Bolus tube feeding suppresses food intake and circulating ghrelin concentrations in healthy subjects in a short-term placebo-controlled trial

Background: previous investigations suggest continuous tube feeding (TF) schedules do not suppress appetite and food intake, but bolus TF has been little studied. OBJECTIVE: We tested the hypothesis that 1) bolus TF does not suppress appetite and food intake and 2) there is no interrelation between food intake and appetite mediators (including ghrelin). Design: a single-blind, placebo-controlled trial within which 6 healthy men [body mass index (in kg/m(2)): 21.1 +/- 1.61] received 3 d of bolus TF (6.93 +/- 0.38 MJ/d of 4.18 kJ/mL multinutrient feed). For 2 d before and after TF, placebo boluses (&lt;0.4 MJ/d) were given by tube. Hourly tracking of appetite, weighed measurements of daily ad libitum food intake, and metabolic and hormonal (including ghrelin) measurements were undertaken. Results: total energy intake was significantly increased with bolus TF (18.2 +/- 1.86 MJ; P = 0.0005) despite a partial reduction in food intake compared with placebo periods (P = 0.013) and during the TF period (by 15%; P = 0.007). There was little change in hunger and fullness with bolus TF, and within-day temporal patterns did not differ whether TF or placebo was given. Changes in fasting concentrations of ghrelin (1003.6-756.0 pmol/L; P = 0.013) and other mediators (including leptin, insulin, and glucose) were significantly related to subsequent daily food intake (eg, ghrelin: r(2) = 0.81, P = 0.022). Conclusions: in this short-term study, subjects maintained appetite ratings during bolus TF by a significant reduction in food intake and changes in ghrelin and some appetite mediators related to subsequent daily food intake. Longer-term studies are required to fully ascertain the effect of TF on appetite, food intake, and appetite mediators<br/

Obesity in the elderly

In developed countries, there is a general increase in body weight and body mass index (BMI) with age, until ~60 years of age, when body weight and BMI begin to decline. The proportion of intra-abdominal fat, which is related to increased morbidity and mortality, progressively increases with age. There is also a progressive decline in energy intake and daily total energy expenditure (165 kcal/decade in men and 103 kcal/decade in women in developed countries), which is primarily due to a decrease in physical activity, and to a lesser extent, a decrease in basal metabolic rate. The decrease in physical activity is more pronounced in those with chronic disabilities and diseases. The BMI–mortality curves have been reported to move upward (greater overall mortality), become flatter (less effect of BMI on mortality), and in some cases shift to the right (minimum mortality occurs at a higher BMI), for a variety of possible reasons. Weight loss in the elderly has been reported to increase, decrease, or not alter mortality, but the studies are confounded by numerous methodological problems. It has been argued that there may be little benefit in encouraging weight loss in extreme old age (short life expectancy), especially when there are no obesity-related complications or biochemical risk factors and when strong resistance and distress arise from changes in lifelong habits of eating and exercise. In contrast, weight loss in the elderly can reduce morbidity from arthritis, diabetes and other conditions, reduce cardiovascular risk factors, and improve well-being. BMI also predicts morbidity in those without disease. Furthermore, increased physical activity in the elderly, which is an important component of weight management, can produce beneficial effects on muscle strength, endurance, and well-being

Nutritional support in Chronic Obstructive Pulmonary Disease (COPD): A randomised trial [Conference Abstract]

Rationale Nutritional support is effective in managing malnutrition in COPD (Collins et al., 2012) leading to functional improvements (Collins et al., 2013). However, comparative trials of first line interventions are lacking. This randomised trial compared the effectiveness of individualised dietary advice by a dietitian (DA) versus oral nutritional supplements (ONS). Methods A target sample of 200 stable COPD outpatients at risk of malnutrition (‘MUST’; medium + high risk) were randomised to either a 12-week intervention of ONS (ONS: ~400 kcal/d, ~40 g/d protein) or DA with supportive written advice. The primary outcome was quality of life (QoL) measured using St George’s Respiratory Questionnaire with secondary outcomes including handgrip strength, body weight and nutritional intake. Both the change from baseline and the differences between groups was analysed using SPSS version 20. Results 84 outpatients were recruited (ONS: 41 vs. DA: 43), 72 completed the intervention (ONS: 33 vs. DA: 39). Mean BMI was 18.2 SD 1.6 kg/m2, age 72.6 SD 10 years, FEV1% predicted 36 SD 15% (severe COPD). In comparison to the DA group, the ONS group experienced significantly greater improvements in protein intakes above baseline values at both week 6 (+21.0 SEM 4.3 g/d vs. +0.52 SEM 4.3 g/d; p < 0.001) and week 12 (+19.0 SEM 5.0 g/d vs. +1.0 SEM 3.6 g/d; p = 0.033;ANOVA). QoL and secondary outcomes remained stable at 12 weeks in both groups with slight improvements in the ONS group but no differences between groups. Conclusion In outpatients at risk of malnutrition with severe COPD, nutritional support involving either ONS or DA appears to maintain in tritional status, functional capacity and QoL. However, larger trials, and earlier, multi-modal nutritional interventions for an extended duration should be explored

Nutrition in acute care

Malnutrition is common in hospitalised patients but is underrecognised and undertreated. It increases mortality and complications, and delays recovery from illness during and after hospital stay. The doctor therefore has the responsibility of ensuring that malnutrition is recognised and treated appropriately. Since hospital stays are often short, there is a need to ensure continuity of care so that treatment that begins in hospital is continued in the community. Hospital physicians have the opportunity to diagnose obesity related problems, which may go unrecognised. The most obvious example is type 2 diabetes but sleep apnoea,1 which is linked to loud snoring and disrupted sleep, can present as tiredness, headaches, depression, loss of energy and even loss of memory. It commonly occurs in overweight individuals, especially those with large neck size (neck adipose tissue deposition) and responds to weight loss, although in severe cases continuous positive airway pressure may be needed. The management of obesity takes place predominantly in the community; hence the discussion that follows focuses mainly on the problem of malnutrition.<br/

The lung

Malnutrition causes loss of lung tissue and a reduction in the size and contractility of the muscles associated with breathing, such as the diaphragm. Weak respiratory muscles are unable to generate sufficient cough pressure to effectively expectorate and clear the lung of secretions, which may be infected. This chapter focuses on chronic obstructive pulmonary disease (COPD), which encompasses both chronic bronchitis and emphysema. It provides an overview of both the causes of nutritional depletion in COPD and potential therapeutic targets. While nutritional support often focuses on the fat, carbohydrate, and protein content of the diet and supplements, the provision of other nutrients is also important, especially since micronutrient deficiencies may coexist with protein‐energy deficiency. Nutritional modulation of muscle metabolism by amino acids or other substrates and co‐factors may not only be relevant to tissue repletion of wasted patients, but also in anabolism induced by exercise training

Who benefits from nutritional support: what is the evidence?

Nutritional support, including oral nutritional supplements, enteral tube feeding and parenteral nutrition, can be an important part of the management of any patient. Malnutrition is common and costly, clinically and financially, if left untreated. In patients with, or at risk of, malnutrition, the appropriate use of nutritional support can prevent complications arising, produce other clinical, functional and financial benefits, and can be life saving in some situations. This article discusses the evidence from systematic reviews and meta-analyses of the effectiveness of nutritional support

Geographical inequalities in nutrient status and risk of malnutrition among English people aged 65 y and older

Objective: Geographical inequalities in health continue to be a problem within developed countries. This study investigated whether there were north-south geographical inequalities among older people living in England with respect to risk of protein-energy malnutrition and status of nutrients, particularly those derived from fruit and vegetables.Methods: A secondary analysis of data collected prospectively by the National Diet and Nutrition Survey of people aged 65 y and older was undertaken to assess geographical prevalence of risk of protein-energy malnutrition (1155 subjects) and nutrient status (881 to 1046 subjects).Results: A north-south gradient was found in risk of protein-energy malnutrition (19.4%, 12.3%, and 11.2% in the northern, central, and southern regions, respectively; P = 0.013, P for trend = 0.002). This was accompanied by a north-south gradient in the status of vitamin C (30, 38, and 46 ?mol/L in the respective regions, P &lt; 0.001), which was associated with deficiency (&lt;11 ?mol/L) in a third of subjects in the northern region, a range of carotenoids (P = 0.023 to &lt;0.001), vitamin D (P &lt; 0.001), and selenium (P &lt; 0.001). These inequalities were accompanied by gradients in indices of health status and socioeconomic status, which could account only partly for the “geographical” inequalities. Circulating vitamin C and carotenoid concentrations were related to the intake of fruit and vegetables.Conclusions: This study suggests there is a north-south divide in the risk of protein-energy malnutrition and a range of nutrients, which have been implicated in the development of common chronic diseases