[Pregnancy weight gain and nutritional therapy on the outcome of gestational diabetes mellitus]

OBJECTIVE

To study the relationship of bodyweight gain and the occurrence of gestational diabetes mellitus (GDM) during pregnancy, and analyze the effect of the nutritional therapy on the outcome of GDM.

METHODS

We collected 265 pregnant women who were diagnosed to be GDM and 571 pregnant women as the control group in the Xiamen Maternal and Child Health Hospital during 2007 - 2009. The general information of the subjects were collected. The bodyweight of the subjects were measured before the 20(th) week of pregnancy, 26 - 27(th) week (mid-gestation), 35 - 36(th) week (late-gestation) of pregnancy and prior to delivery. The bodyweight gain of different pregnancy weeks of the two groups and the effect of bodyweight on GMD occurrence before 28(th) week of pregnancy were analyzed by ages (< 25, 25-, 30-, ≥ 35). Meanwhile, we prescribed the nutrition therapy to the GDM pregnant woman and the effect of the blood sugar control on the outcome of the pregnancy were evaluated.

RESULTS

The bodyweight gain of 25-, 30-, older than 35 year-old subjects of the GDM group were (16.9 ± 6.3), (16.8 ± 6.1), (16.5 ± 6.0) kg, respectively, the bodyweight gain of the control group were (13.9 ± 3.0), (13.8 ± 2.7), (13.3 ± 2.7) kg (t = 6.259, 5.885, 3.533, respectively, all P values < 0.05). During the 20(th) to 27(th) week of the pregnancy, the bodyweight gain of the subjects younger than 25, 25-, 30-year-old in GDM group were (5.2 ± 1.0), (5.4 ± 1.7), (4.8 ± 1.3) kg, respectively, the bodyweight gain of the control group were (3.3 ± 1.3), (3.7 ± 1.6) and (3.5 ± 0.7) kg (t = 5.026, 9.659, 11.19, respectively, all P values < 0.05). During the period between 26(th) to 36(th) week, the bodyweight gain of subjects older than 35 year-old in GDP group was (3.6 ± 2.0) kg which was less than the control group ((4.0 ± 0.9) kg, t = -2.449, P < 0.05). 41.22% (54/131) and 44.94% (40/89) of 25-, 30-year-old subjects in GDM group showed bodyweight gain more than 13 kg, but 30.04% (76/253) and 26.07% (55/211) in the control group (OR values were 1.633 and 2.315, both P values < 0.05). The rate of the abnormal birth weight of the GDM group with blood sugar controlled and the control group were 6.6% (12/182) and 9.4% (54/571) which was lower than the GDP group with blood sugar control failure (20.5% (17/83)) (χ(2) values were 11.460, 9.119, respectively, both P values < 0.0125). The rate of premature delivery was 21.7%(18/83), higher than the control group (10.8%, 62/571) (χ(2) = 7.945, P < 0.0125). The rate of the cesarean in the control group was 25.4%(145/571) which was lower than the two GDM groups, including the group which the blood sugar was well controlled (46.7%, 85/182) and not well controlled (65.0%, 54/83) (χ(2) values were 29.540, 53.860, respectively, both P values < 0.0125).

CONCLUSION

The bodyweight gain in the mid-gestation could affect the occurrence of GDM. The bodyweight gain should be less than 13 kg before 28(th) week of the pregnancy whose age was 25-year-old. Nutritional therapy and blood sugar control in GDM pregnant women could improve the pregnancy outcome.

[Severe acute malnutrition in children]

Severe acute malnutrition (SAM) affects approx. 19 million children below five years of age in low and middle income countries. Both shortage and low quality of foods are important determinants of SAM. With the development of special ready-to-use foods and by using simple treatment protocols, it is now possible to treat SAM successfully outside hospitals and treatment centers thereby reducing the case-fatality rate. However, only a small percentage of children with SAM have access to correct treatment.

Nutritional support for extremely low-birth weight infants: abandoning catabolism in the neonatal intensive care unit

PURPOSE OF REVIEW

Obviously, the ultimate goal in neonatology is to achieve a functional outcome in premature infants that is comparable to healthy term-born infants. As nutrition is one of the key factors for normal cell growth, providing the right amount and quality of nutrients could prove pivotal for normal development. However, many premature infants are catabolic during the first week of life, which has directly been linked to growth failure, disease, and suboptimal long-term outcome. This review describes the progress in research on parenteral nutrition for premature infants with a focus on amino acids and the influence of nutrition on later outcome.

RECENT FINDINGS

Although randomized clinical trials on early nutrition for premature infants remain relatively sparse, evidence is accumulating on its beneficial effects both on the short-term and long-term. However, some research also warns for adverse effects.

SUMMARY

Despite the fact that substantially improved nutritional therapies for preterm neonates have been implemented, still, some reluctance exists when it comes to providing high amounts of nutrition to the most immature infants. Pros and cons are outlined, as well as deficits in knowledge, when it comes to providing the optimal nutrient strategy in the first postnatal phase.

[Adherence to a medical nutrition therapy program in pregnant women with diabetes, measured by three methods, and its association with glycemic control]

INTRODUCTION

The measurement of adherence to nutrition therapy is essential to evaluate if the outcomes are related to given recommendations.

MATERIAL AND METHODS

The aim of this study was to describe adherence to a Medical Nutrition Therapy Program in Mexican pregnant women with diabetes, using three different methods; and evaluate its association with glycemic control. Adherence was measured with a questionnaire (0-100%), women's self-perception (0-100%) and energy intake adequacy by multiple pass 24 hour recall (85-115% of recommendation). Women were randomly assigned to two different dietary strategies. Glycemic control was determined by capillary glucose self-monitoring.

RESULTS

Women analyzed in this study (n=69) had an age range of 22-42 years; 47.8% had type 2 diabetes (DM2) and 52.2% had gestational diabetes (GDM). Energy intake adequacy was higher in women with GDM (41.9% vs. 37.7%, p = 0.001). Average adherence measured with the questionnaire was 55%; no differences were found by type of diabetes. Self-perception was higher in women with DM2 (84%) when compared to women with GDM (70%) (p = 0.039). No differences were found in the three methods by study group. Optimal glycemic control was observed in 50% of women; no association was found with adherence measured with any of the three methods studied.

CONCLUSIONS

The observed differences in adherences suggest that it may be recommendable to combine different measurement methods and include social and psychological factors that affect behavioral change.

Obesity and gestational diabetes

The prevalence of both obesity and gestational diabetes mellitus (GDM) is increasing worldwide. GDM affects about 7% of all pregnancies and is defined as any degree of impaired glucose tolerance during gestation. The presence of obesity has a significant impact on both maternal and fetal complications associated with GDM. These complications can be addressed, at least in part, by good glycaemic control during pregnancy. The significance and impact of obesity in women with GDM are discussed in this article, together with treatment options, the need for long-term risk modification and postpartum follow-up.

[Integrated Chinese and Western medicine and clinical nutrition]

Nutritional support, an important measure for critical patients subject to monitoring, is widely used in clinical practice now. Nutrients have been used early in the Chinese medicine therapy. A number of Chinese medicine prescriptions show nutritional improvement and immune function enhancing effects on critical and/or postoperative patients, and some Chinese herbs are nutrient substances. Although the theoretical bases of Chinese medicine and Western medicine are different, they could work together in the clinical nutritional treatment to form a therapeutic measure with Chinese characteristics, which could promote the heritage and development of Chinese medicine. A discussion regarding the relationship between Chinese medicine drug-therapy, acupuncture and nutrition was also given.

[Nutrition therapy for adult patients with caustic injuries to gastrointestinal tract]

OBJECTIVES

To present here the experience of our Nutrition Therapy Team of the Hospital El Tunal, for the nutritional management of adult patients with caustic injuries to gastrointestinal tract.

MATERIALS AND METHODS

This is a retrospective, descriptive study of patients with caustic injuries to gastrointestinal tract managed by our Nutrition Therapy Team between January 2000 and December 2007. We revisited the clinical history of patients with diagnosis of caustic injury. Various nutritional variables, as well as the evolution and outcome were pooled and analyzed.

RESULTS

A total of 30 patients, 17 male y 13 female with a mean age of 34.4 +/- 17.2 years old were found. The ingestion of caustics was suicidal intent in 22 (73.3%) and accidental in 8 (26.7%). The global mortality was high (43.3%). Weight loss was found in 46.9% of the patients and a negative nitrogen balance in 62.5%. Sixteen patients (53.12%) were managed with mixed nutrition (enteral and/or parenteral) for a mean time of 24 +/- 22 days. We compared two groups Moderate vs Severe, according to the severity of the caustic injury to gastrointestinal tract and found that mortality, the length of hospital stay and the final albumin value were significantly different among groups.

CONCLUSIONS

Caustic injuries to gastrointestinal tract are not frequent, they are found mainly in young patients with suicidal intent and are associated with high mortality, especially in severe injuries. This aggression causes important catabolic state leading to a negative nitrogen balance and weight loss. These patients require early nutritional intervention sometimes extended for months.

[Impact of nutritional treatment in the evolution of inflammatory bowel disease]

Inflammatory bowel disease is an entity with not wellknown pathogenesis, and important nutritional and metabolic implications because of the high prevalence of malnutrition, the possible implication of dietary factors in its pathogenesis and because of the hypothesis that nutritional intervention could be a primary treatment for the disease. Some nutrients could induce a low antigenic stimuli, regulate inflammatory and immunological responses and stimulate intestinal mucosal trophism. Present available evidence supports enteral nutrition in Crohn's disease as a primary treatment if treatment with steroids is not possible (failure or contraindication) (grade of recommendation A) or either combined treatment with drugs in malnourished patients or those with inflammatory bowel stenosis. In those patients with sustained clinical remission, no benefit of either enteral nutrition or supplements in the absence of nutritional deficits has been shown. Elemental or modified formula (glutamine, omega 3 fatty acids) could not be recommended. In ulcerative colitis, nutritional influence over the activity of the disease has not been shown, although there are some promising results regarding enteric coated W3 fatty acids and a possible role for probiotics. In the treatment and prevention of pouchitis, there could be a role for probiotics (VSL#3). Nutritional treatment should be considered an integral component in the Management of patients with inflammatory bowel disease.

Weight loss in head and neck cancer patients little noticed in general practice

INTRODUCTION

In head and neck cancer patients, weight loss increases morbidity and mortality, and decreases treatment tolerance and quality of life. Early nutritional intervention has beneficial effects on these factors.

AIM

We observed patients' weight courses after specialists' care and surveyed nutrition-related documentation by general practitioners (GPs).

METHODS

From a Head and Neck Oncology Centre (HNOC) study, 68 patients were asked to participate in an extended general practice cohort. Twenty-six patients participated in the prospective three-monthly weight measurements during the year after HNOC care. We extracted nutritional information contained in referral letters (n = 24) and medical records from the year before referral (n = 45) and after HNOC care (n = 26). An impaired nutritional status was assigned to weight loss > or = 10% within six months or Body Mass Index (BMI) < 18.5 kg/m2 and 'at risk' to weight loss > or = 5% but < 10% within six months.

RESULTS

Three (12%) participants were nutritionally impaired and two (8%) were deemed 'at risk'. Although GPs suspected a (pre-) malignancy in 11 cases (46%), only two (8%) documented weight loss or BMI and four (17%) nutrition-related complaints in their referral letters. Medical records more often contained information on nutrition-related complaints and tube feeding later in the disease course, as opposed to concern over weight loss or BMI.

DISCUSSION

Therefore, we call for nutritional management in general practice, by urging practitioners to assess patients' nutritional status throughout the disease course and intervene if necessary. The passing on of related information in case of referral promotes continuity of care.

A misdiagnosed patient: 16 years of locked-in syndrome, the influence of rehabilitation

BACKGROUND

LiS can be mistakenly recognized as a vegetative state, minimally conscious state or akinetic mutism. It can be caused by isolated lesions--bilateral infarction, vertebrobasilar artery osslusion, haemorrhage or tumor of the ventral portion of the basis pontis or midbrain.

CASE REPORT

The case of a 65-year-old patient with a brain tumor localized in the posterior part of the posterior commissure of the brain was presented. He lost consciousness in 1991, was diagnosed as being at a terminal stage and from 2005 he started to improve. In MRI brain tumor stated in 1989 with the same localization and size in 2007 without any disturbance in cerebral fluid flow. The patients remained in this condition for 14 years without any rehabilitation, because he was diagnosed as a terminal stage, a non-operative stage. When exercises were introduced in 2005 the patient started to recover. In 2007 he was conscious with quadriplegia, a neuropsychological test showed memory problems, without any dementia. After intensive rehabilitation functional improvement and speech improvement was observed, GOS (4), Ranczo Los Amigos Scale (6), DRS (18).

CONCLUSIONS

It is important to carry out full diagnostics before determining a terminal stage and to continue a rehabilitation program and multisensory stimulation. Even after 16 year of lying in bed without communication there is a chance in LiS to witness improvement after stimulation, without any signs of dementia.

Themed section: Advances in nutritional pharmacology. Editorial

A themed section in this issue of Br J Pharmacol, on 'Advances in Nutritional Pharmacology', provides a valuable and timely update on progress in this area. The value of dietary components to improvement in health and, particularly, to prevention of cardiovascular disease and cancer, is frequently reported in the media and therefore often captures the attention of the wider public. Understanding the pharmacological mechanisms by which nutritional elements confer their health benefits enables us to keep the public informed, but also aids in the identification of new targets for drug development. In recent years there has been significant progress in this field. Four rapidly developing areas are reviewed. Vosper (2009) covers the identification of a receptor for niacin and the subsequent development of selective agonists as lipid lowering agents. Wu-Wong (2009) describes the development of new Vitamin D analogues for the treatment of cardiovascular disease. de Roos et al. (2009) provide detailed insight into how omega-3 fatty acids, also known as longchain n-3 polyunsaturated fatty acids (PUFAs) protect against cardiovascular disease. Zhou et al. (2009) cover the mechanisms underlying the beneficial effects of resveretrol in protection against cancer. These reviews are complimented by three key original articles focusing on endogenous mechanisms of weight control involving endocannabinoids (Izzo et al., 2009), a circulating protein, the soluble leptin receptor (Zhang & Scarpace, 2009) and a treatment, zinc plus cyclo-(His-Pro) (CHP), known to increase insulin metabolism (Song et al., 2009).

[Neuroemergency and rehabilitation--consideration of a comprehensive stroke care system in the community]

According to the data-bank on the patients with acute illness transferred to the emergency hospitals in Nagasaki city and surrounding towns (population: approximately 550,000, 18-22% of the patients were aged 65 years and more), the number of stroke patients per year has been the highest among those patients each year from 1998 to 2007. And over 50% of these stroke patients were 70 years or more. These results suggest that care of elderly patients who have had stroke is a main community-wide concern in emergency medicine. Further, it is well known that older patients who suffer an acute illness and are consequently hospitalized often become physically dependent; this greatly influences to prognosis and the quality of life. In addition, older patients are probably undernourished, and their immune system tends toward functional decline. Therefore, to maximize the effectiveness of stroke care and to improve its outcome in terms of functional effectiveness, it is critical that hospital management of acute stroke patients focuses not only on stroke-specific medical care, but also on the nutritional interventions and rehabilitation offered by a multidisciplinary team. And after acute medical treatment, stabilization, nutrition interventions, and early rehabilitation, patients with disability could be transferred to kaifukuki- rehabilitation wards, in where measures to overcome their disabilities (impairments, activity limitations and also participation restrictions) can be taken by a interdisciplinary team, which can provide effective enriched rehabilitation. Eventually, these patients could be discharged and sent either home, or to care houses, community-based long-term rehabilitation center or to hospital-based long-term rehabilitation center.

Teaching in small portions dispersed over time enhances long-term knowledge retention

BACKGROUND

A primary goal of education is to promote long-term knowledge storage and retrieval.

OBJECTIVE

A prospective interventional study design was used to investigate our research question: Does a dispersed curriculum promote better short- and long-term retention over a massed course?

METHODS

Participants included 20 gastroenterology residents from the University of Calgary (N = 10) and University of Toronto (N = 10). Participants completed a baseline test of nutrition knowledge. The nutrition course was imparted to University of Calgary residents for 4 h occurring 1 h weekly over 4 consecutive weeks: dispersed delivery (DD). At the University of Toronto the course was taught in one 4h academic half-day: massed delivery (MD). Post-curriculum tests were administered at 1 week and 3 months to assess knowledge retention.

RESULTS

The baseline scores were 46.39 +/- 6.14% and 53.75 +/- 10.69% in the DD and MD groups, respectively. The 1 week post-test scores for the DD and MD groups were 81.67 +/- 8.57%, p < 0.001 and 78.75 +/- 4.43, p < 0.001 which was significantly higher than baseline. The 3-month score was significantly higher in the DD group, but not in the MD group (65.28 +/- 9.88%, p = 0.02 vs. 58.93 +/- 12.06%, p = 0.18). The absolute pre-test to 1-week post-test difference was significantly higher at 35.28 +/- 7.65% among participants in the DD group compared to 25.0 +/- 11.80% in the MD group, p = 0.048. Similarly, the absolute pre-test to 3-month post-test difference was significantly higher at 18.9 +/- 6.7% among the participants in the DD group, compared to 6.8 +/- 11.8% in the MD group, p = 0.021.

CONCLUSIONS

Long-term nutrition knowledge is improved with DD compared with MD.

[Osmolality of products and formulas for nutritional therapy]

The objective was to determine the osmolality of products and formulas for nutritional therapy available in Venezuela. The samples were grouped as follows: infant formulas, premature infant, follow up, 1 to 4 years, soy based, lactose free, anti-reflux, hypoallergenic, complete beverages, polymeric formulas, semi-elemental, caloric and protein modules. A vapor pressure digital osmometer was used, analyzing five samples of each product from different lots, prepared by weigth or with scoop. When the variation coefficient of the osmolality measurements was higher than 10%, five additional samples were analyzed. Averages, standard deviation, and the variation coefficient of the osmolality measures (95% reliability) were calculated. The osmolality (mmol/kg) of infant and premature infant formulas were between 258 and 309; follow up formulas ranged between 256-390; 1 to 4 years: 343-399; soy based: 155-252; lactose free: 163-248; anti-reflux: 230-292; hypoallergenic: 220-335; complete beverages: 205-454; polymeric formulas: 247-588; semi-elemental: 238-289; caloric module: 89-99 and protein module: 30-60. We found that almost all the formulas prepared with scoop had higher osmolality and variability than the same products prepared by weight. Some follow up, polymeric, 1 to 4 years formulas and complete beverages had high osmolalities and therefore should not be administered to infants, and must be administered with caution to children and adolescents when the gastrointestinal tract is compromised.

Management of the open abdomen: from initial operation to definitive closure

The open abdomen is a relatively new and increasingly common strategy for the management of abdominal emergencies in both trauma and general surgery. The use of an abbreviated laparotomy can reduce mortality associated with conditions such as abdominal compartment syndrome; however, the resulting open abdomen is a complex clinical problem. Modern techniques and technologies are now available that allow for improved management of the open abdomen and the progressive reduction of the fascial defect. Indeed, recent evidence indicates that a large proportion of patients treated with open abdomen can now be closed within the initial hospitalization. These techniques and technologies include the appropriate use of negative pressure therapy and synthetic or biologic repair materials. It is essential that general and trauma surgeons understand the core principles underlying the need for and management of the open abdomen. Toward this goal, an Open Abdomen Advisory Panel was established to identify core principles in the management of the open abdomen and to develop a set of recommendations based on the best available evidence. This review presents the principles and recommendations identified by the Open Abdomen Advisory Panel and provides brief case studies for the illustration of these concepts.

Validated treatments and therapeutic perspectives regarding nutritherapy

Nutritherapy seeks to prevent or correct disease by the use of nutritional supplements including vitamins, trace elements, or macronutrients. This chapter of the "Les Entretiens du Carla" reviews the potential of nutritherapy for the prevention or improvement of sarcopenia, which is the progressive reduction in muscle mass and muscle strength prevalent in late-life. It is critical that we review nutrients and their potential to maintain muscle mass and strength which ultimately will help minimize falls and fractures among the older population. Evidence from randomized-controlled trials will be reviewed for muscle mass as well as important sarcopenia-related endpoints including lower extremity strength and function, as well as falls and fall-related fractures. This chapter will focus on vitamin D as a compelling strategy with evidence for strength gain, fall and fracture prevention from double-blind randomized controlled trials. The other strategy discussed is increased protein intake although longer-term trials and evidence for clinically important endpoints are limited. Today, there is no consistent data on other micronutrients or macronutrients with an established potential to combat sarcopenia.