Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Randomized Controlled Trial Comparative Study
Randomized phase III clinical trial of a combined treatment with carnitine + celecoxib ± megestrol acetate for patients with cancer-related anorexia/cachexia syndrome.
A phase III, randomized non-inferiority study was carried out to compare a two-drug combination (including nutraceuticals, i.e. antioxidants) with carnitine + celecoxib ± megestrol acetate for the treatment of cancer-related anorexia/cachexia syndrome (CACS): the primary endpoints were increase of lean body mass (LBM) and improvement of total daily physical activity. Secondary endpoint was: increase of physical performance tested by grip strength and 6-min walk test. ⋯ The results of the present study showed a non-inferiority of arm 1 (two-drug combination) vs arm 2 (two-drug combination + megestrol acetate). Therefore, this simple, feasible, effective, safe, low cost with favorable cost-benefit profile, two-drug approach could be suggested in the clinical practice to implement CACS treatment.
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Randomized Controlled Trial
Oral nutritional support in malnourished elderly decreases functional limitations with no extra costs.
Older people are vulnerable to malnutrition which leads to increased health care costs. The aim of this study was to evaluate the cost-effectiveness of nutritional supplementation from a societal perspective. ⋯ A multi-component nutritional intervention to malnourished elderly patients for three months after hospital discharge leads to significant improvement in functional limitations and is neutral in costs. A follow-up of three months is probably too short to detect changes in QALYs or physical activities.
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We aimed to test the capacity in identifying patients at nutritional risk, by comparing BMI, recent %weight loss,Nutritional Risk Screening 2002(NRS-2002),Malnutrition Universal Screening Tool(MUST) and Nutritional Risk Index(NRI) with Subjective Global Assessment(SGA),considered the Standard. The main purpose was to select the most consistent screening method for effective integration in daily surgical wards' practice. ⋯ In surgical patients, MUST + NRS-2002 are valid for nutritional screening; recent weight loss ≥ 5% also proved highly efficient; its easy/quick calculation may facilitate adherence/integration by health professionals as a minimum obligatory in clinical practice.
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Large surveys auditing feeding regimen in the ICU consistently reported hypocaloric 23 enteral feedings patterns and many studies described the association between 24 energy deficit and increased complication rate. ESPEN and ASPEN experts 25 recommend early (after 48 h) or late (after 7-10 days) catch up of the 26 energy deficit with parenteral nutrition (PN) respectively, but the level of evidence 27 was poor and larger PRCT were missing. ⋯ However, weaknesses 30 in the study design and some mixing of the 3 questions have created confusion in the 31 message delivered. In addition, the severity of the acute illness was not always similar 32 in these studies, mixing short-term acutely ill patients (less than 4 days in the ICU) 33 with long term patients (more than 10 days in the ICU).