Protein Requirements in the Critically Ill Ferrie, Suzie; Allman-Farinelli, Margaret; Daley, Mark ...
JPEN. Journal of parenteral and enteral nutrition,
08/2016, Letnik:
40, Številka:
6
Journal Article
Recenzirano
Background: Current recommendations for higher protein/amino acid provision in the critically ill are based on weak evidence. This double-blinded randomized controlled trial aimed to compare standard ...amino acid intake with the higher level recommended as the minimum for critically ill patients. Methods: In total, 119 patients requiring parenteral nutrition (PN) in an intensive care unit (ICU) were randomized to receive blinded PN solutions containing amino acids at either 0.8 g/kg or 1.2 g/kg. Primary outcome was handgrip strength at ICU discharge. Secondary outcomes measured at study day 7 included handgrip strength, fatigue score (using the Chalder scale), and ultrasound measurements of muscle thickness at defined body sites. Analysis of covariance was used to control for age, sex, nutrition status (Subjective Global Assessment), Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and baseline measurement. Results: Actual amino acid delivery to the 2 groups was 0.9 and 1.1 g/kg respectively, averaged over the first 7 days. Grip strength at ICU discharge was not significantly different between groups (P = .054) despite being improved at study day 7 in the group receiving the higher level of amino acids (mean SD, 22.1 10.1 vs 18.5 11.8 kg, P = .025). These patients also had less fatigue (Chalder score, mean SD, 5.4 2.2 vs 6.2 2.2, P = .045) and greater forearm muscle thickness on ultrasound (mean SD, 3.2 0.4 vs 2.8 0.4 cm, P < .0001). Nitrogen balance was significantly better at study day 3 but not at day 7. There was no difference between groups in mortality or length-of-stay measures. Conclusion: The higher level of amino acids was associated with small improvements in a number of different measures, supporting guideline recommendations for ICU patients. This trial was registered at Australian New Zealand Clinical Trials Registry (www.anzctr.org.au) as ACTRN12609000366257.
Aim
The COVID‐19 pandemic has disrupted the Australian food supply with potential ramifications on food security. This scoping review aimed to synthesise current evidence on the prevalence of food ...insecurity and changes to factors related to food insecurity during the COVID‐19 pandemic in Australia.
Methods
A comprehensive search strategy was used to search seven databases (MEDLINE, CINAHL, Embase, Global Health, Cochrane Database of Systematic Reviews, PsycINFO, Informit Online) and Google Scholar. Included studies were written in English, published in 2020–2021 and examined food security status in Australia during the COVID‐19 pandemic and/or factors associated with food insecurity in free‐living Australian residents. Articles with participants residing in institutional settings, where meals were supplied, were excluded.
Results
A total of 700 records were identified from database, grey literature and hand searching, and nine articles were included. All studies indicated that the prevalence of food insecurity had increased due to negative changes to food availability, accessibility, usability and stability. The downturn in employment and economic circumstances following the onset of the COVID‐19 pandemic appeared to create a new group of food‐insecure Australians consisting of newly unemployed, and international students.
Conclusion
COVID‐19 has exacerbated vulnerabilities in the Australian food supply and food security. Suggested actions include ongoing data collection on the long‐term impact of COVID‐19 on food supply and security in addition to coordinated national and community responses that improve the stability of the local food supply and address underlying determinants of food insecurity.
Obesity and venous thrombosis: a review Allman-Farinelli, Margaret A
Seminars in thrombosis and hemostasis,
11/2011, Letnik:
37, Številka:
8
Journal Article
Recenzirano
The world is experiencing an obesity pandemic, with rates of obesity rising for more than two decades. Obesity is defined as a body mass index (BMI) of 30 kg/m (2) or greater. Of particular concern ...are the risks that millions of obese people are likely to develop chronic diseases and at earlier ages than their parents might have. The risk of venous thrombosis increases with obesity, so that the incidence of this pathology is also expected to rise significantly. There is remarkable and consistent evidence from a systematic review, as well as cohort and case-control studies that obesity might predispose to venous thromboembolism (VTE). The risk appears to be at least double that for normal weight subjects (BMI 20 to 24.9 kg/m (2)). Plausible mechanisms exist to explain this relationship, including the physical effects of body fat limiting venous return and a proinflammatory, prothrombotic, and hypofibrinolytic milieu. Loss of body weight has been shown to reduce the concentrations of coagulation factors and plasminogen activator inhibitor-1 toward the normal range. Whether weight loss would prevent secondary occurrence of VTE in the absence of anticoagulant therapy could not be discerned from this literature search.
Abstract Current limitations of conventional dietary assessment methods restrict the establishment of diet–disease relationships and efficacy of dietary interventions. Technology, in particular the ...use of mobile phones, may help resolve methodologic limitations, in turn improving the validity of dietary assessment and research and associated findings. This review aims to evaluate the validity, feasibility, and acceptability of dietary assessment methods that have been deployed on mobile phone platforms. In August 2013, electronic databases for health sciences were searched for English, peer-reviewed, full-text articles, published from January 1, 2001 onward; and accompanied by a hand search of available relevant publications from universities and government bodies. Studies were not limited by design, length, setting, or population group. Of 194 articles, 12 met eligibility criteria: mobile phone as the dietary recording platform and validation of energy and/or macronutrient intake against another dietary or biological reference method. Four dietary recoding methods had been validated on mobile phone platforms: electronic food diary, food photograph-assisted self-administered, 24 h recall, food photograph analysis by trained dietitians, and automated food photograph analysis. All mobile phone dietary assessment methods showed similar, but not superior, validity or reliability when compared with conventional methods. Participants' satisfaction and preferences for mobile phone dietary assessment methods were higher than those for conventional methods, indicating the need for further research. Validity testing in larger and more diverse populations, over longer durations is required to evaluate the efficacy of these methods in dietary research.
Issue Addressed: More attention to the diet and nutritional status of international students in Australian universities is indicated. This qualitative research aimed to provide an in-depth ...understanding of dietary changes among international students after they arrived in Australia.
Methods: Semi-structured interviews were conducted with international students from China and India who were studying at a large urban Australian university. An approach of interpretative phenomenological analysis was employed for coding and data analysis.
Results: A total of 14 interviews were included. International students were able to consume more international foods, dairy products and animal proteins in Australia as a result of increased exposure to a larger variety of these foods compared with their home countries. However, they experienced some difficulties in eating vegetables and authentic traditional foods due to limited availability and higher prices in Australia. It was challenging for these students to live independently and cook for themselves for the first time and with a limited food budget and time, but many students improved their cooking skills over time. Less frequent main meals with more snacking sessions were reported. Weight fluctuations were commonly experienced and craving for traditional foods no longer accessible May negatively impact mental health.
Conclusions: International students adapted to the Australian food environment but believed the food choices available did not meet their food preferences or perhaps nutritional requirements.
So What: Some intervention from universities and/or government May be needed to ease the barriers to consumption of affordable and desirable meals in a time-saving manner for international students.
Background
The rapid adoption and sustained use of social media globally has provided researchers with access to unprecedented quantities of low‐latency data at minimal costs. This may be of ...particular interest to nutrition research because food is frequently posted about and discussed on social media platforms. This scoping review investigates the ways in which social media is being used to understand population food consumption, attitudes and behaviours.
Methods
The peer‐reviewed literature was searched from 2003 to 2021 using four electronic databases.
Results
The review identified 71 eligible studies from 25 countries. Two‐thirds (n = 47) were published within the last 5 years. The USA had the highest research output (31%, n = 22) and Twitter was the most used platform (41%, n = 29). A diverse range of dataset sizes were used, with some studies relying on manual techniques to collect and analyse data, whereas others required the use of advanced software technology. Most studies were conducted by disciplines outside health, with only two studies (3%) being conducted by nutritionists.
Conclusions
It appears the development of methodological and ethical frameworks as well as partnerships between experts in nutrition and information technology may be required to advance the field in nutrition research. Moving beyond traditional methods of dietary data collection may prove social media as a useful adjunct to inform recommended dietary practices and food policies.
Key points
The use of social media analysis for nutrition research has grown significantly in the last 5 years and may prove as a useful adjunct to inform recommended dietary practices and food policies.
Most studies were conducted by researchers from non‐health disciplines such as IT and business, highlighting an opportunity for cross‐disciplinary collaborations with nutrition researchers.
The development of methodological and ethical frameworks for social media analysis is needed to increase the academic rigour of studies and support future research.
Aim
Dietetic intervention delivered by Accredited Practising Dietitians is demonstrated to improve clinical outcomes of type 2 diabetes. The aim of the present study was to assess the accessibility ...to dietetic intervention for people with type 2 diabetes in Australia.
Methods
Prevalence data and dietitian workforce distribution data were sourced from Diabetes Australia and Dietitians Association of Australia, respectively. Geographical information system mapping and statistical analysis were used to compare the ratios of dietitians to people with type 2 diabetes across the states of Australia and by index of socio‐economic advantage and disadvantage in each state.
Results
An inequitable distribution of the dietetic workforce and that of the people with type 2 diabetes across Australia was demonstrated. An uneven distribution of the workforce is evidenced across states when compared to the distribution of type 2 diabetes prevalence; with New South Wales having a better ratio than Victoria and South Australia. Maps and prevalence data revealed the dietetic workforce was mostly concentrated in affluent urban centres whereas the type 2 diabetes prevalence rates were higher in rural and remote areas and in areas of lower socio‐economic status.
Conclusions
This research highlights the need to address the limited access to dietetic intervention for those in rural, remote and disadvantaged areas which also have the greatest need. The financial burden of treating diabetic complications on the national health budget necessitates government initiatives. These should include better use of telehealth dietetic consultations and incentives for dietitians to work in rural, remote and disadvantaged areas.
Summary
Background
Painful muscle cramps occur in the majority of patients with cirrhosis impacting significantly on quality of life and sleep patterns. They are frequently unrecognised or ...overlooked. Current management is based on anecdotal evidence or case study reports.
Aim
To investigate the effect of oral taurine supplementation on frequency, duration, and intensity of muscle cramps in patients with chronic liver disease.
Methods
Patients with chronic liver disease who experienced three or more muscle cramps/week were enrolled in a double‐blinded, randomised control, crossover, taurine dose‐variable study. Each participant received either taurine supplementation or placebo for 4 weeks then crossed to the alternative arm. Primary outcome data for frequency, duration, and intensity of muscle cramps was recorded by participants. Participants recorded frequency, duration, and location of muscle cramps. Biochemical parameters, including serum taurine and methionine levels, were measured at each time point. Linear mixed models were used to analyse outcomes.
Results
Forty‐nine patients were enrolled in the study and 30 patients completed the protocol. Participants who were unable to complete the protocol were not included in the final analysis due to the absence of outcome data. The mean age of participants was 54.7 years and 70% were males. Oral taurine supplementation increased serum taurine levels (P < 0.001). There were no adverse side effects associated with taurine supplementation. Participants receiving 2 g taurine/d experienced a reduction in cramp frequency (seven cramps fewer/fortnight, P = 0.03), duration (89 minutes less/fortnight P = 0.03), and severity (1.4 units less on a Likert scale P < 0.004) compared to placebo.
Conclusions
Oral supplementation with 2 g taurine/d results in a clinically significant reduction in the frequency, duration, and intensity of muscle cramps in patients with chronic liver disease. Taurine should be considered as a safe and effective intervention in the management of muscle cramps in individuals with chronic liver disease.
This study was registered with the Australian New Zealand Clinical Trials Register: ACTRN12612000289819.
A 2011 review associated eating out with increased energy intake. Popular outlets, nutrient composition, and menus may have changed since 2011. This study aimed to investigate relative contributions ...of foods prepared outside of home to total energy, total and saturated fat, sugars, and sodium intakes. Studies were included if they were observational cohort or cross-sectional, investigated the contributions that foods prepared out of home made to energy, nutrient intakes and/or nutrient densities of adults aged 18-64 years, published between 2009 and 2019. Socio-demographic differences were explored. Data were extracted guided by the STROBE Statement for cohort and cross-sectional studies. A descriptive, qualitative synthesis was conducted. Study quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklists for Analytical Cross-sectional and Cohort Studies. Evidence strength was assessed using GRADE. Twenty-six studies were included. Higher consumption of foods purchased outside home increased intakes of energy and nutrients of public health concern, particularly in males and younger adults. Heterogeneity of definitions of foods prepared outside of home made comparison difficult. Studies frequently used self-reported consumption data, prone to misreporting. Foods prepared outside of home are associated with poorer diets. Policy and practice initiatives are required to address this.
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