ObjectiveTo explore the relationship of the level of inflammation and nutritional status with the occurrence and prognosis of refractory diabetic foot.MethodsA total of 70 patients with refractory diabetic foot between August 2015 and August 2017 were randomly selected as the observation group. Another 70 patients with diabetes mellitus (without foot ulcer) who visited the hospital in the same period were set as the control group. The observation group was subgrouped into the non-amputation group and the amputation group according to the follow-up endpoint events, and into the grade Ⅲ, Ⅳ, and Ⅴ groups according to Wagner classification method. The blood levels of inflammatory markers and nutritional markers between groups were compared.ResultsIn the observation group, vascular cell adhesion molecule-1 (VCAM-1), fibroblast growth factor 2 (FGF2), fibrinogen (FIB), tumor necrosis factor-α (TNF-α), interleukin (IL)-6, IL-18, lipoprotein phospholipase A2 (LP-PLA2), C-reactive protein (CRP) levels were significantly higher than those in the control group, and albumin (ALB), prealbumin (PA), and transferrin (TRF) levels were significantly lower than those in the control group, with statistically significant differences (P<0.01). The blood levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, and CRP in the amputation group were significantly higher than those in the non-amputation group, and the levels of TRF, ALB, and PA were significantly lower than those in the non-amputation group (P<0.01). There were statistically significant differences in the levels of FGF2, FIB, IL-6, IL-18, LP-PLA2, CRP, TRF, ALB, and PA in patients with diabetic foot with different Wagner grades (P<0.05). The result of multiple logistic regression analysis showed that IL-6 [odds ratio (OR)=1.487, 95% confidence interval (CI) (1.023, 2.120), P<0.001], IL-18 [OR=1.274, 95%CI (1.052, 1.665), P<0.001], LP-PLA2 [OR=1.478, 95%CI (1.126, 1.789), P<0.001], and CRP [OR=2.085, 95%CI (1.574, 2.782), P<0.001] were independent risk factors for the occurrence of refractory diabetic foot, and TRF [OR=0.645, 95%CI (0.002, 0.898), P<0.001], ALB [OR=0.838, 95%CI (0.429, 0.923), P<0.001], and PA [OR=0.478, 95%CI (0.201, 0.984), P<0.001] were independent protective factors for the occurrence of refractory diabetic foot.ConclusionIn the clinical treatment of diabetic foot, we should pay attention to the monitoring of the level of inflammatory factors and nutritional status, and it is necessary to timely carry out anti-inflammatory treatment and appropriate nutritional support treatment.
This study was disigned to determine the effect of nutritional status on the energy metabolism of liver. Rat liver of four nutritional groups (Group Ⅰ： fasting; Group Ⅱ: surgar feeding diet; Group Ⅲ: normal feeding diet; Group Ⅳ: group Ⅰ and group Ⅱ accepted patenteral nutrition) were removed for study. The adenosine triphosphate (ATP) level, total addenosine nucleotides (TAN) level, and adenylaty energy charge (EC) of liver decreased in group Ⅰ and group Ⅱ in contrasted with group Ⅲ (Plt;0.001), result of group Ⅳ was similar to that of group Ⅲ when the liver specimens were collected. The rusults indicate that a short period of starvation and low sugar intake will result in the malnutrition of liver and derangement of hapatic energy metabolism and material metabolism. But this status can be corrected by a short perios of parenteral nutrition.
ObjectiveTo explore the diagnostic efficacy of Geriatric Nutritional Risk Index (GNRI) in malnutrition of elderly patients with chronic obstructive pulmonary disease (COPD) in outpatient department. MethodsOne hundred and five elderly outpatients with COPD were enrolled in the study, and their nutritional screening was carried out. The clinical and laboratory parameters of patients in the normal nutrition group (high GNRI group) and malnutrition group (low GNRI group) were compared, and the correlation analysis was conducted. The diagnostic efficacy of GNRI was evaluated based on the malnutrition universal screening tool (MUST). ResultsThe prevalence of malnutrition was high in COPD elderly outpatients. The prevalence of malnutrition in group D was 61.8%. There were significant differences between the two groups in body mass index, serum albumin, FEV1 percentage in the predicted value, 6-minute walk distance, and the number of acute exacerbations in the past year. GNRI was significantly related to the above parameters. The sensitivity, specificity and accuracy of GNRI were 81.8%, 83.6% and 82.9%, using MUST as the standard. ConclusionGNRI can be used for nutritional screening of COPD patients in elderly outpatients, which is simple, convenient and relatively accurate, and can be popularized in other medical institutions.
Chronic kidney disease (CKD) has become an important public health problem that seriously affects the physical and mental health of Chinese people. Nutritional therapy has become one of the important treatments for CKD. Domestic and international guidelines for CKD clinical nutrition therapy have been introduced, and the intake of various nutrients in CKD patients, especially protein intake, has been guided. In recent years, with the continuous development of nutrition assessment and treatment, the content of the guidelines has gradually improved, but some views are still controversial. This article explains the relevant guidelines for the treatment of CKD at home and abroad to provide reference for the clinical nutritional treatment of CKD patients.
ObjectiveTo evaluate nutritional risk of patients with esophagus cancer before operation using nutritional risk screening 2002 (NRS2002), and explore the relationship between nutritional risk score and postoperative results. MethodsWe prospectively evaluated the nutritional risk of 225 patients with esophagus carcinoma patients who were admitted in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine between March 2012 and March 2013 using NRS2002, in accordance with disease severity score, nutritional status score and age score(age≥70 years old score was 1 point, < 70 years old for 0 point). There were 136 males and 89 females with age of 64.0±8.2 years (ranged from 41 to 85 years). Postoperative results include postoperative complications, mortality, and length of hospital stay. ResultsThe number of patients with preoperative score≥3 points was 75 (33.3%), < 3 points was 150 (66.7%). The incidence rate of postoperative complications was 26.7% in the patients with NRS2002 score≥3 points, and was 12.0% in those with NRS2002 score < 3 points(P < 0.05). And the total hospital stay time was longer in the patients with NRS2002 score≥3 points than that with NRS2002 score < 3 points(29.80±7.94 d vs. 15.30±2.05 d, P < 0.05). Logistic regression analysis showed that the preoperative NRS2002, the underlying diseases, and surgical method were risk factors for postoperative complications. ConclusionsPreoperative NRS2002 score≥3 points can predict more postoperative complications and longer hospital stay time in patients with esophagus carcinoma. It indicates that scientific nutrition support is necessary for esophagus carcinoma patients with NRS2002 score≥3 points. NRS2002 can be used as a predictive index of nutritional risk after operation of esophagus carcinoma.
In the context of accelerated rehabilitation, nutritional support for patients with orthopedic cervical spondylosis is an important condition for lessening postoperative stress response, reducing postoperative complications, shortening patient’s length of hospital stay, lowering medical expenses, and promoting early recovery of patients. Based on this, West China Hospital of Sichuan University explored and established the West China Hospital program for nutritional management in cervical spondylosis from the aspects of team building, nutritional assessment and monitoring, and nutritional intervention.
Objective To assess the effect and safety of clinical nutritional supplementation with different patterns for treating systematic inflammatory response syndrome (SIRS). Methods Randomized controlled trials (RCTs) were identified from MEDLINE (1996 to Nov. 2004), EMBASE (1984 to Nov. 2002), Cochrane Controlled Trials Register (Issue 4, 2004), Chinese Cochrane Centre Database (Issue 4, 2004), CBMdisc (1978 to Nov. 2004). We handsearched related published and unpublished data and their references. All RCTs of nutritional interventions for SIRS were included. Data were extracted and evaluated by two reviewers independently with designed extraction form. RevMan 4.2.7 software was used for data analysis. Results Six RCTs involving 353 patients were included. All the results of meta-analysis were listed as the following: ① Mortality: compared with routine nutrition, one study showed that glutamine had a statistical difference with RR 0.67 and 95%CI 0.31 to 1.32. Compared with no treatment, one study showed selenium had a statistical difference with RR 1.19, 95%CI 0.59 to 2.41. ② Compared with routine nutrition, one study showed that glutamine had a statistical difference on reducing the ratio of nasocomial infection of SIRS with RR 0.5, 95%CI 0.27 to 0.91, but had no statistical difference on reducing the ratio of multiple organ dysfunction syndrome with RR 1.53, 95%CI 0.64 to 3.66. ③ Improvement of the critical condition of SIRS: compared with routine nutrition, one study showed that glutamine had a statistical differences with WMD 4.0, 95%CI 2.36 to 5.64; compared with high calorie intake, two studies showed low calorie intake had a statistical difference with WMD 4.9, 95%CI 1.76 to 8.04. ④ Reduction of the complication of hyperglycemia and hypertriglyceridemia: compared with high calorie intake, one study showed low calorie intake had statistical difference with WMD －0.70, 95%CI －1.20 to －0.20 and WMD －1.80, 95% CI －2.42 to －1.16 respectively and all P≤0.01. ⑤ Increasing of the plasma IgG concentration: compared with routine nutrition, two studies showed that glutamine had a statistical difference with WMD 4.20, 95% CI 2.23 to 6.16. ⑥ Increasing of the nitrogen balance, intestinal permeability, the level of plasma concentration of anlbumin, prealbumin and TRF: compared with control interventions, glutamine, low calorie intake, selenium supplementation and fructose-glucose-xylitol mixture showed no statistical difference. Conclusions Glutamine, low calorie intake, selenium supplementation, FGX mixture may decrease the complication of infection or metabolism and be better than the controlled interventions; but there is no benefit on reducing the rate of death result from SIRS compared with controlled interventions. The evidence of most RCTs with poor quality is too weak to draw a conclusion. More high quality trials are required.
Objective To compare the clinical effects of early enteral and parenteral nutrition, and to study their effects on cytokine release, cellular immune function and protein metabolism in early postoperative patients with gastrointestinal cancer. Methods Thirty-six patients with gastrointestinal cancer were randomly divided into early postoperative enteral nutrition (EN) group (19 cases) and parenteral nutrition (PN) group (17 cases), and they were supported with EN or PN during postoperative period of 1-7 days, respectively. The levels of serum tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and interleukin-10 (IL-10) were measured by ELISA. The total lymphocyte count (TLC) and subgroups of lymphocyte (CD3, CD4, CD8, CD4/CD8 and NK cell) were determined with flow cytometer. The urea and creatinine of the 24 h excretory urine were examined at four different phases: preoperative (pre), 1st d, 3rd d and 5th d after operation (pod). The clinical recovery indicators and the complication incidence were also observed. Results All the patients followed the project of nutritional support and relevant examinations, and there was no severe complication and no patient died during the research. The IL-1β, IL-6 and IL-10, the 24 h urea and creatinine increased, while the serum TNF-α and TLC (except 3, 5 pod of EN group) decreased. There was no marked change of the proportion of lymphocyte subgroups after operation and there was no significant difference of the changes of IL-1β, IL-10 and TNF-α between the two groups as well. The levels of IL-6 (3, 5 pod), the 24 h urea (3, 5 pod) and creatinine (3, 5 pod) were significantly lower in EN group than those in PN group （P＜0.05）, whereas TLC (3, 5 pod) were significantly higher than that in EN group （P＜0.05）. In addition, the postoperative infection incidence （10.5% vs 35.3%）, fever duaration, rehabilitation time and medical cost were significantly lower in EN group than those in PN group （P＜0.05）.Conclusion The early postoperative EN has an advantage over PN in the patients with gastrointestinal cancer, which could decrease the release of cytokine and suppress protein metabolism resulting from operational stress, and could reduce the incidence of postoperative infection and inflammatory reaction time. They could also improve the cellular immune function and decrease the rebilitation duration and medical cost.
ObjectiveTo explore the role of nutritional support in adjuvant therapy for respiratory failure. MethodsWe took 72 patients with respiratory failure who were treated in our hospital from August 2011 to January 2013 as the research objects. They were divided into two groups:control group and trial group, with 36 patients in each group. The division of the groups was in accordance with the state food and drug administration clinical trial institution ethics committee standard operating procedures. In the control group, 36 patients were provided with regular treatments according to their condition, like maintaining the respiratory tract unobstructed, oxygen therapy, mechanical ventilation and anti-infection. In the trial group, we offered nutritional support in addition to the normal treatment. Consecutive 20 days was a course of treatment. After four courses, we inspected and put down two groups' respective clinical features, and made a contrast of their treatment conditions. We analyzed the treatments through observational indexes including assessment of eutrophication, treatment efficiency, pulmonary function and arterial blood gases. ResultsBoth groups had obvious therapeutic effects. The observational indexes in the trial group were better than those in the control group. The total effective rate was 91.7% in the trail group after treatment, significantly higher than that in the control group (66.7%) (χ2=8.692, P=0.003); the lung capacity, the ventilation flow ratio and arterial blood gas analysis values in the trial group was better than those in the control group. ConclusionThe effect of the nutritional support for the respiratory failure treatment is much better than the regular treatment. The total effective rate is improved while the death rate is lower than before and the patients recover quickly.
In response to the specific requirements of nutrition research, Schwingshackl’s research group developed the NutriGrade grading system, which independently assessed the quality of evidence in randomized controlled trials and cohort studies in nutrition, aiming to summarize the associations or effects between different nutritional factors and outcomes and meet the specific needs of evidence users. It has the advantages of novel classification, quantifiability, independence and pertinence, and it has better consistency, fairness, reliability and feasibility. Well-designed prospective cohort studies are more feasible in the field of nutrition than randomized controlled trials. The grading of the evidence quality for cohort studies included the following eight items: a) risk of bias, study quality, and study limitations; b) precision; c) heterogeneity; d) directness; e) publication bias; f) funding bias; g) effect size; and h) dose-response. Based on the evaluation results of the above items, the evidence quality could be divided into four grades: high (8-10), moderate (<8), low (<6), and very low (<4). The purpose of this paper was to introduce the basic principles, specific contents, and application methods of the NutriGrade grading system for cohort studies and cite examples to provide references for relevant researchers.