营养干预对维持性血液透析患者营养状况的影响

目的：探讨营养干预对维持性血液透析（MHD）患者营养状况的影响。方法：将研究对象随机分为实验组（50例）和对照组（58例）,实验组实施营养干预6个月。采用主观全面评定法（SGA）,评价实验前后两组患者营养状况的变化。结果：两纽研究对象的基线资料有可比性,实验组营养干预前后营养不良发生率无统计学差异;对照组营养不良发生率增加;两组相比,差异有统计学意义。结论：营养干预可延缓维持性血液透析患者营养不良的进展或加重,有必要推出个体化的MHD患者营养干预措施。     

Effects of a food supplementation program on the nutritional status of pregnant women in Bangladesh

BACKGROUND: The Government of Bangladesh implemented a comprehensive nutrition intervention in 1997 to reduce the rates of malnutrition among women and children. The pilot program, the Bangladesh Integrated Nutrition Program (BINP), adopted a multisectoral approach targeting women and children through food supplementation, home gardening, and health and nutrition education. OBJECTIVE: This paper estimates the effectiveness of BINP's food supplementation and nutrition education on the nutritional status of pregnant women. Methods. Three effectiveness measures were considered: target efficiency, improvements in the nutritional status of beneficiaries, and the persistence of nutritional effects. To isolate the effects of the intervention, the nutritional status of participants and nonparticipants was compared after controlling for various demographic and socioeconomic characteristics. Data were collected in 2000 from a random sample of 3262 households in a BINP intervention area. RESULTS: Thirty-nine percent of pregnant women were correctly targeted by the program's food supplementation activities. The nutrition program reduced the prevalence of thinness among participant pregnant women by about 3 percentage points per month of enrollment. The prevalence of thinness among program graduates was 62%, which was much higher than that of the matched (nonparticipant) group (35%). This finding is perplexing but it may simply imply that those who enrolled at the initial phase of the project were severely underweight and they fell back to their original status within a short period of time. CONCLUSIONS: The nutrition program was intended to improve the nutritional status of women in the longer run through the provision of nutrition education during the food supplementation phase. The prevalence of thinness or severe underweight in women who exited the program after completion of the enrollment period was found to be much higher than in women of similar age and socioeconomic status in the community. This apparent lack of persistence of program benefits requires careful re-evaluation of alternative mechanisms for improving the long-term nutritional status of women.     

早期肠内营养联合肠外营养对食管癌患者术后营养状况及生活质量的影响

目的:探讨肠内营养联合肠外营养对食管癌术后患者免疫功能、营养状况的影响,并观察其对临床结局和生活质量的影响。方法:选取2015年5月—2018年3月就诊于我院确诊为食管癌行食管癌根治术的患者106例,按照随机数字表法分为试验组和对照组,每组患者53例,对照组患者术后行单纯肠外营养(TPN组)7d,观察组患者术后行肠内营养联合肠外营养(EEN+PN组)7d,对两组患者行营养支持期间的免疫学指标[淋巴细胞计数(LYM)、免疫球蛋白A(lgA)、免疫球蛋白M(lgM)、免疫球蛋白G(lgG)]、营养指标(白蛋白、转铁蛋白、前白蛋白)、住院情况(肛门排气时间、排便时间、术后住院时间以及住院费用)以及并发症等情况进行比较。结果:(1)两组患者营养治疗后免疫学指标(LYM、lgA、lgA及lgG)较前均有所改善,且试验组改善程度显著高于对照组;(2)两组患者营养治疗后其营养学指标(白蛋白、前白蛋白、转铁蛋白)较前均有所提高,试验组患者营养学指标显著高于对照组;(3)试验组患者首次肛门排气时间、排便时间、术后住院时间较对照组明显缩短,试验组患者住院费用显著低于对照组;(4)两组患者营养支持期间并发症发生率之间差异不显著。结论:早期肠内营养联合肠外营养能够提高患者围术期的免疫功能,改善术后营养状况,促进疾病的康复,提高患者的生活质量。     

戒毒人员的营养状况分析及营养饮食干预对戒毒人员身体状况的影响

目的分析戒毒人员的营养状况,探讨营养饮食干预对戒毒人员身体状况的影响。方法分析2015年3月~2016年6月在第四军医大学军事预防医学系营养与食品卫生学教研室的戒毒人员100例,根据其是否发生营养不良,将其分为营养不良组(n=65)和非营养不良组(n=35),采用简易营养评价法(mini nutritional assessment,MNA)对戒毒人员进行营养状况调查,并对其实施营养饮食干预,统计分析所有戒毒人员营养状况评价结果、干预前后营养状况指标及身体状况变化情况。结果 2组戒毒人员性别、毒品类型、吸食方式基本相同,无明显差异(P0.05);戒毒人员年龄及吸食时间与其发生营养不良有关(P0.05);戒毒人员营养饮食干预后身体质量指数(body mass index,BMI)、血红蛋白、总蛋白、上臂围及小腿围均明显高于干预前,差异有统计学意义(P0.05);戒毒人员营养饮食干预后疲倦、食欲丧失、失眠、气促及便秘、腹泻症状评分明显均低于干预前,差异有统计学意义(P0.05)。结论戒毒人员普遍存在营养不良问题,实施营养饮食干预能有效改善其营养状况和身体状况,促进康复治疗。     

临床营养师在营养支持小组中的作用及临床实践

目的：临床营养师在营养支持小组（nutrition support team,NST）中具有重要作用,但在很多儿童专科医院中并未受到重视。本文分析2011—2013年上海儿童医学中心临床营养师开展营养支持治疗工作的情况,旨在为我国儿科营养学的发展提供依据。方法：回顾性分析上海儿童医学中心临床营养科2011年1月—2013年12月期间临床营养师会诊工作情况,总计患儿414例。用统计学分析方法分析会诊原因、随访率、会诊科室类别、随诊率、营养指导方式、患儿会诊前后营养状况比较等。结果：2011—2013年上海儿童医学中心临床营养科会诊量以22%—38%的速度逐年增加,申请会诊科室由原先的10个增加到15个。营养不良患儿体重由干预前的13.22kg提高到13.41kg（P〈0.01）。营养风险评分由干预前的STAMP评分=5分下降至干预后的4.23分（P〈0.01）。在会诊中,喂养指导人数占69%、疾病饮食指导人数占31%。结论：在会诊治疗过程中,临床营养师应与临床医生、护士紧密联系,开展营养评估与营养治疗,及时筛查出有营养风险的患儿并进行针对性的营养干预和营养宣教,最终改善患儿营养状况及临床结局。     

短肽型肠内营养制剂对危重病人营养支持效果观察

目的:探讨短肽型肠内营养制剂对危重病人营养状况改善的效果及肠道耐受性观察。方法:选取54例ICU患者,实验组27例,对照组27例,实验组给予短肽型肠内营养制剂联合肠外营养支持,对照组给予整蛋白型肠内营养制剂联合肠外营养支持。比较两组病人血清总蛋白、白蛋白、前白蛋白、血红蛋白、淋巴细胞计数及腹泻的发生率。结果:实验组营养支持后与营养支持前相比,总蛋白、白蛋白、前白蛋白显著升高(p<0.05);与对照组相比,总蛋白、白蛋白显著升高(p<0.05)。实验组的腹泻发生率为11.1%,显著低于对照组腹泻发生率37.0%(p<0.05)。结论:短肽型肠内营养制剂能明显改善危重病人的营养状况,提高免疫力,及良好的肠道耐受性。     

Non-invasive assessment of oestrous cycles and evaluation of reproductive seasonality in the female wild black rhinoceros (Diceros bicornis minor)

Female wild black rhinoceroses in Zimbabwe were monitored non-invasively using faecal progesterone metabolite analysis and observation of reproductive behaviour. A postpartum period of reproductive inactivity of at least 4 months, followed by a period of 4-7 months of oestrous cyclicity, was detected in six multiparous females. Three-quarters of the oestrous cycles (n = 21) had a total duration (mean +/- SEM) of 26.8 +/- 1 days. Other types of cycle were characterized either by an extended luteal phase, lasting on average twice as long as the normal cycle, or by an extended follicular phase. These extended cycles may have resulted from early embryo loss and heat stress. Female rhinoceroses did not conceive before 8 months after giving birth and some females (n = 2) most likely aborted after 3.0-3.5 months of gestation. The detected period of cyclic oestrus occurred between May and March in females (n = 9), and there was a 3 month extended interoestrous interval in nulliparous females during the period of decreasing daylengths that can be presumed to be the period of poorest fertility for the black rhinoceros under tropical latitudes. In contrast, the period of optimum fertility in the Southern hemisphere coincided with the late spring and early summer, and corresponded to the early rainy season. As a result, a higher incidence of births was detected in the late rainy season, providing the lactating female with the most suitable environment in terms of nutritional requirements.     

Nutritional aspects of preconceptional period as related to pregnancy and early infancy

The maternal nutritional status is considered as one of the most important factors influencing the pregnancy and the state of the offspring. There are limited data available on inadequate intake, especially before conception. A variety of nutritional and non-nutritional factors can act during the preconceptional period. Prepregnancy body weight and gestational weight gain have an independent but cumulative influence on the birth weight. The vitamin deficiency in preconceptional period, especially of folates, seems to be associated with neural tube defects. The infants of women with total gestational weight gain below 9 kg have the mean birth weight always lower than those of women with weight gain more than 9 kg in all three categories of preconceptional relative weight (i.e. less than 95%, from 95% to 105% and greater than 105%). Also the proportion of infants with birth-weight greater than 2500 g is higher in average (6.2%) and under-weight (4.4%) groups than in those over-weight (1.8%). Several other maternal nutritional as well as non nutritional variables are related with the pregnancy outcome. Among those with harmful effect on pregnancy outcome since preconceptional period, are alcohol drinking and smoking. Work outside the home can be associated with preterm deliveries and low-birth-weight infants, but the results are not consistent. Nutritional intervention, energy and/or protein supplementation also contribute to an increase of the birth-weight. As far as the antenatal care is concerned, only few studies investigated, with a scientific rigour the relation if any between prenatal care and pregnancy outcome. We concluded that the available evidence confirms a significant impact of preconceptional nutrition on pregnancy outcome. A sensitive evaluation of nutritional status in preconceptional period seems to be a positive strategy for prevention of at risk pregnancies. There is a clear need of prospective human studies with aim to relate the nutrient status of future mother to the evolution of her pregnancy.     

Impact of gut microbiota on neurological diseases: Diet composition and novel treatments

ABSTRACT

Gut microbiota has significant effects on the structure and function of the enteric and central nervous system including human behaviour and brain regulation. Herein, we analyze the role of this intestinal ecosystem, the effects of dietary changes and the administration of nutritional supplements, such as probiotics, prebiotics, or fecal transplantation in neuropsychiatric disorders. Numerous factors have been highlighted to influence gut microbiota composition, including genetics, health status, mode of birth delivery and environment. However, diet composition and nutritional status has been repeatedly shown to be one of the most critical modifiable factors of this ecosystem. A comprehensively analysis of the microbiome-intestine-brain axis has been performed, including the impact of intestinal bacteria in alterations in the nervous, immune and endocrine systems and their metabolites. Finally, we discuss the latest literature examining the effects of diet composition, nutritional status and microbiota alterations in several neuropsychiatric disorders, such as autism, anxiety, depression, Alzheimer's disease and anorexia nervosa.     

我国未来营养改善的策略与措施建议

营养问题不仅关系居民的健康,也影响经济发展的人力资源质量。我国正处在经济发展的关键时期,居民的营养状况并不会因为经济的发展而自然改善,营养缺乏和营养过剩问题也不会自己消失,需要采取有效策略和措施,才能保证居民营养与健康状况向着良好的方向发展。国家需要根据发展的不同阶段和需求,确立近期和远期的营养目标、策略和措施。     

Effect of harvest date on the nutritional quality and antioxidant capacity in 'Hass' avocado during storage

The effect of harvest date on nutritional compounds and antioxidant activity (AOC) in avocado (Persea americana Mill. cv Hass) fruit during storage was determined. The fruits were harvested at seven different dates and ripened at 25 °C following 21 or 35 days of cold storage. The results indicated that the phenolic and glutathione contents were increased and the ascorbic acid content was not significantly different in early harvested fruit (January to March), and the phenolic, ascorbic acid and glutathione contents were increased slightly and then decreased on late harvested fruit (April to June). Similar trends were observed in the changes of AOC. Furthermore, AOC in early harvested fruit after storage for 35 days was much higher than that in late harvested fruit after storage for 21 days. Therefore, avocado can be harvested earlier for economic benefits according to the market and can keep high nutritional value for human health benefits.     

加强膳食营养对长期血液透析患者营养及炎症状态的影响

目的探究加强膳食营养对长期血液透析患者营养指标及炎症反应的影响。方法收集2012年3月至2017年3月我院收治的维持性血液透析患者90例,其中43例患者采用常规护理设为对照组,另外47例患者则在常规护理的基础上给予膳食营养摄入干预护理设为研究组。比较2组患者护理干预前、后的营养指标及炎症因子水平变化情况。结果护理干预后,研究组患者的营养不良发生率明显低于对照组患者(P0.05);研究组患者的各项血清营养指标水平均明显高于对照组患者(P0.05);研究组患者的各项血清炎症因子水平均显著低于对照组患者(P0.05),差异均存在统计学意义。结论加强膳食营养干预可明显缓解长期血液透析患者的微炎症反应,并改善患者的营养状况,值得临床进一步推广应用。     

The nutritional status in malabsorption syndrome following gastrointestinal operations

The nutritional status which includes selected biochemical, anthropometric and immunologic parameters was determined in 36 patients with malabsorption syndromes following gastrointestinal operations. The examinations revealed: Postoperative malabsorption syndromes often lead to considerable nutritional disturbances which cannot be sufficiently estimated by the sole determination of body mass. The nutritional status is a precious tool in judging deficiency symptoms, in instituting a targeted alimentary or substitutive therapy,and in evaluating the therapeutic accomplishment. Optimal long-time alimentary or substitutive therapy permits to achieve and maintain a good or sufficient nutritional status in patients with malabsorption syndromes even if the syndromes are due to extended gastrointestinal operations.     

不同体质酒精性肝硬化患者营养状况评价

目的统计136例酒精性肝硬化患者中医体质分布的特征,分析不同体质者的营养状况。方法测定酒精性肝硬化不同体质者的体重指数、三头肌皮褶厚度(triceps skin fold,TSF),上臂肌围(mid-arm muscle circumference,MAMC)及上臂围(mid-arm circumference,MAC)、血清白蛋白、淋巴细胞总数,统计分析数据,比较其差异。结果酒精性肝硬化出现频率较高的中医体质依次为湿热体质、血瘀体质、痰湿体质,3种体质之间营养状况的差异具有统计学意义。结论酒精性肝硬化患者因体质状态不同,其营养状况也有差异。     

不同筛查工具对老年肿瘤患者营养筛查的比较

目的：探讨在老年肿瘤患者中合理选择营养风险筛查工具,以便及时实施营养干预,改善由于营养因素所导致的不良临床结局。方法：对130例老年肿瘤患者应用微型营养评价精法（MNA-SF）和患者主观全面评价法（PG-SGA）进行营养筛查,以白蛋白和前白蛋白为标准评定上述工具的灵敏度、特异度。结果：以白蛋白为参考标准,MNA-SF、PG-SGA的灵敏度分别为55.7%、68.3%,特异度分别为45.1%、89.7%。以前白蛋白为参考标准,MNA-SF、PG-SG的灵敏度分别为67.1%、75.2%,特异度分别为51.0%、93.1%。结论：PG-SGA考虑到多个影响营养的复杂问题,使评价结果更接近于肿瘤患者的实际营养状况。较之MNA-SF,PG-SGA更适用于老年肿瘤患者,值得推广。     

自制膳食营养处方护理对老年慢性心衰病情恢复及营养状态的影响

目的分析自制膳食营养处方护理对老年慢性心衰病情恢复及营养状态的影响。方法随机将2017年5月至2018年5月就诊于本院的100例老年慢性心衰患者分为2组,均实施常规护理。对照组50例,采取自主饮食方式;研究组50例,实施自制膳食营养处方护理。随访6个月,对比2组病情恢复效果、营养不良发生率、营养状态、生存质量及预后。结果研究组病情恢复总有效率(86.00%)比对照组(68.00%)高,营养不良发生率(6.00%)比对照组(22.00%)低,差异有统计学意义(P0.05);护理后6个月后研究组血清白蛋白(serum albumin, Alb)、转铁蛋白(treansferrin, TF)、前白蛋白(prealbumin, PA)、血红蛋白(hemoglobin, Hb)均比对照组高,改良定量主观综合营养整体评估表(modified quantitative subjective global assessment, MQSGA)、明尼苏达心力衰竭生活质量问卷(Minnesota living the heart failure questionnaire, MLHFQ)评分比对照组低,差异有统计学意义(P0.05);研究组住院时间比对照组短,再入院率(22.00%)、病死率(4.00%)比对照组(40.00%、18.00%)低,差异有统计学意义(P0.05); 2组主要不良心血管事件(major adverse cardiovascular events, MACE)发生率相比,差异无统计学意义(P0.05)。结论自制膳食营养处方护理用于老年慢性心衰中利于促进患者病情恢复,预防营养不良发生,改善营养状态,提高生存质量,降低再入院及病死风险,利于预后。     

Complementary hepatic metabolomics and proteomics reveal the adaptive mechanisms of dairy cows to the transition period

The transition period from late pregnancy to early lactation is a vital time of the lifecycle of dairy cows due to the marked metabolic challenges. Besides, the liver is the pivot point of metabolism in cattle. Nevertheless, the hepatic physiological molecular adaptation during the transition period has not been elucidated, especially from the metabolomics and proteomics view. Therefore, the present study aims to investigate the hepatic metabolic alterations in transition cows by using integrative metabolomics and proteomics methods. Gas chromatography quadrupole-time-of-flight mass spectrometry-based metabolomics and data-independent acquisition-based quantitative proteomics methods were used to analyze liver tissues collected from 8 healthy multiparous Holstein dairy cows 21 d before and after calving. In total, 44 metabolites and 250 proteins were identified as differentially expressed from 233 metabolites and 3,539 proteins detected from the liver biopsies during the transition period. Complementary functional analysis of different metabolites and proteins indicated the upregulated gluconeogenesis, tricarboxylic acid cycles, AA degradation, fatty acid oxidation, AMP-activated protein kinase signaling pathway, peroxisome proliferator-activated receptor signaling pathway, and ribosome proteins in postpartum dairy cows. In terms of the metabolites and proteins, glucose-6-phosphate, fructose-6-phosphate, carnitine palmitoyltransferase 1A, and phosphoenolpyruvate carboxykinase played a significant role in these pathways. The upregulated oxidative status may be accompanied by the pathways mentioned above. In addition, the upregulated glucagon and insulin signaling pathways also indicated the significant requirement for glucose in postpartum dairy cows. These outcomes, from the view of global metabolites and proteins, may present a better comprehension of the biology of the transition period, which can be helpful in further developing nutritional regulation strategies targeting the liver to help cows overcome this metabolically challenging time.     

The management of neuroendocrine tumours: A nutritional viewpoint

Nutritional status in patients with neuroendocrine tumours (NETs), especially of gastroenteropancreatic origin, can be deeply affected by excessive production of gastrointestinal hormones, peptides, and amines, which can lead to malabsorption, diarrhoea, steatorrhea, and altered gastrointestinal motility. Besides, the surgical and/or medical management of NETs can lead to alteration of gastrointestinal secretory, motor, and absorptive functions, with both dietary and nutritional consequences. Indeed, disease-related malnutrition is a frequently encountered yet both underrecognized and understudied clinical phenomenon in patients with NETs, with substantial prognostic and socioeconomic consequences. Most of these conditions can be alleviated by a tailored nutritional approach, also with the aim of improving the efficacy of cancer treatments. In this setting, skilled nutritionists can play a fundamental role in the multidisciplinary health care team in NETs management and their presence should be recommended. The aim of this review is to provide dietary advices for each specific condition in patients with NETs, underlining the importance of a nutritional approach to treat malnutrition in this setting. Further, we will provide preliminary evidence coming from our data on the assessment of nutritional status in a single cohort of patients with NETs.     

“通用营养补充食品”改善身体机能的实验研究

目的：观察食用“通用营养补充食品”一个月,受试人员体格、营养状况、免疫功能及体能的改善情况。方法：受试人员80人,随机分为对照组和补充组,每组40人,分别于试吃实验开始和结束时,进行体格测量、血清矿物元素含量测定、维生素营养状况测定、免疫功能测定以及体能测定,综合评价受试对象营养状况及身体素质的改善情况。结果：服用“通用营养补充食品”一个月,受试对象体内脂肪含量有所减少,肌肉组织有所增加;钙、锌、硒、VB1、VB2、VC的营养状况有所改善或提高;体液免疫及细胞免疫功能有所增强;体能得到提高。结论：食用“通用营养补充食品”一个月,可以改善受试人员的体格状况、营养状况、免疫功能及体能。     

营养干预在糖尿病治疗中的研究进展

在专业人士指导下通过改变营养状况或摄食量来改善健康状况或治疗疾病的营养干预(Medical Nutrition Therapy,MNT)对于糖尿病管理十分重要。基本目标是:促进和支持健康的饮食模式,根据文化背景、知识结构、饮食习惯和自我控制能力来实现个性化营养需求,强调食物选择的人性化、科学限制食物的选择以及提供糖尿病患者日常膳食规划。文章根据2019年初发表在《Diabetes Care》杂志上的《旨在提供有关成人糖尿病或糖尿病前期个性化营养治疗循证指导的共识报告》等系列文献,综述了MNT等相关知识及其在糖尿病方面的相关应用,提出了根据中国饮食结构与中医药文化背景构建中药营养干预(Chinese Medical Nutrition Therapy,CMNT)优势体系,并展望了其在糖尿病预防和治疗方面的前景。