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Malnutrition is closely related to clinical outcomes and accurate evaluation of nutritional status is the cornerstone of nutritional therapy. However, consistent diagnostic criteria for malnutrition have been absent for quite a long period. The Global Leadership Initiative on Malnutrition (GLIM) criteria were introduced in September 2018 and served as a consensus-based evaluation tool. As per GLIM criteria, evaluation of malnutrition should follow a two-step approach with nutritional screening as the first step and then malnutrition diagnosis assessment and severity grading based on etiologic as well as phenotypic metrics. Since debut, GLIM criteria have been applied in different countries, healthcare settings and populations, showing good accuracy and prognostic value for outcomes such as complications and survival. However, most of the studies are retrospective in nature and high-quality prospective studies are needed to better validate GLIM criteria. The way to steer nutritional interventions based on GLIM criteria is also worth future investigation.
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Objective:To study the genetic profile of neonatal hyperbilirubinemia with unknown etiology in Guangdong Province and the clinical significance of jaundice-related genetic screening.Methods:From July to September, 2021, neonates with hyperbilirubinemia of unknown etiology born in different hospitals in Guangdong Province were studied. 24 neonatal jaundice-related exons were sequenced using targeted capture and high-throughput sequencing technology. The pathogenic variants were analyzed.Results:A total of 331 cases, 139 (42.0%) cases showed positive screening results with five diseases, including 65 (19.6%) cases of Gilbert syndrome, 48 (14.5%) cases of glucose-6-phosphate dehydrogenase (G6PD) deficiency,18 (5.4%) cases of sodium taurocholate cotransporting polypeptide deficiency, 4 (1.2%) cases of Citrin deficiency and 4 (1.2%) cases of Dubin-Johnson syndrome. 149 (45.0%) cases carried one or more genetic variants and 43 (13.0%) cases showed no clinically significant variants. The 8 high-frequency mutation loci (carrier rate >1%) are UGT1A1 gene c.211G>A and c.1091C>T, G6PD gene c.1466G>T and c.1478G>A, SLC10A1 gene c.800C>T, SLC25A13 gene c.852_855del TATG, HBB gene c.126_129delCTTT and c.316-197C>T.Conclusions:Genetic factors are important for neonatal hyperbilirubinemia with unknown etiology in Guangdong. The common pathogenic genes are UGT1A1, G6PD, SLC10A1, and SLC25A13 and the population carries high-frequency mutation loci. Therefore, genetic screening in neonates with hyperbilirubinemia of unknown etiology has important clinical significance.
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Malnutrition and dehydration are prevalent in the elderly poplulation, and obesity is also a growing problem, which pose a serious challenge to the nutritional management in geriatrics. In order to better guide clinical practice, the European Society for Clinical Nutrition and Metabolism (ESPEN) published the practical guideline on clinical nutrition and hydration in geria-trics on March 5, 2022. This guideline provides 82 recommendations on clinical nutrition and hydration in geriatrics based on clinical practicability, covering basic problems and general prin-ciples, prevention and treatment of malnutrition/nutri-tional risk, prevention and treatment of specific diseases, as well as prevention and treatment of obesity, along with flow-charts, hoping to be convenient for doctors, nutritionists and nurses to use in clinical practice.
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The European Society for Clinical Nutrition and Metabolism held the 43 rd annual academic conference online from September 9 to 14,2021. Based on reports from the con-ference, the authors launched a review on the current hot topics in clinical nutrition.
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Skeletal muscle is the largest tissue as well as organ of human body. It is also the major form of lean mass and proteins. Loss of skeletal muscle will reduce the tolerance of illness and trauma, negatively affect clinical treatments, increase the incidence of complications and lead to decreasing of quality of life and increasing of mortality, which will affect the prognosis. Due to the factors such as the underlying disease and surgical trauma, patients undergoing surgeries face a high risk of skeletal muscle loss. However, not enough attention has been paid to the prevention and treatment of skeletal muscle loss. Based on the latest researches and his own clinical and research experience, the author discusses the epidemiologic feature of skeletal muscle loss in surgical candi-dates, and the impacts of skeletal muscle loss on prognosis, its detecting methods as well as preven-tion and treatment strategies, in order to raise the awareness of prevention and treatment of skeletal muscle in surgical patients.
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The American Society for Parenteral and Enteral Nutrition (ASPEN) held the annual academic conference online from March 20 to 23,2021. The current hot topics of clinical nutrition were widely discussed on the conference. The authors briefly report and analyze the hot topics of the conference in order to share and exchange with surgical colleagues.
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Objective:To investigate the clinical features of preoperative gastric cancer cachexia patients, with the focus on changes of abdominal fat distribution and serum inflammatory factors.Methods:128 gastric cancer patients admitted to General Surgery Department of Zhongshan Hospital, Fudan University from January 2018 to December 2018 were included. Relevant clinical information was collected, including age, gender, height, weight, hematological test results and blood lipid profiles (including free fatty acids ,FFA). Concurrent serum IL-6 and TNF-α levels were examined using enzyme-linked immunosorbent assay. Areas of subcutaneous and visceral fat were both measured at umbilical level on CT. Data mentioned above were compared between gastric cancer patients with cachexia and pre-cachexia.Results:The 128 patients were divided into stable pre-cachexia group (97 patients) and cachexia group (31 patients). Compared with pre-cachexia group, patients in the cachexia group showed significant decline in BMIs (23.4±0.3 vs 21.9±0.6, t=2.359, P=0.019), apparent elevation in serum IL-6 levels [(3.73±0.32) ng/L vs(5.26±0.77) ng/L, t=2.214, P=0.036], significant decrease in lymphocyte counts [(1.67±0.05)×10 9/L vs (1.42±0.12)×10 9/L, t=2.251, P=0.026], as well as predominant decrease in total protein levels, [(64.9 ± 0.8) g/L vs (61.5±1.1) g/L, t=2.208, P=0.029], total cholesterol levels [(4.09±0.09) mmol/L vs (3.74±0.15) mmol/L, t=2.393, P=0.046] and pre-albumin levels [(0.22±0.01) g/L vs (0.19±0.01) g/L, t=1.987, P=0.049]. Additionally, there was a noticeable decrease in subcutaneous fat area [(151.6±8.73) cm 2vs (112.4±15.9) cm 2, t=2.192, P=0.042]. The other markers displayed no remarkable differences. Conclusion:Based on our investigation, it's highly suspected that IL-6 plays a more important role than TNF-α in the fat loss of gastric cancer cachexia patients, and these patients have increased lipid catabolism predominated by subcutaneous fat loss.
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The European Society for Clinical Nutrition and Metabolism (ESPEN) online released the latest practical guideline on clinical nutrition in cancer on 15th March, 2021. The new practical guideline is shortened from the ESPEN guideline on nutrition in cancer patients in 2017 for easier use in clinical practice and provides 43 recommendations (without changes compared with the previous guidelines), combined with the diagnosis and treatment flow diagram, on general principles of nutritional therapy for cancer patients and individualized nutritional therapy strategies. Therefore, this new practical guideline is a practical tool for all professionals including physicians, dieticians, nutritionists and nurses in clinical practices.
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Cancer cachexia is a complex metabolic syndrome characterized by muscle wasting, fat decomposition, unplanned weight loss, anorexia and immune dysfunction. Cachexia can significantly reduce the efficacy of antitumor therapies and increase treatment-related toxicity on cancer patients. It increases the symptom burden in patients, affects the quality of their life, ultimately shortens patients' survival. Lucubrating the pathogenesis of cachexia is of great significance to provide rationale treatment guidance. Here we reviewed the research progress on pathogenesis of cancer cachexia, including inflammatory response mediated by TNF-α, IL-1, IL-6 and STAT-3 and abnormal nutrition metabolism, as well as mitochondrial dysfunction.
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Postoperative ileus (POI), one of the most common postoperative complications, impacts digestive function through neural reflex and intestine inflammation, and severely influences the therapeutic effect as well as the long-term outcome of the patients. As a major component of comprehensive peri-operative therapies, nutrition support treatment provides necessary daily energy and nutrient support for the patients, effectively prevents POI and promotes digestive motility. Therefore, the authors further elaborate on nutrition support treatment for postoperative ileus based on the latest research worldwide.
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Objective To evaluate the blood clearance,tissue uptake and distribution as well as safety of high dose-40 mg intravenous fish oil/'medium chain triglycerides (FO/MCT:2 ∶ 8,wt/wt) lipid emulsions iu mice by measuriug the contents of triglycerides (TG) and free fatty acids (FFA) level in blood.Methods FO/MCT emulsions were radiolabeled with nondegradable [3H] cholesteryl ether to trace core particle metabolism in C57BL/6J mice following a bolus injection.For high dose,TG was 40 mg,100 times of low dose.Blood samples were obtained within 25 min to analyze TG and FFA concentrations;extracted organs were used to measure the tissue distribution of lipid emulsions.Results No animal in either group died,and no fat overload syndrome evidence was found after high dose injection.Compared with low dose,high dose injection increased the plasma TG and FFA concentrations rapidly;the emulsions were cleared significantly slower during 25 min after administration in mice;blood has a higher uptake ratio in organs,but heart has a lower one;there was no significant difference in liver and lung uptake ratio between the two groups.Conclusions High dose injection of FO/MCT is not fatal in mice.The animals only experience hypertriglyceridemia and high level of free fatty acids during a significant slower blood clearance period compared to low dose.Although blood clearance is slower,the blood uptake rate increases for further metabolism and clearance.Heart and lung functions are not affected as a lower cardiac and pulmonary uptake;blood uptakes more emulsions to further metabolize.FO/MCT may not induce fat overload syndrome in mice when administered with a super high dose.
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Objective@#To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA).@*Methods@#A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding" . The goal of quality control was achieved by establishment of the preliminary standard.@*Results@#The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003.@*Conclusions@#The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
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Objective@#To investigate the effect of oral nutritional supplements(ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer.@*Methods@#All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge.@*Results@#The body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge.(2 months after discharge: 1.65±2.11vs. 2.70±1.90 kg, t=-2.385 3, P=0.019 3; 3 months after discharge: 1.95±2.75vs. 3.67±2.29 kg, t=-3.134 7, P=0.002 4), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score(56.82±13.65%vs. 51.71±9.72%, t=2.014 8, P=0.047 2) and QOL score(41.91±6.92 vs. 38.39±8.77, t=2.059 7, P=0.042 6) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients.@*Conclusion@#ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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Nutritional therapy is one of the most important treatment measures for surgical critically ill patients, and it is also a difficult point in clinical nutritional support practice. In recent years, nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice. Many large-scale, multi-center clinical studies have been completed worldwide. Consensus has been formed on many hot issues and relevant guidelines have been issued. Based on the latest evidence-based medicine achievements, the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years.
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Nutritional therapy is one of the most important treatment measures for surgical critically ill patients,and it is also a difficult point in clinical nutritional support practice.In recent years,nutritional support treatment for surgical critically ill patients has achieved rapid development both in theory and practice.Many large-scale,multi-center clinical studies have been completed worldwide.Consensus has been formed on many hot issues and relevant guidelines have been issued.Based on the latest evidence-based medicine achievements,the author summarizes and interprets the hot and controversial issues of nutritional therapy for surgical critically ill patients in recent years.
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Objective To establish a quality control model ensuring good stability and compatibility of manually compounded total nutrient admixtures (TNA). Methods A parenteral nutrition medication order entry system was establish for standardizing nutritional medication usage and supporting physician's TNA prescribing. TNA medication orders were reviewed by pharmacists for validating the stability and compatibility. TNAs were compounded by pharmacists in a standard way following "four factors of sterile compounding". The goal of quality control was achieved by establishment of the preliminary standard. Results The quality of manually compounded total nutrient admixtures achieved the goal since pharmacy intravenous admixture service (PIVAS) started on 2003. Conclusions The quality of TNA is well assured while manually compounded by pharmacists in PIVAS.
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Objective To investigate the effect of oral nutritional supplements (ONS) on body weight loss and life quality in post-discharge patients with gastric and colorectal cancer. Methods All the enrolled post-operative gastric or colorectal cancer patients were randomly divided into ONS group and control group. Body weight loss, middle arm circumference, triceps skinfold thickness and right-hand grip strength were measured and the Karnofsky score, ECOG score and QOL score were calculated 3 months after the discharge. ResultsThe body weight loss of gastric cancer patients was lower in ONS group than in control group since 2 months after discharge. (2 months after discharge: 1. 65±2. 11vs. 2. 70±1. 90 kg, t = -2. 3853, P = 0. 0193; 3 months after discharge: 1. 95±2. 75vs. 3. 67±2. 29 kg, t = -3. 1347, P = 0. 0024), There was no difference of body weight loss between two groups in colorectal cancer patients. The middle arm circumference, triceps skinfold thicknessand right-hand grip strength showed no statistic difference between two groups both in gastric and colorectal cancer patients. The Karnofsky score (56. 82±13. 65％vs. 51. 71± 9. 72％, t = 2. 0148, P = 0. 0472) and QOL score (41. 91±6. 92 vs. 38. 39±8. 77, t = 2. 0597, P = 0. 0426) were higher in ONS group than in control group in gastric cancer patients. While all 3 types of scores had no difference between two groups in colorectal cancer patients. Conclusion ONS can efficiently reduce the body weight loss and improve the performance status and life qualityin post-discharge gastric cancer patients, but not in colorectal cancer patients.
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OBJECTIVE@#To investigate the levels of serum inflammatory cytokines and Resolvin D1 (RvD1) and their association with pathological staging of colon cancer.@*METHODS@#Clinical data of 50 colon cancer patients (colon cancer group) admitted to the General Surgery Department of Zhongshan Hospital of Fudan University from January to December 2016 and 5 ml of whole blood specimen were collected at admission. During the same period, 50 healthy volunteers were enrolled (healthy volunteer group). Inclusion criteria for the colon cancer group: colon cancer diagnosed by preoperative colonoscopy and pathology; no recent enteral or parenteral nutrition support treatment or use of oral nutrition preparation; age ≤85 years; no surgical contraindications by preoperative evaluation; no history of taking fish oil-related preparations; no radiotherapy or chemotherapy before surgery. Healthy volunteer group enrollment criteria: no history of malignant tumors; no organ with organic lesions detected by the healthy examination center of our hospital; detection indicators in normal reference range; no administration of fish oil-related preparations; age ≤ 85 years. Serum inflammatory factors(IL-1β, IL-6, IL-10 and TNF-α) concentrations were detected by chemiluminescence immunoassay; serum RvD1 concentration was measured by enzyme-linked immunosorbent assay. The levels of inflammatory factors and RvD1 were compared between the two groups, and their associations with TNM staging of colon cancer patients were analyzed.@*RESULTS@#There were no significant differences in age, gender and nutrition-related indicators between the two groups (all P>0.05). There were 31 males and 19 females in the healthy volunteer group with age of (61.8±11.6) years. There were 23 males and 27 females in the colon cancer group with age of (65.4±12.4) years. According to the 7th edition of the American Cancer Society TNM staging criteria, 10 cases were stage I, 13 cases stage II, 17 cases stage III, and 10 cases stage IV. Compared with healthy volunteer group, colon cancer group had higher serum IL-1β [(3.89±0.24)×10 μg/L vs.(1.55±0.37)×10 μg/L, t=37.52, P<0.01], higher IL-6 [(129.14±3.07)×10 μg/L vs.(51.46±3.14)×10 μg/L, t=125.08, P<0.01], higher IL-10 [(100.59±8.69)×103 μg/L vs.(27.57±4.77)×10 μg/L, t=52.09, P<0.01] and higher TNF-α [(114.31±4.43)×10 μg/L vs.(41.04±5.27)×10 μg/L, t=75.25, P<0.01], while lower RvD1 [(34.19±1.93)×10 μg/L vs.(77.76±1.02)×10 μg/L, t=140.56, P<0.01], all the differences were statistically significant. Subgroup analysis revealed that concentrations of IL-6, IL-1β, IL-10 and TNF-α gradually increased with the advancement of TNM staging (P<0.01). In stage III, concentrations of IL-6, IL-1β, and IL-10 were the highest, TNF-α concentration was the highest in stage IV. RvD1 concentration gradually decreased with the advancement of TNM staging(P<0.01).@*CONCLUSIONS@#Compared with healthy volunteers, the levels of serum inflammatory cytokines in colon cancer patients increase significantly while the level of RvD1 decreases significantly. Both are associated with higher TNM stage of colon cancer.
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Aged , Female , Humans , Male , Middle Aged , Colonic Neoplasms , Blood , Allergy and Immunology , Pathology , Cytokines , Blood , Docosahexaenoic Acids , BloodABSTRACT
As people are getting a better understanding of organism′s metabolism and the concept of disease treatment is being continuously updated, parenteral and enteral nutrition become an inter discipline subject that serves for the clinic and involves a number of disciplines. Just in the past five years, related guidelines at home and abroad have been published as much as more than 40. In order to better serve the clinical decision making, this text attempts to give a carding and interpretation from the three aspects of nutrition screening and assessment, the implementing of nutritional intervention and the progress of special nutrition support. It is observed that the standard clinical nutrition diagnosis and treatment process has been formed consensus. But in the practical application, there are still many details need to confirm and further study.
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In recent years,the scientific literatures have revealed exponential advances in the understanding of molecular basis of nutritional support therapy and evolution of clinical protocols aimed at treating artificial nutritional support as a therapeutic intervention,preventing loss of lean body mass and metabolic deterioration to improve clinical outcomes in the critical illness.According to the evidence-based medicine,this review will summarize recent findings,highlight areas of consensus and controversy and define priorities for further researches.