Taiwan Society of Colon and Rectum Surgeons (TSCRS) Consensus for Anti-Inflammatory Nutritional Intervention in Colorectal Cancer

Malnutrition and systemic inflammatory response (SIR) frequently occur in patients with colorectal cancer (CRC) and are associated with poor prognosis. Anti-inflammatory nutritional intervention is not only a way to restore the malnourished status but also modulate SIR. Nine experts, including colorectal surgeons, physicians and dieticians from 5 hospitals geographically distributed in Taiwan, attended the consensus meeting in Taiwan Society of Colon and Rectum Surgeons for a 3-round discussion and achieved the consensus based on a systematic literature review of clinical studies and published guidelines. The consensus recommends that assessment of nutritional risk and SIR should be performed before and after CRC treatment and appropriate nutritional and/or anti-inflammatory intervention should be adapted and provided accordingly.

Objective Assessment of Superiority of Enteral Feeding by Traditional Home Kitchen-Based Feed V/S Commercial Formula Feed in Patients of Esophagogastric Corrosive Injury

Background: Corrosive ingestion can cause severe chemical injury to upper gastrointestinal tract which leads to dysphagia, malnutrition and weight loss. Early nutritional assessment and support through feeding jejunostomy is important and it should be nutritionally optimum and economically balanced. The aim is to compare cost and nutritional status after nutritional support with traditional home kitchen made and commercial formula feed through feeding jejunostomy.Methods:A prospective study included patients on enteral nutrition based on traditional home kitchen feed (cohort-1) and on commercial formula feed (cohort-2). Patient’s body weight, BMI, haemoglobin, serum albumin, nutritional risk index, controlling nutritional status score were checked at the admission, 3rd and 6th month follow up.Results: In cohort 1 mean albumin and haemoglobin raised by 33.13% & 14.60% at 3rd month and 47.23% & 22.3% at 6th month respectively; In cohort 2 it was 9.12% & 2.69% at 3rd month and 17.62% & 6.53% at 6th month respectively. At 6th month in cohort 1 and 2 mean weight gain was 7.56% & 4.0%; mean increase in NRI was 34.78% & 11.5% respectively. Mean CONUT score at six months was better improved in cohort 1 which is 6 to 1 as compared to cohort 2 which was 6 to 3. Mean monthly cost of home-based feeds was significantly lower as compared to commercial feeds (62.14 Rs v/s 682-2354 Rs/day).Conclusions:In corrosive GI tract injury patient enteral nutrition with traditional home kitchen-based feeds is safe, cost effective and associated with better improvement in nutritional status objective parameters.

Nutritional Risk Index Predicts Survival in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy

Nutritional risk index (NRI) is an index based on ideal body weight that aims to present body weight and serum albumin levels. It has been utilized to discriminate patients at risk of postoperative complications and predict the postoperative outcome of major surgeries. However, this index remains limited for breast cancer patients treated with neoadjuvant chemotherapy (NACT). The research explores the clinical and prognostic significance of NRI in breast cancer patients. This study included 785 breast cancer patients (477 cases received NACT and 308 cases did not) were enrolled in this retrospective study. The optimal NRI cutoff value was evaluated by receiver operating characteristic (ROC) curve, then reclassified as low NRI group (<112) and high NRI group (≥112). The results demonstrated that NRI independently predicted survival on disease-free survival (DFS) and overall survival (OS) by univariate and multivariate Cox regression survival analyses [P = 0.019, hazard ratio (HR): 1.521, 95% CI: 1.071–2.161 and P = 0.004, HR: 1.415, 95% CI: 1.119–1.789; and P = 0.026, HR:1.500, 95% CI: 1.051–2.143 and P < 0.001, HR: 1.547, 95% CI: 1.221–1.959]. According to the optimal cutoff value of NRI, the high NRI value patients had longer mean DFS and OS time in contrast to those with low NRI value patients (63.47 vs. 40.50 months; 71.50 vs. 56.39 months). Furthermore, the results demonstrated that the high NRI score patients had significantly longer mean DFS and OS time than those with low NRI score patients in early-stage breast cancer (χ2 = 9.0510, P = 0.0026 and χ2 = 9.2140, P = 0.0024) and advanced breast cancer (χ2 = 6.2500, P = 0.0124 and χ2 = 5.8880, P = 0.0152). The mean DFS and OS values in patients with high NRI scores were significantly longer in contrast to those with low NRI scores in different molecular subtypes. The common toxicities after NACT were hematologic and gastrointestinal reactions, and the NRI had no statistically significant effects on toxicities, except in nausea (χ2 = 9.2413, P = 0.0024), mouth ulcers (χ2 = 4.8133, P = 0.0282), anemia (χ2 = 8.5441, P = 0.0140), and leukopenia (χ2 = 11.0951, P = 0.0039). NRI serves as a minimally invasive, easily accessible and convenient prognostic tool for evaluating breast cancer prognoses and treatment efficacy, and may help doctors in terms of selecting measures of greater efficiency or appropriateness to better treat breast cancer.

A study of serum zinc levels in children admitted with pneumonia in a tertiary care hospital in India

Background: Worldwide, pneumonia is a leading cause of morbidity and mortality in children under 5 years of age; especially, in developing countries. Objectives: The objective of the study is to investigate whether zinc deficiency and other nutritional factors are related to pneumonia in children between 6 months and 5 years old. Methodology: In this casecontrol study, a valid written consent was obtained from mothers of enrolled children. The cases included 75 children fulfilling the World Health Organization criteria for pneumonia, between the age group of 6 months and 5 years. They were interrogated for potential nutritional risk factors as per a predesigned proforma followed by a measurement of serum zinc levels. In the control group, 75 children of the same age group who were siblings of admitted children were included along with other children of the same age group admitted for non-respiratory complaints. A detailed case history was obtained and physical examination was done according to a predesigned proforma to elicit various potential risk factors. A semi-auto analyzer was used to measure the serum zinc levels through colorimetric methods using 5-bromo-PAS. Results: Significant nutritional risk factors identified were low serum zinc level, malnutrition, and anemia. Conclusion: The present study has identified various nutritional risk factors for pneumonia which can be tackled through effective education of the community and appropriate initiatives.

The Role of Fructose as a Cardiovascular Risk Factor: An Update

There is increasing presence of fructose in food and drinks, and some evidence suggests that its higher consumption increases cardiovascular risk, although the mechanisms still remain not fully elucidated. Cardiovascular diseases (CVD) are still responsible for one-third of deaths worldwide, and therefore, their prevention should be assessed and managed comprehensively and not by the evaluation of individual risk factor components. Lifestyle risk factors for CVD include low degree of physical activity, high body mass index, alcohol consumption, smoking, and nutritional factors. Indeed, nutritional risk factors for CVD include unhealthy dietary behaviors, such as high intake of refined foods, unhealthy fats, added sugars, and sodium and a low intake of fruits, vegetables, whole grains, fiber, fish, and nuts. Even though there is no definitive association between CVD incidence and high consumption of total sugar, such as sucrose and fructose, there is, however, evidence that total sugars, added sugars, and fructose are harmfully associated with CVD mortality. Since high fructose intake is associated with elevated plasma triglyceride levels, as well as insulin resistance, diabetes hyperuricemia, and non-alcoholic fatty liver disease, further longitudinal studies should be conducted to fully elucidate the potential association between certain sugars and CVD.

Unplanned Hemodialysis Initiation and Low Geriatric Nutritional Risk Index Scores are Associated with End-Stage Renal Disease Outcomes

Background Patients with end-stage renal disease (ESRD) have low nutritional status, presenting a high mortality risk. The geriatric nutritional risk index (GNRI) is a predictive marker of malnutrition. However, it is unclear whether the association between unplanned hemodialysis (HD) and GNRI scores is related to mortality. Methods The 180 patients who underwent HD at our hospital were divided into two groups: unplanned initiation with a central venous catheter (CVC; n=73) or planned initiation with prepared vascular access (n=107). Results There were no significant differences in sex, age, malignant tumor, hypertension, and vascular disease, while there were significant differences in time from the first visit to HD initiation (0 vs. 7 times, p=0.012) and days between the first visit and HD (12 vs. 186 days, p<0.001). The CVC insertion group had significantly lower GNRI scores at initiation (85.5 vs. 98.8, p<0.001). The adjusted hazard ratios were 4.115 and 3.077 for the GNRI scores and frequency, respectively. Three-year survival was significantly lower in the CVC + low GNRI group (p<0.0001). GNRI after 1 month was significantly inferior in the CVC insertion group. Conclusions Inadequate general management due to late referral to the nephrology department is a risk factor for patients with ESRD.

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.

The Role of Geriatric Nutritional Risk Index in Predicting Postoperative Pulmonary Complications in Elderly Lung Cancer Patients Undergoing Surgical Resection

Background The relationship between immunonutritional status (eg. Prognostic nutritional index [PNI] and Controlling Nutritional Status [COUNT] score) and risk of postoperative pulmonary complications (PPCs) after surgical resection of lung cancer had reported before. However, another immunonutritional parameter- Geriatric Nutritional Risk Index (GNRI)-had never explored. Method To address this issue, in this study we retrospectively analyzed patients’ characteristics and PPCs in a cohort of lung cancer patients who were treated by surgical resection at our center. The clinical utility of patients’ characteristics for predicting PPCs was evaluated by receiver operating characteristic curve analysis and the Youden index. Univariate and multivariate analysis were applied to find the most important factors. Result A total of 128 patients met the inclusion criteria for this study. Significant differences in sex, GNRI, FEV1%, LY% were found between the PPC and non-PPC groups (all P<0.05). The difference in pathology between the 2 groups showed borderline statistical significance (P=0.052). We determined the best cutoff value of each parameter and calculated the corresponding sensitivity and specificity, and found that GNRI, FEV1% and LY% had similar diagnostic value. Multivariate analysis reveled GNRI, sex, LY% and FEV1% were filtered to be correlated to PPCs of elderly lung cancer patients received surgery therapy. Conclusion These results indicate that preoperative immunonutritional parameters of GNRI can be used to identify elderly lung cancer patients at risk of PPCs.