Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
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Observational Study
Adequacy of nutrition support during extracorporeal membrane oxygenation.
The use of veno-venous extracorporeal membrane oxygenation (vv-ECMO) is increasing in adults with severe respiratory failure. Observational data suggest that there are significant challenges to providing adequate nutrition support for patients on vv-ECMO. We aimed to describe firstly the nutrition support practices in a large single-centre providing vv-ECMO to adults and secondly any association with clinical outcome. ⋯ Adequate energy and protein delivery during vv-ECMO is possible but underfeeding is still common, especially in those who are more severely ill or who have more severe organ dysfunction. Patients with inadequate energy or protein delivery did not differ in ICU and 6-month survival. Prospective studies investigating optimal feeding in this patient cohort are required.
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The amount of energy required to improve clinical outcomes in critically ill adults is unknown. ⋯ The delivery of near target energy when compared to standard care in adult critically ill patients was not associated with an effect on mortality. Because the quality of the evidence across outcomes was very low there is considerable uncertainty surrounding this estimate. This has implications for clinical utility of the evidence within the included reviews.
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Physical functioning declines with advancing age and compounds malnutrition, common in elderly populations. A dual-intervention combining oral nutritional support and exercise may delay these changes. Our aims were to assess whether exercise combined with oral nutritional support (ONS) has greater improvements on physical functioning, quality of life and nutritional status than nutrition intervention alone in nutritionally vulnerable older adults. ⋯ This trial was registered at http://www.crd.york.ac.uk/PROSPERO/ as CRD42015027323.
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To determine the association of body mass index (BMI) and central adiposity measures with coronary heart disease (CHD)/stroke, and to quantify the impact of blood pressure, cholesterol and glucose as metabolic mediators on these associations. ⋯ Overweight and obesity for CHD and, obesity for stroke were associated with increased risk; the negative effect of obesity was potentially ameloriated about 70% after adjustment for mediators. However, overweight status and central adiposity highlighted significant risk that did not decrease after controlling for traditional risk factors.