sudiyeh hejri zarifi

Enteral tube feeding intolerance (ETFI) is one of the most common complications of enteral nutrition (EN), which may lead to increased mortality and length of intensive care unit (ICU) stay. This study aimed to determine the prevalence of ETFI and effects on feeding intolerance on nutrition and clinical outcomes in Iran.

This cross‑sectional study was conducted in 2019 at the three general ICUs of Imam Reza Hospital in Mashhad, Iran, during 7 days on 245 patients. The collected data included demographic characteristics, primary diagnosis, the Acute Physiology and Chronic Health Evaluation II (APACHE ІІ) score, Sequential Organ Failure Assessment (SOFA) score, duration of mechanical ventilation, and length of ICU stay. Feeding intolerance was assessed using daily questionnaires for 7 days. ETFI was determined as the interruption of EN based on gastrointestinal causes, including large gastric residuals, abdominal distension, vomiting, diarrhea, and subjective discomfort.

Overall, 245 critically ill patients (122 males and 123 females) were included in this study, with a mean age of 58.43 ± 19.2 years in three general ICUs. The highest prevalence rate of ETFI was 91.8%, which occurred on the 2nd day although the rate decreased in the following days. The minimum ETFI was observed on the last day (38.8%). Feeding intolerance was associated with the increased APACHE II scores (P = 0.04), SOFA scores (P < 0.001), and duration of mechanical ventilation (P < 0.001) compared with the tolerant patients. The most common causes of ETFI in the patients admitted to the ICU were gastric residual volume (GRV), large GRV, vomiting, and distension.

ETFI was prevalent in almost two‑third (66%) of the critically ill patients receiving EN based on the GRV. ETFI was associated with deteriorated nutritional status and clinical outcomes.

Kidney transplantation is usually performed as a preferred treatment and last resort in chronic kidney disease after the end stage of renal disease. Considering that nutrition can play an essential role in post-transplant recovery, the aim of this study was to review the nutritional assessment and dietary requirements of kidney transplant patients. Articles were collected via searching in databases such as PubMed-Medline, Google Scholar, Scopus, and Web of Science using relevant keywords and phrases, including kidney transplantation, end stage renal disease, nutrition, dietary intake, nutritional assessment, and nutrition evaluation. Medical nutrition therapy can play a vital role in the recovery after transplantation in kidney failure patients. It seems that nutritional and medical evaluation through laboratory methods, vital signs, and anthropometric measurements are necessary to improve the quality of nutritional interventions after kidney transplantation and can help to decrease the risk of kidney transplant rejection, therefore periodic evaluation and follow-up of these patients can lead to beneficial results.

Sepsis is one of the major causes of high morbidity and mortality in intensive care units (ICU) and severe sepsis leads to some metabolic disorder. The previous studies indicate that l-carnitine deficiency in septic patients and causing mitochondria dysfunction and worsening metabolic disorder. Reducing mortality in sepsis by nutritional supplements may help mitigate the risk of clinical outcomes in sepsis patients. 

Our systematic search to find relevant studies was performed up to March 2020, using ISI Web of Science, Google Scholar, EMBASE, PubMed/MEDLINE and SCOPUS databases. In this systematic review, the aim was to assess whether l-carnitine or levocarnitine may reduce the risk of mortality in patients with sepsis. 

10 articles were included in our systematic review. The results of the review showed that plasma carnitine levels were significantly associated with the Sequential Organ Failure Assessment score (SOFA) (p<0.001). On the other hand, other studies showed carnitine supplementation had no significant effect on SOFA score change in a short time, while carnitine deficiency was associated with significantly increased SOFA score in critically ill patients.  L-carnitine supplementation indicated a significant decline in 28 days’ mortality as well. 

 Evidencefrom limited data suggested that carnitine may helps to reduce mortality risk in sepsis patients, but further studies are required with different doses and durations.

Flat breads are the main dietary staple in many Middle Eastern and North African countries. In today’s demanding world, the use of bread improvers has become an indispensable part of enhancing the quality of bakery products. Bread improvers are technically sophisticated blends of functional ingredients, which if formulated correctly, will enhance the development of dough structure, facilitate trouble-free production, and provide the desired result of consistent products having optimal quality at the lowest possible cost. Among the functional food additives, polyols have been increasingly used to improve the quality and shelf life of bread. Polyols have been used successfully to extend the shelf life of ready to eat bread used by the military, Barbari bread fortified with soy flour, as well as flour tortillas. Emulsifiers, a subset of surfactants, have been widely used by the baking industry. The function of surfactants, as crumb softening agents, is closely related to their interaction or complex formation with starch, particularly the linear amylose fraction, to retard bread staling. Surfactants, such as SSL and DATEM that are the most efficient in breadmaking are able to form lamellar mesophases or gel structures in water. It has been shown that for polar lipids the lamellar liquid-crystalline phase is the most effective form in which this component can be added to bread dough in order to improve loaf volume. Mechanical properties of dough play an important role in baking industries. In a few cases, it can be desirable, for example, to fix some ingredients on bakery products. The dough is expected not to stick to metal surfaces and to show a good resistance to vibration and mechanical shock to minimize detrimental effects such as process breakdown, production loss and contamination of the equipment. Thus, the present study was designed: (a) to examine the effects of different emulsifiers (sodium stearoyl-2-lactylate and diacetyl tartaric acid esters of monoglycerides) and polyol (propylene glycol) on Barbari flat bread performance when used singly and in combination at different levels; (b) to obtain the relationship between mechanical and rheological properties of dough and quality, shelf life, sensory and image parameters of bread using the asymmetric methods (response surface methodology and partial least squares regression) and symmetric methods (coefficients of determination and Principal components analysis) and (c) to determine the optimum formulations for Barbari flat bread improver.
Commercial Triticum aestivum wheat flour (locally named Setareh) was procured from the AceeArd Co., Khorasan, Iran. Propylene glycol (PG) was purchased from J.T. Baker Chemical Company (Phillipsburg, NJ). Sodium stearoyl-2-lactylate (SSL) and diacetyl tartaric acid esters of monoglycerides (DATEMs) were provided by Vista Tejarat Company (Tehran, Iran). Moisture, ash, fat, protein, wet gluten and falling number were determined according to standard AACC methods. Three replications were taken for each characteristic. Gel samples were prepared using sodium stearoyl-2-lactylate (SSL), diacetyl tartaric acid esters of monoglyceride (DATEM) and propylene glycol (PG) in the range of 0-0.5 g/100g. Bread making was carried out according to the method of Maleki et al. (1981). Quality analysis of fresh bread samples was carried out by measuring specific volume. Sensory attributes of bread were selected according to the Iranian flat bread evaluation method, including bread form and shape; upper surface property; bottom surface property; cavity and porosity; firmness and softness of texture; chewiness; odor, flavor and taste and overall quality score. Staling phenomenon and its changes were evaluated by penetration test after 1 hour, 3, 5 and 7 days. The average values of L*, a*and b* colors describing the outer crust regions were obtained. The crumb grain features were the mean cell area, porosity, and cell density. A central composite design was constructed using the software Design Expert Version and was used for sampling of different combination of gel constituents. In addition, Lack of fit, coefficients of determination (R2), adj-R2, coefficient of variation (CV) and significant probabilities were calculated to check the model adequacy. Multivariate correlation matrix, coefficients of determination and principal components analysis were performed by using Minitab 15 software.
The characteristics of the flour are in the range of typical values of medium strong flour, suitable for Iranian Barbari flat bread. The results showed dough adhesiveness was increased by SSL addition but it was decreased by quadratic effect of SSL like as resilience. All of three components to the gel formula caused decrement in the hardness, gumminess and chewiness. But the interaction of them influenced on them. On the other hand, although cohesiveness increased by addition of all components but influenced significantly by interaction of them. Dough mechanical properties were furthermore correlated with dough farinographic aspects, quality, sensory parameters, image processing and shelf life of bread. It was proved that principal components analysis (PCA) is able to extract relevant information and offer an easy and promising approach for the interpretation of dough mechanical properties and its correlation with other properties and dough and bread. Partial least squares regression (PLSR) models were applied to determine the relationships between dough mechanical properties and dough farinographic properties, bread quality, sensory, image processing and shelf life aspects. Results from statistical analysis suggest that the mechanical parameters of dough are capable in predicting more than 50% of dough and bread properties

The aim of this study was to compare biochemical tests, body composition and anthropometric parameters in Nonalcoholic Fatty Liver Disease (NAFLD) patients before and after Ramadan fasting. fifty NAFLD patients including 33 males and 17 females aged 18-65 year, were recruited. Subjects attended after diagnosis based on ultrasound imaging, with at least 10 hour fasting, before and after Ramadan who were been fasting for at least 10 days. A fasting blood sample was obtained, blood pressure was measured and body mass index(BMI) and fat mass (FM) and fat free mass (FFM) were calculated. Lipid profile, fasting blood sugar (FBS),insulin, ALT and AST enzymes were analyzed on all blood samples. There was a significant increase in HDL-c in females and higher total plasma cholesterol, triglyceride (TG) and FBS in both gender while lower systolic blood pressure (SBP), diastolic blood pressure (DBP) and ALT decreasing after Ramadan (P<0.05, t test), the change in BMI, LDL- c, FM and FFM after Ramadan were not significant (P>0.05, t test). This study shows significant effects on NAFLD patient parameters during Ramadan fasting such as decreasing in insulin, ALT enzyme, SBP and DBP and increasing in HDL-c after an average of 27 d fasting, Result from this study suggested that Ramadan fasting may be useful to improve NAFLD, so further studies are needed in this area.