A multidisciplinary group of international physicians involved in the medical nutrition therapy (MNT) of adult critically ill patients met to discuss the value, role, and open questions regarding ...supplemental parenteral nutrition (SPN) along with oral or enteral nutrition (EN), particularly in the intensive care unit (ICU) setting. This manuscript summarizes the discussions and results to highlight the importance of SPN as part of a comprehensive approach to MNT in critically ill adults and for researchers to generate new evidence based on well-powered randomized controlled trials (RCTs). The experts agreed on several key points: SPN has shown clinical benefits, resulting in this strategy being included in American and European guidelines. Nevertheless, its use is heterogeneous across European countries, due to the persistence of uncertainties, such as the optimal timing and the risk of overfeeding in absence of indirect calorimetry (IC), which results in divergent opinions and barriers to SPN implementation. Education is also insufficient. The experts agreed on actions needed to increase evidence quality on SPN use in specific patients at a given time point during acute critical illness or recovery.
Energy metabolism is tightly linked with circadian rhythms, exposure to ambient light, sleep/wake, fasting/eating, and rest/activity cycles. External factors, such as shift work, lead to a disruption ...of these rhythms, often called circadian misalignment. Circadian misalignment has an impact on some physiological markers. However, these proxy measurements do not immediately translate into major clinical health outcomes, as shown by later detrimental health effects of shift work and cardio-metabolic disorders. This review focuses on the effects of shift work on circadian rhythms and its implications in cardio-metabolic disorders and eating patterns. Shift work appears to be a risk factor of overweight, obesity, type 2 diabetes, elevated blood pressure, and the metabolic syndrome. However, past studies showed discordant findings regarding the changes of lipid profile and eating patterns. Most studies were either small and short lab studies, or bigger and longer cohort studies, which could not measure health outcomes in a detailed manner. These two designs explain the heterogeneity of shift schedules, occupations, sample size, and methods across studies. Given the burden of non-communicable diseases and the growing concerns about shift workers’ health, novel approaches to study shift work in real contexts are needed and would allow a better understanding of the interlocked risk factors and potential mechanisms involved in the onset of metabolic disorders.
Cancer patients suffer from metabolic and pathophysiological changes that contribute to malnutrition. These metabolic changes lead to loss of cell integrity, which induces dehydration intracellular ...and increase extracellular fluid. Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) is considered a good tool to evaluate hydration status, but in cancer patients it is not fully elucidated. Thus, in cancer patients the aims of this study were to (1) verify the association between PhA and fatigue, (2) verify the association between PhA and fatigue after adjustment for extracellular fluid accumulation, and (3) assess the prevalence of fatigue. This cross-sectional study was conducted with 124 patients of both genders on cancer treatment. Body weight, height, body mass index, handgrip strength, performance status, and cachexia were collected. In addition, body composition was evaluated by BIA to obtain hydration status and PA. The cut-off point used to classify patients with low PhA was set <4°. To identify fatigue, the Functional Assessment of Cancer Therapy Fatigue questionnaire was applied. Of the 124 patients evaluated (n = 98/79% men), 26% had fatigue. The prevalence of fatigue was higher in patients with lower PhA <4° (65.63%). In the logistic regression analyses, we found that patients with PhA >4° had lower risk for fatigue (OR: 0.92 95% CI 0.86-0.99, p = 0.03) in the crude model, however after adjustments by weight loss percentage in 6 months, age, sex, and hydration the association was not maintained (OR: 0.94 95% CI 0.85-1.04, p = 0.26). In conclusion, we found that ~26% of cancer patients have fatigue. In spite of adjustment for extracellular fluid, PhA is not associated with fatigue. The importance of measuring PhA to assess intra and extracellular hydration in cancer patients is highlighted.
Summary Background & aims Since the publications of the ESPEN guidelines on enteral and parenteral nutrition in ICU, numerous studies have added information to assist the nutritional management of ...critically ill patients regarding the recognition of the right population to feed, the energy-protein targeting, the route and the timing to start. Methods We reviewed and discussed the literature related to nutrition in the ICU from 2006 until October 2013. Results To identify safe, minimal and maximal amounts for the different nutrients and at the different stages of the acute illness is necessary. These amounts might be specific for different phases in the time course of the patient's illness. The best approach is to target the energy goal defined by indirect calorimetry. High protein intake (1.5 g/kg/d) is recommended during the early phase of the ICU stay, regardless of the simultaneous calorie intake. This recommendation can reduce catabolism. Later on, high protein intake remains recommended, likely combined with a sufficient amount of energy to avoid proteolysis. Conclusions Pragmatic recommendations are proposed to practically optimize nutritional therapy based on recent publications. However, on some issues, there is insufficient evidence to make expert recommendations.
To evaluate the association of inflammation (C-reactive protein (CRP) and neutrophil-lymphocyte ratio (NLR) levels) with muscle strength in older adults. We also aimed to evaluate whether these ...associations are sex-specific. A cross-sectional study was performed with data from the National Health and Nutrition Examination Survey (NHANES) 1999–2000 and 2001–2002. A total of 2387 individuals over 50 years of both sexes were evaluated, according to the eligibility criteria for the strength test. Muscle strength was measured by Kinetic Communicator isokinetic dynamometer; while the NLR was obtained by the ratio of the total neutrophil for lymphocyte count and CRP was quantified by latex nephelometry. Linear regression analyses, crude and adjusted for confounders, were used to estimate the coefficients and 95 % confidence intervals for peak strength (muscle strength) by tertiles of NLR and CRP. There was no association between NLR and peak strength for both sexes. CRP levels were inversely associated with peak force in men 2nd tertile β = −3.33 (−15.92; 9.25); 3rd tertile β = −24.69 (−41.18; −8.20), p for trend = 0.005, but not in women 2nd tertile β = −3.22 (−15.00; 8.56); 3rd tertile β = −9.23 (−28.40; −9.94), p for trend = 0.332. In conclusion, NLR levels were not associated with muscle strength in both sexes. CRP levels were inversely associated with muscle strength in older men, but not in women, suggesting that the association between inflammation and muscle strength in older adults can be sex-specific.
•There was no association between NLR and peak strength for both sexes.•CRP levels were inversely associated with peak force in older adult men, but not in women.•The association between inflammation and muscle strength in older adults can be sex-specific.
Summary The evaluation of quality of life (QoL) assesses patients’ well-being by taking into account physical, psychological and social conditions. Cancer and its treatment result in severe ...biochemical and physiological alterations associated with a deterioration of QoL. These metabolic changes lead to decreased food intake and promote wasting. Cancer-related malnutrition can evolve to cancer cachexia due to complex interactions between pro-inflammatory cytokines and host metabolism. Beside and beyond the physical and the metabolic effects of cancer, patients often suffer as well from psychological distress, including depression. Depending on the type of cancer treatment (either curative or palliative) and on patients’ clinical conditions and nutritional status, adequate and patient-tailored nutritional intervention should be prescribed (diet counselling, oral supplementation, enteral or total parenteral nutrition). Such an approach, which should be started as early as possible, can reduce or even reverse their poor nutritional status, improve their performance status and consequently their QoL. Nutritional intervention accompanying curative treatment has an additional and specific role, which is to increase the tolerance and response to the oncology treatment, decrease the rate of complications and possibly reduce morbidity by optimizing the balance between energy expenditure and food intake. In palliative care, nutritional support aims at improving patient's QoL by controlling symptoms such as nausea, vomiting and pain related to food intake and postponing loss of autonomy. The literature review supports that nutritional care should be integrated into the global oncology care because of its significant contribution to QoL. Furthermore, the assessment of QoL should be part of the evaluation of any nutritional support to optimize its adequacy to the patient's needs and expectations.
Summary Background & aims We hypothesize that an optimal and simultaneous provision of energy and protein is favorable to clinical outcome of the critically ill patients. Methods We conducted a ...review of the literature, obtained via electronic databases and focused on the metabolic alterations during critical illness, the estimation of energy and protein requirements, as well as the impact of their administration. Results Critically ill patients undergo severe metabolic stress during which time a great amount of energy and protein is utilized in a variety of reactions essential for survival. Energy provision for critically ill patients has drawn attention given its association with morbidity, survival and long-term recovery, but protein provision is not sufficiently taken into account as a critical component of nutrition support that influences clinical outcome. Measurement of energy expenditure is done by indirect calorimetry, but protein status cannot be measured with a bedside technology at present. Conclusions Recent studies suggest the importance of optimal and combined provision of energy and protein to optimize clinical outcome. Clinical randomized controlled studies measuring energy and protein targets should confirm this hypothesis and therefore establish energy and protein as a power couple.
Summary Background & aims Optimal nutritional care for intensive care unit (ICU) patients requires precise determination of energy expenditure (EE) to avoid deleterious under- or overfeeding. The ...reference method, indirect calorimetry (IC), is rarely accessible and inconstantly feasible. Various equations for predicting EE based on body weight (BW) are available. This study aims at determining the best prediction strategy unless IC is available. Methods Mechanically ventilated patients staying ≥72 h in the ICU were included, except those with contraindications for IC measurements. IC and BW measurements were routinely performed. EE was predicted by the ESPEN formula and other predictive equations using BW (i.e. anamnestic (AN), measured (MES), adjusted for cumulated water balance (ADJ), calculated for a body mass index (BMI) of 22.5). Comparisons were made using Pearson correlation and Bland & Altman plots. Results 85 patients (57 ± 19 y, 61 men, SAPS II 43 ± 16) were included. Correlations between IC and predicted EE using the ESPEN formula with different BW (BWAN , BWMES , BWADJ , and BWBMI22.5 ) were 0.44, 0.40, 0.36, and 0.47, respectively. Bland & Altman plots showed wide and inconsistent variations. Predictive equations including body temperature and minute ventilation showed the best correlations, but when using various BWs, differences in predicted EE were observed. Conclusion No EE predictive equation, regardless of the BW used, gives statistically identical results to IC. If IC cannot be performed, predictive equations including minute ventilation and body temperature should be preferred. BW has a significant impact on estimated EE and the use of measured BWMES or BWBMI 22.5 is associated with the best EE prediction. Clinical trial registration number on ClinicalTrial.gov: NCT02552446. Ethical committee number: CE-14-070.
The review aims at elucidating the role of lipid peroxidation of polyunsaturated fatty acids (PUFAs) in colorectal cancer (CRC) risk and treatment.
CRC is one of the most overriding threats to public ...health. Despite a broad range of treatments, up to 50% of patients will inevitably develop incurable metastatic disease. Peroxidation of PUFAs contributes to augmentation of oxidative stress and causes in consequence inflammation, which is one of the possible carcinogenic factors of CRC. End products of PUFAs might be used as biomarkers for CRC detection and surveillance for treatment. They also have cytotoxic effect in CRC cells. Experimental results suggest that ω-3 PUFAs could increase the efficacy of radiotherapy and chemotherapy of CRC.
Lipid peroxidation, one factor of oxidative stress, might play a paramount role not only in carcinogenesis but also in potential therapeutic strategy on CRC. End products of lipid peroxidation, such as malondialdehyde, 4-hydroxy-2-nonenal, and isoprostanes, could be used as biomarkers for cancer detection, surveillance of treatment outcome and prognostic index for CRC patients. Furthermore, malondialdehyde and 4-hydroxy-2-nonenal have cytotoxic effect not only in normal cells but also in CRC cancer cells, which implies the potential role of PUFAs in CRC treatment.
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