Effect of nutritional support on clinical outcome in patients at nutritional risk

BACKGROUND & AIMS: Undernourished patients have an increased risk of complications and a prolonged hospital stay, compared to those who are not undernourished. The aim of this study was to evaluate the effect of nutritional intervention in a random sample of hospitalized patients at nutritional risk. METHODS: A randomized, controlled trial of nutritional intervention in 212 patients. Intervention consisted of a specialized nutritional team (nurse and dietician) who attended patients and staff for motivation, detailed a nutritional plan, assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate. The control group received the standard regime used in the department. The primary endpoint was the part of the length of stay (LOS) that was considered to be sensitive to nutritional support, designated LOSNDI. The nutritional discharge index (NDI) consists of three objective criteria: (1) the patient is able to manage toilet visits without assistance, reflecting mobilization; (2) the patient is without fever (tp < 38 degrees C), reflecting absence of infection; and (3) the patient has no intravenous access, reflecting absence of complications in general. On the day when all three criteria were fulfilled, hospital stay was no longer considered to be sensitive to nutritional support. Actual LOS is also reported. Incidence and severity of complications were recorded to explain LOSNDI findings. As a secondary endpoint, quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. RESULTS: Intervention led to an intake of > or = 75% of requirements in 62% of the intervention patients, as compared to 36% of the control patients. Rates of complications, mean LOSNDI and LOS were not significantly different between the two study groups. However, among patients with complications a difference in LOSNDI between intervention patients (14 +/- 2 days, mean +/- SE) and control patients (20 +/- 2 days) was statistically significant (P = 0.015). In the same patients, LOS was 17 +/- 2 days in the intervention group and 22 +/- 2 days in the control group (P = 0.028). The SF-36 questionnaire did not show a significant effect of treatment. CONCLUSIONS: Protein and energy intake of nutritionally at-risk patients was increased which resulted in shortening of the part of the length of stay that was considered to be sensitive to nutritional support (LOSNDI) and shorter length of stay (LOS) among patients with complications.     

Perioperative nutritional support: a randomised clinical trial

Ever since methods of artificial nutritional support became available, attempts have been made using this form of treatment to reduce mortality and morbidity in surgical patients. Many trials have addressed this question, but very few have given a meaningful answer because of conceptual and methodological flaws. We therefore undertook a prospective randomised trial investigating the effects of at least 10 days pre-operative total parenteral nutrition (TPN) (n = 51) or total enteral nutrition (TEN) (n = 50) providing 150% basal energy expenditure (BEE) non-protein energy, to reduce major postoperative complications and mortality in a homogeneous patient group with signs of depletion. 50 patients served as a depleted control group (D) and 49 patients served as a non-depleted reference group (ND) and were operated upon without delay. Depleted control patients suffered significantly more septic complications than did patients in the non-depleted reference group (p < 0.05). There was no significant difference, however, in septic complications between either of the nutritional support groups and the non-depleted control group. In high risk patients, with weight loss >10% of body weight and over 500 ml blood loss during operation, a significant decrease in major complications was observed (p < 0.05) as a result of nutritional support. We conclude that pre-operative nutritional support, in patients with severe depletion, results in a reduction in major complications to a degree that justifies its routine use in this selected group of patients.     

Impact of preoperative nutritional support on clinical outcome in abdominal surgical patients at nutritional risk

ObjectiveThis multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).MethodsA consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing, China were recruited from March 2007 to July 2008. Data were collected on the nutritional risk screening (NRS-2002), the application of perioperative nutritional support, surgery, complications, and length of stay. A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support.ResultsIn total 1085 patients were recruited, and 512 of them were at nutritional risk. Of the 120 patients with an NRS score at least 5, the complication rate was significantly lower in the preoperative nutrition group compared with the control group (25.6% versus 50.6%, P = 0.008). The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group (13.7 ± 7.9 versus 17.9 ± 11.3 d, P = 0.018). Of the 392 patients with an NRS score from 3 to 4, the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support (P = 1.0 and 0.770, respectively).ConclusionThis finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate.     

Acute effects of mind-body practices and exercise in depressed inpatients: A randomized clinical trial

AimTo analyze acute effects of exercise (EX) and mind-body practices (MB) on anxiety, affect and well-being as well as on changes in markers of neurogenesis and inflammation in a sample of inpatients with depression.MethodA randomized, controlled crossover trial involving 33 inpatients (72.7% female, mean age 37.03 ± 14.32 years-old) with a depressive episode (DE). The participants performed a single bout of EX, MB, and a control activity (CA) and were randomized into groups that performed the activities in the order of EX-CA-MB or MB-CA-EX. EX involved mixed aerobic and anaerobic exercises, MB combined mindfulness, yoga and meditation practices while CA involved coloring figures or free hand drawing. Stait-Trait Anxiety Inventory (STAI), the Positive Affect and Negative Affect Schedule (PANAS), and an analogue visual scale (AVS) for well-being were used to assess effects on anxiety and well-being. Levels of brain-derived neurotrophic factor (BDNF), interleukins (IL) 1β, 6, 10 and tumor necrosis factor-alpha (TNF-a) were analyzed in samples collected immediately before and after each intervention.ResultsAll interventions showed a time-dependent effect on clinical and biological variables, except for IL-10. Among clinical variables, EX had a time-group interaction for well-being. EX and MB both had a time-group interaction for negative affect, and the effect was stronger than that for EX. Among biological variables, MB acutely decreased (IL) 1β, and EX acutely decreased TNF-α.ConclusionsEX and MB have acute effects in reducing negative affect and anxiety, while promoting well-being and positive affect. These findings support that MB and EX (anaerobic and aerobic) alone can have acute effects on biological and clinical variables.     

Effect of changed organisation of nutritional care of Danish medical inpatients

Background  

Many patients are undernourished during hospitalisation. The clinical consequences of this include lassitude, an increased risk of complications and prolonged convalescence. The aim of the study is 1) to implement a new organisation with a focus on improving the quality of the nutritional care of medical inpatients at risk of undernutrition, and 2) to investigate the effect of the intervention.     

呼吸科住院病人营养风险筛查和营养支持的调查研究

目的:探讨呼吸科病人的营养状况以及营养支持的应用情况,了解营养风险在疾病诊断上的差异。方法:采用营养风险筛查方法(NRS 2002)对呼吸内科712例住院病人进行营养风险筛查,统计营养不良、营养风险发生率和营养支持情况,分析不同性别、年龄和不同疾病的病人营养风险情况以及营养风险与营养指标之间的关系。结果:在住院病人中,营养不良发生率为13.4%(96/712),营养风险发生率为20.2%(144/712)。男性病人有营养风险者高于女性,但无显著性差异(P0.05)。≥60岁的病人有营养风险者多于60岁者,且差异有显著性统计学意义(P0.05)。在144例有营养风险的病人中,行营养支持者42例(29.2%),有营养风险组病人的营养指标均低于无营养风险组,差异有显著性统计学意义(P0.05)。结论:呼吸科病人营养不良和有营养风险的发生率较高,尤其是老年病人。NRS 2002适用于呼吸疾病病人的营养风险筛查,可作为其营养治疗方案的依据。     

Impact of nutritional support on clinical outcome in patients at nutritional risk: A multicenter,prospective cohort study in Baltimore and Beijing teaching hospitals

ObjectiveTo evaluate the impact of nutritional support on clinical outcomes in patients at nutritional risk defined by the Nutritional Risk Screening 2002.MethodsIn this prospective cohort study, hospitalized patients from three departments in Johns Hopkins Hospital in Baltimore and two teaching hospitals in Beijing were recruited from March 2007 to May 2008. Data were collected on the nutritional risk screening, application of parenteral nutrition and enteral nutrition, surgery, complications, and length of stay.ResultsThere were 1831 patients recruited, with 45.2% of them at nutritional risk. Of the “at-risk” patients, the complication rate was significantly lower in the nutritional-support group than in the no-support group (20.3% versus 28.1%, P = 0.009), mainly because of the lower rate of infectious complications (10.5% versus 18.9%, P < 0.001). Subgroup analysis showed the complication rate was significantly lower in the enteral nutrition group (P < 0.001) but not in the parenteral nutrition group (P = 0.29) when compared with the no-support group. Of the patients without nutritional risk, the complication rate was not different between the nutritional-support group and the no-support group (P = 0.10). Multivariate analysis showed nutritional support was a protective factor for complications in at-risk patients when adjusted for confounders (odds ratio 0.54, P < 0.001). No difference in length of stay was found.ConclusionThe findings suggested that nutritional support was beneficial to the patients at nutritional risk according to Nutritional Risk Screening 2002 by a lower complication rate.