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Introduction: Daily food consumption is a basic factor for improving both the quality of life and the well-being of people. Hospital medical nutrition needs to suit certain standards and requirements, so as to provide all the necessary micro- and macronutrients for patients. It has to be high-quality food and also has to mind the technological requirements for its preparation in the hospital, in addition to looking aesthetically pleasing and tasting good. Objective: This report’s goal is to study the hospital dietary nutrition in the hospitals for active care in Ruse, Bulgaria – University hospital Kanev; University hospital Medika; Mental health center Ruse; Complex-oncological center Ruse and the Specialized Hospital for active treatment of pneumo-phthisiatric diseases - Dr Dimitar Gramatikov. Methods: The survey was conducted between the months of April and September 2020. The criteria for inclusion of those hospitals are: to perform an organized hospital nutrition, and the medical institution to be a hospital itself. Results: In the medical establishments that are included in the study, medical dietary nutrition is carried out in accordance with the normative documents and standards which are in force for the country. The numerological system of nutrition Pevzner is applied, as the basic diets are from №1 to 15, as well as their varieties according to the disease’s acuteness. Conclusions: We find that, just because contemporary requirements for nutrition in the Republic of Bulgaria have been presented in developed national recommendations for healthy eating, this is not enough. What is needed is to develop and apply a fully adequate hospital diet, based on an individual assessment of nutrition status, and degree of risk from malnutrition.

Научно обоснованная структура здорового питания, ориентированная на регуляцию метаболических процесов и улучшение иммунной устойчивости организма, позитивно повлияет на результативность специализированной медпомощи, улучшит механизмы регенерации и ускорит воссоздание разрушенных структур и функций организма. Схема действия диеты для больных туберкулезом была внедрена в 1940-х годах и не была изменена последними исследовательскими и техническими достижениями в сфере питания и гастроэнтерологии. Таким образом, нет никаких сомнений в том, что улучшение пищевых привычек для улучшения здоровья этой группы пациентов рассматривается как многообещающий способ улучшения эффективности лечения ТБ, что делает вышеуказанное исследование важным. В документе будет проанализирована текущая гигиеническая эффективность здорового питания в противотуберкулезных учреждениях и даны рекомендации по повышению стандартов гигиены пищевых продуктов. Это также определяет важность правильного питания при лечении туберкулеза. A scientifically-based system of therapeutic nutrition aimed at normalizing metabolic processes and increasing the body's immunoresistance will positively affect the effectiveness of specialized medical care, enhance reparative processes and accelerate the recovery of damaged structures and functions of the body. The current standard of food ration for tuberculosis patients was developed in the 40s of the last century and was not adjusted in accordance with the latest scientific achievements of dietetics and gastroenterology. Therefore, there is no doubt that improving the system of medical nutrition for this category of patients is a promising direction for improving the effectiveness of treatment of tuberculosis, which determines the relevance of this study. This paper will consider the current hygienic indicators of the organization of medical nutrition in TB institutions and recommendations for improving the hygienic standards of nutrition. In addition, the importance of proper nutrition in treatment against tuberculosis will be revealed.

Acute intestinal infections are the most common cause of a diarrheal syndrome at an early age and represent a great challenge in paediatrics. Over one billion people suffer from acute infectious diarrhoea worldwide every year, of which 65–70% are children under 5 years of age. Along with pharmaceutical (etiotropic and pathogenetic) therapy, nutritional therapy is the most important part of the treatment of children suffering from acute intestinal infections, as the unbalanced and improperly selected nutrition may cause development of a long-lasting diarrheal syndrome resulting in a weight loss, lactase deficiency and some other unfavourable conditions. It is obvious that the issue of adequate nutrition becomes important in case of intestinal infections in children, as it should be easily digested and assimilated, replenishing energy and microbiocenotic losses. An early return to a normal nutrition ration helps reduce duration of the disease, speed up recovery in both functional and anatomical aspects. Today, there is a sufficiently large selection of products in the paediatric practice, which contribute, to one degree or another, to a balanced nutrition of children in the acute stage of the disease. Probiotic products hold a most unique position among these products. The article pays special attention to the baby foods produced by the Russian manufacturer, which is the leader in the Russian paediatric nutrition market and has been producing natural and healthy products for babies for about 30 years. The product line of this manufacturer includes a wide range of probiotic and functional products for patients of older age groups for the management of microbiota dysbiosis in acute intestinal infections.

Observational ecological and epidemiological studies have suggested increased risks of SARS-CoV-2 infection and severity in groups with high prevalence of vitamin D deficiency (older adults, and those with obesity, pre-existing medical conditions or darker skin). Emerging observational clinical studies have confirmed these associations, reporting higher risk of SARS-CoV-2 infection, severe Covid-19 disease and mortality in those who are vitamin D deplete. Further experimental studies have described the immunological and metabolomic mechanisms by which vitamin D deficiency increases these risks, while recent prospective RCT data have shown reduced Covid-19 disease severity and mortality with vitamin D supplementation, further supporting a causal association. Dietary vitamin D intakes are low (~3-6μg/d (120-240 IU/d)) and sunshine exposure inadequate to achieve optimal vitamin D status in Ireland. Consequently, vitamin D deficiency (serum 25(OH)D50nmol/l on a year round basis. Supplementation with 20-25μg/d (800-1000 IU/d) is therefore required to avoid deficiency and meet the minimum 25(OH)D threshold of 50nmol/l for enhanced immunity to viral respiratory infection. For older adults, and those with obesity, underlying conditions or darker skin, supplementation at higher doses under medical supervision is indicated. Practice and policy development are now required to ensure that Irish adults are supplemented with vitamin D3 at these safe and effective doses to reduce their risks of SARS-CoV-2 infection and severe disease.

The objectiveis to present current data about the role of oral nutrition supplements (ONS) in cancer surgery. Results:this type of nutritional support should be considered as an integral part of the enhanced recovery after surgery. Despite the apparent simplicity of prescription, it should be treated as one of the types of medical nutrition with its own indications, providing for the individual selection of specific formulas and evaluation of effectiveness. For the initial assessment of cancer patient nutritional status, European Society for Medical Oncology scale (ESMO, 2008) is the most appropriate. ONS should be combined with diet recommendations and physical activity maintaining. Inability to provide with ONS > 60% of the daily energy requirements within 5–7 days, should be considered as an indication to start artificial nutrition – enteral and/or parenteral.

Many aspects of the mechanisms underlying the symbiosis between humans and gut microbes remain unknown and encompass some of the most intriguing questions in microbiome research. An important factor in this symbiosis is the interplay between microbes and human-produced glycans in mucin and breast milk. In this Opinion paper, I propose a synergy between the structural diversity of human mucin glycans and the enzymatic repertoire of the gut microbiome. The contribution of microbes to mucosal health is discussed, and the role of breast milk glycans in mucosal colonization by microbes is explained. The use of prebiotic mucin glycans in general, and specialized infant and medical nutrition in particular, should be considered as the field of interest to modulate the microbiota and improve mucosal health.

Целью данного исследования было изучить эффективность и переносимость специализированных продуктов детского диетического лечебного питания у детей с наследственными нарушениями обмена аминокислот с рождения до трех лет. Проведено открытое, многоцентровое, проспективное, неконтролируемое исследование. В исследование включены 8 пациентов с установленным диагнозом в возрасте от рождения до 2 лет 11 месяцев. Пациенты были распределены на группы в зависимости от диагноза и вида исследуемого продукта (ИП). Оценка эффективности проводилась в соответствии с принципами надлежащей клинической практики, на основании полученных клинических и лабораторных данных. На протяжении всего исследования все пациенты успешно принимали ИП. Диспепсических явлений, аллергических реакций, ухудшения соматического и неврологического статуса не зарегистрировано ни в одном случае. На фоне лечения зафиксированы оптимальные уровни нейротоксичных метаболитов в крови и моче. Показана высокая клиническая эффективность ИП у детей с наследственными нарушениями обмена аминокислот с рождения до трех лет. To assess the efficacy, safety and tolerability of the products specialized children's dietary nutritional therapy in children with Inherited disorders of amino acid metabolism from birth to three years. 8 children from birth to 2y 11m with verified diagnoses were enrolled in this open-label multicenter prospective non-controlled study. Patients were separated to the groups depending on diagnose and nutritional treatment products. Clinical efficacy of the products was assessed according to the Good Clinical Practice guidelines based on clinical and laboratory tests. All patients taken nutritional treatment products throughout the study. No dyspepsia, allergic reactions, impairment of somatic and neurological status were reported. After the treatment, levels of neurotoxic metabolites in the blood and urine were optimal. Nutritional therapy is highly effective in children with Inherited disorders of amino acid metabolism from birth to three years.

Financial reimbursement (MediFund) of medical nutrition products (MNPs) was recently implemented in some of the public hospitals in Singapore for patients with financial difficulties. This study aimed to investigate the sustainability of this policy and the benefits conferred.We performed a 1-year retrospective audit of patients in a tertiary hospital who received MediFund. Demographics, presupport and postsupport clinical outcomes, and cost of support were determined and analyzed.A total of 129 patients received MediFund for MNPs. The median length of financial support was 115 days (interquartile range, 37-269). Overall, body mass index increased after nutrition support (20.9 ± 5.1 vs 20.4 ± 5.3; P = .012). There was a significant decrease in the number of malnourished patients (final, 55.1% vs initial, 86.8%; P.001) and a significant increase in 7-point subjective global assessment scores (final, 4.9 ± 1.3 vs initial, 4.1 ± 1.3; P.001) after MNP support. MNP adherence was high for 88.5% of patients who returned for follow-up appointments. Patients who defaulted follow-up appointments were more likely to have 30-day readmission (50% vs 19.5%; P.001) and had higher mortality rates (35.7% vs 10.3%; P.001). Total reimbursement of S $108,960 was provided to subsidize MNPs over 1 year.Supporting patients with financial difficulties led to an improvement in their nutrition status. Regular dietitian reviews of patients and monitoring compliance to consumption of MNPs are essential to ensure patients benefit from the support.

Introduction: Type 1 diabetes is considered as one of the most widespread chronic diseases in the world, which happens due to autoimmune damage of beta cells in islets of langerhans in the pancreas. It is the most widespread type of diabetes in young age below 18 years. The beginning or progress of autoimmune cellular injury of pancreatic beta cells could occur through the presence of many autoantiges which are detected in the pancreatic beta cells. It was found that GABA promoting proliferation of beta cells which may have good impact on type 1diabetes. Design: Randomised, placebo controlled trial, 6 month trial. Materials and Methods: 100 type 1 diabetes patients were randomized into 2 groups. Result: The results show a statistically significant decrease of antigad antibodies and an increase of c peptide levels after 6 months of treatment with GABA. Conclusion: GABA may be used for decreasing antigad antibodies and beta-cell regeneration., {"references":["Lipton RB, Drum M, Burnet D, Rich B, Cooper A, Baumann E, Hagopian W. (2005), \"Obesity at the onset of diabetes in an ethnically diverse population of children: what does it mean for epidemiologists and clinicians?\", Pediatrics, Volume 115, Issue 5, pp. e553-560, DOI: https://doi.org/10.1542/peds.2004-1448","JM, Liu LL, Loots B, Linder B, Marcovina S, Rodriguez B, Standiford D, Williams DE. (2006), \"The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study\", Pediatrics, Volume 118, Issue 4, pp. 1510-1518, DOI: https://doi.org/10.1542/peds.2006-0690","\"International Diabetes Federation\", Diabetes atla, 8th edition 2017, Available at: https://www.idf.org/e-library/epidemiology-research/diabetes-atlas/134-idf-diabetes-atlas-8th-edition.html","Onkamo P, Väänänen S, Karvonen M, et al. (1999 Dec.), \"Worldwide increase in incidence of type I diabetes - the analysis of the data on published incidence trends\" Diabetologia, Volume 42, Issue 12, pp. 1395-1403, DOI: https://doi.org/10.1007/s001250051309","Adeloye D, Chan KY, Thorley N, et al. (2018 Dec), \"Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis\", J. Glob. Health., Volume 8, Issue 2, DOI: https://dx.doi.org/10.7189%2Fjogh.08.021101","Maahs DM, West NA, Lawrence JM, et al. (2010 Sep.), \"Epidemiology of type 1 diabetes\", Endocrinol. Metab. Clin. North. Am., Volume 39, Issue 3, pp. 481-497, DOI: https://doi.org/10.1016/j.ecl.2010.05.011","Beyan H, Riese H, Hawa MI, Beretta G, Davidson HW, Hutton JC, Burger H, Schlosser M, Snieder H, Boehm BO, et al. (2012), \"Glycotoxin and autoantibodies are additive environmentally determined predictors of type 1 diabetes: a twin and population study\", Diabetes, Volume 61, pp. 1192–1198, DOI: https://doi.org/10.2337/db11-0971","Redondo MJ, Rewers M, Yu L, Garg S, Pilcher CC, Elliott RB, Eisenbarth GS. (1999 Mar.),\"Genetic determination of islet cell autoimmunity in monozygotic twin, dizygotic twin, and non-twin siblings of patients with type 1 diabetes: prospective twin study\", BMJ, Volume 13, DOI: https://doi.org/10.1136/bmj.318.7185.698","Størling J, Pociot F. Genes (Basel) (2017 Feb 16), \"Type 1 Diabetes Candidate Genes Linked to Pancreatic Islet Cell Inflammation and Beta-Cell\", Apoptosis, Volume 8, Issue 2, DOI: https://doi.org/10.3390/genes8020072","Aly TA, Ide A, Jahromi MM, Barker JM, Fernando MS, Babu SR, Yu L, Miao D, Erlich HA, Fain PR, Barriga KJ, Norris JM, Rewers MJ, Eisenbarth GS. (2006 Sep 19), \"Extreme genetic risk for type 1A diabetes\", Proc. Natl. Acad. Sci. U S A., Volume 103, Issue 38, pp. 14074-14079, DOI: https://doi.org/10.1073/pnas.0606349103"]}

The current principles for medical nutrition support in critically ill patients are early implementation of enteral nutrition, and appropriate supplemental parenteral nutrition when intestinal nutrient is not enough (1). Perioperative patients with hepatobiliary surgery usually have complicated conditions, especially those with complicated cirrhosis, portal hypertension, bile duct obstruction, and diabetes. The nutritional metabolism process and nutritional methods in patients with hepatobiliary surgery are different from other patients and should be treated specially.

Background The term medical nutrition (MN) refers to nutritional products used under medical supervision to manage disease- or condition-related dietary needs. Standardized MN definitions, aligned with regulatory definitions, are needed to facilitate outcomes research and economic evaluation of interventions with MN. Objectives Ascertain how MN terms are defined, relevant regulations are applied, and to what extent MN is valued. Methods ISPOR’s Nutrition Economics Special Interest Group conducted a scoping review of scientific literature on European and US MN terminology and regulations, published between January 2000 and August 2015, and pertinent professional and regulatory Web sites. Data were extracted, reviewed, and reconciled using two-person teams in a two-step process. The literature search was updated before manuscript completion. Results Of the initial 1687 literature abstracts and 222 Web sites identified, 459 records were included in the analysis, of which 308 used MN terms and 100 provided definitions. More than 13 primary disease groups as per International Classification of Disease, Revision 10 categories were included. The most frequently mentioned and defined terms were enteral nutrition and malnutrition. Less than 5% of the records referenced any MN regulation. The health economic impact of MN was rarely and insufficiently (n = 19 [4.1%]) assessed, although an increase in economic analyses was observed. Conclusions MN terminology is not consistently defined, relevant European and US regulations are rarely cited, and economic evaluations are infrequently conducted. We recommend adopting consensus MN terms and definitions, for example, the European Society for Clinical Nutrition and Metabolism consensus guideline 2017, as a foundation for developing reliable and standardized medical nutrition economic methodologies.

Introduction: Data suggest a potential role for vitamin D in autism spectrum disorder (ASD) prevention and treatment. It is likely that the serum response to vitamin D supplementation contributes to its effectiveness. Multiple factors affect serum vitamin D 25(OH)D response to supplementation. Methods: We conducted post-hoc analysis of two double-blind, randomized, placebo-controlled trials (RCT) of vitamin D3 supplementation, one RCT involving children with ASD and another involving children with asthma. Both trials were conducted in the same geographic location (Dublin, Ireland, 53°N), conducted over Winter season and utilized the same vitamin D3 dose (2000 IU/day). Results: We included 18 children with ASD and 17 children with asthma. There was no significant difference in 25(OH)D or age at baseline, however, BMI was significantly lower in ASD (P = 0.03). Compliance with vitamin D supplementation was high in both trials. Despite a significantly longer intervention period (20w vs. 15w; P < 0.0001), ASD children had a significantly lower absolute increase (+26 vs. +45 nmol/l) in 25(OH)D (P = 0.04). Conclusions: Despite similar demographics, children with ASD had a lower increase in 25(OH)D levels with supplementation. Potential mechanisms include altered absorption/metabolism as well as well genetic factors. Clinical and research work relating to vitamin D is ASD should measure 25(OHO)D response to supplementation to assess therapeutic doses.

Children with phenylketonuria (PKU) and severe cow's milk protein allergy (CMPA) consume prescribed, specially formulated, foods for special medical purposes (FSMPs) in addition to having restricted intake of normal foods. These vulnerable patients are exposed to artificial sweeteners from the consumption of a combination of both free and prescribed foods. Young patients with PKU and CMPA aged from 1 to 3 years have a higher risk of exceeding the acceptable daily intake (ADI) for sweeteners than age-matched healthy children. A probabilistic modelling approach has been adapted successfully to assess the exposure of young patients with PKU and CMPA to low-calorie sweeteners. To assist professionals in the screening and formulation of foods containing food additives for such patients, a simplified exposure method/tool has been developed. The tool is intended to ensure that total dietary exposure can be considered. The simplified tool is not intended to replace the probabilistic model but may be used as a screening tool to determine if further investigation on exposure is warranted. The aim of this study was to develop and validate this simplified exposure tool to support those currently used by healthcare professionals (HCPs) using data available from the probabilistic modelling of exposure in young children with PKU and CMPA. The probabilistic model does not allow for swift screening of exposure scenarios nor is the present EFSA Food Additive Intake Assessment Model (FAIM) fully suitable for application to medical foods. The simplified exposure tool in medical nutrition (SETIM) reported here is both reliable and consistent and provides additive usage levels which minimise regular exposure above the ADI in patients. In addition to the usefulness of SETIM for the medical nutrition industry, the tool has the potential to enhance the practice of evidence-based medical nutrition by official risk assessment bodies, registration authorities and healthcare professionals.

High-quality nourishment of school children is an important factor of ensuring health and wellbeing of nation. The article gives information about providing hot meals to school children of comprehensive secondary institutions in the Voronezh region, which is one of the biggest entities of the Russian Federation. The region has its own specific features, typical illnesses included. For instance, school children in the region have a higher rate of illnesses of the digestion system, metabolism disorders, including overweight, some school children are registered in the TB prophylactic centers. The regional administration pays serious attention to organization of catering in education institutions. It was shown that provision of hot meals to school children in the region makes 92.7% on the average, while in 10 out of 31 municipal districts this figure reaches 100%. The governor’s program is functioning in the region, according to which school children from the 1 to the 10 form are provided with milk. The diet of school children includes iodized salt, bakery enriched with iodine-casein, vitamin drinks. However, school children have no opportunity to get complex prophylactic and medical nutrition, which corresponds to regional peculiarities on illnesses. In general, organization of school children catering is done in accordance with the current legislative regulations on the basis of state policy of the Russian Federation and its entities.

Nutritional support is recommended for malnourished patients receiving anticancer treatment. In a recently executed pilot, double-blind, comparator-controlled trial evaluating the safety, and toler...

This paper presents the implementation and findings of a pilot activity evaluating an educational activity which involved students from Diagnostic Medical Sonography (DMS) and Medical Nutrition Education (MNE) programs within a College of Allied Health Professions. The activity was implemented in three parts: First, the students worked independently on library modules using a case-based scenario to focus on the use of library resources and evaluation of fetal growth. Second, a hands-on activity focused on assessing fetal growth, and the final component was group education session on nutrition during pregnancy. The student learning objectives for this activity included: 1). Develop student appreciation for the benefits of interprofessional teamwork, 2). Demonstrate an understanding of the assessment of fetal growth, and 3). Demonstrate an understanding of nutrients requirements during pregnancy. Learner outcomes were measured using pre- and post-tests of case study-related and evidence-based search skills-related knowledge, observation during the activity, and a post-activity survey and debriefing. Post-test scores showed a statistically significant increase from the pre-test scores, and the students qualitatively expressed an increased understanding of the roles of each respective discipline. The apparent success of an IPE activity involving DMS and MNE students highlights the fact that successful IPE activities can be created for students whose professional roles may not have obvious clinical overlap.

espanolLa incidencia de cancer aumenta a medida que avanza la edad. Con el envejecimiento, y con una enfermedad cronica como el cancer, aumenta la prevalencia de desnutricion relacionada con la enfermedad (DRE), de sarcopenia, de caquexia y de fragilidad. Estas se asocian a mortalidad, a toxicidad por tratamiento antineoplasico y a complicaciones posquirurgicas. En este articulo se repasan, de forma diferencial en mayores, la prevalencia de DRE, sarcopenia y caquexia, la manera de diagnosticar estas situaciones en la clinica diaria, su fisiopatologia, su relacion con el pronostico clinico y las evidencias sobre la eficacia del tratamiento medico nutricional y multimodal, con el ejercicio fisico como principal aliado. Por el momento, son escasas las guias que se refieren unicamente al paciente mayor y, hasta que se generen mas estudios en este grupo de enfermos, las actuaciones en materia de nutricion deberan basarse en las ya publicadas de forma general en oncologia. Si el paciente mayor presenta desnutricion, y esta puede condicionar la calidad de vida o el pronostico clinico, el tratamiento medico nutricional debe progresar, de forma individualizada, desde el consejo dietetico hasta las formas mas complejas de tratamiento como la suplementacion oral, la nutricion enteral o la nutricion parenteral. EnglishThe incidence of cancer increases as age progresses. With aging, and with a chronic disease such as cancer, the prevalence of disease-related malnutrition (DRE), sarcopenia, cachexia and frailty increases. These are associated with mortality, toxicity due to antineoplastic treatment and post-surgical complications. In this article, the prevalence of DRE, sarcopenia and cachexia, the way to diagnose these situations in the daily clinic, their pathophysiology, their relationship with clinical prognosis, and the evidence on the effectiveness of medical nutrition treatment and multimodal therapy, with physical exercise as the main ally, are reviewed differentially in older patients. At the moment, there are few guidelines that refer only to the elderly patient, and until more studies are generated in this group of patients, the actions, in matters of nutrition, should be based on those already published in general oncology. If the elderly patient has malnutrition, and this can condition quality of life or clinical prognosis, medical nutrition therapy should progress, individually, from dietary advice to more complex forms of treatment such as oral supplementation, enteral nutrition or parenteral nutrition.

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Evidence-based medicine is the art of combining "best external evidence", "clinical judgement" and "patient values" for improved daily clinical decision making and is the ultimate goal in modern medicine. Historically, in the field of medical nutrition, there had been a lack of strong evidence from large and high-quality trials resulting in often weak guideline recommendations and therefore insufficient implementation in clinical practice. Particularly in the field of malnutrition, the medical community has long struggled to find evidence-based approaches for effective management by means of screening, assessment and treatment of patients. With recent trials showing that individual medical nutrition therapy has strong effects on clinical outcomes, we should now aim to practice "evidence-based medical nutrition" (EBMN) by combining clinical judgement (e.g., thorough clinical assessment of the malnourished patient), patient preferences (e.g., integration of perspectives of patients and relatives, consideration of comorbidities to define specific energy/protein goals and appropriate route of medical nutrition therapy) and the most current scientific evidence (e.g., trial-supported use of nutritional interventions for individual patients). Such an approach may certainly be helpful to improve clinical outcomes of the vulnerable population of malnourished medical inpatients.

In caring for dying patients, family medicine practitioners intentionally adopt care plans that affect the manner and timing of death. These decisions are morally weighty. This article provides guidance regarding the ethical and legal appropriateness of practitioner decisions near the end of life. Topics include surrogate decision making, advance care planning, medical nutrition and hydration, double effect, futile care, physician-assisted death, voluntarily stopping eating and drinking, palliative sedation to unconsciousness, and cultural humility.

Background: Muscle atrophy is defined as decreased muscle mass, associated with aging as well as with various chronic diseases and is a fundamental cause of frailty, functional decline and disability. Frailty represents a huge potential public health issue worldwide with high impact on healthcare costs. A major clinical issue is therefore to devise new strategies preventing muscle atrophy. In this study, we tested the efficacy of Vital01, a novel oral nutritional supplement (ONS), on body weight and muscle mass using a caloric restriction-induced mouse model for muscle atrophy.Methods: Mice were calorically restricted for 2 weeks to induce muscle atrophy: one control group received 60% kcal of the normal chow diet and one intervention group received 30% kcal chow and 30 kcal% Vital01. The effects on body weight, lean body mass, muscle histology and transcriptome were assessed. In addition, the effects of Vital01, in mice with established muscle atrophy, were assessed and compared to a standard ONS. To this end, mice were first calorically restricted on a 60% kcal chow diet and then refed with either 100 kcal% chow, a mix of Vital01 (receiving 60% kcal chow and 40 kcal% Vital01) or with a mix of standard, widely prescribed ONS (receiving 60 kcal% chow and 40 kcal% Fortisip Compact).Results: Vital01 attenuated weight loss ( -15% weight loss for Vital01 vs. -25% for control group, p < 0.01) and loss of muscle mass (Vital01 with -13%, -12% and -18%, respectively, for gastrocnemius, quadriceps and tibialis vs. 25%, -23% and -28%, respectively, for control group, all p < 0.05) and also restored body weight, fat and muscle mass more efficiently when compared to Fortisip Compact. As assessed by transcriptome analysis and Western blotting of key proteins (e.g. phospoAKT, mTOR and S6K). Vital01 attenuated the catabolic and anabolic signaling pathways induced by caloric restriction and modulated inflammatory and mitochondrial pathways. In addition, Vital01 affected pathways related to matrix proteins/collagens homeostasis and tended to reduce caloric restriction-induced collagen fiber density in the quadriceps (with -27%, p = 0.051).Conclusions: We demonstrate that Vital01 preserves muscle mass in a calorically restricted mouse model for muscle atrophy. Vital01 had preventive effects when administered during development of muscle atrophy. Furthermore, when administered in a therapeutic setting to mice with established muscle atrophy. Vital01 rapidly restored body weight and accelerated the recurrence of fat and lean body mass more efficiently than Fortisip Compact. Bioinformatics analysis of gene expression data identified regulatory pathways that were specifically influenced by Vital01 in muscle. (C) 2019The Authors. Published by Elsevier Inc.

OBJECTIVES: Chronic disease prevalence is increasing, and healthcare costs of heart disease, diabetes (DM), and chronic kidney disease (CKD) exceed $600 billion annually. Adherence to dietary guidelines is low (

OBJECTIVES: The aim was to examine the clinical course and dietary patterns among patients incorporating autoimmune protocol (AIP) for management of inflammatory bowel disease (IBD). METHODS: An anonymous online survey was sent through electronic newsletters and support groups utilizing AIP. The survey assessed demographics, IBD disease activity, and medication use. Participants were asked about AIP utilization and food group reintroductions. Abdominal pain (AP), stool frequency (SF), and rectal bleeding (RB) were compared at baseline (BL, prior to starting AIP), week 6 (after starting AIP), and present, for both Crohn's disease (CD) and ulcerative colitis (UC). RESULTS: There were 78 respondents. Mean age was 39.4 years, with mean IBD duration 13.2 years. 78% had prior steroid exposure. 35% currently on immunosuppressive agents. 73% perceived achieving clinical remission due to AIP. This was more common among patients not on immunosuppression (76% vs. 24% on immunosuppression, P

OBJECTIVES: Conduct a systematic review (SR) to determine the relationship between dietary macronutrient distribution and nutrition-related outcomes in pediatric and adult participants with cystic fibrosis (CF). METHODS: A literature search of Medline, CINAHL and Embase databases was conducted to identify peer-reviewed articles published from January 2002- May 2018 that examined human participants with CF and addressed the research objective. Articles were screened for relevance, data was extracted and summarized, and risk of bias was assessed by a multidisciplinary team of researchers, practitioners, patient advocates and SR methodologists. RESULTS: A total of 2409 articles were identified in the search and eight cross-sectional studies and one case-control study met inclusion criteria (N = 4 in pediatrics, N = 4 in adults, N = 1 combined). Evidence quality was low due to weak study designs, small samples size and inconsistent outcome reporting. Available studies did not show statistically significant relationships between dietary macronutrient distribution and lung function (FEV1%) (3 studies) when estimated protein intake ranged from 10–23% of energy, fat intake from 20–46% of energy and carbohydrate intake from 32–67% of energy. Macronutrient distribution was not significantly associated with anthropometric measurements/growth (3 studies), gastrointestinal symptoms (2 studies), glucose fluctuations (1 study) or lipid profile (1 study) in this SR. There were no studies identified examining the relationship between macronutrient distribution and mortality or Quality of Life. Meta-analysis was not possible due to the low quality of data reported. CONCLUSIONS: Recent evidence describing the relationship between dietary macronutrient distribution and nutrition-related outcomes in participants with CF is sparse and low in quality. The evidence reviewed does not suggest that dietary macronutrient distribution is related to key clinical CF outcomes. Higher-quality trials and longitudinal studies are needed to confirm these findings. The need for updated dietary studies is particularly important in light of recent therapeutic advances that are changing the clinical course of individuals with CF. FUNDING SOURCES: Academy of Nutrition and Dietetics and the Medical Nutrition Practice Group DPG.

OBJECTIVES: The objective of this project was to assess if best practice guidelines for the use of total parenteral nutrition (TPN) in pancreatitis are being followed at a university teaching hospital. METHODS: This retrospective study was an exploratory analysis of de-identified data pulled from a university teaching hospital clinical data repository and electronic medical records for patients who had a diagnosis of pancreatitis between the years of 2014 and 2018. Variables of interest included diagnosis, reason for initiating TPN, diet order, past medical history, age, gender, and race. Feeding modalities were compared to best practice guidelines for nutrition support initiation in pancreatitis provided by the American Society for Parenteral and Enteral Nutrition (ASPEN), European Society for Parenteral and Enteral Nutrition (ESPEN), American Pancreatic Association and the International Association of Pancreatology (IAP/APA), Best Practice in Surgery group at the University of Toronto, and the American College of Gastroenterology (ACG). RESULTS: A total of 57 patients were admitted between 2014 and 2018 with the diagnosis of pancreatitis. Chart reviews of each patient were assessed for an initial nutrition regimen of either enteral nutrition (EN) or TPN. Of the 57 patients started on nutrition support, 12 patients (21%) received a trial of EN prior to starting TPN. After exclusion of eight patients who had a diagnosis of either ileus, small bowel obstruction (SBO) or bowel perforation, there were 37 (65%) patients who were started on TPN initially without an EN trial. CONCLUSIONS: Despite best practice guidelines from multiple groups advocating for EN over TPN, it was found that TPN appears to be a first line feeding strategy in the majority of patients admitted with or who developed pancreatitis at this hospital. Development of an interdisciplinary nutrition support team at this hospital is recommended to facilitate adherence to best practices regarding treatment of patients with pancreatitis. FUNDING SOURCES: Not Applicable.

OBJECTIVES: Determine to what extent IBS patients relate their symptoms to diet and what role diet has in their treatment plan. METHODS: Participants ages 18 to 65 with self-reported IBS were prospectively recruited to an online questionnaire study on IBS and diet administered through PsychData. Recruitment was through Texas Woman's University student, faculty, and staff and the researcher's social media accounts. RESULTS: There were 148 completed surveys and 12 partial responses submitted. Around 57% (n = 85) of participants believe their IBS symptoms are related to what they eat with another 33% are unsure. Most participants (92%, n = 133) attempted to manage their IBS with dietary changes with 81% (n = 122) currently avoiding foods due to sensitivities. Only 21 patients had attempted the Low FODMAP Diet, though many more avoid foods high in FODMAPs including wheat, dairy, soy, foods high in fructose, onions, garlic, and corn. Over half of participants (55%, n = 62) reported that their doctor prescribed a specific diet or changes to their current diet to help manage their IBS. While 8 patients were referred to a RDN. only 6 actually consulted with one. CONCLUSIONS: Many physicians are not addressing diet in the context of IBS and few patients with IBS meet with RDNs. Thus, patients with IBS are largely self-managing their symptoms with diet and avoiding many foods due to perceived sensitivities. FUNDING SOURCES: Moore-Khourie Award from the Department of Nutrition, Texas Woman's University. SUPPORTING TABLES, IMAGES AND/OR GRAPHS

OBJECTIVES: Plasma Arginine (Arg) and Glutamine (Gln) are often depleted in early acute illness and sepsis. Treatment methods involving supplementation with one or both amino acids continue to be evaluated for merit. Both Arg and Gln have strong effects on the Area Postrema(AP), a highly vascularized medullary region controlling appetite and nutrient-regulated autophagy. It is plausible that Arg/Gln depletion, observed in acute illness, is a normal physiological sequestration and that supplementation in conjunction with non-protein energy intake (NPEI) counteracts these adaptive responses and healing mechanisms. This study examines the current evidence regarding energy intake and Arg/Gln provision in early critical illness. METHODS: Comprehensive review of in vitro, murine, and human interventional studies involving AP lesioning, Arg/Gln turnover measures, and effects of Arg/Glnprovision in acute illness. RESULTS: Serum Arg/Gln were negatively associated with severity of illness in murine and human studies. In vivoand murine models suggest Arg/Gln contribute to a nutrient-sensing anorectic intracellular relationship with the APduring acute stress. Associated elevations of cytokines TNFα and NF-kB lead to cellular uptake of Arg/Gln, with plasma concentrations of Arg/Gln modulating AP-mediated anorexia. To date, no clinical studies have examined this plausible relationship between nutrition support and AP feedback mechanisms. Human studies, however, have shown that total protein provision, but not Arg/Glnsupplementation, in early critical illness upregulates autophagy and benefits clinical outcomes. CONCLUSIONS: Strong evidence suggests that illness-associated anorexia and the decline in serum Arg/Gln serve as mediators in autophagy and in stimulating repair pathways. The AP appears to regulate these processes and may be negatively impacted by supplementation ofArg/Gln and increased NPEI. Further examination is needed to elucidate the AP-regulated nutrient-sensing appetite mechanisms and the potential effects of total protein intake versus specific amino acids. The labile nature of serum Arg/Glnin acute illness represents a potentially misguided and incomplete point of consideration for stress-state physiology and medical nutrition therapy. FUNDING SOURCES: none.

OBJECTIVES: Refeeding syndrome is characterized by rapid and severe hypokalemia, hypophosphatemia, hypomagnesemia, and/or Wernicke's encephalitis occurring subsequent to reintroduction of calories, usually after prolonged starvation. These electrolyte decrements may lead to complications such as organ failure and death, which should be prevented with effective monitoring and supplementation. However, there is poor agreement on the definition of refeeding syndrome, limited understanding of its risk factors, and, unsurprisingly, poorly described patient outcomes. This pilot evaluation is part of an ongoing study seeking to better define the syndrome and elucidate predictive factors enabling preventive and treatment strategies and develop clear guidelines. METHODS: A retrospective case-control study was performed at New York Presbyterian Hospital with inpatients admitted during 2015–2017. Patients with low levels of potassium, phosphorus, and/or magnesium within 3 days of the introduction of any oral, enteral, or parenteral source of calories were included. Type of diet and supplementation, demographics, nutritional history including weight change and intake, as well as comorbid conditions and medications, particularly those likely to cause alterations in electrolyte balance, as well as outcomes such as length of stay (LOS) and mortality were also noted for each admission. RESULTS: Nearly 48,000 unique qualifying admissions were identified and verified with random quality checks. Preliminary results demonstrate a significant positive relationship between the degree of initial low magnesium or potassium level, but not with phosphorus, and length of stay. Magnesium values in the lowest third of low values had mean LOS 7.1, vs 6.3 days in those with highest levels (OR 1.18; 1.09–1.29). Low potassium values, by lowest to highest quartile, were associated with mean LOS of 7.0, 6.2, 6.1 days, vs. 4.7 days in those with the highest levels (OR 1.57 (1.47–1.68); 1.37 (1.28–1.45); 1.29 (1.21–1.37)). CONCLUSIONS: Despite identification in the literature of phosphorus as the prime component of refeeding syndrome, low levels had no impact on LOS, unlike magnesium and potassium. Next steps include comparison against a matched control group to identify factors that may increase refeeding syndrome risk. FUNDING SOURCES: None.

OBJECTIVES: The link between diet quality and reproductive health in women is unclear. Ultrasonographic markers of ovarian morphology including ovarian volume (OV) and follicle number per ovary (FNPO) reflect disturbances in folliculogenesis and provide an objective and non-invasive means of gauging the severity of reproductive dysfunction. To test the hypothesis that lower diet quality is associated with adverse ovarian morphology, we evaluated the associations between dietary patterns with OV and FNPO in premenopausal women. METHODS: One hundred and eleven women (18–45y) were evaluated for OV and FNPO 2–5, 6–9, and 2–9 mm by ultrasonography. Dietary patterns were scored by the Healthy Eating Index (HEI) 2015, alternative HEI-2010, alternate Mediterranean Diet (aMED), and Dietary Approaches to Stop Hypertension (DASH) indices using a food frequency questionnaire. Linear regressions were used to test the direct effect of dietary patterns on OV and FNPO, and simple and serial mediation analyses tested the indirect effects of dietary patterns on OV and FNPO through obesity, insulin resistance (IR), hyperandrogenism, and oligo-anovulation (OA). RESULTS: There were no direct associations between dietary patterns and OV or FNPO (P ≥ 0.89). However, inverse indirect associations were observed between aMED and DASH scores with OV and FNPO (P

OBJECTIVES: HIV infection has previously been associated with malnutrition and wasting; however, with the initiation of antiretroviral therapy (ART), a growing number of people living with HIV (PLWH) are becoming centrally obese, with disproportionate weight accumulation around the abdominal area and fat losses in the rest of their body (periphery face, arms and legs), indicative of lipodystrophy. As a result, some PLWH may struggle simultaneously with central fat accumulation and peripheral losses, trying to balance these 2 opposite effects. METHODS: PB is a 62-year-old, African-American male infected with HIV for 12 years, receiving an NRTI regimen. Participating in the Miami Adult Studies in HIV (MASH) Cohort, PB started a 6-month nutrition intervention targeted to lower diabetes risk in prediabetic PLWH. Baseline body mass index (BMI) was 24.1 kg/m(2) and waist circumference (WC) was 36.5 inches. Despite having the initial intention to lose weight, PB gained ∼12.4 lbs just a month after initiation. When questioned about the weight gain, PB revealed that he had started taking an appetite stimulant (Megace) to address the wasting on his periphery, claiming that he looked “sickly”. PB stopped taking Megace after he gained >20 lbs (12.3% Wt∆) in 4 months. BMI at this time was 26.3 kg/m(2) and WC was 45.5 inches, reflecting a substantially increased risk for metabolic complications. With WC increasing 9 inches and hip circumference increasing only 2 inches, it is evident that a considerable amount of the weight accumulation occurred around the waist. As can be seen, he among others in his situation, are struggling with conflicting goals by simultaneously trying to reduce central obesity and prevent peripheral losses and wasting, something that may be unique to PLWH. RESULTS: Despite the participant's difficulties in weight management, his fasting blood glucose (FBG) improved after the 6-month nutrition intervention, with a −14 mg/dL improvement, lowering associated risk for diabetes and cardiometabolic complications. CONCLUSIONS: This improvement in FBG levels suggests that despite the difficulty of effective weight management in these patients, proper glucose values may still be achieved with nutrition counseling and education, thus lowering risk for diabetes and associated complications. FUNDING SOURCES: NIGMS-RISE funding, National Institute on Drug Abuse 5U01DA040381-03 and FIU-Dissertation Funding.

OBJECTIVES: Introduction: Scar assessment scales are used for a number of scars related to surgical procedures, burns and trauma. These objective and subjective scales help to assess the physical characteristics, pathological wound healing and overall esthetics related to scarring. Select nutrients play a vital role in tissue repair and wound healing. METHODS: Case Description: A 28-year old female underwent a cesarean section delivery due to a frank breech positioning of the baby. The patient was considered to be within a healthy BMI range pre-pregnancy (BMI = 23.5) and consumed an overall healthy diet, as determined by the Dietary Guidelines for Americans. After surgery, she consumed two packets of Juven© daily mixed with 500–1000 mL water, for two weeks, to aid in wound healing. This oral nutrition supplement is composed of L-arginine, L-glutamine, collagen protein, β-hydroxy-β -methylbutyrate and vitamins and minerals; each nutrient with evidence-based support to boost wound healing. An obstetrician performed scar evaluations at two-weeks postpartum to identify short-term wound outcomes. The Stony Brook Scar Evaluation Scale (score 5 of 5) and the Manchester Scar Scale (score 8 of 18) revealed positive measures. RESULTS: Discussion: Pathological scarring can be associated with substantial physical and psychological complications. Women who undergo cesarean sections are seeking ways to minimize the physical scar appearance and pathological wound healing. A twice daily supplementation of Juven© can assist in improvement in the visual cosmetic appearance and overall physical characteristics of scarring due to cesarean section. According to the results from scar scales utilized in this case, this surgical incision indicates “best possible scar”. CONCLUSIONS: An oral nutrition supplement, used as an intervention post-cesarean section, can optimize scar appearance and overall wound healing. This case report gives insight as to how nutrition can play a role in revitalizing standard treatment after surgery. While this is just one case, there is an opportunity to enhance the physiological and psychological recovery from surgical scars, such as from a cesarean section. FUNDING SOURCES: No funding to report.

OBJECTIVES: The prevalence of adults with obesity in the United States continues to increase [1]. Obesity remains a relative contraindication to lung transplantation due to the potential for negative effects on post-transplant survival, including primary graft dysfunction [2]. We report a case of implementing a modified very low calorie diet for weight loss in an inpatient setting to improve candidacy for lung transplantation. METHODS: A 47 year-old male with morbid obesity, chronic hypercapneic respiratory failure status post tracheostomy seven years prior, and progressive pulmonary fibrosis was admitted to the intensive care unit for worsening hypoxia at home. On admission his weight was 108.9 kilograms with body mass index of 37 kg/m², making him ineligible for lung transplantation listing and evaluation. Due to persistently high oxygen requirements and nocturnal ventilator dependence, care for the patient could not safely be transitioned outside of an acute care setting. To achieve weight loss, we implemented a modified very low calorie diet to provide 800 kilocalories and 90–100 grams of protein per day. At the time of this report, the patient has achieved a 10.9 kilogram decrease in body weight over four weeks with stable clinical status and without new adverse events during the period on the calorie restricted diet. RESULTS: Median survival after lung transplantation is approximately five years. In transplant recipients, a BMI > 30 may be associated with increased short-term and long-term mortality and is a relative contraindication to transplantation [2,3]. Importantly, in patients with obesity, weight loss prior to lung transplantation may improve survival and decrease peri-operative morbidity [4]. While this is difficult in patients with limited exercise capacity and urgent indications for transplantation, utilizing a very low calorie diet for weight loss can be effective in the proper setting, especially a monitored inpatient unit [5]. This is important because it may allow for transplant eligibility and the possibility of transplantation for a patient that would otherwise have a limited survival period. CONCLUSIONS: The use of a calorie restricted diet should be considered as a safe and effective method for rapid weight loss in an inpatient, monitored setting to allow for lung transplantation eligibility. FUNDING SOURCES: None.

OBJECTIVES: In this study we want to investigate the effects of Q-CAN® Plus, the nutritional fermented soy drink on the hematological parameters in lean and obese individuals. METHODS: Prospective study comprised of lean (10) and obese (10) individuals without a known diagnosis. 11 clinic visits over 14 weeks (visit 1/wk −2, visit 2/wk −1, visit 3/wk 0, visit 4/wk 1, visit 5/wk 2, visit 6/wk 3, visit 7/wk 4, visit 8/wk 6, visit 9/wk 8, visit 10/wk 10, visit 11/wk 12). Visits 1, 2 and 3 occurred prior to treatment. 237 ml of soy was dispensed at visit 3 and was consumed twice daily for 4 weeks until visit 7 (weeks 1–4). Visits 8, 9, 10 and 11 were post treatment. Blood was collected during visits 1, 3, 5, 7, 8, 9, 10,11, and various hematological parameters were quantified at Yale New haven health, hematology lab at the Department of laboratory medicine (Yale new haven health, Yale University, CT, USA). The values were statistically analyzed using one-way ANOVA and the results were considered significant for P

OBJECTIVES: Inadequate food intake is associated with mortality in hospitalized patients. Even with the emphasis on malnutrition-related dangers, investigating all hospitalized patients in Korea for food intake and factors affecting food intake is difficult but we need to food intake in hospitalized patients for efficient nutrition management. Therefore, A large-scale nutrition investigation was conducted to examine food intake in all hospitalized patients. We aimed to examine food intakes in hospitalized patients in Korea, to evaluate the relationship between inadequate food intake and mortality, and to ascertain mortality-related risk factors. METHODS: A one-day cross-sectional study on food intake and mortality was conducted on 1074 hospitalized adult patients on June 23, 2011. Food intake, assessed using questionnaires, was divided into four categories: 0%, 25%, 50%, and 100%. We collected disease-related factors and meal-related factors from electronic medical records. We also evaluated "length of hospital stay" and "probability of death in hospital" using a post-survey after 60 days. We identified risk factors for mortality using multivariate analysis. Gray's test was adopted for survival analysis of “probability of death in hospital” according to food intake. RESULTS: We included 1074 patients from 56 wards, including the intensive care unit. The following characteristics were observed: average age, 57 years; average body mass index, 22.8 kg/m2; and sex ratio, 55.2% male. On survey day, 35.4% patients ate a whole meal, 56.4% ate half of the meal, 20.2% ate quarter of the meal, and 8.2% ate nothing. Patients who consumed nothing had a 7.2-times higher mortality risk (HR) than patients who consumed a whole meal (P = 0.001). The mortality risk increased by 2.9 (P = 0.056) and 2.6 times (P = 0.102) in patients who consumed 50% and 25% of the meal, respectively. Risk factors contributing to mortality risk included heart/circulation (HR 18.026, P = 0.005), cancer (HR 17.990, P

OBJECTIVES: High postprandial lipemia is a characteristic of metabolic abnormality recognized as a risk factor inducing cardiovascular disease. The objective of this study was to investigate the effects of Platycodi radix (PR) beverage on postprandial lipemia response after challenging with a high-fat/sugar load using both single-dose cross-over and 8-week repeated paralleled designs in healthy subjects. METHODS: A total of 52 and 96 subjects were included in the two studies, respectively. Postprandial blood samples were collected at designated time points from 0 to 6 hours after a high-fat load at each visit to determine triglyceride (TG) and lipoprotein lipase (LPL) activity and mass in plasma, chylomicron and very low-density lipoprotein (VLDL). A general linear mixed-effect model analysis of time point values and area under the curves (AUCs) was performed to estimate the effect of PR beverage on postprandial lipemia response. RESULTS: In a single-dose cross-over design study, PR beverage consumption significantly increased lipoprotein lipase mass (P = 0.011, β estimate = 4.295) and reduced TG concentration in VLDL (P = 0.038, β estimate = −52.69) at 6-hour as compared to those in placebo consumption with a high-fat load. Postprandial TG responses as measured by AUC for 6 hours were significantly correlated with a high-fat dietary score MEDFICTS in chylomicron (r = 0.276, P = 0.008) and VLDL (r = 0.213, P = 0.040). In a 8-week repeated parallel design study, postprandial lipemia responses were compared considering the interaction between group and week. PR beverage consumption decreased postprandial serum TG response (AUCn, P = 0.039; total AUC, P = 0.088). In addition, PR increased plasma LPL mass (AUCn, P = 0.076) that is a clearing factor that hydrolyzed TG of chylomicron and VLDL in the lipoprotein metabolism. CONCLUSIONS: In both of single and long-term intake, PR beverage consumption improved the degradation of postprandial TG level with increasing postprandial LPL mass. However, detail LPL mechanisms of PR consumption should be further analyzed. FUNDING SOURCES: This work was carried out with the support of “Cooperative Research Program for Agriculture Science & Technology Development” Rural Development Administration, Republic of Korea and the BK21 PLUS program of the Ministry of Education.

OBJECTIVES: The present systematic review and meta-analysis investigates the effectiveness of S. officinalis leaves in management of dyslipidemia of chronic disease. Dyslipidemia is one of the main indicators of cardiovascular disease (CVD). It is typically characterized by elevated levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL) and triglyceride (TG) along with reduction of high-density lipoprotein cholesterol (HDL) in blood. The handling of dyslipidemia is a crucial factor in the general control of the cardiovascular risk in individuals suffering from diseases such as diabetes, CVD or hypertension. Plant foods have played an important role in chronic disease management. S. officinalis leaves (sage) have been identified as improving glucose homeostasis and serum lipids in animal and human models. METHODS: PubMed, FSTA, Web of Science, CINAHEL and MEDLINE databases were searched using keywords (“Serum lipids” OR triglyceride* OR cholesterol* OR “LDL” OR “HDL” OR dyslipidemia) AND (sage or "Salvia officinalis") up to January 2019. Review articles, animal studies, non-trial, non-specific related plants, and articles which did not examine lipid profiles were included in the exclusion criteria. Articles that met the inclusion criteria included effects of administration of Salvia officinalis on serum lipid in clinical trials. All statistical calculations were performed using SAS software version 9.2 (SAS, Cary NC, USA). RESULTS: From 243 studies, four of the trials met the selection criteria of the meta-analysis. Salvia officinalis significantly improved serum lipids. The estimated value for TC was −52.64 mg/dl, 95% CI: −71.0505 to −34.23, P = 0.0001 and LDL −23.28 mg/dl, 95% CI: −40.07 to −6.48, P = 0.006. Moreover, TG was −74.98 mg/dl, 95% CI: −129.16 to −20.8190, P = 0.006 and HDL-C at 6.3424 mg/dl, 95% CI: 1.58 to 11.1033, P = 0.009) was significantly improved after Salvia officinalis administration CONCLUSIONS: Although the systematic review and meta-analysis investigation involved few studies it revealed promising efficiency of Salvia officinalis on improving the serum lipids in clinical trials and suggested that Salvia officinalis can be an appropriate plant food to manage dyslipidemia of chronic diseases. FUNDING SOURCES: N/A.

OBJECTIVES: Se and selenoproteins play critical metabolic roles, as in glutathione peroxidase (antioxidant defense) and iodo-thyronine deiodinase 2 (thyroid hormone production). Other Se-dependent pathways can promote apoptosis and decrease oncogene expression. Se deficiency (SeD) is rare in the US, given its abundance in food and soil. SeD is linked to tobacco use, excessive ETOH consumption, birth control pills, and inflammatory bowel disease. SeD can increase the risk of prostate cancer and Burkitt's lymphoma. Severe SeD can cause skeletal muscle dysfunction and endemic cardiomyopathy (Keshan disease). We present herein a case of SeD 7 + years after heart transplantation, in whom prostate cancer and Burkitt's post transplant lymphoproliferative disorder (PTLD) developed. METHODS: A 77-year-old male with hypertension, dyslipidemia, diabetes mellitus and non-ischemic cardiomyopathy underwent OHT in 2011. He developed prostate cancer in 2015, treated with hormonal and radiation therapy. In January, 2019 he had progressive dyspnea, muscle weakness, abdominal pain, weight loss and diarrhea x 1 week. An ascending colonic mass revealed Burkitt's PTLD. A metabolic evaluation uncovered a serum Se of 31 mcg/L (normal range 63–160). The patient received TPN with additional Se. He underwent chemotherapy and developed tumor lysis syndrome, requiring renal replacement therapy. He remained on single drug immunosuppression with Tacrolimus. Renal function and oral intake returned after 3 weeks. RESULTS: Our patient presented with a severe SeD without apparent predisposing factors. He has developed 2 SeD-related neoplasms: prostate cancer and Burkitt's PTLD. The congruence of his clinical course and biochemical results support the diagnosis of a true SeD. However, the etiology of the SeD state remains unknown. We hypothesize that his immunosuppression therapy with Tacrolimus may have played a role. If so, it could be a previously unidentified drug effect. CONCLUSIONS: Serum Se monitoring should be considered in post OHT patients who develop prostate cancer or Burkitt's PTLD. Given the increased risk of prostate cancer in OHT patients, routine screening of Se levels and Se supplementation of deficiency states should be considered after OHT. FUNDING SOURCES: none.

OBJECTIVES: PN is a mainstay for ECF after pancreatoduodenectomy. LC has been studied for cutaneous wound healing. Oct lacks consistent evidence in ECF but may be beneficial with soft pancreatic texture or small ducts, as in pediatric patients. Prior experience suggests that intravenous Oct is superior for ECF than intermittent forms. This case demonstrates the value of isonitrogenous PN, LC and Oct infusion in ECF management. METHODS: A 59-year-old male with familial adenomatous polyposis underwent pancreaticoduodenectomy. He returned to the OR after 4 weeks for abscess drainage, cholecystojejunostomy with transhepatic stent, and small bowel resection. The patient returned from rehabilitation 6 months later with persistent fistula output from recurrent ECF. We started on PN and subcutaneous Oct (100 mg TID). The PN amino acid content was guided based on nitrogen balance data. Carnitine levels were very low and LC (1000 mg) was added to the PN. The patient continued to have high volume fistula output and returned to the OR for closure of an anterior ECF, which was followed by development of a right-sided and left-sided ECFs. Continuous infusion of Oct was initiated at 250 mcg/d and gradually ramped-up by 250 mcg/d increments to 1500 mcg/d. ECF fluid output decreased with each step. Complete closure of ECFs was seen after 4 weeks. Oct drip was ramped downward by 250 mcg increments/d and discontinued. The patient advanced his diet and PN was discontinued. He was discharged to rehabilitation without re-emergence of ECF. RESULTS: This case demonstrates the value of combination isonitrogenous PN, LC and continuous Oct for ECF. Nitrogen balance based amino acid intake ensured PN nutritional adequacy. Car was similarly based on actual patient data rather than empiric therapy. A continuous Oct ramping protocol enabled judgement of the beneficial effect and determine the need for further dosage increases. Continuous infusion was superior to the previous intermittent Oct. It is possible that the continuous infusion induced more significant suppression of gastrointestinal secretions than subcutaneous Oct administration, thereby improving its efficacy. CONCLUSIONS: Combination therapy with PN, Car continuous Oct could be an effective approach for ECF management for patients who have failed surgery and standard medical therapy. FUNDING SOURCES: None.

OBJECTIVES: Individuals with cystic fibrosis (CF) are at high risk for malnutrition and poor growth. New drugs that modulate CF transmembrane receptor (CFTR) function are available, although their effects on anthropometric parameters are not clear. This systematic review aimed to determine if various CFTR modulator therapies affect weight and growth parameters in individuals with CF. METHODS: A literature search was conducted using MEDLINE, CINAHL and Embase databases for peer-reviewed, randomized controlled trials (RCT) published from January 2002 to May 2018 that examined the effect of CFTR modulation therapy on weight and growth parameters in children and adults with CF. Articles were screened for relevance, data was extracted and summarized, and risk of bias was assessed to determine the quality of evidence. RESULTS: A total of 612 original articles were identified, and 13 articles representing 10 RCTs were included in qualitative synthesis and three were included in quantitative synthesis. All but one RCT demonstrated low risk of bias. The targeted class of CFTR mutation varied by RCT. Studies indicated that, in children and adults with CF with class III mutations, ivacaftor treatment alone increased weight and BMI (4 RCTs), but it did not influence growth in individuals with class II (1 RCT) or class IV mutations (1 RCT). Treatment with ivacaftor + lumacaftor in adults homozygous for the F508del CFTR mutation (class II) increased BMI following 24 weeks of treatment (2 RCTs), but there was no effect in adults heterozygous for the mutation treated for 8 weeks (1 RCT). Treatment with lumacaftor + tezacaftor in individuals ages 12–20 years with class II mutations did not change growth parameters (1 RCT). CONCLUSIONS: Effects of CFTR modulators on increasing weight and growth in individuals with CF are likely dependent on the therapy formulation (single vs combination therapy) and the targeted CFTR mutation. Whereas ivacaftor alone increases weight and growth parameters in individuals with class III mutations, ivacaftor + lumacaftor is more effective at increasing BMI in adults homozygous for the class II F508del CFTR mutation. Additional studies are needed to determine effects of other CFTR modulator drugs on growth parameters in individuals with varying CFTR mutations. FUNDING SOURCES: Academy of Nutrition and Dietetics/Medical Nutrition DPG, National Institutes of Health.

OBJECTIVES: Hemoglobin A1c (HbA1c) is associated with hypertension in prediabetes (PD) and type 2 diabetes (T2D), both of which are associated with increased cardiovascular disease (CVD) risk. Traditionally, HbA1c is the standard approach to assessing glycemic status, however, glycemic variability (GV)—the daily fluctuations in blood glucose concentrations—may be more predictive of CVD. Little is known regarding the relationship between GV and blood pressure (BP). Therefore, we examined GV and HbA1c and their associations with BP in overweight adults with PD and early stage T2D enrolled in a weight loss study. METHODS: Participants had a history of PD or T2D treated with lifestyle alone or lifestyle and metformin. Data for this report were obtained at baseline and included sociodemographics, height, weight, BP, and HbA1c. Up to two weeks of continuous glucose monitoring data were collected using the Abbott Freestyle Libre Pro, and mean amplitude of glycemic excursions (MAGE) was computed using EasyGV. Linear mixed models were used to test the associations of MAGE and HbA1c with BP, with adjustment for sociodemographic characteristics, as well as to compare MAGE on weekdays versus weekends. Repeated measures ANOVA was used to investigate the within-subject and between-subject variation of MAGE. All analyses were performed using R software. RESULTS: Study participants (n = 35) were mostly female (66%) and non-Hispanic white (69%), with a mean (SD) age of 57 (11) years, BMI of 33.0 (4.0) kg/m2, HbA1c of 5.6 (0.5) %, and systolic and diastolic BP (SBP, DBP) of 124 (14) and 71 (8) mmHg, respectively. MAGE differed significantly between participants (P

OBJECTIVES: It is well known that excessive sodium intake increases the risk for developing cardiovascular diseases. Taste perception contributes food choice and may be important in determining nutrient intake. The purpose of this study was to examine the relationship between taste perceptions for salt and blood pressure in Korean adults. METHODS: Detection and recognition thresholds to salt and salty taste preference to the salty bean sprout soup were measured in healthy adults and hypertensive patients (n = 280). RESULTS: Recognition threshold to NaCl was significantly higher in hypertensive females than in normotensive females (0.076% and 0.054%, respectively, P

OBJECTIVES: To evaluate the effect of consuming ¾ cup/day of mixed dried fruits versus a calorie- and carbohydrate-matched snack, on vascular health in adults at risk for cardiometabolic disease. METHODS: Men and women (n = 55) with overweight or obesity and at least one additional risk factor for cardiometabolic disease were enrolled in a 2-period single-blind randomized crossover trial. Participants received the following treatments for 4 weeks (separated by a 2–4 week washout): 1) ¾ cup mixed unsweetened dried fruits (equal parts raisins, dried plums, figs, and dates); 2) a calorie- and carbohydrate-matched processed snack. Endpoints were assessed at baseline, and the end of each treatment. Participants were advised to consume 1 serving/day of fresh fruit and incorporate study foods into their usual diets. The SphygmoCor XCEL was used to evaluate brachial and central blood pressure (BP), augmentation index, and carotid-femoral pulse wave velocity (PWV). RESULTS: At baseline, participants (47% female) had a mean BMI of 28.5 ± 2.7 kg/m2 and mean BP was 111 ± 9/77 ± 8 mmHg. More than half the subjects (56%) had a normal BP ( 0.05). There was a significant difference in mean central pulse pressure (PP) following the dried fruit treatment versus control (1.6 ± 0.8 mmHg, P = 0.048). This was likely driven by a trend toward lower central diastolic BP (−1.2 ± 0.7 mmHg; P = 0.12) after the fruit, versus control. CONCLUSIONS: Daily consumption of 1.5 cup-equivalents of mixed dried fruits for 4 weeks did not affect systolic BP or measures of arterial stiffness versus an isocaloric carbohydrate-matched snack in adults at increased risk of cardiometabolic disease. A significant difference in end-of-treatment mean central PP merits further study. FUNDING SOURCES: International Nut & Dried Fruit Council; the California Dried Plum Board; National Center for Advancing Translational Sciences, NIH.

OBJECTIVES: EDS-4 comprises ∼4% of all EDS, involving mutations in type III procollagen rather than type V. It causes spontaneous vascular and visceral rupture but not large joint or skin hypermotility. Nutritional deficiencies and malabsorption have been described in classical EDS, but not in EDS-4. METHODS: A 30-year-old female with EDS-4, bowel obstruction, spontaneous colon rupture, spontaneous pneumothorax and cholecystitis had fatigue, diarrhea, abdominal pain, hair loss and dry skin. Stools were malodorous and floating; oily and often orange in color. There was no response to bile acid sequestration. The patient weighed 40.4 KG (BMI = 16.9) with intact muscle mass and near total absence of subcutaneous adipose tissue. There were sparse hair follicles; hair was easily pluckable and lanugo-like. The skin was thin and translucent; dry with flaking and peeling both tibial regions. Vitamin levels (A, D, E, K1, C, B1, B6, B9, B12) were normal as were zinc, iron, copper and carnitine. Levels of palmitoleic (C16:1w7), hexadecenoic (C16:1w9), linoleic (C18:2w6), alpha linolenic (C18:3w3), gamma linolenic (C18:3w6), vaccenic (C18:3w7), arachidic (C20:0), arachidonic (C20:4w6), docosenoic (C22:1) and nervoic (C24:1w9) acids were deficient. The triene-tetraene ratio was 0.028 (range = 0.01–0.038). RESULTS: We diagnosed fat malabsorption (FM) with EFAD and began pancreatic enzyme replacement with a blend of vegetable oils (coconut, corn, soy, safflower, olive and avocado). After 6 months, there was reversal of all deficiencies. GI symptoms, general strength and vitality improved. Her scalp hair increased. The hair shafts were less fragile and normal in color. The skin dryness, flaking and peeling had resolved. CONCLUSIONS: EDS-4 patients may present with FM and develop EFAD. The pathogenensis of FM in EDS-4 may involve disordered collagen type III within the bowel wall, pancreatic matrix or ductal system. Dysbiosis and dysautonomia may also play a role. The combination of pancreatic enzyme replacement and fatty acid supplementation was beneficial in this case and may be appropriate for other patients with EDS-4 and FM. FUNDING SOURCES: none.

OBJECTIVES: Postoperative pulmonary complications (PPCs) significantly impact surgical outcome, but the clinical usefulness of various models used to predict PPCs is questionable. The controlling nutritional status (CONUT) score reflects nutritional deficiency and inflammation and is used to predict clinical outcomes in various malignancies. We aimed to investigate the ability of the CONUT score to predict PPCs after lung resection in patients with non-small cell lung cancer (NSCLC). METHODS: We retrospectively reviewed data of 922 patients with NSCLC who underwent complete resection at Severance Hospital in South Korea during January 2016–December 2017. We analyzed the predictability of the CONUT score for PPCs compared with other inflammatory prognostic markers and PPCs risk scoring systems (prognostic nutritional index [PNI], Glasgow prognostic score [GPS], and assessment of respiratory risk in surgical patients in Catalonia [ARISCAT] score) using receiver operating characteristic curves analysis. RESULTS: Of 922 study subjects, 522 (56.6%) were male; the mean age was 64.2 years. Lobectomy was the most common type of operation (n = 737, 79.9%). Total incidence of PPCs was 8.6% (n = 79). Prolonged air leak (44.3%) was the most common PPC, followed by pneumonia (32.9%) and pneumothorax (11.4%). The proportion of pneumonia was significantly larger in the high CONUT group (P