Managing Patients with Gastrostomy Tubes in the Community: Can a dedicated enteral feed dietetic service reduce hospital readmissions?
Post-gastrostomy complications range from 8 to 30%. These complications often occur following discharge into the community and may result in hospital readmission. Our unit previously reported a readmission rate of 23% in 6 months. There is a paucity of data evaluating community gastrostomy management. We therefore aimed to evaluate the benefits of a dedicated dietetic home enteral feed (HEF) team.
SUBJECTS/METHODS: Demographic data, gastrostomy complications, readmission rates and HEF team input was prospectively collected from a cohort of discharged gastrostomy patients over a 1-year period and comparisons made with a similar historical cohort.
RESULTS: A total of 371 complications were encountered in 313 gastrostomy patients during this period, with the commonest complication being over-granulated stoma sites (27%). Of these, 227 hospital admissions were avoided because of direct actions taken by the HEF team. Fifty-nine gastrostomy patients were admitted to the hospital, of which only seven (12%) were specifically for gastrostomy-related problems. Introduction of the HEF team significantly reduced gastrostomy-related hospital readmissions from 23 to 2% (P=0.0001).
CONCLUSION: Although patients with gastrostomies may need attention to a variety of complex medical problems, many encounter problems specifically related to their gastrostomy after discharge. This is the largest prospective study demonstrating how dietitians trained in gastrostomy aftercare may optimise the management of gastrostomy complications and reduce
unnecessary hospital readmissions. Kurien M, et al (2012). Eur J Clin Nutr. Feb 22. doi: 10.1038/ejcn.2012.19. [Epub ahead of print].
Dietary Fat and Semen Quality among Men Attending a Fertility Clinic
BACKGROUND: The objective of this study was to examine the relation between dietary fats and semen quality parameters.
METHODS: Data from 99 men with complete dietary and semen quality data were analysed. Fatty acid levels in sperm and seminal plasma were measured using gas chromatography in a subgroup of men (n = 23). Linear regression was used to determine associations while adjusting for potential confounders.
RESULTS: Men were primarily Caucasian (89%) with a mean (SD) age of 36.4 (5.3) years; 71% were overweight or obese; and 67% were never smokers. Higher total fat intake was negatively related to total sperm count and concentration. Men in the highest third of total fat intake had 43% (95% confidence interval (CI): 62–14%) lower total sperm count and 38% (95% CI: 58–10%) lower sperm concentration than men in the lowest third (Ptrend = 0.01). This association was driven by intake of saturated fats. Levels of saturated fatty acids in sperm were also negatively related to sperm concentration (r= ?0.53), but saturated fat intake was unrelated to sperm levels (r = 0.09). Higher intake of omega-3 polyunsaturated fats was related to a more favorable sperm morphology. Men in
the highest third of omega-3 fatty acids had 1.9% (0.4–3.5%) higher normal morphology than men in the lowest third (Ptrend = 0.02).
CONCLUSIONS: In this preliminary cross- sectional study, high intake of saturated fats was negatively related to sperm concentration whereas higher intake of omega-3 fats was positively related to sperm morphology. Further, studies with larger samples are now
required to confirm these findings. Attaman JA, et al (2012). Hum. Reprod.; doi: 10.1093/humrep/des065.
Red Meat Consumption and Mortality – Results From 2 Prospective Cohort Studies
BACKGROUND: Red meat consumption has been associated with an increased risk of chronic diseases. However, its relationship with mortality remains uncertain.
METHODS: We prospectively observed 37,698 men from the Health Professionals Follow-up Study (1986-2008) and 83 644 women from the Nurses' Health Study (1980-2008) who were free of cardiovascular disease (CVD) and cancer at baseline. Diet was assessed by validated food frequency questionnaires and updated every 4 years.
RESULTS: We documented 23,926 deaths (including 5910 CVD and 9464 cancer deaths) during 2.96 million person-years of follow- up. After multivariate adjustment for major lifestyle and dietary risk factors, the pooled hazard ratio (HR) (95% CI) of total mortality for a 1-serving-per-day increase was 1.13 (1.07-1.20) for unprocessed red meat and 1.20 (1.15-1.24) for processed red meat. The corresponding HRs (95% CIs) were 1.18 (1.13- 1.23) and 1.21 (1.13-1.31) for CVD mortality and 1.10 (1.06-1.14) and 1.16 (1.09-1.23) for cancer mortality. We estimated that substitutions of 1 serving per day of other foods (including fish, poultry, nuts, legumes, low-fat dairy, and whole grains) for 1 serving per day of red meat were associated with a 7% to 19% lower mortality risk. We also estimated that 9.3% of deaths in men and 7.6% in women in these cohorts could be prevented at the end of follow-up if all the individuals consumed fewer than 0.5 servings per day (approximately 42 g/d) of red meat.
CONCLUSIONS: Red meat consumption is associated with an increased risk of total, CVD, and cancer mortality. Substitution of other healthy protein sources for red meat is
associated with a lower mortality risk. An Pan, et al (2012). Arch Intern Med.;doi:10.1001/archinternmed.2011.2287.
Diet Soft Drink Consumption is Associated with an Increased Risk of Vascular Events in the Northern Manhattan Study
BACKGROUND: Diet and regular soft drinks have been associated with diabetes and the metabolic syndrome, and regular soft drinks with coronary heart disease.
OBJECTIVE: To determine the association between soft drinks and combined vascular events, including stroke.
DESIGN: A population-based cohort study of stroke incidence and risk factors. PARTICANTS: Participants (N=2564, 36% men, mean age 69±10, 20% white, 23% black, 53% Hispanic) were from the Northern Manhattan Study.
MAIN MEASURES:We assessed diet and regular soft drink consumption using a food frequency questionnaire at baseline, and categorised: none (<1/month, N=1948 diet, N=1333 regular), light (1/month-6/week, N=453 diet, N=995 regular), daily (1/day, N=163 diet, N=338 regular). Over a mean follow-up of 10 years, we examined the association between soft drink consumption and 591 incident vascular events (stroke, myocardial infarction, vascular death) using Cox models.
KEY RESULTS: Controlling for age, sex, race/ethnicity, education, smoking, physical activity, alcohol consumption, BMI, daily calories, consumption of protein, carbohydrates, total fat, saturated fat, and sodium, those who drank diet soft drinks daily (vs. none) had an increased risk of vascular events, and this persisted after controlling further for the metabolic syndrome, peripheral vascular disease, diabetes, cardiac disease, hypertension, and hypercholesterolemia (HR=1.43, 95% CI=1.06-1.94). There was no increased risk of vascular events associated with regular soft drinks or light diet soft drink consumption.
CONCLUSIONS: Daily diet soft drink consumption was associated with several vascular risk factors and with an increased risk for vascular events. Further research is needed before any conclusions can be made regarding the potential health consequences
of diet soft drink consumption. Gardener H, et al (2012). J Gen Intern Med.; Jan 27 [Epub ahead of print].
Restriction of Meat, Fish, and Poultry in Omnivores Improves Mood: A pilot randomised controlled trial
BACKGROUND: Omnivorous diets are high in arachidonic acid (AA) compared to vegetarian diets. Research shows that high intakes of AA promote changes in brain that can disturb mood. Omnivores who eat fish regularly increase their intakes of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), fats that oppose the negative effects of AA in vivo. In a recent cross-sectional study, omnivores reported significantly worse mood than vegetarians despite higher intakes of EPA and DHA. This study investigated the impact of restricting meat, fish, and poultry on mood.
FINDINGS: Thirty-nine omnivores were randomly assigned to a control group consuming meat, fish, and poultry daily (OMN); a group consuming fish 3-4 times weekly but avoiding meat and poultry (FISH), or a vegetarian group avoiding meat, fish, and poultry (VEG). At baseline and after 2 weeks, participants completed a food frequency questionnaire, the Profile of Mood States questionnaire and the Depression Anxiety and Stress Scales. After the diet intervention, VEG participants reduced their EPA, DHA, and AA intakes, while FISH participants increased their EPA and DHA intakes. Mood scores were unchanged for OMN or FISH participants, but several mood scores for VEG participants improved significantly after two weeks.
CONCLUSIONS: Restricting meat, fish, and poultry improved some domains of short- term mood state in modern omnivores. To our knowledge, this is the first trial to examine the impact of restricting meat, fish,
and poultry on mood state in omnivores. Beezhold BL, Johnston CS (2012). Nutr J.; 11(1): 9. [Epub ahead of print].
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