Refeeding Syndrome: A Critical Reality in Patients with Chronic Disease

Malnutrition is one of the most frequent metabolic challenges in the population of chronically ill patients. This results in increased administration of nutritional therapy in inpatient settings, which poses the risk of side effects, in particular, the development of refeeding syndrome. If not managed accordingly, it leads to a significant rise in morbidity and mortality. However, despite its importance, evidence-based recommendations on the management of refeeding syndrome are largely lacking, and only a few randomized controlled trials have been conducted. In light of this, the aim of this review is to raise awareness of refeeding syndrome in chronically ill patients by critically reviewing recent literature and providing a short overview as well as diagnosis and treatment algorithms of this underreported metabolic condition. In summary, recent findings suggest undergoing risk assessment and stratification for every patient receiving nutritional therapy. According to this, adaptation of energy and fluid support during the replenishment phase should be implemented in the nutritional therapy for patients at high risk. Additionally, continuous monitoring should take place, and appropriate actions should be initiated when necessary.     

养老机构膳食营养服务的困境与对策

膳食营养服务是养老机构服务中的痛点与难点。目前,养老机构的膳食营养服务缺乏标准的引领,尚未形成有效的运作体系;机构内部的管理规章制度不全面、不协调,加上缺乏必要的服务技术、人才和质量评估,膳食营养服务是被投诉的焦点和老年人最不满意的服务。因此,加快标准制定,引导养老机构膳食营养服务体系的建立,协调和系统化机构内部的各项规章制度、强化技术和人才要素,推进膳食营养服务质量的评估,才能满足不同需求老年人的精准营养要求,从而促进老年人的健康老龄化,提升养老机构膳食营养服务的能力与水平,使养老机构的膳食营养服务高质量地发展。     

肾衰养真胶囊对慢性肾衰竭营养不良大鼠下丘脑神经肽Y mRNA及原阿片黑皮素mRNA表达的影响

目的 观察肾衰养真胶囊对慢性肾衰竭(CRF)营养不良大鼠下丘脑神经肽Y(NPY)mRNA及原阿片黑皮素(POMC)mRNA的表达及其营养状态的影响.方法 采用含0.5%腺嘌呤及4%酪蛋白饲料联合喂养的方法制作CRF营养不良大鼠模型,观察其营养不良发生时间,符合CRF营养不良模型的随机分为模型组、肾衰养真胶囊组和开同组.治疗4周后,检测下丘脑NPY mRNA和POMC mRNA表达水平.结果 肾衰养真胶囊组大鼠营养状况明显改善,下丘脑的NPY mRNA表达上调及POMC mRNA表达下调.结论 肾衰养真胶囊可改善CRF营养不良大鼠的营养状况,其机制可能是通过上调下丘脑NPY mRNA表达,下调下丘脑POMC mRNA表达,从而促进大鼠摄食.     

Malnutrition in Older Adults—Effect on Falls and Fractures: A Narrative Review

Malnutrition in older adults impacts health status, increased mortality, and morbidity. Malnutrition may increase the development of geriatric syndromes and contribute to a higher prevalence of falls and osteoporotic fractures that lead to loss of independence and an increased rate of institutionalization. The role of malnutrition in the pathogenesis of other geriatric syndromes seems to be well established. However, the data concerning nutritional interventions are confounding. Moreover, long-term undernutrition seems to be one of the factors that strongly influences the efficacy of interventions. This review outlines the current literature on this topic, and aims to guide physicians to make proper decisions to prevent the vicious cycle of falls, fractures, and their negative outcomes in patients with malnutrition.     

锦州铁路地区2~6岁儿童营养状况分析

目的 了解锦州铁路地区儿童生长发育和营养状况,保护儿童的身体健康。方法 对2010年锦州铁路地区市内及沿线6所幼儿园的2 367名2~6岁儿童体检资料进行分析。结果 锦州铁路地区2~6岁儿童营养不良检出率为3.25%,其中生长迟缓率、低体重和消瘦率分别为1.56%、0.68%和1.01%;儿童超重率和肥胖率分别为6.39%和5.83%;市内组与沿线组进行比较,低体重率、消瘦率和肥胖率差异均有统计学意义（P<0.05）;儿童贫血检出率为3.76%,2岁组儿童贫血率明显高于其他年龄组;市内与沿线2组贫血检出率比较有统计学意义（χ²=7.85,P<0.01）。结论 锦州铁路地区儿童营养状况较好,但少数年龄组的肥胖和贫血检出率较高。     

Effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty: A meta‐analysis

We performed a meta‐analysis to evaluate the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty. A systematic literature search up to April 2022, was performed and 446 501 subjects with total joint arthroplasty at the baseline of the studies; 200 433 of them were confirmed serologic malnutrition, and 246 068 were confirmed normal nutrition. Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to assess the effect of serologic malnutrition on postoperative wound infection problems after total joint arthroplasty using the dichotomous method with a random or fixed‐effect model. The serologic malnutrition subjects had a significantly higher wound disruption (OR, 1.97; 95% CI, 1.53–2.53, P < 0.001), higher superficial incisional surgical site infection (OR, 2.89; 95% CI, 1.67–5.01, P < 0.001), higher deep incisional surgical site infection (OR, 3.06; 95% CI, 2.36–3.96, P < 0.001), and higher organ space surgical site infection (OR, 3.15; 95% CI, 2.34–4.24, P < 0.001) in subjects after total joint arthroplasty compared with normal nutrition. The serologic malnutrition subjects had a significantly higher wound disruption, superficial incisional surgical site infection, deep incisional surgical site infection, and organ space surgical site infection in subjects after total joint arthroplasty compared with normal nutrition. The analysis of outcomes should be with caution because of the low number of studies in certain comparisons.     

Association between Geriatric Nutritional Risk Index and Depression after Ischemic Stroke

Background: Malnutrition is associated with poor outcomes after stroke. However, the association between malnutrition and post-stroke depression (PSD) remains unelucidated. We aimed to explore the association between geriatric nutritional risk index (GNRI) and depression after ischemic stroke. Methods: In total, 344 patients with ischemic stroke were included in this analysis. The GNRI was calculated from serum albumin level, weight, and height at admission. Malnutrition was defined using the GNRI cutoff points. A lower GNRI score indicates an elevated nutritional risk. The outcome was depression, measured 14 days after ischemic stroke. Logistic regression models were used to estimate the association between the GNRI and risk of PSD. Results: A total of 22.9% developed PSD 14 days after stroke. The mean GNRI was 99.3 ± 6.0, and 53.8% of the patients had malnutrition. After adjusting for covariates, baseline malnutrition was not associated with risk of PSD (OR, 0.670; 95%CI, 0.370–1.213; p = 0.186). The restricted cubic splines revealed a U-shaped association between the GNRI and PSD. Compared to moderate GNRI, higher GNRI (OR, 2.368; 95%CI, 0.983–5.701; p = 0.085) or lower GNRI (OR, 2.226; 95%CI, 0.890–5.563; p = 0.087) did not significantly increase the risk of PSD. Conclusion: A low GNRI was not associated with an increased risk of depression after ischemic stroke.     

创伤严重程度与住院不同时间营养不良的关系

目的 探讨创伤病人损伤严重程度与其住院不同时间营养不良的关系.方法 对外伤后24 h内入院的120例创伤病人,入院首日依据创伤严重程度评分（ISS）分为轻度损伤、中度损伤及重度损伤,各40例.入院次日对病人进行营养不良风险筛查（NRS）,住院期间每周进行NRS评分,共4次.并对评分结果进行统计分析.结果 ISS与住院期间第1～3周NRS评分呈正相关（r=0.408～0.752,P〈0.01）.重度损伤组第1～3周NRS评分明显高于其他两组,差异有显著性（F=11.16～121.28,q=2.15～21.15,P〈0.001）.结论 创伤病人营养不良风险与创伤严重程度有关.对创伤病人进行ISS测定可预测病人住院期间不同时间存在营养不良的风险.     

Bacteraemia among severely malnourished children in jimma university hospital, ethiopia

Background

Sever acute malnutrition severely suppresses every component of the immune system leading to increased susceptibility and severity to infection. However, symptoms and signs of infections are often unapparent making prompt clinical diagnosis and early treatment very difficult. The aim of the study was to determine the magnitude of bacteraemia and antimicrobial sensitivity among severely malnourished children.

Methods

Severely malnourished children admitted in Jimma University Specialized Hospital were enrolled between October, 2009 to May, 2010. Blood samples were collected, processed and bacterial isolates were identified using standard bacteriological procedures. Then, antibiotic susceptibility pattern of the isolates was determined by using Kirby-Bauer technique.

Results

Bacteraemia was seen in 35 (20.6%) of the 170 study subjects. There were a total of 35 bacterial isolates, Gram positive bacteria constitute 24(68.6%) of the isolates, where Staphylococcus aureus was the leading Gram positive isolate while Klebsiella species were the dominant Gram negative isolates. Twelve (7.1%) children died and 4 (33.3%) of them had bacteraemia. While susceptibility was more than 80% to Gentamicin, Ciprofloxacin and Ceftriaxone, increased level of resistance was documented to commonly used antibiotics, such as Amoxycillin, Co-trimoxazole and Chloramphenicol.

Conclusion

High prevalence of bacteraemia with predominating Gram positive isolates and increased level of resistance to commonly used antibiotics was shown among severely malnourished children in Jimma. Further studies are required to revise the current guideline for antibiotic choice.     

宁夏1～24月回族农村儿童喂养方式与生长发育状况调查

为了解宁夏回族农村儿童的健康状况及喂养方式中存在的问题,对宁夏1～24月回族农村儿童的生长发育状况及喂养方式进行了调查。1　方　法1.1　资料来源与方法　　资料来源于宁夏回族人口健康素质抽样调查数据,按《全国少数民族人口健康素质抽样调查工作手册》要求,于1994、1995年在宁夏回族人口聚居区,按经济水平上、中、下,随机抽取灵武、泾源、海原3县中的9个乡,在回族人口占95%以上的9个村镇,对0～14岁回族儿童填写《体格发育调查表》,并进行全面体检和体格测量,将1～24月儿童的体格发育数据与WHO标准比较,根据1～12月儿童的喂养方式,分…