Elderly inpatients with coronavirus disease 2019 (COVID-19) are often at nutritional risk and at higher risk of critical disease. The standardized nutrition treatment could effectively improve the nutritional status, quality of life, and clinical outcomes of COVID-19 patients, and is an important component of the comprehensive management of COVID-19. The individualized nutrition diagnosis, treatment and monitoring should be conducted in compliance to standard procedures of medical nutrition therapy, with consideration of the clinical characteristics of elderly COVID-19 inpatients. The Department of Clinical Nutrition at Peking Union Medical College Hospital has integrated the latest clinical nutrition guidelines and clinical practice of nutrition support of COVID-19, with the aim to provide evidence-based, concise and practical recommendations on nutritional management for elderly inpatients with COVID-19. The recommendations here are to inform effective and standardized nutrition support practice.

Objective:To investigate the effects of omega-3 polyunsaturated fatty acid (n-3 PUFA) supplementation on muscle mass and strength improvement through systematic review and meta-analysis.Methods:Electronic databases, namely Cochrane Library database, MEDLINE, EMBASE, CENTRAL, China National Knowledge Infrastructure, and Wanfang were searched for publications in English and Chinese from database establishment to June 20, 2022. All randomized controlled trials involving any n-3 fatty acid (fish oil capsules, pure fish oil and oral nutritional supplements) interventions for more than 4 weeks among adults aged ≥ 18 years were included in the analysis. The effects of n-3 PUFA on muscle mass and strength were compared with controls using RevMan 5.4. The mean differences (MDs) or standardized mean differences (SMDs) with 95% confidence intervals (CI) were calculated and pooled effects were assessed. The quality of the included studies was evaluated using the Cochrane risk-of-bias tool.Results:27 trials were included, with both healthy adults and patients with various types of cancer, with chronic obstructive pulmonary disease and on hemodialysis due to chronic renal failure. Most trials were judged as "low" to "high" risk of bias. The meta-analysis showed that n-3 PUFA supplementation significantly improved the lean body mass in the group without physical activity intervention compared to the control group, while showing no significant increase in muscle mass or handgrip strength in overall participants. There was no significant difference between intervention and control groups in subgroup analyses based on health/disease condition, intervention duration, route of administration and dosage and risk of bias. However, significant increases in mid-arm muscle circumference (MAMC) and lower body strength (MD = 0.8, 95% CI: 0.26 to 1.34, P = 0.005; SMD = 0.45, 95% CI: 0.21 to 0.69, P = 0.0002) were observed in n-3 PUFA supplement group. Conclusions:This meta-analysis indicates that n-3 PUFA supplementation does not improve muscle mass or handgrip strength in healthy adults as well as patients, but do improve MAMC and lower body strength. The limited sample size and prominent heterogeneity of the included studies impede the extrapolation to clinical practice and warrants individual analysis based on population characteristics. Well-designed large-scale RCTs are required to verify these findings.

Objective:To explore the effect of the nutritional status on the clinical outcome and adverse effects of patients with concurrent radiochemotherapy for cervical cancer and analyze the cost-effectiveness of this treatment.Method:This study is a prospective, observational cohort study continuously enrolling patients with cervical cancer who received concurrent radiochemotherapy from 2018-05-01 to 2018-09-01 in Peking Union Medical College Hospital. According to the criteria, patients were divided into two groups: nutritional disorders and normal nutrition groups. There were 81 and 94 cases of abnormal and normal nutrition, respectively. Blood tests, liver function tests, treatment costs for adverse effects, and nutritional support were employed. We observed the incidence of vomiting, diarrhea, bone marrow suppression, infection, and other responses in the two groups, followed by clinical outcomes and the cost-effectiveness analysis.Results:Compared with the normal nutrition group, the infection rate (27.2% vs 14.9%, χ 2=4.007, P=0.045), the incidence of bone marrow suppression (86.4% vs 69.1%, χ 2=7.36, P= 0.007), the cost of bone marrow suppression treatment [324.0 (164.2-648.0) vs 587.8 (243.6-1 728.0), z=2.698, P=0.007), and the treatment cost [71.4 (45.2-123.7) vs 85.1 (57.0-198.9), z=1.994, P=0.030) significantly increased in the nutritional disorder group. There were more patients with poor clinical outcomes in the nutritional disorder group than in the normal group (29.6% vs 8.5%, χ 2= 12.987, P<0.001). Only 7.2% of the patients had visited a nutrition clinic, and the rate of nutrition intervention was extremely low. Conclusion:In patients with cervical cancer undergoing concurrent radiochemotherapy, there is a higher incidence of adverse effects, such as infection and bone marrow suppression, as well as higher treatment costs and worse clinical outcomes.

Objective:To investigate the impact of oat beta-glucans on blood levels of lipids, glucose, and inflammatory factors in patients with hyperlipemia/hyperglycemia.Methods:A total of 120 patients with hyperlipemia/hyperglycemia were randomized into intervention ( n = 60) and control groups ( n = 60). In addition to the routine nutritional consultation, two groups received oral oat beta-glucan at 3 g/d (intervention) or lotus root powder at 3 g/d (control), respectively. Blood levels of lipids, glucose, insulin and inflammatory factors, body composition and bowel movement were compared between the two groups after 12 weeks of study intervention. The treatment effect was represented by intention-to-treat analysis. Results:A total of 109 participants completed the study. The total cholesterol [(5.18±0.69) mmol/L vs (5.25±0.88) mmol/L, P=0.024] and fasting plasma glucose [(5.50±0.82) mmol/L vs (5.98±1.33) mmol/L, P=0.002] in the intervention group were significantly decreased compared with the control group. Conclusion:Oral oat beta-glucans could decrease the total cholesterol and fasting plasma glucose in participants with mild hyperlipemia/hyperglycemia.

透明质酸(hyaluronic acid,HA)广泛存在于人体各个组织中,具有保湿、润滑等多种生理功能,并且参与到伤口愈合、炎症反应、组织修复等多个生物过程中.HA作为重要的医疗和美容材料,已被广泛应用于医药和化妆用品.2021年1月7日,国家卫生健康委员会发文,批准透明质酸钠为"新食品原料",可应用于普通食品添加.口服作为最理想和经济、方便的给药方式,具有更高的使用依从性.本文综述了目前已发表的经口给予HA相关代表性研究成果,主要关注其在体内的吸收、分布和代谢途径,以及其对于不同组织、器官的保护功能,并结合药理、毒理研究为新型口服HA制剂的开发和应用提供科学依据,同时提高大众对于口服HA的正确认知.

Objective:To describe and compare the perioperative changes of body weight, skeletal muscle and fat mass in patients with benign and malignant gastrointestinal tumors.Methods:All adult patients admitted to the surgery department of a referral hospital in Beijing with voluntary consent were included in the study. For all participants, preoperative medical history were collected and body composition measurements were performed 1-2 days prior to the surgery and 3-6 days after the surgery. Pathological results and tumor diagnosis were recorded.Results:A total of 80 participants completed the study. There was no significant difference in weight and body composition between patients with benign and malignant tumors before operation, but patients experiencing a weight loss of more than 5% in the past 6 months were dramatically more in malignant tumor group compared with benign tumor group (9.1% vs. 42.0%, P=0.024). With the parenteral and enteral nutrition support, there was no significant difference in the changes of weight, muscle, or fat mass between benign and malignant tumor patients in different stages (all P>.05). Patients with malignant tumors were divided into severe weight loss group and observational group with the percentage weight loss cut-off of 5%. Analysis showed that patients in the severe weight loss group had significantly decreased weight [(-4.3±1.6)kg vs. (-1.9±1.1)kg, P<0.01], BMI[(-1.3±0.9)kg/m 2vs. (-0.7±0.4)kg/m 2, P<0.01], muscle[(-1.2±2.0)kg vs. (-0.4±1.2)kg, P=0.046] and fat mass [(-2.6±2.0)kg vs. (-1.1±0.9)kg, P=0.018] compared with observational group, while visceral [(-0.5±0.6)kg vs. (-0.2±0.7)kg, P=0.107] and subcutaneous fat [(-2.2±1.9)kg vs. (-1.4±1.8)kg, P=0.235] of two groups had no significant difference. Univariate analysis revealed age as the only influencing factor for perioperative weight loss ( P=0.036). Fat loss was predominant in the overall weight loss compared with muscle loss ( P=0.026) among patients with gastrointestinal malignant tumors. Conclusion:With parenteral and enteral nutrition support, there is no significant difference in perioperative changes of weight, muscle or fat mass among patients with benign and malignant tumors. Muscle and fat loss both have contributed to the overall weight loss, which is noteworthy.

Objective To evaluate the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus.Methods A meta-analysis of randomised controlled trials was conducted.PubMed, EMBASE, OVID, Cochrane Library, China National Knowledge Infrastructure (CNKI) and Chinese WanFang Database were searched for the literatures related to the effect of medical nutritional intervention on clinical outcome of gestational diabetes mellitus from January 2005 to January 2015.At the same time, manual searching and reference review were conducted.Strict screening of the searched literatures was performed based on inclusion and exclusion criteria.All the included trials were divided into two groups based on whether the intervention involved insulin or not.The tool which Cochrane Handbook recommended was used to assess the risk of bias for included literatures.All the studies were graded and extracted by two researchers independently after reading research method in detail.Meta-analysis was conducted using RevMan5.2 software.The effect of medical nutritional intervention was described in terms of fasting blood glucose, birth body mass, and incidences of macrosomia, cesarean section, postpartum glucose intolerance and neonatal long-term chronic disease.Results Totally 27 trials were found, of which 13 met the inclusion and exclusion criteria.1 trial was excluded because the outcomes were using different sample sizes, and finally 12 trials were included in the final meta-analysis, involving 1 392 patients.Among the 12 included trials, 7 only administered nutritional intervention, while the other 5 added insulin with nutritional intervention.The results showed that in the nutritional intervention group, medical nutritional intervention decreased the incidence of macrosomia [risk difference (RD) :-0.35, 95％ CI:-0.55--0.15, P ＜ 0.001, 1 trial], birth body mass [mean difference (MD) :-581.27, 95％ CI:-790.32--372.22, P ＜ 0.001, 2 trials], the rate of cesarean section (RD:-0.40, 95％ CI:-0.58--0.21, P＜0.001, 2 trials), fasting blood glucose (MD:-0.32, 95％ CI:-0.59--0.06, P =0.02, 5 trials), and the incidence of postpartum glucose intolerance (RD:-0.34, 95 ％ CI:-0.44--0.23, P ＜0.001, 1 trial).However, in the multiple intervention group (nutritional intervention plus insulin), no significant differences were shown in the incidence of macrosomia (RD:-0.02, 95％ CI:-0.07-0.03, P=0.39, 3 trials), birth body mass (MD: 86.06, 95％ CI:-104.97-277.09, P=0.38,2 trials) , the rate of cesarean section (RD: 0.02, 95％ CI:-0.05-0.08, P =0.64, 5 trials) , and fasting blood glucose (MD:-0.03, 95％ CI:-0.16-0.11, P =0.71, 3 trials).Conclusion Medical nutritional intervention may be a protective measure against gestational diabetes mellitus, which could help to maintain serum glucose levels within the normal range and improve maternal and neonatal outcomes.

近年,代谢综合征(metabolic syndrome,MS)及其高发病率严重威胁着人类的健康和生命.代谢综合征病因学的核心是胰岛素抵抗(insulin resistance,IR),然而,其相关机制并不是十分清楚,研究显示血浆中某些炎性因子(如:C反应蛋白、白细胞介素-6、肿瘤坏死因子-α)浓度的升高与IR的发生密切相关,表明炎性因子在IR过程中具有重要作用.本文将就这些炎性因子影响胰岛素敏感性的机制加以介绍.