The Pharmaceutical Journal
Vol 277 No 7429 p670
2 December 2006

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Nutrition and the hospital inpatient more
Dealing with chronic constipation in children more
Red grape remedy may offset adverse effects of obesity more
Filthy lucre the great corruption / Using the owl as a symbol / What is this culture? more

Nutrition and the hospital inpatient

An article in the November issue of Hospital Pharmacist, by Pamela Mason, draws attention to the problem of undernutrition of patients who are in hospital. Malnutrition is apparently a common but often ignored aspect of their care. Moreover, the patient’s medical notes frequently make no mention of nutritional status. A malnourished person’s hospital stay may be lengthened and he or she less able to respond adequately to medication, with the risk of therapeutic failure and adverse reactions.

In malnutrition there may be an imbalance of energy and protein reserve, so that body function suffers. Undernutrition presents problems to public health in both hospitals and the community in general. A study in the US in 1974 indicated that half the incidents of malnutrition occurred in surgical patients, while two years later there was 44 per cent malnutrition in both surgical and medical patients, and in the UK in 1977, half of surgical patients were malnourished.

There are many causes of undernutrition. Physical aspects are complicated by psychological ones such as poverty, educational status and social isolation. Poor appetite, pain or sickness may put someone off eating properly, while digestion or absorption may be impaired by surgery. Tissue demands may be increased, and losses increased by vomiting or diarrhoea. Aged patients and those taking a prolonged course of medication, or kept in hospital for long periods, are at particular risk.

Medicines may increase the risk of malnutrition by reducing appetite, changing taste, suppressing saliva production or causing confusion or gastrointestinal adverse effects. This in turn may impair immune response and wound healing, as well as reducing muscle strength. Inactivity may result in pressure sores and impaired thermoregulation. All these are intensified by apathy, depression, self-neglect and poor motivation to eat and to observe a medication regimen.

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Dealing with chronic constipation in children

According to a clinical review in the 18 November issue of the BMJ, chronic constipation in children is a frequent phenomenon, claimed to account for some 25 per cent of the work of paediatric gastroenterologists, and ranking among the 10 most common problems encountered in their routine.

In early childhood the frequency of defecation diminishes from more than four stools per day to 1.2 at the age of four. By that time 98 per cent of children are toilet trained. The characteristics of constipation are infrequent emptying of the bowel, unduly large stools and difficult or painful defecation. There may be a family history of constipation, and it is often associated with a diet that is deficient in fibre. The stages of growth at which children are threatened with constipation are weaning, toddling and starting school.

In the search for effective treatment, osmotic laxatives have been given. In children aged between eight months and 16 years, no significant difference has been found between lactulose and lactitol after two to four weeks of treatment, although some trials have indicated that lactulose produces more abdominal pain and flatulence than lactitol. In some children polyethylene glycol has been better tolerated than lactulose.
Stimulant laxatives have sometimes shown less activity, senna being less effective than mineral oil products. Retained faeces can be cleared by a three-day course of mineral oil or polyethylene glycol.
The most effective remedy is an osmotic laxative with adequate fluids and fibre. Behavioural patterns may need to be modified.

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Red grape remedy may offset adverse effects of obesity

Resveratrol is a polyphenolic compound found in many plants, particularly red grapes. It follows that it is a constituent of red wine, which may explain why this beverage has a reputation for boosting health. In the 2 November issue of Nature some interesting light is thrown on the therapeutic properties of resveratrol.

So far little is established regarding its effects on humans, and its long-term effects are unknown. A research team has reported that the compound counteracts the ill effects of a high-fat, high-calorie diet in mice. Suggestions have therefore been advanced that it might be used to block the toxic effects associated with obesity in humans.

Workers in the US fed a group of one-year-old mice on a regular diet, another group on high-calorie food and a third group on high-calorie food with a daily dose of resveratrol. After six months all animals on the high-calorie diet were fat. After one year, those also given resveratrol were healthier than the others, and had shown no sign of diabetes-like illness or liver damage. Their risk of death was estimated to have been reduced by 30 per cent.

Since the mice were taking resveratrol when they started the diet it is not known whether the drug reverses damage caused by the toxic diet as well as preventing it. Then little is known of the actual effect of it in mice, or whether it works in humans.

Resveratrol is believed to act upon enzymes called sirtuins. This apparently happens in yeast, worms and fruit flies but no one knows if it happens in primates. Moreover, nothing is known of its mode of action or possible long-term effects. It will be interesting to discover whether it prolongs the life of animals that have not been fed the high-calorie diet.

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And I quote …

Filthy lucre the great corruption
“Races petrified in dogma or demoralised by lucre are unfit to lead civilisation. Genuflexion before the idol or the dollar atrophies the muscle which walks and the will which goes.”
— Victor Hugo: ‘Les Miserables’ (1862)

Using the owl as a symbol
“Owls, being associated with night, are used in many cultures as symbols for two things — first for death, and second, rather differently, for wisdom. Going out in the dark brings danger of death. But, if you have to go out, then it is surely a good thing to have with you a creature that can penetrate the darkness”.
—Mary Midgley: ‘The owl of Minerva’ (2005)

What is this culture?
“Culture, the acquainting ourselves with the best that has been known and said in the world, and thus with the history of the human spirit”
—Matthew Arnold: ‘Literature and dogma’ (1873)

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