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ABSTRACT: OBJECTIVE: To prospectively explore the prevalence of nutritional risks and undernutrition, obesity and the application of nutritional support in First Affiliated Hospital of Chongqing Medical University and compare the data with those of big hospitals in Beijing. METHODS: A total of 2255 inpatients from the department of gastroenterology, gastrointestinal surgery, neurology and respiratory medicine at our hospital were consecutively recruited from June to October 2011. Nutritional Risk Screening 2002 (NRS2002) was performed at 24 h post-admission. And nutritional support was examined during the period of hospitalization. RESULTS: Among them, 2166 patients (96.1%) received NRS2002. The overall prevalence of nutritional risk was 29.5% (638/2166), undernutrition 12.2% (265/2166) and the incidence of obesity 2.4% (52/2166). For the patients at nutritional risks, only 9.2% (59/638) of them received nutrition support. The nutrition support of gastrointestinal surgery department was higer than Beijing, and that of neurology department was lower than Beijing. For those not at nutritional risks, 1.0% (16/1528) received nutritional support. And that of 4 department were all lower than Beijing (all P < 0.01). CONCLUSIONS: The nutritional risk patients on nutritional support rates is lower at First Affiliated Hospital of Chongqing Medical University and excessive use ofparenteral nutrition support seems routine. The Chinese Society for Parenteral and Enteral Nutrition (CSPEN) guidelines of rational nutrition support should be vigorously promoted.
Zhonghua yi xue za zhi 12/2012; 92(48):3417-3419.
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ABSTRACT: This multicenter, prospective cohort study evaluated the effect of preoperative nutritional support in abdominal surgical patients at nutritional risk as defined by the Nutritional Risk Screening Tool 2002 (NRS-2002).
A consecutive series of patients admitted for selective abdominal surgery in the Peking Union Medical College Hospital and the Beijing University Third Hospital in Beijing, China were recruited from March 2007 to July 2008. Data were collected on the nutritional risk screening (NRS-2002), the application of perioperative nutritional support, surgery, complications, and length of stay. A minimum of 7 d of parenteral nutrition or enteral nutrition before surgery was considered adequate preoperative nutritional support.
In total 1085 patients were recruited, and 512 of them were at nutritional risk. Of the 120 patients with an NRS score at least 5, the complication rate was significantly lower in the preoperative nutrition group compared with the control group (25.6% versus 50.6%, P = 0.008). The postoperative hospital stay was significantly shorter in the preoperative nutrition group than in the control group (13.7 ± 7.9 versus 17.9 ± 11.3 d, P = 0.018). Of the 392 patients with an NRS score from 3 to 4, the complication rate and the postoperative hospital stay were similar between patients with and those without preoperative nutritional support (P = 1.0 and 0.770, respectively).
This finding suggests that preoperative nutritional support is beneficial to patients with an NRS score at least 5 by lowering the complication rate.
Nutrition 06/2012; 28(10):1022-7. · 3.03 Impact Factor
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Chinese medical journal 07/2010; 123(13):1793-5. · 0.86 Impact Factor
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ABSTRACT: To evaluate the impact of nutritional support on clinical outcomes in patients at nutritional risk defined by the Nutritional Risk Screening 2002.
In this prospective cohort study, hospitalized patients from three departments in Johns Hopkins Hospital in Baltimore and two teaching hospitals in Beijing were recruited from March 2007 to May 2008. Data were collected on the nutritional risk screening, application of parenteral nutrition and enteral nutrition, surgery, complications, and length of stay.
There were 1831 patients recruited, with 45.2% of them at nutritional risk. Of the "at-risk" patients, the complication rate was significantly lower in the nutritional-support group than in the no-support group (20.3% versus 28.1%, P = 0.009), mainly because of the lower rate of infectious complications (10.5% versus 18.9%, P < 0.001). Subgroup analysis showed the complication rate was significantly lower in the enteral nutrition group (P < 0.001) but not in the parenteral nutrition group (P = 0.29) when compared with the no-support group. Of the patients without nutritional risk, the complication rate was not different between the nutritional-support group and the no-support group (P = 0.10). Multivariate analysis showed nutritional support was a protective factor for complications in at-risk patients when adjusted for confounders (odds ratio 0.54, P < 0.001). No difference in length of stay was found.
The findings suggested that nutritional support was beneficial to the patients at nutritional risk according to Nutritional Risk Screening 2002 by a lower complication rate.
Nutrition 12/2009; 26(11-12):1088-93. · 3.03 Impact Factor
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ABSTRACT: To investigate the influence of short-term high-fat diet (HFD) on glucose and lipid metabolism in male Han Chinese with type 2 diabetes mellitus (T2DM).
Middle-aged T2DM men supported with solely diet or diet and metformin were enrolled into the study. The design was an unblinded crossover design. Each of the subjects randomly received one from two types of isocalorie (8786.4 kJ/d) standard diet for three consecutive days on two occasions, with a 6-week wash-out period in between. The component ratios of fat, carbohydrate, and protein were 50%, 35%, and 15% vs. 25%, 60%, and 15% in patients administered with HFD or high carbohydrate diet (HCD). The 24-hour blood samples during the third day were collected. On the morning of the forth day an intravenous glucose tolerance test (IVGTT) was conducted with 25g of glucose.
According to the determination results of 24-hour profile samples, HFD resulted in a markedly increased circulating level of non-esterified fatty acid (NEFA) as compared to HCD (P < 0.001). Nearly significant higher (P = 0.056) FPG was observed 72 hours after the administration of HFD. Circulating insulin levels were comparable between the two diets. A significantly higher HDL-C was also observed after HFD administration (P < 0.05). As assessed by the IVGTT, acute insulin response of glucose (AIRg) tended to increase after the HFD administration (P = 0.06). Fasting plasma glucagons (GLG) level and AUC(Glucagon) during breakfast period (8:00-12:00) were significantly higher after HFD administration than that of after HCD administration.
Short-term HFD induced the increase of NEFA with lower glucose exposure to the patietns. Fasting plasma glucose increased at the fourth day without remarkable changes of insulin levels which may be due to the increase of hepatic glucose output after HFD administration. The short-term HFD in our study induced early stage of insulin resistance. GLG seemed to play a role in this procedure. beta-cell dysfunction may need a longer high NEFA exposure.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 09/2008; 30(4):509-15.
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ABSTRACT: To study the relationship between intake of nutrients and bone density in the middle-aged and the old people.
Dietary investigation was conducted and bone densities of lumbar 2-4, tuberositas of femur and the neck of femur were measured in 200 healthy subjects who received physical check-up in our hospital. Subjects were distributed into 6 groups including young or middle-aged, pre-old and old groups of men and women. Comparison was conducted within those groups.
The average intake of protein, carbohydrate and energy per day in old men-group were (71.4 +/- 11.7) g, (294.2 +/- 54.7) g and (2196.9 +/- 311.3) kcal, respectively, which were significantly lower than those in young or middle-aged groups, and the average amounts of protein, carbohydrate and energy intake per day in old men-group were (91.7 +/- 19.5) g, (81.8 +/- 85.2) g and (2716.0 +/- 451.7) kcal, respectively. The average intake of calcium in women-old group was (362.0 +/- 167.1) mg, the lowest in the groups. The incidence of abnormal bone densities of lumbar 2-4, the tuberositas of femur and the neck of femur in old men group was significantly higher than those in young or middle-aged men groups (P < 0.05) and the pre-old men group. There were significantly different incidence rates of abnormal bone densities between the 3 women groups (P < 0.05), especially between young or middle-aged groups and in the old women-group (P < 0.0001). The incidences of abnormal bone density in pre-old men group and old men group were significantly lower than those in-pre-old and old women groups.
The decrease of calcium intake seemed to be one of the factors leading to abnormity of bone density in old women. While the increase of calcium intake served as one of the nutritional factors affecting the bones.
Zhonghua liu xing bing xue za zhi = Zhonghua liuxingbingxue zazhi 07/2008; 29(6):608-10.
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ABSTRACT: This prospective, randomized, controlled study was designed to investigate the effects of a diabetes specific formula (Diason low energy: 313.8 kJ/100 ml), compared with a standard formula, on insulin sensitivity, serum C peptide, serum lipids and free fatty acid (FFA) in type 2 diabetics.
In total of 71 type 2 diabetics completed the study. Enteral formulas were given orally as the sole source of nutrition to the subjects for 6 days. Venous blood samples (0.5, 1, 2, 3 hours) were collected at day-7 after a 75 g oral glucose tolerance test (OGTT), day 1 after a standard test meal (1673.6 kJ) and after 6 days of either the test diabetes specific formula or a standard formula. Plasma glucose, serum insulin, C peptide and lipids were measured.
After the intervention period, the diabetes specific formula resulted in a significantly lower postprandial rise in blood glucose concentrations at 0.5 hour (P < 0.05) and 1 hour (P < 0.01); significantly lower peak height of plasma glucose (P = 0.05); significantly lower plasma insulin concentrations at 0.5 hour (P < 0.01), 1 hour (P < 0.01) and 2 hours (P < 0.01); and a significantly lower plasma insulin peak compared to controls; both OGTT and a standard test meal (P < 0.05). The glucose and insulin area under the curve after the diabetes specific formula compared to the standard formula were significantly lower. The C peptide level was lower after 6 days of both nutrition formulas compare to 75 g OGTT, but not different from the standard mixed meal. Both formulas were well tolerated.
In summary the diabetes specific formula with a relatively high monounsaturated fatty acid and high multi fiber proportion significantly improved glycemic control. On top of this, the insulin sensitivity (HOMA-IS) was significantly improved and may therefore directly improve the impact on long term complications. The disease specific formula should therefore be the preferred option to be used by diabetic and hyperglycemic patients in need of nutritional support.
Chinese medical journal 05/2008; 121(8):691-5. · 0.86 Impact Factor
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Yu-xiu Li,
Shi-hai Pan,
Jing-bo Zeng, Kang Yu,
Qi Sun,
Qiu-ying Liu,
Wei Qin,
Qian Zhang,
Qing-rong Pan,
Jian-chun Yu,
Tao Xu,
Shao-mei Han,
Heng Wang
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ABSTRACT: To investigate the effect of a new enteral nutrition suspension (diabetes) (TPF-DM) (Dixson 0.75 kcal/ml) (1 kcal = 4.184 kJ) on blood glucose, serum insulin and lipids as compared with a standard formula (Nutrition MF 0.75 kcal/ml) in patients with type 2 diabetes.
A randomized, controlled, paralleled and single center trial was carried out. A total of 76 patients with type 2 diabetes without using insulin and obvious complications were randomized into a study group and a control group. 36 patients in the study group and 35 in the control group completed the trial. The observation lasted 6 days. All calories came from enteral nutrition. At baseline all the patients had standard mixed meal (bread 50 g, egg 50 g, milk 250 ml, total calorie 400 kcal) test and at the end of the trial a enteral nutrient meal (enteral nutrient 400 ml, total calorie 300 kcal) test. Blood samples were taken before the meal and 30, 60, 120 and 180 minutes after the meal to test plasma glucose, serum insulin, serum lipids and some safety parameters. The area under curve (AUC) for plasma glucose, serum insulin, serum lipids was calculated.
Compared with the mixed meal test, the AUC of plasma glucose and serum insulin during both Dixson 0.75 kcal/ml test and standard formula (Nutrition MF 0.75 kcal/ml) test were significantly lower (P < 0.01). The change at baseline in the study group was more than that in the control group [the change of AUC for plasma glucose (-6.42 +/- 8.62) h x mmol x L(-1) vs (-1.87 +/- 5.30) h x mmol x L(-1), P < 0.01; that of AUC for serum insulin (-36.94 +/- 49.77) h x mIU x L(-1) vs (-18.20 +/- 32.62) h x mIU x L(-1), P < 0.05]. Both the enteral nutrition formula can reduce insulin resistance (calculated by HOMA-IR), but there was no difference between them. There was no significant effect on total cholesterol, high density lipoprotein and low density lipoprotein. AUC of serum triglycerides was lower during the tests with both enteral nutrients than that during mixed meal test, but there was no significant difference between the two groups. There was no safety concern about the enteral nutrition.
Enteral nutrition suspension (diabetes) (TPF-DM) (Dixson 0.75 kcal/ml) is an effective and safe enteral nutrient to be used in patients with type 2 diabetes.
Zhonghua nei ke za zhi [Chinese journal of internal medicine] 04/2007; 46(3):193-6.
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ABSTRACT: To evaluate the impact of glutamine dipeptide-supplemented parenteral nutrition (GLN-PN) on clinical outcomes in surgical patients.
MEDLINE, EMBASE, Web of Science, and the Cochrane Controlled Clinical Trials Register were searched to retrieve the eligible studies. The studies were included if they were randomized controlled trials that evaluated the effect of GLN-PN and standard PN on clinical outcomes of surgical patients. Clinical outcomes of interest were postoperative morbidity of infectious complication, mortality, length of hospital stay, and cost. Statistical analysis was conducted by RevMan 4.2 software from the Cochrane Collaboration.
Fourteen randomized controlled trials (RCTs) (N = 587) were included in this meta-analysis. The results showed that glutamine dipeptide significantly reduced the length of hospital stay by around 4 days in the form of alanyl-glutamine (weighted mean difference [WMD] = -3.84; 95% confidence interval [CI] -5.40, -2.28; z = 4.82; P < .001) and about 5 days in the form of glycyl-glutamine (WMD = -5.40; 95% CI -8.46, -2.33; z = 3.45; P < .001). The overall effect indicated a significant decrease in the infectious complication rates of surgical patients receiving GLN-PN (risk ratio = 0.69; 95% CI 0.50, 0.95; z = 2.26; P = .02).
GLN-PN was beneficial to postoperative patients by shortening the length of hospital stay and reducing the morbidity of postoperative infectious complications.
Journal of Parenteral and Enteral Nutrition 34(5):521-9. · 3.29 Impact Factor
