- Comparison of the effect of three different protein content enteral diets on serum levels of proteins, nitrogen balance, and energy expenditure in critically ill infants: study protocol for a randomized controlled trial. [Journal Article]Trials 2019; 20(1):585T
- CONCLUSIONS: This RCT will provide new data about the amount of protein needed to improve levels of serum protein and nitrogen balance, a surrogate of protein balance, in critically ill infants receiving enteral nutrition.
- Nutritional Status of Adolescent Girls Belonging to the Tea Garden Estates of Sivasagar District, Assam, India. [Journal Article]Indian J Community Med 2019 Jul-Sep; 44(3):238-242IJ
- CONCLUSIONS: Thinness and stunting along with protein-energy malnutrition and inadequate intake of important food groups were prevalent in adolescent tea community girls. Overall, the public health burden of malnutrition is still a persisting health problem in the tea gardens of Assam.
- Prevalence of Malnutrition among Elderly People in Iran: A protocol for a Systematic Review. [Journal Article]JMIR Res Protoc 2019JR
- CONCLUSIONS: It is targeted to provide comprehensive evidence about the prevalence of malnutrition among elderly people in Iran by doing this review. It can help the Iranian health managers and policymakers to make informed decisions for preventing the malnutrition and promoting the health status of elderly people.
- Screening Community-Living Older Adults for Protein Energy Malnutrition and Frailty: Update and Next Steps. [Review]J Community Health 2019JC
- Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven scre…
Protein-energy malnutrition (PEM)/undernutrition and frailty are prevalent, overlapping conditions impacting on functional and health outcomes of older adults, but are frequently unidentified and untreated in community settings in the United States. Using the World Health Organization criteria for effective screening programs, we reviewed validity, reliability, and feasibility of data-driven screening tools for identifying PEM and frailty risk among community-dwelling older adults. The SCREEN II is recommended for PEM screening and the FRAIL scale is recommended as the most promising frailty screening tool, based on test characteristics, cost, and ease of use, but more research on both tools is needed, particularly on predictive validity of favorable outcomes after nutritional/physical activity interventions. The Malnutrition Screening Tool (MST) has been recommended by one expert group as a screening tool for all adults, regardless of age/care setting. However, it has not been tested in US community settings, likely yields large numbers of false positives (particularly in community settings), and its predictive validity of favorable outcomes after nutritional interventions is unknown. Community subgroups at highest priority for screening are those at increased risk due to prior illness, certain demographics and/or domiciliary characteristics, and those with BMI < 20 kg/m2 or < 22 if > 70 years or recent unintentional weight loss > 10% (who are likely already malnourished). Community-based health professionals can better support healthy aging by increasing their awareness/use of PEM and frailty screening tools, prioritizing high-risk populations for systematic screening, following screening with more definitive diagnoses and appropriate interventions, and re-evaluating and revising screening protocols and measures as more data become available.
- The future of cystic fibrosis care: a global perspective. [Review]Lancet Respir Med 2019LR
- The past six decades have seen remarkable improvements in health outcomes for people with cystic fibrosis, which was once a fatal disease of infants and young children. However, although life expectancy for people with cystic fibrosis has increased substantially, the disease continues to limit survival and quality of life, and results in a large burden of care for people with cystic fibrosis and …
The past six decades have seen remarkable improvements in health outcomes for people with cystic fibrosis, which was once a fatal disease of infants and young children. However, although life expectancy for people with cystic fibrosis has increased substantially, the disease continues to limit survival and quality of life, and results in a large burden of care for people with cystic fibrosis and their families. Furthermore, epidemiological studies in the past two decades have shown that cystic fibrosis occurs and is more frequent than was previously thought in populations of non-European descent, and the disease is now recognised in many regions of the world. The Lancet Respiratory Medicine Commission on the future of cystic fibrosis care was established at a time of great change in the clinical care of people with the disease, with a growing population of adult patients, widespread genetic testing supporting the diagnosis of cystic fibrosis, and the development of therapies targeting defects in the cystic fibrosis transmembrane conductance regulator (CFTR), which are likely to affect the natural trajectory of the disease. The aim of the Commission was to bring to the attention of patients, health-care professionals, researchers, funders, service providers, and policy makers the various challenges associated with the changing landscape of cystic fibrosis care and the opportunities available for progress, providing a blueprint for the future of cystic fibrosis care. The discovery of the CFTR gene in the late 1980s triggered a surge of basic research that enhanced understanding of the pathophysiology and the genotype-phenotype relationships of this clinically variable disease. Until recently, available treatments could only control symptoms and restrict the complications of cystic fibrosis, but advances in CFTR modulator therapies to address the basic defect of cystic fibrosis have been remarkable and the field is evolving rapidly. However, CFTR modulators approved for use to date are highly expensive, which has prompted questions about the affordability of new treatments and served to emphasise the considerable gap in health outcomes for patients with cystic fibrosis between high-income countries, and low-income and middle-income countries (LMICs). Advances in clinical care have been multifaceted and include earlier diagnosis through the implementation of newborn screening programmes, formalised airway clearance therapy, and reduced malnutrition through the use of effective pancreatic enzyme replacement and a high-energy, high-protein diet. Centre-based care has become the norm in high-income countries, allowing patients to benefit from the skills of expert members of multidisciplinary teams. Pharmacological interventions to address respiratory manifestations now include drugs that target airway mucus and airway surface liquid hydration, and antimicrobial therapies such as antibiotic eradication treatment in early-stage infections and protocols for maintenance therapy of chronic infections. Despite the recent breakthrough with CFTR modulators for cystic fibrosis, the development of novel mucolytic, anti-inflammatory, and anti-infective therapies is likely to remain important, especially for patients with more advanced stages of lung disease. As the median age of patients with cystic fibrosis increases, with a rapid increase in the population of adults living with the disease, complications of cystic fibrosis are becoming increasingly common. Steps need to be taken to ensure that enough highly qualified professionals are present in cystic fibrosis centres to meet the needs of ageing patients, and new technologies need to be adopted to support communication between patients and health-care providers. In considering the future of cystic fibrosis care, the Commission focused on five key areas, which are discussed in this report: the changing epidemiology of cystic fibrosis (section 1); future challenges of clinical care and its delivery (section 2); the building of cystic fibrosis care globally (section 3); novel therapeutics (section 4); and patient engagement (section 5). In panel 1, we summarise key messages of the Commission. The challenges faced by all stakeholders in building and developing cystic fibrosis care globally are substantial, but many opportunities exist for improved care and health outcomes for patients in countries with established cystic fibrosis care programmes, and in LMICs where integrated multidisciplinary care is not available and resources are lacking at present. A concerted effort is needed to ensure that all patients with cystic fibrosis have access to high-quality health care in the future.
- [Personalised nutrition care or standard care?] [Journal Article]Ned Tijdschr Geneeskd 2019; 163NT
- Optimal nutrition is an important condition for optimal recovery from illness, both in and outside the hospital setting. In addition, in developed countries hospital-related malnutrition remains a major problem which can lead to complications, longer hospital stays and increased costs. The EFFORT study investigated if individualised nutritional support targeted at reaching protein and caloric goa…
Optimal nutrition is an important condition for optimal recovery from illness, both in and outside the hospital setting. In addition, in developed countries hospital-related malnutrition remains a major problem which can lead to complications, longer hospital stays and increased costs. The EFFORT study investigated if individualised nutritional support targeted at reaching protein and caloric goals, would reduce the risk of adverse outcomes. Achieving optimal nutrition is difficult due to illness-induced anorexia, inadequate education of medical doctors and little financial incentive. Guidelines focus on protein and energy, negating those illness-induced anorexia and individual patient aspects such as taste, portion size and eating habits. Although the EFFORT study showed benefit on the composite and individual endpoints, we should point out that the intervention group received standard care. Malnutrition needs multidisciplinary and transmural care including physiotherapy/exercise. As such, a more holistic approach is needed; optimal care as described by the EFFORT study should be the standard.
- Adequacy of Nutrients Intake among Jordanian Pregnant Women in Comparison to Dietary Reference Intakes. [Journal Article]Int J Environ Res Public Health 2019; 16(18)IJ
- CONCLUSIONS: While the intake of some nutrients from food alone remains below the DRIs in the diets of pregnant women, the intake of other nutrients is above the UL. Raising the awareness of pregnant women about their diet and how a supplement intake can reduce the risk of inadequate intake for many micronutrients and improve their pregnancy outcomes is of great importance.
- Food groups intake of cirrhotic patients, comparison with the nutritional status and disease stage. [Journal Article]Gastroenterol Hepatol Bed Bench 2019; 12(3):226-232GH
- CONCLUSIONS: These findings suggest that selection of healthy foods was negatively associated with severity of hepatic cirrhosis whereas unhealthy food groups had a positive relation with disease severity and malnutrition.
- Effective elements of home-delivered meal services to improve energy and protein intake: A systematic review. [Review]Nutrition 2019; 69:110537N
- Home-delivered meal services are an example of a nutritional intervention in the home setting developed to enhance dietary intake and contribute to the independence of especially older adults. There is a lack of evidence about the contribution of specific elements of any home-delivered meal service on the improved outcomes. Therefore, a systematic review was performed to evaluate which elements o…
Home-delivered meal services are an example of a nutritional intervention in the home setting developed to enhance dietary intake and contribute to the independence of especially older adults. There is a lack of evidence about the contribution of specific elements of any home-delivered meal service on the improved outcomes. Therefore, a systematic review was performed to evaluate which elements of home-delivered meal services are effective to improve energy and protein intake, nutritional status, functional outcomes and satisfaction in adults. Pubmed, Embase and Web of Science databases were searched for studies assessing energy and protein intake, nutritional or functional status, or satisfaction of these services. The quality of the studies was assessed using the Quality Criteria Checklist for Primary Research. Of 138 studies meeting the search criteria, 19 were included, none of which met the criteria to be rated as high quality. These studies show that various elements of home-delivered meal services such as Meals on Wheels providing protein-enriched bread or snacks in addition to meals or providing meals and snacks for whole days can improve outcomes such as energy and protein intake and satisfaction. A distinction can be made between services focusing on supporting homebound, essentially healthy, older adults and services aiming at the optimal, nutritional, transmural care for patients at risk for malnutrition. This review shows that various elements of these meal services can improve key outcomes. Following the rising interest and importance of these interventions, there is an urgent need to optimize such services to improve nutritional care at home regarding the increasingly limited time frame of admission in hospitals.
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- The role of adiponectin system in acute fasting-impaired mouse ovaries. [Journal Article]Reproduction 2019R
- Adiponectin is an important white adipose-derived adipokine linked to energy homeostasis and reproductive function. This study aims to reveal the expression and role of adiponectin system in ovaries under the acute malnutrition. In this study, 48 h food deprivation significantly inhibited ovarian growth by suppressing cell proliferation and inducing cell apoptosis in the ovaries of gonadotrophin-…
Adiponectin is an important white adipose-derived adipokine linked to energy homeostasis and reproductive function. This study aims to reveal the expression and role of adiponectin system in ovaries under the acute malnutrition. In this study, 48 h food deprivation significantly inhibited ovarian growth by suppressing cell proliferation and inducing cell apoptosis in the ovaries of gonadotrophin-primed immature mice. It was also accompanied by significantly decelerated basic metabolism (glucose, triacylglycerol and cholesterol), varied steroid hormones (follicle-stimulating hormone, luteinizing hormone and estradiol) and vanishment of the peri-ovarian fat. It is noteworthy that after acute fasting, the adiponectin levels in ovaries rather than in blood were significantly elevated. Immunohistochemical study demonstrated that adiponectin and its receptors (AdipoR1 and AdipoR2) primarily appeared in ovarian somatic and/or germ cells, and their protein expressions were up-regulated in the ovaries from fasted mice. Further in vitro study verified that adipoR1/2 agonist obviously inhibited follicle-stimulating hormone-induced oocyte meiotic resumption, while the antagonist significantly enhanced the percentage of oocyte maturation in the absence of follicle-stimulating hormone. Furthermore, the building up of peri-ovarian fat under physiological status in mice showed a positive correlation with both the hypertrophy of adipocytes and growth of ovaries. Taken together, these findings indicate that the up-regulation of adiponectin system disturb the normal female reproductive function under the malnutrition status, and it may be associated with the loss of peri-ovarian fat depots.