Jane Ziegler

Impact of Standardized Feeding Guidelines on Enteral Nutrition Administration, Growth Outcomes, Metabolic Bone Disease, and Cholestasis in the NICU

Objectives: The objectives of this study were to determine whether the implementation of standardized feeding guidelines (SFGs) in a neonatal intensive care unit had an impact on the administration of enteral nutrition, growth, and bone and liver health. Methods: This was a retrospective chart review of infants ⩽32 weeks’ gestation and ⩽1500 g at birth who received enteral nutrition either via traditional care (TC) or via SFGs. The outcomes of the study were to determine the day of life the first enteral feedings were started, the day of life full, fortified enteral feedings were established, the day of life the infant returned to birth weight, the change in weight z score from birth to day of life 30, and the presence of metabolic bone disease and cholestasis. Results: There were 128 infants in the TC group and 125 infants in the SFG group. Based on the Cox regression, no significant differences were found between the 2 groups in the length of time to the first feed (P = 0.110; CI 1.03–1.70), in the length of time to full, fortified enteral feedings (P = 0.334; CI 0.87–1.44), in the length of time to return to birth weight (P = 0.545; CI 0.77–1.28), incidence of metabolic bone disease (P = 0.990), or incidence of cholestasis (P = 0.926). Conclusions: This study provides preliminary evidence that SFGs have an effect on enteral nutrition administration, growth, and morbidity for preterm infants. Although the findings were not statistically significant, they are clinically relevant.

Lingzhi and Cordyceps Two Commonly Used Chinese Medicinal Herbs, Safe or Not?

One principal practice of traditional Chinese medicine (TCM) is preventive treatment or predisease intervention. People who are influenced by the TCM culture, especially people of Chinese descent, may use medicinal herbs in cooking or take dietary supplements to maintain health and prevent diseases. The cultural beliefs of consuming medicinal plants for health can affect people’s choice in using dietary supplements. Lingzhi (Ganoderma lucidum) and Cordyceps (Cordyceps sinensis) are 2 commonly used TCM herbs. The purpose of this article is to raise the awareness about the potential benefits and risks for patients using these 2 TCM herbs.

Pregnancy, Child Nutrition, and Oral Health

Adequate nutritional status prior to and during pregnancy supports the development of oral health in infants and children Recommended infant feeding practices, introduction of foods, and healthful dietary choices promote optimum growth and development and decreased risk of early childhood caries Caries in children is associated with multiple dietary factors including frequent fermentable carbohydrate consumption Poor oral health in children with childhood disorders and diseases is associated with possible increased risk for malnutrition and growth impairment

Dental considerations for patients taking weight-loss medications

BACKGROUND In this article, the authors examine prescription weight-loss medications and related dental considerations for oral health care professionals (OHCPs). The authors focus on the most common prescription weight-loss drugs and their potential interactions with medications frequently used in dental practice, and they include recommendations for modification in patient care. METHODS The authors reviewed the literature regarding interactions between weight-loss drugs and medications commonly used in dentistry, including patient-treatment considerations. They also address the interactions of greatest clinical concern that have a high-quality evidence-based foundation in either randomized controlled clinical trials or meta-analyses. CONCLUSIONS Dental treatment can be performed and medications commonly used in dentistry can be administered safely to patients taking orlistat, an inhibitor of fat absorption. The same may not be true, however, for other weight-loss medications that modify the central nervous system neurotransmission of norepinephrine, dopamine or serotonin. OHCPs should be aware of the potential theoretical and pharmacokinetic risks relative to the actual clinical and reported risks for hypertension and cardiotoxicity in particular. PRACTICAL IMPLICATIONS Recognition and avoidance of potential weight-loss drug interactions, especially those with medications commonly used in dentistry, can help clinicians optimize patient treatment while emphasizing patient safety.

Is Energy Expenditure of Infants Predictable After Surgery? A Review of the Evidence

Infants undergoing surgery have unique metabolic demands. The stress of an operation and recovery combined with expectations for growth and development imply elevations in energy expenditure beyond that of healthy, free-living infants. In contrast, surgery may trigger a diversion of energy utilization from tissue accumulation and growth toward the catabolic stress response and cytokine production. Predictive equations are commonly used in clinical settings to estimate basal or resting energy expenditure because measurement techniques such as indirect calorimetry may not be feasible or available. Investigations of measured energy expenditure in surgical infants have portrayed mixed results, however, and estimation equations may not consistently lead to accurate assessment of actual energy needs. Studies are limited in number and quality and often involve a heterogeneous, small population. Grouped outcomes may conceal the wide variability frequently observed in these studies. Measurement of energy expenditu...

Nutritional and dental issues in patients with intellectual and developmental disabilities

BACKGROUND People with intellectual and developmental disabilities are among the most disadvantaged and underserved groups of dental patients. Considerable health care disparities for this population have been identified, particularly oral and dental health as well as access to dental care services. People with Down syndrome and cerebral palsy have a variety of nutritional and dental considerations. CONCLUSIONS These people have a higher prevalence of untreated caries and periodontal disease than the general population and may have higher rates of obesity, edentulism, and chronic oral and systemic diseases. Diet choices may affect the oral health and may play an important role in the systemic health of these people. Suggestions to improve and affect dietary intake are provided. CLINICAL IMPLICATIONS Health issues within this population require a holistic approach to care. Concerns about oral health and diet must be addressed to support optimal health.

Managing Complexity in Evidence Analysis: A Worked Example in Pediatric Weight Management

Nutrition interventions are often complex and multicomponent. Typical approaches to meta-analyses that focus on individual causal relationships to provide guideline recommendations are not sufficient to capture this complexity. The objective of this study is to describe the method of meta-analysis used for the Pediatric Weight Management (PWM) Guidelines update and provide a worked example that can be applied in other areas of dietetics practice. The effects of PWM interventions were examined for body mass index (BMI), body mass index z-score (BMIZ), and waist circumference at four different time periods. For intervention-level effects, intervention types were identified empirically using multiple correspondence analysis paired with cluster analysis. Pooled effects of identified types were examined using random effects meta-analysis models. Differences in effects among types were examined using meta-regression. Context-level effects are examined using qualitative comparative analysis. Three distinct types (or families) of PWM interventions were identified: medical nutrition, behavioral, and missing components. Medical nutrition and behavioral types showed statistically significant improvements in BMIZ across all time points. Results were less consistent for BMI and waist circumference, although four distinct patterns of weight status change were identified. These varied by intervention type as well as outcome measure. Meta-regression indicated statistically significant differences between the medical nutrition and behavioral types vs the missing component type for both BMIZ and BMI, although the pattern varied by time period and intervention type. Qualitative comparative analysis identified distinct configurations of context characteristics at each time point that were consistent with positive outcomes among the intervention types. Although analysis of individual causal relationships is invaluable, this approach is inadequate to capture the complexity of dietetics practice. An alternative approach that integrates intervention-level with context-level meta-analyses may provide deeper understanding in the development of practice guidelines.

Body Composition in Adults With Intellectual Disabilities: Implications for Practice

Health care professionals require increased knowledge of health and disabilities to effectively implement health promotion initiatives at both the individual and group level for adults with intellectual disabilities (ID). The aim of this review is to examine the feasibility, reliability, and validity of various field-based measurements to assess body composition among adults with ID as compared to nondisabled controls. The literature was systematically searched from 1990 to 2017 for primary articles pertaining to the subject matter that were published in the English language and included only individuals ≥18 years of age. 1,989 studies were screened and 8 studies were included for review. Several field-based measurements for body composition are feasible and reliable yet none have been validated for use in adults with ID. Awareness of the various methods for assessing body composition in adults with ID in clinical practice, while simultaneously understanding their limitations, is necessary.

Role of Probiotics in Managing Gastrointestinal Dysfunction in Children with Autism Spectrum Disorder: An Update for Practitioners

Children with autism spectrum disorder (ASD) are 4 times as likely to experience gastrointestinal symptoms as children without ASD. The gut microbiota has increasingly been the subject of investigation as a contributing factor to these symptoms in this population because there is evidence to suggest that alterations in the intestinal microflora are correlated with gastrointestinal and ASD symptom severity. Probiotic therapy has been proposed as a treatment for augmented gastrointestinal symptom severity in children with ASD. This narrative review systematically searched the literature to provide an update for practitioners on the state of the evidence surrounding probiotic therapy in children with ASD as a treatment option for reducing gastrointestinal symptoms. A total of 186 articles were screened and 5 articles met the inclusion criteria. A collective sample of 117 children with ASD is represented and outcomes addressed include improvement in gastrointestinal symptoms as well as influence of probiotic supplementation on the gut microbiota and ASD symptoms and behavior. There is promising evidence to suggest that probiotic therapy may improve gastrointestinal dysfunction, beneficially alter fecal microbiota, and reduce the severity of ASD symptoms in children with ASD. Future research is still warranted in this area because there are methodologic flaws in the available literature and optimal species, strains, dosages, and duration of treatment have not been identified.

Antibiotic Treatment of Small Intestinal Bacterial Overgrowth: What Is the Evidence?

Small intestinal bacterial overgrowth (SIBO) is characterized by an abnormally high concentration of bacteria in the small bowel, and is often associated with abdominal pain, bloating, and/or stool changes. Antibiotics, prebiotics, and probiotics have been considered as treatment options for individuals with SIBO. The aim of this literature review was to evaluate the evidence supporting antibiotic therapy for SIBO treatment. A systematic search of PubMed, Cochrane Library, and Web of Science databases was performed, and 13 studies were included for analysis. The analysis of the available data suggests that antibiotics, particularly rifaximin, may be effective in normalizing breath tests and improving gastrointestinal symptoms in patients with SIBO.