Critical Care and Anaesthesia
Tjun Tang, Elizabeth O'Riordan, Stewart Walsh in Cracking the Intercollegiate General Surgery FRCS Viva, 2020
Why is nutrition important to maintain in surgical patients?Malnutrition and catabolismImpairs wound healingIncreases incidence of pressure ulcersOvergrowth of bacteria in the gastrointestinal tractIncreases infective complications due to immune dysfunctionProlongs requirements for mechanical ventilatory supportIncreases muscle wasting resulting in reduced limb and respiratory muscle function.Nutritional support slows catabolism and should prevent malnutrition. This improves outcomes and reduces recovery time. This reduces length of inpatient stay as well as hospital costs overall.
Disorders in tHemostasis System and Changes in the Rheological Properties of the Blood in Ischemic Heart Disease and Diabetes Mellitus Patients
E.I. Sokolov in Obesity and Diabetes Mellitus, 2020
Many investigations were devoted to studying the synthesis and secretion of these factors in the vessel wall [67, 97, 98]. It was proved first of all that the endothelial cells are the main place of synthesizing these cells. Receptors and intracellular mediator signals were discovered that control the synthesis and secretion of these substances. The most important stimulators of the secretion of these inhibitors of thrombocyte aggregation are acetylcholine, bradikinin, vasopressin, and adenine nucleotides. Special significance is attached to the synthesis of prostacyclin in the endothelial cells. It was proved that the regulation of its synthesis is associated with the level of free arachidonic acid. In vessels injured by atherosclerosis, the formation of prostacyclin lowers: the content of cAMP and enzymes in the cells diminishes. The properties of the cells alter: their proliferation and migration grow, the resistance to injury lowers, and processes of anabolism predominate over catabolism. An increased risk of thrombus formation appears.
Metabolic response to injury
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie in Bailey & Love's Short Practice of Surgery, 2018
The majority of trauma patients (except possibly those with extensive burns) demonstrate energy expenditures approximately 15-25% above predicted healthy resting values. The predominant cause appears to be a complex interaction between the central control of metabolic rate and peripheral energy utilisation. In particular, central thermodysregulation (caused by the proinflammatory cytokine cascade), increased sympathetic activity, abnormalities in wound circulation (ischaemic areas produce lactate, which must be metabolised by the adenosine triphosphate [ATP]-consuming hepatic Cori cycle; hyperaemic areas cause an increase in cardiac output), increased protein turnover and nutritional support may all increase patient energy expenditure. Theoretically, patient energy expenditure could rise even higher than observed levels following surgery or trauma, but several features of standard intensive care (including bed rest, paralysis, ventilation and external temperature regulation) counteract the hypermetabolic driving forces of the stress response. Furthermore, the skeletal muscle wasting experienced by patients with prolonged catabolism actually limits the volume of metabolically active tissue (see below).
Nutritional Assessment in Early Allogenic Hematopoietic Stem Cell Transplant Patients, a Cross-Sectional Study
Published in Nutrition and Cancer, 2023
Pan Yang, Yaya Song, Xiuchen Jing, Yongqin Ge, Minghong Liu, Fang Tang, Ying Chen, Qin Li, Feng Wei, Yanqin Mao, Xiang Xu, Xiaming Zhu, Yin Lu
There is no found high prevalence of malnutrition in early allo-HSCT in our samples according to ESPEN guidelines on definitions. However, the results show a high risk of malnutrition by multiple assessment tools. This inconsistency may be due to the diagnosis of malnutrition is BMI < 18.5 based on ESPEN. Nevertheless, BMI can be misleading as the growing obesity epidemic renders a number of seriously ill and malnourished patients in the normal BMI range (20). Additionally, patients receiving allo-HSCT are often treated with parenteral nutrition and large volumes of fluid therapy during transplantation and post-recovery, which may mask any loss of body weight. Therefore, relying solely on body weight or BMI to evaluate the nutritional status may be inadequate. Sufficient nutritional support can reduce catabolic metabolism in the body. Therefore, nutritional intervention should be initiated as early as possible. The detection rate of sarcopenia in our study was lower compared to previous research (21), which may be attributed to different diagnostic criteria and the differences between time points in both studies. Further research is needed to validate these findings.
Functional decline in people with diabetes: Bidirectional relationships between body function and activity–participation components in a two-wave longitudinal structural equation modeling
Published in Physiotherapy Theory and Practice, 2023
Kaio C. Pinhal, Pedro S. Figueiredo, Vinícius C. De Oliveira, Wellington F. Gomes, Andrei P. Pernambuco, Marcus A. Alcantara
The absence of a control group makes it difficult to determine whether these changes are caused either by diabetes or by natural causes related to age. However, only a quarter of participants in present study were over 65 years old. Therefore, it is possible that changes associated with aging have a low impact on the participants. Although the association between functional decline and aging is recognizable, it is known that this relation is aggravated by the presence of chronic diseases such as diabetes (Rekeneire and Volpato, 2015). The loss of functional capability in people with diabetes is explained, at least in part, by the accelerated loss of muscle mass and intrinsic strength associated with the aging process (Gregg et al., 2000). The effects of aging are potentialized by chronic hyperglycemia, since insulin deficiency or resistance leads to a state of protein catabolism. Insulin therapy may attenuate these metabolic conditions (Landi, Onder, and Bernabei, 2013). Although our study did not control for insulin use among participants, we speculate about the limited effect of clinical interventions like this on the functional decline of people with diabetes, given the significant worsening in pain, activity, and participation levels found in this study.
The Prognostic Role of GLIM Criteria in Postoperative Outcomes after Upper Gastrointestinal Cancer Surgery: A Meta-Analysis of Observational Studies
Published in Nutrition and Cancer, 2023
Irene Lidoriki, Maximos Frountzas, Evgenia Mela, Dimitrios Papaconstantinou, Michail Vailas, Maria Sotiropoulou, Nikolaos Koliakos, Konstantinos G. Toutouzas, Dimitrios Schizas
In our meta-analysis, GLIM-based malnutrition was significantly associated with an increased rate of overall complications in patients who underwent esophagectomy or gastrectomy due to esophageal or gastric cancer. High levels of stress observed in patients who undergo major operations trigger excessive catabolism of protein stores, resulting in muscle mass degradation, especially in patients with limited metabolic and functional reserves [31]. Among the postoperative outcomes, pulmonary complications were consistently associated with malnutrition, supporting previous findings pertaining to the close relationship between muscle mass loss and respiratory function [32]. The decline in respiratory muscle strength [33], lung atelectasis and pneumonia incidence seem to be the culprit for the increased rate of respiratory complications occurrence [34].