Research

• Anthropometry - Powell-Tuck and Hennessy (2003)

  • found 7.1x increased risk of mortality in patients that had clinically significant weight loss (>10% over 3 months)
  • found 1.9x increased risk of longer length of stay in patients with >10% weight loss over 3 months
  • found that BMI <20kg/m2 was not associated with longer length of stay
  • found 6.4x increased risk of mortality in patients with MUAC <25
• Critical Care - ESPEN guidelines


  Energy expenditure should be determined using indirect calorimetry
• Critical Care - Zusman et al (2019)

  • Significant difference in REE between predictive equations and indirect calorimetry
• Critical Care - Graf et al (2017) 


  Found predictive equations with minute ventilation and body temperature had better correlations with indirect calorimetry
• Critical Care - Predictive Equations


  predictive equations are associated with up to 60% inaccuracy
• Cystic Fibrosis in Children - ESPEN

  evidence suggests that tube feeding improves weight gain, nutritional status and respiratory status according to ESPEN guidelines
• Cystic Fibrosis in Children - Cochrane Review (2019)


  could not find any studies eligible for inclusion to investigate efficacy of EN
• Short Bowel - Jeppesen & Mortensen (1998) 


  In Jejuno-colic anastomosis, substituting LCT with MCT increased fat and energy absorption
• Short Bowel - Nordgaard et al 1994


  In jejuno-colic anastomosis, a higher carbohydrate diet increased energy absorption
• Short Bowel - Woolf, Messing and Crenn 


  people with short bowel absorb 2/3 of oral energy and protein intake
• Acute Pancreatitis - Bourne et al (2021)


  Found patients had a mean decrease in weight of 12.2kg (14%) from pre-morbidity to discharge from hospital
• Acute Pancreatitis - NICE gudielines 


  Offer enteral nutrition within 72 hours of presentation in severe acute pancreatitis
• Acute Pancreatitis - Cochrane review (2010) 


  EN significantly reduced mortality, multiple organ failure, systemic infection and the need for operative interventions vs TPN
• Acute Pancreatitis - ESPEN (2022) 


  Route of feeding - NG unless patient has digestive intolerance, then NJ should be used
• Acute Pancreatitis - Cochrane review (2020) 


  Little to no difference in outcomes for severe acute pancreatitis patients between NG and NJ feeding routes
• Acute Pancreatitis - ESPEN 


  If PN is required, recommended to have at least a small amount of EN running, to prevent gut atrophy
• Acute Pancreatitis - Cochrane review (2015)

  • investigated different enteral feed formulations
  • no difference in outcomes between formulas
  • however investigated unique formulas like immunonutrition or added probiotic feeds
• Liver - Sarcopenia 


  Reported to occur in 30-70% of cirrhotic patients
• Diabetes - Ojo et al (2019)

  • all studies showed diabetes-specific feeds were effective in lowering blood glucose parameters
  • it improved glycaemic control and lowered insulin requirements
  • also provided better clinical outcomes, reduced risk of acquired infections, pressure ulcers, reduced body weight
  • DSF also lowered postprandial blood glucose compared to SF
  • but different studies observed different effects on lipid profiles
• Diabetes - Ojo et al (2019)


  Limitations:

  • old studies (1998 - 2009)
  • different feed formulas
  • different feeding modes
• HIV - REPRIEVE study (2023)

  • large international trial that randomised participants to daily pitvastatin or placebo, whilst all being given basic healthy eating and exercise advice annually
  • the primary outcome was a major CVD event
  • the incidence of CVD events was so much higher in the placebo group than statin group (hazard ratio 0.65) that the trial had to be stopped early after a median of 5 years
  • also found greater reduction in LDL and non-HDL cholesterol in statin group at 12 months
• HIV - Best Foods for your Heart (2021)

  • study investigated effect of Med Portfolio diet with low sat fat diet in people living with HIV experiencing dyslipidaemia
  • inclusion criteria was >3mmol/L LDL-C in stable HIV
  • randomised to either dietary advice of reducing saturated fat to <10% of energy intake or Mediterranean-style diet with choelsterol lowering foods (Portfolio, e.g. nuts, plant stanols, soy protein, soluble fibre)
  • primary outcome was attrition as this was a pilot study
  • but other outcomes included diet quality/adherence to Med/Portfolio diets, and blood lipid profiles
• HIV - Best Foods for your Heart (2021)

  • found Med/Portfolio diet was feasible and showed greater improvement in diet quality and blood lipid profile
  • diet scores in mediterranean diet and portfolio diets increased by a greater amount on the Med/Portfolio diet groups compared to low sat fat groups
  • LDL-C at 6 months was lower in the intervention group compared to low sat fat group
  • markers of CVD risk deteriorated in the low sat fat group over the 1 year follow up compared to markers improving in the intervention group over follow up
• Vitamin D and Sarcopenia


  Vitamin D deficiency is linked to reduced muscle contractile function in the general population
• NASH and sarcopenia


  NASH-related cirrhosis patients may be at increased risk of sarcopenia due to impacts of insulin resistance and chronic systemic inflammation
• Alcohol-associated cirrhosis and sarcopenia


  Patients with alcohol-associated cirrhosis were found to have the fastest rate of reduction in muscle compared to other aetiologies
• Aetiology of Liver Disease and Sarcopenia (DiMartini et al, 2013)


  80% of alcohol-induced cirrhosis patients had sarcopenia, compared to 60% with non-alcoholic steatohepatitis, Chronic Hepatitis C or autoimmune hepatitis
• Aetiology of Liver Disease and Sarcopenia


  Patients with alcohol-associated liver disease have been found to have a greater likelihood of sarcopenia
• Vitamin D and Sarcopenia


  There is limited evidence for the direct relationship between vitamin D and sarcopenia in cirrhosis
• Magnesium and Sarcopenia 


  Magnesium deficiency is exacerbated by diuretic use, and is associated with reduced muscle strength in cirrhotic adults
• Zinc and Sarcopenia


  Zinc is a co-factor in the urea cycle, and deficiency is associated with sarcopenia in cirrhosis
• Short Bowel - Crenn et al 2004



  Strong correlation between fat ingestion and absorption in jejunostomy, no benefit in following low fat intake
• Cystic Fibrosis - Calico Trial (2006)

  Found no significant impact on nutritional status in long term ONS use in moderately malnourished children

  Small sample size and incomplete follow-up