tannaz jami al ahmadi

Non-alcoholic fatty liver disease (NAFLD), non-alcoholic steatohepatitis (NASH), and hepatic fibrosis have emerged as one of the leading causes of chronic liver disease. The prevalence of the NAFLD spectrum has increased, which can be attributed to the rise in obesity. As NAFLD can ultimately lead to liver cirrhosis, it is imperative to identify modifiable risk factors associated with its onset and progression to provide timely intervention to prevent potentially disastrous consequences. Considering the pivotal role of the endocrine axis in several metabolic pathways such as obesity and insulin resistance, thyroid hormones are crucial in the pathophysiology of NAFLD. The study is focused on the identification of an association between thyroid function and radiographic and histological parameters of NAFLD in patients with severe obesity.

Ninety patients were recruited for this study and underwent initial assessments, including demographic profiles, anthropometric measurements, hepatic biopsy, and basic laboratory tests. Liver stiffness was evaluated using two-dimensional shear wave elastography (2D-SWE) at least 2 weeks before liver biopsy.

Among the 90 participants, 80% were women. The mean age was 38.5 ± 11.1 years, and the mean body mass index (BMI) was 45.46 ± 6.26 kg/m2. The mean levels of serum T3 and free T4 in patients with positive histology were not statistically significant compared with patients with negative histology. Furthermore, there was no statistical significance in the mean T3 and free T4 levels between patients diagnosed with hepatic steatosis or fibrosis (on ultrasonography and elastography) and those with negative hepatic imaging. Serum levels of thyroid-stimulating hormone (TSH) were negatively correlated with ultrasonography (P = 0.007). Binary logistic regression analysis revealed that none of the thyroid hormones was a predictive factor for liver histology in both adjusted and crude models.

The results from our analysis did not suggest an association between thyroid hormones and NAFLD, which is in line with several previously published studies. However, the authors note that there are published data that do propose a link between the two entities. Therefore, well-designed large-scale clinical studies are required to clarify this discrepancy.

Malnutrition is one of the major problems in patients admitted to intensive care units. Intestinal nutrition is important for patients who do not have oral intake. Nutrition in hospitals is often done through a solution prepared in the hospital kitchen. A study on nutritional value in hospitals in Mashhad was carried out to provide a clearer vision for the best nutrition in order to provide the nutritional needs for hospitalized patients.

In this cross-sectional study, the contents of the baking instruction in the hospitals were analyzed using Nut4 software and the existing nutritional value was compared with the standard RDI of 2000 kilocalories per person. Data analysis was done using SPSS software and t-test. (Significance level <0.05).

Mean calories, macronutrients and micronutrients were significantly lower than RDI standards. The average of vitamins, vitamin B12, vitamin E and vitamin D was lower than the standard RDI, but vitamin A, folic acid, vitamin C, and vitamin K were optimal. The amount of iron, calcium, zinc, copper was significant. However, no significant difference was observed between manganese and chromium.

The gavage solution prepared in hospitals has been inadequate to meet the needs of patients. Due to the high use of hand gavage hospitals in our country, these recipes are designed to be of an acceptable nutritional value.

Non-alcoholic fatty liver disease (NAFLD) is considered to be a severe health threat across the world, the prevalence of which has significantly increased in recent years. Considering the role of diet in the pathogenesis of NAFLD, the present study aimed to evaluate and compare the dietary intakes of patients with NAFLD with healthy subjects.  This case-control study was conducted on 120 participants aged more than 18 years. The case group included 60 patients who were diagnosed with NAFLD based on Fibroscan assessment. The diet records of the subjects were analyzed using a three-day dietary record questionnaire.  After modulation based on energy intake, the total intakes of energy, fiber, vitamin D, and vitamin E were significantly lower in the patients with NAFLD compared to the control group. In addition, the level of trans-fatty acids after energy adjustment was significantly higher in NAFLD patients compared to the controls. However, analysis after the energy adjustment indicated no significant difference between the case and control groups in terms of protein, carbohydrate, saturated fatty acid, monounsaturated fatty acid, and polyunsaturated fatty acid intakes.  According to the results, the diet records of the patients with NAFLD and healthy subjects differed in terms of the intakes of energy, fiber, trans-fatty acids, vitamin D, and vitamin E. Therefore, special attention must be paid to the dietary patterns of these individuals in order to improve their lifestyle and prevent the occurrence and progression of NAFLD.

Malnutrition is a prevalent problem in hospitalized patients, causing a wide range of negative clinical and economic challenges. Protected mealtimes (PM) aim to enhance the quality of mealtime experience, improve nutrient status in hospitalized patients, and limit all non-essential interruptions so that patients might eat in a clean, quiet, and safe environment.
This study is a clinical audit and was conducted in Mashhad teaching hospitals in order to evaluate mealtime interruptions that occurred among non-nutritional staff and influenced their food intake. Data were collected by direct observation. Lunchtime was chosen for audit because medical interruptions were more likely to happen during this meal. Two researchers (one dietitian, student and one dietetic assistant) observed lunch mealtime. The mealtime environment was monitored, and every negative interruption was registered. Exclusion criteria included patients who were nil-by-mouth or received enteral or parenteral nutrition.
A total of 208 patients were involved in the audit. The recorded negative interruptions included medical round, educational round, nurses’ change-of-shift, and activities of environmental service workers. Among interruptions, both medical round and nurses’ change-of-shift were the most frequent. All mealtime interruptions summarized to medical round (2.5%) (including serum replace, drug injection, and IV replace), change-of-shift (2.5%), environmental-service-worker activities (2%), and educational round (2%).
Our study demonstrated that non-urgent interruptions during mealtimes were not adhered to PM guidelines, indicating the importance of addressing mealtime related issues in hospitals.