Nutrition assessment and management in advanced liver disease.

Malnutrition commonly complicates the course of patients with cirrhosis and has a multifactorial etiology. Despite the important role that nutrition plays in the prognosis of those with cirrhosis, the nutrition assessment process can be challenging in this setting. A number of tools are available to aid in the nutrition assessment of the cirrhotic patient; however, none are without limitations. Although the assessment process can be difficult, the ability to properly manage the nutrient needs of the patient presents an additional set of challenges because of the catabolic nature of the disease process and common occurrence of anorexia and other symptoms leading to poor oral intake. In this review, the nutrition assessment tools and general guidelines for nutrition management in patients with advanced liver disease are discussed to promote recognition of the nutrition issues affecting this patient population and lead to their improved survival and reduced morbidity.

Nutrition assessment, care, and considerations of ventricular assist device patients.

A ventricular assist device (VAD) is an implantable mechanical device that is used to partially or completely replace the circulatory function of a failing heart. VADs may serve as a bridge to heart transplantation or as permanent circulatory assistance, also referred to as destination therapy. There is a paucity of information regarding the nutrition complications in VAD patients, and as such, little is presently known of the optimal means of nutrition assessment and management of these complex and often critically ill patients. In this review, a general overview of the VAD, comparisons of nutrition assessment measures, and strategies to meet the nutrition needs of these patients are provided using evidence-based information wherever possible. Because there is a lack of nutrition studies and assessment guidelines specifically for VAD patients, many of the guidelines for care of these patients are currently based on the information available for the care of patients with heart failure. Although the optimal measure to assess nutrition status remains poorly studied, a systematic, thorough nutrition assessment of patients with heart failure and heart transplant candidates prior to VAD placement appears to be important to identify those at nutrition risk and, with appropriate nutrition therapy, decrease their risk for morbidity and mortality. VAD patients with inadequate oral intake may require nutrition support to meet their nutrition needs; however, feeding the hemodynamically compromised patient provides additional challenges.

Almond ingestion at mealtime reduces postprandial glycemia and chronic ingestion reduces hemoglobin A(1c) in individuals with well-controlled type 2 diabetes mellitus.

Cohort studies are equivocal regarding a relationship between regular nut consumption and reduced risk of type 2 diabetes mellitus. Although acute trials show reductions in postprandial glycemia in healthy individuals ingesting 60 to 90 g almonds, trials have not been conducted using a single serving of almonds (28 g) in individuals with type 2 diabetes mellitus. This randomized crossover trial examined the impact of one serving of almonds at mealtime on postprandial glycemia, insulinemia, and plasma glucagon-like peptide-1 in healthy individuals and individuals with type 2 diabetes mellitus. On 2 occasions separated by at least 1 week, 19 adults (including 7 adults with type 2 diabetes mellitus) consumed a standardized evening meal and fasted overnight before ingesting the test meal (bagel, juice, and butter) with or without almonds. A small pilot study (6-7 subjects per group) was also conducted to observe whether chronic almond ingestion (1 serving 5 d/wk for 12 weeks) lowered hemoglobin A(1c) in individuals with type 2 diabetes mellitus. A standard serving of almonds reduced postprandial glycemia significantly in participants with diabetes (-30%, P = .043) but did not influence glycemia in participants without diabetes (-7%, P = .638). Insulinemia and glucagon-like peptide-1 at 30 minutes postmeal were not impacted by almond ingestion for either group. In the pilot study, regular almond ingestion for 12 weeks reduced hemoglobin A(1c) by 4% (P = .045 for interaction) but did not influence fasting glucose concentrations. These data show that modest almond consumption favorably improves both short-term and long-term markers of glucose control in individuals with uncomplicated type 2 diabetes mellitus.