Clinical nutrition : official journal of the European Society of Parenteral and Enteral Nutrition
-
Randomized Controlled Trial Clinical Trial
Effect of early postoperative enteral immunonutrition on wound healing in patients undergoing surgery for gastric cancer.
One of the most frequent complications in patients with cancer and malnutrition is the surgical wound healing delay or failure. Some studies have shown that arginine improves wound healing in rodents and in healthy human beings. The main objective of this study was to assess the effect of early postoperative enteral immunonutrition on the wound healing process in patients undergoing surgery for gastric cancer. ⋯ Early postoperative enteral nutrition with a formula supplemented with arginine, omega 3 fatty acids and RNA increased hydroxyproline synthesis and improved surgical wound healing in patients undergoing gastrectomy for gastric cancer.
-
Randomized Controlled Trial Clinical Trial
The administration of an oral carbohydrate-containing fluid prior to major elective upper-gastrointestinal surgery preserves skeletal muscle mass postoperatively--a randomised clinical trial.
Recent evidence suggests that the provision of energy-containing fluids is safe and may impact positively on markers of recovery. The aims of this study were to assess the tolerance of preoperative carbohydrate fluid administration and to determine its effect on postoperative metabolic and clinical responses. ⋯ Preoperative consumption of carbohydrate-containing fluids is safe. Provision of a carbohydrate energy source prior to surgery may attenuate depletion of muscle mass after surgery. Further studies are required to determine if this preservation of muscle mass is reflected in improved function and reduced rehabilitation time.
-
Review
Hyperlactataemia and lactic acidosis in HIV-infected patients receiving antiretroviral therapy.
Nucleoside reverse-transcriptase inhibitors (NRTIs) have been associated with functional and structural mitochondrial abnormalities, leading to several adverse events, such as increased serum lactic acid levels and lactic acidosis. Mild-to-moderate, asymptomatic hyperlactataemia has been frequently reported in human immunodeficiency virus (HIV)-infected patients treated with NRTIs, with an estimated prevalence between 15% and 35%. ⋯ The clinical presentation of lactic acid syndrome is non-specific and includes asthenia, malaise, nausea, vomiting, abdominal pain, weight loss, tachypnoea, dyspnoea, liver steatosis and increased transaminase levels, and risk factors include previous or concurrent therapy with stavudine or didanosine. Management of symptomatic lactic acid alterations involves NRTI-therapy interruption and supportive care, while natural history of hyperlactataemia is still unknown, and it is uncertain whether asymptomatic patients with increased lactate concentrations are at increased risk of developing lactic acidosis.
-
Reduced lean tissue as well as high fat mass may be independent nutritional risk factors resulting in increased length of hospital stay (LOS). This controlled population study (1707 patients, 1707 volunteers) aimed to evaluate the association between LOS in Geneva and Berlin patients at hospital admission and high fat mass index (FMI, kg/m2) and low fat-free mass index (FFMI, kg/m2), and the respective value of body mass index (BMI) and of FFMI and FMI for nutritional assessment. ⋯ Increased LOS is associated with adiposity (high FMI) and low muscle mass (low FFMI). The current study shows that both depletion of lean tissue and excess of fat mass negatively affect the LOS. Finally, we found that excess fat mass reduces the sensitivity of BMI to detect nutritional depletion.
-
The study was designed to investigate and quantify nutritional support, and particularly enteral nutrition (EN), in critically ill patients with severe hemodynamic failure. ⋯ EN is possible in the majority of patients with severe hemodynamic failure, but usually results in hypocaloric feeding. EN should be considered in patients with careful abdominal and energy monitoring.