Background & aims: Eating habits may influence the life span and the quality of ageing process by modulating inflammation. The RISTOMED project was developed to provide a personalized and balanced diet, enriched with or without nutraceutical compounds, to decrease and prevent inflammageing, oxidative stress and gut microbiota alteration in healthy elderly people. This paper focused on the effect on inflammation and metabolism markers after 56 days of RISTOMED diet alone or supplementation with three nutraceutical compounds.Methods: A cohort of 125 healthy elderly subjects was recruited and randomized into 4 arms (Arm A, RISTOMED diet; Arm B, RISTOMED diet plus VSL#3 probiotic blend; Arm C, RISTOMED diet plus AISA d-Limonene; Arm D, RISTOMED diet plus Argan oil). Inflammatory and metabolism parameters as well as the ratio between Clostridium cluster IV and Bifidobacteria (CL/B) were collected before and after 56 days of dietary intervention, and their evolution compared among the arms. Moreover, participants were subdivided according to their baseline inflammatory parameters (erythrocytes sedimentation rate (ESR), C-Reactive Protein, fibrinogen, Tumor Necrosis Factor-alfa (TNF-alpha), and Interleukin 6) in two clusters with low or medium-high level of inflammation. The evolution of the measured parameters was then examined separately in each cluster.Results: Overall, RISTOMED diet alone or with each nutraceutical supplementation significantly decreased ESR. RISTOMED diet supplemented with d-Limonene resulted in a decrease in fibrinogen, glucose, insulin levels and HOMA-IR. The most beneficial effects were observed in subjects with a medium-high inflammatory status who received RISTOMED diet with AISA d-Limonene supplementation. Moreover, RISTOMED diet associated with VSL#3 probiotic blend induced a decrease in the CL/B ratio.Conclusions: Overall, this study emphasizes the beneficial anti-inflammageing effect of RISTOMED diet supplemented with nutraceuticals to control the inflammatory status of elderly individuals. (C) 2015 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Hintergrund/Einleitung: Stent-Dysfunktion oder Verschluss stellen eine schwerwiegende Einschränkung von TIPSS bei Leberzirrhose (LCI) dar und sind häufig die Ursache für ein Therapieversagen. Kann dieses Problem durch den Einsatz von Polytetrafluorethylen (ePTFE)-beschichteten TIPS-Stents anstelle unbeschichteter Stents gelöst werden?

Hintergrund/Einleitung: Die Diagnostik der Laktoseintoleranz ist eine häufige gastroenterologische Fragestellung. Kürzlich wurden zwei DNA Varianten, C/C-13910 and G/G-22018 als mögliche genetische Marker für die Laktoseintoleranz identifiziert.

Einleitung: In der Literatur finden sich nur wenige prospektive Daten zum klinischen Wert der Power-Dopplersonographie bei Morbus Crohn. Der Goldstandard zur Bewertung der Aktivität ist die Ileokoloskopie.

Hintergrund/Einleitung: Die Harnstoffproduktionsrate (HPR) ist eine etablierte Methode zum Nachweis einer Katabolie, die jedoch mit großem methodischem Aufwand verbunden ist. Eine einfachere, schnell durchführbare Methode wäre deshalb wünschenswert. Da eine pathologisch erhöhte HPR mit einem erhöhten Protein-(Muskel-)abbau assoziiert ist, stellten wir uns die Frage, ob eine Muskelfunktionsbestimmung eine Katabolie erfassen könnte.

Hintergrund/Einleitung: Es liegen bisher methodenbedingt kaum humane in vivo Daten über den Beitrag des Darms bei der Freisetzung von Mediatoren zur Regulation der Energiehomöostase vor. In der aktuellen Studie haben wir in einem Modell an Patienten mit transjugulärem portosystemischen Shunt (TIPS), welcher einen Zugang zum intestinalen Stromgebiet ermöglicht, die systemische und intestinale Freisetzung von o.g. Neuromediatoren nach einer oralen und parenteralen Kalorienaufnahme untersucht.

Fragestellung: Die Bedeutung der Ernährung bei der Entstehung und Behandlung von chronisch-entzündlichen Darmerkrankungen (CED) wird teilweise kontrovers diskutiert. Klar ist, dass bei CED die Prävalenz von Mangelernährung erhöht ist und dass Mangelernährung die Prognose verschlechtert. In der vorliegenden Leitlinie werden evidenzbasierte Empfehlungen zur ernährungsmedizinischen Diagnostik und Therapie bei CED präsentiert. Methodik: Die Leitlinie basiert auf den früheren Leitlinien der DGEM (2006/2007), der ESPEN (2006, 2009), der ECCO (2010) und des NICE (2012). Es wurde eine systematische Analyse der Literatur 2007 – 2013 zur oralen, enteralen und parenteralen Ernährung bei CED vorgenommen und gegenüber den früheren Leitlinien um die Themen Prävention und Screening von Malnutrition bei CED ergänzt. Die Empfehlungen wurden auf einer Konsensuskonferenz am 18.10.2013 verabschiedet. Ergebnisse: Die Leitlinie umfasst 24 Empfehlungen zur Klinischen Ernährung bei CED. Screening auf Mangel- und Unterernährung sowie auf Mikronährstoffmangel wird bei CED empfohlen. Die Therapie der nachgewiesenen Malnutrition basiert auf Ernährungsberatung für eine bedarfsgerechte orale Ernährung und adäquater Ernährungstherapie. Neben Supplementen und oraler Trinknahrung kommen enterale und parenterale Ernährung als supplementäre Therapie infrage. Während die parenterale Ernährung nur in wenigen Sonderfällen meist passager durchgeführt wird, spielen die enterale Ernährung und orale Nahrungssupplemente eine bedeutsamere Rolle. Gerade bei Kindern wird die enterale Ernährung auch als primäre Therapie des akuten Schubs eines Morbus Crohn verwendet, um die unerwünschten Wirkungen von Medikamenten zu vermeiden. Schlussfolgerung: Fachgerechte ernährungsmedizinische Diagnostik, Ernährungsberatung und enterale Ernährung spielen eine wichtige Rolle in der Behandlung von CED, sie können den Krankheitsverlauf sowie die Lebensqualität verbessern.

Purpose: The importance of nutrition in the development and treatment of inflammatory bowel disease (IBD) is partially controversial. It is clear that in IBD, the prevalence of malnutrition is increased and that malnutrition worsens the prognosis. In the present guideline evidence-based recommendations for nutritional diagnostics and therapy in IBD are presented.Methods: The guideline is based on the previous guidelines of DGEM (2006/2007), ESPEN (2006, 2009), ECCO (2010) and NICE (2012). We performed a systematic review of the literature 20072013 on oral, enteral and parenteral nutrition in IBD and we extended the earlier guidelines on the topics of prevention and screening of malnutrition in IBD. The recommendations were approved at a consensus conference on October 18th, 2013.Results: The guideline includes 24 recommendations for clinical nutrition in IBD. Screening for malnutrition/undernutrition and micronutrient deficiency is recommended in IBD. The treatment of proven malnutrition is based on diet counseling for an appropriate oral nutrition and adequate nutrition therapy. In addition to micronutrient supplements and oral nutrition supplements enteral and parenteral nutrition are used as supplementary therapy. While parenteral nutrition is usually performed only in a few special cases, enteral nutrition as well as oral supplements play a significant role. Especially in children, enteral nutrition is also used as primary treatment of active Crohn's disease in order to avoid the undesirable effects of drugs.Conclusion: Professional nutritional diagnostics, dietary counseling and enteral nutrition play an important role in the management of IBD, they can improve the course of disease and quality of life.

Purpose: The nomenclature in clinical nutrition differs locally, between (para)medical disciplines, nationally and internationally. The inconsistencies hamper public, professional and scientific discussions. The main aim was to work out German consensus definitions for pertinent terms in clinical nutrition to unify their use in all chapters of the 2013 guideline update Clinical Nutrition of the German Society of Nutritional Medicine (DGEM). It should facilitate correct interpretation of recommendations.Methods: The definitions were developed based on national and international hard print technical literature (medical dictionaries, text books for clinical nutrition, national and international guidelines) and online research (PubMed, Embase, CINAHL, Google Scholar, Internet in general). National and international consensus definitions were preferentially treated.Results: In total 46 definitions were developed and organised in five categories: 1. General definitions (clinical nutrition, medical nutrition, care catering, dietetics, nutritional support, nutrition support team, obesity team, nutrition steering committee, malnutrition screening, nutritional assessment), 2. Nutritional status (disease-related malnutrition, cachexia, sarcopenia, specific nutrient deficiencies, refeeding syndrome), 3. Interventions (nutritional care, nutrition, diet, regular diet, fortified food, artificial nutrition, oral nutritional supplementation, enteral nutrition = tube feeding, parenteral nutrition, dietary advice, nutritional intervention/therapy, nutritional support therapy, nutrition intervention/therapy plan), 4. Products/techniques for oral nutritional supplementation and enteral nutrition (tube feeding techniques, oral nutritional supplements and enteral formulae, nutritionally complete formulae, nutritionally incomplete formulae, whole protein formulae, peptide-based formulae, elemental formulae, standard formulae, disease specific formulae), 5. Products/techniques for parenteral nutrition (parenteral techniques, total parenteral nutrition, partial parenteral nutrition, home parenteral nutrition, total nutrient admixture, multi-chamber systems, multi bottle systems).Conclusion: For the first time, a comprehensive, science-based terminology for clinical nutrition was created, which is to support the communication among experts and formulating guidelines.

Continuous Glucose Monitoring Following Consumption of Everyday Foods and their Effect on Postprandial Glucose and Insulin Levels

Malnutrition is a prominent feature in liver cirrhosis, with deleterious impact on clinical outcome. The objective of this study is to investigate whether malnutrition is associated with increased gastrointestinal permeability in liver cirrhosis reflected by altered urinary excretion of non-metabolizable sugar probes. Patients with advanced liver cirrhosis (Child Pugh Score B or C) were recruited. Nutritional status was determined according to the Subjective Global Assessment. Intestinal permeability was assessed by measuring the urinary excretion of orally administered, non-metabolized sugar probe molecules. The lactulose/mannitol ratio served as marker for intestinal permeability and reflects non-carrier-mediated transcellular and paracellular transport of the small intestine during the first 5 h. Sucrose recovery in urine within the first 5 h reflects gastroduodenal permeability; sucralose recovery in urine 5–26 h after consumption reflects colonic permeability. Sixty-four patients (56.7±10.8 years; 33% female) were included in the study. Twenty-one patients were considered well nourished according to the Subjective Global Assessment, 23 moderately nourished and 20 patients severely malnourished; 74% had alcoholic liver disease and 67% had cirrhosis stage Child C. Gastroduodenal and colonic permeability was significantly increased in patients with liver cirrhosis compared with 63 healthy controls (0.23±0.22 and 1.37±1.42% vs 0.14±0.10 and 0.41±0.72% in controls), but not different between well and malnourished subjects. Small intestinal permeability (lactulose/mannitol ratio) was increased in all patients (0.069±0.055%) and further increased in malnourished patients (0.048±0.031% vs 0.084±0.061%, P=0.004) due to decreased mannitol recovery only. Gastric, small intestinal and even colonic permeability was altogether increased in liver cirrhosis, and malnutrition was associated with further increased small intestinal permeability indicative of villous atrophy.

Ziel: Die bestehenden Hürden für eine sachgerechte Verordnung und Erstattung von Trinknahrungen zu diskutieren. Ausführung: Experten aus relevanten Disziplinen diskutierten unterschiedliche Aspekte dieser aktuellen Fragestellung. Schlussfolgerung: Es herrscht Einvernehmen über die Notwendigkeit von Trinknahrungen in der ambulanten Patientenversorgung. Die Verordnung und Erstattung von Trinknahrungen im ambulanten Bereich wird erschwert durch: Lösungsansätze bieten neue Bewertungskriterien. Diskutiert wurden hier insbesondere die Möglichkeiten der nachvollziehbaren Diagnose eines therapiebedürftigen Ernährungszustands, eine systematische Überprüfung von Indikation und Nutzen von Trinknahrungen sowie eine kontinuierliche Dokumentation über deren Zweckbestimmung und Verwendung, die sich an geeigneten Outcomeparametern orientiert sowie die Grenze zwischen erstattungsfähiger Therapie und selbst bezahlter Wunschbehandlung bestimmen kann.

The aim of this article is to discuss criteria for an appropriate prescription and reimbursement of food for special medical purposes (FSMP). During the panel discussion, experts from relevant disciplines argued different facets of this current topic. In sum, two discussion points became evident: the agreement with the necessity of FSMP in ambulant treatments, and the accordant challenges of the practical implications, namely prescriptions and reimbursement. Another question aroused regarding the methods of an appropriate assessment of when and how FSMP products can be prescribed. New assessment criteria can provide possible solutions. The following topics were discussed: the possibilities of a comprehensible diagnosis of a nutritional condition which requires treatment; a systematic inspection of utility and benefit of FSMP; and a continuous monitoring of the latter's purpose and implementation, which complies with respective outcome-parameters.

Effects of a Protein Optimized Diet Combined with Moderate Resistance Training on the Postoperative Course in Older Patients with Hip Fracture