One hundred thirty-eight pediatric liver transplant outpatients, who had visited the nutrition clinic in Shanghai Children’s Medical Center between January 2017 and December 2019, were recruited. The bone mineral density [BMD] z-scores were determined by dual energy X-ray absorptiometry [DXA]. Nutritional assessment was performed, and their corresponding height-for-age z-scores [HAZs]/weight-for-age z-scores [WAZs]/BMI-for-age z-scores [BMIZs] were obtained.
Adequacy of Enteral Nutritional Therapy Offered to Patients in an Intensive C...asclepiuspdfs
The document summarizes a study that evaluated the nutritional status and adequacy of enteral nutritional therapy (ENT) provided to patients in an intensive care unit (ICU) in Brazil. The study found that most patients were elderly and malnourished or at nutritional risk upon admission. However, the average calorie and protein requirements were not met, with only 40% of calorie and protein needs being adequately provided. The main reasons for inadequate ENT were delays initiating enteral tube feeding and fasting periods for clinical procedures. As a result, over 90 liters of prescribed enteral nutrition were wasted. The study concludes that malnutrition, delays starting ENT, and fasting may increase mortality risk for critically ill ICU patients.
Globally 165 million children under-five
years of age are stunted. Hence development of local
therapeutic nutritional intervention is recommended by WHO.
Present study was designed to find the efficacy of the
nutritional intervention for the recovery of impaired lipid
metabolism and correlation of weight for height% with
cholesterol, triglyceride in malnourished children. 105 test and
100 control SAM children without infection, of 1 to 5 years of
age and either sex were enrolled. Test group was given
treatment of nutritional intervention therapy, providing 2.5 to
3gm Protein and 90-100 kcal /kg body Weight/day, for the
three months. Their Anthropometric, and Biochemical
parameters were measured before and after the nutritional
therapy. Before the nutritional intervention treatment P values
for Serum Total cholesterol, Triglyceride, Weight for height
%, were insignificant suggestive of similar baseline
characteristics at enrollment. After nutritional intervention
treatment P values for Serum Total cholesterol, Triglyceride,
Weight for height % were highly significant. The r value of
Pearson correlation coefficient for triglycerides in the study
group and its ANOVA model was very significant, showing
poor positive correlation with weight for height % while for
total cholesterol it was found to be insignificant. Depending on
results we conclude that it is the most effective food supplement
for the speedy recovery of the impaired lipid metabolism in
SAM children and the use of weight for height % as a
anthropometric marker for the pre-indication of fatty liver in
malnourished children
Effects of Daily Consumption of Synbiotic Bread on Insulin Metabolism and Ser...Haleh Hadaegh
1) This randomized controlled trial examined the effects of consuming synbiotic, probiotic, or control bread on insulin metabolism and inflammation markers in 81 diabetic patients over 8 weeks.
2) Patients who consumed synbiotic bread had a significant reduction in insulin levels, insulin resistance scores, and beta-cell function compared to the probiotic and control bread groups.
3) The synbiotic bread, containing Lactobacillus sporogenes and inulin, improved insulin metabolism but did not significantly affect other measures like blood glucose, insulin sensitivity, or CRP levels compared to the other breads.
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
This document summarizes several studies on the impacts of supplementary feeding for adults living with HIV. A randomized controlled trial in Kenya found that supplementary food led to greater improvements in nutritional status and higher clinic attendance among pre-ART clients. A study in Malawi found patients receiving a fortified spread had greater BMI increases than those receiving corn-soy blend, with no differences in mortality, CD4, or viral load. A study in Zambia found food supplementation was associated with better antiretroviral therapy adherence. A study in India found supplementation resulted in weight and BMI gains only for patients with low CD4 counts.
The document discusses optimal nutrition for intensive care unit (ICU) patients, specifically the role of protein delivery. It summarizes recent studies showing:
1) Short-term high-level amino acid infusions can change protein balance in critically ill patients from negative to positive.
2) This positive effect on protein balance from supplemental amino acid infusions can last for at least 24 hours.
3) More research is still needed to determine if improving protein balance through nutrition can change patient outcomes and whether the same strategies apply to all heterogeneous ICU patients.
This pilot study assessed differences in body composition and response to a high protein liquid diet in obese adolescents with and without type 2 diabetes (T2D). 28 subjects were recruited, 19 obese without T2D and 9 obese with T2D. At baseline, the obese without T2D group had higher average body weight, fat percentage, and total fat mass than the obese with T2D group, though differences were not statistically significant due to small sample sizes. Following a 2-week high protein liquid diet, both groups saw reductions in fat mass, with average reductions of 1.4% for those without T2D and 1.2% for those with T2D. However, high dropout rates and noncompliance with
Adequacy of Enteral Nutritional Therapy Offered to Patients in an Intensive C...asclepiuspdfs
The document summarizes a study that evaluated the nutritional status and adequacy of enteral nutritional therapy (ENT) provided to patients in an intensive care unit (ICU) in Brazil. The study found that most patients were elderly and malnourished or at nutritional risk upon admission. However, the average calorie and protein requirements were not met, with only 40% of calorie and protein needs being adequately provided. The main reasons for inadequate ENT were delays initiating enteral tube feeding and fasting periods for clinical procedures. As a result, over 90 liters of prescribed enteral nutrition were wasted. The study concludes that malnutrition, delays starting ENT, and fasting may increase mortality risk for critically ill ICU patients.
Globally 165 million children under-five
years of age are stunted. Hence development of local
therapeutic nutritional intervention is recommended by WHO.
Present study was designed to find the efficacy of the
nutritional intervention for the recovery of impaired lipid
metabolism and correlation of weight for height% with
cholesterol, triglyceride in malnourished children. 105 test and
100 control SAM children without infection, of 1 to 5 years of
age and either sex were enrolled. Test group was given
treatment of nutritional intervention therapy, providing 2.5 to
3gm Protein and 90-100 kcal /kg body Weight/day, for the
three months. Their Anthropometric, and Biochemical
parameters were measured before and after the nutritional
therapy. Before the nutritional intervention treatment P values
for Serum Total cholesterol, Triglyceride, Weight for height
%, were insignificant suggestive of similar baseline
characteristics at enrollment. After nutritional intervention
treatment P values for Serum Total cholesterol, Triglyceride,
Weight for height % were highly significant. The r value of
Pearson correlation coefficient for triglycerides in the study
group and its ANOVA model was very significant, showing
poor positive correlation with weight for height % while for
total cholesterol it was found to be insignificant. Depending on
results we conclude that it is the most effective food supplement
for the speedy recovery of the impaired lipid metabolism in
SAM children and the use of weight for height % as a
anthropometric marker for the pre-indication of fatty liver in
malnourished children
Effects of Daily Consumption of Synbiotic Bread on Insulin Metabolism and Ser...Haleh Hadaegh
1) This randomized controlled trial examined the effects of consuming synbiotic, probiotic, or control bread on insulin metabolism and inflammation markers in 81 diabetic patients over 8 weeks.
2) Patients who consumed synbiotic bread had a significant reduction in insulin levels, insulin resistance scores, and beta-cell function compared to the probiotic and control bread groups.
3) The synbiotic bread, containing Lactobacillus sporogenes and inulin, improved insulin metabolism but did not significantly affect other measures like blood glucose, insulin sensitivity, or CRP levels compared to the other breads.
This document discusses enteral nutrition in preterm neonates. It notes that providing adequate nutrition to preterm infants is challenging due to immaturity of bowel function and inability to suck and swallow. While parenteral nutrition can provide nutrients, lack of enteral intake can impair gut development and function. The document reviews evidence from several Cochrane reviews on different approaches to enteral feeding in preterm infants, finding insufficient evidence to recommend one approach over others and calling for additional large randomized controlled trials to evaluate effects on important outcomes.
Works Cited Milne, Anne C., Alison Avenell, and Jan Potter. Meta-.docxkeilenettie
Works Cited
Milne, Anne C., Alison Avenell, and Jan Potter. "Meta-Analysis: Protein and Energy Supplementation in Older People."
Annals of Internal Medicine
144.1 (2006): 37-48.
ProQuest.
Web. 1 Oct. 2014.
Meta-Analysis: Protein and Energy Supplementation in Older People Anne C. Milne, MSc; Alison Avenell, MD; and Jan Potter, MBChB Background: Protein and energy undernutrition is common in older people, and further deterioration may occur during illness. Purpose: To assess whether oral protein and energy supplementa tion improves clinical and
nutritional outcomes for older people in the hospital, in an institution, or in the community. Data Sources: Cochrane Central Register of Controlled Trials (CEN TRAL), MEDLINE, EMBASE,
HealthStar, CINAHL, BIOSIS, and CAB abstracts. The authors included English- and non-English-language studies and hand-searched journals, contacted manufacturers, and sought information from trialists. The date of the most recent search of CENTRAL and MEDLINE is June 2005. Study Selection: Randomized and quasi-randomized controlled tri als of oral protein and energy
supplementation compared with placebo or control treatment in older people. Data Extraction: Two reviewers independently assessed trials for inclusion, extracted data, and assessed trial quality. Differences were resolved by consensus. Data Synthesis: Fifty-five trials were included (n = 9187 randomly tions (Peto odds ratio, 0.72 [95% Cl, 0.53 to 0.97]) and reduced mortality (Peto odds ratio, 0.66 [CI, 0.49 to 0.90]) for those un dernourished at baseline. Few studies reported evidence that suggested any change in mortality, morbidity, or function for those given supplements at home. Ten trials reported gastrointestinal disturbances, such as nausea, vomiting, and diarrhea, with oral supplements. Limitations: The quality of most studies, as reported, was poor, particularly for concealment of allocation and blinding of outcome assessors. Many studies were too small or the follow-up time was too short to detect a statistically significant change in clinical out come. The clinical results are dominated by 1 very large recent trial in patients with stroke. Although this was a high-quality trial, few participants were undernourished at baseline. Conclusions: Oral nutritional supplements can improve nutritional status and seem to reduce mortality and complications for under nourished elderly patients in the hospital. Current evidence does not support routine supplementation for older people at home or for well-nourished older patients in any setting. assigned participants). For patients in short-term care hospitals who were given oral supplements, evidence suggested fewer complica-Ann Intern Med. 2006:144:37-48. For author affiliations, see end of text.
www.annals.OIJ
ndernutrition among older people is a continuing source of concern (1, 2). Older people have longer periods of illness and longer hospital stays (3), and data show tha.
This document summarizes several studies on the impacts of supplementary feeding for adults living with HIV. A randomized controlled trial in Kenya found that supplementary food led to greater improvements in nutritional status and higher clinic attendance among pre-ART clients. A study in Malawi found patients receiving a fortified spread had greater BMI increases than those receiving corn-soy blend, with no differences in mortality, CD4, or viral load. A study in Zambia found food supplementation was associated with better antiretroviral therapy adherence. A study in India found supplementation resulted in weight and BMI gains only for patients with low CD4 counts.
The document discusses optimal nutrition for intensive care unit (ICU) patients, specifically the role of protein delivery. It summarizes recent studies showing:
1) Short-term high-level amino acid infusions can change protein balance in critically ill patients from negative to positive.
2) This positive effect on protein balance from supplemental amino acid infusions can last for at least 24 hours.
3) More research is still needed to determine if improving protein balance through nutrition can change patient outcomes and whether the same strategies apply to all heterogeneous ICU patients.
This pilot study assessed differences in body composition and response to a high protein liquid diet in obese adolescents with and without type 2 diabetes (T2D). 28 subjects were recruited, 19 obese without T2D and 9 obese with T2D. At baseline, the obese without T2D group had higher average body weight, fat percentage, and total fat mass than the obese with T2D group, though differences were not statistically significant due to small sample sizes. Following a 2-week high protein liquid diet, both groups saw reductions in fat mass, with average reductions of 1.4% for those without T2D and 1.2% for those with T2D. However, high dropout rates and noncompliance with
This study evaluated the effects of adequate protein intake through dietary counseling or protein supplementation on sarcopenic older adults. 56 sarcopenic participants were provided either dietary counseling to encourage protein intake of 1.2-1.5 g/kg body weight per day or an isocaloric protein supplement containing whey protein, leucine and vitamin D. Both groups experienced increases in muscle mass and strength after 12 weeks. However, the supplement group achieved higher protein intake and saw greater improvements in walking speed for those under age 75. The study suggests protein supplementation is a convenient way for sarcopenic older adults to meet protein requirements and may provide additional benefits for physical performance in younger older groups.
Nutrition in icu closed system nutrition benefitsSubha Deep
This document discusses the importance of ready-to-hang enteral feeding systems for critically ill patients. It notes that gastrointestinal dysfunction is common in ICU patients and can lead to malnutrition if adequate nutrition is not provided. Ready-to-hang systems have advantages over open systems like less risk of contamination, better maintenance of nutritional adequacy, and reduced nursing time. Guidelines recommend ready-to-hang formulations for critically ill patients. Clinical evidence shows benefits of ready-to-hang systems like lower rates of infection, better nutritional outcomes, and more cost-effective care.
Bone marrow transplant (BMT) recipients often require parenteral nutrition (PN) to meet their nutrient needs. While general guidelines for the provision of PN support by nutrition support teams (NSTs) have been shown to decrease inappropriate PN use, recommendations for nutrition in BMT recipients are lacking. We reviewed the charts of patients status post BMT on PN to determine whether institutional guidelines for PN initiation and continuous supervision of NSTs could be applied in this population. With the Institutional Review Board (IRB) approval, charts of adult BMT recipients on PN between June 14, 2006 and June 30, 2007 were examined. Sixty-nine charts were reviewed. Indications for initiation of PN included severe mucositis, graft versus host disease (GVHD), and other transplant related side effects resulting in poor oral intake. Among 69 patients, 37 (54%) had severe mucositis, 12 (17%) had GVHD, 2 (3%) had both mucositis and GVHD, and 18 (26%) had other side effects. It was determined that all patients met the criteria for initiation of PN support, as outlined in the guidelines form. Comprehensive guidelines for initiating PN support, developed by NSTs can also be used for BMT recipients in order to optimize their nutritional status.
This document discusses several studies that evaluated nurse-driven enteral feeding protocols in the ICU. Standard enteral feeding protocols often fail to adequately nourish critically ill patients. The studies found that nurse-driven protocols that set caloric intake targets and required starting feeds within 48 hours led to earlier initiation of feeds and higher caloric intake compared to standard protocols. One study found the percentage of patients reaching 80% of caloric needs increased from 44% to 90% with a nurse-driven protocol. The proposed intervention would implement a similar nurse-driven protocol in a randomized ICU to determine if it improves patient nourishment compared to the standard protocol.
This document summarizes a study on biochemical nutritional indicators in children with protein energy malnutrition (PEM) in Nepal. The study aimed to determine biochemical parameters related to PEM and compare them to well-nourished children. 120 children aged 6-59 months were divided into a PEM group and control group based on weight-for-height measurements. Biochemical tests found significantly lower mean total protein, albumin, and calcium levels in the PEM group compared to controls, indicating higher rates of hypoproteinemia, hypoalbuminemia, and hypocalcemia in PEM children. Educational status and occupations of parents of PEM children also differed significantly from parents of control children.
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
This essay is based on a patient who was admitted to Gondar university Hospital in the
paediatric ward with a diagnosis of sever acute malnutrition (SAM). The essay will discuss
the assessment and management of a patient by using the holistic care approach that
focuses the rehabilitation issues. After analysing the patient’s assessment and
rehabilitation aspects will be discuss with its rational supported by literature, guidelines
and standards. Finally recommendation will be given based on the evaluation of the care
to improve the quality of nursing practice to nurses in the Hospital based on its rule and
regulations
1) Enteral nutrition involves providing calories, protein, electrolytes, vitamins, and minerals through the gastrointestinal tract and is the preferred method of nutrition for critically ill patients who can tolerate it.
2) Early initiation of enteral nutrition within 48 hours for critically ill patients is recommended to provide clinical benefits over parenteral nutrition or no nutrition support.
3) Factors such as underlying disease state, severity of illness, nutritional status, and ability to be fed enterally must be considered when determining a patient's eligibility for and initiation of enteral nutrition.
Under nutrition is often an invisible and silent
emergency.2 It recognizes that hunger and malnutrition are rooted
in poverty, deprivation, and under development, and that they are
the result of inadequate access to the basic requirements for
nutritional well-being, including safe and adequate food, care,
health, education and a clean environment.1 Present study was
designed to find the efficacy of the nutritional intervention for the
recovery of impaired carbohydrate metabolism and correlation of
weight and height with PP-Sugar and BMI after nutritional
rehabilitation.105 test and 100 control SAM children without
infection, of 1 to 5 years of age and either sex were enrolled. Test
group was given treatment of nutritional intervention therapy,
providing 2.5 to 3gm Protein and 90-100 kcal / kg body
Weight/day, for the three months.
Their blood sugar, BMI, weight and height were measured before
and after the nutritional therapy. Before the nutritional
intervention treatment P values for F and PP blood glucose, BMI,
Weight and height were insignificant suggestive of similar baseline
characteristics at enrollment. After nutritional intervention
treatment P values for F and PP blood glucose, BMI, Weight and
height were significant suggestive.
The r value of Pearson correlation coefficient for Sugar PP in the
study group was, showing poor positive correlation with height and
r value for BMI in the study group was showing poor negative
correlation with height.
The r value of Pearson correlation coefficient for Sugar PP in the
study group was, showing poor negative correlation with weight
and r value for BMI in the study group was showing poor positive
correlation with weight.
Depending on results the investigators conclude that for the speedy
recovery of the impaired carbohydrate metabolism in SAM
children it is the most effective food supplement.
This document discusses enteral nutrition in infants and children. It covers nutritional assessment, indications for enteral nutrition such as inability to meet nutritional needs orally or increased metabolic demands, disease-specific considerations, formula selection, nutritional requirements, and administration methods. Enteral nutrition provides nutrients through the gastrointestinal tract and is preferable to parenteral nutrition when possible due to lower costs and health benefits from GI tract utilization.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining energy needs, choosing the route of nutrition (enteral vs parenteral), and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps in knowledge to guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide best practices for nutritional therapy and identify gaps in knowledge to help guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps requiring further research.
This document provides guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) on clinical nutrition for patients in the intensive care unit (ICU). It defines who is at nutritional risk, how to assess a patient's nutritional status, how to determine energy needs, and the appropriate route (enteral vs parenteral) and progression of nutrition support. Recommendations are given for the amount and composition of macronutrients (carbohydrates, fat, protein) to provide. Special clinical situations like dysphagia, trauma, sepsis, and obesity are also addressed. The guidelines aim to guide practitioners in providing optimal evidence-based medical nutrition therapy to critically ill patients.
Cnw170 heyland nutrition risk assessment.v3 feb 19 17 revisedbejo10
This document summarizes a presentation on nutrition risk assessment in critically ill patients. It discusses various tools and factors that can help identify patients who may benefit most from nutrition therapy, including the NUTRIC score. The NUTRIC score was developed using several variables to predict outcomes like mortality and ventilator days. Studies have since validated the NUTRIC score in different populations and databases. However, not all low NUTRIC score patients may be the same, and certain subgroups like those with low BMI or longer ICU stays may still benefit from optimal nutrition intake.
A cross-sectional study was conducted in Pakistan to evaluate maternal knowledge, attitudes and practices regarding newborn care and breastfeeding. 218 mothers were interviewed using a questionnaire. Logistic regression analysis found that presence of a professional birth attendant, sterilization of feeding bottles, and knowledge about the reasons for vaccination were significantly associated with urban residence. Maternal education level was significantly associated with several appropriate newborn care practices and knowledge, such as correct timing of weaning, adequacy of breast milk, handwashing before breastfeeding, and knowledge about jaundice. The results suggest that young, literate mothers were more likely to initiate breastfeeding earlier than older, illiterate mothers. Traditional risky newborn care practices were common. Improving
1) The study examined the effect of probiotics in preventing necrotizing enterocolitis (NEC) in preterm neonates compared to a control group.
2) 115 preterm infants weighing 750-1500g or less than 32 weeks gestation received probiotics or did not (control). The probiotic group had significantly lower incidence of NEC and fewer cases of elevated C-reactive protein.
3) However, there were no significant differences between the groups in duration of oxygen therapy, total parenteral nutrition, time to full feeding, or length of hospital stay. The study results suggest probiotics have a protective effect against NEC in preterm infants.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
Objective: Food habits may be associated with inflammation, but there is little information about processed and ultra-processed foods in children. Thus, our aim was to investigate the relationship between processed and ultra-processed foods, energy intake, total fat and saturated fats intake and high sensitivity C - reactive protein levels (hs - CRP) in children.
Design: A cross-sectional study with a population-based cluster sample.
Challenges and Practices in Modern Hand Surgery Nursingsemualkaira
Purpose This study aims to explore the changes in the patient spectrum and the challenges and practices in nursing brought about by
the evolution of modern hand surgery patients and medical development. Methods A retrospective study was conducted on clinical
data from 21,512 hand surgery patients in our hospital over the
past 15 years. T
The Impact Visceral Abdominal Fat and Muscle Mass Using CT on Patients with S...semualkaira
The association between abdominal visceral
fatty area (VFA) and muscle mass and mortality is not fully understood despite the fact that being overweight is an established
risk factor for the onset and severity of acute pancreatitis (AP). We
assessed the effect of VFA on severe AP (SAP) mortality
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Similar to Analysis of Nutritional Status and Nutritional Intervention in Infants undergoing Liver Transplantation
This study evaluated the effects of adequate protein intake through dietary counseling or protein supplementation on sarcopenic older adults. 56 sarcopenic participants were provided either dietary counseling to encourage protein intake of 1.2-1.5 g/kg body weight per day or an isocaloric protein supplement containing whey protein, leucine and vitamin D. Both groups experienced increases in muscle mass and strength after 12 weeks. However, the supplement group achieved higher protein intake and saw greater improvements in walking speed for those under age 75. The study suggests protein supplementation is a convenient way for sarcopenic older adults to meet protein requirements and may provide additional benefits for physical performance in younger older groups.
Nutrition in icu closed system nutrition benefitsSubha Deep
This document discusses the importance of ready-to-hang enteral feeding systems for critically ill patients. It notes that gastrointestinal dysfunction is common in ICU patients and can lead to malnutrition if adequate nutrition is not provided. Ready-to-hang systems have advantages over open systems like less risk of contamination, better maintenance of nutritional adequacy, and reduced nursing time. Guidelines recommend ready-to-hang formulations for critically ill patients. Clinical evidence shows benefits of ready-to-hang systems like lower rates of infection, better nutritional outcomes, and more cost-effective care.
Bone marrow transplant (BMT) recipients often require parenteral nutrition (PN) to meet their nutrient needs. While general guidelines for the provision of PN support by nutrition support teams (NSTs) have been shown to decrease inappropriate PN use, recommendations for nutrition in BMT recipients are lacking. We reviewed the charts of patients status post BMT on PN to determine whether institutional guidelines for PN initiation and continuous supervision of NSTs could be applied in this population. With the Institutional Review Board (IRB) approval, charts of adult BMT recipients on PN between June 14, 2006 and June 30, 2007 were examined. Sixty-nine charts were reviewed. Indications for initiation of PN included severe mucositis, graft versus host disease (GVHD), and other transplant related side effects resulting in poor oral intake. Among 69 patients, 37 (54%) had severe mucositis, 12 (17%) had GVHD, 2 (3%) had both mucositis and GVHD, and 18 (26%) had other side effects. It was determined that all patients met the criteria for initiation of PN support, as outlined in the guidelines form. Comprehensive guidelines for initiating PN support, developed by NSTs can also be used for BMT recipients in order to optimize their nutritional status.
This document discusses several studies that evaluated nurse-driven enteral feeding protocols in the ICU. Standard enteral feeding protocols often fail to adequately nourish critically ill patients. The studies found that nurse-driven protocols that set caloric intake targets and required starting feeds within 48 hours led to earlier initiation of feeds and higher caloric intake compared to standard protocols. One study found the percentage of patients reaching 80% of caloric needs increased from 44% to 90% with a nurse-driven protocol. The proposed intervention would implement a similar nurse-driven protocol in a randomized ICU to determine if it improves patient nourishment compared to the standard protocol.
This document summarizes a study on biochemical nutritional indicators in children with protein energy malnutrition (PEM) in Nepal. The study aimed to determine biochemical parameters related to PEM and compare them to well-nourished children. 120 children aged 6-59 months were divided into a PEM group and control group based on weight-for-height measurements. Biochemical tests found significantly lower mean total protein, albumin, and calcium levels in the PEM group compared to controls, indicating higher rates of hypoproteinemia, hypoalbuminemia, and hypocalcemia in PEM children. Educational status and occupations of parents of PEM children also differed significantly from parents of control children.
ABSTRACT- Background: Malnutrition constitutes a major public health concern worldwide and serves as an indicator
of hospitalized patient’s prognosis. Nutritional support is an essential aspect of the clinical management of children
admitted to hospital. Malnutrition has been long associated with poor quality, poor diet and inadequate access to health
care, and it remains a key global health issue that both stems from and contributes to weakness, with 50% of childhood
deaths due to principal under nutrition.
Methods: The present hospital based cross sectional study was conducted in April to Dec 2015 among 300 rural
adolescents of 9-18 years age (146 boys and 154 girls) attending the outpatient department at Patna Medical College and
Hospital, Bihar, India, belonging to the all caste communities. The nutritional status was assessed in terms of under
nutrition (weight-for-age below 3rd percentile), stunting (Height-for-age below 3rd percentile) and thinness (BMI-for-age
below 5th percentile). Diseases were accepted as such as diagnosed by pediatrician, skin specialist and medical officer.
Results: The prevalence of underweight, stunting and thinness were found to be 31%, 22.3% and 30.7% respectively. The
maximum prevalence of malnutrition was observed among early adolescents (23% - 54%) and the most common
morbidities were diarrhoea (16.7%), carbuncle / furuncle (16.7%) and scabies (12%).
Conclusion: Malnutrition among hospitalized under five children and around suffers moderately high rates of
malnutrition. Present nutrition programs attention on education for at risk children and referral to regional hospitals for
malnourished children. Screening tools to classify children at risk of developing malnutrition might be helpful.
Key-words- Malnutrition, Hospitalized children, Morbidities, Prevalence, Stunting
This essay is based on a patient who was admitted to Gondar university Hospital in the
paediatric ward with a diagnosis of sever acute malnutrition (SAM). The essay will discuss
the assessment and management of a patient by using the holistic care approach that
focuses the rehabilitation issues. After analysing the patient’s assessment and
rehabilitation aspects will be discuss with its rational supported by literature, guidelines
and standards. Finally recommendation will be given based on the evaluation of the care
to improve the quality of nursing practice to nurses in the Hospital based on its rule and
regulations
1) Enteral nutrition involves providing calories, protein, electrolytes, vitamins, and minerals through the gastrointestinal tract and is the preferred method of nutrition for critically ill patients who can tolerate it.
2) Early initiation of enteral nutrition within 48 hours for critically ill patients is recommended to provide clinical benefits over parenteral nutrition or no nutrition support.
3) Factors such as underlying disease state, severity of illness, nutritional status, and ability to be fed enterally must be considered when determining a patient's eligibility for and initiation of enteral nutrition.
Under nutrition is often an invisible and silent
emergency.2 It recognizes that hunger and malnutrition are rooted
in poverty, deprivation, and under development, and that they are
the result of inadequate access to the basic requirements for
nutritional well-being, including safe and adequate food, care,
health, education and a clean environment.1 Present study was
designed to find the efficacy of the nutritional intervention for the
recovery of impaired carbohydrate metabolism and correlation of
weight and height with PP-Sugar and BMI after nutritional
rehabilitation.105 test and 100 control SAM children without
infection, of 1 to 5 years of age and either sex were enrolled. Test
group was given treatment of nutritional intervention therapy,
providing 2.5 to 3gm Protein and 90-100 kcal / kg body
Weight/day, for the three months.
Their blood sugar, BMI, weight and height were measured before
and after the nutritional therapy. Before the nutritional
intervention treatment P values for F and PP blood glucose, BMI,
Weight and height were insignificant suggestive of similar baseline
characteristics at enrollment. After nutritional intervention
treatment P values for F and PP blood glucose, BMI, Weight and
height were significant suggestive.
The r value of Pearson correlation coefficient for Sugar PP in the
study group was, showing poor positive correlation with height and
r value for BMI in the study group was showing poor negative
correlation with height.
The r value of Pearson correlation coefficient for Sugar PP in the
study group was, showing poor negative correlation with weight
and r value for BMI in the study group was showing poor positive
correlation with weight.
Depending on results the investigators conclude that for the speedy
recovery of the impaired carbohydrate metabolism in SAM
children it is the most effective food supplement.
This document discusses enteral nutrition in infants and children. It covers nutritional assessment, indications for enteral nutrition such as inability to meet nutritional needs orally or increased metabolic demands, disease-specific considerations, formula selection, nutritional requirements, and administration methods. Enteral nutrition provides nutrients through the gastrointestinal tract and is preferable to parenteral nutrition when possible due to lower costs and health benefits from GI tract utilization.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining energy needs, choosing the route of nutrition (enteral vs parenteral), and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps in knowledge to guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide best practices for nutritional therapy and identify gaps in knowledge to help guide future research.
This document provides guidelines for clinical nutrition in the intensive care unit (ICU) developed by an expert panel. It defines key aspects of nutritional support for critically ill patients such as assessing nutritional status, determining calorie and protein needs, choosing an enteral or parenteral route, and adapting support for various clinical conditions. Special conditions like trauma, surgery, and sepsis are also addressed. The guidelines aim to provide evidence-based recommendations to optimize nutritional therapy and identify gaps requiring further research.
This document provides guidelines from the European Society for Clinical Nutrition and Metabolism (ESPEN) on clinical nutrition for patients in the intensive care unit (ICU). It defines who is at nutritional risk, how to assess a patient's nutritional status, how to determine energy needs, and the appropriate route (enteral vs parenteral) and progression of nutrition support. Recommendations are given for the amount and composition of macronutrients (carbohydrates, fat, protein) to provide. Special clinical situations like dysphagia, trauma, sepsis, and obesity are also addressed. The guidelines aim to guide practitioners in providing optimal evidence-based medical nutrition therapy to critically ill patients.
Cnw170 heyland nutrition risk assessment.v3 feb 19 17 revisedbejo10
This document summarizes a presentation on nutrition risk assessment in critically ill patients. It discusses various tools and factors that can help identify patients who may benefit most from nutrition therapy, including the NUTRIC score. The NUTRIC score was developed using several variables to predict outcomes like mortality and ventilator days. Studies have since validated the NUTRIC score in different populations and databases. However, not all low NUTRIC score patients may be the same, and certain subgroups like those with low BMI or longer ICU stays may still benefit from optimal nutrition intake.
A cross-sectional study was conducted in Pakistan to evaluate maternal knowledge, attitudes and practices regarding newborn care and breastfeeding. 218 mothers were interviewed using a questionnaire. Logistic regression analysis found that presence of a professional birth attendant, sterilization of feeding bottles, and knowledge about the reasons for vaccination were significantly associated with urban residence. Maternal education level was significantly associated with several appropriate newborn care practices and knowledge, such as correct timing of weaning, adequacy of breast milk, handwashing before breastfeeding, and knowledge about jaundice. The results suggest that young, literate mothers were more likely to initiate breastfeeding earlier than older, illiterate mothers. Traditional risky newborn care practices were common. Improving
1) The study examined the effect of probiotics in preventing necrotizing enterocolitis (NEC) in preterm neonates compared to a control group.
2) 115 preterm infants weighing 750-1500g or less than 32 weeks gestation received probiotics or did not (control). The probiotic group had significantly lower incidence of NEC and fewer cases of elevated C-reactive protein.
3) However, there were no significant differences between the groups in duration of oxygen therapy, total parenteral nutrition, time to full feeding, or length of hospital stay. The study results suggest probiotics have a protective effect against NEC in preterm infants.
Comparison of prolonged low volume milk and routine volume milk onamir mohammad Armanian
This study compared outcomes for very low birth weight neonates who were fed using either a prolonged low volume milk strategy (20 mL/kg/day for 7 days before increasing) or a routine advancing volume strategy (increasing volumes by 20 mL/kg/day). The study found that the incidence of necrotizing enterocolitis was significantly lower in infants fed with the prolonged low volume strategy compared to those fed with advancing volumes. However, infants fed with advancing volumes reached full enteral feeding volumes sooner. Overall hospital stay times and weight gain at 30 days were similar between the two groups. The study suggests prolonged low volume feeding may help reduce NEC risk in very low birth weight neonates.
Objective: Food habits may be associated with inflammation, but there is little information about processed and ultra-processed foods in children. Thus, our aim was to investigate the relationship between processed and ultra-processed foods, energy intake, total fat and saturated fats intake and high sensitivity C - reactive protein levels (hs - CRP) in children.
Design: A cross-sectional study with a population-based cluster sample.
Similar to Analysis of Nutritional Status and Nutritional Intervention in Infants undergoing Liver Transplantation (20)
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2. Volume 6 Issue 14 -2021 Research Article
clinicsofsurgery.com 2
patients’ bones based on BMD measured by DXA. We also aimed
to observe patients’ nutritional status after nutritional intervention,
including any improvement of nutritional status of patients’bones.
Our ultimate purpose was to define the significance of nutritional
intervention in improving the nutritional status of liver transplant
infants, particularly the nutritional status of their bones.
3. Materials and Methods
3.1. Research subject and data collection
One hundred thirty-eight pediatric liver transplant outpatients,
who went to the nutrition clinic in Shanghai Children’s Medical
Center between January 2017 and December 2019, were select-
ed as study subjects. Patients’ basic information including gender,
height, weight, primary disease, date of liver transplantation and
feeding status were collected. The BMD of the infants was mea-
sured and the BMD z-score was determined by DXA [DXA-3000,
Shanghai Osteosys Co., Ltd.]. A z-score equal to or greater than
zero indicated a normal BMD. Serum calcium, serum 1,25-[OH]2
-
VitD3, serum alanine aminotransferase, and serum AKP levels
were also measured.
This study was approved by the ethics committee of Shanghai
Children's Medical Center affiliated to Shanghai Jiao Tong Uni-
versity School of Medicine.
3.2. Nutritional assessment and intervention
The height and weight of outpatients who visited our nutrition
clinic were measured. The nutritional status of patients aged 0-2
was assessed according to HAZs/WAZs, and that of patients
aged greater than 2 was assessed according to BMIZ values. An
application [version 3.2.2] provided by WHO for height/weight/
BMI measurements was downloaded from http://www.who.int/
childgrowth/software/en/. It was used to assess patients’ nutri-
tional status according to their height/weight/BMI-for-age/HAZ/
WAZ/BMIZ values. A WAZ/BMI z-score lower than -2 was de-
fined as acute malnutrition, and a HAZ lower than -2 was defined
as chronic malnutrition. We also carefully asked about patients’
nutritional intake, particularly the intake of vitD. Individualized
diets were made according to children’s food intake and nutritional
status, where the energy intake was recommended to be 110%-
150% RNI. Nutrients in the diets were distributed as follows:
12%-16% total kcal was from protein, 30%-40% was from fat,
and 40%-45% was from carbohydrate. We recommended patients
to take high-quality protein and high MCT formulas. Patients after
liver transplantation should also pay careful attention to the sup-
plementation of water-soluble vitamins and minerals, including
selenium, zinc, calcium, and magnesium. We recommended a sup-
plementation of 800-1000 IU/d of vitD for patients with negative
BMD z-scores, and a supplementation of 400-800 IU/d of vitD for
patients with zero or positive BMD z-scores.
3.3. Follow-up visit
Patients were recommended for a follow-up visit to our nutrition
outpatient clinic in 1-2 months. We re-measured children’s height,
weight, BMD, and AKP levels during their follow-up visit.
3.4. Statistical analysis
SPSS 16.0 software was used for statistical analysis. Measurement
data were presented as mean ± standard deviation. Wilcoxon test
was used for the comparison of data of the same category. Mann
Whitney rank sum test was applied for the comparison of BMD
z-scores between those of malnourished and non-malnourished in-
fants. Spearman correlation analysis and cross table analysis were
used for determining the relationship between BMD z-scores and
nutritional status z-scores, and that between BMD z-scores and
AKP levels. A p value <0.05 was considered statistically signifi-
cant.
4. Results
4.1. General and baseline characteristics of patients
A total of one hundred thirty-eight children with liver transplanta-
tion in perioperative period visited our nutrition outpatient clinic,
and their BMD were measured. Among 138 pediatric patients, 68
were boys [49.3%] and 70 were girls [50.7%]. The average age of
the patients was [1.48±1.56] years old, of which 113 [81.9%] were
under 2 years old and 25 [18.1%] were over 2 years old. The study
population included 13 patients [9.4%] before liver transplanta-
tion, 80 patients [58.0%] within 100 days after transplantation, and
45 patients [32.6%] more than100 days after transplantation. 115
patients’ primary disease was biliary atresia. All the above infor-
mation was shown in Table 1.
Table 1: General and Baseline Characteristics of Pediatric Patients with Liver Transplantation
Clinical Status
Gender(n,%)
Boys 68(49.3%)
Girls 70 (50.7%)
Age(years old) 1.48±1.56
Primary disease(n, %)
Ornithine aminotransferase deficiency 1(0.7%)
Progressive familial intrahepatic cholestasis 1(0.7%)
Wilson’s disease 1(0.7%)
Alagille Syndrome 4(2.9%)
Propionic acidemia 1(0.7%)
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clinicsofsurgery.com 3
Biliary atresia 115(83.4%)
Cholestasis 3(2.3%)
Hepatoblastoma 2(1.5%)
Liver cirrhosis 1(0.7%)
Methylmalonic acidemia 4(2.9%)
Antitrypsin deficiency 1(0.7%)
Langerhans cell histiocytosis 1(0.7%)
Tyrosinemia 1(0.7%)
Cavernous transformation of portal vein 1(0.7%)
Niemann-Pick disease 1(0.7%)
At the clinic visit, had liver transplantation or not (n, %)
Before liver transplantation 13(9.4%)
Within 100 days after transplantation 80(58.0%)
More than 100 days after transplantation (including 100 days) 45(32.6%)
4.2. Nutritional status assessment and BMD measurements
Patients’nutritional status was assessed based on their WAZ, HAZ,
and BMIZ values. Forty-four patients [31.9%] had acute malnutri-
tion with WAZ/BMIZ value [-1.22±1.64], and fifty-three patients
[38.4%] had chronic malnutrition with HAZ value [-1.43±1.59].
Among patients under 2 years old, 41 of them [36.3%] with WAZ
value of [-1.50±1.51] had acute malnutrition, and 43children
[38.0%] with HAZ value of [-1.40±1.62] had chronic malnutri-
tion [Table 2]. Patients were grouped according to whether they
already had liver transplantation or not when they visited the nutri-
tion outpatient clinic. Among 13 patients who visited our nutrition
outpatient clinic before liver transplantation, 7 [53.8%] had acute
malnutrition, and 4 [30.8%] had chronic malnutrition. Among pa-
tients who visited our nutrition outpatient clinic within 100 days
after liver transplantation, 26 [32.5%] had acute malnutrition, and
30 [37.5%] had chronic malnutrition. Among patients who visited
our nutrition outpatient clinic more than 100 days after liver trans-
plantation, 11 [24.4%] had acute malnutrition, and 19 [42.2%] had
chronic malnutrition [Figure 1 and 2]. The more days’ patients
were after liver transplantation, the lower proportion of acute mal-
nutrition was, and the higher proportion of chronic malnutrition
was. However, there was no statistically significant differences
between different groups [p=0.062 and 0.435 respectively by chi
square test]. 96 patients [69.6%] had a BMD lower than normal,
and 42 patients [30.4%] had a normal BMD [z≥0]. The average
BMD z-score of patients was [-0.33±0.84]. For patients who vis-
ited our nutrition outpatient clinic before liver transplantation,
the average BMD z-score was [-0.57±0.49]. The average BMD
z-score of patients who visited nutrition clinic within 100 days af-
ter liver transplantation was [-0.34±0.85], and that of patients who
visited nutrition clinic more than 100 days after liver transplanta-
tion was [-0.24±0.91]. Spearman correlation analysis was used to
analyze the relationship between patients’ BMD results and WAZ/
HAZ/BMIZ values. As a result, there was a significant correlation
between BMD z-scores and WAZ/BMIZ values [Spearman cor-
relation coefficient=0.334, p<0.001], but there was no significant
correlation between BMD z-scores and HAZ values [Spearman
correlation coefficient=0.131, p=0.128].
Table 2: Changes of Anthropometric Parameters, BMD Levels, and Serum Indexes in Patients’ First and Follow-up Visits
At first visit At follow-up visit T-value p-value
WAZ/BMIZ-values -1.22±1.64 -0.91±1.49 -3.16 0.003
HAZ values -1.43±1.59 -1.52±1.68 0.20 0.841
BMD z-values -0.33±0.84 -0.00±0.78 -3.10 0.004
1,25-(OH)2
-D3(ng/ml) 25.18±11.25 /
Serum calcium levels(mmol/L) 1.68±0.93 /
Serum ALT levels(IU/L) 52.63±74.24 83.21±145.81 -1.14 0.261
Serum AKP levels (IU/L) 295.65±221.17 335.74±164.08 -2.65 0.012
Abbreviations: WAZ/BMIZ: weight-for-age z-scores/BMI-for-age z-scores; HAZ: height-for-age z-scores; BMD:bone
mineral density
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clinicsofsurgery.com 4
Figure 1: Comparison of the proportions of acute and chronic malnourished patients in different groups when visited our nutrition outpatient clinic.
Figure 2: The correlation analysis between BMD z-values and anthropometric z-values.
Figure 2A: There was a significant positive relationship between BMD z-values and WAZ/BMIZ values (Spearman correlation coefficient=0.334,
p<0.001).
Figure 2B: There was no significant relationship between BMD z-values and HAZ values (Spearman correlation coefficient=0.131, p=0.128).
4.3. Patients’ follow-up visits to nutrition outpatient clinic
A total of 37 children re-visited our nutrition outpatient clinic af-
ter [147±127] days of their last visit. The WAZ/BMIZ value of
these patients [-0.91±1.49]at the follow-up visit was significantly
improved compared to that at their first visit [t=0.20, p=0.841].
The HAZ value of these patients [-1.52±1.68]at the follow-up visit
was not statistically different from that at their first visit [t=0.20,
p=0.841]. The BMD z-score [-0.00±0.78] of the re-visited patients
was significantly improved from that of patients at their first visit
[t=-3.10, p=0.004].
4.4. Serological examination
At patients’ first clinic visit, their serum 1,25-[OH]2
-VitD3 lev-
el was [25.18±11.25]ng/mL [normal range: >30ng/mL], serum
calcium concentration was [1.68±0.93] mmol/L [normal range:
2.23-2.8mmol/L], serum ALT level was [52.63±74.24] IU/L [nor-
mal range: 0-75IU/L], and serum AKP level was [295.65±221.17]
IU/L [normal range: 40-150 IU/L]. At patients’ follow-up visit,
their serum ALT level was [83.21±145.81] IU/L, and their AKP
level was [335.74±164.08] IU/L.
5. Discussion
The liver is the largest and the most important metabolic organ
of human body. It plays a key role in the metabolism of various
macronutrients and micronutrients [1]. With the continuous devel-
opment of surgical technology in the field of liver transplantation,
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clinicsofsurgery.com 5
liver transplantation has become the optimal treatment for pediat-
ric patients with end-stage liver disease, liver failure, liver-based
genetic metabolic diseases and liver tumors that cannot be treated
with conventional treatments [2,3].
As the surgical technology continues to improve, the 1-year sur-
vival rate of pediatric liver transplant patients could reach 90%,
and the 15-20-year survival rate of them could reach 75% [4].
Therefore, long-term maintenance of life quality after liver trans-
plantation has become more and more significant. The nutritional
status of patients is a relevant factor to determine the progression
of liver disease. Metabolic disorders, inadequate nutrients intake,
absorption disorders, and a hyper metabolic status may lead to
malnutrition in patients during the perioperative period of liver
transplantation, increase the surgical risk, increase the incidence
of postoperative complications, prolong the length of hospital stay,
increase the cost of hospitalization, and affect the prognosis of pa-
tients after liver transplantation [5,6,7].
As the results of this study, 31.9% of the patients who have visited
our nutrition outpatient clinic had acute malnutrition, and 38.4%
of them had chronic mal nutrition. After we provided nutritional
guidance and individualized diets for liver transplant patients, the
nutritional status of the patients in their follow-up visit was signifi-
cantly improved from that in their first visit, where the difference
had a statistical significance.
In 2017, the Nutrients Magazine published a review article on
suggestions and literature review of the nutritional status assess-
ment and nutrition care plan management for perioperative liver
transplantation patients. It was suggested that the management
of liver transplant patients should include a comprehensive nutri-
tional assessment. Adequate nutritional support should be given at
all stages of liver transplantation. Oral nutrition was the primary
choice, and nutritional formulas, tube feeding and other modes of
nutrition support could be selected as needed to achieve the goal
of calorie intake. Due to the higher requirements for nutritional
intake of pediatric patients during growth and development stage
scientific feeding guidance and management was critical to reduce
the incidence of malnourishment, thus affecting patients’ long-
term prognosis [8].
In this study, we assessed the nutritional status of all the patients
who visited our nutrition outpatient clinic. The results showed that
in the patients before liver transplantation, the proportion of acute
malnourished infants was higher than that of chronic malnourished
infants. In the patients more than 100 days after liver transplanta-
tion, the proportion of chronic malnourished infants was higher
than that of acute malnourished infants.
Individualized diets were made for patients based on their target
nutrition intake, dietary habits and current diets. Formulas high in
calorie and MCT were delivered to increase patients’intake of cal-
ories and various nutrients, so as to improve patients’ nutritional
status.
Bone mass loss is common in liver transplant patients [9,10]. Stud-
ies have found that only 15% liver transplant patients had a normal
BMD. Most patients already had bone mass loss before liver trans-
plant, which would lead to bone pain, growth retardation, and even
bone fracture. Bone mass loss is particularly common in patients
within one year after liver transplantation [11-14]. In the early
stage after liver transplantation, because of the use of high-dose
glucocorticoids and other immunosuppressive drugs, the loss of
patients’ bone mass was rapid, particularly the loss of bone mass
in the spine and proximal femur. BMD measurement is one of the
key methods for the diagnosis of nutritional status of bones. It is
of great significance for fracture risk prediction, care plan deter-
mination, and follow-up management. A study has reported that
malnutrition exerts a negative impact on BMD in non-cirrhotic in-
dividuals [15]. Currently being recognized as the “gold standard”
for the diagnosis of osteoporosis, the DXA can eliminate the ef-
fects of surrounding soft tissues and bone fats on the measurement
results. It is known to be convenient, safe, noninvasive, accurate,
and precise. Another key advantage of DXA is the low radiation
exposure. The BMD, BMD z-score, and other result values were
calculated based on the bone mineral content [BMC] of the mea-
sured body position. In this study, we used DXA to measure the
BMD in liver transplant patients. It was easy to operate, and also
took a short measurement time. Almost all pediatric patients were
cooperative to complete the measurement. Approximately 70% of
the patients had a low BMD.
In a retrospective study conducted by Xuguang Zhang et al.,
55,925 children’s serum samples were collected to study the serum
vitD levels. They found that the overall rate of hypo vitaminosis
D of 65.60% [16] was similar to our study results. We further an-
alyzed the correlation between BMD and nutritional status. As a
result, the decrease of BMD was significantly correlated with the
index of acute malnutrition [WAZ/BMIZ], suggesting that the dai-
ly intake of nutrients has a significant impact on nutritional status
of bones in pediatric patients. Our nutrition outpatient clinic pro-
vided nutritional guidance and recommended a 400-800 IU/d vitD
supplementation. The BMD was significantly improved when the
patients re-visited our nutrition clinic.
Vitamin D is a type of fat-soluble ring opening steroid. It has ex-
tra skeletal effects on body’s muscles, cardiovascular system, me-
tabolism, immunity, tumorigenesis, pregnancy and fetal develop-
ment. The main physiological functions of vitD are to promote the
absorption of calcium and phosphorus in the intestine, to inhibit
the release of parathyroid hormone, to maintain the normal serum
calcium and phosphorus levels, so as to maintain bone health and
normal neuromuscular function. By mitigating the glucocorticoid
induced reduction of intestinal calcium absorption, active vitamin
D3 can alleviate the secondary hyperparathyroidism of parathy-
6. Volume 6 Issue 14 -2021 Research Article
clinicsofsurgery.com 6
roid glands, promote the differentiation and maturation of osteo-
blast precursors, enhance the immunosuppressive effect of cyclo-
sporine A, and reduce bone loss after liver transplantation [17,18].
Even in healthy children, vitamin D deficiency is very common.
China and other countries have all issued domestic and internation-
al guidelines for the prevention and treatment of vitD deficiency
[19,20]. Healthy infants, kids and adolescents are recommended to
take 400 IU of vitamin D per day, and high-risk groups should take
800-1000 IU of vitamin D per day. It has been reported that par-
ents’misunderstandings often affect their children’s intake of vitD.
The more scientific facts parents were educated on, the more ap-
propriate their children’s vitD supplementation was. In this study,
about 70% of the liver transplant children had a low BMD when
visited our nutrition outpatient clinic for the first time, and their
parents didn’t have enough knowledge on vitD supplementation.
Through the nutritional guidance given at our nutrition clinic, the
BMD of the follow-up children was significantly improved than
that of the first-visit ones [p=0.004]. It is suggested that liver trans-
plant patients should be followed up not only in the transplantation
outpatient clinic, but also in the nutrition outpatient clinic. In nutri-
tion clinic, patients’ nutrition related problems could be observed
in time, and scientific guidance of nutrients supplementation could
be given to them, so as to improve their nutritional status including
that of their bones. Ultimately, an improvement of the quality of
life and the prognosis of patients are expected.
6. Conclusion
Malnutrition, including malnutrition in bones, is common in pe-
diatric patients undergoing liver transplantation. Professional nu-
tritionists and dietitians are needed to conduct nutritional assess-
ment, and to provide individualized nutritional guidance plus vitD
supplementation suggestions for liver transplant pediatric patients.
The ultimate goal of improving patients’ nutritional status includ-
ing that of their bones will be achieved then.
7. Statement of Conflicts of Interest
The authors declare that they have no conflict of interests.
8. Funding
This work was supported by the Key Subject Program for Clini-
cal Nutrition from Shanghai Municipal Health Commission for Li
HONG [No. 2019ZB0103].
9. Financial Disclosure
The authors have indicated they have no financial relationships
relevant to this article to disclose.
10. Conflict of Interest
The authors have indicated they have no potential conflicts of in-
terest to disclose.
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