Prevalence of Malnutrition, Its Risk Factors, and the Use of Nutrition Support in Patients with Inflammatory Bowel Disease

Background Malnutrition is prevalent among patients with inflammatory bowel disease (IBD). Nutritional profiles among Asian patients with IBD have seldom been investigated. We assessed the prevalence of and risk factors for malnutrition, use of nutrition support, and sociopsychological status associated with malnutrition among patients with IBD in China. Methods Patients with ulcerative colitis (UC) and Crohn’s disease (CD) recruited from 43 tertiary referral hospitals were screened for malnutrition and nutrient deficiencies in this cross-sectional study. The use of nutrition support was recorded. The sociopsychological status was assessed by subjective questionnaires. Factors associated with malnutrition were analyzed, and multivariate regression was used to determine independent predictors for malnutrition. Results We recruited 1013 patients with a median age of 35.0 years, 58.5% of them had CD, and 61.4% of all patients were male. Overall, 49.5% (501) of patients were diagnosed with malnutrition, including 57.0% of patients with CD, 38.8% of patients with UC, and 44.1% of patients with quiescent or mildly active disease. Nutrient deficiencies were prevalent despite the absence of malnutrition. Malnutrition was associated with adverse sociopsychological status, including decreased social support, higher perceived stress, and impaired quality of life. Moderate to severe disease activity and extensive disease were two independent risk factors for malnutrition. In total, 41.6% of patients received nutrition support, and patients with risk factors were more likely to receive nutrition support. Conclusions Malnutrition was highly prevalent and associated with adverse consequences in Chinese patients with IBD. Malnutrition screening and early initiation of nutrition support are essential components in IBD care.

Opportunities to prevent and manage undernutrition to amplify efforts to end TB

The bidirectional relationship between TB and nutrition is well recognized – primary undernutrition is a risk factor for developing TB disease, while TB results in wasting. Although nutrition support is acknowledged as an important intervention in TB programmes, it is seldom afforded commensurate priority for action. TB incidence and deaths worldwide are falling too slowly to meet WHO End TB Strategy milestones, and the number of undernourished people is increasing, likely to be further exacerbated by the ongoing COVID-19 pandemic. Undernutrition needs to be more urgently and intensively addressed. This is especially true for the WHO South-East Asia Region, where the high rates of undernutrition are a key driver of the TB epidemic. The evidence base has been sufficiently robust for clear and workable programmatic guidance to be formulated on assessment, counselling and interventions for TB patients. Many high-burden countries have developed policies addressing TB and nutrition. Gaps in research to date have frustrated the development of more refined programmatic approaches related to addressing TB and malnutrition. Future research can be shaped to inform targeted, actionable policies and programmes delivering dual benefits in terms of undernutrition and TB. There are clear opportunities for policy-makers to amplify efforts to end TB by addressing undernutrition.

Nutrition Management in Diabetes Patients during COVID-19: The Role of Nutrients in Immunity

Diabetes patients are vulnerable to coronavirus disease 2019 (COVID-19) infection. Therefore, challenges arise concerning how to manage nutrition support to strengthen the immune system in diabetes patients. The purpose of this paper is to review the roles of macronutrients and specific micronutrients such as vitamin D, B12, folate, selenium, and zinc in supporting the immune system and examine the nutritional management method of diabetes patients during the COVID-19 pandemic. Evidence indicates that adequate amounts of protein, high omega-3 fatty acids, low refined sugars, high fiber content such as whole grains, and micronutrients including vitamin D, Bsub>12, folate, selenium, and zinc impact immune system function in diabetes patients. Consumption of a balanced diet with these nutrients is best to support the immune system in diabetes patients during the COVID-19 pandemic.

Evaluation the Role of Nutrition Support Team for Monitoring the Types, Complication, Nutrients and Drugs Provision in the Parenteral Nutrition

Parenteral nutrition (PN) is a form of administering nutrients, include water, macro and micronutrients and is one of widely used mode of therapy used in patients who are unable to tolerate oral or enteral feeding. Therefore, the success of nutritional therapy depends chiefly on nutrition support teams. The aim of the present work to evaluation the provision of parenteral nutrition in the Benghazi medical center. A total of 86 patients were involved in the study and numbers of questions were answered from nutrition support team at the hospital. The result revealed that PPN (IV drip) most common used and mixture of dextrose and sodium chloride were highly provision in the hospital. Furthermore the Doctors at the ward were shown have fully responsibility for provided PN but there were neglected role of dietitian and pharmacist. Patients monitoring were not carried out routinely. Most drug delivered by PN found NSAIDs and insulin. Dextrose and sodium chlorides commonly used in the hospital for delivery medication. The present study also demonstrated that, PN did not fulfill the patients requirement and there were no patients monitoring. PN found to be used most frequently in some condition were where in real need such as pulmonary disease, GIT disorder and renal disease. Furthermore, TPN provided for the admitted patients include in emergencies, therapeutic and for unconscious patients. There were reported a number of complication in patient received PN due to lack of monitoring and prolong replacements of PN drainage. PPN (Iv drips) were the most common uses at the hospital and longer duration was proved which might led to patients burden in the hospital. Furthermore, due to the uses of PPN for longer times this could contribute for patients malnutrition. Our data suggested that, comprehensive nutrition support team and provision of intervention programs in order to increased quality and reduced patients burden and also the result of our study needed to be validated in large sample to know the real role of dietitian and pharmacist for ordered of drugs and nutrients and nutrients drug interactions. Keywords: Nutrients, Provision, TPN, PN, complication, medications.

Physicians’ Knowledge of Clinical Nutrition Discipline in Riyadh Saudi Arabia

Background: Nutrition plays a major role in the prevention and management of diet-related disease. With the absence of clinical nutrition dietitians, physicians are considered responsible for prescribing nutritional support. Identifying weaknesses in nutritional knowledge among Saudi physicians may provide guidance to improve their nutritional knowledge. Methods: A cross-sectional study that used an anonymous electronic questionnaire to investigate physicians’ knowledge of the clinical nutrition discipline. In addition to demographics, the questionnaire consisted of 15 questions covering six areas in the clinical nutrition discipline (macro- and micronutrients, nutrition and chronic diseases, nutrition and metabolic diseases, nutrition care process, nutrition support therapy, and research). For continuous variables, independent t-tests and one-way ANOVA were used. Results: A total of 332 had completed the questionnaire and were included in the study. Most of the physicians were Saudi (87%), male (73.5%), aged between 26 and 35 years (63.3%), and without health problems (56.3%). The mean score of the physicians’ knowledge was 5.3 ± 1.97 out of 15. Physicians who reported that they received some sort of nutritional training or course (M = 5.57, SD = 2.08) scored significantly more than physicians who did not (M = 5.10, SD = 1.86); t(330) = −2.174, p = 0.30. Conclusions: Nutrition should be reinforced as an important component of continuing medical education. There is a need for hiring more dietitians in health care settings in Saudi Arabia as an integral part of a multidisciplinary team delivering medical care services.