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Limeil-Brévannes, France

Aussel C.,Unite de nutrition | Woelffle E.,Service Dietetique | Lemoigne P.,Institut Universitaire de France | Depailler L.,University Blaise Pascal | Bouillanne O.,University of Paris Descartes
Cahiers de Nutrition et de Dietetique

Sarcopenia is a major cause of increased dependence, falls, illness and death in elderly persons. Malnutrition, which is frequent in hospital settings, worsens sarcopenia. The causes of this effect are multiple, but preventive measures exist. These are essentially physical resistance exercise and dietary strategies, both qualitative (provision of amino acids involved in protein synthesis) and quantitative (greater amounts of protein or improved bioavailability of amino acids after a meal either by using "fast" proteins or through protein chrononutrition, also called pulsed protein diet or more simply senior diet). Pulsed protein diet is a new nutritional strategy supplying 75% of daily protein intake in the midday meal. It has shown its efficacy for lean weight gain in a prospective randomized trial. This new strategy preserves a familiar meal pattern and prioritizes traditional tastes and foods. It was adopted by the National Diet Programme in 2010. This novel approach breaks new ground in the nutritional care of elderly persons, and is currently being implemented in geriatric centres. Its long-term efficacy on health and life expectancy needs to be tested in a large-scale clinical trial. © 2012 Published by Elsevier Masson SAS on behalf of Société française de nutrition. Source

Laigle-Donadey F.,Groupe hospitalier Pitie Salpetriere and AP HP | Laigle-Donadey F.,University Pierre and Marie Curie | Cantal-Dupart M.-D.,Groupe hospitalier Pitie Salpetriere and AP HP | Bayen E.,University Pierre and Marie Curie | And 22 more authors.
Medecine Palliative

Background: Despite recent data suggesting a high burden of care among relatives of individuals with a malignant brain tumour, few institutional initiatives are undertaken. Objectives: We decided to develop a global multidisciplinary support project addressing key elements of the disease, from diagnosis to end of life. Our objective was to increase the involvement of relatives in care, giving them a sense of security, in order to concretely improve their everyday life and indirectly that of patients. Methods: A structured educational program for caregivers of patients with brain tumour was developed based on multidisciplinary expert opinion and caregiver feedback, complaining of a lack of information, particularly concerning the management of neurological disabilities at home. These sessions were recorded and posted online (patient association site) to promote the distribution. Results: A total of 34 caregiver participants, including 13 regular participants, were enrolled in our program between October 2012 and June 2013. Topics discussed were: symptoms, chemoradiotherapy, supportive care, management of motor, cognitive and speech disorders, palliative care. The satisfaction questionnaires analysis showed a clear individual benefit for caregivers, globally evaluated at 8.4/10. Moreover, the sessions available online are frequently viewed, with up to 1010 views regarding the filmed session (motor disability). Conclusion: A specific program dedicated to the practical formation of caregivers appears useful in the management of patients with brain tumour. © 2015 Elsevier Masson SAS. Source

Hubert A.,University Claude Bernard Lyon 1 | Ford-Chessel C.,Service Dietetique | Berthiller J.,University of Lyon | Peretti N.,Service de nutrition et gastroenterologie pediatrique | And 2 more authors.
Archives de Pediatrie

Introduction: Malnutrition, known as a cause of morbidity, has not been studied in children admitted to pediatric intermediate care units. This study aimed to describe the association between patients' nutritional status and the relative severity of illness that characterizes this population. Patients and methods: In this prospective longitudinal study, a dedicated nutrition support team assessed the nutritional status of all children, aged 5 days to 18 years, admitted to our university pediatric intermediate care unit (Hôpital Femme-Mère-Enfants, Lyon, France) over one year (2012-2013). Weight, height, body mass index, weight-for-age ratio, height-for-age ratio, and the analysis of growth curves were collected at admission. We monitored patients' weight, which allowed us to detect malnutrition occurrence during the stay, and its progression up to 3 months after discharge. Results: A total of 459 patients were enrolled. Based on the analysis integrating all nutritional indices and the progression of growth curves, malnutrition at admission was detected in 23.8% of children (20.5% and 6.8% suffered from acute and chronic malnutrition, respectively). Based only on the body mass index, malnutrition was detected in 15.5% of children. Chronic disease appeared as a risk factor for malnutrition at admission (P = 0.0001) and young age for acute malnutrition (P = 0.04). The incidence of acquired malnutrition during the stay (in children with a length of stay > 5 days) was up to 26%, and dyspnea was the only risk factor identified. This population recovered with a normal nutritional status late (66% after 2 months and 16% after 3 months). Conclusions: The prevalence of malnutrition is high in our pediatric intermediate care unit. The occurrence of acquired malnutrition during the stay is frequent. All children should benefit from systematic nutritional assessment at admission as well as careful monitoring during the stay and after discharge, to adapt early and individualized nutritional support. © 2015 Elsevier Masson SAS. Source

Pradignac A.,Unite de nutrition therapeutique | Petitdemange A.M.,Hopitaux Universitaires Of Strasbourg | Sery V.,Service Dietetique | Hubsch A.,Service Dietetique | And 2 more authors.

Background and aim: Nutritional practices are still insufficient in daily practice due to a lack of understanding or interest in nutritional issues. The aim of this study was to assess whether a nutritional education program for the nursing staff could improve hospitalized patients' nutritional diagnosis and management. Methods: Each year since 2005, members of our hospital's nursing staff received training in nutritional diagnosis and management. Since 2006, nutritional targets aimed at facilitating the detection of nutritional disorders in patients have been used. The effects of this approach on nutritional practices were assessed on an annual basis using targeted external audit. Results: The prescence of the nutrition referents led to a significant improvement in the patients' nutritional assessment and management. These effects were enhanced by using nutritional targets, and the combination of these two parameters resulted in the most significant improvements. Conclusions: A regular training program on nutritional problems designed for nursing staff along with the use of nutritional targets allows for significantly improved nutritional practices for hospitalized patients. © 2011 European Society for Clinical Nutrition and Metabolism. Source

De Rouvray C.,Limoges University Hospital Center | Desport J.-C.,Limoges University Hospital Center | Desport J.-C.,University of Monastir | Boutet A.,Service Dietetique | And 4 more authors.
Nutrition Clinique et Metabolisme

Maple syrup disease (MSD) is a rare autosomal recessive disorder caused by a decreased activity of branched-chain-ketoacid dehydrogenase, the second enzyme in the pathway of degradation of branched-chain aminoacids (leucine, isoleucine and valine). The three main clinical forms described are: classical form, at the neonatal period, marked by a severe neurological toxicity, subacute form appearing later and thiamine sensitive form. In every case, diagnosis is based on an increase of leucine, isoleucine and valine in blood and urines, with an associated presence of alloisoleucine. Diagnosis is confirmed by molecular analysis of corresponding genes. In several situations of protein catabolism, episodes of intoxication can occur. Emergency treatment for neonates and acutely sick children or adults uses hypoenergetic artificial nutrition (parenteral or enteral nutrition) without aminoacids and consequently involving only glucido-lipidic nutriments. Forty-eight hours later, proteins are progressively reintroduced. Natremia must be controlled, and a supplementation with isoleucine et valine is mandatory. Hemodialysis or hemofiltration can be necessary. Chronic treatment needs a strictly limited diet concerning branched-chain aminoacids. Natural proteins are limited as well as fruits and vegetables intakes. Lipids and sweetened food are permitted ad libitum. Food is supplemented by hyprotidic produces available in some hospital pharmacies. Oncoming of deficiencies is prevented by suplementations in minerals, vitamins, trace-elements, n-3 fatty acids and non-essential aminoacids. Follow-up is performed for children by a pediatrist and by an informed practitioner for adults. Psychomotricity and growth of children must be as normal as possible. All along the life, a metabolic equilibrium is needed and nutritional assessments are recommended at least once a year. Blood leucine level is regularly measured. A diagnosis before birth is possible when MSD has been identified in a member of the family. Pregnancy must be carefully prepared and followed. © 2011 Elsevier Masson SAS. Source

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