Glycemic Indices of Multiple Oral Nutritional Supplements: A Randomized Cross-Over Study in Indian Adults

Background: A randomized cross-over study was conducted to assess the glycemic index (GI) of seven Oral Nutritional Supplements (ONSs). These ONSs are designed to support the nutritional requirements of different age-groups, physiological states, or health conditions among Indian adults. Methods: The study had two phases viz., phase1 (n = 18) studied two ONSs: A1 and B1 and phase 2 (n = 20) studied five ONSs: A2, B2, C2, D2 & E2. The subjects were healthy, non-diabetic adults, aged between 20 - 44 years with a mean Body Mass Index of 21.2 ± 1.52 kg/m2 (Phase 1) and 21.0 ± 1.45 kg/m2 (Phase 2). All these ONSs were compared with reference drinks (glucose). The carbohydrates in one serving of each ONS were matched to carbohydrates from 25 grams of glucose following ISO 2010 guidelines. Capillary blood was assessed for blood glucose response at baseline, 15, 30, 45, 60, 90 and 120 minutes. GI was calculated as the incremental area under the curve (iAUC) for the test drinks and expressed as a percentage of the average iAUC from glucose. Results: Phase 1 indicated that the high fiber diabetes-specific nutrition supplement A1 with higher protein (23% energy), higher fat (25% energy) and reduced carbohydrates (40% energy) had a significantly (p = 0.002) lower GI [34 (±6)] as compared to B1 [63 (±7)] (protein 19%, fat 7% and carbohydrates 60% energy) even with similar amount (22%) and type of fiber. Phase 2 reported that all test products [A2 (32 ± 5), B2 (37 ± 4), C2 (31 ± 5), D2 (31 ± 5) and E2 (55 ± 4)] had a low GI. As compared to phase 1, ONSs in phase 2 had lower fiber content (1.6% - 4.6% energy). Conclusion: The glycemic index of oral nutrition supplements is influenced not only by their fiber content, but also by the overall macronutrient composition including protein (≥17% energy), fat (≥10% - 27% energy) and carbohydrates (40% - 57.5% energy).

Reduction of Cancer Risk With an Oral Supplement of Selenium

The hypothesis that a dietary Supplement of selenium (Se) may reduce cancer risk was tested experimetally in humans. Patients with histories of basal/squarnous cell carcinomas of the skin were assigned randomly in double-blind fashion to dally oral supplements of either Seenriched yeast (200 μg Se/day), or a low-Se yeast placebo. A total of 1312 patients recruited in 1983-1990 were followed with regular dermatologic examinations through 1993 for a total of 8269 person-years of observation. Skin cancer diagnoses were confirmed histologically.Plasma Se concentration was determined at 6-12 months intervals. All deaths and patient-reported illnesses were recorded; reported cancers were confirmed and documented by consultation with the patient medical care providers. The results indicate that Se did not significantly affect the primary endpoints: incidences of recurrent basal/squarnous cell carcinomas of the skin. However, Setreatment was associated with reductions in several secondary endpoints:total mortality, mortality from all cancers combined, as well as the incidence of all cancers combined, lung cancer, colorectal cancer and prostate cancer. The consistencies of these associations over time, between study clinics and for the leading cancer sltes strongly suggests benefits of Se-supplementation for this cohort of patients, supporting the hypopthesis that supplemental Se can reduce cancer risk. Although Se did no shown protective effects against nonmelanoma skin cancers, the suggested reductions in risks to other frequent cancers demand further evaluation in well controlled cliflical intervention trials

Benefits of post-operative oral protein supplementation in gastrointestinal surgery patients: A systematic review of clinical trials

AIM: To evaluate published trials examining oral postoperative protein supplementation in patients having undergone gastrointestinal surgery and assessment of reported results.METHODS: Database searches(MEDLINE, BIOSIS, EMBASE, Cochrane Trials, Cinahl, and CAB), searches of reference lists of relevant papers, and expert referral were used to identify prospective randomized controlled clinical trials. The following terms were used to locate articles: "oral'' or "enteral'' and "postoperative care'' or "post-surgical'' and "proteins' ' or "milk proteins' ' or "dietary proteins' ' or "dietary supplements' ' or "nutritional supplements' '. In databases that allowed added limitations, results were limited to clinical trials that studied humans, and publications between 1990 and 2014. Quality of collated studies was evaluated using a qualitative assessment tool and the collective results interpreted.RESULTS: Searches identified 629 papers of which, following review, 7 were deemed eligible for qualitative evaluation. Protein supplementation does not appear to affect mortality but does reduce weight loss, and improve nutritional status. Reduction in grip strength deterioration was observed in a majority of studies, and approximately half of the studies described reduced complication rates. No changes in duration of hospital stay or plasma protein levels were reported. There is evidence to suggest that protein supplementation should be routinely provided post-operatively to this population. However, despite comprehensive searches, clinical trials that varied only the amount of protein provided via oral nutritional supplements(discrete from other nutritionalcomponents) were not found. At present, there is some evidence to support routinely prescribed oral nutritional supplements that contain protein for gastrointestinal surgery patients in the immediate post-operative stage.CONCLUSION: The optimal level of protein supplementation required to maximise recovery in gastrointestinal surgery patients is effectively unknown, and may warrant further study.

Assessment of effectiveness of oral supplementation of isolated fiber of carrot on metabolic parameters in mature rats

This present study was conducted to evaluate the metabolic effects of isolated fi ber of carrot supplementation in rats.Physicochemical properties of fi ber were determined.The groups were as follows:animals fed a standard diet,control group;high fi ber supplementation(70 mg);low fi ber supplementation(35 mg);for 12 weeks.Blood samples were collected at the time of sacrifi ce.The weights of heart,liver,kidneys and spleen of the experimental rats with respect to body weight were recorded.Commercial kits were used to determine serum glucose concentration,lipid profi le(cholesterol,HDL-cholesterol,triglycerides),and the two main aminotransferases glutamic-oxalacetic transaminase(GOT)/glutamate-pyruvate transaminase(GPT).A histopathological assay was performed on the heart,liver,and spleen tissues of animals.Supplementation with fi ber favors weight loss in female((242.03±23.73)-(197.81±10.45)g);and male rats((262.50±32.21)-(213.96±12.56)g and induces a decrease in glucose levels in the supplemented animals.With the exception of total high-density lipoprotein cholesterol,the other lipid fractions decrease signifi cantly in rats supplemented.Fiber supplementation did not induce changes in the dissected organs of the supplemented animals.In conclusion supplementation of fiber,improves glucose control,lower plasma lipid concentrations and reduced body weight in normal rats.

Treatment of Peripheral Neuropathy: Combination Therapy Using LED Light, Extracorporeal Shockwave Therapy, Platelet Rich Plasma, and an Oral Dietary Supplement

Objectives: Peripheral neuropathy (PN) is a significant contributor to disability in the elderly. It is also one of the most prevalent complications of type 2 diabetes, prediabetes and metabolic syndrome. PN is commonly associated with pain, numbness, tingling, burning, and cramping in the feet and legs. Current treatment options are limited to controlling pain, seizures and use of antidepressant medications. These treatments have undesirable side effects and don’t stop PN progression. Here we utilized a combination of individual-specific modalities to improve local circulation and relieve PN symptoms. Methods: We conducted an open-label, multicenter pilot trial with 34 subjects (19 males and 15 females ranging from 40 - 85 years of age). All of the participants were diagnosed with peripheral neuropathy and had bilateral symptoms in their feet, and many reported the same symptoms (pain, numbness, tingling, burning, and cramping) in their lower legs. The duration of symptoms ranged from four months to over six years. On Day 0, subjects were given a 90-day supply of the oral supplement with dosing instructions and a LED light therapy device. They also received three platelet-rich plasma (PRP) injections in their lower extremities. Subjects also received an extracorporeal shockwave therapy (ESWT) treatment for each foot and subsequently twice per week for the first six weeks, then once weekly for the duration of the study. Subjects filled out the Brief Pain Index (BPI) at weekly intervals. On Day 90, subjects completed the Patient Global Impression of Change (PGIC) survey. Results: There were significant responses to pain, as evidenced by BPI scores at weeks 8, 9, 10 and 11 (p = 0.02, 0.01, 0.02, and 0.003, respectively). Analysis of the final day PGIC survey showed a favorable outcome for 73% of participants (p = 0.003), with the majority reporting Very Much Improved. Conclusions: By utilizing a multi-modality treatment protocol that includes PRP, LED light therapy, ESWT and an oral dietary supplement, we observed significant reductions in BPI scores. Quality of life and their overall impression of change (PGIC) were significantly improved, and there were no significant side effects.

Efficacy of Oral Micronutrient Supplementation on Linear Nail Growth in Healthy Individuals

Introduction: Several studies demonstrate the effects of the oral supplementations on the skin while there are limited data for their effects on the nail quality in healthy individuals. Only placebo controlled double blind studies could provide the reliable data considering the physiologic nail growth. Objective: The objective of this study was to evaluate the efficacy of consumption of a micronutrient supplementation on linear nail growth and thickness. Subjects and Method: 60 healthy female volunteers aged 35 to 65 years old were enrolled, randomized blindly in treatment and placebo groups, taking one tablet per day for 3 months. The evaluation was performed on D0 and D90 ± 3 days by measuring the linear nail growth, nail thickness by high frequency ultrasound imaging and also subjects’ self-assessment. Results: All 60 subjects finished the study without any serious adverse event. At D90 both groups revealed a significant linear nail growth (5.20 ± 0.35 for treatment group (p = 0.001) and 5.15 ± 0.30 for placebo group (p = 0.001)). However, the difference between the treatment and placebo group was statistically significant (p = 0.01) demonstrating the efficacy of oral supplementation on linear nail growth. No significant difference was observed at D90 for nail thickness measured with HFUS between 2 groups. The self-assessment score regarding ?brittle nails? and ?split nails? was diminished non-significantly in both groups. Conclusion: The results observed in this trial revealed that the oral micronutrient supplementation can provide beneficial effect on nail growth. This result may be due to the whole formula as the single vitamin treatment like biotin was shown to be non-effective. A longer study would be needed to confirm the efficacy on nail thickness.

镁补充改善糖尿病患者血清胰岛素水平的Meta分析

系统评价口服镁补充改善糖尿病患者血清胰岛素水平的效果。采用计算机检索PubMed、EBSCO、The Cochrane Library、CNKI、Web of Science数据库,搜集口服镁补充改善糖尿病患者血清胰岛素水平的相关研究,独立筛查文献、提取资料并评价纳入研究的偏倚风险后采用R studio软件进行Meta分析。亚组分析结果显示,口服镁补充在镁缺乏糖尿病患者中[SMD=-0.29,95%CI(-1.07,0.48),P>0.01]、4~6周补充周期[SMD=-0.74(-1.69,0.20),P>0.01]、250~300 mg/d剂量[SMD=-63(-1.25,0),P<0.01]改善血清胰岛素水平效果更佳,说明口服镁补充对于改善糖尿病患者血清胰岛素水平具有良好的效果。

从虚论治慢性复发性口腔溃疡

口腔溃疡是一种常见的口腔黏膜溃疡损伤性疾病。该病病因复杂,复发率高,对患者的饮食、说话等均有一定影响。以20年的临床经验为基础,通过辨证、辨体、辨病的中医辨证方法,认识到该病多为“上虚不足”,导致反复发作,并通过补虚升提的方法治疗,取得了较好的效果。

结直肠癌病人口服营养补充依从性评估量表的构建

目的:构建结直肠癌病人口服营养补充(ONS)依从性评估量表。方法:以知信行理论为量表结构框架,参考相关指南及文献,形成结直肠癌病人ONS依从性评估量表条目池,并采用专家函询法构建结直肠癌病人ONS依从性评估量表。结果:共进行两轮专家函询,问卷回收率分别为90.91%和100.00%,专家意见提出率分别为45.00%和25.00%,专家权威系数分别为0.878和0.893。第2轮专家函询量表维度的重要性均分为4.80~4.90分,满分比为85%~90%,变异系数为0.06~0.11,肯德尔和谐系数为0.874(P<0.001);量表条目的重要性均分为4.30~4.95分,满分比为35%~95%,变异系数为0.05~0.24,肯德尔和谐系数为0.410(P<0.001)。最终形成包括3个维度、33个条目的结直肠癌病人ONS依从性评估量表。结论:构建的结直肠癌病人ONS依从性评估量表具有较好的科学性和可靠性,可作为结直肠癌病人ONS依从性的测评工具。

口服营养补充对急性淋巴细胞白血病儿童诱导化疗期血液系统并发症等的影响——随机对照研究的中期结果

目的探讨口服营养补充(ONS)对急性淋巴细胞白血病(ALL)儿童诱导化疗期间血液系统并发症及感染的影响。方法2022年1月—2022年12月年龄<16岁ALL儿童36例符合入组条件且完成诱导治疗,按1∶1比例随机分为干预组和对照组各18例。对照组给予低脂饮食(膳食脂肪供能≤每日总能量的20%),干预组给予低脂饮食及高中链甘油三酯、高蛋白、高热卡的短肽型ONS 20mL/(kg·d),食用时间为诱导化疗VDLD阶段。比较两组诱导化疗期间血液系统并发症、输血制品和感染的发生情况。结果干预组与对照组比较,中性粒细胞缺乏持续时间更短(12.50±9.38d和19.11±10.06d,P=0.049)、恢复时间更早(25.39±4.5d和30.06±3.80d,P=0.002);血小板最低值水平较高(P=0.048),Ⅳ度血小板减少的出现时间更晚(P=0.009)、持续时间更短(P=0.024)和恢复时间更早(P=0.012),输血小板的例数和次数均低于对照组(P<0.05);发热天数、抗菌药的使用、总体感染均倾向于较少,但差异未显出统计学意义(P>0.05)。结论ALL儿童在诱导化疗期间使用短肽型ONS有助于提高血液系统对化疗的耐受性。终期研究结果将会得出更确切的结论。

基于COM-B理论的口服营养补充健康教育在胰腺癌术后患者中的应用

目的探讨基于能力、机会、动机-行为(COM-B)理论的口服营养补充(ONS)健康教育在胰腺癌术后患者中的应用效果。方法便利选取2021年9月-2022年9月于南京医科大学第二附属医院胰腺中心收治的72例术后行ONS治疗的胰腺癌患者为研究对象,采用随机数字表法分为对照组和观察组,各36例。对照组给予常规ONS相关健康教育,观察组实施基于COM-B理论的ONS健康教育。分别于术前1 d以及ONS后7 d、14 d和30 d对2组患者的自我效能感、依从性和营养相关指标(白蛋白、前白蛋白和视黄醇结合蛋白)进行观察和比较。结果2组患者术前1 d自我效能感及营养相关指标比较,差异无统计学意义(P>0.05);观察组ONS后7 d、14 d和30 d的自我效能感得分高于对照组,ONS后14 d和30 d的依从性优于对照组,观察组ONS后30 d白蛋白、ONS后14 d和30 d前白蛋白和视黄醇结合蛋白均优于对照组,差异有统计学意义(P<0.05)。结论基于COM-B理论的ONS健康教育能增强胰腺癌患者术后对ONS的自我效能感,提高依从性,改善其营养状况。

住院患者口服营养补充依从性管理的最佳证据总结

目的整合住院患者口服营养补充(oral nutritional supplements,ONS)依从性管理的最佳证据,为改善患者ONS依从性状况提供参考。方法根据PIPOST构建循证问题,系统检索Up To Date、BMJ最佳临床实践、知网等国内外数据库、指南网和专业协会数据库,纳入提高ONS依从性的相关研究。检索时限为建库至2024年1月。由4名研究者筛选文献并进行质量评价,汇总证据条目并总结证据,做出证据的推荐等级。结果共纳入14篇文献,其中指南3篇、专家共识5篇、系统评价6篇。整合评估依从性、建立多学科管理团队、影响ONS摄入的症状或疾病管理、ONS制剂及服用过程管理、提高社会支持、健康教育6个方面的18条证据。结论总结的住院患者ONS依从性管理的最佳证据具有科学性和临床实用性,能为提高患者ONS依从性提供参考。

经口营养补充对食管癌同期放化疗患者疗效及不良反应的影响

目的探究在食管癌同期放化疗患者治疗中采取经口营养补充后的效果和对不良反应的影响。方法随机选取2022年7月—2023年7月聊城市人民医院收治的100例食管癌同期放化疗患者作为研究对象,根据治疗方法不同分成两组,对照组(50例)均接受常规营养治疗,观察组(50例)均接受常规与肠内营养支持治疗。对比两组治疗效果、营养水平、免疫功能及不良反应。结果观察组的客观缓解率、疾病控制率分别为54.00%(27/50)、94.00%(47/50),均高于对照组的34.00%(17/50)和80.00%(40/50),差异有统计学意义(χ^(2)=4.058、4.332,P均<0.05)。观察组体重指数、血清总蛋白、前白蛋白以及白蛋白均高于对照组,差异有统计学意义(P均<0.05)。观察组免疫球蛋白A、免疫球蛋白G和免疫球蛋白M均高于对照组,差异有统计学意义(P均<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论针对食管癌同期放化疗患者,实施经口营养补充,有助于提高疗效,改善营养状态以及免疫功能,安全性高。

术前口服营养补充用于结直肠癌根治术患者的干预效果评价

目的探讨术前口服营养补充(ONS)对结直肠癌患者术后的营养状况和临床预后的影响。方法回顾性收集我院2020年4月1日~2021年3月31日接受结直肠癌根治术的108例患者的资料。根据术前营养支持方式不同,51例术前予ONS的患者为观察组,57例术前予普通饮食的患者为对照组;在亚组分析中,根据患者使用的ONS制剂是否含ω-3多不饱和脂肪酸(ω-3 PUFAs)分为肠内营养乳剂(TPF-T)组和肠内营养粉剂(TP)组。对比评估术前ONS对患者术后营养状态、肝肾功能、临床预后的影响。结果观察组术后第7天血清白蛋白水平高于对照组,差异有统计学意义(P<0.05);观察组术后住院时间少于对照组,差异有统计学意义(P<0.05);TPF-T组患者术后第7天CRP水平显著低于TP组,差异有统计学意义(P<0.05)。结论术前予ONS有利于改善结直肠癌根治术患者的术后营养状态,缩短住院时间,改善临床预后;术前补充ω-3 PUFAs,可减轻患者术后炎症反应。

炎症性肠病合并缺铁性贫血的诊治进展

贫血是炎症性肠病(Inflammatory bowel disease,IBD)最常见的合并表现,患病率为6%~74%,对患者生存率及生活质量有负面影响。其中缺铁性贫血(Iron deficiency anemia,IDA)是IBD患者中最常见的贫血类型。临床上评估IBD患者的铁状态一般采取血红蛋白、红细胞压积、平均血红蛋白量等常见的血生化指标,但忽略了炎症状态对其检测值的影响。因此,需要较新的铁指标,如网织红细胞含量、低色素红细胞百分比、铁调素水平等对IBD患者铁状态进行评估。口服铁剂通常是临床上用于IDA的一线治疗,但大多数患者有严重的胃肠道反应,另外,国内外多项研究表明,在IBD患者中口服铁剂可能会导致疾病本身恶化,因此,目前的指南建议IBD患者采用静脉补铁方式。本文就IDA合并IBD的病因、临床表现、改进的诊断和治疗策略进行综述。

围手术期口服营养补充对老年股骨转子间骨折术后营养状况及生活质量的影响

目的 :探讨围手术期口服营养补充对老年股骨转子间骨折病人术后营养状况及生活质量的影响。方法 :选取采用闭合复位髓内固定治疗的老年股骨转子间骨折病人60例随机分为对照组和实验组。对照组给予常规饮食指导;实验组在原有普通饮食的基础上口服肠内营养粉剂。术后比较两组营养状况、胃肠道并发症、首次下床活动时间、日常生活能力(Barthel评分表)及住院天数的差异。结果:肠内营养干预组术后总蛋白、血清白蛋白和前白蛋白的含量、营养风险评分、围手术期食物每日摄入的热量、蛋白含量与对照组比较,差异有统计学意义(P <0.05)。胃肠道并发症(便秘)发生例数实验组与对照组比较,差异无统计学差异(P> 0.05)。肠内营养干预后,病人平均首次下床时间提前了4.5 h,住院时间缩短了0.53 d,生活能力评分提高了6.84分,差异有统计学意义(P <0.05)。两组术前营养潜在风险病人在术后总蛋白、白蛋白、前白蛋白、生活能力评分、下床时间和住院天数差异有统计学意义(P <0.05)。结论 :老年股骨转子间骨折病人围手术期使用肠内营养制剂可改善病人术后营养状况,提高病人术后生活质量。

营养专科护士主导的目标执行管理模式对胃肠道肿瘤病人围术期口服营养补充依从性的效果研究

目的:探讨营养专科护士主导的目标执行管理模式对于改善胃肠道恶性肿瘤病人围术期口服营养补充(ONS)依从性和营养状况的效果。方法:招募2020年12月1日至2021年11月30日收治北京协和医院胃肠外科的76例胃肠道恶性肿瘤病人并进行随机分组,对照组予以常规营养支持护理,研究组由营养专科护士主导的营养支持小组(NST)提供以目标执行管理理念为核心的营养管理模式,包括制定目标执行计划、营养耐受性监测及针对性干预等。结果:对照组、研究组术前平均每日ONS摄取能量无显著性差异[(1094.05±201.13)kcal/d vs(1180.84±235.99)kcal/d];与对照组病人相比,研究组病人术后平均每日ONS摄取能量[(484.57±191.86)kcal/d vs(774.78±273.34)kcal/d]、平均每日肠内营养摄取能量[(522.04±193.26)kcal/d vs(805.29±106.23)kcal/d]、平均每日ONS达标率(63.17%±24.23%vs 101.84%±10.36%)及体质量、白蛋白、前蛋白等营养指标有显著性提高,术后喂养不耐受发生情况减少(P均<0.05)。结论:营养专科护士主导的目标执行管理模式可改善胃肠道恶性肿瘤病人术后ONS依从性及机体营养状况。

术后口服营养补充和规范化饮食干预对剖宫产产妇早期恢复情况的效果研究

目的:探讨口服营养补充(ONS)对剖宫产术后产妇胃肠功能恢复、泌乳及营养状况等的影响。方法:自2018年3月至2019年3月,筛选符合纳入标准的剖宫产产妇410例,随机分为实验组和对照组各205例,实验组术后6 h开始给予口服肠内营养液、标准化的过渡期和月子期膳食,对照组仍采用传统自制饮食方式;观察两组术后肛门排气时间、泌乳开始时间、泌乳量水平、术后血清营养指标(血清总蛋白、白蛋白、血红蛋白)、术后发热和胃肠道不适发生率。结果:实验组肛门排气时间和泌乳开始时间均早于对照组,两组比较差异有统计学意义(P<0.05);实验组24 h内和48 h后的泌乳量水平均高于对照组,两组比较差异有统计学意义(P<0.05);实验组术后3 d的血清总蛋白和白蛋白水平均高于对照组,两组比较差异有统计学意义(P<0.05);实验组术后发热和胃肠道不适症状的发生率低于对照组,两组比较差异有统计学意义(P<0.05)。结论:剖宫产术后早期ONS可促进胃肠道功能恢复,促进早泌乳和增加泌乳量;同时配合后续的标准化饮食干预,可改善剖宫产产妇营养状态,促进产后快速恢复,避免产褥期感染等并发症和术后不适症状的发生。