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Arutla M, Raghunath M, Deepika G, Jakkampudi A, Murthy HVV, Rao GV, Reddy DN, Talukdar R. Efficacy of enteral glutamine supplementation in patients with severe and predicted severe acute pancreatitis- A randomized controlled trial. Indian J Gastroenterol 2019; 38:338-347. [PMID: 31612309 DOI: 10.1007/s12664-019-00962-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 05/14/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND In severe acute pancreatitis (AP), intravenous glutamine has been shown to reduce the rate of complications, hospital stay, and mortality. In the present randomized trial, we aimed to evaluate the effect of enteral glutamine supplementation on clinical outcomes, gut permeability, systemic inflammation, oxidative stress, and plasma glutamine levels in patients with severe and predicted severe AP. METHODS Patients with AP admitted within 72 h of onset of symptoms were included. The primary outcome measure was development of infected pancreatic and peri-pancreatic necrosis and in-hospital mortality. High-sensitivity C-reactive protein (HS-CRP) and interleukin-6 (IL-6) were evaluated as markers of inflammation; plasma thiobarbituric acid reactive substances (TBARS) and activities of serum superoxide dismutase and glutathione peroxidase were determined to evaluate oxidative stress; serum polyethylene glycol (PEG) was tested for intestinal permeability; subjective global assessment (SGA) was used for nutritional assessment, and an improvement in organ function was measured by the Modified Marshall score. Intention-to-treat analysis was used. A p-value of < 0.05 was considered statistically significant. RESULTS After power calculation, we enrolled 18 patients in the glutamine and 22 in the control arm. There was no significant improvement in the development of infected necrosis and in-hospital mortality between the groups. Improvement in Modified Marshall score was observed in a higher proportion of patients receiving glutamine (15 [83.3%] vs. 12 [54.5%]; p = 0.05). Plasma glutamine levels improved more in glutamine-treated group (432.72 ± 307.83 vs. 618.06 ± 543.29 μM/L; p = 0.004), while it was lower in controls (576.90 ± 477.97 vs. 528.20 ± 410.45 μM/L; p = 0.003). PEG level was lower after glutamine supplementation (39.91 ± 11.97 vs. 32.30 ± 7.39 ng/mL; p = 0.02). Statistically significant reduction in IL-6 concentration was observed in the glutamine group at the end of treatment (87.44 ± 7.1 vs. 63.42 ± 33.7 μM/L; p = 0.02). CONCLUSIONS Despite absence of improvement in infected necrosis and in-hospital mortality, enteral glutamine supplementation showed improvement in gut permeability, oxidative stress, and a trend towards improvement in organ function as depicted by improvement in the Modified Marshall score. TRIAL REGISTRATION NCT01503320.
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Affiliation(s)
- Madhulika Arutla
- Department of Clinical Nutrition, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - M Raghunath
- Department of Endocrinology and Metabolism, National Institute of Nutrition, Near Tarnaka, Jamai-Osmania, Hyderabad, 500 007, India
| | - G Deepika
- Department of Biochemistry, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - Aparna Jakkampudi
- Wellcome DBT Labs., Institute of Translational Research, Asian Healthcare Foundation, Hyderabad, 500 082, India
| | - H V V Murthy
- Department of Biostatistics, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - G V Rao
- Department of Surgical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - D Nageshwar Reddy
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India
| | - Rupjyoti Talukdar
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India. .,Pancreas Clinic, Pancreas Research Group, Asian Healthcare Foundation, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500 082, India.
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Olesen SS, Frandsen LK, Poulsen JL, Vestergaard P, Rasmussen HH, Drewes AM. The prevalence of underweight is increased in chronic pancreatitis outpatients and associates with reduced life quality. Nutrition 2017; 43-44:1-7. [DOI: 10.1016/j.nut.2017.06.019] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 06/21/2017] [Accepted: 06/25/2017] [Indexed: 02/06/2023]
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Zhang Z, Pereira SL, Luo M, Matheson EM. Evaluation of Blood Biomarkers Associated with Risk of Malnutrition in Older Adults: A Systematic Review and Meta-Analysis. Nutrients 2017; 9:E829. [PMID: 28771192 PMCID: PMC5579622 DOI: 10.3390/nu9080829] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/22/2017] [Accepted: 07/31/2017] [Indexed: 01/04/2023] Open
Abstract
Malnutrition is a common yet under-recognized problem in hospitalized patients. The aim of this paper was to systematically review and evaluate malnutrition biomarkers among order adults. Eligible studies were identified through Cochrane, PubMed and the ProQuest Dialog. A meta-regression was performed on concentrations of biomarkers according to malnutrition risks classified by validated nutrition assessment tools. A total of 111 studies were included, representing 52,911 participants (55% female, 72 ± 17 years old) from various clinical settings (hospital, community, care homes). The estimated BMI (p < 0.001) and concentrations of albumin (p < 0.001), hemoglobin (p < 0.001), total cholesterol (p < 0.001), prealbumin (p < 0.001) and total protein (p < 0.05) among subjects at high malnutrition risk by MNA were significantly lower than those without a risk. Similar results were observed for malnutrition identified by SGA and NRS-2002. A sensitivity analysis by including patients with acute illness showed that albumin and prealbumin concentrations were dramatically reduced, indicating that they must be carefully interpreted in acute care settings. This review showed that BMI, hemoglobin, and total cholesterol are useful biomarkers of malnutrition in older adults. The reference ranges and cut-offs may need to be updated to avoid underdiagnosis of malnutrition.
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Affiliation(s)
- Zhiying Zhang
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Champaign, IL 61820, USA.
- Abbott Nutrition Research and Development Asia-Pacific Center, 138668 Singapore, Singapore.
| | | | - Menghua Luo
- Abbott Nutrition Research and Development, Columbus, OH 43219, USA.
| | - Eric M Matheson
- Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29412, USA.
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Olesen SS, Holst M, Køhler M, Drewes AM, Rasmussen HH. Can we rely on predicted basal metabolic rate in chronic pancreatitis outpatients? Clin Nutr ESPEN 2015; 10:e66-e70. [PMID: 28531461 DOI: 10.1016/j.clnesp.2014.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 12/18/2014] [Accepted: 12/22/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND/OBJECTIVES Malnutrition is a common complication to chronic pancreatitis (CP) and many patients need nutritional support. An accurate estimation of the basal metabolic rate (BMR) is essential when appropriate nutritional support is to be initiated, but in the clinical settings BMR is cumbersome to measure. We therefore investigated whether BMR can be reliable predicted from a standard formula (the Harris-Benedict equation) in CP outpatients. METHODS Twenty-eight patients with clinical stable CP and no current alcohol abuse were enrolled. Patients were stratified according to nutritional risk using the Nutrition Risk Screening 2002 system. Body composition was estimated using bioelectrical impedance. BMR was measured using indirect calorimetry and predicted using the Harris-Benedict equation based on anthropometric data. RESULTS The average predicted BMR was 1371 ± 216 kcal/day compared to an average measured BMR of 1399 ± 231 kcal/day (P = 0.4). The corresponding limits of agreement were -347 to 290 kcal/day. Twenty-two patients (79%) had a measured BMR between 85 and 115% of the predicted BMR. When analysing patients stratified according to nutritional risk profiles, no differences between predicted and measured BMR were evident for any of the risk profile subgroups (all P > 0.2). The BMR was correlated to fat free mass determined by bioelectrical impedance (rho = 0.55; P = 0.003), while no effect modification was seen from nutritional risk stratification in a linear regression analysis (P = 0.4). CONCLUSION The Harris-Benedict equation reliable predicts the measured BMR in four out of five clinical stable CP outpatients with no current alcohol abuse.
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Affiliation(s)
- Søren Schou Olesen
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark; Centre for Nutrition and Bowel Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark.
| | - Mette Holst
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
| | - Marianne Køhler
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
| | - Asbjørn Mohr Drewes
- Mech-Sense, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
| | - Henrik Højgaard Rasmussen
- Centre for Nutrition and Bowel Disease, Department of Gastroenterology & Hepatology, Aalborg University Hospital, Denmark
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Roberts SR. Improving Patient Outcomes Through Registered Dietitian Order Writing. Nutr Clin Pract 2013; 28:556-65. [DOI: 10.1177/0884533613499375] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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