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1.
Nutrients ; 13(4)2021 Apr 14.
Artículo en Inglés | MEDLINE | ID: mdl-33919840

RESUMEN

The novel severe acute respiratory syndrome coronavirus (COVID-19) has hit older adults harder due to a combination of age-related immunological and metabolic alterations. The aim of this review was to analyze the COVID-19 literature with respect to nutritional status and nutrition management in older adults. No studies only on people aged 65+ years were found, and documentation on those 80+ was rare. Age was found to be strongly associated with worse outcomes, and with poor nutritional status. Prevalence of malnutrition was high among severely and critically ill patients. The studies found a need for nutrition screening and management, and for nutrition support as part of follow-up after a hospital stay. Most tested screening tools showed high sensitivity in identifying nutritional risk, but none were recognized as best for screening older adults with COVID-19. For diagnosing malnutrition, the Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended but were not used in the studies found. Documentation of olfactory and gustatory dysfunction in relation to nutritional status is missing in older adults. Other COVID-19-associated factors with a possible impact on nutritional status are poor appetite and gastrointestinal symptoms. Vitamin D is the nutrient that has attracted the most interest. However, evidence for supplementation of COVID-19 patients is still limited and inconclusive.


Asunto(s)
Envejecimiento , Evaluación Nutricional , Terapia Nutricional/métodos , Estado Nutricional , Factores de Edad , Anciano , Anciano de 80 o más Años , Agnosia/epidemiología , Síndrome de Liberación de Citoquinas/epidemiología , Femenino , Enfermedades Gastrointestinales/epidemiología , Hospitalización , Humanos , Masculino , Desnutrición/epidemiología , Persona de Mediana Edad , Trastornos del Olfato/epidemiología , Prevalencia , Factores de Riesgo , Sarcopenia/epidemiología , Vitamina D/uso terapéutico
2.
Nutrients ; 13(3)2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33809826

RESUMEN

BACKGROUND: People with upper gastrointestinal cancer are at high risk for malnutrition without universal access to early nutrition interventions. Very little data exist on the attitudes and views of health professionals on providing nutrition care to this patient cohort delivered by electronic health methods. COVID-19 has fast-tracked the adoption of digital health care provision, so it is more important than ever to understand the needs of health professionals in providing health care via these modes. This study aimed to explore the perspectives of health professionals on providing nutrition care to upper gastrointestinal cancer patients by electronic methods to allow the future scaling-up of acceptable delivery methods. METHODS: Semi-structured qualitative interviews were conducted face-to-face or by telephone and recorded, de-identified and transcribed. Thematic analysis was facilitated by NVivo Pro 12. RESULTS: Interviews were conducted on 13 health professionals from a range of disciplines across several public and private health institutions. Thematic analysis revealed three main themes: (1) the ideal model, (2) barriers to the ideal model and (3) how to implement and translate the ideal model. Health professionals viewed the provision of nutrition interventions as an essential part of an upper gastrointestinal cancer patient's treatment with synchronous, telephone-based internal health service models of nutrition care overwhelmingly seen as the most acceptable model of delivery. Mobile application-based delivery methods were deemed too challenging for the current population serviced by these clinicians. CONCLUSION: The use of novel technology for delivering nutrition care to people receiving treatment for upper gastrointestinal cancers was not widely accepted as the preferred method of delivery by health professionals. There is an opportunity, given the rapid uptake of digital health care delivery, to ensure that the views and attitudes of health professionals are understood and applied to develop acceptable, efficacious and sustainable technologies in our health care systems.


Asunto(s)
Actitud del Personal de Salud , Neoplasias Gastrointestinales/terapia , Terapia Nutricional/métodos , Adulto , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Aplicaciones Móviles , Terapia Nutricional/psicología , Telemedicina/métodos , Confianza
3.
Nutrients ; 13(2)2021 Feb 11.
Artículo en Inglés | MEDLINE | ID: mdl-33670314

RESUMEN

This study assessed whether a high provided energy of ≥30 kcal/ideal body weight (IBW)/day (kg) for patients with sarcopenic dysphagia effectively improved swallowing ability and the activities of daily living (ADLs). Among 110 patients with sarcopenic dysphagia (mean age, 84.9 ± 7.4 years) who were admitted to a post-acute hospital, swallowing ability and the ADLs were assessed using the Food Intake LEVEL Scale (FILS) and the Functional Independence Measure (FIM), respectively. The primary outcome was the FILS at discharge, while the secondary outcome was the achievement of the FIM with a minimal clinically important difference (MCID) at discharge. We created a homogeneous probability model without statistically significant differences using the inverse probability of treatment weighting (IPTW) method with and without a mean provided energy of ≥30 kcal/IBW/day (kg) for a period of 1 week of hospitalization and compared the outcomes between groups. A mean provided energy of ≥30 kcal/IBW/day (kg) was achieved in 62.7% of patients. In the IPTW model, the FILS and the rates of achieved MCID of the FIM at discharge were significantly higher in the mean provided energy of ≥30 kcal/IBW/day (kg) group (p = 0.004 and p < 0.001, respectively). A high provided energy for patients with sarcopenic dysphagia may improve swallowing ability and produce clinically meaningful functional outcomes.


Asunto(s)
Trastornos de Deglución/terapia , Ingestión de Energía/fisiología , Terapia Nutricional/métodos , Sarcopenia/complicaciones , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Deglución/fisiología , Trastornos de Deglución/etiología , Trastornos de Deglución/fisiopatología , Dieta , Femenino , Humanos , Masculino , Estudios Prospectivos , Sarcopenia/fisiopatología
4.
Nutr Clin Pract ; 36(2): 275-281, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33734477

RESUMEN

Iatrogenic malnutrition and underfeeding are ubiquitous in intensive care units (ICUs) worldwide for prolonged periods after ICU admission. A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC). Key evidence supporting the routine use of IC in the ICU includes (1) universal societal ICU nutrition guidelines recommending IC to determine energy requirements; (2) data showing predictive equations or body weight calculations that are consistently inaccurate and correlate poorly with measured energy expenditure, ultimately leading to routine overfeeding and underfeeding, which are both associated with poor ICU outcomes; (3) recent development and worldwide availability of a new validated, accurate, easy-to-use IC device; and (4) recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery. As we would not deliver vasopressors without accurate blood pressure measurements, the ICU community is only likely to embrace an increased focus on the importance of early nutrition delivery when we can consistently provide objective IC measures to ensure personalized nutrition care delivers the right nutrition dose, in the right patient, at the right time to optimize clinical outcomes.


Asunto(s)
/complicaciones , Calorimetría Indirecta/normas , Cuidados Críticos/normas , Desnutrición/diagnóstico , Evaluación Nutricional , /fisiopatología , Calorimetría Indirecta/métodos , Cuidados Críticos/métodos , Resultados de Cuidados Críticos , Enfermedad Crítica/terapia , Metabolismo Energético , Humanos , Unidades de Cuidados Intensivos , Desnutrición/prevención & control , Desnutrición/virología , Terapia Nutricional/métodos , Terapia Nutricional/normas , Necesidades Nutricionales , Estado Nutricional
5.
Nutrients ; 13(3)2021 Feb 26.
Artículo en Inglés | MEDLINE | ID: mdl-33652997

RESUMEN

This narrative review was conducted using searches of the PubMed/Medline and Google Scholar databases from inception to November 2019. Clinical trials and relevant articles were identified by cross-referencing major depressive disorder (and/or variants) with the following terms: folate, homocysteine, S-adenosylmethionine (SAMe), L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, L-tryptophan, zinc, magnesium, vitamin D, omega-3 fatty acids, coenzyme Q10, and inositol. Manual reviews of references were also performed using article reference lists. Abnormal levels of folate, homocysteine, and SAMe have been shown to be associated with a higher risk of depression. Numerous studies have demonstrated antidepressant activity with L-methylfolate and SAMe supplementation in individuals with depression. Additionally, the amino acids L-acetylcarnitine, alpha-lipoic acid, N-acetylcysteine, and L-tryptophan have been implicated in the development of depression and shown to exert antidepressant effects. Other agents with evidence for improving depressive symptoms include zinc, magnesium, omega-3 fatty acids, and coenzyme Q10. Potential biases and differences in study designs within and amongst the studies and reviews selected may confound results. Augmentation of antidepressant medications with various supplements targeting nutritional and physiological factors can potentiate antidepressant effects. Medical foods, particularly L-methylfolate, and other supplements may play a role in managing depression in patients with inadequate response to antidepressant therapies.


Asunto(s)
Suplementos Dietéticos , Trastornos del Humor/terapia , Terapia Nutricional/métodos , Oligoelementos/uso terapéutico , Vitaminas/uso terapéutico , Adulto , Antidepresivos/uso terapéutico , Terapia Combinada , Trastorno Depresivo Mayor/terapia , Femenino , Humanos , Masculino , Ensayos Clínicos Controlados Aleatorios como Asunto
6.
Nutr Rev ; 79(3): 289-300, 2021 02 11.
Artículo en Inglés | MEDLINE | ID: mdl-33570583

RESUMEN

Worldwide, there is an array of clinical trials under way to evaluate treatment options against coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2. Concurrently, several nutritional therapies and alternative supportive treatments are also being used and tested to reduce the mortality associated with acute respiratory distress in patients with COVID-19. In the context of COVID-19, improved nutrition that includes micronutrient supplementation to augment the immune system has been recognized as a viable approach to both prevent and alleviate the severity of the infection. The potential role of micronutrients as immune-boosting agents is particularly relevant for low- and middle-income countries, which already have an existing high burden of undernutrition and micronutrient deficiencies. A systematic literature review was performed to identify nutritional interventions that might prevent or aid in the recovery from COVID-19. The PubMed, ScienceDirect, Cochrane, Scopus, Web of Science, and Google Scholar databases were searched electronically from February to April 2020. All abstracts and full-text articles were examined for their relevance to this review. The information gathered was collated under various categories. Deficiencies of micronutrients, especially vitamins A, B complex, C, and D, zinc, iron, and selenium, are common among vulnerable populations in general and among COVID-19 patients in particular and could plausibly increase the risk of mortality. Judicious use of need-based micronutrient supplementation, alongside existing micronutrient fortification programs, is warranted in the current global pandemic, especially in low- and middle-income economies.


Asunto(s)
/prevención & control , Dieta , Micronutrientes , Terapia Nutricional/métodos , Estado Nutricional , /inmunología , Suplementos Dietéticos , Humanos , Sistema Inmunológico , Hierro , Selenio , Oligoelementos , Vitamina A , Zinc
7.
Nutrients ; 13(1)2021 Jan 18.
Artículo en Inglés | MEDLINE | ID: mdl-33477671

RESUMEN

Access to renal transplantation guarantees a substantial improvement in the clinical condition and quality of life (QoL) for end-stage renal disease (ESRD) patients. In recent years, a greater number of older patients starting renal replacement therapies (RRT) have shown the long-term impact of conservative therapies for advanced CKD and the consequences of the uremic milieu, with a frail clinical condition that impacts not only their survival but also limits their access to transplantation. This process, referred to as "inflammaging," might be reversible with a tailored approach, such as RRT accompanied by specific nutritional support. In this review, we summarize the evidence demonstrating the presence of several proinflammatory substances in the Western diet (WD) and the positive effect of unprocessed food consumption and increased fruit and vegetable intake, suggesting a new approach to reduce inflammaging with the improvement of ESRD clinical status. We conclude that the Mediterranean diet (MD), because of its modulative effects on microbiota and its anti-inflammaging properties, may be a cornerstone in a more precise nutritional support for patients on the waiting list for kidney transplantation.


Asunto(s)
Inflamación/etiología , Inflamación/terapia , Trasplante de Riñón , Terapia Nutricional/métodos , Insuficiencia Renal Crónica/terapia , Terapia de Reemplazo Renal/efectos adversos , Adulto , Anciano , Dieta Mediterránea , Dieta Occidental/efectos adversos , Femenino , Frutas , Microbioma Gastrointestinal/fisiología , Humanos , Inflamación/prevención & control , Fallo Renal Crónico/terapia , Masculino , Calidad de Vida , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/microbiología , Verduras
8.
J Pediatr ; 231: 124-130.e1, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33359473

RESUMEN

OBJECTIVE: To evaluate the effect of a standardized feeding approach using a clinical nutrition pathway on weight-for-age Z score (WAZ) over hospital length of stay (HLOS) for infants with congenital heart disease (CHD). STUDY DESIGN: A 10-year retrospective cohort study examined eligible infants who underwent neonatal cardiac surgery between July 2009 and December 2018 (n = 987). Eligibility criteria included infants born at least 37 weeks of gestation and a minimum birth weight of 2 kg who underwent cardiac surgery for CHD within the first 30 days of life. Using the best linear unbiased predictions from a linear mixed effects model, WAZ change over HLOS was estimated before and after January 2013, when the standardized feeding approach was initiated. The best linear unbiased predictions model included adjustment for patient characteristics including sex, race, HLOS, and class of cardiac defect. RESULTS: The change in WAZ over HLOS was significantly higher from 2013 to 2018 than from 2009 to 2012 (ß = 0.16; SE = 0.02; P < .001), after controlling for sex, race, HLOS, and CHD category, indicating that infants experienced a decreased WAZ loss over HLOS after the standardized feeding approach was initiated. Additionally, differences were found in WAZ loss over HLOS between infants with single ventricle CHD (ß = 0.26; SE = 0.04; P < .001) and 2 ventricle CHD (ß = 0.04; SE = 0.02; P = .04). CONCLUSIONS: These data suggest that an organized, focused approach for nutrition therapy using a standardized pathway improves weight change outcomes before hospital discharge for infants with single and 2 ventricle CHD who require neonatal cardiac surgery.


Asunto(s)
Cardiopatías Congénitas/cirugía , Terapia Nutricional/normas , Atención Perioperativa/normas , Aumento de Peso , Pérdida de Peso , Vías Clínicas , Femenino , Cardiopatías Congénitas/fisiopatología , Hospitalización , Humanos , Lactante , Recién Nacido , Modelos Lineales , Modelos Logísticos , Masculino , Terapia Nutricional/métodos , Atención Perioperativa/métodos , Estudios Retrospectivos , Resultado del Tratamiento
9.
Nutr. hosp ; 37(6): 1285-1288, nov.-dic. 2020. ilus
Artículo en Español | IBECS | ID: ibc-198319

RESUMEN

INTRODUCCIÓN: la vitamina cobalamina es esencial para el buen funcionamiento del SNC, la hematopoyesis y la síntesis de ADN. Su déficit es frecuentemente secundario a la anemia perniciosa o a las dietas vegetarianas estrictas. CASO CLÍNICO: lactante varón de 18 meses con disminución del nivel de conciencia y trastorno del movimiento (temblor y movimientos coreiformes) de horas de duración. Como antecedentes, presenta retraso de la adquisición de los hitos motores (no bipedestación, lenguaje monosilábico) y pérdida progresiva de los mismos en las últimas semanas (sostén cefálico y sedestación). Alimentado mediante lactancia materna desde el nacimiento. La familia sigue una alimentación vegetariana. En las pruebas de neuroimagen, la TC y la RM craneales muestran atrofia supratentorial generalizada de ambas sustancias y de los ganglios basales. Se inicia tratamiento con vitamina B12 intramuscular, aumentando sus niveles. Posteriormente se procede a la diversificación alimentaria y la administración de cianocobalamina oral, con normalización clínica al cabo de 6 meses y radiológica al cabo de 7 meses. DISCUSIÓN: recalcamos la importancia de la suplementación con B12 durante el embarazo y la lactancia tanto en la mujer como en el lactante


INTRODUCTION: the vitamin cobalamin is essential for a proper functioning of the CNS, hematopoiesis, and DNA synthesis. Its deficiency is frequently secondary to pernicious anemia or strict vegetarian diets. CASE REPORT: an 18-month-old male infant presented with a decreased level of consciousness and movement disorder (tremor and choreiform movements) of several hours' standing. He had a history of delayed acquisition of motor milestones (not standing, monosyllabic language), and progressive loss of these over the last few weeks (head support and sitting). He had been breastfed from birth. His family has a vegetarian diet. In neuroimages, cranial CT and MRI scans showed generalized supratentorial atrophy involving both matters and the basal ganglia. Treatment was started with intramuscular vitamin B12, which increased its levels. Subsequently, the patient was subjected to dietary diversification and oral cyanocobalamin, with clinical normalization after 6 months and radiological normalization after 7 months. DISCUSSION: we emphasize the importance of vitamin B12 supplementation during pregnancy and lactation in vegetarian mothers and their infants


Asunto(s)
Humanos , Masculino , Lactante , Encefalopatías/diagnóstico por imagen , Encefalopatías/tratamiento farmacológico , Deficiencia de Vitamina B 12/terapia , Terapia Nutricional/métodos , Vitamina B 12/administración & dosificación , Terapia Nutricional/efectos adversos , Trastornos de la Conciencia/complicaciones , Temblor/complicaciones , Neuroimagen , Tomografía Computarizada por Rayos X
10.
Nutrients ; 12(12)2020 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-33339167

RESUMEN

Asthma is a chronic inflammatory disease of the airways, characterized by T-helper (Th) 2 inflammation. Current lifestyle recommendations for asthma patients are to consume a diet high in fruits and vegetables and to maintain a healthy weight. This raises the question of whether other nutritional interventions may also improve asthma-related outcomes and whether these changes occur via immunomodulation. Therefore, we systematically reviewed studies that reported both asthma-related outcomes as well as immunological parameters and searched for relations between these two domains. A systematic search identified 808 studies, of which 28 studies met the inclusion criteria. These studies were divided over six nutritional clusters: herbs, herbal mixtures and extracts (N = 6); supplements (N = 4); weight loss (N = 3); vitamin D3 (N = 5); omega-3 long-chain polyunsaturated fatty acids (LCPUFAs) (N = 5); and whole-food approaches (N = 5). Fifteen studies reported improvements in either asthma-related outcomes or immunological parameters, of which eight studies reported simultaneous improvements in both domains. Two studies reported worsening in either asthma-related outcomes or immunological parameters, of which one study reported a worsening in both domains. Promising interventions used herbs, herbal mixtures or extracts, and omega-3 LCPUFAs, although limited interventions resulted in clinically relevant results. Future studies should focus on further optimizing the beneficial effects of nutritional interventions in asthma patients, e.g., by considering the phenotypes and endotypes of asthma.


Asunto(s)
Asma/inmunología , Asma/terapia , Dieta/métodos , Inmunomodulación , Terapia Nutricional/métodos , Adulto , Enfermedad Crónica , Suplementos Dietéticos , Femenino , Humanos , Masculino , Resultado del Tratamiento
11.
Nutrients ; 12(12)2020 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-33339220

RESUMEN

Spinal muscular atrophy (SMA), the main genetic cause of infant death, is a neurodegenerative disease characterized by the selective loss of motor neurons in the anterior horn of the spinal cord, accompanied by muscle wasting. Pathomechanically, SMA is caused by low levels of the survival motor neuron protein (SMN) resulting from the loss of the SMN1 gene. However, emerging research extends the pathogenic effect of SMN deficiency beyond motor neurons. A variety of metabolic abnormalities, especially altered fatty acid metabolism and impaired glucose tolerance, has been described in isolated cases of SMA; therefore, the impact of SMN deficiency in metabolic abnormalities has been speculated. Although the life expectancy of these patients has increased due to novel disease-modifying therapies and standardization of care, understanding of the involvement of metabolism and nutrition in SMA is still limited. Optimal nutrition support and metabolic monitoring are essential for patients with SMA, and a comprehensive nutritional assessment can guide personalized nutritional therapy for this vulnerable population. It has recently been suggested that metabolomics studies before and after the onset of SMA in patients can provide valuable information about the direct or indirect effects of SMN deficiency on metabolic abnormalities. Furthermore, identifying and quantifying the specific metabolites in SMA patients may serve as an authentic biomarker or therapeutic target for SMA. Here, we review the main epidemiological and mechanistic findings that link metabolic changes to SMA and further discuss the principles of metabolomics as a novel approach to seek biomarkers and therapeutic insights in SMA.


Asunto(s)
Atrofia Muscular Espinal/metabolismo , Terapia Nutricional/métodos , Fenómenos Fisiológicos de la Nutrición/genética , Proteínas del Complejo SMN/deficiencia , Proteína 1 para la Supervivencia de la Neurona Motora , Biomarcadores/metabolismo , Humanos , Metaboloma , Metabolómica/métodos , Atrofia Muscular Espinal/genética , Atrofia Muscular Espinal/terapia , Evaluación Nutricional
12.
Trials ; 21(1): 1031, 2020 Dec 28.
Artículo en Inglés | MEDLINE | ID: mdl-33371905

RESUMEN

BACKGROUND: With the lack of effective therapy, chemoprevention, and vaccination against SARS-CoV-2, focusing on the immediate repurposing of existing drugs gives hope of curbing the COVID-19 pandemic. A recent unbiased genomics-guided tracing of the SARS-CoV-2 targets in human cells identified vitamin D among the three top-scoring molecules manifesting potential infection mitigation patterns. Growing pre-clinical and epidemiological observational data support this assumption. We hypothesized that vitamin D supplementation may improve the prognosis of COVID-19. The aim of this trial is to compare the effect of a single oral high dose of cholecalciferol versus a single oral standard dose on all-cause 14-day mortality rate in COVID-19 older adults at higher risk of worsening. METHODS: The COVIT-TRIAL study is an open-label, multicenter, randomized controlled superiority trial. Patients aged ≥ 65 years with COVID-19 (diagnosed within the preceding 3 days with RT-PCR and/or chest CT scan) and at least one worsening risk factor at the time of inclusion (i.e., age ≥ 75 years, or SpO2 ≤ 94% in room air, or PaO2/FiO2 ≤ 300 mmHg), having no contraindications to vitamin D supplementation, and having received no vitamin D supplementation > 800 IU/day during the preceding month are recruited. Participants are randomized either to high-dose cholecalciferol (two 200,000 IU drinking vials at once on the day of inclusion) or to standard-dose cholecalciferol (one 50,000 IU drinking vial on the day of inclusion). Two hundred sixty participants are recruited and followed up for 28 days. The primary outcome measure is all-cause mortality within 14 days of inclusion. Secondary outcomes are the score changes on the World Health Organization Ordinal Scale for Clinical Improvement (OSCI) scale for COVID-19, and the between-group comparison of safety. These outcomes are assessed at baseline, day 14, and day 28, together with the serum concentrations of 25(OH)D, creatinine, calcium, and albumin at baseline and day 7. DISCUSSION: COVIT-TRIAL is to our knowledge the first randomized controlled trial testing the effect of vitamin D supplementation on the prognosis of COVID-19 in high-risk older patients. High-dose vitamin D supplementation may be an effective, well-tolerated, and easily and immediately accessible treatment for COVID-19, the incidence of which increases dramatically and for which there are currently no scientifically validated treatments. TRIAL REGISTRATION: ClinicalTrials.gov NCT04344041 . Registered on 14 April 2020 TRIAL STATUS: Recruiting. Recruitment is expected to be completed in April 2021.


Asunto(s)
/terapia , Suplementos Dietéticos , Terapia Nutricional/métodos , Pandemias , Vitamina D/administración & dosificación , Anciano , Relación Dosis-Respuesta a Droga , Femenino , Humanos , Masculino , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Vitaminas/administración & dosificación
13.
Medicine (Baltimore) ; 99(46): e22873, 2020 Nov 13.
Artículo en Inglés | MEDLINE | ID: mdl-33181655

RESUMEN

BACKGROUND: A comprehensive geriatric assessment (CGA) of elderly patients is useful for detecting the patients vulnerabilities. Exercise and early rehabilitation, nutritional intervention, traditional Chinese medicine (TCM), standardized medication guidance, and patient education can, separately, improve and even reverse the physical frailty status. However, the effect of combining a CGA and multi-disciplinary management on frailty in elderly patients remains unclear. The present study assessed the effects of a CGA and multi-disciplinary management on elderly patients with frailty in China. METHODS: In this study, 320 in patients with frailty ≥70 years old will be randomly divided into an intervention group and a control group. The intervention group will be given routine management, a CGA and multi-disciplinary management involving rehabilitation exercise, diet adjustment, multi-drug evaluation, acupoint massage in TCM and patient education for 12 months, and the control group will be followed up with routine management for basic diseases. The primary outcomes are the Fried phenotype and short physical performance battery (SPPB). The secondary outcomes are the clinical frailty scale (CFS), non-elective hospital readmission, basic activities of daily living (BADL), 5-level European quality of life 5 dimensions index (EQ-5D), nutrition risk screening-2002 (NRS-2002), medical insurance expenses, fall events, and all-cause mortality. In addition, a cost-effectiveness study will be carried out. DISCUSSION: This paper outlines the protocol for a randomized, single-blind, parallel multi-center clinical study. This protocol, if beneficial, will demonstrate the interaction of various intervention strategies, will help improve elderly frailty patients, and will be useful for clinicians, nurses, policymakers, public health authorities, and the general population. TRIAL REGISTRATION: Chinese Clinical Trials Register, ChiCTR1900022623. Registered on April 19, 2019, http://www.chictr.org.cn/showproj.aspx?proj=38141.


Asunto(s)
Atención Integral de Salud/métodos , Anciano Frágil , Fragilidad/rehabilitación , Evaluación Geriátrica/métodos , Servicios de Salud para Ancianos , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , China , Terapia por Ejercicio/métodos , Femenino , Humanos , Masculino , Medicina China Tradicional/métodos , Terapia Nutricional/métodos , Estado Nutricional , Grupo de Atención al Paciente , Educación del Paciente como Asunto/métodos , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Índice de Severidad de la Enfermedad , Método Simple Ciego , Resultado del Tratamiento
14.
R I Med J (2013) ; 103(9): 30-33, 2020 Nov 02.
Artículo en Inglés | MEDLINE | ID: mdl-33126784

RESUMEN

BACKGROUND: Traditional rehabilitation services, whether they are cardiac, pulmonary, or vascular, consist of 6-36 center-based, supervised sessions; however, due to COVID-19, in-person visits were suspended. This study sought to implement a transitional home-based treatment plan (HBTP) to patients. METHOD: Patients enrolled in a rehabilitation service at the Miriam Hospital during the time of temporary closure were provided with a HBTP that was individualized to their needs and multi-disciplinary in nature. Patients were called weekly for continual guidance and support. RESULTS: Of the 129 patients that received a HBTP, 115 (89%) participated in follow-up correspondence (63±12 years, 83% white, 66% male, 81% enrolled in cardiac rehab). Nearly 70% of patients continued to participate in regular exercise and upon re-opening, 69 (60%) of patients returned to center-based care. Psychosocial factors appeared to inhibit treatment adherence. CONCLUSIONS: Patients are receptive to an HBTP and subsequent follow-up throughout temporary closure of rehabilitation services.


Asunto(s)
Rehabilitación Cardiaca/métodos , Infecciones por Coronavirus , Terapia por Ejercicio/métodos , Cardiopatías/rehabilitación , Enfermedades Pulmonares/rehabilitación , Pandemias , Neumonía Viral , Enfermedades Vasculares/rehabilitación , Adaptación Psicológica , Anciano , Betacoronavirus , Terapia por Ejercicio/organización & administración , Femenino , Servicios de Atención de Salud a Domicilio/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Terapia Nutricional/métodos , Mejoramiento de la Calidad , Terapia por Relajación/métodos
15.
Nutr Hosp ; 37(5): 984-998, 2020 Oct 21.
Artículo en Español | MEDLINE | ID: mdl-32960639

RESUMEN

Introduction: Introduction: in SARS-CoV-2-infected patients nutritional requirements are increased. These patients present symptoms that make food intake and nutrient absorption difficult, therefore involving nutritional risk. On the other hand, acute respiratory complications require prolonged ICU stays, and this predisposes to increased malnutrition and loss of skeletal muscle mass and function, which can lead to poor quality of life, disability and morbidity long after discharge. For this reason, the world's leading nutrition societies and associations believe that nutritional therapy should be considered a part of the basic treatment of patients with COVID-19. Methods: we have reviewed and compared 9 expert recommendations (ER) published by nutrition societies and associations from China, Spain, Brazil, Europe, Colombia, Australia, America, and the United Kingdom, in relation to critical and non-critical hospitalized patients due to the COVID-19 pandemic. Conclusions: the 9 ERs reviewed agree on the importance of nutritional management in critical and non-critical hospitalized patients with COVID-19, as well as on the early detection of nutritional risk, the intervention, and subsequent follow-up. Even so, each published document has its own particularities and puts a special stress on some specific aspect.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pacientes Internos , Desnutrición , Terapia Nutricional/normas , Necesidades Nutricionales , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto/normas , Australia , Brasil , China , Colombia , Infecciones por Coronavirus/terapia , Europa (Continente) , Humanos , Desnutrición/diagnóstico , Desnutrición/dietoterapia , Terapia Nutricional/métodos , Pandemias , Neumonía Viral/terapia
17.
J. negat. no posit. results ; 5(9): 1040-1058, sept. 2020. tab, graf
Artículo en Español | IBECS | ID: ibc-199380

RESUMEN

El presente trabajo describe las particularidades en el manejo nutricional y la presentación clínica de los pacientes diabéticos con trastornos de la conducta alimentaria. Es importante el diagnóstico precoz de estas comorbilidades, para tomar las medidas necesarias y evitar complicaciones. Los profesionales sanitarios deben estar alerta a los signos de alarma (incremento de HbA1c, cambios de peso, omisión del tratamiento, excesiva preocupación en la calidad y cantidad de comida, etc.). Según algunos estudios, hasta el 60% de los pacientes con Diabetes Mellitus tipo 1 y hasta el 40% de los pacientes con Diabetes Mellitus tipo 2 pueden cumplir criterios de trastornos de la conducta alimentaria (Diabulimia, Trastorno por atracón, Síndrome del comedor nocturno y formas no específicas). El tratamiento debe llevarse a cabo por un equipo interdisciplinar, teniendo como objetivo principal el restablecimiento del peso adecuado y el control de los comportamiento propios de los trastornos de la conducta alimentaria (purgas, omisiones de tratamiento, atracones, restricciones), se debe establecer un plan dietético nutricional progresivo, evitando centrar la atención en el recuento de raciones de hidratos de carbono, sino en la educación nutricional adecuada y en aquellos con insulina asegurar su adecuada administración. Es importante establecer con el paciente objetivos reales (peso, controles glucémicos, HbA1c) y hablar sobre las complicaciones agudas y crónicas de la diabetes con el paciente y la familia. Todavía quedan muchas áreas de estudio para mejorar el tratamiento integral de estos pacientes


This paper describes the special characteristics in nutritional management and clinical presentation of patients with diabetes and eating disorders at the same time. The screening of these two comorbidities is important in order to take the necessary measures and to avoid complications. Professionals should be aware for warning signs (High HbA1c, weight changes, treatment omission , excessive concern about the quality and quantity of meal, etc.). Some studies show that more than 60% of type 1 Diabetes Mellitus and more than 40% of type 2 Diabetes Mellitus meet criteria for eating disorders (Diabulimia, Binge Eating Disorder, Night eating syndrome and non-specific forms). The treatment must be carried out by an interdisciplinary team, with the main objective of restoring adequate weight and avoiding of eating disorders' behavior (purges, treatment omission, binge eating, restrictions), a progressive dietary plan must be established, not to be focus on counting carbohydrate rations, but on adequate nutritional education and on those patients with insulin to ensure its adequate administration. It is important establish real objectives (weight, blood measure test, HbA1c) and to discuss acute and chronic complications of diabetes not only with the patient but with his/her family. There are still many study'areas to improve the comprehensive treatment of these patients


Asunto(s)
Humanos , Trastornos de Alimentación y de la Ingestión de Alimentos/epidemiología , Complicaciones de la Diabetes/prevención & control , Diabetes Mellitus/dietoterapia , Terapia Nutricional/métodos , Bulimia Nerviosa/epidemiología , Anorexia Nerviosa/epidemiología , Hemoglobina A Glucada/análisis
18.
PLoS One ; 15(8): e0216848, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32764747

RESUMEN

Maternal nutritional status influences fetal development and long-term risk for adult non-communicable diseases. However, the underlying mechanisms remain poorly understood. We examined whether biomarkers for metabolism and inflammation during pregnancy were associated with maternal health and with child biomarkers and health at 9-12 years of age in 44 maternal-child dyads from the Supplementation with Multiple Micronutrients Intervention Trial (SUMMIT, ISRCTN34151616) in Lombok, Indonesia. Archived blood for each dyad from maternal enrollment, later in pregnancy, postpartum, and from children at 9-12 years comprised 132 specimens. Multiplex microbead immunoassays were used to quantify vitamin D-binding protein (D), adiponectin (A), retinol-binding protein 4 (R), C-reactive protein (C), and leptin (L). Principal component analysis (PCA) revealed distinct variance patterns, i.e. principal components (PC), for baseline pregnancy, bp.pc1.D↓A↓R↓ and bp.pc2.C↓L↑; combined follow-up during pregnancy and postpartum, dp-pp.pc1.D↑↓A↑R↑↓L↓ and dp-pp.pc2.A↑C↑L↑; and children, ch.pc1.D↑R↑C↑ and ch.pc2.D↓A↑L↑. Maternal multiple micronutrient (MMN) supplementation led to an association of baseline maternal bp.pc2.C↓L↑ with decreased post-supplementation maternal dp-pp.pc2.A↑C↑L↑ (p = 0.022), which was in turn associated with both increased child ch.pc1.D↑R↑C↑ (p = 0.036) and decreased child BMI z-score (BMIZ) (p = 0.022). Further analyses revealed an association between maternal dp-pp.pc1.D↑↓A↑R↑↓L↓ and increased child BMIZ (p = 0.036). Child ch.pc1.D↑R↑C↑ was associated with decreased birth weight (p = 0.036) and increased child BMIZ (p = 0.002). Child ch.pc2.D↓A↑L↑ was associated with increased child BMIZ (p = 0.005), decreased maternal height (p = 0.030) and girls (p = 0.002). A pattern of elevated maternal adiponectin and leptin in pregnancy was associated with increased C-reactive protein, vitamin A, and D binding proteins pattern in children, suggesting biomarkers acting in concert may have qualitative as well as quantitative influence beyond single biomarker effects. Patterns in pregnancy proximal to birth were more associated with child status. In addition, child patterns were more associated with child status, particularly child BMI. MMN supplementation affects maternal biomarker patterns of metabolism and inflammation in pregnancy, and potentially in the child. However, child nutrition conditions after birth may have a greater impact on metabolism and inflammation.


Asunto(s)
Fenómenos Fisiologicos Nutricionales Maternos/fisiología , Micronutrientes/metabolismo , Estado Nutricional/fisiología , Adiponectina/análisis , Adiponectina/sangre , Adulto , Biomarcadores/sangre , Proteína C-Reactiva/análisis , Niño , Suplementos Dietéticos , Familia , Femenino , Ácido Fólico/análisis , Humanos , Indonesia , Recién Nacido , Inflamación , Leptina/análisis , Masculino , Terapia Nutricional/métodos , Embarazo , Proteínas Plasmáticas de Unión al Retinol/análisis , Vitamina A/análisis , Proteína de Unión a Vitamina D/análisis , Proteína de Unión a Vitamina D/sangre
20.
Medicine (Baltimore) ; 99(29): e21282, 2020 Jul 17.
Artículo en Inglés | MEDLINE | ID: mdl-32702919

RESUMEN

INTRODUCTION: Intensive care unit-acquired weakness (ICU-AW) occurs in 25% to 100% of critically ill patients, and is associated with prolonged mechanical ventilation, extended ICU stay, and total hospital stay, increased hospital costs, higher risk of death, impaired physical function, and decreased quality of life. However, there are not any current guidelines that mention management of ICU-AW. The present study will evaluate the effects of a combination of early nutrition and early exercise compared to those of either early exercise alone or the standard care for patients in ICUs. METHODS: This is a 3-arm, parallel, randomized controlled trial including an estimated 147 critically ill patients aged ≥18 years recruited from the ICUs of 2 hospitals in Heilongjiang, China. Patients will be prospectively randomized 1:1:1 to receive early mobilization, early nutrition combined with early mobilization, or standard care (minimal exercises, experience-based initiation and enrollment of nutrition support). Outcomes are assessed at ICU discharge after baseline. The primary outcome is occurrence of ICU-AW according to the Medical Research Council scale at the end of treatment. Muscle strength, organ failure, functional independence, self-care ability, time of ICU stay, duration of mechanical ventilation, and ICU mortality are secondary outcome measures. DISCUSSION: This trial has the potential to identify a novel strategy for preventing or managing ICU-AW. The findings may increase the clinical knowledge about nutrition and mobilization interventions for people with ICU-AW, and contribute to the formation of practice guidelines for managing this condition. TRIAL REGISTRATION NUMBER: ChiCTR2000033482.


Asunto(s)
Ambulación Precoz , Unidades de Cuidados Intensivos , Debilidad Muscular/etiología , Terapia Nutricional , Adulto , Ambulación Precoz/métodos , Terapia por Ejercicio/métodos , Femenino , Humanos , Masculino , Debilidad Muscular/prevención & control , Terapia Nutricional/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Método Simple Ciego
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