Folate fortification of food: Insufficient for women with epilepsy.

OBJECTIVE: Folic acid supplementation during the periconceptual period has been shown to improve cognitive outcomes in children of women with epilepsy taking anti-seizure medications (ASMs). The dose of folic acid necessary to provide positive cognitive outcomes is unclear. In many countries including the United States, food is fortified with folic acid, but no data exist on how food fortification may affect cognition in children with fetal-ASM exposure. This study evaluated the effect of dietary folate from natural folates plus folic acid fortification, separate from folic acid vitamin supplements, on age-6 year IQ in children with fetal-ASM exposure. METHODS: Data from the Neurodevelopmental Effects of Antiepileptic Drugs (NEAD) study were retrospectively analyzed for this investigation. Assessment of nutrient intake was conducted using the Block Food Frequency Questionnaire-98. The primary outcome of the present study was to assess association of maternal prepregnancy nutrient levels to child age-6 IQ. RESULTS: Folate from food alone without supplement was not associated with improvement of age-6 IQ in children with fetal ASM exposure (95% CI: -11.7-2.3, p = 0.187). Periconceptual folate supplement use was associated with a 10.1-point higher age-6 IQ (95% CI: 5.2-15.0, p < .001). Total combined folate from food plus supplement also showed that higher intake of folate was associated with higher age-6 IQ (Coefficient: 4.5, 95% CI: 2.0-6.9, p < .001). Six other nutrients from food and supplements were analyzed (Vitamin C, Vitamin D, Vitamin E, Omega 3, Gamma Tocopherol, and Vitamin B12) and had no significant association with age 6-IQ. SIGNIFICANCE: Dietary content of folate, even in a country where food is fortified with folic acid, is not sufficient to provide improved cognitive outcomes for children of women taking ASMs during pregnancy. Folate supplementation is needed for significant improvement in cognitive outcomes, specifically age-6 IQ.

A Quality Improvement Study: Comparison of Volume-Based and Rate-Based Tube Feeding Efficacy and Clinical Outcomes in Critically Ill Patients.

BACKGROUND: Adequate nutrition (receiving ≥80% of estimated energy requirements [EER]) is important in preventing and treating malnutrition and improving clinical outcomes. In conventional rate-based tube feeding (RBTF), patients are prescribed a constant infusion rate. Per volume-based tube feeding (VBTF), the hourly infusion rate can be increased (max 150 mL/h) to make up for feeding deficits, ensuring patients receive the targeted 24-hour volume. This study compared clinical outcomes between patients on VBTF vs RBTF. METHODS: Data were collected from medical charts of patients within a 5-month period. Inclusion criteria included patients ≥18 years of age who were admitted to an intensive care unit and receiving enteral nutrition for at least 24 hours. RESULTS: More patients on VBTF (n = 77; 55.8% females, age 59.9 ± 18.1 years, body mass index [BMI] 29.7 ± 17.7 kg/m2 ) received adequate nutrition (VBTF: 88.3%, 93.1 ± 11.3% EER; RBTF: 36.4%, 71.3 ± 35.8% EER) than those on RBTF (n = 206; 35.9% females, age 61 ± 15 years, BMI 28.3 ± 6.5 kg/m2 ) during the first crucial 7 days of nutrition support. No significant differences in adverse outcomes (hyperglycemia P = 0.052, hypoglycemia P = 0.168, emesis P = 0.084, diarrhea P = 0.470, and high gastric output P = 0.096) were found between the groups. CONCLUSION: VBTF can help promote nutrition adequacy. This study provides evidence for clinicians to be more proactive and aggressive in providing tube feeding in the critical care setting when patients are deemed appropriate for VBTF.