Protein-Energy Malnutrition in Patients with Liver Cirrhosis

Protein-energy malnutrition (PEM) is frequently seen in patients with liver cirrhosis. This condition is associated with a poorprognosis and reduced survival. We investigated the protein and energy metabolic status, including serum albumin concentration,and resting energy expenditure (REE) and respiratory quotient (RQ) measured by indirect calorimetry in 23 patients withliver cirrhosis (8 men and 15 women; mean age, 60.3 years). The median value of %REE (measured REE / predicted REE)was highest in Child-Pugh grade A and lowest in grade C, and the range of RQ tended to be highest in Child-Pugh grade Aand lowest in grade C, although there were not statistically significant (p=0.871 and 0.664, respectively). Serum triglycerideconcentration was significantly lower in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85 ormore, and free fatty acid tended to be higher in patients who had an RQ less than 0.85 than in patients who had an RQ of 0.85or more. Of the 23 patients, 78.3% were in a state of protein and/or energy malnutrition and 47.8% had PEM. Our results suggestthat %REE and RQ were not significantly associated with liver function, but the oxidation rate of fat was increased in advancedliver cirrhosis. A longitudinal study in a large population is needed to determine the efficacy of %REE and RQ measurementsfor adequate nutritional treatment and improvement of patient outcome

The Relationship between Energy Expenditure and Type or Stage of Cancer

Malnutrition commonly occurs in patients with cancer. This situation can be associated with increased morbidity and mortality.The etiology is not clearly understood but decreased energy intake and increased energy expenditure may be involved. Weaimed to investigate the energy metabolic status including energy expenditure in patients with various cancers. The clinicalfeatures and energy metabolic status measured by indirect calorimetry of 74 patients with cancer (50 men and 24 women;mean age, 64.7 years) were obtained from the medical records. Hypermetabolism was more common and REE/kg (resting energyexpenditure / kg body weight) seems to be more reliable in estimating the true energy expenditure than %REE (measuredREE / predicted REE). The REE/kg and VO2 /kg (oxygen consumption per minute / kg body weight) varied among cancertypes, i.e., they were significantly higher in gastric cancer than in hepatocellular carcinoma. Moreover, REE/kg and VO2/kg wassignificantly higher in cancer stage IV than in stage I, or stages I and II. Patients with or at risk for malnutrition should receiveappropriate nutritional support, which has to be personalized according to tumor site, tumor stage, and the nutritional statusof the patient. This nutritional support should improve not only the patients\u27 quality of life but also their survival

テレビ電話を利用した在宅虚弱高齢者同士のネットワーク形成

在宅虚弱高齢者の生きがいと社会参加を促進すると共に、社会的孤立感の解消や自立生活の助長をはかることを目的として、在宅虚弱高齢者14名のネットワークをテレビ電話を活用して形成する試みを開始し1年が経過した。1年間におけるネットワーク形成の過程の分析から、テレビ電話をほぼ毎日利用するグループとテレビ電話を週1回程度利用するグループおよび月1回程度利用するグループに分類できた。さらに、テレビ電話の利用は、社会的孤立感の解消や自立生活の援助になりえていることが明らかになった

コーディネーター介入による在宅虚弱高齢者同士のテレビ電話を活用したネットワーク形成

在宅虚弱高齢者の社会的孤立感の解消や自立生活の助長をはかることを目的として、在宅虚弱高齢者同士のネットワークをテレビ電話を活用し、コーディネーターの介入により形成する試みを開始した。対象者及びネットワークの形成を促進するコーディネーターを選定した後、対象者にテレビ電話を設置し評価基準を定めて介入をした。2ヶ月間の介入をした段階で、在宅虚弱高齢者同士のネットワークの形成に向けての動きが見られた