It is not just about prescription. A cohort study of the impact of enteral nutrition on mortality of hospitalized patients with COVID-19.

Introduction: Introduction: during COVID-19 pandemic, international societies released guidelines and recommendations for patients requiring nutritional support according to previous similar respiratory diseases. Objectives: the aim of the study was to evaluate the nutritional support provided by enteral nutrition (EN) in patients with COVID-19 infection, identify if the recommendations from international societies were met and their impact on mortality rate. Methods: a cohort study was conducted on adult patients with COVID-19 admitted to a tertiary hospital. Demographic, clinical, biochemical, and nutritional variables were obtained. A random-effect parametric survival-time model was performed to quantify the risk of death for each variable, and the Hausman test was used to confirm the model. Results: two hundred and twenty-nine patients were enrolled. The delivered energy was > 80 % of adequacy in the first two days, as suggested by international guidelines (11.7 ± 4.9 kcal/kg); however, an adequacy rate less than 60 % was achieved on day 14 (25.4 ± 7.4 kcal/kg). The protein adequacy was > 75 % on the first days of infusion (1.3 ± 0.3 g/kg); however, the infusion was < 50 % (1.5 ± 0.4 g/kg) after being extubated. Age, sex, and nutritional risk were related to higher mortality in patients with EN, whereas the infused energy and protein, the percentage of protein adequacy, arginine, and n-3 PUFA were associated with lower mortality. Conclusion: achieving at least 80 % of the energy and protein requirements, as well as n-3 PUFA and arginine supplementation could be associated with lower mortality in COVID-19 patients. More studies are needed to confirm the role of these nutrients on the mortality rate.

Introducción: Introducción: durante la pandemia de COVID-19, las sociedades internacionales publicaron guías y recomendaciones para pacientes que requieren apoyo nutricional basándose en lo previamente recomendado en enfermedades respiratorias similares. Objetivos: evaluar el soporte nutricional con nutrición enteral (NE) en pacientes con COVID-19 e identificar el cumplimiento de las recomendaciones hechas por las sociedades internacionales y su impacto en la tasa de mortalidad. Métodos: estudio de cohorte en adultos con COVID-19 ingresados en un hospital de tercer nivel. Se registraron variables demográficas, clínicas, bioquímicas y nutricionales. Se realizó un modelo de supervivencia de efectos aleatorios para cuantificar el riesgo de muerte para cada variable y la prueba de Hausman para confirmar el modelo. Resultados: se incluyeron 229 pacientes. La energía administrada fue > 80 % de adecuación en los dos primeros días (11,7 ± 4,9 kcal/kg); sin embargo, fue < 60 % el día 14 (25,4 ± 7,4 kcal/kg). La adecuación de proteínas fue > 75 % en los primeros días de infusión (1,3 ± 0,3 g/kg), pero < 50 % (1,5 ± 0,4 g/kg) después de ser extubado. La edad, el sexo y el riesgo nutricional se relacionaron con mayor mortalidad, mientras que la energía y proteína infundidas, el porcentaje de adecuación proteica, la arginina y el contenido de ácidos grasos poliinsaturados (AGPI) n-3 se asociaron con menor mortalidad. Conclusión: aunque se necesitan más estudios para confirmarlo, alcanzar al menos el 80 % de los requerimientos energéticos y proteicos, así como la suplementación de fórmulas con AGPI n-3 y arginina, podría asociarse con menor mortalidad en pacientes con COVID-19.

Is intradialytic oral nutritional supplementation safe and effective on clinical outcomes? A systematic review with conventional meta-analysis and network meta-analysis.

AIM: determine the effect of intradialytic oral nutrition (ION) on clinical and safety outcomes. DESIGN: Systematic Review with conventional Meta-analysis, and a Network Meta-analysis (NMA) as sensitivity analysis. We searched on MEDLINE, LILACS, CENTRAL, and EMBASE in June 2020, and the last update was until August 2022. We selected observational and randomized controlled trials with ION for at least four weeks. Primary outcomes were all-cause mortality and quality of life (QoL); adverse events, physical performance, and appetite were secondary outcomes. RESULTS: Seven clinical trials and three observational studies were selected. Even when we did not obtain significant differences in physical performance and gastrointestinal symptoms, we identified a clinical improvement in the QoL's physical role, bodily pain, and physical performance domains. After pooling the data on mortality, a protection rate trend was observed in the ION group without statistical significance. The home-prepared ION was the best nutritional supplementation when assessing the appetite outcome through NMA. CONCLUSIONS: ION seems to have a protective trend in mortality risk; the current evidence is insufficient to establish a relationship with adverse events or other clinical outcomes. The lack of homogeneity in the trials makes it difficult to generalize these results. PROSPERO REGISTRATION: CRD42020186311.

Frequency of Intradialytic Hypotension Events Do Not Increase with Oral Nutritional Supplementation during Hemodialysis Treatment: A Randomized Controlled Trial.

OBJECTIVE: This study aimed to compare the effect of the use of a renal-specific oral nutritional supplement (RS-ONS) during hemodialysis sessions and the use of RS-ONS at home on the incidence of intradialytic hypotension. METHODS: A single-center, 12-week, open-label, randomized controlled clinical trial was conducted. The intervention was a RN-ONS divided into two portions: 100 and 137 mL. The first portion was given after 1 hour of hemodialysis (HD) treatment, while the second portion was given 45 minutes before the end of HD. The research staff registered the baseline and final nutritional parameters and systolic arterial pressure (SAP) from the screen of the HD device during 36 HD sessions. Hypotension symptoms were also recorded every hour during each HD session. The nutritional and functional status was also assessed. RESULTS: We registered a total of 16 hypotensive events during 1082 HD sessions: 9 were in patients supplemented at home (551 HD sessions) and 7 occurred in patients supplemented during HD P = .668. Incidence of intradialytic hypotension (IH) during 1082 HD sessions was 1.4%. The total malnutrition inflammation score (MIS) decreased in both groups (P < .01), and the percentage of cachexia improved in the supplemented-during-HD group (P < .05). CONCLUSIONS: In this randomized controlled trial, intradialytic hypotension events did not increase with the RS-ONS during HD treatment. This strategy appears to be a safe anabolic nutritional strategy for the prevention of PEW, selecting stable patients and administering a fractioned volume of the supplement after the first hour of HD treatment. More studies with larger samples size are required to confirm these findings.

Hospital nutrition care informs potential cost-savings for healthcare: A budget impact analysis.

BACKGROUND AND AIM: In Mexico, about half of hospitalized patients are malnourished or at risk of malnutrition upon hospital admission, while many others experience deterioration of their nutritional status while in the hospital. Such patients often experience poor health outcomes and have increased hospital costs. The aim of our budget-impact analysis was to estimate potential savings associated with the implementation of a Mexican hospital-based program of nutrition care for patients at malnutrition risk or malnourished. METHODS: The budget-impact model was based on data published previously. Our model compared patients assigned to receive individualized early nutrition therapy (initiated within 24-48 h of hospital admission) with those who received standard delayed nutrition therapy (not initiated early). Outcomes included length of stay, infectious complications, and 30-day readmissions. We modeled a 30-day time-horizon, estimated event probabilities on the basis of published data, and projected costs in 2020 US dollars. RESULTS: Average total healthcare costs over 30-days were $3527 for patients with early nutrition therapy vs $6032 for patients with standard nutrition therapy-a savings of $2505 per early nutrition-treated patient (41.5% lower). Cost differences between the groups were $2336 vs $3065 for hospital-associated costs (23.8% lower), $262 vs $780 for 30-day readmissions (66.4% lower) and $1348 for malnutrition-associated infections. Applying these potential savings from individualized early nutrition care to a one-year estimate of 3.22 million Mexican hospital patients with malnutrition or its risk, the total overall savings for public health expenditures was equivalent to $8.1 billion per year or 32.1% of total healthcare expenditures. CONCLUSIONS: The results demonstrated the potential for hospital-based nutrition care programs to reduce costs of patient hospitalizations. These notable findings provide a rationale for Mexican healthcare institutions to implement programs of comprehensive nutrition-focused care for inpatients with malnutrition or its risk. To this end, we advise implementation of professional programs for education and training in order to increase awareness of patients' nutritional needs and to better prepare clinical personnel to identify, treat, and monitor patients at-risk/malnourished.

Adaptation of the medical-nutrition therapy for patients with intestinal failure in a developing country: A modified Delphi survey.

BACKGROUND & AIMS: Intestinal Failure (IF) is a complex disease with huge impacts on our society due to complications. Therefore, in a developing country like Mexico without specialized IF clinics, health care professionals must provide evidence-based interventions for the IF patient. This study aims to achieve consensus on how to adapt the existing guidelines for IF to the local practices considering the available resources and local practices. METHODS: A three-round modified Delphi process was used to build consensus on the most important interventions for our IF patients. For each round, data was collected and consensus was defined as ≥80% of agreement for each item. Descriptive statistics were used to determine whether a consensus was achieved. RESULTS: Ten content experts completed the three-round modified Delphi survey. Consensus was achieved for 98% of the items related to the hospitalized patient, ambulatory care management, and drug therapy. Some of these items are not included in the ESPEN guidelines for IF, but we considered that they are relevant in our clinical practice, like the calculation of fluids for patients with very low body weight, screening for refeeding syndrome and the use of some conventional drugs to promote intestinal rehabilitation. CONCLUSIONS: Using a three-round modified Delphi process, consensus was achieved for nearly all items. This represents a starting point for the improvement of our local practices towards this complex disease, leading to better outcomes and the implementation of evidence-based protocolized interventions which can have an important impact due to the lack of access to some of the most novel pharmacological therapies like the glucagon-like-peptide (GLP-2) analog.

SURVEY ON THE PERCEPTION OF HEALTH PROFESSIONALS ON THE USE OF INTRADIALYTIC ORAL NUTRITION IN PATIENTS UNDER HEMODIALYSIS.

BACKGROUND: Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. OBJECTIVE: The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. METHODS: Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. RESULTS: From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic's policy (41%). CONCLUSIONS: The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.

Survey on the perception of health professionals on the use of intradialytic oral nutrition in patients under hemodialysis

Abstract Background Intradialytic oral nutrition (ION) has been shown to improve many clinical outcomes, including lowering mortality, in hemodialysis (HD) patients. Despite the benefits, ION is underused in many countries. Objective The objective of our study was to determine the perception of health-care professionals (HCP) in our environment of the use of ION in patients undergoing HD. Methods Survey applied to HCP in Mexico who worked or had worked in an HD unit in their locality. Results From 272 HCP who answered the survey, 74.3% believed that the use of ION has at least one beneficial effect; of these, the most frequently mentioned were an improvement in quality of life (QoL) (54.7%) followed by an improvement in serum albumin (37.9%) and muscle anabolism (31.6%). However, 49% consider that its use involves some risks. Of the respondents, 22% reported that their HD units allowed patients to consume food or supplements during HD sessions; the main reason given to forbid the introduction of food or supplements was the clinic’s policy (41%). Conclusions The personnel surveyed heterogeneous opinions regarding ION, but most believe that it may improve the QoL or the nutritional status of the patients. Nevertheless, the use of ION is uncommon in our country as it is against the internal regulations of most HD units.

Review of complementary feeding practices in Mexican children.

BACKGROUND: The early introduction of food is consistent with a significant increase in the prevalence of overweight and obesity, particularly in children, partly because of the resulting changes in feeding patterns. The purpose of this study was to describe the complementary feeding practices of Mexican children younger than two years of age. METHODS: Medline, Lilacs and manual methods were used to search for studies that assessed feeding practices in children younger than two years of age in Mexico. The following terms were used: complementary feeding, supplementary feeding, Mexico and weaning. Data on complementary feeding practices, including the age of initiation, the type of foods eaten, the frequency of food intake and the reasons for starting complementary feeding, were collected. The information gathered was subjected to qualitative analysis, and the data are presented as proportions in the tables. RESULTS: The seven studies included in this evaluation revealed that children were introduced to complementary feeding before the age of 6 months. Although fruits were the foods most commonly provided when complementary feeding began, processed juices, soft drinks and fried snacks were also offered. The intake of these products increased as the children grew older and coincided with a low intake of foods containing high-biological value protein, particularly red meats. CONCLUSIONS: The results of the included studies showed that during complementary feeding, infants receive high-energy density foods, whereas the intake of foods that provide animal protein and iron in particular is low. In addition, common conditions associated with complementary feeding include overweight, obesity, malnutrition, and anemia, which may contribute to health problems.

Antecedentes: El inicio de la alimentación complementaria temprana coincide con un aumento significativo en la prevalencia de sobrepeso y obesidad especialmente en los niños, lo cual se debe entre otras causas a los cambios en los patrones de alimentación que se han experimentado. El objetivo del estudio fue describir las prácticas de alimentación complementaria en niños mexicanos. Métodos: Se realizó una búsqueda de los estudios que evaluaron las prácticas alimentarias en menores de 2 años en México en Medline, Lilacs y de forma manual con los siguientes términos: alimentación complementaria, alimentación suplementaria, México, ablactación y destete. Se recabó la edad de inicio de la alimentación complementaria, tipo de alimento consumido, frecuencia de consumo de los alimentos y motivo por el que iniciaban la alimentación complementaria. Se realizó un análisis cualitativo de la información recolectada y los datos en las gráficas son mostrados como proporciones. Resultados: Se incluyeron 7 estudios que mostraron que los niños inician la alimentación complementaria antes de los 6 meses predominantemente con frutas, aunque también consumieron jugos industrializados, refrescos y frituras. El consumo de estos productos aumenta con el crecimiento de los niños, aunado a un bajo consumo de alimentos con proteína de alto valor biológico, especialmente las carnes rojas. Conclusiones: Los resultados de los estudios incluidos mostraron que los menores reciben alimentos con alta densidad energética, mientras que es bajo el consumo de aquellos que aportan proteína animal y hierro en particular, lo que puede contribuir a problemas de salud como sobrepeso, obesidad, desnutrición y anemia.