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PubMed1976

Effect of nutrition education on the nutritional status of low-income pregnant women of Mexican descent.

Low-income pregnant women of Mexican descent were studied to determine whether their food habits could be improved by nutrition education. Biochemical indices of nutritional status were also investigated. Twenty-four-hour dietary recalls were obtained at an initial interview and again at a final interview after a nutrition education program, which was offered to a randomly selected treatment group. At the initial interview, the mean nutrient intakes that were most often below two-thirds of the Recommended Dietary Allowance (RDA) were iron, vitamin A, thiamin, and calcium. The mean energy value of the diets was also frequently below the RDA. At the final intakes, although the mean energy values and the calcium and carbohydrate of both the control and treatment groups increased significantly, the following improvements in dietary intakes were seen only within the treatment group: 1) there were significant increases in the mean intake of protein, ascorbic acid, niacin, riboflavin, and thiamin, 2) there were significant decreases in the percentage of intakes below two-thirds of the RDA for ascorbic acid and riboflavin, and 3) there was a significant decrease in the incidence of multiple low nutrient intakes. These dietary improvements, which occurred only in the treatment group, suggest the effectiveness of the nutrition education program. The most common biochemical deficiencies were of folic acid, thiamin, and riboflavin. Except for an improvement in mean serum folate levels, the biochemical indices for the treatment group did not appear to be influenced by the nutrition education. It is possible that the vitamin and mineral supplements which were taken by 80% of the women could have obscured improvements in biochemical indices which may have been due to the education program.

Adult↗
PubMedDate not supplied

Parenteral nutrition and nutritional support in Veterans Administration Medical Centers.

Two surveys eliciting information regarding parenteral nutrition and nutritional support in Veterans Administration Medical Centers were performed in 1981. Of 133 answering Veterans Administration Medical Centers, 45% had nutritional support teams. Two-thirds of these nutritional support groups were reported to be active. If an attempt to assess the quality of these programs is made by establishing performance criteria, then 23 medical centers have active and well-functioning nutritional support programs.

Hospitals, Veterans↗
PubMedDate not supplied

Nutrition education in schools of nursing in the United States. Part 2: The status of nutrition education in schools of nursing.

To explore whether nurses in academic institutions are being adequately educated to care for patients' nutritional needs, we conducted a survey of National League for Nursing accredited baccalaureate programs in the United States and their associated graduate programs. Data indicate that nutrition content is an integral part of baccalaureate nursing programs. Less emphasis is reported on nutrition content at the graduate level. Recommendations include revision of the substantive nutritive content and increased clinical experience in nutrition in both undergraduate and graduate nursing education.

Curriculum↗
PubMedDate not supplied

Parenteral nutrition in cancer patients receiving chemotherapy: effects on toxicity and nutritional status.

The role of total parenteral nutrition (TPN) in reducing toxicity related to cancer chemotherapy (CT) is presently a controversial issue. To evaluate the effectiveness of TPN in reducing CT-associated toxicity and correcting and preventing CT-related impairments of nutritional status, a prospective crossover controlled study was performed in 43 cancer patients (19 normally nourished and 24 malnourished) randomly divided into two groups (A and B). Group A patients received TPN concomitantly with the first course of chemotherapy, and the second course was administered 21 to 28 days later without TPN support; group B patients were treated in the opposite sequence. The rates of myelotoxicities and gastrointestinal toxicities after CT courses with or without TPN were essentially similar in normally nourished and malnourished patients. No changes in nutritional indexes were detected in normally nourished subjects after each course. Conversely, in undernourished subjects, prealbumin, retinol-binding protein, and nitrogen balance increased in CT+TPN courses (p < .02). In CT-only courses, undernourished subjects showed a decrease in prealbumin and nitrogen balance. Significant changes of nitrogen balance in CT vs CT+TPN courses were detected in malnourished subjects. TPN appears to be unable to reduce CT-associated toxicity. CT administration does not result in any impairment of the nutritional status in normally nourished cancer patients. From our study, it appears that TPN should be limited to severely malnourished neoplastic patients undergoing CT, because of its ability to prevent further impairment of nutritional status and to improve the nitrogen balance and the levels of fast-turnover visceral proteins.

Adult↗
PubMedDate not supplied

Postoperative nutritional management after esophagectomy: is TPN the standard of nutritional care?

We investigated the feasibility of early postoperative enteral diet after esophagectomy. Sixteen patients who underwent esophagectomy followed by reconstruction using gastrictube were divided into two groups based on nutritional protocol after surgery: either total parenteral nutrition (TPN) or enteral diet (ENT). TPN patients were nutritionally maintained with only intravenous hyperalimentation. The ENT group was challenged mainly with enteral diet started on day 1. Serum rapid turnover proteins (RTPs; transferrin, prealbumin, retinal-binding protein, and insulin like growth factor-1: IGF-1) were measured two days before (preoperative value) and 3, 5, 7, 10, and 14 days after surgery. The percent value of the four RTPs were decreased at day 3 and gradually recovered. There were no significant differences between the groups according to four RTPs. No major complications due to early enteral diet occurred in ENT patients. We conclude that early enteral diet is nutritionally adequate and might be recommended as standard nutritional care after subtotal esophagectomy.

Aged↗
PubMed2005

[Recommendations for nutritional assessment and specialized nutritional support of critically ill patients].

Due to the characteristics of critically ill patients, elaborating recommendations on nutritional support for these patients is difficult. Usually the time of onset of nutritional support or its features are not well established, so that its application is based on experts' opinion. In the present document, recommendations formulated by the Metabolism and Nutrition Working Group of the Spanish Society of Intensive and Critical Medicine and Coronary Units (SEMICYUC) are presented. Recommendations are based on the literature analysis and further discussion by the working group members in order to define, consensually, the more relevant issues of metabolic and nutritional support of patients in a critical condition. Several clinical situations have been considered which are developed in the following articles of this publication. The present recommendations aim at providing a guideline for the less experienced clinicians when considering the metabolic and nutritional issues of critically ill patients.

Critical Care↗
PubMed1991

Parenteral and enteral nutrition and the enterocutaneous fistula treatment. I. Investigations on fistula output, nutritional status complications.

Prospective evaluation were made of 45 patients with postoperative small bowel fistulas treated with total parenteral nutrition (TPN) and enteral nutrition (EN) between 1971-1988. The administration of TPN in the early treatment of enteric fistulas decreased the mean fistula output significantly (p < 0.05-0.001) and provided an effective tool in the control of high-output fistulas. The electrolyte contents of different fistula secretions were unchanged and the losses through the fistulas depended on the daily output. In patients with high-output fistulas acid-base balance disturbances had to be corrected. When comparing two parenteral nutrition regimens (carbohydrate+amino acids /CH + AA/ versus carbohydrate + amino acids + fat /CH + AA + F/) both facilitated the reduction of fistula secretion (in high-output fistulas. CH + AA = -50.2%; CH + AA + F = -49%). Positive nitrogen balance was achieved in non septic patients after 13 days of treatment. Improvement of serum protein and albumin occurred by the time of fistula healing. In non surviving patients significant decrease in protein synthesis was observed. Out 7 of 75 central venous catheters yielded positive bacterial cultures (9.3%). In 5 patients autopsy proved generalized sepsis. The use of parenteral and enteral nutrition proved to be a powerful method for controlling the enterocutaneous fistulas and maintaining the nutritional integrity of patients.

Adult↗
PubMed1994

Nutritional status in cirrhosis. Italian Multicentre Cooperative Project on Nutrition in Liver Cirrhosis.

Malnutrition frequently occurs in patients with chronic liver disease and may represent a risk factor influencing both short- and long-term survival in these patients. Previously published studies have tended to be confined to alcoholic patients and there are few data on the prevalence of nutritional abnormalities in patients with cirrhosis not of alcoholic origin. Anthropometric measurements and a clinical evaluation of the nutritional status of 1402 patients with cirrhosis (883 males and 519 females) were recorded between January 1988 and 1989 by the Italian Multicentre Cooperative project on Nutrition in Liver Cirrhosis. The origin of liver disease was alcohol-related in 37% of patients. Child-Pugh criteria were used to establish the severity of the liver disease. Patients with cirrhosis exhibited a wide range of nutritional abnormalities. While 29% of females and 18% of males appeared to be overnourished, a significant reduction in fat stores, as estimated by the mid-arm fat area, and/or muscle mass, as estimated by mid-arm muscle area, was observed in 30% of patients with cirrhosis. The prevalence of signs of nutritional depletion increased in both sexes as liver function deteriorated. Mean values for mid-arm fat area decreased by 30% in males and by 40% in females with moderate to severe liver failure (Child-Pugh Classes B and C). The reduction in mid-arm muscle area was more evident in males (17% decrease) than in females (9% decrease). Patients with alcohol-related cirrhosis showed a higher prevalence of malnutrition and had more frequent severe liver impairment (Child-Pugh Classes B and C).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1993

[Nutrition on the world map. The UN International Conference on Nutrition].

The first International Conference on Nutrition ever organized by the United Nations took place in Rome in December 1992. The conference was attended by representatives of 159 countries and of various non-governmental organizations and the food industry. Preparations for the conference included preparation of a number of background documents, including an analysis of the nutritional situation in the different countries (country papers), twelve in-depth studies, eight theme papers and an assessment of the global nutrition situation. This article describes the process leading up to the conference, some of the problems and conflicts that appeared, controversial issues that were discussed and the final outcome of the conference (The world declaration and Plan of action for nutrition). The countries that participated in the conference pledged to make every effort to eliminate, before the end on this decade, famine and famine-related deaths, starvation and nutritional deficiencies related to natural and man-made disasters, and deficiencies of iodine and vitamin A.

Global Health↗
PubMed1993

[Nutritional counseling to patients with HIV infection. Can nutritional intervention prevent, expose or relieve symptoms in HIV-positive persons?].

Patients with HIV-infection often exhibit progressive loss of weight and poor nutritional status. The problems, which may appear during all stages of the HIV-infection, may be explained by low intake of food or selected nutrients as a result of anorexia and eating problems, and by impaired gastro-intestinal function and increased metabolic rate following secondary to opportunistic infections or the HIV-infection itself. The extent of weight loss and depletion of body cell mass is discussed in relation to the possible effect on development of the disease and time of death in AIDS-patients. Compromising on nutritional status may have a negative effect on the outcome of treatment, and may lead to malnutrition-related immune depression and rates of infection. Nutrition issues are of vital importance to HIV-infected persons. Although nutrition does not promise of a "magic bullet", dietary counselling and nutritional intervention may prevent cachexia and alleviate some symptoms of the disease.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Nutrition beyond nutrition: plausibility of immunotrophic nutrition for space travel.

BACKGROUND AND AIMS: Microgravity has adverse effects on the immune system. We examined the effects of supplemental dietary nucleotides on immune function in ground-based in vivo anti-orthostatic tail-suspended (AOS) mice and in vitro (bioreactor-BIO) analogs of microgravity. METHODS: BALB/c mice were divided into the following three groups: group housed, single isolation, and AOS. Mice were fed either control chow or chow supplemented with RNA or uracil. Immune function was assessed by in vivo popliteal lymph node proliferation (PLN), in vitro PHA-stimulated proliferation of splenocytes and cytokine production. BIO splenocytes were cultured in vitro with/without PHA, a nucleoside-nucleotide mixture (NS/NT) or uridine. The cell proliferation and scanning electron microscopic examination for cells were carried out. RESULTS: PLN response was significantly suppressed in AOS mice (P<0.05) and was restored by RNA and uracil diets. Splenocytes from AOS mice had decreased phytohemagglutinin (PHA)-stimulated proliferation, decreased IL-2 and IFN-gamma cytokine levels (P<0.05). These responses were restored by RNA and uracil diets. In BIO cultures, PHA response was suppressed significantly, and uridine and NS/NT restored the proliferative responses. Scanning electron microscopic analysis of cells cultured in BIO revealed cells with pinched, distorted and eroded membranes. Nucleotide supplementation especially uridine restored normal activated cell surface appearance and ruffling. CONCLUSION: In the microgravity analog environment of AOS and BIO, supplemental nucleotides and especially uracil/uridine have up-regulating and immunoprotective effects with potential as a countermeasure to the observed immune dysfunction in true microgravity.

Animals↗
PubMed2005

[Critical appraisal: enteral nutrition is better than parenteral nutrition for patients with acute pancreatitis].

OBJECTIVE: To compare the safety and clinical outcomes of enteral and parenteral nutrition in patients with acute pancreatitis. DATA SOURCES: Medline, Embase, Cochrane controlled trials register, and citation review of relevant primary and review articles. STUDY SELECTION: Randomized controlled studies that compared enteral nutrition with parenteral nutrition in patients with acute pancreatitis. From 117 articles screened, six were identified as randomized controlled trials and were included for data extraction. DATA EXTRACTION: Six studies with 263 participants were analyzed. Descriptive and outcome data were extracted. Main outcome measures were infections, complications other than infections, operative interventions, length of hospital stay, and mortality. The metaanalysis was performed with the random effects model. DATA SYNTHESIS: Enteral nutrition was associated with a significantly lower incidence of infections (relative risk 0.45; 95% confidence interval 0.26 to 0.78, P= 0.004), reduced surgical interventions to control pancreatitis (0.48, 0.22 to 1.0, P= 0.05), and a reduced length of hospital stay (mean reduction 2.9 days, 1.6 days to 4.3 days, P <0.001). There were no significant differences in mortality (relative risk 0.66, 0.32 to 1.37, P = 0.3) or non-infectious complications (0.61, 0.31 to 1.22, P= 0.16) between the two groups of patients. CONCLUSIONS: Enteral nutrition should be the preferred route of nutritional support in patients with acute pancreatitis.

English Abstract↗
PubMed2003

Nutrition in the critically ill patient: part II. Parenteral nutrition.

OBJECTIVE: To review the human nutrition in the critically ill patient in a three-part presentation. DATA SOURCES: Articles and published peer-review abstracts and a review of studies reported and identified through a MEDLINE search of the English language literature on parenteral nutrition. SUMMARY OF REVIEW: Intravenous nutrition plays an important supportive role in the management of the critically ill patient who has prolonged gastrointestinal failure. Energy substrates consist of concentrated glucose and lipid solutions, although the former requires central venous access for its administration. The nitrogen requirement is supplied as L-amino acids which usually consist of a solution containing the essential amino acids which are supplemented by a few of the non-essential amino acids. While, amino acid mixtures of glutamine dipeptides, ornithine alpha-ketoglutarate, asparagine, oxaloacetate, arginine, aspartate and glutamate have been used in a variety of conditions, prospective randomised controlled trials have not consistently demonstrated improved survival with their use in the critically ill patient. The water soluble vitamins and vitamin K should supplement intravenous nutrition with amounts at least to meet the recommended daily allowance. Additional supplementation of thiamine, folic acid and ascorbic acid are often administered in the critically ill patient. Apart from zinc, the body stores of the essential trace elements of zinc, copper, iodine, iron, manganese, cobalt, selenium, chromium, fluoride and molybdenum are usually adequate to meet the needs of patients requiring parenteral nutrition for less than 3 months. CONCLUSIONS: In the critically ill patient with prolonged gastrointestinal failure, intravenous nutrition plays a supportive role in the management of a patient.

Journal Article↗
PubMed1984

The nutrition care profile: an aid to delivery of quality nutrition care in a small community hospital.

In an effort to improve nutrition care in a small community hospital with one registered dietitian (R.D.), a system using a nutrition care profile (NCP) and a certified dietetic assistant (C.D.A.) was developed. The NCP includes criteria recognized in the literature or through clinical experience to be indicators of nutrition care needs. The profile is completed by the C.D.A. and reviewed by the R.D., who determines priorities for the patient's nutrition care needs. The NCP has proved to be an effective and efficient tool for prioritizing and systematizing follow-up of nutrition care needs. Indeed, because the NCP form is itself so effective as a follow-up tool for dietary records, the R.D. has found she must make a conscious effort to document nutrition care in the medical record.

Adult↗
PubMed1995

[Nutritional knowledge of patients in the hypertension clinic. An evaluation using the "Nutrition IQ'].

In this study the nutritional knowledge of 117 patients attending a hypertension clinic was evaluated with the use of the 'Nutrition IQ' questionnaire developed by the National Heart Lung, and Blood Institute. Overweight was identified as a risk factor for hypertension by 98% of the subjects, but more than 10% of the subjects did not identify weight reduction as an important therapeutic tool in the control of hypertension. Around 30% of the patients misjudged the importance of weight reduction in the treatment of hypertension as compared to a low salt diet. 25% believed that a salt reduction will always normalise hypertension. Only 5% of the subjects failed to identify exercise and caloric restriction as the major strategies for weight control. More than two thirds of the patients believed that skipping meals is the best way to reduce energy intake. Carbohydrates were wrongly identified as the major factor for weight gain by 50% of the subjects. The same patients did not recognize reduction in fat intake as the major nutritional tool to maintain or reduce weight. Only 25% of the subjects knew that polyunsaturated fatty acids do have the same caloric content per weight as saturated fatty acids. The nutrition IQ questionnaire can be used as an easy and quick screening method of the nutritional knowledge of patients in a hypertension clinic. The data confirm that there is still a large gap between the knowledge of a certain nutritional (risk) factor and its implementation in daily life, and suggest that patient education should be targeted more on life-style issues.

Adult↗