Nutrition Therapy in Critically Ill Patients with Liver Disease: A Narrative Review

Nutrition therapy in critically ill patients with liver disease represents a challenge for Intensive Care Units (ICUs). Nutritional status is correlated with the degree of hepatic dysfunction and the presence of malnutrition worsens outcomes in these patients. The nutritional risk that critically ill patients represent, together with the pathophysiological alterations of liver disease, especially in terms of nutrition intake and protein depletion, leads to malnutrition and sarcopenia. Nutrition therapy improves the survival of these patients; however, this is challenging since they more frequently experience difficulties with nutrition delivery. In consequence, both evaluation of nutritional status and an individualized approach seem mandatory for achieving nutrition objectives. The present narrative review discusses the importance of nutrition therapy, the recommendations of contemporary clinical practice guidelines, and a practical approach to provide the best possible nutrition therapy in patients with liver disease admitted to ICUs

Impact of standard nutrition therapy and medical nutrition therapy on the immune status i.e. complement C3 and C4 in severely acute malnourished children

Background: The objective of this study is to scientifically study and assess the levels of C3 and C4 in SAM children pre-and post-supplementation with MNT and SNT.Methods: In this comparative study we have analyzed C3 in 40 severely acute malnourished children pre and post medical nutrition therapy (MNT) and 35 severely acute malnourished children pre and post standard nutrition therapy (SNT) in the age group of 1 month to 3 years and C4 in 40 severely acute malnourished children pre and post medical nutrition therapy (MNT) and 35 severely acute malnourished children pre and post standard nutrition therapy (SNT) in the age group of 1 month to 3 years at LTM medical college and general hospital. C3 and C4 were analyzed by immunoturbidimetric assay method on RX Daytona analyzer.Results: The level of C3 was significantly low prior to the supplementation which increased after nutrition therapy, in both the groups. However, C4 levels decreased in both the groups. This decreased was found to be significant. The decrease of C4 in children supplemented with MNT was greater than those supplemented with SNT children.Conclusions: The values of C3 which increased after supplementation and the decreased values of C4 after supplementation were more significant in the MNT group this confirms MNT is a better therapy for curing malnutrition than that of the SNT

Therapeutic Effectiveness of Nutrition Therapy in Pediatric Patients with Chronic Liver Diseases Awaiting Liver Transplantation

Abstract It is important to prevent protein/calorie malnutrition in children with end stage liver diseases prior to transplantation. This study involved 34 patients between the ages of 10 and 156 months (mean value 25.69 months 32.2) (13 females and 21 males) on the liver transplant waiting list. Data collected as of three months before transplant and up to ten months after the procedure concerned gender, age, weight, height, Pediatric End Stage Liver Disease Score, baseline pathology, type of nutrition, type of transplant, immunosuppression, pulse steroid therapy, length of stay, and post transplant complications. Linear regression analysis showed that the length of hospital stay was 24.5 days more for females than for males, but also that intensive nutrition therapy shortens this stay for both female patients (P = 0.085) and younger patients (P = 0.023). The study population was divided into two groups according to the different nutritional therapies adopted. The Student’s t-test and Mann-Whitney test evidenced that the group receiving intensive nutrition therapy grew taller compared with the group following an oral diet (mean -1.37 and Prob = 0.043); that females grew taller compared to males (mean -1.65 +/- 0.56); and that there was an increase in height among the children in the group receiving intensive nutrition therapy despite the presence (-1.37 +/- 0.56) or absence (-14.8 +/- 5.44 and Prob = 0.035) of complications, and despite the administration (-1.03 +/- 0.33) or non administration (-1.48 +/- 0.55 and Prob = 0.019) of steroids. Intensive nutrition therapy enhances the velocity of growth in height and shortens the length of hospital stay, thus optimizing the final prognosis of the baseline pathology

Effect of medical nutrition therapy on vitamin C and malondialdehyde in HIV positive malnourished children

Background: The objective is to assess the effect of medical nutrition therapy on biochemical parameters like Vitamin C and Malondialdehyde by estimating oxidative stress in HIV positive malnourished childrens’ sample. Any alteration in the antioxidant markers can help to assess the effectiveness of MNT as a therapeutic agent. There is limited data on the use of Ready to Use Therapeutic Food (RUTF) in India. Therefore, the study was conducted to determine the effect of prepared Ready to Use Therapeutic Food (RUTF) also termed as Medical Nutrition Therapy (MNT) in HIV positive malnourished children.Methods: In this prospective comparative study, pre MNT and post MNT sample as well as the parameters-Malondialdehyde and Vitamin C were analyzed in 19 HIV positive malnourished children in the age group of 6-12 years at L.T.M.M. College. HIV positive malnourished children showed adverse effects on nutrition as well as immune system. Thus, to supply adequate micronutrients and macronutrients, the subjects were treated with Medical Nutrition Therapy (MNT).Results: The post MNT HIV positive malnourished childrens’ samples revealed significant results than pre MNT HIV positive malnourished childrens’ samples.Conclusions: The level of antioxidant marker (vitamin C) increased and peroxidation marker (MDA) decreased post medical nutrition therapy. The increased post levels of vitamin C activity helped in the eradication of excess free radicals, thereby reducing oxidative stress and hence the oxidative damage to cells as well as inhibiting lipid peroxidation (which is indicated by decreased post level MDA).

Low-carbohydrate diets for gestational diabetes

Nutrition therapy provides the foundation for treatment of gestational diabetes (GDM), and has historically been based on restricting carbohydrate (CHO) intake. In this paper, randomized controlled trials (RCTs) are reviewed to assess the effects of both low- and higher CHO nutrition approaches in GDM. The prevailing pattern across the evidence underscores that although CHO restriction improves glycemia at least in the short-term, similar outcomes could be achievable using less restrictive approaches that may not exacerbate IR. The quality of existing studies is limited, in part due to dietary non-adherence and confounding effects of treatment with insulin or oral medication. Recent evidence suggests that modified nutritional manipulation in GDM from usual intake, including but not limited to CHO restriction, improves maternal glucose and lowers infant birthweight. This creates a platform for future studies to further clarify the impact of multiple nutritional patterns in GDM on both maternal and infant outcomes

Transculturalization of a Diabetes-Specific Nutrition Algorithm: Asian Application

The prevalence of type 2 diabetes (T2D) in Asia is growing at an alarming rate, posing significant clinical and economic risk to health care stakeholders. Commonly, Asian patients with T2D manifest a distinctive combination of characteristics that include earlier disease onset, distinct pathophysiology, syndrome of complications, and shorter life expectancy. Optimizing treatment outcomes for such patients requires a coordinated inclusive care plan and knowledgeable practitioners. Comprehensive management starts with medical nutrition therapy (MNT) in a broader lifestyle modification program. Implementing diabetes-specific MNT in Asia requires high-quality and transparent clinical practice guidelines (CPGs) that are regionally adapted for cultural, ethnic, and socioeconomic factors. Respected CPGs for nutrition and diabetes therapy are available from prestigious medical societies. For cost efficiency and effectiveness, health care authorities can select these CPGs for Asian implementation following abridgement and cultural adaptation that includes: defining nutrition therapy in meaningful ways, selecting lower cutoff values for healthy body mass indices and waist circumferences (WCs), identifying the dietary composition of MNT based on regional availability and preference, and expanding nutrition therapy for concomitant hypertension, dyslipidemia, overweight/obesity, and chronic kidney disease. An international task force of respected health care professionals has contributed to this process. To date, task force members have selected appropriate evidence-based CPGs and simplified them into an algorithm for diabetes-specific nutrition therapy. Following cultural adaptation, Asian and Asian-Indian versions of this algorithmic tool have emerged. The Asian version is presented in this report