1.
Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial.
Azevedo, JRA, Lima, HCM, Montenegro, WS, Souza, SCC, Nogueira, IROM, Silva, MM, Muniz, NA
Revista Brasileira de terapia intensiva. 2019;(2):171-179
Abstract
OBJECTIVE To evaluate differences in outcomes for an optimized calorie and high protein nutrition therapy versus standard nutrition care in critically ill adult patients. METHODS We randomized patients expected to stay in the intensive care unit for at least 3 days. In the optimized calorie and high protein nutrition group, caloric intake was determined by indirect calorimetry, and protein intake was established at 2.0 to 2.2g/kg/day. The control group received 25kcal/kg/day of calories and 1.4 to 1.5g/kg/day protein. The primary outcome was the physical component summary score obtained at 3 and 6 months. Secondary outcomes included handgrip strength at intensive care unit discharge, duration of mechanical ventilation and hospital mortality. RESULTS In total, 120 patients were included in the analysis. There was no significant difference between the two groups in calories received. However, the amount of protein received by the optimized calorie and high protein nutrition group was significantly higher compared with the control group. The physical component summary score at 3 and 6 months did not differ between the two groups nor did secondary outcomes. However, after adjusting for covariates, a negative delta protein (protein received minus predetermined protein requirement) was associated with a lower physical component summary score at 3 and 6 months postrandomization. CONCLUSION In this study optimized calorie and high protein strategy did not appear to improve physical quality of life compared with standard nutrition care. However, after adjusting for covariates, a negative delta protein was associated with a lower physical component summary score at 3 and 6 months postrandomization. This association exists independently of the method of calculation of protein target.
2.
The Efficacy of an Oral Elemental Diet in Patients Undergoing Hematopoietic Stem Cell Transplantation.
Morishita, T, Tsushita, N, Imai, K, Sakai, T, Miyao, K, Sakemura, R, Kato, T, Niimi, K, Ono, Y, Sawa, M
Internal medicine (Tokyo, Japan). 2016;(24):3561-3569
Abstract
Objective Conditioning regimens for hematopoietic stem cell transplantation (HSCT) are well known to cause severe gastrointestinal toxicities that often disturb the oral intake of the patients followed by poor nutrition and life-threatening infection. An oral elemental diet (ED) is an easily consumed and assimilated form of liquid nutrients mainly composed of amino acids. It alleviates the digestive loading from the intestine and is mainly used for enteral nutritional support in patients with Crohn's disease. We herein report, for the first time, the efficacy of ED for patients undergoing HSCT. Methods We evaluated the efficacy of ED in a prospective cohort study. The primary endpoint for this study was the hospitalization period. The secondary endpoint was the occurrence of oral mucositis, nausea, diarrhea and fever. Patients A total of 73 patients were consecutively enrolled between March 2011 and March 2013. Twenty-three patients underwent autologous HSCT and 50 patients underwent allogeneic HSCT. The first 21 patients did not receive ED (non-ED group; NEG) while in the successive 52 patients (ED group; EG), oral ED was started before conditioning and was continued until 28 days after transplantation. Results The patient characteristics were similar between the two groups. The mean duration of ED administration for EG was 28.7 days (range, 3-37 days), and the mean total-dose of ED administration was 1904 g (range, 240-2,960 g). The median hospitalization period was significantly shorter in EG compared to NEG, (34 days vs. 50 days; p=0.007). Grade 3-4 oral mucositis occurred less in EG than NEG (25% vs. 48%; p=0.06). Conclusion Oral ED may promote an early mucosal recovery and thereby shorten the duration of hospitalization.
3.
[Value of nutritional support in patients with pharingocutaneous fistula].
Trinidad Ruiz, G, Luengo Pérez, LM, Marcos García, M, Pardo Romero, G, González Palomino, A, Pino Rivero, V, Blasco Huelva, A
Acta otorrinolaringologica espanola. 2005;(1):25-30
Abstract
INTRODUCTION A prospective and statistic study is presented to evaluate the efficacy of nutritional support in the postoperative care of patients with pharyngocutaneous fistula after laryngectomy. PATIENTS AND METHODS All patients who developed pharyngocutaneous fistula after total o partial laryngectomy between 2001 and 2004 were included and assigned to the study group if a supplementary and enteral nutrition was started through the nasogastric tube, and to the control group if a conventional liquid diet was given. Nutrition of patients in the study group was controlled by an Endocrinologist. RESULTS 32 patients were included (14 in the study group and 18 in the control group). Both groups were similar for all variables measured except for the length of hospital stay (mean difference 31.02 days) and the need for surgical closure (33% in the control group and 0% in the study group). These differences were found statistically significant. DISCUSSION AND CONCLUSIONS Postoperative supplementary enteral nutrition controlled by the Endocrinologist reduced the need for surgical treatment of pharyngocutaneous fistula and shortened the stay in hospital of these patients. More studies are needed to prove the efficacy of preoperative nutrition in reducing the incidence of fistula after laryngectomy.
4.
Randomized controlled trial of nutritional supplementation in patients with newly diagnosed tuberculosis and wasting.
Paton, NI, Chua, YK, Earnest, A, Chee, CB
The American journal of clinical nutrition. 2004;(2):460-5
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Abstract
BACKGROUND Nutritional support is often recommended as part of the treatment of tuberculosis, but it has never been properly tested. OBJECTIVE We assessed the effects of early nutritional intervention on lean mass and physical function in patients with tuberculosis and wasting. DESIGN Patients who started antituberculous therapy within the previous 2 wk were randomly assigned to receive standard nutritional counseling (control group) or nutritional counseling to increase their intake through diet and high-energy supplements (nutritional supplement group) for 6 wk. Body composition was measured by dual-energy X-ray absorptiometry, and physical function was assessed by maximum grip strength. RESULTS Patients in the nutritional supplement group (n = 19) had a significantly greater increase in body weight (2.57 +/- 1.78 compared with 0.84 +/- 0.89 kg, P = 0.001), total lean mass (1.17 +/- 0.93 compared with 0.04 +/- 1.26 kg, P = 0.006), and grip strength (2.79 +/- 3.11 compared with -0.65 +/- 4.48 kg, P = 0.016) than did the control subjects (n = 17) at week 6. During subsequent follow-up, the increase in body weight remained greater in the nutritional supplement group, but this increase was due mainly to a greater gain in fat mass in the nutritional supplement group than in the control group. CONCLUSIONS Early intervention to increase nutritional intake increases lean mass and physical function. This adjunct to tuberculosis therapy could confer socioeconomic and survival benefits that deserve investigation in large-scale trials. Nutritional intervention after the initial phase of treatment could be less beneficial because it mainly increases fat.