Summer 2018

Newsletter of the Parenteral and Enteral Nutrition Group of the British Dietetic Association

Latest News

HOT OFF THE PRESS – Winners of 2018 PENG Award Announced

We are pleased to congratulate the following people on being the winners of this year's PENG Award:

1st

Outcomes for patients with multiple sclerosis following insertion of gastrostomy tube:
A single centre service evaluation.
By S. White, J. Denning, L. Grandidge and S. Nair, Sean White, Dietetic Department, Northern General Hospital, Herries Road, Sheffield, England, S10 4DN

2nd

Protein supplementation can help to meet requirements in critically ill patients on a mixed surgical and medical intensive care unit.
By J. Leyland and R. He, Dietetics Department, Northern General Hospital, Herries Road, Sheffield,
S5 7AU

3rd

A service evaluation investigating energy and protein consumption on an older adults ward before and after the implementation of lunchtime picture menu.
By R. Reeve, King’s College London University, WC2R 2LS; and D. Gray, Guy’s and St Thomas’ Hospital, SE1 7HE

Further information will follow in future issues of PENlines.

 

 

Chance to Have Your Say in the Malnutrition Priority Setting Partnership's Survey – Deadline for completion 30th September 2018

Have you come across the Malnutrition Priority Setting Partnership (PSP) whose aim is to set research priorities for malnutrition and screening? This is a project being delivered by the University of Manchester and managed by the James Lind Alliance.

The aim of the project is to find out what uncertainties or questions people with experience of malnutrition have about Malnutrition and Nutritional Screening and what they think research should be looking at next. The survey is aimed at patients, carers, health professionals and anyone else with any kind of malnutrition experience.

In order to reach as wide an audience as possible the Malnutrition PSP would be really grateful for your help in the completing of the survey which is available online and also as a downloadable pdf that can be printed and completed by hand (details are below). In addition, if you are happy to share this survey with others that would also be really appreciated.

 

Updates from the BDA

 

Writing Opportunities

Did you know that PENG work with a number of different online and print publications such as NHD
and CN?

Check out The Essential Guide to Whole Protein Feeds in the July edition of CN written by PENG member Jaimeet Jassal, which provides an up-to-date and comprehensive guide to the indications and contraindications for whole protein feeds across a range of clinical conditions.

There are further opportunities available this year with CN. These include:

Nov issue – deadline: 21st September 2018

  • Cerebral Palsy
  • Bariatrics
  • Anorexia Refeeding syndrome.

Dec/Jan issue – deadline: 6th November 2018

  • ERAS
  • Prader-Willi
  • Paediatric Home Parenteral Feeding.

A PENG committee member will support you throughout and also can also help with proof reading if desired.

If you are interested or would like any further information please reply to PENG@bda.uk.com FAO Linda Cantwell and CC: cantwel@tcd.ie.

 

Intensive Care Patients' Muscles Unable to Use Fats for Energy

The muscles of people in intensive care are less able to use fats for energy, contributing to extensive loss of muscle mass, finds a new study co-led by UCL, King's College London and Guy's and St Thomas' NHS Foundation Trust.

Intensive care patients can lose 20% of their muscle mass in just 10 days, which can contribute to long-term disability. Nutrition and exercise programmes designed to prevent this muscle loss have largely been unsuccessful, and this new finding, published in Thorax, helps explain why.

"We already knew that our patients have difficulty using glucose to generate energy. Our new data suggests they also find it hard to use fats in the feed we give them to generate energy," said lead author Dr Zudin Puthucheary (UCL Medicine, Institute of Sport, Exercise and Health, and Royal Free London NHS Foundation Trust).

The findings suggest the inability to generate energy is likely a result of the widespread muscle inflammation experienced by patients in the early days of intensive care.

The research team took leg muscle biopsies and blood samples from 62 patients on their first and seventh days in intensive care, and tested them for key proteins that are involved in energy conversion. They found that the quantity of fat in a patient's tube feed was unrelated to the amount of energy in the muscle and to changes in quantity of muscle, instead finding a close and direct relationship between impaired energy conversion and loss of muscle quantity.

They also found a build-up of fats in the muscle, suggesting it wasn't being effectively used for energy.

"Fats typically make up close to half of the energy content of tube feeds for critically ill patients. Previous studies into increasing nutrition for intensive care patients have shown conflicting results; our findings help clarify why our patients aren't benefiting from higher-calorie feeds as fats are an ineffective source of energy in the first few days of intensive care," said senior co-author Professor Nicholas Hart (Guy's and St Thomas' NHS Foundation Trust).

The researchers are now investigating whether different types of nutrition that use alternative energy sources, such as ketones, could be more effective, and perhaps treating muscle inflammation before exercise interventions could help maintain or restore muscles.

"Muscle wasting is associated with increased length of intensive care unit stay and with mortality, so it's vital that we find better ways to ensure that nutrition and rehabilitation programmes are effective at preventing muscle wasting," said senior co-author Professor Stephen Harridge (King's College London).

"By clarifying the complex relationship between inflammation, metabolic processes and signalling, and resulting loss of muscle mass, we have identified where researchers should focus their efforts on finding better ways to keep intensive care patients as healthy as possible," said senior co-author Professor Hugh Montgomery (UCL Medicine and Institute of Sport, Exercise and Health).

Dr Puthucheary added: "Exercise and rehabilitation in this group is going to be difficult if our patients' muscles lack energy to work and grow. Our patients may need a coordinated nutrition and exercise regime to recover just like athletes do - not just one or the other. This needs to be put in place once the muscle inflammation has subsided."

The study was conducted at King's College Hospital and the Whittington Hospital, and funded by the National Institute for Health Research.

Puthucheary ZA, Astin R, Mcphail MJW, et al. Metabolic phenotype of skeletal muscle in early critical illness. Thorax. Published Online First: 06 July 2018. doi: 10.1136/thoraxjnl-2017-211073.

 

Patients Maintain Muscle Mass Five Years after Surgically Induced Weight Loss

Research dispels fear that gastric bypass surgery leads to long-term muscle issues Newly-published research on surgically-induced weight loss provides important evidence supporting the long-term safety and viability of bariatric surgery.

The study, appearing in the academic journal Obesity, finds that muscle mass and fat-free mass (organs, bones, tissues) levels are maintained in the body following a rapid post-surgical weight loss. The finding dispels fears that gastric bypass surgery may result in a detrimental loss of muscle that continues for years after initial weight loss, leading to long-term muscle insufficiency despite weight regain.

"This study demonstrated that after the first year of weight loss, there is some loss of muscle that happens over time, but apparently not any more than age-related loss," said lead author Lance Davidson, assistant professor of exercise science at Brigham Young University."This research is the first to tell the whole story of what is happening with muscle and fat-free mass beyond initial weight loss and up to five years after surgery."

Previous research has demonstrated that the more rapid and dramatic the post-surgical weight loss, the more fat free mass is lost. Researchers and clinicians have previously expressed concerns that excessive loss of fat-free mass negatively impacts metabolic rates, the integrity of skeletal muscle and the ability to function and maintain a physically active lifestyle when aging. The new study reveals that the steep losses to fat-free mass post-surgery don't continue as the years go on.

"When you lose weight after the surgery, 70-80% of the tissue you lose is fat," said Davidson, who joined this research collaboration as a post-doctoral fellow at Columbia University. "Although a majority of the fat free mass lost is muscle, there is nothing to fear. Your body tends to retain the remaining muscle mass in subsequent years."

Researchers also point out that losing a bit of muscle mass along with the fat after bariatric surgery makes sense, since people generally gain a little muscle to support excess weight.

Thanks to the significant losses in fat mass from the operation, the study found the muscle mass of patients, expressed as a percent of total body weight, actually increases: up to 4.4% in females and 5.4% in males. Because muscle is more metabolically active than fat, this means gastric bypass patients become more metabolically active post-surgery.

"This may explain why many people successfully maintain their weight loss after gastric bypass: because the favourable ratio of muscle to fat creates a relative increase in metabolic rate," Davidson said. "This could be one reason why bariatric surgery continues to be a good weight loss tool long-term."

Lance E. Davidson et al, Fat-Free Mass and Skeletal Muscle Mass Five Years After Bariatric Surgery, Obesity (2018). DOI: 10.1002/oby.22190

 

 

 

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