ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00400.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Very low‐calorie diets (400 kcal:1.7 MJ) with different proportions of carbohydrate, protein and fat were given to obese in‐patients for 1 week using a Latin Square study design. This type of diet with a relatively high carbohydrate content produced a smaller weight loss when compared with diets with relatively high protein or fat content. In a second study, two very low‐calorie diets with a high or low carbohydrate content were compared in a randomized cross‐over design in obese patients for 1 week. Those patients receiving the diet with high carbohydrate content had a significantly lower weight loss. In a third study, these diets were continued for 2 weeks. A significant difference in weight loss was observed in the first week but not the second. In a fourth study the same effect of carbohydrate content was also observed using low‐calorie diets (800 kcal:3.4 MJ) for one week in obese patients. The explanation of this effect appears to be a decrease in the diuresis which usually accompanies the introduction of a very low‐c

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00401.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In experiment 1, normal weight male subjects were provided with three types of breakfast consumed in the Human Appetite Research Unit on separate experimental days 1 week apart. The intensity of hunger, fullness and other subjective feelings were tracked by means of visual analogue rating scales at intervals during the day. Energy and nutrient intakes were measured directly fromad libitumtest meals consumed at lunch and dinner. During the rest of the day and until after breakfast the following day, food intake was measured indirectly through weighed food records. The test breakfasts comprised a basic meal 184 1 kJ (440 kcal) and the same meal supplemented with similar amounts of either fat (1515 kJ, 362 kcal) or carbohydrate (1527 kJ, 365 kcal). No differences were detected between the effects of the basic breakfast compared with the fat‐supplemented breakfast. The carbohydrate supplement suppressed hunger ratings during a limited period after consumption (the post‐ingestive window) coinciding with the expected metabolism of carbohydrate. In experiment 2, a direct test of consumption during this post‐ingestive window confirmed that the carbohydrate supplemented breakfast suppressed intake but the fat supplement did not. These results demonstrate that carbohydrate and fat can produce quite different effects on satiety. Under these experimental conditions the supplement of fat produced no detectable effect on the expression of appetite and illustrates how dietary fat could lead to passive over‐consumption of energy. However this effect may be modified by the particular pattern of food consumption during the course o

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00402.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

There are no reports of controlled trials of management practices in anorexia nervosa, and a paucity of follow‐up data. We investigated the nutritional requirements of four adolescent females with the condition, and describe a management approach based on nutritional principles. The aim was to reverse the initial state of catabolism by enteral nutrition prior to any negotiation regarding oral energy consumption.The median age of presentation was 14.15 years (range 14–16.1 years). All girls had abnormal perceptions relating to food and phenotype. The median weight loss in the preceding 6 months was 27% (range 21–33%). At presentation the median energy intake was 2710 kJ per day (range 2083–4166 kJ) and represented a median of 26% of that expected. The mean initial energy requirements to reverse the state of severe malnutrition were 14 634 kJ per day. The median time to regain 50% of lost weight was 44 days.Energy requirements in this disease have been underestimated by both patients and caregivers. Supplementing oral intake with energy‐dense defined formulae delivered by nasogastric tube is a safe and rapid method of achieving nutritional rehabilitation in the early stages of self

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00403.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

We have reviewed the outcome and feeding of the 28 cystic fibrosis (CF) infants diagnosed at St James's University Hospital, Leeds, during 15 years between 1974–1988. During this period most infants were fed on either standard formula milk feeds or a lower fat, higher protein mix (CF milk). It was the practice to prescribe pancreatic enzymes from the diagnosis of CF, wean the infant on to solids between 2 and 3 months of age and provide extra calorie supplements if infants were not thriving adequately. The mean weight at birth (s.d.) was 3.33 (0.45) kg and at 12 months was 9.56 (1.21) kg. It is concluded that CF infants provided with adequate energy intake and appropriate pancreatic enzymes should thrive satisfactoril

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00404.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

Energy intakes in cystic fibrosis (CF) are affected by malabsorption, despite the use of enteric‐coated pancreatic enzymes. Relaxation of fat restrictions was introduced to aid consumption of a diet sufficient to compensate for malabsorption and help prevent malnutrition. We examined the energy intakes and losses of 50 CF patients on a normal fat intake (mean age 9.6 [s.d.=6.67] years, M:F ratio 33:17). Mean standard deviation scores for height and weight were –1.03 and –0.80, respectively. Nutrient balances were made by means of 7‐day weighed dietary inventories and 3‐day faecal collections. Mean metabolizable energy intake was 97.3 [s.d. 23.1)% RDA. Mean digestibility coefficient for energy was 0.89 (s.d. 0.07), reducing mean energy intakes to 91.9 (s.d. 24.0)% RDA. The results indicate that despite relaxation of dietary restrictions and the use of enteric‐coated pancreatic enzymes, energy intakes of CF patients are still inadequate. Closer monitoring of energy losses as well as intakes is required, to optimize growth and nutritional status in

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00405.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

In view of the large Asian population in Leicester and the continuing uncertainty about the level of vitamin D deficiency in this group, a preliminary study was undertaken to review the results of all 25(OH) vitamin D assays which had been performed in the previous 2 years with reference to the ethnic origin of the patients.Results indicated that not only were more assays performed on Asian patients but also that these patients were significantly more likely to have low or undetectable levels of 25(OH) vitamin D. Over 50% of Asian patients screened had subnormal levels of 25(OH) vitamin D. Within the Asian group, women of child‐bearing age appeared in substantial numbers amongst those who had low 25(OH) vitamin D levels. The study indicates a continuing problem of vitamin D deficiency in Asians which requires further stud

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00406.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The HACCP (hazard analysis critical control point) concept is now widely applied in the food industry and provides a structured and critical approach to the identification and control of hazards that may affect food safety. It has shifted the emphasis for control from retrospective end‐product testing to the effective control of raw materials and key processing operations.This paper discusses how the HACCP approach can be applied to enteral feeding. This involves each unit assembling a multidisciplinary team of personnel involved in enteral feeding. This team will then carry out a detailed analysis of the process from selection of ingredients and feeding systems through to consumption of the feed by the patient by constructing a flow chart that relates specifically to each unit. They can then identify and assess the hazards associated with the handling of the product at each stage in the process. This will enable them to identify the points where control over an identified hazard can be achieved (critical control points, CCP) such as quality of ingredients, design of administration systems, preparation and distribution of the feeds and the procedures involved in the assembly and manipulation of the systems. Control and monitoring procedures can then be specified and implemented at relevant stages in the process. The major strengths of the HACCP procedure are that it entails a team effort from key personnel involved in the full range of activities associated with the product and each detailed analysis is specific to each unit's practices and resources and can be continually reviewed and modified in response to changing circumstance

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00407.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

This paper presents the results of a 3‐month survey of tube feeding and parenteral nutrition in hospital in‐patients, undertaken to provide information for the development of guidelines by the Hospitals Nutritional Advisory Group and a baseline for future monitoring. This represents the first steps in the audit cycle. The results highlighted the following problems.1Total parenteral nutrition is often continued after bowel sounds have returned.2Enteral tube feeding is often instituted for only a very short period of time and may be of little nutritional benefit to the patient.3Significantly lower amounts of energy and nitrogen are received by the patients in the enterally tube‐fed group than is indicated by their estimated energy and nitrogen requirements.4The medical staff noted the start of feeding in 60% of the case notes, however, the aims of feeding and the reason for commencing feeding were never documented. Nutritional aims were defined in the case notes by dietitians for all tube‐fed and 18 of the 20 patients who were parentera

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00408.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY

摘要:

The development of a school Nutrition Action Group (SNAG) is discussed, that would look at schools and their approach to nutrition and that would try to ensure that there is consistency between what is taught in the classroom and what food is actually available to the children. A SNAG involving the caterers, children, teachers and health professionals could influence food choices in a subtle rather than a dictatorial manner. All food outlets in a school need to be considered from breakfast to tuck‐shops, vending machines, school meals and social catering. Success depends upon the involvement and ownership of all food provision in the school by both consumers and provider

ISSN:0952-3871    

DOI:10.1111/j.1365-277X.1994.tb00409.x

出版商:Blackwell Publishing Ltd    

年代:1994

数据来源: WILEY