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Current application and indications of dietary medium-chain triglycerides in hospitalized patients: an investigation and evaluation

Rongrong LI ; Kang YU

Chinese Journal of Clinical Nutrition.2014;22(5):267-272. doi:10.3760/cma.j.issn.1674-635X.2014.05.002

Objective To analyze the current dietary application of medium-chain triglycerides (MCT) in hospitalized patients,and clarify the appropriate indications and the role of MCT in clinical practice through evidence-based evaluation.Method A retrospective analysis was conducted on 46 cases of hospitalized patients who were administered dietary MCT between January,2012 and December,2013 in Peking Union Medical College Hospital.Results Dietary MCT were utilized in a small but increasing number of patients,who distributed in departments of gastroenterology,pediatrics,pneumology,general internal medicine,and general surgery.37.0％ of the patients had malnutrition,while 56.5％ had hypoalbuminemia.The leading indications of MCT therapy were gastrointestinal dysfunction (21 cases) and lymph circulation disorder (15 cases),while dyslipidemia (5 cases),exocrine pancreatic insufficiency (4 cases),and intractable epilepsy (1 case) served as other indications of MCT administration.Conclusions The indications of current dietary MCT application are approximately consistent with evidence from literature.However,given the scarcity of relevant researches and limited clinical application,further clinical researches with larger samples on dietary MCT are needed to provide more high-quality evidences for guidance of clinical practice.

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Methods for the prevention of internal jugular vein malposition of peripherally inserted central catheter in patient with limited neck motion

Yanxian HE ; Sha XIAO ; Zhenhui GUO ; Fang LI

Chinese Journal of Clinical Nutrition.2014;22(5):317-320. doi:10.3760/cma.j.issn.1674-635X.2014.05.015

Objective To evaluate the methods for the prevention of internal jugular vein malposition of peripherally inserted central catheter (PICC) in patient with limited neck motion.Methods 210 patients who underwent PICC placement using ultrasound-guided modified Seldinger technique were divided into observation group (n =106) and control group (n =104) with a random number table.Ultrasound probe compression on the internal jugular vein was used in the observation group,while finger compression was used in the control group.The 2 groups were compared in terms of incidence of internal jugular vein malposition,accuracy of PICC tip position in X-ray,and incidence of complications.Results Incidence of PICC malposition was significantly lower in the observation group than the control group [3 (2.8％) vs.36 (34.6％),P =0.000].The accuracy of PICC tip position in both groups was 100％.No complication was observed in the observation group,while the rate of complication in the control group was 4.8％,with a statistically significant difference (P =0.022).Conclusion The ultrasound probe compression method can significantly lower the incidence of internal jugular vein malposition of PICC and is safer than the finger compression method.

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Effects of early enteral nutrition support on the nutritional status and outcomes of patients with post-stroke dysphagia

Yuhui LI ; Yuping PEI ; Min SUN

Chinese Journal of Clinical Nutrition.2014;22(6):334-338. doi:10.3760/cma.j.issn.1674-635X.2014.06.003

Objective To evaluate the effect of enteral nutrition support on the nutritional status and clinical outcomes of patiems with dysphagia after stroke.Methods 148 patients with acute stroke and associated dysphagia were enrolled from August 2013 to July 2014 in the Fifth Affiliated Hospital of Zhengzhou University,and randomly divided into 2 groups by drawing lots within 48 hours after admission:enteral nutrition group (n =75,early enteral nutrition support) and control group (n =73,routine diet).The nutritional status (triceps skinfold thickness,levels of serum total protein,albumin and hemoglobin),incidence of lung infection,mortality,and neurological function were compared between the two groups on day 1 and day 21 after admission.Results On day 1 after admission,the triceps skinfold thickness,levels of serum total protein,albumin,and hemoglobin in the enteral nutrition group were not significantly different from those in the control group [(15.4 ±4.1) mm vs.(15.1 ± 3.7) mm,t=1.36,P=0.392; (75.7±2.6) g/Lvs.(76.6±3.1) g/L,t=1.12,P=0.254; (39.2± 1.8) g/Lvs.(38.7±2.1) g/L,t=1.24,P=0.200; (137.4±14.5) g/Lvs.(135.1±15.3) g/L,t=1.01,P =0.461].On day 21 after admission,all the 4 nutrition indicators were significantly higher in the enteral nutrition group than in the control group [(13.5 ±3.9) mmvs.(11.2±4.6) mm,t=2.08,P=0.019; (63.3±4.1) g/Lvs.(57.1±4.7) g/L,t=4.01,P=0.001; (35.7±1.6) g/Lvs.(34.1± 2.0) g/L,t=2.31,P=0.022; (125.7 ±17.9) g/Lvs.(120.3 ±16.7) g/L,t=2.39,P=0.027].The enteral nutrition group showed lower incidence of lung infection,mortality,and reduced scores of American National Institutes of Health Stroke Scale compared with the control group (41.3％ vs.63.2％,x2 =9.69,P =0.002; 15.3％ vs.21.2％,x2=3.27,P=0.014; 11.1 ±4.1 vs.14.7 ±3.9,t=2.98,P=0.007).Conclusions Early enteral nutrition support can improve the nutritional status and outcomes of stroke patients with dysphagia.In addition,early enteral nutrition support may also be helpful for the improvement of the neurological function.

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Effect of energy balance on body weight in patients receiving peritoneal dialysis

Xinhong LU ; Chunyan SU ; Tao WANG

Chinese Journal of Clinical Nutrition.2014;22(6):343-347. doi:10.3760/cma.j.issn.1674-635X.2014.06.005

Objective To investigate the energy intakes and energy consumption in continuous ambulatory peritoneal dialysis (CAPD) patients,and to identify the possible influence factors for overweight and obesity of CAPD patients.Methods A total of 115 CAPD patients were enrolled from May to December 2011 in Peking University Third Hospital.Based on body mass index (BMI),they were divided into normal group (18.5 kg/m2 ≤ BMI < 24 kg/m2,n =61) and obese group (BMI ≥ 24 kg/m2,n =54).Three-day dietary intakes including dietary energy,protein,fat,and carbohydrates intakes were collected.Glucose absorption from dialysate was measured.Three-day activities were recorded for the calculation of resting energy expenditure (REE) and total energy expenditure (TEE).Body composition of the patients was analyzed.Results There were no significant differences in age,height,dietary energy intake,protein intake,carbohydrate intakes,lean tissue mass,and hydration status between the two groups.Glucose absorption from dialysate and dietary fat intake were significantly higher in the obese group than in the normal group [(1 920.5 ± 506.3) kJ/d vs.(1 673.6 ±535.6) kJ/d,x2 =2.536,P=0.013; (62.5 ±19.8) g/dvs.(53.1 ±18.7) g/d,x2=2.575,P =0.011].Although REE was higher in the obese group as compared with the normal group [(5 066.8 ±1 029.3) kJ/d vs.(4 556.4 ± 799.1) kJ/d,x2 =2.979,P =0.004],there was no significant difference in TEE between the two groups [(7 819.9 ±728.0) kJ/d vs.(7 803.2 ± 1 092.0) kJ/d,x2 =0.770,P =0.939].Logistic regression showed that glucose absorption from dialysate and dietary fat intakes were risk factors for obesity in the study population (OR =1.003,95％ CI =1.000-1.007,P =0.029 ; OR =1.024,95％ CI =1.003-1.046,P =0.027).Conclusions Obese CAPD patients may absorb more glucose from peritoneal dialysate and consume more fat than non-obese CAPD patients,but TEE is not significantly different.It indicates that obese CAPD patients are at positive energy balance.Less use of high glucose dialysate and more physical exercises are recommended for these patients.

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Correlation between serum magnesium and malnutrition-inflammation-atherosclerosis syndrome in maintenance hemodialysis patients

Ling YU ; Han LI ; Shixiang WANG

Chinese Journal of Clinical Nutrition.2014;22(6):348-353. doi:10.3760/cma.j.issn.1674-635X.2014.06.006

Objective To investigate the potential correlation between serum magnesium and malnutrition-inflammation-atherosclerosis (MIA) syndrome in maintenance hemodialysis (MHD) patients.Methods A total of 120 patients who received MHD in Department of Blood Purification of Beijing Chaoyang Hospital from March to August 2013 were enrolled.Anthropometric and laboratory data were collected for the analysis of correlation between serum magnesium and indicators relating to malnutrition,chronic inflammation,and atherosclerosis,and the analysis of relevant factors of MIA syndrome.Results In the 120 MHD patients,the mean serum magnesium level was (1.11 ±0.14) mmol/L.44 patients had malnutrition (36.7％),whose serum magnesium level was significantly lower than that of patients in normal nutritious status [(1.04 ±0.12) mmol/L vs.(1.14 ±0.15) mmol/L,t =3.576,P =0.001] ; 43 patients had chronic inflammation (35.8％),with serum magnesium level significantly lower than that of patients without inflammation [(1.07 ±0.13) mmol/L vs.(1.13 ±0.15) mmol/L,t =2.138,P =0.035]; 79 patients had atherosclerosis (65.8％),whose serum magnesium level was significantly lower than that of patients without atherosclerosis [(1.08 ±0.12) mmol/L vs.(1.15 ±0.08) mmol/L,t =0.385,P =0.019] ; and 26 patients had MIA syndrome (21.7％),whose serum magnesium level was significantly lower than that of non-MIA patients [(1.02 ± 0.10) mmol/L vs.(1.13 ± 0.14) mmol/L,t =3.534,P =0.001].Serum magnesium level was found negatively correlated with high-sensitivity C-reactive protein (hs-CRP,r =-0.237,P =0.010) and carotid intima-media thickness (IMT,r =-0.331,P =0.000),and positively correlated with serum albumin,blood urea nitrogen,serum creatinine,uric acid,serum potassium,triceps skin-fold thickness,mid-arm circumference,mid-arm muscle circumference and hemoglobin (r =0.191,P =0.037; r =0.345,P =0.000; r =0.242,P=0.008; r =0.282,P=0.002; r=0.254,P=0.005; r=0.265,P=0.011; r=0.233,P=0.018; r=0.282,P=0.007; r=0.374,P =0.000).Multivariate logistic regression analysis showed that age (OR =1.142,95％ CI =1.026-1.271,P=0.049),hs-CRP (OR=1.415,95％ CI=1.152-1.740,P=0.001),IMT (OR =1.386,95％ CI=1.009-1.904,P=0.044),serum albumin (OR =0.944,95％ CI=0.910-0.978,P=0.002) and serum magnesium (OR =0.886,95％ CI =0.788-0.996,P =0.042) were related factors of MIA syndrome.Conclusions Serum magnesium level is correlated to malnutrition,inflammation,atherosclerosis,and MIA syndrome in MHD patients.

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Effect of different concentrations of calpain inhibitor ALLN on proliferation and apoptosis of C2C12 myoblasts

Sizeng CHEN ; Zhiqiang DAI ; Chunfa WENG ; Qinglin YE

Chinese Journal of Clinical Nutrition.2015;23(1):35-40. doi:10.3760/cma.j.issn.1674-635X.2015.01.007

Objective To explore the effect of different concentrations of ALLN on proliferation and apoptosis of C2C12 myoblasts.Methods After intervention with Ca2+ and ALLN,methyl thiazolyl tetrazolium and flow cytometry were used to determine the effect of Ca2+ and ALLN on the proliferation and apoptosis of C2C12 cells,respectively.The morphological changes of C2C12 myoblasts were observed using Giemsa staining.Results The absorbance of Ca2 + group was significantly lower than that of the control group (P ＜0.05).After 6,12,24,36 hours of intervention,the absorbance in ALLN groups 1 to 7 (cultured in serum-free media containing 16 mmol/L Ca2+ and ALLN at final concentrations of 3.125,6.25,12.5,25,50,100,200 μmol/L) were all significantly higher than that in the 16 mmol/L Ca2+ group (after 6 hours:0.449±0.024,0.472±0.022,0.513 ±0.008,0.540±0.014,0.588±0.016,0.607±0.030,0.700±0.020 vs.0.355 ±0.012,all P =0.000; after 12 hours:0.407 ±0.007,0.414 ±0.006,0.434 ±0.004,0.441 ±0.003,0.460 ±0.010,0.484 ± 0.006,0.525 ± 0.006 vs.0.368 ± 0.027,all P =0.000; after 24 hours:0.436±0.005,0.431 ±0.015,0.441 ±0.006,0.459 ±0.013,0.527 ±0.009,0.581 ±0.005,0.599 ±0.011 vs.0.386 ± 0.007,all P =0.000 ; after 36 hours:0.464 ± 0.022,0.460 ± 0.018,0.461 ± 0.007,0.434 ± 0.020,0.454 ± 0.028,0.479 ± 0.006,0.524 ± 0.011 vs.0.379 ± 0.011,all P =0.000),while no significant differences were observed after 48-72 hours of intervention.After treatment for 36 hours,the apoptosis rate in ALLN 10,50,100,and 200 μmol/L groups were (6.00 ± 1.20) ％,(5.02 ± 1.13) ％,(4.89±1.11)％,and (2.71 ± 1.15)％,all significantly lower than that in the Ca2+ group [(13.70 ±2.30)％] (all P =0.000).Giemsa staining showed apoptotic morphological changes in the Ca2+ group,which were obviously alleviated in the ALLN group.Conclusions Ca2+ at a concentration of 16mmol/L can induce apoptosis of C2C12 cells.In contrast,ALLN can inhibit cell apoptosis and promote proliferation in a time-and dose-dependent manner.

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Effects of maternal vitamin D deficiency on mother and children

Mingxu ZHANG ; Lei LI

Chinese Journal of Clinical Nutrition.2015;23(1):60-64. doi:10.3760/cma.j.issn.1674-635X.2015.01.013

Vitamin D is a kind of fat-soluble vitamins essential for maintaining the body's normal functions.Vitamin D deficiency is common across the globe,it has become a public health problem.Pregnant women,as a special population,are at high risk of vitamin D deficiency.The level of vitamin D during pregnancy has a great effect on maternal,fetal,neonatal and infant health.For prevention and treatment of vitamin D deficiency in pregnant women,it is necessary to monitor and supplement vitamin D.This article reviews studies on vitamin D deficiency and supplementation in pregnant women,in order to better prevent related diseases.

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A prospective evaluation of postoperative pain due to various therapeutic catheters after abdominal surgery

Peng LIU ; Lei LI ; Xianghui JIN ; Shenling FU ; Jifang MEN ; Hongyuan CUI ; Mingwei ZHU

Chinese Journal of Clinical Nutrition.2014;22(5):281-284. doi:10.3760/cma.j.issn.1674-635X.2014.05.005

Objective To evaluate the postoperative pain induced by various therapeutic catheters after abdominal surgery.Methods A prospective study was conducted in patients selected based on the inclusion criteria.The general condition of the patients was recorded,and nutritional risk screening was performed.The indwelling of therapeutic catheters after abdominal surgery were recorded,including urinary catheter,nasogastric tube,peritoneal drainage tube,common bile duct drainage tube,wound drainage tube,central venous catheter and peripherally inserted central catheter.The pain caused by each type of catheters was evaluated using visual analog scale at 24,48 and 72 hours after tube/catheter insertion.Results A total of 157 patients were selected,including 70 males and 87 females,aged (60.5 ± 12.5) years,with a body mass index of (23.8 ± 3.2) kg/m2,and a total nutritional risk rate of 42％.According to visual analog scale scores,the degrees of pain due to the therapeutic catheters,in descending order,were as follows:4.9 ± 1.7 for nasogastric tube,3.6 ± 0.9 for wound drainage tube,3.0 ±0.9 for urinary catheter,2.6 ±0.9 for central venous catheter,2.4 ± 1.0 for peritoneal drainage tube,1.9 ± 0.7 for common bile duct drainage tube,and 1.8 ± 0.8 for peripherally inserted central catheter.The catheter-induced pain accounted for (44.9 ± 14.1)％ of the total pain during the hospital stay.Conclusions Nasogastric tube,wound drainage tube and urinary catheter can increase the pain of patients.It is therefore recommended to remove the indwelling tubes as early as possible if only the removal does not harm the outcome of the patient.

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Serum concentration of B vitamins and their correlation to epilepsy

Jun LI ; Jing LIU ; Meiyan WU ; Chao CHE ; Xiuli JU ; Baomin LI

Chinese Journal of Clinical Nutrition.2014;22(5):285-287. doi:10.3760/cma.j.issn.1674-635X.2014.05.006

Objective To investigate the correlation of serum concentration of B vitamins B1,B6,B12) with the incidence of epilepsy.Methods We recruited 50 newly diagnosed patients with epilepsy (not receiving antiepileptic drugs) and 50 patients without epilepsy.Serum concentrations of B vitamins (B1,B6,and B12) in both groups were detected with a LK3000V vitamin detector.Results The concentrations of vitamin B1 and B12 in epileptic patients were (132.81 ±7.3l) nmol/L and (221.41 ±26.09) pg/ml,respectively,not significantly different from those in non-epileptic patients [(130.44 ± 5.12) nmol/L,P =0.095 ;(197.87 ± 19.36) pg/ml,P =0.077].The concentration of vitamin B6 in epileptic children was (44.61 ±2.49) μmol/L,significantly lower than that in non-epileptic children [(64.63 ± 5.71) μmol/L,P =0.031].Conclusion Though serum concentrations of vitamin B1 and B12 may not be associated with epilepsy,lower concentration of vitamin B6 in serum may increase the risk of epilepsy.

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Clinical observation of early feeding tolerance to amino acid-based formula combined with rice oil in children with persistent diarrhea induced by cow's milk protein allergy

Junhong YANG ; Ying LIN ; Xi TIAN ; Ping LI ; Yingxin CHEN ; Wenzhuo ZHAO ; Dong AN

Chinese Journal of Clinical Nutrition.2014;22(5):288-292. doi:10.3760/cma.j.issn.1674-635X.2014.05.007

Objective To evaluate the clinical effects of amino acid-based formulae (AAF) combined with rice oil in treating children with persistent diarrhea caused by cow's milk protein allergy (CMPA).Methods We selected 60 infants (6-12 months) with CMPA-induced persistent diarrhea treated in Tianjin Children's Hospital between April 2011 and December 2013 and divided them into control group (n =30) and observation group (n =30) with a random number table.The control group was given AAF treatment,while the observation group was given the combination treatment of AAF + rice oil The two groups were compared in terms of treatment efficiency,period before improvement of stools,antidiarrheal time,early adverse reactions (vomit,abdominal distension),and the period before disappearance of systemic symptoms (frequent crying).Results The effective rate was 89.3％ in the control group and 96.7％ in the observation group,with no statistically significant difference (P =0.267).Adverse reactions disappeared significantly earlier in the observation group than in the control group [abdominal distension:(7.2 ± 1.7) days vs.(9.4 ±2.3) days; vomit:(8.6 ±2.5) days vs.(12.5 ±2.0) days; frequent crying:(8.0 ± 1.6) days vs.(10.0 ± 2.1) days; all P =0.000].Conclusions AAF is the first choice to treat CMPA-induced diarrhea.Early use of AAF in combination with rice oil could achieve better feeding tolerance in infant with CMPA-induced diarrhea.

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