Effectiveness of registered dietitian-led management of early nutritional support in the emergency intensive care unit: a retrospective observational study.

BACKGROUND: Appropriate nutritional management in critically ill patients positively impacts prognosis. This study evaluated the effectiveness of a dietitian-led early enteral nutrition protocol in an intensive care unit (ICU). METHODS: This retrospective analysis of prospectively collected data included patients who stayed in the emergency ICU (EICU) for at least 5 days between April 2021 and May 2022. Patients were divided into control and early support groups based on the implementation of the early enteral nutrition protocol in November 2021. RESULTS: The time to start enteral nutrition after admission was significantly shorter in the early support group (41.9 h) than in the control group (59.8 h). The early support group (n = 58) also had higher nutritional sufficiency rates than the control group (n = 56) and a lower incidence of diarrhea (10% vs. 37.5%). CONCLUSIONS: The dietitian-led early nutritional support system effectively reduced the time to enteral nutrition initiation, improved nutritional sufficiency rates, and decreased the incidence of diarrhea in the EICU.

Effect of Early Nutritional Support on Quality of Life by EORTC QLQ-C30 in Allogeneic Hematopoietic Stem Cell Transplantation.

Purpose: Increasing attention is being paid to the importance of nutritional management of allogeneic hematopoietic stem cell transplant (allo-HSCT) patients. However, few studies have conducted detailed evaluations of both nutritional intake and quality of life (QOL) in allo-HSCT patients. Therefore, we investigated the nutritional status and quality of life of our allo-HSCT patients. Methods: The subjects were 26 adults who underwent allo-HSCT at Hamamatsu University Hospital between August 2018 and October 2021. Early nutritional intervention was provided from the time of the decision to perform allo-HSCT to the time of discharge, and it incorporated regular QOL assessments. The analyzed indices were nutritional intake, anthropometric measurements, body mass index (BMI), grip strength, body composition analyzer (InBody S10) measurements, and blood laboratory values including transthyretin levels. QOL was assessed using the QLQ-C30 questionnaire of the European Organization for Research and Treatment of Cancer (EORTC) (version 3.0) and calculated according to the EORTC scoring manual. The indices were compared at pre-transplantation, 30 days post-transplantation, 60 days post-transplantation, and at discharge. The association between pre-transplantation nutritional status and QOL was examined. Results: The median hospital stay after transplantation was 97 days (range, 78-123 days). Energy intake was maintained at 31 kcal/day/kg through 30 days post-transplantation, 60 days post-transplantation, and discharge, and protein intake was maintained at 1.0 g/day/kg throughout all time periods. There was a significant positive correlation between the pre-transplantation transthyretin level and the 60-day post-transplantation QOL scores for "global health", "physical functioning", "cognitive functioning", and "emotional functioning", and there were significant negative correlations with "fatigue" and "pain" that indicated improvement. Conclusion: Early nutritional management of allo-HSCT patients prior to transplantation allowed maintenance of nutritional intake, and higher pre-transplant transthyretin levels were associated with higher QOL scores at 60 days post-transplantation.

Involvement of DNA fragmentation of enterocytes in mucosal injury to a mouse jejunum incubated in ussing chambers.

A mouse jejunum, when incubated in vitro in Ussing chambers, was found to exhibit morphological deterioration of the villi with denudation of the epithelia (J Nutr Sci Vitaminol, 51: 406, 2005). Our study examined the involvement of apoptosis in an intestinal injury model by a DNA ladder assay and terminal deoxynucleotidyl transferase-mediated dUTP nick end-labeling (TUNEL) assay. Electrophoresis of mucosal DNA revealed ladders, indicating the occurrence of DNA fragmentation. Cells with TUNEL-positive nuclei were detected among the villus epithelial cells (enterocytes), whereas they are rarely seen among crypt epithelial cells. These features were evident within 1 h after the start of incubation. Apoptotic death of the enterocytes was thus involved in the destruction of villi when incubated in Ussing chambers.

The electrophysiological properties of the mucosal barrier in the injured mouse jejunum in Ussing chambers.

We previously suggested in the in vitro mouse jejunum that when the primary epithelial barrier on the villi was largely disabled, a secondary mucosal barrier substitutes for the primary one. This study showed that the mucosal Ca(2+) removal did not further deteriorate the histology but increased transmural conductance and lucifer yellow flux, and decreased forskolin-induced potential difference. It is suggested that in this injury model the postulated secondary barrier is Ca(2+)-dependent and likely to be present on or immediately beneath the mucosal surface.

In vitro diffusion barriers of the mouse jejunum in Ussing chambers.

Epithelial cells and their intercellular junctions play a primary role in the intestinal mucosal diffusion barrier to the invasion of noxious agents. Our previous study has shown that the mouse jejunum, when incubated in Ussing chambers for 4 h, exhibited morphological deterioration of the villi with denudation of the epithelia while it retained cAMP-induced potential difference (PD), suggesting that some subepithelial tissues had taken part in the barrier functions when the primary epithelial barrier on the villous surface was broken. To further characterize the barrier function of the jejunum in Ussing chambers, we measured the unidirectional lucifer yellow flux (J(LY)), which represents the permeation of a medium-sized anion, the transmural electrical conductance (G(t)), which reflects the permeation of electrolytes, mainly NaCl, and forskolin-induced PD. The values of J(LY), G(t) and forskolin-induced PD were not affected by removing the muscularis propria, suggesting that this tissue did not substantially contribute to the barrier. In addition, the values of J(LY), G(t) and forskolin-induced PD were not correlated with the degree of denudation of epithelial cells on the mucosal surface, supporting the notion that the main barrier function is constituted by the subepithelial tissues rather than the epithelium. Loosening the tissue (thereby approximating the free diffusion condition) by removing Ca(2+) from the bathing solution increased both J(LY) and G(t), with the former being larger than the latter. In conclusion, the mucosa propria and/or the submucosa constitute a diffusion barrier that restricted the permeation of lucifer yellow more tightly than NaCl in the injured jejunum incubated in Ussing chambers.