Survey of Nutrition Practice in Patients with Severe Sepsis among Canadian Registered Dietitians.

PURPOSE: The purpose of this study was to determine the opinions and reported nutrition practices of Canadian Registered Dietitians (RDs) with regard to feeding patients with severe sepsis. METHODS: In 2017, surveys were sent to 112 eligible Canadian RDs in 10 provinces who were practicing in an intensive care environment. The survey included embedded branching logic questions developed to address major facets of sepsis, critical illness, and nutrition. The survey instrument assimilated all data in an anonymous manner, so respondents could not be linked to their answers. RESULTS: Of the 64 RDs who responded (57% response rate), the majority practiced in adult intensive care (81%), within an academic center (59%), and in a mixed unit (73%). A wide variability of Canadian RDs' opinions and practice was reported in determining energy requirements, enteral nutrition (EN) practice, EN with vasoactive agents, parenteral nutrition (PN), and supplemental micronutrients. CONCLUSIONS: Practice variability of Canadian RDs likely reflects gaps in both evidence and guidelines for severe sepsis. Further research efforts are needed to customize nutritional requirements in the patient with evolving sepsis, EN with patients at high risk for gastrointestinal dysfunction, optimizing PN, and the role of micronutrients.

Does the Subjective Global Assessment Predict Outcome in Critically Ill Medical Patients?

BACKGROUND: The Subjective Global Assessment (SGA) is a validated nutrition assessment tool that is not commonly used to evaluate the nutritional status of patients admitted to the intensive care unit (ICU). OBJECTIVES: The aims of this study were to determine the prevalence of malnutrition in critically ill medical patients using the SGA and to determine whether the SGA was predictive of patient outcome. MATERIALS AND METHODS: A retrospective chart review was performed on 57 consecutive patients admitted to a single tertiary care medical ICU and requiring mechanical ventilation over a 6-month time period. All SGA assessments were performed by a single dietitian trained in this assessment technique. Multiple factors including patient demographics, severity of illness, length of mechanical ventilation, length of ICU stay, and mortality were abstracted from the charts. RESULTS: The prevalence of malnutrition on admission as assessed by the SGA was 35%. Severity of illness as determined by Acute Physiology and Chronic Health Evaluation II (APACHE II) score was not different between the SGA groups. Mortality rates were significantly higher in the moderately (45.5%) and severely malnourished (55.6%) groups than in the well-nourished group (10.8%; P = .004). CONCLUSION: Malnutrition on admission is common in critically ill medical patients. Malnutrition, as assessed by SGA at admission to ICU, is associated with increased mortality and thus can serve as a valuable prognostic tool in the assessment of critically ill patients. Given that that the SGA is a simple bedside assessment, it should be considered for routine use in assessing critically ill patients.

Nutrition assessment of patients with inflammatory bowel disease.

BACKGROUND: Malnutrition among inflammatory bowel disease (IBD) subjects is well documented in the literature and may arise from factors including inadequate dietary intake, malabsorption, and disease activity. The aims of this present study were to complete a comprehensive nutrition assessment of IBD subjects. METHODS: One hundred twenty-six consecutive adults with IBD completed anthropometric measures, 4-day food-record assessments, and biochemical markers of nutrition. RESULTS: A high prevalence of inadequate nutrient consumption was observed: vitamin E (63%), vitamin D (36%), vitamin A (26%), calcium (23%), folate (19%), iron (13%), and vitamin C (11%). Several biochemical deficiencies were also observed. The prevalence of subnormal serum levels was hemoglobin (40%), ferritin (39.2%), vitamin B(6) (29%), carotene (23.4%), vitamin B(12) (18.4%), vitamin D (17.6%), albumin (17.6%), and zinc (15.2%). Dietary intake was not correlated with serum levels in all instances; there was a highly significant correlation between diet and serum values of vitamin B(12), folate, and vitamin B(6) for all IBD subjects, independent of disease activity, and for vitamin D among all IBD subjects in remission. CONCLUSIONS: Subjects with IBD have a high rate of iron deficiency and anemia, which are most likely not secondary to diet. Supplementing with iron should be warranted only if a true iron deficiency exists. The routine evaluation of serum vitamin B(6) and vitamin D levels is recommended. Routine multivitamin supplementation is warranted in IBD in view of numerous dietary and biochemical deficiencies observed among adult IBD subjects. Even if subjects with IBD seem to be well nourished, they may harbor vitamin/mineral deficiencies.

Lack of relationship of calcium and vitamin D intake to bone mineral density in premenopausal women with inflammatory bowel disease.

OBJECTIVES: Low bone mineral density has been widely reported in patients with inflammatory bowel disease (IBD). The exact etiology of this condition is not completely understood but is suggested to be multifactorial, possibly including low calcium and vitamin D intake. The objective of this study was to assess calcium and vitamin D intake and its relationship to bone mineral density (BMD) in premenopausal women with IBD. METHODS: A total of 70 premenopausal women with IBD (mean age 33.3 yr, range 18-44 yr) drawn from the population-based University of Manitoba IBD Research Registry participated in the study. Calcium and vitamin D intake was determined using a semiquantitative food frequency questionnaire and compared to the Dietary Reference Intake values for adequacy. BMD of total body, lumbar spine, femoral neck, and hip was measured using dual-energy x-ray absorptiometry. RESULTS: Of the 70 subjects, 66 successfully completed the study. Inadequate calcium intake (<1000 mg/day) was found in 69.7% of the subjects. This low intake group had a mean calcium intake of 508 mg/day. Inadequate vitamin D intake (<200 IU/day) was found in 53% of the subjects with a mean vitamin D intake of 76 IU/day in this group. Calcium and vitamin D intake correlated with each other with R2=0.57, p<0.00001. Daily calcium intake was not significantly different for subjects with T scores greater than -1 (901 mg) and for subjects with T scores less than -1 (875 mg, p=0.44). Daily vitamin D intake was not significantly different for subjects with T scores greater than -1 (297 IU) compared with subjects with T scores less than -1 was (267 IU, p=0.33). Comparing subjects with T scores greater than -1 to those with T score less than -1, there was no difference in the percentage of subjects ingesting >1 g/day calcium (14/43 vs 8/23, p=0.86) or in those with vitamin D intake >200 IU/day (21/43 vs 9/23, p=0.45). CONCLUSIONS: The results show that, on average, premenopausal women with IBD have less than the recommended intake for calcium and vitamin D. However, this does not seem to influence BMD. Calcium and vitamin D intake is not a predictor of bone status in premenopausal women with IBD.