Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory ...Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory bowel disease admitted to the Shanghai Zhangjiang Institute of Medical Innovation were chosen.This study was carried out from August 2022 to October 2023.The patients were randomly divided into a study group(40 cases)and a control group(40 cases).The treatment plan for the control group was the conventional treatment model,while the treatment plan for the study group was to provide enteral and parenteral nutrition therapy combined with a health belief education model based on the control group.The efficacy of both groups was compared.Results:In the study group,the therapeutic effect for 31 patients(77.50%)was markedly effective and 7 was effective(17.50%),accounting for 95.0%of the total,which was higher than the control group at 80.0%(P<0.05).The relief time of relevant symptoms in the study group was shorter than that of the control group(P<0.05).Before treatment,there were no differences in the high-sensitivity C-reactive protein(hs-CRP),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)between both groups(P>0.05).After treatment,the levels of inflammatory factors in the study group(hs-CRP(8.02±1.13)mg/L,IL-10(9.24±1.25)pg/mL,and TNF-α(7.19±1.04)ng/L)were lower than those in the control group(P<0.05).Conclusion:Enteral and parenteral nutritional therapy combined with a health belief education model showed significant efficacy in inflammatory bowel disease patients.Patient symptoms were relieved and inflammatory reactions were reduced.This method is worthy of popularization.展开更多
Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe t...Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.展开更多
AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combin...AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery.The assessment of clinical outcome was based on postoperative complications.Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge.Readmission within 30 d afterdischarge was also recorded.RESULTS:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN group.Total bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our study.Compared with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN group.The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.展开更多
Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 ...Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 patients with gastric cancer treated in our hospital from January 2016 to December 2017 were selected, and randomly divided into the control group and the observation group by computer, each with 90 cases. Control group received parenteral nutrition intervention, and observation group received enteral and parenteral nutritional diet intervention. Cellular immune function, humoral immune function, nutritional status, and complications occurrence rate were compared between two groups.Results: The levels of cellular immune function between the two groups had no difference before intervention (P>0.05). After intervention, the observation group had higher levels of CD3+, CD4+, and CD4+/CD8+ as well as lower level of CD8+ than those of control group (P<0.05). The IgM, IgA, and IgG levels between the two groups had no difference before treatment (P>0.05), which were decreased after treatment (P<0.05), and were lower in the observation group than those in the control group (P<0.05). The albumin and prealbumin levels between the two groups had no difference before intervention (P>0.05), which were increased after treatment, and were higher in observation group than those in the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:The application of enteral and parenteral nutritional diet intervention can promote the recovery, improve the nutritional status and immune function for gastric cancer patients after radical gastrectomy, which has fewer complications.展开更多
AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).METHODS: Three hundred and ...AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed.RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.展开更多
AIM: To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS: Fifteen dogs were randomly divided into parenteral nutrition (n = 7) and early...AIM: To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS: Fifteen dogs were randomly divided into parenteral nutrition (n = 7) and early intrajejunal nutrition groups (n = 8). An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy tube after the model was established for 24 h. On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10^6 Bq L-3H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS: The 3H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean number and area of zymogen granules did not show any significant statistical difference in both groups on d i or on d 7 (P 〉 0.05). CONCLUSION: Early intrajejunal nutrition might be effective in dogs with acute pancreatitis.展开更多
Objective To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrec...Objective To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group (n=20) and PN group (n=21 ). From the first postoperative day to the seventh day, patients received either EN (EN group) or PN (PN group) with isocalofic (84.9kJ·kg^-1·d^-1) and isonitrogenous (0.11g·kg^-1·d^-1) intake. Serum gastrin (GAS), plasma mofilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the first and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy ( P 〈 0. 001 ), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained ( P 〈 0. 001 ). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group ( P 〈 0.05 ). There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.展开更多
The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the result...The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the results of multi-center clinical nutrition research for congenital heart disease following thefirst Chinese consensus edition of 2016.The consensus was also shaped by the results of three discussion sessions and two questionnaires con-ducted by the 13-member collaboration group.This process was informed by both clinical guidelines and expert consensus.The quality of literature,both in English and Chinese,and the level of recommendations were evaluated using the Grading of Recommendations Assessment,Development,and Evaluations(GRADE)system.展开更多
Objective:To evaluate relationship between changes in the beneficial bacteria in intensive care unit(ICU)patients and nutritional therapy type.Methods:Ten patients aged≥18 years admitted to the ICU between January an...Objective:To evaluate relationship between changes in the beneficial bacteria in intensive care unit(ICU)patients and nutritional therapy type.Methods:Ten patients aged≥18 years admitted to the ICU between January and December 2020,were included.Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding.The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group.Among all patients,five each were in the increase and decrease groups.We investigated patient background,changes in sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation(APACHE)Ⅱscores,nutritional doses or methods,and clinical outcomes.Results:No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHEⅡscores at the time of admission.The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group(4/5 vs.0/5,P=0.01).Conclusions:An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition.In the future,accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.展开更多
BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the opti...BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.展开更多
Obesity,diabetes,cardiovascular and respiratory diseases,cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which can quickly induce severe respira...Obesity,diabetes,cardiovascular and respiratory diseases,cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which can quickly induce severe respiratory failure in 5%of cases.Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease,and damage to the liver parenchyma can be caused by infection of hepatocytes.Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction.Furthermore,pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage.In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients.As guidelines for SARS-CoV-2 in intensive care(IC)specifically are not yet available,strategies for management of sepsis and SARS are suggested in SARS-CoV-2.Early enteral nutrition(EN)should be started soon after IC admission,preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day.Monitoring is necessary to identify signs of intolerance,hemodynamic instability and metabolic disorders,and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN.Nutrients including vitamins A,C,D,E,B6,B12,folic acid,zinc,selenium andω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation.Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.展开更多
Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation.Methods Overall,120 patients were randomly d...Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation.Methods Overall,120 patients were randomly divided into the partial parenteral nutrition(PPN),early enteral nutrition(EEN),and diabetes mellitus special enteral nutritional emulsion(DEN)groups.The differences in the effects of three nutritional modes were compared.Results(1)On postoperative day four,the total protein level in the EEN and DEN groups was significantly higher than that in the PPN group(P<0.05).On postoperative day ten,body mass index,lymphocyte count,total protein level,and pre-albumin level in the DEN group were significantly higher than those in the PPN group(P<0.05).(2)On postoperative day four,there was no significant difference in the fasting blood glucose level between the EEN and DEN groups(P>0.05),but this level was significantly lower than that in the PPN group(P<0.05).On postoperative day ten,fasting and postprandial blood glucose levels in the DEN group were significantly lower than those in the PPN group.(3)On postoperative day four,the C-reactive protein level in the DEN group was significantly lower than that in the other groups(P<0.05).(4)The incidence rates of complications in the PPN,EEN,and DEN groups were 25.0%,10.0%,and 5.0%,respectively.The incidence of complications in the PPN group was significantly higher than that in the other groups.However,there was no significant difference in perioperative indexes among the three groups(P>0.05).Conclusion Enteral nutrition is more conducive to the recovery of patients with gastric cancer and type 2 diabetes mellitus after operation;the special enteral nutrition emulsion for diabetes mellitus is more effective than the conventional nutrition solution in stabilizing blood sugar levels and reducing the degree of inflammation.展开更多
Inflammatory bowel diseases(IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities,...Inflammatory bowel diseases(IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.展开更多
INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal org...INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal organ dysfunction and rapid recovery ,while severe disease is associated with multiple organ system failure and local complications such as necrosis , abscess , fistulas and pseudocyst formation [4-6].展开更多
Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were stud...Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were studied.EN was given through jejunostomy tube (or Beng-mark tube) after a period of PN maintenance. ENstarted when serum and urine amylase activity re-turned to normal with regular peristaltic sound, defe-cation or break wind. The sequence of preparationwas as follows: saline glucose→chemically defined di-et→polymeric diet→normal diet.Results: In all the patients, none died. The rate of latecomplications was lower, and the levels of serum albu-min and transferritin significantly increased in thepost-EN period as compared with the pre-EN period,although the count of lymphocytes was less changed.Conclusions: Nutritional support should be trans-formed from PN to EN as early as possible during thetreatment of patients with severe acute pancreatitis. ENcould not only continue sufficient nutritional support,but also avoid the unfavorable effects of long-timePN, thus reducing complications as well as mortality.展开更多
Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clea...Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.展开更多
Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with...Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.展开更多
Nutrient deficiencies are common in patients with inflammatory bowel disease (IBD). Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not usef...Nutrient deficiencies are common in patients with inflammatory bowel disease (IBD). Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not useful for primary therapy. Dietary intervention with omega-3 polyunsaturated fatty acids contained in fish oil may be useful for the care of IBD patients, and recent studies have slyessed the role of PPAR on NFKB activity on the potential beneficial effect of dietary lipids on intestinal function.展开更多
GASTROESOPHAGEAL anastomotic fistula is aserious and potentially life-threatening complicationafter the resection of esophagus, gastricand cardia tumor.1 Before 1987, the incidenceof gastroesophageal anastomotic fistu...GASTROESOPHAGEAL anastomotic fistula is aserious and potentially life-threatening complicationafter the resection of esophagus, gastricand cardia tumor.1 Before 1987, the incidenceof gastroesophageal anastomotic fistula is about 2%-4% inChina, and the mortality rate is as high as 50% or more.2 Inthe last 30 years, with the rapid development of clinicalnutrition support method, nutritional support.展开更多
BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate ...BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate therole of individually staged nutritional support (ISNS) in thetreatment of SAP.METHODS: One hundred patients with SAP admitted toour hospital from January 1997 to October 2002 were ran-domly divided into total parenteral nutrition group (TPNgroup, 50 patients) and individually staged nutrition group(individualized group, 50 patients), between which thetherapeutic outcome and the incidence of complicationswere carefully analyzed.RESULTS: Compared with the TPN group, the individuali-zed group had less complications (62 vs 94 patients) inclu-ding incubation related complications (2% vs 16%), super-infections (8% vs 30%), hepatic functional insufficiency(4% vs 24%) and intra-peritoneal infections (4% vs 12%),in addition to a sooner restoring of oral nutrition (18.5 vs24.8 days, P<0.05), a shorter hospital stay (24.5 vs 30.2days) and a lower hospital cost (4.1 vs 5.8 10 000 yuan, P<0.05).CONCLUSION: ISNS, which provides SAP patients withsufficient energy and nutrients according to their truepathological status, is an ideal nutrition planning with low-ered incidence of complications, shortened hospital stayand lightened financial burden.展开更多
文摘Objective:To evaluate the application effect of enteral and parenteral nutrition therapy combined with a health belief education model in patients with inflammatory bowel disease.Methods:80 patients with inflammatory bowel disease admitted to the Shanghai Zhangjiang Institute of Medical Innovation were chosen.This study was carried out from August 2022 to October 2023.The patients were randomly divided into a study group(40 cases)and a control group(40 cases).The treatment plan for the control group was the conventional treatment model,while the treatment plan for the study group was to provide enteral and parenteral nutrition therapy combined with a health belief education model based on the control group.The efficacy of both groups was compared.Results:In the study group,the therapeutic effect for 31 patients(77.50%)was markedly effective and 7 was effective(17.50%),accounting for 95.0%of the total,which was higher than the control group at 80.0%(P<0.05).The relief time of relevant symptoms in the study group was shorter than that of the control group(P<0.05).Before treatment,there were no differences in the high-sensitivity C-reactive protein(hs-CRP),interleukin 10(IL-10),and tumor necrosis factor-α(TNF-α)between both groups(P>0.05).After treatment,the levels of inflammatory factors in the study group(hs-CRP(8.02±1.13)mg/L,IL-10(9.24±1.25)pg/mL,and TNF-α(7.19±1.04)ng/L)were lower than those in the control group(P<0.05).Conclusion:Enteral and parenteral nutritional therapy combined with a health belief education model showed significant efficacy in inflammatory bowel disease patients.Patient symptoms were relieved and inflammatory reactions were reduced.This method is worthy of popularization.
基金Supported by the Natural Science Foundation of Shandong province(Y2008C35)Technology Supporting Program of Qingdao(12-1-3-5-(1)-nsh)
文摘Objective To compare the conjoint effect of enteral nutrition (EN) and parenteral nutrition (PN)with single EN or PN on immune function, nutritional status, complications and clinical outcomes of patientswith severe traumatic brain injury (STBI).Methods A prospective randomized control trial was carried out from January 2009 to May 2012 inNeurological Intensive Care Unit (NICU). Patients of STBI who met the enrolment criteria (Glasgow ComaScale score 6~8; Nutritional Risk Screening ≥3) were randomly divided into 3 groups and were administratedEN, PN or EN+PN treatments respectively. The indexes of nutritional status, immune function,complications and clinical outcomes were examined and compared statistically.
基金Supported by Grants from Jiangsu Provincial GovernmentChinaNo.ZX200605
文摘AIM:To investigate the effect of early enteral nutrition(EEN)combined with parenteral nutritional support in patients undergoing pancreaticoduodenectomy(PD).METHODS:From January 2006,all patients were given EEN combined with parenteral nutrition(PN)(EEN/PN group,n=107),while patients prior to this date were given total parenteral nutrition(TPN)(TPN group,n=67).Venous blood samples were obtained for a nutrition-associated assessment and liver function tests on the day before surgery and 6 d after surgery.The assessment of clinical outcome was based on postoperative complications.Follow-up for infectious and noninfectious complications was carried out for 30 d after hospital discharge.Readmission within 30 d afterdischarge was also recorded.RESULTS:Compared with the TPN group,a significant decrease in prealbumin(PAB)(P=0.023)was seen in the EEN/PN group.Total bilirubin(TB),direct bilirubin(DB)and lactate dehydrogenase(LDH)were significantly decreased on day 6 in the EEN/PN group(P=0.006,0.004 and 0.032,respectively).The rate of gradeⅠcomplications,gradeⅡcomplications and the length of postoperative hospital stay in the EEN/PN group were significantly decreased(P=0.036,0.028and 0.021,respectively),and no hospital mortality was observed in our study.Compared with the TPN group(58.2%),the rate of infectious complications in the EEN/PN group(39.3%)was significantly decreased(P=0.042).Eleven cases of delayed gastric emptying were noted in the TPN group,and 6 cases in the EEN/PN group.The rate of delayed gastric emptying and hyperglycemia was significantly reduced in the EEN/PN group(P=0.031 and P=0.040,respectively).CONCLUSION:Early enteral combined with PN can greatly improve liver function,reduce infectious complications and delayed gastric emptying,and shorten postoperative hospital stay in patients undergoing PD.
文摘Objective:To explore the effect of enteral and parenteral nutritional diet intervention on recovery, nutritional status and immune function for gastric cancer patients after radical gastrectomy.Methods:A total of 180 patients with gastric cancer treated in our hospital from January 2016 to December 2017 were selected, and randomly divided into the control group and the observation group by computer, each with 90 cases. Control group received parenteral nutrition intervention, and observation group received enteral and parenteral nutritional diet intervention. Cellular immune function, humoral immune function, nutritional status, and complications occurrence rate were compared between two groups.Results: The levels of cellular immune function between the two groups had no difference before intervention (P>0.05). After intervention, the observation group had higher levels of CD3+, CD4+, and CD4+/CD8+ as well as lower level of CD8+ than those of control group (P<0.05). The IgM, IgA, and IgG levels between the two groups had no difference before treatment (P>0.05), which were decreased after treatment (P<0.05), and were lower in the observation group than those in the control group (P<0.05). The albumin and prealbumin levels between the two groups had no difference before intervention (P>0.05), which were increased after treatment, and were higher in observation group than those in the control group (P<0.05). The incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).Conclusion:The application of enteral and parenteral nutritional diet intervention can promote the recovery, improve the nutritional status and immune function for gastric cancer patients after radical gastrectomy, which has fewer complications.
基金Supported by the National Natural Science Foundation,No.81372582“New-Star”Young Scientists Program of Shaanxi Province,No.2014kjxx-30the Fundamental Research Funds for the Central Universities
文摘AIM: To analyze and compare postoperative morbidity between patients receiving total parenteral nutrition (TPN) and early enteral nutrition supplemented with parenteral nutrition (EEN + PN).METHODS: Three hundred and forty patients receiving pancreaticoduodenectomy (PD) from 2009 to 2013 at our center were enrolled retrospectively. Patients were divided into two groups depending on postoperative nutrition support scheme: an EEN + PN group (n = 87) and a TPN group (n = 253). Demographic characteristics, comorbidities, preoperative biochemical parameters, pathological diagnosis, intraoperative information, and postoperative complications of the two groups were analyzed.RESULTS: The two groups did not differ in demographic characteristics, preoperative comorbidities, preoperative biochemical parameters or pathological findings (P > 0.05 for all). However, patients with EEN + PN following PD had a higher incidence of delayed gastric emptying (16.1% vs 6.7%, P = 0.016), pulmonary infection (10.3% vs 3.6%, P = 0.024), and probably intraperitoneal infection (18.4% vs 10.3%, P = 0.059), which might account for their longer nasogastric tube retention time (9 d vs 5 d, P = 0.006), postoperative hospital stay (25 d vs 20 d, P = 0.055) and higher hospitalization expenses (USD10397 vs USD8663.9, P = 0.008), compared to those with TPN.CONCLUSION: Our study suggests that TPN might be safe and sufficient for patient recovery after PD. Postoperative EEN should only be performed scrupulously and selectively.
基金Supported by grant from the Morning Star Fund of Shanghai, China, No. 99QB14010
文摘AIM: To study the effect of early intrajejunal nutrition on enzyme-protein synthesis and secretion during acute pancreatitis. METHODS: Fifteen dogs were randomly divided into parenteral nutrition (n = 7) and early intrajejunal nutrition groups (n = 8). An acute pancreatitis model was induced by injecting 5% sodium taurocholate and trypsin into the pancreas via the pancreatic duct. Intrajejunal nutrition was delivered with a catheter via a jejunostomy tube after the model was established for 24 h. On d 1 and 7 and at the beginning of nutritional support, radioactive tracing and electron microscopes were used to evaluate the enzyme-protein synthesis in acinar cells, the subcellular fractionation and the change in zymogen granules after 1.85 × 10^6 Bq L-3H phenylalanine was infused at 30, 60, 120, and 180 min. RESULTS: The 3H radioactivity in pancreatic acinar cells reached its peak level at 60 min, and the contents in the early intrajejunal nutrition group were higher than those in the parenteral nutrition group, which were then decreased. The mean number and area of zymogen granules did not show any significant statistical difference in both groups on d i or on d 7 (P 〉 0.05). CONCLUSION: Early intrajejunal nutrition might be effective in dogs with acute pancreatitis.
文摘Objective To investigate the effects of enteral nutrition (EN) and parenteral nutrition (PN) on gastric motility and gastroentefic hormones after subtotal gastrectomy. Methods Forty-one patients underwent gastrectomy were randomly divided into EN group (n=20) and PN group (n=21 ). From the first postoperative day to the seventh day, patients received either EN (EN group) or PN (PN group) with isocalofic (84.9kJ·kg^-1·d^-1) and isonitrogenous (0.11g·kg^-1·d^-1) intake. Serum gastrin (GAS), plasma mofilin (MTL), and plasma cholecystokinin (CCK) were measured on preoperative day, the first and seventh postoperative day. Electrogastrography (EGG) was measured on preoperative day and the seventh postoperative day. Results Compared with preoperafion, blood GAS, MTL, and CCK levels of 41 patients decreased significantly on the first day after subtotal gastrectomy ( P 〈 0. 001 ), but returned to the preoperative levels one week later. EGG after gastrectomy showed that gastric basal electrical rhythm was significantly restrained ( P 〈 0. 001 ). On the seventh day after subtotal gastrectomy, plasma MTL and CCK levels in EN group were higher than those in PN group ( P 〈 0.05 ). There was no difference in GAS level between two groups. EGG in EN group was better than that in PN group postoper- atively. Conclusions The levels of gastroentefitic hormones and the gastric motility decrease significantly after subtotal gastrectomy. In contrast with PN, EN can accelerate the recovery of MTL, CCK, and gastric motility after subtotal gastrectomy.
基金supported by the National Natural Science Foundation of China(81970265,82270310)a Sub-Project of the National Key R&D Program“The recognition and Identification of Genetic Pathogenic Genes for Structural Birth Defects”(2021YFC2701002)+1 种基金Nanjing Science and Technology Development Project(2019060007)Jiangsu Provincial Key Research and Development Program(BE2023662).
文摘The second edition of the expert consensus on pediatric nutrition was formed based on a global update of pedia-tric nutrition guidelines or consensus worldwide,the management of congenital heart disease,and the results of multi-center clinical nutrition research for congenital heart disease following thefirst Chinese consensus edition of 2016.The consensus was also shaped by the results of three discussion sessions and two questionnaires con-ducted by the 13-member collaboration group.This process was informed by both clinical guidelines and expert consensus.The quality of literature,both in English and Chinese,and the level of recommendations were evaluated using the Grading of Recommendations Assessment,Development,and Evaluations(GRADE)system.
文摘Objective:To evaluate relationship between changes in the beneficial bacteria in intensive care unit(ICU)patients and nutritional therapy type.Methods:Ten patients aged≥18 years admitted to the ICU between January and December 2020,were included.Good enteral nutrition was defined as early achievement of target calorie intake through enteral feeding.The ratio of beneficial bacteria at the first and second bowel movements after each patient’s admission was calculated and the patients were classified into the increase or decrease group.Among all patients,five each were in the increase and decrease groups.We investigated patient background,changes in sequential organ failure assessment(SOFA)and acute physiology and chronic health evaluation(APACHE)Ⅱscores,nutritional doses or methods,and clinical outcomes.Results:No relationship was found between changes in the ratio of beneficial bacteria and changes in SOFA/APACHEⅡscores at the time of admission.The rate of good enteral nutrition was significantly higher in the increase group than in the decrease group(4/5 vs.0/5,P=0.01).Conclusions:An increase in beneficial bacteria may be significantly related to the early establishment of enteral nutrition.In the future,accumulating cases may make it possible to establish a new nutritional strategy for critically ill patients from an intestinal microbiota perspective.
基金Supported by Ningxia Natural Science Foundation Project,No.2022AAC03488the National Key Research and Development Program of China,No.2016YFD0400605.
文摘BACKGROUND Sepsis exacerbates intestinal microecological disorders leading to poor prognosis.Proper modalities of nutritional support can improve nutrition,immunity,and intestinal microecology.AIM To identify the optimal modality of early nutritional support for patients with sepsis from the perspective of intestinal microecology.METHODS Thirty patients with sepsis admitted to the intensive care unit of the General Hospital of Ningxia Medical University,China,between 2019 and 2021 with indications for nutritional support,were randomly assigned to one of three different modalities of nutritional support for a total of 5 d:Total enteral nutrition(TEN group),total parenteral nutrition(TPN group),and supplemental parenteral nutrition(SPN group).Blood and stool specimens were collected before and after nutritional support,and changes in gut microbiota,short-chain fatty acids(SCFAs),and immune and nutritional indicators were detected and compared among the three groups.RESULTS In comparison with before nutritional support,the three groups after nutritional support presented:(1)Differences in the gut bacteria(Enterococcus increased in the TEN group,Campylobacter decreased in the TPN group,and Dialister decreased in the SPN group;all P<0.05);(2)different trends in SCFAs(the TEN group showed improvement except for Caproic acid,the TPN group showed improvement only for acetic and propionic acid,and the SPN group showed a decreasing trend);(3)significant improvement of the nutritional and immunological indicators in the TEN and SPN groups,while only immunoglobulin G improved in the TPN group(all P<0.05);and(4)a significant correlation was found between the gut bacteria,SCFAs,and nutritional and immunological indicators(all P<0.05).CONCLUSION TEN is recommended as the preferred mode of early nutritional support in sepsis based on clinical nutritional and immunological indicators,as well as changes in intestinal microecology.
文摘Obesity,diabetes,cardiovascular and respiratory diseases,cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2(SARS-CoV-2),which can quickly induce severe respiratory failure in 5%of cases.Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease,and damage to the liver parenchyma can be caused by infection of hepatocytes.Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction.Furthermore,pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage.In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients.As guidelines for SARS-CoV-2 in intensive care(IC)specifically are not yet available,strategies for management of sepsis and SARS are suggested in SARS-CoV-2.Early enteral nutrition(EN)should be started soon after IC admission,preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day.Monitoring is necessary to identify signs of intolerance,hemodynamic instability and metabolic disorders,and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN.Nutrients including vitamins A,C,D,E,B6,B12,folic acid,zinc,selenium andω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation.Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients.
基金Supported by a grant from the General Project of Youth Science Foundation(No.81604115).
文摘Objective To explore the difference in the effects of three nutritional pathways on the rehabilitation of patients with gastric cancer and diabetes mellitus after operation.Methods Overall,120 patients were randomly divided into the partial parenteral nutrition(PPN),early enteral nutrition(EEN),and diabetes mellitus special enteral nutritional emulsion(DEN)groups.The differences in the effects of three nutritional modes were compared.Results(1)On postoperative day four,the total protein level in the EEN and DEN groups was significantly higher than that in the PPN group(P<0.05).On postoperative day ten,body mass index,lymphocyte count,total protein level,and pre-albumin level in the DEN group were significantly higher than those in the PPN group(P<0.05).(2)On postoperative day four,there was no significant difference in the fasting blood glucose level between the EEN and DEN groups(P>0.05),but this level was significantly lower than that in the PPN group(P<0.05).On postoperative day ten,fasting and postprandial blood glucose levels in the DEN group were significantly lower than those in the PPN group.(3)On postoperative day four,the C-reactive protein level in the DEN group was significantly lower than that in the other groups(P<0.05).(4)The incidence rates of complications in the PPN,EEN,and DEN groups were 25.0%,10.0%,and 5.0%,respectively.The incidence of complications in the PPN group was significantly higher than that in the other groups.However,there was no significant difference in perioperative indexes among the three groups(P>0.05).Conclusion Enteral nutrition is more conducive to the recovery of patients with gastric cancer and type 2 diabetes mellitus after operation;the special enteral nutrition emulsion for diabetes mellitus is more effective than the conventional nutrition solution in stabilizing blood sugar levels and reducing the degree of inflammation.
文摘Inflammatory bowel diseases(IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.
文摘INTRODUCTIONAcute pancreatitis (AP) is a common severe illness of the digestive tract with variable involvement of other regional tissues and / or remote organ sysems[1-3],Mild disease is associated with minimal organ dysfunction and rapid recovery ,while severe disease is associated with multiple organ system failure and local complications such as necrosis , abscess , fistulas and pseudocyst formation [4-6].
文摘Objective: To observe the role and the timing of EN inthe treatment of patients with severe acute pancreatitis(SAP).Methods: Eleven patients with severe acute pancreatitisunderwent systemic nutrition support were studied.EN was given through jejunostomy tube (or Beng-mark tube) after a period of PN maintenance. ENstarted when serum and urine amylase activity re-turned to normal with regular peristaltic sound, defe-cation or break wind. The sequence of preparationwas as follows: saline glucose→chemically defined di-et→polymeric diet→normal diet.Results: In all the patients, none died. The rate of latecomplications was lower, and the levels of serum albu-min and transferritin significantly increased in thepost-EN period as compared with the pre-EN period,although the count of lymphocytes was less changed.Conclusions: Nutritional support should be trans-formed from PN to EN as early as possible during thetreatment of patients with severe acute pancreatitis. ENcould not only continue sufficient nutritional support,but also avoid the unfavorable effects of long-timePN, thus reducing complications as well as mortality.
文摘Nutritional therapy has an important role in the management of patient with severe acute pancreatitis.This article reviews the endoscopist's approach to manage nutrition in such cases.Enteral feeding has been clearly validated as the preferred route of feeding,and should be started early on admission.Parenteral nutrition should be reserved for patients with contraindications to enteral feeding such as small bowel obstruction.Moreover,nasogastric feeding is safe and as effective as nasojejunal feeding.If a prolonged course of enteral feeding(>30d) is required,endoscopic placement of feeding gastrostomy or jejunostomy tubes should be considered.
基金funded by the Special Funding for Clinical Research of Wu Jieping Medical Foundation(No.320.2710.1848)the Clinical Research Supporting Project of PLA Genenral Hospital(No.109310)the Beijing Municipal Science and Technology Project(No.D171100006517002 and No.D171100006517004)。
文摘Objective:To avoid perioperative complications caused malnutrition,nutrition therapy is necessary in gastric outlet obstruction(GOO)patients.Compared to parenteral nutrition(PN),enteral nutrition(EN)is associated with many advantages.This study aimed to investigate whether preoperative EN has beneficial clinical effects compared to preoperative PN in gastric cancer patients with GOO undergoing surgery.Methods:According to the methods of preoperative nutrition therapy,143 patients were divided into EN group(n=42)and PN group(n=101)between January 2013 and December 2017 at the Chinese People’s Liberation Army General Hospital.Multiple logistic regression models were used to assess the association between the methods of preoperative nutrition therapy and postoperative day of flatus passage.The generalized additive model and twopiecewise linear regression model were used to calculate the inflection point of the preoperative nutritional therapy time on the postoperative day of flatus passage in the PN group.Results:EN shortened the postoperative day of flatus passage in gastric cancer patients with GOO,which is a protective factor,especially in patients who underwent non-radical operations and the postoperative day of flatus passage reduced when the preoperative PN therapy was up to 3 d and a longer PN therapy(>3 d)did not accelerate the postoperative recovery of gastrointestinal functions.Conclusions:Preoperative EN therapy would benefit gastric cancer patients with GOO by accelerating postoperative recovery.For patients with absolute obstruction,no more than 3-day PN therapy is recommended if patients can tolerate general anesthesia and surgery.
文摘Nutrient deficiencies are common in patients with inflammatory bowel disease (IBD). Both total parenteral and enteral nutrition provide important supportive therapy for IBD patients, but in adults these are not useful for primary therapy. Dietary intervention with omega-3 polyunsaturated fatty acids contained in fish oil may be useful for the care of IBD patients, and recent studies have slyessed the role of PPAR on NFKB activity on the potential beneficial effect of dietary lipids on intestinal function.
基金Supported by a grant from the Health Research Development Program of Beijing(2014-3-4014)a grant from the National High Technology Research and Development Program of China(2010AA023007)
文摘GASTROESOPHAGEAL anastomotic fistula is aserious and potentially life-threatening complicationafter the resection of esophagus, gastricand cardia tumor.1 Before 1987, the incidenceof gastroesophageal anastomotic fistula is about 2%-4% inChina, and the mortality rate is as high as 50% or more.2 Inthe last 30 years, with the rapid development of clinicalnutrition support method, nutritional support.
文摘BACKGROUND: Severe acute pancreatitis ( SAP) as acommon acute abdomen due to complicated causes is cha-racterized by lots of morbidities, difficult treatment, andhigh mortality. This study was designed to investigate therole of individually staged nutritional support (ISNS) in thetreatment of SAP.METHODS: One hundred patients with SAP admitted toour hospital from January 1997 to October 2002 were ran-domly divided into total parenteral nutrition group (TPNgroup, 50 patients) and individually staged nutrition group(individualized group, 50 patients), between which thetherapeutic outcome and the incidence of complicationswere carefully analyzed.RESULTS: Compared with the TPN group, the individuali-zed group had less complications (62 vs 94 patients) inclu-ding incubation related complications (2% vs 16%), super-infections (8% vs 30%), hepatic functional insufficiency(4% vs 24%) and intra-peritoneal infections (4% vs 12%),in addition to a sooner restoring of oral nutrition (18.5 vs24.8 days, P<0.05), a shorter hospital stay (24.5 vs 30.2days) and a lower hospital cost (4.1 vs 5.8 10 000 yuan, P<0.05).CONCLUSION: ISNS, which provides SAP patients withsufficient energy and nutrients according to their truepathological status, is an ideal nutrition planning with low-ered incidence of complications, shortened hospital stayand lightened financial burden.