P-OGC93 Weight Loss and Complications in Oesophagectomy and Gastrectomy Patients

Background Oesophagectomy and gastrectomy are major surgeries which often involve patients fasting for prolonged periods of time post operatively thus requiring alternative nutrition regimens. In addition, patients often suffer dysphagia, anorexia, chemotherapy side effects and significant weight loss prior to surgery. Post-operative concerns include delayed gastric emptying, refeeding syndrome and dumping syndrome. Whilst placement of enteral feeding tubes aids the transition back to normal diet there are often still social, physical and dietary challenges that hinder nutrition. The aim of this study was to review weight loss in patients post operatively and to optimise post-operative nutrition. Methods The records of 113 patients who had undergone an oesophagectomy (43) or gastrectomy (64) between June 2018 and November 2019 at a single regional cancer centre were retrospectively examined. These patients’ contemporaneous weights had been recorded at set peri operative timelines and the greatest percentage weight loss calculated. The percentage weight loss was matched to the highest Clavien-Dindo post-operative complication. Results 89 patients had weights routinely reviewed post operatively, with the remainder not having regular post operative weights documented. The median weight loss was 7.53. For patients undergoing a total gastrectomy (27) weight loss ranged from 7.36-29.2%. Median weight loss was 11.45%. Patients who underwent subtotal gastrectomy (26) had between 0.37-18.5% with a median of 7.83% weight loss. Those who underwent an oesophagectomy (36) had between 0 - 28.67% weight loss with the median being 7.21%. 6 patients had their operations abandoned. Post-operative complications, inclusive of Grade II and above, occurred in 16.8% of cases. Majority of complications occurred in those undergoing an oesophagectomy (64%), however complications did not correlate with percentage weight loss. The most common complication was grade IIIb (Grade I: 8, Grade II: 1, Grade IIIa: 1, Grade IIIb: 14, Grade IVa: 2, Grade V: 2). Conclusions Significant post-operative weight loss is common after oesophagectomy or gastrectomy surgery. Postoperative weight loss did not correlate with complications. Furthermore, there did not appear to be a correlation with weight loss and type of procedure. Nutritional status plays an important prognostic role in patients undergoing oesophagectomy or gastrectomy. Optimising nutrition perioperatively and post operatively is important to enhance post-operative recovery and reduce post operative risk. Reviewing a larger cohort of patients would improve the robustness of this study.

Features of food preferences of schoolchildren when choosing alternative diet for prevention of alimentary-dependent diseases

The features of food preferences of schoolchildren and the role of alternative nutrition in the prevention of alimentary-dependent diseases have been revealed. Food preferences have been determined: for breakfast, lunch, afternoon tea and dinner. Children with allergies, diseases of the gastrointestinal tract and other nutritional diseases had the opportunity to choose an alternative diet, fully balanced on the days of the week, in accordance with sanitary standards and the requirements of the Russian Federal Service for Surveillance on Consumer Rights Protection and Human Welfare. Meeting the needs of schoolchildren for nutrients and energy during the day provides for the presence of a basic diet at school (alternative food, in case of intolerance or allergy to certain foods), a regulated range of buffets in an educational organization (additional meals) and meals at home (dinner). Correctly compiled diet during the day contributes to the prevention of alimentary-dependent diseases. The necessity of organizing alternative nutrition at school to ensure the provision of children with intolerance to certain food products by means of an equivalent substitution for products permitted by a pediatrician and a nutritionist in the diet of children with alimentary diseases, including allergies, celiac disease, etc.

The effect of CDED diet on the development of remission in a patient with persistent Crohn’s disease activity – a case report and workplace experience

The CDED diet (Crohn‘s disease exclusion diet) is the first elimination diet that induces and maintains remission in adult patients with mild to moderate Crohn‘s disease. It is based on mandatory, recommended and prohibited foods. In our article we present our workplace experience, that is still limited, as well as the case report of a patient with a long history of Crohn‘s disease in ileocecal localization on immunosuppressive therapy with azathioprine. He has benefited significantly from the CDED diet, his abdominal symptomatology and laboratory parameters have improved. There has also been a significant improvement in the quality of his life. Key words: CDED – Crohn’s disease – diet – alternative nutrition – relapse of the disease

Dysphagia Phenotypes in Spinal Muscular Atrophy: The Past, Present, and Promise for the Future

Purpose The aim of this study was to provide clinicians with an overview of literature relating to dysphagia in spinal muscular atrophy (SMA) to guide assessment and treatment. Method In this clinical focus article, we review literature published in Scopus and PubMed between 1990 and 2020 pertaining to dysphagia in SMA across the life span. Original research articles that were published in English were included. Searches were conducted within four themes of inquiry: (a) etiology and phenotypes, (b) respiratory systemic deficits and management, (c) characteristics of natural history dysphagia and its treatment, and (d) dysphagia outcomes with disease-modifying therapies. Articles for the first two themes were selected by content experts who identified the most salient articles that would provide clinicians foundational background knowledge about SMA. Articles for the third theme were identified using search terms, including spinal muscular atrophy, swallow, dysphagia, bulbar, nutrition, g-tube, alternative nutrition, jaw, mouth, palate, OR mandible . Search terms for the fourth theme included spinal muscular atrophy AND nusinersen OR AVXS-101/onasemnogene abeparvovec-xioi . Review of Pertinent Literature Twenty-nine articles were identified. Findings across identified articles support the fact that patients with SMA who do not receive disease-modifying therapy exhibit clinically significant deficits in oropharyngeal swallow function. Few investigations provided systematic information regarding the underlying physiological deficits responsible for this loss in function, the timing of the degradation, or how disease-modifying therapies change these outcomes. Conclusion Future research outlining the physiological and functional oropharyngeal swallowing deficits among patients with SMA who receive disease-modifying therapy is critical in developing standards of dysphagia care to guide clinicians.

Virtual nutrition consultation: what can we learn from the COVID-19 pandemic?

Objective: To investigate the extent, quality and challenges of dietetic counselling during the pandemic. Design: A cross-sectional online thirty-six-item Google Survey. The survey queried demographics and information on usage and perceived telemedicine quality. Setting: The survey was distributed to Israeli Dietetic Association (ATID) mailing list between 31 March and 5 May 2020. Participants: Clinical dietitians, members of ATID, who consented to participated in the survey. Results: Three hundred dietitians (12 % of ATID members; 95 % women; mean age 4·41 (sd 10·2) years) replied to the survey. Most dietitians reported a significant ∼30 % decrease in work hours due to the pandemic. The most prevalent form of alternative nutrition counselling (ANC) was over the phone (72 %); 53·5 % used online platforms. Nearly 45 % had no former ANC experience. Both ANC formats were reported inferior to face-to-face nutritional consultation (consultation quality median scores 8 and 7, on a 1–10 scale, for online and phone, respectively). ANC difficulties on either phone or online platforms were technical (56 and 47 %, respectively), lack of anthropometric measurements (28 and 25 %, respectively) and interpersonal communication (19 and 14·6 %, respectively). Older age and former phone counselling experience were associated with higher quality scores, respectively (OR = 1·046, 95 % CI 1·01, 1·08, P = 0·005), (95 % CI 1·38, 4·52, P = 0·02). Those who continued to work full time had five-time greater odds for a higher quality score using online platforms (OR = 5·33, 95 % CI 1·091, 14·89, P = 0·001). Conclusions: Our findings suggest telemedicine holds considerable promise for dietary consultation; however, additional tools and training are needed to optimise remote ANC, especially in light of potential crisis-induced lockdown.

In vivo and in silico studies on the mechanisms of egg white peptides in the relieving of acute colitis symptoms

Active peptides, as an alternative nutrition supplement, have been confirmed beneficial efficacy against acute colitis. Herein, egg white peptides (EWPs) were used as a nutrition supplement to relieve dextran sulfate...

Economic evaluation of interventions to address undernutrition: a systematic review

Strategies to address undernutrition in low- and middle-income countries (LMICs) include various interventions implemented through different sectors of the economy. Our aim is to provide an overview of published economic evaluations of such interventions and to compare and contrast evaluations of interventions in different areas. We reviewed economic evaluations of nutrition interventions in LMICs published since 2015 and/or included in the Tufts Global registry or Disease Control Priorities 3rd edition. We categorized the studies by intervention type (preventive; therapeutic; fortification; delivery platforms), nutritional deficiency addressed and characteristics of the economic evaluation (e.g. type of model, costs and outcomes included). Of the 62 economic evaluations identified, 56 (90%) were cost-effectiveness analyses. Twenty-two (36%) evaluations investigated fortification and 23 (37%) preventive interventions. Forty-three percentage of the evaluations of preventive interventions did not include a model, whereas most of fortification strategies used the same reference model. We identified different trends in cost categories and inclusion of health and non-health outcomes across evaluations in the four different topic areas. To illustrate the implications of such trends for decision-making, we compared a set of studies evaluating alternative strategies to combat zinc deficiency. We showed that the use of ‘off-the-shelf’ models and tools can potentially conceal what outcomes and costs and value judgements are used. Comparing interventions across different areas is fundamental to assist decision-makers in developing their nutrition strategy. Systematic differences in the economic evaluations of interventions delivered within and outside the health sector can undermine the ability to prioritize alternative nutrition strategies.

The Evaluation of Childhood Foods and Infant Formula Exposure to Furan, Chloropropanols and Acrylamide Contamination by Food Processing

This review attempted to evaluate the exposure of thermal processing contaminants such as furan, chloropropanols and acrylamide from infant formulas. Furan, chloropropanols and acrylamide exist at varying levels in several types of foods that are consumed in daily diet including infant formulas. The consumption of these foods leads to the exposure to the thermal processing contaminants. In this sense, it is apparent that humans face hidden danger through dietary exposure throughout their lives. Infants are considered as the age group that expose to the highest levels of these substances as a result of the fact that they have low body weight and consume infant formulas in their diets as alternative nutrition. The review emphasizes that the infant formulas are not innocent, on the contrary, they can be considered as safety critical for infants considering that infant formulas include furan, chloropropanols and acrylamide. Therefore, this review suggests that in this sense all shareholders’ (university, non-governmental organizations, public and private sector) acting in concert with each other is crucially important for the health of individuals and overall society.