Quotes, notes and references

"Up-to-date, practical information from dynamic, knowledgable speakers; overall, a valuable learning experience worth the trade-off of being indoors on a rare sunny Saturday in October; I feel inspired, challenged and better informed."

This was my evalution of the recent Education Day I attended. Listening to expert speakers in a supportive, collegial atmosphere boosted my morale as well as knowledge. The next step: translate this into daily practice.

So this week I've been reviewing my handouts. I thought I'd post some quotes, notes and key references pertaining to best practice in nutrition support (enteral and parenteral feeding) and vitamin-mineral supplementation.

Session: Enteral feeding: the practice vs the evidence (Carol Rees Parrish, MS, RD)

"To date, adequately powered studies have not been conducted to demonstrate a significant relationship between GRV [gastric residual volume] and aspiration pneumonia."

"Good evidence exists for maintaining a backrest elevation of greater than 30 degrees to decrease gastric reflux and aspiration events."

Parrish CR, McClave SA. Checking Gastric Residual Volumes: A Practice in Search of a Science? Practical Gastroenterology 2008; XXXII(10):33-47 (PDF)

Session: Parenteral feeding: passé in patients with pancreatitis? (Carol Rees Parrish, MS, RD)

"Jejunal feeding is safe, effective, low risk; best route (NJ, N-G-J vs PEG/J, surgical J) has yet to be determined by a prospective controlled trial."

Krenitsky, J., Makola D., Parrish, C. Parenteral Nutrition in Pancreatitis is Passé: But Are We Ready for Gastric Feeding? A Critical Evaluation of the Literature-Part I (PDF)

Krenitsky J, Makola D, Parrish CR. Pancreatitis Part II - Revenge of the Cyst: A Practical Guide to Jejunal Feeding (PDF)

"In patients with predicted severe acute pancreatitis, probiotic prophylaxis with this combination of probiotic strains did not reduce the risk of infectious complications and was associated with an increased risk of mortality.

Probiotics can no longer be considered to be harmless adjuncts to enteral nutrition, especially in critically ill patients or patients at risk for non-occlusive mesenteric ischemia."

Besselink MG, van Santvoort HC, Buskens E, Boermeester MA, van Goor H, Timmerman HM, et al. Probiotic prophylaxis in predicted severe acute pancreatitis: a randomised, double-blind, placebo-controlled trial Lancet 2008; 371(9613):651-9.

Session: Drug-induced nutrient depletion and supplementation -- Literature picks (Liz da Silva, RD)

Bardia A, et al. Efficacy of antioxidant supplementation in reducing primary cancer incidence and mortality: a systematic review and meta-analysis. Mayo Clin Proc;83(1)23-34. (PDF)

Bjeklakovic G, et al. Antioxidant supplements for prevention of mortality in healthy participants and patients with various disease. Cochrane Database of Systematic Rev 2008 Apr 16;(2):CD007176

Expert Group on Vitamins and Minerals. Safe upper levels for vitamins and minerals, food standards agency, London. 2003 (PDF)

Mulholland CA, Benford DJ. What is known about the safety of multivitamin-multimineral supplements for the generally healthy population? Theoretical basis for harm. Am J Clin Nutr 2007;85(suppl):318S-322S. (PDF)

Wildish ED. An evidence-based approach for dietitian prescription of multiple vitamins with minerals. J Am Diet Assoc 2004;104:779-86.

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Complete schedule and speakers' biographies (PDF)

Vitamin & Mineral Supplementation in Canada

  Image credit: 500 mg calcium supplements with vitamin D

This afternoon I was reading the June issue of the Dietitians of  Canada (DC) newsletter that, among several articles pertinent to my practice,  features Dr.  Susan Whiting's recent presentation on Vitamin & Mineral Supplementation in Canada.

Some much-anticipated preliminary research results were presented on Thursday, May 8 at the Canadian Foundation for Dietetic Research's annual Partners' Breakfast.  Susan Whiting, PhD, University of Saskatchewan, spoke about her project on vitamin and mineral supplementation in Canada.

The research project, which is nearing completion, is a collaborative project between CFDR and Dietitians of Canada. The project had three main objectives:

1. to identify who in Canada is at risk for nutrient deficiency

2. to look at the attitudes, knowledge and practices of vitamin and mineral use, and

3. to identify research knowledge gaps with respect to vitamin and mineral use.

While the research team is still gathering data and the project is not quite complete yet, Susan was able to answer some preliminary questions....

If you are a DC member, you can read the entire newsletter article here.  But the main reason I'm highlighting this article is that everyone can download Dr. Whiting's presentation from the public side of the DC website.  (Kudos to DC for uploading this Powerpoint presentation and making it widely available.)