Anthropometric nutritional assessment is of value in colorectal patients

Eighty patients undergoing elective major colorectal surgery were nutritionally assessed using simple anthropometric methods and serum albumin. Although most of the patients were not malnourished, these tests were able to detect a small group of high-risk patients. Thirty major complications were recorded. The incidence of complications was 72 per cent in patients with low body weight, 69 per cent with low forearm muscle circumference, 55 per cent with recent weight loss, and 57 per cent with serum albumin below 35 g/l. Anthropometric tests were better in predicting postoperative complications than serum albumin. Of those patients who developed complications, 60 per cent had low grip strength, 37 percent weight loss, 37 per cent high malnutrition score, 33 per cent low body weight, and 27 per cent had lower serum album. Anthropometric tests were more sensitive and more accurate than serum albumin. Anthropometry has the additional advantages of being simple, noninvasive, and independent of laboratory facilities; it also provides instant bedside assessment.     

简易营养评价法及简易营养评价精法对老年人营养不良的评价

目的将简易营养评价法(MNA)、简易营养评价精法(MNASF)及传统营养评价法进行比较。方法对144例住院老年患者同时应用MNA、MNASF及传统营养评价法进行调查,比较3种方法的异同。结果(1)MNA调查显示住院老年人营养不良患病率为361%,潜在营养不良为465%;MNASF对营养不良检出率为715%;传统方法的检出率在132%~722%之间;(2)MNA与传统营养评价法中的体质指数(BMI)、腓肠肌围、上臂肌围、三头肌皮褶厚度、白蛋白、前白蛋白、甘油三酯(TG)和血红蛋白(Hb)的相关系数在0204~0671之间(P<005);MNASF值与上述指标的相关系数在0233~0622之间(P<005);(3)MNA和MNASF相关系数为0933(P<005);与MNA相比,MNASF敏感性为857%,特异性960%,准确性875%。结论MNA和MNASF皆是老年人营养状况评价的可靠方法,MNA项目较详细,更适合于科研;MNASF简便,比较适用于临床。     

老年血液透析患者营养状态与生存质量的关系

目的 探讨老年血液透析(HD)患者营养状态和生存质量之间的关系.方法 测定106例老年HD患者的血红蛋白(Hb)、血清白蛋白(ALB)、转铁蛋白(TF)和胰岛素样生长因子-1(IGF-1),使用改良定量主观整体评估(MQSGA)表评估患者营养状况;使用肾脏疾病生存质量量表(KDQOL-SFTM)调查老年血液透析患者生存质量,并计算生存质量评分.结果 106例老年HD患者营养不良的发生率为69.8%;生存质量评分一般健康相关生活质量(SF-36)为68.23±5.99,肾脏病和透析相关生活质量(KDTA)为49.19±4.86;MQSGA评估得分与肾脏病和透析相关生活质量(KDTA)总分及其分支领域的症状的不适、认知功能、睡眠质量显著相关,与一般健康相关生活质量(SF-36)总分及其分支领域的生理机能、生理职能、躯体疼痛、总体健康和活力显著相关;营养指标Hb、ALB、TF、IGF-1与KDTA总分及其分支领域的症状与不适,肾脏病对日常生活的影响,工作状况,睡眠质量及一般健康相关生活质量(SF-36)总分及其分支领域的生理机能、总体健康、感觉愉快、活力、生理健康总分及精神健康总分显著相关.结论 老年血液透析患者营养不良发生率高,营养状态是影响老年血液透析患者生存质量的重要因素,改善血液透析患者营养状况能提高老年血液透析患者生存质量.     

2009年宁夏婴幼儿尿碘监测结果分析

目的 了解宁夏0～30个月婴幼儿的碘营养水平,为是否有必要开展特需人群强化补碘和下调盐含碘量提供参考依据.方法 采用二阶段抽样法,在全区22个县(市、区)的664个行政村中抽取1483名婴幼儿,用砷铈催化分光光度法检测其尿碘并进行相关影响因素调查.结果 全区婴幼儿的尿碘中位数为216.5μg/L,<100μg/L所占比例为19.1%(283/1483),100～300 μg/L所占比例为49.3%(731/1483),>300μg/L所占比例为31.6%(469/1483);各县尿碘中位数在130.6 ～328.4μg/L,均>100μg/L以上;尿碘中位数男性略高于女性,分别为223.2、210.2 μg/L,两者比较差异无统计学意义(Z=-1.76,P>0.05);1岁以内尿碘几乎无变化(Z=-0.624,P>0.05),1岁后开始逐渐下降(χ2=13.59,P<0.05),随着月龄的增加,尿碘<100μg/L的比例逐渐增多;母亲服用过碘油的婴幼儿,尿碘高于未服用者,分别为257.5、22 1.2μg/L,两者比较差异有统计学意义(Z=-2.54,P<0.05).1岁以内接受母乳喂养的婴幼儿尿碘高于未服用者,分别为239.1、204.2μg/L,两者比较差异有统计学意义(Z=-2.74,P<0.05).结论 现行的食盐加碘量对宁夏婴幼儿可能造成其碘营养超过适宜量,故宁夏居民盐碘总体上有下调的空间.宁夏除西吉县外,其他山区县可不必对特需人群再进行强化补碘.     

重症急性胰腺炎患者早期肠内营养的应用研究

背景:传统全胃肠外营养(TPN)对重症急性胰腺炎(SAP)的疗效不理想,早期肠内营养(EN)在SAP治疗中的作用越来越受到重视。目的:探讨早期EN在SAP治疗中的作用。方法:35例SAP患者随机分为TPN组(18例)和肠外营养(PN) EN组(17例),比较两组治疗前后生化指标、APACHEⅡ评分和临床指标的差异。结果:治疗2周后,PN EN组C反应蛋白和APACHEⅡ评分较治疗前和TPN组治疗后显著下降(P<0.05),血清白蛋白水平较治疗前和TPN组治疗后显著升高(P<0.05)。PN EN组的感染率、并发症发生率、手术干预率、平均住院天数和平均住院费用均显著低于TPN组(P<0.05),两组死亡率无显著差异。结论:早期EN在SAP的治疗中起重要作用,只要条件允许,应尽早开始EN。     

日常生活受限的老年患者营养状况的调查

目的:调查日常生活活动能力下降的老年患者的营养状况。方法:使用简易营养评价简表(MNA-SF)评估我院干部病房住院老年患者的营养状况,并按照日常生活自理能力程度分为4组进行分析。结果:共53例患者纳入研究,23(43.40%)例患者发生营养不良,且4组随着日常生活自理能力下降,MNA-SF评分(营养不良发生率)分别为13.00±1.30(4.76%),10.13±1.64(62.50%),9.40±2.50(60.00%),7.36±3.15(76.57%)(P<0.05)。简易营养评价简表评分和白蛋白、前白蛋白、血红蛋白具有良好的相关性。结论:老年患者随着日常生活自理能力的下降,其营养不良发生率逐渐增加,MNA-SF可以用于这类人群营养不良的筛查。     

Serum total bilirubin level, prevalent stroke, and stroke outcomes: NHANES 1999-2004

Background

Bilirubin inhibits experimental atherosclerosis, is inversely associated with carotid plaque burden, and confers neuroprotection in experimental stroke. Clinical data addressing the association of bilirubin with stroke are not available. We hypothesized that higher bilirubin levels would be associated with reduced stroke prevalence and improved stroke outcomes.

Methods

We used the National Health and Nutrition Examination Survey 1999 to 2004, a nationally representative cross-sectional examination of the United States civilian population, to examine the association of bilirubin with stroke. Of 13,214 adult participants with data on stroke history, serum total bilirubin level, and stroke risk factors, 453 reported a history of stroke. Of these, 138 participants reported an adverse stroke outcome, defined as a long-term health problem or disability due to stroke. We performed multivariable logistic regression to estimate odds ratios (ORs) and 95% confidence intervals (CIs) with adjustment for demographic characteristics and stroke risk factors.

Results

After multivariable adjustment, a 1.71 μmol/L (0.1 mg/dL) increment in bilirubin level was associated with a 9% reduced odds of stroke (OR 0.91; 95% CI, 0.86-0.96) among all participants and with a 10% reduced odds of an adverse stroke outcome (OR 0.90; 95% CI, 0.80-1.00) among participants with a history of stroke.

Conclusions

These results suggest that a higher serum total bilirubin level is associated with reduced stroke prevalence and improved stroke outcomes. Our findings support the hypothesis that bilirubin may protect from stroke events and from neurologic damage in stroke.     

Current trends in acute pancreatitis:Diagnostic and therapeutic challenges

Acute pancreatitis(AP) is an inflammatory disease of the pancreas,which can progress to severe AP,with a high risk of death.It is one of the most complicated and clinically challenging of all disorders affecting the abdomen.The main causes of AP are gallstone migration and alcohol abuse.Other causes are uncommon,controversial and insufficiently explained.The disease is primarily characterized by inappropriate activation of trypsinogen,infiltration of inflammatory cells,and destruction of secreto...     

Nutrition Algorithms for Infants with Hypoplastic Left Heart Syndrome; Birth through the First Interstage Period

Failure to thrive is common in infants with hypoplastic left heart syndrome and its variants and those with poor growth may be at risk for worse surgical and neurodevelopmental outcomes. The etiology of growth failure in this population is multifactorial and complex, but may be impacted by nutritional intervention. There are no consensus guidelines outlining best practices for nutritional monitoring and intervention in this group of infants. The Feeding Work Group of the National Pediatric Cardiology Quality Improvement Collaborative performed a literature review and assessment of best nutrition practices from centers participating in the collaborative in order to provide nutritional recommendations and levels of evidence for those caring for infants with single ventricle physiology.     

Nutritional status and quality of life of the gastric cancer patients in Changle County of China

AIM: To analyze the relation between nutrition and quality of life in the stomach cancer patients, evaluate the intake of daily nutrition of the patients, and study the feasibility of nutrition intervention in improving quality of life of the stomach cancer patients. METHODS: A total of 285 surgical stomach cancer patients reported in the Changle Cancer Registry from 2002 to 2003 were investigated with respect to their diet and quality of life. Daily nutrition intakes of the patients were calculated according to the Food Composition Database, and these data were compared with the reference values proposed by the Chinese Nutrition Society. The partial correlation was used to analyze the relationship between nutrition and quality of life in the patients. Stepwise multiple regression analyses were conducted to analyze the factors influencing nutrition intake in stomach cancer patients. RESULTS: Except vitamin C, there were statistical correlations between the nutrition and quality of life in stomach cancer patients, and differences of the daily nutrition intake among three groups (good, modest and bad quality of life) of the patients were significant. Most of the stomach cancer patients had a lower daily nutrition intake than the reference values. At the significance level α=0.05, the factors influencing the daily nutrition intake of the patients were number of meals a day, family income, way of operation, exercise and age. CONCLUSION: The nutritional status of the operated patients with stomach cancer may impact on their quality of life. The stomach cancer patients in Changle County have a low level of daily nutrition intake, which suggests that they have a bad nutritional status. To improve the quality of life of the patients, the nutrition intervention should be conducted. Increasing times of meals a day and having a high-protein, high-calorie foods can improve the nutritional status of the stomach cancer patients. Moreover, exercise for rehabilitation can whet the appetite of the patients and recover their body function, which in turn may improve the quality of life of the stomach cancer patients.     

Dynamic aspects of whole body glycine metabolism: Influence of protein intake in young adult and elderly males

The influence of adult age and adequacy of dietary protein intake on whole body glycine metabolism was studied in human subjects. Five healthy young adult males (19–25 yr) and six elderly males (64–78 yr) were given an adequate-protein diet (1.5 g protein/kg/day) for 7 days and a low-protein diet (0.4 g protein/kg/day) for 14 days. At the end of each dietary period, whole body glycine flux and rates of glycine synthesis were estimated with the use of a continuous 60 hr oral administration of ¹⁵N-glycine and determination of ¹⁵N enrichment of plasma glycine by gas chromatography-mass spectrometry with selected ion monitoring. Mean whole body glycine flux and the rate of endogenous glycine synthesis were 458 and 351 μmole/kg body weight/hr, respectively, for young adults receiving the diet adequate in protein; similar values were obtained in the elderly group. Feeding the diet low in protein resulted in an extensive and significant reduction in both parameters in young adults and also in elderly subjects to a similar extent. Measurement of ¹⁵N enrichment in plasma serine gave a constant ratio of ¹⁵n enrichment in plasma free serine relative to glycine for both age groups and at the two protein intake levels. It is concluded that aging of adults has little impact on the quantitative aspects of whole body glycine metabolism, but that it responds extensively to changes in protein intake. Thus, it appears that glycine synthesis and flux are integrated with the body's total nitrogen metabolism and requirement for dietary nitrogen.     

Assessing the nutritional status of the elderly living at home

PurposeMalnutrition is an important and often unrecognized problem in the elderly living at home, with the estimated prevalence of malnutrition ranging from 13% to 30% depending on the methods used and characteristics of the studied individuals. The aim of the study was to compare three tools for assessing the nutritional status of the elderly in the home setting. The sensitivity and usability of these tools in patients over 65 years of age were studied.Subjects and methodsThe MNA, SGA and MUST assessment tools were tested in the elderly living at home. The study comprised 470 senior citizens (46% of males and 54% of females; a mean age of 74.1 years). Statistical analysis was performed with the SPSS v. 17.0 software. Correlations and dependencies were tested with a Chi² goodness of fit test, Cohen's kappa coefficient (α = 0.05) and Pearson's correlation coefficient.ResultsThe study detected malnutrition in a relatively high proportion of the participants, ranging from 33% to 57.7% depending on the tools used. There were significant differences between individual nutritional assessment tools with respect to identification of at-risk or malnourished patients. The MNA revealed more at-risk or malnourished patients (57.7%) than the MUST (48.3%) or SGA (33.0%).DiscussionThe results are consistent with the high prevalence rates of malnutrition in senior citizens receiving community care reported by other studies.ConclusionsMNA, SGA, and NRS identify different individuals as malnourished or at risk for malnutrition. MNA should be used to assess the nutritional status in elderly in the home setting.     

Pioglitazone does not enhance the effectiveness of lifestyle modification in preventing conversion of impaired glucose tolerance to diabetes in Asian Indians: results of the Indian Diabetes Prevention Programme-2 (IDPP-2)

Aims/hypothesis  The objective of this prevention programme was to study whether combining pioglitazone with lifestyle modification would enhance the efficacy of lifestyle modification in preventing type 2 diabetes in Asian Indians with impaired glucose tolerance. Methods  In a community-based, placebo-controlled 3 year prospective study, 407 participants with impaired glucose tolerance (mean age 45.3 ± 6.2 years, mean BMI 25.9 ± 3.3 kg/m²) were sequentially grouped to receive either: lifestyle modification plus pioglitazone, 30 mg (n = 204) or lifestyle modification plus placebo (n = 203). The participants and investigators were blinded to the assignment. The primary outcome was development of diabetes. Results  At baseline, both groups had similar demographic, anthropometric and biochemical characteristics. At year 3, the response rate was 90.2%. The cumulative incidence of diabetes was 29.8% with pioglitazone and 31.6% with placebo (unadjusted HR 1.084 [95% CI 0.753–1.560], p = 0.665). Normoglycaemia was achieved in 40.9% and 32.3% of participants receiving pioglitazone and placebo, respectively (p = 0.109). In pioglitazone group, two deaths and two non-fatal hospitalisations occurred due to cardiac problems; in the placebo group there were two occurrences of cardiac disease. Conclusions/interpretation  Despite good adherence to lifestyle modification and drug therapy, no additional effect of pioglitazone was seen above that achieved with placebo. The effectiveness of the intervention in both groups was comparable with that of lifestyle modification alone, as reported from the Indian Diabetes Prevention Programme-1. The results are at variance with studies that showed significant relative risk reduction in conversion to diabetes with pioglitazone in Americans with IGT. An ethnicity-related difference in the action of pioglitazone in non-diabetic participants may be one explanation. Trial registration: ClinicalTrials.gov NCT00276497 Funding: This study was funded by the India Diabetes Research Foundation     

酒精性肝病的营养支持

酒精性肝病（alcoholic liver disease,ALD）是由于大量饮酒所致的肝脏疾病,初期通常表现为脂肪肝,可发展成酒精性肝炎、酒精性肝纤维化和酒精性肝硬化,在严重酗酒时可诱发广泛肝细胞坏死,甚至发生肝功能衰竭。ALD的治疗原则是戒酒和营养支持,减轻ALD的严重程度;改善已存在的继发性营养不良和对症治疗酒精性肝硬化及其并发症。合理的营养是防治疾病的物质基础,营养状况的好坏直接影响疾病的转归。     

肠内、肠外营养对胃大部切除术后患者胃肠激素水平的影响

背景：术后早期肠内营养（EN）越来越受到临床医师的重视，但早期EN对胃大部切除术后患者胃肠激素水平的影响研究较少。目的：通过对胃大部切除术后患者胃肠激素水平的检测．为术后早期应用EN提供依据。方法：将41例拟择期行胃大部切除术的患者随机分为EN组（n=20）和肠外营养组（PN组，n=21），术后第1～7d分别给予EN或PN支持治疗。于术前、术后第1、7d清晨分别测定患者血清胃泌素（GAS）、血浆胃动素（MTL）、血浆胆囊收缩素（CCK）水平。结果：41例胃大部切除患者术后第1d血清GAS、血浆MTL和CCK水平较术前显著下降（P〈0．01），术后第7d恢复至术前水平。EN组术后第7d血浆MTL、CCK水平显著高于PN组（P〈0．05和P〈0．01），而两组血清GAS水平无显著差异（P〉0．05）。结论：胃大部切除术后应用EN制剂能增加患者血浆MTL和CCK水平，有助于促进残胃动力功能的恢复，促进胃肠道消化和吸收，促进胆囊收缩，预防胆汁淤积等胆囊疾病的发生。     

Nutrition in acute pancreatitis: a critical review

Severe acute pancreatitis poses unique nutritional challenges. The optimal nutritional support in patients with severe acute pancreatitis has been a subject of debate for decades. This review provides a critical review of the available literature.

According to current literature, enteral nutrition is superior to parenteral nutrition, although several limitations should be taken into account. The optimal route of enteral nutrition remains unclear, but normal or nasogastric tube feeding seems safe when tolerated. In patients with predicted severe acute pancreatitis an on-demand feeding strategy is advised and when patients do not tolerate an oral diet after 72 hours, enteral nutrition can be started. The use of supplements, both parenteral as enteral, are not recommended. Optimal nutritional support in severe cases often requires a tailor-made approach with day-to-day evaluation of its effectiveness.     

Levels of homocysteine are inversely associated with cardiovascular fitness in women, but not in men: data from the National Health and Nutrition Examination Survey 1999-2002

OBJECTIVES:Cardiovascular fitness represents the ability of active skeletal muscle to utilize oxygen during aerobic exercise. Elevated homocysteine, causing tissue injury by such mechanisms as oxidative stress, endothelial damage, and protein homocysteinylation, is associated with increased risk of cardiovascular disease, dementia and osteoporotic fracture. However, the association between elevated homocysteine and cardiovascular fitness has not been reported. DESIGN: Population-based cross-sectional study. SETTING: National Health and Nutrition Examination Survey from 1999 to 2002 in the USA. SUBJECTS: A total of 1444 noninstitutionalized adults aged 20--49 years with reliable measures of cardiovascular fitness and non-missing values in homocysteine. Main outcome measures. Cardiovascular fitness, estimated maximal oxygen uptake or VO(2)max (mL kg(-1) min(-1)), was obtained by a submaximal exercise test. Levels of homocysteine were measured by the Abbott homocysteine assay, a fully automated fluorescence polarization immunoassay method and were natural-log-transformed due to right skewness. RESULTS. After adjustment for age, race and body mass index, there was a 0.70 mL kg(-1) min(-1) decrease (P=0.033) in the estimated VO(2)max for each standard deviation (SD) increase in the natural-log-transformed homocysteine level for women. Additional adjustment of hypertension, diabetes, smoking status, alcohol intake, use of lipid-lowering agents, physical activity, self-report health condition, as well as levels of folate, vitamin B(12), creatinine, C-reactive protein, total cholesterol and haemoglobin seemed to influence the association. In the fully adjusted model, we observed a 1.18 mL kg(-1) min(-1) decrease (P=0.003) in the estimated VO(2)max for each SD increase in the natural-log-transformed homocysteine level in women. There was no association between cardiovascular fitness and homocysteine levels in men. CONCLUSION. High homocysteine levels were inversely associated with cardiovascular fitness in women, but not in men. The results suggest that homocysteine levels are important indicators of exercise tolerance amongst women and may be useful in targeting female individuals requiring endurance intervention to prevent loss of cardiovascular fitness and function.