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1.
Nutr Hosp ; 38(6): 1287-1303, 2021 Dec 09.
Artigo em Inglês | MEDLINE | ID: mdl-34448398

RESUMO

INTRODUCTION: In order to develop evidence-based recommendations and expert consensus for the nutritional management of patients with short bowel syndrome (SBS), we conducted a systematic literature search using the PRISMA methodology plus a critical appraisal following the GRADE scale procedures. Pharmacological treatment with antisecretory drugs, antidiarrheal drugs, and somatostatin contributes to reducing intestinal losses. Nutritional support is based on parenteral nutrition; however, oral intake and/or enteral nutrition should be introduced as soon as possible. In the chronic phase, the diet should have as few restrictions as possible, and be adapted to the SBS type. Home parenteral nutrition (HPN) should be individualized. Single-lumen catheters are recommended and taurolidine should be used for locking the catheter. The HPN's lipid content must be greater than 1 g/kg per week but not exceed 1 g/kg per day, and omega-6 fatty acids (ω6 FAs) should be reduced. Trace element vials with low doses of manganese should be used. Patients with chronic SBS who require long-term HPN/fluid therapy despite optimized treatment should be considered for teduglutide treatment. All patients require a multidisciplinary approach and specialized follow-up. These recommendations and suggestions regarding nutritional management in SBS patients have direct clinical applicability.


INTRODUCCIÓN: Con el fin de desarrollar recomendaciones basadas en la evidencia y el consenso de expertos para el manejo nutricional de los pacientes con síndrome de intestino corto (SIC), realizamos una búsqueda bibliográfica sistemática utilizando la metodología PRISMA junto a una valoración crítica siguiendo los procedimientos de la escala GRADE. El tratamiento farmacológico con fármacos antisecretores, antidiarreicos y somatostatina contribuye a reducir las pérdidas intestinales. El apoyo nutricional se basa en la nutrición parenteral; sin embargo, la ingesta oral y/o la nutrición enteral deben introducirse lo antes posible. En la fase crónica, la dieta debe tener las menores restricciones posibles y adaptarse al tipo de SIC. La nutrición parenteral domiciliaria (NPD) debe individualizarse. Se recomiendan catéteres de un solo lumen y se debe utilizar taurolidina para bloquear el catéter. El contenido de lípidos de la HPN debe ser superior a 1 g/kg por semana, pero no debe exceder 1 g/kg por día, y debe reducirse el ácido graso omega-6 (AG ω6). Deben utilizarse viales de oligoelementos con dosis bajas de manganeso. Los pacientes con SIC crónico que requieren NPD/fluidoterapia a largo plazo a pesar del tratamiento optimizado deben considerarse para el tratamiento con teduglutida. Todos los pacientes requieren un abordaje multidisciplinar y un seguimiento especializado. Estas recomendaciones y sugerencias con respecto al manejo nutricional de los pacientes con SIC tienen aplicabilidad clínica directa.


Assuntos
Consenso , Nutrição Parenteral/normas , Síndrome do Intestino Curto/dietoterapia , Adulto , Prática Clínica Baseada em Evidências/métodos , Humanos , Nutrição Parenteral/métodos , Nutrição Parenteral/tendências
2.
Nutrients ; 12(3)2020 Mar 08.
Artigo em Inglês | MEDLINE | ID: mdl-32182654

RESUMO

Parenteral nutrition has evolved tremendously, with parenteral formulas now safer and more accessible than ever. "All-in-one" admixtures are now available, which simplify parenteral nutrition usage and decrease line infection rates alongside other methods of infectious control. Recently published data on the benefits of parenteral nutrition versus enteral nutrition together with the widespread use of indirect calorimetry solve many safety issues that have emerged over the years. All these advances, alongside a better understanding of glycemic control and lipid and protein formulation improvements, make parenteral nutrition a safe alternative to enteral nutrition.


Assuntos
Ciências da Nutrição/tendências , Nutrição Parenteral/tendências , Calorimetria Indireta/tendências , Nutrição Enteral/tendências , Alimentos Formulados , Humanos
4.
Physiol Res ; 68(4): 681-688, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31177800

RESUMO

Parenteral nutrition-associated liver disease (PNALD) is a severe complication in patients completely dependent on parenteral nutrition (PN). The gold diagnostic standard, liver biopsy, is associated with significant health risk and therefore its use is limited. MicroRNAs (miRNAs) are small non-coding regulatory RNA molecules with highly tissue-specific expression and the secreted miRNAs may serve as non-invasive diagnostic biomarkers. The aim of this study was to evaluate the expression of a panel of specific miRNAs associated with liver diseases of different origin in PN-dependent adult patients in order to design miRNA panel enabling to precise monitoring of PNALD progression. Twelve PN-dependent patients with short bowel syndrome (SBS) were monitored on three/four-month basis for up to 24 months. Forty-five age- and sex-matched subjects without any known liver pathology served as controls. Specific miRNAs expression was determined by RT-qPCR using TaqMan probes (Thermofisher). Liver function test parameters were determined in certified clinical laboratories. Six of the tested miRNAs exhibited significantly altered expression compared with healthy controls, three of them (MIR122, MIR1273g, and MIR500a) were upregulated while three were down-regulated (MIR505, MIR199a, MIR139). MIR122 positively correlated with serum AST and ALT activities while MIR1273g positively correlated with serum CRP concentration and GGT activity. MIR505, MIR199a, and MIR139 negatively correlated with serum GGT activity. Fluctuation of these parameters well paralleled serum miRNA concentrations in all patients throughout the whole observation period. We identified six miRNAs whose serum concentrations are significantly altered in PN-dependent patients with PNALD and correlate with markers of inflammation, cholestasis or hepatic injury. Their reliability as markers of PNALD progression needs to be further evaluated.


Assuntos
Hepatopatias/sangue , Hepatopatias/etiologia , MicroRNAs/sangue , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/tendências , Adulto , Idoso , Biomarcadores/sangue , Estudos de Coortes , Feminino , Humanos , Hepatopatias/diagnóstico , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Crit Care ; 23(1): 105, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30940173

RESUMO

BACKGROUND: Underfeeding in critical illness is common and associated with poor outcomes. According to large prospective hospital studies, volume-based feeding (VBF) safely and effectively improves energy and protein delivery to critically ill patients compared to traditional rate-based feeding (RBF) and might improve patient outcomes. A before-and-after study was designed to evaluate the safety, efficacy and clinical outcomes associated with VBF compared to RBF in a single intensive care unit (ICU). METHODS: The sample included consecutively admitted critically ill adults, mechanically ventilated for at least 72 h and fed enterally for a minimum of 48 h. The first cohort (n = 46) was fed using RBF, the second (n = 46) using VBF, and observed for 7 days, or until extubation or death. Statistical comparison of percentage feed volume, energy and protein delivered, plus indices of feed intolerance, were the primary outcomes of interest. Secondary observations included ventilation period, mortality, and length of ICU stay (LOICUS). RESULTS: Groups were comparable in baseline clinical and demographic characteristics and nutrition practices. Volume delivered to the VBF group increased significantly by 11.2% (p ≤ 0.001), energy by 13.4% (p ≤ 0.001) and protein by 8.4% (p = 0.02), compared to the RBF group. In the VBF group, patients meeting > 90% of energy requirements increased significantly from 47.8 to 84.8% (p ≤ 0.001); those meeting > 90% of protein requirements changed from 56.5 to 73.9% (p = 0.134). VBF did not increase symptoms of feed intolerance. Adjusted binomial logistic regression found each additional 1% of prescribed feed delivered decreased the odds of vomiting by 0.942 (5.8%), 95% CI [0.900-0.985], p = 0.010. No differences in mortality or LOICUS were identified. Kaplan-Meier found a significantly increased extubation rate in patients receiving > 90% of protein requirements compared to those meeting < 80%, (p = 0.006). Adjusted Cox regression found the daily probability of being extubated tripled in patients receiving > 90% of their protein needs compared to the group receiving < 80%, hazard ratio 3.473, p = 0.021, 95% CI [1.205-10.014]. CONCLUSION: VBF safely and effectively increased the delivery of energy and protein to critically ill patients. Increased protein delivery may improve extubation rate which has positive patient-centred and financial implications, warranting larger confirmatory trials. This investigation adds weight to the ICU literature supporting VBF, and the growing evidence which advocates for enhanced protein delivery to improve patient outcomes.


Assuntos
Alimentos Formulados/normas , Nutrição Parenteral/métodos , Segurança do Paciente/normas , Idoso , Idoso de 80 Anos ou mais , Estado Terminal/terapia , Ingestão de Energia/fisiologia , Feminino , Alimentos Formulados/estatística & dados numéricos , Humanos , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Necessidades Nutricionais/fisiologia , Nutrição Parenteral/tendências , Segurança do Paciente/estatística & dados numéricos , Estudos Prospectivos , Respiração Artificial/métodos
6.
Nutrition ; 59: 188-194, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30529820

RESUMO

Since the early 1990s enteral nutrition (EN) has been considered the optimal route of feeding rather than parenteral nutrition (PN), which was considered harmful in critically ill patients with intense inflammation. The aim of this review was to summarize recent developments and progress in PN, which have changed the view on this feeding technique. PubMed and personal databases were searched for studies and reviews reporting historical development of PN, and for clinical trials conducted after 2010 investigating PN in critical illness, comparing it to EN or not. Trials from the past decade have explored modalities and timing of artificial feeding. Trials based on equation-estimated energy targets and applying an early full feeding strategy have generally had negative results in terms of complications (infections, prolonged ventilation, and intestinal complications with EN). The few trials that based their targets on measured energy targets have achieved reduction of complications regardless of the route. Opposing enteral and parenteral feeding is no longer rational in the critical care setting. A pragmatic and reasonable approach offers better options for the individual patient. Although PN is simpler to deliver than EN, its metabolic consequences are more complicated to handle. A combination of both techniques may be a more reasonable approach in the sickest patients.


Assuntos
Cuidados Críticos/tendências , Estado Terminal/terapia , Unidades de Terapia Intensiva , Nutrição Parenteral/tendências , Humanos
7.
Mil Med ; 183(suppl_2): 153-160, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30189073

RESUMO

The purpose of this Clinical Practice Guideline is to provide an approach for optimal nutritional support in the postinjury period for those injured in combat. Indications and contraindications for enteral and parenteral nutrition are addressed. Timing of nutritional support, nutritional goals, energy requirements, and ideal formula selection for various types of traumatic injuries are addressed. Challenges encountered providing nutrional support for the traumatically injured in the deployed environment are also discussed.


Assuntos
Nutrição Enteral/métodos , Nutrição Parenteral/métodos , Estado Terminal , Nutrição Enteral/tendências , Guias como Assunto , Humanos , Necessidades Nutricionais/fisiologia , Apoio Nutricional/tendências , Nutrição Parenteral/tendências , Fatores de Tempo
8.
Drug Dev Ind Pharm ; 44(10): 1565-1571, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-29863908

RESUMO

Excipients form a major component of pharmaceutical formulations and are classified as any ingredient other than the active ingredient which is included within the product formulation to improve drug product performance. Functional uses of excipients include improving solubility and stability, safety and efficacy, as bulking agents in lyophilized formulations, tonicity agents, and aiding in controlled or prolonged drug delivery. Parenteral formulations are sterile, pyrogen-free; free of particulate matter and by-pass the body's natural defense mechanisms. Excipients may demonstrate a synergistic effect when combined with an active ingredient but may also lead to unwanted reactions with the drugs and packaging components. Ideal excipients are required to be considered safe, inert and multifunctional. Contrary to the past, safety of excipients needs to be well established in order for their use in the pharmaceutical formulations. Therefore, careful consideration should be given while selecting an excipient. This review article provides an overview of the excipients used exclusively in small molecule and biological parenteral products including solutions, suspensions, and lyophilized formulations, information on the possible drug-excipient and drug-packaging interactions and the regulatory requirements for the use of pharmaceutical excipients. The readers will be able to have a comprehensive understanding of the excipients used in parenteral formulations.


Assuntos
Produtos Biológicos/química , Excipientes/química , Nutrição Parenteral , Animais , Produtos Biológicos/metabolismo , Composição de Medicamentos/métodos , Interações Medicamentosas/fisiologia , Excipientes/metabolismo , Liofilização/métodos , Humanos , Nutrição Parenteral/tendências
9.
Pediatrics ; 141(4)2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29496904

RESUMO

BACKGROUND AND OBJECTIVES: Iodine is an essential trace element for maintenance of normal thyroid function. Normal thyroid function is a prerequisite for neurocognitive development and growth in children. In the United States, iodine is not routinely added as a trace element in parenteral nutrition (PN). Our objective was to determine the prevalence of iodine deficiency and hypothyroidism in children on chronic PN. METHODS: This was a cross-sectional study of children <17 years of age and using PN for >6 months at a tertiary children's hospital. Primary outcomes were spot urine iodine concentration (UIC), serum thyrotropin, and free thyroxine levels. RESULTS: Twenty-seven patients were identified (74% male). The median age at screening was 48 months (range: 7-213 months). The median duration on PN was 27 months (range: 11-77 months). Seventeen out of 20 patients (85%) were iodine deficient (spot UIC <100 µg/L), whereas 11 out of 20 patients (55%) were severely iodine deficient (spot UIC <20 µg/L). The prevalence of acquired hypothyroidism (elevated thyrotropin, low free thyroxine, and UIC <100 µg/L) was 33% (n = 8). None of the children with hypothyroidism screened for autoimmune thyroiditis had positive test results. There was no statistically significant association between duration of PN use and development of iodine deficiency (P = .08) or hypothyroidism (P = .96). CONCLUSIONS: Children on chronic PN are at risk for developing iodine deficiency and resultant hypothyroidism; hence, these children should be screened for these outcomes. Further studies are needed to define the temporal onset of iodine deficiency and timing to thyroid dysfunction related to PN.


Assuntos
Hipotireoidismo/diagnóstico , Hipotireoidismo/urina , Iodo/deficiência , Iodo/urina , Nutrição Parenteral/tendências , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Hipotireoidismo/etiologia , Masculino , Nutrição Parenteral/efeitos adversos , Testes de Função Tireóidea/tendências
11.
Crit Care ; 21(1): 142, 2017 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-28599676

RESUMO

BACKGROUND: Nutrition guidelines recommendations differ on the use of parenteral nutrition (PN), and existing clinical trial data are inconclusive. Our recent observational data show that amounts of energy/protein received early in the intensive care unit (ICU) affect patient mortality, particularly for inadequate nutrition intake in patients with body mass indices (BMIs) of <25 or >35. Thus, we hypothesized increased nutrition delivery via supplemental PN (SPN) + enteral nutrition (EN) to underweight and obese ICU patients would improve 60-day survival and quality of life (QoL) versus usual care (EN alone). METHODS: In this multicenter, randomized, controlled pilot trial completed in 11 centers across four countries, adult ICU patients with acute respiratory failure expected to require mechanical ventilation for >72 hours and with a BMI of <25 or ≥35 were randomized to receive EN alone or SPN + EN to reach 100% of their prescribed nutrition goal for 7 days after randomization. The primary aim of this pilot trial was to achieve a 30% improvement in nutrition delivery. RESULTS: In total, 125 patients were enrolled. Over the first 7 post-randomization ICU days, patients in the SPN + EN arm had a 26% increase in delivered calories and protein, whereas patients in the EN-alone arm had a 22% increase (both p < 0.001). Surgical ICU patients received poorer EN nutrition delivery and had a significantly greater increase in calorie and protein delivery when receiving SPN versus medical ICU patients. SPN proved feasible to deliver with our prescribed protocol. In this pilot trial, no significant outcome differences were observed between groups, including no difference in infection risk. Potential, although statistically insignificant, trends of reduced hospital mortality and improved discharge functional outcomes and QoL outcomes in the SPN + EN group versus the EN-alone group were observed. CONCLUSIONS: Provision of SPN + EN significantly increased calorie/protein delivery over the first week of ICU residence versus EN alone. This was achieved with no increased infection risk. Given feasibility and consistent encouraging trends in hospital mortality, QoL, and functional endpoints, a full-scale trial of SPN powered to assess these clinical outcome endpoints in high-nutritional-risk ICU patients is indicated-potentially focusing on the more poorly EN-fed surgical ICU setting. TRIAL REGISTRATION: NCT01206166.


Assuntos
Sobrepeso/dietoterapia , Nutrição Parenteral/normas , Magreza/dietoterapia , Adulto , Idoso , Índice de Massa Corporal , Distribuição de Qui-Quadrado , Estado Terminal/terapia , Ingestão de Energia/fisiologia , Feminino , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral/métodos , Nutrição Parenteral/tendências , Projetos Piloto , Fatores de Tempo
12.
Anesthesiol Clin ; 35(2): 181-190, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28526141

RESUMO

Appropriate nutrition in the hospital setting, particularly in critically ill patients, has long been tied to improving clinical outcomes. During critical illness, inflammatory mediators and cytokines lead to the creation of a catabolic state to facilitate the use of endogenous energy sources to meet increased energy demands. This process results in increasing the likelihood of overfeeding. The literature has revealed exponential advances in understanding the molecular basis of nutritional support 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 critically ill.


Assuntos
Estado Terminal , Nutrição Enteral/tendências , Unidades de Terapia Intensiva , Nutrição Parenteral/tendências , Interações Medicamentosas , Ingestão de Energia , Nutrição Enteral/efeitos adversos , Humanos , Nutrição Parenteral/efeitos adversos
13.
Nutr Clin Pract ; 32(4): 508-515, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28358595

RESUMO

BACKGROUND: An enterocutaneous fistula (ECF) is an aberrant connection between the gastrointestinal tract and the skin or atmosphere (enteroatmospheric fistula [EAF]). Multimodal treatment includes surgical procedures, nutrition support, and wound care. We evaluated our practice and compared our outcomes with previous results published from our institution. MATERIALS AND METHODS: We performed a retrospective analysis of hospitalized ECF/EAF patients admitted between January 2011 and November 2015. Patients with internal fistulas; active inflammatory bowel disease; malignancy; radiation treatment; end-stage renal, hepatic, or cardiac disease; and active alcoholism were excluded. Data collected included demographics, fistula characteristics, nutrition therapy, treatment, operative success, and hospital mortality. Parametric and nonparametric tests for independent and paired groups were performed. RESULTS: Thirty-one patients were included in the analysis. The median (interquartile range) age was 60 (53-76) years, and 81% were female. Parenteral nutrition was initially prescribed in 80% of patients, but 61% received enteral nutrition (EN) at some point during their hospitalization. Two patients were fed by fistuloclysis. Eighty percent of the patients underwent surgical repair a median of 12 months after diagnosis with 92% operative success. Surgical repair had a modest correlation with home discharge (ρ = 0.517, P = .003). A large proportion of patients (77%) were discharged home. The in-hospital mortality at our institution decreased from 44% in 1960 to 21% in 1970 to 3% in the current study. CONCLUSIONS: Modern treatment of ECF/EAF, including EN and advanced local wound care, is associated with improvements in clinical outcomes such as hospital mortality.


Assuntos
Nutrição Enteral/tendências , Fístula Intestinal/terapia , Nutrição Parenteral/tendências , Idoso , Feminino , Seguimentos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Cicatrização
14.
Crit Care ; 20(1): 361, 2016 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-27829456

RESUMO

Glutamine has been launched as a conditionally indispensible amino acid for the critically ill. Supplementation has been recommended in guidelines from international societies. Although data have been presented pointing out that glutamine supplementation may not be for everybody, recommendations for treatments and design of study protocols have included all critically ill patients. Results from more recent studies and meta-analyses indicate that indiscriminate use of glutamine supplementation in critically ill patients may actually cause harm rather than beneficial effects. This viewpoint sorts out arguments of controversy in the glutamine story.


Assuntos
Estado Terminal/terapia , Suplementos Nutricionais , Glutamina/administração & dosagem , Glutamina/sangue , Humanos , Nutrição Parenteral/métodos , Nutrição Parenteral/tendências
15.
World J Pediatr ; 12(4): 450-454, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27286688

RESUMO

BACKGROUND: Most of the evidence on early feeding of preterm infants was derived from high income settings, it is equally important to evaluate whether it can be successfully implemented into less resourced settings. This study aimed to compare growth and feeding of preterm infants before and after the introduction of a new aggressive feeding policy in Penang Hospital, a tertiary referral hospital in a middle income country. METHODS: The new aggressive feeding policy was developed mainly from Cochrane review evidence, using early parenteral and enteral nutrition with standardized breastfeeding counselling aimed at empowering mothers to provide early expressed milk. A total of 80 preterm babies (34 weeks and below) discharged from NICU were included (40 pre- and 40 post-intervention). Pre and post-intervention data were compared. The primary outcome was growth at day 7, 14, 21 and at discharge and secondary outcomes were time to full oral feeding, breastfeeding rates, and adverse events. RESULTS: Complete data were available for all babies to discharge. One baby was discharged prior to day 14 and 10 babies before day 21, so growth data for these babies were unavailable. Baseline data were similar in the two groups. There was no significant weight difference at 7, 14, 21 days and at discharge. More post-intervention babies were breastfed at discharge than pre-intervention babies (21 vs. 8, P=0.005). Nosocomial infection (11 vs. 4, P=0.045), and blood transfusion were significantly lower in the postintervention babies than in the pre-intervention babies (31 vs. 13, P=0.01). The post-intervention babies were more likely to achieve shorter median days (interquartile range) to full oral feeding [11 (6) days vs. 13 (11) days, P=0.058] and with lower number affecting necrotising enterocolitis (0 vs. 5, P=0.055). CONCLUSION: Early aggressive parenteral nutrition and early provision of mother's milk did not result in improved growth as evidenced by weight gain at discharge. However we found more breastfeeding babies, lower nosocomial infection and transfusion rates. Our findings suggest that implementing a more aggressive feeding policy supported by high level scientific evidence is able to improve important outcomes.


Assuntos
Aleitamento Materno/tendências , Recém-Nascido Prematuro/crescimento & desenvolvimento , Política Nutricional , Avaliação de Resultados em Cuidados de Saúde , Nutrição Parenteral/normas , Distribuição de Qui-Quadrado , Estudos de Coortes , Países em Desenvolvimento , Feminino , Seguimentos , Idade Gestacional , Humanos , Fenômenos Fisiológicos da Nutrição do Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Malásia , Masculino , Nutrição Parenteral/tendências , Alta do Paciente , Formulação de Políticas , Gravidez , Estudos Retrospectivos , Estatísticas não Paramétricas , Centros de Atenção Terciária
16.
World J Gastroenterol ; 22(3): 1045-66, 2016 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-26811646

RESUMO

Inflammatory bowel diseases (IBD), including ulcerative colitis and Crohn's disease are chronic, life-long, and relapsing diseases of the gastrointestinal tract. Currently, there are no complete cure possibilities, but combined pharmacological and nutritional therapy may induce remission of the disease. Malnutrition and specific nutritional deficiencies are frequent among IBD patients, so the majority of them need nutritional treatment, which not only improves the state of nutrition of the patients but has strong anti-inflammatory activity as well. Moreover, some nutrients, from early stages of life are suspected as triggering factors in the etiopathogenesis of IBD. Both parenteral and enteral nutrition is used in IBD therapy, but their practical utility in different populations and in different countries is not clearly established, and there are sometimes conflicting theories concerning the role of nutrition in IBD. This review presents the actual data from research studies on the influence of nutrition on the etiopathogenesis of IBD and the latest findings regarding its mechanisms of action. The use of both parenteral and enteral nutrition as therapeutic methods in induction and maintenance therapy in IBD treatment is also extensively discussed. Comparison of the latest research data, scientific theories concerning the role of nutrition in IBD, and different opinions about them are also presented and discussed. Additionally, some potential future perspectives for nutritional therapy are highlighted.


Assuntos
Colite Ulcerativa/terapia , Doença de Crohn/terapia , Nutrição Enteral , Nutrição Parenteral , Composição Corporal , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/etiologia , Colite Ulcerativa/fisiopatologia , Doença de Crohn/diagnóstico , Doença de Crohn/etiologia , Doença de Crohn/fisiopatologia , Dieta/efeitos adversos , Difusão de Inovações , Nutrição Enteral/efeitos adversos , Nutrição Enteral/tendências , Humanos , Estado Nutricional , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/tendências , Fatores de Risco , Resultado do Tratamento
17.
Am J Clin Nutr ; 103(2): 622S-8S, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26791178

RESUMO

Neonatal dysphagia, or abnormalities of swallowing, represent a major global problem, and consequences of dysfunctional feeding patterns carry over into infancy and toddler age groups. Growth, development, and independent feeding skills are all delayed among high-risk infants. Such a group comprises premature birth, low-birth-weight, congenital anomalies, perinatal asphyxia, postsurgical, and sepsis categories. The conflict between pathophysiologic and pragmatic feeding strategies remains a major conundrum and is largely due to a lack of validated diagnostic approaches amid heterogeneity of the patient phenotype. Thus, well-tested feeding management strategies that can be generalizable are lacking. Furthermore, the aerodigestive symptoms and signs, potential risk factors, and contributory etiologies remain nonspecific. This article presents mechanistic evidence related to the pathophysiologic basis of neonatal dysphagia as well as potential opportunities to improve feeding abilities and long-term development.


Assuntos
Desenvolvimento Infantil , Transtornos de Deglutição/etiologia , Trato Gastrointestinal/fisiopatologia , Fenômenos Fisiológicos da Nutrição do Lactente , Neurogênese , Medicina de Precisão , Nascimento Prematuro/fisiopatologia , Terapia Combinada/tendências , Congressos como Assunto , Transtornos de Deglutição/diagnóstico , Transtornos de Deglutição/epidemiologia , Transtornos de Deglutição/terapia , Nutrição Enteral/tendências , Trato Gastrointestinal/crescimento & desenvolvimento , Trato Gastrointestinal/fisiologia , Humanos , Recém-Nascido de Baixo Peso , Recém-Nascido , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/tendências , Guias de Prática Clínica como Assunto , Nascimento Prematuro/dietoterapia , Nascimento Prematuro/terapia , Prevalência , Fatores de Risco
18.
Am J Clin Nutr ; 103(2): 599S-605S, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26791179

RESUMO

Preterm birth (infants born at <37 wk of gestational age) is a significant clinical and public health challenge in the United States and globally. No universally accepted practice guidelines exist for the nutritional care of preterm infants. To address the current state of knowledge and to support systematic reviews that will be used to develop evidence-informed guidance, a consortium consisting of the American Academy of Pediatrics, the ASN, the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, the Food and Drug Administration, the CDC, the USDA/Agricultural Research Service (USDA/ARS), and the Eunice Kennedy Shriver National Institute of Child Health and Human Development/NIH initiated the Pre-B Project. The project included the constitution of 4 thematic working groups charged with the following tasks: 1) develop a series of topics/questions for which there is sufficient evidence to support a systematic review process to be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL), leading to the development of new guidelines for nutritional care of preterm infants, and 2) develop a targeted research agenda to address priority gaps in our understanding of the role of nutrition in the health and development of preterm/neonatal intensive care unit infants. This review consists of a project overview including a summary of a workshop hosted by the USDA/ARS Children's Nutrition Research Center and summary reports of the 4 working groups established to address the following themes: 1) nutrient specifications, 2) clinical/practical issues in enteral feeding, 3) gastrointestinal and surgical issues, and 4) current standards for assessing infant feeding outcomes. These reports will serve as the basis for the ultimate guideline development process to be conducted by the Academy of Nutrition and Dietetics' EAL.


Assuntos
Nutrição Enteral , Medicina Baseada em Evidências , Fenômenos Fisiológicos da Nutrição do Lactente , Nascimento Prematuro/dietoterapia , Centers for Disease Control and Prevention, U.S. , Ciências da Nutrição Infantil/tendências , Congressos como Assunto , Nutrição Enteral/tendências , Assistência Alimentar , Humanos , Fórmulas Infantis/química , Fórmulas Infantis/metabolismo , Fórmulas Infantis/normas , Recém-Nascido , Leite Humano/química , Leite Humano/metabolismo , National Institute of Child Health and Human Development (U.S.) , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/tendências , Pediatria/tendências , Guias de Prática Clínica como Assunto , Nascimento Prematuro/metabolismo , Nascimento Prematuro/fisiopatologia , Nascimento Prematuro/terapia , Sociedades Médicas , Sociedades Científicas , Estados Unidos , United States Department of Agriculture , United States Food and Drug Administration
19.
Am J Clin Nutr ; 103(2): 648S-78S, 2016 02.
Artigo em Inglês | MEDLINE | ID: mdl-26791182

RESUMO

The "Evaluation of the Evidence to Support Practice Guidelines for the Nutritional Care of Preterm Infants: The Pre-B Project" is the first phase in a process to present the current state of knowledge and to support the development of evidence-informed guidance for the nutritional care of preterm and high-risk newborn infants. The future systematic reviews that will ultimately provide the underpinning for guideline development will be conducted by the Academy of Nutrition and Dietetics' Evidence Analysis Library (EAL). To accomplish the objectives of this first phase, the Pre-B Project organizers established 4 working groups (WGs) to address the following themes: 1) nutrient specifications for preterm infants, 2) clinical and practical issues in enteral feeding of preterm infants, 3) gastrointestinal and surgical issues, and 4) current standards of infant feeding. Each WG was asked to 1) develop a series of topics relevant to their respective themes, 2) identify questions for which there is sufficient evidence to support a systematic review process conducted by the EAL, and 3) develop a research agenda to address priority gaps in our understanding of the role of nutrition in health and development of preterm/neonatal intensive care unit infants. This article is a summary of the reports from the 4 Pre-B WGs.


Assuntos
Nutrição Enteral , Medicina Baseada em Evidências , Transtornos do Crescimento/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Nutrição Parenteral , Medicina de Precisão , Nascimento Prematuro/terapia , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Ciências da Nutrição Infantil/educação , Ciências da Nutrição Infantil/métodos , Ciências da Nutrição Infantil/tendências , Terapia Combinada/efeitos adversos , Terapia Combinada/tendências , Congressos como Assunto , Nutrição Enteral/tendências , Transtornos do Crescimento/etiologia , Prioridades em Saúde , Humanos , Recém-Nascido , Necessidades Nutricionais , Nutrição Parenteral/efeitos adversos , Nutrição Parenteral/tendências , Guias de Prática Clínica como Assunto , Nascimento Prematuro/dietoterapia , Nascimento Prematuro/fisiopatologia
20.
Am J Clin Nutr ; 103(2): 629S-34S, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26791189

RESUMO

Long-term parenteral nutrition (PN) carries the risk of progressive liver disease in infants with intestinal failure. Although PN-associated liver disease (PNALD) is multifactorial in etiology, components of soybean oil lipid emulsions have been implicated in the disease's pathogenesis. Historically, infants with PNALD who were unable to wean from PN to full enteral feeding developed cirrhosis and end-stage liver disease, which require liver transplantation to survive. Over the past 2 decades, novel strategies for the management of parenteral lipids have improved morbidity and mortality from PNALD in infants with intestinal failure. Current strategies for the treatment of PNALD include restricting the dose of parenteral soybean oil lipid emulsion and/or replacing the soybean oil with a parenteral fish-oil lipid emulsion or emulsions of mixed-lipid sources. The purpose of this report is to review published data that evaluate these strategies in parenteral lipid management for the treatment and prevention of PNALD.


Assuntos
Medicina Baseada em Evidências , Emulsões Gordurosas Intravenosas/uso terapêutico , Insuficiência Hepática/prevenção & controle , Fenômenos Fisiológicos da Nutrição do Lactente , Enteropatias/terapia , Nutrição Parenteral/efeitos adversos , Medicina de Precisão , Pré-Escolar , Terapia Combinada/efeitos adversos , Terapia Combinada/tendências , Emulsões Gordurosas Intravenosas/efeitos adversos , Óleos de Peixe/administração & dosagem , Óleos de Peixe/efeitos adversos , Óleos de Peixe/uso terapêutico , Insuficiência Hepática/etiologia , Insuficiência Hepática/terapia , Humanos , Lactente , Recém-Nascido , Enteropatias/etiologia , Enteropatias/fisiopatologia , Nutrição Parenteral/tendências , Nascimento Prematuro/fisiopatologia , Nascimento Prematuro/terapia , Óleo de Soja/administração & dosagem , Óleo de Soja/efeitos adversos , Óleo de Soja/uso terapêutico
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