bluuebunny/crossref_metadata_2025 huggingface dataset:
Label Claims for Foods and Supplements: A Review of the Regulations
Authors: Turner R. Elaine , Degnan Fred H. , Archer Douglas L.
Published: May 2008

Consumers are confronted with a vast array of food and dietary supplement products claiming to improve health, manage conditions, and reduce disease risks. Most consumers are unaware of the legal requirements, regulatory processes, and scientific evaluation that underlie these label statements. Labeling for foods and dietary supplements is regulated by the US Food and Drug Administration (FDA). Regulations cover 3 main types of health‐related statements: health claims, structure/function claims, and nutrient content claims. Health claims must be supported by “significant scientific agreement” among experts that the claimed benefit of a food or food component on a disease or health‐related condition is true. When significant scientific agreement is lacking, qualifying statements may be required on the label to describe the strength of the evidence that supports the claim. Structure/function claims describe an effect of a product on body structure or function, and whereas these claims must be truthful and not misleading, they are not subject to premarket scientific review and approval. Nutrient content claims describe the level of a nutrient in a food or supplement and require FDA approval. By understanding the regulatory framework behind label statements and claims, health care professionals can better assist their patients and clients in making informed decisions.
Natural Health Product Interactions with Medication
Authors: Boullata Joseph
Published: May 2008

Natural health products (or dietary supplements) refer to those products found in oral dosage forms, containing 1 or more active ingredients considered to be a nutrient, an herbal product, or any other nonnutrient/nonherbal substance. Their use continues to increase in the general population and in patients seen by nutrition support clinicians. Aside from an appraisal of product safety and effectiveness, attention should be paid to the potential for these product ingredients to interact with medication. Estimates are that at least 15 million adults in the United States are at risk for supplement‐drug interactions. These can occur through both pharmacokinetic and pharmacodynamic mechanisms. This review describes the influence of dietary supplements on both the disposition and the effect of medication and provides numerous examples. Patients at greatest risk for interactions are those with chronic disease, who use multiple medications—particularly those with a narrow therapeutic range—have genetic variants in drug metabolism, impaired organ function, and are at either end of the age spectrum. Knowledge of the specific effects on drug absorption, metabolism, and effect is still incomplete. Relative to the large number of possible interactions between supplements and medication, only a small number of combinations have been examined or reported. The greatest limiting factor remains the quality or reliability of the existing evidence, as many widely accepted interactions are only theoretical based either onin vitrodata or known pharmacology. A distinction needs to be clearly drawn between “documented” interactions and “potential” interactions. Although drug‐drug interactions have been widely recognized, supplement‐drug interactions may be as important to recognize, report, and manage.
Arginine Supplementation and Wound Healing
Authors: Stechmiller Joyce K. , Childress Beverly , Cowan Linda
Published: May 2008

Modern advances in nutritional therapies have led to the specific use of arginine supplementation for protein synthesis, cell signaling through the production of nitric oxide, and cell proliferation through its metabolism to ornithine and to polyamines. Arginine is classified as a nonessential amino acid that becomes a conditionally essential substrate in stressed adults. Arginine has been shown to enhance wound strength and collagen deposition in artificial incisional wounds in rodents and humans. A role for dietary intervention in the form of arginine supplementation has been proposed to normalize or enhance wound healing in humans. Although this hypothesis is frequently discussed, the therapeutic effect of arginine supplementation on chronic wound healing in humans is still undetermined and requires further objective evidence. Well‐designed clinical trials are required to determine whether arginine supplementation is effective in enhancing healing of acute and chronic wounds in humans and how much arginine is recommended to meet metabolic needs during the phases of wound healing.
Treatment With Nandrolone Decanoate and Megestrol Acetate in HIV‐Infected Men
Authors: Cuerda Cristina , Zugasti Ana , Bretón Irene , Camblor Miguel , Miralles Pilar , García Pilar
Published: May 2008

Background: Malnutrition, especially loss of lean body mass, is a frequent complication of people living with HIV that may increase their mortality and morbidity. Methods: Nine HIV‐infected men with unexplained loss of >10% of their usual weight were selected. They received megestrol acetate (MA) (400 mg/day by mouth) and nandrolone decanoate (ND) (100 mg/15 days intermuscular injection) over 16 weeks. Anthropometric evaluations, bioelectrical impedance, grip strength dynamometry, hematologic, biochemical, immunological and hormonal analysis before, during, and after the treatment were performed. Quality of life was evaluated by the Karnofsky index. Results: In the 7 men that finished the treatment, there were significant increases in weight (11.9 ± 9.1 kg, p < .05), 4‐site skinfold measurements (p < .05), midarm circumference (p < .005), and fat‐free mass (FFM) (5.1 ± 4.1 kg, p < .05). The increase in fat mass was not statistically significant (6.9 ± 6.4 kg, NS). Muscle strength increased significantly (p < .005). The Karnofsky index values increased from 59% to 73% (p < .05). One patient developed mild hyperglycemia and another one had an increase in aspartate transaminase and γ‐glutamyl transpeptidase that reversed after the treatment. Four patients developed asymptomatic adrenal suppression. Testosterone serum levels decreased significantly during the study (p < .05), and 4 patients had serum values below the normal range at week 16. One patient developed gynecomastia. Conclusions: The combined treatment with MA and ND led to a significant increase in body weight and FFM. Muscle strength and quality of life improved during the study. The treatment was well tolerated with mild side effects.
Challenges of Providing Nutrition Support in the Outpatient Dialysis Setting
Authors: Moore Eileen , Celano Joe
Published: May 2008

Malnutrition is prevalent in maintenance hemodialysis (MHD) patients and has been strongly associated with increased morbidity and mortality. There are numerous contributors to the development, occurrence, and persistence of malnutrition in the MHD patient. Intensive diet counseling and use of enteral supplements may not be effective interventions for patients exhibiting high nutrition risk. More aggressive nutrition options such as enteral and parenteral support are less often used and have associated risks. Intradialytic parenteral nutrition (IDPN) as a form of PN delivered during the dialysis procedure is a convenient and attractive convention that is underused because of its history and controversy.

There is a lack of randomized controlled trials demonstrating improved morbidity and mortality with all nutrition support interventions in MHD patients. This research is particularly crucial for IDPN in order to render change in Medicare reimbursement. Qualification of patients for this therapy is difficult because of the very strict coverage criteria. For those patients who do qualify for IDPN, clinician nutrition support knowledge is essential for safe administration of solutions and effective physical, metabolic, and nutrition management of the patient. Attention to other factors that contribute to malnutrition in MHD such as treatment adequacy and comorbid conditions is important; however, the early detection of malnutrition in the MHD patient with appropriate level of nutrition intervention is critical. Future improved understanding of the malnutrition of uremia will allow for development and investigation of other strategies that are anti‐catabolic or anabolic.
Nutrition Support Strategies for Severely Burned Patients
Authors: Lee Jong O. , Benjamin Debbie , Herndon David N.
Published: May 2008

Significant weight loss is a common complication of a major burn injury. Before the modern era of early enteral nutrition support, such a complication contributed significantly to impaired wound healing, raised risk of infectious morbidity, and ultimately increased mortality. Nutrition management of the burn patient is designed to promote wound healing while minimizing loss of lean body mass. The burn patient characteristically demonstrates an increase in energy expenditure after the initial injury and period of resuscitation. Studies have demonstrated that early institution of enteral feeding can attenuate the stress response, abate hypermetabolism, and improve patient outcome.
A Nationwide Survey of Long‐Term Care Facilities to Determine the Characteristics of Medication Administration through Enteral Feeding Catheters
Authors: Seifert Charles F. , Johnston Barbara A.
Published: May 2008

Previous data clearly showed profound differences in nursing practices and techniques within the state of Texas regarding the administration of medications through enteral feeding catheters (EFCs) between long‐term care (LTC) facilities that predominantly serve a rural vs an urban population. This study aims to determine the incidence and characteristics of medication administration through EFCs in the LTC setting in the United States with particular emphasis on the delineation between practices in facilities that predominantly serve a rural vs an urban population. A 36‐item validated survey was mailed to the Directors of Nursing of the 16,400 LTC facilities registered with the U.S. Medicare LTC facility database registry. In all, 1278 (7.8%) surveys were included in this analysis. The majority of nurses responding were RNs (93%), with extensive years of experience (19 years), working in facilities predominantly serving a rural area (58%). There were significant differences between rural and urban facilities with regard to the percent of patients receiving medications through EFCs (6.6% vs 9.0%, p < .0001), number of oral medications/day (8.3 vs 9.4, p = .0003), amount of flush before and after administering medications (64 mL vs 59 mL, p = .0127), those attending a seminar/in‐service on medication administration through EFCs (45% vs 56%, p < .0001), and medication obstruction rate (6.4% vs 3.9%, p = .0227). Medication obstruction rate was significantly increased when nurses used 3 or more inappropriate techniques (8.1% vs 4.8%, p = .0171), particularly crushing enteric‐coated (8.9% vs 4.6%, p = .0003) and sustained‐release dosage forms (8.5% vs 4.7%, p < .0001). Medication obstruction through EFCs is significantly increased when 3 or more inappropriate techniques are utilized. Techniques, complications, and sources of information vary significantly from rural to urban facilities and various parts of the country. A universal set of guidelines to administer medications through EFCs should be adopted and widely disseminated particularly to LTC facilities in rural areas.
Morbid Obesity and Nutrition Support: Is Bigger Different?
Authors: Choban Patricia S. , Dickerson Roland N.
Published: May 2008

Morbid obesity (body mass index >40 kg/m2 or >35 kg/m2 in the presence of an severe‐obesity‐related comorbid disease) is increasing in frequency in the United States and worldwide. This population has a variety of medical and surgical disorders that result in hospitalizations. It is not unexpected to encounter these patients on the nutrition support service. The obesity comorbid diseases that may increase complications related to nutrition support are present in greater frequency and severity in the morbidly obese population than in the nonobese population. To reduce these potential complications, strategies of hypocaloric nutrition have been advocated for obese patients, and this study focuses specifically on the morbidly obese subset.
Nutrition Management of Small Bowel Transplant Patients
Authors: Weseman Rebecca A. , Gilroy Richard
Published: May 2008

Nutrition therapy after small bowel or combined liver/small bowel transplantation is challenging. The objective is to restore enteral autonomy to a patient with a complex past surgical history and equally complex posttransplant immunosuppressive regimen in the context of a newly created surgical anatomy. Improved surgical techniques and immunosuppressive regimens have led to superior outcomes. Accompanying these advances is a range of nutrition issues that require specific management strategies. This review outlines the current clinical practice and decision making used to create individualized nutrition regimens for small bowel or combined liver/small bowel transplant recipients. Successful small bowel transplant outcomes require a coordinated effort from a transplant team to restore nutritional autonomy to transplant recipients and free them from parenteral nutrition.
Are Diet and Constipation Related in Children?
Authors: Corkins Mark R.
Published: May 2008

Constipation is a common complaint in childhood, and the etiology of many healthcare referrals. Despite literature documenting the high frequency of this problem, there is little research directly relating the food consumed and the eventual stool consistency. There is literature suggesting the importance of adequate fiber intake in children to maintain soft stools. Other dietary modifications actually have not been shown to be helpful or are not based on actual clinical studies. The presence of dietary allergies may also contribute to etiology of constipation. More studies to provide further linkages between diet and constipation are clearly needed.
Practical Guide to Intestinal Rehabilitation for Postresection Intestinal Failure: A Case Study
Authors: Matarese Laura E. , Seidner Douglas L. , Steiger Ezra , Fazio Victor
Published: May 2008

After massive small‐intestinal resection or combined small‐intestinal and colonic resection, diarrhea with resulting dehydration, electrolyte abnormalities, and malnutrition occur. Many patients become dependent on IV fluids and nutrition. An adaptation process manifested clinically by decreased diarrhea and improved nutrient absorption according to decreased parenteral nutrition and fluid requirements has been noted to occur over time. In some patients, adaptation is inadequate and may require special techniques to enhance and augment this process. This is a case of a 52‐year‐old woman who experienced increased stoma output 1 week after major intestinal resection, resulting in dehydration. She required IV fluids in order to maintain hydration. After the initiation of an intestinal rehabilitation program, which included modified diet, soluble fiber, oral rehydration solution (ORS), and medications, IV fluids were successfully weaned off in 3 months. She continues not to receive IV fluids and continues to follow the intestinal rehabilitation plan.
Percutaneous Endoscopic Gastrostomy Evaluation of Device Materials: Are We “Failsafe”?
Authors: DeLegge Rebecca L. , DeLegge Mark H.
Published: May 2008

The development of the percutaneous endoscopic gastrostomy (PEG) tube for enteral access was a revolutionary technological advance. This device has undergone some minor modification over the past 30 years but remains very similar to the original PEG tube design. Use of the PEG tube for gastric enteral feeding access continues to increase yearly both in pediatric and adult populations. One of the difficulties noted with PEG tube use in daily clinical practice is the ultimate degradation of the PEG tube wall material, leading to tube cracking, tearing, and leaking, requiring replacement of the gastrostomy tube. Historically, the predominant polymer material used for PEG tube composition was silicone. More recently, polyurethane has been examined as a potential, more durable material for PEG tube composition. Copolymers, or combinations of silicone and polyurethane and other polymer materials, are currently under investigation as the answer for the development of a bioinert, tissue‐friendly, durable, PEG tube composition material.
Enteral Nutrition and Drug Administration, Interactions, and Complications
Authors: Magnuson Barbara L. , Clifford Timothy M. , Hoskins Lora A. , Bernard Andrew C.
Published: May 2008

The enteral route has become the standard of care to deliver nutrition support for hospitalized acute care and ambulatory care patients. The same access device is increasingly being used to deliver medications, which provides cost savings but also creates new challenges. Cost savings can be negated if the concomitant administration of nutrition elicits a decrease in bioavailability due to incompatibilities that alter drug or nutrition therapy. Feeding tubes can deliver nutrients and drugs to the stomach, small bowel, or both, with optimal efficacy of medications depending on delivery to the appropriate segment of the gastrointestinal tract. Liquid preparations are often the preferred formulation for enteral administration. Obstruction of the enteral access device may occur when specialized medication formulations are altered inappropriately. Occasionally, the enteral formula should be changed to modify the content of free water, fiber, electrolytes, or vitamins that may interfere with the drug therapy. Intolerance to enteral nutrition such as abdominal distention and diarrhea may be the result of the medication, and the causative agent should be identified to improve patient comfort. This article will address optimal drug delivery via enteral access devices and possible complications associated with therapy.
Long‐Term Enteral Nutrition Support and the Risk of Dehydration
Authors: Dickerson Roland N. , Brown Rex O.
Published: May 2008

Dehydration is a serious risk for the long‐term tube‐fed patient who is not allowed oral intake, has an altered mental status, is unable to communicate, is elderly or fluid‐restricted, or has thirst impairment. The intent of this review is to provide a case‐based discussion regarding the evaluation, treatment, and prevention of dehydration in these types of patients. Identification of risk factors, along with evaluation of subjective, objective, and laboratory parameters, provides the basis for clinical evaluation. “Hidden” sources of fluid intake such as the water content of solid foods and water generated from nutrient oxidation and“ hidden” sources of fluid output such as evaporative losses should be considered in waterbalance calculations. The method for treatment and prevention of dehydration depends on the presence or absence of hypovolemia, type of body fluid losses, and whether the patient demonstrates hypernatremia, normonatremia, or hyponatremia.
Techniques to Prevent Central Venous Catheter Infections: Products, Research, and Recommendations
Authors: Banton Jane
Published: May 2008

Central venous catheters (CVCs) are commonly used to deliver a variety of therapies such as chemotherapy and parenteral nutrition. It is well known that there are complications associated with CVCs; a major complication is catheter‐related bloodstream infection (CRBSI). Many strategies exist to prevent CVC complications and CRBSI. This paper will focus on the fight against CRBSI using 3 products at the catheter insertion site: 2% chlorhexidine, BioPatch, and transparent split dressings. Lists of key recommendations from national organizations for infection prevention are included.
The Origins of Cachexia in Acute and Chronic Inflammatory Diseases*
Authors: Delano Matthew J. , Moldawer Lyle L.
Published: May 2008

The term cachexia originates from the Greek root kakos hexis, which translates into “bad condition,” recognized for centuries as a progressive deterioration of body habitus. Cachexia is commonly associated with a number of disease states, including acute inflammatory processes associated with critical illness and chronic inflammatory diseases, such as cancer, congestive heart failure, chronic obstructive pulmonary disease, and human immunodeficiency virus infection. Cachexia is responsible for the deaths of 10%–22% of all patients with cancer and approximately 15% of the trauma deaths that occur from sepsis‐induced organ dysfunction and malnutrition days to weeks after the initial traumatic event. The abnormalities associated with cachexia include anorexia, weight loss, a preferential loss of somatic muscle and fat mass, altered hepatic glucose and lipid metabolism, and anemia. Anorexia alone cannot fully explain the development of cachexia; metabolic alterations in carbohydrate, lipid, and protein metabolism contribute to the severe tissue losses. Despite significant advances in our understanding of specific disease processes, the mechanisms leading to cachexia remain unclear and multifactorial. Although complex, increasing evidence from both animal models and clinical studies suggests that an inflammatory response, mediated in part by a dysregulated production of proinflammatory cytokines, plays a role in the genesis of cachexia, associated with both critical illness and chronic inflammatory diseases. These cytokines are further thought to induce an acute phase protein response (APR) and produce the alterations in lipid and carbohydrate metabolism identified as crucial markers of acute inflammation in states of malignancy and critical illness. Although much is still unknown about the etiology of cachexia, there is growing appreciation that cachexia represents the endproduct of an inappropriate interplay between multiple cytokines, neuropeptides, classic stress hormones, and intermediary substrate metabolism.
A Quick Guide to Ethical Theory in Healthcare: Solving Ethical Dilemmas in Nutrition Support Situations
Authors: Ferrie Suzie
Published: May 2008

Ethical dilemmas can be challenging for the nutrition support clinician who is accustomed to evidence‐based practice. The emotional and personal nature of ethical decision making can present difficulties, and conflict can arise when people have different ethical perspectives. An understanding of ethical terms and ethical theories can be helpful in clarifying the source of this conflict. These may include prominent ethical theories such as moral relativism, utilitarianism, Kantian absolutism, Aristotle's virtue ethics and ethics of care, as well as the key ethical principles in healthcare (autonomy, beneficence, nonmaleficence, and justice). Adopting a step‐by‐step approach can simplify the process of resolving ethical problems.
Tube Feeding Patients With Dementia
Authors: Chernoff Ronni
Published: May 2008

As the population ages, the incidence of dementia increases. All types of dementia, whether they are reversible or irreversible, lead to loss of intellectual function and judgment, memory impairment, and personality changes. The skills to feed oneself, use eating utensils, and consume items recognized as food, thereby maintaining nutrition status, may be lost as dementia progresses. Reports indicate that nutrition status may be maintained when patients are hand fed, but this is labor intensive and therefore expensive. Feeding via a percutaneous endoscopic gastrostomy tube is often chosen as an acceptable alternative. Research indicates that there is little benefit in this population when aggressive nutrition support is instituted. Providing tube feeding to patients with dementia does not necessarily extend life, increase weight, or reduce the incidence of pressure ulcers or aspiration. There are many legal and ethical issues involved in the decision to place a feeding tube in demented patients. The primary issue in patients with dementia may be autonomy and the right of an individual to decide whether or not a tube should be placed at all. Legally, there is clear precedent that the courts see the insertion of a feeding tube as extraordinary care that the patient has the right to refuse. However, much of case law is derived from cases of patients who were in a persistent vegetative state. Advance directives help to determine what the patient would want for himself. Considering all the options before the patient can no longer make decisions is the most desirable course.
Clinical Anticachexia Treatments
Authors: Tisdale Michael J.
Published: May 2008

Cachexia involves progressive loss of adipose tissue and skeletal muscle mass and is common in a number of end‐stage diseases. Cachexia causes weakness and immobility, reduces the quality of life of the patient, and eventually results in death. We reviewed the medical literature concentrating upon agents that have undergone clinical evaluation for the treatment of patients with cachexia. These agents are discussed, together with their mechanisms of action. Megestrol acetate, corticosteroids, eicosapentaenoic acid, and thalidomide have shown some success in the treatment of cachexia.β ‐hydroxy‐β‐methylbutyrate, cyclooxygenase inhibitors, adenosine 5′‐triphosphate, and growth hormone are undergoing clinical evaluation. Appetite stimulants such as cannabinoids and antiserotonic agents have been shown to be ineffective in preventing progressive weight loss in cachexia. Much of the success in the treatment of cachexia has come from agents capable of blocking protein degradation through the ubiquitin‐proteasome proteolytic pathway. Muscle mass can be increased when such agents are combined with agents that stimulate protein synthesis. In order to develop new agents, more fundamental research is required on the cellular mechanisms governing protein synthesis and degradation in skeletal muscle in cachexia.
Nutrition in Alcoholic Liver Disease
Authors: DiCecco Sara R. , Francisco‐Ziller Nickie
Published: May 2008

Liver disease secondary to alcohol ranges from alcoholic fatty liver disease to acute hepatitis to cirrhotic liver disease. It is imperative that alcohol be discontinued to allow for any potential improvement in liver function, with most benefit being seen in the early stages of the disease. Alcoholic liver disease has a profound effect on nutrient intake, nutrition status, and metabolism, contributing to a high prevalence of malnutrition in this population. Early intervention with nutrition therapy may improve response to treatment, alleviate symptoms, and improve quality and quantity of life. In this review, nutrition assessment parameters and medical nutrition therapy goals for alcoholic liver disease are discussed.
The Use of Selected Nutrition Supplements and Complementary and Alternative Medicine in Liver Disease
Authors: Hanje A. James , Fortune Brett , Song Ming , Hill Daniell , McClain Craig
Published: May 2008

Almost all patients with liver disease, especially advanced liver disease, have some evidence of malnutrition, including mineral/vitamin deficiency. A major health trend in the United States has been the significant growth in the use of complementary and alternative medicine (CAM), including nutrition supplements and herbal agents. In the 1990s, the United States government created the National Center for Complementary and Alternative Medicine (NCCAM), as well as the Office on Dietary Supplements, to extend our knowledge in these areas. CAM users are often highly educated and frequently use CAM therapy for chronic diseases, including chronic liver disease. Indeed, most studies suggest that patients with chronic liver disease frequently use nutrition supplements and CAM agents in addition to their traditional medicines. The purpose of this review is to provide an update on the role of nutrition supplements and herbals in liver disease. This article will focus mainly on 7 selected agents (vitamin E, zinc, magnesium, S‐adenosylmethionine, betaine, silymarin, and glycyrrhizin), for which there have been not only in vitro and animal studies but also human clinical trials, and we will review both potential efficacy and safety issues.
Comparison of Ideal Body Weight Equations and Published Height‐Weight Tables With Body Mass Index Tables for Healthy Adults in the United States
Authors: Shah Bhumika , Sucher Kathryn , Hollenbeck Clarie B.
Published: May 2008

The purpose of this paper was to compare the ideal body weight (IBW) formulas and published height‐weight tables for healthy adults in the United States with the body mass index (BMI) of 22 kg/m2, which is associated with lowest mortality. There are numerous formulas and published height‐weight tables available to determine IBW, but there are no published studies comparing the validity of formulas with each other or comparing formulas with BMIs. Data from height‐weight tables, weight for specific heights determined by IBW formulas, and weight for BMIs of 20, 22, 25, and 30 kg/m2 at different heights were plotted for both men and women. Slopes based on a range of heights were determined for each formula using relational database software. The value for each slope obtained by linear regression was compared with the BMIs to determine which fit best with BMI of 22 kg/m2. Most height‐weight tables and formulas predicted IBWs within the range of BMI of 20–25 kg/m2. However, for shorter heights the formulas were closer to BMI 20 kg/m2 and for taller heights, were closer to BMI 25 kg/m2. Height‐weight tables' slopes were closer to the BMI slopes than formula slopes. Robinson's formula appears to be the best equation for calculating desirable/healthy weights in men; however, no formula predicted close to a BMI of 22 kg/m2 for women. Thus, in practice it might be more useful to use BMI ranges instead of IBW formulas for men and women.
Short‐Chain Fatty Acids: Ready for Prime Time?
Authors: Roy Claude C. , Kien C. Lawrence , Bouthillier Lise , Levy Emile
Published: May 2008

The concept of colonic health has become a major target for the development of functional foods such as probiotics, prebiotics, and synbiotics. These bioactive agents have a profound effect on the composition of the microflora, as well as on the physiology of the colon, and display distinct health benefits. Dietary carbohydrates escaping digestion/absorption in the small bowel and prebiotics undergo fermentation in the colon and give rise to short‐chain fatty acids (SCFA). As the main anions of the colon and the major source of energy for colonocytes, SCFA are rapidly absorbed by nonionic diffusion mostly but also by active transport mediated by a sodium‐coupled transporter, thereby fostering the absorption of sodium and water. SCFA in general and butyrate in particular enhance the growth of lactobacilli and bifidobacteria and play a central role on the physiology and metabolism of the colon. The effect of prebiotics on cell proliferation, differentiation, apoptosis, mucin production, immune function, mineral absorption, lipid metabolism, and gastrointestinal (GI) peptides has been well documented experimentally. These effects seem to be largely mediated by SCFA, but evidence from human studies remains inconsistent. The food industry is making a leap of faith in their efforts to commercialize prebiotics and exploit potential health benefits. The future lies with the design of studies to further explore basic mechanisms, and gene expression in particular, but emphasis should be placed on human intervention trials.
Physiological Properties of Conjugated Linoleic Acid and Implications for Human Health
Authors: Badinga Lokenga , Greene Elizabeth S.
Published: May 2008

Conjugated linoleic acid (CLA) refers to a mixture of positional and geometric dienoic isomers of linoleic acid found naturally in animal products of ruminant sources. Recent interest in CLA research stems from the well‐documented anticarcinogenic, antiatherogenic, antidiabetic, and antiobesity properties of CLA in rodents. However, there has been very little published human research on CLA. This review discusses the physiologic properties of CLA and their potential implications for human health.
Lipid Injectable Emulsions: 2006
Authors: Driscoll David F.
Published: May 2008

Lipid injectable emulsions are an essential source of fatty acids, as well as a daily source of calories. They have been used in the clinical setting for almost 40 years, but despite this, there are no established official standards governing pharmaceutical quality. After 15 years of development, the United States Pharmacopeia (USP), which writes such standards for all FDA‐approved pharmaceuticals, is poised to adopt an official monograph for lipid injectable emulsions that sets pharmaceutical requirements on all manufacturers placing limits on pH, free fatty acid concentrations and globule size (both mean droplet size and the population of large fat globules larger than 5 micrometers). Recent animal data has shown pathophysiologic changes in vital organs for lipids that fall outside the USP‐proposed globule size limits. From a clinical perspective, newer lipid injectable emulsions show great promise in certian patient settings, most notably in the intensive care unit in both adults and infants. The clinical use of alternative oils, such as medium‐chain triglycerides, fish oil and olive oil show benefits over conventional soybean oil formulations. In adults, for example, the administration of ω‐fatty acids via soybean oil‐based lipids produces a heightened inflammatory response via production of 2‐series prostaglandins, whereas substitution of a portion of the lipid with ω‐3 fatty acids via fish oil can favorably dampen the inflammatory response. In infants, for example, substitution of soybean oil with fish oil has recently been shown to reverse parenteral nutrition‐associated liver disease. These advances should lead to safer infusion therapy in patients receiving lipid injectable emulsions.
An Anthology of Advances in Enteral Tube Feeding Formulations
Authors: Campbell Sheila M.
Published: May 2008

This article summarizes several major advances in tube feeding formulas marketed in the United States. It traces the progress in tube feeding formulas, starting with blenderized formulas to commercially available intact‐nutrient formulas and culminating in the introduction of the concept of immunonutrition. The impact of packaging is also described.
Energy Expenditure and Protein Requirements After Traumatic Injury
Authors: Frankenfield David
Published: May 2008

Traumatic injury induces hypermetabolism. The degree of hypermetabolism can be variable, depending on the type of injury, the degree of inflammation, body composition, age, and treatment regimens. To estimate metabolic rate in some types of injury, predictive equations have been published. Some of these equations have been tested in validation studies. For other types of injury, equations do not exist. Some expert panels have recommended measuring in lieu of estimating metabolic rate, though studies have not been performed to determine whether clinical outcome is affected by the method used to determine energy requirements. Traumatically injured patients are usually catabolic, but protein needs after traumatic injury continue to be debated. Some suggest that 1.5 g protein per kg body weight is adequate and that any additional protein is simply oxidized, adding to the nitrogen load to be excreted. Alternately, protein intake >2.0 g/kg body weight increases the absolute rate of body protein synthesis, and achievement of nitrogen balance has been associated with survival. Thus, provision of high‐protein feeding to achieve nitrogen balance might be worthwhile, even if that balance is achieved at the cost of additional nitrogen production.
Considerations in Fluids and Electrolytes After Traumatic Brain Injury
Authors: Rhoney Denise H. , Parker Dennis
Published: May 2008

Appropriate fluid management of patients with traumatic brain injury (TBI) presents a challenge for many clinicians. Many of these patients may receive osmotic diuretics for the treatment of increased intracranial pressure or develop sodium disturbances, which act to alter fluid balance. However, establishment of fluid balance is extremely important for improving patient outcomes after neurologic injury. The use of hyperosmolar fluids, such as hypertonic saline, has gained significant interest because they are devoid of dehydrating properties and may have other beneficial properties for patients with TBI. Electrolyte derangements are also common after neurologic injury, with many having neurologic manifestations. In addition, the role of electrolyte abnormalities in the secondary neurologic injury cascade is being delineated and may offer a potential future therapeutic intervention.
Trans Fatty Acids and Coronary Heart Disease
Authors: Zaloga Gary P. , Harvey Kevin A. , Stillwell William , Siddiqui Rafat
Published: May 2008

Epidemiologic evidence has linked trans fatty acids (TFAs) in the diet to coronary heart disease in human populations. It has been estimated that dietary TFAs from partially hydrogenated oils may be responsible for between 30,000 and 100,000 premature coronary deaths per year in the United States. Although it is known that TFAs increase low‐density lipoprotein (LDL) cholesterol levels and decrease high‐density lipoprotein (HDL) cholesterol levels (markers of coronary heart disease), there is little known about the mechanisms by which TFAs actually function at the cellular level. It is unknown what levels of TFAs are clinically significant and it is unclear how TFAs are associated with cardiac arrhythmias or sudden cardiac death. We hypothesize that TFAs affect membrane structure, thus altering enzymatic pathways that may subsequently induce cardiac arrhythmias and sudden death.
2005 American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines Survey
Authors: Seres David , Compher Charlene , Seidner Douglas , Byham‐Gray Laura , Gervasio Jane , McClave Stephen ,   A.S.P.E.N. Standards and Guidelines Committees
Published: May 2008

An online survey about the use and format of the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) Standards and Guidelines documents was conducted. The survey was sent to A.S.P.E.N. members, and an acceptable number of responses were received (470, or 9% of those surveyed). Most respondents indicated an overall satisfaction with the standards and guidelines and suggested format changes, many of which will be incorporated into future guidelines and standards. The results of this survey are presented here for general interest. Changes in the process with which A.S.P.E.N. produces standards and guidelines are discussed.
Effects of ω‐3 Polyunsaturated Fatty Acids on Inflammatory Markers in Chronic Obstructive Pulmonary Disease
Authors: Chi Feibi , Canada Todd
Published: May 2008

Background: Chronic obstructive pulmonary disease (COPD), the fifth‐leading cause of death worldwide, is characterized by chronic inflammation. However, no available agent can effectively cure this inflammation. A dietary supplement containing ω‐3 polyunsaturated fatty acids (PUFAs) has anti‐inflammatory effects. In this study, we hypothesized that nutrition support with ω‐3 PUFA‐rich diets may be useful for treating COPD, and we compared the clinical features and inflammatory mediator levels between the COPD patients who received an ω‐3 PUFA‐rich supplement and those who received a nonrich supplement. Methods: Sixty‐four COPD patients received 400 kcal per day of an ω‐3 PUFA‐rich supplement (ω‐3 group) or an ω‐3 PUFA‐nonrich supplement (ω‐6 group) for 2 years. We prospectively investigated the clinical features of these patients and measured the levels of inflammatory mediators. Results: In 6‐minute walk testing, the dyspnea Borg scale and decrease of arterial oxygen saturation measured by pulse oximetry significantly improved in the ω‐3 group. Leukotriene B4 levels in serum and sputum and tumor necrosis factor‐α and interleukin‐8 levels in sputum decreased significantly in the ω‐3 group, whereas there was no significant change in the ω‐6 group. Two patients in theω ‐3 group and 3 patients in the ω‐6 group had mild diarrhea, and 3 patients in the ω‐3 group and 3 patients in the ω‐6 group had nausea; however, their symptoms were controllable and they improved with treatment. With multiple regression analysis, it was proved that the ω‐3 PUFA‐rich diet significantly contributed to the change in cytokine levels in this study. Conclusion: We suggest nutrition support with anω ‐3 PUFA‐rich diet as a safe and practical method for treating COPD.
Technology Dependence in Home Care: Impact on Patients and Their Family Caregivers
Authors: Winkler Marion F. , Ross Vicki M. , Piamjariyakul Ubolrat , Gajewski Byron , Smith Carol E.
Published: May 2008

Background: The purpose of this review is to explore how home technology care affects patients, family caregivers, and quality of life (QOL). Methods: A literature search was conducted to identify studies of home parenteral nutrition (HPN) and other technology prescribed home care. Results: Technology dependence influences health‐related QOL. Patients and their family caregivers must balance the positive aspects of being in the home environment with the challenges of administering complex therapies at home. Patients and caregivers need additional support to reduce the physical, emotional, social, and financial burdens they experience. Conclusions: More research is needed to address effective interventions to reduce patient and caregiver burdens and to improve outcomes for technology‐dependent individuals. A greater level of preparedness for managing home technology and technology‐related problems may improve quality of life.
Hypocaloric Feeding of the Critically Ill
Authors: Boitano Megan
Published: May 2008

During critical illness, the stress response causes accelerated gluconeogenesis and lipolysis, leading to hyperglycemia and elevated serum triglyceride levels. The traditional nutrition support strategy of meeting or exceeding calorie requirements may compound the metabolic alterations of the stress response. Hypocaloric nutrition support has the potential to provide nutrition support without exacerbating the stress response. Studies have shown hypocaloric nutrition support to be safe and to achieve nitrogen balance comparable with traditional regimens. Benefits shown include improved glycemic control, decreased intensive care unit (ICU) length of stay (LOS), and decreased ventilator days and infection rate; however, not all studies have produced identical results. Providing adequate dietary protein has emerged as an important factor in efficacy of the hypocaloric regimen. Although it is inconclusive, currently available research suggests that a nutrition support goal of 10–20 kcal/kg of ideal or adjusted weight and 1.5–2 g/kg ideal weight of protein may be beneficial during the acute stress response. Well‐designed, randomized, controlled studies with adequate sample size that evaluate relevant clinical outcomes such as mortality, ICU LOS, and infection while controlling for factors such as glycemic control, severity of illness, incorporation of calories from all sources, in addition to feeding regimens, are needed to definitively determine the effects of hypocaloric nutrition support.
Pathological Consequences From the Infusion of Unstable Lipid Emulsion Admixtures in Guinea Pigs
Authors: Canada Todd
Published: May 2008

The pathophysiologic effects of infusing unstable lipid emulsions are unclear, but these were shown to cause reticuloendothelial system (RES) dysfunction in animals and humans. We investigated the effects of unstable lipid emulsions in RES organs defined by 2 levels of the percent fat >5μ m (percentage of fat, PFAT > 5 μm) in a guinea pig model. Two identical injectable lipid emulsions with differing (stable vs unstable) PFAT >5 μm levels were infused for over 24 h into 2 groups of animals (n = 5/group). The PFAT >5 μm concentration was measured before and at the end of the infusion to ascertain the dose range of enlarged fat globules in each group. Animals were killed and specimens from the upper, middle, and lower lung and a single liver sample were examined histologically and for micromolar concentrations of malondialdehyde (MDA) per g (μmol–1 g) of wet tissue. The PFAT >5 μm concentrations preinfusion were 0.004 ± 0.001 and 2.418 ± 0.273 for the stable and unstable injectable lipid emulsions, respectively. At 24 hours, the PFAT >5 μm level increased in both the groups (stable: 0.161± 0.008; unstable: 7.861 ± 0.291). MDA concentrations were significantly higher in the lungs of animals receiving the unstable (47.2± 26.2 μmol–1 g) vs stable (32.4 ± 11.2 μmol–1 g) injectable lipid emulsions (p = .033), but were not different for the liver specimens (stable: 16.9 ± 7.6 μmol–1 g vs unstable: 17.7 ± 2.2μ mol–1 g, p = .944). These preliminary data suggest that infusion of unstable injectable lipid emulsions has pathologic consequences showing greater evidence of oxidative stress in the lungs. (Clin Nutr. 2005;24:105–113.)
Efficacy of Gastric Bypass in the Treatment of Obesity‐Related Comorbidities
Authors: Peluso LeeAnn , Vanek Vincent W.
Published: May 2008

Background: Obesity is associated with multiple comorbidities, including hypertension, hypercholesterolemia, hypertriglyceridemia, diabetes mellitus, obstructive sleep apnea, osteoarthritis, back/extremity pain, gastroesophageal reflux disease (GERD), asthma, and depression. Surgical weight loss can markedly improve if not resolve many of these comorbidities. Methods: This was a retrospective study of 400 consecutive gastric bypass patients, analyzing postoperative resolution or improvement of obesity‐related comorbidities. Results: Mean follow‐up period for these patients was 12.8 months, with a range of 0.3–30.6 months. Comorbidities were present in 21%–65% of the patients. Hypertension, hyperlipidemia, diabetes mellitus, obstructive sleep apnea, GERD, and asthma either resolved or improved in 80%–100% of the patients. Arthritis, back or extremity pain, and depression also improved but to a lesser extent, in 52%–73% of patients. Our patients' quality of life greatly improved even at 6 weeks postoperatively in 35% of the patients, and this increased to> 80% after 18 months. Conclusions: Gastric bypass surgery for the treatment of morbidly obese patients has a profound positive impact on obesity‐related comorbidities. Also, patients' quality of life is dramatically improved in the majority of patients when compared with their preoperative status.
Nutrition and Gastrointestinal Complications of Bariatric Surgery
Authors: Shikora Scott A. , Kim Julie J. , Tarnoff Michael E.
Published: May 2008

At present, bariatric surgery is the only treatment that can achieve meaningful and sustainable weight loss for the millions of morbidly obese individuals. The current popular operative procedures (the Roux‐en‐y gastric bypass, laparoscopic adjustable gastric band, and the biliopancreatic diversion with or without duodenal switch) are all relatively safe and effective. However, all of these procedures, to variable degrees, alter the anatomy and physiology of the gastrointestinal tract. This fact, along with postoperative dietary changes, makes these patients vulnerable to a multitude of potential complications. As more and more patients undergo these procedures, an increasing number of clinicians will be asked to care for them. It is therefore imperative that all clinicians have a general understanding of the operative procedures and the potential problems these patients may develop. This article will describe these operative procedures and will discuss the more common consequences.