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Tian W, Luo L, Xu X, Zhao R, Tian T, Li W, Zhao Y, Yao Z. Nomogram for predicting intolerable postoperative early enteral nutrition following definitive surgery for small intestinal fistula: a cohort study. Int J Surg 2024; 110:5595-5604. [PMID: 38814286 PMCID: PMC11392138 DOI: 10.1097/js9.0000000000001655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 05/08/2024] [Indexed: 05/31/2024]
Abstract
BACKGROUND This study was designed to develop and validate a nomogram for predicting intolerable early enteral nutrition (EEN) following definitive surgery (DS) for small intestinal fistula. METHODS A total of 377 patients, recruited from January 2016 to September 2023, was randomly allocated into development ( n =251) and validation ( n =126) groups in a 2:1 ratio. Risk factors were identified using the nomogram. Its performance was assessed based on calibration, discrimination, and clinical utility, with validation confirming its effectiveness. RESULTS Of the 377 patients, 87 (23.1%) were intolerant to EEN, including 59 (23.1%) in the development cohort and 28 (22.1%) in the validation cohort ( P =0.84). Four factors were identified as predictive of intolerable EEN: severe abdominal adhesion, deciliter of blood loss during DS, human serum albumin (Alb) input >40 g during and within 48 h post-DS, and the visceral fat area (VFA)/total abdominal muscle area index (TAMAI) ratio. The model demonstrated excellent discrimination, with a C-index of 0.79 (95% CI: 0.74-0.87, including internal validation) and robust calibration. In the validation cohort, the nomogram showed strong discrimination (C-index=0.77; 95% CI: 0.64-0.87) and solid calibration. Decision curve analysis affirmed the nomogram's clinical utility. CONCLUSION This research introduces a nomogram that enables the individualized prediction of intolerable EEN following DS for small intestinal fistula, demonstrating a possible clinical utility.
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Affiliation(s)
- Weiliang Tian
- Research Institute of General Surgery, Jinling Hospital, Nanjing Medical University
| | - Lei Luo
- Department of General Surgery, The Affiliated Zhuzhou Hospital Central South University, Zhuzhou
| | - Xin Xu
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu
| | - Risheng Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu
| | - Tao Tian
- Department of General Surgery, Shanghai 9th Hospital, Shanghai
| | - Wuhan Li
- Department of General Surgery, Anhui Provincial Hospital, Hefei, Anhui, People's Republic of China
| | - Yunzhao Zhao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu
| | - Zheng Yao
- Department of General Surgery, Jiangning Hospital, Nanjing, Jiangsu
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2
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Chen Y, Xian X, Zhu C, Huang B, Kuang Y, Xu D. Compliance analysis of oral nutritional supplements in hospitalized postsurgical patients with colorectal cancer: A prospective study. J Clin Nurs 2024. [PMID: 38894587 DOI: 10.1111/jocn.17297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/12/2024] [Accepted: 05/16/2024] [Indexed: 06/21/2024]
Abstract
PURPOSE There are few reports on compliance with oral nutritional supplements (ONS) after surgery in hospitalized patients. This study aimed to investigate the compliance with ONS and its influencing factors after surgery in colorectal cancer patients. METHODS STROBE checklist was used during the preparation of this paper. A total of 103 postoperative colorectal cancer patients were selected from November 2020 to April 2021 from the Department of Anorectal Surgery in our institution, which is a tertiary hospital in Hangzhou, China. The compliance with ONS was recorded by a self-record sheet, and sociodemographic and disease-related information of these patients was gathered through a self-designed questionnaire. RESULTS The overall ONS compliance rate of patients with colorectal cancer was 57.6%. Results of univariate analysis revealed that ONS compliance rate was related to sex, admission body mass index, abdominal distension, attitude towards ONS, and satisfaction with ONS. Multi-factor analysis showed that age, sex, and perceived benefits of nutrition therapy independently influenced the ONS compliance rate. CONCLUSIONS The postoperative ONS compliance rate of colorectal cancer patients needs to be further improved. Healthcare professionals should pay more attention to the postoperative ONS compliance and acknowledging the influence of age, gender, and attitudes towards ONS on ONS compliance. Notably, patients' perspectives towards ONS play a crucial and modifiable role in determining ONS compliance. Nurses ought to assist patients in cultivating a positive attitude towards ONS. RELEVANCE TO CLINICAL PRACTICE Dosage form and delivery method are also influence factors that deserves further exploration in the future. Future research endeavours should endeavour to craft tailored, meticulous nutritional intervention strategies tailored to the diverse factors that influence ONS compliance, ultimately leading to enhanced ONS adherence. Our findings could serve as valuable evidence for the development of strategies aimed at enhancing ONS usage practices.
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Affiliation(s)
- Yilin Chen
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
| | - Xuemei Xian
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
| | - Chenping Zhu
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
| | - Binbin Huang
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
| | - Yuanyuan Kuang
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
| | - Didi Xu
- Sir Run Run Shaw Hospital, Zhejiang University, Zhejiang, Hangzhou, China
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Gholamalizadeh M, Salimi Z, Mobarakeh KA, Mahmoudi Z, Tajadod S, Mousavi Mele M, Alami F, Bahar B, Doaei S, Khoshdooz S, Rahvar M, Gholami S, Pourtaleb M. The association between enteral nutrition with survival of critical patients with COVID-19. Immun Inflamm Dis 2024; 12:e1261. [PMID: 38717056 PMCID: PMC11078021 DOI: 10.1002/iid3.1261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 02/16/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) results in several complications and mortality in intensive care unit (ICU) patients. Limited studies have investigated the effect of enteral nutrition (EN) on the survival of COVID-19 patients in the ICU. The aim of this study was to investigate the association of EN with biochemical and pathological indices associated with mortality in ICU patients with COVID-19. METHODS This case-control study was conducted on 240 patients with COVID-19 hospitalized in the ICU including 120 eventual nonsurvived as the cases and 120 survived patients as the controls. All of the patients received EN as a high protein high volume or standard formula. Data on general information, anthropometric measurements, and the results of lab tests were collected. RESULTS The recovered patients received significantly more high protein (60.8% vs. 39.6%, p = .004) and high volume (61.6% vs. 42.3%, p = .005) formula compared to the nonsurvived group. Mortality was inversely associated with high volume (odds ratio [OR]: 0.45 confidence interval [CI]95%, p = .008) and high protein (OR: 0.42 CI95%, p = .003) formula. The results remained significant after adjusting for age and sex. Further adjustment for underlying diseases, smoking, body mass index, and the acute physiology and chronic health evaluation II (APACHE II) score did not change the results. CONCLUSION The findings of the study showed that there was a significant inverse association between mortality and high volume and high protein formula in patients with COVID-19. Further investigation is warranted.
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Affiliation(s)
| | - Zahra Salimi
- Student Research Committee, Faculty of Nutrition and Food TechnologyShahid Beheshti University of Medical SciencesTehranIran
| | - Khadijeh Abbasi Mobarakeh
- Department of Community Nutrition, Nutrition and Food Security Research Center, School of Nutrition and Food ScienceIsfahan University of Medical SciencesIsfahanIran
| | - Zahra Mahmoudi
- Department of NutritionScience and Research Branch Islamic Azad UniversityTehranIran
| | - Shirin Tajadod
- Department of Nutrition, School of Public Health, International CampusIran University of Medical SciencesTehranIran
| | | | - Farkhondeh Alami
- Nutrition Sciences and Applied Food Safety Studies, Research Centre for Global Development, School of Sport and Health SciencesUniversity of Central LancashirePrestonUK
| | - Bojlul Bahar
- Department of Nutrition, Student Research Committee, Faculty of MedicineUrmia University of Medical SciencesUrmiaIran
| | - Saeid Doaei
- Cancer Research CenterShahid Beheshti University of Medical SciencesTehranIran
| | - Sara Khoshdooz
- Razi Clinical Research Development Unit, Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Masoume Rahvar
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Somayeh Gholami
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
| | - Masoume Pourtaleb
- Intensive Care Unit (ICU), Razi HospitalGuilan University of Medical SciencesRashtIran
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Wu Y, Liu RT, Zhou XY, Fang Q, Huang D, Jia ZY. The Global Leadership Initiative on Malnutrition criteria for diagnosis of malnutrition and outcomes prediction in emergency abdominal surgery. Nutrition 2024; 119:112298. [PMID: 38176361 DOI: 10.1016/j.nut.2023.112298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/13/2023] [Accepted: 11/01/2023] [Indexed: 01/06/2024]
Abstract
OBJECTIVES Malnutrition has adverse postoperative outcomes, especially in emergency surgery. Among the numerous tools for nutritional assessment, this study aims to investigate malnutrition diagnosed by Global Leadership Initiative on Malnutrition criteria and the Global Leadership Initiative on Malnutrition predictive value for outcomes after emergency abdominal surgery. METHODS This was a prospective observational study. Among the 468 patients undergoing emergency abdominal surgery admitted to a department of emergency surgery from June 2020 to December 2021, 53 patients were not eligible for enrollment, and 19 patients had missing data. Thus, the final number of participants was 396. Muscle mass was evaluated by skeletal muscle index at the third lumbar vertebra on computed tomography scans, and the lower quartile was defined as the threshold of muscle mass reduction. The associations of Global Leadership Initiative on Malnutrition, Global Leadership Initiative on Malnutrition (muscle mass reduction excluded), and skeletal muscle index with in-hospital mortality, postoperative complications, and postoperative stay were evaluated using χ2. In addition, confounding factors were screened, regression models were established, and the Global Leadership Initiative on Malnutrition predictive value was analyzed for clinical outcome. Ethical approval was obtained from the appropriate department. RESULTS Malnutrition was observed in 19.9% of the total 396 patients based on the Global Leadership Initiative on Malnutrition and in 12.4% on the Global Leadership Initiative on Malnutrition (muscle mass reduction excluded). Sarcopenia by skeletal muscle index was found in 24.7% of patients. Univariate analysis indicated that in-hospital mortality, postoperative complications, infective complication rate, and postoperative hospital stay were significantly higher in malnourished and sarcopenic patients. Multivariate analysis found that malnutrition diagnosed by the Global Leadership Initiative on Malnutrition was predictive for complications, infective complications, and postoperative stay (total postoperative complications: odds ratio = 3.620; 95% CI, 1.635-8.015; P = 0.002; infective complications: odds ratio = 3.127; 95% CI, 1.194-8.192; P = 0.020; and postoperative stay: regression coefficient = 2.622; P = 0.022). The Global Leadership Initiative on Malnutrition (muscle mass reduction excluded) identified postoperative complications and postoperative stay (total postoperative complications: odds ratio = 3.364; 95% CI, 1.247-9.075; P = 0.017 and postoperative stay: regression coefficient = 3.547; P = 0.009). Sarcopenia by skeletal muscle index was a risk factor for postoperative complications (odds ratio = 3.366; 95% CI, 1.587-7.140; P = 0.002). CONCLUSION The Global Leadership Initiative on Malnutrition and Global Leadership Initiative on Malnutritison (muscle mass reduction excluded) had predictive value for adverse clinical outcomes due to malnutrition in patients undergoing emergency abdominal surgery.
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Affiliation(s)
- Yue Wu
- Huashan Hospital, Fudan University, Shanghai, China; Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruo-Tao Liu
- Department of Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiao-Yue Zhou
- Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Fang
- Department of Clinical Nutrition, Putuo People's Hospital, Tongji University, Shanghai, China
| | - Dongpin Huang
- Department of Clinical Nutrition, Putuo People's Hospital, Tongji University, Shanghai, China
| | - Zhen-Yi Jia
- Department of Surgery, Shanghai Sixth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China; Department of Clinical Nutrition, Putuo People's Hospital, Tongji University, Shanghai, China.
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5
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Cikwanine JPB, Yoyu JT, Alumeti DM, Mugisho B, Kivukuto JM, Iteke RF, Longombe Ahuka O, Kalau Arung W. Benefits of Early Enteral Feeding with a Locally Prepared Protein-Energy Ration after Surgery for Acute Generalised Peritonitis: A Randomised Trial in Two Hospitals in Bukavu, Eastern Democratic Republic of Congo. Gastroenterol Res Pract 2023; 2023:1764242. [PMID: 38024526 PMCID: PMC10673662 DOI: 10.1155/2023/1764242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 10/15/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023] Open
Abstract
Background Acute generalised peritonitis (AGP) is a common and serious digestive surgery pathology. Undernutrition exacerbates patient condition and compromises their postoperative prognosis. Early enteral nutrition is recommended to reduce postoperative complications, but its availability and cost are problematic in low-income countries. The objective of this study was to evaluate the impact of providing early enteral feeding (EEF) to postoperative patients with intestinal perforation AGP using a locally prepared protein-energy food ration in two hospitals in Bukavu, a city of South Kivu, in the eastern part of the Democratic Republic of Congo. Methods A prospective, randomised controlled trial with two groups of patients was conducted to investigate the effects of EEF with a local mixture versus enteral feeding after peristalsis had returned (control group) in patients who underwent laparotomy for AGP caused by ileal perforation. The local mixture consisted of soybean, maize, white rice, and pineapple. The trial included 66 patients with ileal perforation peritonitis. Results The results comparing early enteral fed and nonfed patients showed significant differences in peristalsis recovery time (2.1 (0.6) days vs. 3.8 (1.2) days, p < 0.0001) and length of hospital stay (25.5 (14.9) days vs. 39.4 (25.3) days, p = 0.0046). Bivariate analyses indicated a significant early enteral feeding (EEF) reduced of 9.1% (vs. 36.4%, p = 0.0082) in parietal infections and 3.4% (28.1%, p = 0.009) in fistulas (p = 0.009) when EEF was included. In addition, EEF significantly reduced reintervention rates by 9.1% (p = 0.0003) and eliminated evisceration rates. EEF was also shown to reduce the incidence of malnutrition by 63.6% (p < 0.0001). Multivariate analysis showed that enteral nutrition significantly reduced the time to recovery of peristalsis (p = 0.0278) with an ORa of 0.3 and a 95% CI of 0.1-0.9. Moreover, EEF reduced malnutrition (p = 0.0039) with an ORa of 0.1 and a 95% CI of 0-0.4. Conclusion EEF with locally sourced protein-energy rations can enhance a patient's nutritional status and facilitate postoperative recovery. This procedure is advantageous and involved early enteral nutrition using locally manufactured rations, especially for those operated on for acute generalised peritonitis in the Democratic Republic of Congo.
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Affiliation(s)
- Jean Paul Buhendwa Cikwanine
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Jonathan Tunangoya Yoyu
- International Centre for Advanced Research and Training, Bukavu, Democratic Republic of the Congo
- Progressive Medical Systems/Department of Works and Medical Research, Goma, Democratic Republic of the Congo
| | - Désiré Munyali Alumeti
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Panzi Hospital, Bukavu, Democratic Republic of the Congo
| | - Bernard Mugisho
- Rau Ciriri Hospital, Bukavu, Democratic Republic of the Congo
| | | | - Rivain Fefe Iteke
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
| | - Ona Longombe Ahuka
- Faculty of Medicine, Evangelical University in Africa, Bukavu, Democratic Republic of the Congo
- Department of Surgery, University of Kisangani, Democratic Republic of the Congo
| | - Willy Kalau Arung
- University of Lubumbashi, Lubumbashi, Democratic Republic of the Congo
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Shao YR, Ke X, Luo LH, Xu JD, Xu LQ. Application of early enteral nutrition nursing based on enhanced recovery after surgery theory in patients with digestive surgery. World J Gastrointest Surg 2023; 15:1910-1918. [PMID: 37901724 PMCID: PMC10600773 DOI: 10.4240/wjgs.v15.i9.1910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 06/25/2023] [Accepted: 08/02/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Postoperative nursing can improve the restlessness and gastrointestinal function of patients with tracheal intubation under general anesthesia in digestive surgery. Wide application of various nursing methods and routine nursing in perioperative nursing of patients with general anesthesia in digestive surgery. AIM To investigate the impact of early postoperative enteral nutrition nursing based on the enhanced recovery after surgery (ERAS) theory on postoperative agitation and gastrointestinal recovery in patients undergoing general anesthesia that experienced tracheal intubation. METHODS The data of 126 patients with digestive surgery from May 2019 to February 2022 were retrospectively analyzed. According to different nursing methods, they were divided into control group and observation group, with 63 cases in observation group and 63 cases in control group. The patients in the control group had standard perioperative nursing care, whereas those in the observation group got enteral nourishment as soon as possible after surgery in accordance with ERAS theory. Both the rate and quality of gastrointestinal function recovery were compared between the two groups after treatment ended. Postoperative anesthesia-related adverse events were tallied, patients' nutritional statuses were monitored, and the Riker sedation and agitation score (SAS) was used to measure the incidence of agitation. RESULTS When compared to the control group, the awake duration, spontaneous breathing recovery time, extubation time and postoperative eye-opening time were all considerably shorter (P < 0.05). There was no significant difference in the recovery time of orientation force between the two groups (P > 0.05); however, the observation group had a lower SAS score than the control group (P < 0.05). The recovery time for normal intestinal sounds, the time it took to have the first postoperative exhaust, the time it took to have the first postoperative defecation, and the time it took to have the first postoperative half-fluid feeding were all faster in the observation group than in the control group (P < 0.05); Fasting blood glucose was lower in the observation group compared to the control group (P < 0.05), while the albumin and hemoglobin levels were higher on the first and third postoperative days; however, there was no statistically significant difference in the incidence of anesthesia-related adverse reactions between the two groups (P > 0.05). CONCLUSION The extremely early postoperative enteral nutrition nursing based on ERAS theory can reduce the degree of agitation, improve the quality of recovery, promote the recovery of gastrointestinal function, and improve the nutritional status of patients in the recovery period after tracheal intubation under general anesthesia.
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Affiliation(s)
- Yan-Ru Shao
- Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510062, Guangdong Province, China
| | - Xia Ke
- Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510062, Guangdong Province, China
| | - Li-Hua Luo
- Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510062, Guangdong Province, China
| | - Jin-Dong Xu
- Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510062, Guangdong Province, China
| | - Li-Qian Xu
- Department of Anesthesiology, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou 510062, Guangdong Province, China
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7
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Bou‐Samra P, Chang A, Zhang K, Azari F, Kennedy G, Guo E, Hwang W, Singhal S. Strategies to reduce morbidity following pleurectomy and decortication for malignant pleural mesothelioma. Thorac Cancer 2023; 14:2770-2776. [PMID: 37574596 PMCID: PMC10518225 DOI: 10.1111/1759-7714.15067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/26/2023] [Accepted: 07/27/2023] [Indexed: 08/15/2023] Open
Abstract
BACKGROUND Pleurectomy and decortication (PD) in malignant pleural mesothelioma has a high morbidity mostly associated with aspiration pneumonia (PNA), deep vein thrombosis (DVT), and foreign catheter sepsis. We instituted four strategies to reduce these complications and report our experience. METHODS This was a retrospective review of patients who underwent PD at the University of Pennsylvania between 2015 and 2022. Our patients underwent standard of care PD in addition to tracheostomy and gastrostomy/jejunostomy tube with therapeutic anticoagulation (AC) leading up to surgery. Measured outcomes were postoperative PNA, DVT, and sepsis. The predicted risk of those same outcomes had patients not undergone the interventions was calculated based on the American College of Surgeons (ACS) surgical risk calculator (SRC). A McNemar's test was used to determine whether the risk of having PNA, DVT and sepsis differed between the two subgroups. RESULTS Fifty-five patients were included in the study. The mean age was 70 years (SD 6.2) with a mean of 21 (SD 19) pack-years of smoking. PNA, DVT, and catheter-related sepsis occurred in 12, four, and seven patients, respectively. Upon using the ACS SRC prediction model of the nonintervention group, PNA, DVT and catheter related sepsis was predicted to occur in 24 (paired data OR 5, 95% CI: 1.4-17.2; McNemar's test p = 0.008), 14 (paired data OR 3.5, 95% CI: 1.15-10.6; McNemar's test p = 0.03), and 17 (paired OR 3, 95% CI: 1.09-8.3; McNemar's test p = 0.04) patients, respectively. DISCUSSION Patients undergoing tracheostomy creation, therapeutic AC at the time of diagnosis, and gastrostomy tube placement had a reduced risk of aspiration PNA, DVT, and catheter sepsis.
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Affiliation(s)
- Patrick Bou‐Samra
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Austin Chang
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Kevin Zhang
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Feredun Azari
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Gregory Kennedy
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Emily Guo
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
| | - Wei‐Ting Hwang
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- Department of Biostatistics, Epidemiology, and Informatics (DBEI)University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Sunil Singhal
- Department of Thoracic SurgeryUniversity of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
- University of Pennsylvania Perelman School of MedicinePhiladelphiaPennsylvaniaUSA
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Talebi S, Zeraattalab-Motlagh S, Vajdi M, Nielsen SM, Talebi A, Ghavami A, Moradi S, Sadeghi E, Ranjbar M, Habibi S, Sadeghi S, Mohammadi H. Early vs delayed enteral nutrition or parenteral nutrition in hospitalized patients: An umbrella review of systematic reviews and meta-analyses of randomized trials. Nutr Clin Pract 2023; 38:564-579. [PMID: 36906848 DOI: 10.1002/ncp.10976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/02/2023] [Accepted: 02/05/2023] [Indexed: 03/13/2023] Open
Abstract
We conducted an umbrella review to summarize the existing evidence on the effect of early enteral nutrition (EEN) compared with other approaches, including delayed enteral nutrition (DEN), parenteral nutrition (PN), and oral feeding (OF) on clinical outcomes in hospitalized patients. We performed a systematic search up to December 2021, in MEDLINE (via PubMed), Scopus, and Institute for Scientific Information Web of Science. We included systematic reviews with meta-analyses (SRMAs) of randomized trials investigating EEN compared with DEN, PN, or OF for any clinical outcomes in hospitalized patients. We used "A Measurement Tool to Assess Systematic Reviews" (AMSTAR2) and the Cochrane risk-of-bias tool for assessing the methodological quality of the systematic reviews and their included trial, respectively. The certainty of the evidence was rated using the "Grading of Recommendations Assessment, Development, and Evaluation" (GRADE) approach. We included 45 eligible SRMAs contributing with a total of 103 randomized controlled trials. The overall meta-analyses showed that patients who received EEN had statistically significant beneficial effects on most outcomes compared with any control (ie, DEN, PN, or OF), including mortality, sepsis, overall complications, infection complications, multiorgan failure, anastomotic leakage, length of hospital stay, time to flatus, and serum albumin levels. No statistically significant beneficial effects were found for risk of pneumonia, noninfectious complications, vomiting, wound infection, as well as number of days of ventilation, intensive care unit days, serum protein, and pre-serum albumin levels. Our results indicate that EEN may be preferred over DEN, PN, and OF because of the beneficial effects on many clinical outcomes.
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Affiliation(s)
- Sepide Talebi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.,Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Sheida Zeraattalab-Motlagh
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Vajdi
- Student Research Committee, Department of Community Nutrition, School of Nutrition and Food Science, Isfahan, Iran
| | - Sabrina Mai Nielsen
- Section for Biostatistics and Evidence-Based Research, The Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Ali Talebi
- Clinical Pharmacy Department, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Abed Ghavami
- Department of Clinical Nutrition, School of Nutrition and Food Science, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Sajjad Moradi
- Halal Research Center of IRI, FDA, Tehran, Iran.,Nutritional Sciences Department, School of Nutritional Sciences and Food Technology, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Erfan Sadeghi
- Research Consultation Center (RCC), Shiraz University Of Medical Sciences, Shiraz, Iran
| | - Mahsa Ranjbar
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sajedeh Habibi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Sara Sadeghi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamed Mohammadi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
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9
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Bischoff SC, Bager P, Escher J, Forbes A, Hébuterne X, Hvas CL, Joly F, Klek S, Krznaric Z, Ockenga J, Schneider S, Shamir R, Stardelova K, Bender DV, Wierdsma N, Weimann A. ESPEN guideline on Clinical Nutrition in inflammatory bowel disease. Clin Nutr 2023; 42:352-379. [PMID: 36739756 DOI: 10.1016/j.clnu.2022.12.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 12/05/2022] [Indexed: 01/15/2023]
Abstract
The present guideline is an update and extension of the ESPEN scientific guideline on Clinical Nutrition in Inflammatory Bowel Disease published first in 2017. The guideline has been rearranged according to the ESPEN practical guideline on Clinical Nutrition in Inflammatory Bowel Disease published in 2020. All recommendations have been checked and, if needed, revised based on new literature, before they underwent the ESPEN consensus procedure. Moreover, a new chapter on microbiota modulation as a new option in IBD treatment has been added. The number of recommendations has been increased to 71 recommendations in the guideline update. The guideline is aimed at professionals working in clinical practice, either in hospitals or in outpatient medicine, and treating patients with IBD. General aspects of care in patients with IBD, and specific aspects during active disease and in remission are addressed. All recommendations are equipped with evidence grades, consensus rates, short commentaries and links to cited literature.
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Affiliation(s)
- Stephan C Bischoff
- Institute of Nutritional Medicine, University of Hohenheim, Stuttgart, Germany.
| | - Palle Bager
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | - Johanna Escher
- Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, the Netherlands.
| | - Alastair Forbes
- Institute of Clinical Medicine, University of Tartu, Tartu, Estonia.
| | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU of Nice, University Côte d'Azur, Nice, France.
| | - Christian Lodberg Hvas
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark.
| | - Francisca Joly
- Department of Gastroenterology and Nutrition Support, CHU de Beaujon, APHP, University of Paris, Paris, France.
| | - Stansilaw Klek
- Surgical Oncology Clinic, Maria Sklodowska-Curie National Cancer Institute, Krakow, Poland.
| | - Zeljko Krznaric
- Department of Gastroenterology, Hepatology and Nutrition, University Hospital Centre Zagreb, University of Zagreb, Croatia.
| | - Johann Ockenga
- Medizinische Klinik II, Klinikum Bremen-Mitte, Bremen FRG, Bremen, Germany.
| | - Stéphane Schneider
- Department of Gastroenterology and Clinical Nutrition, CHU de Nice, University Côte d'Azur, Nice, France.
| | - Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center of Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Kalina Stardelova
- University Clinic for Gastroenterohepatology, Clinical Campus "Mother Theresa", University St Cyrul and Methodius, Skopje, North Macedonia.
| | - Darija Vranesic Bender
- Unit of Clinical Nutrition, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia.
| | - Nicolette Wierdsma
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
| | - Arved Weimann
- Department of General, Visceral and Oncological Surgery, St. George Hospital, Leipzig, Germany.
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Gormsen J, Brunchmann A, Henriksen NA, Jensen TK, Laugesen KB, Motavaf E, Possfelt-Møller EM, Poulsen KA, Skovsen AP, Svenningsen P, Tengberg LT, Burcharth J. Perioperative clinical management in relation to emergency surgery for perforated peptic ulcer: A nationwide questionnaire survey. Clin Nutr ESPEN 2022; 47:299-305. [DOI: 10.1016/j.clnesp.2021.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/08/2021] [Accepted: 11/23/2021] [Indexed: 11/26/2022]
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11
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Weimann A, Wobith M. Update enterale und parenterale Ernährung. Zentralbl Chir 2021; 146:535-542. [PMID: 34872110 DOI: 10.1055/a-1545-6801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Arved Weimann
- Abteilung für Allgemein- und Viszeralchirurgie, Klinikum St. Georg
| | - Maria Wobith
- Klinik für Allgemein- und Viszeralchirurgie, Klinikum St. Georg Leipzig, Leipzig, Deutschland
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12
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Oral Nutritional Supplements and Enteral Nutrition in Patients with Gastrointestinal Surgery. Nutrients 2021; 13:nu13082655. [PMID: 34444812 PMCID: PMC8400187 DOI: 10.3390/nu13082655] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 12/11/2022] Open
Abstract
Nowadays, patients undergoing gastrointestinal surgery are following perioperative treatment in enhanced recovery after surgery (ERAS) protocols. Although oral feeding is supposed not to be stopped perioperatively with respect to ERAS, malnourished patients and inadequate calorie intake are common. Malnutrition, even in overweight or obese patients, is often underestimated. Patients at metabolic risk have to be identified early to confirm the indication for nutritional therapy. The monitoring of nutritional status postoperatively has to be considered in the hospital and after discharge, especially after surgery in the upper gastrointestinal tract, as normal oral food intake is decreased for several months. The article gives an overview of the current concepts of perioperative enteral nutrition in patients undergoing gastrointestinal surgery.
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