Dépister la dénutrition de l’enfant

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. PEM increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Paediatric Society recommends weighing and measuring any child when hospitalized or seen as outpatients. Body mass index (BMI) must be calculated and analyzed according to references anytime growth kinetics cannot be analyzed. Any child with a BMI below the third centile or –2 standard deviations for age and sex needs to be examined looking for clinical signs of malnutrition and signs orienting toward an aetiology, and requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing a nutritional strategy along with the global care plan. A target weight needs to be determined as well as the quantitative, qualitative and modality of nutritional care. This plan must be evaluated afterwards in order to adapt nutritional therapy.     

Étude observationnelle QALICO (étude qualitative de l’alimentation après chirurgie de l’obésité)

QALICO study, a food quality study following bariatric surgery. Only a few clinical studies have studied food quality following bariatric surgery in obese patient. In 2007 Suter et al., a Lausanne ‘team in Switzerland’, published results regarding changes in food according to a score based on three main items following gastric band and gastric by-pass. On this basis, FNAMN (Suter et al., 2007) [1] wishes to update these results, adding two main items: first, evaluation regarding modification of food behavior, second, regarding taste variation, and comparing three surgical process: gastric band, sleeve gastrectomy and gastric by-pass. This is the objective of the QALICO study, which is a follow-up clinical study in obese patient following a bariatric surgery.     

Nutrition de l’obèse agressé

The pandemic increase in obesity prevalence leads to a large increase in the number of obese patients admitted in the intensive care unit. The “obesity paradox” defines the protective effect of overweight and obesity (until 40 of body mass index) on intensive care unit mortality. In critically ill patients, obesity-related mortality is likely to be underestimated because of the use of non-suitable prognostic scores. During critical illness, the adipose tissue of obese patients stores lipids instead of utilizing them as energy source. It leads to the worsening of the muscle protein catabolism. The metabolic response to critical illness in obese patients may involve qualitative changes of the adipose tissue. Hyperglycemia is frequent and associated with patients’ poor prognosis making mandatory the glycemic control. Overnutrition must be avoided as it is deleterious. The main objective of nutritional support is to limit the malnutrition secondary to critical illness. In the critically ill obese patients, no method is validated for assessing nutritional status and protein–energy needs. The strategy of nutrition support is still largely debated, including the use of hypocaloric–hyperproteic feeding. The scarcity of scientific data makes urgent the biomedical research on the topic of the critically ill obese patients.     

Nutrition de l’hémodialysé chronique

Malnutrition in dialysis is of public health concern: in 25% of French hemodialysis patients, survival is compromised by nutritional depletion. To day, nutritional requirements have been defined and nutritional efficacy of supplementation established. Controlled studies are needed to evaluate the effects of nutritional support on the quality of life, health-care requirements and survival, as well as to precise the interest of anabolizing hormones and rehabilitation. Malnutrition in hemodialysis implies to look for treatable causes of anorexia and catabolism and to adapt nutritional therapy to nutritional evaluation: dietary counseling and oral supplement in moderately depleted patients, intradialytic parenteral nutrition or enteral nutrition in severely malnourished.     

L’albuminémie est-elle un marqueur de l’état nutritionnel ?

Serum albumin level is the most widely used diagnostic and follow-up marker of malnutrition. However, there are numerous contradictions between in-practice use of serum albumin and results of scientific studies, exemplified in the fact that serum albumin is used to diagnose malnutrition even though it values are neither correlated to protein mass nor decreased in characterized malnutrition such as marasmus or anorexia nervosa. Furthermore, protein restriction does not systematically lead to hypoalbuminemia, and efficient nutritional management does not always increase serum albumin levels. Serum albumin level is also a marker or morbidity-mortality independently of nutritional status. The serum albumin values used as diagnosis cut-off levels for malnutrition status, as set by health authorities or learned societies, are taken from studies where serum albumin levels correlated to non-anthropometric parameters such as mean hospital stay, infections, bedsores or rehospitalization, making it a marker of morbidity-mortality rather than malnutrition. Nevertheless, serum albumin level should remain part of the nutritional status assessment, either alone or – ideally – as part of a composite body weight index such as the Nutritional Risk Index or the Geriatric Nutritional Risk Index in order to guide the implementation of a nutritional strategy integrating the risks of malnutrition-related complications defined by the index. It is time the French health authority (Haute Autorité de santé [HAS]) recommendations to be updated to take this burgeoning evidence into account.     

Altérations métaboliques au cours de l’insuffisance rénale chronique

Chronic renal failure results in metabolic derangements, nutritional and hormonal dysfunction which in turn may lead to several complications such as anemia, bone disease, insulin resistance, dyslipidemia and malnutrition. Furthermore, the increased oxidative stress and the accumulation of pro-inflammatory cytokines in addition to repeated infections lead to a persistent inflammatory state. There is a close association between malnutrition and inflammation, and both of which are strong predictors of poor outcome among predialysis and dialysis patients. It is essential to assess early these metabolic disturbances and treat them before the initiation of dialysis in order to prevent the increased cardio-vascular morbi-mortality and malnutrition in chronic renal failure patients.     

Contamination fongique de l’alimentation des patients d’onco-hématologie

ObjectiveThe aim of our study was to evaluate the level of fungal contamination of food served to patients in the hematology unit of Farhat Hached hospital, Sousse (Tunisia).MethodsWe analyzed 159 food served to 90 patients during the post-chemotherapy aplasia period.ResultsThe overall rate of fungal contamination was 66.6%. Fruits and green salads’ contamination was very high (90 and 100%, respectively). Aspergillus species were the most frequent (48.4%) followed by Candida (25.1%), Penicillium (22%), Rhizopus (17.6%) and Cladosporium (17%). The presence of Aspergillus on fruits (66.6%) represents a real source of contamination by inhalation of spores and the presence of Candida (25.1%) in any type of food is a source of gastrointestinal colonization.ConclusionThe diet of neutropenic patients should be submitted to a strict surveillance to reduce the risk of fungal infections of food.     

En quoi l’industrie pharmaceutique contribue-t-elle à l’amélioration de la qualité en antibiothérapie ?

Do studies made by the pharmaceutical industry contribute to improving quality in antibiotic therapy? In addition to conventional preclinical studies, structure-toxicity and pharmacotoxicological studies help select antibiotics that are better tolerated. Microbiological studies determine the antibacterial spectrum, the critical concentration values to sort clinical strains, and the incidence of resistance of these strains in Europe. Continuing efforts to achieve standardization are still necessary in order to carry out genuine European studies. A number of clinical recommendations (CPMP, ICH, ESCMID, FDA) have been issued in the past few years (investigations for drug interactions, choice of comparator, conduct of non-inferiority trials...) that standardize studies and make the results increasingly reliable. Can marketing contribute to improving quality in antibiotic therapy? Promotional documents, which have to be validated in France by the Publicity Commission so as to discourage drug misuse or over consumption, have progressively improved so as to communicate a message that is consistent with the summary of product characteristics and the recommendations for appropriate use. Medical training, partnership without reciprocal obligations, and sponsorship also contribute to a better quality of antibiotic therapy. Research is making progress: the genome of the main bacteria has been sequenced, and thanks to genomics and proteomics, in the near future there will be new antibiotics, free from any cross-resistance put on the market. This, combined with the production of detection kits for biological markers of infection and of new vaccines, should contribute to an improvement in the quality of antibiotic therapy.     

Dépister la dénutrition de l’enfant en pratique courante

Protein energy malnutrition (PEM) occurs when energy and protein intake do not meet requirements. It has a functional and structural impact and increases both morbidity and mortality of a given disease. The Nutrition Committee of the French Pediatric Society recommends weighing and measuring any child when hospitalized or seen in consultation. The body mass index (BMI) must be calculated and analyzed according to references any time growth kinetics cannot be analyzed. Any child with a BMI below the third centile or ?2 standard deviations for age and sex (1) needs to be examined looking for clinical signs of malnutrition and signs orienting toward an etiology and (2) requires having his BMI and height dynamics plotted on a chart. PEM warrants drawing up a nutritional strategy along with the overall care plan. A target weight needs to be determined as well as the quantitative and qualitative nutritional care as well as its implementation. This plan must be evaluated afterwards in order to adapt the nutritional therapy.