zahra mousavi shirazi fard

Multiple sclerosis (MS) is associated with many healthrelated problems and changes in diet were shown to help the patients reduce some symptoms. This cross sectional study investigated the relationship between dietary acid load with fatigue, quality of life, and nutrient adequacy ratio in MS patients. Totally, 283 MS patients were enrolled in Shiraz, Iran between June 2018 and February 2019. Dietary acid load indices including potential renal acid load (PRAL) and net endogenous acid production (NEAP) were determined for the patients. The level of fatigue and quality of life of the individuals were evaluated by the modified fatigue impact scale (MFIS) and the multiple sclerosis quality of life-54 questionnaires (MSQoL-54), respectively. Nutrient intake was determined to calculate the mean adequacy ratio (MAR) using a food frequency questionnaire (FFQ). The mean score of MAR, NEAP, and PRAL was 0.9±0.18, 87.71±44.86, and 36.27±33.81, respectively. After adjusting for confounders, a significant, negative and very weak association was observed between physical health composite (PHC) of the quality of life and NEAP (p=0.003) and PRAL (p=0.007). Also, a significant, negative, and very weak correlation was found between MAR and NEAP (p=0.006) and PRAL (p=0.028) in a crude model. Furthermore, after adjusting for confounders, the association between MAR and NEAP remained significant (p=0.003). Our findings revealed that there might be an association between dietary acid load indices, physical dimension of MSQoL-54 and MAR.

Individualized Medical Nutrition Therapy (IMNT) is recommended as a part of glycemic control in hospitalized diabetic patients. However, it is provided only for a small number of patients. This study aimed to compare the effects of IMNT and Consistent Carbohydrate Meal-Planning (CCMP) on glycemic control, energy, and carbohydrate and protein intake in hospitalized diabetic patients.

This randomized clinical trial was conducted on 164 hospitalized diabetic patients. The patients were randomly selected from internal wards of Namazi hospital, Shiraz, Iran from September 2016 to October 2017. They were allocated to IMNT or CCMP groups using simple randomization for four days. Blood glucose was measured before each meal and at bedtime. A 24-h food recall was also completed to measure the energy and carbohydrate and protein intake during the study. The data were analyzed using independent sample t-test and repeated measures ANOVA via the SPSS software, version 19.

The results showed a significant decrease in the IMNT group compared to the CCMP group regarding the mean blood glucose level measured prior to breakfast, lunch, dinner, and bedtime during the first, second, third, and fourth days of the study (p=0.025, p=0.030, p=0.002, and p=0.011, respectively). Besides, mean peak and nadir of glucose level (p=0.042 and p=0.036, respectively) and the means of energy, carbohydrate, and protein intake were significantly increased in the IMNT group compared to the CCMP group.

IMNT could help to control the blood glucose. In addition, it could improve energy and nutrients intake, which might play a role in patient recovery.

Adequate energy intake is an important factor in intensive care unit (ICU) patients, and it can decrease the patients' complications, length of hospitalization, mortality and health care costs. Choosing an appropriate type of formula may be effective in providing the sufficient energy for these patients.

This study aimed to assess the adequacy of energy intake, and to investigate the effect of different types of the formulas on the calorie intake and gastric residual volumes (GRV) in ICU patients in the first week of starting enteral feeding.

This prospective observational study was conducted on 128 ICU patients of two hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. The patients were randomly assigned to one of the four groups of formulas including Ensure, Entrameal standard, Nutricomp standard and Enterameal high fiber formulas. Energy intake and GRV were recorded daily for 7 consecutive days from the beginning of enteral feeding.

About 85% of the patients had traumatic brain injury. The average calculated energy requirement of the patients was 2293 kcal while the average energy intakes in seven days, and on the last day were 668 and 977 kcal, respectively. Only two patients (1.5%) received nearly all their energy requirement in the last day, however, only 5.5% and 35% of the subjects received ≥ 60% and ≥ 80% of their energy requirement, respectively. Enterameal high fiber formula was associated with a significant increase in GRV compared to Ensure formula (p = 0.02), but no significant relationship was found between calorie intake and gastrointestinal symptoms. No statistically significant difference was found in the energy intake between the four types of formulas.

It seems that enteral feeding in our ICUs is not successful in practice using the common available formulas. More attention should be paid to the incomplete delivery of the prescribed enteral nutrition in ICU patients.