Abstract. The aim of this systematic review was to determine the efficacy and potential benefits of enteral nutritional support [oral nutritional supplements (ONS) or enteral tube feeding (ETF)], and eicosapentaenoic acid (EPA, free acid, ethyl esters or fish oil; provided as capsules or enriched ONS or ETF) in patients with cancer. Clinical studies were identified using electronic databases, and studies were selected according to predetermined criteria. For each treatment modality (chemo/radiotherapy, surgery, and palliative care), the comparisons of interest were nutritional support vs. routine care (no nutritional support), EPA supplement (capsule or enriched ONS or ETF) vs. routine care (no supplement or standard supplement), ETF vs. parenteral nutrition (PN). The reviewed outcomes were dietary intake, anthropometry, clinical (mortality, length of hospital stay, complications, and quality of life) and haematological/biochemical (white blood cell count, serum transferrin and albumin, CD3-positive lymphocytes, and inflammatory markers). Meta-analyses were performed where possible. In patients undergoing radiotherapy, meta-analysis showed that ONS significantly increase dietary intake (381 kcal/day, 95% CI 193 to 569 in 3 RCTs) compared to routine care. In patients undergoing surgery, meta-analyses showed that ETF results in a significantly shorter length of hospital stay (1.72 fewer days, 95% CI 0.90 to 2.54 in 8 RCTs), lower incidence of any complications (OR 0.62, 95% CI 0.50 to 0.77 in 4 RCTs) and infectious complications (OR 0.67, 95% CI 0.55 to 0.82 in 11 RCTs) and lower sepsis scores (2.21 points, 95% CI 1.49 to 2.92 in 2 RCTs), but no difference in mortality (OR 0.72, 95% CI 0.40 to 1.29 in 7 RCTs) compared to PN. There was also no difference in mortality between ONS or ETF vs. routine care in patients undergoing chemotherapy/radiotherapy (OR 1.00, 95% CI 0.62-1.61 in 4 RCTs) or surgery (OR 2.44, 95% CI 0.75 to 7.95 in 4 RCTs). Individual studies of EPA supplementation as capsules showed improvements in survival, complications and inflammatory markers in patients undergoing bone marrow transplant (BMT). In palliative care patients receiving EPA-enriched ONS or capsules, there were inconsistent positive effects on survival and quality of life. In those undergoing surgery, EPA-enriched ETF had no effect. Further research is required to elucidate the clinical efficacy of enteral nutrition support, including the potential benefits of EPA supplementation, in patients with cancer.
The objective of the present study was to evaluate the effect of a paediatric tube feed supplemented with a multifibre mixture on the gut microbiota and nutritional and micronutrient status of children on long-term enteral nutrition (EN). A randomised, controlled, double-blind, cross-over trial (2 £ 3 months) with a washout period of 1 month was carried out. Twenty-seven children (80 % neurologically impaired) aged 11·9 (SD 3·9) years, on long-term EN (4·8 (SD 3·9) years) were recruited. The analyses of the children's faecal pH, microbiota along with anthropometric measures, bowel movements and markers of blood micronutrient status were made. Twenty children completed the study. A significant increase in the proportion of stool bifidobacteria (þ 16·6 %, P, 0·05) was observed during the multifibre period than during the fibre-free period, together with a significant reduction in stool pH (P, 0·001). Stool frequency and consistency as well as growth did not differ between the two periods. There was a significant increase (P,0·05) in plasma ferritin at the end of the fibre-free period, but plasma ferritin levels remained within normal ranges during both periods. No diet effects on other blood parameters were observed. In conclusion, addition of a multifibre mixture with prebiotic components to paediatric EN is well tolerated, promotes bifidobacteria and reduces stool pH, indicating an improved gut health.
Background: A large proportion of infants with congenital heart defects (CHD) suffer from malnutrition. The aim of this study was to assess the impact of using energy- and nutrient-dense formula on weight gain in malnourished infants with CHD before surgery. Methods: This was a one arm, open label intervention study, conducted in the pediatric cardiology department of children’s medical center, Teheran, Iran. 49 infants with moderate/high risk cardiac defects who were undernourished (WFA z-score ≤ - 2) and were candidates for surgical repair were enrolled in this study. Infants on regular infant formula were switched completely to energy- and nutrient-dense formula. The infants were evaluated for growth parameters (weight and length) at enrolment and every 3 weeks thereafter at the center for a period of 12 weeks. Results: The average head circumference was 37.1+2.8 cm at baseline and 39.0+3.46 cm at the final assessment (p=0.079). The mean MUAC increased from 11.25+1.39 cm at baseline to 14.75+2.06 cm at the final assessment (p=0.001). The average intake of energy- and nutrient-dense formula was 148.24+214.737 Kcal/day (36.23+ 52.49 Kcal/kg/day) at study start and 455.4+177.21 Kcal/day (98.61 ± 38.27 Kcal/kg/day) at the end of the study. The WFA z-score improved significantly on each visit during the follow-up interval (p<0.0001). Conclusion: The results of the current study highlight the efficacy of preoperative feeding with energy- and nutrient dense formula in improving weight gain of malnourished infants with CHD.reference number: IR.TUMS.VCR.REC.1396.3543
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