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[Nutritional rehabilitation and evaluation of the nutritional state. Validity of anthropometric measures for following, in hospitalized patients, the course of nutritional status and of body compartments during nutritional recovery].

A population suffering from a serious form of malnutrition was examined. The effectiveness of nutritional rehabilitation is demonstrated by the statistically significant changes observed in clinical and laboratory indicators. Several anthropometric measurements related to nutritional status are also compared with total body potassium (TBK) in patients with a positive nitrogen balance during the process of nutritional rehabilitation. It is concluded that weight (W), arm circumference (AC), middle arm muscle circumference (MAMC) and skinfold thickness (ST) measures are useful, and sufficiently accurate and precise to follow the evolution of nutritional status and body compartments.

Adult

[Biological hepatic abnormalities, cholestatic jaundice and hospital artificial nutrition. A comparative study in adults with cyclic total parenteral nutrition and enteral nutrition].

Two hundred and fourteen hospitalized nonsurgical, nonacutely stressed adult patients, who were receiving, either prolonged (greater than 21 days) cyclic total parenteral nutrition (n = 106) or enteral nutrition (n = 108), including lipids, for gastrointestinal disorders, and who were free of prenutrition liver function test abnormalities were prospectively investigated for hepatic dysfunction: 41 p. 100 and 17 p. 100 of parenteral and enteral nutrition patients, respectively, developed abnormalities of liver function tests after 25 +/- 5 and 21 +/- 4 days (p less than 0.01). This prevalence was unrelated to catheter sepsis, blood transfusion, caloric load, site of digestive disease or initial nutritional status, and decreased by 50 and 40 p. 100 before the end of total parenteral nutrition and enteral nutrition respectively. In the parenteral nutrition group, separate infusion of lipids, as compared with mixed infusion, was associated with a lower rate of hepatic dysfunction (29 vs 54 p. 100; p less than 0.02). Nine (8.5 p. 100) parenteral nutrition but no enteral nutrition patients developed severe cholestatic jaundice, 47 +/- 39 days after the onset of liver function test abnormalities; no identifiable cause excepting parenteral nutrition per se was found in 3 patients with diffuse obstructive small intestinal disease; jaundice led to death from noncirrhotic hepatic failure in the 2 patients who remained totally parenteral nutrition-dependent.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult

Priorities for nutrition content within a medical school curriculum: a national consensus of medical educators. American Society for Clinical Nutrition Committee on Medical/Dental School and Residency Nutrition Education.

Two studies, one using a questionnaire completed by 40 medical school curriculum administrators and 178 nutrition educators, the other using a workshop for 100 medical-nutrition educators, were conducted in 1988 by the American Society for Clinical Nutrition. The goal of these investigations was to formulate recommendations for the number of hours that should be devoted to teaching nutrition in a medical school and to obtain a consensus on the relative importance of specific nutrition topics to be included in the medical curriculum. The results indicate close agreement between curriculum administrators and nutrition educators on the time that should be devoted to nutrition coursework and the relative importance of nutrition topic areas. The value of these findings is that specific nutrition topic areas that deserve relatively high (and low) priorities in the curriculum have now been identified. This is particularly valuable information for medical educators in institutions that have few curriculum hours available for teaching nutrition.

Attitude of Health Personnel

Nutrition education for medical students: evaluation of the relative contribution of freshman courses in biochemistry and nutrition to performance on a standardized examination in nutrition.

An examination previously developed and used for assessment of nutrition knowledge of medical students in the Southeastern Regional Medical-Nutrition Education Network was used to compare the effectiveness of a basic medical biochemistry course and a 58-hour required nutrition course. The examination was administered to a cohort of freshman students upon entry to medical school, after biochemistry, and then after nutrition. Two other student groups took the examination at the end of the sophomore and senior years, respectively. In the freshman cohort, mean nutrition knowledge scores increased slightly after biochemistry, (52% to 56%), which contained 37 nutrition-related lectures. The mean score of the cohort was 75% after the nutrition course. The sophomores scored 75% and the seniors 73%. These findings suggest 1) basic science courses such as biochemistry cannot be relied upon to add significantly to nutrition knowledge, and 2) a required freshman course can be an effective way to introduce basic and clinical nutrition with good retention of knowledge in subsequent years.

Biochemistry

Effectiveness of central parenteral nutrition versus peripheral parenteral nutrition plus enteral nutrition in reversing protein-energy malnutrition in children with advanced neuroblastoma and Wilms' tumor: a prospective randomized study.

The effectiveness of central parenteral nutrition (CPN) versus peripheral parenteral nutrition (PPN) plus enteral nutrition in reversing protein-energy malnutrition was evaluated in 19 children (nine CPN, 10 PPN) with advanced neuroblastoma or Wilms' tumor. Weekly dietary, anthropometric, and biochemical measurements were compared for 15 patients (eight CPN, seven PPN) who completed more than 25 days of nutrition support. The groups had similar mean energy and protein intakes (CPN: 95 +/- 5% of healthy children, 2.5 +/- 0.3 g/kg; PPN: 102 +/- 5% of healthy children, 2.9 +/- 0.3 g/kg). Increases in weight (p less than 0.001), subscapular skinfold thickness (p less than 0.001), albumin (p less than 0.05), and transferrin (p less than 0.05) for the first 28 days were significant and did not differ between groups. Fever, sepsis, elevated SGOT, and severe anemia occurred with both CPN and PPN. PPN resulted in subcutaneous infiltrations and more psychological trauma. PPN with enteral nutrition seems most appropriate for short term intravenous nutrition support or as a temporary substitute for CPN; CPN is preferred for long-term support.

Body Weight

Improvement of nutritional measures during preoperative parenteral nutrition in patients selected by the prognostic nutritional index: a randomized controlled trial.

Patients undergoing major gastrointestinal surgery who had a prognostic nutritional index (PNI) score of greater than 30% were randomized to receive a preoperative course of 10 days of intravenous nutrition or to undergo surgery at the next convenient operation list. Two groups of 17 patients were well matched for age, sex, and nutritional status. Although they underwent diverse operations, the extent of these was similar: 12 +/- 3 days of parenteral nutrition resulted in weight gain, 3.2 +/- 2.3 kg p less than 0.01; increased triceps skinfold, 0.6 +/- 1.2 mm p less than 0.05; improved immunological state, p less than 0.02; and improved PNI, 5.5 +/- 10.1% p less than 0.05. The changes in serum albumin and transferrin were not significant. There were only three major complications with one death in the treatment group but this was not significantly different from the control group which had six major complications and three deaths. This study suggests that patients with demonstrable nutritional depletion who require major gastrointestinal surgery will benefit from a preoperative course of parenteral nutrition, but to conclusively prove this a large and probably multicentre study will be required.

Aged

Liver function tests abnormalities in patients with inflammatory bowel disease receiving artificial nutrition: a prospective randomized study of total enteral nutrition vs total parenteral nutrition.

Liver and biliary abnormalities are well-known complications of inflammatory bowel disease (IBD). It has been suggested that using total parenteral nutrition (TPN) may further impair liver function in these patients; this seems not to be so with total enteral nutrition (TEN). However, prospective trials comparing the incidence of liver function test (LFT) abnormalities with either TPN or TEN have not been carried out. Twenty-nine IBD inpatients with normal LFT, randomized to receive either TEN with a polymeric diet or isocaloric, isonitrogenous "all-in-one" TPN because of protein-energy malnutrition and/or severe disease, were included in the study. Sixteen patients (five with ulcerative colitis and 11 with Crohn's disease) received TEN, and 13 patients (eight ulcerative colitis and five Crohn's disease) were on TPN. All patients were on systemic steroids, and nine of them were on oral metronidazole. Both groups were homogeneous regarding age, sex, diagnosis, disease activity, nutritional status, daily nutrient supply, and days on artificial nutrition. Serum albumin levels significantly increased with TEN (32 +/- 1 to 38.2 +/- 1.6 g/liter, p less than 0.01), but not with TPN (32.1 +/- 2.2 to 33.9 +/- 1.4 g/liter, NS). Clinical improvement occurred in both groups of patients as shown by the change in the disease activity indexes. In all cases, measurements of serum alkaline phosphatase, serum bilirubin, aspartate aminotransferase, alanine aminotransferase, and gamma-glutamyltransferase were performed weekly. There were no significant differences in the initial LFT between both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Anthropometry

Nutrition and aging: nutritional status of "apparently healthy" elderly (Dutch nutrition surveillance system).

In a nationwide survey the nutritional status was assessed of 539 apparently healthy, independently living elderly aged 65-79 years. Anthropometric data showed no energy deficits. The prevalence of anemia was 4 and 1% among men and women, respectively. Many elderly showed a low level of 25-hydroxyvitamin D in plasma (less than 31 nmol/L: men 35%; women 43%), indicating a marginal status. Although the prevalence of low blood levels of folate, pyridoxal-5'-phosphate, and total carotenoids was higher among the elderly than among younger adults, clear (clinical) signs of nutritional deficiencies were not observed. Prevalence of obesity (13%), hypercholesterolemia (38%), and hypertension (63%) was found to be high, the percentages being higher for women than for men. Several indicators of the nutritional status appeared to differ among age groups. It is concluded that few differences can be considered as being due to physiological aging, which finding should be reflected in reference values for elderly people.

Age Factors

[Nutritional assessment of patients with esophageal cancer. "Nutritional Assessment Index (NAI)" to estimate nutritional conditions in pre-and postoperative period].

We studied on 66 patients with esophageal cancer with preoperative enteral hyperalimentation by elemental diet, comparing with 64 patients without it, and the following results were obtained; Items such as TP, Alb, etc. in surviving patients, as well as those who died within 3 months, were worse immediately before operation than those at the time of admission when neither TPN nor ED was yet in use. In 35 of 66 patients, there were significant differences between the patients with or without postoperative complications, and who were died after surgery, in arm circumference (AC), triceps skinfold (TSF), arm muscle circumference (AMC), albumin (Alb), prealbumin (PA), retinol-binding protein (RBP) and PPD skin test. From the studies of about 60 items with the computer, the index as follow were obtained. Nutritional Assessment Index (NAI) = 2.64 AC + 0.6 PA + 3.76 RBP + 0.017 PPD - 53.8 Nutritional status of the patients was divided retrospectively broadly to three groups, good (NAI greater than or equal to 60), intermediate (60 greater than NAI greater than or equal to 40), and poor (40 greater than NAI) in preoperative period. The incidence of postoperative complications and mortality rates were reflected significantly in NAI. NAI would be useful to know prospectively the probability of all kinds of postoperative complications as well as estimating the nutritional assessment.

Esophageal Neoplasms

Nutritional status of the elderly. IV. Nutritional knowledge, food preferences and life styles connected with the nutritional process.

On 106 women and 101 men aged 65 and over, elderly pensioners of the city of Perugia (Italy), a survey was carried out to identify their nutritional knowledge, their food preferences and some life styles connected with the nutritional process. The group of elderly people demonstrates a low level of nutritional knowledge. Meat, pasta and soup are the most suitable foods, with no great difference between males and females. Vegetables, fruit, milk and cheese are indicated as important only by low percentages of both sexes, fish, eggs, offal and rice are practically ignored. From the analysis of the sequency with which the various foods are indicated, it appears that a greater importance is attributed to pasta and soup. A higher percentage of women think that meat is a more suitable food for elderly people, and in respect to the men, they have a greater preference for this food. The harmfulness of foods is concentrated in the fatty foods by both sexes, but in particular by the women. Foods which are given up with the greatest sacrifice are mainly cakes, meat and pasta. Women and men show similar percentages of energy expenditure both in time and in frequency in relation to sleep and sedentary activities. For the activities that require a greater energy expenditure, the values are relatively low. This group of elderly people is well integrated into family life. They usually eat their meals with their families. There are frequent occasions when they are at home alone for periods of time that vary from two to four hours of more a day. The percentage of people living alone is small.

Aged

[Problems in child nutrition. 1. Nutrition in children with low-birth weight. Nutrition of normal neonates and infants].

The author recommends to change the system of enteral nutrition of low-birth-weight infants. These infants should be fed according to recent findings as follows: 1. by their mother's partly fortified milk, 2. by fully fortified human milk of another woman, 3. by adapted milk suitable for the given age group. The author recommends to adhere to the valid system of infant nutrition. In bottle-fed infants with a allergological case-history or severe atopic eczema it is possible to use hypoallergic milk.

Breast Feeding

[Nutritional condition, food consumption and nutritional intake in students in Saudi Arabia. II. Food consumption and nutritional intake].

In field surveys in 13 schools in different regions of Saudi-Arabia, energy expenditure, food consumption, and nutrient intake were studied. Cereal products, especially bread, have the greatest significance in nutrition. Many students do not eat other foodstuffs regularly. A certain dependency of food consumption from the region was found in regard to the schools. The frequency of foodstuffs was generally low, but lowest in remote villages. In some age groups, the sufficient energy intake leaves much to be desired, 70 % do not reach recommended dietary allowances of animal protein and 100 % in fat. Intake of carbohydrates was too high, while intake of linoleic acid, minerals and vitamins is too low of nearly all test persons. To secure regularly a sufficient intake of essential nutrients, a school lunch program for the Saudi-Arabian boys is to be recommended.

Adolescent

Establishing the need for nutrition education: II. Elementary teachers' nutrition knowledge, attitudes, and practices.

Nutrition knowledge, attitudes, and practices and nutrition education practices of elementary teachers were assessed to provide data for planning a Kansas Nutrition Education and Training Program. Teachers from a random sample of elementary schools throughout the state were surveyed. The nutrition knowledge test scores of the teachers statewide or among the districts and schools did not differ significantly. Teachers who had completed one or more college or continuing education nutrition courses or who were teaching nutrition currently had higher scores on nutrition knowledge, attitudes, and practices and on nutrition education practices than did teachers who had no nutrition training or were not teaching the subject. In general, nutrition knowledge scores correlated positively with scores on nutrition-related attitudes and practices and on nutrition education practices. Kansas elementary teachers tended to have favorable attitudes toward nutrition. Almost all of the teachers indicated that nutrition should be taught in all elementary grades; however, few teachers taught nutrition concepts. Nutrition was integrated in science, health, and social studies more often than in other subjects. Teachers rarely or never used school food service personnel as resource people in the classroom or used the school cafeteria as a laboratory for instruction. However, in those schools with on-premise food production facilities, teachers tended to work with the school food service personnel and use the cafeteria as a laboratory for instruction more frequently than did teachers in schools with only satellite service centers. Attending nutrition workshops during the school year and having access to more nutrition education materials were listed by teachers as the preferred ways to receive additional nutrition training.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult