Handgrip Strength at Admission and Time to Discharge in Medical and Surgical Inpatients

Background and Objective: Handgrip strength is a relevant marker of functional status and is also a component of nutrition assessment. The simplicity of this measurement supports its usefulness as a tool to predict who will likely take longer to hospital discharge. The aim of this study was to quantify the association between sex‐specific handgrip strength at hospital admission and time to discharge alive. We intended to include a group of diverse diagnoses and to compare medical and surgical wards, taking into account the potential confounders’ effect of patients’ characteristics and severity of disease. Subjects and Methods: Prospective study in 2 public acute‐care general hospitals in Porto, Portugal, in 2004. Handgrip strength was evaluated using a handgrip dynamometer in a probability sample of 425 patients from medical and surgical wards. The association between baseline handgrip strength and time to discharge was evaluated using survival analysis with discharge alive as the outcome and deaths and transfers being censored. Results: In medical wards, women with high admission handgrip strength had a very short hospital stay (all had been discharged by the sixth day), and among men, patients with low handgrip strength had a particularly longer stay (approximately 50% were discharged after 15 days of hospitalization). In surgical wards, an increasing length of stay with decreasing handgrip strength quartiles was also observed in both sexes. Conclusions: Lower handgrip strength at hospital admission was associated with a longer time in the hospital, in patients of both sexes, in medical and surgical wards. Although this association was explained in part by age, height, education level, cognitive status, and disease severity, its direction remained unchanged regardless of the aforementioned factors.     

Modulation of Intestinal Inflammation by Minimal Enteral Nutrition With Amniotic Fluid in Preterm Pigs

Background: Necrotizing enterocolitis (NEC) is a severe inflammatory disorder, associated with the difficult transition from parenteral to enteral feeding after preterm birth. We hypothesized that minimal enteral nutrition (MEN) with amniotic fluid (AF), prior to enteral formula feeding, would improve resistance to NEC in preterm pigs. Methods: Experiment 1: IEC‐6 cells were incubated with porcine (pAF) and human AF (hAF) to test AF‐stimulated enterocyte proliferation and migration in vitro. Experiment 2: Cesarean‐delivered, preterm pigs were fed parenteral nutrition and MEN with pAF, hAF, or control fluid (MEN‐pAF, MEN‐hAF, or MEN‐CTRL; all n = 9) for 2 days before tissue collection. Experiment 3: Preterm pigs were fed MEN diets as in experiment 2, but followed by 2 days of enteral formula feeding, which predisposes to NEC (NEC‐pAF, NEC‐hAF, or NEC‐CTRL; n = 10–12). Results: Both pAF and hAF stimulated enterocyte proliferation and migration in vitro. In experiment 2, MEN‐pAF and MEN‐hAF pigs showed increased body weight gain and reduced intestinal interleukin (IL)–8 and colonic IL‐6 levels, indicating reduced inflammatory response. In experiment 3, body weight gain was highest in the 2 groups fed AF as MEN, but NEC incidences were similar (NEC‐pAF) or increased (NEC‐hAF) compared with controls. Conclusions: Intake of pAF or hAF improved body growth and modulated intestinal inflammatory cytokines during a period of parenteral nutrition, but did not protect against later formula‐induced NEC in preterm pigs. Further studies are required to show if MEN feeding with species‐specific AF, combined with an optimal enteral diet (eg, human milk), will improve adaptation during the transition from parenteral to enteral feeding in preterm neonates.     

Nitrite and Nitrate Concentrations and Metabolism in Breast Milk,Infant Formula,and Parenteral Nutrition

Dietary nitrate and nitrite are sources of gastric NO, which modulates blood flow, mucus production, and microbial flora. However, the intake and importance of these anions in infants is largely unknown. Nitrate and nitrite levels were measured in breast milk of mothers of preterm and term infants, infant formulas, and parenteral nutrition. Nitrite metabolism in breast milk was measured after freeze‐thawing, at different temperatures, varying oxygen tensions, and after inhibition of potential nitrite‐metabolizing enzymes. Nitrite concentrations averaged 0.07 ± 0.01 μM in milk of mothers of preterm infants, less than that of term infants (0.13 ± 0.02 μM) (P < .01). Nitrate concentrations averaged 13.6 ± 3.7 μM and 12.7 ± 4.9 μM, respectively. Nitrite and nitrate concentrations in infant formulas varied from undetectable to many‐fold more than breast milk. Concentrations in parenteral nutrition were equivalent to or lower than those of breast milk. Freeze‐thawing decreased nitrite concentration ~64%, falling with a half‐life of 32 minutes at 37°C. The disappearance of nitrite was oxygen‐dependent and prevented by ferricyanide and 3 inhibitors of lactoperoxidase. Nitrite concentrations in breast milk decrease with storage and freeze‐thawing, a decline likely mediated by lactoperoxidase. Compared to adults, infants ingest relatively little nitrite and nitrate, which may be of importance in the modulation of blood flow and the bacterial flora of the infant GI tract, especially given the protective effects of swallowed nitrite.     

Extending cluster lot quality assurance sampling designs for surveillance programs

Lot quality assurance sampling (LQAS) has a long history of applications in industrial quality control. LQAS is frequently used for rapid surveillance in global health settings, with areas classified as poor or acceptable performance on the basis of the binary classification of an indicator. Historically, LQAS surveys have relied on simple random samples from the population; however, implementing two‐stage cluster designs for surveillance sampling is often more cost‐effective than simple random sampling. By applying survey sampling results to the binary classification procedure, we develop a simple and flexible nonparametric procedure to incorporate clustering effects into the LQAS sample design to appropriately inflate the sample size, accommodating finite numbers of clusters in the population when relevant. We use this framework to then discuss principled selection of survey design parameters in longitudinal surveillance programs. We apply this framework to design surveys to detect rises in malnutrition prevalence in nutrition surveillance programs in Kenya and South Sudan, accounting for clustering within villages. By combining historical information with data from previous surveys, we design surveys to detect spikes in the childhood malnutrition rate. Copyright © 2014 John Wiley & Sons, Ltd.     

Effect of Digital Nutrition Education Intervention on the Nutritional Knowledge Levels of Information Technology Professionals

The purpose of the study was to determine the changes in knowledge of information technology (IT) professionals after receiving a nutrition education intervention for a month. The sample comprised of 40 IT professionals (29 males and 11 females). The sample was drawn from four IT companies of Hyderabad city using random sampling techniques. The data on the general information of the subjects was collected. The data regarding the commonly accessed sources of nutrition and health information by the subjects was also obtained from the study. The intervention study group received nutrition education by distribution of the developed CD-ROMs to them followed by interactive sessions. To assess the impact of nutrition education intervention, the knowledge assessment questionnaire (KAQ) was developed and administered before and after the education programme. A significant improvement in the mean nutritional knowledge scores was observed among the total study subjects from 22.30 to 40.55 after the intervention (p < 0.05). The findings support the importance of providing professionals with nutrition knowledge to promote healthy dietary behaviors.Thus, the method of e-learning and development of CD-Rom is essential for teaching the educated groups on nutrition, physical activity and overall health education to improve their health, lifestyle and eating habits.     

Medical Nutrition Therapy Is Effective in the Management of Hypoglycemia Caused by Insulin Antibodies: A Case Report and Literature Review

Autoimmune antibodies, induced by exogenous insulin preparations, may result in labile glucose control and frequent hypoglycemia in some rare cases. In addition to insulin cessation, immune suppressants and/or plasmapheresis have been used as the primary remedies for these patients. Some previous studies also indicate that the condition tends to remit spontaneously after discontinuation of insulin exposure. Because of this, the clinical importance of nutritional interventions and behavioral approaches, which may play a role in ameliorating the symptoms, should also be emphasized. Herein, we report on a 64-year-old man with hypoglycemia induced by insulin antibodies (IAs), whose hypoglycemic symptoms significantly improved after the implementation of nutrition therapy. This rare case expands our knowledge of the management of hypoglycemia, and for the first time highlights the significance of nutritional and lifestyle intervention in treatment of IA-induced hypoglycemia.

 

Key teaching points:

• ? Exogenous insulin administration may induce autoimmune antibodies to insulin, leading to frequent hypoglycemia.

• ? We report a case with frequent hypoglycemia caused by IAs after exogeneous insulin exposure.

• ? The patient's symptoms were alleviated by nutrition therapy.

• ? We demonstrate for the first time the significance of dietary and behavioral interventions in management of IA-induced hypoglycemia.

     

肠内营养对肠瘘非甲状腺疾病综合征病人甲状腺功能的作用研究

目的:肠瘘病人容易发生非甲状腺疾病综合征(NTIS),探讨肠内营养(EN)治疗对肠瘘合并NTIS病人甲状腺功能的作用. 方法:回顾性分析80例肠瘘合并NIIS并接受EN治疗的病人,统计纳入病人住院期间甲状腺功能和其他实验室指标的变化. 结果:80例病人EN支持治疗后,66例NTIS病情缓解,14例未缓解,有效率82.50％.多变量Cox比例风险模型表明,从入院到开始接受全量EN治疗的时间为NTIS获得缓解的独立风险因素. 结论:EN治疗有助于缓解肠瘘病人NTIS的症状.     

脑卒中合并吞咽功能障碍的老年病人序贯肠内营养支持治疗的研究

目的:探讨序贯肠内营养(EN)支持治疗在脑卒中合并吞咽功能障碍老年病人治疗中的应用和临床效果. 方法:将62例急性缺血性脑卒中合并吞咽功能障碍的老年病人随机分为研究组和对照组.研究组(n=32)病人给予短肽型EN制剂,逐步过渡至整蛋白型EN制剂的序贯EN治疗方案.对照组(n=30)病人直接给予整蛋白型EN制剂.观察两组病人人组第1和第14天的营养指标、免疫功能指标和神经功能缺损评分(NIHSS)的变化以及并发症的发生情况. 结果:入组第14天,两组病人的营养指标、免疫功能指标和NIHSS评分均较第1天明显下降(P＜0.05).研究组与对照组比,营养指标和免疫功能指标下降的程度均较轻(P＜0.05),NIHSS评分下降程度无显著性差异(P＞0.05).研究组病人总并发症的发生率少于对照组(P＜0.05). 结论:序贯EN支持治疗能减轻脑卒中合并吞咽功能障碍的老年病人营养不良发展程度和免疫功能下降程度,促进神经功能恢复,降低并发症发生的风险.     

短肽型肠内营养制剂对肠黏膜炎大鼠营养状况的影响

目的:探讨短肽型肠内营养制剂(PBEN)对肠黏膜炎大鼠营养状况的影响. 方法:利用甲氨喋呤(MTX)建立大鼠肠黏膜炎模型.60只大鼠随机分为6组,即基础饲料(BF)组,短肽型肠内营养制剂(PBEN)组,整蛋白型肠内营养制剂(IPEN)组,MTX+ BF组,MTX+ PBEN组和MTX+ IPEN组.于第0天和第6天,给予MTX+BF组、MTX+ PBEN组和MTX+ IPEN组腹腔注射10 mg/kg MTX造成大鼠肠道持续损伤.从第1天开始,BF组和MTX+ BF组饲喂BF;PBEN组和MTX+ PBEN组饲喂PBEN;IPEN组和MTX+ IPEN组饲喂IPEN.每组大鼠每天按159.0 kJ(38 kcal)/100 g给予膳食.每天记录各组大鼠的体重和进食量.于第11天处死大鼠,检测血浆中D-乳酸、二胺氧化酶(DAO)和血清总蛋白(TP)、清蛋白(ALB)、前清蛋白(PA)、转铁蛋白(TF)和视黄醇结合蛋白(RBP)水平. 结果:大鼠进食BF或PBEN、IPEN后各指标间无显著性差异(P＞0.05).MTX造模导致大鼠肠黏膜严重损伤,MTX+ BF组各项指标与BF组比有显著性差异(P＜0.05).MTX+ PBEN组大鼠体重下降程度低于MTX+BF组和MTX +IPEN组(P＜0.05).第11天时,MTX+ PBEN组大鼠血浆D-乳酸和DAO水平均低于MTX+ BF组和MTX+ IPEN组,且血清TP、ALB、PA、TF和RBP水平均高于MTX+ BF组和MTX+ IPEN组(P＜0.05).结论:PBEN可有效地改善肠黏膜炎大鼠的营养状况.     

强化支链氨基酸和谷氨酰胺的肠内营养支持对肝硬化病人的治疗作用

目的:探讨强化支链氨基酸(BCAA)和谷氨酰胺(Gln)的肠内营养(EN)支持对肝硬化病人营养状况、肝功能和凝血功能的影响. 方法:选择存在营养不良风险的肝硬化病人87例,随机分为对照组(n=44)和治疗组(n=43).治疗组病人给予口服BCAA粉50 g/d和Gln 15g/d;对照组给予等热量等氮的复方氨基酸颗粒.分别测定两组病人在营养治疗前、营养治疗第4周末和第9周末的营养指标(血清总蛋白、前清蛋白、清蛋白和转铁蛋白)、肝功能指标(丙氨酸氨基转移酶、门冬氨酸氨基转移酶、总胆红素、直接胆红素)和凝血指标(凝血酶原时间测定和凝血酶原活动度).分析比较两组病人治疗前后各项指标的变化. 结果:治疗组病人的营养指标和肝功能指标在治疗第4周末和第9周末较治疗前和较对照组均有明显改善(P＜0.05).而凝血指标的改善仅在治疗第9周末时有显著性差异(P＜0.05). 结论:强化BCAA和Gln的EN支持可增加肝硬化病人的蛋白质合成,改善其营养状况,有益于肝功能的恢复,进而防止肝性脑病的发生.