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News Round-up

 

Chance to Have Your Say in the Malnutrition Priority Setting Partnership's Survey – Deadline for completion 30th September 2018

Have you come across the Malnutrition Priority Setting Partnership (PSP) whose aim is to set research priorities for malnutrition and screening? This is a project being delivered by the University of Manchester and managed by the James Lind Alliance.

The aim of the project is to find out what uncertainties or questions people with experience of malnutrition have about Malnutrition and Nutritional Screening and what they think research should be looking at next. The survey is aimed at patients, carers, health professionals and anyone else with any kind of malnutrition experience.

In order to reach as wide an audience as possible the Malnutrition PSP would be really grateful for your help in the completing of the survey which is available online and also as a downloadable pdf that can be printed and completed by hand (details are below).

In addition, if you are happy to share this survey with others that would also be really appreciated.

 

Thinking of funding? Think GET

The British Dietetic Association General Education Trust (BDA GET) is a grant-giving fund which supports research that advances the science and practice of dietetics.

Click here for further information.

 

Can manipulating gut microbes improve cardiac function in patients with heart failure?

A clinical study called the GutHeart Trial is poised to examine the potential relationship between the bacterial composition of the gut and inflammatory and metabolic pathways in the cardiovascular system.

As described in an ESC Heart Failure article, the phase II randomized controlled trial will enrol patients with heart failure who will receive an antibiotic, a probiotic yeast, or no treatment on top of recommended heart failure treatment.

"To the best of our knowledge, the GutHeart trial is the first intervention study to assess the profile of the gut microbiota in heart failure patients and the way this profile is affected by drugs that act locally in the gut," said first author Dr Cristiane C. K. Mayerhofer, of Oslo University Hospital, in Norway. "The new knowledge can pave the way for new innovative treatment strategies and will lead to a better understanding of how gut leakage is associated with inflammatory processes and heart failure."

The potential significance of the study extends beyond the cardiovascular system, noted co-author Dr Ayodeji Awoyemi, of Oslo University Hospital Ulleval. "It will most definitely expand our knowledge with regard to the clinical implications of modulating the gut microbiome," he said.

 

Intensive Care Patients' Muscles Unable to Use Fats for Energy

The muscles of people in intensive care are less able to use fats for energy, contributing to extensive loss of muscle mass, finds a new study co-led by UCL, King's College London and Guy's and St Thomas' NHS Foundation Trust.

Intensive care patients can lose 20% of their muscle mass in just 10 days, which can contribute to long-term disability. Nutrition and exercise programmes designed to prevent this muscle loss have largely been unsuccessful, and this new finding, published in Thorax, helps explain why.

"We already knew that our patients have difficulty using glucose to generate energy. Our new data suggests they also find it hard to use fats in the feed we give them to generate energy," said lead author Dr Zudin Puthucheary (UCL Medicine, Institute of Sport, Exercise and Health, and Royal Free London NHS Foundation Trust).

The findings suggest the inability to generate energy is likely a result of the widespread muscle inflammation experienced by patients in the early days of intensive care. The research team took leg muscle biopsies and blood samples from 62 patients on their first and seventh days in intensive care, and tested them for key proteins that are involved in energy conversion. They found that the quantity of fat in a patient's tube feed was unrelated to the amount of energy in the muscle and to changes in quantity of muscle, instead finding a close and direct relationship between impaired energy conversion and loss of muscle quantity.

They also found a build-up of fats in the muscle, suggesting it wasn't being effectively used for energy.

"Fats typically make up close to half of the energy content of tube feeds for critically ill patients. Previous studies into increasing nutrition for intensive care patients have shown conflicting results; our findings help clarify why our patients aren't benefiting from higher-calorie feeds as fats are an ineffective source of energy in the first few days of intensive care," said senior co-author Professor Nicholas Hart (Guy's and St Thomas' NHS Foundation Trust).

The researchers are now investigating whether different types of nutrition that use alternative energy sources, such as ketones, could be more effective, and perhaps treating muscle inflammation before exercise interventions could help maintain or restore muscles.

"Muscle wasting is associated with increased length of intensive care unit stay and with mortality, so it's vital that we find better ways to ensure that nutrition and rehabilitation programmes are effective at preventing muscle wasting," said senior co-author Professor Stephen Harridge (King's College London).

"By clarifying the complex relationship between inflammation, metabolic processes and signalling, and resulting loss of muscle mass, we have identified where researchers should focus their efforts on finding better ways to keep intensive care patients as healthy as possible," said senior co-author Professor Hugh Montgomery (UCL Medicine and Institute of Sport, Exercise and Health).

Dr Puthucheary added: "Exercise and rehabilitation in this group is going to be difficult if our patients' muscles lack energy to work and grow. Our patients may need a coordinated nutrition and exercise regime to recover just like athletes do - not just one or the other. This needs to be put in place once the muscle inflammation has subsided." The study was conducted at King's College Hospital and the Whittington Hospital, and funded by the National Institute for Health Research.

Puthucheary ZA, Astin R, Mcphail MJW, et al. Metabolic phenotype of skeletal muscle in early critical illness. Thorax. Published Online First: 06 July 2018. doi: 10.1136/thoraxjnl-2017-211073.

 

Patients Maintain Muscle Mass Five Years after Surgically Induced Weight Loss

Research dispels fear that gastric bypass surgery leads to long-term muscle issues. Published research on surgically-induced weight loss provides important evidence supporting the long-term safety and viability of bariatric surgery.

The study, appearing in the academic journal Obesity, finds that muscle mass and fat-free mass (organs, bones, tissues) levels are maintained in the body following a rapid post-surgical weight loss. The finding dispels fears that gastric bypass surgery may result in a detrimental loss of muscle that continues for years after initial weight loss, leading to long-term muscle insufficiency despite weight regain.

"This study demonstrated that after the first year of weight loss, there is some loss of muscle that happens over time, but apparently not any more than age-related loss," said lead author Lance Davidson, assistant professor of exercise science at Brigham Young University. "This research is the first to tell the whole story of what is happening with muscle and fat-free mass beyond initial weight loss and up to five years after surgery." Previous research has demonstrated that the more rapid and dramatic the post-surgical weight loss, the more fat free mass is lost. Researchers and clinicians have previously expressed concerns that excessive loss of fat-free mass negatively impacts metabolic rates, the integrity of skeletal muscle and the ability to function and maintain a physically active lifestyle when aging. The new study reveals that the steep losses to fat-free mass post-surgery don't continue as the years go on.

"When you lose weight after the surgery, 70-80% of the tissue you lose is fat," said Davidson, who joined this research collaboration as a post-doctoral fellow at Columbia University. "Although a majority of the fat free mass lost is muscle, there is nothing to fear. Your body tends to retain the remaining muscle mass in subsequent years." Researchers also point out that losing a bit of muscle mass along with the fat after bariatric surgery makes sense, since people generally gain a little muscle to support excess weight.

Thanks to the significant losses in fat mass from the operation, the study found the muscle mass of patients, expressed as a percent of total body weight, actually increases: up to 4.4% in females and 5.4% in males. Because muscle is more metabolically active than fat, this means gastric bypass patients become more metabolically active post-surgery.

"This may explain why many people successfully maintain their weight loss after gastric bypass: because the favourable ratio of muscle to fat creates a relative increase in metabolic rate," Davidson said. "This could be one reason why bariatric surgery continues to be a good weight loss tool long-term."

https://onlinelibrary.wiley.com/doi/10.1002/oby.22190

 

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