(Press-News.org) Patients in the intensive care unit who do not tolerate adequate nutrition from tube feeding should wait a week before receiving intravenous (IV) feeding because, compared with early IV feeding, it enhances recovery from critical illness. Results of a new multicenter study from Belgium will be presented Saturday at The Endocrine Society's 93rd Annual Meeting in Boston.
"These findings have enormous impact for improving quality and reducing the cost of medical care for critically ill patients," said the study's principal investigator, Greet Van den Berghe, MD, PhD, a professor at the Catholic University of Leuven.
Results of this large randomized, controlled clinical trial contradict European clinical guidelines on IV nutritional support in ICU patients, and lend support to American and Canadian recommendations. Van den Berghe said, "The standard of care in Europe should change."
At issue is the optimal timing to initiate parenteral nutrition (PN), also called IV feeding, in critically ill patients who are not getting enough calories through the gut by enteral nutrition, or tube feeding. To avoid ICU patients becoming weak from nutritional deficit, European experts recommend that they begin PN within two days of admission to the ICU, Van den Berghe explained. However, PN is linked to an increased frequency and severity of hyperglycemia, or high blood sugar. Experts in the U.S. and Canada advise withholding PN during the first week in the ICU if patients were not malnourished before admission.
"Until now there has been no good scientific evidence to support either of the widely implemented nutritional strategies in intensive care," she said.
This study, called the EPaNIC trial for Early Parenteral Nutrition to supplement insufficient enteral nutrition in Intensive Care patients, compared the timing of PN initiation in adults at seven ICUs in Belgium who were at risk of malnutrition. Of the 4,640 participants, 2,312 patients were randomly assigned to receive "early" PN (within 48 hours of admission), and 2,328 received "late" PN (no earlier than day 8 in the ICU). Both groups received early enteral nutrition support and insulin to target normal blood sugar levels.
The researchers found that late PN was superior to early PN, with time in the ICU a median of one day shorter. "Withholding IV nutrition for one week in the ICU, even in patients who could not be fed at all via the normal enteral route, surprisingly accelerated alive discharge from the ICU and from the hospital, without threatening their ability to function," Van den Berghe said.
Late PN also lowered the frequency of complications compared with early PN, including reducing severe infections (22.8 versus 26.2 percent, respectively), the authors reported. Also, late PN shortened the time on a ventilator and on dialysis, "thus allowing faster recovery from organ failure," and it "prevented liver function abnormalities," Van den Berghe said.
The investigator-initiated study received funding from the Fund for Scientific Research in Flanders, Belgium, the Catholic University of Leuven (GOA), and the Methusalem program from the Flemish government in Belgium. A nonrestricted grant to the Catholic University of Leuven came from Baxter Healthcare in France.
### END
Intravenous nutrition in critically ill patients should be delayed, study finds
2011-06-07
ELSE PRESS RELEASES FROM THIS DATE:
Women's risk of heart disease after gestational diabetes differs by race
2011-06-07
New research finds that gestational diabetes, or pregnancy-related diabetes, may not raise the risk of heart disease independent of other cardiovascular risk factors except in certain high-risk populations, such as Hispanics. The results will be presented Monday at The Endocrine Society's 93rd Annual Meeting in Boston.
"The prevalence of gestational diabetes is increasing, and its impact for the mother can extend well beyond pregnancy by raising her risk of developing type 2 diabetes and heart disease," said study co-author Rhonda Bentley-Lewis, MD, of Massachusetts ...
Low vitamin D levels are related to decreased response to osteoporosis medicine
2011-06-07
Women with low bone density are seven times more likely to benefit from a bisphosphonate drug when their vitamin D blood levels are above recent recommendations from the Institute of Medicine (IOM) as adequate for bone health. These new study results will be presented Saturday at The Endocrine Society's 93rd Annual Meeting in Boston.
"Maintaining adequate vitamin D levels above those recently recommended by the IOM is important for optimizing a standard therapy for osteoporosis: bisphosphonates," said coauthor Richard Bockman, MD, PhD, chief of the endocrine service at ...
Desserts with a low glycemic index may benefit weight-loss efforts for obese children
2011-06-07
Overweight girls lose more weight and can better stay on a healthy diet if they eat sugar-free, low-fat desserts several times weekly, as opposed to any dessert once a week, a new study finds. The results will be reported Monday at The Endocrine Society's 93rd Annual Meeting in Boston.
"Dieters commonly splurge on dessert once a week, usually choosing fattening items," said lead investigator Antonia Dastamani, MD, PhD, a pediatrician and research fellow at Athens University School of Medicine in Athens, Greece. "However, we found a positive effect of more frequent consumption ...
Testosterone therapy improves memory in postmenopausal women
2011-06-07
Post-menopausal women have better memory after daily treatment with a testosterone spray for six months, a new preliminary study finds. The results will be presented Saturday at The Endocrine Society's 93rd Annual Meeting in Boston.
"Women have a higher risk of developing dementia compared to men," said Sonia Davison, MD, PhD, the study's lead investigator and a postdoctoral research fellow at Monash University, Melbourne. "These results offer a potential therapy, where none currently exists, to slow cognitive decline in women."
The researchers compared a control group ...
Father's Day 2011: Children's Book Author Dad, Grandfather Regales His Children and Grandchildren with 'Wanda and the Oblahlahs' Story, Lost in Attic for 35 Years
2011-06-07
This Father's Day, Joe Sutton's charming children's tale starring Wanda, a mischievous, gum-chewing yet lovable little girl, launches, giving a nod to the lost art of storytelling -- passing stories, family histories and values from one generation to the next. "Wanda and the Oblahlahs", (Bright Sky Press, September 2011), the brainchild of then Army Colonel Sutton, emerged at bedtime for his rambunctious young daughters, Gretchen and Megan. Now 35 years later, Wanda's imaginative adventure lives on for Sutton's grandchildren and, as a children's book, can share ...
Yearly zoledronic acid at lower-than-standard doses increases bone density
2011-06-07
A lower dose of zoledronic acid than currently recommended for prevention of bone fractures due to osteoporosis decreases bone resorption and increases bone density, and may be effective in reducing the risk of osteoporotic fractures, a study finds. The new research findings will be presented Monday at The Endocrine Society's 93rd Annual Meeting in Boston.
"Our research suggests that one fifth or one half of the recommended dose might be sufficient to decrease fracture risk," said Andrew Grey, MD, principal investigator of the study and an associate professor of medicine ...
Yo-yo dieting appears to be healthier than lifelong obesity
2011-06-07
A new study comparing lifelong obesity with the weight fluctuations of "yo-yo dieting" suggests it is better to attempt to lose weight despite repeated failures at keeping the weight off than to not diet and remain obese. The results will be presented Monday at The Endocrine Society's 93rd Annual Meeting in Boston.
"It is clear that remaining on a stable, healthy diet provides the best outcome for health and longevity," said the study's principal investigator, Edward List, PhD, a scientist at Ohio University, Athens. "However, obese individuals commonly weight cycle—they ...
High amounts of the hormone leptin are linked to decreased depression
2011-06-07
Women who have higher levels of the appetite-controlling hormone leptin have fewer symptoms of depression, and this apparent inverse relationship is not related to body mass index (BMI), a new study finds. On Monday the results will be presented at The Endocrine Society's 93rd Annual Meeting in Boston.
"Animal data suggest that leptin may reduce anxiety and improve depression. Our study in women suggests that leptin may indeed have antidepressant qualities," said the study's lead author, Elizabeth Lawson, MD, of Massachusetts General Hospital and Harvard Medical School ...
BSSA tip sheet for June 2011
2011-06-07
Buried mangrove layer dampens seismic shaking along Caribbean coasts
Engineers have long used a soft flexible layer, often made of rubber bearings, between a rigid building and the soil to reduce the impact of ground shaking on the structure. Now French scientists have determined that a buried mangrove layer along the coasts of Guadeloupe Island, close to the Caribbean subduction zone, serves a similar purpose. The mangrove swamps limit the effects of seismic waves on the uppermost sandy layer, reducing the potential of liquefaction from shaking caused by earthquakes. ...
Many of those living with HIV face a new life-threatening challenge: cancer
2011-06-07
CHICAGO – As the world marks the 30-year anniversary of the first reporting of HIV/AIDS, now comes the realization of a new challenge for people with the incurable disease. For reasons not yet clear, people with HIV face a higher rate of cancers not usually associated with HIV. This increasing rate of "non-AIDS defining cancers" includes lung, head and neck, liver, kidney, and anal cancers, among others. The alarming uptick in cancer rates highlights the critical need to understand how to treat tumors in people taking highly active anti-retroviral therapy (HAART) for ...