We thank Dr. Chen et al. very much for their comments [ [1] Kang J. Li H. Chen W. ESPEN guideline on home parenteral nutrition: comment. Clin Nutr. 2021; 40: 657 Scopus (1) Google Scholar ] on recommendation #13 of the ESPEN guidelines on home parenteral nutrition (HPN) [ [2] Pironi L. Boeykens K. Bozzetti F. Joly F. Klek S. Lal S. et al. ESPEN guideline on home parenteral nutrition. Clin Nutr. 2020 Jun; 39 (Epub 2020 Apr 18. PMID: 32359933): 1645-1666https://doi.org/10.1016/j.clnu.2020.03.005 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar ], which suggest a preference for right-sided central venous access devices (CVAD) since these are associated with a lower risk of CVAD-related vein thrombosis (CVAD-VT). ESPEN guideline on home parenteral nutrition: CommentClinical NutritionVol. 40Issue 2PreviewWe read with great interest the recently published guideline by Pironi L et al. [1], entitled, ‘ESPEN Guideline on Home Parenteral Nutrition’. In the recommendation 13, right-sided central venous access devices were recommended for lower risk of thrombosis compared with left-sided approaches. This issue described in this article warrant further discussion. Full-Text PDF
BackgroundIron deficiency (ID) is one of the most common postoperative deficiencies that may develop after Roux-en-Y gastric bypass (RYGB). The optimal mode of treatment is uncertain.AimTo compare the efficacy of oral ferrous fumarate (FF), oral ferrous gluconate (FG), and a single intravenous infusion of ferric carboxymaltose (FCM) in women with ID after RYGB.MethodsMulticenter randomized controlled trial including 120 women with a serum ferritin <20 μg/l during follow-up after RYGB. They were randomized into three groups: 41 patients were treated with FF 200 mg three times a day (total daily dose: 195 mg elemental iron), 39 received FG 695 mg twice a day (total daily dose: 160 mg elemental iron) for three months, and 39 patients were treated with a single intravenous dose of FCM (1000 mg elemental iron). Serum ferritin levels were measured at six weeks, and three, six and twelve months after the start of supplementation.ResultsAt three months, persistence of ID was observed in 29.4% and 42.4% of the patients treated with FF and FG, respectively, but in none of those treated with FCM (p < 0.001). Over the next nine months, recurrence of ID was observed in 56.5% of patients treated with FF, in 52.9% treated with FG, and in 27.8% of those treated with FCM. Adverse effects were most common during oral treatment.ConclusionIn women developing ID after RYGB, a single dose of intravenous FCM is more effective and better tolerated than the standard treatment with either FF or FG.Clinical trial registry number and websiteThe study was registered at clinicaltrials.gov under number NCT02271997.
Background & aims: A low muscle mass before start of treatment and loss of muscle mass during chemotherapy is related to adverse outcomes in patients with cancer. In this randomized controlled trial, the effect of nutritional counseling on change in muscle mass and treatment outcome in patients with metastatic colorectal cancer during first-line chemotherapy was studied. Methods: Patients scheduled for first-line chemotherapy (n = 107) were randomly assigned to individualized nutritional counseling by a dietitian (NC) or usual care (UC). NC was aimed at sufficient protein-and energy intake, supported by oral supplements or enteral feeding if indicated. Furthermore, physical activity was encouraged. Outcomes were assessed at baseline (T0) and the time of the first (T1) and second (T2) regular follow-up computed tomography scans. The proportion of patients with a clinically relevant decrease in skeletal muscle area of >6.0 cm(2), measured by computed tomography, was the primary outcome. Secondary outcomes included body weight, quality of life, treatment toxicity and progression free and overall survival. Results: A total of 107 patients were enrolled (mean age, 65 years (SD, 11 years), 63% male). Mean change in skeletal muscle area from T0 till T1 was -2.5 (SD, 9.5) cm(2), with no difference between NC versus UC (p = 0.891). The proportion of patients with a clinically relevant decrease in skeletal muscle area of >= 6.0 cm(2) did not differ (NC 30% versus UC 31%, p = 0.467). NC compared with UC had a significant positive effect on body weight (B coefficient 1.7, p = 0.045), progression free survival (p = 0.039) and overall survival (p = 0.046). Conclusions: NC of patients undergoing chemotherapy for metastatic colorectal cancer had no effect on muscle mass. However, we found that NC may increase body weight and improve progression free survival and overall survival compared to UC in this group of patients. These findings need further evaluation in future clinical trials. (C) 2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.
C1683 Preoperative Fasting Protects Aged Obese Mice Against Renal Ischemia-Reperfusion Injury. F. Jongbloed,1,2 R. de Bruin,1 S. van den Engel,1 L. van der Laan,1 H. van Steeg,2 J. Ijzermans,1 M. Dollé.2 1Department of Surgery, Laboratory for Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus Medical Center, Rotterdam, Netherlands; 2Laboratory of Health Protection Research, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands. Introduction. Ischemia-reperfusion injury (IRI) is inevitable during kidney transplantation and leads to oxidative stress and infl ammation. We previously reported that preoperative fasting in young-lean male mice protects against IRI. Since patients are generally of older age and overweight, factors that may lead to a different response to fasting, we investigated the effects of preoperative fasting on renal IRI in aged overweight male and female mice. Methods. Male and female F1-FVB/C57BL6-hybrid mice, average age 73 weeks weighing 47.2 grams, were randomized to preoperative ad libitum feeding or 3 days fasting, followed by renal IRI. Body weight, kidney function and survival of the animals were monitored until day 28 postoperatively. Histopathology was examined for all animals and scored for acute tubular necrosis and tubular regeneration. All experiments had the approval of the local Animal Experiments Committee of the National Institute of Public Health and the Environment, the Netherlands. Results. Preoperative fasting signifi cantly improved survival after renal IRI in both sexes compared with normal fed mice. Fasted groups had a better kidney function shown by lower serum urea levels after IRI. Histopathology showed less acute tubular necrosis and more regeneration in kidneys from fasted mice. Fasting resulted in a body weight loss of 14-17% in male and female mice. In the fi rst week after IRI, body weight declined followed by recovery in the weeks thereafter. The normal fed mice showed a larger and faster weight loss after IRI. Conclusions. Similar to young-lean, healthy male mice, preoperative fasting protects against renal IRI in aged overweight mice of both genders. These fi ndings suggest a general protective response of fasting against renal IRI regardless of age, gender, body weight and genetic background. Therefore, fasting could be a non-invasive intervention inducing increased oxidative stress resistance in older and overweight patients as well. Abstract# C1684 Microarray Analysis After Preoperative Dietary Restriction Reveals Potential Mechanisms Involved in the Protection Against Ischemia-Reperfusion Injury. F. Jongbloed,1,2 T. Saat,1 M. Dollé,2 H. van Steeg,2 J. Hoeijmakers,3 C. Payan Gomez,3 L. van der Laan,1 J. Ijzermans,1 R. de Bruin.1 1Department of Surgery, Laboratory for Experimental Transplantation and Intestinal Surgery (LETIS), Erasmus University Medical Center, Rotterdam, Netherlands; 2Laboratory of Health Protection Research, National Institute of Public Health and the Environment, Bilthoven, Netherlands; 3Department of Genetics, Erasmus University Medical Center, Rotterdam, Netherlands. Background. Ischemia-reperfusion injury (IRI) is inevitable during kidney transplantation and leads to oxidative stress and infl ammation. We previously reported that short-term preoperative dietary restriction (DR), 3-day fasting and protein-free diets protect against renal IRI while a fat-free or carbohydrate-free (CHO-free) diet do not. To understand underlying mechanisms, we performed microarrays and compared gene expression profi les of (non)-protective diets in search for pathways involved in the effect. Methods. Male C57BL/6 mice were randomized to preoperative normal food or: 2 weeks 30%DR, 3-day fasting, 3-day protein-free, 3-day CHO-free or 3-day fat-free diet. Kidneys were harvested after each diet. Gene expressions were analysed by Affymetrix array and pathway analysis was done with Ingenuity. Cut-off for signifi cance was set on fold change ≥1.5 and p-value <0.05. Results. Compared to ad libitum fed, 2 weeks 30%DR resulted in 492 differentially expressed genes (DEG). Similarly, 3-day fasting led to 2604 DEG and a protein-free diet to 391 DEG. The fat-free diet resulted in zero DEG and a CHO-free diet in 1717 DEG. Seventy DEG overlapped in all 3 protective diets, with an overlap of 30 with CHO-free. Ingenuity analysis revealed the involvement of metabolic processes like retinol biosynthesis as well as stress responses like Nrf2-pathway. Preliminary in depth analysis shows differences in these pathways between the protective diets and CHO-free, in which genes like txnip and mrp1 may play a central role. Conclusions. This unique microarray dataset of different dietary interventions points to the involvement of pathways related to oxidative stress resistance and retinol metabolism in the benefi cial effects against renal IRI. Since the non-protective CHO-free diet also induced activation of these pathways, further exploration is needed. Collectively, these data suggest that a combined action of both metabolic and stress resistance pathways results in protection against IRI given by preoperative dietary interventions. Abstract# C1685 STAT3/CCR5 Signal Regulation Mitigates Renal IschemiaReperfusion Injury. K. Yoo,1 J. Park,1 S. Han,1 J. An,1 H. Lee,1 Y. Kim,1,2 S. Yang.2 1Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of; 2Kidney Research Institute, Seoul, Korea, Republic of. Signal transducer and activator of transcription3 (STAT3) is unique transcription factor and known for a key member of the JAK-STAT signaling pathway. STAT3 was recently revealed to play roles in chemokine receptor 5 (CCR5) expression in human monocytes. CCR5 promoter regions contain STAT3 binding sites. In kidney disease, its role is unclarifi ed. Therefore, we studied the interaction of STAT3 and CCR5 signals on renal ischemia-reperfusion injury (IRI). B6 wild type and CCR5 KO mice were performed in bilateral renal artery pedicles clamping for 30 min followed by reperfusion. After then, we quantifi ed intrarenal cytokine expression using real-time PCR. Moreover, we cultured human tubular epithelial cells (TEC) in hypoxic condition and evaluated the effect of caffeic acid 3,4-dihydroxy-phenethyl ester (CADPE, JAK2/STAT3 inhibitor) treatment. IRI produced more severe tubular damage in B6 wild type mice than in CCR5 KO mice (BUN, 191.0 ± 2.7 vs. 176.3 ± 2.3 mg/dL; creatinine, 2.37 ± 0.04 vs. 1.75 ± 1.16 mg/dL, p < 0.05). Although infl ammatory cytokines/chemokines, such as monocyte chemotactic protein-1, IL-1β, CCR5, CCL4, and CCL5 were increased by IRI in wild type mice compared to sham mice, they were signifi cantly attenuated in CCR5 KO mice. The expression of STAT3α as well as total STAT3 was more reduced in CCR5 KO mice than in wild type mice, whereas STAT3β level was not different between the two groups. These fi ndings were supported by in vitro study with human TEC. The level of CCR5 and pSTAT3 were elevated in the hypoxia-conditioned TECs, however, decreased in CADPE treated cells. We demonstrated that the activation of CCR5 via STAT3 (dominantly STAT3α) may be associated with progression of ischemia-reperfusion injury. These mechanisms of STAT3/CCR5 signaling suggest a novel strategy for management of acute kidney injury with STAT3 inhibitor. C1685 STAT3/CCR5 Signal Regulation Mitigates Renal IschemiaReperfusion Injury. K. Yoo,1 J. Park,1 S. Han,1 J. An,1 H. Lee,1 Y. Kim,1,2 S. Yang.2 1Internal Medicine, Seoul National University College of Medicine, Seoul, Korea, Republic of; 2Kidney Research Institute, Seoul, Korea, Republic of. Signal transducer and activator of transcription3 (STAT3) is unique transcription factor and known for a key member of the JAK-STAT signaling pathway. STAT3 was recently revealed to play roles in chemokine receptor 5 (CCR5) expression in human monocytes. CCR5 promoter regions contain STAT3 binding sites. In kidney disease, its role is unclarifi ed. Therefore, we studied the interaction of STAT3 and CCR5 signals on renal ischemia-reperfusion injury (IRI). B6 wild type and CCR5 KO mice were performed in bilateral renal artery pedicles clamping for 30 min followed by reperfusion. After then, we quantifi ed intrarenal cytokine expression using real-time PCR. Moreover, we cultured human tubular epithelial cells (TEC) in hypoxic condition and evaluated the effect of caffeic acid 3,4-dihydroxy-phenethyl ester (CADPE, JAK2/STAT3 inhibitor) treatment. IRI produced more severe tubular damage in B6 wild type mice than in CCR5 KO mice (BUN, 191.0 ± 2.7 vs. 176.3 ± 2.3 mg/dL; creatinine, 2.37 ± 0.04 vs. 1.75 ± 1.16 mg/dL, p < 0.05). Although infl ammatory cytokines/chemokines, such as monocyte chemotactic protein-1, IL-1β, CCR5, CCL4, and CCL5 were increased by IRI in wild type mice compared to sham mice, they were signifi cantly attenuated in CCR5 KO mice. The expression of STAT3α as well as total STAT3 was more reduced in CCR5 KO mice than in wild type mice, whereas STAT3β level was not different between the two groups. These fi ndings were supported by in vitro study with human TEC. The level of CCR5 and pSTAT3 were elevated in the hypoxia-conditioned TECs, however, decreased in CADPE treated cells. We demonstrated that the activation of CCR5 via STAT3 (dominantly STAT3α) may be associated with progression of ischemia-reperfusion injury. These mechanisms of STAT3/CCR5 signaling suggest a novel strategy for management of acute kidney injury with STAT3 inhibitor. © The Authors. Compilation © The American Society of Transplant Surgeons, The Transplantation Society and the American Society of Transplantation
Rationale: Malnutrition is common in hospitalized patients, however, it is not always identified and treated appropriately by physicians. One of the reasons is lack of clinical nutrition education for physicians. Firstly, physicians are generally unaware of the incidence of malnutrition and its impact on their patient’s health and the treatment outcomes. Secondly, most physicians have limited nutrition knowledge. Total Nutrition Therapy (TNTTM) is a 2-day, postgraduate, continuing educational seminar developed for physicians to learn the global standard of clinical nutrition. Objective: To evaluate the effect of TNTTM seminar on the knowledge of clinical nutrition in Japanese physicians. Methods: The TNTTM seminar in Japan was started in 1999 and has been held more than 400 times and educated more than 17,000 physicians. Since 2004, the participants in the Kinki area have completed a short pre and post test about clinical nutrition knowledge. The content of the test includes the definitions for abbreviations, the composition of TPN solutions, energy produced by 1 gram of carbohydrate, protein, and fat, and other basic knowledge related to clinical nutrition practice. The pre and post test scores were compared to evaluate the seminar outcome. Results: The number of physicians who attended TNTTM seminars in the Kinki area for last 6 years was 1024. The average pretest score was very low: only 50% of the physicians correctly estimated the energy yield per gram of macronutrients. 41.9% of the participants correctly selected the definitions for abbreviations and 67% correctly answered questions about other basic nutrition knowledge. The scores significantly improved after the seminar. Conclusion: We may conclude that nutrition education for physicians with TNTTM seminar can improve the physicians’ knowledge regarding clinical nutrition and also can raise the awareness of the importance of clinical nutrition.
software. The area (Area-B) was also quantified based on preestablished thresholds of CT value (30 120 Hounsfield units). Data (mean±SD) were compared by Student’s t test. Significance was set at p < 0.05. Results: Area value was reduced by 68.2% (from 15.7±4.7 to 10.4±3.6 cm2) in Area-A and 57.7% (from 13.8±4.7 to 7.8±3.4 cm2) in Area-B, respectively. Decrease was observed significantly higher in Area-B (P< 0.05). There was a positive correlation (r = 0.615) between the two changes. Conclusion: The PMNA change from the contour tends to be little in measurement by non-contractile tissue, is still a good indicator to evaluate the progress of cachexia.
