Clinical Nutrition Unit

San Carlo Canavese, Italy

Clinical Nutrition Unit

San Carlo Canavese, Italy
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Gallo F.,Clinical Nutrition Unit | Haupt E.,Ospedale Lavagna | Marchello C.,Clinical Nutrition Unit | Garbarini R.,Ospedale Lavagna | And 3 more authors.
Mediterranean Journal of Nutrition and Metabolism | Year: 2011

Protein-energy malnutrition (PEM) in hospitalized patients is associated with poor outcomes. Prealbumin (PAB) has been shown to be a potentially useful tool in PEM assessment. PAB plasma concentrations are closely related to nutritional state and nutritional intervention. However, PAB is also inversely correlated to C-reactive protein (CRP), making difficult the interpretation of PAB changes during tratment of severely ill patients with inflammation and/or infection. Methods: To assess the confounding role of CRP we investigated the role of two seriate measures of PAB and CRP in monitoring the response to nutritional intervention in 83 hospitalized patients enrolled in a nutritional care program (group 1). Data were also collected from 60 patients with low PAB not enrolled in any nutritional program (group 2). Results: When nutritional needs were not satisfied (nutritional intake/needs ratio <75%) we found no PAB increase, whereas there was a significant PAB increase in patients with adequate intake (mean delta-PAB 4.2 mg/dL). Covariance analysis showed a statistically significant mean PAB increase of 2.38 mg/dL in the adequate intake subset, value controlled for the confounder delta-CRP (p < 0.005). In the inadequate intake subset and in group 2 an improvement in CRP status was not associated with a proportional improvement in PAB levels. Conclusions: Although the complex interplay between PAB and inflammation cannot be completely solved, we suggest that in subjects receiving an adequate nutritional support a significant improvement of PAB can be considered, at least partially, a real marker of nutrional improvement. © Springer-Verlag 2011.


Goals of work The aim of this study was to evaluate the prevalence and influence of malnutrition (unintentional weight loss >5% in the last 3 months) on quality of life (QoL) and performance status (PS) in head and neck cancer patients (HNC) before treatment. Patients and methods Sixty-one consecutive outpatients affected by locally advanced HNC (III-IVA stage) were enrolled. In all patients, nutritional intake (by diet history), nutritional status (Patient Generated Subjective Global Assessment), unintentional weight loss (UWL), serum prealbumin, hemoglobin level (Hb), C-reactive protein, QoL(European Organization for Research and Treatment of Cancer Quality of Life Questionnaire C-30 v. 3.0), and PS (Eastern Cooperative Oncology Group (ECOG) PS) were assessed before radio or concomitant chemoradiotherapy. Main results Thirty-six percent of HNC were malnourished before treatment. The median ECOG PS in malnourished patients was 1 (0-2), whereas in nonmalnourished was 0 (0-2; p=0.018). Physical (p=0.043), role (p=0.047), and social functions (p=0.024) scores were significantly worse in malnourished than in nonmalnourished HNC. Fatigue (p<0.001), appetite loss (p<0.001), and nausea and vomiting (p=0.002) scores were worse in malnourished patients than in nonmalnourished. In the multivariate analysis, UWL and Hb level independently influenced physical (p=0.002; p=0.005), role (p=0.004; p=0.001), and social functions (p=0.024; p=0.009). Conclusion Our data suggest that an early and intensive nutritional support might reduce weight loss before, during, and after treatment completion, improving outcome, QoL, and PS. © Springer-Verlag 2009.


PubMed | Liver Unit, Clinical Nutrition Unit and Ultrasonography Unit
Type: | Journal: International journal of endocrinology | Year: 2015

Background. Multiple weight loss failures among obese patients suggest the design of new therapeutic strategies. We investigated the role of 2-week course of enteral treatment with a very low-calorie protein-based formula in the management of severe obesity. Methods. We evaluated the feasibility, safety, and efficacy of 2-week continuous administration of a protein-based formula (1.2g/kg of ideal body weight/day) by nasogastric tube in severely obese adults (body mass index (BMI) 40kg/m(2)). Results. In total, 364 patients (59% women; BMI = 46.6 7.2kg/m(2)) were recruited. The intervention was discontinued within 48 hours in 26 patients, due to nasogastric tube intolerance. No serious adverse events occurred. During the first and the second week, 65% and 80% patients, respectively, reported no side effects. All biochemical safety parameters were affected by the intervention, particularly uric acid (+45%) and aminotransferases (+48%). In the other cases the change was negligible. We observed significant weight loss (5.7 2.3%) and improvement in blood pressure and glucose and lipid metabolism parameters (P < 0.001). Conclusions. A 2-week course of enteral treatment with a very low-calorie protein-based formula appeared a feasible, likely safe, and efficacious therapeutic option to be considered for inclusion into a composite weight loss program for the management of severe obesity. This trial is registered with ClinicalTrials.gov Identifier: NCT01965990.


Noe D.,Clinical Nutrition Unit | Cursano R.,Clinical Pharmacy Unit | Lanzi P.,Clinical Nutrition Unit | Albrecht M.,Clinical Pharmacy Unit
Nutritional Therapy and Metabolism | Year: 2014

Introduction: The ISMP list of high-alert medications includes both parenteral nutrition preparations and concentrated electrolyte solutions. A wide selection of premixed parenteral nutrition solutions is available, but they do not always comply with the electrolyte requirements of critically ill patients. It is possible to make additions on the ward but this may cause problems (microbial contamination, incompatibilities, risk errors), whereas the setup in a pharmacy asset allows to meet the standards of the Joint Commission as regards patient safety. The aim of this study is to assess the frequency of manipulation of premixed solutions required to balance patients’ electrolyte needs, as an indicator of clinical risk. Materials and Methods: We examined the composition of 3309 parenteral nutrition solutions prepared in our pharmacy in 2012 and compared the electrolyte content of these preparations with several widely used premixed solutions. We then calculated the number of bags which would have required the addition of a concentrated solution of electrolytes to meet the clinical needs. We also examined the frequency of day-to-day variations in bag composition, as this is suggestive of critical clinical situations that would be difficult to manage with standard mixtures. Results: Compared with the premixed solutions, the majority of pharmacy-prepared solutions had higher sodium (40.2 vs 29.5 mmol/L) and calcium (5.3 vs 1.9 mmol/L) concentrations and lower magnesium (2.7 vs 3 mmol/L) and phosphate (6.2 vs 11 mmol/L) concentrations. Changes in electrolyte composition from one day to the next were fairly frequent (25%). Conclusions: In our hospital, premixed parenteral nutrition preparations would have often required the addition of electrolytes due to the severe imbalances of critically ill hospitalized patients; moreover, the addition of other nutritional components would often have been necessary. Pharmacy compounding of individualized parenteral nutrition solutions could be a valid tool both for reducing manipulationassociated risks and meeting patients’ requirements. © 2014 SINPE-GASAPE.


Sukkar S.G.,Clinical Nutrition Unit | Vaccaro A.,Clinical Nutrition Unit | Ravera G.B.,University of Genoa | Borrini C.,Clinical Nutrition Unit | And 4 more authors.
Mediterranean Journal of Nutrition and Metabolism | Year: 2013

Whey proteins represent the most satiating nutrients. In particular, their effects are due to enterohormonal changes (CCK, GLP-1 and PYY 1-36) observed after their exclusive ingestion. Glucomannan has important satiety property due to volume increase following gelification. The aim of the study is the evaluation of subjective rate of hunger and enterohormone concentrations (CCK, GLP-1, PYY 1-36) following oral loading of a mixture containing WP (8 g) or casein (8 g) plus glucomannan (1 g) (Colordiet®, Inpha DUEMILA Srl Lecco, Italy). The study was conducted as a double-blind crossover with five healthy volunteers (BMI 22-26 kg/m2 aging 18-65 years) in acute and a wash-out period of 1 week between the first and the second evaluation. From the analysis of the data, we observe that the load with WP induces a significant decrease in the desire to eat after 90 min (P < 0.0446) when compared with casein. As far as plasma hormones are concerned, there was a significant increase only in GLP-1 at 90 min after WP (P < 0.00166) and 180 min after casein (T0 vs. T180 P = 0.000129). There is a significant correlation between the increase in GLP-1 and decrease of desire to eat (R = -0.93). There is a tendency to the increasing of CCK after 90 min, which is not significant (P = 0.091). These results could be due to (a) the low number of cases or (b) the low dose of protein used. The present study suggests that a mixture of WP plus glucomannan exerts a decrease in the desire to eat which is correlated to enterohormonal modification (GLP-1 increase) despite the low content of protein (8 g) and the presence of glucomannan, which could reduce the fast absorption of WP in relation to the net forming during the gelification of the gastric environment. © 2013 The Author(s).


Noe D.,Clinical Nutrition Unit | Lanzi P.,Clinical Nutrition Unit | Spiti R.,Clinical Nutrition Unit
Nutritional Therapy and Metabolism | Year: 2012

Asthma and allergy prevalence rates have increased in recent years especially in countries with Westernized lifestyles. This could be the result of a complex interaction between genetic and environmental factors, due to the changes in dietary habits. Many studies have investigated the role of specific nutrients in different stages of life, but their results have not been conclusive. Food allergens, low intake of antioxidants and omega 3, some minerals, and breastfeeding, all play beneficial or negative roles in asthma onset. It is likely that nutrients may exert their strongest effect early in life when the immune system is still not fully developed. © 2012 SINPE-GASAPE - ISSN 1828-6232.


Noe D.,Clinical Nutrition Unit | Lanzi P.,Clinical Nutrition Unit | Rubino N.,Clinical Nutrition Unit | Braggiotti S.,Clinical Nutrition Unit | And 4 more authors.
Nutritional Therapy and Metabolism | Year: 2012

Introduction: Hospital malnutrition is a clinical priority and nutritional screening is strongly recommended upon admission. Among the nutritional indices, the MUST (Malnutrition Universal Screening Tool for adults) is the most validated for adult inpatients. The aim of our work was to assess the risk of malnutrition upon admission and its recognition by the hospital's health staff. Materials and methods: During a 3-month period, 307 newly admitted adult patients at the San Carlo Borromeo Hospital in Milan, Italy, were randomly screened and the MUST score was calculated within 72 hours. The number of nutritional checks for a more in-depth evaluation was also assessed. Results and conclusion: Forty-nine percent of patients presented a high risk of malnutrition on admission to hospital. In 28% of this sample, a nutritional evaluation had been requested. So 72% of patients who presented a severe risk of malnutrition (MUST ≥2) would not have been recognized and would therefore have remained untreated. Nutritional screening is an urgent need and strategies in this direction are required. © 2012 SINPE-GASAPE.


Castaldo G.,Clinical Nutrition Unit | Monaco L.,Ultrasonography Unit | Castaldo L.,Clinical Nutrition Unit | Galdo G.,Clinical Nutrition Unit | Cereda E.,Nutrition and Dietetics Service
International Journal of Food Sciences and Nutrition | Year: 2016

The impact of a rehabilitative multi-step dietary program consisting in different diets has been scantily investigated. In an open-label study, 73 obese patients underwent a two-phase weight loss (WL) program: a 3-week protein-sparing, very low-calorie, ketogenic diet (<500 kcal/day; Oloproteic® Diet) and a 6-week hypocaloric (25–30 kcal/kg of ideal body weight/day), low glycemic index, Mediterranean-like diet (hypo-MD). Both phases improved visceral adiposity, liver enzymes, GH levels, blood pressure and glucose and lipid metabolism. However, the hypo-MD was responsible for a re-increase in blood lipids and glucose tolerance parameters. Changes in visceral adiposity and glucose control-related variables were more consistent in patients with metabolic syndrome. However, in these patients the hypo-MD did not result in a consistent re-increase in glucose control-related variables. A dietary program consisting in a ketogenic regimen followed by a balanced MD appeared to be feasible and efficacious in reducing cardiovascular risk, particularly in patients with metabolic syndrome. © 2016 Informa UK Limited, trading as Taylor & Francis Group


PubMed | Clinical Nutrition Unit
Type: | Journal: Mediterranean journal of nutrition and metabolism | Year: 2013

Whey proteins represent the most satiating nutrients. In particular, their effects are due to enterohormonal changes (CCK, GLP-1 and PYY 1-36) observed after their exclusive ingestion. Glucomannan has important satiety property due to volume increase following gelification. The aim of the study is the evaluation of subjective rate of hunger and enterohormone concentrations (CCK, GLP-1, PYY 1-36) following oral loading of a mixture containing WP (8g) or casein (8g) plus glucomannan (1g) (Colordiet

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