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Nutritional status assessment in patients with hepatopathy
Pirklová, Kristýna ; Novák, František (advisor) ; Ševela, Stanislav (referee)
In patients with liver cirrhosis, a high prevalence of malnutrition should be expected. Although the early diagnosis of malnutrition and well-chosen nutritional support have a positive effect on the patient's prognosis, early diagnosis of malnutrition might be difficult. There is currently no standardized diagnostic protocol for the nutritional status assessment of patients with liver cirrhosis. In patients with liver cirrhosis fluid retention occurs, which distorts the otherwise commonly used diagnostic criteria. The aim of the study: We wanted to evaluate the nutritional status of patients with liver cirrhosis in comparison with a acontrol group without severe comorbidity using anthropometric measurements, electrical bioimpedance, functional tests and laboratory parameters using diagnostic criteria GLIM (Global Leadership Initiative On Malnutrition) and various malnutrition screening tools. The work also focused on evaluating the quality of life of patients with chronic liver disease. Methods: The observational study included 11 patients with Child-Pugh stage cirrhosis A (n = 10) and B (n = 1), who were compared with a control group of 11 study participants without severe comorbidities. An examination panel consisting of anthropometric measurements, indirect calorimetry, electrical bioimpedance,...
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Impact of Immunonutrition on the Patients With Cystic Fibrosis
Hloch, Ondřej ; Charvát, Jiří (advisor) ; Kohout, Pavel (referee) ; Rušavý, Zdeněk (referee)
The impact of immunonutrition in patiens with cystic fibrosis Abstract The aim of the study was to evaluate the application of immunonutrition in adults with cystic fibrosis (CF) and malnutrition, who have been receiving enteral nutrition in the form of standard sipping for at least a year. In 30 adult patients, immunonutrice (Impact) was given for 8 weeks. After 8 weeks, patients returned to standard nutritional support. The application of immunonutrition led to a significant reduction in systolic blood pressure and heart rate, to an increase in glomerular filtration and significant changes in the plasma aminoacidogram. Serum amyloid-A (SAA) levels decreased significantly and increased again after the intervention. However, immunonutrition administration was associated with an increase in serum malonyldialdehyde, a decrease in serum glutathione peroxidase and selenium. Thus, administration of immunonutrition led to an increase in oxidative stress, but almost all values remained within physiological limits. At 6-year follow-up, the long- term prognosis in the multivariate analysis depended only on baseline FEV1 and the degree of pulmonary involvement, respectively. The frequency and duration of subsequent hospitalizations and long-term prognosis were significantly associated with plasma fibrinogen levels....
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Evaluation of nutritional status and cardiac risk in patients with anorexia nervosa.
Pálová, Sabina ; Charvát, Jiří (advisor) ; Ošťádal, Petr (referee) ; Zamrazil, Václav (referee)
Anorexia nervosa (MA) is serious psychiatric disease associated with significant mortality. One of the main causes of mortality in these patients is cardiac complications. In 2003 - 2010 we examined 30 patients with established diagnosis of MA. Routinely used nutritional parameters are normal even in severe malnutrition in MA patients and we can ́t use them to diagnose or monitor nutritional status. Therefore we evaluated plasma aminoacids levels to detect minor changes of protein metabolism. According to our results we found mild hyperaminoacidemia and significant elevation of Gly/Val and Phe/Tyr ratio. In the second part of our research we performed non invasive examination s in risky patients with AN to consider possible cardiac complications. Results of ECG and echocardiography confirm results of the previous published studies. Original finding is significant decrease in flow mediated dilatation of brachial artery and its normalization after realimentation. We found also in ambulatory blood pressure monitoring significant decrease in blood pressure during the active period which was the consequence of changes in the heart rate variability. Decrease of the blood pressure in patients with AN in standing position was associated with increase of HF power in supine position and particularly with the lack of...
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The Nutrition Day at the standard and intensive care beds in the teaching hospital
Lupoměská, Petra ; Meisnerová, Eva (advisor) ; Novák, František (referee)
The Bachelor thesis consists of two parts - the theoretical and the practical one. The theoretical part is divided into several chapters; the first one is focused on the main information about malnutrition such as its definition, prevalence, classification, causes, impact and the methods of diagnosing. The following chapter describes the algorithm for nutritional care; the rest of the chapters deal with the artificial nutrition, where the indications, contraindications, complications and other essential information related to enteral and parenteral nutrition are described. The practical part is dedicated to the worldwide programme "Nutrition day" and also to the evaluation of the data given by patients of the 4th internal clinic VFN in Prague during the programme. The research part was carried out on grounds of quantitative survey through a standardized questionnaire. There are two aims to the study; the first one was to find out the food intake of all patients of the 4th internal clinic. This goal was not accomplished, because not every patient placed in the standard ward was willing to complete the questionnaire. However, the study showed that only 29 % out of 62 patients who completed the questionnaire ate the whole portion of meal. The second aim was to find out if the daily calorie intake...
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The influence of enteral nutrition on the course of Crohn's disease
Homzová, Nikola ; Lukáš, Milan (advisor) ; Bortlík, Martin (referee)
Introduction: Crohn's disease is an illness of the digestive tract with an uncertain etiology which threatens the nutritional state of patients and in addition to other problems results in a worsening of the disease in reaction to primary treatment. The possibilities of optimizing the nutritional state are several: changing diet, enteral or parenteral nutrition or combination of both. It is necessary to arrange an entirely individual approach for ensuring the highest measure of attention and nutritional effectiveness. Methods: The influence of enteral nutrition was monitored during a course of Crohn's disease. 84 patients with malnutrition and with an active form of Crohn's disease were included in this study. They were divided into 2 groups according to the type and dosage of enteral nutrition. The first group included patients who used partial enteral nutrition in the form of sipping with an energy value of 1200 kcal daily. Patients covered the remaining energy needs with a low-residue diet enriched by soluble fiber. The second group included patients who were given exclusive oligomeric enteral nutrition with a nasojejunal tube for a period of eight weeks. The amount of enteral nutrition in both groups was individually adjusted and calculated, according to the Harris-Benedict equation. The...
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Effect of malnutrition on prognosis of patients with liver cirrhosis after bleeding from esophageal varices
Zagrebelná, Valérie ; Hrabák, Petr (advisor) ; Brůha, Radan (referee)
Liver cirrhosis is the final stage of chronic liver disease that arises from various causes (mainly chronic alcohol abusus, autoimmune and chronic viral hepatitis B and C, NAFLd - non-alcoholic fatty liver disease, bile duct disease or congenital metabolic disease - haemochromatosis and Wilson's disease). During development of liver cirrhosis, inflammatory liver cell damage, their necrosis and their conversion to fibrotic tissue occur. Most of the complications of hepatic cirrhosis are based in hepatic insufficiency and portal hypertension. Major complications of hepatic cirrhosis include bleeding from esophageal varices (the most serious complication that is fatal), hepatic encephalopathy, ascites, hepatorenal syndrome and hepatocelular cancer. The aim of the work was to determine how many patients suffered from protein-calorie malnutrition, and what effect malnutrition had on the survival and condition of patients. The work also dealt with bleeding from esophageal varices, reccurrence of varicose bleeding and complications associated with liver cirrhosis. One of the goal was to see if fit matched the predicted survival of patients, according to Child-Pugh's classification. The methodology of the work was retrospective research with the help of obtaining data from histories and findings obtained...
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Novel biomarkers in patients with renal disease
Zakiyanov, Oskar ; Kalousová, Marta (advisor) ; Teplan, Vladimír (referee) ; Průša, Richard (referee)
Chronic kidney disease (CKD) and acute kidney injury (AKI) are major public health problems. It is important to be able to identify those at high risk of adverse outcome, CKD progression and associated cardiovascular disease. The aim of the thesis was to study novel promising biomarkers, their relationship to kidney function, chronic inflammation and/or cardiovascular risk - placental growth factor (PlGF), pregnancy associated plasma protein A (PAPP-A), matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9), soluble receptor for advanced glycation end products (sRAGE), calcium binding protein S100A12 or extracellular newly identified RAGE binding protein (EN-RAGE), and high mobility group box protein-1 (HMGB-1) in patients with renal diseases including CKD, haemodialysis (HD), AKI patients, and healthy controls for comparison. First study revealed that PlGF is elevated in patients with decreased renal function. Second study demonstrated the association of MMP-2 and PAPP-A with proteinuria in patients with CKD. Moreover, serum MMP-2, MMP-9 and PAPP-A levels significantly differed in patients with various nephropathies. EN-RAGE levels are not elevated in patients with CKD, but are related to inflammatory status. PAPP-A, EN-RAGE and HMGB-1 levels are significantly elevated, but sRAGE and PlGF...
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Malnutrition - Causes nad Preventive Measures
Veselá, Kristýna ; Křížová, Jarmila (advisor) ; Jambor, Daniel (referee)
This diploma thesis deals with the topic of malnutrition, its causes and prevention. The aim of this thesis is to find out, wheter the respondetns of the questionnaire survey prevent by their habits the development of malnutrition. The number of participants of this survey is 347 in productive age, women are 212 and men are 135. In the theoretical part of this thesis, there is a desription of the importance of nutritents (macronutrients and micronutrients), there are also desription od nutrition intake disorder and their causes (health, psychical, social, lifestyle factors) and prevention, especially nutritional recommendations. The practical part of this thesis analyzes data obtained by the survey using quantitative method. The questionnare is devided into three parts: anthropometric, factors of life-style, factors of health status. Based on the results of analysis of questionare, it was found that most of the respondents neither men nor women do prevent the development of malnutrtion by behavioral habits, women are better in terms of lifestyle factors. Key words Nutrition, malnutrition, obesity, undernutrition, prevention
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Nutritional status of patients hospitalized for diabetic foot syndrome - retrospective analysis
Horáková, Markéta ; Gojda, Jan (advisor) ; Krauzová, Eva (referee)
Diabetic foot syndrome is a serious chronic complication of diabetes mellitus, caused by a number of factors such as neuropathy, angiopathy, infection, and above all, this syndrome is consequence of a poor diabetes compensation and cardiovascular risk factors. It is characterized by particularly impaired wound healing and a higher tendency to chronicity, which can often be a reason for disability of the patient. Nutrition plays a very important role in a patient hospitalized with diabetic foot syndrome, as adequate coverage of energy and nutritional needs is essential for successful treatment and healing of ulcers. The theoretical part of this diploma thesis first mentions diabetes mellitus, its basic characteristics and briefly describes the types of diabetes that are associated with diabetic foot syndrome. Acute and chronic complications of diabetes are also discussed, followed by a more extensive chapter on the diabetic foot syndrome itself. This is the very definition of the term, epidemiology, pathogenesis, classification, diagnosis, treatment and prevention of this syndrome. The last chapter deals briefly with general nutritional recommendations for diabetics and the nutritional status of patients in which they are most often found when they are admitted to hospital, which is malnutrition,...
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