Young Japanese Underweight Women with "Cinderella Weight" Are Prone to Malnutrition, including Vitamin Deficiencies.

Undernutrition among young women at "Cinderella weight" is socially important in Japan. To determine the nutritional status of Cinderella-weight women, we conducted an exploratory cross-sectional study on the health examination results of employees aged 20 to 39 (n = 1457 and 643 for women and men, respectively). The percentage of underweight women was found to be much higher than that of men (16.8% vs. 4.5%, respectively). In underweight women (n = 245), handgrip strength (22.82 ± 5.55 vs. 25.73 ± 5.81 kg, p < 0.001), cholesterol level (177.8 ± 25.2 vs. 194.7 ± 31.2 mg/dL, p < 0.05), and lymphocyte count (1883 ± 503 vs. 2148 ± 765/µL, p < 0.001) were significantly lower than in overweight women (n = 116). Then, the BMI < 17.5 group (n = 44) was referred to the outpatient nutrition evaluation clinic. Lower prealbumin, cholesterol, and lymphocyte levels were also observed in 34%, 59%, and 32% of the patients, respectively. Regarding dietary characteristics, 32% of the underweight women in this study skipped breakfast, and 50% had low dietary diversity scores. Lower total energy intake, carbohydrate and fiber intake, and Ca and Fe intake were also observed in 90% of the patients. Deficiencies in vitamin B1, B12, D, and folate were diagnosed in 4.6%, 25%, 14%, and 98% of the patients, respectively. Thus, young underweight women may be prone to malnutrition.

Methods of Enteral Nutrition Administration in Critically Ill Patients: Continuous, Cyclic, Intermittent, and Bolus Feeding.

There are several methods of enteral nutrition (EN) administration, including continuous, cyclic, intermittent, and bolus techniques, which can be used either alone or in combination. Continuous feeding involves hourly administration of EN over 24 hours assisted by a feeding pump; cyclic feeding involves administration of EN over a time period of <24 hours generally assisted by a feeding pump; intermittent feeding involves administration of EN over 20-60 minutes every 4-6 hours via pump assist or gravity assist; and bolus feeding involves administration of EN over a 4- to 10-minute period using a syringe or gravity drip. In practice, pump-assisted continuous feeding is generally acceptable for critically ill patients to prevent EN-related complications. However, a limited number of studies have been conducted to support this practice. In addition, regarding muscle protein synthesis and gastrointestinal hormone secretion, intermittent or bolus feeding may be more beneficial than continuous EN feeding for critically ill patients. For medically stable patients with feeding tubes terminating in the stomach, bolus feeding is favored with respect to practical factors, such as cost, convenience, and patient mobility. However, few studies have shown whether intermittent or bolus feeding is beneficial in a critical care setting at present. Additional randomized controlled studies comparing intermittent with bolus feeding are required.

Energy intake in the first week in an emergency intensive care unit may not influence clinical outcomes in critically ill, overweight Japanese patients.

BACKGROUND AND OBJECTIVES: The American Society for Parenteral and Enteral Nutrition recommends hypocaloric feeding for critically ill patients with a BMI of >=30.0 kg/m2. However, the cut-off value of obesity in Japan is BMI >25.0 kg/m2, due to the higher prevalence of type 2 diabetes mellitus, and cardiovascular risk factors, even at a lower BMI than in Western populations. Thus, the optimal energy intake for critically ill, overweight Asian patients is unknown. METHODS AND STUDY DESIGN: A retrospective chart review was conducted in patients with BMI of >=25.0 kg/m2 in an emergency intensive care unit (EICU). Patients were categorized into two groups by average daily energy intake during the first week in the EICU, with Group A at <50% of requirement and Group B at >=50%. RESULTS: A total of 72 patients with a median BMI of 27.5 kg/m2 were included in the study. No significant differences between the groups were observed for all-cause mortality, ICU-free days, or length of hospital stay. The number of ventilator-free days (VFDs) was significantly higher in Group A than Group B (20.0 [15.5-24.5] vs 17.0 [2.0-21.0] days; p=0.042). On multiple adjusted analysis, however, we found that %energy intake/requirement was not independently associated with VFDs (regression coefficient=0.019; 95% confidence interval, -0.115-0.076). CONCLUSIONS: Energy intake in the first week in the EICU did not influence clinical outcomes in critically ill, overweight Japanese patients. Confirmation of these results in larger, randomized trials is required.

Low energy intake during the first week in an emergency intensive care unit is associated with reduced duration of mechanical ventilation in critically ill, underweight patients: a single-center retrospective chart review.

BACKGROUND: Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients. METHODS: A retrospective chart review was conducted in patients with body mass index (BMI) of <20.0 kg/m(2) in an emergency intensive care unit (EICU). Patients were categorized into 4 groups by initial Sequential Organ Failure Assessment score (I-SOFA) and average daily energy intake during the first week: group M-1, I-SOFA ≤8 and <16 kcal/kg/d; group M-2, I-SOFA ≤8 and ≥16 kcal/kg/d; group S-1, I-SOFA >8 and <16 kcal/kg/d; and group S-2, I-SOFA >8 and ≥16 kcal/kg/d. RESULTS: The study included 51 patients with a median age of 69 years. No significant differences were noted in all-cause mortality and length of stay in the EICU and hospital between groups M-1 and M-2 or groups S-1 and S-2. The mechanical ventilation duration (MVD) was significantly shorter in group M-1 than M-2 (2.7 [1.0-5.7] vs 9.2 [4.2-17.4] days; P = .040) and in group S-1 than S-2 (3.1 [0.7-6.0] vs 8.8 [6.1-23.1] days; P = .006). The number of patients who underwent tracheostomy in hospital was significantly lower in group S-1 than in S-2 (20% vs 32%; P = .002). Multivariable analyses to adjust for confounders revealed that average energy intake during the first week in EICU was a significant factor independently associated with MVD but not with the requirement of tracheostomy. CONCLUSION: Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m(2).

Nutrition in the Great East Japan Earthquake Disaster.

The Great East Japan Earthquake Disaster (GEJED) struck the northeast region of Honshu, the main island of Japan, on March 11, 2011. This mega-disaster claimed more than 15,000 lives, with approximately 3000 later deaths being disaster related. The GEJED consisted of a mega-earthquake, tsunami, and nuclear accident. Survivors living in temporary shelters might have received insufficient levels of vitamins, with the exception of vitamin B1, which appeared to be overestimated, and excess levels of sodium. However, scientific data collection and surveys following the GEJED were extremely limited. This experience highlights the need to prepare an "emergency nutrition assessment" system for optimal nutrition in future disasters.

Changes of energy metabolism, nutritional status and serum cytokine levels in patients with Crohn's disease after anti-tumor necrosis factor-α therapy.

We investigated the effects of treatment with antibodies against tumor necrosis factor (TNF)-α on energy metabolism, nutritional status, serum cytokine levels in patients with Crohn's disease (CD). Twelve patients were enrolled. Resting energy expenditure (REE) levels were measured by indirect calorimetry. Crohn's disease activity index (CDAI) significantly decreased after treatment with anti-TNF-α therapy. Anti-TNF-α therapy did not affect REE, but respiratory quotient (RQ) significantly increased after treatment. Serum interleukin-6 levels were significantly decreased and RQ were significantly increased in high REE (≥25 kcal/kg/day) group as compared to low REE (<25 kcal/kg/day) group. In conclusion, high REE value on admission is a predictive factor for good response to treatment with anti-TNF-α antibodies in active CD patients.

Impact of energy intake on the survival rate of patients with severely ill stroke.

INTRODUCTION: Stroke accounts for approximately 10% of all deaths. We examined whether energy intake influences the survival rate of severely ill stroke patients. METHODS: We analyzed 86 consecutive severely ill stroke patients. Patients' background was compared between survivors and non-survivors. Average energy intakes in seven different periods from day one to seven following neurosurgical care unit (NCU) admission were compared between two groups, to examine which period is proper to show an energy difference. Groups were stratified by average total energy intake (group E-I, -II, -III, and -IV; ≤.25, 8.25-16.5, 16.5-25, and >25kcal/kg/day, respectively), and cumulative survival rate for 90 days after NCU admission was analyzed. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated to examine the effect of confounder factors. RESULT: Patients' background did not differ significantly between the two groups. Average daily energy intake for the first seven NCU days of non-survivors was significantly lower than that of survivors (p=0.034). The survival rate of group E-II was significantly higher than that of group E-I, which was set as a reference (p=0.030). The adjusted HR of E-II was also significantly lower than that of group E-I (HR=0.19, p=0.047), although E-III did not show significance (HR=0.52, p=0.279). CONCLUSION: Energy intake assessment should be conducted for at least seven days following NCU admission. An average total energy intake ranging from 8.25 to 16.5 kcal/kg/day and enteral feeding increases survival rate in severely ill stroke patients.

The application of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy tubes by the intermittent or bolus methods: a single-center, retrospective chart review.

BACKGROUND: While previous studies have reported that feeding protocols improved clinical outcomes in critical care settings, the evidence supporting the application of feeding protocols in older patients has not yet been assessed. Here, we evaluated the effects of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy (PEG) tubes. METHODS: We conducted a retrospective chart review of 109 patients aged >=65 who underwent PEG placement between April 2010 and March 2012 at a single acute care hospital. The protocol group was administered enteral nutrition (EN) according to a feeding protocol, while the non-protocol group was administered EN at the attending physician's discretion. RESULTS: Length of hospital stay (LOS) overall and after EN initiation were significantly shorter in the protocol group than in the non-protocol group. (LOS: p=0.001; LOS after EN initiation: p=0.026). During the second week after EN initiation, significantly fewer patients had percutaneous oxygen saturation (SpO2) <93% and required oxygen therapy in the protocol group (p=0.032 for both comparisons). Nutrition intakes via PEG in the protocol group were significantly greater from Days 6 to 13 for energy and from Days 6 to 11 for protein compared with the non-protocol group. CONCLUSION: The application of a feeding protocol after PEG placement in older patients was associated with shorter LOS, more efficient EN delivery, and lower incidence of low SpO2 than non-protocol group. Larger prospective studies are required to determine whether a feeding protocol is useful in improving health outcomes in this population.

Which is more effective to prevent enteral nutrition-related complications, high- or medium-viscosity thickened enteral formula in patients with percutaneous endoscopic gastrostomy?: a single-center retrospective chart review.

BACKGROUND: Administration of thickened enteral formula (TEF) through a percutaneous endoscopic gastrostomy (PEG) tube is becoming a common practice in Japan to prevent enteral nutrition (EN)-related complications. However, what constitutes an adequate viscosity of TEF remains unclear. The aim of this study was to examine the clinical effects of TEFs with different viscosities administered through PEG. METHODS: The subjects were 50 patients admitted to a single institution who underwent PEG placement. Viscosities of TEFs frequently administered to the patients were measured, and EN-related complications, nutrition intakes, and clinical outcomes were compared between high- and medium-viscosity TEFs during the first 2 weeks after TEF feeding initiation. RESULTS: The measured viscosities of high- and medium-viscosity TEFs were 10,382 ± 931 and 3492 ± 296 mPa·s, respectively. Protein and fluid intakes with TEF were significantly less in the high-viscosity group. There was no significant difference in EN-related complications, energy intakes, or clinical outcomes between high- and medium-viscosity TEFs. CONCLUSION: In this study, high-viscosity TEFs showed no statistical difference in either EN-related complications or clinical outcomes, in comparison with medium-viscosity TEF.

Determinant factors of the viscosity of enteral formulas: basic analysis of thickened enteral formulas.

BACKGROUND: Thickened enteral formula (TEF), which is made by adding thickener to enteral formula, has been used mainly in Japan to reduce the incidence of clinical complications associated with enteral nutrition. However, the optimal viscosity of TEF needed to achieve a high efficiency is different for each medical complication and for individual patients. METHODS: The viscosity of TEF, which consists of enteral formula and thickener, was determined by 5 factors: (1) formula energy density, (2) formula temperature, (3) stirring speed, (4) stirring time, and (5) time elapsed since preparation. Then, the changing index (CI) was calculated for each of the 5 factors to determine which exerts the most influence on TEF viscosities. RESULTS: The most influential factor (CI ≥-50%) for the decrease in TEF viscosity was formula energy density. In contrast, the most influential factors (CI ≥50%) for the increase in TEF viscosity were stirring time and time elapsed since preparation. CONCLUSION: The results of this study indicate that formula energy density, stirring time, and time elapsed since preparation are the most influential factors to consider during manipulation of TEF viscosity.