Nutritional Approach to Cancer Cachexia: A Proposal for Dietitians

Cachexia is one of the most common, related factors of malnutrition in cancer patients. Cancer cachexia is a multifactorial syndrome characterized by persistent loss of skeletal muscle mass and fat mass, resulting in irreversible and progressive functional impairment. The skeletal muscle loss cannot be reversed by conventional nutritional support, and a combination of anti-inflammatory agents and other nutrients is recommended. In this review, we reviewed the effects of nutrients that are expected to combat muscle loss caused by cancer cachexia (eicosapentaenoic acid, β-hydroxy-β-methylbutyrate, creatine, and carnitine) to propose nutritional approaches that can be taken at present. Current evidence is based on the intake of nutrients as supplements; however, the long-term and continuous intake of nutrients as food has the potential to be useful for the body. Therefore, in addition to conventional nutritional support, we believe that it is important for the dietitian to work with the clinical team to first fully assess the patient’s condition and then to safely incorporate nutrients that are expected to have specific functions for cancer cachexia from foods and supplements.

Effect of Early Nutritional Assessment and Nutritional Support on Immune Function and Clinical Prognosis of Critically Ill Children

The aim of this study was to study the effect of early nutritional assessment and nutritional support on immune function and clinical prognosis of critically ill children. 90 critically ill children at the same level of severity admitted to the pediatric intensive care unit (PICU) of our hospital (June 2019–June 2020) were chosen as the research objects and were equally separated into the experimental group and the control group by the random number table method. The children in the control group were admitted to the PICU according to the routine process, and the nutritional support was provided to the malnourished ones. After admission to the PICU, the children in the experimental group were given nutritional assessment, nutritional risk screening, and nutritional support according to the screening results. The PICU stay time and total hospitalization time of the experimental group were obviously shorter than those of the control group ( P < 0.05 ), the hospitalization expenses of the experimental group were obviously lower than those of the control group ( P < 0.05 ), the clinical outcomes and immune function of the experimental group were obviously better than those of the control group ( P < 0.05 ), and the nutrition indicators of the experimental group were obviously higher than those of the control group ( P < 0.05 ). Early nutritional assessment and nutritional support can effectively improve the immune function and reduce the incidence of adverse clinical outcomes of critically ill children, which are worthy of clinical application and promotion.

Multifactorial Mechanism of Sarcopenia and Sarcopenic Obesity. Role of Physical Exercise, Microbiota and Myokines

Obesity and ageing place a tremendous strain on the global healthcare system. Age-related sarcopenia is characterized by decreased muscular strength, decreased muscle quantity, quality, and decreased functional performance. Sarcopenic obesity (SO) is a condition that combines sarcopenia and obesity and has a substantial influence on the older adults’ health. Because of the complicated pathophysiology, there are disagreements and challenges in identifying and diagnosing SO. Recently, it has become clear that dysbiosis may play a role in the onset and progression of sarcopenia and SO. Skeletal muscle secretes myokines during contraction, which play an important role in controlling muscle growth, function, and metabolic balance. Myokine dysfunction can cause and aggravate obesity, sarcopenia, and SO. The only ways to prevent and slow the progression of sarcopenia, particularly sarcopenic obesity, are physical activity and correct nutritional support. While exercise cannot completely prevent sarcopenia and age-related loss in muscular function, it can certainly delay development and slow down the rate of sarcopenia. The purpose of this review was to discuss potential pathways to muscle deterioration in obese individuals. We also want to present the current understanding of the role of various factors, including microbiota and myokines, in the process of sarcopenia and SO.

A Study of Early Parenteral Nutritional Support and Factors Associated with Clinical Outcomes in Major Pediatric Burn Patients

Objectives: Adequate nutritional support is one of the challenging treatments of major pediatric burns. Parenteral nutrition (PN) is one of the options to achieve daily caloric goal. Latest nutritional guidelines recommend late PN initiation due to unclear benefit over risk based on the limited data. Our study provides the data of parenteral nutrition within 7 days post admission (early PN) and factors affecting clinical outcomes in major pediatric burn patients. Methods: A retrospective study was conducted regarding pediatric burn patients who had over 15% of their total body surface area (TBSA) with second- or third-degree burns. All the patients were classified as requiring early PN support or non-early PN support. Results: 124 major pediatric burns were reviewed. Eighty-six patients (65.2%) were male, and the median age was three years (0.3-15 years). Early PN showed no association with length of hospital stay (LOS) (p=0.480) or a 30-day mortality (p=0.529). The children’s age, wound infections, and abdominal distension were the independent associated factors of LOS (p=0.025, 0.001, and 0.003 respectively). Pneumonia and urinary tract infection were independent factors associated with 30-day mortality (p=0.025). Conclusions: Early PN in acute pediatric burns was not associated with LOS or 30-day mortality. It can be considered as options of nutritional support in acute, major pediatric burns. Effective management of wound infections and abdominal distension may reduce LOS.

Sarcopenia and nutritional support for elderly and senile patients

Демографическое старение населения приводит к значительному увеличению доли лиц пожилого и старческого возраста как на амбулаторном, так и стационарном этапах лечения. За последнее десятилетие средний возраст основного контингента больных в отделениях реанимации и интенсивной терапии составляет более 65 лет, с тенденцией к увеличению, что предопределяет стратегию более тщательной оценки подходов к проведению лечебных мероприятий с учетом полиморбидности и функциональных возможностей пациентов старших возрастных групп как в период пребывания в стационаре, так и на дальнейших этапах восстановления и реабилитации. Известно, что в целом длительность пребывания в отделениях интенсивной терапии пожилых пациентов значительно выше, а результаты лечения и реабилитации достоверно ниже, чем у более молодых. Это связано с сочетанием целого ряда факторов: коморбидности/полиморбидности пациентов пожилого и старческого возраста, снижения функциональных резервов организма, синдрома старческой астении, главными составляющими которого являются саркопения, недостаточность питания. Связь старческой астении с увеличением длительности госпитализации, снижением физической активности, развитием функциональных дефицитов, увеличением риска падений, переломов и смертности достаточно хорошо изучена, однако в рутинной клинической практике оценке нутритивного статуса, диагностике недостаточности питания и решению проблемы недостаточности питания пациентов с синдромом старческой астении и саркопении уделяется недостаточное внимание, несмотря на известные факты о взаимосвязи недостаточности питания, снижения массы скелетных мышц, в том числе их силы или функции с неблагоприятным исходами заболевания. В амбулаторном этапе, кроме малоподвижного образа жизни, развитию и прогрессированию саркопении часто способствуют наличие тяжелого заболевания, сопровождающегося системным воспалением, метаболическая резистентность, нутритивная недостаточность и депрессия, характерные для данной категории больных. Современные подходы к лечению пациента пожилого и старческого возраста подразумевают проведение регулярной оценки нутритивного статуса и консультирование по вопросам рационального питания с внедрением методов нутритивной поддержки в комплексную программу ведения пожилого пациента наряду с основными лечебными и реабилитационными мероприятиями с целью замедления прогрессирования синдрома астении и саркопении. Demographic aging of the population leads to a significant increase in the proportion of elderly and senile people, both at the outpatient and inpatient stages of treatment. Over the past decade, the average age of the main contingent of patients in intensive care and intensive care units is more than 65 years, with a tendency to increase, which predetermines the strategy for a more thorough assessment of approaches to treatment measures, taking into account polymorbidity and functional capabilities of patients of older age groups, as the period of stay in hospital, and at further stages of recovery and rehabilitation. It is known that, in general, the duration of stay in intensive care units for elderly patients is much longer, and the results of treatment and rehabilitation are significantly lower than that of younger patients. This is due to a combination of a number of factors: comorbidity/polymorbidity of elderly and senile patients, decreased functional reserves of the body, senile asthenia syndrome, the main components of which are sarcopenia, and malnutrition. The relationship of senile asthenia with an increase in the duration of hospitalization, a decrease in physical activity, the development of functional deficits, an increase in the risk of falls, fractures and mortality is well understood, however, in routine clinical practice, assessing nutritional status, diagnosing malnutrition and solving the problem of malnutrition in patients with senile asthenia syndrome and Insufficient attention is paid to sarcopenia, despite the known facts about the relationship of malnutrition, a decrease in skeletal muscle mass, including their strength or function, with unfavorable outcomes of the disease. In the outpatient phase, in addition to a sedentary lifestyle, the development and progression of sarcopenia is often facilitated by the presence of a severe illness accompanied by systemic inflammation, metabolic resistance, nutritional deficiency and depression characteristic of this category of patients. Modern approaches to the treatment of an elderly and senile patient imply a regular assessment of the nutritional status and counseling on rational nutrition with the introduction of nutritional support methods into a comprehensive management program for an elderly patient, along with basic treatment and rehabilitation measures in order to slow the progression of asthenia and sarcopenia syndrome.

Nutritional Risk Screening (NRS 2002) as a tool to predict clinical outcomes in hospitalized patients: a literature review

The presence of malnutrition in hospitalized patients is prevalent and studies show its association with a higher incidence of complications, mortality, length of stay, costs, and increased frequency of hospital readmission. Routine use of simple tracking procedures is recommended. Nutritional screening detects individuals who are malnourished or at risk of developing malnutrition, and who can receive specific nutritional support. Nutritional Risk Screening (NRS 2002) is a nutritional screening method recommended by the European Society for Clinical and Metabolism (ESPEN) and identifies the risk of developing malnutrition in hospitalized patients. The aim of this paper is to review the literature on the NRS screening method (2002) and its relationship with clinical outcomes in hospitalized patients.

The effect of early oral feeding after subtotal esophagectomy with immediate esophageal reconstruction on the patients’ nutritional status: randomized single-center study.

Background: The efficiency of early oral feeding (EOF) in the postoperative period is well known. Though in the esophagus surgery doctors still prefer another types of nutritional support after esophagectomy (EE) with immediate gastric tube reconstruction. Aims: to improve the results of patients treatment after EE with gastric tube reconstruction by choosing the method of nutritional support and to evaluate nutritional status of the patients with EOF. Materials and methods: weve conducted prospective single-center randomized study. Subtotal esophagectomy with immediate gastric tube reconstruction was performed to 60 patients. In the postoperative period we evaluated the results of treatment, the frequency and severity of complications, as well as anthropometric and laboratory indicators of the nutritional status before the operation, on 1, 3 and 6 postoperative day (POD). Results: Patients without high risk of malnutrition were randomly divided in 2 groups: main group (n=30) starting EOF on the 1 POD and control group (n=30) that remained nil by mouth and got parenteral feeding within 4 POD. The patients of EOF group had statistically significant earlier gas discharge (2[2;3] POD vs 4[3;6] POD, р = 0,000042) and stool appearance (3[2;4] POD vs 5[4;7] POD, р = 0,000004). There is a tendency of reduction of the duration of postoperative hospitalization in EOF group (8[7;9] POD vs 9[8;9] POD, р=0,13). EOF does not affect on frequency (46,6% vs 53,3%, р=0,66) and character of postoperative complications. After evaluation of the parameters of nutritional status we found statistically significant decrease of prealbumin level on 3 POD in EOF group (0,17 [0,13;0,21] vs 0,2 [0,16;0,34], р=0,03) of due to inability to compensate daily calorie needs in the first days after the operation. At 6 POD prealbumin became the same in both groups. There were no other significant differences between the groups. Conclusions: EOF after EE with immediate gastric tube reconstruction is safe and effective. EOF doesnt increase the frequency of anastomotic insufficiency and other complications.

Nutritional Support With Oral Polymeric Formulation Enriched With Transforming Growth Factor beta 2 (TGF-β2) in Allogenic Hematopoietic Stem Cells Transplantation (Allo-hsct): A Prospective Interventional Study

PurposeIn the allogeneic transplant setting (allo-HSCT), the prevalence of malnutrition at admission is usually low, but at discharge, may be 60% or more and it may affect the transplant outcome.The aim of this study was to reduce the incidence of severe malnutrition (PG-SGA C) at day + 28 days from allo-HSCT in patients supported with an oral polymeric formulation enriched with Transforming Growth Factor beta 2 (TGF-β2).MethodsFifty-one patients were consecutively enrolled between March 2020 and June 2021 in this prospective interventional study. As a group of control, we have retrospectively analyzed an observational cohort composed by thirty patients submitted to allo-HSCT from august 2017 and august 2018 in our institution.ResultsThe incidence of severe malnourished patients (PG-SGA C) at + 28 days was significantly lower in the group with an oral nutritional support (ONS) treatment ratio (TR) major than 50% (TR>50%) in comparison to the ones with less than 50% ONS assumption (TR<50%) (13% vs 88.9% P=0.000). Interestingly, cumulative incidence of gastrointestinal (GI) aGVHD was significantly lower in patients assuming 50% or more of the prescribed ONS dose in comparison to those who assumed less than 50% of ONS (0%, vs 29.6%; p=0.005). Pneumonia was more frequent in patients with TR < 50% compared to patients with TR > 50% (48.1 % and 12.5 % respectively)(p=0.006).ConclusionMODULEN-IBD® seems to be a promising ONS to reduce malnutrition in allogeneic stem cell transplantation and should be tested in a randomized controlled prospective trial. MODULEN-IBD® may also have some positive immunological effects on gastrointestinal GVHD and infections that should be explored in larger studies.