Effect of preoperative nutrition therapy type and duration on short-time outcomes in gastric cancer patient with gastric outlet obstruction

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.

Relationship between nutritional therapy and beneficial bacteria ratio in severe disease

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.

Nutritional therapy for gastroparesis

Gastroparesis is a common postoperative complication of abdominal surgery,mainly manifested by postprandial fullness,early satiety,nausea,vomiting,and bloating.Gastroparesis should be addressed with a comprehensive treatment plan that includes nutritional therapy and medications such as metoclopramide,domperidone,cisapride,and antiemetic drugs.Surgical treatment,such as pyloroplasty or partial gastrectomy,should be considered if the conservative therapy is ineffective.Enteral and parenteral nutrition therapy can promote the recovery of gastrointestinal function,maintain the mucosal integrity and immunity,and reduce complications.Thus,nutrition can play an important role in the treatment of gastroparesis.

Effects of enteral nutrition intervention on immune and nutritional indexes of patients with gastric malignant cancer during postoperative chemotherapy

Objective The aim of this study was to investigate changes in nutritional status and related indexes in patients with Nutritional Risk Score(NRS)≥3 gastric cancer after nutritional support treatment.Methods A total of 50 patients with gastric cancer were divided into two groups according to the different nutritional support treatment they received during postoperative chemotherapy:immune-enhanced enteral nutrition group(n=25)and conventional enteral nutrition group(n=25).Changes in patient’body mass index(BMI),hemoglobin(HB),serum total protein(TP),serum albumin(ALB),and immune indexes(CD3+,CD4+/CD8+,CD3+/CD8+)were monitored before and after chemotherapy.At the same time,the incidence and classification of gastrointestinal adverse reactions after chemotherapy were assessed.Results Compared with the conventional enteral nutrition group,the nutritional and immune indexes in the immune-enhanced enteral nutrition group were significantly improved.After chemotherapy,the incidence of adverse reactions in the digestive tract was relatively lower and the grade was reduced.Conclusion Immune-enhanced enteral nutrition support can significantly improve the nutritional status of patients,improve immune function,increase the susceptibility of cancer patients to chemotherapy,reduce toxicity and adverse effects,and improve the quality of life of tumor patients compared with conventional enteral nutrition support.

Nutritional Therapy in Patients Undergoing Elective Colorectal Cancer Surgery

The high incidence of malnutrition in patients with colorectal cancer directly affects their clinical outcomes,and is associated with increased postoperative complications,prolonged hospital stays,and decreased tolerance of chemotherapy and radiotherapy.Therefore,the nutritional management of patients with colorectal cancer is important.The perioperative nutritional management of patients includes preoperative education,nutritional screening and evaluation,preoperative intestinal preparation,and postoperative nutritional management.This article summarizes the current status of perioperative nutritional therapy and bowel preparation for patients with colorectal cancer.

Effect of Nutritional Diet Therapy in Pediatric Diabetic Patients

Objective:To analyze the effect nutritional diet therapy in pediatric diabetic patients.Methods:The study object was 60 cases of children with diabetes,which were divided into groups and treated separately according to the time of admission,and the treatment effects were compared.Results:After treatment,the glycated hemoglobin level,fasting blood glucose level,blood glucose level at 2 hours after meal,serum calcium level,transferrin level,albumin level,prealbumin level,hemoglobin level,the height,weight,and head circumference of the experimental group were better than those of the control group,and there were significant differences between the groups(P<0.05).Conclusion:The application of nutritional diet therapy in the treatment of pediatric diabetic patients can significantly improve blood glucose levels,nutritional indicators and physical indicators of patients.

Early prediction and prevention of infected pancreatic necrosis

Approximately 20%-30%of patients with acute necrotizing pancreatitis develop infected pancreatic necrosis(IPN),a highly morbid and potentially lethal complication.Early identification of patients at high risk of IPN may facilitate appropriate preventive measures to improve clinical outcomes.In the past two decades,several markers and predictive tools have been proposed and evaluated for this purpose.Conventional biomarkers like C-reactive protein,procalcitonin,lymphocyte count,interleukin-6,and interleukin-8,and newly developed biomarkers like angiopoietin-2 all showed significant association with IPN.On the other hand,scoring systems like the Acute Physiology and Chronic Health Evaluation II and Pancreatitis Activity Scoring System have also been tested,and the results showed that they may provide better accuracy.For early prevention of IPN,several new therapies were tested,including early enteral nutrition,anti-biotics,probiotics,immune enhancement,etc.,but the results varied.Taken together,several evidence-supported predictive markers and scoring systems are readily available for predicting IPN.However,effective treatments to reduce the incidence of IPN are still lacking apart from early enteral nutrition.In this editorial,we summarize evidence concerning early prediction and prevention of IPN,providing insights into future practice and study design.A more homo-geneous patient population with reliable risk-stratification tools may help find effective treatments to reduce the risk of IPN,thereby achieving individualized treatment.

Role of nutritional status and nutritional support in outcome of hepatitis B virus-associated acute-on-chronic liver failure

BACKGROUNDHepatitis B virus-associated acute-on-chronic liver failure (HBV-ACLF) is animportant type of liver failure in Asia. There is a direct relationship between HBVACLFand gastrointestinal barrier function. However, the nutritional status ofHBV-ACLF patients has been poorly studied.AIMTo investigate the nutritional risk and nutritional status of HBV-ACLF patientsand evaluated the impact of nutritional support on the gastrointestinal barrier and28-d mortality.METHODSNutritional risk screening assessment and gastrointestinal barrier biomarkers ofpatients with HBV-ACLF (n = 234) and patients in the compensatory period ofliver cirrhosis (the control group) (n = 234) were compared during the periodbetween 2016 and 2018. Changes were analyzed after nutritional support in HBVACLFpatients. Valuable biomarkers have been explored to predict 28-d death.The 28-d survival between HBV-ACLF patients with nutritional support (n = 234)or no nutritional support (2014-2016) (n = 207) was compared.RESULTSThe nutritional risk of the HBV-ACLF patients was significantly higher than thatof the control group. The nutritional intake of the patients with HBV-ACLF waslower than that of the control group. The decrease in skeletal muscle and fatcontent and the deficiency of fat intake were more obvious (P < 0.001). Thecoccus-bacillus ratio, secretory immunoglobulin A, and serum D-lactate weresignificantly increased in HBV-ACLF patients. The survival group had a lowernutritional risk, lower D-lactate, and cytokine levels (endotoxin, tumor necrosisfactor alpha, interleukin-10, and interleukin-1). Interleukin-10 may be a potentialpredictor of death in HBV-ACLF patients. The 28-d survival of the nutritionalsupport group was better than that of the non-nutritional support group (P =0.016).CONCLUSIONPatients with HBV-ACLF have insufficient nutritional intake and high nutritionalrisk, and their intestinal barrier function is impaired. Individualized and dynamicnutritional support is associated with a better prognosis of 28-d mortality in HBVACLFpatients.

Computational Nutrition: An Algorithm to Generate a Diet Plan to Meet Specific Nutritional Requirements

Many methods have been proposed to generate meal plans, but most of them only consider proximates. However, the human body requires a combination of proximates and several macronutrients, micronutrients, vitamins, and minerals. Furthermore, the models designed to generate these meal plans do not take into account an individual’s specific nutritional needs. These needs are often expressed as a combination of lower bound amount (LBA), ideal amount (IA), and upper bound amount (UBA) necessary for the human body to thrive. The aim of this project is to generate an algorithm to produce a list of food items that will meet specific nutritional requirements. With the proposed algorithm, each nutrient receives a score based on the amount of nutrient contained in the food list in relation to the LBA, IA, and UBA. These scores are aggregated to give the meal plan an overall score.

Liver disorders in COVID-19,nutritional approaches and the use of phytochemicals

Coronavirus disease 2019(COVID-19),which is caused by severe acute respiratory syndrome-coronavirus-2(SARS-CoV-2),has affected millions of people globally.It was declared a pandemic by the World Health Organization in March 2020.The hyperinflammatory response to the entry of SARS-CoV-2 into the host through angiotensin-converting enzyme 2 is the result of a“cytokine storm”and the high oxidative stress responsible for the associated symptomatology.Not only respiratory symptoms are reported,but gastrointestinal symptoms(diarrhea,vomiting,and nausea)and liver abnormalities(high levels of aspartate aminotransferase,alanine aminotransferase transaminases,and bilirubin)are observed in at least 30%of patients.Reduced food intake and a delay in medical services may lead to malnutrition,which increases mortality and poor outcomes.This review provides some strategies to identify malnutrition and establishes nutritional approaches for the management of COVID-19 and liver injury,taking energy and nutrient requirements and their impact on the immune response into account.The roles of certain phytochemicals in the prevention of the disease or as promising target drugs in the treatment of this disease are also considered.

COVID-19 and liver dysfunction:What nutritionists need to know

The coronavirus disease 2019(COVID-19)pandemic caused by severe acute respiratory syndrome coronavirus-2 has brought serious challenges for the medical field.Patients with COVID-19 usually have respiratory symptoms.However,liver dysfunction is not an uncommon presentation.Additionally,the degree of liver dysfunction is associated with the severity and prognosis of COVID-19.Prevention,diagnosis,and treatment of malnutrition should be routinely recommended in the management of patients with COVID-19,especially in those with liver dysfunction.Recently,a large number of studies have reported that nutrition therapy measures,including natural dietary supplements,vitamins,minerals and trace elements,and probiotics,might have potential hepatoprotective effects against COVID-19-related liver dysfunction via their antioxidant,antiviral,anti-inflammatory,and positive immunomodulatory effects.This review mainly focuses on the possible relationship between COVID-19 and liver dysfunction,nutritional and metabolic characteristics,nutritional status assessment,and nutrition therapy to provide a reference for the nutritionists while making evidence-based nutritional decisions during the COVID-19 pandemic.

Nutritional Status,Sarcopenia and the Importance of Prehabilitation of Gastrointestinal Tumor Patients:a Surgical Point of View

Background Surgery may be the field of healthcare where malnutrition and sarcopenia have their greatest impact on patient morbidity and mortality.However,there are limited data on the nutritional status of surgical patients and the effects of prehabilitation on the outcomes of surgery.Methods A prospective analysis was conducted on all patients surgically-treated for malignant gastrointestinal tumors at St.John Hospital during a two-year period.The patient’s gender,age,body weight,height,BMI and weight loss were registered,then a risk score was determined by the MUST survey.Measurement of the triceps and thigh skin-fold thickness and the circumference of the upper arm and thigh were done to calculate muscle area and muscle index,respectively.The body composition was assessed using an OMRON-BF511 device.Muscle function was evaluated based on hand clamping force measurement and activity tests.Patients who were diagnosed as being at-risk received preoperative prehabilitation,which included physiotherapy and nutritional therapy.Results A total of 231 patients(133 males/98 females)were analyzed.They had a mean age of 68.9 years(18~98).Seventy-four patients(32%)lost weight,with an average loss of 7 kilograms(3~15 kg).Anthropometric data showed an average upper-arm circumference of 27.4 cm(14.3~38.1)and thigh circumference of 44.7 cm(19.3~60.1),so the median muscle index was 1.29.The mean BMI was 26,which is above normal,and the elevated BMI was consistent documented in each patient subgroup stratified by age and tumor type.A body composition analysis was performed for 75 patients(44 male/31 female),who had a median age of 68(37~88 y).The average BMI of these patients was 25.7 y and their average MUST score was 1.12.The total body fat percentage(of the total body mass)was 29.5%,total muscle was 30.1%and visceral fat was 10%.Thirty patients(40%)had sarcopenia,with a mean BMI of 28.7,fat comprising 34.2%of the body mass,visceral-fat 11%,and muscle 27.1%,and their median MUST score was 1.23.Patients who received preoperative training(physiotherapy)showed improvements in physical function ranging from 12%~33%.Conclusion Gastrointestinal tumor patients have a higher than normal BMI regardless of age or tumor type.Patients with sarcopenia show measurable improvement after two weeks of prehabilitation.

Nutritional supplementation on wound healing in diabetic foot:What is known and what is new?

Non-healing diabetic foot ulcers(DFU)are the most notable and striking complications of diabetes mellitus.More than 25% of nonhealing DFU can ultimately lead to amputation of the lower extremity within 6-18 mo after the first manifestation of the wound.Although wound healing is complex,nutritional status is crucial in soft tissue repair.Malnutrition is highly prevalent and overlooked in patients with diabetes and chronic wounds.Moreover,to date,we do not have clear recommendations or evidence about the use of nutritional supplements for improving wound healing in patients with DFU.In this article the authors briefly analyzed the current evidence on the use of nutritional supplements of proteins or amino acids,fatty acids,probiotics,vitamins,and trace elements in the wound healing process in patients with DFU.

A Baseline Studies on the Nutritional Interplay between HIV Drugs and Kidney, Liver and Heart Indices in Patients Receiving HIV Treatment in North-East Nigeria

Human Immunodeficiency Virus (HIV) patients on Antiretroviral Therapy (ART) have shown impressive improvement and death rates have drastically reduced, even though complications still exist. This research carried out a baseline study to determine the nutritional interplay between HIV-drugs and kidney, liver, and heart indices among subjects undergoing HIV treatment and attending the Medical Out-Patient Department of a Federal Medical Center in the North-Eastern part of Nigeria, using a sample size of 50 individuals both male and female, who have been shown to be HIV positive and have been on ART for over 12 months. Anthropometric data was collected in triplicate, two from patients’ file, and one was measured directly and the average was obtained. The electrolytes were determined by the colorimetric method while total protein and albumin in blood concentration were determined by spectrophotometric method, but globulin and A/G ratio were determined by calculation. TC was determined using Spectrophotometric method while HDL was determined after precipitation of LDL with phosphotungstate and magnesium were calculated from Friedwaldís formular, and TG was measured using the colorimetric enzymatic method. The results showed that the mean systolic and diastolic blood pressure which were 119.9 mmHg ± 17.5, and 76. 6 mmHg ± 10.1 respectively, were with the range of the reference values. The mean body mass index was 25.1 ± 4.9;also within range of the reference value. Major indices from the liver function test were mean ALT which was 36.5 ± 29.4 with a reference value of 7 - 55 U/L;AST was 40.0 ± 32.3, with a reference value of 8 - 48 U/L. The mean value for albumin was 4.6 ± 7.1 with a reference range of 3.5 - 5.0 g/dl, these values also were within the reference range values. The electrolyte test showed all other electrolytes to be within the reference range values except for Zinc which was 19.5 μmol/L, with a normal range of 70 - 100 μmol/L and magnesium which was found to be 0.7 mEq/L, with a normal range of 1.5 - 2.0 mEq/L;Zinc and magnesium play vital roles in over 300 enzymatic reactions, and are known to be important in the immune response. Shortfalls in these minerals could compromise the patients’ recovery process and place them at risk of hearts conditions such as arrhythmia or heart attack among many other conditions. There is a need for an immediate review of these treatments in the direction of Zinc and magnesium, either by supplementation or by diet therapy. HIV patients undergoing ART should be placed under strict Zinc and magnesium-rich diet to avert untimely death among these patients. The controlled study should be done to ascertain the best approach to quell the residue of malnutrition in these patients in order to further improve their nutritional status.

Dietary adherence and the associated factors among Indonesian patients with type 2 diabetes: what should we be concerned about?

Objective: To identify the level of dietary adherence for particular foods and determine which are challenging for patients with diabetes in Indonesia, as well as the associated factors. Methods: This study was conducted in a primary health care facility, using a cross-sectional design. Diabetic patients who had received dietary education, agreed to par ticipate, and adult age were invited. All patients with type 1, gestational, and other types of diabetes who did not join regular meetings of Prolanis and were repor ted moving or dying were excluded. The data collection used demographic and perceived dietary adherence questionnaires(PDAQs). Moreover, the height, weight, and blood glucose level were recorded. Data were analyzed using Pearson, point biserial correlation, and one-way analysis of variance(ANOVA) tests. Results: The respondents were mostly female, married, and non-smoking with a mean age of 60.2 ± 8.48 years. Mean score for dietary adherence was 29.7 ± 8.85 with scores from the specific food groups between 0.72 ± 1.89 and 4.60 ± 2.30. The lower scores of adherence were identified on low-sugar foods, high-fiber foods, fish and foods with high omega-3, and olive/organic oils in cooking. Additionally, people living with diabetes for more than 10 years and not having any comorbidity showed a higher score of dietary adherence. Conclusions: There were 4 groups of foods that had a low score of adherence. Accordingly, health care providers working in primary health care should be concerned about those 4 food groups during diabetes education and counseling. Public health workers should make more effor ts to promote consumption of the healthy diet among patients with diabetes, par ticularly those who have had diabetes for less than 10 years and other comorbidities.

Advances in intermittent fasting and neurodegeneration

Intermittent fasting is a kind of diet that extends the fasting time every day or several days per week.It mainly includes time-limited eating,alternate day fasting and periodic fasting.Intermittent fasting triggers evolutionary indications and conserved cellular responses to protect and improve body status by triggering a"metabolic switch"from hepatogenic glucose to adipocyte-derived ketone bodies.Gut microbiota and circadian rhythms have also been linked to intermittent fasting.This article focuses on the research progress of intermittent fasting and neurodegenerative diseases in order to provide a theoretical basis for nutritional treatment of neurodegenerative diseases.

Gestational diabetes from A to Z

Gestational diabetes mellitus(GDM) is defined as any degree of hyperglycaemia that is recognized for the first time during pregnancy. This definition includes cases of undiagnosed type 2 diabetes mellitus(T2 DM) identified early in pregnancy and true GDM which develops later. GDM constitutes a greater impact on diabetes epidemic as it carries a major risk of developing T2 DM to the mother and foetus later in life. In addition, GDM has also been linked with cardiometabolic risk factors such as lipid abnormalities, hypertensive disorders and hyperinsulinemia. These might result in later development of cardiovascular disease and metabolic syndrome. The understanding of the different risk factors, the pathophysiological mechanisms and the genetic factors of GDM, will help us to identify the women at risk, to develop effective preventive measures and to provide adequate management of the disease. Clinical trials have shown that T2 DM can be prevented in women with prior GDM, by intensive lifestyle modification and by using pioglitazone and metformin. However, a matter of controversy surrounding both screening and management of GDM continues to emerge, despite several recent welldesigned clinical trials tackling these issues. The aim of this manuscript is to critically review GDM in a detailed and comprehensive manner, in order to provide a scientific analysis and updated write-up of different related aspects.

Participant attrition and perinatal outcomes in prenatal vitamin Dsupplemented gestational diabetes mellitus patients in Asia: A metaanalysis

BACKGROUND The role of vitamin D supplementation in gestational diabetes mellitus(GDM)patients is unclear.AIM To determine the burden and risk of post-randomization GDM patient attrition from vitamin D-supplemented arms of randomized controlled trials(RCTs).The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.METHODS RCTs were searched in the PubMed,Embase,and Scopus databases.Randomeffect prevalence and pairwise meta-analysis were performed for the primary objective.The auxiliary aim was to compare the effects of nutritional supplements on their fasting blood glucose(FPG)levels and perinatal outcomes.Fixed-effect network meta-analyses were undertaken for the secondary goals.All analyses were performed using Stata software,and statistical significance was determined at P<0.05.RESULTS Thirteen RCTs from Iran and China were reviewed.The participant attrition burden in vitamin D recipients was 6%[95%confidence interval(CI):0.03,0.10],and its risk did not vary from non-recipients.Vitamin D and calcium co-supplementation reduced the cesarean section incidence in GDM patients[risk ratio(RR):0.37;95%CI:0.18,0.74].The hyperbilirubinemia or hospitalization risk in their newborns decreased with vitamin D supplementation(RR:0.47;95%CI:0.27,0.83)and co-supplementation with calcium(RR:0.35;95%CI:0.16,0.77)or omega3 fatty acids(RR:0.25;95%CI:0.08,0.77).Vitamin D and probiotics co-supplementation decreased newborn hyperbilirubinemia risk(RR:0.28;95%CI:0.09,0.91).FPG levels and macrosomia risk did not vary across interventions.CONCLUSION In RCTs,vitamin D supplementation or co-supplementation in GDM patients showed a low participant attrition burden and low risk of cesarean section,newborn hyperbilirubinemia,and newborn hospitalization.

Effects of Radiation on Protein

Radiotherapy is one of the most common treatments used for solid tumors.Proteins are important components of all cells and tissues,and the main material basis of life.In the present research,more attention has been paid to the relationship between tumor radiotherapy and glycolipid metabolism,but less attention has been paid to the post-radiation effect of proteins.This article discusses the direct and indirect effects of radiation on proteins.The direct effects include changes in the structure and function of proteins,as well as to their synthesis and degradation,with the most specific effects observed on the post-translational modification of proteins.Indirect effects include changes in the whole-body nutrition level of patients,including the process of protein intake,digestion,absorption and metabolism.This article also addresses the impact of advanced radiotherapy technology,such as proton therapy and heavy ion therapy on proteins,and emphasizes the importance and feasibility of protein-supplying nutritional treatment during the“peri-radiotherapy period”.

Diets for Patients with Amyotrophic Lateral Sclerosis： Pay Attention to Nutritional Intervention

INTRODUCTIONAmyotrophic lateral sclerosis （ALS） is characterized by the progressive degeneration of upper and lower motor neurons. Typical clinical features orALS are limb paralysis, muscle atrophy, dysphagia, dysarthria, shortness of breath＋ and respiratory failure.