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Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Bischoff SC. Corrigendum to 'ESPEN guideline: Clinical nutrition in inflammatory bowel disease' [Clinical Nutrition 36 (2) (2016) 321-347]. Clin Nutr 2019; 38:1485. [PMID: 30955984 DOI: 10.1016/j.clnu.2019.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich, NR4 7UQ, United Kingdom.
| | - Johanna Escher
- Erasmus Medical Center e Sophia Children's Hospital, Office Sp-3460, Wytemaweg 80, 3015 CN, Rotterdam, the Netherlands
| | - Xavier Hébuterne
- Gastroent_erologie et Nutrition Clinique, CHU de Nice, Universit_e Cˆote d'Azur, Nice, France
| | - Stanisław Kłęk
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050, Skawina, Krakau, Poland
| | - Zeljko Krznaric
- Clinical Hospital Centre Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Stéphane Schneider
- Gastroent_erologie et Nutrition Clinique, CHU de Nice, Universit_e Cˆote d'Azur, Nice, France
| | - Raanan Shamir
- Tel-Aviv University, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petach-Tikva, 49202, Israel
| | - Kalina Stardelova
- University Clinic for Gastroenterohepatology, Clinical Centre "Mother Therese", Mother Therese Str No 18, Skopje, Macedonia
| | - Nicolette Wierdsma
- VU University Medical Center, Department of Nutrition and Dietetics, De Boelelaan 1117, 1081 HV, Amsterdam, the Netherlands
| | - Anthony E Wiskin
- Paediatric Gastroenterology & Nutrition Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom
| | - Stephan C Bischoff
- Institut für Ern€ahrungsmedizin (180) Universit€at Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany
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Abstract
In our ageing society diabetes imposes a significant burden in terms of the numbers of people with the condition, diabetes-related complications including disability, and health and social care expenditure. Older people with diabetes can represent some of the more complex and difficult challenges facing the clinician working in different settings, and the recognition that we have only a relatively small (but increasing) evidence base to guide us in diabetes management is a limitation of our current approaches. Nevertheless, in this review we attempt to explore what evidence there is to guide us in a comprehensive scheme of treatment for older adults, often in a high-risk clinical state, in terms of glucose lowering, blood pressure and lipid management, frailty care and lifestyle interventions. We strive towards individualized care and make a call for action for more high-quality research using different trial designs.
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Affiliation(s)
- A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, Droitwich, UK
| | | | | | - M Munshi
- Harvard Medical School and Joslin Clinic, Boston, MA, USA
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Papada E, Amerikanou C, Torović L, Kalogeropoulos N, Tzavara C, Forbes A, Kaliora AC. Plasma free amino acid profile in quiescent Inflammatory Bowel Disease patients orally administered with Mastiha (Pistacia lentiscus); a randomised clinical trial. Phytomedicine 2019; 56:40-47. [PMID: 30668352 DOI: 10.1016/j.phymed.2018.08.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/04/2018] [Accepted: 08/06/2018] [Indexed: 06/09/2023]
Abstract
BACKGROUND Natural products have been studied regarding their effectiveness on Inflammatory Bowel Disease (IBD). HYPOTHESIS/PURPOSE To examine the effects of Mastiha (Pistacia lentiscus var. Chia) on clinical course and amino acid (AA) profile of patients in remission. STUDY DESIGN This is a randomised, double-blind, placebo-controlled clinical trial. METHODS Patients (n = 68) were randomly allocated to Mastiha (2.8 g/day) or placebo adjunct to stable medication. Free AAs were identified applying Gas Chromatography-Mass Spectrometry in plasma. Medical-dietary history, Inflammatory Bowel Disease Questionnaire, Harvey-Bradshaw Index, Partial Mayo Score, biochemical, faecal and blood inflammatory markers were assessed. Primary endpoint was the clinical relapse rate at 6 months. Secondary endpoints included variations in free AAs, inflammatory biomarkers and quality of life. Statistical significance was set at 0.05. RESULTS Concerning AAs and biochemical data, alanine (p = 0.006), valine (p = 0.047), proline (p = 0.022), glutamine (p < 0.001) and tyrosine (p = 0.043) along with total cholesterol (p = 0.032) and LDL cholesterol (p = 0.045) increased only in placebo group compared with baseline and the change between the study groups was significantly different. Inflammatory markers had not a significantly different change between the two groups, even serum IL-6, faecal calprotectin and faecal lactoferrin increased only in the placebo group. Although Mastiha was not proven superior to placebo in remission rate (17.6% vs. 23.5%, p = 0.549), attenuation in increase of free AAs levels in verum group is reported. CONCLUSION Mastiha inhibited an increase in plasma free AAs seen in patients with quiescent IBD. Since change of AAs is considered an early prognostic marker of disease activity, this indicates a potential role of Mastiha in remission maintenance.
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Affiliation(s)
- Efstathia Papada
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Charalampia Amerikanou
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Ljilja Torović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Nick Kalogeropoulos
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Chara Tzavara
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich NR4 7UQ, United Kingdom
| | - Andriana C Kaliora
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, Athens, Greece.
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54
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Vijayakumar A, Rosales-Guzmán C, Rai MR, Rosen J, Minin OV, Minin IV, Forbes A. Generation of structured light by multilevel orbital angular momentum holograms. Opt Express 2019; 27:6459-6470. [PMID: 30876231 DOI: 10.1364/oe.27.006459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/19/2019] [Indexed: 05/23/2023]
Abstract
Structured light has been created by a myriad of near-and far-field techniques and has found both classical and quantum applications. In the case of orbital angular momentum (OAM), continuous spiral phase patterns in dynamic or geometric phase are often employed with the phase patterns existing across the entire transverse plane. Here, we exploit the uncertain relationship between OAM and angle in order to create structured OAM fields by using multilevel OAM holograms. We show theoretically and experimentally that only a multilevel angular phase contour in the near-field is needed to create structured OAM light in the far-field, exploiting the reciprocal nature of angular momentum and angle. We use this approach to demonstrate exotic 3D structured light control to show the Poynting vector's evolution in such fields and to highlight the physics underlying this phenomenon.
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Papadia C, Bassett P, Cappello G, Lazarescu V, Forbes A, Shidrawi R. Therapeutic action of ketogenic enteral nutrition in obese and overweight patients: an interventional study. Clin Med (Lond) 2019. [DOI: 10.7861/clinmedicine.19-2-s118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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56
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Parsons J, Sparrow K, Ismail K, Hunt K, Rogers H, Forbes A. A qualitative study exploring women's health behaviours after a pregnancy with gestational diabetes to inform the development of a diabetes prevention strategy. Diabet Med 2019; 36:203-213. [PMID: 30098217 DOI: 10.1111/dme.13794] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/06/2018] [Indexed: 01/20/2023]
Abstract
AIM To inform targeted interventions for women with gestational diabetes mellitus (GDM) by exploring the factors that influence their health behaviours and their preferences for lifestyle support. METHODS Participants were women with previous GDM taken from a diverse inner-city UK population. Data collection involved focus groups (n = 35 women in six groups) and semi-structured interviews (n = 15 women). The transcribed data were analysed using framework analysis. RESULTS Eight themes relating to factors influencing health behaviour were identified: psychological legacy of pregnancy, relationships with healthcare professionals, physical impacts of pregnancy, social support and cultural norms, life-scheduling, understanding and risk perception, appetite regulation, and prioritization of the baby. The women's recommendations for intervention components included addressing the emotional stress of pregnancy; conveying personalized risk in a motivational way, adopting a family-centered approach, focusing on women's health rather than just the infant's, and developing flexible interventions. These recommendations were used to construct a model integrating the behaviour-regulating factors with a suggested framework for intervention. CONCLUSIONS This study identified some common drivers that may regulate the health behaviours of women following GDM, and recognized some ways to improve care to impact on this. Interventions for diabetes prevention in this population need to address factors at both the individual and systemic levels.
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Affiliation(s)
- J Parsons
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
| | - K Sparrow
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
| | - K Hunt
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - H Rogers
- Diabetes Research Group, Diabetes & Nutritional Sciences Division, King's College London, London, UK
| | - A Forbes
- Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, London, UK
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Myles PS, Smith JA, Kasza J, Silbert B, Jayarajah M, Painter T, Cooper DJ, Marasco S, McNeil J, Bussières JS, McGuinness S, Byrne K, Chan MT, Landoni G, Wallace S, Forbes A, Myles P, Smith J, Cooper DJ, Silbert B, McNeil J, Marasco S, Esmore D, Krum H, Tonkin A, Buxton B, Heritier S, Merry A, Liew D, McNeil J, Forbes A, Cooper D, Wallace S, Meehan A, Myles P, Wallace S, Galagher W, Farrington C, Ditoro A, Wutzlhofer L, Story D, Peyton P, Baulch S, Sidiropoulos S, Potgieter D, Baker R, Pesudovs B, O'Loughlin J Wells E, Coutts P, Bolsin S, Osborne C, Ives K, Smith J, Hulley A, Christie-Taylor G, Painter T, Lang S, Mackay H, Cokis C, March S, Bannon P, Wong C, Turner L, Scott D, Silbert B, Said S, Corcoran P, Painter T, de Prinse L, Bussières J, Gagné N, Lamy A, Semelhago L, Chan M, Underwood M, Choi G, Fung B, Landoni G, Lembo R, Monaco F, Simeone F, Marianello D, Alvaro G, De Vuono G, van Dijk D, Dieleman J, Numan S, McGuinness S, Parke R, Raudkivi P, Gilder E, Byrne K, Dunning J, Termaat J, Mans G, Jayarajah M, Alderton J, Waugh D, Platt M, Pai A, Sevillano A, Lal A, Sinclair C, Kunst G, Knighton A, Cubas G, Saravanan P, Millner R, Vasudevan V, Patteril M, Lopez E, Basu R, Lu J. Tranexamic acid in coronary artery surgery: One-year results of the Aspirin and Tranexamic Acid for Coronary Artery Surgery (ATACAS) trial. J Thorac Cardiovasc Surg 2019; 157:644-652.e9. [DOI: 10.1016/j.jtcvs.2018.09.113] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/13/2018] [Accepted: 09/27/2018] [Indexed: 11/30/2022]
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Reintam Blaser A, Ploegmakers I, Benoit M, Holst M, Rasmussen HH, Burgos R, Forbes A, Shaffer J, Gabe S, Irtun O, Thibault R, Klek S, Olde Damink SW, van de Poll M, Panisic-Sekeljic M, Wanten G, Pironi L. Acute intestinal failure: International multicenter point-of-prevalence study. Clin Nutr 2019; 39:151-158. [PMID: 30683610 DOI: 10.1016/j.clnu.2019.01.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 12/18/2018] [Accepted: 01/04/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND & AIMS Intestinal failure (IF) is defined from a requirement or intravenous supplementation due to failing capacity to absorb nutrients and fluids. Acute IF is an acute, potentially reversible form of IF. We aimed to identify the prevalence, underlying causes and outcomes of acute IF. METHODS This point-of-prevalence study included all adult patients hospitalized in acute care hospitals and receiving parenteral nutrition (PN) on a study day. The reason for PN and the mechanism of IF (if present) were documented by local investigators and reviewed by an expert panel. RESULTS Twenty-three hospitals (19 university, 4 regional) with a total capacity of 16,356 acute care beds and 1237 intensive care unit (ICU) beds participated in this study. On the study day, 338 patients received PN (21 patients/1000 acute care beds) and 206 (13/1000) were categorized as acute IF. The categorization of reason for PN was revised in 64 cases (18.9% of total) in consensus between the expert panel and investigators. Hospital mortality of all study patients was 21.5%; the median hospital stay was 36 days. Patients with acute IF had a hospital mortality of 20.5% and median hospital stay of 38 days (P > 0.05 for both outcomes). Disordered gut motility (e.g. ileus) was the most common mechanism of acute IF, and 71.5% of patients with acute IF had undergone abdominal surgery. Duration of PN of ≥42 days was identified as being the best cut-off predicting hospital mortality within 90 days. PN ≥ 42 days, age, sepsis and ICU admission were independently associated with 90-day hospital mortality. CONCLUSIONS Around 2% of adult patients in acute care hospitals received PN, 60% of them due to acute IF. High 90-day hospital mortality and long hospital stay were observed in patients receiving PN, whereas presence of acute IF did not additionally influence these outcomes. Duration of PN was associated with increased 90-day hospital mortality.
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Affiliation(s)
- Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Puusepa 8, 51014, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Ilse Ploegmakers
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6221 HX, Maastricht, the Netherlands.
| | - Michael Benoit
- Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Spitalstrasse, 6000, Lucerne, Switzerland.
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Faculty of Health, Aalborg University, 9000, Aalborg, Denmark
| | - Henrik Hojgaard Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Faculty of Health, Aalborg University, 9000, Aalborg, Denmark.
| | - Rosa Burgos
- Nutritional Support Unit, University Hospital Vall d'Hebron, Passeig Vall d'Hebron 119-129, 08035, Barcelona, Spain.
| | - Alastair Forbes
- Norwich Medical School and Norfolk and Norwich University Hospital, Norwich, United Kingdom.
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Hospital, UK.
| | - Simon Gabe
- Lennard Jones Intestinal Failure Unit, St Marks Hospital, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
| | - Oivind Irtun
- University Hospital North-Norway, Tromso, Norway.
| | - Ronan Thibault
- Nutrition Metabolisms and Cancer Institute, NuMeCan, INRA, INSERM, Univ Rennes, Nutrition Unit, CHU Rennes, 35000, Rennes, France.
| | | | - Steven Wm Olde Damink
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6221 HX, Maastricht, the Netherlands
| | - Marcel van de Poll
- Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6221 HX, Maastricht, the Netherlands
| | - Marina Panisic-Sekeljic
- Department for Perioperative Nutrition, Clinic for General Surgery, Military Medical Academy Belgrade, Serbia.
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, the Netherlands.
| | - Loris Pironi
- Department of Digestive System, Center for Chronic Intestinal Failure, St Orsola-Malpighi Hospital, University of Bologna, Via Massarenti, 9, 40138, Bologna, Italy.
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Leslie K, Myles PS, Forbes A, Chan MTV, Short TG, Swallow SK. Recovery from Bispectral Index-guided Anaesthesia in a Large Randomized Controlled Trial of Patients at High Risk of Awareness. Anaesth Intensive Care 2019; 33:443-51. [PMID: 16119484 DOI: 10.1177/0310057x0503300404] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Electroencephalographic monitors of anaesthetic depth are reported to assist anaesthetists in reducing recovery times. We explored the effect of bispectral index (BIS) monitoring on recovery times in a double-blind, randomized controlled trial of 2,463 patients at high risk of awareness. Patients were randomized to BIS-guided anaesthesia or routine care. In the BIS group, anaesthesia was adjusted to maintain a BIS value of 40–60 from the commencement of laryngoscopy to the start of wound closure, and 55–70 during wound closure. In the routine care group, anaesthesia was adjusted according to traditional clinical signs. In multivariate models, BIS monitoring, female gender, lower American Society of Anesthesiologists’ physical status and shorter duration of anaesthesia predicted faster time to eye-opening after anaesthesia, and faster time to post-anaesthesia care unit discharge. BIS monitoring did not affect times to tracheal extubation among patients admitted to the intensive care unit. We conclude that BIS monitoring has statistically significant, but clinically modest, effects on recovery times in high risk surgical patients.
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Affiliation(s)
- K Leslie
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Parkville, Vic
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Pironi L, Corcos O, Forbes A, Holst M, Joly F, Jonkers C, Klek S, Lal S, Blaser AR, Rollins KE, Sasdelli AS, Shaffer J, Van Gossum A, Wanten G, Zanfi C, Lobo DN. Intestinal failure in adults: Recommendations from the ESPEN expert groups. Clin Nutr 2018; 37:1798-1809. [PMID: 30172658 DOI: 10.1016/j.clnu.2018.07.036] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/30/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND & AIMS Intestinal failure (IF) is defined as "the reduction of gut function below the minimum necessary for the absorption of macronutrients and/or water and electrolytes, such that intravenous supplementation is required to maintain health and/or growth". Functionally, it may be classified as type I acute intestinal failure (AIF), type II prolonged AIF and type III chronic intestinal failure (CIF) The ESPEN Workshop on IF was held in Bologna, Italy, on 15-16 October 2017 and the aims of this document were to highlight the current state of the art and future directions for research in IF. METHODS This paper represents the opinion of experts in the field, based on current evidence. It is not a formal review, but encompasses the current evidence, with emphasis on epidemiology, classification, diagnosis and management. RESULTS IF is the rarest form of organ failure and can result from a variety of conditions that affect gastrointestinal anatomy and function adversely. Assessment, diagnosis, and short and long-term management involves a multidisciplinary team with diverse expertise in the field that aims to reduce complications, increase life expectancy and improve quality of life in patients. CONCLUSIONS Both AIF and CIF are relatively rare conditions and most of the published work presents evidence from small, single-centre studies. Much remains to be investigated to improve the diagnosis and management of IF and future studies should rely on multidisciplinary, multicentre and multinational collaborations that gather data from large cohorts of patients. Emphasis should also be placed on partnership with patients, carers and government agencies in order to improve the quality of research that focuses on patient-centred outcomes that will help to improve both outcomes and quality of life in patients with this devastating condition.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola Hospital, University of Bologna, Italy.
| | - Olivier Corcos
- Intestinal Stroke Center (SURVI)/ Gastroenterology, IBD and Nutrition Support Department, Beaujon Hospital, and Laboratory for Vascular Translational Science UMR 1148, University Paris VII, France
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, Norwich Research Park, Norwich, NR4 7UQ, UK
| | - Mette Holst
- Center for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital and Department of Clinical Medicine, Aalborg University, Denmark
| | - Francisca Joly
- Gastroenterology, IBD and Nutrition Support Department, Beaujon Hospital, and Gastrointestinal and Metabolic Dysfunctions in Nutritional Pathologies UMR 1149, University Paris VII, France
| | - Cora Jonkers
- Amsterdam University Medical Center, Location AMC, Amsterdam, The Netherlands
| | - Stanislaw Klek
- Stanley Dudrick's Memorial Hospital, General Surgery Unit with Intestinal Failure Center, Skawina, Poland
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal & Manchester University, Manchester, UK
| | - Annika Reintam Blaser
- Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia; Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Katie E Rollins
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Anna S Sasdelli
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola Hospital, University of Bologna, Italy
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal & Manchester University, Manchester, UK
| | - Andre Van Gossum
- Clinic of Intestinal Diseases and Nutritional Support, Hopital Erasme, Free University of Brussels, Brussels, Belgium
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Chiara Zanfi
- Department of Organ Failure and Transplantation, Sant'Orsola Hospital, University of Bologna, Italy
| | - Dileep N Lobo
- Gastrointestinal Surgery, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
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Papada E, Gioxari A, Amerikanou C, Forbes A, Tzavara C, Smyrnioudis I, Kaliora AC. Regulation of faecal biomarkers in inflammatory bowel disease patients treated with oral mastiha (Pistacia lentiscus
) supplement: A double-blind and placebo-controlled randomised trial. Phytother Res 2018; 33:360-369. [DOI: 10.1002/ptr.6229] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 10/05/2018] [Accepted: 10/16/2018] [Indexed: 01/10/2023]
Affiliation(s)
- Efstathia Papada
- Department of Dietetics and Nutritional Science, School of Health Science and Education; Harokopio University; Athens Greece
| | - Aristea Gioxari
- Department of Dietetics and Nutritional Science, School of Health Science and Education; Harokopio University; Athens Greece
| | - Charalampia Amerikanou
- Department of Dietetics and Nutritional Science, School of Health Science and Education; Harokopio University; Athens Greece
| | - Alastair Forbes
- Norwich Medical School; University of East Anglia; Norwich UK
| | - Chara Tzavara
- Department of Dietetics and Nutritional Science, School of Health Science and Education; Harokopio University; Athens Greece
| | | | - Andriana C. Kaliora
- Department of Dietetics and Nutritional Science, School of Health Science and Education; Harokopio University; Athens Greece
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Papada E, Forbes A, Amerikanou C, Torović L, Kalogeropoulos N, Tzavara C, Triantafillidis JK, Kaliora AC. Antioxidative Efficacy of a Pistacia Lentiscus Supplement and Its Effect on the Plasma Amino Acid Profile in Inflammatory Bowel Disease: A Randomised, Double-Blind, Placebo-Controlled Trial. Nutrients 2018; 10:E1779. [PMID: 30453494 PMCID: PMC6267573 DOI: 10.3390/nu10111779] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022] Open
Abstract
Oxidative stress is present in patients with Inflammatory Bowel Disease (IBD), and natural supplements with antioxidant properties have been investigated as a non-pharmacological approach. The objective of the present study was to assess the effects of a natural Pistacia lentiscus (PL) supplement on oxidative stress biomarkers and to characterise the plasma-free amino acid (AA) profiles of patients with active IBD (Crohn's disease (CD) N = 40, ulcerative colitis (UC) N = 20). The activity was determined according to 5 ≤ Harvey Bradshaw Index ≤ 16 or 2 ≤ Partial Mayo Score ≤ 6. This is a randomised, double-blind, placebo-controlled clinical trial. IBD patients (N = 60) were randomly allocated to PL (2.8 g/day) or to placebo for 3 months being under no treatment (N = 21) or under stable medical treatment (mesalamine N = 24, azathioprine N = 14, and corticosteroids N = 23) that was either single medication (N = 22) or combined medication (N = 17). Plasma oxidised, low-density lipoprotein (oxLDL), total serum oxidisability, and serum uric acid were evaluated at baseline and follow-up. OxLDL/LDL and oxLDL/High-Density Lipoprotein (HDL) ratios were calculated. The plasma-free AA profile was determined by applying a gas chromatography/mass spectrometry analysis. oxLDL (p = 0.031), oxLDL/HDL (p = 0.020), and oxLDL/LDL (p = 0.005) decreased significantly in the intervention group. The mean change differed significantly in CD between groups for oxLDL/LDL (p = 0.01), and, in the total sample, both oxLDL/LDL (p = 0.015) and oxLDL/HDL (p = 0.044) differed significantly. Several changes were reported in AA levels. PL ameliorated a decrease in plasma-free AAs seen in patients with UC taking placebo. In conclusion, this intervention resulted in favourable changes in oxidative stress biomarkers in active IBD.
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Affiliation(s)
- Efstathia Papada
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich NR4 7UQ, UK.
| | - Charalampia Amerikanou
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Ljilja Torović
- Department of Pharmacy, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
| | - Nick Kalogeropoulos
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | - Chara Tzavara
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
| | | | - Andriana C Kaliora
- Department of Dietetics and Nutritional Science, School of Health Science and Education, Harokopio University, 17671 Athens, Greece.
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Corcoran T, Kasza J, Short TG, O'Loughlin E, Chan MTV, Leslie K, Forbes A, Paech M, Myles P. Intraoperative dexamethasone does not increase the risk of postoperative wound infection: a propensity score-matched post hoc analysis of the ENIGMA-II trial (EnDEX). Br J Anaesth 2018; 118:190-199. [PMID: 28100522 DOI: 10.1093/bja/aew446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND In a post hoc analysis of the ENIGMA-II trial, we sought to determine whether intraoperative dexamethasone was associated with adverse safety outcomes. METHODS Inverse probability weighting with estimated propensity scores was used to determine the association of dexamethasone administration with postoperative infection, quality of recovery, and adverse safety outcomes for 5499 of the 7112 non-cardiac surgery subjects enrolled in ENIGMA-II. RESULTS Dexamethasone was administered to 2178 (40%) of the 5499 subjects included in this analysis and was not associated with wound infection [189 (8.7%) vs 275 (8.3%); propensity score-adjusted relative risk (RR) 1.10; 95% confidence interval (CI) 0.89-1.34; P=0.38], severe postoperative nausea and vomiting on day 1 [242 (7.3%) vs 189 (8.7%); propensity score-adjusted RR 1.06; 95% CI 0.86-1.30; P=0.59], quality of recovery score [median 14, interquartile range (IQR) 12-15, vs median 14, IQR 12-16, P=0.10), length of stay in the postanaesthesia care unit [propensity score-adjusted median (IQR) 2.0 (1.3, 2.9) vs 1.9 (1.3, 3.1), P=0.60], or the primary outcome of the main trial. Dexamethasone administration was associated with a decrease in fever on days 1-3 [182 (8.4%) vs 488 (14.7%); RR 0.61; 95% CI 0.5-0.74; P<0.001] and shorter lengths of stay in hospital [propensity score-adjusted median (IQR) 5.0 (2.9, 8.2) vs 5.3 (3.1, 9.1), P<0.001]. Neither diabetes mellitus nor surgical wound contamination status altered these outcomes. CONCLUSION Dexamethasone administration to high-risk non-cardiac surgical patients did not increase the risk of postoperative wound infection or other adverse events up to day 30, and appears to be safe in patients either with or without diabetes mellitus. CLINICAL TRIAL REGISTRATION NCT00430989.
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Affiliation(s)
- T Corcoran
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia .,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Western Australia Health Department, Perth, Western Australia, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - J Kasza
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - T G Short
- Department of Anaesthesia, Auckland City Hospital, Park Road, Grafton, Auckland, New Zealand
| | - E O'Loughlin
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Anaesthesia and Pain Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - M T V Chan
- Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - K Leslie
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Anaesthesia, Perioperative and Pain Medicine Unit, and Department of Pharmacology and Therapeutics, University of Melbourne, Melbourne, Victoria, Australia
| | - A Forbes
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - M Paech
- Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - P Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Melbourne, Victoria, Australia
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Papada E, Amerikanou C, Torovic L, Kalogeropoulos N, Tzavara C, Forbes A, Kaliora A. On the identification of plasma free amino acid profile in patients with quiescent IBD. A placebo-controlled randomised clinical trial with mastiha supplement. Clin Nutr 2018. [DOI: 10.1016/j.clnu.2018.06.1164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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65
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Correia MITD, Forbes A. Nutrition in gastroenterology - clinical implications of current interdisciplinary innovations. Curr Opin Clin Nutr Metab Care 2018; 21:375-376. [PMID: 30067542 DOI: 10.1097/mco.0000000000000500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- M Isabel T D Correia
- Department of Surgery, Federal University of Minas Gerais Medical School, Belo Horizonte, Minas Gerais, Brazil
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Player EL, Morris P, Thomas T, Chan WY, Vyas R, Dutton J, Tang J, Alexandre L, Forbes A. Bioelectrical impedance analysis (BIA)-derived phase angle (PA) is a practical aid to nutritional assessment in hospital in-patients. Clin Nutr 2018; 38:1700-1706. [PMID: 30170780 DOI: 10.1016/j.clnu.2018.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/01/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Nutritional status can be difficult to assess. Bioelectrical impedance analysis (BIA)-derived phase angle (PA), and the plasma markers citrulline and transthyretin (pre-albumin) have the potential to assist, but the protocol of fasting and resting for BIA renders the investigation impractical for routine use, especially so in populations at high risk of malnutrition. AIMS 1 To clarify whether starving and resting are necessary for reliable measurement of PA. 2 To identify whether PA, citrulline and transthyretin correlate with nutritional status. METHODS Eighty consenting adult in-patients were recruited. Nutritional status was determined by subjective global assessment (SGA) used as gold standard. The Malnutrition Universal Screening Tool (MUST) was used and anthropometric measurements were performed. Serum was analysed for citrulline and transthyretin. PA was measured using Bodystat 4000. The PA was considered to define malnutrition when lower than reference ranges for sex and age, and severe malnutrition if more than 2 integers below the lower limit. Anthropometric measurements were categorised according to WHO reference centiles. Ordinal logistic regression estimated the strength of association of PA, citrulline and transthyretin with SGA. PA values in the different metabolic states were compared using paired t tests. RESULTS All 80 subjects completed the BIA and the nutritional assessments in the 3 different states; 14 declined to provide blood samples for the biochemical assays. Malnutrition was identified in 32 cases, severe malnutrition in 14 cases, the remaining 34 cases were deemed not to be malnourished. PA was strongly inversely associated with SGA (Odds Ratio [OR] per unit increase = 0.21, CI 0.12-0.37, p < 0.001). PA was not influenced by exercise (p = 0.134) or food intake (p = 0.184). Transthyretin was inversely associated with malnourished/severely malnourished states (OR = 0.98, 95% CI 0.97-0.99, p = 0.001), but had poorer predictive values than PA. There was no significant association between citrulline concentration and SGA (OR = 1.01, 95% CI 0.99-1.04, p = 0.348). CONCLUSIONS The BIA-derived PA reliably identifies malnutrition. It is strongly associated with SGA but requires less skill and experience, and out-performs circulating transthyretin, rendering it a promising and less operator-dependent tool for assessing nutritional status in hospital patients. Our novel demonstration that fasting and bed-rest are unnecessary consolidates that position.
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Affiliation(s)
- E L Player
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - P Morris
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - T Thomas
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - W Y Chan
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - R Vyas
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - J Dutton
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - J Tang
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - L Alexandre
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
| | - A Forbes
- Norwich Medical School, University of East Anglia, Norwich, NR4 7UQ, UK.
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Puylaert CAJ, Schüffler PJ, Naziroglu RE, Tielbeek JAW, Li Z, Makanyanga JC, Tutein Nolthenius CJ, Nio CY, Pendsé DA, Menys A, Ponsioen CY, Atkinson D, Forbes A, Buhmann JM, Fuchs TJ, Hatzakis H, van Vliet LJ, Stoker J, Taylor SA, Vos FM. Semiautomatic Assessment of the Terminal Ileum and Colon in Patients with Crohn Disease Using MRI (the VIGOR++ Project). Acad Radiol 2018; 25:1038-1045. [PMID: 29428210 DOI: 10.1016/j.acra.2017.12.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/20/2017] [Accepted: 12/25/2017] [Indexed: 01/18/2023]
Abstract
RATIONALE AND OBJECTIVES The objective of this study was to develop and validate a predictive magnetic resonance imaging (MRI) activity score for ileocolonic Crohn disease activity based on both subjective and semiautomatic MRI features. MATERIALS AND METHODS An MRI activity score (the "virtual gastrointestinal tract [VIGOR]" score) was developed from 27 validated magnetic resonance enterography datasets, including subjective radiologist observation of mural T2 signal and semiautomatic measurements of bowel wall thickness, excess volume, and dynamic contrast enhancement (initial slope of increase). A second subjective score was developed based on only radiologist observations. For validation, two observers applied both scores and three existing scores to a prospective dataset of 106 patients (59 women, median age 33) with known Crohn disease, using the endoscopic Crohn's Disease Endoscopic Index of Severity (CDEIS) as a reference standard. RESULTS The VIGOR score (17.1 × initial slope of increase + 0.2 × excess volume + 2.3 × mural T2) and other activity scores all had comparable correlation to the CDEIS scores (observer 1: r = 0.58 and 0.59, and observer 2: r = 0.34-0.40 and 0.43-0.51, respectively). The VIGOR score, however, improved interobserver agreement compared to the other activity scores (intraclass correlation coefficient = 0.81 vs 0.44-0.59). A diagnostic accuracy of 80%-81% was seen for the VIGOR score, similar to the other scores. CONCLUSIONS The VIGOR score achieves comparable accuracy to conventional MRI activity scores, but with significantly improved reproducibility, favoring its use for disease monitoring and therapy evaluation.
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Affiliation(s)
- Carl A J Puylaert
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands.
| | - Peter J Schüffler
- Department of Computer Sciences, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland; Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Robiel E Naziroglu
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Jeroen A W Tielbeek
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands
| | - Zhang Li
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands; College of Aerospace Science and Engineering, National University of Defense Technology, Changsha, China
| | - Jesica C Makanyanga
- Center for Medical Imaging, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Charlotte J Tutein Nolthenius
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands
| | - C Yung Nio
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands
| | - Douglas A Pendsé
- Center for Medical Imaging, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Alex Menys
- Center for Medical Imaging, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Cyriel Y Ponsioen
- Department of Gastroenterology, Academic Medical Centre, Amsterdam, The Netherlands
| | - David Atkinson
- Center for Medical Imaging, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Joachim M Buhmann
- Department of Computer Sciences, Eidgenössische Technische Hochschule Zurich, Zurich, Switzerland
| | - Thomas J Fuchs
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | | | - Lucas J van Vliet
- Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
| | - Jaap Stoker
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands
| | - Stuart A Taylor
- Center for Medical Imaging, University College London Hospitals National Health Service Foundation Trust, London, UK
| | - Frans M Vos
- Department of Radiology and Nuclear Medicine, Academic Medical Centre, Meibergdreef 9, P.O 22660, 1100DD, Amsterdam, The Netherlands; Department of Imaging Physics, Delft University of Technology, Delft, The Netherlands
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Arasaradnam RP, Brown S, Forbes A, Fox MR, Hungin P, Kelman L, Major G, O'Connor M, Sanders DS, Sinha R, Smith SC, Thomas P, Walters JRF. Guidelines for the investigation of chronic diarrhoea in adults: British Society of Gastroenterology, 3rd edition. Gut 2018; 67:1380-1399. [PMID: 29653941 PMCID: PMC6204957 DOI: 10.1136/gutjnl-2017-315909] [Citation(s) in RCA: 164] [Impact Index Per Article: 27.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/28/2018] [Accepted: 03/11/2018] [Indexed: 02/07/2023]
Abstract
Chronic diarrhoea is a common problem, hence clear guidance on investigations is required. This is an updated guideline from 2003 for the investigations of chronic diarrhoea commissioned by the Clinical Services and Standards Committee of the British Society of Gastroenterology (BSG). This document has undergone significant revision in content through input by 13 members of the Guideline Development Group (GDG) representing various institutions. The GRADE system was used to appraise the quality of evidence and grading of recommendations.
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Affiliation(s)
- Ramesh P Arasaradnam
- University Hospital Coventry, Coventry, UK
- Department of Applied Biological Sciences, University of Coventry, Coventry, UK
- Clinical Sciences Research Institute, University of Warwick, Warwick, UK
| | | | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Mark R Fox
- University of Zürich, Zürich, Switzerland
- Abdominal Centre, St Claraspital, Basel, Switzerland
| | - Pali Hungin
- School of Medicine, Pharmacy & Health, University of Durham, Durham, UK
| | | | - Giles Major
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham University Hospitals NHS Trust and the University of Nottingham, Nottingham, UK
| | | | | | - Rakesh Sinha
- Department of Radiology, South Warwickshire Hospitals, Warwick, UK
| | - Stephen Charles Smith
- Department of Clinical Biochemistry, Midlands and NW Bowel Cancer Screening Hub, Rugby, UK
| | - Paul Thomas
- Department of Gastroenterology, Musgrave Park Hospital, Taunton, UK
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Winkley K, Upsher R, Keij SM, Chamley M, Ismail K, Forbes A. Healthcare professionals' views of group structured education for people with newly diagnosed Type 2 diabetes. Diabet Med 2018; 35:911-919. [PMID: 29633382 DOI: 10.1111/dme.13637] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2018] [Indexed: 11/28/2022]
Abstract
AIM To determine healthcare professionals' (HCP) views of group structured education for people with newly diagnosed Type 2 diabetes. METHODS This was a qualitative study using semi-structured interviews to ascertain primary care HCPs' views and experiences of education for people with newly diagnosed Type 2 diabetes. A thematic framework method was applied to analyse the data. Participants were HCPs (N = 22) from 15 general practices in three south London boroughs. RESULTS All but one HCP viewed diabetes education favourably and all identified that low attendance was a problem. Three key themes emerged from the qualitative data: (1) benefits of diabetes education, including the group mode of delivery, improved patient interactions, saving HCPs' time and improved patient outcomes; (2) factors limiting uptake of education, including patient-level problems such as access and the appropriateness of the programme for certain groups, and difficulties communicating the benefits to patients and integration of education management plans into ongoing diabetes care; and (3) suggestions for improvement, including strategies to improve attendance at education with more localized and targeted marketing and enhanced programme content including follow-up sessions and support for people with pre-existing psychological issues. CONCLUSIONS Most HCPs valued diabetes education and all highlighted the lack of provision for people with different levels of health literacy. Because there was wide variation in terms of the level of knowledge regarding the education on offer, future studies may want to focus on how to help HCPs encourage their patients to attend.
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Affiliation(s)
- K Winkley
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Upsher
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - S M Keij
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - M Chamley
- Lambeth Clinical Commissioning Group Diabetes Intermediate Care Team, London, UK
| | - K Ismail
- Diabetes Psychiatry & Psychology, Department of Psychological Medicine and Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing & Midwifery, King's College London, London, UK
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Ajabnoor SM, Forbes A. Effect of fat composition in enteral nutrition for Crohn's disease in adults: A systematic review. Clin Nutr 2017; 38:90-99. [PMID: 29310893 DOI: 10.1016/j.clnu.2017.12.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 11/10/2017] [Accepted: 12/20/2017] [Indexed: 01/16/2023]
Abstract
BACKGROUND & AIMS The role of enteral nutrition (EN) fat composition in regulating inflammation in Crohn's disease (CD) is not clear. There is, moreover, insufficient evidence to guide the choice of EN in CD with any confidence. We have reanalysed the findings of previous studies in a systematic review focussing on the relationship between EN fat content and remission rates (RR). METHODS A systematic search with no language restriction was undertaken in Medline and Embase databases supplemented by a manual search in the reference lists of identified studies. The selection criteria were: clinical trial, exclusive EN, adults and CD. Data on the type of EN, its fat composition, achieved RR, and study design were extracted. An established assessment tool was used to assess the quality of the studies. RESULTS A total of 29 clinical trials are included in this review. The quality of the studies was highly variable. No fewer than 27 formulations of enteral feed were identified including 4 elemental and 23 non-elemental preparations. There was a positive correlation between the total n-6 fatty acid content and response rates, which was significant when expressed as the ratio between n-6 and n-3 fatty acids (r = 0.378, p = 0.018). A non-significant positive trend was founded (r = 0.072; p = 0.643) between medium chain triglycerides (MCT) delivery as a percentage of the total energy provision and RR. While a non-significant negative trend was reported for the delivery of monounsaturated fatty acids (MUFA) (r = -0.23, p = 0.13). A qualitative advantage to regimens based on safflower oil suggest that optimised therapeutic approaches are within reach.
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Affiliation(s)
- Sarah M Ajabnoor
- Norwich Medical School, University of East Anglia, Norwich Research Park, UK; Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Saudi Arabia
| | - Alastair Forbes
- Norwich Medical School, University of East Anglia, Norwich Research Park, UK.
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Bouzid O, Haddadi S, Fromager M, Cagniot E, Ferria K, Forbes A, Ait-Ameur K. Focusing anomalies with binary diffractive optical elements. Appl Opt 2017; 56:9735-9741. [PMID: 29240119 DOI: 10.1364/ao.56.009735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 11/02/2017] [Indexed: 06/07/2023]
Abstract
Binary diffractive optics have been extensively studied to date as tools for arbitrary laser beam shaping and experimentally implemented with etched transparent optics and spatial light modulators. Here we demonstrate that a simple one-step binary optic is able to enhance the intensity of a focused beam, displaying some counterintuitive focusing anomalies. We explain these effects by considering the optical aberrations in binary diffractive optics and outline how this may be exploited for further improvements in refractive/diffractive combinations for super-resolution microscopy.
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Ajabnoor S, Williams M, Parris A, Shaikh I, Forbes A. Effect of enteral nutrition with a pre-defined fat composition on the pathogenesis of Crohn's disease. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ajabnoor S, Forbes A. Effect of fat composition in enteral nutrition for Crohn's disease in adults: A systematic review. Clin Nutr ESPEN 2017. [DOI: 10.1016/j.clnesp.2017.07.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Fragkos KC, Forbes A. Citrulline as a marker of intestinal function and absorption in clinical settings: A systematic review and meta-analysis. United European Gastroenterol J 2017; 6:181-191. [PMID: 29511548 DOI: 10.1177/2050640617737632] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 09/26/2017] [Indexed: 12/15/2022] Open
Abstract
Background Citrulline has been described as a marker of intestinal function or absorption but evidence varies according to clinical settings. Objective The objective of this article is to examine the evidence of plasma citrulline as a marker of intestinal function and absorption in various clinical settings. Methods Studies were examined for p values, means and standard deviations, correlation coefficients or other metrics depicting the association of citrulline with intestinal function. A random effects model was used to produce a pooled estimate. A hierarchical summary receiver operating curve model was fitted for diagnostic accuracy measures. Results Citrulline levels are correlated strongly with small bowel length in short bowel syndrome patients (r = 0.67). Citrulline is strongly negatively correlated (r = -0.56) with intestinal disease severity with regards to enteropathies (coeliac disease, tropical enteropathy, Crohn's disease, mucositis, acute rejection in intestinal transplantation). Citrulline cut-off levels have an overall sensitivity and specificity of 80% and 84% respectively. Citrulline levels in untreated coeliac patients compared to controls were reduced by 10 µmol/l. Citrulline levels increase with gluten-free diet and with improvement of enteropathy. Citrulline is decreased in critical illness and sepsis. Conclusion These findings allow us to advocate quite reasonably that citrulline is a marker of acute and chronic intestinal insufficiency.
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Affiliation(s)
| | - Alastair Forbes
- University of East Anglia, Norwich and Norfolk Medical School, Norwich, UK
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Affiliation(s)
- Alastair Forbes
- aNorwich Medical School, Norwich, England, UK bDepartment of Surgery, Federal University of Minas Gerais Medical School, Belo Horizonte, Minas Gerais, Brazil
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Thomas T, Player E, Chan W, Alexandre L, Forbes A. MON-P208: Bioelectrical Impedance Analysis Derived Phase Angle as a tool for Detecting Malnutrition in Hospital In-Patients. Clin Nutr 2017. [DOI: 10.1016/s0261-5614(17)30880-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Thomas T, Player E, Chan WY, Alexandre L, Forbes A. PTU-121 Bioelectrical impedance analysis derived phase angle as a tool for detecting malnutrition in hospital in-patients. Nutrition 2017. [DOI: 10.1136/gutjnl-2017-314472.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Fragkos KC, Forbes A. PWE-101 Citrulline as a marker of intestinal function and absorption in clinical settings: a systematic review meta-analysis. Nutrition 2017. [DOI: 10.1136/gutjnl-2017-314472.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cummin T, Araf S, Du M, Barrans S, Bentley M, Clipson A, Wang M, Ahmed S, Rahim T, Shah C, Hamid D, Dhondt J, Maishman T, Vaughan-Spickers N, Pocock C, Forbes A, O'Callaghan A, Westhead D, Griffiths G, Fitzgibbon J, Tooze R, Care M, Burton C, Davies A, Johnson P. PROGNOSTIC SIGNIFICANCE AND CORRELATION TO GENE EXPRESSION PROFILE OF EZH2
MUTATIONS IN DIFFUSE LARGE B-CELL LYMPHOMA (DLBL) IN 2 LARGE PROSPECTIVE STUDIES. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- T.E. Cummin
- Cancer Sciences; University of Southampton; Southampton UK
| | - S. Araf
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - M. Du
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Barrans
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - M.A. Bentley
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - A. Clipson
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - M. Wang
- Division of Molecular Histopathology Department of Pathology; University of Cambridge; Cambridge UK
| | - S. Ahmed
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - T. Rahim
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - C. Shah
- Bioinformatics group,IMCB; University of Leeds; Leeds UK
| | - D. Hamid
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Dhondt
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - T. Maishman
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - N. Vaughan-Spickers
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - C. Pocock
- Haematology Department; East Kent Hospitals University NHS Foundation Trust; Canterbury UK
| | - A. Forbes
- Haematology Department; Royal Cornwall Hospital; Truro UK
| | - A. O'Callaghan
- Haematology Department; Queen Alexandra Hospital, PO6 3LY; Portsmouth UK
| | - D. Westhead
- School of Molecular and Cellular Biology; University of Leeds; Leeds UK
| | - G.O. Griffiths
- Southampton Clinical Trials Unit, Southampton Clinical Trials Unit; University of Southampton; Southampton UK
| | - J. Fitzgibbon
- Centre for Haemato-Oncology, Barts Cancer Institute; Queen Mary University of London; London UK
| | - R.M. Tooze
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - M.A. Care
- Faculty of Medicine and Health, Leeds Institute of Cancer & Pathology; University of Leeds; Leeds UK
| | - C.H. Burton
- Haematological Malignancy Diagnostic Service, Haematological Malignancy Diagnostic Service; St. James's Institute of Oncology; Leeds UK
| | - A.J. Davies
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - P.W. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
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80
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Gleeson M, Peckitt C, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Chua S, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Cunningham D. CHOP VERSUS GEM-P IN THE FIRST-LINE TREATMENT OF T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NRCI PHASE II RANDOMISED CHEMO-T TRIAL. Hematol Oncol 2017. [DOI: 10.1002/hon.2437_63] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology Research; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Victoria Hospital; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; The Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology; Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology; Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
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81
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Gleeson M, Peckitt C, Cunningham D, To Y, Edwards L, Chau I, Johnson P, Ardeshna K, Wotherspoon A, Attygalle A, Begum R, Zerizer I, Hawkes E, Macheta M, Collins G, Radford J, Forbes A, Hart A, Montoto S, McKay P, Benstead K, Morley N, Kalakonda N, Hasan Y, Turner D, Chua S. THE ROLE OF 18F FDG-PET/CT IN PERIPHERAL T-CELL LYMPHOMA (PTCL): INITIAL RESULTS OF THE UK NCRI MULTICENTRE PHASE II RANDOMISED CHEMO-T TRIAL PET/CT SUBSTUDY. Hematol Oncol 2017. [DOI: 10.1002/hon.2438_108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- M. Gleeson
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - C. Peckitt
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - D. Cunningham
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - Y.M. To
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - L. Edwards
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Chau
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - P. Johnson
- Cancer Research UK Centre; University of Southampton; Southampton UK
| | - K.M. Ardeshna
- Department of Haematology; University College Hospital; London UK
| | - A. Wotherspoon
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - A. Attygalle
- Department of Histopathology; The Royal Marsden Hospital; London UK
| | - R. Begum
- GI and Lymphoma Unit; The Royal Marsden Hospital; Sutton UK
| | - I. Zerizer
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
| | - E.A. Hawkes
- Department of Oncology; Eastern Health; Melbourne Australia
| | - M.P. Macheta
- Department of Haematology; Blackpool Teaching Hospitals; Blackpool UK
| | - G.P. Collins
- Oxford Cancer and Haematology Centre; Churchill Hospital; Oxford UK
| | - J.A. Radford
- Manchester Academic Health Science Centre; University of Manchester and the Christie NHS Foundation Trust; Manchester UK
| | - A. Forbes
- Department of Haematology; Royal Cornwall Hospital; Truro UK
| | - A. Hart
- Department of Haematology; New Victoria Hospital; Glasgow UK
| | - S. Montoto
- Department of Haemato-oncology; St Bartholomew's Hospital; London UK
| | - P. McKay
- Department of Haematology; Beatson West of Scotland Cancer Centre; Glasgow UK
| | - K. Benstead
- Department of Oncology, Gloucestershire Hospitals NHS Foundation Trust; Gloucester UK
| | - N. Morley
- Department of Haematology; Royal Hallamshire Hospital; Sheffield UK
| | - N. Kalakonda
- Department of Haematology; Royal Liverpool University Hospital; Liverpool UK
| | - Y. Hasan
- Department of Haematology, Sandwell and West Birmingham Hospitals NHS Trust; West Bromwich UK
| | - D. Turner
- Department of Haematology; Torbay Hospital; Torquay UK
| | - S. Chua
- Department of Radiology; The Royal Marsden Hospital; Sutton UK
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82
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Pironi L, Konrad D, Brandt C, Joly F, Wanten G, Agostini F, Chambrier C, Aimasso U, Zeraschi S, Kelly D, Szczepanek K, Jukes A, Di Caro S, Theilla M, Kunecki M, Daniels J, Serlie M, Poullenot F, Wu J, Cooper SC, Rasmussen HH, Compher C, Seguy D, Crivelli A, Pagano MC, Hughes SJ, Guglielmi FW, Kozjek NR, Schneider SM, Gillanders L, Ellegard L, Thibault R, Matras P, Zmarzly A, Matysiak K, Van Gossum A, Forbes A, Wyer N, Taus M, Virgili NM, O'Callaghan M, Chapman B, Osland E, Cuerda C, Sahin P, Jones L, Lee ADW, Bertasi V, Orlandoni P, Izbéki F, Spaggiari C, Díez MB, Doitchinova-Simeonova M, Garde C, Serralde-Zúñiga AE, Olveira G, Krznaric Z, Czako L, Kekstas G, Sanz-Paris A, Jáuregui EP, Murillo AZ, Schafer E, Arends J, Suárez-Llanos JP, Shaffer J, Lal S. Clinical classification of adult patients with chronic intestinal failure due to benign disease: An international multicenter cross-sectional survey. Clin Nutr 2017; 37:728-738. [PMID: 28483328 DOI: 10.1016/j.clnu.2017.04.013] [Citation(s) in RCA: 94] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/19/2017] [Accepted: 04/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND & AIMS The aim of the study was to evaluate the applicability of the ESPEN 16-category clinical classification of chronic intestinal failure, based on patients' intravenous supplementation (IVS) requirements for energy and fluids, and to evaluate factors associated with those requirements. METHODS ESPEN members were invited to participate through ESPEN Council representatives. Participating centers enrolled adult patients requiring home parenteral nutrition for chronic intestinal failure on March 1st 2015. The following patient data were recorded though a structured database: sex, age, body weight and height, intestinal failure mechanism, underlying disease, IVS volume and energy need. RESULTS Sixty-five centers from 22 countries enrolled 2919 patients with benign disease. One half of the patients were distributed in 3 categories of the ESPEN clinical classification. 9% of patients required only fluid and electrolyte supplementation. IVS requirement varied considerably according to the pathophysiological mechanism of intestinal failure. Notably, IVS volume requirement represented loss of intestinal function better than IVS energy requirement. A simplified 8 category classification of chronic intestinal failure was devised, based on two types of IVS (either fluid and electrolyte alone or parenteral nutrition admixture containing energy) and four categories of volume. CONCLUSIONS Patients' IVS requirements varied widely, supporting the need for a tool to homogenize patient categorization. This study has devised a novel, simplified eight category IVS classification for chronic intestinal failure that will prove useful in both the clinical and research setting when applied together with the underlying pathophysiological mechanism of the patient's intestinal failure.
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Affiliation(s)
- Loris Pironi
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Denise Konrad
- Home Nutrition Support, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Francisca Joly
- Centre for Intestinal Failure, Department of Gastroenterology and Nutritional Support, Hôpital Beaujon, Clichy, France
| | - Geert Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Federica Agostini
- Center for Chronic Intestinal Failure, Department of Digestive System, St. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Cecile Chambrier
- Unité de Nutrition Clinique Intensive, Hospices Civils de Lyon, Hôpital de la Croix Rousse, Lyon, France
| | | | - Sarah Zeraschi
- Nutrition Team Office, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Darlene Kelly
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | - Kinga Szczepanek
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, Skawina, Poland
| | - Amelia Jukes
- University Hospital of Wales, Cardiff, United Kingdom
| | | | | | | | - Joanne Daniels
- Nottingham University Hospital NHS Trust, Nottingham, United Kingdom
| | | | - Florian Poullenot
- Service de Gastroentérologie, Hôpital Haut-Lévêque, CHU de Bordeaux, Pessac, France
| | - Jian Wu
- Intestinal Failure Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Sheldon C Cooper
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Henrik H Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology, Aalborg University Hospital, Aalborg, Denmark
| | - Charlene Compher
- Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - David Seguy
- Service de Nutrition, CHRU de Lille, Lille, France
| | - Adriana Crivelli
- Unidad de Soporte Nutricional, Rehabilitación y Trasplante de Intestino, Hospital Universitario Fundacion Favaloro, Buenos Aires, Argentina
| | | | - Sarah-Jane Hughes
- Belfast Health and Social Care Trust, Belfast, Northern Ireland, United Kingdom
| | | | | | - Stéphane M Schneider
- Gastroenterology and Clinical Nutrition, CHU of Nice, University of Nice Sophia Antipolis, Nice, France
| | - Lyn Gillanders
- National Intestinal Failure Service, Auckland City Hospital, Auckland, New Zealand
| | - Lars Ellegard
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Ronan Thibault
- Gastrointestinal and Nutritional Rehabilitation Medicine, Clinique Saint Yves, Rennes Cedex, France
| | - Przemysław Matras
- Department of General and Transplant Surgery and Clinical Nutrition, Medical University of Lublin, Lublin, Poland
| | - Anna Zmarzly
- Department of Clinical Nutrition, J. Gromkowski City Hospital, Wroclaw, Poland
| | - Konrad Matysiak
- Centre for Intestinal Failure, Department of General, Endocrinological and Gastroenterological Surgery, Poznan University of Medical Science, Poznań, Poland
| | - Andrè Van Gossum
- Medico-Surgical Department of Gastroenterology, Hôpital Erasme, Free University of Brussels, Belgium
| | - Alastair Forbes
- Norfolk and Norwich University Hospital, University of East Anglia, Norwich, United Kingdom
| | - Nicola Wyer
- University Hospital, Coventry, United Kingdom
| | - Marina Taus
- Centro di Riferimento Regionale NAD Ospedali Riuniti Ancona, Ancona, Italy
| | - Nuria M Virgili
- Unitat Nutrició i Dietética, Servei Endocrinologia i Nutrició, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | | | - Emma Osland
- Royal Brisbane and Women's Hospital, Herston, Australia
| | - Cristina Cuerda
- Nutrition Unit, Hospital General Universitario Gregorio Marañon, Madrid, Spain
| | | | - Lynn Jones
- Royal Prince Alfred Hospital, Camperdown, Australia
| | - Andre D W Lee
- Hospital das Clinicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Paolo Orlandoni
- Centro di Riferimento Regionale NAD, INRCA -IRCCS, Ancona, Italy
| | - Ferenc Izbéki
- Szent György Teaching Hospital of County Fejér, Székesfehérvár, Hungary
| | | | - Marta Bueno Díez
- Servei d'Endocrinologia i Nutrició, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | | | - Carmen Garde
- Hospital Universitario Donostia, San Sebastian, Spain
| | | | | | - Zeljko Krznaric
- Centre of Clinical Nutrition, Department of Medicine, University Hospital Centre, Zagreb, Croatia
| | - Laszlo Czako
- First Department of Internal Medicine, Szeged, Hungary
| | | | | | | | | | - Eszter Schafer
- Magyar Honvedseg Egészségügyi Központ (MHEK), Budapest, Hungary
| | - Jann Arends
- Department of Medicine, Oncology and Hematology, University of Freiburg, Germany
| | - José P Suárez-Llanos
- Hospital Universitario Nuestra Señora de Candelaria, Santa Cruz de Tenerife, Spain
| | - Jon Shaffer
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
| | - Simon Lal
- Intestinal Failure Unit, Salford Royal Foundation Trust, Salford, UK
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83
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Forbes A, Murrells T, Sinclair AJ. Examining factors associated with excess mortality in older people (age ≥ 70 years) with diabetes - a 10-year cohort study of older people with and without diabetes. Diabet Med 2017; 34:387-395. [PMID: 27087619 DOI: 10.1111/dme.13132] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/11/2016] [Indexed: 12/28/2022]
Abstract
AIMS To compare all-cause mortality in older people with or without diabetes and consider the associated risk of comorbidity and polypharmacy. METHODS A 10-year cohort study using data from the Health Innovation Network database (2003-2013) comparing mortality in people aged ≥ 70 years with diabetes (DM cohort) (n = 35 717) and without diabetes (No DM cohort) (n = 307 918). RESULTS The mean age of the DM cohort was 78.1 ± 5.8 years vs. 79.0 ± 6.3 years in the No DM cohort. Mean diabetes duration was 8.2 ± 8.1 years, and 30% had diabetes for > 10 years. The DM cohort had a greater comorbidity load and people in this cohort were prescribed more therapies than the No DM cohort. The 5- and 10-year survival rates were lower in the DM cohort at 64% and 39%, respectively, compared with 72% and 50% in the No DM cohort. The excess mortality in the DM cohort was greatest in those aged < 75 years with longer duration diabetes, the relative hazard for mortality was higher in females. Although comorbidity and polypharmacy were associated with increased mortality risk in the DM cohort, this risk was lower compared with the No DM cohort. The hazard ratios (95% confidence interval) for comorbidities > 4 and medicines ≥ 7 were 1.29 (1.19 to 1.41) and 1.34 (1.25 to 1.43) in the DM cohort and 1.63 (1.57 to 1.70) and 1.48 (1.40 to 1.56) in the No DM cohort, respectively. CONCLUSIONS There is significant excess mortality in older people with diabetes, which is unexplained by comorbidity or polypharmacy. This excess is greatest in the younger old with longer disease duration, suggesting that it may be related to the effect of diabetes exposure.
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Affiliation(s)
- A Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - T Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London
| | - A J Sinclair
- Diabetes Frail and the University of Aston, Birmingham, UK
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84
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Kitchen PA, Goodlad RA, FitzGerald AJ, Mandir N, Ghatei MA, Bloom SR, Berlanga-Acosta J, Playford RJ, Forbes A, Walters JRF. Intestinal Growth in Parenterally-Fed Rats Induced by the Combined Effects of Glucagon-like Peptide 2 and Epidermal Growth Factor. JPEN J Parenter Enteral Nutr 2017; 29:248-54. [PMID: 15961680 DOI: 10.1177/0148607105029004248] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Parenteral nutrition and the absence of luminal feeding result in impaired intestinal growth and differentiation of enterocytes. Glucagon-like peptide 2 (GLP-2) and epidermal growth factor (EGF) have each been shown to have trophic effects on the intestine, and thus have the potential to benefit patients fed parenterally, such as those with intestinal failure from short bowel syndrome. We report studies aimed to determine whether there may be synergistic effects of these 2 peptides. METHODS Rats were established on parenteral nutrition (PN) and infused for 6 days with GLP-2 (20 microg/d), EGF (20 microg/d), or GLP-2 + EGF (20 microg/d of each). These groups were compared with untreated PN-fed and orally-fed controls. Tissue was obtained from small intestine and colon to determine growth, proliferation, and representative gene expression. RESULTS Small intestinal weight was increased by 75%, 43%, and 116% in the GLP-2, EGF, and GLP-2 + EGF groups, respectively, compared with PN controls (all p < .001). Cell proliferation increased with GLP-2, EGF, and GLP-2 + EGF in proximal small intestine by factors of 2.3, 1.7, and 3.4 respectively (p < .001). A synergistic effect on villous and crypt area was observed in the proximal small intestine when GLP-2 and EGF were combined (p < .05). GLP-2 had no effect in the colon, unlike EGF. Further studies showed GLP-2 + EGF significantly increased expression in distal small intestine of transcripts for the bile acid transport protein IBABP (p < .05) and showed a significant correlation between the expression of IBABP and the transcription factor HNF-4. CONCLUSIONS Both GLP-2 and EGF upregulate growth of the small intestine, and this is augmented when GLP-2 and EGF are combined. These findings may lead to improved treatment of patients receiving PN.
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Affiliation(s)
- Paul A Kitchen
- St Mark's Hospital, Imperial College London, Harrow, United Kingdom
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Filipović B, Forbes A, Tepeš B. Current Approaches to the Functional Gastrointestinal Disorders. Gastroenterol Res Pract 2017; 2017:4957154. [PMID: 28115931 PMCID: PMC5237729 DOI: 10.1155/2017/4957154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 11/13/2016] [Indexed: 11/17/2022] Open
Affiliation(s)
- Branka Filipović
- Clinical and Hospital Center “Bežanijska Kosa”, Medical Faculty, University of Belgrade, Autoput s/n, 4/2 Dr. Subotića Starijeg, 11000 Belgrade, Serbia
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich Research Park, Norwich NR4 7UQ, UK
- ABAKUS MEDICO d.o.o., Diagnostični Center Rogaška, Prvomajska 29, SI-3250 Rogaška Slatina, Slovenia
| | - Alastair Forbes
- Clinical and Hospital Center “Bežanijska Kosa”, Medical Faculty, University of Belgrade, Autoput s/n, 4/2 Dr. Subotića Starijeg, 11000 Belgrade, Serbia
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich Research Park, Norwich NR4 7UQ, UK
- ABAKUS MEDICO d.o.o., Diagnostični Center Rogaška, Prvomajska 29, SI-3250 Rogaška Slatina, Slovenia
| | - Bojan Tepeš
- Clinical and Hospital Center “Bežanijska Kosa”, Medical Faculty, University of Belgrade, Autoput s/n, 4/2 Dr. Subotića Starijeg, 11000 Belgrade, Serbia
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich Research Park, Norwich NR4 7UQ, UK
- ABAKUS MEDICO d.o.o., Diagnostični Center Rogaška, Prvomajska 29, SI-3250 Rogaška Slatina, Slovenia
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Forbes A, Escher J, Hébuterne X, Kłęk S, Krznaric Z, Schneider S, Shamir R, Stardelova K, Wierdsma N, Wiskin AE, Bischoff SC. ESPEN guideline: Clinical nutrition in inflammatory bowel disease. Clin Nutr 2016; 36:321-347. [PMID: 28131521 DOI: 10.1016/j.clnu.2016.12.027] [Citation(s) in RCA: 377] [Impact Index Per Article: 47.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/28/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION The ESPEN guideline presents a multidisciplinary focus on clinical nutrition in inflammatory bowel disease (IBD). METHODOLOGY The guideline is based on extensive systematic review of the literature, but relies on expert opinion when objective data were lacking or inconclusive. The conclusions and 64 recommendations have been subject to full peer review and a Delphi process in which uniformly positive responses (agree or strongly agree) were required. RESULTS IBD is increasingly common and potential dietary factors in its aetiology are briefly reviewed. Malnutrition is highly prevalent in IBD - especially in Crohn's disease. Increased energy and protein requirements are observed in some patients. The management of malnutrition in IBD is considered within the general context of support for malnourished patients. Treatment of iron deficiency (parenterally if necessary) is strongly recommended. Routine provision of a special diet in IBD is not however supported. Parenteral nutrition is indicated only when enteral nutrition has failed or is impossible. The recommended perioperative management of patients with IBD undergoing surgery accords with general ESPEN guidance for patients having abdominal surgery. Probiotics may be helpful in UC but not Crohn's disease. Primary therapy using nutrition to treat IBD is not supported in ulcerative colitis, but is moderately well supported in Crohn's disease, especially in children where the adverse consequences of steroid therapy are proportionally greater. However, exclusion diets are generally not recommended and there is little evidence to support any particular formula feed when nutritional regimens are constructed. CONCLUSIONS Available objective data to guide nutritional support and primary nutritional therapy in IBD are presented as 64 recommendations, of which 9 are very strong recommendations (grade A), 22 are strong recommendations (grade B) and 12 are based only on sparse evidence (grade 0); 21 recommendations are good practice points (GPP).
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Affiliation(s)
- Alastair Forbes
- Norwich Medical School, University of East Anglia, Bob Champion Building, James Watson Road, Norwich, NR4 7UQ, United Kingdom.
| | - Johanna Escher
- Erasmus Medical Center - Sophia Children's Hospital, Office Sp-3460, Wytemaweg 80, 3015 CN, Rotterdam, The Netherlands.
| | - Xavier Hébuterne
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - Stanisław Kłęk
- General and Oncology Surgery Unit, Stanley Dudrick's Memorial Hospital, 15 Tyniecka Street, 32-050, Skawina, Krakau, Poland.
| | - Zeljko Krznaric
- Clinical Hospital Centre Zagreb, University of Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia.
| | - Stéphane Schneider
- Gastroentérologie et Nutrition Clinique, CHU de Nice, Université Côte d'Azur, Nice, France.
| | - Raanan Shamir
- Tel-Aviv University, Schneider Children's Medical Center of Israel, 14 Kaplan St., Petach-Tikva, 49202, Israel.
| | - Kalina Stardelova
- University Clinic for Gastroenterohepatology, Clinical Centre "Mother Therese", Mother Therese Str No 18, Skopje, Republic of Macedonia.
| | - Nicolette Wierdsma
- VU University Medical Center, Department of Nutrition and Dietetics, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Anthony E Wiskin
- Paediatric Gastroenterology & Nutrition Unit, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol, BS2 8BJ, United Kingdom.
| | - Stephan C Bischoff
- Institut für Ernährungsmedizin (180) Universität Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany.
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87
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Chan M, Peyton P, Myles P, Leslie K, Buckley N, Kasza J, Paech M, Beattie W, Sessler D, Forbes A, Wallace S, Chen Y, Tian Y, Wu W. Chronic postsurgical pain in the Evaluation of Nitrous Oxide in the Gas Mixture for Anaesthesia (ENIGMA)-II trial. Br J Anaesth 2016; 117:801-811. [DOI: 10.1093/bja/aew338] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2016] [Indexed: 12/18/2022] Open
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88
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Klek S, Forbes A, Gabe S, Holst M, Wanten G, Irtun Ø, Damink SO, Panisic-Sekeljic M, Pelaez RB, Pironi L, Blaser AR, Rasmussen HH, Schneider SM, Thibault R, Visschers RG, Shaffer J. Management of acute intestinal failure: A position paper from the European Society for Clinical Nutrition and Metabolism (ESPEN) Special Interest Group. Clin Nutr 2016; 35:1209-1218. [DOI: 10.1016/j.clnu.2016.04.009] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Revised: 03/31/2016] [Accepted: 04/06/2016] [Indexed: 01/22/2023]
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89
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Soeters P, Bozzetti F, Cynober L, Forbes A, Shenkin A, Sobotka L. Defining malnutrition: A plea to rethink. Clin Nutr 2016; 36:896-901. [PMID: 27769782 DOI: 10.1016/j.clnu.2016.09.032] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/19/2016] [Accepted: 09/30/2016] [Indexed: 01/07/2023]
Abstract
In a recent consensus report in Clinical Nutrition the undernourished category of malnutrition was proposed to be defined and diagnosed on the basis of a low BMI or unintentional weight loss combined with low BMI or FFMI with certain cut off points. The definition was endorsed by ESPEN despite recent endorsement of a very different definition. The approach aims to assess whether nutritional intake is sufficient but is imprecise because a low BMI does not always indicate malnutrition and individuals with increasing BMI's may have decreasing FFM's. The pathophysiology of individuals, considered to be malnourished in rich countries and in areas with endemic malnutrition, results predominantly from deficient nutrition combined with infection/inflammation. Both elements jointly determine body composition and function and consequently outcome of disease, trauma or treatment. When following the consensus statement only an imprecise estimate is acquired of nutritional intake without knowing the impact of inflammation. Most importantly, functional abilities are not assessed. Consequently it will remain uncertain how well the individual can overcome stressful events, what the causes are of dysfunction, how to set priorities for treatment and how to predict the effect of nutritional support. We therefore advise to consider the pathophysiology of malnourished individuals leading to inclusion of the following elements in the definition of malnutrition: a disordered nutritional state resulting from a combination of inflammation and a negative nutrient balance, leading to changes in body composition, function and outcome. A precise diagnosis of malnutrition should be based on assessment of these elements.
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Affiliation(s)
- P Soeters
- Faculty of Medicine and Life Sciences, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - F Bozzetti
- Faculty of Medicine, University of Milan, 20100 Milan, Italy
| | - L Cynober
- Service de Biochimie, Hôpital Cochin, AP-HP, Hôpitaux Universitaires Paris Centre, Paris, France; Biological Nutrition Laboratory, EA 4466, Faculty of Pharmacy, Paris Descartes University, Paris, France
| | - A Forbes
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - A Shenkin
- Department of Clinical Chemistry, University of Liverpool, Liverpool, United Kingdom
| | - L Sobotka
- Third Department of Medicine, Medical Faculty Hospital Hradec Králové, Charles University, Prague, Czech Republic
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90
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Pavlidis P, Komorowski L, Teegen B, Liaskos C, Koutsoumpas AL, Smyk DS, Perricone C, Mytilinaiou MG, Stocker W, Forbes A, Bogdanos DP. Diagnostic and clinical significance of Crohn's disease-specific pancreatic anti-GP2 and anti-CUZD1 antibodies. Clin Chem Lab Med 2016; 54:249-56. [PMID: 26351932 DOI: 10.1515/cclm-2015-0376] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/03/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pancreatic autoantibodies (PAB) targeting GP2 and CUZD1 are Crohn's disease (CrD)-markers. The clinical significance of anti-GP2 antibodies has been assessed, but that of anti-CUZD1 remains elusive. The aim of the study was to assess the clinical utility of anti-CUZD1/anti-GP2 by novel cell-based indirect immunofluorescence (IIF) assays in CrD. METHODS A total of 212 CrD and 249 UC patients followed up at a London IBD centre were investigated to simultaneously detect PABs, anti-GP2 and anti-CUZD1 by IIF using primate pancreatic tissue, and HEK293 over-expressing CUZD1 or GP2. RESULTS Overall, 88 (41.5%) CrDs compared to 26 (10.4%) UCs (p<0.001) tested positive for IgA and/or IgG anti-GP2 and/or anti-CUZD1 antibodies, while ASCA were found in 67.5% CrDs versus 19.2% UCs (p<0.0001); ASCA and/or PAB (anti-GP2 or anti-CUZD1) were detected in 76% CrD versus 34% UC patients. IgG anti-GP2 antibodies were less prevalent in L2 phenotype (p=0.002) and more prevalent in patients with stricturing disease (p=0.0418), even when a higher cut-off (≥1000 RU) was used (p=0.0396). Also, anti-GP2 IgG positive CrD patients had younger age of disease onset. IgA and/or IgG ASCA and anti-GP2 IgG antibody positive CrDs had younger onset of disease (p<0.0001), were more likely to have both ileal and colonic disease (p<0.0001) and had more stricturing (p<0.0001) than seronegative patients. Clinical correlates were not found for anti-CUZD1 positivity. CONCLUSIONS PAB testing increases ASCA's serological sensitivity for CrD. Anti-GP2 detection, in isolation or in combination with ASCA, stratify CrD patients who phenotypically are characterised by a much younger onset of disease, extensive and stricturing behaviour.
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91
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McNelly AS, Monti M, Grimble GK, Norton C, Bredin F, Czuber-Dochan WJ, Berliner S, Forbes A. The effect of increasing physical activity and/or omega-3 supplementation on fatigue in inflammatory bowel disease. ACTA ACUST UNITED AC 2016. [DOI: 10.12968/gasn.2016.14.8.39] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
| | - Marilina Monti
- University College London Hospitals NHS Foundation Trust
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92
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Biancheri P, Di Sabatino A, Rescigno M, Giuffrida P, Fornasa G, Tsilingiri K, Pender SLF, Papadia C, Wood E, Pasini A, Ubezio C, Vanoli A, Forbes A, MacDonald TT, Corazza GR. Abnormal thymic stromal lymphopoietin expression in the duodenal mucosa of patients with coeliac disease. Gut 2016; 65:1670-80. [PMID: 26342013 PMCID: PMC5036244 DOI: 10.1136/gutjnl-2014-308876] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Accepted: 06/23/2015] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The short isoform of thymic stromal lymphopoietin (TSLP), a cytokine constitutively expressed by epithelial cells, is crucial in preserving immune tolerance in the gut. TSLP deficiency has been implicated in sustaining intestinal damage in Crohn's disease. We explored mucosal TSLP expression and function in refractory and uncomplicated coeliac disease (CD), a T-cell-mediated enteropathy induced by gluten in genetically susceptible individuals. DESIGN TSLP isoforms-long and short-and receptors-TSLPR and interleukin (IL)-7Rα-were assessed by immunofluorescence, immunoblotting and qRT-PCR in the duodenum of untreated, treated, potential and refractory patients with CD. The ability of the serine protease furin or CD biopsy supernatants to cleave TSLP was evaluated by immunoblotting. The production of interferon (IFN)-γ and IL-8 by untreated CD biopsies cultured ex vivo with TSLP isoforms was also assessed. RESULTS Mucosal TSLP, but not TSLPR and IL-7Rα, was reduced in untreated CD and refractory CD in comparison to treated CD, potential CD and controls. Transcripts of both TSLP isoforms were decreased in active CD mucosa. Furin, which was overexpressed in active CD biopsies, was able to cleave TSLP in vitro. Accordingly, refractory and untreated CD supernatants showed higher TSLP-degrading capacity in comparison to treated CD and control supernatants. In our ex vivo model, both TSLP isoforms significantly downregulated IFN-γ and IL-8 production by untreated CD biopsies. CONCLUSIONS Reduced mucosal TSLP expression may contribute to intestinal damage in refractory and untreated CD. Further studies are needed to verify whether restoring TSLP might be therapeutically useful especially in refractory patients with CD.
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Affiliation(s)
- Paolo Biancheri
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy,Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Antonio Di Sabatino
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy
| | - Maria Rescigno
- Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Paolo Giuffrida
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy,Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Giulia Fornasa
- Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | - Katerina Tsilingiri
- Department of Experimental Oncology, European Institute of Oncology, Milan, Italy
| | | | - Cinzia Papadia
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eleanor Wood
- Academic Department of Medical and Surgical Gastroenterology, Homerton University Hospital, London, UK
| | - Alessandra Pasini
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy
| | - Cristina Ubezio
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy
| | - Alessandro Vanoli
- Department of Molecular Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy
| | - Alastair Forbes
- Department of Gastroenterology, Norfolk and Norwich University Hospital, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Thomas T MacDonald
- Centre for Immunobiology, Barts and the London School of Medicine and Dentistry, London, UK
| | - Gino R Corazza
- First Department of Internal Medicine, St Matteo Hospital, University of Pavia, Pavia, Italy
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93
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Rogulska J, Osowska S, Giebułtowicz J, Zawada K, Forbes A, Majewska K, Sobocki J, Wroczyński P. MON-P178: The Oxidative Stability Estimation of All-In-One Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions after 24. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30812-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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94
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Ajabnoor S, Forbes A. SUN-LB276: Effect of Fat Composition in Enteral Nutrition for Crohn'S Disease in Adults: A Systematic Review. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30632-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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95
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Rudzki S, Armstrong D, Jeppesen P, Forbes A, Lee HM. MON-P083: Post HOC Analysis of Polyps in 9 Short Bowel Syndrome Patients Treated with Teduglutide. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30717-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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96
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Holt RIG, Nicolucci A, Kovacs Burns K, Lucisano G, Skovlund SE, Forbes A, Kalra S, Menéndez Torre E, Munro N, Peyrot M. Correlates of psychological care strategies for people with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. Diabet Med 2016; 33:1174-83. [PMID: 26939906 DOI: 10.1111/dme.13109] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/18/2016] [Accepted: 03/01/2016] [Indexed: 01/30/2023]
Abstract
AIMS To assess the ways in which healthcare professionals address psychological problems of adults with diabetes in the second Diabetes Attitudes, Wishes and Needs (DAWN2(™) ) study. METHODS Approximately 120 primary care physicians, 80 diabetes specialists and 80 nurses and dietitians providing diabetes care participated in each of 17 countries (N=4785). Multiple regression analyses were used to evaluate independent statistically significant associations of respondent attributes concerning psychological care strategies, including assessment of diabetes impact on the patient's life, assessment of depression, provision of psychological assessment and support, and coordination with mental health professionals. RESULTS Psychological care strategies were positively associated with each other but differed by healthcare practice site and discipline; nurses and dietitians were less likely to assess depression than other healthcare professionals, while primary care physicians were less likely to coordinate with mental health specialists or ask patients how diabetes affects their lives. Psychological care was positively associated with healthcare professionals' beliefs that patients need help dealing with emotional issues and that clinical success depends on doing so, and also with level of psychological care training, multidisciplinary team membership and availability of resources for psychological care. There were significant between-country variations in psychological care strategies, before and after adjustment for individual-level factors, and significant country-by-covariate interactions for almost all individual-level factors investigated. CONCLUSIONS Improvements in training and resources, recognition and assessment of psychological problems, and increased belief in the efficacy of psychological support may enhance healthcare professionals' efforts to address psychological problems in adults with diabetes.
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Affiliation(s)
- R I G Holt
- Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - K Kovacs Burns
- Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB, Canada
| | - G Lucisano
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | | | - A Forbes
- Kings College London, London, UK
| | - S Kalra
- Bharti Hospital and BRIDE, Karnal, India
| | | | - N Munro
- University of Surrey, Guildford, UK
| | - M Peyrot
- Loyola University Maryland, Baltimore, MD, USA
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97
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Bellet C, Green M, Vickers M, Forbes A, Berry E, Kaler J. Ostertagia spp ., rumen fluke and liver fluke single- and poly-infections in cattle: An abattoir study of prevalence and production impacts in England and Wales. Prev Vet Med 2016; 132:98-106. [DOI: 10.1016/j.prevetmed.2016.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/24/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
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98
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Rogulska J, Osowska S, Giebuttowicz J, Forbes A, Sobocki J, Wroczyński P. MON-P176: Estimation of the Oxidative Stability of All-In-One (AIO) Admixtures for Parenteral Nutrition with 3 Different Lipid Emulsions After Three Days of Storage in the Fridge. Clin Nutr 2016. [DOI: 10.1016/s0261-5614(16)30810-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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99
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Basudev N, Crosby-Nwaobi R, Thomas S, Chamley M, Murrells T, Forbes A. A prospective randomized controlled study of a virtual clinic integrating primary and specialist care for patients with Type 2 diabetes mellitus. Diabet Med 2016; 33:768-76. [PMID: 27194175 DOI: 10.1111/dme.12985] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/30/2015] [Indexed: 12/29/2022]
Abstract
AIMS To investigate the effectiveness of a diabetes virtual clinic to enhance diabetes in primary care by developing clinical management plans for patients with suboptimal metabolic control and/or case complexity. METHODS A prospective study with randomized allocation to virtual clinic or usual care. Patients with Type 2 diabetes (n = 208) were recruited from six general practices in South London. The primary outcome for the study was glycaemic control, secondary outcomes included: lipids, blood pressure, weight (kg and BMI) and renal function (eGFR). Data were collected from participants' records at baseline and 12 months. We also considered process measures including therapy optimization. RESULTS The 12-month data show equivalence between the virtual clinic and control groups for glycaemic control with both achieving clinically significant reductions in HbA1c of 8 mmol/mol (0.6 ± 1.7%) and 10 mmol/mol (0.8 ± 1.9%), respectively (P = 0.4). The virtual clinic group showed superiority over the intervention group for blood pressure control with a mean reduction in systolic blood pressure of 6 ± 16 mmHg compared with an increased of 2 ± 18 mmHg in the control group (P = 0.008). There were no significant differences between the groups in terms of cholesterol, weight and renal function. Process measures showed an increased level of therapy adjustment in the virtual clinic group. CONCLUSION The virtual clinic model explored in this study showed a clinically important improvement in glycaemic control. Although this improvement was not superior to that observed in the control participants, this might be attributable to the systemic impact of the virtual clinic on the practice as a whole.
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Affiliation(s)
- N Basudev
- Lambeth Diabetes Intermediate Care Team, King's College London, London, UK
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - R Crosby-Nwaobi
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - S Thomas
- St Thomas's Hospital, London, UK
| | - M Chamley
- Lambeth Diabetes Intermediate Care Team, King's College London, London, UK
| | - T Murrells
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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100
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Anderson JL, Hedin CR, Benjamin JL, Koutsoumpas A, Ng SC, Hart AL, Forbes A, Stagg AJ, Lindsay JO, Whelan K. Dietary intake of inulin-type fructans in active and inactive Crohn's disease and healthy controls: a case-control study. J Crohns Colitis 2015. [PMID: 26221003 DOI: 10.1093/ecco-jcc/jjv136] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Prebiotic inulin-type fructans are widely consumed in the diet and may have contrasting effects in Crohn's disease by stimulating gut microbiota and/or by generating functional gastrointestinal symptoms. The aim of this study was to measure fructan and oligofructose intakes in patients with active and inactive Crohn's disease compared with healthy controls. METHODS Patients with active Crohn's disease (n = 98), inactive Crohn's (n = 99) and healthy controls (n = 106) were recruited to a case-control study. Dietary intake of inulin-type fructans was measured using a specific food frequency questionnaire and was compared between the three groups and between patients with different disease phenotypes (Montreal classification). Associations between intakes and disease activity (Harvey-Bradshaw Index, HBI) were also undertaken. RESULTS Patients with active Crohn's disease had lower fructan intakes (median 2.9 g/d, interquartile range [IQR] 1.8) than those with inactive Crohn's (3.6 g/d, 2.1, p = 0.036) or controls (3.9 g/d, 2.1, p = 0.003) and lower oligofructose intakes (2.8 g/d, 1.8) than those with inactive Crohn's (3.5 g/d, 2.2, p = 0.048) or controls (3.8 g/d, 2.1, p = 0.003). There were no differences in intakes related to disease site or behaviour. There were negative correlations between HBI well-being score and fructan intake (ρ = -0.154, p = 0.03) and oligofructose intake (ρ = -0.156, p = 0.028) and for the HBI abdominal pain score and fructan (ρ = -0.164, p = 0.021) and oligofructose intake (ρ = -0.157, p = 0.027). CONCLUSIONS Patients with active Crohn's disease consume lower quantities of fructans and oligofructose than their inactive counterparts and healthy controls. The impact of lower intakes of prebiotic fructans on gut microbiota is unknown and warrants further research.
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Affiliation(s)
- Jacqueline L Anderson
- King's College London, Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, London , UK
| | - Charlotte R Hedin
- King's College London, Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, London , UK
| | - Jane L Benjamin
- King's College London, Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, London , UK
| | - Andreas Koutsoumpas
- King's College London, Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, London , UK
| | - Siew C Ng
- St Marks's Hospital, Harrow, Middlesex, UK Department of Medicine and Therapeutics, Institute of Digestive Disease, State Key Laboratory of Digestive Diseases, LKS Institute of Health Science, Chinese University of Hong Kong, Hong Kong
| | | | - Alastair Forbes
- Centre for Gastroenterology and Nutrition, University College London, London, UK
| | - Andrew J Stagg
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - James O Lindsay
- Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK Digestive Diseases Department, The Royal London Hospital, Barts Health NHS Trust, London , UK
| | - Kevin Whelan
- King's College London, Faculty of Life Sciences and Medicine, Diabetes and Nutritional Sciences Division, London , UK
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