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REFEEDING HYPOPHOSPHATEMIA IN PARENTERALLY FED ONCOLOGY PATIENTS
Journal of the American Dietetic Association Online
TITLE: EVALUATION OF A PROBLEM-BASED, CULTURALLY SPECIFIC, PATIENT EDUCATION PROGRAM ON FOOD AND CHOLESTEROL PARAMETERS FOR AFRICAN AMERICANS WITH DIABETES AUTHOR(S): R.B. Nwankwo MPH, RD, CDE, M. Oh, BS, M.L. Gillard MS RN, CDE, M.M. Funnell, MS, RN, CDE and R.M. Anderson, Ed.D University of Michigan, Ann Arbor, Michigan LEARNING OUTCOME: Implementing a non-traditional problem-based patient education program can improve food choices and lipid values. TEXT: Type 2 diabetes is a major cause of preventable morbidity and mortality in the United States, with African Americans bearing a disproportionate share of the burden. Over 90% of diabetes management decisions are made by the patient, so providing patients with tools to make informed decisions through a problem-based format may yield effective and sustained results. This study examined the effects of attending a 6-week (six 2-hour group sessions) problem-based, diabetes patient education program tailored to meet the needs of African Americans. There were 239 patients participating in the study; each attended group sessions to the extent of personal choice. Patients were 82% women, 96% African Americans and 34% insulin users, with mean age 61.0 years and 8.5 years since diagnosis. TITLE: REFEEDING HYPOPHOSPHATEMIA IN PARENTERALLY FED ONCOLOGY PATIENTS AUTHOR(S): H. Harnois, MS, RD, CNSD; L. Hildebrandt, RD, PhD; Central Michigan University, Mt. Pleasant, MI LEARNING OUTCOME: The learner will be able to state electrolyte abnormalities experienced by parenterally fed oncology patients and discuss nutrition care that prevents these abnormalities. TEXT: A malnourished oncology patient fed parenterally may be at risk for electrolyte abnormalities. Forty-one mild to moderately malnourished oncology patients receiving parenteral nutrition support supplying 1.92 ± 0.62 milligrams carbohydrate/kilogram/minute and 18.6 ± calories/kilogram/day were evaluated for refeeding complications. Serum electrolyte levels were measured at baseline and at 39 or 63 hours after parenteral nutrition was initiated. The subjects experienced a statistically significant (p<0.05) decline in serum phosphorus values within 63 hours of parenteral nutrition administration. No significant decline was noted for serum magnesium, potassium and corrected calcium values. Thirtynine percent of subjects with normal phosphorus values at baseline experienced hypophosphatemia (<2.5mg/dL) within 63 hours after parenteral nutrition administration. Refeeding hypophosphatemia, defined as a reduction in serum phosphorus of at least 0.5mg/dL to less than 2.0mg/dL, developed in 12% of patients and was significantly related to basal metabolic index. Oncology patients should be considered at risk for refeeding hypophosphatemia and refed conservatively with phosphate supplemented parenteral nutrition when parenteral nutrition is indicated. Monitoring of plasma electrolytes is recommended as tolerance to parenteral nutrition is being established in the oncology http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (74 of 117) [3/21/2008 8:45:19 AM]
Journal of the American Dietetic Association Online
patient. TITLE: BOTH EXTENSIVELY AND PARTIALLY HYDROLYZED INFANT FORMULAS HAVE A ROLE IN ALLERGY PREVENTION IN HIGH-RISK INFANTS AUTHOR(S): T.L. Hays, MS, RD, LN;R.A. Wood, MD; Johns Hopkins Hospital, Department of Pediatrics, Baltimore, MD LEARNING OUTCOME: To increase awareness of the role of hydrolysate formulas in allergy prevention. TEXT: The incidence of atopic disease in infants and children is increasing in developed countries and is contributing significantly to childhood morbidity and health care costs; causing the medical community to emphasize prevention. Dietary manipulation during early infancy plays a key role in such prevention strategies and the goal should be to avoid sensitization while inducing oral tolerance to potential food allergens. As a result, researchers have recently given greater attention to the role of hydrolysate formulas in allergy prevention. From 1985 to present, six published prospective controlled trials evaluated the use of extensively hydrolyzed formula (eHF) and eleven evaluated the use of partially hydrolyzed formula (pHF) in high-risk infants. The reports have compared hydrolyzed formula to breastfeeding (BF), cow's milk formula (CMF), soy formula, and combinations therein. This cohort shows significant reductions in the cumulative incidence of atopic disease from twelve to sixty months of age among high-risk infants fed eHF or pHF versus CMF. However, neither eHF nor pHF meet the American Academy of Pediatrics' (AAP) criteria for allergy prevention because the studies did not consistently use clinical scoring systems to identify allergy symptoms or Double Blind Placebo Controlled Food Challenges (DBPCFC) to confirm reactions. Falling short of these strict criteria, the AAP and several other medical societies recommend feeding “hypoallergenic” formulas to high-risk infants when breast feeding is insufficient, but also acknowledge that pHF have a potential role in allergy prevention. In summary, both eHF and pHF are appropriate alternatives to breast milk for allergy prevention in infants at risk. The use of these formulas in the general population must weigh cost, compliance, and long-term benefits. TITLE: SYSTEMATIC ENHANCEMENT OF FOOD OVER SHORT TERM INCREASED CALORIE INTAKE BY RESIDENTS WITH DEMENTIA AUTHOR(S): V.H. Castellanos, PhD RD; S.C. Surloff, MS; W.L. Giordan, RD LD. Long Term Care Institute, National Policy and Resource Center on Nutrition & Aging, Department of Dietetics & Nutrition, Florida International University, Miami, and John Knox Village of Florida, Pompano Beach, FL LEARNING OUTCOME: Audience will be able to describe these findings, and other evidence, that support food enhancement as an effective way to increase calorie intake in nursing home residents. TEXT: Many nursing home residents eat a limited amount of food. This experiment evaluated the shortterm effects of systematic food enhancement on calorie and food intake of residents with dementia. Usable data were obtained from 28 consented residents of a nursing home dementia unit. Exclusion criteria included extensive assistance with eating or a restrictive diet, such as renal or pureed. http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (75 of 117) [3/21/2008 8:45:19 AM]
TITLE: EVALUATION OF A PROBLEM-BASED, CULTURALLY SPECIFIC, PATIENT EDUCATION PROGRAM ON FOOD AND CHOLESTEROL PARAMETERS FOR AFRICAN AMERICANS WITH DIABETES AUTHOR(S): R.B. Nwankwo MPH, RD, CDE, M. Oh, BS, M.L. Gillard MS RN, CDE, M.M. Funnell, MS, RN, CDE and R.M. Anderson, Ed.D University of Michigan, Ann Arbor, Michigan LEARNING OUTCOME: Implementing a non-traditional problem-based patient education program can improve food choices and lipid values. TEXT: Type 2 diabetes is a major cause of preventable morbidity and mortality in the United States, with African Americans bearing a disproportionate share of the burden. Over 90% of diabetes management decisions are made by the patient, so providing patients with tools to make informed decisions through a problem-based format may yield effective and sustained results. This study examined the effects of attending a 6-week (six 2-hour group sessions) problem-based, diabetes patient education program tailored to meet the needs of African Americans. There were 239 patients participating in the study; each attended group sessions to the extent of personal choice. Patients were 82% women, 96% African Americans and 34% insulin users, with mean age 61.0 years and 8.5 years since diagnosis. TITLE: REFEEDING HYPOPHOSPHATEMIA IN PARENTERALLY FED ONCOLOGY PATIENTS AUTHOR(S): H. Harnois, MS, RD, CNSD; L. Hildebrandt, RD, PhD; Central Michigan University, Mt. Pleasant, MI LEARNING OUTCOME: The learner will be able to state electrolyte abnormalities experienced by parenterally fed oncology patients and discuss nutrition care that prevents these abnormalities. TEXT: A malnourished oncology patient fed parenterally may be at risk for electrolyte abnormalities. Forty-one mild to moderately malnourished oncology patients receiving parenteral nutrition support supplying 1.92 ± 0.62 milligrams carbohydrate/kilogram/minute and 18.6 ± calories/kilogram/day were evaluated for refeeding complications. Serum electrolyte levels were measured at baseline and at 39 or 63 hours after parenteral nutrition was initiated. The subjects experienced a statistically significant (p<0.05) decline in serum phosphorus values within 63 hours of parenteral nutrition administration. No significant decline was noted for serum magnesium, potassium and corrected calcium values. Thirtynine percent of subjects with normal phosphorus values at baseline experienced hypophosphatemia (<2.5mg/dL) within 63 hours after parenteral nutrition administration. Refeeding hypophosphatemia, defined as a reduction in serum phosphorus of at least 0.5mg/dL to less than 2.0mg/dL, developed in 12% of patients and was significantly related to basal metabolic index. Oncology patients should be considered at risk for refeeding hypophosphatemia and refed conservatively with phosphate supplemented parenteral nutrition when parenteral nutrition is indicated. Monitoring of plasma electrolytes is recommended as tolerance to parenteral nutrition is being established in the oncology http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (74 of 117) [3/21/2008 8:45:19 AM]
Journal of the American Dietetic Association Online
patient. TITLE: BOTH EXTENSIVELY AND PARTIALLY HYDROLYZED INFANT FORMULAS HAVE A ROLE IN ALLERGY PREVENTION IN HIGH-RISK INFANTS AUTHOR(S): T.L. Hays, MS, RD, LN;R.A. Wood, MD; Johns Hopkins Hospital, Department of Pediatrics, Baltimore, MD LEARNING OUTCOME: To increase awareness of the role of hydrolysate formulas in allergy prevention. TEXT: The incidence of atopic disease in infants and children is increasing in developed countries and is contributing significantly to childhood morbidity and health care costs; causing the medical community to emphasize prevention. Dietary manipulation during early infancy plays a key role in such prevention strategies and the goal should be to avoid sensitization while inducing oral tolerance to potential food allergens. As a result, researchers have recently given greater attention to the role of hydrolysate formulas in allergy prevention. From 1985 to present, six published prospective controlled trials evaluated the use of extensively hydrolyzed formula (eHF) and eleven evaluated the use of partially hydrolyzed formula (pHF) in high-risk infants. The reports have compared hydrolyzed formula to breastfeeding (BF), cow's milk formula (CMF), soy formula, and combinations therein. This cohort shows significant reductions in the cumulative incidence of atopic disease from twelve to sixty months of age among high-risk infants fed eHF or pHF versus CMF. However, neither eHF nor pHF meet the American Academy of Pediatrics' (AAP) criteria for allergy prevention because the studies did not consistently use clinical scoring systems to identify allergy symptoms or Double Blind Placebo Controlled Food Challenges (DBPCFC) to confirm reactions. Falling short of these strict criteria, the AAP and several other medical societies recommend feeding “hypoallergenic” formulas to high-risk infants when breast feeding is insufficient, but also acknowledge that pHF have a potential role in allergy prevention. In summary, both eHF and pHF are appropriate alternatives to breast milk for allergy prevention in infants at risk. The use of these formulas in the general population must weigh cost, compliance, and long-term benefits. TITLE: SYSTEMATIC ENHANCEMENT OF FOOD OVER SHORT TERM INCREASED CALORIE INTAKE BY RESIDENTS WITH DEMENTIA AUTHOR(S): V.H. Castellanos, PhD RD; S.C. Surloff, MS; W.L. Giordan, RD LD. Long Term Care Institute, National Policy and Resource Center on Nutrition & Aging, Department of Dietetics & Nutrition, Florida International University, Miami, and John Knox Village of Florida, Pompano Beach, FL LEARNING OUTCOME: Audience will be able to describe these findings, and other evidence, that support food enhancement as an effective way to increase calorie intake in nursing home residents. TEXT: Many nursing home residents eat a limited amount of food. This experiment evaluated the shortterm effects of systematic food enhancement on calorie and food intake of residents with dementia. Usable data were obtained from 28 consented residents of a nursing home dementia unit. Exclusion criteria included extensive assistance with eating or a restrictive diet, such as renal or pureed. http://www2.us.elsevierhealth.com/inst/serve?article=jjada0310309ab01&arttype=full (75 of 117) [3/21/2008 8:45:19 AM]