Sunday, March 1, 2015

Child Malnutrition


New approach to childhood malnutrition may reduce relapses, deaths


 

            Moderate acute malnutrition is experienced by 35 million children worldwide. A new study led by researchers from Washington University School of Medicine in St. Louis has suggested that feeding children until they have met target measures of arm circumference and weight may be more important than a set 12 week feeding time. However, researchers have found that the current targets, set by the World Health Organization (WHO) may not be sufficient and raising these targets slightly could significantly reduce the risk of relapse in malnourished children; a condition that has a 37% relapse rate. The study took place in rural Malawi and was comprised of 2,349 moderately malnourished children aged 6 months to 5 years old. Children were evaluated 12 months after treatment; 1,967 received a soy-based supplement for 12 weeks while the other 382 were treated until they met WHO standards for weight and arm circumference. The finding was that when treated with a 12 week supplement, 71% of children remained well-nourished at follow-up versus 62% of children treated until WHO standards. However, the researchers did note that the greater the child’s WHZ and the bigger the child’s arm circumference, the more likely they were to not suffer a relapse. Regardless of this limitation, the findings suggest that even slightly raising WHO targets (1.5-1.75 instead of 2 SD below the mean for WHZ and raising arm circumference from 12.5 to 13 cm) could decrease relapse rates in moderately malnourished children.

            This finding is crucial for clinical dietitians because treating malnourishment is a huge job, especially in children. Knowing what works best to prevent relapse, including the possibility of raising current standards, could help us treat this problem and save lives.
 
-ER

Monday, February 16, 2015

formula


Formula Improves Bedsores for Malnourished Patients
http://www.medpagetoday.com/HospitalBasedMedicine/GeneralHospitalPractice/49841

 

            A randomized trial published in a recent issue of Annals of Internal Medicine found that malnourished adult patients in Italy with pressure ulcers have benefited from oral formulas including zinc, arginine and antioxidant supplements. The supplement was given to 100 of 200 malnourished patients with stage 2, 3 and 4 pressure ulcers. After 8 weeks, the group receiving the oral supplement showed a greater reduction in ulcer area. No other study has found that oral formula could improve outcomes for older patients with pressure ulcers, however, no other study has looked at these specific nutrients working together.

            This is important for clinical management, because pressure ulcers are a very common hospital-acquired condition. Being able to improve the severity of these ulcers in malnourished patients through a nutrition supplement further validates the necessity of dietitians as key players on the healthcare team.
 
-ER

Wednesday, February 11, 2015

Micro Intakes


Pharmavite Study Using NHANES Data Shows Obese Adults Have Lowest Micronutrient Intakes



 

            A new study published by the Journal of the American College of Nutrition looked at the typical consumption of micronutrients between normal, overweight and obese American adults. The information came from 2001-2008 NHANES data and found that overweight and obese Americans were less likely to reach their EAR in nutrients like calcium than their normal weight counterparts. This study also looked at vitamins A, C, D and E, as well as choline, fiber, potassium and magnesium and in every category, overweight and obese individuals showed a lower intake than normal weight individuals.

            This study and results are important for clinical dietitians because it gives evidence to what is already known: overweight and obese Americans aren't eating a nutritionally-dense diet. Although the information can seem repetitive, it is important to continue educating patients on the importance of consuming diets that are micronutrient-rich.
 
-ER

Monday, February 9, 2015

Nutrition Before Surgery


       In the January issue of Today’s Dietitian, dietitian Dr. Denise Webb highlights the future of clinical dietetics and the role dietitians can play in enhancing recovery of patients after surgery (ERAS).  50% of patients enter the hospital malnourished and only about 20% receive a nutritional consult.  These results also play a role into patient recovery post surgery.  Malnutrition significantly increases risk of death after surgery, complications, and readmission.  At the Academy of Nutrition and Dietetics Food and Nutrition Conference and Expo in Atlanta, Georgia this past October, David Evans, MD stated, “Traditional beliefs still persist among surgeons to delay nutrition support, despite recommendations to the contrary.”  The ERAS recommends incorporating preoperative nutrition intervention and urge use of prebiotic/probiotic administration, limiting preoperative fast to two to three hours instead of the traditional 12 hours, and immediate fluid and diet initiation after surgery. 

       It was also interested how Evans also highlighted the recommendations of hydration, carbohydrate loading, and muscle strengthening pre-surgery!  Carbohydrate loading pre-surgery is a procedure in other countries and not yet in the U.S.  Carbohydrate loading could prevent insulin resistance and hyperglycemia, as well as increase anabolic state post-surgery.  Studies have shown the importance of hydration pre-surgery to prevent nausea and pain with caution to assure aspiration does not occur.  Building lead muscle mass prior to surgery can also help with recovery.  

-DH

Webb, D. (2015). Optimizing nutrition before surgery. Today’s Dietitian, 17(1), 10-11.

Tuesday, January 27, 2015

5 Uncommon Diabetes Diagnoses

We all know about diabetes, type I and II. However, there are many different and uncommon diabetes diagnosis that we as dietitians need to be familiar with. Between 1 and 5% of people diagnosed with diabetes do not have the traditional type one or type two diabetes. This article discusses the five types of diabetes that are uncommon. LADA is known as "type 1.5 diabetes". It is a slowly progressing type of type one diabetes that is often misdiagnosed as type 2. MODY is a type of diabetes that is most often found in young people. People with this type of diabetes are unable to have their beta cells release insulin. CFRD occurs when damage is done to the pancreas and is caused due to decreased numbers of beta cells. Cushing's Syndrome can cause diabetes and is seen in many cases. Antiretroviral-associated diabetes results from therapies for HIV. This article dives into more detail on each of these different diagnosis and processes of diabetes progression. Seeing as how diabetes is one of the top diseases we are dealing with in the US, it is really important for us as dietitians to know the disease in and out. This article really gives a good overview to condition that would otherwise remain unknown by many dietitians.
-JR

Brown-Riggs, C. (2014). 5 uncommon diabetes diagnoses. Today's Dietitian, 16(10), 36.
http://www.todaysdietitian.com/newarchives/100614p36.shtml

Starving for Two

"Pregorexia" has been a term recently used in the media, it is not currently a medical term and therefor has no medical definition. However, it is becoming more and more common in the world of pregnant women struggling to maintain their weight while pregnant. This can occur in women that have previously had an eating disorder, but can also occur in women who have never had trouble with eating disorders in the past but are horrified to see a weight on the scale they are not use to.  OB/GYN's see their pregnant patients the most, and would therefore be the best line of defense when it comes to pregnancy eating disorders. Unfortunatly, most OB/GYN's do not know the signs and symptoms to look for when evaluating for an eating disorder. And with new standards and hospital regulations, patients are in and out of the office in 15 minutes or less, making it difficult to have the time to get the answers need to diagnose. Treatment requires counseling and looking out for tricks (such as overexercising to compensate for calorie intake) that OB/GYN's might miss. It is important to be educated about the signs to avoid life threatening complications.

I think this article is really cool for anyone going into the prenatal nutrition area of practice. I have been at WIC for weeks now, and have worked with pregnant women before, and NEVER have I though, "I wonder if she has an eating disorder". This article is a real eye opener for anyone working with soon-to-be moms!
-JR

Getz, L. (2015). Starving for Two. Today's Dietitian, 17(1), 14-           16. http://www.todaysdietitian.com/newarchives/011315p14.shtml.

Monday, January 19, 2015

Preoperative Nutrition Protocols


“Traditional beliefs still persist among surgeons to delay initiating nutrition support, despite recommendations to the contrary” said David Evans, MD at last year’s Food & Nutrition Conference and Expo in October 2014. David Evans is an Assistant Professor of Surgery, Medical Director, and Director of Nutrition Support Service at The Ohio State University. And the recommendations in question, a collection of strategies to improve surgical outcomes before, during, and after surgery, are garnering some press. The Sweden-based society, known as Enhanced Recovery After Surgery (ERAS) have considered the application of pre- and postsurgical nutrition interventions to surgical patients. Some of the interventions selected include “nutrition assessments and counseling; prebiotic/probiotics administration; limiting preoperative fasting to two to three hours, rather than the traditional six to 12 hours; and immediate postoperative fluid and diet initiation” (Webb, 2015), carbohydrate loading presurgery and increasing protein intake. Such interventions have shown to benefit postoperative mobilization, reduce post-op complications, prevent nutritional deficiencies, reduce aspiration risk, minimize incidence of post-op insulin resistance, promote healing and preservation of lean tissue, and improve recovery time, to a few (Hegazi et al., 2014; Hayhurst, et al., 2014; Webb, 2015).

Not all patients benefit from preoperative nutritional assessment equally. Two basic rules for nutritional assessment presurgery: 1. Determine nutritional status and nutrition risk in patients and 2. Identify high- vs low-risk surgeries. Practical guidelines for dietitians to be mindful of in a surgical patient’s initial nutritional assessment are listed below:

·       Degree of weight loss/trends in recent month(s)

·       BMI

·       Current dietary intake  

·       Supplementation and medication use

·       Clinical status – current diagnosis, type, severity of the disease, etc.

·       Nitrogen balance

·       Hydration status

Given the above guidelines, characteristics that predominate among high-risk patients include weight loss >5% over the past 1-3 months, BMI <18.5, food intake ≤75% of requirements, take steroids and have immunosuppression or cancer (Webb, 2015). Parenteral nutrition (PN) administration would be beneficial in this case, however, do bear in mind the solution’s composition and rate. (To those interested, I included a review article written by Evans and colleagues that further discusses the nutrition screening protocols). Doing so can help avoid complications and infections. Esophageal, gastric, colorectal surgeries, major orthopedic and neurological surgeries are cited as surgeries with high nutrition risk.

The Ohio State University surgeon, David Evans, MD, has this to say about delivering convincing evidence to surgeons and anesthesiologists of routine preoperative nutrition screening and support: “Bring evidence that will encourage them to buy into these nutrition protocols."
CP

References

Evans, D., Martindale, R., Kiraly, L., & Jones, C. Nutrition optimization prior to surgery. Nutr Clin Pract. 2014;29(1):10-21. doi: 10.1177/0884533613517006

Hayhurst C, Durieux ME. Enteral hydration prior to surgery: the benefits are clear. Anesth Analg. 2014;118(6):1163-1164.

Hegazi RA, Hustead DS, Evans DC. Preoperative standard oral nutrition supplements vs immunonutrition: results of systematic review and meta-analysis. J Am Coll Surg. 2014;219(5):1078-1087.

Webb, D. Optimizing nutrition before surgery. Today’s Dietitian. 2015;17(1):19. http://www.todaysdietitian.com/newarchives/011315p10.shtml. Accessed January 19, 2015.