This study was disigned to determine the effect of nutritional status on the energy metabolism of liver. Rat liver of four nutritional groups (Group Ⅰ： fasting; Group Ⅱ: surgar feeding diet; Group Ⅲ: normal feeding diet; Group Ⅳ: group Ⅰ and group Ⅱ accepted patenteral nutrition) were removed for study. The adenosine triphosphate (ATP) level, total addenosine nucleotides (TAN) level, and adenylaty energy charge (EC) of liver decreased in group Ⅰ and group Ⅱ in contrasted with group Ⅲ (Plt;0.001), result of group Ⅳ was similar to that of group Ⅲ when the liver specimens were collected. The rusults indicate that a short period of starvation and low sugar intake will result in the malnutrition of liver and derangement of hapatic energy metabolism and material metabolism. But this status can be corrected by a short perios of parenteral nutrition.
Objective To compare the clinical effects of early enteral and parenteral nutrition, and to study their effects on cytokine release, cellular immune function and protein metabolism in early postoperative patients with gastrointestinal cancer. Methods Thirty-six patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition (EN) group (19 cases) and parenteral nutrition (PN) group (17 cases), and they were supported with EN or PN during postoperative period of 1-7 days, respectively. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured by ELISA. The total lymphocyte count (TLC) and subgroups of lymphocyte (CD3, CD4, CD8, CD4/CD8 and NK cell) were determined with flow cytometer. The urea and creatinine of the 24 h excretory urine were examined at four different phases: preoperative (pre), 1st d, 3rd d and 5th d after operation (pod). The clinical recovery indicators and the complication incidence were also observed. Results All the patients followed the project of nutritional support and relevant examinations, and there was no severe complication and no patient died during the research. The IL-1β, IL-6 and IL-10, the 24 h urea and creatinine increased, while the serum TNF-α and TLC (except 3, 5 pod of EN group) decreased. There was no marked change of the proportion of lymphocyte subgroups after operation and there was no significant difference of the changes of IL-1β, IL-10 and TNF-α between the two groups as well. The levels of IL-6 (3, 5 pod), the 24 h urea (3, 5 pod) and creatinine (3, 5 pod) were significantly lower in EN group than those in PN group （P＜0.05）, whereas TLC (3, 5 pod) were significantly higher than that in EN group （P＜0.05）. In addition, the postoperative infection incidence （10.5% vs 35.3%）, fever duaration, rehabilitation time and medical cost were significantly lower in EN group than those in PN group （P＜0.05）.Conclusion The early postoperative EN has an advantage over PN in the patients with gastrointestinal cancer, which could decrease the release of cytokine and suppress protein metabolism resulting from operational stress, and could reduce the incidence of postoperative infection and inflammatory reaction time. They could also improve the cellular immune function and decrease the rebilitation duration and medical cost.
Objective To investigate the status of nutrition, nutritional support, and postoperative nutrition-related complications in patients with spinal deformity during orthopedic perioperative period. Methods From February to August 2021, patients who underwent spinal orthopedic surgery for spinal deformity in Peking University Third Hospital were collected. A survey was conducted using self-designed questionnaire, including patient’s general information (gender, age, and type of spinal deformity), nutrition-related information (risks of malnutrition, forms of nutritional support), and postoperative nutrition-related complications. Results A total of 39 patients with spinal deformity were enrolled, and 46.2% (18 cases) were at risk of malnutrition. There were a total of 174 times of nutritional support, and 96.0% (167 times) were parenteral nutrition. The patients’ energy intake from nutritional support accounted for 34.41% of the daily goal energy intake averagely. At admission, one day after operation, and at discharge, the prealbumin was (215.51±34.69), (172.85±31.85), and (163.67±29.15) mg/L, respectively, and the hemoglobin was (138.08±15.67), (119.92±18.01), and (117.69±14.76) g/L, respectively, which were significantly lower one day after operation and at discharge than those at admission (P<0.01). The incidence of postoperative nutrition-related complications during hospitalization was 5.1% (2/39). Conclusions Patients undergoing spinal deformity orthopedics are at high risk of overall malnutrition during the perioperative period, their clinical nutritional interventions are mostly based on parenteral nutrition with a single infusion of nutritional preparations, and the nutritional status is not significantly improved. However, the incidence of postoperative nutrition-related complications is low. Standardized nutrition interventions should be strengthened in the future.
ObjectiveTo systematically review the implementation status, effectiveness and existing problems of nutrition improvement measures for vulnerable populations in rural areas of China. MethodsAll studies about the implementation status, effectiveness and existing problems of nutrition improvement measures for vulnerable populations in rural areas of China were electronically searched in VIP, CNKI, WanFang Data and CBM from inception to January 1st, 2014. Two reviewers independently screened literature according to inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies, and then performed qualitative analysis in terms of implementation effectiveness and situation. ResultsA total of 79 studies were finally included. The results of qualitative analysis showed that:the earliest study was published in 1990; 38.0% of these studies were carried out in the southwest and northwest areas of China; 31.6% of these studies were financially supported, and most funds were provided by some international institutions; 90.0% of these research subjects focused on infants and children (under the age of 10); a variety of nutrition improvement measures had been taken, and 55.7% of these interventions measures were nutrition education which could be implemented easily; the implementation duration of 38.0% of these measures lasted less than half a year; 32.9% of these studies adopted the blood test to evaluate the outcomes of nutrition measures; all of the studies showed that nutrition levels of vulnerable populations in rural areas of China had been obviously improved by these measures. ConclusionThe nutrition improvement measures for vulnerable populations in rural areas of China have been implemented relatively earlier focusing on populations in West China where was less developed. However, an imbalance exists in the attention to target populations, especially to the elderly. Face to face nutrition education is most frequently taken; however, it could not directly reflect the changing of nutritional status. In addition, implementation duration is fairly short which indicates that more fund supports are needed from the government or institutions.
ObjectiveTo explore the role of nutritional support in adjuvant therapy for respiratory failure. MethodsWe took 72 patients with respiratory failure who were treated in our hospital from August 2011 to January 2013 as the research objects. They were divided into two groups:control group and trial group, with 36 patients in each group. The division of the groups was in accordance with the state food and drug administration clinical trial institution ethics committee standard operating procedures. In the control group, 36 patients were provided with regular treatments according to their condition, like maintaining the respiratory tract unobstructed, oxygen therapy, mechanical ventilation and anti-infection. In the trial group, we offered nutritional support in addition to the normal treatment. Consecutive 20 days was a course of treatment. After four courses, we inspected and put down two groups' respective clinical features, and made a contrast of their treatment conditions. We analyzed the treatments through observational indexes including assessment of eutrophication, treatment efficiency, pulmonary function and arterial blood gases. ResultsBoth groups had obvious therapeutic effects. The observational indexes in the trial group were better than those in the control group. The total effective rate was 91.7% in the trail group after treatment, significantly higher than that in the control group (66.7%) (χ2=8.692, P=0.003); the lung capacity, the ventilation flow ratio and arterial blood gas analysis values in the trial group was better than those in the control group. ConclusionThe effect of the nutritional support for the respiratory failure treatment is much better than the regular treatment. The total effective rate is improved while the death rate is lower than before and the patients recover quickly.
Maintenance hemodialysis patients face great risk and challenges in the current coronavirus disease 2019 (COVID-19) epidemic, and adequate and reasonable nutrition is an important weapon in the prevention and treatment of COVID-19. Therefore, the Chinese Society of Parenteral and Enteral Nutrition proposed Dietary Expert Advice on Prevention and Treatment of COVID-19 in Hemodialysis Patients for hemodialysis patients. In this paper, the nine pieces of advice on hemodialysis patients’ staple food, intake of high-quality protein, vegetables and fruits, food types and combinations, prevention of virus transmission, fluid intake, nutritional supplements, regular rest and adequate sleep, as well as supplement of anti-inflammatory and antioxidant preparations are interpreted in detail.
ObjectiveTo investigate the prevalence of the nutritional risks, the relationship between application of nutritional support and the clinical outcome of patients with gastrointestinal major surgery in the Frist People's Hospital of Shuangliu. MethodsGastrointestinal major surgery patients in Department of General Surgery in the Frist People's Hospital of Shuangliu from March 2010 to March 2014 were consecutively enrolled. Patients who provided informed consent were screened by NRS 2002, tracking nutrition support status and analysis the relationship between nutrition support and clinical outcome. In this study, the clinical outcome index included postoperative complications and hospitalization time. ResultsThere were totally 130 cases enrolled, 112 cases completed assessment by NRS 2002. The prevalence of nutritional risk was 75.9%(85/112), there were totally 57 patients(50.9%) received nutrition support, and all for parenteral nutrition. The prevalence of postoperative complication was 46.4%(52/112). The prevalence of postoperative complication in patients who had nutritional risk and received nutritional support was 41.7%(15/36), whereas, in patients who had nutritional risk but not received nutritional support was 73.5%(36/49), there was statistically significant difference between the 2 groups(P=0.002). In patients who not had nutritional risk, the postoperative complication rate was only 3.7%(1/27). ConclusionsBecause of noninvasive and easy to operate, NRS 2002 are adpted to hospitalized patients with gastrointestinal major surgery. Because of the specific of disease metabolism, the higher nutritional risk occurres in patients with gastrointestinal major surgery, appropriate nutritional support for this kinds of patients can reduce the incidence of postoperative complication, and improve the prognosis.
ObjectiveTo investigate the effect of enteral nutrition support on postoperative nutritional status and clinical outcomes in patients with upper digestive tract ulcer perforation. MethodsSeventy-twe patients with upper gastrointestinal ulcer perforation who treated in Heze Municipal Hospital from 2012 to 2014 were randomly divided into early enteral nutrition (EEN) group (n=36) and parenteral nutrition (TPN)group (n=36) according to their different ways of nutrition, the body weight, body mass index, the levels of prealbumin and albumin before operation and on day 7 ofter operation were analyzed. The time of resumption of gastrointestinal function, the time of hospital stay, hospitalization cost, and postoperative complication were recorded. ResultsThere were no significant differences on levels of body weight, body mass index, serum albumin, and prealbumin before operation between the 2 groups (P > 0.05). On day 7 after operation, the levels of body weight, body mass index, prealbumin, and albumin were significantly low in both groups, and the TPN group was decreased more than EEN group (P < 0.05). The inffect complications in EEN group was lower than in TPN group, the time of resumption of gastrointestinal function in EEN group was shorter than in TPN group, and the hospital stay and hospitalization cost in EEN group were both lower than in TPN group, there were significant difference between the 2 groups (P < 0.05). ConclusionsEarly postoperative enteral nutrition for the patients with upper gastrointestinal ulcer perforation after operation can be effective to improve the nutrition status, reduce the incidence of infectious complications, promote early recovery of gastrointestinal function, reduce hospitalization cost, and accelerate the rehabilitation of patients.
ObjectiveTo explore the effect of perioperative nutritional management on patients with spinal cord injury under the enhanced recovery after surgery (ERAS) theory.MethodsA total of 82 patients with spinal cord injury admitted to a tertiay hospital in Shanghai between August 2018 and May 2020 were selected by convenience sampling method. They were randomly divided into intervention group and control group, with 41 cases in each group. The patients in the control group received conventional orthopaedics elective surgery nutritional management, while the patients in the intervention group adopted perioperative nutritional management based on ERAS concept, including establishing a multidisciplinary nutritional management team, conducting admission and regular nutritional screenings, and then developing targeted nutritional interventions based on the screening results. Biochemical indexes of nutritional assessment, electrolyte indexes, nutrition-related complications and general inpatient indexes were observed and compared between the two groups.ResultsThere were statistically significant differences in albumin, prealbumin, total protein, hemoglobin, potassium, sodium, and chlorine between the two groups on the first day after surgery and one day before discharge (P<0.05). The incidences of hypoglycemia (2.4% vs. 19.5%) and total complications (19.5% vs. 61.0%) in the intervention group were lower than those in the control group, and the differences were statistically significant (P<0.05). The total hospital stay [(10.48±2.61) vs. (12.09±2.74) d], postoperative hospital stay [(5.57±2.35) vs. (7.55±3.01) d], and hospital expenses [(11.21±4.42)×104 vs. (14.73±5.51)×104 yuan] in the intervention group were less than those in the control group (P<0.01).ConclusionPerioperative nutritional management under the ERAS theory can effectively improve the nutritional status of patients with spinal cord injury, maintain electrolyte balance, reduce the incidence of complications, shorten the length of hospitalization, reduce the cost of hospitalization, and promote postoperative rehabilitation of patients.
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.