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1.
Nutrients ; 16(5)2024 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-38474867

RESUMO

The effectiveness of rehabilitation programs (RP) for chronic obstructive pulmonary disease (COPD) exacerbation remains controversial. However, few studies have investigated the combined effects of exercise and nutritional therapy. This study aimed to determine the effects of combined nutritional therapy on the physical function and nutritional status of patients with COPD exacerbation who underwent early RP. A randomized controlled trial was conducted in patients hospitalized for COPD exacerbations. Patients were assigned to receive a regular diet in addition to RP (control group) or RP and nutrition therapy (intervention group). Physical function, including quadricep strength and body composition, was assessed. The intervention group was administered protein-rich oral nutritional supplements. A total of 38 patients with negligible baseline differences were included in the analysis. The intervention group showed a notably greater change in quadriceps strength. Lean body mass and skeletal muscle indices markedly decreased in the control group but were maintained in the intervention group. Logistic regression analysis identified nutritional therapy as a significant factor associated with increased muscle strength. No serious adverse events were observed in either group. Therefore, nutritional therapy combined with RP is safe and effective for improving exercise function while maintaining body composition in patients with COPD exacerbation.


Assuntos
Terapia Nutricional , Doença Pulmonar Obstrutiva Crônica , Humanos , Estado Nutricional , Estudos Prospectivos , Apoio Nutricional , Qualidade de Vida
4.
Kidney360 ; 5(2): 310-319, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-38297445

RESUMO

Sarcopenia, defined as age-related decline in skeletal muscle mass and functional capacity, is a hallmark nutritional abnormality observed in patients with moderate-to-advanced CKD. Uremic state and associated medical conditions also predispose older patients with CKD to protein-energy wasting, a nutritional abnormality that could include sarcopenia. Prevention of protein and energy depletion and replenishing the already low nutritional reserves elderly patients with CKD should focus on conventional and innovative strategies. This review aims to provide an overview of the mainstay of nutritional therapy in this patient population, such as intake of adequate amounts of protein and energy along with preserving fluid, electrolyte, and mineral balance, and to discuss more innovative interventions to aid these approaches.


Assuntos
Terapia Nutricional , Insuficiência Renal Crônica , Sarcopenia , Humanos , Idoso , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapia , Sarcopenia/terapia , Sarcopenia/complicações , Apoio Nutricional , Caquexia/complicações , Caquexia/terapia , Proteínas
6.
Nutr. hosp ; 41(1): 11-18, Ene-Feb, 2024. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-230880

RESUMO

Introduction: during COVID-19 pandemic, international societies released guidelines and recommendations for patients requiring nutritionalsupport 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, andnutritional 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 suggestedby 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). Theprotein 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 extu-bated. Age, sex, and nutritional risk were related to higher mortality in patients with EN, whereas the infused energy and protein, the percentageof 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 asso-ciated with lower mortality in COVID-19 patients. More studies are needed to confirm the role of these nutrients on the mortality rate.(AU)


Introducción: durante la pandemia de COVID-19, las sociedades internacionales publicaron guías y recomendaciones para pacientes querequieren 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 recomenda-ciones 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 variabley 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 ± 0,3g/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, asícomo la suplementación de fórmulas con AGPI n-3 y arginina, podría asociarse con menor mortalidad en pacientes con COVID-19.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Terapia Nutricional , /mortalidade , Nutrição Enteral , Mortalidade , Estado Nutricional , Proteínas/administração & dosagem , Ciências da Nutrição , Estudos de Coortes , /epidemiologia
7.
Nutr. hosp ; 41(1): 138-144, Ene-Feb, 2024. tab, graf
Artigo em Inglês | IBECS | ID: ibc-230893

RESUMO

Objective: the Controlling Nutritional Status (CONUT) score is an objective tool widely used to assess nutritional status of patients. We aimed toinvestigate the value of CONUT score on predicting length of hospital stay (LOS) and the risk of long COVID in patients with COVID-19.Methods: a total of 151 patients with COVID-19 were enrolled for analysis. Patients were followed up for two years from three months after theonset of SARS-CoV-2 infection. CONUT score was calculated on admission. The correlation between CONUT score and LOS were assessed bySpearman’s rank correlation coefficient and multivariate linear analysis. The association between different CONUT grade and long COVID wasevaluated by Kaplan-Meier survival curves with log-rank test and Cox proportional hazard models.Results: Spearman’s rank correlation coefficient showed that CONUT scores were positively correlated with LOS (r = 0.469, p < 0.001). Multivari-ate linear analysis showed that CONUT score is the only independent determinant of LOS (B 2.055, 95 % CI: 1.067-3.043, p < 0.001). A total of 53(35.10 %) patients with long COVID were identified. Kaplan-Meier cumulative survival curves and Cox proportional hazards analyses showed thatthe incidence of long COVID in patients with a higher CONUT score was significantly higher than in patients with lower CONUT score (p < 0.001).Conclusions: higher CONUT score predicts longer LOS and the risk of long COVID in patients with COVID-19. The CONUT score might be usefulfor risk stratification in COVID-19 patients and help to develop new nutritional treatment strategies for long COVID.(AU)


Objetivo: la escala de valoración del estado nutricional CONUT es una herramienta objetiva ampliamente utilizada para evaluar el estado nutricionalde los pacientes. Nuestro objetivo fue investigar el valor de la puntuación CONUT para predecir la duración de la estancia hospitalaria (LOS) y elriesgo de COVID persistente en pacientes con COVID-19.Métodos: se inscribieron para el análisis un total de 151 pacientes con COVID-19. Los pacientes se sometieron a un seguimiento de dos añosa partir de los tres meses posteriores al inicio de la infección por SARS-CoV-2. La puntuación CONUT se calculó al ingreso. La correlación entrela puntuación CONUT y la LOS se evaluó mediante el coeficiente de correlación de rangos de Spearman y el análisis lineal multivariante. Laasociación entre diferentes grados CONUT y COVID persistente se evaluó mediante curvas de supervivencia de Kaplan-Meier con prueba derango logarítmico y modelos de riesgo proporcional de Cox.Resultados: el coeficiente de correlación de rango de Spearman mostró que las puntuaciones CONUT se correlacionaron positivamente con LOS(r = 0,469, p <0,001). El análisis lineal multivariante mostró que la puntuación CONUT es el único determinante independiente de LOS (B 2,055,IC 95 %: 1,067-3,043, p < 0,001). Se identificaron un total de 53 (35,10 %) pacientes con COVID persistente. Las curvas de supervivenciaacumulada de Kaplan-Meier y los análisis de riesgos proporcionales de Cox mostraron que la incidencia de COVID persistente en pacientes conuna puntuación CONUT más alta fue significativamente mayor que en pacientes con una puntuación CONUT más baja (p < 0,001).Conclusiones: una puntuación CONUT más alta predice una LOS más larga y el riesgo de COVID persistente en pacientes con COVID-19. Lapuntuación CONUT podría ser útil para la estratificación de riesgo en pacientes con COVID-19 y ayudar a desarrollar nuevas estrategias detratamiento nutricional para COVID persistente.(AU)


Assuntos
Humanos , Masculino , Feminino , Estado Nutricional , Tempo de Internação , Terapia Nutricional , Avaliação Nutricional
8.
Nutr. hosp ; 41(1): 244-248, Ene-Feb, 2024. tab
Artigo em Espanhol | IBECS | ID: ibc-230904

RESUMO

El presente documento tiene como objetivo plantear y justificar la incorporación del dietista-nutricionista en los equipos multidisciplinares deatención integrada en la educación, el tratamiento y el seguimiento de aquellos pacientes con patologías que cursen con alteraciones del estadonutricional, tanto en su defecto como en su exceso, en el área sanitaria de la Comunidad Autónoma de Madrid.El estado nutricional de los pacientes hospitalizados se beneficiará de la incorporación del dietista-nutricionista al equipo multidisciplinar que,actualmente, se ocupa de la atención de estos. El manejo de la terapia nutricional por dietistas-nutricionistas ha demostrado ser costo-efectiva,habida cuenta de la repercusión sanitaria que tiene el estado nutricional en la evolución clínica y prevención de enfermedades como la diabetes,los trastornos de la conducta alimentaria, la obesidad, el cáncer, la insuficiencia cardiaca, la osteoporosis, la enfermedad celiaca y la enfermedadrenal crónica, entre otras.(AU)


The present document has the objective of justifying the incorporation of a dietician/nutritionist to the multidisciplinary teams of specialized carethat provide education, food anamnesis, nutritional recommendations, treatment and follow up of those patients in risk of malnutrition in Madrid.The appropriate nutritional status of hospitalized patients bears a close relationship with the existence of dieticians at hospitals. Dieticians usenutrition therapy as a cost-effective means to achieve significant health benefits by preventing or altering the course of diabetes, obesity, hyper-tension, lipid metabolism disorders, heart failure, osteoporosis, celiac disease, and chronic kidney disease, among other diseases.(AU)


Assuntos
Humanos , Masculino , Feminino , Nutricionistas , Seleção de Pessoal , Pacientes , Estado Nutricional , Terapia Nutricional , Espanha , Hospitais Públicos , Desnutrição , Programas de Rastreamento
9.
Nutr. hosp ; 41(1): 249-254, Ene-Feb, 2024.
Artigo em Espanhol | IBECS | ID: ibc-230905

RESUMO

La Federación Latinoamericana de Terapia Nutricional, Nutrición Clínica y Metabolismo – FELANPE, fue fundada en el año 1988. Reúne a Socie-dades y Asociaciones Interdisciplinarias de Nutrición Clínica y Terapia Nutricional de América Latina y el Caribe, además de España y Portugal.Actualmente la conforman representaciones de 18 países.Se describen los objetivos de la Federación teniendo en cuenta el compromiso asumido.Se trata de estudio observacional transversal, multicéntrico en que se incluyeron 132 hospitales con más de 100 camas, de alta complejidad,estatales y privados de 14 países de Latinoamérica miembros de FELANPE. Se evaluaron las características del hospital, la implementación dela valoración nutricional, el diagnóstico nutricional de pacientes, el equipo responsable de la terapia nutricional, la terapéutica nutricional (oral,enteral y parenteral), la monitorización y el seguimiento nutricional.Para tal, se diseñó y validó un cuestionario digital y un video explicativo para garantizar la calidad de los datos recolectados. La validación seefectúo mediante un estudio piloto realizado en Paraguay, aprobado por el Comité de ética en la Investigación de la Facultad de Ciencias Médicasde la Universidad Nacional de Asunción. La investigación actual cuenta con la aprobación del Comité de ética de Investigación de la Facultad deCiencias Químicas de la Universidad Nacional de Asunción y del Comité de ética de FELANPE.Los resultados presentados en el XVIII Congreso Latinoamericano de FELANPE, en Asunción del Paraguay, el 12 de octubre del 2023, sirven comobase para caracterizar la implementación de la Terapia Nutricional Parenteral y Enteral (terapia nutricional médica) en Hospitales de Latinoaméricay son utilizados como sustento técnico del presente Compromiso de Asunción.(AU)


The Latin American Federation of Nutritional Therapy, Clinical Nutrition, and Metabolism – FELANPE, was founded in 1988. It brings togetherinterdisciplinary societies and associations in Clinical Nutrition and Nutritional Therapy from Latin America and the Caribbean, as well as Spainand Portugal. Currently, it comprises representations from 18 countries.The objectives of the Federation are described, taking into account the assumed commitment. This is an observational cross-sectional, multicenterstudy that included 132 hospitals with more than 100 beds, of high complexity, both state-owned and private, from 14 countries in Latin Americathat are members of FELANPE. The study assessed hospital characteristics, implementation of nutritional assessment, nutritional diagnosis ofpatients, the team responsible for nutritional therapy, nutritional therapy (oral, enteral, and parenteral), monitoring, and nutritional follow-up.For this purpose, a digital questionnaire and an explanatory video were designed and validated to ensure the quality of the collected data. Validationwas carried out through a pilot study conducted in Paraguay, approved by the Ethics Committee for Research at the Faculty of Medical Sciences ofthe National University of Asunción. The current research has the approval of the Research Ethics Committee of the Faculty of Chemical Sciencesof the National University of Asunción and the Ethics Committee of FELANPE.The results presented at the XVIII Latin American Congress of FELANPE in Asunción, Paraguay, on October 12, 2023, serve as a basis for cha-racterizing the implementation of Parenteral and Enteral Nutritional Therapy (medical nutritional therapy) in hospitals in Latin America and areused as technical support for the present Asunción Commitment.(AU)


Assuntos
Humanos , Masculino , Feminino , Terapia Nutricional/tendências , Educação Alimentar e Nutricional , Nutricionistas , Avaliação Nutricional , Fenômenos Fisiológicos da Nutrição , Estudos Transversais , Ciências da Nutrição , Inquéritos e Questionários , Paraguai
10.
Nutr. hosp ; 41(supl.1): 1-60, Feb. 2024. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-230912

RESUMO

La anorexia nerviosa (AN) es una enfermedad de origen multifactorial. Recientemente se ha sumado el papel de las redes sociales y la microbiota intestinal en la patogenia. La pandemia por COVID-19 ha tenido un impacto negativo en los pacientes con AN. La potencial afectación médica y nutricional derivada de la desnutrición o las conductas compensatorias dan lugar a una compleja enfermedad de gravedad variable, cuyo manejo precisa un equipo multidisciplinar con elevado nivel de conocimientos en la materia. Es fundamental la coordinación entre niveles asistenciales y en la transición de pediatría a adultos. Una adecuada valoración clínica permite detectar eventuales complicaciones, así como establecer el riesgo orgánico del paciente y, por tanto, adecuar el tratamiento médico-nutricional de forma individualizada. El restablecimiento de un apropiado estado nutricional es un pilar fundamental del tratamiento en la AN. Para ello es necesario diseñar una intervención de renutrición individualizada que incluya un programa de educación nutricional. Según el escenario clínico puede ser necesaria la nutrición artificial. Aunque la decisión de qué nivel de atención escoger al diagnóstico o durante el seguimiento depende de numerosas variables (conciencia de enfermedad, estabilidad médica, complicaciones, riesgo autolítico, fracaso del tratamiento ambulatorio o contexto psicosocial, entre otros), el tratamiento ambulatorio es de elección en la mayoría de las ocasiones. No obstante, puede ser necesario un escenario más intensivo (hospitalización total o parcial) en casos seleccionados. En pacientes gravemente desnutridos debe prevenirse la aparición de un síndrome de alimentación cuando se inicia la renutrición. La presencia de una AN en determinadas situaciones (gestación, vegetarianismo, diabetes mellitus de tipo 1, etc.) exige un manejo particular. En estos pacientes también debe abordarse de forma correcta el ejercicio físico.(AU)


Anorexia nervosa (AN) is a multifactorial disorder. A possible role of the social network and the gut microbiota in pathogenesis has been added.Exogenous shocks such as the COVID19 pandemic have had a negative impact on patients with AN.The potential medical and nutritional impact of malnutrition and/or compensatory behaviors gives rise to a complex disease with a wide range ofseverity, the management of which requires a multidisciplinary team with a high level of subject matter expertise. Coordination between levelsof care is necessary as well as understanding how to transition the patient from pediatric to adult care is essential. A proper clinical evaluationcan detect possible complications, as well as establish the organic risk of the patient. This allows caregivers to tailor the medical-nutritionaltreatment for each patient.Reestablishing adequate nutritional behaviors is a fundamental pillar of treatment in AN. The design of a personalized nutritional treatment andeducation program is necessary for this purpose. Depending on the clinical severity, artificial nutrition may be necessary. Although the decisionregarding the level of care necessary at diagnosis or during follow-up depends on a number of factors (awareness of the disease, medical stability,complications, suicidal risk, outpatient treatment failure, psychosocial context, etc.), outpatient treatment is the most frequent and most preferredchoice. However, more intensive care (total or partial hospitalization) may be necessary in certain cases. In severely malnourished patients, theappearance of refeeding syndrome should be prevented during renourishment.The presence of AN in certain situations (pregnancy, vegetarianism, type 1 diabetes mellitus) requires specific care. Physical activity in thesepatients must also be addressed correctly.(AU)


Assuntos
Humanos , Masculino , Feminino , Anorexia Nervosa , Terapia Nutricional , Educação Alimentar e Nutricional , Desnutrição , Síndrome da Realimentação , Comportamento Alimentar
11.
Clin Nutr ; 43(2): 413-445, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38169175

RESUMO

BACKGROUND: Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS: The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS: The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.


Assuntos
Fibrose Cística , Terapia Nutricional , Lactente , Criança , Adulto , Humanos , Fibrose Cística/terapia , Estado Nutricional , Vitaminas , Vitamina A
15.
Nutr Clin Pract ; 39(1): 210-217, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37132047

RESUMO

BACKGROUND AND AIMS: Nutrition societies recommended remote hospital nutrition care during the coronavirus disease 2019 (COVID-19) pandemic. However, the pandemic's impact on nutrition care quality is unknown. We aimed to evaluate the association between remote nutrition care during the first COVID-19 wave and the time to start and achieve the nutrition therapy (NT) goals of critically ill patients. METHODS: A cohort study was conducted in an intensive care unit (ICU) that assisted patients with COVID-19 between May 2020 and April 2021. The remote nutrition care lasted approximately 6 months, and dietitians prescribed the nutrition care based on medical records and daily telephone contact with nurses who were in direct contact with patients. Data were retrospectively collected, patients were grouped according to the nutrition care delivered (remote or in person), and we compared the time to start NT and achieve the nutrition goals. RESULTS: One hundred fifty-eight patients (61.5 ± 14.8 years, 57% male) were evaluated, and 54.4% received remote nutrition care. The median time to start NT was 1 (1-3) day and to achieve the nutrition goals was 4 (3-6) days for both groups. The percentage of energy and protein prescribed on day 7 of the ICU stay concerning the requirements did not differ between patients with remote and patients with in-person nutrition care [95.5% ± 20.4% × 92.1% ± 26.4% (energy) and 92.9% ± 21.9% × 86.9% ± 29.2% (protein); P > 0.05 for both analyses]. CONCLUSION: Remote nutrition care in patients critically ill with COVID-19 did not impact the time to start and achieve the NT goals.


Assuntos
COVID-19 , Terapia Nutricional , Humanos , Masculino , Feminino , Pandemias , Estudos de Coortes , Estudos Retrospectivos , Estado Terminal/terapia , Objetivos , Unidades de Terapia Intensiva
16.
J Acad Nutr Diet ; 124(3): 408-415, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38040115

RESUMO

Providing interventions that facilitate improvement of dietary intake and other health behaviors can improve nutrition-related outcomes in adults with overweight or obesity. Medical nutrition therapy (MNT) behavioral interventions require expertise from registered dietitian nutritionists or international equivalents (dietitians), which no other health care provider can provide for adults with obesity. Current evidence supports the role of MNT behavioral interventions for adults with overweight or obesity as an effective treatment option, when appropriate for and desired by the client. This Academy of Nutrition and Dietetics Position Paper describes potential benefits and concerns regarding dietitian-provided MNT behavioral interventions for adults with overweight and obesity and informs dietitians about implications for practice. This Position Paper is supported by a systematic review examining effectiveness of MNT interventions provided by dietitians and by an evidence-based practice guideline. It is the position of the Academy of Nutrition and Dietetics that MNT behavioral interventions for adults (aged 18 years and older) with overweight or obesity should be a treatment option, when appropriate and desired by the client, to improve cardiometabolic, quality of life, and anthropometric outcomes. Dietitians providing MNT recognize the complex contributors to overweight and obesity, and thus individualize interventions, based on a shared decision-making process, and deliver interventions in an inclusive, compassionate, and client-centered manner. Interventions should include collaboration with an interprofessional team when needed. Dietitians strive to increase health equity and reduce health disparities by advocating and providing opportunities for increased access to effective nutrition care services. This position remains in effect until December 31, 2031.


Assuntos
Dietética , Terapia Nutricional , Nutricionistas , Adulto , Humanos , Sobrepeso/terapia , Qualidade de Vida , Obesidade/terapia
17.
Curr Opin Anaesthesiol ; 37(1): 24-34, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37865830

RESUMO

PURPOSE OF REVIEW: No specific guidelines on medical nutrition therapy (MNT) in patients on different types of mechanical circulatory support (MCS) devices yet exist and overall evidence is limited. The purpose of this narrative review is to provide an overview about current existing evidence, which might be of underrecognized importance for the patients' short-term and long-term clinical and functional outcomes. RECENT FINDINGS: Patients on MCS inherit substantial metabolic, endocrinologic, inflammatory, and immunologic alterations, and together with the specificities of MCS therapy, technical modalities of respective devices, and concomitant medication, the consideration of individualized MNT approaches is indicated in routine clinical practice. Exemplarily, the evaluation of the patients' individual nutrition status, determination of nutrition targets, progressive increase of energy and protein supply throughout the different phases of disease, prevention of micronutrient deficiencies, implementation of nutrition protocols, appropriate monitoring strategies, and continuous quality improvement are essential elements of MNT in patients on MCS. SUMMARY: The importance of MNT for patients on MCS still often remains underrecognized, which might be of particular relevance in view of the significant metabolic alterations, the long treatment period, and severity of illness in these patients. Further research on more targeted MNT approaches in those patients is urgently needed for the generation of evidence-based guidelines for this specific cohort of critically ill patients.


Assuntos
Desnutrição , Terapia Nutricional , Humanos , Apoio Nutricional , Terapia Nutricional/métodos , Desnutrição/prevenção & controle , Cuidados Críticos/métodos , Pacientes
18.
JBI Evid Synth ; 22(2): 305-313, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37641802

RESUMO

OBJECTIVE: The objective of this review is to synthesize the effects of nutritional counseling compared with no intervention (maintaining lifestyle habits) or nutritional counseling in combination with other interventions (eg, nutritional supplementation, physical activity) on physical performance and muscle strength in older adults. INTRODUCTION: Nutritional counseling, which is considered the first line of nutrition therapy, could play an important role in geriatric care programs by helping older adults understand the importance of nutrition and by promoting healthy, sustainable eating habits. However, the effects of nutritional counseling on physical function and muscle strength among older adults are not clear. INCLUSION CRITERIA: This review will consider randomized controlled trials and non-randomized controlled trials. Participants aged 65 years or older, who have received nutritional counseling alone or in combination with another intervention (eg, nutritional supplementation, physical exercise) will be considered for inclusion. Comparators will include another intervention or no intervention, but physical performance (ie, gait, endurance, balance) or muscle strength must be measured. METHODS: This systematic review will be conducted in accordance with the JBI methodology for systematic reviews of effectiveness. The databases to be searched will include MEDLINE (Ovid), Embase, CENTRAL (Ovid), CINAHL (EBSCOhost), and Scopus. Sources of unpublished studies and gray literature will include Google Scholar and protocol registers. Two independent reviewers will select relevant studies, critically appraise the studies, and extract data. Studies will be pooled in a statistical meta-analysis or presented in narrative format. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach will be used to grade the certainty of the evidence. REVIEW REGISTRATION: PROSPERO CRD42022374527.


Assuntos
Força Muscular , Terapia Nutricional , Humanos , Idoso , Revisões Sistemáticas como Assunto , Força Muscular/fisiologia , Aconselhamento , Desempenho Físico Funcional , Terapia Nutricional/métodos , Metanálise como Assunto , Literatura de Revisão como Assunto
19.
Mol Genet Metab ; 141(1): 108114, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-38142628

RESUMO

Phenylketonuria is characterized by intellectual disability and behavioral, psychiatric, and movement disorders resulting from phenylalanine (Phe) accumulation. Standard-of-care treatment involves a Phe-restricted diet plus medical nutrition therapy (MNT), with or without sapropterin dihydrochloride, to reduce blood Phe levels. Pegvaliase is an injectable enzyme substitution treatment approved for adult patients with blood Phe >600 µmol/L despite ongoing management. A previous comparative effectiveness analysis using data from the Phase 3 PRISM trials of pegvaliase (NCT01819727 and NCT01889862) and the Phenylketonuria Demographics, Outcomes and Safety Registry (PKUDOS; NCT00778206) suggested that pegvaliase was more effective at lowering mean blood Phe levels than sapropterin + MNT or MNT alone at 1 and 2 years of treatment. The current work augments and complements the previous analysis by including additional follow-up from the completed studies, robust methods reflecting careful consideration of issues with the distribution of Phe, and alternative methods for adjustment that are important for control of potential confounding in comparative effectiveness. Median blood Phe levels were lower, and median intact protein intakes were higher, in the pegvaliase group (n = 183) than in the sapropterin + MNT (n = 82) and MNT (n = 67) groups at Years 1, 2, and 3. In the pegvaliase group, median blood Phe levels decreased from baseline (1244 µmol/L) to Year 1 (535 µmol/L), Year 2 (142 µmol/L), and Year 3 (167 µmol/L). In the sapropterin + MNT group, median blood Phe levels decreased from baseline (900 µmol/L) to Year 1 (588 µmol/L) and Year 2 (592 µmol/L), and increased at Year 3 (660 µmol/L). In the MNT group, median blood Phe levels decreased slightly from baseline (984 µmol/L) to Year 1 (939 µmol/L) and Year 2 (941 µmol/L), and exceeded baseline levels at Year 3 (1157 µmol/L). The model-estimated proportions of participants achieving blood Phe ≤600 µmol/L were 41%, 100%, and 100% in the pegvaliase group at Years 1, 2, and 3, respectively, compared with 55%, 58%, and 38% in the sapropterin + MNT group and 5%, 16%, and 0% in the MNT group. The estimated proportions of participants achieving more stringent blood Phe targets of ≤360 µmol/L and ≤120 µmol/L were also higher in the pegvaliase group than in the other groups at Years 2 and 3. Overall, our results indicate that, compared with standard therapy, pegvaliase induces a substantial, progressive, and sustained decrease in blood Phe levels - to a much greater extent than sapropterin + MNT or MNT alone - which is expected to improve long-term outcomes in patients with phenylketonuria.


Assuntos
/análogos & derivados , Terapia Nutricional , Fenilcetonúrias , Adulto , Humanos , Fenilcetonúrias/terapia , Fenilalanina Amônia-Liase , Fenilalanina , Proteínas Recombinantes
20.
J Nutr ; 154(2): 777-784, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38141775

RESUMO

BACKGROUND: Diabetes complicates ≤7% of pregnancies in the United States. Although medical nutrition therapy is the mainstay of diabetes treatment, many barriers exist to the successful implementation of dietary modifications. Home-delivered medically tailored meals (MTMs) are promising to overcome such barriers. OBJECTIVE: The objective of this study was to evaluate the feasibility and acceptability of home-delivered MTM in pregnant patients with diabetes. METHODS: We performed a prospective cohort study of home-delivered MTM for pregnant patients with diabetes using a mixed-methods approach. Participants <35 wk of gestation at the time of enrollment received weekly home delivery of diabetes-specific meals. Qualitative semistructured interviews were conducted to gain insight into participants' experience. Diabetes self-efficacy was assessed pre- and postintervention using the Diabetes Self-Efficacy Scale and 2-Item Diabetes Distress Screening Scale. The difference in mean scores was compared using t-tests with P value of <0.05 considered significant. Feasibility and acceptability were evaluated through participants' attitude toward MTM in qualitative interviews and indirectly evaluated through diabetes self-efficacy surveys. RESULTS: Twenty pregnant people with diabetes who received home-delivered MTM during pregnancy were interviewed postpartum. Participants found this program convenient for various reasons, including reduced time for grocery shopping and preparing meals. Participants were satisfied with meals, citing a positive impact on diabetes management, accessibility of healthy foods, reduced stress with meal planning, and greater perceived control of blood glucose. Most participants shared meals with their families or received specific meals for their dependents, which was positively received. Reduced financial and mental stress was also widely reported. Diabetes self-efficacy was significantly improved postintervention with MTM. CONCLUSION: Home-delivered MTM is feasible and acceptable in pregnant patients with diabetes and may improve diabetes self-efficacy. Individual experiences offered insight into various barriers overcome by using this service. Home-delivered MTM may help ensure an accessible, healthy diet for pregnant patients with diabetes.


Assuntos
Diabetes Mellitus , Terapia Nutricional , Gravidez , Feminino , Humanos , Estados Unidos , Estudos Prospectivos , Estudos de Viabilidade , Refeições
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