-
1.
Effect of initiating enteral protein feeding on whole-body protein turnover in critically ill patients.
Liebau, F, Wernerman, J, van Loon, LJ, Rooyackers, O
The American journal of clinical nutrition. 2015;(3):549-57
-
-
Free full text
-
Abstract
BACKGROUND Critically ill patients are susceptible to protein catabolism. Enteral feeding may ameliorate protein loss, but its effect is not well characterized in terms of protein kinetics. OBJECTIVE We established a method of quantifying the effect of enteral protein feeding on whole-body protein turnover and studied critically ill patients receiving early enteral nutrition. DESIGN In a proof-of-concept study, we established, in healthy subjects (n = 6), a method of measuring the effect of continuous enteral protein feeding on whole-body protein turnover by using ¹³C-phenylalanine (¹³C-Phe) intrinsically labeled casein by a nasogastric feeding tube and an intravenous ²H₅-Phe tracer. The protocol was applied to study critically ill patients (n = 10) during the initial hypocaloric-hyponitrogenous dose of enteral nutrition. RESULTS Patients were catabolic with a negative protein balance. The median splanchnic extraction fraction of hourly dietary Phe intake was 92% (range: 86-99%); that is, the availability of dietary Phe in arterial plasma was low. In patients with a stable parenteral amino acid supply (n = 7), the median net protein balance improved during enteral feeding from -8.6 to -5.8 μmol · kg body weight⁻¹ · h⁻¹ (P = 0.018). CONCLUSIONS Whole-body protein turnover and the contribution of dietary protein can be quantified in critically ill patients by using intravenous and enteral stable-isotope Phe tracers. The whole-body protein balance improved during early hypocaloric-hyponitrogenous enteral protein feeding in these patients.
-
2.
[Development and evaluation of an enteral nutrition protocol for dysphagia in patients with acute stroke].
Yoo, SH, Kim, SS
Journal of Korean Academy of Nursing. 2014;(3):280-93
Abstract
PURPOSE The study was done to develop an evidence-based enteral nutrition (EN) protocol for effective nutritional support for dysphagia in patients with acute stroke, and to evaluate effects of this protocol on clinical outcomes. METHODS A methodological study was used to develop the EN protocol and a quasi-experimental study to verify the effectiveness of the protocol. The preliminary EN protocol was drawn by selecting recommendations from previous well-designed EN guidelines, and then developing additional recommendations based on high-quality evidence. Content validation was assessed by an expert group, and clinical applicability by care providers and patients. The scale-level content validity index of the final EN protocol was 0.99. Assessment was done of differences in percentage of caloric goals achieved and presence of undernutrition, aspiration pneumonia, and gastrointestinal (GI) complications after application of the EN protocol. RESULTS In the EN protocol group, the percentage of caloric goals achieved (R(2)=.24, p=.001) and the reduction of GI complications (p=.045) were significantly improved, but the presence of undernutrition (p=.296) and aspiration pneumonia (p=.601) did not differ from the usual care group. CONCLUSION Results indicate that the new EN protocol for dysphagia in patients with acute stroke significantly increased their nutritional intake and reduced GI complications.
-
3.
Nutrient infusion bypassing duodenum-jejunum improves insulin sensitivity in glucose-tolerant and diabetic obese subjects.
Salinari, S, Carr, RD, Guidone, C, Bertuzzi, A, Cercone, S, Riccioni, ME, Manto, A, Ghirlanda, G, Mingrone, G
American journal of physiology. Endocrinology and metabolism. 2013;(1):E59-66
Abstract
The mechanisms of type 2 diabetes remission after bariatric surgery is still not fully elucidated. In the present study, we tried to simulate the Roux-en-Y gastric bypass with a canonical or longer biliary limb by infusing a liquid formula diet into different intestinal sections. Nutrients (Nutrison Energy) were infused into mid- or proximal jejunum and duodenum during three successive days in 10 diabetic and 10 normal glucose-tolerant subjects. Plasma glucose, insulin, C-peptide, glucagon, incretins, and nonesterified fatty acids (NEFA) were measured before and up to 360 min following. Glucose rate of appearance (Ra) and insulin sensitivity (SI), secretion rate (ISR), and clearance were assessed by mathematical models. SI increased when nutrients were delivered in mid-jejunum vs. duodenum (SI × 10⁴ min⁻¹·pM⁻¹: 1.11 ± 0.44 vs. 0.62 ± 0.22, P < 0.015, in controls and 0.79 ± 0.34 vs. 0.40 ± 0.20, P < 0.05, in diabetic subjects), whereas glucose Ra was not affected. In controls, Sensitivity of NEFA production was doubled in mid-jejunum vs. duodenum (2.80 ± 1.36 vs. 1.13 ± 0.78 × 10⁶, P < 0.005) and insulin clearance increased in mid-jejunum vs. duodenum (2.05 ± 1.05 vs. 1.09 ± 0.38 l/min, P < 0.03). Bypass of duodenum and proximal jejunum by nutrients enhances insulin sensitivity, inhibits lipolysis, and increases insulin clearance. These results may further our knowledge of the effects of bariatric surgery on both insulin resistance and diabetes.
-
4.
[Comparison of two types of enteral nutrition in patients with intestinal fistula].
Wang, Y, Kang, Y, Zhou, JR
Zhonghua yi xue za zhi. 2013;(30):2364-6
Abstract
OBJECTIVE To evaluate the impact between home versus hospital enteral nutrition in patients with intestinal fistula. METHODS A clinical trial containing 82 patients of intestinal fistula with enteral nutrition was conducted. All cases were divided into 3 groups: home enteral nutrition (n = 42), hospital enteral nutrition (n = 40) and normal control for assessment of quality of life (n = 40). The incidence of complications, hospitalization duration, days of enteral nutrition and medical costs were compared between two enteral nutrition ways. Quality of life was assessed with SF-36 questionnaire at the same time. RESULTS Compared with the hospital enteral nutrition group, the home enteral nutrition group had a shorter hospital stay. The costs of treatment showed a significant decrease and the quality of life significantly improved. No significant difference existed between two types in the length of enteral nutrition and the incidence of complications. CONCLUSION Home enteral nutrition is safe, rational and effective for patients with intestinal fistula.
-
5.
[Aspiration pneumonia after spinal cord injury. Placement of PEG tubes as effective prevention].
Ramczykowski, T, Grüning, S, Gurr, A, Muhr, G, Horch, C, Meindl, R, Swol, J
Der Unfallchirurg. 2012;(5):427-32
Abstract
BACKGROUND Pulmonary infections are dreaded complications in acute spinal cord injuries. The prevention of pneumonia is essential for reducing mortality and the period of hospitalization. Swallowing disorders occur frequently in patients with cervical cord injuries and are accompanied by aspiration with a high risk of pneumonia. PATIENTS AND METHODS In this study the identification and analysis of patients with newly acquired cervical cord injuries were carried out with respect to respiratory complications, treatment and prevention. RESULTS A total of 27 patients with a cervical cord injury (tetraplegia) were identified. Of these 20 patients (74%) were identified with a swallowing disorder and a high risk of aspiration. Of these patients 11 (PEG group) received a percutaneous feeding tube (PEG tube), 9 patients (non-PEG group) with diagnosed dysphagia were treated without PEG tube. A total of 6 patients in the non-PEG group (67%) acquired pneumonia compared to 3 patients (27%) in the PEG group. CONCLUSION A swallowing disorder is a major risk factor for a pulmonary infection after a cervical cord injury. An early placement of a PEG tube has a preventive effect with respect to aspiration pneumonia in patients with dysphagia.
-
6.
[Dysphagia treatment in a clinical-geriatric setting PEG and functional therapy of dysphagia].
Schulz, RJ, Nieczaj, R, Moll, A, Azzaro, M, Egge, K, Becker, R
Zeitschrift fur Gerontologie und Geriatrie. 2009;(4):328-35
Abstract
OBJECTIVES Patients with dysphagia whose food intake is inadequate and who may compromise their airways need to receive nasogastric (NG) or gastrostomic (PEG) feeding. There are controversial discussions about the best time for intervention and the best method. Each approach has its advantages and disadvantages. Further research is required to assess the optimum method of treating patients with dysphagia. A retrospective study was undertaken to investigate the influence of functional dysphagia therapy with or without PEG feeding. METHODS A total of 164 patients with dysphagia were investigated in a center for geriatric medicine (EGZB) within one year. Patients were divided into two groups: those with PEG (group 1, n=59) and those without (group 2, n=105). Both groups received functional training (training of oral motor skills and sensation, compensatory swallowing techniques) by speech-language therapists.Geriatric basic assessment was used. Speech-language therapists also evaluated language, speech and swallowing disorders pre- and post-training. Diet modification for oral intake altering viscosity and texture of foods and liquids was used. Additional data on the time between being admitted to hospital and receiving a PEG tube, the hospitalization period, the number of complications and mortality were collected. RESULTS Both groups benefited from functional dysphagia therapy. The patients of group 2 showed a significant improvement in functional oral intake post-treatment. In most of the cases, diet modification improved from pasty consistency to firm meals. Swallowing abilities were much better than those of the more severely disabled patients of group 1. Group 1 still needed PEG feeding post-treatment but could also take in some food orally. However even the patients of group 1 showed a significant increase in functional oral intake.Group 2 also showed significantly stronger improvements in communication abilities and speech intelligibility after training compared to the severely disabled patients of group 1.In terms of the clinical outcome of group 1 it was demonstrated that the sooner a PEG was placed, the more significantly functional oral intake improved. The results of a multiple regression analysis showed a small but nevertheless significant association between an early supply of PEG and improvement of functional oral intake which had been achieved by functional dysphagia therapy.Significantly more complications and significantly higher mortality occurred in group 1 (PEG feeding) compared to group 2 (exclusively oral feeding). CONCLUSION The treatment of dysphagia in the elderly requires a multi-professional setting, differentiated assessment and functional training of oral motor skills and sensation and swallowing techniques. Compared to patients with severe dysphagia, however, patients with mild to moderate dysphagia benefit most from functional training. The results reveal the importance of precise and early diagnosis of swallowing disorders in order to introduce PEG supply early in cases of persistent dysphagia.
-
7.
The addition of fiber and the use of continuous infusion decrease the incidence of diarrhea in elderly tube-fed patients in medical wards of a general regional hospital: a controlled clinical trial.
Shimoni, Z, Averbuch, Y, Shir, E, Gottshalk, T, Kfir, D, Niven, M, Moshkowitz, M, Froom, P
Journal of clinical gastroenterology. 2007;(10):901-5
Abstract
GOALS To determine if feeds high in fiber continuously administered might minimize diarrhea. BACKGROUND The addition of soluble fiber to enteral feedings has not consistently decreased diarrhea in controlled clinical trials, and the effect of the use of intermittent or continuous infusions on the rate of diarrhea is similarly controversial. STUDY We studied 148 of 160 selected elderly well-nourished patients with acute disease prohibiting oral intake in a controlled clinical trial in the setting of an internal medicine departments in a regional hospital who were divided into 4 groups and fed according to combinations of intermittent or continuous systems, with fiber-free or fiber rich formulas. The 5-day rate of diarrhea was defined as 2 liquid stools or 3 or more semisolid or liquid bowel movements during a 24-hour period. Other outcome variables included mortality, hospital days, prolonged hospitalization (over 20 d), fever, and stools positive for Clostridium difficile cytotoxin A/B. RESULTS The increased relative risk of the continuous/fiber-free, intermittent/fiber, and intermittent/fiber-free groups compared with the continuous/fiber group was 2.8 [95% confidence interval (CI)=1.0-8.1], 2.5 (95% CI=0.9-7.1), and 5.0 (95% CI=1.9-13.2), respectively. These findings were independent of age (>80 y), female sex, being treated with antibiotics for respiratory or urinary infections, receiving respiratory support, or being fully conscious. There were no significant differences in the other outcomes. CONCLUSIONS We conclude that in elderly well-nourished hospitalized patients with acute diseases prohibiting oral intake, continuous and closed enteral feedings with the addition of fiber is effective in reducing the rate of diarrhea.
-
8.
Induction of early meconium evacuation promotes feeding tolerance in very low birth weight infants.
Shim, SY, Kim, HS, Kim, DH, Kim, EK, Son, DW, Kim, BI, Choi, JH
Neonatology. 2007;(1):67-72
Abstract
BACKGROUND A delay in reaching full enteral feeding is linked to poorer outcome in preterm neonates. Meconium retention has been viewed as a cause of bowel dysfunction in very low birth weight infants (VLBWI). Thus, adequate evacuation of meconium could help to promote feeding tolerance. OBJECTIVES Our goal was to determine the effect of the induction of early meconium evacuation on feeding tolerance in VLBWI. METHODS An observational study involving two subsequent periods was performed in inborn infants with birth weights of <1,500 g, before (control) and after (study) the induction of early meconium evacuation by routine glycerin enema. The total duration of these periods was from January 2003 to December 2005. To evaluate feeding tolerance, we measured time to achieve full enteral feeding. Complications such as sepsis and necrotizing enterocolitis were compared. RESULTS The study group achieved full enteral feeding significantly faster than the control group (hazard ratio (HR) = 2.9; 95% confidence interval (CI) = 1.8-4.8), and this effect was more definite in infants with a birth weight of <1,000 g (HR = 4.6; 95% CI = 1.9-11.1). The study group passed first meconium faster than the control group (median = 1.4 vs. 3.7 days; p < 0.001). Sepsis, especially as determined by positive culture in central venouscatheter, was significantly reduced in the study group (7.7 vs. 27.8%; p = 0.02). CONCLUSIONS The induction of early meconium evacuation had a significantly positive effect on feeding tolerance and sepsis prevention in VLBWI.
-
9.
Use of percutaneous endoscopic gastrostomy feeding tubes and functional recovery in stroke rehabilitation: a case-matched controlled study.
Iizuka, M, Reding, M
Archives of physical medicine and rehabilitation. 2005;(5):1049-52
Abstract
OBJECTIVE To compare the morbidity, mortality, and functional recovery of patients who require percutaneous endoscopic gastrostomy (PEG) placement for the management of dysphagia after stroke. DESIGN Retrospective case-matched controlled study. SETTING Acute stroke rehabilitation inpatient unit. PARTICIPANTS Patients (N=193) who were admitted for stroke rehabilitation with a PEG tube in place from January 1, 1993, to December 31, 2002, were matched with 193 case controls without PEG. Patients and controls were within 90 days of stroke onset, and were matched for age, sex, type of stroke, FIM instrument score, duration from onset to stroke unit admission, and year of admission. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Length of rehabilitation hospital stay, improvement in FIM scores, FIM efficiency score, need for transfer back to acute care hospital, diagnosis for which transfer was required, final discharge destination, and survival status. RESULTS Significant differences were found between the 2 groups, PEG versus control, respectively, in the following variables: FIM efficiency (.42+/-.57 vs .56+/-.55, P =.016); need for transfer back to acute hospital (58/193 vs 23/193, P =.001); and survival status dead/alive (14/179 vs 3/190, P =.006). Nonsignificant differences were as follows: length of rehabilitation hospital stay (46.9+/-24.8d vs 43.3+/-19.7d, P =.11), improvement in total FIM score from admission to discharge (16.9+/-17.9 vs 21.0+/-15.5, P =.72), and final discharge destination home/institutional care (96/83 vs 101/89, P =.93). Pneumonia was the most frequent reason for transfer to acute care for patients with PEG. CONCLUSIONS Patients who meet criteria for admission to a stroke rehabilitation unit and who have a PEG in place are at increased risk for medical complications and death. Those who survive, however, show similar functional recovery and rate of home discharge as case-matched controls.
-
10.
The effect of megestrol acetate on oral food and fluid intake in nursing home residents: a pilot study.
Simmons, SF, Walker, KA, Osterweil, D
Journal of the American Medical Directors Association. 2005;(3 Suppl):S5-11
Abstract
OBJECTIVES The objective of this study was to evaluate the effect of megestrol acetate (Megace OS; Bristol-Myers Squibb, Princeton, NJ) on the oral food and fluid intake of nursing home (NH) residents under two conditions: usual NH care and optimal mealtime feeding assistance. DESIGN AND SETTING We conducted a prospective, preliminary trial in four NHs. PARTICIPANTS Participants (n = 17) were recruited from a larger study designed to assess nutritional care quality. Eligibility for the Megace OS trial required participants to consistently eat less than 75% of most meals under both usual NH care and optimal feeding assistance conditions at baseline. INTERVENTION Megace OS, an oral liquid suspension of megestrol acetate, was given daily in a 400-mg dose for 63 days. MEASUREMENTS Each participant's oral food and fluid intake was monitored weekly for 1 day (three meals) during which research staff conducted direct observations of usual NH care (weeks 1, 3, and 5 and day 63) or provided optimal feeding assistance (weeks 2, 4, and 6). Average total percent intake was compared from baseline across the assessment weeks of the trial under the two mealtime care conditions. RESULTS Megace OS had a significant effect on oral food and fluid intake only under the optimal mealtime feeding assistance condition, in which average total percent eaten increased from 50% (+/-15%) at baseline to 63% (+/-14%) post-63 days of the trial. There was no change in participants' oral food and fluid intake under the usual NH care condition (average total percent intake at baseline 43% +/- 12% vs. 43% +/- 20% post-63 days). CONCLUSION The results of this preliminary study suggest that Megace OS is not an effective nutritional intervention to increase oral intake under usual NH care conditions, which is often characterized by inadequate feeding assistance. However, Megace OS in combination with optimal mealtime feeding assistance does significantly increase oral intake in a frail NH sample at high risk for weight loss.