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1.
Radiologe ; 62(4): 331-342, 2022 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-35201396

RESUMEN

Modern patient-centered and cost-efficient care concepts in hospitals require the mapping of multidisciplinary process chains into clinical pathways. Clinical decision support systems and operations research methods use algorithms to classify patients into homogeneous groups and to model a complete clinical pathway for scheduling individual procedures. An improvement of the economic situation of the care facility can be achieved through improved resource utilization, reduced patient waiting times and a shortening of the length of stay. The interdisciplinary use of centrally stored interoperable information and comprehensive care management via information technology (IT) services lay the foundation for the dissolution of traditional IT system architectures in medicine and the development of flexibly integrable modern system platforms. New IT approaches such as the semantically standardized definition of procedures and resource properties, the use of clinical decision support systems and the use of service-oriented system architectures form the basis for the deep integration of radiology services into comprehensive interdisciplinary care concepts.


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Prestación Integrada de Atención de Salud , Radiología , Algoritmos , Humanos
2.
J Nutr Health Aging ; 23(9): 771-787, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31641726

RESUMEN

OBJECTIVE: The task force of the International Conference of Frailty and Sarcopenia Research (ICFSR) developed these clinical practice guidelines to overview the current evidence-base and to provide recommendations for the identification and management of frailty in older adults. METHODS: These recommendations were formed using the GRADE approach, which ranked the strength and certainty (quality) of the supporting evidence behind each recommendation. Where the evidence-base was limited or of low quality, Consensus Based Recommendations (CBRs) were formulated. The recommendations focus on the clinical and practical aspects of care for older people with frailty, and promote person-centred care. Recommendations for Screening and Assessment: The task force recommends that health practitioners case identify/screen all older adults for frailty using a validated instrument suitable for the specific setting or context (strong recommendation). Ideally, the screening instrument should exclude disability as part of the screening process. For individuals screened as positive for frailty, a more comprehensive clinical assessment should be performed to identify signs and underlying mechanisms of frailty (strong recommendation). Recommendations for Management: A comprehensive care plan for frailty should address polypharmacy (whether rational or nonrational), the management of sarcopenia, the treatable causes of weight loss, and the causes of exhaustion (depression, anaemia, hypotension, hypothyroidism, and B12 deficiency) (strong recommendation). All persons with frailty should receive social support as needed to address unmet needs and encourage adherence to a comprehensive care plan (strong recommendation). First-line therapy for the management of frailty should include a multi-component physical activity programme with a resistance-based training component (strong recommendation). Protein/caloric supplementation is recommended when weight loss or undernutrition are present (conditional recommendation). No recommendation was given for systematic additional therapies such as cognitive therapy, problem-solving therapy, vitamin D supplementation, and hormone-based treatment. Pharmacological treatment as presently available is not recommended therapy for the treatment of frailty.


Asunto(s)
Fragilidad/diagnóstico , Fragilidad/terapia , Sarcopenia/diagnóstico , Sarcopenia/terapia , Anciano , Anciano de 80 o más Años , Envejecimiento/fisiología , Ejercicio Físico/fisiología , Humanos , Tamizaje Masivo/métodos
3.
Internist (Berl) ; 60(2): 141-148, 2019 02.
Artículo en Alemán | MEDLINE | ID: mdl-30673824

RESUMEN

Since 2016 sarcopenia, the age-associated loss of muscle mass, strength and function, has the ICD-10-GM code M62.50 (International Statistical Classification of Diseases and Related Health Problems, 10th Revision, German Modification). The diagnosis of sarcopenia requires the combined presence of low muscle strength and low muscle mass. Well-established approaches for the prevention and therapy of sarcopenia are exercise programs-in particular strength, endurance and power training-and nutritional interventions, preferably a combination of both. Adequate protein intake is considered highly relevant, while the role of other nutrients involved in muscle metabolism (e. g. creatine, vitamin D, antioxidants, omega-3 fatty acids) is less clear, being still the subject of controversial discussions. Innovative pharmacological therapies are currently under investigation and their future relevance for this indication is unclear. In general, it has to be stated that there are still only few intervention studies available that focused specifically on sarcopenia in older individuals. More studies in this rapidly increasing population are urgently needed.


Asunto(s)
Envejecimiento/fisiología , Ejercicio Físico , Fuerza Muscular/fisiología , Terapia Nutricional , Sarcopenia/diagnóstico , Sarcopenia/terapia , Anciano , Anciano de 80 o más Años , Proteínas en la Dieta/administración & dosificación , Suplementos Dietéticos , Terapia por Ejercicio , Humanos , Vitamina D/administración & dosificación , Vitamina D/uso terapéutico
4.
J Nutr Health Aging ; 22(10): 1148-1161, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30498820

RESUMEN

OBJECTIVES: Sarcopenia, defined as an age-associated loss of skeletal muscle function and muscle mass, occurs in approximately 6 - 22 % of older adults. This paper presents evidence-based clinical practice guidelines for screening, diagnosis and management of sarcopenia from the task force of the International Conference on Sarcopenia and Frailty Research (ICSFR). METHODS: To develop the guidelines, we drew upon the best available evidence from two systematic reviews paired with consensus statements by international working groups on sarcopenia. Eight topics were selected for the recommendations: (i) defining sarcopenia; (ii) screening and diagnosis; (iii) physical activity prescription; (iv) protein supplementation; (v) vitamin D supplementation; (vi) anabolic hormone prescription; (vii) medications under development; and (viii) research. The ICSFR task force evaluated the evidence behind each topic including the quality of evidence, the benefit-harm balance of treatment, patient preferences/values, and cost-effectiveness. Recommendations were graded as either strong or conditional (weak) as per the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Consensus was achieved via one face-to-face workshop and a modified Delphi process. RECOMMENDATIONS: We make a conditional recommendation for the use of an internationally accepted measurement tool for the diagnosis of sarcopenia including the EWGSOP and FNIH definitions, and advocate for rapid screening using gait speed or the SARC-F. To treat sarcopenia, we strongly recommend the prescription of resistance-based physical activity, and conditionally recommend protein supplementation/a protein-rich diet. No recommendation is given for Vitamin D supplementation or for anabolic hormone prescription. There is a lack of robust evidence to assess the strength of other treatment options.


Asunto(s)
Tamizaje Masivo/métodos , Sarcopenia/diagnóstico , Sarcopenia/terapia , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Sarcopenia/patología
5.
J Hum Nutr Diet ; 31(6): 818-824, 2018 12.
Artículo en Inglés | MEDLINE | ID: mdl-29952057

RESUMEN

BACKGROUND: Malnutrition is prevalent across acute care facilities, particularly in older patients, and contributes to poor surgical outcomes. Clinical practice guidelines recommend the early reintroduction of a full oral diet post-operatively. The present study aimed to compare estimated energy (EEI) and protein (EPI) intake of patients who received early diet upgrade with those who did not. METHODS: Patients ≥65 years admitted post-operatively to general surgical wards were included. EEI and EPI were calculated and dichotomised as meeting ≥50% or <50% estimated energy (EER) and protein (EPR) requirements. Mean intake and proportion of patients meeting <50% estimated requirements were compared between those who received early upgrade and those who did not at post-operative day (POD)2. RESULTS: Thirty-four patients [mean (SD) age 72.9 (5.7) years, 59% male] were analysed at POD2 [EEI: mean 4.2 (2.6) MJ day-1 , 56% (n = 19) met ≥50% EER; EPI: mean 38.7 (29.5) g day-1 , 26% (n = 9) met ≥50% EPR]. The majority (n = 25, 74%) were upgraded to a nonfluid diet by POD2. More patients on fluid diets consumed <50% EER (P = 0.025) and <50% EPR (P = 0.073). No patient on a fluid diet met ≥50% of EPR. CONCLUSIONS: Although the majority of older patients received early diet upgrade and these patients consumed more energy and protein than those on fluid diets, as a whole, older patients ate poorly post-operatively. Fluid diets should therefore not be used indiscriminately and other approaches to improve post-operative intake of older patients, such as fortified diets, oral nutritional supplements and meal environment interventions, should be adopted.


Asunto(s)
Proteínas en la Dieta/administración & dosificación , Dietética/métodos , Ingestión de Energía , Conducta Alimentaria , Desnutrición/prevención & control , Evaluación Nutricional , Cuidados Posoperatorios/métodos , Anciano , Envejecimiento/fisiología , Dieta , Ingestión de Alimentos , Femenino , Hospitalización , Humanos , Masculino , Comidas , Necesidades Nutricionales , Proyectos Piloto , Complicaciones Posoperatorias/prevención & control
6.
Osteoporos Int ; 28(2): 447-462, 2017 02.
Artículo en Inglés | MEDLINE | ID: mdl-27761590

RESUMEN

The place of calcium supplementation, with or without concomitant vitamin D supplementation, has been much debated in terms of both efficacy and safety. There have been numerous trials and meta-analyses of supplementation for fracture reduction, and associations with risk of myocardial infarction have been suggested in recent years. In this report, the product of an expert consensus meeting of the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO) and the International Foundation for Osteoporosis (IOF), we review the evidence for the value of calcium supplementation, with or without vitamin D supplementation, for healthy musculoskeletal ageing. We conclude that (1) calcium and vitamin D supplementation leads to a modest reduction in fracture risk, although population-level intervention has not been shown to be an effective public health strategy; (2) supplementation with calcium alone for fracture reduction is not supported by the literature; (3) side effects of calcium supplementation include renal stones and gastrointestinal symptoms; (4) vitamin D supplementation, rather than calcium supplementation, may reduce falls risk; and (5) assertions of increased cardiovascular risk consequent to calcium supplementation are not convincingly supported by current evidence. In conclusion, we recommend, on the basis of the current evidence, that calcium supplementation, with concomitant vitamin D supplementation, is supported for patients at high risk of calcium and vitamin D insufficiency, and in those who are receiving treatment for osteoporosis.


Asunto(s)
Calcio/uso terapéutico , Suplementos Dietéticos , Fracturas Osteoporóticas/prevención & control , Conservadores de la Densidad Ósea/uso terapéutico , Calcio/efectos adversos , Suplementos Dietéticos/efectos adversos , Enfermedades Gastrointestinales/inducido químicamente , Humanos , Cálculos Renales/inducido químicamente , Metaanálisis como Asunto , Músculo Esquelético/efectos de los fármacos , Músculo Esquelético/fisiología , Osteoporosis/tratamiento farmacológico , Vitamina D/uso terapéutico
7.
Radiat Prot Dosimetry ; 172(4): 346-355, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26718399

RESUMEN

A systematic study of photon and neutron radiation doses generated in high-intensity laser-solid interactions is underway at SLAC National Accelerator Laboratory. These laser-solid experiments are being performed using a 25 TW (up to 1 J in 40 fs) femtosecond pulsed Ti:sapphire laser at the Linac Coherent Light Source's (LCLS) Matter in Extreme Conditions (MEC) facility. Radiation measurements were performed with passive and active detectors deployed at various locations inside and outside the target chamber. Results from radiation dose measurements for laser-solid experiments at SLAC MEC in 2014 with peak intensity between 1018 and 7.1 × 1019 W cm-2 are presented.


Asunto(s)
Rayos Láser , Neutrones , Aceleradores de Partículas/instrumentación , Fotones , Monitoreo de Radiación/instrumentación , Monitoreo de Radiación/métodos , Óxido de Aluminio/química , Humanos , Monitoreo de Radiación/normas , Titanio/química
8.
J Anim Physiol Anim Nutr (Berl) ; 99(1): 190-200, 2015 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-24605953

RESUMEN

Beginning in the fall of 2010, an increasing and alarming number of cases of calves suffering from liver dystrophy were reported in the south of Germany. An epidemiological investigation was carried out by the authors between November 2010 and July 2011, leading to the implication of a commercial dietary supplement as the potential cause for this outbreak. The components of this product were first tested in a cell culture model and two of them (dietary chestnut extract and glycerol monolaurate) showed a cytotoxic effect. The objective of this study was therefore to evaluate the effect of supplemental feeding of both components alone or in combination on liver function in newborn calves on a commercial dairy farm. Ten calves were enrolled in each of the three treatment groups and the control group (group O) following a blocked design. Treatment consisted of supplementation with chestnut extract at 0.02% of birth body mass (BM) (group C), supplementation with glycerol monolaurate at 0.006% of BM (group G) or a combined treatment (group CG) for five consecutive days. The effect of treatments on liver function was evaluated clinically and by measurement of glutamate dehydrogenase (GLDH) and aspartate aminotransferase (AST) activities as well as the determination of the concentrations of glucose, L-lactate and total bilirubin in serum. There was a significant increase in GLDH and AST activities and a significant decrease in glucose concentration in treatment groups C and CG compared with the control group (p ≤ 0.035), whereas no difference was shown for group G. Survival was significantly decreased in groups C (p = 0.029) and CG (p = 0.001) compared with both group G and the control group. These results suggest that dietary chestnut extract in an amount of 0.02% of BM alone or in combination has a toxic effect on liver function in newborn calves.


Asunto(s)
Aesculus/química , Animales Recién Nacidos , Enfermedad Hepática Inducida por Sustancias y Drogas/veterinaria , Lauratos/efectos adversos , Hígado/efectos de los fármacos , Monoglicéridos/efectos adversos , Extractos Vegetales/efectos adversos , Animales , Aspartato Aminotransferasas/genética , Aspartato Aminotransferasas/metabolismo , Bovinos , Femenino , Regulación Enzimológica de la Expresión Génica , Glutamato Deshidrogenasa/genética , Glutamato Deshidrogenasa/metabolismo , Lauratos/administración & dosificación , Hígado/metabolismo , Masculino , Monoglicéridos/administración & dosificación , Extractos Vegetales/química
9.
J Hum Nutr Diet ; 26(6): 538-43, 2013 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-24147972

RESUMEN

BACKGROUND: The Australasian Nutrition Care Day Survey (ANCDS) reported that two-fifths of patients consume ≤50% of the offered food in Australian and New Zealand hospitals. After controlling for confounders (nutritional status, age, disease type and severity), the ANCDS also established an independent association between poor food intake and increased in-hospital mortality. The present study aimed to evaluate whether medical nutrition therapy (MNT) could improve dietary intake in hospital patients eating poorly. METHODS: An exploratory pilot study was conducted in the respiratory, neurology and orthopaedic wards of an Australian hospital. At baseline, percentage food intake (0%, 25%, 50%, 75% and 100%) was evaluated for each main meal and snack for a 24-h period in patients hospitalised for ≥2 days and not under dietetic review. Patients consuming ≤50% of offered meals as a result of nutrition-impact symptoms were referred to ward dietitians for MNT. Food intake was re-evaluated on the seventh day after recruitment (post-MNT). RESULTS: One hundred and eighty-four patients were observed over 4 weeks; 32 patients were referred for MNT. Although baseline and post-MNT data for 20 participants [mean (SD) age 68 (17) years, 65% females] indicated a significant increase in median energy and protein intake post-MNT (3600 kJ day(-1) ; 40 g day(-1) ) versus baseline (2250 kJ day(-1) ; 25 g day(-1) ) (P < 0.05), the increased intake met only 50% of dietary requirements. Persistent nutrition impact symptoms affected intake. CONCLUSIONS: In the present pilot study, although dietary intake improved, it remained inadequate to meet participants' estimated requirements as a result of ongoing nutrition-impact symptoms. Appropriate medical management and early enteral feeding could be a possible solution for such patients.


Asunto(s)
Pacientes Internos , Evaluación Nutricional , Terapia Nutricional/métodos , Estado Nutricional , Adulto , Anciano , Anciano de 80 o más Años , Australia , Estudios Transversales , Dieta , Ingestión de Alimentos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas Nutricionales , Necesidades Nutricionales , Proyectos Piloto
10.
J Hum Nutr Diet ; 26(5): 452-8, 2013 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-23627791

RESUMEN

BACKGROUND: Nutrition supplements enriched with immune function enhancing nutrients have been developed to aid wound-healing, although evidence regarding their effectiveness is limited and systematic reviews have lead to inconsistent recommendations. The present pragmatic, randomised, prospective open trial evaluated a wound-specific oral nutrition supplement enriched with arginine, vitamin C and zinc compared to a standard supplement with respect to outcomes in patients with chronic wounds in an acute care setting. METHODS: Twenty-four patients [11 males and 13 females; mean (SD) age: 67.8 (22.3) years] with chronic wounds (14 diabetic or venous ulcers; 10 pressure ulcers or chronic surgical wounds) were randomised to receive either a wound-specific supplement (n = 12) or standard supplement (n = 12) for 4 weeks, with ongoing best wound and nutrition care for an additional 4 weeks. At baseline, and at 4 and 8 weeks, the rate of wound-healing, nutritional status, protein and energy intake, quality of life and product satisfaction were measured. Linear mixed effects modelling with random intercepts and slopes were fitted to determine whether the wound-specific nutritional supplement had any effect. RESULTS: There was a significant improvement in wound-healing in patients receiving the standard nutrition supplement compared to a wound-specific supplement (P = 0.044), although there was no effect on nutritional status, dietary intake, quality of life and patient satisfaction. CONCLUSIONS: The results of the present study indicate that a standard oral nutrition supplement may be more effective at wound-healing than a specialised wound supplement in this clinical setting.


Asunto(s)
Suplementos Dietéticos , Úlcera por Presión/dietoterapia , Cicatrización de Heridas/efectos de los fármacos , Administración Oral , Anciano , Anciano de 80 o más Años , Ácido Ascórbico/administración & dosificación , Enfermedad Crónica , Proteínas en la Dieta/administración & dosificación , Ingestión de Energía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Terapia Nutricional/métodos , Estado Nutricional , Úlcera por Presión/patología , Estudios Prospectivos , Calidad de Vida , Resultado del Tratamiento , Zinc/administración & dosificación
11.
J Vet Intern Med ; 27(2): 217-26, 2013.
Artículo en Inglés | MEDLINE | ID: mdl-23323770

RESUMEN

Fish oil omega-3 fatty acids, mainly eicosapentaenoic acid and docosahexaenoic acid, are used in the management of several diseases in companion animal medicine, many of which are inflammatory in nature. This review describes metabolic differences among omega-3 fatty acids and outlines potential adverse effects that may occur with their supplementation in dogs and cats with a special focus on omega-3 fatty acids from fish oil. Important potential adverse effects of omega-3 fatty acid supplementation include altered platelet function, gastrointestinal adverse effects, detrimental effects on wound healing, lipid peroxidation, potential for nutrient excess and toxin exposure, weight gain, altered immune function, effects on glycemic control and insulin sensitivity, and nutrient-drug interactions.


Asunto(s)
Enfermedades de los Gatos/inducido químicamente , Enfermedades de los Perros/inducido químicamente , Ácidos Grasos Omega-3/metabolismo , Ácidos Grasos Omega-3/envenenamiento , Aceites de Pescado/metabolismo , Aceites de Pescado/envenenamiento , Animales , Gatos , Suplementos Dietéticos , Perros , Ácidos Grasos Omega-3/efectos adversos , Aceites de Pescado/administración & dosificación
12.
Exp Gerontol ; 48(1): 76-80, 2013 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22683512

RESUMEN

INTRODUCTION: Sarcopenia is considered to be an enormous burden for both the individuals affected and for society at large. A multifactorial aetiology of this geriatric syndrome has been discussed. Amongst other pathomechanisms, the degeneration of the neuromuscular junction (NMJ) may be of major relevance. The intact balance between the pro-synaptic agent agrin and the anti-synaptic agent neurotrypsin ensures a structurally and functionally intact NMJ. Excessive cleavage of the native motoneuron-derived agrin by neurotrypsin into a C-terminal Agrin Fragment (CAF) leads to functional disintegration at the NMJ and may consecutively cause sarcopenia. The present study evaluates the hypothesis that CAF serum concentration is a potential marker for the loss of appendicular lean mass in older adults. It also explores how CAF concentration is influenced by vitamin D supplementation and physical exercise. METHOD: Serum was taken from 69 (47 female) prefrail community-dwelling older adults participating in a training intervention study to measure the CAF concentration using the Western blot technique. All participants were supplemented orally with vitamin D3 before the training intervention period commenced. Appendicular lean mass (aLM) was evaluated by dual energy X-ray absorptiometry. Multiple linear regression models were used to identify factors significantly associated with CAF concentration. RESULTS: Appendicular lean mass, age and sex were identified as significant explanatory factors for CAF concentration. Gait speed and hand grip strength were not associated with CAF concentration. Male participants showed a strong correlation (r=-0.524) between CAF serum concentration and aLM, whereas this was not the case (r=-0.219) in females. Vitamin D supplementation and physical exercise were significantly associated with a reduction in CAF concentration, especially in participants with initially high CAF concentrations. CONCLUSIONS: C-terminal Agrin Fragment could be a potential marker for identifying sarcopenia in a subgroup of affected individuals in the future. The decline of muscle mass seems to be a CAF-associated process in males, whereas the situation in females may be more complex and multifactorial. CAF concentration is reduced by vitamin D supplementation and physical exercise and therefore suggests a potentially positive effect on NMJs. Further prospective studies of sarcopenic patients in addition to muscle biopsy and electromyographical investigations are planned to verify the external validity of the CAF concept.


Asunto(s)
Agrina/sangre , Unión Neuromuscular/fisiopatología , Sarcopenia/diagnóstico , Factores de Edad , Anciano , Anciano de 80 o más Años , Agrina/efectos de los fármacos , Biomarcadores/sangre , Colecalciferol/farmacología , Suplementos Dietéticos , Ejercicio Físico/fisiología , Femenino , Fuerza de la Mano/fisiología , Humanos , Masculino , Unión Neuromuscular/efectos de los fármacos , Fragmentos de Péptidos/sangre , Entrenamiento de Fuerza , Sarcopenia/fisiopatología , Factores Sexuales , Método Simple Ciego
13.
Curr Oncol ; 19(4): 209-16, 2012 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-22876147

RESUMEN

OBJECTIVES: We set out to create a psychosocial oncology care framework and a set of relevant recommendations that can be used to improve the quality of comprehensive cancer care for Ontario patients and their families.meet the psychosocial health care needs of cancer patients and their families at both the provider and system levels. DATA SOURCES AND METHODS: The adapte process and the practice guideline development cycle were used to adapt the 10 recommendations from the 2008 U.S. Institute of Medicine standard Cancer Care for the Whole Patient: Meeting Psychosocial Health Needs into the psychosocial oncology care framework. In addition, the evidence contained in the original document was used, in combination with the expertise of the working group, to create a set of actionable recommendations. Refinement after formal external review was conducted. DATA EXTRACTION AND SYNTHESIS: The new framework consists of 8 defining domains. Of those 8 domains, 7 were adapted from recommendations in the source document; 1 new domain, to raise awareness about the need for psychosocial support of cancer patients and their families, was added. To ensure high-quality psychosocial care and services, 31 actionable recommendations were created. The document was submitted to an external review process. More than 70% of practitioners rated the quality of the advice document as high and reported that they would recommend its use. CONCLUSIONS: This advice document advocates for a multidisciplinary approach to cancer care in response to the distress experienced by cancer patients and their families. The recommendations will be useful in future to measure performance, quality of practice, and access to psychosocial services.

14.
Internist (Berl) ; 52(8): 946-54, 2011 Aug.
Artículo en Alemán | MEDLINE | ID: mdl-21710213

RESUMEN

With increasing age alterations of metabolism, appetite regulation, and body composition have been observed. As a consequence the risk of malnutrition is much higher in older than in younger persons. Though the highest prevalence rates have been described for the hospital and rehabilitation setting, most older persons with overt malnutrition are found in the community. Here persons with chronic comorbidity and low functionality show the highest risk. Routine screening for malnutrition is therefore indicated in older persons. For the successful treatment of malnutrition it is important to consider also medical and social etiologic factors before starting nutritional therapy. With regard to the preservation of muscle mass and muscle strength, adequate protein intake deserves careful consideration. Besides the implementation of regular snacks between meals, temporary application of oral supplements which are high in energy and protein is indicated. Especially during and after hospital stays, the beneficial interaction between nutrition and exercise has to be considered with regard to functionality and quality of life in older persons.


Asunto(s)
Actividades Cotidianas/clasificación , Evaluación Geriátrica/métodos , Evaluación Nutricional , Calidad de Vida , Anciano , Anciano de 80 o más Años , Composición Corporal , Comorbilidad , Proteínas en la Dieta/administración & dosificación , Suplementos Dietéticos , Ejercicio Físico , Alemania , Humanos , Tamizaje Masivo , Necesidades Nutricionales , Desnutrición Proteico-Calórica/diagnóstico , Desnutrición Proteico-Calórica/epidemiología , Desnutrición Proteico-Calórica/prevención & control , Factores de Riesgo , Sarcopenia/diagnóstico , Sarcopenia/epidemiología , Sarcopenia/prevención & control
15.
Nervenarzt ; 82(4): 459-61, 2011 Apr.
Artículo en Alemán | MEDLINE | ID: mdl-20628720

RESUMEN

Insufficient maternal folate concentrations appear to be a fetal risk factor for neural tube defects (NTD). Erythrocyte folate concentrations are widely accepted as an indicator of tissue folate storage. We retrospectively evaluated erythrocyte folate concentrations to examine if a recommended daily dosage of 5 mg folic acid is sufficient to balance the impact of antiepileptic drugs (AED) on folate metabolism in women with epilepsy. Data of 48 women (mean age 30.3 years) with idiopathic epilepsy with generalized seizures (n=12) or symptomatic epilepsy with focal seizures (n=36) were available, 43 women submitted to further analysis and 30 women received AED monotherapy. Duration of folic acid supplementation varied between 0.5 and 12 months. The daily dosage of folic acid ranged from 0.4 to 15 mg and 32 women received 5 mg/day. Erythrocyte folate concentrations ranged from 282 to 1596 ng/ml (mean 780 ng/ml). In 29 out of the 32 women (90.6%) on 5 mg folic acid per day, red cell folate was ≥400 ng/ml. In previous studies the risk for NTD was estimated to be 0.8‰ if red cell folate was ≥400 ng/ml. Our results suggest that 5 mg/day folic acid as preconception supplementation in women with epilepsy is effective to balance the impact of AEDs on folate metabolism in women with epilepsy.


Asunto(s)
Anticonvulsivantes/efectos adversos , Epilepsia/tratamiento farmacológico , Eritrocitos/metabolismo , Deficiencia de Ácido Fólico/inducido químicamente , Deficiencia de Ácido Fólico/tratamiento farmacológico , Ácido Fólico/administración & dosificación , Ácido Fólico/farmacocinética , Adolescente , Adulto , Anticonvulsivantes/uso terapéutico , Relación Dosis-Respuesta a Droga , Interacciones Farmacológicas , Epilepsia/diagnóstico , Femenino , Deficiencia de Ácido Fólico/metabolismo , Humanos , Persona de Mediana Edad , Resultado del Tratamiento , Adulto Joven
16.
J Hum Nutr Diet ; 23(4): 416-25, 2010 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-20456591

RESUMEN

BACKGROUND: Haemodialysis patients show signs of chronic inflammation and reduced appetite, which is associated with a worse clinical status and an increased mortality risk. Fish oil has anti-inflammatory properties and may be useful as a therapeutic treatment. There is limited evidence to indicate the feasibility and efficacy of this intervention in dialysis patients. The present study aimed to compare the effect of 12 weeks of supplementation with fish oil on markers of appetite and inflammation in male and female haemodialysis patients. METHODS: The study was conducted in 28 haemodialysis patients. All patients were prescribed 3 g of fish oil per day for 12 weeks. Changes in appetite, plasma fatty acid profiles and inflammatory markers were measured at baseline and at 12 weeks. RESULTS: The mean (SD) increase in percent plasma eicosapentaenoic acid was statistically significant [1.1 (0.8) to 4.1 (2.2), P < 0.001], which was a strong indicator of good adherence. There were trends towards reductions in peptide YY (-9%; P = 0.078) and an increase in subjective sensations of hunger (+12%; P = 0.406), which reflects an increase in motivation to eat. Males (n = 13) experienced a more marked increase in hunger compared to females (+23% versus -6%), which was associated with maintenance in C-reactive protein and interleukin-6, and a reduction in soluble intercellular adhesion molecule-1. CONCLUSIONS: The results obtained demonstrate meaningful trends towards improvements in subjective appetite and certain inflammatory markers (although no change in dietary intake) and this effect was more pronounced in males. However, the levels of some inflammatory markers increased in females and this requires further study. The high level of adherence achieved indicates that an intervention requiring patients to consume four fish oil capsules per day is achievable. This was a short-term study and the effects need to be confirmed in a randomised controlled trial.


Asunto(s)
Apetito/efectos de los fármacos , Aceites de Pescado/uso terapéutico , Inflamación/sangre , Estado Nutricional/efectos de los fármacos , Diálisis Renal/efectos adversos , Anciano , Biomarcadores/sangre , Proteína C-Reactiva/efectos de los fármacos , Suplementos Dietéticos , Ácidos Grasos/sangre , Estudios de Factibilidad , Trastornos de Alimentación y de la Ingestión de Alimentos/etiología , Trastornos de Alimentación y de la Ingestión de Alimentos/prevención & control , Femenino , Aceites de Pescado/sangre , Humanos , Inflamación/etiología , Inflamación/prevención & control , Interleucina-6/sangre , Recuento de Leucocitos , Masculino , Persona de Mediana Edad , Distribución por Sexo , Resultado del Tratamiento
17.
J Vet Intern Med ; 24(3): 487-95, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20337921

RESUMEN

BACKGROUND: Feline degenerative joint disease (DJD) is common and there are no approved therapies for the alleviation of the associated pain. OBJECTIVE: To test a diet high in eicosapentaenoic acid (EPA), and docosahexaenoic acid (DHA) content and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate (test-diet) for its pain-relieving and activity-enhancing effects in cats with painful, mobility-impairing DJD over a 9-week period. ANIMALS: Forty client-owned cats. METHODS: Randomized, controlled, blinded, parallel group, prospective clinical study. Cats with no detectable systemic disease, and with at least 1 appendicular joint with radiographic evidence of DJD where manipulation elicited an aversive response were included. Cats were randomly allocated to the test-diet or control diet (C-diet). Outcome measures were subjective owner and veterinarian assessments, and objective activity monitoring (accelerometry). Nonparametric statistics were used to evaluate changes within and between groups for both subjective and objective data, and locally weighted scatterplot smoothing regression analysis was used to predict activity changes. RESULTS: The primary objective outcome measures indicated that activity declined significantly (P < .001) in the C-diet group, significantly increased (P < .001) in the test-diet group and there was a significant difference between the groups (P < .001). CONCLUSION AND CLINICAL IMPORTANCE: A diet high in EPA and DHA and supplemented with green-lipped mussel extract and glucosamine/chondroitin sulfate improved objective measures of mobility. Dietary modulation might be 1 method to use to improve mobility in cats with DJD-associated pain.


Asunto(s)
Alimentación Animal/análisis , Enfermedades de los Gatos/dietoterapia , Dieta/veterinaria , Ácidos Docosahexaenoicos/farmacología , Ácido Eicosapentaenoico/farmacología , Osteoartritis/veterinaria , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Gatos , Ácidos Docosahexaenoicos/química , Ácido Eicosapentaenoico/química , Osteoartritis/dietoterapia
18.
J Anim Physiol Anim Nutr (Berl) ; 93(4): 505-11, 2009 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-18700855

RESUMEN

It is generally believed that diets containing increased amounts of polyunsaturated fatty acids (PUFA) result in improved canine skin and hair coat (SHC). However, the extent to which dietary fat amount and type play a role remains to be systematically investigated. The objective of this study was to investigate the role of both increased dietary fat amount and type on SHC assessments of dogs. Improvements of SHC conditions were investigated after feeding three diets containing increased total dietary fat (i.e. 13% total fat) for 12 weeks in relation to a lower fat acclimation diet (i.e. 9% total fat). The higher fat diets varied in polyunsaturated and saturated fat types and amounts but total fat was kept constant. Skin and hair coat assessments were performed at selected intervals by a trained group of veterinarians and graduate students. In addition, hair lipids were fractionated by thin layer chromatography after extraction of plucked hair samples. Significant improvements were found in hair coat glossiness and softness in all dogs fed the higher fat diets in relation to the acclimation diet. Improvements as a result of fat type were also seen but only at 12 weeks. A parallel finding was a marked increase in hair cholesteryl ester content determined at the end of the study at which time SHC scores were significantly improved. Skin and hair coat condition improvements may thus be related to increased cholesteryl ester deposited on the hair shaft surface when high fat diets are fed. Whereas this finding is preliminary, hair lipid analysis may be a useful, non-invasive technique with which to help assess dietary effects on canine SHC.


Asunto(s)
Alimentación Animal/análisis , Grasas de la Dieta/farmacología , Ácidos Grasos Insaturados/farmacología , Cabello/efectos de los fármacos , Piel/metabolismo , Aclimatación , Fenómenos Fisiológicos Nutricionales de los Animales , Animales , Dieta/veterinaria , Grasas de la Dieta/análisis , Perros , Ácidos Grasos Insaturados/química , Femenino , Masculino , Piel/efectos de los fármacos
20.
Nervenarzt ; 79(6): 691-5, 2008 Jun.
Artículo en Alemán | MEDLINE | ID: mdl-18389204

RESUMEN

BACKGROUND: The aim of this study was to evaluate the treatment of women with epilepsy investigated prior to or during pregnancy. PATIENTS: One hundred eighteen women (median age 28.9 years) with idiopathic (n=43), cryptogenic (n=41), or symptomatic (n=29) epilepsy and appearing for special pregnancy planning advice at a German epileptology clinic were evaluated. All patients were investigated between 2002 and 2007. FINDINGS: Of the study patients, 69 were seen prior to pregnancy, 41 (59.4%) were on monotherapy with antiepileptic drugs (AED), and 22 (31.9%) were already on folic acid supplementation. A change in AED medication was recommended in 50 (72.5%). Ninety-three of the patients were seen during pregnancy, most often during the first trimenon (n=44). Fifty-one (55%) were on AED monotherapy, most often with lamotrigine (n=24) or valproate (n=13). During pregnancy, seizure frequency increased in 33 women (35.5%) and decreased in 14 (15%). CONCLUSION: Monotherapy with AED should be established if possible, and folic acid supplementation should be started prior to pregnancy.


Asunto(s)
Anticonvulsivantes/administración & dosificación , Epilepsia/tratamiento farmacológico , Epilepsia/epidemiología , Ácido Fólico/administración & dosificación , Pautas de la Práctica en Medicina/estadística & datos numéricos , Complicaciones del Embarazo/tratamiento farmacológico , Complicaciones del Embarazo/epidemiología , Adolescente , Adulto , Femenino , Alemania , Hematínicos/administración & dosificación , Humanos , Persona de Mediana Edad , Embarazo , Prevalencia , Estudios Retrospectivos , Resultado del Tratamiento
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