Re-assessing the role of peri-operative nutritional therapy in patients with pancreatic cancer undergoing surgery: a narrative review.

Pancreatic cancer is the most common medical condition that requires pancreatic resection. Over the last three decades, significant improvements have been made in the conditions and procedures related to pancreatic surgery, resulting in mortality rates lower than 5%. However, it is important to note that the morbidity in pancreatic surgery remains r latively high, with a percentage range of 30-60%. Pre-operative malnutrition is considered to be an independent risk factor for post-operative complications in pancreatic surgery, such as impaired wound healing, higher infection rates, prolonged hospital stay, hospital readmission, poor prognosis, and increased morbidity and mortality. Regarding the post-operative period, it is crucial to provide the best possible management of gastrointestinal dysfunction and to handle the consequences of alterations in food digestion and nutrient absorption for those undergoing pancreatic surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) suggests that early oral feeding should be the preferred way to initiate nourishing surgical patients as it is associated with lower rates of complications. However, there is ongoing debate about the optimal post-operative feeding approach. Several studies have shown that enteral nutrition is associated with a shorter time to recovery, superior clinical outcomes and biomarkers. On the other hand, recent data suggest that nutritional goals are better achieved with parenteral feeding, either exclusively or as a supplement. The current review highlights recommendations from existing evidence, including nutritional screening and assessment and pre/post-operative nutrition support fundamentals to improve patient outcomes. Key areas for improvement and opportunities to enhance guideline implementation are also highlighted.

Novel trends and concepts in the nutritional management of glycemia in type 2 diabetes mellitus-beyond dietary patterns: a narrative review.

A variety of eating patterns are recommended by international guidelines to help people with type 2 diabetes mellitus (T2DM) achieve general health and glycemia goals. Apart from eating patterns, there is evidence that other approaches related to the everyday application of dietary advice, such as meal frequency, breakfast consumption, daily carbohydrate distribution, and order of food consumption during meals, have significant effects on glycemia management. The aims of this review were to examine published diabetes nutrition guidelines concerning specific recommendations with regard to the above approaches, as well as to review evidence from studies that have investigated their effect on glycemia in T2DM. The data suggest that eating breakfast regularly, consuming most carbohydrates at lunch, avoiding large dinners late at night, and applying the carbohydrate-last meal pattern are effective practices towards better nutritional management of T2DM.

Effects of Two Workload-Matched High-Intensity Interval Training Protocols on Regional Body Composition and Fat Oxidation in Obese Men.

The effects of two high-intensity interval training (HIIT) protocols on regional body composition and fat oxidation in men with obesity were compared using a parallel randomized design. Sixteen inactive males (age, 38.9 ± 7.3 years; body fat, 31.8 ± 3.9%; peak oxygen uptake, VO2peak, 30.9 ± 4.1 mL/kg/min; all mean ± SD) were randomly assigned to either HIIT10 (48 × 10 s bouts at 100% of peak power [Wpeak] with 15 s of recovery) or HIIT60 group (8 × 60 s bouts at 100% Wpeak with 90 s of recovery), and subsequently completed eight weeks of training, while maintaining the same diet. Analyses of variance (ANOVA) showed only a main effect of time (p < 0.01) and no group or interaction effects (p > 0.05) in the examined parameters. Total and trunk fat mass decreased by 1.81 kg (90%CI: -2.63 to -0.99 kg; p = 0.002) and 1.45 kg (90%CI: -1.95 to -0.94 kg; p < 0.001), respectively, while leg lean mass increased by 0.86 kg (90%CI: 0.63 to 1.08 kg; p < 0.001), following both HIIT protocols. HIIT increased peak fat oxidation (PFO) (from 0.20 ± 0.05 to 0.33 ± 0.08 g/min, p = 0.001), as well as fat oxidation over a wide range of submaximal exercise intensities, and shifted PFO to higher intensity (from 33.6 ± 4.6 to 37.6 ± 6.7% VO2peak, p = 0.039). HIIT, irrespective of protocol, improved VO2peak by 20.0 ± 7.2% (p < 0.001), while blood lactate at various submaximal intensities decreased by 20.6% (p = 0.001). In conclusion, both HIIT protocols were equally effective in improving regional body composition and fat oxidation during exercise in obese men.

Cardiorespiratory characteristics and cholesterol responses to a single session of heavy leg press exercise.

The effect of resistance exercise on blood lipids is not clear yet. The purpose of this study was to examine the cholesterol responses to a heavy resistance leg press exercise emphasizing on the eccentric movement 24 and 48 hours following exercise and to quantify the cardiorespiratory responses of the exercise bout in an attempt to clarify the exercise characteristics that may be responsible for the effects of heavy resistance exercise on blood lipids. Nine healthy, untrained male volunteers aged 27.2 ± 1.1 yrs (76.2 ± 2.5 kg, 1.79 ± 0.02 m) performed a session of heavy RE emphasizing on the eccentric movement consisting of eight sets of inclined leg presses at six repetition maximum with 3-min rest intervals. Venous blood samples were obtained at rest (control) and 24 and 48 hours following exercise. Average VO2 at rest was 4.0 ± 0.4 ml·min(-1)·kg(-1), during exercise 19.6 ± 0.2 ml·min(-1)·kg(-1) and during the 180 sec recovery period between sets 12.5 ± 0.2 ml·min(-1)·kg(-1). RER values decreased with the progression of the exercise and were significantly lower during the last four sets compared with the first four sets of the exercise session. Resting heart rate was 67 ± 2 bpm, and maximum heart rate during exercise was 168 ± 1 bpm. Serum creatine kinase was significantly elevated on day 1 (1090 ± 272 U·L(-1), p < 0.03) and peaked on day 2 (1230 ± 440 U·L(-1) p < 0. 01). Total cholesterol, HDL cholesterol and calculated LDL cholesterol concentration did not change significantly following with exercise. This protocol of heavy resistance exercise has no effect on TC or cholesterol sub-fraction concentration 24 and 48 hours following exercise which may be due to the low energy expenditure of the exercise and/or to the gender of the participants. Key pointsRepeated sets of heavy resistance exercise significantly increase oxygen uptake both during exercise and the following recovery period.Even though exercise was of low volume (8 sets x 6 repetitions) the elevated oxygen uptake during the rest intervals in combination with the total exercise session duration (26 min) resulted in aerobic energy expenditure that is equivalent to low to moderate intensity cycling.Leg press resistance exercise emphasizing on the eccentric movement that caused muscle damage had no effect on total cholesterol, HDL-C and LDL-C during the two days following exercise in young healthy male subjects.

Phosphorus nutritional knowledge among dialysis health care providers and patients: A multicenter observational study.

BACKGROUND-AIMS: Phosphorus nutritional knowledge level of hemodialysis patients and renal nurses has been found to be low, while respective knowledge of nephrologists has not been studied yet. There are equivocal results regarding the association of phosphorus nutritional knowledge level and serum phosphorus values. The aim of this study was to assess phosphorus nutritional knowledge of hemodialysis patients, nephrologists and renal nurses and seek potential interventions to improve patients' adherence to phosphorus and overall nutritional guidelines. METHODS: This cross-sectional observational study was conducted on sixty eight hemodialysis patients, 19 renal nurses and 11 nephrologists who were recruited from 3 hemodialysis units in Greece. Phosphorus nutritional knowledge of the participants was assessed by a 25-item item questionnaire (CKDKAT-N) which included 15 questions on phosphorus and 10 questions on protein, sodium, and potassium knowledge. RESULTS: Nephrologists had higher CKDKAT-N total (19.1 ± 3.6 vs 14.1 ± 2.8 and 13.2 ± 2.8, P < 0.01) and phosphorus knowledge scores (10.6 ± 2.7 vs 7.6 ± 2.2 and 7.3 ± 2.0, P < 0.01) compared to renal nurses and patients respectively. There were no differences in total and phosphorus knowledge scores between nurses and patients. Patients and nurses answered correctly significantly less questions regarding phosphorus compared with the rest of the questions (P < 0.01) while no such difference was found in nephrologists. Serum phosphorus was positively correlated with phosphorus knowledge score (r = 0.31, P = 0.02), and negatively correlated with patient age (r = -0.34, P < 0.05). None of the patients, 11% of the nurses and 27% of the nephrologists answered correctly all three questions regarding P, K and Na dietary recommendations (P < 0.01). CONCLUSIONS: The study confirms that hemodialysis patients have low renal nutrition knowledge while higher nutritional phosphorus knowledge does not lead to lower serum phosphorus values. Alarmingly, renal nurses have been found to have a similar level of knowledge with hemodialysis patients, something that needs to be taken into account when training the new dialysis staff. Nephrologists have superior knowledge; however they are still lacking essential nutritional knowledge that could affect patients' and nurses' overall understanding. Continuing education on nutrition of nephrologists and renal nurses could improve nutrition care of hemodialysis patients.

Translation of the modified NUTRIC score and adaptation to the Greek ICU setting.

BACKGROUND & AIMS: Patients in the intensive care unit are experiencing an increased malnutrition risk. The NUTrition Risk in the Critically ill score (NUTRIC) is a validated tool for the identification of patients that will benefit the most, from nutritional intervention. The aim of the study was twofold, including: 1) to translate and adapt the NUTRIC score in the Greek language for more efficient and comprehensive use among clinicians, and 2) to assess its prognostic performance in a pilot sample. METHODS: The translation process followed standardized steps: 1) initial translation, 2) synthesis of different translations, 3) back -translation to the English language, 4) revision and cultural adaptation of the instrument by an expert committee. A pilot application study was conducted on 80 critically ill patients from three ICUs in Greek hospitals. The NUTRIC score was calculated using the final translated version. RESULTS: The translated score was considered easy to use, fast and comprehensive. No specific corrections were suggested by the expert committee. According to the translated version of the score 56% of the screened patients were classified as of high nutritional risk (score between 5 and 9). Compared to the low - NUTRIC patients, high - NUTRIC patients were older (56.4 ± 16.4 vs. 68.7 ± 12.7 yrs, p < 0.001), had increased APACHE (13.8 ± 6.5 vs. 23.8 ± 6.5, p < 0.001) and SOFA scores (4.7 ± 3.1 vs. 10.4 ± 3.1, p < 0.001) and demonstrated more comorbidities. Elevated 28 -day mortality was observed among high -NUTRIC patients compared to the low - NUTRIC ones (6 vs. 18 patients, p < 0.05). CONCLUSIONS: The Greek version of the NUTRIC score is ready for use among health care professionals employed in intensive care units in Greek speaking countries, aiming to discriminate critically ill patients benefiting from enhanced nutritional support.

Postprandial lipemia 16 and 40 hours after low-volume eccentric resistance exercise.

PURPOSE: There is evidence to suggest that muscle damage caused by resistance exercise (RE) may increase postprandial lipemia (PPL). This study examined PPL for two consecutive days after a protocol of low-volume eccentric RE that caused muscle damage. METHODS: Nine healthy, untrained male volunteers aged 27.2 +/- 1.1 yr performed a session of eccentric RE consisting of eight sets of inclined leg presses at six repetition maximum with 3-min rest intervals. A high-fat meal (1.2 g fat, 1.2 g carbohydrate, 0.22 g protein, and 68.6 kJ kg(-1) body mass) was administered 16 h (day 1) and 40 h (day 2) after exercise as well as after an overnight fast with no prior exercise (control condition [C]). Venous blood samples were obtained before and hourly for 6 h after each meal. RESULTS: The duration of the exercise session (including rest intervals) was 25.6 +/- 0.2 min, whereas net exercise time was 4.6 +/- 0.2 min. Total energy expenditure was 0.64 +/- 0.04 MJ. Serum creatine kinase and ratings of perceived muscle soreness were significantly elevated on day 1 and peaked on day 2. Triacylglycerol total area under the curve was 12.1% lower on day 1 compared with C (7.51 +/- 0.99 vs. 8.54 +/- 1.07 mmol L(-1) 6h(-1), P < 0.02), whereas no difference existed between C and day 2. Serum insulin incremental area under the curve was significantly elevated on day 2 compared with C, indicating transient insulin resistance. CONCLUSION: These results show that low-volume eccentric RE is effective in reducing postprandial triacylglycerol concentration despite the low energy expenditure. Muscle damage does not have a detrimental effect on PPL.