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Ren Y, Wang L, Zhan J, Liao W, Hu R, Luo J, Cheng X. An overview of current research on nutritional support for burn patients: a bibliometric analysis from 1983 to 2022. Nutrition 2023; 111:112027. [PMID: 37087943 DOI: 10.1016/j.nut.2023.112027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/18/2023]
Abstract
OBJECTIVES Burn patients are reportedly prone to complications, such as skeletal muscle wasting, anemia, and slow wound healing, during treatment, due to disease and metabolic depletion, which affect prognosis. Nutritional support is essential in treating burns and can significantly improve patient survival and reduce complications such as infection. This study aimed to perform a bibliometric analysis of the existing literature on nutritional support for burns and to explore possible future research trends. METHODS The literature related to nutritional support for burns from 1983 to 2022 was searched on Web of Science. The included literature was used for bibliometric analysis using VOSviewer and CiteSpace software. RESULTS There were 260 publications on nutritional support for burns. The United States contributes significantly to research in this area. The United States has the highest number of publications (n = 119) and citations (n = 4424). Nutrition support was the keyword with strongest burst intensity. A diet of ≥ 60% carbohydrates and 12% to 15% fat is suitable for burn patients, but the optimal ratios have not been fully determined. CONCLUSIONS An optimal nutritional support program is essential for treating burn patients. Individualized nutritional support programs are the trend in this field. At present, more rigorous multicenter prospective studies with large samples are needed to explore the optimal ratios for specific dietary programs, especially macronutrients, to achieve satisfactory nutritional support and improve patient prognosis.
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Affiliation(s)
- Yujie Ren
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lihui Wang
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jianhua Zhan
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Wenqiang Liao
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Renchao Hu
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Jinhua Luo
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
| | - Xing Cheng
- Medical Center of Burn Plastic and Wound Repair, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.
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Effects of Different Ratios of Carbohydrate-Fat in Enteral Nutrition on Metabolic Pattern and Organ Damage in Burned Rats. Nutrients 2022; 14:nu14173653. [PMID: 36079913 PMCID: PMC9460118 DOI: 10.3390/nu14173653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/31/2022] [Accepted: 09/01/2022] [Indexed: 11/21/2022] Open
Abstract
(1) Background: Nutritional support is one of the most important cornerstones in the management of patients with severe burns, but the carbohydrate-to-fat ratios in burn nutrition therapy remain highly controversial. In this study, we aimed to discuss the effects of different ratios of carbohydrate–fat through enteral nutrition on the metabolic changes and organ damage in burned rats. (2) Methods: Twenty-four burned rats were randomly divided into 5%, 10%, 20% and 30% fat nutritional groups. REE and body weight were measured individually for each rat daily. Then, 75% of REE was given in the first week after burns, and the full dose was given in the second week. Glucose tolerance of the rats was measured on days 1, 3, 7, 10 and 14. Blood biochemistry analysis and organ damage analysis were performed after 7 and 14 days of nutritional therapy, and nuclear magnetic resonance (NMR) and insulin content analysis were performed after 14 days. (3) Results: NMR spectra showed significant differences of glucose, lipid and amino acid metabolic pathways. The energy expenditure increased, and body weight decreased significantly after burn injury, with larger change in the 20%, 5% and 30% fat groups, and minimal change in the 10% fat group. The obvious changes in the level of plasma protein, glucose, lipids and insulin, as well as the organ damage, were in the 30%, 20% and 5% fat groups. In relative terms, the 10% fat group showed the least variation and was closest to normal group. (4) Conclusion: Lower fat intake is beneficial to maintaining metabolic stability and lessening organ damage after burns, but percentage of fat supply should not be less than 10% in burned rats.
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Geometric framework reveals that a moderate protein, high carbohydrate intake is optimal for severe burn injury in mice. Br J Nutr 2020; 123:1056-1067. [PMID: 31983360 DOI: 10.1017/s0007114520000276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Nutritional therapy is a cornerstone of burns management. The optimal macronutrient intake for wound healing after burn injury has not been identified, although high-energy, high-protein diets are favoured. The present study aimed to identify the optimal macronutrient intake for burn wound healing. The geometric framework (GF) was used to analyse wound healing after a 10 % total body surface area contact burn in mice ad libitum fed one of the eleven high-energy diets, varying in macronutrient composition with protein (P5-60 %), carbohydrate (C20-75 %) and fat (F20-75 %). In the GF study, the optimal ratio for wound healing was identified as a moderate-protein, high-carbohydrate diet with a protein:carbohydrate:fat (P:C:F) ratio of 1:4:2. High carbohydrate intake was associated with lower mortality, improved body weight and a beneficial pattern of body fat reserves. Protein intake was essential to prevent weight loss and mortality, but a protein intake target of about 7 kJ/d (about 15 % of energy intake) was identified, above which no further benefit was gained. High protein intake was associated with delayed wound healing and increased liver and spleen weight. As the GF study demonstrated that an initial very high protein intake prevented mortality, a very high-protein, moderate-carbohydrate diet (P40:C42:F18) was specifically designed. The dynamic diet study was also designed to combine and validate the benefits of an initial very high protein intake for mortality, and subsequent moderate protein, high carbohydrate intake for optimal wound healing. The dynamic feeding experiment showed switching from an initial very high-protein diet to the optimal moderate-protein, high-carbohydrate diet accelerated wound healing whilst preventing mortality and liver enlargement.
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Shields BA, VanFosson CA, Pruskowski KA, Gurney JM, Rizzo JA, Cancio LC. High-Carbohydrate vs High-Fat Nutrition for Burn Patients. Nutr Clin Pract 2019; 34:688-694. [PMID: 31441112 DOI: 10.1002/ncp.10396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Nutrition is an essential component of the healing and recovery process after severe burn injury. For many burn patients, nutrition support is necessary to meet nutrition goals. The ratio of carbohydrates and fat is particularly important for burn patients, as an essential fatty acid deficiency can contribute to poor wound healing. However, there is evidence to suggest that diets containing more carbohydrates and less fat may result in better patient outcomes. A literature search was conducted to identify studies related to nutrition support and macronutrient ratios in burn patients. Eleven published papers were found that considered macronutrient use in enteral and parenteral nutrition therapies among 9 different burn patient samples. No negative outcomes associated with lower fat, higher carbohydrate nutrition for severely burned patients were found in the literature. Conversely, the literature review revealed improved outcomes among severely burned patients receiving lower fat, higher carbohydrate nutrition to include fewer incidences of pneumonia, wound infections, acute respiratory distress syndrome, fatty liver, and sepsis. These patients also experienced shorter hospital length of stay and shorter wound healing times, as well as lower spleen and kidney weights, lower urinary nitrogen losses, improved nitrogen balance, higher insulin levels, higher insulin-like growth factor-1, lower cortisol, and less muscle protein breakdown. The evidence available to date supports the clinical use of nutrition support providing ≤15% fat and ≥60% carbohydrate for critically ill burn patients.
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Affiliation(s)
- Beth A Shields
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | | | - Kaitlin A Pruskowski
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Jennifer M Gurney
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Julie A Rizzo
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
| | - Leopoldo C Cancio
- United States Army Institute of Surgical Research, Joint Base San Antonio, Texas, USA
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Ciampa BP, Reyes Ramos E, Borum M, Doman DB. The Emerging Therapeutic Role of Medical Foods for Gastrointestinal Disorders. Gastroenterol Hepatol (N Y) 2017; 13:104-115. [PMID: 28450817 PMCID: PMC5402682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In addition to drugs approved by the US Food and Drug Administration (FDA) that treat, cure, or mitigate disease, medical foods are a tool to help manage chronic conditions and diseases. A medical food, according to the FDA, is a food that is developed to be eaten or administered enterally under the guidance of a physician and that is meant for the specific dietary management of a condition or disease for which distinctive nutritional requirements, based upon known scientific principles, are established by medical evaluation. A variety of medical foods exist to help manage a wide range of medical conditions, from Alzheimer disease to HIV-associated enteropathy. EnteraGam contains serum-derived bovine immunoglobulin/protein isolate, which has been studied extensively in diarrhea-predominant irritable bowel syndrome, inflammatory bowel disease (IBD), and HIV-associated enteropathy. VSL#3 is a probiotic that is used in pouchitis for patients with ulcerative colitis as well as irritable bowel syndrome. Modulen IBD is a whole-protein, sole-nutrition formulation used to manage the active phase of Crohn's disease. Vivonex is an elemental diet that is used in a variety of diseases associated with severe gastrointestinal dysfunction. Medical foods are safe and must have proven efficacy in helping to manage a variety of gastrointestinal conditions and diseases. These therapies represent tools that can be used prior or in addition to traditional medical therapies. This article discusses the history and development of medical foods under the FDA and concentrates specifically on medical foods used to help manage diseases of the gastrointestinal tract.
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Affiliation(s)
- Brian P Ciampa
- Dr Ciampa and Dr Reyes Ramos are gastroenterology fellows in the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center and are affiliated with Medical Faculty Associates, both in Washington, DC. Dr Borum is a professor of medicine at George Washington University School of Medicine in Washington, DC; director of the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center; and is affiliated with Medical Faculty Associates. Dr Doman is a clinical professor of medicine at George Washington University School of Medicine
| | - Emmanuel Reyes Ramos
- Dr Ciampa and Dr Reyes Ramos are gastroenterology fellows in the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center and are affiliated with Medical Faculty Associates, both in Washington, DC. Dr Borum is a professor of medicine at George Washington University School of Medicine in Washington, DC; director of the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center; and is affiliated with Medical Faculty Associates. Dr Doman is a clinical professor of medicine at George Washington University School of Medicine
| | - Marie Borum
- Dr Ciampa and Dr Reyes Ramos are gastroenterology fellows in the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center and are affiliated with Medical Faculty Associates, both in Washington, DC. Dr Borum is a professor of medicine at George Washington University School of Medicine in Washington, DC; director of the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center; and is affiliated with Medical Faculty Associates. Dr Doman is a clinical professor of medicine at George Washington University School of Medicine
| | - David B Doman
- Dr Ciampa and Dr Reyes Ramos are gastroenterology fellows in the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center and are affiliated with Medical Faculty Associates, both in Washington, DC. Dr Borum is a professor of medicine at George Washington University School of Medicine in Washington, DC; director of the Division of Gastroenterology and Liver Diseases at George Washington University Medical Center; and is affiliated with Medical Faculty Associates. Dr Doman is a clinical professor of medicine at George Washington University School of Medicine
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Tihista S, Echavarría E. Effect of omega 3 polyunsaturated fatty acids derived from fish oil in major burn patients: A prospective randomized controlled pilot trial. Clin Nutr 2017; 37:107-112. [PMID: 28153504 DOI: 10.1016/j.clnu.2017.01.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 12/10/2016] [Accepted: 01/09/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND & AIMS The burn patient is the clearest example of prolonged inflammatory response. Various nutrients, particularly omega-3 polyunsaturated fatty acids (ω-3 PUFAs), have been demonstrated as attenuating the inflammatory response, and reduce infectious complications. In absence of definitive evidence in major burns the study aimed at investigating the effect particularly on infectious complications of enteral nutrition enriched with ω-3 PUFAs. METHOD Prospectively randomized controlled trial. INCLUSION CRITERIA adult patients admitted to intensive care (ICU), burns > 15% body surface area (BSA), with inhalation injury requiring mechanical ventilation for ≥ 6 days and enteral nutrition. INTERVENTION low-fat (18% energy as fat) modular diet (LF-EN) or identical with 50% of fat as fish oil (FO-EN). Study endpoints: infectious and other complications, length of mechanical ventilation time, mortality. RESULTS Altogether 92 patients, aged 40 years old and burned 38% BSA were analyzed (45 patients in LF-EN and 47 in FO-EN). Baseline characteristics were similar. Severe sepsis and septic shock together were significantly fewer in FO-EN group, 15% versus 33%, p = 0.03, (others infections unchanged). Non-infectious complications were less frequent in group FO-EN, with a significant reduction of high gastric residual volume (33% versus 8.5%: p = 0.003). Mechanical ventilation was non-significantly shorter with FO-EN (22 versus 26 days). Mortality did not differ. CONCLUSION The inclusion of ω-3 PUFAs in a low fat diet in ICU burned patients was associated with significant clinical benefits compared to a conventional low fat diet, with lower rates of severe sepsis, septic shock and pyloric dysfunction. TRIAL IDENTIFICATION NCT02189538.
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Affiliation(s)
- Serrana Tihista
- Departamento de Nutrición, Centro Nacional de Quemados (CENAQUE), Montevideo, Uruguay.
| | - Estrella Echavarría
- Departamento de Medicina Intensiva, Centro Nacional de Quemados (CENAQUE), Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
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Ravat F, Le Floch R. [Not Available]. ANNALS OF BURNS AND FIRE DISASTERS 2015; 28:296-309. [PMID: 27777551 PMCID: PMC5068899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Chaque année, le congrès de la SFB est l'occasion d'une mise au point sur un thème (« table ronde ».) Celui choisi en 2015 était la nutrition. Huit orateurs se sont succédés, faisant le point sur les données actuelles de la science, les pratiques dans les centres, et les recommandations actuelles, datant de 2013. Cet article se propose de diffuser les interventions.
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Affiliation(s)
- F. Ravat
- Centre hospitalier St Joseph & St Luc, Lyon, France
| | - R. Le Floch
- Réanimation chirurgicale et des brûlés, ChU nantes, France
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Akers KS, Shields BA, Akers ME, Mende K, Beckius ML, Murray CK, Chung KK. Microbial Contamination of Enteral Nutrition Mixtures in a Hyperthermal Environment: A Follow-Up Investigation. Nutr Clin Pract 2015. [PMID: 26206953 DOI: 10.1177/0884533615586203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Perry J, Stankorb SM, Salgueiro M. Author's Response to "Microbial Contamination of Enteral Nutrition Mixtures in a Hyperthermal Environment: A Follow-Up Investigation". Nutr Clin Pract 2015. [PMID: 26206954 DOI: 10.1177/0884533615586204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Perry J, Stankorb SM, Salgueiro M. Microbial Contamination of Enteral Feeding Products in Thermoneutral and Hyperthermal ICU Environments. Nutr Clin Pract 2014; 30:128-33. [DOI: 10.1177/0884533614541680] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Jeffery Perry
- Military-Baylor Graduate Program in Nutrition, JBSA Fort Sam Houston, Texas
- Brooke Army Medical Center, San Antonio, Texas
| | - Susan M. Stankorb
- Military-Baylor Graduate Program in Nutrition, JBSA Fort Sam Houston, Texas
- Brooke Army Medical Center, San Antonio, Texas
| | - Marybeth Salgueiro
- Military-Baylor Graduate Program in Nutrition, JBSA Fort Sam Houston, Texas
- Brooke Army Medical Center, San Antonio, Texas
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Review of burn research for the year 2011. J Burn Care Res 2013; 34:211-8. [PMID: 23370995 DOI: 10.1097/bcr.0b013e3182839b34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The year 2011 was another robust year for burn research. Over 1100 articles were published on a wide range of burn injury and treatment topics. In this review, we highlight some of the interesting and potentially influential research in the following areas: critical care, infection, inhalation injury, epidemiology, wound characterization and treatment, nutrition and metabolism, pain management, burn reconstruction, psychology, and rehabilitation. As in years past, burn injury research reflects the multidisciplinary and holistic care that is needed to treat this challenging injury condition.
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