Clinical nutrition ESPEN最新文献

Background & aim: This study aimed to investigate the prevalence and prognostic impact of cachexia in patients with unresectable hepatocellular carcinoma (HCC) receiving systemic targeted therapy.

Methods: This single-center retrospective study included patients with HCC who underwent systemic targeted therapy. Cachexia was defined using novel criteria proposed in 2023. The prognostic impact of cachexia was evaluated using the Cox proportional hazards model.

Results: Of the 200 patients (160 males [80%]; median age, 73 years), cachexia was identified in 70 patients and associated with higher des-gamma-carboxy prothrombin levels, and extrahepatic spread. Patients with cachexia had significantly shorter overall survival (OS) (median 14.1 vs. 20.9 months, p = 0.002) and post-progression survival (PPS) (4.8 vs. 11.1 months, p = 0.001) compared to patients without cachexia. Multivariable analyses revealed cachexia as an independent adverse factor for OS (hazard ratio 1.54; 95% confidence interval 1.03-2.30, p = 0.035) and PPS (hazard ratio 1.64; 95% confidence interval 1.08-2.47, p = 0.018). No significant differences were observed in Progression-free survival between the two groups. Treatment discontinuation due to general appearance deterioration was more common in cachectic patients.

Conclusions: Cachexia was prevalent among patients with HCC receiving systemic targeted therapy and was identified as an independent predictor of poorer OS and PPS. Given the prognostic impact, the evaluation of cachexia is crucial in managing patients with HCC undergoing systemic targeted therapy.

Objective: More than half of the individuals with type 2 diabetes mellitus (T2DM) are accompanied by Non-alcoholic fatty liver disease (NAFLD). This study aimed to explore the relationship between nutrient intake, lifestyle, and the risk NAFLD in patients with T2DM.

Methods: This study comprised 2110 adult patients with diabetes from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2018. We employed weighted logistic regression to assess the associations between nutrient intake, lifestyle and NAFLD, while exploring potential non-linear relationships using restrictive cubic spline analysis. Additionally, we validated our findings through subgroup analyses and sensitivity analyses to ensure the robustness and reliability of our results.

Result: Out of 2110 diabetes patients, 1743 were diagnosed with NAFLD, and 53.43% of them were male. After adjusting for potential confounders, we found a negative correlation between Vitamin K intake and the occurrence of NAFLD in patients with T2DM (OR = 0.885 [0.829, 0.959]). This dose-response relationship was further validated through stratification analysis by tertiles of vitamin K intake. Lycopene intake is identified as a risk factor for NAFLD in patients with T2DM. Specifically, for every 100 μg of lycopene ingested, there was a 0.2% higher likelihood of NAFLD (OR = 1.002 [1.0001, 1.005], p < 0.05). Conversely, a 0.5% reduction in NAFLD risk was observed with the same amount of lutein intake (OR = 0.995 [0.992, 0.999], p < 0.05). Furthermore, we also found that a high-quality diet can reduce the risk of NAFLD in patients with T2DM, with an odds ratio of 0.208 (0.101, 0.430).

Conclusion: Increasing intake of Vitamin K and lutein, reducing intake of lycopene, and improving dietary quality may lower the risk of NAFLD in patients with T2DM.

Background: The prognostic significance of body composition in metastatic colorectal cancer (mCRC) patients receiving systemic chemotherapy is increasingly recognized. This study aimed to explore the relationship between various body composition metrics measured using bioelectrical impedance analysis (BIA) and patient outcomes in patients with mCRC.

Methods: In a retrospective cohort of 164 mCRC patients, body composition was assessed using BIA before first-line chemotherapy. Metrics evaluated included the extracellular water/total body water ratio (ECW/TBW), skeletal muscle mass, body fat mass, protein, and mineral levels. This study examined the relationship between these parameters and survival outcomes and their impact on chemotherapy-induced toxicity and relative dose intensity.

Results: Patients with a higher ECW/TBW ratio had significantly lower overall survival (OS) (p<0.001) across quartiles (median OS: Q1=38.6 months, Q4=19.1 months) and a significantly lower progression-free survival (median progression-free survival: Q1=10.5 months, Q4=8.3 months; p=0.03). Multivariate analysis identified ECW/TBW as an independent predictor of OS (hazard ratio: 2.12; 95% confidence interval: 1.36-3.23; p<0.001). Subgroup analysis indicated a significant interaction between ECW/TBW quartiles and the effectiveness of anti-endothelial growth factor receptor and anti-vascular endothelial growth factor therapies on overall survival (p for interaction <0.001). Body composition was significantly associated with chemotherapy relative dose intensity and hematologic adverse events, particularly thrombocytopenia, which was significantly correlated with ECW/TBW, skeletal muscle mass, lean body mass, and protein levels.

Conclusion: This study highlights the value of comprehensive body composition assessment using BIA in predicting outcomes for patients with mCRC, supporting its incorporation into clinical practice for enhanced patient care.

Background and aims: A decline in appetite is associated with poor health in older adults (≥65 years). Subjective methods of appetite assessment used in older adults living in the community have not previously been fully documented and their validity and reliability have not been evaluated and described. The aims of this scoping review were to identify methods used to assess self-reported/subjective appetite as a primary outcome in studies in older adults living in the community and community settings, and to establish which, and how methods were evaluated for validity and/or reliability.

Methods: A scoping review of three online databases: CINAHL, PubMed and EMBASE was undertaken.

Results: One-hundred and one articles were included, with 30 different types of appetite assessment methods identified and categorized into three groups: Likert-scales, visual analogue scales (VAS) and question-based methods. Likert-scales were used most frequently (61%), followed by VAS (23%) and question-based methods. Twenty-two studies evaluated the validity and/or reliability of 11 types of appetite assessment methods (Likert-scales, n=10, VAS, n=1). Thirty comparators were used to evaluate validity and reliability, with predictive validity and internal consistency reliability evaluated most frequently. Likert-scales were predominantly reported to predict health risks; however, have not been validated for appetite per se. In contrast, albeit limited, VAS have been validated against ad libitum test meal energy intake.

Conclusions: Agreement on best practice when evaluating the validity and reliability of assessment methods is required. Given the current evidence, a recommended method will likely depend on the context and goals of assessment.

Background: Ketogenic diet therapy (KDT) is a group of high-fat, low-carbohydrate, moderate protein diets that are an effective treatment option for children and young people with drug-resistant epilepsy. However, 45% of patients referred to start KDT, who are medically eligible to do so, do not start diet. A further 25% discontinue KDT before 3 months.

Aim: to explore barriers and facilitators for children and young people with epilepsy to start or continue on KDT, and their families. Based on the Participants, Concept and Context (PCC) framework, this review included children and young people with drug-resistant epilepsy (P) referred for KDT (C) or their families, who had expressed their views regarding barriers or facilitators for starting or continuing on dietary treatment (C).

Methods: This scoping review followed JBI methodology. Identified barriers/facilitators were matched to relevant sections of the 'Capability, Opportunity, Motivation - Behaviour' (COM-B) model and organised according to the phases of the patient journey: pre-diet, diet initiation and maintenance.

Results: 60 studies were included. 15 barriers and 9 facilitators were identified for the pre-diet and initiation stages; 19 barriers and 14 facilitators were identified for staying on KDT once the diet had been fully established.

Conclusions: Barriers and facilitators for children and young people who are considering starting KDT, or who are currently following KDT, and their families, are multifactorial and extend beyond the level of the individual. Our findings will help identify areas to prioritise for interventions to support patients and their families.

Background & aims: In utero exposure to deficiencies of certain nutritional factors such as vitamin D has been related to adverse cardiometabolic outcomes in the offspring, but results are conflicting. The aim of this study was to investigate the association between maternal vitamin D status during pregnancy and markers of cardiometabolic risk in childhood.

Methods: Serum 25-hydroxyvitamin D (25OHD) concentrations were measured at 11- and 33-weeks' gestation. At 7-8 years of age, the children were examined regarding anthropometry, body composition (by bioelectrical impedance), and blood pressure, and a blood sample was drawn. Cardiometabolic risk was assessed using individual cardiometabolic risk factors and a composite score of adiposity, blood pressure, blood lipids, and hemoglobin A1c, using age- and sex-specific z-scores. Associations between maternal vitamin D status in early and late pregnancy and z-scores of markers of cardiometabolic risk were evaluated using adjusted linear and logistic regression analyses.

Results: In total, n=172 mother-child pairs were included. Neither was an association found between maternal 25OHD concentration with a composite score of cardiometabolic risk in childhood (Odds Ratio (OR) 1.02 (confidence interval (CI) 0.99-1.05), and OR 0.99 (CI 0.97-1.01) in early and late pregnancy, respectively), nor with any individual marker of cardiometabolic risk.

Conclusion: In conclusion, there were no evidence of an association between maternal vitamin D status during pregnancy and cardiometabolic risk factors in the child at 7-8 years of age.

Background and aims: Irritable bowel syndrome (IBS) is a frequent disorder thought to be caused by a disturbance of the gut-brain axis. Nutrition interventions are an essential pillar of its treatment. However, there is no consensus on which outcomes should be applied to assess the effectiveness of nutrition care in IBS. Standardized outcome sets, or "core outcome sets" (COS), have been proposed to harmonize outcomes in clinical research and practice. This project aims to develop a COS for dietitian-provided nutrition care in adults with IBS or food intolerances with intestinal symptoms, to be implemented in routine outpatient practice.

Methods: A comprehensive outcomes list was developed based on quantitative and qualitative studies, COS and guidelines on IBS, and important outcomes named by participants. Health service users, dietitians, gastroenterologists, and health care decision makers rated the outcomes in two Delphi survey rounds on their importance and ranked them in a third round. Data was analyzed by panel to account for the different views and sample sizes.

Results: A total of 192 participants registered for the Delphi process. The following 14 outcomes reached consensus in all panels after two rounds: perception of symptom triggering foods/nutrients, intake of trigger foods/nutrients, practicability of diet, adherence, digestive symptoms overall, abdominal pain, abdominal bloating, stool consistency, stool frequency, physical functioning related QoL, nutrition related QoL, social functioning related QoL, empowerment of self-care.

Conclusions: The Delphi process yielded in a 14 outcomes COS, which exceeds what is typically considered feasible in routine nutrition care. Further work is needed to refine the COS and to identify standardised measurement tools for each outcome.

Background & aims: There is a general paucity of data on energy needs during critical illness and the subsequent hospital course, particularly in cardiothoracic surgical patients. We measured resting energy expenditure (mREE) via indirect calorimetry post-cardiothoracic surgery and conducted repeat measures throughout hospitalization to evaluate trends and begin to describe metabolic needs in this patient population.

Methods: Prospective descriptive cohort study design. Patients status post cardiothoracic surgery and admitted to the intensive care unit were enrolled, and indirect calorimetry measurements were obtained within 72 hours post-operative and every 5-7 days thereafter.

Results: A total of 11 patients (4 with obesity and 7 without obesity) and 35 indirect calorimetry measurements were included in the analysis. Overall mean resting energy expenditure was 1598 kcals/day [859-2506], and 21 kcals/kg [13.0-37.4 kcals/kg]. Overall, the patients with obesity had higher resting energy expenditure than those without obesity in kcals/day (1930 vs. 1425, respectively). This trend continued regardless of the patient being in the intensive care unit (obese 1845 kcals/day vs. non-obese 1244 kcals/day) or the step-down unit (obese 2099 kcals/day vs. 1624 kcals/day). Additionally, measurements on the ventilator were lower than those off the ventilator (1310 kcals vs. 1769 kcals, respectively). Inter-patient variability in mREE was diverse, with some energy needs remaining stable throughout hospitalization while others varied greatly.

Conclusions: Measured resting energy expenditure in post-cardiothoracic surgical patients is highly variable. Ventilator and unit status also significantly influenced energy needs, with distinct differences between patients with obesity and those without.

Background&aims: Low muscle mass is associated with poor immune checkpoint inhibitor (ICI) efficacy in patients with melanoma; however, whether this is true in all populations remains to be explored. The current study aimed to investigate the effect of low muscle mass on overall survival (OS) and progression-free survival (PFS) of patients with advanced melanoma treated with ICI.

Methods: We retrospectively collected the clinical data of consecutive patients with advanced melanoma who received ICI as first-line treatment between 2013 and 2024 at our institution. To diagnose low muscle mass, the skeletal muscle index (SMI) at the third lumbar spine was calculated from computed tomography (CT) images, and SMI values < 42 cm2/m2 for men and < 38 cm2/m2 for women diagnosed low muscle mass. The association of low muscle mass, OS, and PFS with ICI treatment in patients was investigated.

Results: Seventy-six patients with advanced melanoma were assessed retrospectively at our institution; 32 were in the low muscle mass group, while 44 were in the normal muscle mass group. The median OS in patients with and without low muscle mass was 7.1 and 26.6 months (hazard ratio [HR] 3.12, 95% confidence interval [Cl], 1.65-5.89; p < 0.001) and median PFS was 2.1 and 14.8 months, respectively (HR, 3.10; 95% Cl 1.74-5.54, p < 0.001). Multivariate analysis showed significantly poor differences in OS (HR, 2.46; 95% CI, 1.20-5.03; p = 0.01) and significant differences in PFS independently in the low muscle mass group (HR, 3.10; 95% CI, 1.74-5.54; p < 0.001).

Conclusions: Low muscle mass may be a poor prognostic factor for patients with advanced melanoma treated with ICI.