Evaluation of supporting role of early enteral feeding via tube jejunostomy following resection of upper gastrointestinal tract

Today, early diagnosis of upper gastrointestinal [GI] tract malignancies and their surgical resection is becoming more feasible. One of the important side effects in upper GI tract malignancies is malnutrition which has direct relationship with postoperative complications. Nonetheless, there is no easy regimen of nutrition for these patients especially for the first week after operation. Accordingly we present a simple method for improving feeding such patients via tube jejunostomy. The aim of this study was to investigate the impact of early enteral feeding [EEF] on postoperative course after complete resection of upper gastrointestinal tract malignancy and reconstruction. Between September 2005 to September 2008, 60 consecutive patients [22 female, 38 male] with upper GI tract malignancies who had undergone complete resection and reconstruction enrolled in this study. The patients randomly divided equally in two groups of control and EEF. Control group was treated with traditional management of nil by mouth and intravenous fluids for the first five postoperative days and then with liquids and enteral regular diet when tolerated. In EEF group the patients were fed by tube jejunostomy from 1[st] postoperative day and assessed for nutritional status before surgery and 5 days after surgery. Both groups were monitored on the basis of weight gain, clinical and paraclinical parameters and postoperative complications. Sixty patients were randomly divided to two equal groups. Surgical procedures were similar in two groups and no significant difference in demographic and basic nutritional status were found. On 5[th] postoperative day serum albumin was 4.2 +/- 0.4 g/dl in EEF and 3.6 +/- 0.3 g/dl in control group [p= 0.041]. Also serum transferrin was 260.8 +/- 2.5 mg/dl and 208 +/- 1.8 mg/dl in EEF and control group respectively [p<0.001]. Moreover, hospital stay was shorter in EEF group [7.7 +/- 3.1 vs. 14 +/- 2.5 days, p=0.009].There were four [13.3%] anasatomotic leakages in control group and one [3.3%] in EEF group [p=0.353]. Also there was six [20%] wound infection in control group and three [10%] in EEF group [p=0.472]. The EEF by tube jejunostomy can be an effective method of feeding patients in postoperative days of resection of GI malignancies. Postoperative hospital stay would be shorter and the level of laboratory parameters especially serum transferrin is higher in EEF in comparison with control group. It also may reduce postoperative complications such as wound infection and enterocutaneous fistula

Effect of soymilk consumption on waist circumference and cardiovascular risks among overweight and obese female adults

Soy milk replacement in the diet might have beneficial effects on waist circumference and cardiovascular risk factors for overweight and obese subjects. Therefore, we are going to determine the effects of soy milk replacements on the waist circumference and cardiovascular risk factors among overweight and obese female adults. In this crossover randomized clinical trail, 24 over weight and obese female adults were on a diet with soy milk or the diet with cow's milk for four weeks. In the diet with soy milk only one glass of soy milk [240 cc] was replaced instead of one glass of cow's milk [240 cc]. Measurements were done according to the standard protocol. Waist circumference reduced significantly following soy milk period [mean percent change in soy milk period for waist circumference: -3.79 +/- 0.51 vs. -1.78 +/- 0.55%; P = 0.02 in the cow's milk period]. Blood pressure, weight, liver enzymes and glycemic control indices did not changed significantly after soy milk period compared to the cow's milk period. Among over weight and obese patients, soy milk can play an important role in reducing waist circumference. However, soy milk replacement had no significant effects on weight, glycemic control indices, liver enzymes, fibrinogen and blood pressure in a short term trial

Vitamins, minerals, and flavonoids intake and risk of cardiovascular diseases

Diseases of heart and stroke cause most deaths in both sexes of all ethnic groups. For more than 40 years epidemiological studies, experimental studies, and clinical trials have shown that numerous dietary risk factors affect serum lipids, atherogenesis and coronary heart disease [CHD]. Substantial interest has recently focused on the hypothesis that the naturally occurring antioxidant vitamins such as vitamin E, vitamin C, and beta-carotene may prevent myocardial infarction, progression of coronary heart disease. Substantial laboratory, animal, and human data suggest that oxidation of low-density lipoprotein [LDL] cholesterol is an important step in the pathogenesis of atherosclerotic lesions. Oxidation of LDL cholesterol is important in both the initiation and progression of plaque or increases the risk for plaque rupture. The major lipid-soluble antioxidant vitamins are vitamin E [-tocopherol] and beta-carotene, a precursor of vitamin A. The major water-soluble antioxidant vitamin is vitamin C [ascorbic acid]. Vitamin E is important in preventing oxidation of LDL cholesterol. beta-Carotene prevents oxidation of LDL cholesterol. Vitamin C prevents oxidation of LDL cholesterol and preserves vitamin E and beta-carotene levels during oxidative stress. It is increasingly recognized that folate and vitamin B6 may play a role in the prevention of cardiovascular disease. The primary mechanism proposed for their effect on coronary vascular disease [CVD] is a reduction in plasma homocysteine concentration by remethylation of homocysteine back to methionine. Minerals like magnesium, Potassium and calcium and also vitamin D have protective effect in blood pressure. Selenium is an important component of antioxidant defence and flavonoids which are derived from plants have been shown to inhibit platelet aggregation and adhesion, which may be another way they lower the risk of heart disease. In this article the role of micronutrients in prevention of cardiovascular diseases will be reviewed