Diagnosis of hospital malnutrition in the adult population

No abstract

Use of intravenous fat emulsions in adult critically ill patients: does omega 3 make a difference?

Critical illness is a multisystem process that can result in significant morbidity and mortality. In most patients, critical illness is preceded by a physiological deterioration, characterized by a catabolic state and intense metabolic changes, resulting in malnutrition and impaired immune functions.1 Intravenous lipid emulsions (IVLE) constitute the main source of energy and fatty acids (FA) in parenteral nutrition formulations and remain associated with the development of adverse effects. Different types of lipid emulsions (LE) have different effects on blood function tests and metabolic functions including inflammatory and immune response, coagulation and cell signalling. These effects appear to be based on complex modifications in the composition and structure of cell membranes, through eicosanoid and cytokine synthesis and by modulation of gene expression. Proinflammatory properties of omega-6 polyunsaturated fatty acids (PUFA) have been associated with poor clinical outcomes and have led to the development of newer generation IVLE. There is clinical data suggesting that omega-3 PUFA, particularly fish oil, have beneficial effects on the immune system, organ function and improves clinical outcomes in surgical and acute respiratory distress syndrome (ARDS) patients. In addition, there is some promising data on their use in septic patients.2-4This literature review focuses on the administration of different lipid emulsions, in particular omega-3 PUFA via the parenteral nutrition route, in critically ill adult patients. The clinical consequences associated with critical illness as well as the administration of different intravenous lipid emulsions are addressed, focusing on how omega-3 PUFA can possibly attenuate inflammation, improve outcomes and reduce complications associated with the administration of parenteral nutrition

Efficacy and safety of Saccharomyces boulardii in the treatment of acute gastroenteritis in the paediatric population: a systematic review

Context: Gastroenteritis (GE) remains the second major cause of death in the most vulnerable of the world’s populations. Potential treatments include the use of probiotics, with the yeast Saccharomyces boulardii being one such option. Objectives: The primary objective was to assess the efficacy and safety of Saccharomyces boulardii in the treatment of acute GE in the paediatric population. Method: Major electronic databases were searched from April 2014 to January 2015. Additional literature was obtained through hand-searching and reviewing of reference lists of articles and other systematic reviews. Randomised controlled trials (RCTs) in a hospital setting, involving participants < 16 years were used as the data source. Two reviewers independently screened studies for eligibility, assessed study quality and performed data extraction. Review Manager 5 was used to analyse data and a random-effects model of meta-analysis was applied owing to heterogeneity. Results: Ten of 190 articles were selected for final inclusion. A meta-analysis of five of the included studies showed that Saccharomyces boulardii compared with the control significantly shortened the duration of diarrhoea (in days) (MD –0.57, 95% CI –0.83 to –0.30, p < 0.0001), but there was no difference between groups regarding time to achieving formed stools. No adverse effects were reported. The GRADE tool assessed overall methodological quality as moderate. Conclusion: Saccharomyces boulardii showed a potential benefit in treating acute GE in the paediatric patient. A dose of 250 mg 1–2 times per day for up to 5 days showed some benefit and appears safe. Larger, rigorous RCTs are needed to investigate the efficacy and safety of Saccharomyces boulardii in order to offer specific treatment guidelines. Trial registration: CRD42014009913

Probiotic effect and dietary correlations on faecal microbiota profiles in irritable bowel syndrome

Objective: Probiotics and nutrient intakes modulate gastrointestinal (GIT) microbiota and symptoms of irritable bowel syndrome (IBS). The extent to which these factors influence the microbiota is relatively unknown. The primary objective of this paper was to investigate the effect of a probiotic on gut microbiota and IBS symptoms. The secondary objective was exploring correlations between dietary intake and gut microbiota.Design: This study was an extension of a randomised clinical trial (Clinical Trials Registry NCT018867810). Dietary intake was recorded by three-day estimated food records. Faecal samples were collected at three time points: (1) baseline (A), (2) after eight weeks’ probiotic supplementation (Lactobacillus plantarum 299v) (B) and (3) following a two-week washout period (C). Total Bacteroides spp., Bifidobacteria bifidum and Lactobacillus plantarum were quantified by quantitative real-time polymerase chain reaction (qPCR).Results: Twenty-eight diarrhoea-predominant IBS (D-IBS) and 24 constipation-predominant IBS (C-IBS) patients participated. Lactobacillus plantarum profiles at baseline (A) were significantly different between C-IBS and D-IBS (−0.956 ± 1.239 vs. −1.700 ± 1.239; p = 0.024). There was no significant change in bacterial counts after completion of the trial (B) and following the washout period (C) between groups. In both groups there were significant direct correlations between fibre and Lactobacillus plantarum and inverse correlations between fibre and Bacteroides spp. There was no difference in symptom severity scores between treatment and placebo groups during the study.Conclusion: The probiotic had no effect on symptoms and GIT microbiota. Certain nutrients strongly correlate to certain bacterial profiles, suggesting that nutrients can significantly influence gastrointestinal microbiota composition

Adjunct n-3 Long-Chain Polyunsaturated Fatty Acid Treatment in Tuberculosis Reduces Inflammation and Improves Anemia of Infection More in C3HeB/FeJ Mice With Low n-3 Fatty Acid Status Than Sufficient n-3 Fatty Acid Status

Populations at risk for tuberculosis (TB) may have a low n-3 polyunsaturated fatty acid (PUFA) status. Our research previously showed that post-infection supplementation of n-3 long-chain PUFA (LCPUFA) in TB without TB medication was beneficial in n-3 PUFA sufficient but not in low-status C3HeB/FeJ mice. In this study, we investigated the effect of n-3 LCPUFA adjunct to TB medication in TB mice with a low compared to a sufficient n-3 PUFA status. Mice were conditioned on an n-3 PUFA-deficient (n- 3FAD) or n-3 PUFA-sufficient (n-3FAS) diet for 6 weeks before TB infection. Postinfection at 2 weeks, both groups were switched to an n-3 LCPUFA [eicosapentaenoic acid (EPA)/docosahexaenoic acid (DHA)] supplemented diet and euthanized at 4- and 14- days post-treatment. Iron and anemia status, bacterial loads, lung pathology, lung cytokines/chemokines, and lung lipid mediators were measured. Following 14 days of treatment, hemoglobin (Hb) was higher in the n-3FAD than the untreated n-3FAS group (p = 0.022), whereas the n-3FAS (drug) treated control and n-3FAS groups were not. Proinflammatory lung cytokines; interleukin-6 (IL-6) (p = 0.011), IL-1a (p = 0.039), MCP1 (p = 0.003), MIP1- a (p = 0.043), and RANTES (p = 0.034); were lower, and the antiinflammatory cytokine IL-4 (p=0.002) and growth factor GMCSF (p=0.007) were higher in the n-3FAD compared with the n-3FAS mice after 14 days. These results suggest that n-3 LCPUFA therapy in TB-infected mice, in combination with TB medication, may improve anemia of infection more in low n-3 fatty acid status than sufficient status mice. Furthermore, the low n-3 fatty acid status TB mice supplemented with n-3 LCPUFA showed comparatively lower cytokine-mediated inflammation despite presenting with lower pro-resolving lipid mediators

Omega-3 long-chain polyunsaturated fatty acids promote antibacterial and inflammation-resolving effects in Mycobacterium tuberculosis-infected C3HeB/FeJ mice, dependent on fatty acid status

AbstractNon-resolving inflammation is characteristic of tuberculosis (TB). Given their inflammation-resolving properties,n-3 long-chain PUFA (n-3 LCPUFA) may support TB treatment. This research aimed to investigate the effects ofn-3 LCPUFA on clinical and inflammatory outcomes ofMycobacterium tuberculosis-infected C3HeB/FeJ mice with either normal or lown-3 PUFA status before infection. Using a two-by-two design, uninfected mice were conditioned on either ann-3 PUFA-sufficient (n-3FAS) or -deficient (n-3FAD) diet for 6 weeks. One week post-infection, mice were randomised to eithern-3 LCPUFA supplemented (n-3FAS/n-3+ andn-3FAD/n-3+) or continued onn-3FAS orn-3FAD diets for 3 weeks. Mice were euthanised and fatty acid status, lung bacterial load and pathology, cytokine, lipid mediator and immune cell phenotype analysed.n-3 LCPUFA supplementation inn-3FAS mice lowered lung bacterial loads (P= 0·003), T cells (P= 0·019), CD4+T cells (P= 0·014) and interferon (IFN)-γ(P< 0·001) and promoted a pro-resolving lung lipid mediator profile. Compared withn-3FAS mice, then-3FAD group had lower bacterial loads (P= 0·037), significantly higher immune cell recruitment and a more pro-inflammatory lipid mediator profile, however, significantly lower lung IFN-γ, IL-1α, IL-1βand IL-17, and supplementation in then-3FAD group provided no beneficial effect on lung bacterial load or inflammation. Our study provides the first evidence thatn-3 LCPUFA supplementation has antibacterial and inflammation-resolving benefits in TB when provided 1 week after infection in the context of a sufficientn-3 PUFA status, whilst a lown-3 PUFA status may promote better bacterial control and lower lung inflammation not benefiting fromn-3 LCPUFA supplementation

Editorial: Hospital malnutrition in children: what are the challenges?

No Abstrac

The impact of existing diabetes self-management education interventions on knowledge, attitudes and practices in public health care institutions in Harare, Zimbabwe

Introduction: Diabetes self-management education (DSME) and medical nutrition therapy (MNT), provided by diabetes educators and registered dietitians respectively, considerably improve glycaemic control. However, it is unknown what interventions exist in many African countries and the impact thereof. Aim: To determine the impact of existing DSME interventions on knowledge, attitudes and practices (KAP) of adults with type 2 diabetes attending public health care facilities in Harare, Zimbabwe. Methods: A cross-sectional, researcher-administered survey was designed to assess DSME KAP at eight outpatient diabetes clinics that provide diabetes services. Participants were conveniently sampled. Associations between mean scores for knowledge, attitudes and practices were compared between characteristics of DSME interventions. Results: A total of 154 participants were recruited and divided evenly between two tertiary (n = 77) and six primary outpatient clinics (n = 77). The mean age was 61.8 years (SD ± 12.7), mean years since diagnosis with diabetes was 8.1 years (SD ± 8.3) and the majority were females (66.9%, n = 103). Most participants (90.3%, n = 139) reported receiving some DSME. Participants most frequently cited a tertiary clinic as the place where DSME was received. Fewer had consulted a dietitian (49.0%, n = 76) or diabetes educator (52.0%, n = 80). Higher levels of diabetes knowledge were observed for tertiary clinic attendees (p = 0.00), consultation with a dietitian (p < 0.01) and diabetes educator (p = 0.00). Only those who had consulted a dietitian reported better adherence to dietary guidelines (p = 0.00) and physical activity (p = 0.02) self-care behaviours. Conclusion: Dietitian-led interventions significantly improved both knowledge and practices, highlighting a need to scale up dietetic intervention, particularly in primary clinics where limited interventions occur

Assessment of knowledge, attitude and practice of nurses regarding enteral nutrition at a military hospital

Background and objectives: Enteral nutrition (EN) support plays a vital role in reducing malnutrition in hospitalised patients, and its provision is primarily a nurse’s role. Therefore, nurses need to have adequate knowledge and a positive attitude regarding EN. This study aimed to determine the knowledge, attitudes and practices (KAPs) regarding enteral nutrition of nursing personnel at 1 Military Hospital and to determine the need for updated in-service training. Method: A descriptive, cross-sectional study with an analytical component was used to collect data from military nurses through a validated self-administered questionnaire. A score of 80% and above was rated as adequate knowledge. Descriptive statistics were employed to describe the results and correlations were used to determine relationships between continuous variables. Results: In total, 207 (86.2% response rate) questionnaires were completed. The median knowledge score was 46.3% (mean 45.8 ± 13.7%, range 6.3–81.2%). Only one participant achieved the target score of ≥ 80%, and 16.3% scored ≥ 60%. No significant differences were found between knowledge and professional rank (p = 0.14) and knowledge and years of working experience (r = −0.01; p = 0.85). A positive attitude towards EN was found and 96.1% of participants expressed the need for additional in-service training. Conclusion: The nursing personnel have inadequate EN knowledge, irrespective of their professional rank and experience. However, they are perceived to have positive attitudes towards the importance and administration of EN. Therefore, in-service training should be conducted regularly to mitigate the gap in knowledge