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Nutrition Support Blog: Update on the Latest Nutrition Support Research

Posted by SF8N at Oct 07, 2014 11:00 AM |
October 7, 2014
Nutrition Support Blog: Update on the Latest Nutrition Support Research

by Joe Krenitsky, MS, RD

Although the pace of change in the world of nutrition support often feels excruciatingly slow, and I have said or written far too many times that “we need more data”, in the last month there has been such a flood of new research, that trying to take it all in has felt a bit like trying to take a drink from a fire hose. Here are some of the most recent articles that are starting to pile up on my desk while I attend to those “we are going to change your job description to permanent calorie count technician if you don’t get this done before the deadline” work necessities.

This article stands to be one of the biggest controversies in the past, or next several years: a “pragmatic, randomized” study of PN versus EN in the ICU that reports no increase in infectious complications from PN.  It is already on schedule for our October journal club.

Harvey SE, Parrott F, Harrison DA, Bear DE, Segaran E, Beale R, Bellingan G, Leonard R, Mythen MG, Rowan KM; the CALORIES Trial Investigators. Trial of the Route of Early Nutritional Support in Critically Ill Adults.  N Engl J Med. 2014 Oct 1. [Epub ahead of print]

This is a randomized study of vitamin D supplements in the ICU that highlights why the data from observational studies needs to be tested with randomized trials.  Vitamin D supplements did not have the impact that was expected in critically ill patients.  However, the real data is in the details (as usual), and it may be that severely deficient patients may benefit.

Amrein K, Schnedl C, Holl A, et al.  Effect of High-Dose Vitamin D3 on Hospital Length of Stay in Critically Ill Patients With Vitamin D Deficiency: The VITdAL-ICU Randomized Clinical Trial.  JAMA. 2014 Sep 30. doi: 10.1001/jama.2014.13204. [Epub ahead of print]

Next is a study of glutamine-containing “immunonutrition” in a mixed adult ICU population that have just finished evaluating this study in our journal club.  Look for the full details in our e-journal club soon, but (spoiler alert) supplemental enteral glutamine does not appear to have a place in the ICU.

loovan Zanten AR, Sztark F, Kaisers UX, Zielmann S, Felbinger TW, Sablotzki AR, De Waele JJ, Timsit JF, Honing ML, Keh D, Vincent JL, Zazzo JF, Fijn HB, Petit L, Preiser JC, van Horssen PJ, Hofman Z.   High-protein enteral nutrition enriched with immune-modulating nutrients vs standard high-protein enteral nutrition and nosocomial infections in the ICU: a randomized clinical trial.  JAMA. 2014 Aug 6;312(5):514-24.

The results of this next study suggest that I may need to go back and re-write part of my December 12, 2012 blog on iron supplements in the ICU.  Although 3X/week IV iron infusions did not reduce transfusion requirements, the iron did also not seem to increase risk of infection.

Pieracci FM, Stovall RT, Jaouen B, et al. A multicenter, randomized clinical trial of IV iron supplementation for anemia of traumatic critical illness.  Crit Care Med. 2014 Sep;42(9):2048-2057.

And last, but not least, here is a clinical study on the benefits of rhubarb with EN in the treatment of pancreatitis.  I don’t know exactly why the thought of therapeutic rhubarb seems to hold some intrinsic mirth.  After all, plants contain a number of complex biologic substances with therapeutic potential, and rhubarb extract (emodin) has been studied in a number of animal and in-vitro studies, and appears to have anti-proliferative and anti-metastatic effects on pancreatic cancer.  Just remember that if we do see a RhubarbiCal/RhubarbiSure EN formula someday, that you read it here first.

Wan B, Fu H, Yin J, Xu F.   Efficacy of rhubarb combined with early enteral nutrition for the treatment of severe acute pancreatitis: a randomized controlled trial.  Scand J Gastroenterol. 2014 Sep 16:1-10. [Epub ahead of print]

Liu A, Chen H, Wei W, et al. Antiproliferative and antimetastatic effects of emodin on human pancreatic cancer. Oncol Rep. 2011 Jul;26(1):81-89.


“But there never seems to be enough time

To do the things you want to do

Once you find them”

        - Jim Croce, Time in a Bottle, 1972


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