Influence of nutritional therapy on short-term efficacy of gastric cancer patients with mal-nutrition after radical gastrectomy: a prospective randomised clinical trial / 中华消化外科杂志

Objective:To investigate the influence of nutritional therapy on short-term efficacy of gastric cancer patients with malnutrition after radical gastrectomy.Methods:The prospec-tive randomized control study was conducted. The clinicopathological data of patients with malnutri-tion after radical resection of gastric cancer who were admitted to the Zhongshan Hospital of Fudan University from December 2020 to December 2022 were selected. Based on random number table, all patients were allocated into the nutritional therapy group and the control group. Patients in the nutritional therapy group were given dietary guidance and daily oral nutrition supplements for 90 days after discharge, while patients in the control group were only given the same dietary guidance. Observation indicators: (1) grouping situations of the enrolled patients; (2) follow-up; (3) comparison of nutritional indicators at 90 days after discharge; (4) comparison of inflammation and physical function indicators at 90 days after discharge; (5) comparison of clinical outcome indicators at 90 days after discharge. Measurement data with normal distribution were expressed as Mean± SD, and independent sample t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(IQR), and non-parameter rank sum test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and chi-square test was used for comparison between groups. Comparison of ordinal data was conducted using the chi-square test. Results:(1) Grouping situations of the enrolled patients. A total of 187 patients were selected for eligibility. There were 131 males and 56 females, aged (65±12)years. Of the 187 patients, there were 95 patients in the nutritional therapy group and 92 patients in the control group, respectively. The gender (male, female), age, cases with cardiovascular complications, cases with respiratory complications, cases with diabetes, surgical methods (partial gastrectomy, total gastrectomy), tumor staging (Ⅰ stage, Ⅱ stage, Ⅲ stage), body mass, body mass index (BMI), skeletal muscle index, albumin (Alb), hemoglobin (Hb), neutrophil-to-lymphocyte ratio (NLR), 6-minutes walking distance, grip strength were 68, 27, (64±12)years, 21, 4, 7, 59, 36, 17, 27, 51, (59±11)kg, (21.5±3.1)kg/m 2, (42±7)cm 2/m 2, (39±5)g/L, (112±25)g/L, 2.3(8.0), (456±97)m, (29±8)kg in patients of the nutritional therapy group, versus 63, 29, (66±13)years, 22, 3, 9, 56, 36, 14, 24, 54, (58±11)kg, (21.1±2.9)kg/m 2, (42±7)cm 2/m 2, (39±4)g/L, (111±26)g/L, 2.2(8.4), (459±98)m, (29±8)kg in patients of the control group, showing no significant difference in the above indicators between the two groups ( χ2=0.21, t=-1.29, χ2=0.09, 0, 0.35, 0.03, 0.51, t=0.80, 0.85, 0.19, 0.14, 0.16, Z=-0.28, t=-0.17, 0.43, P>0.05). (2) Follow-up. All 187 patients were followed up for 90 days after surgery. During the follow-up period, all patients had good compliance and were able to follow the dietary guidance. Five patients in the nutrition therapy group experienced diarrhea and nausea adverse reactions, which were relieved after symptomatic treatment. No adverse reactions were found in the control group. (3) Comparison of nutritional indicators at 90 days after discharge. The body mass, body mass loss, BMI, skeletal muscle index, Alb, Hb were (58±10)kg, 2(6)kg, (21.0±2.9)kg/m 2, (41±7)cm 2/m 2, (41±4)g/L, (125±18)g/L in patients of the nutritional therapy group, versus (56±10)kg, 3(6)kg, (20.4±2.7)kg/m 2, (39±7)cm 2/m 2, (41±4)g/L, (121±21)g/L in patients of the control group. There were significant differences in body mass loss and skeletal muscle index between the two groups ( Z=-4.70, t=2.39, P<0.05), and there was no significant difference in body mass, BMI, Alb, and Hb ( t=1.30, 1.51, 0.80, 1.32, P>0.05). (4) Comparison of inflammation and body function indicators at 90 days after discharge. The NLR, 6-minutes walking distance, grip strength were 2.1(5.1), (478±99)m, and (33±9)kg in patients of the nutritional therapy group, versus 2.2(5.7), (465±96)m, (30±8)kg in patients of the control group. There was a significant difference in grip strength between the two groups ( t=2.08, P<0.05), and there were no significant difference in NLR and 6-minutes walking distance ( Z=-1.28, t=0.91, P>0.05). (5) Comparison of clinical outcome indicators at 90 days after discharge. The quality of life score and readmission rate were (79±14)points, 4.2%(4/95) in patients of the nutritional therapy group, versus (78±16)points, 6.5%(6/92) in patients of the control group, showing no significant difference in the above indicators between the two groups ( t=0.58, χ2=0.14, P>0.05). Conclusion:Nutritional therapy with daily oral nutrition supplements can improve the short-term nutritional status and body function of patients with malnutrition after radical gastrectomy for gastric cancer.

Retrospective analysis of the effect of oral nutritional supplements during labor on delivery outcomes in low-risk pregnant women / 中华临床营养杂志

Objective:To explore the effect of oral nutritional supplements (ONS) during labor on delivery outcomes in low-risk pregnant women and the risk factors of cesarean section.Methods:A retrospective analysis was conducted in a total of 206 full-term pregnant women with singleton and cephalic presentation at the delivery center in our hospital from March 15th to May 15th, 2022. Standard diet education was given to all those women by midwives. Pregnant women who received the enteral nutrient solution prepared by the Department of Clinical Nutrition during labor were in the ONS group ( n = 110), while those who did not were in the control group ( n = 96). The baseline characteristics and delivery outcomes were compared between the two groups, and the risk factors of cesarean section were also analyzed. Results:There were no significant differences in terms of maternal age, height, baseline weight, baseline body mass index (BMI), weight gain during pregnancy, prenatal BMI, gestational week, intraspinal labor analgesia, oxytocin, gastrointestinal intolerance, neonatal length, and weight between the two groups ( P > 0.05). However, the total oral energy intake during labor in the ONS group was significantly higher than that in the control group ([1 349.99± 569.51] kJ vs [249.59 ± 455.19] kJ, P < 0.01). The rate of vaginal delivery in the ONS group was significantly higher than that in the control group (93.6% vs 81.3%, P = 0.01), and the duration of the first stage of labor ([487.06 ± 232.94] min vs [416.17 ± 191.13] min, P = 0.03) was also significantly longer in the ONS group. There were no significant differences between the two groups in terms of the duration of the second and third stages of labor, perineal laceration, cervical laceration, vaginal laceration, amount of bleeding, hospital stay, and Apgar score after birth ( P > 0.05). Multivariate logistic regression analysis showed that maternal age was a risk factor for changing to cesarean section in women with low-risk pregnancies ( OR 1.20, 95% CI 1.03 to 1.40, P = 0.02), while ONS during labor ( OR 0.31, 95% CI 0.11 to 0.85, P = 0.02) and intraspinal labor analgesia ( OR 0.10, 95% CI 0.04 to 0.26, P < 0.01) were protective factors. Conclusions:ONS during labor can significantly increase the vaginal delivery rate, without increasing the incidence of gastrointestinal intolerance in low-risk pregnant women. Maternal age is a risk factor for cesarean section while ONS during labor and intraspinal labor analgesia are protective factors in women with low-risk pregnancies.

Application progress on perioperative oral nutritional supplements / 中国实用护理杂志

Patients in the perioperative period are often at risk of malnutrition due to the disease itself, surgical trauma, stress, and fasting. Oral nutritional supplementation is widely used in the perioperative period as the first choice for nutritional therapy. This article summarizes the effects, usage, adverse reactions and coping methods of oral nutritional supplementation during perioperative period, aiming to understand the current status of oral nutritional supplementation in perioperative period, and provide reference for subsequent application research of oral nutritional supplementation in perioperative period.

Can oral nutritional supplements increase energy and protein intake among hospitalized patients? / ¿Los suplementos nutricionales orales pueden aumentar la energía y la proteína en pacientes hospitalizados?

ABSTRACT Background: Oral nutritional supplements aim at offsetting dietary deficits and helping to meet energy and protein targets. Due to the absence of data about their role in food intake, it is necessary to evaluate the contribution of these products to the estimated needs of hospitalized patients. Methods: This is a prospective longitudinal study with hospitalized patients over 18 years of age, admitted to a public university hospital, who were given oral nutritional supplements, according to clinical guidelines. Food intake was quantified throughout the period such products were prescribed. Results: 805-day food intake follow-up and record of 128 patients, who took supplements for 6.4 days on average. The use of nutritional supplements demonstrated a significant contribution to the input of both energy (1576 kcal/day versus 1263 kcal/day, p<0.001) and protein (68.7 g/day versus 50.3 g/day, p<0.001). Conclusions: Nutritional supplements help increase food intake and achieve nutritional goals when prescribed in a hospital setting.

RESUMEN Antecedentes: los suplementos nutricionales orales tienen como objetivo compensar los déficits dietéticos y ayudar a cumplir los objetivos de energía y proteínas. Debido a la ausencia de datos sobre su papel en la ingesta de alimentos, es necesario evaluar la contribución de estos productos a las necesidades estimadas de los pacientes hospitalizados. Métodos: Este es un estudio longitudinal prospectivo con pacientes hospitalizados mayores de 18 años, ingresados en un hospital universitario público, que recibieron suplementos nutricionales orales, según la derivación clínica. La ingesta de alimentos se cuantificó durante todo el período en que se prescribieron dichos productos. Resultados: seguimiento de la ingesta alimentaria de 805 días y registro de 128 pacientes, que tomaron suplementos durante 6,4 días en promedio. El uso de suplementos nutricionales demostró una contribución significativa al aporte de energía (1576 kcal/día versus 1263 kcal/día, p< 0,001) y proteína (68,7 g/día versus 50,3 g/día, p<0,001). Conclusiones: los suplementos nutricionales ayudan a aumentar la ingesta de alimentos y alcanzar objetivos nutricionales cuando se prescriben en un entorno hospitalario.

Nutritional management for Alzheimer ' s disease in all stages: mild, moderate, and severe

Alzheimer's disease corresponds to 50­70% of all dementia syndromes, classified as a progressive neurodegenerative disease showing diffuse cortical atrophy with three stages of evolution: mild, moderate, and severe. Behavioral symptoms and memory loss are major manifestations of the disease. Non-pharmacological interventions are essential to improve the quality of life of these patients. Interdisciplinary assistance is essential throughout the disease course. Regarding nutrition for patients with Alzheimer's disease, weight loss and behavioral changes related to food are major objects of scientific study, as they trigger deterioration of the quality of life of patients and caregivers. Knowing which nutritional guidelines should be used helps in clinical decisions. The study of nutrition in dementia is, therefore, critical for patient management.

Effect of oral nutritional supplementation on nutritional status and quality of life in patients with gastric cancer after operation(23 cases RCT observations) / 中华临床营养杂志

Objective To investigate the effect of oral nutritional supplementation on the nutritional status and quality of life in patients with gastric cancer after operation.Methods In this prospective,single blind,randomized,controlled clinical study,25 postoperative patients with gastric cancer received neoadjuvant chemotherapy in outpatient clinic were enrolled.All patients received dietary guidance.In the intervention group,in addition to standard diet,oral nutritional supplements with 2 090 kJ/d of Intacted Protein Enteral Nutrition Powder were added,which lasted 90 days.The changes of body mass,body mass index(BMI),hemoglobin,prealbumin,albumin,gastrointestinal function score,and life quality score 30,60,and 90 days after discharge were recorded.Patients on standard diets were used as the control group.Results In the intervention group,the body mass increased by(0.66 ±1.47)kg 60 d after discharge and(-0.90±1.82)kg on 90 d after discharge,which were [60 d:(-5.13±1.79)kg,90 d:(-9.56±2.44)kg] in the control group,and the difference was statistically significant(P=0.027,P=0.015).The BMI of intervention group increased by(0.20 ±0.55)kg/m2 on 60 d and(-0.32±0.55)kg/m2 on 90 d after discharge,which were(-2.06±0.67)kg/m2 on 60d and(-3.21± 0.73)kg/m2 on 90 d in the control group(P=0.014,P=0.003).There was no significant difference in terms of serum albumin,prealbumin and other laboratory indicators.Intestinal functional status and quality of life also showed no significant difference between these two groups.ConclusionOral nutrition supplementation can reduce the body mass loss and improve the nutritional status in patients with gastric cancer during chemotherapy after operation.

Clinical study on nutriti0nal interventi0n in patients with Alzheimer(s) disease / 肠外与肠内营养

Objective:To explore the effects of nutritional intervention on the nutritional status,cognitive function and activities of daily living (ADL) in patients with Alzheimer's Disease (AD).Methods:90 AD patients were randomly divided into the control group and the intervention group,with 45 cases in each group.Patients in the control group received anti-dementia drugs,and patients in the intervention group additionally received TPF-T as the oral nutritional supplement.The nutritional status and nutritional biochemical indicators,cognitive function and ADL of two groups were evaluated when enrolled and 6 months later after the treatment.Results:After 6 months'treatment,the nutritional status,MMSE,ADL scores and nutritional indicators of patients in the intervention group were significantly improved compared to the control group (P ＜ 0.05).Conclusion:Nutritional intervention can effectively improve the nutritional status,cognitive function and ADL of patients with dementia.

Use of Oral Nutritional Supplements for Patients with Diabetes / 임상당뇨병

Dietary counseling and oral nutritional supplements (ONS) should be considered to increase the nutritional intake of people malnourished or at risk of malnutrition. These supplements are typically ready-made liquids and contain a balanced mix of energy, protein, and micronutrients. The diabetes-specific ONS are specifically designed for patients with hyperglycemia or diabetes mellitus in order to provide better glycemic control such as postprandial glucose and HbA1c compared to the standard ONS. These supplements are lower in carbohydrates and higher in fat than standard supplements and are rich in monounsaturated fats. Using diabetes-specific ONS in malnourished diabetic patients can allow increasing energy intake while maintaining glucose control and improving nutritional status and also providing economic benefits. However, inadequate intake of ONS that do not fit the patient's condition can be a problem. Therefore, when using ONS for patients with diabetes, it is necessary to clinically evaluate the nutritional status of the patient and to provide individualized education and management accordingly.

A Community Based Dietetic-Led Service to Extend the Citywide Care of Patients at Risk of Malnutrition and to Reduce Inappropriate Prescribing Costs of Oral Nutritional Supplements.

Background: Malnutrition is a cause and consequence of disease, affecting at least 3 million UK adults (Elia, 2010 [1]) of which 93% are in the community at a cost to the NHS of £13 billion/year, BDA [2]. Food should be first line treatment for anyone identified as at risk of malnutrition, Crawley and Hocking [3]. Oral nutritional supplements (ONS) are often inappropriately prescribed to treat malnutrition Gall et al. [4]. The current annual spend on ONS in Leeds is approximately £1.7million for around 1500 patients. This innovative service aims to receive 1000 new patient referrals and as a consequence make £300,000 of savings through clinical and cost effective use of ONS usage in the community. Process: The success of a pilot project led to the citywide dietetic-led service. This process is outlined below. Ethics approval was not required. 1. A 12 month pilot project in Leeds North CCG involved a retrospective audit which was carried out with 8 GP practices in 2011/12, to assess current ONS prescribing. Concurrently all Leeds North CCG practices could refer any adult patient on ONS, directly to the dietetic team. 2. This pilot project identified 315 people on ONS with 83 patients assessed and reviewed by a dietitian. The audit showed less than 20% of patients were appropriately prescribed ONS. Dietetic intervention made an average saving of £2.62 per patient per day by getting the right patient on the right product for the right length of time. This equates to an annual saving of £79,372.90. 3. The impact of this work led to investment (until 03/2014) to implement a city wide community ‘Eating and Drinking Team’ to raise awareness of the need to identify and treat malnutrition, through nutritional screening, promoting ‘food first’ principles, appropriate prescribing practices, and pathways, to ensure the best outcomes for Leeds residents. 4. Targets for the new team were set at 1000 new patient referrals, with 3000 patient contacts to enable annual cost savings of 20% per year (approx £300,000). Outcomes: In the first two full quarters of activity (Jan-Jun 2013), the service has: Cost savings are generated by preventing inappropriate prescribing by getting the right patient on the right product for the right length of time. Increase in referrals, activity and outcomes (not discussed here) demonstrate the need for a dietetic-led service, with additional and longer term investment to recognise the referral rate and the savings. Conclusion: Dietetic-led interventions for reducing the risk of malnutrition can be successful in promoting the role of the dietitian and achieving significant cost savings.