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4. The relationship between enteral nutrition, energy metabolism and gut homeostasis during the course of critical illness

Author

Zaher, Sara, Pathan, Nazima, and Meyer, Rosan

Subjects
Nutrition, Paediatrics, Critical care, Microbiome
Abstract

Nutrition has an indirect effect on the gastrointestinal function of the host and thereby on health, mainly by influencing the composition and activity of the human gut microbiota. The aim of this PhD project was to investigate the effect of nutrition as a factor affecting the intestinal microbiome-host relationship in critically ill children and whether it has an impact on clinical disease severity. The balance between requirement and delivery of energy and macronutrients was assessed in a cohort of 124 critically ill children. Then an integrated approach of metataxonomics and metabolomics analysis was undertaken to examine how feeding during critical illness affects the gut-host relationship. Collection of faecal samples was required for the assessment of faecal calprotectin, gut microbiota and their metabolites while serum samples were used for the analysis of inflammatory cytokines, and intestinal injury biomarkers. Overall this project has recorded a cross-link between feed, gut homeostasis with systemic inflammation and host metabolism. Within the feed delivered, fat delivery was often above requirements compared to protein and carbohydrate. In addition, both protein deficit and higher delivery of fat were associated with elevation in the levels of pro-inflammatory cytokines. The results also showed that abnormalities in gut health biomarkers were associated with elevation in inflammatory cytokines. Finally this study also recorded a profound loss of diversity in the faecal microbiome of critically ill children. This was associated with the loss of key commensal species and increased levels of opportunistic pathogens. Consequently resulted in reduced functionality of the gut microbiome manifested by reduced production of SCFAs and abnormalities in BAs metabolism. The current study showed for the first time that energy underfeeding appeared to influence the microbial composition of critically ill children. In conclusion this work provided an insight about the potential contribution of nutrition as a factor to improve the disease state in critically ill children, if targeted to modulate gut microbiome and host response to critical illness.

Published
2019
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7. Incorporating ultrasonography to the nutritional assessment process in intensive care settings to improve the prescription of enteral and parenteral nutrition.

Author

Zaher, Sara

Subjects
NUTRITIONAL assessment, CRITICAL care medicine, ENTERAL feeding, PARENTERAL feeding, LEAN body mass, CRITICALLY ill patient care
Abstract

The validity of the traditional nutritional assessment tools in intensive care settings might be compromised when the patient has conditions such as oedema and inflammation. Ultrasound (US) is considered a noninvasive, bedside tool that can be utilized to assess changes in muscle mass. Hence, US could guide healthcare practitioners in identifying the varying degrees of malnutrition and adjusting the nutritional prescription accordingly. This review discusses the currently available data regarding the feasibility and practicality of using US measurements in intensive care settings. Overall, the data suggest that using US as part of the standard anthropometric assessment for critically ill patients is a promising tool to track variations in muscle mass. This has the potential to enhance nutritional prescription and tailor the provision of protein and energy to critically ill patients based on their lean body mass measurements. Therefore, it is recommended to train dietitians on utilizing US for body composition measurements. [ABSTRACT FROM AUTHOR]

Published
2024
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9. Multi-Compartment Profiling of Bacterial and Host Metabolites Identifies Intestinal Dysbiosis and Its Functional Consequences in the Critically Ill Child

Author

Wijeyesekera, Anisha, Wagner, Josef, De Goffau, Marcus, Thurston, Sarah, Rodrigues Sabino, Adilson, Zaher, Sara, White, Deborah, Ridout, Jenna, Peters, Mark J., Ramnarayan, Padmanabhan, Branco, Ricardo G., Torok, M. Estee, Valla, Frederic, Meyer, Rosan, Klein, Nigel, Frost, Gary, Parkhill, Julian, Holmes, Elaine, and Pathan, Nazima

Published
2019
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10. A Cross Sectional Survey-Based Study to Investigate the Availability and Utilisation of Home Nutrition Support in Saudi Arabia

Author

Zaher,Sara, Ajabnoor,Sarah M, Zaher,Sara, and Ajabnoor,Sarah M

Abstract

Sara Zaher,1,2 Sarah M Ajabnoor2,3 1Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia; 2National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi FDA), Riyadh, Saudi Arabia; 3Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi ArabiaCorrespondence: Sara Zaher, Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Saudi Arabia, Email Sz332@cam.ac.uk; szaher@taibahu.edu.saBackground and Aims: Many patients require long-term nutrition support, typically in the form of home nutrition support (HNS). The availability and utilisation of HNS in Saudi Arabia is currently unknown; therefore, this study was conducted to assess the availability of HNS in Saudi hospitals and to explore factors associated with the availability of HNS in different healthcare facilities in Saudi Arabia.Methods: A cross-sectional study was conducted among physicians, dietitians, and pharmacists working in Saudi Arabia with regular practice in nutrition support. Data was collected through self-administered web-based survey, which was distributed via social-media platforms.Results: A total of 114 responses were received from healthcare providers involved in nutrition support across Saudi Arabia. Of the respondents, 55 (48.2%) indicated that nutrition support services were available at their facility. Regression analysis showed that other regions in Saudi Arabia had lower odds of having HNS compared with the Western region (OR=0.01; 95% CI=0.01– 0.69). The university and specialised hospitals had lower odds of having HNS compared with Ministry of Health hospitals (OR=0.11; 95% CI=0.02− 0.71, OR=0.11; 95% CI=0.02− 0.56, respectively). Hospitals with capacities of 100– 250 beds and 251– 500 had higher odds of having HNS than smaller hospitals (OR=13.17; 95% CI=1.09– 159.5, OR=3.11; 95% CI=2.04– 248.7

Published
2023

11. A Cross Sectional Survey-Based Study to Investigate the Availability and Utilisation of Home Nutrition Support in Saudi Arabia [Corrigendum]

Author

Zaher,Sara, Ajabnoor,Sarah M, Zaher,Sara, and Ajabnoor,Sarah M

Abstract

Zaher S, Ajabnoor SM. J Multidiscip Healthc. 2023;16:41–50. The authors have advised the affiliation list on page 41 is incorrect. The correct author list and affiliations are as follows. Sara Zaher,1,2 Sarah M Ajabnoor3 1Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Saudi Arabia; 2National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi FDA), Riyadh, Saudi Arabia; 3Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia

Published
2023

14. A Snapshot of the Experience of Dietitians during the COVID-19 Crisis in Five Arab Countries: Findings from a Regional Cross-Sectional Study

Author

Bookari, Khlood, primary, Arrish, Jamila, additional, Zaher, Sara, additional, Alkhalaf, Majid, additional, Alharbi, Mudi, additional, Alkhattaf, Najla, additional, Harb, Ziad, additional, Al Hinai, Eiman, additional, Alanqodi, Nahla, additional, Almajed, Sana, additional, Aldwarji, Maryam, additional, Alqaoud, Nawal, additional, Elati, Jalila, additional, and Hoteit, Maha, additional

Published
2022
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18. Barriers to Delivery of Enteral Nutrition in Intensive Care Settings in Saudi Arabia: A Comparative Study of the Perceptions of Health Care Providers Working in Adult and Paediatric ICUs

Author

Zaher,Sara and Zaher,Sara

Abstract

Sara Zaher1,2 1Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, Madinah, Kingdom of Saudi Arabia; 2National Nutrition Committee (NNC), Saudi Food and Drug Authority (Saudi FDA), Riyadh, Saudi ArabiaCorrespondence: Sara Zaher, Clinical Nutrition Department, Faculty of Applied Medical Sciences, Taibah University, P.O. Box 344, Madinah, 42353, Kingdom of Saudi Arabia, Email Sz332@cam.ac.uk; szaher@taibahu.edu.saBackground and Aims: Achieving optimal nutrition prescription is challenging in critically ill patients. Many factors can hinder the adequate delivery of enteral nutrition (EN) in intensive care units (ICUs). In this study, we aim to describe EN barriers and compare the perceptions of health care practitioners working in adult and paediatric ICUs regarding these barriers.Methods: In this cross-sectional study, data were collected via online survey. All physicians, dietitians, and nurses working in adult or paediatric ICUs across Saudi Arabia were eligible to participate. The survey contained 24 potential EN barriers and participants were asked to rate their importance on a scale from 1 to 5. A total Likert rating score of the 24 items was later calculated.Results: We recruited 244 health care providers working in adult and paediatric ICUs. The most important perceived barriers were “Delay in physician ordering EN initiation” (3.33 ± 1.32), and ‘Waiting for dietitians to assess patients’ (3.22 ± 1.20). There was a statistical difference between the responses of health care providers based on their work settings for the following items; “Nurses failing to progress feeds according to feeding protocol” (p=0.006) and ‘Feeding being held too far prior procedures or operating-room visits’ (p=0.021). Profession significantly influenced the total Likert rating score of the 24 items (r=− 0.234, p=0.001).Conclusion: This study identified some barriers of EN delivery in ICUs and showed that participants’ perception

Published
2022

22. Association between enteral macronutrient delivery and inflammatory response in critically ill children

Author

Zaher, Sara, White, Deborah, Ridout, Jenna, Valla, Frederic, Branco, Ricardo, Meyer, Rosan, Pathan, Nazima, Pathan, Nazima [0000-0002-9447-4252], and Apollo - University of Cambridge Repository

Subjects
Inflammation, Adolescent, Critical Illness, Enteral feeding, Malnutrition, Infant, Newborn, Infant, Underfeeding, Nutrients, Dietary Fats, Respiration, Artificial, Enteral Nutrition, Treatment Outcome, Child, Preschool, Dietary Carbohydrates, Cytokines, Humans, Macronutrients, Prospective Studies, Child
Abstract

BACKGROUND AND AIMS: An important goal of nutrition support in paediatric critical illness is minimising catabolism. While focussing on providing full energy requirements, macronutrient balance is often neglected. Studies suggest that there is interplay between nutrition and inflammation. We aimed to assess the amount of enteral macronutrients delivered compared to estimated requirements, and the association between delivered macronutrients and systemic inflammation in critically ill children. METHOD: We prospectively evaluated energy and macronutrient intake in critically ill children who required at least 72 h of mechanical ventilation. Data on enteral energy and macronutrient intake was collected and expressed as a percentage of the estimated requirements. Circulating levels of inflammatory cytokines were measured by ELISA and association assessed with delivery of macronutrients from the previous 24 h. RESULTS: A total of 87 children (0-16 years) were included in this study. By day 3 the median (IQR) intake of energy, fat, carbohydrate (CHO) and protein were 75% (50-103), 85% (43-120), 63% (42-102) and 45% (23-65) respectively. We have also shown that delivery of enteral fat and protein was associated with elevation in the levels of tumour necrosis factor alpha (TNF-α) and interleukin-6 (IL-6). CONCLUSION: The inflammatory response in critically ill children is influenced by the amount of enteral fat and protein delivered. Our data suggests that within the feed delivered, fat is often higher than protein and CHO. It is crucial to take into account the proportion of macronutrients required and not only aim to achieve the energy goal.

Published
2018
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24. Pilot Study to Investigate Enteral Feeding Practices and the Incidence of Underfeeding Among Mechanically Ventilated Critically Ill Patients at a Specialist Tertiary Care Hospital in Saudi Arabia.

Author

Zaher, Sara A., AL‐Subaihi, Raghad, AL‐Alshaya, Aeshah, AL‐Saggaf, Manar, AL Amoudi, Mariam O., Babtain, Hala, and Neyaz, Arwa

Subjects
ARTIFICIAL respiration, ENTERAL feeding, CRITICALLY ill, TERTIARY care, NUTRITIONAL requirements
Abstract

Background: Enteral nutrition (EN) is an essential therapeutic intervention. Many studies internationally have reviewed feeding practices in intensive care units (ICUs) and recorded the incidence of underfeeding in these settings, yet none were performed in the Middle East, including Saudi Arabia. The purpose of the study is to assess the adequacy of EN delivery and investigate the enteral feeding practices in the ICU at a specialized tertiary care hospital in Saudi Arabia. Methods: In this observational study, we prospectively monitored energy and protein delivery for 6 consecutive days in critically ill patients. Malnutrition was assessed by Nutrition Risk Screening (NRS‐2002) scores. Underfeeding was identified by comparing the intake against the calculated requirements. Patients were categorized into early and late EN starters to investigate whether the time of EN initiation impacts the cumulative nutrition intake. Results: This study included 43 patients. About 44% (19 of 43) of the patients were malnourished on admission to ICU, and the prevalence of underfeeding was >90%. The median cumulative intake of energy and protein was 39% and 31% of the estimated requirements, respectively. Patients who started early EN had statistically higher cumulative energy and protein intake (P‐value =.00). Patients treated with inotropes received less energy and protein compared with those who did not receive inotropes (P‐value =.00). Higher NRS‐2002 score was associated with fewer ventilation‐free hours (r = −0.369, P‐value =.045). Conclusion: Protein underfeeding remains a significant problem in ICU settings. The time of EN initiation plays a major role in determining when the nutrition requirements will be met. Therefore, it is crucial to implement effective feeding protocols to ensure early initiation of EN when permissible. [ABSTRACT FROM AUTHOR]

Published
2021
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25. CONFUSION BREEDS CONFUSION.

Author

ZAHER, SARA

Abstract

The article discusses visual art and design photography. Topics include visual art done through photography, digital collage, and photo manipulation to create a new narrative, and purpose is to encourage the viewer to question the place in silly, superficially satisfying, and sometimes destructive relationship.

Published
2019

26. SARA ZAHER.

Author

Zaher, Sara

Subjects
IDENTITY (Psychology) in art, SATIRE in art
Published
2019

27. Effect of nutrition status and inflammatory stimuli on ghrelin and peptide-YY levels among critically ill children: A prospective and observational study

Author

Sara Zaher, Deborah White, Jenna Ridout, Ricardo Garcia Branco, Rosan Meyer, Nazima Pathan, Zaher, Sara [0000-0002-7478-0113], and Apollo - University of Cambridge Repository

Subjects
Inflammation, Nutrition and Dietetics, PYY, pediatrics, Critical Illness, digestive, oral, and skin physiology, Medicine (miscellaneous), Nutritional Status, ghrelin, enteral nutrition, Humans, Peptide YY, Prospective Studies, Child, hormones, hormone substitutes, and hormone antagonists
Abstract

BACKGROUND: Ghrelin and peptide-YY (PYY) are two gut peptides with apparent opposing actions. In normal conditions, ghrelin and PYY work together in synergy to regulate energy homeostasis. During critical illness, series of metabolic, endocrine, and inflammatory changes take place in response to a severe insult. Emerging studies recorded alterations in gut hormone levels in critically ill adults. This study aims to assess the effect of inflammation, nutrition, and feeding status on ghrelin and PYY levels in critically ill children. METHODS: In this prospective study, we collected blood samples from critically ill children on days 2 or 3 of pediatric intensive care unit (PICU) admission for the analysis of serum ghrelin, PYY, and inflammatory markers. Data related to the intake anthropometry, as well as other clinical data, were collected from patients' records. Multiple linear regression analysis was used to identify factors affecting serum levels of these hormones. RESULTS: Forty-two children admitted to the PICU were included in this study. Ghrelin level was influenced by admission nutrition status of the children and age. PYY was influenced by macronutrient intake and age. Inflammatory markers also showed an association with the measured levels of these hormones, with C-reactive protein being positively associated with ghrelin levels and tumor necrosis factor alpha showing a positive association with PYY levels. CONCLUSION: Although ghrelin and PYY have been linked to feeding status in healthy patients, during critical illness there might be other factors, such as inflammation and nutrition status, that might contribute to the changes observed in ghrelin/PYY profiles.

Published
2022

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