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Y N Berner

Publications and source records attributed to Y N Berner.

18 recordsLinked to original sources
PubMed2006

ESPEN Guidelines on Enteral Nutrition: Geriatrics.

Nutritional intake is often compromised in elderly, multimorbid patients. Enteral nutrition (EN) by means of oral nutritional supplements (ONS) and tube feeding (TF) offers the possibility to increase or to insure nutrient intake in case of insufficient oral food intake. The present guideline is intended to give evidence-based recommendations for the use of ONS and TF in geriatric patients. It was developed by an interdisciplinary expert group in accordance with officially accepted standards and is based on all relevant publications since 1985. The guideline was discussed and accepted in a consensus conference. EN by means of ONS is recommended for geriatric patients at nutritional risk, in case of multimorbidity and frailty, and following orthopaedic-surgical procedures. In elderly people at risk of undernutrition ONS improve nutritional status and reduce mortality. After orthopaedic-surgery ONS reduce unfavourable outcome. TF is clearly indicated in patients with neurologic dysphagia. In contrast, TF is not indicated in final disease states, including final dementia, and in order to facilitate patient care. Altogether, it is strongly recommended not to wait until severe undernutrition has developed, but to start EN therapy early, as soon as a nutritional risk becomes apparent.

Aged↗
PubMed2002

Recommended micronutrient supplementation for institutionalized elderly.

A committee nominated by the Israel Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily micronutrient supplementation for institutionalized elderly living in institutions supervised by the Ministry of Health. The micronutrient preparatory, tailored for this population, is designed to contain about half the RDA for most of the vitamins and some microelements. Biotin and vitamins C, D and B12 as well as zinc, copper, chromium and molybdenum are suggested at a level higher than half the RDA, whereas fluorine, at a lower level. Major elements (calcium, magnesium and phosphorus) are excluded and should be supplied separately. Vitamin K and iron are also excluded. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation for institutionalized elderly is part of the Ministry of Health s balanced nutrition policy. The committee s recommendations are also applicable to the free-living elderly population.

Journal Article↗
PubMed2002

Dietary intake analysis in institutionalized elderly: a focus on nutrient density.

BACKGROUND: Inadequate food intake in old age can lead to marginal or suboptimal nutrient intakes causing the deterioration of physiological and health states. OBJECTIVE: To describe, by intake assessment, nutritional status of institutionalized elderly and to compare the data to other studies findings. DESIGN: Dietary intake was assessed in 50 (18 males, 32 females, average age 84 6 years) institutionalized elderly according to data collected by using structured food frequency questionnaires based on the institutional kitchen recipes, weekly menu and portion size. RESULTS: Daily energy intake was 1.91 0.48 Mcal and energy density was 4.97 kcal/g dry matter. Energy derived from protein and fat was 15.1% and 35.4%, respectively. Dietary fiber consumption was very low, 3.92 g/Mcal. Calcium intake of all of the subjects, and magnesium, zinc and copper intakes of most of them, were low. Iron intake of almost all of the subjects was sufficient or above RDA. Intake of vitamins D, E, B6, thiamin (vitamin B1) and folic acid in all or most of the subjects was low. In almost all of the 39 studies and reviews, including ours, densities of at least two nutrients did not meet the calculated RDA density. Particularly low were the nutrient densities of vitamins C and E, thiamin, vitamin B6, folic acid and vitamin D, as well as of calcium, magnesium, zinc and copper. CONCLUSION: Supplementation with half the RDA of micronutrients (except for vitamin A and iron) may result in micronutrient intakes that are higher than two-thirds of the RDA.

Aged↗
PubMed2001

[Micronutrient (vitamins and minerals) supplementation for the elderly, suggested by a special committee nominated by Ministry of Health].

The elderly tend to be at a higher risk for nutritional deficiencies and in particular for micronutrient deficiencies. A committee nominated by Ministry of Health examined the relevant literature and the local recommendations as well as the recommendations from other countries and suggested a daily special micronutrient supplementation for institutionalized elderly. The preparatory will contain about half the RDA for most of the micronutrients, except for fluorine that is recommended at a lower level and biotin, vitamins D, C, B12 as well as zinc, copper and molybdenum at a level higher than half the RDA. Major elements such as calcium, are not included in the preparatory and would be supplied separately when needed. Vitamin K and iron are excluded as well. The suggested preparatory composition, mg: vitamin A, 0.450; vitamin D, 0.015; vitamin E, 10; thiamin, 0.6 Pound riboflavin, 0.7; biotin, 0.030; pantothenic acid, 3; niacin, 8; vitamin C, 60; vitamin B6, 0.8; folic acid, 0.120; vitamin B12, 0.0024; choline up to 275; zinc, 8; copper, 0.9; fluorine, 0.5; manganese, 1.2; chromium 0.020; molybdenum, 0.045; selenium, 0.030; and iodine, 0.075. Fat-soluble vitamins should be microencapsulated. Micronutrient supplementation is part of Ministry of Health balanced nutrition policy. The committees recommendations are also applicable for the free-living elderly.

Aged↗
PubMed2000

[Nutritional status and vitamin B6 supplementation in the institutionalized elderly].

Nutritional status and vitamin B6 status were assessed in 18 men and 32 women, average age 84, living in a home for the aged. Average proportion of energy derived from protein was higher than the recommended; fiber intake was very low. Also low were intakes of calcium, magnesium, zinc, copper, vitamins D and E, thiamin, folic acid and vitamin B6. Supplementation with vitamin B6 (10 mg/d) for 28 days in those with the lowest B6 status assessed by B6 intake, activation coefficient of aspartate transaminase and plasma pyridoxamine concentrations led to improved B6 status (marked decrease in activation coefficient) and increased synthesis and decreased degradation of many short-lived neutrophil proteins. Though our elderly enjoy a variety of foods, some have marginal deficiencies that can be improved. Therefore, in the institutionalized elderly, micronutrient supplementation should be administered at a level low enough to be safe (below recommended upper level of intake) but high enough to be effective.

Aged↗
PubMed1999

Effect of vitamin B6 supplementation on degradation rates of short-lived proteins in human neutrophils.

Metabolic pathways are controlled primarily by protein degradation rates. Degradation rates, in turn, are controlled by changes in physiologic condition or nutrient supply. Vitamin B(6) is associated with a greater variety of reactions than most other vitamins. Moreover, the vitamin B(6) needs of the elderly tend to be higher than those of young adults. Neutrophils seem to be appropriate cells for assessing protein turnover as affected by macronutrients and micronutrients. Thus, we assumed that vitamin B(6) supplementation, particularly in an elderly population, would change the turnover rates of the neutrophil proteins. Protein synthesis was measured after 30 minutes of (35)S-Met incorporation followed by a 30-minute washout incubation; degradation was measured after an additional 5-hour incubation. Following protein separation, radioactive images of short-lived proteins were electronically separated into bands. Vitamin B(6) supplementation significantly increased the synthesis of most neutrophil protein bands. There was a significant decrease of 25 to 66% in the degradation rates of 235 protein bands. We even detected by statistical evaluation a 20% decrease in the degradation rates of distinct protein bands. Activation coefficients of erythrocyte aspartate aminotransferase (AC-AST) decreased markedly. There was a significant positive correlation between the decrease in AC-AST and protein degradation. The N-end rule proposes that pyridoxal 5'-phosphate decreases degradation rates of short-lived proteins by binding to lysyl residues. A biochemical model of the mechanism of cellular protein turnover, as affected by nutritional intervention, in human neutrophils is demonstrated.

Journal Article↗
PubMed1989

Selected ultratrace elements in total parenteral nutrition solutions.

Ultratrace elements are potentially essential (eg. boron, molybdenum, nickel, and vanadium) or toxic (eg, aluminum and cadmium) in humans. Long-term total parenteral nutrition (TPN) patients can inadvertently receive significant amounts of ultratrace elements present as contaminants in TPN solutions. We determined the intake of selected ultratrace elements from a standard TPN solution and compared it with the amount reported to be absorbed from food in normal subjects. Contamination of TPN solutions with ultratrace elements was widespread and variable. The daily intakes of Mo, Ni, V. and Cd from this contamination were comparable to the amounts reported to be absorbed through the gastrointestinal tract in normal subjects. Al intake was high; B intake was low, approximately 10% of the amount absorbed by normal subjects. Thus, TPN solutions are contaminated with significant amounts of ultratrace elements. The biological significance of the intravenous infusion of these ultratrace elements is unclear and requires further investigation, particularly in home TPN patients.

Aluminum↗
PubMed1989

TPN-induced catch-up of growth in a 22-y-old male with radiation enteritis.

Nutritional rehabilitation of malnourished children with growth arrest is generally associated with a catch-up of growth but the occurrence of this compensatory phenomenon in adulthood is not well recognized. We investigated a case of maturation and growth acceleration secondary to nutritional intervention in a 22-y-old patient. After treatment for a rhabdomyosarcoma of the bladder at age 7 y, the patient developed severe malabsorption secondary to radiation enteritis and short bowel syndrome. As a result of profound malnutrition, growth and maturation were severely impaired. Initiation of home total parenteral nutrition at age 22 y led to an increase in height, substantial weight gain, advancement of bone age, and sexual maturation evidenced by appearance of secondary sex characteristics and normalization of hormone concentrations. The development of signs of puberty and a growth spurt appearing at this late age clearly show the potential for maturation and growth once malnutrition is corrected.

Adult↗
PubMed1989

Percutaneous endoscopic gastrostomy and jejunostomy for long-term feeding in patients with cancer of the head and neck.

Enteral feeding is often required in patients with cancer of the head and neck. Percutaneous endoscopic gastrostomies (PEGs) and jejunostomies (PEJs) can facilitate enteral feeding in patients who require this treatment. The endoscopic technique allows for the placement of feeding gastrostomies and jejunostomies without a surgical procedure and eliminates the need for nasal tubes for long-term enteral feeding. Forty-two patients with head and neck tumors were referred for placement of PEGs because of severe dysphagia induced by tumors, surgery, radiation, or chemotherapy. The procedure was performed in the gastroenterology suite. Patients were sedated with intravenous meperidine and diazepam, and local anesthetic with lidocaine was applied to the area of incision. Average procedure time was approximately 20 minutes. The procedure was successful in 39 patients in whom tubes were placed ranging in diameter from 15F to 22F. PEGs were placed in 36 patients with intact stomachs and PEJs in three patients with previous gastrectomies. The remaining three procedures were unsuccessful because of technical reasons. There were three localized skin infections, and all responded to antibiotic therapy. Neither peritonitis nor any other immediate complication occurred. In 16 nonhospitalized patients, the procedure was performed on an outpatient basis. After a mean followup of 4.5 +/- 6 months of enteral feeding in the home, there was only one case of aspiration and subsequent pneumonia, and this case responded to antibiotics. No other long-term complications were noted. Thus feeding gastrostomies and jejunostomies can be placed safely and easily in patients with cancers of the head and neck by endoscopic methods without abdominal surgery. These tubes can be used for enteral feeding and eliminate the need for nasogastric tubes. They are better tolerated, are of a wider diameter, and have a reduced risk for migration, clogging, and aspiration-related complications.

Combined Modality Therapy↗
PubMed1988

Consequences of phosphate imbalance.

Phosphorus is the sixth most abundant element in the body after oxygen, hydrogen, carbon, nitrogen, and calcium. It comprises about 1% of the total body weight of humans. Eighty-five percent of it is stored in the bone in the form of hydroxyapatite crystal; 14% is in the soft tissues in the form of energy-storing bonds with nucleotides (ATP, GTP), nucleic acids in chromosomes and ribosomes, 2,3-DPG in the red blood cells, and phospholipids in the cells' membranes. Less than 1% is in the extracellular fluids. Phosphate balance is maintained by multiple systems. The gut is responsible for the absorption of two thirds of the 4-30 mg/kg/day of phosphate intake. Absorption sites are all along the gut; in humans the most active site is the jejunum. The kidney filters 90% of the plasma phosphate and reabsorbs it in the tubuli. In states of hypophosphatemia the kidney can reabsorb the filtered phosphates very efficiently, reducing the amount excreted in the urine virtually to zero. The healthy kidney can excrete high loads of phosphate and rid the body of phosphate overload. Through the vitamin D-PTH axis the endocrine system regulates the phosphate balance by influencing the kidney, gut, and bone. Other hormones, including thyroid, insulin, glucagon, glucocorticosteroid, and thyrocalcitonin, play a lesser role in regulation of phosphate metabolism. Because of the complex control of phosphate homeostasis, various clinical conditions may lead to hypophosphatemia. These include nutritional repletion, gastrointestinal malabsorption, use of phosphate binders, starvation, diabetes mellitus, and increased urinary losses due to tubular dysfunction. The clinical picture of phosphate depletion is manifested in different organs and is due mainly to the fall in intracellular levels of ATP and decreased availability of oxygen to the tissues, secondary to 2,3-DPG depletion. The various manifestations of phosphate depletion are listed in Table 2. The treatment of hypophosphatemia consists of administering enteral or parenteral phosphate salts. An important aspect of dealing with the potentially serious effects of phosphate depletion is to prevent the depletion from happening in the first place. Hyperphosphatemia can occur in renal failure, hemolysis, tumor lysis syndrome, and rhabdomyolysis. The treatment of hyperphosphatemia usually consists of fluid administration (in the absence of kidney failure). In chronic hyperphosphatemia, phosphate binders such as aluminum and magnesium salts can reduce the phosphate load. The use of these phosphate binders is limited by their potential side effects.

Female↗
PubMedDate not supplied

Low plasma carnitine in patients on prolonged total parenteral nutrition: association with low plasma lysine.

Plasma carnitine levels were determined in 17 patients maintained on long-term total parenteral nutrition (TPN) for a mean (+/- SEM) period of 69 +/- 11 months (range 12-196). All had severe malabsorption and were dependent on intravenous feeding. Plasma carnitine was determined by a modified Cederblad enzymatic method. Mean plasma carnitine was significantly below the mean normal for females (p less than 0.02) and borderline low for males (p = 0.07). In six patients the levels were below the low normal range, and in five others they were at the lowest levels of normal. Of the six patients with normal levels, three had elevated serum creatinine, indicating renal dysfunction which may by itself elevate plasma carnitine. In 10 patients the plasma levels of lysine (a carnitine precursor) were determined and found to be lower than normal (p less than 0.05). Plasma carnitine levels correlated positively with serum albumin (r = 0.62, p less than 0.05), and negatively with serum alkaline phosphatase (r = -0.64, p less than 0.05). Thus, patients maintained on long-term TPN may have low plasma carnitine, which could represent carnitine deficiency. The low plasma carnitine may be related to a deficiency of the carnitine precursor lysine. Further studies are required to determine the significance of the low plasma carnitine and whether carnitine supplementation should be required in long-term TPN.

Adult↗