Impaired glucose tolerance, body mass index and respiratory function in patients with cystic fibrosis: A systematic review.

OBJECTIVES: This systematic review aims to evaluate body mass index (BMI) and forced expiratory volume in one second (FEV1 ) in patients with cystic fibrosis (CF) diagnosed with impaired glucose tolerance (IGT) compared to those with normal glucose tolerance (NGT). The significance of this topic stems from concern that individuals with CF and IGT may have an overall worse clinical status as indicated by BMI and FEV1 . DATA SOURCE: An exhaustive literature search was completed between July 2017 and September 2017 using PubMed, CINAHL, Web of Science, Dissertations & Theses, PsycINFO, and Open Grey. Studies were limited to human subjects with CF. There were no restrictions on publication date, study design or language. STUDY SELECTION: Included studies examined BMI and FEV1 as outcome measures in individuals with CF and IGT compared to those with NGT. After screening for inclusion criteria, 12 observational studies met the specified conditions. RESULTS: Two studies showed a significantly worse BMI and FEV1 in subjects with CF and IGT compared to those with NGT. The remaining 10 studies found no significant associations with BMI and FEV1 in subjects with CF and IGT compared to NGT. CONCLUSION: Although this review does not prove cause and effect, BMI and FEV1 are important outcome measures in patients with CF. Considering the inconclusive findings, practitioners should individualize care for this patient population. Additional research should focus on clinical status and interventions/treatment for individuals with CF and IGT.

Evaluation of Key Factors Impacting Feeding Safety in the Neonatal Intensive Care Unit: A Systematic Review.

BACKGROUND: Individualized feeding care plans and safe handling of milk (human or formula) are critical in promoting growth, immune function, and neurodevelopment in the preterm infant. Feeding errors and disruptions or limitations to feeding processes in the neonatal intensive care unit (NICU) are associated with negative safety events. Feeding errors include contamination of milk and delivery of incorrect or expired milk and may result in adverse gastrointestinal illnesses. PURPOSE: The purpose of this review was to evaluate the effect(s) of centralized milk preparation, use of trained technicians, use of bar code-scanning software, and collaboration between registered dietitians and registered nurses on feeding safety in the NICU. METHODS/SEARCH STRATEGY: A systematic review of the literature was completed, and 12 articles were selected as relevant to search criteria. Study quality was evaluated using the Downs and Black scoring tool. FINDINGS/RESULTS: An evaluation of human studies indicated that the use of centralized milk preparation, trained technicians, bar code-scanning software, and possible registered dietitian involvement decreased feeding-associated error in the NICU. IMPLICATIONS FOR PRACTICE: A state-of-the-art NICU includes a centralized milk preparation area staffed by trained technicians, care supported by bar code-scanning software, and utilization of a registered dietitian to improve patient safety. These resources will provide nurses more time to focus on nursing-specific neonatal care. IMPLICATIONS FOR RESEARCH: Further research is needed to evaluate the impact of factors related to feeding safety in the NICU as well as potential financial benefits of these quality improvement opportunities.

The use of enteral nutrition in the treatment of eating disorders: a systematic review.

PURPOSE: Enteral nutrition (EN) is frequently used in the treatment of anorexia nervosa (AN), and less commonly, bulimia nervosa (BN); yet, no standardized guidelines for treatment exist at this time. The aim of this review is to investigate the efficacy of EN in the treatment of eating disorders and make recommendations for clinical practice and future research. METHODS: An exhaustive literature search of 7 databases was completed. The search strategy combined key terms anorexia nervosa, bulimia, and eating disorders with terms associated with EN. There were no restrictions on publication date or language. Studies that assessed the effect of EN on weight restoration, refeeding syndrome, and binge/purge behaviors in the treatment of AN and BN were included. RESULTS: Of 73 full-text articles reviewed, 22 met inclusion criteria. Nineteen studies reported that significant short-term weight gain was achieved when EN was used for refeeding malnourished AN patients; however, results varied for the six studies reporting on long-term weight gain, maintenance, and recovery. In studies with a comparator, no significant differences were found between the EN and oral refeeding cohorts regarding gastrointestinal disturbance, refeeding syndrome, or electrolyte abnormalities. Five studies examined the effect of EN on binge/purge behaviors, suggesting that temporary exclusive EN decreases the frequency and severity of binge/purge episodes. CONCLUSION: Although EN is an essential life-saving treatment in severe cases of AN, it does not guarantee long-term success or recovery. The results of this systematic review highlight the need for prospective controlled trials with adequate sample sizes to make comparisons between specific feeding methods, formulations, and defined short and long-term outcomes. Evidence-based standards for clinical practice are needed with specific guidelines for best results for AN and BN treatment. LEVEL OF EVIDENCE: I, systematic review.

Improving Documentation of Pediatric Height, Weight, and Body Mass Index by Primary Care Providers.

The regular documentation of anthropometric data in an electronic medical record (EMR) is one tracking method used by primary care providers to follow the growth trajectory and development of children in their health care practices. EMR reminders have been proposed as a method to increase recording of pediatric height and weight by primary care providers, leading to potentially better detection and management of children classified as overweight or obese. The aim of this pre-post study was to improve a Family Health Team's physician documentation of pediatric height and weight through the implementation of an EMR reminder alert tool. The documentation rate for children 4-7 years old in the 6 months before intervention was 36% of children seen. After implementation of EMR reminder alerts, primary care physicians' documentation rate rose to 45% (9% increase; P < 0.01), but it was below the 15% target increase. Better documentation of pediatric height and weight by family physicians is needed to improve monitoring of children's growth trajectories. Additional strategies to increase documentation rates are needed.

Evaluating the effectiveness of five screening tools used to identify malnutrition risk in hospitalized elderly: A systematic review.

This systematic review investigated 5 frequently used nutrition screening tools (NSTs) used in hospitals and their effectiveness at identifying malnutrition risk in the elderly. A literature review was conducted to obtain research articles focused on malnutrition screening in hospitalized elderly and effectiveness of the NST used. Twenty six articles were reviewed and evaluated, resulting in 8 that met inclusion criteria. The Mini Nutritional Assessment-Short Form, designed for use in the elderly, resulted in overestimation of malnutrition. Four screening tools did demonstrate more effectiveness in identifying malnutrition risk; however, several different biochemical and anthropometric parameters were used, which prevented meaningful comparisons. There is a need for a universal NST "gold standard" for use in the elderly, and further research is indicated.

Effects of serum phosphorus on vascular calcification in a healthy, adult population: A systematic review.

Cardiovascular disease has been associated with elevated serum phosphorus levels, which have been associated with cardiovascular mortality. This is commonly seen in the chronic kidney disease (CKD) population where studies have shown that high phosphorus levels cause coronary artery calcification. Although studies have independently associated vascular stiffness and serum phosphorus in those with and without CKD, there are fewer data in individuals without CKD. Therefore, the aim of this systematic review was to analyze whether serum phosphorus levels are associated with cardiovascular calcification in healthy individuals. A systematic review of the literature that was conducted revealed 10 articles, all cross-sectional studies, that met eligibility criteria. These criteria were peer-reviewed studies on a healthy, adult population written in the English language. Studies lacking data on serum phosphorus and measured to assess its association with vascular calcification were excluded. Studies on subjects with CKD, other chronic diseases, or on children were also excluded. Of the 10 studies located, 8 indicated an association between serum phosphorus and vascular calcification. One study did not indicate an association. One study indicated a statistically significant association between serum phosphorus and vascular calcification prevalence, but not incidence. Studies were limited since no randomized controlled trials were available. This systematic review generates gaps in research. Due to considerable amounts of phosphorus additives in the food supply, there may be a connection to dietary phosphorus and vascular calcification. Additionally, phosphorus binders may assist in the prevention of vascular calcification but have not been studied in a healthy population. Further study on both dietary phosphorus restriction and phosphorus binders is needed. While 8 out of 10 cross-sectional studies found an association in this systematic review, the topic of vascular calcification and serum phosphorus needs further study if a cause and effect relationship is to be detected.

Bacterial Lipopolysaccharide, Lipopolysaccharide-Binding Protein, and Other Inflammatory Markers in Obesity and After Bariatric Surgery.

Obesity is associated with altered gut microbiota and low-grade inflammation. A key factor in the inflammatory process is endotoxin lipopolysaccharide (LPS). Plasma LPS levels and sensory agent lipopolysaccharide-binding protein (LBP) are shown to be elevated in obesity. This elevation may be due to increased intestinal permeability and incorporation of a high-fat diet accompanied by overfeeding. Bariatric surgery has become a popular treatment option that results in stable weight loss and improvement of obesity-related conditions. Studies outlined in this review show reduced LPS and LBP levels after different bariatric procedures. LPS receptor CD14 and mRNA expression toll-like receptor 2 (TLR2) and toll-like receptor 4 (TLR4) were also shown to have reduced levels following surgery. Changes in LPS and LPS components after bariatric surgery are shown to be linked to the surgical technique of the procedure and restriction of caloric intake. Additionally, changes in the gut microbiota provide some insight to the reduction of inflammatory markers after surgery. The beneficial effects of bariatric surgery are not dependent on weight loss alone. The inflammatory pathway plays a key role in the improvement of metabolic complications following surgery that should be further examined. Additional research is needed to evaluate short- and long-term changes of LPS and LPS components after bariatric surgery, including how those assessments can be applied to clinical practice.

Anemia in Chronic Obstructive Pulmonary Disease and the Potential Role of Iron Deficiency.

The purpose of this review is to evaluate the role of anemia on patient outcomes in chronic obstructive pulmonary disease (COPD), the potential contribution that low iron stores may play in this process, and possible treatment considerations. A review of research studies found that anemia is associated with declining functional outcomes, increased health care utilization and costs, and increased mortality in COPD. Associations exist between reduced iron intake and progression of COPD and in reduction of iron status with declining lung function. Currently data are limited on the effects of either treating anemia or utilizing iron supplementation in anemic COPD patients. If iron supplementation might therefore reverse some of the declines that patients experience, then routine screening and treatment may turn out to be an effective, simple and inexpensive intervention. Iron supplementation models utilized in other inflammatory-related disease states were reviewed as a possible starting point to evaluate treatment options in COPD. Future research can be directed to establish best practice standards for the use of iron supplementation in COPD.

Using megestrol acetate to ameliorate protein-energy wasting in chronic kidney disease.

BACKGROUND: Various populations are affected by chronic kidney disease (CKD), and a low dose appetite stimulant megestrol acetate (MA) is sometimes recommended in patients with CKD to ameliorate protein-energy wasting (PEW). Patients with CKD are at greater risk of developing PEW since the progression of their disease can cause decreased nutrient intake, catabolic effects, systemic inflammation and metabolic changes. Providers can detect PEW in CKD by identifying low serum levels ≤3.8 g/dl of albumin, <30 mg/dl of transthyretin, or <100 mg/dl of cholesterol. Other characteristics include BMI <22 kg/m(2) (for ≤65 years), unintentional weight loss of ≥5% in three months or ≥10% in six months, body fat percentage <10%, with muscle wasting of a reduction of ≥5% in three months or ≥10% in six months of muscle mass. METHOD: A review of research was completed and data collected from small population-based retrospective studies to determine the effect of MA. RESULTS: Clinical trials demonstrated the effectiveness of MA by showing increases in BMI up to 9%, albumin levels up to 1.1 g/dl, with reported protein and energy intake increases from 27% to 42%. There are potential adverse effects of using MA in CKD. CONCLUSION: After reviewing the available literature, the benefits of using MA should be evaluated against the potential side effects. For further examination of MA's potential benefits, long-term, prospective, large clinical trials should be carried out.

The Association Between Carotenoid Status and Body Composition in Children 2 - 18 Years of Age - A Systematic Review.

The aim of this review was to determine the association between carotenoid status and body composition in children 2 - 18 years of age. Obesity is often related to poor dietary habits and lower fruit and vegetable consumption in children. Fruit and vegetables are the primary sources of antioxidant-rich dietary carotenoids; decreased intake may lead to increased risk of chronic diseases. Identifying those with lower carotenoid status in childhood could be an important target for public health intervention. Research methods for the review were conducted using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist and the Central Michigan University library, via multiple scientific databases. Medical Subject Heading (MeSH) terms were utilized to identify relevant studies for inclusion. Twenty-three studies were included in the review (n = 16,285). Thirteen studies reported a significant inverse association between carotenoid status and body composition in children (p < 0.05), (n = 15,206). Five additional studies had varying associations between body composition and carotenoid status based on the type of carotenoid and/or measure of carotenoid status (n = 763). Carotenoid status is inversely associated with body composition; however, varying degrees of association were observed in this review. It remains to be determined whether this association is related to intake, fat mass or a combination of the two.

Relationship of vitamin D status and cardiometabolic risk factors in children and adolescents.

Metabolic syndrome is a constellation of cardiometabolic risk factors that includes insulin resistance, obesity, hypertension, and hyperlipidemia. A review of the literature was conducted to determine the relationship between low serum vitamin D status and risk factors for metabolic syndrome in children and adolescents. A review of human, animal, and cellular studies demonstrates conflicting evidence that a low serum vitamin D level is linked to the cause of obesity, hyperlipidemia, hypertension, and insulin resistance. However, there does appear to be an association between low serum vitamin D and these features, especially obesity. Due to a lack of concrete evidence for causation, current recommendations of up to 600 IU of vitamin D daily should be supplied to prevent deficiency in children.