Frequency and Related Risk Factors of Refeeding Hypophosphatemia in Patients with Liver Cirrhosis: A Pilot Study.

BACKGROUND AND AIM: Refeeding hypophosphatemia (RH) is associated with poor clinical outcomes and mortality. The presence of RH in patients with liver cirrhosis remains unclear. This study aims to determine the frequency of RH related to nutritional status and disease severity in liver cirrhosis. METHODS: This study was prospectively conducted in a-single center gastroenterology clinic. Malnutrition was identified by Subjective Global Assessment (SGA). The disease severity was defined using Child score and MELD score. Serum phosphate levels <2.0 mg/dl are defined as hypophosphatemia. RESULTS: Twelve of 50 cirrhotic patients (24%) had RH during hospitalization. The most common RH was determined in 4 patients on day 4 during study follow up. The sharpest decline of serum phosphate levels was on day 4 (median: 2.3mg/dL). The Child score and MELD score were not significantly different between RH and Non-RH groups (p>0.05). The rate of malnutrition according to SGA was 56.0%. A total of 82%, 4%, 8%, and 4% of participants received regular diet and oral nutritional supplements, only enteral tube feeding, only parenteral nutrition, and combined enteral and parenteral nutrition, respectively. In the RH group, 32% of participants received only parenteral nutrition and had a higher presence of RH than patients receiving only oral or enteral tube feding (p<0.05). CONCLUSIONS: RH developed in » of the study participants. This study also showed that artificial feeding carries a significant risk in terms of RH. Malnourished patients with liver cirrhosis receiving parenteral nutrition, closely monitored regarding high risk of RH.

Gut barrier protein levels in serial blood samples from critically ill trauma patients during and after intensive care unit stay.

PURPOSE: In an effort to better manage critically ill patients hospitalised in the intensive care unit (ICU) after experiencing multiple traumas, the present study aimed to assess whether plasma levels of intestinal epithelial cell barrier proteins, including occludin, claudin-1, junctional adhesion molecule (JAM-1), tricellulin and zonulin, could be used as novel biomarkers. Additional potential markers such as intestinal fatty acid-binding protein (I-FABP), D-lactate, lipopolysaccharide (LPS) and citrulline were also evaluated. We also aimed to determine the possible relationships between the clinical, laboratory, and nutritional status of patients and the measured marker levels. METHODS: Plasma samples from 29 patients (first, second, fifth and tenth days in the ICU and on days 7, 30 and 60 after hospital discharge) and 23 controls were subjected to commercial enzyme-linked immunosorbent assay (ELISA) testing. RESULTS: On first day (admission) and on the second day, plasma I-FABP, D-lactate, citrulline, occludin, claudin-1, tricellulin and zonulin levels were high in trauma patients and positively correlated with lactate, C-reactive protein (CRP), number of days of ICU hospitalisation, Acute Physiology and Chronic Health Evaluation II (APACHE II) score and daily Sequential Organ Failure Assessment (SOFA) scores (P < 0.05-P < 0.01). CONCLUSION: The results of the present study showed that occludin, claudin-1, tricellulin and zonulin proteins, as well as I-FABP, D-lactate and citrulline, may be used as promising biomarkers for the evaluation of disease severity in critically ill trauma patients, despite the complexity of the analysis of various barrier markers. However, our results should be supported by future studies.

Evaluation of refeeding hypophosphatemia frequency, risk factors, and nutritional status during stem cell transplantation in patients with hematologic malignancy.

BACKGROUND: Refeeding Hypophosphatemia (RH) occurs with feeding after an extended period of not feeding. Hematological Stem Cell Transplantation (HSCT) is one of the effective methods for hematologic malignancy. Nutritional disorders are frequently observed in hematologic malignancies due to the disease's pathology and the treatment's effect. The study aims to determine the influencing factors by determining the frequency of RH in patients treated with HSCT. METHODS: The study was conducted prospectively and randomly with 50 patients treated with HSCT for the first time. The study followed patients for 22 days, seven days before, and 14 days after. During the follow-up, data such as Scored Patient-Generated Subjective Global Assessment (PG-SGA), weight changes, nausea, vomiting, diarrhea, mucositis, infection and Graft Versus Host Disease development, need for intensive care, and 12-month mortality were recorded. RH states were evaluated during treatment. RESULTS: RH developed in 78% of patients treated with HSCT. Pre-transplantation PGSGA score, frequency of vomiting, and development of infection were higher in patients with RH (p < 0.05). The patients had a mean weight loss of 2.9% after transplantation. Pre-transplantation, 88% of patients were well-nourished (PGSGA 0-3), post-transplantation, 70% of patients were moderately undernourished (PGSGA 4-8), and 30% were severely malnourished (PGSGA ≥ 9). While total protein and albumin decreased after transplantation, CRP increased (p < 0.05). According to multivariate logistic regression analysis, infection (95% CI: 1.375-61.379, p = 0.022) and pre-transplant PGSGA (95% CI: 1.035-45.454, p = 0.046) independently affect RH development. CONCLUSIONS: RH was detected at a high rate in patients treated with HSCT. Elevated risk of malnutrition before transplantation, frequency of vomiting, and development of infection were determined as factors affecting RH development.

Enteral nutrition interruptions in critically ill patients: A prospective study on reasons, frequency and duration of interruptions of nutritional support during ICU stay.

BACKGROUND & AIMS: Enteral Nutrition (EN) may be interrupted due to various reasons in the setting of intensive care unit (ICU) care. This study aimed to investigate the reasons, frequency, and duration of EN interruptions in critically ill patients within the first 7 days of ICU stay. METHODS: A total of 122 critically ill patients (median age: 63 years, 57% were males) initiating EN within the first 72 h of ICU admission and continued EN for at least 48 h during ICU stay were included in this observational prospective study conducted at a Medical ICU. Patients were followed for hourly energy intake as well as the frequency, reason, and duration of EN interruptions, for the first seven nutrition days of ICU stay or until death/discharge from ICU. RESULTS: The median APACHE II score was 22 (IQR, 17-27). The per patient EN interruption frequency was 2.74 and the median total EN interruption duration was 960 (IQR, 105-1950) minutes. The most common reason for EN interruption was radiological procedures (91 episodes) and the longest duration of EN interruption was due to tube malfunctions (1230 min). Target energy intake were achieved on the 6th day at a maximum rate of 89.4%. Logistic regression showed that there was relationship between increased mortality and patients with ≥3 EN interruptions (OR: 6.73 (2.15-30.55), p = 0.004) after adjusting for confounding variables (age and APACHE II score). According to Kaplan Meier analysis, patients with ≥3 EN interruptions had significantly lower median survival times than patients with <3 EN interruptions (24.0 (95% CI 8.5-39.5) vs 18.0 (95% CI 13-23) days, p = 0.014). CONCLUSION: During the first week of EN support, the most common reason of EN interruptions was related to radiological procedures and the longest EN interruptions was due to feeding tube malfunctions. There was relationship between ≥3 EN interruptions and increased mortality.

Effects of Ramadan fasting on lean body mass in the older people.

PURPOSE: In Islam, Ramadan fasting is a unique model that is associated with the restriction of food and fluid intake. We aimed to estimate the physiological effects of Ramadan fasting on muscle function and muscle mass in the older people. METHODS: A random sample was recruited from healthy older Muslims people aged 60 years and older, who expressed an intention to fast for 30 days during the month of Ramadan. Walking speed was expressed in meters per second (m/s). Muscle strength was assessed by hand grip strength (HGS) with a dynamometer. A Bioelectrical impedance analysis (BIA) device (BodystatQuadScan 1500, UK) was used for the evaluation of body composition. Dietary data of the patients during Ramadan were obtained by a 43-item Food Frequency Questionnaire (FFQ). RESULTS: The mean age [Standard Deviation(SD)] of the older people was 66.7(4.7) years of age and 50% were females. There were no significant changes in body weight, muscle function and muscle mass before and after Ramadan fasting in both genders. The mean SMI, mean (SD) kg/m2, values of females and males with adequate milk and yogurt consumption before and after Ramadan fasting were 8.03 (0.75) kg/m2 and 8.43(1.03) kg/m2 for females (p = 0.133) and 10.11(0.79) kg/m2 and 10.35 (0.93) kg/m2 for males (p = 0.59), respectively. CONCLUSIONS: Ramadan fasting supplied no risk for muscle function and muscle mass in the older people. If the older people consume enough milk and yogurt in Ramadan, they may not loss muscle mass.