Malnutrition treatment and follow-up in clinical nutrition outpatient clinics associated with increased muscle mass.

OBJECTIVE: Clinical nutrition outpatient clinics (CNOCs) are the mainstay of the nutrition bundle in hospitals. They are important for the diagnosis, treatment, and follow-up of outpatients with malnutrition (MN) and sarcopenia. The aim of this study was to evaluate changes in muscle mass during the treatment of MN in patients admitted to CNOCs. METHODS: A total number of 1118 patients were included in this retrospective cohort descriptive study. Data including medical history, weight loss, anthropometric measurements, MN diagnosis (according to ESPEN definition), nutrition treatment, bioelectrical impedance analysis and laboratory examinations were noted for the first admission and the follow-up. RESULTS: This retrospective, cohort descriptive study included 1118 patients. The mean age of the participants was 54 ± 22 y (18-101 y) and half of the patients were men. Of the 1118 patients, 37,7% were ≥65 y of age. Cancer (32.2%) was the most frequent diagnosis followed by diabetes (16.7%) and dementia (11.3%). MN prevalence was 51.6%. Protein- and energy-enriched diet, oral enteral nutrition supplementation, tube enteral feeding, and parenteral nutrition were used in 42.7%, 69.6%, 11%, and 2.7% of the patients with MN, respectively. Skeletal muscle mass was significantly increased in MN, cancer, neuromuscular diseases (NMD) and patients ≥65 y of age in the first 6 mo, and could be maintained during the next 6 mo of follow-up. Patients with cancer, chronic kidney disease, and NMD and those ≥65 y of age were able to increase their body mass index. CONCLUSIONS: MN treatment and follow-up can restore muscle mass especially in patients ≥65 y of age and in those with chronic diseases. CNOCs are beneficial in the treatment and follow-up of MN.

Effect of luteal phase support with vaginal progesterone in intrauterine insemination cycles with regard to follicular response: a prospective randomized study.

OBJECTIVE: To investigate the effect of luteal phase support with vaginal progesterone on pregnancy rates of the gonadotropin-stimulated intrauterine insemination (IUI) cycles in patients with unexplained infertility with regard tofollicular growth. STUDY DESIGN: A total of 149 patients with unexplained infertility who underwent 166 recombinant follicle stimulated hormone--stimulated IUI cycles were prospectively randomized into 2 groups for luteal phase support. The study group (n = 71) received vaginal progesterone gel supplementation, and the control group (n = 78) received no drug for luteal support. The clinical pregnancy rates and live birth rates per cycle and per patient were compared between the groups. RESULTS: The differences between the groups with regard to clinical pregnancy rates and live birth rates per patient or per cycle were not different among all patients. In cycles with > 1 dominant follicle (multifollicular response), the clinical pregnancy rate per patient was significantly higher in the supported cycles as compared with the unsupported cycles (28.2% vs. 11.4%, respectively, p = 0.04). Reproductive outcomes in cycles with a single dominant follicle (monofollicular response) were not different between supported and unsupported cycles. CONCLUSION: Luteal phase support with vaginal progesterone affects the success of gonadotropin-stimulated IUI cycles with multifollicular response but not with monofollicular response.

The relationship between the change in serum high sensitivity C-reactive protein levels and IVF success.

The aim of this study was to assess whether the extent of the change in high sensitivity C-reactive protein (hs-CRP) levels is related with in vitro fertilization (IVF) success. A total of 69 IVF cycles using long luteal GnRH agonist protocol at the IVF unit, were prospectively studied. The serum levels of hs-CRP were measured on the day of initiation of gonadotrophin stimulation and 7 days after embryo transfer. CRP ratio was defined as the levels of CRP on day 7 of transfer/day of initiation of ovarian stimulation. Clinical pregnancy rates were examined. The mean concentrations of hs-CRP were not significantly different on the first day of ovarian stimulation and on day 7 after embryo transfer among pregnant and non-pregnant women. There was a significant rise in hs-CRP levels at 7th day after embryo transfer as compared with the first day of gonadotrophin treatment in both groups (10.58 ± 11.35 versus 3.61 ± 2.86 mg/L for pregnant women and 9.14 ± 11.36 versus 3.24 ± 2.68 mg/L for non-pregnant women, p = 0.001). In addition, the mean CRP ratio was not different between the pregnant and non-pregnant groups. Our data show that serum hs-CRP levels increase during IVF treatment, but the extent of the rise in CRP levels is not a predictive marker of IVF success.