Vivian Zhao - Academia.edu (original) (raw)
Papers by Vivian Zhao
Parenteral Nutrition
Springer eBooks, 2020
Critical Care Medicine, Jun 1, 2012
Objective-Parenteral nutrition has been associated with metabolic and infectious complications in... more Objective-Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil-based lipid emulsions, the only Food and Drug Administration-approved lipid formulation for clinical use. Design-Prospective, double-blind, randomized, controlled trial. Setting-Medical-surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients-Adult medical-surgical intensive care unit patients. Intervention-Parenteral nutrition containing soybean oil-based (Intralipid) or olive oil-based (ClinOleic) lipid emulsions. Measurements-Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results-A total of 100 patients were randomized to either soybean oil-based parenteral nutrition or olive oil-based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil-based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m 2 , and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients
Specialized nutrition support
Elsevier eBooks, 2020
Contributors to Volume 2
Present Knowledge in Nutrition, 2020
1304: Incidence of Micronutrient Alterations During CRRT in Critically Ill Patients: A Pilot Study
Parenteral Nutrition
Surgical Metabolism
Nutrition support in end-stage liver disease
Critical care nursing clinics of North America, 2010
Protein-calorie malnutrition is common in end-stage liver disease, irrespective of cause, and adv... more Protein-calorie malnutrition is common in end-stage liver disease, irrespective of cause, and adversely affects clinical outcomes. Early diagnosis is important to allow appropriate intervention to prevent malnutrition-associated complications. Correction of nutrient deficiencies through oral supplementation, enteral tube feeding, or parenteral feeding can improve clinical outcomes in this patient population. This article addresses the causes of malnutrition, methods used to assess nutritional status, and treatment strategies in end-stage liver disease.
Journal of Clinical Gastroenterology, 2014
BACKGROUND: Malabsorptive bariatric surgery is rapidly becoming a major cause of copper deficienc... more BACKGROUND: Malabsorptive bariatric surgery is rapidly becoming a major cause of copper deficiency given the increasing prevalence of these procedures for morbid obesity. Acquired copper deficiency can present with clinically significant hematologic and neurological manifestations. Although hematologic manifestations of copper deficiency are rapidly reversible, significant neurological improvement after copper supplementation therapy is unusual and many patients remain debilitated and may only experience, at best, stabilization of the neurological manifestations. FINDINGS: Here we present a case of an undiagnosed copper deficiency several years after bariatric gastric bypass surgery, in a patient who concomitantly used zinc-containing denture cream for several years, associated with anemia, neutropenia, myelopathy, respiratory failure, and bilateral optic neuropathy, which caused major vision loss. This patient was also a heterozygote carrier of the 5,10-methylenetetrahydrofolate reductase A1298C gene polymorphism, which may affect copper metabolism. RESULTS: Intravenous copper repletion resulted in rapid correction of hematologic indices. However, neurological manifestations, including vision loss responded only modestly to copper supplementation, despite achieving normal blood copper concentrations. CONCLUSION: Clinicians should consider copper deficiency in patients at risk, as in this case, as a delayed diagnosis can lead to irreversible disability due to neurological manifestations.
Critical Care Medicine, 2012
Objective-Parenteral nutrition has been associated with metabolic and infectious complications in... more Objective-Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil-based lipid emulsions, the only Food and Drug Administration-approved lipid formulation for clinical use. Design-Prospective, double-blind, randomized, controlled trial. Setting-Medical-surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients-Adult medical-surgical intensive care unit patients. Intervention-Parenteral nutrition containing soybean oil-based (Intralipid) or olive oil-based (ClinOleic) lipid emulsions. Measurements-Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results-A total of 100 patients were randomized to either soybean oil-based parenteral nutrition or olive oil-based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil-based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m 2 , and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients
International journal of obesity (2005), 2012
The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass... more The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass (RYGB) surgery is not yet clear. Objectives were to determine the prevalence and incidence of copper deficiency in patients who have undergone RYGB. We sought to determine the number of RYGB patients undergoing medical and nutritional follow-up visits at the Emory Bariatric Center who experienced copper deficiency and associated hematological and neurological complaints (n=136). Separately, in patients followed longitudinally before and during 6 and 24 months following RYGB surgery, we obtained measures of copper status (n=16). Systemic blood cell counts and measures of copper, zinc and ceruloplasmin were determined using standardized assays in reference laboratories including atomic absorption spectrometry and immunoassays. Thirteen patients were identified to have copper deficiency suggesting a prevalence of copper deficiency of 9.6%, and the majority of these had concomitant complica...
How More Options Decrease the Compromise Effect: Investigating Boundary Conditions for the Compromise Effect in Travel Decisions
Journal of Travel Research
Travelers often demonstrate the compromise effect—a tendency to choose the intermediate option(s)... more Travelers often demonstrate the compromise effect—a tendency to choose the intermediate option(s) when facing difficult trade-off decisions. The compromise effect has been replicated in very specific settings where typically only two or three options were available. This research extends our understanding of the compromise effect by examining the impact of the number of options on travelers’ choices. Based on two different accounts (i.e., attribute distance account vs. decision complexity account), we predict that the compromise effect will be attenuated as the number of options in a choice set increases. Four experimental studies provide supporting evidence for this argument and support the attribute distance account as the main underlying mechanism. This research contributes to the extant tourism and travel choice literature by responding to the call to investigate the compromise effect in complex buying contexts.
Ethanol Lock Therapy Markedly Reduces Catheter‐Related Blood Stream Infections in Adults Requiring Home Parenteral Nutrition: A Retrospective Study From a Tertiary Medical Center
Journal of Parenteral and Enteral Nutrition
Micronutrient Alterations During Continuous Renal Replacement Therapy in Critically Ill Adults: A Retrospective Study
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2017
Continuous renal replacement therapy (CRRT) is commonly used to provide renal replacement therapy... more Continuous renal replacement therapy (CRRT) is commonly used to provide renal replacement therapy in the intensive care unit. Limited published data suggest that CRRT may lead to depletion of water-soluble vitamins and trace elements. The goal of this study was to identify the incidence of trace element and vitamin deficiencies in critically ill patients during CRRT. This study is based on a retrospective chart review of patients who were referred to Emory University Hospital's nutrition support services and had at least 1 serum micronutrient level measured during CRRT (thiamin, pyridoxine, ascorbic acid, folate, zinc, and copper) between April 1, 2009, and June 1, 2012. Seventy-five patients were included in the study. Nine of 56 patients (16%) had below-normal whole blood thiamin concentrations, and 38 of 57 patients (67%) had below-normal serum pyridoxine levels. Serum ascorbic acid and folate deficiencies were identified among 87% (13 of 15) and 33% (3 of 9) of the study pat...
Randomized Clinical Trial Comparing Soybean Oil-Based and Olive Oil-Based Lipid Emulsion in Medical-Surgical Patients Requiring Parenteral Nutrition
The Endocrine Society's 93rd Annual Meeting & Expo, June 4–7, 2011 - Boston, 2011
Specialized nutrition support in the surgical patient
A Textbook of Perioperative Medicine, 2013
Intravenous Fat Emulsions
Clinical Management of Intestinal Failure, 2011
Parenteral Nutrition
Surgical Metabolism, 2014
Nutrition, 2013
Objective: Limited data are available on the incidence and risk factors for infection in patients... more Objective: Limited data are available on the incidence and risk factors for infection in patients requiring home parenteral nutrition (HPN). Methods: A retrospective study was conducted in 101 consecutive adults (63 female, 38 male) discharged on HPN from the
Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition
Journal of Parenteral and Enteral Nutrition, 2011
Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-asso... more Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited. To determine the incidence and characteristics of CA-BSI in children receiving HPN. Medical records of 44 children receiving HPN during a 3-year period were reviewed. End points were CA-BSI during the initial 6 months after discharge. CA-BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA-BSI, polymicrobial infections accounted for 52%; gram-positive, 29%; gram-negative, 17%; and fungal, 2%. CA-BSI incidence per 1000 catheter-days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4-109.6). CA-BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA-BSI (odds ratio [OR], 4.4 [95% CI, 1.13-16.99] and 6.6 [1.50-28.49], respectively; P < .05). The incidence of CA-BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.
Current Opinion in Clinical Nutrition and Metabolic Care, 2011
Purpose of review-Complete parenteral nutrition solutions contain mixed amino acid products provi... more Purpose of review-Complete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years. Recent findings-Limited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition. Summary-Despite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition.
Parenteral Nutrition
Springer eBooks, 2020
Critical Care Medicine, Jun 1, 2012
Objective-Parenteral nutrition has been associated with metabolic and infectious complications in... more Objective-Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil-based lipid emulsions, the only Food and Drug Administration-approved lipid formulation for clinical use. Design-Prospective, double-blind, randomized, controlled trial. Setting-Medical-surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients-Adult medical-surgical intensive care unit patients. Intervention-Parenteral nutrition containing soybean oil-based (Intralipid) or olive oil-based (ClinOleic) lipid emulsions. Measurements-Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results-A total of 100 patients were randomized to either soybean oil-based parenteral nutrition or olive oil-based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil-based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m 2 , and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients
Specialized nutrition support
Elsevier eBooks, 2020
Contributors to Volume 2
Present Knowledge in Nutrition, 2020
1304: Incidence of Micronutrient Alterations During CRRT in Critically Ill Patients: A Pilot Study
Parenteral Nutrition
Surgical Metabolism
Nutrition support in end-stage liver disease
Critical care nursing clinics of North America, 2010
Protein-calorie malnutrition is common in end-stage liver disease, irrespective of cause, and adv... more Protein-calorie malnutrition is common in end-stage liver disease, irrespective of cause, and adversely affects clinical outcomes. Early diagnosis is important to allow appropriate intervention to prevent malnutrition-associated complications. Correction of nutrient deficiencies through oral supplementation, enteral tube feeding, or parenteral feeding can improve clinical outcomes in this patient population. This article addresses the causes of malnutrition, methods used to assess nutritional status, and treatment strategies in end-stage liver disease.
Journal of Clinical Gastroenterology, 2014
BACKGROUND: Malabsorptive bariatric surgery is rapidly becoming a major cause of copper deficienc... more BACKGROUND: Malabsorptive bariatric surgery is rapidly becoming a major cause of copper deficiency given the increasing prevalence of these procedures for morbid obesity. Acquired copper deficiency can present with clinically significant hematologic and neurological manifestations. Although hematologic manifestations of copper deficiency are rapidly reversible, significant neurological improvement after copper supplementation therapy is unusual and many patients remain debilitated and may only experience, at best, stabilization of the neurological manifestations. FINDINGS: Here we present a case of an undiagnosed copper deficiency several years after bariatric gastric bypass surgery, in a patient who concomitantly used zinc-containing denture cream for several years, associated with anemia, neutropenia, myelopathy, respiratory failure, and bilateral optic neuropathy, which caused major vision loss. This patient was also a heterozygote carrier of the 5,10-methylenetetrahydrofolate reductase A1298C gene polymorphism, which may affect copper metabolism. RESULTS: Intravenous copper repletion resulted in rapid correction of hematologic indices. However, neurological manifestations, including vision loss responded only modestly to copper supplementation, despite achieving normal blood copper concentrations. CONCLUSION: Clinicians should consider copper deficiency in patients at risk, as in this case, as a delayed diagnosis can lead to irreversible disability due to neurological manifestations.
Critical Care Medicine, 2012
Objective-Parenteral nutrition has been associated with metabolic and infectious complications in... more Objective-Parenteral nutrition has been associated with metabolic and infectious complications in intensive care unit patients. The underlying mechanism for the high risk of complications is not known but may relate to the proinflammatory effects of soybean oil-based lipid emulsions, the only Food and Drug Administration-approved lipid formulation for clinical use. Design-Prospective, double-blind, randomized, controlled trial. Setting-Medical-surgical intensive care units from a major urban teaching hospital and a tertiary referral university hospital. Patients-Adult medical-surgical intensive care unit patients. Intervention-Parenteral nutrition containing soybean oil-based (Intralipid) or olive oil-based (ClinOleic) lipid emulsions. Measurements-Differences in hospital clinical outcomes (nosocomial infections and noninfectious complications), hospital length of stay, glycemic control, inflammatory and oxidative stress markers, and granulocyte and monocyte functions between study groups. Results-A total of 100 patients were randomized to either soybean oil-based parenteral nutrition or olive oil-based parenteral nutrition for up to 28 days. A total of 49 patients received soybean oil-based parenteral nutrition (age 51 ± 15 yrs, body mass index 27 ± 6 kg/m 2 , and Acute Physiology and Chronic Health Evaluation II score 15.5 ± 7 [±SD]), and a total of 51 patients
International journal of obesity (2005), 2012
The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass... more The frequency of copper deficiency and clinical manifestations following roux-en-y gastric bypass (RYGB) surgery is not yet clear. Objectives were to determine the prevalence and incidence of copper deficiency in patients who have undergone RYGB. We sought to determine the number of RYGB patients undergoing medical and nutritional follow-up visits at the Emory Bariatric Center who experienced copper deficiency and associated hematological and neurological complaints (n=136). Separately, in patients followed longitudinally before and during 6 and 24 months following RYGB surgery, we obtained measures of copper status (n=16). Systemic blood cell counts and measures of copper, zinc and ceruloplasmin were determined using standardized assays in reference laboratories including atomic absorption spectrometry and immunoassays. Thirteen patients were identified to have copper deficiency suggesting a prevalence of copper deficiency of 9.6%, and the majority of these had concomitant complica...
How More Options Decrease the Compromise Effect: Investigating Boundary Conditions for the Compromise Effect in Travel Decisions
Journal of Travel Research
Travelers often demonstrate the compromise effect—a tendency to choose the intermediate option(s)... more Travelers often demonstrate the compromise effect—a tendency to choose the intermediate option(s) when facing difficult trade-off decisions. The compromise effect has been replicated in very specific settings where typically only two or three options were available. This research extends our understanding of the compromise effect by examining the impact of the number of options on travelers’ choices. Based on two different accounts (i.e., attribute distance account vs. decision complexity account), we predict that the compromise effect will be attenuated as the number of options in a choice set increases. Four experimental studies provide supporting evidence for this argument and support the attribute distance account as the main underlying mechanism. This research contributes to the extant tourism and travel choice literature by responding to the call to investigate the compromise effect in complex buying contexts.
Ethanol Lock Therapy Markedly Reduces Catheter‐Related Blood Stream Infections in Adults Requiring Home Parenteral Nutrition: A Retrospective Study From a Tertiary Medical Center
Journal of Parenteral and Enteral Nutrition
Micronutrient Alterations During Continuous Renal Replacement Therapy in Critically Ill Adults: A Retrospective Study
Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition, 2017
Continuous renal replacement therapy (CRRT) is commonly used to provide renal replacement therapy... more Continuous renal replacement therapy (CRRT) is commonly used to provide renal replacement therapy in the intensive care unit. Limited published data suggest that CRRT may lead to depletion of water-soluble vitamins and trace elements. The goal of this study was to identify the incidence of trace element and vitamin deficiencies in critically ill patients during CRRT. This study is based on a retrospective chart review of patients who were referred to Emory University Hospital's nutrition support services and had at least 1 serum micronutrient level measured during CRRT (thiamin, pyridoxine, ascorbic acid, folate, zinc, and copper) between April 1, 2009, and June 1, 2012. Seventy-five patients were included in the study. Nine of 56 patients (16%) had below-normal whole blood thiamin concentrations, and 38 of 57 patients (67%) had below-normal serum pyridoxine levels. Serum ascorbic acid and folate deficiencies were identified among 87% (13 of 15) and 33% (3 of 9) of the study pat...
Randomized Clinical Trial Comparing Soybean Oil-Based and Olive Oil-Based Lipid Emulsion in Medical-Surgical Patients Requiring Parenteral Nutrition
The Endocrine Society's 93rd Annual Meeting & Expo, June 4–7, 2011 - Boston, 2011
Specialized nutrition support in the surgical patient
A Textbook of Perioperative Medicine, 2013
Intravenous Fat Emulsions
Clinical Management of Intestinal Failure, 2011
Parenteral Nutrition
Surgical Metabolism, 2014
Nutrition, 2013
Objective: Limited data are available on the incidence and risk factors for infection in patients... more Objective: Limited data are available on the incidence and risk factors for infection in patients requiring home parenteral nutrition (HPN). Methods: A retrospective study was conducted in 101 consecutive adults (63 female, 38 male) discharged on HPN from the
Characterization of Posthospital Bloodstream Infections in Children Requiring Home Parenteral Nutrition
Journal of Parenteral and Enteral Nutrition, 2011
Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-asso... more Home parenteral nutrition (HPN) is lifesaving for children with intestinal failure. Catheter-associated bloodstream infections (CA-BSI) are common in hospitalized patients receiving parenteral nutrition (PN), but data evaluating CA-BSI in children receiving HPN are limited. To determine the incidence and characteristics of CA-BSI in children receiving HPN. Medical records of 44 children receiving HPN during a 3-year period were reviewed. End points were CA-BSI during the initial 6 months after discharge. CA-BSI was defined as isolation of pathogens from blood requiring antimicrobial therapy. The primary indication for HPN was short bowel syndrome (46%), and 59 BSI were documented during the initial 6 months of HPN in 29 (66%) children. Of CA-BSI, polymicrobial infections accounted for 52%; gram-positive, 29%; gram-negative, 17%; and fungal, 2%. CA-BSI incidence per 1000 catheter-days was highest during the first month posthospital discharge (72 episodes; 95% confidence interval [CI], 45.4-109.6). CA-BSI incidence density ratio for children receiving HPN for >90 days compared with those receiving HPN for <30 days was 2.2 (P < .05). Logistic regression revealed that Medicaid insurance and age <1 year were associated with increased risk for CA-BSI (odds ratio [OR], 4.4 [95% CI, 1.13-16.99] and 6.6 [1.50-28.49], respectively; P < .05). The incidence of CA-BSI in children receiving HPN is highest during the first month posthospital discharge. Strategies to address care in the immediate posthospital discharge period may reduce the burden of infectious complications of HPN.
Current Opinion in Clinical Nutrition and Metabolic Care, 2011
Purpose of review-Complete parenteral nutrition solutions contain mixed amino acid products provi... more Purpose of review-Complete parenteral nutrition solutions contain mixed amino acid products providing all nine essential amino acids and a varying composition of nonessential amino acids. Relatively little rigorous comparative efficacy research on altered parenteral nutrition amino acid composition has been published in recent years. Recent findings-Limited data from randomized, double-blind, adequately powered clinical trials to define optimal doses of total or individual amino acids in parenteral nutrition are available. An exception is the growing number of studies on the efficacy of glutamine supplementation of parenteral nutrition or given as a single parenteral agent. Parenteral glutamine appears to confer benefit in selected patients; however, additional data to define optimal glutamine dosing and the patient subgroups who may most benefit from this amino acid are needed. Although some promising studies have been published, little data are available in the current era of nutrition support on the clinical efficacy of altered doses of arginine, branched chain amino acids, cysteine, or taurine supplementation of parenteral nutrition. Summary-Despite routine use of parenteral nutrition, surprisingly little clinical efficacy data are available to guide total or specific amino acid dosing in adult and pediatric patients requiring this therapy. This warrants increased attention by the research community and funding agencies to better define optimal amino acid administration strategies in patient subgroups requiring parenteral nutrition.