News Update on Clinical Nutrition : July -2020

Glutamine dipeptides in clinical nutrition

Glutamine is a conditional indispensable amino acid during stress. However, limited solubility and instability of glutamine prevent its addition to presently available nutritional preparations. To overcome these drawbacks, we propose the dipeptide concept by which stable and highly soluble synthetic glutamine containing dipeptides are used. The synthetic dipeptides fulfill all chemical/physical properties to be considered as parenteral substrates. [1]

Partially hydrolyzed guar gum: Clinical nutrition uses

Objective : This paper provides a review of research on partially hydrolyzed guar gum that is relevant to clinical nutrition practice.

Methods : All relevant papers published on partially hydrolyzed guar gum were reviewed and the results summarized.

Results : Partially hydrolyzed guar gum (PHGG) is a water-soluble dietary fiber with a wide range of uses in clinical nutrition. Its low viscosity allows its use in enteral products and beverages. PHGG can be added to enteral formulas and food products as a dietary fiber source. PHGG provides the benefits associated with dietary fiber ingestion. Addition of PHGG to the diet reduced laxative dependence in a nursing home population. PHGG also reduced the incidence of diarrhea in septic patients receiving total enteral nutrition and reduced symptoms of irritable bowel syndrome. PHGG also increased production of Bifidobacterium in the gut.

Conclusion : The ease of use of PHGG and its clinical effectiveness make it a good choice in clinical nutrition practice. [2]

Invited Review: Use of Indirect Calorimetry in Clinical Nutrition

The tremendous variability in resting energy expenditure makes efforts to predict caloric requirements difficult. Indirect calorimetry has provided a valuable tool in assessing energy expenditure, evaluating the way in which the body uses nutrient fuel, and designing nutritional regimens that best fit the clinical condition of the patient. The many indirect calorimetric instruments available vary in their application to clinical nutrition. The best metabolic studies are achieved by controlling the testing environment, accounting for the many clinical factors that may affect measurements, and eliminating potential sources for error. Although indirect calorimetry would seem to reduce the likelihood of complications from overfeeding, its greatest effect may be in cost savings by avoiding unnecessary nutritional support and in providing a means for clinical research. [3]

Therapeutic Nutrition Evaluation and Management of Acute and Severe Malnourished Children

Severe Acute Malnutrition (SAM) is a major health problem in children between the age groups of 1-5 years of age. According to National Family Health Survey-3, more than 132 million children below 5 are suffering from SAM in our India. The facilities available in hospitals and other health services are not appropriate to combat this major health issue.

The present study was aimed to assess the impact of hospital diet on health status of 253 selected SAM children who were admitted for their rehabilitation in the nutrition ward of a private hospital in Raipur city. All the children were examined thoroughly and necessary investigations including weight, height, BMI, hemoglobin, chest x-ray, etc. were taken to assess the nutritional status of children. The overall results after the treatment show an increase in health status. The result reveals that out of 253 SAM children (39.5%) children had gained weight>10 g/kg/day. It can be proved that continuous follow-up parent’s dietary counseling and monitoring of nutritional status will give better results for SAM children. [4]

Oral Nutrition Supplement Improved Nutritional Status in Malnourished Hip Fracture Patients: A Randomized Controlled Study

Background: Nutritional status has been shown to predict post-surgical recovery and clinical outcomes in orthopedic patients. This study evaluated the effects of an oral nutrition supplement (ONS) in patients undergoing hip fracture surgery.

Materials and Methods: In a multicenter, prospective, randomized study (ClincialTrials.gov, registration number NCT01011608), malnourished patients (n=127) who had surgery within 14 days of hip fracture and had screening serum albumin levels ≤ 38 g/L were enrolled. Patients in the ONS group were fed a calorically dense, high protein ONS, providing 798 kcal, 34 g protein/day for 28 days following surgery. Control patients received standard hospital diet only. Weight, nutritional and clinical markers were measured at Baseline, days 14 and 28. Suture status and functional recovery were evaluated on days 14 and 28.Means ± SEM are reported.

Results: Baseline characteristics were similar between groups. On day 28, albumin level was improved in the ONS group (4.9±1.4 g/L) compared to the control group (1.2±1.0 g/L, p=0.054). A significant increase in prealbumin was observed in the ONS group (5.0±1.0 mg/dL) vs. control (1.0±1.2 mg/dL, p=0.007). Body weight increased in the ONS group (2.1±0.6 kg) but decreased in the control group (-0.8±0.8 kg; p=0.01).

Conclusion: Supplementation of a nutritionally complete, calorically dense, high protein ONS for 28 days significantly improved nutritional status in mild to moderately malnourished patients undergoing hip fracture surgery. [5]

Reference
[1]  Fürst, P., Pogan, K. and Stehle, P., 1997. Glutamine dipeptides in clinical nutrition. Nutrition, 13(7-8), pp.731-737.

[2] Slavin, J.L. and Greenberg, N.A., 2003. Partially hydrolyzed guar gum: clinical nutrition uses. Nutrition, 19(6), pp.549-552.

[3] McClave, S.A. and Snider, H.L., 1992. Invited review: use of indirect calorimetry in clinical nutrition. Nutrition in Clinical Practice, 7(5), pp.207-221.

[4] Joglekar, A., Sharma, G. and Bhoi, S., 2015. Therapeutic Nutrition Evaluation and Management of Acute and Severe Malnourished Children. Current Journal of Applied Science and Technology, pp.606-611.

[5] Luo, M., Golubev, G., Klyukvin, I., Reznik, L., Kuropatkin, G., Oliver, J.S. and Voss, A.C., 2015. Oral Nutrition Supplement Improved Nutritional Status in Malnourished Hip Fracture Patients: A Randomized Controlled Study. Journal of Scientific Research and Reports, pp.480-489.

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