focus on observing growth in babies on SCAMPEarlier introduction of breast–milk fortifier may be helpful to increase protein intake in babies &lt; 1 kg – potential benefits need to be evaluated against risk of adverse effects.ReferencesMorgan C, Herwitker S, Badhawi I, et al. SCAMP: standardised, concentrated, additional macronutrients, parenteral nutrition in very preterm infants: a phase IV randomised, controlled exploratory study of macronutrient intake, growth and other aspects of neonatal care. BMC Pediatrics 2011;11:53.Koletzo B, Goulet O, Hunt J, et al. Guidelines on paediatric parenteral nutrition of the European society of paediatric gastroenterology, hepatology and nutrition (ESPGHAN) and the European society for clinical nutrition and metabolism (ESPEN), supported by the European society of paediatric research (ESPR). J Pediatr Gastroenterol Nutr 2005;41 (Suppl 2):S1–87.

The challenge pays off: Early enhanced nutritional intake for VLBW small-for-gestation neonates improves long-term outcome

BackgroundThe 2019 Enhanced Recovery After Cardiac Surgery (ERACS) guidelines presented perioperative recommendations to optimize treatment for patients undergoing cardiac surgery (CS). However, the guidelines have not established postoperative nutrition recommendations. Limited studies have analyzed oral intakes after CS, but to our knowledge, none have done so in an ERACS pathway. The main objective of this study was to evaluate the adequacy of postoperative oral intakes, including adherence to oral nutrition supplements (ONSs).MethodsThis was an observational prospective study. Postoperative oral intakes were analyzed from postoperative day (POD) 1 to 4, using direct observation of meal plates provided by the hospital. ONSs consumption was evaluated from POD2 to POD4. Adherence to other ERACS recommendations, including nutrition optimization before surgery, was recorded.ResultsForty‐three patients were included in this study. Nutrition optimization before CS was offered to three (7%) patients. Forty‐one (95%) patients resumed oral intakes on POD1. Mean oral calorie and protein intakes from POD2 to POD4 were 1088 ± 437 kcal and 0.8 ± 0.3 g/kg, respectively; however, 17 (41%) patients had calorie and protein intakes ≥70% of their estimated requirements. On POD2, ONSs consumption contributed 35% ± 19% and 38% ± 20% of calorie and protein intake, respectively. There was a significant decrease in ONSs consumption starting on POD3.ConclusionWithin an ERACS pathway and with the contribution of ONSs, 41% of patients achieved sufficient oral intakes within the first 4 days after CS. The optimization of ONSs adherence on postoperative oral intakes should be further studied.

In this study, we investigated placement rate, complication rate and time spent of successful post-pyloric enteral feeding (PPEF) tube insertion procedure guided by ultrasonography (USG). The patients who required enteral nutrition and who admitted to medical intensive care unit (MICU) of Gazi University Hospital were included to this single-center, prospective, cohort study. It was aimed to insert the enteral feeding tube into the proximal duodenum as the post-pyloric area by ultrasonography guidance. During the PPEF tube insertion procedure, the linear probe was used to display the proximal esophagus and the convex probe was used to display the post-pyloric area, antrum and pyloric channel. 33 patients were included in this study. The median age was 68 [IQR 52-79] years. There were 17 (51.5%) woman and 22 (66.7%) intubated patients. The enteral feeding tube was successfully passed into the post-pyloric area in 29 (87.9%) patients with this technique. The median time of successful feeding tube insertion was 14 [IQR 10-25] min. The median level of the enteral feeding tube was 74 [IQR 70-76] cm. in successful placement. There was no significant difference in insertion time according to gender (female vs male; 10 [IQR 8-20] min. vs 17 [IQR 12-25] min., p = 0.052) and endotracheal intubation status (intubated vs non-intubated; 14 [IQR 10-25] min. vs 12 [IQR 10-25] min., p = 0.985). Only one complication was seen during study (self-limiting epistaxis in one patient). PPEF tube insertion under USG guidance could ensure the initiation of enteral feeding safely and rapidly without exposure to radiation in ICU patients.

A nutritional audit was performed to determine whether current feeding regimes were achieving nutritional goals and to evaluate the use of breastmilk (BM) in a neonatal unit (NNU). All fluid consumed or infused daily was documented with daily weight and weekly length and head circumference measurements in 90 preterm infants (gestational age 30.1 +/- 2.6 weeks) while in the NNU for 60 +/- 27 days. Daily protein and energy intakes were calculated using values for South Australian preterm BM. Parenteral nutrition provided 85% of the daily energy in week 1 falling to 11% by week 6. Ninety per cent of infants received some of their mother's BM and 62% were discharged at least partially breastfed. Protein and energy intakes were 1.03 +/- 0.35 g and 55 +/- 10 kcal/kg/day in week 1, increasing to 2.52 +/- 0.60 g and 109 +/- 15 kcal/kg per day by week 4. Protein intake correlated with weight gain (r2 = 0.39). Weight gain was 14.0 +/- 2.0 g/kg per day and z-scores for weight declined from -0.25 on admission to -1.22 on discharge, P < 0.0001. When infants were divided into two groups comprising those who received BM or formula as their predominant enteral feed, growth and protein intake (but not energy intake) were lower in the BM-fed infants. However, enteral feeds were tolerated earlier and more quickly in those infants receiving predominantly BM. Energy requirements were readily met using current feeding regimes for preterm infants but protein intakes were marginal. Mothers of preterm infants had similar breastfeeding rates to mothers of term infants in South Australia. The long-term effects of the lower growth rates of preterm infants fed predominantly BM compared with those fed predominantly formula are unknown and need be balanced against the benefits of BM.