Nutrition
-
A prospective trial was conducted with 14 hospitalized patients who were severely underweight with a mean weight of 40.9+/-5.1 kg and 70.7+/-7.8% of ideal body weight, to compare estimates of resting energy expenditure (REE) with measured values. The 9 women and 3 men, whose mean age was 66.5+/-13.9 y, underwent nutritional assessment and measurement of their REE by indirect calorimetry using the Sensormedics Deltatrac MBM100 indirect calorimeter. Their REE was also estimated by the Harris-Benedict formula (mean 1032+/-66 kcal/d) as well as a previously established empirical formula where REE = 25 x body weight in kg (mean 1023+/-129 kcal/d). ⋯ Our data shows that commonly employed formulae routinely underestimate the energy needs of severely underweight patients below 50 kg in body weight. The Harris-Benedict equation had limited predictive value for the individual, explaining approximately 25% of the variance in energy expenditure. Given the particular importance of matching energy intake to needs in this group of patients with limited reserves, many of whom are critically ill, we suggest an empirical equation using 30-32 kcal/kg be used to estimate the energy requirements of severely underweight patients when direct measurements are unavailable or clinically less imperative.
-
Randomized Controlled Trial Clinical Trial
Medium- and long-chain triacylglycerols in postoperative patients: structured lipids versus a physical mixture.
Forty patients, scheduled for abdominal surgery, were randomized to receive postoperatively either a structured or a physical mixture of long-chain triacylglycerols/medium-chain triacylglycerols (LCT/MCT) emulsions to assess the tolerance and the effectiveness of the structured triacylglycerol emulsion. Total parenteral nutrition started the day after surgery and covered 100% of measured energy expenditure with nitrogen (0.2 g N.kg-1.d-1) and non-protein calories: glucose (50%) and lipids (50%). Blood samples for liver function tests, albumin, transthyretin, and triacylglycerols were checked at 0800 h on the day before surgery and on day 1, day 3, and day 6 after surgery. ⋯ Nitrogen balance and 3 Me His excretion were not significantly different between groups. Structured triacylglycerol (STG) lipid emulsions are as efficacious as the physical mixture on nitrogen balance in postoperative patients. They could have some advantages: no disturbances were found to occur in liver function tests or plasma triacylglycerol levels.
-
Hepatic encephalopathy (HE) is a syndrome of global cerebral dysfunction resulting from underlying liver disease or portal-systemic shunting. HE can present as one of four syndromes, depending on the rapidity of onset of hepatic failure and the presence or absence of preexisting liver disease. The precise pathogenesis is unknown but likely involves impaired hepatic detoxification of ammonia as well as alterations in brain transport and metabolism of amino acids and amines. ⋯ However, reaching nutritional goals is often complicated by protein and carbohydrate intolerance. The use of protein restriction in HE is controversial. Modified formulas that are supplemented in branched chain amino acids may be of value in patients who exhibit protein intolerance with standard feeding solutions or in patients who present with advanced degrees of encephalopathy.
-
Randomized Controlled Trial Clinical Trial
Randomized clinical outcome study of critically ill patients given glutamine-supplemented enteral nutrition.
Glutamine is normally an abundant amino acid in the body. It has many important metabolic roles, which may protect or promote tissue integrity and enhance the immune system. Low plasma and tissue levels of glutamine in the critically ill suggest that demand may exceed endogenous supply. ⋯ However, there was a significant reduction in the median postintervention ICU and hospital patient costs in the glutamine recipients $23,000 versus $30,900 in the control patients (P = 0.036). For patients given glutamine there was a reduced cost per survivor of 30%. We conclude that in critically ill ICU patients enteral feeds containing glutamine have significant hospital cost benefits.
-
The Mini Nutritional Assessment (MNA) has recently been designed and validated to provide a single, rapid assessment of nutritional status in elderly patients in outpatient clinics, hospitals, and nursing homes. It has been translated into several languages and validated in many clinics around the world. The MNA test is composed of simple measurements and brief questions that can be completed in about 10 min. ⋯ The MNA scale was also found to be predictive of mortality and hospital cost. Most important it is possible to identify people at risk for malnutrition, scores between 17 and 23.5, before severe changes in weight or albumin levels occur. These individuals are more likely to have a decrease in caloric intake that can be easily corrected by nutritional intervention.