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The Journal of International Medical... Jan 2024Enteral immunonutrition is a nutritional intervention that has been studied in postoperative patients with gastric cancer, but its effectiveness is controversial. This... (Meta-Analysis)
Meta-Analysis
Comparison of enteral immunonutrition and enteral nutrition in patients undergoing gastric cancer surgery: a systematic review and meta-analysis of randomized, controlled trials.
OBJECTIVE
Enteral immunonutrition is a nutritional intervention that has been studied in postoperative patients with gastric cancer, but its effectiveness is controversial. This study aimed to investigate the effects of enteral immunonutrition and enteral nutrition on immune function in patients who undergo gastric cancer surgery.
METHODS
We performed a systematic review and meta-analysis. A comprehensive search was conducted in PubMed, Embase, Cochrane, Web of Knowledge, and ClinicalTrials.gov from the inception of the review until 10 March 2023. Twelve studies were included for qualitative and quantitative analyses.
RESULTS
We studied 1124 patients, including 565 patients in the enteral immunonutrition group and 559 in the enteral nutrition (controls) group. All included randomized, controlled trials were high quality. CD4+ levels, lymphocytes, transferrin concentrations, and systemic inflammatory response syndrome were not significantly different between the enteral immunonutrition and enteral nutrition groups. However, CD8+, immunoglobulins G and M, and proalbumin concentrations, CD4+/CD8+, and infectious complications were significantly higher in the enteral immunonutrition group than in the enteral nutrition group. A sensitivity analysis showed consistent results after excluding each study. Begg's test showed no publication bias.
CONCLUSIONS
Enteral immunonutrition is an effective nutritional intervention that improves immune function in patients who have undergone gastric cancer surgery.
Topics: Humans; Stomach Neoplasms; Enteral Nutrition; Immunonutrition Diet; Digestive System Surgical Procedures; Postoperative Complications; Randomized Controlled Trials as Topic
PubMed: 38179793
DOI: 10.1177/03000605231220870 -
Journal of Perinatology : Official... Jan 2023Intestinal failure in neonatal and pediatric populations can be debilitating for patients and difficult to manage for clinicians. Management strategies include referral... (Review)
Review
Intestinal failure in neonatal and pediatric populations can be debilitating for patients and difficult to manage for clinicians. Management strategies include referral to an intestinal rehabilitation center, small volume trophic feeds to stimulate the intestine with cautious advancement of enteral nutrition using a standardized and evidence-based feeding protocol, and supplemental parenteral nutrition to optimize an infant's growth and nutrition. In this review, we discuss the causes of intestinal failure, parenteral nutrition strategies, enteral feeding initiation and advancement protocols, as well as the challenges in feeding an infant with intestinal failure.
Topics: Infant, Newborn; Child; Infant; Humans; Infant, Premature; Intestinal Failure; Neonatologists; Parenteral Nutrition; Enteral Nutrition
PubMed: 36127395
DOI: 10.1038/s41372-022-01504-4 -
Sensors (Basel, Switzerland) Oct 2022Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of...
BACKGROUND
Enteral nutrition is often prescribed in acute stroke to meet energy and fluid needs in patients with dysphagia. Tubes clogging represent a common complication of enteral formula delivery, requiring substitution and influencing nutrition administration. Frequent water flushes are recommended as one of the most effective procedures to prevent tube occlusion, but it might be time demanding and not consistently performed by the healthcare staff. This study aimed to assess the efficacy of an automatic flush pump, compared to a manual flush system, to prevent tubes' occlusions in acute-stroke patients, as this might affect nutrition and hydration.
METHODS
Gastrointestinal symptoms, nutrition and hydration biomarkers were also monitored to determine the different devices' safety. Sixty-two patients were included in the study and allocated to the "manual" or "automatic" flushes device.
RESULTS
The mean duration of data collection was 7 ± 2 days. Tube occlusions occurred in 22.6% of the patients in the "manual" group, whereas only one tube clogging was reported in the "automatic" group ( = 0.023). No significant differences between groups were reported for constipation and diarrhea frequency nor nutrition and hydration status. When the nurses were asked to simulate manual flush administration at the same frequency of the automatic device, they were able to meet the recommendations only 10% of the time.
CONCLUSION
This preliminary study suggests the efficacy of automatic flush systems to prevent enteral tube clogging, without affecting health status compared to standard manual flush systems.
Topics: Humans; Enteral Nutrition; Pilot Projects; Stroke; Deglutition Disorders; Water
PubMed: 36298380
DOI: 10.3390/s22208029 -
La Pediatria Medica E Chirurgica :... Jun 2017The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the... (Review)
Review
The administration of the adequate amount of nutrients helps to improve a correct short-term linear growth and long-term neurocognitive development. To reduce the extra-uterine growth delay in very low birth weight infants (VLBW) the best strategy of nutrition (parenteral or enteral) should be established rapidly, since the first day of life. In preterm infants, nutrition can be administered parenterally and enterally. Prematurity is the most frequent indication for parenteral nutritional support due to intestinal functional immune deficiency, deficiency of digestive enzymatic systems and reduced nutritional reserve of these infants. In terms of enteral nutrition, breast milk is the first choice. In case of preterm and VLBW infants, fortifiers are used to overcome breast milk's protein and mineral deficiencies. When breast milk is not available, specific infant formula is the alternative.
Topics: Breast Feeding; Enteral Nutrition; Female; Food, Fortified; Humans; Infant Formula; Infant Nutritional Physiological Phenomena; Infant, Newborn; Infant, Premature; Infant, Very Low Birth Weight; Milk, Human
PubMed: 28673079
DOI: 10.4081/pmc.2017.158 -
Complementary Therapies in Medicine Mar 2022Adult critically ill patients are prone to complications when receiving enteral nutrition, including feeding intolerance. Although abdominal massage is an effective... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Adult critically ill patients are prone to complications when receiving enteral nutrition, including feeding intolerance. Although abdominal massage is an effective intervention, its effects on enteral nutrition complications in adult critically ill patients are controversial.
OBJECTIVE
To summarize and evaluate the effect of abdominal massage on enteral nutrition complications in adult critically ill patients.
METHODS
We searched databases (e.g., PubMed, the Cochrane Library, Embase, and Web of Science) from inception until November 2020 for relevant studies published in English. The methodological quality of selected studies was assessed with the Cochrane Risk of Bias 2.0 tool. And we used of PRISMA 2020 guidelines. The meta-analysis results were reported as mean difference (MD) and events, and the heterogeneity of the studies was evaluated using I.
RESULTS
Seven studies including 472 participants (aged≥18 years) met the inclusion criteria. The mean gastric residual volume (GRV) (MD=-42.41, 95% confidence interval [CI]: -71.43, -13.39; P = 0.004) and incidence of abdominal distension (odds ratio [OR]=0.08, 95%CI: 0.03, 0.19; P < 0.00001) were significantly lower in the massage therapy group compared with controls. The incidence of vomiting (OR=0.09, 95%CI: 0.01, 0.72; P = 0.02) and ventilator-associated pneumonia (VAP) (OR=0.20, 95%CI: 0.05, 0.77; P = 0.02) were statistically significantly lower in the abdominal massage group compared with controls.
CONCLUSION
Abdominal massage reduces GRV, vomiting, abdominal distension, and VAP in adult critically ill patients. Given the limited number of reviewed studies, small number of patients examined, and short intervention periods, further randomized controlled trials are needed that use accurate methodology, longer interventions, and larger sample sizes to confirm the effect of abdominal massage on feeding intolerance in adult critically ill patients.
Topics: Adult; Critical Illness; Enteral Nutrition; Humans; Massage; Stomach; Vomiting
PubMed: 34902566
DOI: 10.1016/j.ctim.2021.102796 -
Ethiopian Journal of Health Sciences Mar 2022In critically ill patients, enteral nutrition is recommended as a route for nutrient delivery. Nurses' knowledge and practice of enteral nutrition influence patients'...
BACKGROUND
In critically ill patients, enteral nutrition is recommended as a route for nutrient delivery. Nurses' knowledge and practice of enteral nutrition influence patients' clinical outcomes. Therefore, this study sought to assess nurses' knowledge, practice, and associated factors regarding enteral nutrition in adult intensive care unit patients in public hospitals in Addis Ababa, Ethiopia.
METHODS
A cross-sectional study design was used to collect data from 196 nurses working in public hospitals in Addis Ababa from April 11 to April 30, 2020. The data were entered into Epi Data version 3.1 and analyzed with SPSS version 21. The correlation between independent variables and dependent variables was estimated using bivariate and multivariate logistic regression at a 95% confidence level.
RESULTS
The level of inadequate knowledge and poor practice of nurses relating to enteral nutrition was 67.7% and 53.8%, respectively. Bachelor's degree holders were less likely to be knowledgeable (AOR= 0.24, 95% CI: (0.61, 0.93)). Nurses' practice about enteral nutrition was significantly associated with nurses' age (AOR = 0.023, 95 % CI: (0.001,0.52), nurses receiving training on enteral nutrition (AOR = 1.951, 95 % CI: (0.06, 0.60)), and nurses from ICUs having a guideline and protocol on enteral feeding practice (AOR = 3.401, 95 % CI: (1.186, 9.789).
CONCLUSIONS
In the study, it was revealed that a substantial proportion of nurses had inadequate knowledge of enteral nutrition and practiced poor enteral nutrition.
Topics: Adult; Clinical Competence; Cross-Sectional Studies; Enteral Nutrition; Ethiopia; Health Knowledge, Attitudes, Practice; Hospitals, Public; Humans; Intensive Care Units; Surveys and Questionnaires
PubMed: 35693571
DOI: 10.4314/ejhs.v32i2.23 -
Asia Pacific Journal of Clinical... Dec 2016This study's main aim was to observe the effects of a fibre-enriched nutrition solution on requisite feeding volume, which is directly proportional to energy intake in...
BACKGROUND AND OBJECTIVES
This study's main aim was to observe the effects of a fibre-enriched nutrition solution on requisite feeding volume, which is directly proportional to energy intake in mechanically ventilated patients with enteral nutrition.
METHODS AND STUDY DESIGN
Some 120 patients who required mechanical ventilation and enteral nutrition with a nasogastric tube were studied. Upon ICU admission, the patient's age, gender, weight, height, comorbidities, diagnosis and APACHE II score were recorded. We assigned two diets to the patients randomly. The control group received the fibre-free nutrition solution. The study group, received the fibreenriched nutrition solution. Prescribed feeding volume and administered feeding volume, gastric residual volume (GRV), volume ratio (VR), diarrhoea score and gastrointestinal complications (GIC) were recorded, along with daily biochemistry.
RESULTS
The two groups did not differ with respect to age, sex, weight, BMI, APACHE II score, target caloric intake or GRV (p>0.05). On days four and five, the study group had higher VR values (p<0.05). Seventy-one (59%) patients had at least one gastrointestinal complication; 44 (73%) of them were controls and 27 (45%) of them study patients. The most commonly observed GIC was diarrhoea. Thirty-eight patients had diarrhoea in control group, and twenty-two patients had diarrhoea in study group, and this difference was statistically significant (p<0.001). There were no significant differences between the groups about vomiting and regurgitation.
CONCLUSIONS
We suggest that ICU staff initiate enteral nutrition with fibre-enriched formulas rather than fibre-free formulas to avoid frequent feeding interruptions that cause protein energy malnutrition in ICU patients.
Topics: APACHE; Adult; Aged; Aged, 80 and over; Body Mass Index; Critical Care; Dietary Fiber; Energy Intake; Enteral Nutrition; Female; Gastrointestinal Diseases; Humans; Intensive Care Units; Intubation, Gastrointestinal; Male; Middle Aged; Respiration, Artificial
PubMed: 27702716
DOI: 10.6133/apjcn.122015.12 -
Nutrients Jan 2023The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and... (Review)
Review
The role of nutrition intervention in surgical settings is constantly developing and evolving. Immunonutrition represents a viable option to reduce perioperative and postoperative complications in surgical oncology. However, as far as we know, little research has been conducted in the orthopedic field. With this review, we aim to summarize the state of the art in the application of immune-enhanced compounds to surgical, orthopedic, and traumatic patients. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were adopted. A comprehensive search was carried out using the PubMed (MEDLINE), EMBASE, and Cochrane Library databases. All the studies dealing with immunonutrition fed to traumatic and orthopedic patients were pooled, the data were extracted, and the studies were discussed. A total of eight studies were included: six focused on trauma surgery and two on elective orthopedic surgery. The epidemiological characteristics of participants and the assessment of results were reported. Data were analyzed using R software (2020; R Core Team). Based on the current available literature, a positive impact of immunonutrition in orthopedic and trauma surgical settings was registered. All studies analyzed showed the favorable impact of the immunonutrition diet on clinical outcomes. The full effect of this type of nutrition and its different applications in the orthopedic and traumatic fields should be critically investigated through more extensive randomized controlled trials.
Topics: Humans; Immunonutrition Diet; Enteral Nutrition; Postoperative Complications
PubMed: 36771245
DOI: 10.3390/nu15030537 -
World Journal of Gastroenterology Nov 2014The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of... (Review)
Review
The use of enteral feeding as part of the management of acute pancreatitis dates back almost two decades. This review describes the indications for and limitations of enteral feeding for the treatment of acute pancreatitis using up-to-date evidence-based data. A systematic review was carried out to analyse current data on the use of enteral nutrition in the management of acute pancreatitis. Relevant literature was analysed from the viewpoints of enteral vs parenteral feeding, early vs delayed enteral nutrition, nasogastric vs nasojejunal feeding, and early oral diet and immunonutrition, particularly glutamine and probiotic supplementation. Finally, current applicable guidelines and the effects of these guidelines on clinical practice are discussed. The latest meta-analyses suggest that enteral nutrition significantly reduces the mortality rate of severe acute pancreatitis compared to parenteral feeding. To maintain gut barrier function and prevent early bacterial translocation, enteral feeding should be commenced within the first 24 h of hospital admission. Also, the safety of nasogastric feeding, which eases the administration of enteral nutrients in the clinical setting, is likely equal to nasojejunal feeding. Furthermore, an early low-fat oral diet is potentially beneficial in patients with mild pancreatitis. Despite the initial encouraging results, the current evidence does not support the use of immunoenhanced nutrients or probiotics in patients with acute pancreatitis.
Topics: Acute Disease; Enteral Nutrition; Humans; Immunologic Factors; Pancreatitis; Practice Guidelines as Topic; Probiotics; Risk Factors; Time Factors; Treatment Outcome
PubMed: 25473164
DOI: 10.3748/wjg.v20.i43.16123 -
Metabolomics : Official Journal of the... Nov 2022Exclusive enteral nutrition is recommended as a first-line treatment in active pediatric Crohn's Disease, but its mechanism of action is still not clear. We aimed to...
BACKGROUND AND AIMS
Exclusive enteral nutrition is recommended as a first-line treatment in active pediatric Crohn's Disease, but its mechanism of action is still not clear. We aimed to assess alterations in the metabolic profile of newly diagnosed pediatric Crohn's Disease patients before and during exclusive enteral nutrition therapy.
METHODS
Plasma samples from 14 pediatric Crohn's Disease patients before and after 3-4 weeks on exclusive enteral nutrition were analyzed using mass spectrometry. T-test, fold change and orthogonal partial least squares discriminant analysis were used for mining significant features. Correlation analysis was performed between the annotated features and the weighted pediatric Crohn's disease activity index using Pearson r distance.
RESULTS
Among the 13 compounds which decreased during exclusive enteral nutrition, most are related to diet, while one is a bacterial metabolite, Bacteriohopane-32,33,34,35-tetrol. The phosphatidic acid metabolite PA(15:1/18:0) was significantly reduced and correlated with the weighted pediatric Crohn's disease activity index. Lipids increased during exclusive enteral nutrition therapy included phosphatidylethanolamines; PE(24:1/24:1), PE(17:2/20:2) and one lactosylceramide; LacCer(d18:1/14:0).
CONCLUSION
Food additives and other phytochemicals were the major metabolites, which decreased following the exclusion of a regular diet during exclusive enteral nutrition. An alteration in bacterial biomarkers may reflect changes in intestinal microbiota composition and metabolism. Thus, metabolomics provides an opportunity to characterize the molecular mechanisms of dietary factors triggering Crohn's Disease activity, and the mechanisms of action of exclusive enteral nutrition, thereby providing the basis for the development and evaluation of improved intervention strategies for prevention and treatment.
Topics: Humans; Child; Enteral Nutrition; Crohn Disease; Remission Induction; Metabolomics
PubMed: 36434414
DOI: 10.1007/s11306-022-01953-0