Nutrition Support Blog: Top Secret Nutrition Support Data

Posted by SF8N at Mar 04, 2014 10:28 AM |

March 4, 2014

Nutrition Support Blog:  Top Secret Nutrition Support Data

by Joe Krenitsky, MS, RDN

We have held a regular nutrition support journal club for nearly 20 years.  It has been valuable beyond measure to have multiple intellects with varied experiences and views contribute to our critique of each article.  Over time this combined brainpower has helped us to develop a better appreciation of what the nutrition support literature really does, and does not support.  We have also realized that careful evaluation of the full text of research articles can reveal “hidden” information that is valuable, but is not mentioned in the abstract and is rarely referenced.

One example is a frequently referenced study which reported that a cumulative calorie deficit was significantly associated with increased ICU length of stay and infectious complications1.  One aspect of this study that did not receive much attention is the fact that it also contributes to the evidence that prealbumin is not a valid indicator of nutrition adequacy.  Prealbumin was not increased in patients that received more nutrition, but it was inversely related to the inflammatory status. See our ejournal club for more details:

http://www.healthsystem.virginia.edu/pub/dietitian/inpatient/dh/E-journal%20Club/ejournalclub.html

We found another gem hidden in a study of aspiration risk with gastric versus jejunal feeding2.  The researchers placed technetium-99m sulfur colloid into the feeding formula, then scanned the lungs for the presence of aspirated feeding.  In the body of the article the investigators noted that they also asked the bedside staff to report if any of the suctioned pulmonary secretions visually appeared to contain feedings.  The researchers found that 82% of the time that the bedside clinicians thought patients had aspirated, there was actually no feeding formula in the secretions2. We would never discount the input of experienced bedside clinicians that are suctioning ICU patients, but it is helpful for nutrition support professionals to remember that at least sometimes, those are merely tan secretions that resemble, but do not contain feeding formula.

Of course, we are not the only clinicians that have realized that there are hidden nutrition studies.  Experts have pointed out that paying attention to the nutrition details in a study can give you insights that others may miss – pearls such as adequate protein intake may actually accelerate (not hinder) recovery from acute kidney injury3.  Or, as one editorial pointed out, a large trial of trophic versus full feeding in ARDS can serve as pragmatic evidence that gastric feeding is generally safe, with a very low incidence of aspiration pneumonia4.  So, admittedly, while this is not really top-secret nutrition data, you would think it was at times by the way people react when we mention or reference some of these studies. 

I have mentioned only some of these easily missed nuggets, but we have found quite a few over the years.   Critically appraising and paying attention to the full text of new research articles is an investment that pays off by providing a richer and more complete vision of the evidence and nutrition literature, and also lets you in on the secret data that others may miss.

 

“I find that a great part of the information I have was acquired by looking up something and finding something else on the way.”

                                                             -  Franklin P. Adams

 

References

1.   Villet S, Chiolero RL, Bollmann MD, Revelly JP, Cayeux R N MC, Delarue J, Berger MM. Negative impact of hypocaloric feeding and energy balance on clinical outcome in ICU patients.   Clinical Nutrition 2005 Aug;24(4) 502-509.

2.   Esparza J1, Boivin MA, Hartshorne MF, Levy H. Equal aspiration rates in gastrically and transpylorically fed critically ill patients. Intensive Care Med. 2001 Apr;27(4):660-4.

3.   Pazirandeh S, Maykel JA, Bistrian BR.  Hidden nutrition studies.  Crit Care Med. 2003 Feb;31(2):662.

4.   Griffiths RD.  Nutrition for critically ill patients: how much is enough?  JAMA. 2012 Feb 22;307(8):845-6.

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