[Comprehensive nutrition therapy in hospitals - Wishful thinking or reality? A survey-based cross-sectional study of the nutritional therapy in hospitals of Baden-Württemberg]. / Flächendeckende Ernährungstherapie ­ Wunsch oder Wirklichkeit? Eine fragebogengestützte Querschnittsstudie zur ernährungstherapeutischen Versorgung in baden-württembergischen Krankenhäusern.

INTRODUCTION: Malnutrition is widespread in German hospitals, has a negative impact on therapeutic success and quality of life, and it leads to increasing costs. An individualized nutritional support by nutritional professionals in accordance with current guidelines was shown to reduce mortality of malnourished inpatients. Ideally, nutritional support is conducted by an interdisciplinary nutrition support team. Current data on the nutritional therapy in German hospitals is missing. METHODS: In order to ascertain the current status of nutritional support in hospitals in the federal state of Baden-Württemberg, clinic managements of all hospitals in Baden-Württemberg received an online questionnaire. Affiliated hospitals, specialist hospitals, as well as hospitals with less than 50 beds were excluded from the analysis. RESULTS: The response rate was 84% (n = 94). The presence of a nutrition support team was reported by 34% of the hospitals. Twelve percent of the hospitals meet the structural characteristic of the OPS Code 8-98j Ernährungsmedizinische Komplexbehandlung, which means that their nutrition support team includes a physician. A validated nutritional risk screening is performed in 72% of the hospitals. Only 40% of the hospitals report that this is performed throughout every department. Nutrition support teams are more often concerned with malnutrition, enteral and parenteral nutrition as compared to nutritionists who are not organized in a team. Moreover, nutrition support teams have a wider range of tasks and more often a physician as a team member. Also, nutritional risk screenings are more often applied in hospitals with nutrition support teams. DISCUSSION: Compared with a nationwide survey from 2004, there are markedly more nutrition support teams available in hospitals in Baden-Württemberg. When compared internationally, however, the rate of nutrition support teams is still low. In addition, there is no comprehensive nutritional care available. High-quality nutritional support is more often found in hospitals with nutrition support teams. CONCLUSION: There is still a great potential of improving clinical nutritional care in hospitals in Baden-Württemberg. Moreover, an increase in nutrition support teams, also comprising medical members, should be achieved. Therefore, legal regulations and a sufficient refinancing are indispensable.

Adipose Mitochondrial Respiratory Capacity in Obesity is Impaired Independently of Glycemic Status of Tissue Donors.

OBJECTIVE: The study aimed to investigate how obesity and glycemic state affect mitochondrial respiration and ATP-generating pathways in mature human adipocytes. METHODS: Subcutaneous (sc) and visceral (vc) adipocytes were isolated from patients undergoing abdominal surgery. Respiratory chain function was analyzed by high-resolution respirometry. Adipocyte ATP levels and lactate release were measured separately in the presence of either glycolysis (2-deoxy-D-glucose) or ATP synthase (oligomycin) inhibitors. RESULTS: A significant negative correlation between oxidative phosphorylation capacity and the BMI of tissue donors found in sc adipocytes (P < 0.05). Furthermore, respirometry revealed an inverse relationship between BMI and the electron transfer system capacity of sc (P < 0.05) but not vc adipocytes. In both depots, the respiratory capacity was not affected by the glycemic state. A positive correlation between BMI and adipocyte lactate release was measured independently of the tissue origin (sc: P = 0.01; vc: P < 0.05). Direct ATP measurements indicated that energy demands of adipocytes were predominantly fulfilled by glycolytic activity. CONCLUSIONS: The study's data suggest that obesity is the primary driver of impaired adipocyte mitochondrial respiration because the glycemic state did not further deteriorate this situation. The adipocytes' energy needs are covered primarily by the glycolytic pathway.