Teruyoshi Amagai

Nutrition Assessment as a Predictor of Clinical Outcomes for Infants With Cardiac Surgery Using the Prognostic Nutritional Index

BACKGROUND The aim of the present study was to determine whether nutrition assessment helps predict clinical outcomes (COs) in infants who have undergone cardiac surgery. METHODS Study subjects were infants, aged less than 18 months, who had undergone cardiac surgery between April 2007 and August 2008. The nutrition parameters assessed include Onoderas prognostic nutritional index (PNI), height for age, weight for height, and weight for age. COs included mortality rate during hospitalization, length of stay in intensive care unit (LOS-1), length of stay in the hospital after surgery (LOS-2), and duration of mechanical ventilation support. Method-1: the correlation between nutrition parameters and COs was examined by statistical analysis. Method-2: the cutoff point of nutrition parameters was determined using the minimum P value approach. RESULTS The following results were obtained: Results-1: PNI was the only nutrition parameter found to be correlated with LOS-1. Results-2: the cutoff point for PNI as a predictor of LOS-1 was 55. CONCLUSIONS It appeared that preoperative PNI was the most influential factor on LOS-1 for infants after they underwent cardiac surgery. The PNI cutoff point 55 in infants who underwent cardiac surgery seems to be the best predictor of CO.

Changes of energy metabolism, nutritional status and serum cytokine levels in patients with Crohn’s disease after anti-tumor necrosis factor-α therapy

We investigated the effects of treatment with antibodies against tumor necrosis factor (TNF)-α on energy metabolism, nutritional status, serum cytokine levels in patients with Crohn’s disease (CD). Twelve patients were enrolled. Resting energy expenditure (REE) levels were measured by indirect calorimetry. Crohn’s disease activity index (CDAI) significantly decreased after treatment with anti-TNF-α therapy. Anti-TNF-α therapy did not affect REE, but respiratory quotient (RQ) significantly increased after treatment. Serum interleukin-6 levels were significantly decreased and RQ were significantly increased in high REE (≥25 kcal/kg/day) group as compared to low REE (<25 kcal/kg/day) group. In conclusion, high REE value on admission is a predictive factor for good response to treatment with anti-TNF-α antibodies in active CD patients.

Determinant factors of the viscosity of enteral formulas: basic analysis of thickened enteral formulas.

BACKGROUND Thickened enteral formula (TEF), which is made by adding thickener to enteral formula, has been used mainly in Japan to reduce the incidence of clinical complications associated with enteral nutrition. However, the optimal viscosity of TEF needed to achieve a high efficiency is different for each medical complication and for individual patients. METHODS The viscosity of TEF, which consists of enteral formula and thickener, was determined by 5 factors: (1) formula energy density, (2) formula temperature, (3) stirring speed, (4) stirring time, and (5) time elapsed since preparation. Then, the changing index (CI) was calculated for each of the 5 factors to determine which exerts the most influence on TEF viscosities. RESULTS The most influential factor (CI ≥-50%) for the decrease in TEF viscosity was formula energy density. In contrast, the most influential factors (CI ≥50%) for the increase in TEF viscosity were stirring time and time elapsed since preparation. CONCLUSION The results of this study indicate that formula energy density, stirring time, and time elapsed since preparation are the most influential factors to consider during manipulation of TEF viscosity.

Intestinal Starvation is Associated with Diarrhea in Older Adult Patients after Percutaneous Endoscopic Gastrostomy(PEG) Creation

Intestinal Starvation is Associated with Diarrhea in Older Adult Patients after Percutaneous Endoscopic Gastrostomy (PEG) Creation Percutaneous endoscopic gastrostomy (PEG) creation is generally recognized to be an easier and safer procedure for creating an enteral route than the open surgery procedure for nutritional supports. However, all enteral nutrition support is associated with gastro-intestinal-related complications such as diarrhea and constipation. Here, we clarified the prevalence of diarrhea and constipation after PEG insertion as less invasive procedure in an older adult (>60 years old) population and determined factors which influence it.

The application of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy tubes by the intermittent or bolus methods: a single-center, retrospective chart review

BACKGROUND While previous studies have reported that feeding protocols improved clinical outcomes in critical care settings, the evidence supporting the application of feeding protocols in older patients has not yet been assessed. Here, we evaluated the effects of a feeding protocol in older patients fed through percutaneous endoscopic gastrostomy (PEG) tubes. METHODS We conducted a retrospective chart review of 109 patients aged >=65 who underwent PEG placement between April 2010 and March 2012 at a single acute care hospital. The protocol group was administered enteral nutrition (EN) according to a feeding protocol, while the non-protocol group was administered EN at the attending physicians discretion. RESULTS Length of hospital stay (LOS) overall and after EN initiation were significantly shorter in the protocol group than in the non-protocol group. (LOS: p=0.001; LOS after EN initiation: p=0.026). During the second week after EN initiation, significantly fewer patients had percutaneous oxygen saturation (SpO2) <93% and required oxygen therapy in the protocol group (p=0.032 for both comparisons). Nutrition intakes via PEG in the protocol group were significantly greater from Days 6 to 13 for energy and from Days 6 to 11 for protein compared with the non-protocol group. CONCLUSION The application of a feeding protocol after PEG placement in older patients was associated with shorter LOS, more efficient EN delivery, and lower incidence of low SpO2 than non-protocol group. Larger prospective studies are required to determine whether a feeding protocol is useful in improving health outcomes in this population.

Which Is More Effective to Prevent Enteral Nutrition–Related Complications, High- or Medium-Viscosity Thickened Enteral Formula in Patients With Percutaneous Endoscopic Gastrostomy? A Single-Center Retrospective Chart Review

BACKGROUND Administration of thickened enteral formula (TEF) through a percutaneous endoscopic gastrostomy (PEG) tube is becoming a common practice in Japan to prevent enteral nutrition (EN)-related complications. However, what constitutes an adequate viscosity of TEF remains unclear. The aim of this study was to examine the clinical effects of TEFs with different viscosities administered through PEG. METHODS The subjects were 50 patients admitted to a single institution who underwent PEG placement. Viscosities of TEFs frequently administered to the patients were measured, and EN-related complications, nutrition intakes, and clinical outcomes were compared between high- and medium-viscosity TEFs during the first 2 weeks after TEF feeding initiation. RESULTS The measured viscosities of high- and medium-viscosity TEFs were 10,382 ± 931 and 3492 ± 296 mPa·s, respectively. Protein and fluid intakes with TEF were significantly less in the high-viscosity group. There was no significant difference in EN-related complications, energy intakes, or clinical outcomes between high- and medium-viscosity TEFs. CONCLUSION In this study, high-viscosity TEFs showed no statistical difference in either EN-related complications or clinical outcomes, in comparison with medium-viscosity TEF.

Low Energy Intake During the First Week in an Emergency Intensive Care Unit Is Associated With Reduced Duration of Mechanical Ventilation in Critically Ill, Underweight Patients A Single-Center Retrospective Chart Review

BACKGROUND Although nutrition support is essential in intensive care units, optimal energy intake remains unclear. Here, we assessed the influence of energy intake on outcomes of critically ill, underweight patients. METHODS A retrospective chart review was conducted in patients with body mass index (BMI) of <20.0 kg/m(2) in an emergency intensive care unit (EICU). Patients were categorized into 4 groups by initial Sequential Organ Failure Assessment score (I-SOFA) and average daily energy intake during the first week: group M-1, I-SOFA ≤8 and <16 kcal/kg/d; group M-2, I-SOFA ≤8 and ≥16 kcal/kg/d; group S-1, I-SOFA >8 and <16 kcal/kg/d; and group S-2, I-SOFA >8 and ≥16 kcal/kg/d. RESULTS The study included 51 patients with a median age of 69 years. No significant differences were noted in all-cause mortality and length of stay in the EICU and hospital between groups M-1 and M-2 or groups S-1 and S-2. The mechanical ventilation duration (MVD) was significantly shorter in group M-1 than M-2 (2.7 [1.0-5.7] vs 9.2 [4.2-17.4] days; P = .040) and in group S-1 than S-2 (3.1 [0.7-6.0] vs 8.8 [6.1-23.1] days; P = .006). The number of patients who underwent tracheostomy in hospital was significantly lower in group S-1 than in S-2 (20% vs 32%; P = .002). Multivariable analyses to adjust for confounders revealed that average energy intake during the first week in EICU was a significant factor independently associated with MVD but not with the requirement of tracheostomy. CONCLUSION Reduced energy intake during the first week in EICU was associated with a reduced MVD in clinically ill patients with BMI <20.0 kg/m(2).

High Serum Essential Amino Acids as a Predictor of Skeletal Muscle Depletion in Patients With Cachexia and Advanced Gastrointestinal Cancers

Background: In recent years, the number of patients with cancer has increased. These patients are prone to sarcopenia as a result of the decrease in muscle mass and muscle weakness that occur in cancer cachexia. Amino Index Cancer Screening is carried out to evaluate cancer cachexia risk by examining amino acid concentration and analyzing amino acid balance. Methods: We conducted a retrospective chart review of consecutive patients with unresectable advanced gastrointestinal cancer (stage IV) receiving chemotherapy treatment (December 2012–September 2015) in an outpatient or in-hospital setting at our institution (N = 46). Data included characteristics, psoas muscle area per computed tomography, and biochemical blood test and serum amino acid profiles. Method 1: Comparison of biomarkers between 2 groups: psoas muscle index change rate (&Dgr;PMI) decrease vs increase. Method 2.1: Correlation between &Dgr;PMI and biomarkers. Method 2.2: Multiple regression of &Dgr;PMI and biomarkers. Results: EAA/TAA ratio (essential amino acids/total amino acids) in the decrease group was significantly higher than that in the increase group. Among all parameters, serum C-reactive protein (CRP), leucine, and isoleucine were negatively related to &Dgr;PMI (correlation coefficients = −0.604, −0.540, −0.518; P = .004, .011, .016, respectively). On multiple regression analysis, serum CRP value was strongly related to &Dgr;PMI (r2 = 0.452, &bgr; = −0.672, P = .001). Conclusions: Higher serum EAA/TAA ratio and CRP were associated with depletion in psoas muscle area, which led to a diagnosis of sarcopenia, in patients with advanced gastrointestinal cancers. These parameters at baseline could be predictors of cancer cachexia.

Determination of the cut-off point of the Functional Independence Measure as a predictor of adverse events in patients with acute stroke

Objective This study was performed to determine the cut-off point of the Functional Independence Measure (FIM) to discriminate patients with acute stroke who develop adverse events during their stay in a stroke care unit (SCU). Methods All consecutive patients with stroke admitted to a single institute from January to March 2015 were enrolled. They were divided into two groups according to their average daily energy intake in the SCU: ≥66% or <66% of the target (high- and low-energy group, respectively). A receiver operating characteristic curve was used to determine the cut-off point of the FIM to predict adverse events in patients with acute stroke. Results The length of stay in the SCU was significantly longer and the serum C-reactive protein level (CRP) was significantly higher in the low- than high-energy group (7 vs. 4 days and 2.15 vs. 0.20 mg/dL, respectively). The total FIM score cut-off value was 63 points. Conclusions An energy intake of <66% of the target was associated with a significantly longer stay in the SCU and a higher CRP level. A total FIM score cut-off value of 63 points is useful to discriminate patients with adverse events among those with acute stroke.

Non-Protein Calorie: Nitrogen Ratio (NPC/N) as anIndicator of Nitrogen Balance in Clinical Settings

Teruyoshi Amagai*1, Mari Hasegawa1, Moeko Kitagawa2 and Seiji Haji3 1Department of Food Sciences and Nutrition, Mukogawa Women’s University, Japan 2Department of Clinical Nutrition, Kitano Hospital, Japan 3Department of Surgery, Takarazuka Iso Hospital, Japan Received: June 19, 2018; Published: June 25, 2018 *Corresponding author: Teruyoshi Amagai, Department of Food Sciences and Nutrition, Japan, Tel: ; Email: DOI: 10.26717/BJSTR.2018.06.001297 Teruyoshi Amagai. Biomed J Sci & Tech Res