bluuebunny/crossref_metadata_2025 huggingface dataset:
Pediatric Intestinal Failure: Nutrition, Pharmacologic, and Surgical Approaches
Authors: Ching Y. Avery , Gura Kathleen , Modi Biren , Jaksic Tom
Published: May 2008

Intestinal failure (IF) is a condition where there is insufficient functional bowel to allow for adequate nutrient and fluid absorption to sustain adequate growth in children. Several etiologies can predispose to IF, including necrotizing enterocolitis, gastroschisis, and intestinal atresias. Intestinal rehabilitation can be seen as a 3‐pronged strategy merging nutrition, pharmacologic, and surgical approaches to achieve the ultimate goal of enteral nutrition. Nutrition approaches should seek to facilitate transition from parenteral nutrition (PN) to enteral nutrition because prolonged use of PN is associated with severe morbidity and mortality. Enteral nutrition, on the other hand, promotes and enhances an adaptive response in the intestine. Medications used in the treatment of IF may help alleviate symptoms of diarrhea, bacterial overgrowth, and gastrointestinal dysmotility. Surgical procedures, such as longitudinal intestinal lengthening and tapering (LILT) or serial transverse enteroplasty (STEP), can increase mucosal surface area and may enhance intestinal adaptation. IF is a difficult disease process with a complex patient population and is best guided through this 3‐pronged approach by a multidisciplinary team featuring surgeons, gastroenterologists, dietitians, pharmacists, and nurses.
Polycystic Ovary Syndrome (PCOS) and Other Androgen Excess–Related Conditions: Can Changes in Dietary Intake Make a Difference?
Authors: Liepa George U. , Sengupta Aditi , Karsies Danielle
Published: May 2008

Polycystic ovary syndrome (PCOS) is a condition that involves the excess production of androgens. It affects up to 10% of all American women and can lead to the development of acne, hirsutism, and infertility. It has also been associated with coronary heart disease, diabetes, and metabolic syndrome. Over half of the women who are diagnosed with PCOS are overweight or obese. Recommendations are made for overweight/obese women to lose weight via diet and exercise. Women with PCOS should also consider maintaining a diet that is patterned after the type 2 diabetes diet. This diet includes an increase in fiber and a decrease in refined carbohydrates, as well as a decrease in trans and saturated fats and an increase in ω‐3 andω ‐9 fatty acids. Foods that contain anti‐inflammatory compounds (fiber,ω ‐3 fatty acids, vitamin E, and red wine) should also be emphasized. Evidence is provided for the impact of these dietary changes on improvements in the androgen profile of PCOS patients.
Microbial Contamination of Enteral Feeding Sets Used in the Home of Pediatric Patients
Authors: Roberts Cristine A. , Lyman Elizabeth
Published: May 2008

Bacterial contamination of enteral feeding sets has been well documented in studies of patients. Much of the literature on this subject validates problems with manipulations of the feeding sets such as mixing formula and handwashing by the caregiver. Rinsing and storing of the set could also have serious implications in the amount of contamination. There is currently no standard recommending the length of time for use of enteral feeding sets for home care patients, particularly in children. Nine homecare patients with ages ranging between 1 and 15 years participated in this study. Cultures of the formula in the feeding set were obtained at zero hours with a new set, and after 24 and 48 hours. The caregivers prepared and administered the formula in their usual manner. Clinical data were collected for 10–14 days before the samplings and for 7 days afterward. Data included weights before, during, and after the culture collection period. Medications, stools, and emesis were recorded during this timeframe. It is difficult to draw statistically significant conclusions based on the small sample size of this study. There was an undesirable level of contamination at 48 hours of enteral feeding set use that was not present at 24 hours in 2 of the patients (22.2%). Neither of these children had diarrhea, vomiting, or other clinical changes, but both showed a small weight loss. The majority of the patients (77.8%) demonstrated that using sets for 48 hours did not increase the amount of contamination.
A Nutrition Support Team Quality Assurance Plan
Authors: Powers Tony , Deckard Marleen , Stark Nathene , Cowan George S.M.
Published: May 2008

The Nutrition Support Team at the Veterans Affairs Medical Center is responsible for the development of guidelines related to the provision of both total parenteral nutrition and enteral nutrition support. A Quality Assurance plan which was approved by the Joint Commission on Accreditation of HealthCare Organizations was implemented by the Nutrition Support Team. This plan addresses: nutritional assessment and consultation, indications for enteral and parenteral nutrition support, provision of optimal nutrition support including attainment of nutritional goals, and the prevention, detection, and management of complications. The indicators and criteria for each aspect of care are described. This program has provided documentation of the activities of the Nutrition Support Team as well as data defining the patient population requiring specialized nutrition support, and has helped identify areas where improvement is required.
Invited Review: Molecular Biology in Nutrition
Authors: Smith Robert J.
Published: May 2008

Recent progress in the field of molecular biology has had a considerable effect on both basic and applied clinical nutrition and offers even greater promise for the future. It is important for individuals working in clinical nutrition, as well as basic science investigators, to have an understanding of the fundamental concepts of molecular biology in order to be able to evaluate and apply new approaches to clinical problems as they become available. The purpose of this review is to provide those who are not molecular biologists with a brief overview of the fundamental concepts of molecular biology and then to describe a number of the recent applications of molecular biological methods and tools in the field of nutrition.
Limiting Bacterial Contamination of Enteral Nutrient Solutions: 6‐Year History With Reduction of Contamination at Two Institutions
Authors: Fagerman Kenneth E.
Published: May 2008

Running enteral nutrient solution (ENS) bacterial contamination logs that were collected over a 6‐year time frame are presented. At hospital A, reconstituted ENS were prepared by the pharmacy department in bulk and were frozen in the final container. These solutions were cultured and counted after 12 hours of storage at room temperature to stimulate this institution's hang time. Major reductions in ENS bacterial counts occurred after improvements in sanitation, a reduction in solution hang time, the conversion to the use of sterile water for dilution and reconstitution of ENS, and most dramatically, after the incorporation of a preservative (potassium sorbate) to reconstituted ENS. At hospital B, ENS usage consisted of canned feedings that were prepared by nursing personnel and were transferred to the feeding container at the bedside. Reductions in final counts of contamination of ENS occurred after procedural changes, which included container changes every 24 hours, use of sterile water for dilution, cleansing of can lids with alcohol swabs before use, rinsing and air drying of intermittent feeding containers between feedings, and limiting feeding container fills to 4‐hour hang time quantities. At both institutions, the value of an ongoing three‐class enteral quality control program with a defined acceptance/ rejection criteria was demonstrated in that ENS contamination was reduced to acceptable levels comparable with federal standards for milk and dairy products.
Home Hyperalimentation for Inflammatory Bowel Disease
Authors: Bodzin Jason H.
Published: May 2008

Total parenteral nutrition (TPN) has become a useful tool in the management of patients with inflammatory bowel disease (IBD). In the past, it was felt that TPN would have a therapeutic role in IBD, but experience has shown that it functions more as an adjunct to other therapeutic interventions. The specific roles of TPN in IBD include: (1) nutritional maintenance in the short bowel syndrome, (2) TPN as adjunctive therapy in jejunoileitis of Crohn's disease, (3) home TPN (HTPN) in Crohn's colitis, and (4) preoperative repletion of significantly depleted patients going to surgery. The adaptation of hospital techniques to the home situation has allowed patients to carry out long‐term TPN therapy at home. Patients with IBD on HTPN are subject to the same mechanical and metabolic problems as are other patients on HTPN and, in addition, have a higher infection rate. When carried out appropriately, however, HTPN is a valuable technique in the management of patients with IBD and may provide an improved quality of life.
Ten‐Year Survival of a Broviac Catheter
Authors: Heimburger Douglas C.
Published: May 2008

We report a patient with regional enteritis and short bowel syndrome who has been treated with home parenteral nutrition for 19 years, during 10 of which he used a single Broviac central venous catheter. The catheter finally required replacement because of progressive lumen occlusion, which was presumed to be caused by thrombosis. At the time of replacement, the catheter was found to be friable and embedded in a hard sheath that made it adherent to the wall of the internal jugular vein and prevented complete removal. At some time during the ensuing 16 months, the retained fragment embolized asymptomatically to the pulmonary artery. During the first 2 months after the placement of a new Hickman catheter, progressive flow resistance developed, probably because of calcium phosphate precipitation, although no change had been made in the parenteral formulation. It resolved immediately upon the instillation of hydrochloric acid into the catheter.
Somatostatin and Its Analogs in the Short Bowel Syndrome
Authors: Rosen Gail H.
Published: May 2008

The use of somatostatin to manage diarrhea associated with the short gut syndrome is impractical because of its need to be given by continuous infusion and a rebound effect on stool output with cessation of therapy. Octreotide has been used more successfully to control stool and electrolyte losses in patients with shortened gastrointestinal tracts. In published series and studies, all subjects appear to decrease stool losses, but clinical benefit for longterm use is not achieved for all patients. In the patients who do respond, the need for parenteral nutrition and intravenous hydration has been decreased or eliminated. The optimal dose is unclear, but many patients respond to 50‐μg injections twice daily. Several investigations noted no additional beneficial effects with escalating dosages. Adverse effects include impairment of fat absorption, which may offset the therapeutic benefits of octreotide. The patients with the greatest response appear to have the least fat malabsorption. Other adverse effects noted when using octreotide for control of the short gut syndrome include pain associated with subcutaneous injection and abdominal complaints. Other potential concerns include the effect on gallstone formation in this high‐risk population and intestinal adaptation.
Invited Review: Immunologic Structure and Function of the Gastrointestinal Tract
Authors: Langkamp‐Henken Bobbi , Glezer Jeffrey A. , Kudsk Kenneth A.
Published: May 2008

Host defenses within the gastrointestinal tract exclude bacteria and other intraluminal substances, which if released into the systemic circulation, would be toxic to the body. This is accomplished via complex interactions between these external pathogens and local immune responses and nonimmunologic processes. In addition to the mechanical and chemical barriers of the nonimmunologic defense system within the gastrointestinal tract, there is an effective immunologic barrier composed of aggregated and nonaggregated lymphoid cells. Gut‐associated lymphoid tissue protects the intestinal mucosa from invading pathogens by intricate pathways of antigen processing. Gut‐associated lymphoid tissue also transfers protection to other secretory sites within the body through the common mucosal immune system. The integrity of both the immunologic and nonimmunologic barriers may be affected by any number of pathologic insults as well as by nutritional influences. This article reviews the structural and functional characteristics of this complex and critically important host defense system. Specific nutrient requirements of the immunologic processes are discussed.
Enteral Feeding in the Critically Injured Patient
Authors: Anderson Jan D. , Moore Frederick A. , Moore Ernest E.
Published: May 2008

Metabolic support is an integral component in the care of the critically injured patient. When hypermetabolism occurs, there are increases in energy demands along with changes in substrate utilization. This article reviews the prospective randomized clinical trials that were undertaken at Denver General Hospital over the past decade that address both the timing of nutritional support and the route of administration in this critically injured population. Also discussed is a review of a meta‐analysis that attests to the feasibility of early postoperative enteral feeding with the possibility of decreased septic morbidity in high‐risk surgical patients. With the clinical knowledge gained from these trials, an algorithm for nutritional intervention was developed that represents our current standard of practice.
Nutrition Management of the Hepatic Transplant Patient
Authors: Berry Scott M. , Lacy Joseph
Published: May 2008

Patients who are candidates for liver transplantation are predisposed to severe nutritional depletion because of their underlying hepatic dysfunction.Nutrition‐associated complications, particularly infection and poor wound healing, are common causes of morbidity and mortality among adults with chronic liver disease and malignancy who are referred for liver transplantation. During the preoperative period, maintenance or repletive nutrition is provided to the patient with hepatic failure. The patient's postoperative period is characterized by the catabolic response to a major operation, the progressive improvement of hepatic graft function, and the persistent compensatory renal abnormalities that are associated with liver failure. The nutrition management of the patient with liver failure has been well described.Nutrition intervention during the intraoperative and postoperative periods remains enigmatic.The following case report describes the nutrition management of a liver transplant recipient in the intraoperative and postoperative periods.
Parenteral Nutrition Support of a Patient With Chronic Mesenteric Artery Occlusive Disease
Authors: Mueller Charles , Borriello Raffaele , Perlov‐Antzis Lea
Published: May 2008

Vascular catastrophe resulting in a bowel infarction requiring massive resection is one of the most common indications for long‐term total parenteral nutrition (TPN). The causes of mesenteric artery disease include embolic and thrombotic occlusions, nonocclusive mesenteric ischemia, and chronic mesenteric ischemia. This paper describes a case of a patient with chronic ischemia. The indication for TPN was intestinal angina limiting oral intake, not short‐bowel syndrome as a result of bowel infarction and surgery. The patient had an extensive history of atherosclerotic disease and abdominal symptoms. Her nutritional status was maintained with TPN and oral intake as symptomatically tolerated. She eventually developed catheter sepsis. Her cardiopulmonary status deteriorated and she died. Progressive mesenteric ischemia and possible infarction may have contributed to her death. The patient had indicated she did not want surgery for a bowel infarction. She did consent to surgical correction of her disease, if feasible. Although TPN can maintain the nutritional and metabolic status of a patient with chronic mesenteric ischemia, the associated risk of catheter sepsis emphasizes the necessity for expedient treatment of the primary pathology.
Invited Review: Vascular Access Devices: Perspectives on Designs, Complications, and Management
Authors: Evans Marsha , Ryder Marcia A.
Published: May 2008

The use of vascular access devices in hospitalized and home care patients has expanded rapidly in the past decade. New designs, materials, insertion techniques, and protocols for care related to vascular access devices have emerged. Complications associated with them, however, have remained a persistent problem. Septicemia, thrombosis, and occlusion are three of the more serious complications that can lead to the need for removal of the device. These complications are reviewed and areas for future research are identified.
Nutrition Screening: Identifying Patients at Risk for Malnutrition
Authors: Nagel Maria R.
Published: May 2008

Studies have identified malnutrition as a common problem among many hospitalized patients. Malnutrition can adversely affect a patient's response to treatment, prolonging recovery time. Nutrition screening is a process that can be initiated early in a patient's hospital stay to identify people who may be at risk for malnutrition. Early identification of these patients can help nutrition professionals focus their efforts on those who would benefit most. Clinical, biochemical, anthropometric, and dietary indicators should be included in a screening program to ensure optimal effectiveness. Screening programs can be developed with minimal effort by using existing staff and data readily available in a patient's medical record. This article describes one such screening program.
Micronutrition in Dialysis
Authors: Wolk Robert
Published: May 2008

A variety of dialysis methods are currently used in the treatment of renal failure. Nutrition support modalities are also frequently used for patients with renal failure who are malnourished or at risk of becoming malnourished. The effects of various dialysis methods on certain micronutrient levels and needs have generally not been extensively studied, however, this article reviews information that has been published regarding carnitine, water soluble vitamin, fat soluble vitamin, and trace element levels during dialysis. Recommendations for provision of micronutrients during dialysis are provided.
Rationale and Efficacy of Specialized Enteral Nutrition
Authors: Matarese Laura E.
Published: May 2008

Enteral nutrition, whenever feasible, is the preferred route of nutrition support. There has been a tremendous increase in the number of enteral products available on the market. Many of these are designed for use in specific disease states. This review will summarize the scientific rationale and supporting research for specialized enteral nutrition.
Nutrition Support Teams: Role in the New Health Care Environment
Authors: Clemmer Terry P.
Published: May 2008

Many hospitals have strong political leaders who question the need for a nutrition support service.1,2 In addition, the pressures of economic and health care reform are forcing administrators to cut unnecessary and unproven, albeit beneficial, services.3,4 The challenge for nutrition support services is clear‐cut: in order to survive, nutrition support teams must understand the changes in health care and must learn how to adapt to them. This article clarifies the issues and assists nutrition support teams in establishing a new direction.
Clinical Comparison of Three Methods to Determine Resting Energy Expenditure
Authors: Osborne Bradley J. , Saba Alexander K. , Wood Steven J. , Nyswonger Gayle D. , Hansen Carolyn W.
Published: May 2008

An accurate and reliable method of determining resting energy expenditure in the critical care setting is crucial because inadequate caloric intake and excessive caloric intake are both associated with a number of complications. Energy requirements were determined by three different methods in a group of 25 post‐cardiac surgery patients in the intensive care unit. Patients were intubated and had a thermodilution pulmonary artery catheter in place. The first method measured resting energy expenditure by indirect calorimetry. For the second method, the results of blood gases drawn at the same time that indirect calorimetry was measured were used in the Fick equation. In the third method, a registered dietitian assessed each patient by using the Harris‐Benedict equation with stress factor modification. Indirect calorimetry was considered the standard with which the other two methods were compared. The results showed that, compared with calorimetry, both the Fick equation and the Harris‐Benedict equation underestimated resting energy needs. Statistically, only the difference between the Fick equation method and indirect calorimetry was significant. Clinically, however, both methods seem to have applicability.
Role of Antioxidants in Health Maintenance
Authors: Sardesai Vishwanath M.
Published: May 2008

Free radicals are produced in the body as by products of normal metabolism and as a result of exposure to radiation and some environmental pollutants. Because they are highly reactive, they can damage cellular components and are implicated in a variety of diseases. Free radicals are normally neutralized by efficient systems in the body that include the antioxidant enzymes (superoxide dismutase, catalase, and glutathione peroxidase) and the nutrient‐derived antioxidant small molecules (vitamin E, vitamin C, carotenes, flavonoids, glutathione, uric acid, and taurine). In healthy individuals, a delicate balance exists between free radicals and antioxidants. In some pathologic conditions such as diabetes, and in critically ill patients, oxidative stress causes the level of antioxidants to fall below normal. Antioxidant supplements for such conditions are expected to be of benefit. As a preventive measure against certain diseases, the best approach for healthy individuals is to regularly consume adequate amounts of antioxidant‐rich foods, eg, fruits and vegetables.
Development of Pediatric and Neonatal Parenteral Nutrition Order Forms
Authors: Storm Heidi M. , Young Sharon L. , Sandler Richard H.
Published: May 2008

The diversity of nutritional needs within the pediatric population makes ordering parenteral nutrition (PN) for infants and children a difficult task for inexperienced clinicians. A well designed PN order form can simplify this task. Standard PN solutions, tables with age‐specific nutrient requirements, and guidelines for advancing substrate may improve PN prescriptions and serve as an educational tool. The development of an optimal PN order form for an institution requires consideration of many factors, including the patient population, requirements of the institution, and the needs of the staff and students. One nutrition support team's experience in developing pediatric PN order forms is described.
Nutrition in the Pediatric Double Lung Transplant Patient With Cystic Fibrosis
Authors: Fulton Judith A. , Orenstein David M. , Koehler Anita N. , Kurland Geoffrey
Published: May 2008

Cystic fibrosis (CF) is the most common lethal genetic disease in the white population. The pulmonary infections and pancreatic insufficiency make CF a medically challenging disease. Although the importance of nutrition in the CF patient is known, approximately 50% of CF patients are in less than the 10th percentile for weight and height as reported by the 1991 CF Foundation Registry of 114 CF Centers in the United States. This paper addresses the nutritional status of 10 pediatric CF patients who underwent double lung transplant at Children's Hospital of Pittsburgh between August 1991 and May 1993. Patients who survived beyond 1 year gained a significant amount of weight sooner after transplant than those who survived less than 1 year. Gastrostomy tube feedings were more effective than oral intake for weight gain after transplant. CF patients with pancreatic insufficiency have more difficulty with adjustment of doses of immunosuppressive agents for reasons that are not clearly understood.
Prolonged Parenteral Nutrition for Cystic Fibrosis Patients
Authors: Allen Elizabeth D. , Mick Anne B. , Nicol Jennie , Mccoy Karen S.
Published: May 2008

To evaluate the clinical impact of prolonged parenteral nutritional (PN) therapy on patients with advanced cystic fibrosis, we conducted a retrospective chart review of 25 cystic fibrosis patients who underwent prolonged PN (median course 295 days) at our institution between August 1988 and May 1992. The patients' survival status, change in percentage of ideal body weight, need for ongoing nutritional intervention, pulmonary function test changes, IV antibiotic use, and complication rates were assessed. Patients gained significant weight while receiving PN, but they lost weight when PN was discontinued. PN did not clearly improve pulmonary status. IV antibiotic therapy nearly doubled during PN. Central venous catheter sepsis rates rose from 1.29 to 3.45 per 1000 catheter days during PN therapy. In conclusion, prolonged PN promotes weight gain in cystic fibrosis patients with severe disease; however, the effect is transient and involves a significantly increased risk of sepsis.
Endothelial Thrombus Formation: An Unusual Complication Related to Peripherally Inserted Central Catheters
Authors: Jepsen Susan T.
Published: May 2008

The Nutritional Support Service (NSS) at William Beaumont Hospital has successfully inserted over 2000 peripherally inserted central catheters (PICCs) since the inception of its PICC program in 1990. The following is a case study of a 43‐year‐old female with diabetes mellitus and multiple drug allergies who presented to the NSS after Wound Clinic personnel were unable to pull a 43 cm PICC more than 38 cm out of her left arm. Radiographic studies showed the remaining 5 cm of the catheter to be untangled, following the course of the cephalic vein. A surgical cutdown was performed to dilate the cephalic vein and remove the device. The PICC tip was encapsulated in an organic material which was confirmed by pathology to be a thrombus with endothelial lining.
Nutrition Assessment in the 1990s: Where Are We Now?
Authors: Charney Pamela
Published: May 2008

This review addresses some of the challenges confronting the modern nutrition support clinician in developing protocols for nutrition assessment. While it is generally agreed upon that patients who are malnourished are at greater risk for development of complications during hospitalization, there is no consensus on the best method for assessment of nutritional status. Assessment parameters currently available include clinical, biochemical, anthropometric, and functional tests designed to evaluate nutrition status as well as estimate body composition. As some of these parameters are expensive or not practical for routine clinical use, they should be evaluated carefully when a nutrition assessment protocol is designed.
Invited Review: Intradialytic Parenteral Nutrition: A Useful Therapy?
Authors: Wolfson Marsha , Foulks Charles J.
Published: May 2008

Malnutrition in hemodialysis patients is common and may affect as much as 40% of this population of patients. There are many causes of malnutrition and all must be considered before utilizing nutrition support to reverse the malnutrition. Intradialytic parenteral nutrition (IDPN) is a therapy that has become popular among US nephrologists despite the fact that there are no clear data that support its use or efficacy. A thorough review of published articles suggests a relationship between the use of IDPN and improved patient outcome measured by hospitalization rate and a decrease in mortality in certain subgroups. However, these studies have many confounding factors that prevent a definitive conclusion concerning the true efficacy of IDPN. This is very problematic since reimbursement changes for parenteral and enteral nutrition have been proposed by HCFA. The best recommendation that can be made for IDPN is that it may represent a useful form of nutrition support in the malnourished hemodialysis patient who has no other active disease processes, cannot ingest adequate nutrition by mouth, and has a contraindication to or a serious complication from enteral feeding. It is clearly not a therapy to be considered as the first line of nutrition support in these patients.
Certification of Staff Nurses to Insert Enteral Feeding Tubes Using a Research‐Based Procedure
Authors: Welch Susan K.
Published: May 2008

Nutrition Support Nurse Clinicians at a Central Texas tertiary care facility have developed a research‐based nasoenteric feeding tube insertion procedure that minimizes the potential for inadvertent passage of a feeding tube containing a stylet into the respiratory tract and maximizes placement of the feeding tube in the desired gastric or duodenal location. The first 79 staff nurses to be certified to use the technique had a 90% duodenal placement success rate under supervision. No bedside feeding tube insertion complications have been noted since the initiation of the certification program 6 years ago. This article describes the feeding tube insertion technique used in the certification process and the research on which it is based.
FDA Safety Alert: Hazards of Precipitation Associated With Parenteral Nutrition
Authors: Mckinnon Barbara T.
Published: May 2008

In April 1994, the Food and Drug Administration issued a Safety Alert regarding the hazards of precipitation associated with parenteral nutrition in response to reports of two deaths and at least two cases of respiratory distress in patients receiving three‐in‐one admixtures. The admixtures were thought to contain a precipitate of calcium phosphate, and patient autopsies revealed diffuse microvascular pulmonary emboli. The American Society for Parenteral and Enteral Nutrition took an active role in informing its members of the alert and responding to their concerns. Release of the alert has caused nutrition practitioners to reevaluate their compounding practices, use of filters, prescribing practices for calcium and phosphate in parenteral nutrition solutions, and use of three‐in‐one admixtures.
Nutrition Management of Patients With Neoplastic Disease of the Head and Neck Treated With Radiation Therapy
Authors: Hunter Anne Marie B.
Published: May 2008

Neoplastic lesions of the head and neck are primarily squamous cell carcinomas of the aerodigestive tract mucosa. Approximately 43,000 new cases of head and neck cancer (8.5% of all malignancies) are diagnosed in the United States each year. Tumors, with a male predominance at age 50 to 60 years, generally occur on the surface of the mucosal lining of the oral cavity, oropharynx, nasopharynx, larynx, maxillary sinus, salivary glands, and the thyroid gland. Tobacco, alcohol, and the combination of tobacco and alcohol are the principle causative agents of head and neck neoplasms. The use of these carcinogenic agents often has a negative impact on lifestyle, and it is not unusual for significant nutritional deficiencies to exist in this population before diagnosis of head and neck cancer. Definitive and adjuvant cancer treatment modalities are rigorous, and sequelae associated with the therapy often further impair nutritional status and increase morbidity. Auspicious nutrition assessment and management before the initiation of therapy can have a significant impact on the course of treatment and the patient's quality of life.
Serum Triglycerides of Breast Milk‐Fed Very‐Low‐Birth‐Weight Infants
Authors: Fenton Tanis R. , Singhal Nalini , Baynton Robert D. , Akierman Albert
Published: May 2008

Normative triglyceride levels were obtained from eighty‐five infants weighing > 1500 g. At least 80% of their nutritional intake was their own mother's breast milk. Triglyceride levels did not correlate with birth weight, gestational age, volume of milk fed, age in days, or use of milk fortifier. The 95th percentile triglyceride value was 2.5 mmol/L. Assuming that breast milk‐fed infants have triglyceride in the normal range, the acceptable limit of triglyceride values in very‐low‐birth‐weight infants receiving IV lipids could be revised upward to 2.5 mmol/L.
Immune‐Enhancing Enteral Formulas: Are They Beneficial in Critically Ill Patients?
Authors: Barton Richard G.
Published: May 2008

Over the last decade there has been considerable interest in the use of specific nutrients to alter the metabolic response to injury and infection, to improve immune function, and to prevent or reverse the severe catabolism and wasting of the lean body mass that accompanies critical illness. In this review, representative animal studies and, when available, human studies examining the potential benefits of these individual nutrients are summarized. The overview of basic investigations is by no means all‐inclusive, and the emphasis of this manuscript is a review of the currently available clinical trials examining the potential benefits of combinations of these individual immunity‐enhancing nutrients in human patients.
Nutrition and Metabolic Support in the 21st Century
Authors: Wilmore Douglas W.
Published: May 2008

New approaches to nutritional support are necessary to test therapies that may potentially enhance outcomes. Such approaches include the move to rely on the enteral route for nutrient delivery, the ability to reduce exogenous calories in our nutritional support systems, the need to utilize nutrients for their pharmacological effects, the ability to use growth factors to enhance nutrient efficacy, and the ability to institute nutritional supplementation before elective operations, thus practicing preventative nutrition. Testing these approaches in the years to come should allow us to identify modalities that will permit us to move away from nutritional therapy as a supportive modality and use it as a primary or secondary method of patient care. (Journal of Parenteral and Enteral Nutrition 24:1–4, 2000)
Electronic Parenteral and Enteral Nutrition
Authors: Schloerb Paul R.
Published: May 2008

Background: With reports of deleterious effects of total parenteral nutrition (TPN) in adults in addition to our surveys, which indicated that ¼, and as many as 1/2, of US academic medical centers were using excess glucose in TPN, our objective was to devise a computer program to optimize nutrients in parenteral and enteral nutrition in adult and pediatric patients. Methods: From review of the literature, body composition, including total body water and body cell mass (BCM), were calculated from large published databases. A computer program, based on a previous algorithm, was developed to determine optimum parenteral and enteral nutritional support, based on calculated BCM as the reference. Flexibility to permit any nutrients, in accordance with individual patient requirements, was included. Results: With entry of simple anthropometric values and an average stress factor equivalent to 20% greater than the Harris‐Benedict energy calculation, energy and nutrients were calculated for TPN as follows: amino acids, 3.4 g/kg BCM/d; carbohydrate, 12 g/kg BCM/d; and fat for remaining energy, usually 2.3 g/kg BCM/d. The program, available on any personal computer, is available using Netscape 3.0 or higher or from Microsoft Internet Explorer 4.0, at http: //epen.kumc.edu. It permits rapid calculation and display of body composition values, a standardized TPN formula, an alternate TPN prescription, enteral nutrition options, a section that explains the calculations, and a list of references. Conclusions: The program, http://epen.kumc.edu, provides rapid definition of the TPN or enteral prescription for adult and pediatric patients, with reduced likelihood of providing excessive glucose and energy in parenteral or enteral nutrition. (Journal of Parenteral and Enteral Nutrition 24:23–29, 2000)
Success Rates and Cost‐Effectiveness of Antibiotic Combinations for Initial Treatment of Central‐Venous‐Line Infections During Total Parenteral Nutrition
Authors: Forchielli M. Luisa , Gura Kathleen , Anessi‐Pessina Eugenio , Richardson Denise , Cai Wei , Lo Clifford W.
Published: May 2008

Background: Central‐venous‐line infections can be successfully treated with appropriate antibiotics, thus avoiding the need for catheter removal. Based on our experience, vancomycin, gentamicin, piperacillin, ceftazidime, and amphotericin, alone or in combination, are usually administered, pending sensitivity results. This empirical list, however, has never been verified against actual sensitivity results nor has it been tested for cost or efficacy. Methods: Medical records of inpatients on hyperalimentation over 1 year were reviewed. Success rate, therapy duration, and drug acquisition cost and charge were assessed for central‐venous‐line infections. Antibiotics then were paired and evaluated in terms of charge and efficacy against all microorganisms as determined by sensitivity results. Results: In 500 inpatients receiving hyperalimentation for 9698 patient‐days, 8.4 central‐venous‐line infections/1000 patient‐days occurred. Staphylococcus non‐aureus, Candida species, Enterococcus faecium, and Staphylococcus aureus predominantly were isolated. Of the infections, 51 (67%) were sensitive to one or more of the initial antibiotics. A 2‐week course of antibiotics successfully treated 50 (66%) catheter infections without line removal. Appropriate initial therapy on average reduced treatment duration by 8 to 10 days and drug charges by $400 to $700. Conclusions: Amikacin‐vancomycin appears to be the most cost‐effective selection for presumed central‐venous‐line infections, pending sensitivity results, followed by valid alternatives. Lower failure rates are well worth the extra cost in pharmaceutical charges. (Journal of Parenteral and Enteral Nutrition 24:119–125, 2000)
Effect of Oral Glutamine Supplementation During Bone Marrow Transplantation
Authors: Coghlin Dickson Tara M. , Wong Ruby M. , Negrin Robert S. , Shizuru Judith A. , Johnston Laura J. , Hu Wendy W. , Blume Karl G. , Stockerl‐Goldstein Keith E.
Published: May 2008

Background: Because all patients receiving bone marrow transplant (BMT) and peripheral blood progenitor cell transplant (PBPCT) experience gastrointestinal (GI) toxicity from the preparative regimen of chemotherapy, with or without radiation, oral glutamine was administered during the preparatory regimen and after transplant to maintain GI structure and function. Methods: To evaluate effects of oral glutamine on nutritional status and overall outcome, a prospective, randomized, double‐blinded study was performed on 58 autologous and allogeneic BMT patients. Patients received 30 g of oral glutamine or placebo daily. Results: The trends of decreased median length of stay and the median number of days of total parenteral nutrition (TPN) were seen in the group supplemented with the >0.285‐g/kg (the recommended dosage) dose of glutamine; however, there was no statistically significant difference in the nutritional status and overall patient outcome as assessed by days receiving TPN, number of days required until oral intake resumed, length of hospitalization, number of days and highest grade of mucositis, and quantity and number of days of diarrhea. Conclusions: This study does not support the hypothesis that oral glutamine may offer benefit. Further investigation is required regarding clinical tools for determining effectiveness, administration for tolerance and compliance, dosage, and potential of oral glutamine usage. (Journal of Parenteral and Enteral Nutrition 24:61–66, 2000)
Malnutrition Impairs Postresection Intestinal Adaptation
Authors: Cronk Daniel R. , Ferguson Debra C. , Thompson Jon S.
Published: May 2008

Background: Postresection intestinal adaptation is influenced by several factors, including luminal nutrients. Adaptation is impaired in the absence of luminal nutrients, even if the nutrition is maintained via total parenteral nutrition (TPN). Reduced enteral intake also inhibits adaptation if malnutrition is present, but the mechanism has not been completely defined. Our aim was to study the effect of reduced enteral nutrition on adaptation and enterocyte production and death after 50% proximal resection in rats. Methods: Eighteen Lewis rats underwent either transection (n =6) or 50% proximal resection (n =12). The resected animals either ate ad libitum (n =6) or were offered 75% of ad libitum intake (n =6). Nutritional status and intestinal adaptation were determined 14 days after surgery. Results: Resected animals receiving 75% normal intake had decreased body weight (89% ± 4% vs 112% ± 2% and 112% ± 1%, p <.05) and serum albumin (2.7 ± 0.1 vs 3.2 ± 0.0 g/dL and 3.0 ± 0.1 g/dL, p <.05) compared with resection with normal intake and transection, respectively. Intestinal weight (0.32 ± 03 vs 0.22 ± 0.02 g/cm and 0.19 ± 0.03 g/cm, p <.05) and diameter (10.5 ± 0.5 vs 8.5 ± 1.0 mm and 7.8 ± 0.8 mm, p <.05) increased after resection alone compared with transection and malnourished resection groups. Gut weight and diameter and villus height were lower in malnourished resected animals than with transection. Crypt cell production rate was significantly lower in the reduced intake animals. Apoptosis was increased in both crypt and villus enterocytes in normally nourished but not malnourished resected animals. Villus apoptosis correlated with villus height. Conclusions: Intestinal adaptation is impaired by a 25% reduction in enteral nutrients, confirming that both the route and quantity of nutrient intake are important in this process. Both enterocyte production and loss via apoptosis are decreased by reduced enteral intake and malnutrition after resection. The correlation between villus height and apoptosis suggests that the reduced apoptosis reflects the smaller enterocyte number in malnourished animals rather than an adaptive response to maintain intestinal structure. (Journal of Parenteral and Enteral Nutrition 24:76–80, 2000)
Long‐Term Risk of Gastrointestinal Tumor Recurrence After Postoperative Treatment with Recombinant Human Growth Hormone
Authors: Tacke Juergen , Bolder Ulrich , Herrmann Armin , Berger Gerd , Jauch Karl‐Walter
Published: May 2008

Background: Recombinant human growth hormone (rhGH) promotes protein synthesis, accelerates wound healing, and maintains immune function in the catabolic state. It has also been claimed that rhGH may promote the activation of residual tumor cells, and therefore, increases the risk of tumor recurrence. This study aimed to investigate whether postoperative administration of rhGH increases the long‐term risk of tumor recurrences in patients undergoing major gastrointestinal surgery for malignancy. Methods: Patients (n =104) received three different doses of rhGH (0.075 IU/kg, 0.150 IU/kg, and 0.300 IU/kg) during 5 postoperative days in a placebo‐controlled trial. Follow‐up was performed for 56–70 months after radical tumor resection. Mean survival period and relapse‐free survival were compared with the control group. Results: Complete data were available for 75 patients. Thirty‐five percent (n = 20) of all patients treated with rhGH showed tumor recurrences in comparison to 44% (n = 8) of patients given placebo. Mean survival period for rhGH‐treated patients was 46 months (median 59 months); in controls, 42 months (median 58 months). The length of relapse‐free survival tended to be longer in rhGH‐treated patients (2–47 months; median, 21 months) compared with the patients who were given placebo (2–18 months; median, 13 months). Conclusions: The results demonstrate no evidence for an increased risk of tumor recurrence after rhGH treatment for a short period of time after removal of a gastrointestinal adenocarcinoma. Therefore, the positive metabolic effects of rhGH application can be used safely in the treatment of the postoperative catabolic state in the patient groups investigated. (Journal of Parenteral and Enteral Nutrition 24:140–144, 2000)
Thiamine Deficiency in Children with Congenital Heart Disease Before and After Corrective Surgery
Authors: Shamir Raanan , Dagan Ovdi , Abramovitch Dana , Abramovitch Tova , Vidne Bernardo A. , Dinari Gabriel
Published: May 2008

Background: Malnutrition is common in children with congenital heart disease, while thiamine deficiency (TD) is common in malnutrition, in critically ill children, and in adults with congestive heart failure treated with loop diuretics. Our goal was to determine whether children with congenital heart disease had TD and whether treatment with loop diuretics is related to TD in these patients. Methods: Twelve children with ventricular septal defect (VSD) treated with furosemide, and 10 children with tetralogy of Fallot (TOF) referred for corrective surgery were consecutively enrolled into a prospective study. Data were collected 24 hours before surgery and 5 days after surgery for nutrition evaluation, medications used, anthropometric measurements, and laboratory markers of malnutrition. Thiamine and pyridoxine deficiencies were evaluated using activated enzyme assays. Results: Seven children (32% of patients) did not meet the recommended daily allowance (RDA) for calories and 18% of patients did not meet the RDA for thiamine intake. Anthropometric measurements were low in both groups, more so in those with VSD, although the difference did not reach statistical significance. Overall, 18% (1/12 with VSD and 3/10 with TOF) of children with congenital heart disease had thiamine deficiency before surgery. Three of the four children with TD had adequate intake of thiamine. Six children (27%) had TD 5 days postsurgery (3 children with VSD and 3 children with TOF). Conclusions: TD is common in children with congenital heart disease (CHD) referred for corrective surgery both before and after surgery. Our results suggest that neither diuretic treatment nor malnutrition can fully explain the development of TD in these children. (Journal of Parenteral and Enteral Nutrition 24:154–158, 2000)
Does the Route of Feeding Modify Gastric Emptying in Rats?
Authors: Shi Guoxiang , Cherbut Christine , des Varannes Stanislas Bruley , Rozé Claude , Galmiche Jean Paul
Published: May 2008

Background: It has been shown that the pattern of previous nutrient intake can influence gastric emptying. However, the effect of the absence of enteral stimulation in the setting of a normal energy supply on gastric emptying has not been examined. The aim of this study was to determine whether the absence of enteral stimulation during total parenteral nutrition (TPN) could modify gastric emptying in rats. Methods: Two experiments were performed. First, gastric emptying of a peptone meal was compared between rats receiving TPN, oral liquid diet (same solution as TPN), or regular diet (control group) for 10 days. In the second experiment, gastric emptying of two test meals (40% peptone and 25% glucose) was studied before and after rats received TPN or intragastric nutrition (same solution as TPN) for 10 to 12 days. Results: In experiment 1, gastric emptying of 40% peptone in the TPN and liquid diet groups was slower than that in the control group. This difference was significant between the TPN group and the control group (p <.01) but not between the liquid diet and control groups (p =.076). Gastric emptying of this meal in the TPN and liquid diet groups was similar. In experiment 2, no difference in gastric emptying of 40% peptone or 25% glucose was found between rats receiving TPN and those receiving intragastric nutrition for 10 to 12 days. Conclusions: The composition of diet not the route of feeding is important in the modification of gastric emptying by the pattern of previous nutrient intake. (Journal of Parenteral and Enteral Nutrition 24:164–169, 2000)