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Romano C, Lionetti P, Spagnuolo MI, Amarri S, Diamanti A, Verduci E, Lezo A, Simona G. Trends and challenges in home enteral feeding methods for children with gastrointestinal disorders: an expert review on bolus feeding delivery methods. Expert Rev Gastroenterol Hepatol 2024; 18:193-202. [PMID: 38030649 DOI: 10.1080/17474124.2023.2289530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/27/2023] [Indexed: 12/01/2023]
Abstract
INTRODUCTION New evidence supports the benefits of bolus feeding for children receiving home enteral feeding (HEN). Current home methods of bolus feeding have certain limitations, particularly in mobile or restless patients. Therefore, innovative delivery methods have been introduced to provide more flexible methods of reducing feeding time and formula handling. AREAS COVERED This manuscript presents an expert review of the updates in HEN for children and the results of an online user experience questionnaire about an innovative new cap-based bolus feeding system. A literature bibliographic search was conducted on Medline via PubMed up to September 2023 to collect relevant studies. We presented recent evidence demonstrating a dramatic increase in HEN use among children requiring EN and its benefits on patients' nutritional status and quality of life. In addition, the article examined the clinical and social benefits of bolus feeding and current challenges in delivery methods. We described the benefits of the new system and its user experience. EXPERT OPINION The uses and indications for bolus feeding in HEN are increasing among children. However, there are still some unmet needs regarding traditional delivery methods. Innovative techniques can improve flexibility, reduce feeding time, and improve user experience and quality of life.
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Affiliation(s)
- Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, University of Messina, Messina, Italy
| | - Paolo Lionetti
- Gastroenterology and Nutrition Unit, Meyer Children's Hospital, Department NEUROFARBA - University of Florence, Florence, Italy
| | - Maria Immacolata Spagnuolo
- Department of Translational Medical Science, Section of Pediatrics, University of Naples Federico II, Naples, Italy
| | - Sergio Amarri
- Pediatric Palliative Care, Fondazione Hospice MT. C. Seràgnoli, BO, Bentivoglio, Italy
| | - Antonella Diamanti
- Artificial Nutrition Unit Bambino Gesù, Children's Hospital, Rome, Italy
| | - Elvira Verduci
- Department of Pediatrics, Buzzi Children's Hospital, Milan, Italy
- Department of Health Sciences, University of Milan, Milan, Italy
| | - Antonella Lezo
- Division of Clinical Nutrition, Regina Margherita Children's Hospital, Turin, Italy
| | - Gatti Simona
- Department of Pediatrics,Università Politecnica delle Marche, Italy
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Mohammad N, Nazli R, Fatima S, Fozia F, Zafar H, Zafar M, Zafar Z, Khan W, Abulmeaty M, Aldisi D, Andrade Laborde J, Aboul-Soud M. Lipid-based Nutritional Supplement Impact on Energy Intake, Appetite, Glucose and Insulin Levels in Under-Weight Pregnant and Lactating Women with Preeclampsia. Biosci Rep 2024; 44:BSR20231344. [PMID: 38206092 PMCID: PMC10830442 DOI: 10.1042/bsr20231344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/30/2023] [Accepted: 01/09/2024] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVE To investigate the response of nutritional supplement (LNS-PLW) on appetite score, energy intake, insulin and glucose levels in preeclamptic women. DESIGN & PARTICIPANTS Sixty under-weight preeclamptic primigravida were divided into two groups randomly and provided LNS-PLW/Placebo in the fasted state. Blood samples were collected at fasting state, after 30mins of supplementation, "ad libitum buffet" breakfast and lunch for glucose and insulin levels. RESULTS Total energy intake was higher significantly in the LNS-PLW group, although during breakfast it was significantly reduced. The insulin and glucose concentration was significantly increased after 30min of supplementation in the LNS-PLW group. CONCLUSION Intake of the LNS-PLW by pre-eclamptic women had short-term suppression on subsequent meal but improved total energy intake during trial.
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Affiliation(s)
- Nabila Sher Mohammad
- Department of Biochemistry, Institute of Basic Medical Science, Khyber Medical University, Peshawar 25000, Pakistan
| | - Rubina Nazli
- Department of Biochemistry, Institute of Basic Medical Science, Khyber Medical University, Peshawar 25000, Pakistan
| | - Sadia Fatima
- Department of Biochemistry, Institute of Basic Medical Science, Khyber Medical University, Peshawar 25000, Pakistan
| | - Fozia Fozia
- Department of Biochemistry, KMU Institute of Dental Science, Kohat 26000, Khyber Pakhtunkhwa, Pakistan
| | - Hafza Zafar
- Department of Biochemistry, Institute of Basic Medical Science, Khyber Medical University, Peshawar 25000, Pakistan
| | - Mashal Zafar
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar 25000, Pakistan
| | - Zarghuna Zafar
- Institute of Physical Medicine and Rehabilitation, Khyber Medical University, Peshawar 25000, Pakistan
| | - Warda Khan
- Rehman Dental Collage, Peshawar 25000, Pakistan
| | - Mahmoud M.A. Abulmeaty
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Kingdom of Saudi Arabia
| | - Dara Aldisi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11362, Kingdom of Saudi Arabia
| | - Juan E. Andrade Laborde
- Department of Food Science and Human Nutrition, University of Florida, 110370 Gainesville, FL, U.S.A
| | - Mourad A.M. Aboul-Soud
- Department of Clinical, Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
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Aitken TJ, Ly T, Shehata S, Sivakumar N, Medina NLS, Gray LA, Dundar N, Barnes C, Knight ZA. Negative feedback control of hunger circuits by the taste of food. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.11.30.569492. [PMID: 38077047 PMCID: PMC10705440 DOI: 10.1101/2023.11.30.569492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
The rewarding taste of food is critical for motivating animals to eat, but whether taste has a parallel function in promoting meal termination is not well understood. Here we show that hunger-promoting AgRP neurons are rapidly inhibited during each bout of ingestion by a signal linked to the taste of food. Blocking these transient dips in activity via closed-loop optogenetic stimulation increases food intake by selectively delaying the onset of satiety. We show that upstream leptin receptor-expressing neurons in the dorsomedial hypothalamus (DMHLepR) are tuned to respond to sweet or fatty tastes and exhibit time-locked activation during feeding that is the mirror image of downstream AgRP cells. These findings reveal an unexpected role for taste in the negative feedback control of ingestion. They also reveal a mechanism by which AgRP neurons, which are the primary cells that drive hunger, are able to influence the moment-by-moment dynamics of food consumption.
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Affiliation(s)
- Tara J Aitken
- Neuroscience Graduate Program, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Truong Ly
- Neuroscience Graduate Program, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Sarah Shehata
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Nilla Sivakumar
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Naymalis La Santa Medina
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Lindsay A Gray
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Naz Dundar
- Neuroscience Graduate Program, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Chris Barnes
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
| | - Zachary A Knight
- Department of Physiology, University of California, San Francisco; San Francisco, CA 94158, USA
- Kavli Institute for Fundamental Neuroscience, University of California, San Francisco; San Francisco, CA 94158, USA
- Neuroscience Graduate Program, University of California, San Francisco; San Francisco, CA 94158, USA
- Howard Hughes Medical Institute, University of California, San Francisco; San Francisco, CA 94158, USA
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Kershner M, Askren AN. It's not only swallowing: a clinician primer to adult food refusal beyond dysphagia. Curr Opin Otolaryngol Head Neck Surg 2022; 30:194-197. [PMID: 35143423 DOI: 10.1097/moo.0000000000000798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Medical teams are frequently faced with challenging clinical scenarios when their patients exhibit reduced intake of food and drink. Speech-language pathologists, who serve as oropharyngeal swallowing specialists in medical settings, are frequently the first to be summoned with the referral, 'Poor PO intake. Please evaluate and treat.' As our practices have illuminated, many differentials other than oropharyngeal dysphagia are often at play. RECENT FINDINGS Changes to taste, salivary supply/dry mouth, hunger drive, and psychosocial circumstances will significantly impact intake per os - each scenario to be explored further in this paper. Consequences to diminished nutrition and hydration include medical complications, lengthier hospital stays, and diminished quality of life. SUMMARY In this review, two medical speech-language pathologists detail more common alternative diagnoses that explain reduced intake by mouth amongst adults with acute and chronic diseases. Ultimately, a multidisciplinary approach should be considered when evaluating such patients to ensure a comprehensive and effective care plan.
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Affiliation(s)
- Marnie Kershner
- MedStar National Rehabilitation Hospital, Washington, District of Columbia
| | - Annette N Askren
- VA Puget Sound Healthcare System, Seattle, WA, USA, West Virginia University School of Medicine, Morgantown, WV, USA
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Weaning children from prolonged enteral nutrition: A position paper. Eur J Clin Nutr 2022; 76:505-515. [PMID: 34462558 DOI: 10.1038/s41430-021-00992-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 07/17/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023]
Abstract
Enteral nutrition (EN) allows adequate nutritional intake in children for whom oral intake is impossible, insufficient or unsafe. With maturation and health improvements, most children ameliorate oral skills and become able to eat orally, therefore weaning from EN becomes a therapeutic goal. No recommendations currently exist on tube weaning, and practices vary widely between centres. With this report, the French Network of Rare Digestive Diseases (FIMATHO) and the French-Speaking Group of Paediatric Hepatology, Gastroenterology and Nutrition (GFHGNP) aim to develop uniform clinical practice recommendations for weaning children from EN. A multidisciplinary working group (WG) encompassing paediatricians, paediatric gastroenterologists, speech-language therapists, psychologists, dietitians and occupational therapists, was formed in June 2018. A systematic literature search was performed on those published from January 1, 1998, to April 30, 2020, using MEDLINE. After several rounds of e-discussions, relevant items for paediatric tube weaning were identified, and recommendations were developed, discussed and finalized. The WG members voted on each recommendation using a nominal voting technique. Expert opinion was applied to support the recommendations where no high-quality studies were available.
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Gonzalez JT, Dirks ML, Holwerda AM, Kouw IWK, van Loon LJC. Intermittent versus continuous enteral nutrition attenuates increases in insulin and leptin during short-term bed rest. Eur J Appl Physiol 2020; 120:2083-2094. [PMID: 32651634 PMCID: PMC7419443 DOI: 10.1007/s00421-020-04431-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/04/2020] [Indexed: 12/26/2022]
Abstract
PURPOSE To compare endocrine responses to intermittent vs continuous enteral nutrition provision during short-term bed rest. METHODS Twenty healthy men underwent 7 days of bed rest, during which they were randomized to receive enteral nutrition (47%E as carbohydrate, 34%E as fat, 16%E as protein and 3%E as fibre) in a continuous (CONTINUOUS; n = 10; 24 h day-1 at a constant rate) or intermittent (INTERMITTENT; n = 10; as 4 meals per day separated by 5 h) pattern. Daily plasma samples were taken every morning to assess metabolite/hormone concentrations. RESULTS During bed rest, plasma leptin concentrations were elevated to a lesser extent with INTERMITTENT vs CONTINUOUS (iAUC: 0.42 ± 0.38 vs 0.95 ± 0.48 nmol L-1, respectively; P = 0.014) as were insulin concentrations (interaction effect, P < 0.001) which reached a peak of 369 ± 225 pmol L-1 in CONTINUOUS, compared to 94 ± 38 pmol L-1 in INTERMITTENT (P = 0.001). Changes in glucose infusion rate were positively correlated with changes in fasting plasma GLP-1 concentrations (r = 0.44, P = 0.049). CONCLUSION Intermittent enteral nutrition attenuates the progressive rise in plasma leptin and insulinemia seen with continuous feeding during bed rest, suggesting that continuous feeding increases insulin requirements to maintain euglycemia. This raises the possibility that hepatic insulin sensitivity is impaired to a greater extent with continuous versus intermittent feeding during bed rest. To attenuate endocrine and metabolic changes with enteral feeding, an intermittent feeding strategy may, therefore, be preferable to continuous provision of nutrition. This trial was registered on clinicaltrials.gov as NCT02521025.
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Affiliation(s)
| | - Marlou L Dirks
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Andrew M Holwerda
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Imre W K Kouw
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
| | - Luc J C van Loon
- Department of Human Biology, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands
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YAĞAN Ö, TAŞ N, AYYILDIZ SN, KARAKAHYA M, NOYAN T. Comparison of the effects of continuous versus intermittent enteral feeding on plasma leptin and ghrelin levels in Intensive Care Units. REV NUTR 2017. [DOI: 10.1590/1678-98652017000400001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective: The aim of this prospective randomized trial is to verify whether there is an association between the methods of administration of enteral nutrition and the leptin and ghrelin hormones, which have a major role in the regulation of energy metabolism. Methods: This study enrolled 38 enteral-fed patients aged 18 to 85 in the Intensive Care Unit. The patients were prospectively randomized to receive either continuous infusion (n=19) or intermittent feeding (n=18) of enteral nutrition. In addition to routine biochemical assays, blood samples were taken from the patients for leptin and ghrelin analyses on the 1th, 7th, and 14th days of enteral nutrition. Results: There was no statistically significant difference between the groups regarding descriptive statistics and categorical variables such as underlying diseases, complications, steroid use and others (p>0.05). The decrease in the number of white blood cells and in creatinine and C-reactive protein levels over time were statistically significant (p=0.010, p=0.026, p<0.001 respectively). There was no statistically significant difference between the groups with respect to leptin and ghrelin levels (p=0.982 and p=0.054). Leptin levels did not change over time; however, the ghrelin levels of both groups were significantly higher on the 7th and 14th days than on the first day of analysis (p=0.003). Conclusion: This study revealed that both continuous and intermittent enteral nutrition feeding regimens were well tolerated in Intensive Care Unit patients showing minor complications. The method of administration of enteral nutrition alone did not affect the leptin and ghrelin levels. Randomized controlled large cohort trials are needed to to compare intermittent and continuous enteral nutrition to determine which one is more adaptable to diurnal patterns of secretion metabolic hormones.
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Denzer-Lippmann MY, Bachlechner S, Wielopolski J, Fischer M, Buettner A, Doerfler A, Schöfl C, Münch G, Kornhuber J, Thürauf N. The Effects of a Normal Rate versus a Slow Intervalled Rate of Oral Nutrient Intake and Intravenous Low Rate Macronutrient Application on Psychophysical Function – Two Pilot Studies. Front Psychol 2017; 8:1031. [PMID: 28701972 PMCID: PMC5487446 DOI: 10.3389/fpsyg.2017.01031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 06/06/2017] [Indexed: 11/21/2022] Open
Abstract
Stomach distension and energy per time are factors influencing satiety. Moreover, different rates of nutrient intake induce different stomach distension. The goal of our studies was to elucidate the influence of different oral rates of nutrient intake (normal rate versus slow intervalled rate; study I) and intravenous low rate macronutrient application (protein, carbohydrate, fat) or placebo (study II) on psychophysical function. The pilot studies investigated the effects of 1) study I: a mixed nutrient solution (1/3 protein, 1/3 fat, 1/3 carbohydrates) 2) study II: intravenous macronutrient infusions (protein, carbohydrate, fat) or placebo on psychophysical function (mood, hunger, food craving, alertness, smell intensity ratings and hedonic ratings) in human subjects. In study I 10 male subjects (age range: 21–30 years) completed the study protocol participating in both test conditions and in study II 20 male subjects (age range: 19–41 years) completed the study protocol participating in all test conditions. Additionally, metabolic function was analyzed and cognitive and olfactory tests were conducted twice starting 100 min before the beginning of the intervention and 240 min after. Psychophysical (mood, hunger, fat-, protein-, carbohydrate-, sweets- and vegetable-craving), alertness and metabolic function tests were performed seven times on each examination day. Greater effects on hunger and food cravings were observed for normal rate of intake compared to slow intervalled rate of intake and intravenous low rate macronutrient application. Our findings potentially confirm that volume of the food ingested and a higher rate of energy per time contribute to satiety during normal rate of food intake, while slow intervalled rate of food intake and intravenous low rate macronutrient application showed no effects on satiation. Our results motivate the view that a certain amount of volume of the food ingested and a certain energy per time ratio are necessary to reduce hunger and food craving.
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Affiliation(s)
- Melanie Y. Denzer-Lippmann
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
- Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Stephan Bachlechner
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Jan Wielopolski
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Marie Fischer
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Andrea Buettner
- Department of Chemistry and Pharmacy, Emil Fischer Center, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
- Department of Sensory Analytics, Fraunhofer Institute for Process Engineering and Packaging IVVFreising, Germany
| | - Arndt Doerfler
- Department of Neuroradiology, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Christof Schöfl
- Division of Endocrinology and Diabetes, Department of Medicine I, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Gerald Münch
- Department of Pharmacology, School of Medicine, University of Western Sydney, PenrithNSW, Australia
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
| | - Norbert Thürauf
- Department of Psychiatry and Psychotherapy, Friedrich-Alexander-Universität Erlangen-NürnbergErlangen, Germany
- *Correspondence: Norbert Thürauf,
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Evans DC, Forbes R, Jones C, Cotterman R, Njoku C, Thongrong C, Tulman D, Bergese SD, Thomas S, Papadimos TJ, Stawicki SP. Continuous versus bolus tube feeds: Does the modality affect glycemic variability, tube feeding volume, caloric intake, or insulin utilization? Int J Crit Illn Inj Sci 2016; 6:9-15. [PMID: 27051616 PMCID: PMC4795366 DOI: 10.4103/2229-5151.177357] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Introduction: Enteral nutrition (EN) is very important to optimizing outcomes in critical illness. Debate exists regarding the best strategy for enteral tube feeding (TF), with concerns that bolus TF (BTF) may increase glycemic variability (GV) but result in fewer nutritional interruptions than continuous TF (CTF). This study examines if there is a difference in GV, insulin usage, TF volume, and caloric delivery among intensive care patients receiving BTF versus CTF. We hypothesize that there are no significant differences between CTF and BTF when comparing the above parameters. Materials and Methods: Prospective, randomized pilot study of critically ill adult patients undergoing percutaneous endoscopic gastrostomy (PEG) placement for EN was performed between March 1, 2012 and May 15, 2014. Patients were randomized to BTF or CTF. Glucose values, insulin use, TF volume, and calories administered were recorded. Data were organized into 12-h epochs for statistical analyses and GV determination. In addition, time to ≥80% nutritional delivery goal, demographics, Acute Physiology and Chronic Health Evaluation II scores, and TF interruptions were examined. When performing BTF versus CTF assessments, continuous parameters were compared using Mann–Whitney U-test or repeated measures t-test, as appropriate. Categorical data were analyzed using Fisher's exact test. Results: No significant demographic or physiologic differences between the CTF (n = 24) and BTF (n = 26) groups were seen. The immediate post-PEG 12-h epoch showed significantly lower GV and median TF volume for patients in the CTF group. All subsequent epochs (up to 18 days post-PEG) showed no differences in GV, insulin use, TF volume, or caloric intake. Insulin use for both groups increased when comparing the first 24 h post-PEG values to measurements from day 8. There were no differences in TF interruptions, time to ≥80% nutritional delivery goal, or hypoglycemic episodes. Conclusions: This study demonstrated no clinically relevant differences in GV, insulin use, TF volume or caloric intake between BTF and CTF groups. Despite some shortcomings, our data suggest that providers should not feel limited to BTF or CTF because of concerns for GV, time to goal nutrition, insulin use, or caloric intake, and should consider other factors such as resource utilization, ease of administration, and/or institutional/patient characteristics.
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Affiliation(s)
- David C Evans
- Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Rachel Forbes
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Christian Jones
- Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Robert Cotterman
- Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Chinedu Njoku
- Department of Surgery, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Cattleya Thongrong
- Department of Anesthesiology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - David Tulman
- Department of Anesthesiology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sergio D Bergese
- Department of Anesthesiology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Sheela Thomas
- Department of Clinical Nutrition, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Thomas J Papadimos
- Department of Anesthesiology, Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Stanislaw P Stawicki
- Department of Research and Innovation, St. Luke's University Hospital, Bethlehem, Pennsylvania, USA
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Abstract
AgRP and POMC neurons are two key cell types that regulate feeding in response to hormones and nutrients. Recently, it was discovered that these neurons are also rapidly modulated by the mere sight and smell of food. This rapid sensory regulation "resets" the activity of AgRP and POMC neurons before a single bite of food has been consumed. This surprising and counterintuitive discovery challenges longstanding assumptions about the function and regulation of these cells. Here we review these recent findings and discuss their implications for our understanding of feeding behavior. We propose several alternative hypotheses for how these new observations might be integrated into a revised model of the feeding circuit, and also highlight some of the key questions that remain to be answered.
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Affiliation(s)
- Yiming Chen
- Department of Physiology, University of California, San Francisco, CA, USA
| | - Zachary A Knight
- Department of Physiology, University of California, San Francisco, CA, USA
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Abstract
OBJECTIVES The present study highlights the occurrence of unintended adverse effects of enteral nutrition in infancy and childhood, as viewed and reported from a parental perspective. METHODS Quantitative analysis of a standardized questionnaire, filled out online by parents of enterally fed children. The questions focused on the nutritive and nonnutritive adverse effects, and other medical and biometric data. Data were collected from January 1, 2009 to December 31, 2013. RESULTS The study cohort consisted of 425 infants and children with different underlying medical conditions and an average age of 2.17 (median = 1.63) years. Nasogastric tubes were used in 44.2% of all the patients, and 55.8% of the children were fed by percutaneous endoscopic gastrostomy tube. Nearly all of the children have been tube-fed since birth. A total of 56.0% of all tube-fed children showed regular gagging and retching episodes, 50.0% vomited frequently, 14.8% experienced nausea, 7.5% experienced extreme nervous perspiration during the feeding, 45.2% showed loss of appetite, 5.2% experienced local granulation tissue, and 1.9% had other skin irritations. No significant correlations could be found between age, sex, medical diagnoses, type of feeding tube, feeding schedules (bolus or continuous), and parental and child's behavior regarding the feeding situation and duration of tube feeding. CONCLUSIONS Enteral nutrition affects the child and the whole family system on more than just nutritional level. It is suggested that children and their families should be followed-up by health professionals periodically for nutritional optimization, growth documentation, and other aspects of tube management.
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Fatima S, Gerasimidis K, Wright C, Tsiountsioura M, Arvanitidou EI, Malkova D. Response of appetite and potential appetite regulators following intake of high energy nutritional supplements. Appetite 2015; 95:36-43. [PMID: 26119811 DOI: 10.1016/j.appet.2015.06.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 06/05/2015] [Accepted: 06/15/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND The net clinical benefit of high-energy nutritional supplements (HENSDs) consumption is lower than expected. OBJECTIVES To investigate the extent to which consumption of oral HENSD in the fasted state reduces energy intake in slim females during consecutive breakfast and lunch, and whether this relates to changes in appetite and metabolic appetite regulators. DESIGN Twenty three females of 24.4 ± 2.8 years with BMI of 18.2 ± 0.8 kg/m(2) consumed HENSD (2.5 MJ) or PLACEBO (0.4 MJ) in fasted state in a single blind randomized cross-over study. Appetite and metabolic rate measurements and blood collection were conducted prior to and during 240 min after the intake of the supplements. Energy intake was recorded during ad libitum buffet breakfast and lunch served 60 min and 240 min post supplementation respectively. RESULTS Energy intake during breakfast was significantly (P < 0.01) lower in the HENSD trial but the net cumulative effect on energy intake was 1.07 ± 0.34 MJ higher in the HENSD compared to PLACEBO. Plasma concentration of CCK and PYY and insulin and were significantly (P < 0.05) higher in the HENSD trial while appetite measures were not significantly different between HENSD and PLACEBO trials. Correlations for the within participant relations between the responses of plasma hormones and appetite scores were significant (P < 0.05) for PYY and insulin but not CCK. The energy expended above resting metabolic rate was significantly (P < 0.05) higher in the HENDS trial but relative increase in energy expenditure was not significantly different between the two trials. CONCLUSION Oral high-energy nutritional supplements have a partial and relatively short lived suppressive action on energy intake and can be expected to increase net energy intake by approximately half the energy value of the supplement consumed.
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Affiliation(s)
| | - Konstantinos Gerasimidis
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Charlotte Wright
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Melina Tsiountsioura
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Eirini-Iro Arvanitidou
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK
| | - Dalia Malkova
- School of Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Scotland, UK.
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Spetter MS, Mars M, Viergever MA, de Graaf C, Smeets PA. Taste matters – effects of bypassing oral stimulation on hormone and appetite responses. Physiol Behav 2014; 137:9-17. [DOI: 10.1016/j.physbeh.2014.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 10/09/2013] [Accepted: 06/01/2014] [Indexed: 10/25/2022]
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15
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Preservation of the celiac branch of the vagus nerve during laparoscopy-assisted distal gastrectomy: impact on postprandial changes in ghrelin secretion. World J Surg 2014; 37:2172-9. [PMID: 23645130 DOI: 10.1007/s00268-013-2078-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Ghrelin is a brain-gut peptide with GH-releasing and appetite-inducing properties. Because ghrelin is secreted mainly by the stomach, fasting levels fall after distal gastrectomy. The vagal nerve is responsible for periprandial changes. The presents study investigated the impact of preserving the celiac branch of the vagus nerve during laparoscopy-assisted distal gastrectomy on postoperative ghrelin secretion. METHOD Between May 2009 and July 2010, 42 consecutive patients who underwent LADG were divided into two groups, the first in which the celiac branch of the vagus was preserved ("Preserved," n = 21) and the second in which it was not ("Not Preserved," n = 21). Blood samples were collected for assays of several hormones, including ghrelin, leptin, and insulin; these were taken before and 2 h after breakfast on postoperative day 7. RESULTS There were no significant differences in the background characteristics of the two groups. Plasma fasting ghrelin decreased significantly after LADG, by about 50 % of the baseline values in both groups. Postprandial plasma ghrelin levels in the Preserved group were significantly lower than those in the Not Preserved group (23 ± 8 vs 32 ± 9 fmol/ml; p = 0.0058). The ratio of the total ghrelin concentration after breakfast to that before was defined as the A/B ratio. The mean preoperative and postoperative A/B ratios were almost the same in the Preserved group (preoperative vs postoperative: 0.41 vs 0.44; p = 0.52). On the other hand, the mean A/B ratio in the Not Preserved group increased from 0.41 to 0.61 postoperatively (preoperative vs postoperative; p = 0.0003). Preservation of the celiac branch of the vagus nerve during LADG was related to the prandial ghrelin changes.
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16
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The sum of its parts--effects of gastric distention, nutrient content and sensory stimulation on brain activation. PLoS One 2014; 9:e90872. [PMID: 24614074 PMCID: PMC3948722 DOI: 10.1371/journal.pone.0090872] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 02/06/2014] [Indexed: 12/15/2022] Open
Abstract
During food consumption the brain integrates multiple interrelated neural and hormonal signals involved in the regulation of food intake. Factors influencing the decision to stop eating include the foods' sensory properties, macronutrient content, and volume, which in turn affect gastric distention and appetite hormone responses. So far, the contributions of gastric distention and oral stimulation by food on brain activation have not been studied. The primary objective of this study was to assess the effect of gastric distention with an intra-gastric load and the additional effect of oral stimulation on brain activity after food administration. Our secondary objective was to study the correlations between hormone responses and appetite-related ratings and brain activation. Fourteen men completed three functional magnetic resonance imaging sessions during which they either received a naso-gastric infusion of water (stomach distention), naso-gastric infusion of chocolate milk (stomach distention + nutrients), or ingested chocolate-milk (stomach distention + nutrients + oral exposure). Appetite ratings and blood parameters were measured at several time points. During gastric infusion, brain activation was observed in the midbrain, amygdala, hypothalamus, and hippocampus for both chocolate milk and water, i.e., irrespective of nutrient content. The thalamus, amygdala, putamen and precuneus were activated more after ingestion than after gastric infusion of chocolate milk, whereas infusion evoked greater activation in the hippocampus and anterior cingulate. Moreover, areas involved in gustation and reward were activated more after oral stimulation. Only insulin responses following naso-gastric infusion of chocolate milk correlated with brain activation, namely in the putamen and insula. In conclusion, we show that normal (oral) food ingestion evokes greater activation than gastric infusion in stomach distention and food intake-related brain areas. This provides neural evidence for the importance of sensory stimulation in the process of satiation. Trial Registration ClinicalTrials.gov NCT01644539.
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17
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Back-transformation of treatment differences—an approximate method. Eur J Clin Nutr 2013; 68:277-80. [DOI: 10.1038/ejcn.2013.259] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 10/31/2013] [Accepted: 11/01/2013] [Indexed: 01/30/2023]
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18
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Continuous enteral and parenteral feeding each reduces heart rate variability but differentially influences monocyte gene expression in humans. Shock 2012; 38:255-61. [PMID: 22777119 DOI: 10.1097/shk.0b013e31826171b9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Enteral (EN) or parenteral (PN) nutrition is used to support critically ill patients until oral feeding resumes. Enteral nutrition is assumed preferable to PN, but the differential influence on immune function is not well defined. Autonomic nervous activity is known to influence innate immune responses, and we hypothesized that EN and PN could influence both autonomic signaling and gene activation in peripheral blood monocytes (PBMs). Ten subjects (aged 18-36 years) received continuous EN or PN for 72 h. Peripheral blood monocytes were isolated from whole blood before and after continuous feeding and were analyzed for gene expression using a microarray platform. Gene expression after feeding was compared from baseline and between groups. To measure autonomic outflow, subjects also underwent heart rate variability (HRV) monitoring during feeding. Time and frequency domain HRV data were compared between groups and five orally fed subjects for changes from baseline and changes over time. During continuous EN and PN, subjects exhibited declines in both time and frequency domain HRV parameters compared with baseline and with PO subjects, indicating a loss of vagal/parasympathetic tone. However, PN feeding had a much greater influence on PBM gene expression compared with baseline than EN, including genes important to innate immunity. Continuous EN and PN are both associated with decreasing vagal tone over time, yet contribute differently to PBM gene expression, in humans. These preliminary findings support assumptions that PN imposes a systemic inflammatory risk but also imply that continuous feeding, independent of route, may impart additional risk through different mechanisms.
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Wijlens AGM, Erkner A, Alexander E, Mars M, Smeets PAM, de Graaf C. Effects of oral and gastric stimulation on appetite and energy intake. Obesity (Silver Spring) 2012; 20:2226-32. [PMID: 22592331 DOI: 10.1038/oby.2012.131] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Appetite is regulated by many factors, including oro-sensory and gastric signals. There are many studies on contributions of and possible interaction between sensory and gastric stimulation, but there are few studies in humans using simultaneous oral and gastric stimulation. We investigated the effect of simultaneous, but independently manipulated, oral and gastric stimulation on appetite ratings and energy intake. We hypothesized that compared with no stimulation, oral and gastric stimulation would equally and additively decrease appetite ratings and energy intake. Healthy men (n = 26, 21 ± 2 years, BMI 22 ± 3 kg/m(2)) participated in a randomized crossover trial with four experimental conditions and a control condition. Experimental conditions consisted of oral stimulation, with either 1 or 8 min modified sham feeding (MSF), and gastric stimulation, with either 100 or 800 ml intragastrically infused liquid (isocaloric, 99 kcal, 100 ml/min). The control condition consisted of no oral or gastric stimulation. Outcome measures were energy intake 30 min after the treatment and appetite ratings. Compared with the control condition, energy intake decreased significantly after the 8 min/100 ml (19% lower, P = 0.001) and 8 min/800 ml conditions (15% lower, P = 0.02), but not after the 1 min/100 ml (14% lower, P = 0.06) and 1 min/800 ml conditions (10% lower, P = 0.39). There was no interaction of oral and gastric stimulation on energy intake. Hunger and fullness differed across all conditions (P ≤ 0.01). In conclusion, duration of oral exposure was at least as important in decreasing energy intake as gastric filling volume. Oral and gastric stimulation did not additively decrease energy intake. Longer oro-sensory stimulation, therefore, may be an important contributor to a lower energy intake.
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Affiliation(s)
- Anne G M Wijlens
- Division of Human Nutrition, Wageningen University, Wageningen, The Netherlands
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