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Sato Y, Hishiki T, Masugi Y, Florence L, Yu YM. Vitamin D administration increases serum alanine concentrations in thermally injured mice. Biochem Biophys Res Commun 2024; 736:150505. [PMID: 39128265 DOI: 10.1016/j.bbrc.2024.150505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2024] [Accepted: 08/05/2024] [Indexed: 08/13/2024]
Abstract
Thermal or burn injury results in profound metabolic changes in the body. This can contribute to muscle atrophy, bone loss, as well as suppression of the immune system. While the mechanisms that underlie this hypermetabolic response remain unclear, patients with burn injury often have low circulating levels of vitamin D. Vitamin D has been shown to regulate bone formation as well as regulate muscle function. We sought to clarify the effects of vitamin D administration on skeletal muscle function following thermal injury using a mouse model. We found that thermal injury resulted in decreased vitamin D levels as well as decreased bone mineral density. Branched chain amino acid (BCAA)s levels were also significantly enhanced in the serum following burn injury. Vitamin D administration reversed the decrease in bone marrow-derived mesenchymal stem cell (BM-MSC)s observed post burn injury. Interestingly, vitamin D administration also resulted in increased tricarboxylic acid cycle (TCA) cycle metabolites in muscle which was decreased after burn conditions, enhanced the supply of alanine and glutamine in the blood which could contribute to gluconeogenesis and wound healing. Therefore, vitamin D supplementation after burn injury may have effects not only in bone metabolism, but may affect substrate metabolism in other organs/tissues.
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Affiliation(s)
- Yukio Sato
- Department of Emergency and Critical Care Medicine, Keio University School of Medicine, Tokyo, Japan; Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children in Boston, Boston, MA, USA.
| | - Takako Hishiki
- Department of Biochemistry, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Masugi
- Department of Pathology, Keio University School of Medicine, Tokyo, Japan
| | - Lin Florence
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children in Boston, Boston, MA, USA
| | - Yong-Ming Yu
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA; Shriners Hospital for Children in Boston, Boston, MA, USA
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Zavala S, Pape KO, Walroth TA, Reger M, Hoyte B, Thomas W, Adams B, Hill DM. Vitamin D Deficiency Is Associated With Increased Length of Stay After Acute Burn Injury: A Multicenter Analysis. J Burn Care Res 2024; 45:728-732. [PMID: 38141248 DOI: 10.1093/jbcr/irad201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Indexed: 12/25/2023]
Abstract
In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis and infectious complications. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). This was a multicenter retrospective study of adult patients at 7 burn centers admitted over a 3.5-year period, who had a 25-hydroxyvitamin D concentration drawn within the first 7 days of injury. Of 1147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient. Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, P < .001), acute kidney injury (AKI) requiring renal replacement therapy (7.3 vs 1.7%, P = .009), more days requiring vasopressors (mean 1.24 vs 0.58 days, P = .008), and fewer ventilator-free days of the first 28 days (mean 22.9 vs 25.1, P < .001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS. After controlling for center, TBSA, age, and inhalation injury, vitamin D deficiency was associated with longer LOS. In conclusion, patients with thermal injuries and vitamin D deficiency on admission have increased LOS and worsened clinical outcomes when compared with patients with nondeficient vitamin D concentrations.
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Affiliation(s)
- Sarah Zavala
- Department of Pharmacy, Jesse Brown VA Medical Center, Chicago, IL 60612, USA
| | - Kate O Pape
- Department of Pharmacy, University of Iowa Health Care, Iowa City, IA 52245, USA
| | - Todd A Walroth
- Department of Pharmacy, Eskenazi Health, Indianapolis, IN 46202, USA
| | - Melissa Reger
- Department of Pharmacy, Community Regional Medical Center, Fresno, CA 93721, USA
| | - Brittany Hoyte
- Department of Pharmacy, Corewell Health, Grand Rapids, MI 49503, USA
| | - Wendy Thomas
- Department of Pharmacy, Corewell Health, Grand Rapids, MI 49503, USA
| | - Beatrice Adams
- Department of Pharmacy, Tampa General Hospital, Tampa, FL 33606, USA
| | - David M Hill
- Department of Pharmacy, Regional One Health, Memphis, TN 38103, USA
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Mortada H, Ali Zahreldin A, Shafiek Saleh M, Shahien M, Elfeky A, Ibrahim Abdelhamed A, Elaraby A, Elzalabany A, Samir Hammad Y, Elshennawy S. The Efficacy of Whole-Body Vibration in Managing Postburn Victims' Complications: A Systematic Review. J Burn Care Res 2024; 45:48-54. [PMID: 37791999 DOI: 10.1093/jbcr/irad151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Indexed: 10/05/2023]
Abstract
Burn injury is a complicated traumatic event with both systemic and local consequences. These complications include long periods of bed rest, pain, muscle weakness, vitamin D deficiency, and bone mineral density loss. Whole-body vibration demonstrated effectiveness in improving muscle power and bone mineral density in various musculoskeletal populations. This systematic review of randomized controlled trials aims to assess evidence for the effectiveness of using whole-body vibration on postburn survivors with at least 1% total body surface area on sensory and motor outcomes. A systematic search was conducted across six databases, which are, PubMed, Cochrane, PEDro, Scopus, Web of Science, and Google Scholar, from inception till March 2022. Retrieved studies were screened by title and abstract and full-text in two stages using Rayyan web-based. Included studies were assessed for risk of bias using the Cochrane risk of bias tool ROB 2.0. Six randomized controlled trials with 203 participants were included. Five of the included studies demonstrated an overall high risk of bias. Compared to conventional physiotherapy programs, whole-body vibration demonstrated improvement in functional mobility and balance using timed up and go and Biodex balance assessment, respectively. However, there were no differences between whole-body vibration and conventional physiotherapy program alone in bone mineral density and muscle power. Although the current evidence of whole-body vibration is limited, whole-body vibration combined with traditional physical therapy programs may improve functional mobility and balance in postburn survivors compared to physical therapy programs alone.
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Affiliation(s)
- Hossam Mortada
- Biomechanics Unit, Faculty of Physical Therapy, Ahram Canadian University, Giza, Egypt
| | | | - Marwa Shafiek Saleh
- Department of Physical Therapy, Faculty of Applied Medical Sciences, Al-Zaytoonah University of Jordan, Amman, Jordan
| | | | - Amr Elfeky
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
| | | | | | - Ahmed Elzalabany
- Faculty of Physical Therapy, Egyptian Chinese University, Cairo, Egypt
| | - Yara Samir Hammad
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
| | - Shorouk Elshennawy
- Faculty of Physical Therapy, Cairo University, Giza, Egypt
- College of Physical Therapy, Misr University for Science and Technology, Giza, Egypt
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Mohammadi AA, Shafaeipour A. Evaluation of Vitamin D3 and Calcium Deficiency after Recovery from Extensive Burn. World J Plast Surg 2021; 10:60-65. [PMID: 33833955 PMCID: PMC8016369 DOI: 10.29252/wjps.10.1.60] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Previous studies in pediatric populations have demonstrated that vitamin D deficiency is common in patients with large burns. The aim of the current comparative study was to investigate the serum level of vitamin D in patients with large burns [>20% total body surface area (TBSA)] after 6 months of therapy. METHODS This case control study was conducted during 6-month period from 2017 to 2018 in Amiralmomenin Hospital, Shiraz, Iran. Forty two patients with large burns (>20% TBSA) and at least 6 months’ post-burn period were enrolled. Also, 42 healthy and age and sex matched controls from those referring for routine check-ups were included for comparison. None of the patients and controls received vitamin D supplements. The serum level of calcium (Ca), parathormone (PTH) and vitamin D were compared between the groups. RESULTS There was no significant difference between the two study groups regarding the baseline characteristics including the age (p=0.085), gender (p=0.275) and duration of sun exposure (p=0.894). We found that those with major burns had significantly higher serum levels of PTH (50.48±26.49 vs. 33.64±15.80; p=0.001). In addition, the serum levels of vitamin D were significantly lower in burn patients compared to healthy controls (18.15±9.18 vs. 31.43±16.27; p<0.001). CONCLUSION Major burns (≥20% TBSA) are associated with increased serum levels of PTH and decreased serum levels of vitamin D. However, serum levels of calcium are not affected by major burns.
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Affiliation(s)
| | - Asma Shafaeipour
- Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
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Blaauw R, Osland E, Sriram K, Ali A, Allard JP, Ball P, Chan LN, Jurewitsch B, Logan Coughlin K, Manzanares W, Menéndez AM, Mutiara R, Rosenfeld R, Sioson M, Visser J, Berger MM. Parenteral Provision of Micronutrients to Adult Patients: An Expert Consensus Paper. JPEN J Parenter Enteral Nutr 2020; 43 Suppl 1:S5-S23. [PMID: 30812055 DOI: 10.1002/jpen.1525] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 02/04/2019] [Indexed: 12/23/2022]
Abstract
BACKGROUND Micronutrients, an umbrella term used to collectively describe vitamins and trace elements, are essential components of nutrition. Those requiring alternative forms of nutrition support are dependent on the prescribed nutrition regimen for their micronutrient provision. The purpose of this paper is to assist clinicians to bridge the gap between the available guidelines' recommendations and their practical application in the provision of micronutrients via the parenteral route to adult patients. METHODS Based on the available evidenced-based literature and existing guidelines, a panel of multidisciplinary healthcare professionals with significant experience in the provision of parenteral nutrition (PN) and intravenous micronutrients developed this international consensus paper. RESULTS The paper addresses 14 clinically relevant questions regarding the importance and use of micronutrients in various clinical conditions. Practical orientation on how micronutrients should be prescribed, administered, and monitored is provided. CONCLUSION Micronutrients are a critical component to nutrition provision and PN provided without them pose a considerable risk to nutrition status. Obstacles to their daily provision-including voluntary omission, partial provision, and supply issues-must be overcome to allow safe and responsible nutrition practice.
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Affiliation(s)
- Renée Blaauw
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Emma Osland
- Department of Nutrition and Dietetics, Royal Brisbane and Women's Hospital, Herston, Queensland, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Krishnan Sriram
- US Department of Veterans Affairs, Regional Tele-ICU System (VISN 23), Hines, Illinois, USA
| | - Azmat Ali
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Johane P Allard
- Division of Gastroenterology, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Patrick Ball
- School of Pharmacy, University of Wolverhampton, Wolverhampton, UK
| | - Lingtak-Neander Chan
- Department of Pharmacy School of Pharmacy, and Graduate Program in Nutritional Sciences, School of Public Health, University of Washington, Seattle, Washington, USA
| | - Brian Jurewitsch
- Specialized Complex Care Program, St. Michael's Hospital, Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Kathleen Logan Coughlin
- Center for Human Nutrition, Digestive Disease and Surgical Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - William Manzanares
- Department of Critical Care, Faculty of Medicine. Hospital de Clínicas, Universidad de la República (UdelaR), Montevideo, Uruguay
| | | | - Rina Mutiara
- Pharmacy Department, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Ricardo Rosenfeld
- Nutrition Support Department, Casa de Saude Sao Jose, Associacao Congregacao de Santa Catarina, Rio de Janeiro, Brazil
| | - Marianna Sioson
- Section of Nutrition, Department of Medicine, The Medical City Hospital, Pasig City, Metro Manila, Philippines
| | - Janicke Visser
- Division of Human Nutrition, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Mette M Berger
- Faculty of Biology and Medicine, Service of Intensive Care Medicine & Burns, University of Lausanne Hospitals (CHUV), Lausanne, Switzerland
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Low Vitamin D Level on Admission for Burn Injury Is Associated With Increased Length of Stay. J Burn Care Res 2018; 38:e8-e13. [PMID: 27679960 DOI: 10.1097/bcr.0000000000000445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently, there have been few studies that have evaluated the incidence of vitamin D deficiency in adult burn patients or correlated vitamin D levels with burn-related outcomes. The primary objective of the study was to identify the incidence of vitamin D deficiency and insufficiency in an adult burn population. The secondary objective was to determine the impact of vitamin D deficiency and insufficiency on clinical outcomes in burn care. A single-center, retrospective, and observational cohort analysis of adult patients admitted for initial management of burn injury, who had a 25-hydroxyvitamin D (25D) level measured on admission, was performed. Patients were categorized as vitamin D deficient (25D <10 ng/ml), insufficient (10-29 ng/ml), or sufficient (30-100 ng/ml) based on admission measurements. Clinical outcomes including complications, intensive care unit (ICU) and hospital length of stay (LOS), and survival were compared between patients with vitamin D deficiency/insufficiency and patients with vitamin D sufficiency. Three-hundred and eighteen patients were eligible for evaluation. Admission 25D level correlated with deficiency in 46 patients (14.5%), insufficiency in 207 (65.1%), and normal in 65 (20.4%). Patients with vitamin D deficiency or insufficiency experienced higher rates of complications and longer ICU and hospital LOS compared with those with normal vitamin D levels. A large proportion of patients with burn injury presented with vitamin D insufficiency and deficiency which was associated with poor outcomes, including prolonged ICU and hospital LOS. Additional studies are needed to further describe the relationship between vitamin D status and clinical outcomes.
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Moreira E, Burghi G, Manzanares W. Update on metabolism and nutrition therapy in critically ill burn patients. Med Intensiva 2017; 42:306-316. [PMID: 28951113 DOI: 10.1016/j.medin.2017.07.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 07/16/2017] [Accepted: 07/24/2017] [Indexed: 11/19/2022]
Abstract
Major burn injury triggers severe oxidative stress, a systemic inflammatory response, and a persistent hypermetabolic and hypercatabolic state with secondary sarcopenia, multiorgan dysfunction, sepsis and an increased mortality risk. Calorie deficit, negative protein balance and antioxidant micronutrient deficiency after thermal injury have been associated to poor clinical outcomes. In this context, personalized nutrition therapy with early enteral feeding from the start of resuscitation are indicated. Over the last four decades, different nutritional and pharmacological interventions aimed at modulating the immune and metabolic responses have been evaluated. These strategies have been shown to be able to minimize acute malnutrition, as well as modulate the immunoinflammatory response, and improve relevant clinical outcomes in this patient population. The purpose of this updating review is to summarize the most current evidence on metabolic response and nutrition therapy in critically ill burn patients.
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Affiliation(s)
- E Moreira
- Centro de Tratamiento Intensivo del Hospital Maciel, ASSE, Montevideo, Uruguay
| | - G Burghi
- Centro Nacional de Quemados, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - W Manzanares
- Cátedra de Medicina Intensiva, Hospital de Clínicas, Facultad de Medicina, Universidad de la República (UdelaR), Montevideo, Uruguay.
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Nogueira GR, Azevedo PS, Polegato BF, Zornoff LA, Paiva SA, Nogueira CR, Araujo NC, Carmona BH, Conde SJ, Minicucci MF. Roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients. Clinics (Sao Paulo) 2016; 71:470-3. [PMID: 27626478 PMCID: PMC4975781 DOI: 10.6061/clinics/2016(08)10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 05/05/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the roles of the Taql and Bsml vitamin D receptor gene polymorphisms in hospital mortality of burn patients. METHODS In total, 105 consecutive burn injury patients over 18 years in age who were admitted to the Burn Unit of Bauru State Hospital from January to December 2013 were prospectively evaluated. Upon admission, patient demographic information was recorded and a blood sample was taken for biochemical analysis to identify the presence of the Taql(rs731236) and Bsml(rs1544410) polymorphisms. All of the patients were followed over their hospital stay and mortality was recorded. RESULTS Eighteen of the patients did not sign the informed consent form, and there were technical problems with genotype analysis for 7 of the patients. Thus, 80 patients (mean age, 42.5±16.1 years) were included in the final analysis. In total, 60% of the patients were male, and 16.3% died during the hospital stay. The genotype frequencies for the Taql polymorphism were 51.25% TT, 41.25% TC and 7.50% CC; for the Bsml polymorphism, they were 51.25% GG, 42.50% GA and 6.25% AA. In logistic regression analysis, after adjustments for age, gender and total body surface burn area, there were no associations between the Taql (OR: 1.575; CI95%: 0.148-16.745; p=0.706) or Bsml (OR: 1.309; CI95%: 0.128-13.430; p=0.821) polymorphisms and mortality for the burn patients. CONCLUSIONS Our results suggest that the Taql and Bsml vitamin D receptor gene polymorphisms are not associated with hospital mortality of burn patients.
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Affiliation(s)
- Glaucia R. Nogueira
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Paula S. Azevedo
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Bertha F. Polegato
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Leonardo A.M. Zornoff
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Sergio A.R. Paiva
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Celia R. Nogueira
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
| | - Natalia C. Araujo
- Instituto Federal São Paulo – IFSP, Campus São Roque, São Roque/SP, Brazil
| | - Bruno H.M. Carmona
- Instituto Federal São Paulo – IFSP, Campus São Roque, São Roque/SP, Brazil
| | - Sandro J. Conde
- Instituto Federal São Paulo – IFSP, Campus São Roque, São Roque/SP, Brazil
| | - Marcos F. Minicucci
- Universidade Estadual Paulista – UNESP, Faculdade de Medicina de Botucatu, Departamento de Medicina Interna, Botucatu/SP, Brazil
- E-mail:
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Abdullahi A, Jeschke MG. Nutrition and anabolic pharmacotherapies in the care of burn patients. Nutr Clin Pract 2015; 29:621-30. [PMID: 25606644 DOI: 10.1177/0884533614533129] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Thermal injury is a devastating injury that results in a number of pathological alterations in almost every system in the body. Hypermetabolism, muscle wasting, depressed immunity, and impaired wound healing are all clinical features of burns. Failure to address each of these specific pathological alterations can lead to increased mortality. Nutrition supplementation has been recommended as a therapeutic tool to help attenuate the hypermetabolism and devastating catabolism evident following burn. Despite the wide consensus on the need of nutrition supplementation in burn patients, controversy exists with regard to the type and amount of nutrition recommended. Nutrition alone is also not enough in these patients to halt and reverse some of the damage done by the catabolic pathways activated following severe burn injury. This has led to the use of anabolic pharmacologic agents in conjunction with nutrition to help improve patient outcome following burn injury. In this review, we examine the relevant literature on nutrition after burn injury and its contribution to the attenuation of the postburn hypermetabolic response, impaired wound healing, and suppressed immunological responses. We also review the commonly used anabolic agents clinically in the care of burn patients. Finally, we provide nutrition and pharmacological recommendations gained from prospective trials, retrospective analyses, and expert opinions based on our practice at the Ross Tilley Burn Center in Toronto, Canada.
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Affiliation(s)
- Abdikarim Abdullahi
- Sunnybrook Health Sciences Centre, Ross Tilley Burn Centre, Rm D7-04B, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
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Rousseau AF, Damas P, Ledoux D, Lukas P, Carlisi A, Le Goff C, Gadisseur R, Cavalier E. Vitamin D status after a high dose of cholecalciferol in healthy and burn subjects. Burns 2015; 41:1028-34. [DOI: 10.1016/j.burns.2014.11.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 11/17/2014] [Accepted: 11/19/2014] [Indexed: 11/30/2022]
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Abstract
Supplementation of micronutrients after burn injury is common practice in order to fight oxidative stress, support the immune system, and optimize wound healing. Assessing micronutrient status after burn injury is difficult because of hemodilution in the resuscitation phase, redistribution of nutrients from the serum to other organs, and decreases in carrier proteins such as albumin. Although there are many preclinical data, there are limited studies in burn patients. Promising research is being conducted on combinations of micronutrients, especially via the intravenous route.
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Rousseau AF, Foidart-Desalle M, Ledoux D, Remy C, Croisier JL, Damas P, Cavalier E. Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength and bone health: a one-year pilot randomized controlled trial in adults with severe burns. Burns 2014; 41:317-25. [PMID: 25239849 DOI: 10.1016/j.burns.2014.07.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 07/03/2014] [Accepted: 07/05/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status, bone and muscle health during sequelar stage of burn injury. DESIGN Monocentric randomized controlled trial. METHODS Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000IU VD3 and daily oral Ca (Group D) or placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol. RESULTS Of all the patients, 66% presented with VD deficiency and 53% (with 3 men <40y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37-61)ng/ml. No significant change in bone health was observed in both groups while Group D significantly improved quadriceps strength when tested at high velocity. CONCLUSIONS This VD3 supplementation was safe and efficient to correct hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life.
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Affiliation(s)
- Anne-Françoise Rousseau
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium.
| | - Marguerite Foidart-Desalle
- Physical Medicine and Sport Traumatology Service, University of Liège, University Hospital, Liège, Belgium
| | - Didier Ledoux
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium
| | - Christophe Remy
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium; Motility Science Department, University of Liège, Liège, Belgium
| | | | - Pierre Damas
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium
| | - Etienne Cavalier
- Clinical Chemistry Department, University of Liège, University Hospital, Liège, Belgium
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Rousseau AF, Damas P, Ledoux D, Cavalier E. Effect of cholecalciferol recommended daily allowances on vitamin D status and fibroblast growth factor-23: an observational study in acute burn patients. Burns 2014; 40:865-70. [PMID: 24462294 DOI: 10.1016/j.burns.2013.11.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 11/17/2013] [Accepted: 11/21/2013] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Burn patients are at risk of hypovitaminosis D. Optimal vitamin D (VD) intakes are not defined in burn nutrition guidelines and studies mostly focused on ergocalciferol (VD2) supplementation in burn children. Aim of our study was to describe adult burns VD status, to measure effects of our cholecalciferol (VD3) supplementation on VD metabolism during acute burn care, and to assess correlation between FGF23 and C-reactive protein (CRP). DESIGN Cohort study. METHODS From March 2012 to January 2013, patients >18 years, admitted within 24 h after injury with burn surface area (BSA) ≥10% were included. Patients daily received VD3 from oral or enteral nutrition (400-600 IU) and from oral or intravenous multivitamin complex (200-220 IU). Serum levels of 25(OH)-D, 1-25(OH)2-D, 3rd generation PTH, C-terminal FGF23, total calcium, phosphate, albumin and CRP were measured at admission (D0) and every week during 4 weeks of follow-up. Data are expressed as percentage or median (min-max). Paired data were compared using Wilcoxon test. Correlation between CRP and FGF23 was assessed using nonparametric Spearman test. A p value <0.05 was considered to be statistically significant. RESULTS We initially included 24 patients. Median age and BSA were, respectively, 46 [19-86] years and 15 [10-85]%. At D0, 75% presented a VD insufficiency (25(OH)-D 21-29 ng/ml) and 17% presented a deficiency (25(OH)-D ≤20 ng/ml). We followed 12 patients until day 28: 25(OH)-D was unchanged while 1-25(OH)2-D and FGF23 decreased without reaching significance. We observed a significant positive correlation between FGF23 and CRP (r=0.59, 95% CI: 0.22-0.82, p=0.0032). CONCLUSIONS Most of our adult burns presented hypovitaminosis D regardless of age. Nutrition supplemented with low dose of VD3 (intakes reaching recommended daily allowances) was insufficient to correct 25(OH)-D level. Moreover, an interesting correlation between CRP and FGF23 was found.
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Affiliation(s)
- Anne-Françoise Rousseau
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium.
| | - Pierre Damas
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium
| | - Didier Ledoux
- Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium
| | - Etienne Cavalier
- Clinical Chemistry Department, University of Liège, University Hospital, Sart-Tilman, Liège, Belgium
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