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Efficacy of alanyl glutamine in nutritional support therapy for patients with sepsis: A protocol for systematic review and meta-analysis.
Su, X, Li, Y, Zhang, Y, Han, S
Medicine. 2021;(11):e24861
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Abstract
BACKGROUND Sepsis is a systemic inflammatory response caused by infection, which is a common complication after severe infection, trauma, shock, and surgery, and is also an important factor in inducing septic shock and multiple organ dysfunction syndrome (MODS), and has become one of the important causes of death in critically ill patients. Septic patients with gastrointestinal transport function weakened, are prone to malnutrition, resulting in decreased immune function, thereby affecting the therapeutic effect. Clinical practice shows that the nutritional metabolism and immune response of patients with sepsis can be effectively improved by giving alanyl glutamine nutritional support treatment, but there is no evidence of evidence-based medicine. The study carried out in this protocol aims to evaluate the effectiveness of alanyl glutamine in nutritional support therapy for patients with sepsis. METHODS The Cochrane Library, PubMed, Embase, Web of Science, WHO International Clinical Trials Registry Platform, CNKI, CBM, VIP, and Wanfang databases were searched by computer, to retrieve all randomized controlled trials (RCTs) on nutritional support for the treatment of sepsis with alanyl glutamine from the date of database establishment to December 2020. Two researchers independently selected the study, extracted and managed the data. RevMan5.3 software was used to analyze the included literature. RESULTS This study observed the changes of serum albumin (ALB), prealbumin (PAB), hemoglobin (Hb), C-reactive protein (CRP), immunoglobulin (IgG, IgA, and IgM), APACHE II score before and after treatment to evaluate the efficacy of alanyl glutamine in nutritional support therapy for patients with sepsis. CONCLUSION This study will provide reliable evidence for the application of alanyl glutamine in nutritional support therapy for patients with sepsis. OSF REGISTRATION NUMBER DOI 10.17605/OSF.IO/VRZPJ.
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Covid 19: Diet Composition and Health.
Skrajnowska, D, Brumer, M, Kankowska, S, Matysek, M, Miazio, N, Bobrowska-Korczak, B
Nutrients. 2021;(9)
Abstract
The virus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes the disease coronavirus disease 2019 (COVID-19). The cumulative number of cases reported globally is now nearly 197 million and the number of cumulative deaths is 4.2 million (26 July to 1 August 2021). Currently we are focusing primarily on keeping a safe distance from others, washing our hands, and wearing masks, and the question of the effects of diet and diet-dependent risk factors remains outside the center of attention. Nevertheless, numerous studies indicate that diet can play an important role in the course of COVID-19. In this paper, based on select scientific reports, we discuss the structure and replication cycle of SARS-CoV-2, risk factors, dietary standards for sick patients, and the roles of the microbiome and dietary components supporting the immune system in preventing COVID-19.
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The snapshot of metabolic health in evaluating micronutrient status, the risk of infection and clinical outcome of COVID-19.
Tsoukalas, D, Sarandi, E, Georgaki, S
Clinical nutrition ESPEN. 2021;:173-187
Abstract
COVID-19 has re-established the significance of analyzing the organism through a metabolic perspective to uncover the dynamic interconnections within the biological systems. The role of micronutrient status and metabolic health emerge as pivotal in COVID-19 pathogenesis and the immune system's response. Metabolic disruption, proceeding from modifiable factors, has been proposed as a significant risk factor accounting for infection susceptibility, disease severity and risk for post-COVID complications. Metabolomics, the comprehensive study and quantification of intermediates and products of metabolism, is a rapidly evolving field and a novel tool in biomarker discovery. In this article, we propose that leveraging insulin resistance biomarkers along with biomarkers of micronutrient deficiencies, will allow for a diagnostic window and provide functional therapeutic targets. Specifically, metabolomics can be applied as: a. At-home test to assess the risk of infection and propose nutritional support, b. A screening tool for high-risk COVID-19 patients to develop serious illness during hospital admission and prioritize medical support, c(i). A tool to match nutritional support with specific nutrient requirements for mildly ill patients to reduce the risk for hospitalization, and c(ii). for critically ill patients to reduce recovery time and risk of post-COVID complications, d. At-home test to monitor metabolic health and reduce post-COVID symptomatology. Metabolic rewiring offers potential virtues towards disease prevention, dissection of high-risk patients, taking actionable therapeutic measures, as well as shielding against post-COVID syndrome.
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Gastrointestinal Manifestations of COVID-19: Impact on Nutrition Practices.
Aguila, EJT, Cua, IHY, Fontanilla, JAC, Yabut, VLM, Causing, MFP
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. 2020;(5):800-805
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Abstract
Although Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease, growing evidence shows that it can affect the digestive system and present with gastrointestinal (GI) symptoms. Various nutrition societies have recently published their guidelines in context of the pandemic, and several points emphasize the impact of these GI manifestations on nutrition therapy. In patients with COVID-19, the normal intestinal mucosa can be disrupted by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, and this could result in GI symptoms and a compromise in nutrient absorption. Optimization of oral diet is still recommended. However, given the GI effects of COVID-19, a fraction of infected patients have poor appetite and would not be able to meet their nutrition goals with oral diet alone. For this at-risk group, which includes those who are critically ill, enteral nutrition is the preferred route to promote gut integrity and immune function. In carrying this out, nutrition support practices have been revised in such ways to mitigate viral transmission and adapt to the pandemic. All measures in the GI and nutrition care of patients are clustered to limit exposure of healthcare workers. Among patients admitted to intensive care units, a significant barrier is GI intolerance, and it appears to be exacerbated by significant GI involvement specific to the SARS-CoV-2 infection. Nevertheless, several countermeasures can be used to ease side effects. At the end of the spectrum in which intolerance persists, the threshold for switching to parenteral nutrition may need to be lowered.
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Impact of oral preoperative and perioperative immunonutrition on postoperative infection and mortality in patients undergoing cancer surgery: systematic review and meta-analysis with trial sequential analysis.
Buzquurz, F, Bojesen, RD, Grube, C, Madsen, MT, Gögenur, I
BJS open. 2020;(5):764-775
Abstract
BACKGROUND Infectious complications occur in 4-22 per cent of patients undergoing surgical resection of malignant solid tumours. Improving the patient's immune system in relation to oncological surgery with immunonutrition may play an important role in reducing postoperative infections. A meta-analysis was undertaken to evaluate the potential clinical benefits of immunonutrition on postoperative infections and 30-day mortality in patients undergoing oncological surgery. METHODS PubMed, Embase and Cochrane Library databases were searched to identify eligible studies. Eligible studies had to include patients undergoing elective curative surgery for a solid malignant tumour and receiving immunonutrition orally before surgery, including patients who continued immunonutrition into the postoperative period. The main outcome was overall infectious complications; secondary outcomes were surgical-site infection (SSI) and 30-day mortality, described by relative risk (RR) with trial sequential analysis (TSA). Risk of bias was assessed according to Cochrane methodology. RESULTS Some 22 RCTs with 2159 participants were eligible for meta-analysis. Compared with the control group, immunonutrition reduced overall infectious complications (RR 0·58, 95 per cent c.i. 0·48 to 0·70; I2 = 7 per cent; TSA-adjusted 95 per cent c.i. 0·28 to 1·21) and SSI (RR 0·65, 95 per cent c.i. 0·50 to 0·85; I2 = 0 per cent; TSA-adjusted 95 per cent c.i. 0·21 to 2·04). Thirty-day mortality was not altered by immunonutrition (RR 0·69, 0·33 to 1·40; I2 = 0 per cent). CONCLUSION Immunonutrition reduced overall infectious complications, even after controlling for random error, and also reduced SSI. The quality of evidence was moderate, and mortality was not affected by immunonutrition (low quality). Oral immunonutrition merits consideration as a means of reducing overall infectious complications after cancer surgery.
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Hypermetabolism and Nutritional Support in Sepsis.
Alverdy, JC
Surgical infections. 2018;(2):163-167
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Abstract
BACKGROUND Surgical metabolism has been a founding field of investigation in surgery without which the boundaries of critical care, trauma, and surgical oncology could not have advanced. Traditionally, understanding the shifts in electrolytes, carbohydrates, fats, and amino acids that could explain the rapidly evolving proteolysis after catabolic stress and tumor growth has been a major focus of research that led to our current approach to maintaining homeostasis over the course of major surgical intervention and injury. METHOD Review of the English-language literature. RESULTS With the emerging field of inflammation and the discovery of cytokines and chemokines, surgical metabolism has taken a second seat in the surgical research arena. Yet central to all patient management after injury is an understanding of how catabolic stress erodes vital organ function and how current approaches can support metabolism through the most physiologically stressful perturbations known to man, for which there is no evolutionary precedent. Although it is well accepted that unabated proteolysis is not a sustainable physiologic state, in the era of modern medicine, precisely how to manipulate the body nutritionally to drive a recovery-directed immune response remains highly debated. This review incorporates multiple lines of inquiry in surgical metabolism, with a particular focus on sepsis. CONCLUSION The changing landscape of previous paradigms in the field is discussed. Finally, how next-generation technology might spark renewed interest in this field among surgical investigators is considered.
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The gastrointestinal immune system: Implications for the surgical patient.
Pierre, JF, Busch, RA, Kudsk, KA
Current problems in surgery. 2016;(1):11-47
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Nutrition for cystectomy with pelvic lymph nodes dissection: perioperative considerations.
Mir, MC, Izquierdo, L
Minerva urologica e nefrologica = The Italian journal of urology and nephrology. 2016;(2):150-60
Abstract
Assessment of nutritional status by an objective measure such as NRS-2002 or sarcopenia in the preoperative workup of major abdominal surgeries helps identify patients at risk for increased surgical morbidity and mortality. Preoperative and immediate postoperative nutritional supplements have demonstrated to decrease risk of complications and length of stay. Enhancing the immune system with immunonutrition has also been suggested as major player in this setting. In this review on nutritional considerations in the perioperative setting of radical cystectomy, we will describe several tools available to improve the complications rates and mortality surrounding this procedure.
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Multimodal perioperative care plus immunonutrition versus traditional care in total hip arthroplasty: a randomized pilot study.
Alito, MA, de Aguilar-Nascimento, JE
Nutrition journal. 2016;:34
Abstract
BACKGROUND Multimodal protocols of perioperative care may enhance postoperative recovery. However, limited information is available on preoperative immune and carbohydrate (CHO)-enriched drinks in patients undergoing hip arthroplasty. We aimed to investigate the effect of a multimodal protocol (ACERTO protocol) plus preoperative immune nutrition on the length of stay (LOS) and the postoperative acute phase response of patients undergoing total hip arthroplasty. METHODS Thirty-two patients (mean age, 58 years; range, 26-85 years; 16 males) were randomized to receive either the ACERTO protocol (n = 15, ACERTO Group), which consisted of 6 h preoperative fasting for solids, an oral drink (200 mL of 12.5 % maltodextrin) up to 2 h before induction of anesthesia, restricted intravenous fluids (only 1000 mL of crystalloid fluid after surgery) and preoperative immune nutrition (600 mL/day of Impact - Nestlé, Brazil) for five days prior to surgery, or traditional care (n = 17; control group), which consisted of 6-8 h preoperative fasting, intravenous hydration until the 1(st) postoperative day and no preoperative immune supplementation. The main endpoint was LOS. C-reactive protein (CRP) was the secondary endpoint and was assessed during induction of anesthesia and on postoperative day 2. RESULTS Neither deaths nor postoperative complications occurred. The median LOS was 3 (2-5) days in the ACERTO group and 6 (3-8) days in controls (P <0.01). Postoperative CRP was higher in the control group (P <0.01). CONCLUSION The ACERTO multimodal protocol of perioperative care plus preoperative immune nutrition may decrease LOS and postoperative CRP levels in total hip arthroplasty. CLINICAL TRIALS NCT02580214.
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Effect of nutritional support on clinical outcomes in perioperative malnourished patients: a meta-analysis.
Zhong, JX, Kang, K, Shu, XL
Asia Pacific journal of clinical nutrition. 2015;(3):367-78
Abstract
Malnutrition is an independent risk factor for complications, mortality, wound healing, length of hospital stay, and costs. Associations between nutritional support and surgical patients remain controversial. Databases, including Pubmed, EMBASE, Web of Science, CNKI, VIP, and the Cochrane Library, were searched to find randomized controlled trials (RCTs) that assessed the effect of nutritional support on clinical outcomes in perioperative malnourished patients. The methodological quality of each included trial was assessed. A meta-analysis was conducted with Rev Man 5.2. Fifteen RCTs, involving 3831 patients, were included in this meta-analysis. Compared with control group, results showed that nutritional support was more effective in decreasing the incidence of infectious [relative risk (RR): 0.58; 95% CI: 0.50, 0.68; p<0.01] and non-infectious complications (RR: 0.74; 95% CI: 0.63, 0.88; p<0.01), and shortening the length of hospital stay [weighted mean difference (WMD): -2.64; 95% CI: -5.13, -0.16; p<0.05]. Moreover, the incidence of infectious complications in the immune nutrition group was significantly lower than that in the standard nutrition group (RR: 0.75; 95% CI: 0.58, 0.97; p<0.05). However, changes in hospital costs (WMD: 894; 95% CI: -1140, 2928; p>0.05) and postoperative mortality (RR: 0.77; 95% CI: 0.41, 1.44; p>0.05) between the nutritional support group and control group were not significantly different. In conclusion, perioperative nutritional support was superior in improving clinical outcomes in malnourished patients, which could significantly reduce the incidence of complications and effectively shorten the length of hospital stay.