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Oliveira-Filho RS, Torrinhas RS, Tesser A, Sampaio GR, Torres E, Garla PC, Waitzberg DL. Effect of a parenteral fish oil-containing lipid emulsion on liver lipid peroxidation and antioxidant defenses in Lewis rats. JPEN J Parenter Enteral Nutr 2023; 47:572-579. [PMID: 36871108 DOI: 10.1002/jpen.2492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/26/2022] [Revised: 12/26/2022] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
Eicosapentaenoic (EPA) and docosahexaenoic (DHA) acids, naturally abundant in fish oil (FO), are known for their anti-inflammatory and potential antioxidant properties. AIM To evaluate the effect of the infusion of a fish oil-containing parenteral lipid emulsion (FOLE) on markers of liver lipid peroxidation and oxidative stress in rats undergoing central venous catheterization (CVC). METHOD After 5 days acclimatization, adult Lewis rats (n=42) receiving 20g/day AIN-93M oral diet were randomly subdivided into 4 groups: 1) Basal control (BC) (n=6): without CVC or LE infusion; 2) SHAM (n=12): with CVC, but without LE infusion; 3) SO/MCT (n=12): with CVC and receiving LE without FO (4.3g fat/kg); 4) SO/MCT/FO (n=12): with CVC and receiving LE containing 10% FO (4.3g fat/kg). Animals from the BC group were sacrificed immediately after acclimatization. The remaining groups of animals were sacrificed after 48 or 72 hours of surgical follow up to assess: liver and plasma fatty acids profiles by gas chromatography, liver gene transcription factor Nrf2, F2-isoprostane lipid peroxidation biomarker, and the antioxidant enzymes glutathione peroxidase (GPx), superoxide dismutase (SOD) and catalase (CAT) by ELISA, respectively. R program (version 3.2.2) was utilized for data analysis. RESULTS Compared to the other groups, liver EPA and DHA levels were higher in the SO/MCT/FO group, which also showed the highest liver Nrf2, GPx, SOD and CAT levels, and lower liver F2-Isoprostane (p<0.05). CONCLUSION Experimental delivery of FO, via EPA and DHA sources in a parenteral lipid emulsion was associated with a liver antioxidant effect. DESCRIPTORS fatty acids, omega-3; fish oils; parenteral nutrition; antioxidant enzymes; nuclear factor erythroid 2-related factor 2 (Nrf2); rats. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ronaldo Sousa Oliveira-Filho
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Raquel Susana Torrinhas
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Alweyd Tesser
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Geni R Sampaio
- Laboratory of Bromatology, Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Elizabeth Torres
- Laboratory of Bromatology, Department of Nutrition, Faculty of Public Health, University of São Paulo, São Paulo, Brazil
| | - Priscila Casarin Garla
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | - Dan Linetzky Waitzberg
- Laboratory of Nutrition and Metabolic Surgery (LIM-35), Department of Gastroenterology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
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Heymsfield SB, Prado CM, Cristina Gonzalez M, Cederholm T, Jensen GL, Barazzoni R, Compher C. Author Response to LTE JPEN-2022-04-138. Reply to: Evans WJ. Lean body mass should not be used as a surrogate measurement of muscle mass in malnourished men and women: Comment on Compher et al. JPEN J Parenter Enteral Nutr. 2022 Apr 19. doi: 10.1002/jpen.2384. Epub ahead of print. PMID: 35437790. JPEN J Parenter Enteral Nutr 2022; 46:1500-1501. [PMID: 35633304 DOI: 10.1002/jpen.2414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 05/24/2022] [Indexed: 11/05/2022]
Abstract
Professor Evans comments (1) on our recent Global Leadership Initiative on Malnutrition (GLIM) Guidance published in the journal (2). In the title of his letter, Dr. Evans uses the term "lean body mass", an archaic body component description long abandoned by experts in the field. We believe this term is being used to refer to fat-free mass, the now accepted terminology for the component derived as the difference between body weight and fat mass This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Steven B Heymsfield
- Pennington Biomedical Research Center, Louisiana State University, Baton Rouge, Louisiana, USA
| | - Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food & Nutritional Science, University of Alberta, Edmonton, Alberta, Canada
| | - M Cristina Gonzalez
- Post-Graduate Program in Health and Behavior, Catholic University of Pelotas, Pelotas, Rio Grande do Sul, Brazil
| | - Tommy Cederholm
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, and Theme Aging, Karolinska University Hospital, Stockholm, Sweden
| | - Gordon L Jensen
- Department of Medicine, Larner College of Medicine, University of Vermont, Burlington, Vermont, USA
| | - Rocco Barazzoni
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Charlene Compher
- Department of Biobehavioral Health Science, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
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Li P, Huang Y, Wong A. An analysis of non-nutritive calories from propofol, dextrose, and citrate among critically ill patients receiving continuous renal replacement therapy. JPEN J Parenter Enteral Nutr 2022; 46:1883-1891. [PMID: 35589384 DOI: 10.1002/jpen.2405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/10/2022] [Accepted: 05/16/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Propofol, dextrose, and citrate infusions are necessary treatment modalities in the intensive care units (ICUs). They are, however, a potential source of non-nutritive calories (NNCs) which may cause over-feeding and adverse complications. The literature surrounding the role of NNCs is limited. We aimed to examine the energy contribution of NNCs. Our secondary aim is to assess the nutritional impact of NNCs, especially among patients receiving continuous renal replacement therapy (CRRT). MATERIALS /METHODS We enrolled 177 mechanically ventilated patients admitted to medical-surgical ICUs from August to December 2019. Patients were monitored over the first 7 days of admission. Infusion rates of EN/PN and NNCs, as well as clinical characteristics, were examined. Patients receiving CRRT were compared to those without. RESULTS In total, 24% received additional energy from citrate. Patients received a maximum of 331kcal from citrate, 492kcal from propofol, and 992kcal from dextrose per ICU day. CRRT-group achieved higher total energy on the first two days (Day 1 - 55.1% vs. 46.4%; p=0.008, Day 2 - 73.2% vs. 55.4%, p=0.025). They also received higher mean NNCs on all days, except for Day 1 (p=0.068). CONCLUSION NNCs, especially citrate, are significant sources of energy. Patients receiving CRRT may have greater nutritional risk. There should be close monitoring and adaption of energy prescription accordingly to prevent over-feeding. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Priscilla Li
- Department of Dietetics and Food Services, Changi General Hospital, Singapore
| | - Yingxiao Huang
- Department of Dietetics and Food Services, Changi General Hospital, Singapore
| | - Alvin Wong
- Department of Dietetics and Food Services, Changi General Hospital, Singapore
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Grentz L, Furfari K, Keifer R, Potter NL. Appetite guided approach to pediatric enteral tube weaning in the home setting pilot study. JPEN J Parenter Enteral Nutr 2022; 46:1725-1730. [PMID: 35526140 DOI: 10.1002/jpen.2394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/06/2022] [Revised: 04/27/2022] [Accepted: 05/02/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants and children, who temporarily use feeding tubes to maintain body composition and growth, often have difficulty resuming oral feeds once medically stable. We report survey results from Growing Independent Eaters (GIE), an interdisciplinary approach providing home-based virtual support during a child-led appetite guided enteral wean. METHOD Surveys addressing participant wean success, weight, and feeding practices were sent to 76 families who participated in a GIE-led wean; 31 surveys were completed and returned. RESULTS All participants who were not eating or drinking orally pre-wean, fully or partially weaned off enteral support. Infants weaned faster (37.7 days) than children (80.1 days). Mean weight loss during the intervention was 6.6% for infants and 5.9% for children. Six-months post-wean 93% of participants surpassed their pre-wean weight. CONCLUSION The GIE method was successful for weaning infants and children off enteral support. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Grentz
- Growing Independent Eaters, Spokane, Washington, USA
| | - Kristin Furfari
- Growing Independent Eaters, Spokane, Washington, USA
- Department of Medicine, University of Colorado Denver, Denver, Colorado, USA
| | - Rebekah Keifer
- Growing Independent Eaters, Spokane, Washington, USA
- Department of Speech and Hearing Sciences, Washington State University, Spokane, Washington, USA
| | - Nancy L Potter
- Department of Speech and Hearing Sciences, Washington State University, Spokane, Washington, USA
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Evans WJ. Commentary on Guidance for assessment of the muscle mass phenotypic criterion for the Global Leadership Initiative on Malnutrition (GLIM) diagnosis of malnutrition. JPEN J Parenter Enteral Nutr 2022; 46:1497-1499. [PMID: 35437790 DOI: 10.1002/jpen.2384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022]
Abstract
The assessment of body composition and its relation to health outcomes has been an integral component of medical research. While body mass index is used as an index of overweight and obesity, the effects of the major individual components of body mass, including fat and skeletal muscle, on outcomes depends upon the accuracy of the method being used. Body composition may be measured using several different methods, each of which rely on assumptions that may not be true in all populations, ages, or clinical conditions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- William J Evans
- Department of Nutritional Sciences and Toxicology, University of California, Berkeley, Berkeley, CA.,Division of Geriatrics, Department of Medicine, Duke Medical Center, Durham, NC
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Rice TW, Bingham AL, Braunschweig C, Compher C, McCall M, Patel J, McKeever L. Reply to Martindale, et al.: Clarity, Scientific Rigor, and A Call to Action. JPEN J Parenter Enteral Nutr 2022; 46:1228-1231. [PMID: 35383997 DOI: 10.1002/jpen.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/18/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022]
Abstract
We thank the authors for their interest in our updates to the critical care nutrition guidelines and appreciate their thoughtful and germane comments. We would like to address each of their concerns, in a point by point manner, with the intention of providing clarity on the 2022 guidelines update. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Todd W Rice
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Angela L Bingham
- Department of Pharmacy, Cooper University Hospital, Camden, New Jersey, USA.,Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, Pennsylvania, USA
| | - Carol Braunschweig
- Division of Epidemiology and Biostatistics, Department of Kinesiology and Nutrition, University of Illinois, Chicago, Illinois, USA
| | - Charlene Compher
- Biobehavioral Health Sciences Department, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | | | - Jayshil Patel
- Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Liam McKeever
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Edwards ST, Glynn EF, Slogic M, Davis AM, Killian HJ, Cocjin J, Attard TM. Demographics of Children with Feeding Difficulties from a large Electronic Health Record Database. JPEN J Parenter Enteral Nutr 2022; 46:1022-1030. [PMID: 35383982 DOI: 10.1002/jpen.2379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 09/08/2021] [Revised: 02/10/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Feeding difficulties are amongst the most common concerns expressed by parents in younger children. However, few studies have reported on the characteristics of patients with clinically significant feeding diagnoses. The aim of the current study is to describe the characteristics of patients diagnosed with feeding difficulties including concurrent conditions, age and gender, sampled nationwide utilizing the Cerner Health Facts® Database (CHFD). METHODS We identified patients with a diagnosis of feeding difficulties (ICD9 783.3 or ICD10 R63.3), age 7 months to 17 years, with an outpatient visit between 2010 and 2017. The demographics and complex clinical conditions of this population were categorized. The cohort was then collapsed into a matrix defining recognized phenotype codes for ICD9 and ICD10 diagnoses to identify associated conditions. RESULTS We identified 39,674 patients (0.95%) representing 101,684 encounters from 68 health systems across the United States; 43% of patients were female. Gastrointestinal conditions were the most common, followed by malnutrition, developmental and behavioral diagnoses, and neurologic conditions. CONCLUSIONS This study is one of the most robust studies defining the prevalence, demographic characteristics and phenotypic profiling of patients with feeding difficulties. In the United States. Our observations have implications on screening and resource allocation to recognize and manage this poorly understood population. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sarah T Edwards
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
| | - Earl F Glynn
- Children's Research Institute, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Michael Slogic
- University of Missouri School of Medicine, Kansas City.,Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ann M Davis
- University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Haley J Killian
- University of Missouri School of Medicine, Kansas City.,University of Kansas Medical Center, Department of Pediatrics, Kansas City, KS, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Jose Cocjin
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
| | - Thomas M Attard
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA.,University of Missouri School of Medicine, Kansas City
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Pauline M, Fouhse J, Hinchliffe T, Wizzard P, Patrick Nation, Huynh H, Wales P, Willing B, Turner J. Probiotic Treatment Versus Empiric Oral Antibiotics for Managing Dysbiosis in Short Bowel Syndrome: Impact on the Mucosal and Stool Microbiota, Short Chain Fatty Acids and Adaptation. JPEN J Parenter Enteral Nutr 2022; 46:1828-1838. [PMID: 35383975 DOI: 10.1002/jpen.2377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 01/17/2022] [Revised: 03/22/2022] [Accepted: 03/25/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Infants and children with short bowel syndrome (SBS) are presumed to be at risk of gut microbial dysbiosis with potential sequelae of bacterial overgrowth that include sepsis, D-lactic acidosis, mucosal inflammation and malabsorption. In neonatal piglets with SBS, we compared intestinal microbial composition, short chain fatty acids (SCFA) and adaptation given probiotic treatment (Lactobacillus and Bifidobacterium spp.) versus oral metronidazole. METHODS Following 75% distal small intestinal resection, piglets were allocated to: probiotic (PRO, 500mg BID n=7), metronidazole (MET, 15mg/kg BID n=8) and placebo (PLA, 500mg BID n=8). After 10 days of parenteral and enteral nutrition, 16S rRNA gene amplicon sequencing (colon tissue and stool) were undertaken and SCFA analysis (stool and colon effluent) performed using gas chromatography. RESULTS In colon, Shannon diversity was higher for PRO compared to MET and PLA (p=0.002). PRO and PLA increased abundance of Bacteroidetes species (e.g. Bacteroides fragilis), compared to MET (p<0.001). PRO compared to PLA increased abundance of Firmicutes species (e.g. Lactobacillus fermentum) (p<0.001). MET increased abundance of Proteobacteria members, predominately Enterobacteriaceae compared to PRO (p=0.004). In stool, microbial findings were similar and SCFA (butyrate) concentrations were highest for PRO (p=0.003) compared to MET. CONCLUSION In pediatric SBS, the empiric use of oral antibiotics, such as metronidazole, is common for presumed clinical consequences of microbial dysbiosis. In this study of SBS piglets, that approach was associated with decreased microbial diversity and increased abundance of potentially inflammatory Proteobacteria. In contrast, a probiotic treatment using Lactobacillus and Bifidobacterium spp. increased both diversity and SCFAs. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mirielle Pauline
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Janelle Fouhse
- Faculty of Agriculture, Life and Environmental Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Tierah Hinchliffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela Wizzard
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick Nation
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Hien Huynh
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Paul Wales
- Department of Surgery, Cincinnati Children's Hospital Medical Center and University of Cincinnati
| | - Benjamin Willing
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Justine Turner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Eliasson J, Hvistendahl MK, Freund N, Bolognani F, Meyer C, Jeppesen PB. Apraglutide, a novel once-weekly glucagon-like peptide-2 analog, improves intestinal fluid and energy absorption in patients with short bowel syndrome: An open-label phase 1/2 metabolic balance trial. JPEN J Parenter Enteral Nutr 2022; 46:1639-1649. [PMID: 35233802 PMCID: PMC9545924 DOI: 10.1002/jpen.2362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/14/2022] [Accepted: 02/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Apraglutide is a novel long-acting glucagon-like peptide-2 (GLP-2) analog designed for once-weekly subcutaneous dosing with the potential to increase fluid and nutrient absorption by the remnant intestine of patients who have short bowel syndrome (SBS) with intestinal insufficiency (SBS-II) or intestinal failure (SBS-IF). This trial investigated the safety and effects on intestinal absorption of apraglutide in patients with SBS-II and SBS-IF. METHODS In this open-label, phase 1/2 trial, adult patients with SBS-II (n=4) or SBS-IF (n=4) and fecal output of ≥1,500 g/day received once-weekly subcutaneous 5 mg apraglutide for four weeks. Safety was the primary endpoint. Secondary endpoints included change from baseline in intestinal absorption of wet weight (indicative of fluid absorption), electrolytes, and energy (by bomb calorimetry) measured by inpatient metabolic balance studies. RESULTS Common treatment-related adverse events were decreased gastrointestinal (GI) stoma output (n=6), stoma complications (n=6), GI stoma complications (n=5), nausea (n=5), flatulence (n=4), abnormal GI stoma output (n=4), polyuria (n=3) and abdominal pain (n=3). The only treatment-related serious adverse event, experienced in one patient, was abdominal pain. Apraglutide significantly increased wet weight and energy absorption by an adjusted mean of 741 g/day (95% CI 194; 1,287; P=0.015) and 1,095 kJ/day (95% CI 196; 1,994; P=0.024), respectively. Sodium and potassium absorption significantly increased by an adjusted mean of 38 mmol/day (95% CI 3; 74; P=0.039) and 18 mmol/day (95% CI 4; 32; P=0.020), respectively. CONCLUSIONS Once-weekly 5 mg apraglutide was well-tolerated in patients with SBS-II and SBS-IF and significantly improved the absorption of fluids, electrolytes, and energy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Johanna Eliasson
- Department of Intestinal Failure and Liver Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Mark K Hvistendahl
- Department of Intestinal Failure and Liver Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Nanna Freund
- Department of Intestinal Failure and Liver Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | | | - Palle B Jeppesen
- Department of Intestinal Failure and Liver Diseases, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Martin L, Tom M, Basualdo-Hammond C, Baracos V, Gramlich L. Piloting a training program in computed tomography (CT) skeletal muscle assessment for Registered Dietitians. JPEN J Parenter Enteral Nutr 2022; 46:1317-1325. [PMID: 35147237 DOI: 10.1002/jpen.2348] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 11/29/2021] [Revised: 01/25/2022] [Accepted: 02/04/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Consensus definitions for disease-associated malnutrition and sarcopenia include reduced skeletal muscle mass as a diagnostic criterion. There is a need to develop and validate techniques to assess skeletal muscle in clinical practice. Skeletal muscle mass can be precisely quantified from computed tomography (CT) images. This pilot study aimed to train Registered Dietitians (RD) to complete precise skeletal muscle measurements using CT. METHODS Purposive sampling identified RDs employed in clinical areas where CT scans are routinely performed. CT training included: 1) a 3-day training session focused on manual segmentation of skeletal muscle cross-sectional areas (cm2 ) from abdominal CT images at the third lumber (L3) vertebra, using SliceOmatic® software, and 2) a precision assessment to quantify the intra- and inter-observer precision error of repeated skeletal muscle measurements (30 images in duplicate). Precision error is reported as the root mean standard deviation (cm2 ) and % coefficient of variation (%CV), our primary performance indicator was defined as a precision error <2%. RESULTS Five RDs completed CT training. RDs were from three clinical areas (cancer care (N=1), surgery (N=2), and critical care (N=1). RDs precision error was low and below the minimal acceptable error of <2%; intra-observer error was ≤1.8 cm2 (range 0.8 - 1.8 cm2 ) or ≤1.5% (range 0.8 - 1.5%) and inter-observer error was 1.2 cm2 or 1.1%. CONCLUSION RDs can be trained to perform precise CT skeletal muscle measurements. Increasing capacity to assess skeletal muscle is a first step toward developing this technique for use in clinical practice. CLINICAL RELEVANCE STATEMENT There is significant interest from both researchers and clinicians to undertake the measurement of skeletal muscle. Reduced skeletal muscle mass places individuals at risk of experiencing adverse outcomes and is a diagnostic criterion for disease-associated malnutrition and sarcopenia. In this study we piloted a training program in computed tomography (CT)-skeletal muscle assessments for RDs, and demonstrated after completion of the program RDs were able to perform CT skeletal muscle measurements with high precision. The addition of new tools to the comprehensive nutrition assessment tool box may benefit clinical practice in multiple ways including improved identification of patients with reduced skeletal muscle mass, individualization of interventions, and monitoring effectiveness of interventions over time. Other clinicians may also benefit from knowing about their patients' skeletal muscle mass to help identify risk and make treatment decisions. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Lisa Martin
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Mei Tom
- Alberta Health Services, Edmonton, Alberta, Canada
| | | | - Vickie Baracos
- Department of Oncology, University of Alberta. Edmonton, Alberta, Canada
| | - Leah Gramlich
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Hinchliffe T, Pauline ML, Wizzard PR, Jovel J, Nation PN, Wales PW, Madsen KL, Turner JM. The effect of fecal microbial transplant on intestinal microbial composition in short bowel neonatal piglets. JPEN J Parenter Enteral Nutr 2022; 46:1393-1403. [PMID: 35043436 DOI: 10.1002/jpen.2333] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 08/09/2021] [Revised: 11/29/2021] [Accepted: 01/03/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Short bowel syndrome (SBS) in neonates is associated with microbial dysbiosis due to intestinal surgery, prolonged hospitalization, enteral nutrition, and repeated antibiotic exposure. Sepsis and liver disease, leading causes of morbidity and mortality in SBS, may relate to such intestinal dysbiosis. We investigated the safety and feasibility of fecal microbial transplant (FMT) to alter intestinal microbial composition in SBS piglets. METHODS Following a 75% distal small intestinal resection, piglets were fed parenteral nutrition (PN) and elemental diet (ED), and randomized to saline (SAL, n=12) or FMT (n=12) treatments delivered by gastric tube on day 2 (d2). FMT donor was a healthy adult pig. Comparisons were also made to healthy sow-fed littermate controls (SOW, n=6). Stool samples were collected daily, and tissue samples were collected at baseline and termination. Microbial DNA was extracted from stool and analyzed using 16S rRNA sequencing. RESULTS All piglets survived to the endpoint. On d2-4, FMT piglets had some differences in microbiota composition, compared to SAL, SOW, and donor. Between base and term, there were transitory changes to alpha and beta diversity in FMT and SAL. CONCLUSION FMT treatment in post-surgical neonatal piglets with SBS appears safe, with no increase in sepsis and no mortality. In SBS piglets, FMT induced transient changes to the intestinal microbiota. However, these changes did not persist long-term. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Tierah Hinchliffe
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Mirielle L Pauline
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Pamela R Wizzard
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Juan Jovel
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick N Nation
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Paul W Wales
- Department of Surgery, Cincinnati Children's Hospital Medical Center and University of Cincinnati
| | - Karen L Madsen
- Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Justine M Turner
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Brown AM, Irving SY, Pringle C, Allen C, Brown MF, Nett S, Singleton MN, Mikhailov TA, Madsen E, Srinivasan V, Anthony H, Forbes ML. Bolus Gastric Feeds Improve Nutritional Delivery to Mechanically Ventilated Pediatric Medical Patients: Results of the COntinuous vs BOlus (COBO2) Multi-Center Trial. JPEN J Parenter Enteral Nutr 2021; 46:1011-1021. [PMID: 34881440 DOI: 10.1002/jpen.2305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/20/2021] [Revised: 09/28/2021] [Accepted: 11/05/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Comparison of bolus (BGF) versus continuous gastric feeding (CGF) with respect to timing and delivery of energy and protein in mechanically ventilated pediatric patients has not been investigated. We hypothesized that bolus delivery would shorten time to goal nutrition and increase the percentage of goal feeds delivered. METHODS Multi-center, prospective, randomized comparative effectiveness trial conducted in seven Pediatric ICUs (PICUs). Eligibility criteria: 1 month - 12 years of age, intubated within 24 hours of PICU admission, expected duration of ventilation at least 48 hours, eligible to begin enteral nutrition within 48 hours. EXCLUSION CRITERIA acute or chronic gastrointestinal pathology, or acute surgery. RESULTS We enrolled 158 mechanically ventilated children between October 2015 and April 2018; 147 patients were included in the analysis (BGF = 72, CGF = 75). The BGF group was slightly older than CGF, otherwise the two groups had similar demographic characteristics. There was no difference in the percentage of patients in each group that achieved goal feeds. Time to goal feeds was shorter in the BGF [Hazard Ratio 1.5 (CI 1.02-2.33); P = 0.0387]. Median percentage of target kilocalories [median kcal 0.78 vs 0.59; p = <.0001], and median percentage of protein delivered [median pro 0.77 vs 0.59; p = <.0001] was higher for BGF patients. There was no difference in serial oxygen saturation index between groups. CONCLUSION Our study demonstrated shorter time to achieve goal nutrition via BGF compared to CGF in mechanically ventilated pediatric patients. This resulted in increased delivery of target energy and nutrition. Further study is needed in other PICU populations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Ann-Marie Brown
- Associate Clinical Professor, Nell Hodgson Woodruff School of Nursing, Emory University, Nurse Scientist, Children's Healthcare of Atlanta, Atlanta, GA
| | - Sharon Y Irving
- Associate Professor, Pediatric Nursing, Vice-Chair Department of Family & Community Health, University of Pennsylvania School of Nursing, Philadelphia, PA
| | - Charlene Pringle
- Pediatric Acute Care Nurse Practitioner, Division of Pediatric Critical Care Medicine, University of Florida, UFHealth Shands Children's Hospital, Gainesville, FL
| | - Christine Allen
- Associate Professor o Pediatrics, Division of Pediatric Critical Care, University of Oklahoma Health Sciences Center, The Children's Hospital at OU Health, Oklahoma City, OK
| | - Miraides F Brown
- Biostatistician, Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, OH
| | - Sholeen Nett
- Associate Professor, Division of Pediatric Critical Care, Dartmouth Hitchcock Medical Center, Lebanon, NH and Baystate Children's Hospital, Springfield, MA
| | - Marcy N Singleton
- Pediatric Acute Care Nurse Practitioner, Dartmouth Hitchcock Medical Center, Instructor in Pediatrics Geisel School of Medicine
| | - Theresa A Mikhailov
- Professor of Pediatrics, Division of Pediatric Critical Care, Medical College of Wisconsin, Pediatric Intensivist, Children's Wisconsin, Milwaukee, WI
| | - Erik Madsen
- Assistant Professor of Pediatrics, Division of Pediatric Critical Care, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital, St. Louis, MO
| | - Vijay Srinivasan
- Assistant Professor of Anesthesiology, Critical Care and Pediatrics, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Attending Pediatric Intensivist, Department of Anesthesiology and Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Heather Anthony
- Clinical Research Support Team Supervisor, GAMUT Program Coordinator, Clinical Research Nurse, Akron Children's Hospital, Akron, OH
| | - Michael L Forbes
- Professor of Pediatrics, Northeast Ohio Medical University, Associate Chair, Department of Pediatrics, Director, Hospital-Based Medical Practices, Director, Critical Care Research & Outcomes Analysis, Akron Children's Hospital, Akron, OH
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Shahmanyan D, Lawrence JC, Lollar DI, Hamill ME, Faulks ER, Collier BR, Chestovich PJ, Bower KL. Early feeding after percutaneous endoscopic gastrostomy tube placement in trauma and surgical intensive care patients: A retrospective cohort study. JPEN J Parenter Enteral Nutr 2021; 46:1160-1166. [PMID: 34791680 DOI: 10.1002/jpen.2303] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Critically ill patients experience frequent interruptions in enteral nutrition(EN). For ventilated patients who undergo percutaneous endoscopic gastrostomy tube(PEG) placement, post-procedure fasting time varies from 1-24hrs, depending on the surgeon's preference. There is no evidence to support prolonged fasting after PEG placement. This study's purpose was to determine if there is an increased complication rate associated with reduced fasting time after PEG. METHODS 150 adult ventilated trauma and surgical ICU patients at a level I trauma center underwent PEG placement March 2015-May 2018 by one of 6 surgical intensivists. Retrospective review revealed variable post-PEG fasting practices among them: 1 started EN at 1hr, 2 at 4hrs, 2 at 6hrs, and 1 at 24hrs. Time to initiation of EN and complication rates were assessed. Patients were divided into early feeding(<4hrs) and prolonged fasting(≥4hrs) groups. RESULTS Median post-procedure fasting time was 5.5hrs. Complications included bleeding(2), infection(1), tube leak(1), feeding intolerance(1) and aspiration(0). The overall complication rate was 3.3%, with feeding intolerance rate 0.7% and aspiration rate 0%. There was no difference in complication rate for early feeding(3.1%) as compared to delayed feeding(3.4%) (OR 0.92, 95%CI 0.10-8.52, p = 0.7). CONCLUSION Complication rates following PEG placement in ventilated trauma and surgical ICU patients are low and do not change with early feeding <4hr compared to prolonged fasting ≥4hr. Early feeding after PEG is probably safe. With this data, a randomized controlled trial is underway that will provide evidence to support a more consistent practice, thus mitigating a source of EN interruption in a population vulnerable to malnutrition. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Davit Shahmanyan
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016
| | - Jeffrey C Lawrence
- Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
| | - Daniel I Lollar
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016.,Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
| | - Mark E Hamill
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016.,Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
| | - Emily R Faulks
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016.,Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
| | - Bryan R Collier
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016.,Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
| | - Paul J Chestovich
- University of Nevada, Las Vegas, Department of Surgery, 1707 W. Charleston Blvd., Suite 160, Las Vegas, NV, 89102
| | - Katie L Bower
- Virginia Tech Carilion School of Medicine and Research Institute, 2 Riverside Circle, Roanoke, VA, 24016.,Carilion Clinic, Department of Surgery, 1906 Belleview Ave., Roanoke, VA, 24014
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