Nutrition Management in Patients With Chronic Gastrointestinal Motility Disorders: A Systematic Literature Review.

BACKGROUND: The aim of this study was to systematically review effects of nutrition interventions on outcomes in patients with chronic gastrointestinal (GI) motility disorders. There is currently a lack of evidence-based guidelines for nutrition management in this group, likely a result of the rarity of the conditions. METHODS: A systematic review of all study types to evaluate current evidence-based nutrition interventions was performed using Medline, Embase, and CINAHL databases. Two independent reviewers participated in the process of this systematic review. A total of 15 studies and a total of 524 subjects were included. RESULTS: Best treatment of this population group was found to include a stepwise process, progressing from oral nutrition to jejunal nutrition and lastly to parenteral nutrition. Small particle, low-fat diets were significantly better tolerated than the converse, with jejunal nutrition prior to consuming oral food significantly improving oral intake and motility. In more progressive cases, percutaneous endoscopic gastrostomy with jejunal extension nutrition had lower reported symptoms than other enteral routes. Exclusive long-term parenteral nutrition is a feasible option for advanced cases, with a 68% survival rate at 15 years duration, though oral intake with parenteral nutrition is associated with higher survival rates. CONCLUSION: Treatment of patients with GI motility disorders should first trial oral nutrition. For patients who progress to jejunal or parenteral feeds, the primary aim should be to maintain or reinstate oral intake to reduce morbidity and mortality risk. Higher-quality studies are still required in this area, particularly in the areas of chronic intestinal pseudo-obstruction and systemic sclerosis.

Do morphometric parameters and geological conditions determine chemistry of glacier surface ice? Spatial distribution of contaminants present in the surface ice of Spitsbergen glaciers (European Arctic).

The chemism of the glaciers is strongly determined by long-distance transport of chemical substances and their wet and dry deposition on the glacier surface. This paper concerns spatial distribution of metals, ions, and dissolved organic carbon, as well as the differentiation of physicochemical parameters (pH, electrical conductivity) determined in ice surface samples collected from four Arctic glaciers during the summer season in 2012. The studied glaciers represent three different morphological types: ground based (Blomlibreen and Scottbreen), tidewater which evolved to ground based (Renardbreen), and typical tidewater glacier (Recherchebreen). All of the glaciers are functioning as a glacial system and hence are subject to the same physical processes (melting, freezing) and the process of ice flowing resulting from the cross-impact force of gravity and topographic conditions. According to this hypothesis, the article discusses the correlation between morphometric parameters, changes in mass balance, geological characteristics of the glaciers and the spatial distribution of analytes on the surface of ice. A strong correlation (r = 0.63) is recorded between the aspect of glaciers and values of pH and ions, whereas dissolved organic carbon (DOC) depends on the minimum elevation of glaciers (r = 0.55) and most probably also on the development of the accumulation area. The obtained results suggest that although certain morphometric parameters largely determine the spatial distribution of analytes, also the geology of the bed of glaciers strongly affects the chemism of the surface ice of glaciers in the phase of strong recession.

Variables explaining health-related quality of life in community-dwelling older adults.

BACKGROUND AND PURPOSE: Although health-related quality of life (HRQL) has been linked to numerous factors in older adults, limited or conflicting studies have investigated variables explaining HRQL in healthy, community-dwelling older adults. The purpose of this study was to determine whether physical activity, gait speed, balance, strength, endurance, and flexibility were associated with HRQL in healthy, community-dwelling older adults. METHODS: Participants of this cross-sectional, correlational research design study included residents of a senior living community, aged 60 years and older who were independent in at least unlimited household ambulation. These residents participated in tests of physical activity, gait speed, balance, strength, endurance, flexibility, and HRQL (Medical Outcomes Study Short-Form Health Survey, SF-36). The physical (PCS) and mental (MCS) component summary scores of the SF-36 were calculated. RESULTS: Data were collected on 84 participants (mean [SD] age = 78.6 (5.9) years, 54.8% women). Significant correlations were found between the PCS and fast gait speed (FGS) (r = 0.43; p < .001), the Fullerton Advanced Balance Scale (r = 0.44; p < .001), 8-ft up-and-go (r = -0.34; p = .002), and chair stand (r = 0.37; P = .001). Only body mass index (BMI) (r = 0.30; p = .007) was significantly correlated with MCS. Forward stepwise linear regression analyses were conducted, controlling for age, sex, and BMI, to identify factors associated with the PCS and MCS. In the model using PCS as the dependent variable, FGS accounted for 26% of the variance (R2 change) in PCS over and above age, sex, and BMI (R2 change = 0.03); for the full model, F = 5.37, p = .001. In the regression analysis using MCS as the dependent variable, only the 8-ft up-and-go was retained (R2 change = 0.06) over and above age, sex, and BMI (R2 change = 0.16); for the full model, F = 3.71, p = .01. DISCUSSION: Fast gait speed, balance, and lower body strength were associated with the PCS of the SF-36; however, FGS was the only variable that uniquely contributed to the variance in the PCS. Body mass index was associated with the MCS; however, only balance uniquely contributed to the variance in the MCS. Physical activity was not associated with the PCS or MCS. CONCLUSIONS: The results of this study support the assessment of FGS in community-dwelling older adults to gain insight into physical health status. Interventions directed toward FGS, balance, and BMI may contribute to optimum HRQL in this population.