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2.
Presse Med ; 48(12): 1496-1501, 2019 Dec.
Artigo em Francês | MEDLINE | ID: mdl-31757727

RESUMO

Nonalcoholic fatty liver disease (NAFLD) is strongly associated with obesity and insulin resistance. There is currently no pharmacological treatment validated in steatosis. The combination of weight loss and adequate physical activity can improve liver steatosis. In randomized trials and cohort studies, a weight loss of at least 7% and a diet approaching the Mediterranean diet have been associated with an improvement in hepatic fat content, an improvement in hepatic biomarkers, and regression of histological signs of steatosis. Bariatric surgery by losing weight can lead to an improvement in hepatic fat content.


Assuntos
Fígado Gorduroso/dietoterapia , Hepatopatia Gordurosa não Alcoólica/dietoterapia , Terapia Nutricional/métodos , Cirurgia Bariátrica/métodos , Exercício/fisiologia , Fígado Gorduroso/cirurgia , Humanos , Hepatopatia Gordurosa não Alcoólica/cirurgia , Perda de Peso/fisiologia
5.
Artigo em Inglês | MEDLINE | ID: mdl-31398932

RESUMO

Obese children are exposed to short and long-term health consequences, such as dyslipidemia, hypertension and diabetes mellitus. For these reasons, the prevention and treatment of obesity in the pediatric population is a challenge for health care professionals. The aim of this study was to evaluate whether an intensive intervention based on diet and physical activity has a better impact on the auxological and biochemical parameters than standard care (intervention). The study included 20 children (six boys, 14 girls), of the mean age 8.9 (SD 1.4) before puberty. The participants were randomly assigned to two groups: Group I (starting treatment with intensive intervention), and II (starting treatment with standard intervention). After three months, the groups were switched. The comparison of the two interventions in the study group indicates a better effectiveness of intensive intervention in the improvement of anthropometric parameters and majority of biochemical ones (except for insulin concentration, HOMA IR index and LDL cholesterol). As the result of intensive intervention, the mean % of weight-to-height excess and hip circumference decreased significantly (p < 0.005). Our results confirm that complex intervention based on systematic control visits, including personalized dietitian counselling and physician care, during the weight reduction process is more effective than a one-off standard visit.


Assuntos
Terapia Comportamental/métodos , Exercício/fisiologia , Terapia Nutricional/métodos , Obesidade Pediátrica/prevenção & controle , Puberdade/fisiologia , Maturidade Sexual/fisiologia , Perda de Peso/fisiologia , Índice de Massa Corporal , Tamanho Corporal , Criança , Feminino , Humanos , Masculino , Polônia
6.
Rev Assoc Med Bras (1992) ; 65(7): 952-958, 2019 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-31389504

RESUMO

PURPOSE: In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. METHODS: 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. RESULTS: There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). CONCLUSION: Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.


Assuntos
Estado Nutricional/fisiologia , Músculo Quadríceps/diagnóstico por imagem , Músculo Quadríceps/patologia , Ultrassonografia/métodos , APACHE , Idoso , Idoso de 80 Anos ou mais , Estado Terminal , Feminino , Humanos , Unidades de Terapia Intensiva , Tempo de Internação , Modelos Logísticos , Masculino , Desnutrição/diagnóstico por imagem , Desnutrição/patologia , Desnutrição/fisiopatologia , Pessoa de Meia-Idade , Avaliação Nutricional , Terapia Nutricional/métodos , Estudos Prospectivos , Músculo Quadríceps/fisiopatologia , Valores de Referência , Respiração Artificial/efeitos adversos , Medição de Risco , Sensibilidade e Especificidade
7.
Nutrients ; 11(8)2019 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-31382527

RESUMO

Personalised nutrition approaches provide healthy eating advice tailored to the nutritional needs of the individual[...].


Assuntos
Terapia Nutricional/métodos , Medicina de Precisão/métodos , Comportamento , Comportamento Alimentar , Humanos , Necessidades Nutricionais
8.
BMC Pregnancy Childbirth ; 19(1): 229, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277585

RESUMO

BACKGROUND: An understanding of the association between adolescent nutrition, adolescent pregnancy and their quest for healthcare services may elucidate a basis for intervention and formulation of programs that enhance post-partum and increase the lifespan of the newborn, improve the quality of life and bridge morbidity, mortality and healthcare-associated cost. However, the nutritional needs of pregnant and lactating adolescent girls aged below 10 years resident in Trans Mara East Sub-County, Kenya remained unestablished. The objective of this study was to assess the nutritional needs of pregnant and lactating adolescent girls (under 19) when accessing and utilizing nutritional advice and services in Trans-Mara East Sub-County, Narok County. METHODS: The study adopted a cross-sectional approach that employed mixed methods with both quantitative and qualitative research approaches. Cochran formula was applied to arrive at a minimum of 291 households. Probability proportionate to size sampling techniques using cluster and simple random methods were used to practically access adolescents who are pregnant or lactating. Data was collected using questionnaires, in-depth interview and Focus Group Discussion. Quantitative data was analyzed descriptively using frequencies and inferentially using odds ratio and z-test. Framework analysis was employed to analyze qualitative data. p ≤ 0.05 was considered statistically significant. RESULTS: The study revealed that access of pieces of nutritional-related advice represented by 67.8% was significantly higher than expected frequency of 50%. Nutrition supplementation, food fortification or blending and complementary feeding were significantly below the expectant frequency (p < 0.01) of 50%. Nutrition service areas such as provision and collection of vitamin A and IFAS were significantly lower than expected frequency (p < 0.01). CONCLUSIONS: The most widely utilized were nutrition services that falls within the preventive-focused services followed by curative-focused services. Nutritionist and nurse more likely to increase overall utilization of nutrition services.


Assuntos
Serviços de Saúde do Adolescente , Acesso aos Serviços de Saúde , Serviços de Saúde Materna , Determinação de Necessidades de Cuidados de Saúde , Terapia Nutricional , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Serviços de Saúde do Adolescente/organização & administração , Serviços de Saúde do Adolescente/estatística & dados numéricos , Fenômenos Fisiológicos da Nutrição do Adolescente , Aleitamento Materno , Criança , Estudos Transversais , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Recém-Nascido , Quênia , Lactação , Fenômenos Fisiológicos da Nutrição Materna , Terapia Nutricional/métodos , Terapia Nutricional/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Adulto Jovem
9.
BMC Med ; 17(1): 148, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31357989

RESUMO

Cancer Research UK and Ludwig Cancer Research convened an inaugural international Cancer Prevention and Nutrition Conference in London on December 3-4, 2018. Much of the discussion focused on the need for systematic, interdisciplinary approaches to better understand the relationships of nutrition, exercise, obesity and metabolic dysfunction with cancer development. Scientists at the meeting underscored the importance of studying the temporal natural history of exposures that may cumulatively impact cancer risk later in life.A robust dialogue identified obesity as a major risk for cancer, and the food environment, especially high energy and low nutrient processed foods, as strong and prevalent risk factors for obesity. Further engagement highlighted challenges in the post-diagnostic setting, where similar opportunities to understand the complex interplay of nutrition, physical activity, and weight will inform better health outcomes.Going forward, holistic research approaches, encompassing insights from multiple disciplines and perspectives, will catalyze progress urgently needed to prevent cancer and improve public health.


Assuntos
Pesquisa Biomédica , Pesquisa Interdisciplinar , Neoplasias/dietoterapia , Neoplasias/prevenção & controle , Terapia Nutricional , Pesquisa Biomédica/métodos , Pesquisa Biomédica/tendências , Peso Corporal/fisiologia , Congressos como Assunto , Dieta , Exercício/fisiologia , Alimentos , Humanos , Comunicação Interdisciplinar , Pesquisa Interdisciplinar/métodos , Pesquisa Interdisciplinar/tendências , Terapia Nutricional/métodos , Terapia Nutricional/tendências , Estado Nutricional , Obesidade/complicações , Obesidade/dietoterapia , Obesidade/epidemiologia , Fatores de Risco , Reino Unido/epidemiologia
10.
Afr Health Sci ; 19(1): 1566-1573, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31148985

RESUMO

Background: Nationwide studies have focused only on prevalence of malnutrition in hospitalized children, while medical nutrition therapies and assessing nutritional interventions is neglected. Methods: This research was conducted in tertiary level children hospitals in the NorthEastern region of Iran for 1 year from 2016 to 2017. Five questions were included in the initial assessment form and, if there was even one positive response, nutritional interventions were prescribed for the patients. Results: A total of 65 children aged ≥ 5 years and hospitalized for ≥ two days were included. 24.6% of patients had 2 >BMI Z-score>-2 at time of admission. At the beginning of the study, weight loss more than 10%, and appetite loss or decreased food intake was observed in 10.8% and 20% of the study population, respectively. Median BMI percentile of patients with nutritional intervention was 8.9 (0.1-98.7) at the beginning of the study and 12.7 (0.1-98.4) at discharge time which shows a significant difference (P=0.01). Conclusion: Medical nutrition therapy employed in this study prevented deterioration of nutritional status of children during hospitalization and was effective in stabilizing indices of nutritional status.


Assuntos
Desnutrição/diagnóstico , Desnutrição/terapia , Programas de Rastreamento/métodos , Terapia Nutricional/métodos , Adolescente , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Hospitalização , Humanos , Irã (Geográfico)/epidemiologia , Tempo de Internação , Masculino , Desnutrição/epidemiologia , Avaliação Nutricional , Estado Nutricional
11.
Nutrients ; 11(6)2019 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-31146408

RESUMO

Those with peripheral arterial disease (PAD) require important considerations with respect to food and nutrition, owing to advanced age, poor diet behaviours and immobility associated with the disease process and co-morbid state. These considerations, coupled with the economic effectiveness of medical nutrition therapy, mandate that dietetic care plays a vital role in the management of PAD. Despite this, optimising dietetic care in PAD remains poorly understood. This narrative review considers the role of medical nutrition therapy in every stage of the PAD process, ranging from the onset and initiation of disease to well established and advanced disease. In each case, the potential benefits of traditional and novel medical nutrition therapy are discussed.


Assuntos
Desnutrição/terapia , Terapia Nutricional/métodos , Doença Arterial Periférica/terapia , Comportamento de Redução do Risco , Humanos , Desnutrição/diagnóstico , Desnutrição/epidemiologia , Desnutrição/fisiopatologia , Estado Nutricional , Valor Nutritivo , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/epidemiologia , Doença Arterial Periférica/fisiopatologia , Fatores de Proteção , Recomendações Nutricionais , Medição de Risco , Fatores de Risco , Resultado do Tratamento
12.
Nutr Hosp ; 36(Spec No2): 57-60, 2019 Jul 01.
Artigo em Espanhol | MEDLINE | ID: mdl-31189324

RESUMO

Introduction: Nutrition therapy and exercise form an essential tandem to maintain the functional capacity of patients and, therefore, improve your quality of life. Oral nutritional supplements are part of the medical nutrition treatment. The success of taking nutritional supplements, lies in the therapeutic adherence. The therapeutic adherence is defined by who as "the degree to which the behavior of a patient, in relation to the taking of medication, monitoring a diet or modifying life habits correspond to the recommendations agreed with the health professional ". There are some factors that limit its achievement. Therefore, we must identify them and have tools to solve them so that the patient does not interrupt the prescribed treatment, both from prevention and intervention.


Assuntos
Terapia por Exercício/métodos , Exercício , Força Muscular/fisiologia , Terapia Nutricional/métodos , Terapia Combinada , Suplementos Nutricionais , Humanos , Cooperação do Paciente
13.
Crit Care ; 23(Suppl 1): 139, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200741

RESUMO

Critically ill patients require adequate nutritional support to meet energy requirements both during and after intensive care unit (ICU) stay to protect against severe catabolism and prevent significant deconditioning. ICU patients often suffer from chronic critical illness causing an increase in energy expenditure, leading to proteolysis and related muscle loss. Careful supplementation and modulation of caloric and protein intake can avoid under- or overfeeding, both associated with poorer outcomes. Indirect calorimetry is the preferred method for assessing resting energy expenditure and the appropriate caloric and protein intake to counter energy and muscle loss. Physical exercise may have favorable effects on muscle preservation and should be considered even early in the hospital course of a critically ill patient. After liberation from the ventilator or during non-invasive ventilation, oral intake should be carefully evaluated and, in case of severe dysphagia, should be avoided and replaced by enteral of parenteral nutrition. Upon transfer from the ICU to the ward, adequate nutrition remains essential for long-term rehabilitation success and continued emphasis on sufficient nutritional supplementation in the ward is necessary to avoid a suboptimal nutritional state.


Assuntos
Estado Terminal/psicologia , Terapia Nutricional/métodos , Ingestão de Energia/fisiologia , Exercício/fisiologia , Humanos , Unidades de Terapia Intensiva/organização & administração , Tempo de Internação , Estado Nutricional , Apoio Nutricional/métodos , Qualidade de Vida/psicologia , Estresse Fisiológico/fisiologia
14.
Medicine (Baltimore) ; 98(25): e16043, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31232938

RESUMO

BACKGROUND: Multiple sclerosis (MS) is a chronic immune mediated disease which affects the central nervous system (CNS), having a substantial financial, functional, and quality of life (QOL) impact on these people. The vitamin A supplementation has been studied as a therapeutic possibility for in MS. Therefore, the objective of this protocol is to build an outline for a future systematic review, which will provide up-to-date available evidence about the clinical impact of nutritional supplementation of vitamin A in the outcomes related to the symptoms in patients with this pathology. METHODS: The search will be performed in the following databases: PubMed, Embase, Scopus, cinahl, Scielo, Web of Science, the Cochrane Library and Science Direct, randomized clinical trials published until May 2019 that evaluate the relationship of the supplementation of vitamin A and health-related outcomes in patients with MS will be included. Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) will be used to outline the protocol, and PRISMA to the systematic review. Undergraduate handbook of quality of evidence and strength of recommendations for decision making in health (GRADE) will be used to assess the quality of evidence and the strength of the recommendation, and the JADAD scale to assess the internal validity of selected studies. For the extraction of all the data found a database in Microsoft Excel will be created. For the summary of the findings the Cochrane Collaboration Handbook recommendations will be used, and for the meta-analysis standard statistical techniques the RevMan software will be used. RESULTS: In this study, we hope to find a considerable number of articles presenting evidence about the effectiveness of vitamin A supplementation in patients with MS. CONCLUSION: Currently, many lines of evidence have been produced when it comes to the use of food supplements. This systematic review proposal might provide recent, important, and trusted information for better treatment of patients. RECORD OF SYSTEMATIC REVIEW: This review was recorded in the International Register of Prospective Systematic Reviews (PROSPERO) on the January 30, 2019 (registration: CRD42019121757). Available at: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42019121757.


Assuntos
Suplementos Nutricionais/normas , Metanálise como Assunto , Esclerose Múltipla/dietoterapia , Ensaios Clínicos Controlados Aleatórios como Assunto/normas , Literatura de Revisão como Assunto , Humanos , Terapia Nutricional/métodos , /normas , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Vitamina A/uso terapêutico , Vitaminas/uso terapêutico
15.
Nutr. hosp ; 36(3): 504-509, mayo-jun. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-184545

RESUMO

Introduction: accidental dislodgement of enteral feeding tubes has been considered as an important quality indicator of the efficacy of enteral nutrition therapy. However, in clinical practice, the use of feeding tube attachment devices (FTADs), as an alternative to the traditional method of adhesive tape alone, has not yet been evaluated for its effectiveness in reducing inadvertent tube dislodgement. Objective: to evaluate the impact of using a dedicated FTAD compared with the traditional securing method with adhesive tape on the occurrence of accidental enteral feeding tube removal. Methods: a randomized clinical trial comparing two strategies for enteral feeding tube securement: use of traditional adhesive tape vs FTAD. The primary endpoint was the percentage of accidental enteral feeding tube dislodgement after randomization. Results: a total of 104 inpatients (mean age: 61.4?±?17.5 years) were included (52 patients per group). Most were women with cerebrovascular disease (35.6%), diabetes (28.8%) and neoplasia (27.9%). There were 39 (37.5%) cases of accidental tube removal, 30.8% in the FTAD group and 44.2% in the adhesive tape group (p?=?0.22). During follow-up, patients in the FTAD group received a mean of 60.0% of the volume of enteral nutrition prescribed, while patients in the adhesive tape group received 57.0% (p?=?0.61). There was no difference in skin lesions between the groups. Conclusion: the strategy of using a dedicated FTAD as the method for securing enteral feeding tubes did not reduce the risk of accidental tube dislodgement compared with the traditional securing method with adhesive tape


Introducción: la expulsión accidental de sondas de alimentación enteral se ha considerado un indicador importante de la calidad de la eficacia de la terapia de nutrición enteral. Sin embargo, en la práctica clínica, el uso de dispositivos de fijación de tubos de alimentación (FTAD, por sus siglas en inglés), como una alternativa al método tradicional de cinta adhesiva exclusivamente, aún no se ha evaluado por su eficacia para reducir el desprendimiento accidental de sondas. Objetivo: evaluar el impacto de usar un FTAD dedicado en comparación con el método tradicional de aseguramiento con cinta adhesiva en caso de que se produzca una extracción accidental de la sonda de alimentación enteral. Métodos: se realizó un ensayo clínico aleatorizado que comparó dos estrategias para asegurar la sonda de alimentación enteral: el uso de cinta adhesiva tradicional frente a FTAD. El punto final primario fue el porcentaje de desplazamiento accidental del tubo de alimentación enteral después de la aleatorización. Resultados: se incluyó un total de 104 pacientes hospitalizados (edad media 61,4 ± 17,5 años) (52 pacientes por grupo). La mayoría eran mujeres con enfermedad cerebrovascular (35,6%), diabetes (28,8%) y neoplasia (27,9%). Hubo 39 casos (37.5%) de extracción accidental de tubos, 30,8% en el grupo FTAD y 44,2% en el grupo de cinta adhesiva (p = 0,22). Durante el seguimiento, los pacientes del grupo FTAD recibieron una media del 60,0% del volumen de nutrición enteral prescrito, mientras que los pacientes del grupo de cinta adhesiva recibieron el 57,0% (p = 0,61). No hubo diferencia en las lesiones de la piel entre los grupos. Conclusión: la estrategia de utilizar un FTAD dedicado como método para asegurar las sondas de alimentación enteral no redujo el riesgo de retiradas accidentales en comparación con el método tradicional de sujeción con cinta adhesiva


Assuntos
Humanos , Pessoa de Meia-Idade , Idoso , Nutrição Enteral/instrumentação , Intubação Gastrointestinal/instrumentação , Terapia Nutricional/métodos , Intubação Gastrointestinal/métodos , Qualidade da Assistência à Saúde , Modelos Logísticos
16.
Pan Afr Med J ; 32: 25, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31143330

RESUMO

A young emaciated male, known case of celiac disease came with complaints of diarrhea along with 5kgs of weight loss in 3 months' time. He had severe electrolyte abnormalities along with low albumin, low calcium and a high phosphate with deranged liver function test. Ultrasound abdomen had shown fatty liver. Nutrition consult was sought and he was found to have a BMI of 6.8kg/m2. He was started on nutrition support along with supportive therapy, which resulted in weight gain and improvement in his condition.


Assuntos
Doença Celíaca/fisiopatologia , Emaciação/etiologia , Hepatopatia Gordurosa não Alcoólica/diagnóstico , Terapia Nutricional/métodos , Diarreia/etiologia , Emaciação/terapia , Humanos , Masculino , Hepatopatia Gordurosa não Alcoólica/terapia , Perda de Peso , Adulto Jovem
17.
Nutrients ; 11(5)2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31121926

RESUMO

Chemotherapy may negatively affect nutritional status and quality of life (QOL) in pancreatic cancer patients. Our aim was to investigate the beneficial effects of oral nutrition supplements (ONS) on pancreatic and bile duct cancer patients undergoing chemotherapy. Among patients with progressive pancreatic and bile duct cancer receiving chemotherapy, the ONS group (n = 15) received two packs of ONS daily for 8 weeks while the non-ONS group (n = 19) did not. Anthropometric measures, dietary intake, nutritional status, and quality of life were assessed. ONS significantly increased daily intakes of energy, carbohydrates, proteins, and lipids at 8 weeks compared to the baseline. After 8 weeks, fat mass significantly increased in the ONS group. For patients in their first cycle of chemotherapy, body weight, fat-free mass, skeletal muscle mass, body cell mass, and fat mass increased in the ONS group but decreased in the non-ONS group. Fat mass increased in second or higher cycle only in the ONS group. Patient-generated subjective global assessments (PG-SGA) and fatigue scores in the Quality of Life Questionnaire Core 30 (QLQ-C30) improved in the ONS group. ONS might improve nutritional status by increasing fat mass and/or maintaining the body composition of pancreatic and bile duct cancer patients with chemotherapy, especially those in the first cycle, and alleviate fatigue symptoms.


Assuntos
Neoplasias dos Ductos Biliares/terapia , Suplementos Nutricionais , Terapia Nutricional/métodos , Neoplasias Pancreáticas/terapia , Idoso , Neoplasias dos Ductos Biliares/tratamento farmacológico , Composição Corporal , Peso Corporal , Dieta , Ingestão de Energia , Feminino , Humanos , Masculino , Estado Nutricional , Neoplasias Pancreáticas/tratamento farmacológico , Estudos Prospectivos , Qualidade de Vida , Inquéritos e Questionários
18.
Crit Care ; 23(1): 111, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30953553

RESUMO

BACKGROUND: Microaspiration of gastric and oropharyngeal secretions is the main mechanism of entry of bacteria into the lower respiratory tract in intubated critically ill patients. The aim of this study is to determine the impact of enteral nutrition, as compared with parenteral nutrition, on abundant microaspiration of gastric contents and oropharyngeal secretions. METHODS: Planned ancillary study of the randomized controlled multicenter NUTRIREA2 trial. Patients with shock receiving invasive mechanical ventilation were randomized to receive early enteral or parenteral nutrition. All tracheal aspirates were collected during the 48 h following randomization. Abundant microaspiration of gastric contents and oropharyngeal secretions was defined as the presence of significant levels of pepsin (> 200 ng/ml) and salivary amylase (> 1685 UI/ml) in > 30% of tracheal aspirates. RESULTS: A total of 151 patients were included (78 and 73 patients in enteral and parenteral nutrition groups, respectively), and 1074 tracheal aspirates were quantitatively analyzed for pepsin and amylase. Although vomiting rate was significantly higher (31% vs 15%, p = 0.016), constipation rate was significantly lower (6% vs 21%, p = 0.010) in patients with enteral than in patients with parenteral nutrition. No significant difference was found regarding other patient characteristics. The percentage of patients with abundant microaspiration of gastric contents was significantly lower in enteral than in parenteral nutrition groups (14% vs 36%, p = 0.004; unadjusted OR 0.80 (95% CI 0.69, 0.93), adjusted OR 0.79 (0.76, 0.94)). The percentage of patients with abundant microaspiration of oropharyngeal secretions was significantly higher in enteral than in parenteral nutrition groups (74% vs 54%, p = 0.026; unadjusted OR 1.21 (95% CI 1.03, 1.44), adjusted OR 1.23 (1.01, 1.48)). No significant difference was found in percentage of patients with ventilator-associated pneumonia between enteral (8%) and parenteral (10%) nutrition groups (HR 0.78 (0.26, 2.28)). CONCLUSIONS: Our results suggest that enteral and parenteral nutrition are associated with high rates of microaspiration, although oropharyngeal microaspiration was more common with enteral nutrition and gastric microaspiration was more common with parenteral nutrition. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03411447 . Registered 18 July 2017. Retrospectively registered.


Assuntos
Vias de Administração de Medicamentos , Terapia Nutricional/normas , Choque/dietoterapia , Idoso , Secreções Corporais , Estado Terminal/terapia , Feminino , Suco Gástrico , Humanos , Inalação/fisiologia , Unidades de Terapia Intensiva/organização & administração , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia Nutricional/instrumentação , Terapia Nutricional/métodos , Estudos Retrospectivos , Fatores de Tempo
19.
Complement Ther Med ; 43: 181-187, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30935528

RESUMO

AIMS: A number of studies have examined the beneficial effects of Coenzyme Q10 (CoQ10) on fatigue in different population, but the findings have been inconclusive. Herein, we systematically reviewed available interventional studies to elucidate the overall effects of CoQ10 supplementation on fatigue among adolescent and adult population. METHODS: PubMed, Cochrane's library, Science direct, Scopus, Google scholar and ISI web of science databases were searched for all available literature until April 2018 for studies assessing the effects of CoQ10 supplementation on fatigue. The Cochrane bias assessment tool were used to assess the quality of studies. RESULTS: A total of 16 studies out of 1316 met our inclusion criteria and included in our systematic review. Among included studies 10 of them showed significant beneficial effects (p < 0.05) of CoQ10 supplementation on fatigue status among healthy, fibromyalgia, statin-related fatigue, multiple sclerosis and end-stage heart failure subjects. CoQ10 supplementation could alleviate fatigue, but differences between studies population should be taken into account. CONCLUSION: It seems CoQ10 has better therapeutic effects in statin-related fatigue and fibromyalgia patients compared with the other disease related fatigue. Finally, in order to draw a firm link between CoQ10 and fatigue, more clinical trials with adequate sample size and with sufficient follow-up periods are needed.


Assuntos
Fadiga/tratamento farmacológico , Ubiquinona/análogos & derivados , Suplementos Nutricionais , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Terapia Nutricional/métodos , Ubiquinona/uso terapêutico
20.
Support Care Cancer ; 27(7): 2371-2384, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30944994

RESUMO

PURPOSE: The optimal components for rehabilitation in patients with incurable cancer are unclear. However, principles of exercise and nutrition-based interventions used in cancer cachexia may be applied usefully to this population of cancer patients. This systematic review examines current evidence for rehabilitation combining exercise and nutritional support in patients with incurable cancer. METHODS: MEDLINE, EMBASE and Cochrane databases were searched. Eligible studies included patients with incurable cancer and rehabilitation programmes combining exercise and nutritional interventions. Studies of cancer survivors, curative treatments, reviews, case note reviews, protocols and abstracts were excluded. Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria were applied to patient-important outcomes. RESULTS: Of the 2424 search results, 67 abstracts were reviewed and 24 full texts examined. Eight studies (n = 685) were included comprising two randomised control trials, three prospective, one exploratory and two secondary analyses. All examined multi-modal outpatient programmes. GRADE analysis revealed moderate evidence (B) for improvements in depression and physical endurance, low-quality evidence (C) for quality of life and fatigue and very low-quality evidence (D) for overall function and nutritional status. CONCLUSION: There are limited data for multi-modal rehabilitation programmes combining exercise and nutritional interventions in patients with incurable cancer. However, studies to date report improvements in multiple domains, most notably physical endurance and depression scores. This supports the concept that multi-modal rehabilitation incorporating principles of cachexia management may be appropriate for the wider group of patients with incurable cancer. Further, high-quality studies are needed to define the optimal approach and outcome measures.


Assuntos
Terapia por Exercício/métodos , Neoplasias/reabilitação , Neoplasias/terapia , Terapia Nutricional/métodos , Qualidade de Vida/psicologia , Humanos , Pacientes Ambulatoriais , Estudos Prospectivos
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