Clinical nutrition ESPEN最新文献

Background & aims: Electronic screening and brief interventions (eSBIs) are promising health promoting approaches but their utilization towards nutrition outcomes has been little documented so far. The aim of this systematic review is to examine the nature and findings of eSBIs targeting diet and/or physical activity (PA) among adult patients in healthcare settings since smartphone technologies emerged.

Methods: Three systematic searches in PubMed, ScienceDirect and PsycINFO were conducted from January 2010 to May 2023. We include all studies assessing eSBI towards lifestyle habits (dietary habits and/or PA at least), implemented in healthcare settings and targeting adult participants.

Results: Of 1981 articles identified, 15 studies met inclusion criteria. Most of them documented eSBIs implemented in primary care (n=11), targeting PA (n=11) and diet (n=9) alone or combined (n=5). Some eSBIs targeted additional behaviors (e.g. smoking, drinking). Delivery modes included computer (n=8), printed documents (n=8) or phone (n=2) but only four eSBIs were interactive (or partially automated). In addition to personalized feedback, most common behavior change techniques were "information about social and environmental consequences" (n=9), "goal setting" (n=7), and "information about health consequences" (n=7). Most studies assessing behavior change had a control group (8 in 10), and eight studies found positive changes in behavior.

Conclusions: Although implementing eSBIs towards PA/diet among adult patients in medical settings seems promising for primary, secondary and tertiary prevention, common conceptual framework, intervention and outcomes are severely lacking, and the extent to which they follow existing SBI guidelines remains unclear. Demonstrating their effectiveness requires fixing these issues before conducting prospective assessment studies in medical settings.

Background & aims: Many people with dementia frequently experience various health-related problems and are known to have poor nutritional status. However, very few studies have examined the nutritional status of dementia residents in group homes, which play an important role in a society-wide system of support for people with dementia, or the relationship between nutritional status and long-term prognosis. This study was conducted to determine the nutritional status of group-home residents and to examine the relationship between nutritional status and the 5-year survival rate.

Methods: Participant characteristic (e.g., age, sex, body mass index, and medical history) and Mini Nutritional Assessment-Short Form (MNA-SF), Barthel index (BI), and Clinical Dementia Rating (CDR) data were collected from 79 older people (12 men/67 women; mean age: 88.3 ± 5.5 years) residing in 5 group homes as a baseline survey. Mortality data were obtained from medical records using an endline survey.

Results: The nutritional status of the participants using the MNA-SF was normal, at risk of malnutrition, and malnourished in 15.2 % (n = 12), 69.6 % (n = 55), and 15.2 % (n = 12) of participants, respectively. Following the survey, mortality data were collected for 5 years, and the 5-year survival rates were 64.3 % in those with normal nutritional status, 30.4 % in those at risk of malnutrition, and 9.1 % in the malnourished group, with a significant difference observed in the Kaplan-Meier analysis (p < 0.001). The hazard ratio for the MNA-SF scores and survival rates adjusted for sex, age, BI, and CDR were significant 0.80 [0.69-0.93, p = 0.003].

Conclusion: This study showed that 84.8 % of patients with dementia residing in group homes were malnourished or at risk of malnutrition and that low MNA-SF levels were an independent determinant of the 5-year survival rate.

Background: Appetite dysregulation in Parkinson's Disease (PD) appears to be linked to physical and cognitive deterioration. PD patients with and without cognitive impairment (CI) were compared to an age-matched control group to explore predictors of appetite control in fasting and post-prandial conditions.

Methods: Fifty-five patients were recruited and divided into three groups: twenty controls (age: 74 y, BMI: 25.8 kg/m²), nineteen PD patients without CI (72.5 y, 25.1 kg/m²) and sixteen PD patients with CI (74.3 y, 24.0 kg/m²). Self-reported appetite perception and circulating blood metabolic biomarkers were measured in fasting and over a 3-h post-prandial period. Biomarkers included glucose, insulin, tumour necrosis factor alpha (TNF-α), leptin, acyl-ghrelin, total ghrelin, peptide YY (PYY), glucagon like peptide 1 (GLP-1), insulin growth factor 1 (IGF-1), growth factor (GF) and triglycerides. Patients were then provided with a mixed meal to eat ad libitum with the aim to evaluate links between metabolic biomarkers and control of energy intake.

Results: PD patients with CI had a significant lower protein intake (7.4 ± 2.5 g, p = 0.01) compared to controls (21.9 ± 3.1 g) and PD patients without CI (14.3 ± 3.0 g). Post-prandial plasma GLP-1 concentrations were associated with decreased hunger perception (B±SE, -5.3 ± 2.4  mm·h^-1, p = 0.04). PYY concentrations were significantly associated with GLP-1 in fasting (r = 0.40, p = 0.005) and post-prandial (r = 0.46, p < 0.001) conditions. In a multivariate model, post-prandial PYY concentrations were a significant predictor of ad libitum energy intake in all subjects (B±SE, -87.5 ± 34.9 kcal, p = 0.01) and in patients with PD (B±SE, -106.8 ± 44.9 kcal, p = 0.04).

Conclusions: PYY and GLP-1 appeared to influence appetite control in PD patients and their roles merit further investigation.

Background and aims: Around 850 million people worldwide are affected by chronic kidney disease (CKD). Patients with CKD often develop malnutrition and sarcopenia and changes in the pharmacokinetics of drugs. A reduced kidney function partially explains the prolonged half-life of certain drugs due to decreased renal clearance, which leads to an increased risk of adverse effects. While the intestine plays a fundamental role in this context, a systematic review of the effects of CKD on intestinal transport is lacking. We aimed to systematically summarize all the available evidence on intestinal transport of organic food components (carbohydrates/sugar, proteins/amino acids, fats, vitamins) and drugs (including drug transporters) in CKD.

Methods: We conducted a systematic search of all the articles published until the 1st of April 2024, on five databases i.e. Embase, PubMed, Web of Science Core Collection, Cochrane Library, and Scopus. This systematic review was registered on the Open Science Framework (OSF) (osf.io/5e6wb) and was carried out according to the PRISMA 2020 guidelines.

Results: From 9205 articles identified, 68 met the inclusion criteria. Absorption of organic food compounds seems to be altered, in general, and reduced for vitamins. The expression of intestinal efflux drug transporters may be altered in CKD.

Conclusions: Despite alterations in intestinal transport is suggested to be altered in CKD, the lack of recent studies, the paucity of human data and the heterogeneity of the methodologies used underscore the need for more research on the effect of CKD and uremia on intestinal transport.

Background and aims: Glucagon-like peptide 2 (GLP-2) analogues are the first available disease-modifying treatments for patients with intestinal failure (IF) due to short bowel syndrome (SBS). Efficacy in terms of reduction of parenteral support (PS) has been demonstrated in multiple studies and real-world reports. However, it remains unclear how many patients are eligible to receive the treatment, when treatment is started after intestinal resection, how treatment efficacy is assessed outside of clinical trials, and how the treatment is modified in case of non-response or adverse events. The aim of this study was to investigate the real-world management of patients treated with GLP-2 analogues in expert centers around the world.

Methods: A survey questionnaire was developed by a multidisciplinary working group consisting of 52 questions related to various aspects of multidisciplinary care of SBS-IF patients. The 17 questions related to the use of GLP-2 analogues in clinical practice were analyzed for this study. The online survey was sent to 33 participating centers in a phase 3 study of a long-acting GLP-2 analogue. Only responses from countries with access to commercially available GLP-2 analogues were included in the study. A descriptive analysis was performed for each question. Results are presented as median (interquartile range).

Results: The responses from the 19 expert IF centers with access to GLP-2 analogues indicated that 10 (10-20) % of patients with SBS-IF were treated with a GLP-2 analogue, which was less than the number of eligible patients (30 (25-40) %). In most centers (10 centers, 53%), GLP-2 therapy was started 6-12 months after the last intestinal resection, with 5 centers (26%) starting later (12-24 months). Multiple parameters were used in combination to determine the response to GLP-2 analogues of which the three most common were >20% decrease in PS (95%), at least 1 day of PS reduction per week (84%) and increased urinary output (68%). In non-responders GLP-2 therapy was stopped within the first year by 67% of the centers. Finally, strategies in case of significant adverse events include stopping the GLP-2 analogue (used by 79% of experts), dose reduction (67%) and temporary treatment interruption (62%).

Conclusion: The results of this survey completed by expert IF centers show the real-life use of GLP-2 analogues in clinical practice. Key learning points identified include the accounting for a period of intestinal adaptation before starting GLP-2 analogues and not stopping the treatment too early in case of non-response. The best strategy in case of adverse effects should be studied further.

Background & aims: The diagnostic criteria for cachexia, as proposed by the Asian Working Group for Cachexia (AWGC), include weight loss, a low body mass index, and additional factors such as a low handgrip strength (HGS), anorexia, or elevated CRP levels. This study aimed to evaluate the significance of low HGS as a diagnostic criterion in patients with advanced cancer.

Methods: This single-centre, retrospective cohort study was conducted between April 2019 and March 2023. Patients aged ≥18 years with malignant diseases were included. Patients without records on HGS were excluded. Low HGS was defined as a HGS <28 kg for men and <18 kg for women. The overall median survival time (MST) was analysed by univariate and multivariate analyses.

Results: A total of 894 patients were analysed. Cachexia was prevalent in 74 %, though only 3.4 % were diagnosed based solely on low HGS. The MST in patients with cachexia was 122 days, and in those with low HGS was 73 days. The associations between low HGS and high mortality remained significant after adjusting for AWGC criteria, modified weight loss grading system, age, gender, performance status, calf circumferenceand fluid retention. The MST varied with the number of additional factors being met: 422 days for one criterion, 92 days for two, and 55 days for all three (p < 0.0001).

Conclusion: This study supports that HGS serve as important prognostic tool in patients with various cancers.

Background: Malnutrition is common among children with congenital heart disease (CHD). We compared the anthropometric indices, serum insulin-like growth factor (IGF), and IGF acid-labile subunit (IGFALS) of children with cyanotic and acyanotic CHD before corrective surgery.

Methods: This 82-patient case-control study included 1- to 24-month-old CHD patients referred for corrective surgery. (41 with tetralogy of Fallot [TOF] and 41 with ventricular septal defect [VSD] or atrial septal defect [ASD]). Anthropometric indices represented as Z-scores were used to determine nutritional status. Serum IGF-1 and IGFALS levels were measured.

Results: The median [quartile] age of the acyanotic group was 8 [7,11] months which was lower than the cyanotic group (11 [8,14.5] months). The prevalence of underweight (weight for age Z [WAZ] < -2), wasting (weight for length Z [WLZ] < -2), and thinness (body mass index Z [BMIZ] < -2) was significantly higher in children with acyanotic than cyanotic children with. WAZ, WLZ, and BMIZ were significantly lower in acyanotic children than cyanotic children with CHD (-2.5 ± 1.2 vs -1.0 ± 1.2, p < 0.001 for WAZ, -2.5 ± 1.5 vs -0.8 ± 1.4, p < 0.001 for WLZ, and -2.5 ± 1.5 vs -0.8 ± 1.4, p < 0.001 for BMIZ), but length for age Z was not different between the two groups (-1.2 ± 1.0 vs -0.8 ± 1.1, p = 0.31). A comparison of preoperative serum albumin, IGF-1, and IGFALS showed no differences.

Conclusions: In CHD children without corrective surgery, moderate to severe underweight and wasting were more common in acyanotic CHD (VSD and ASD) than in cyanotic CHD (TOF), but the higher prevalence of malnutrition was not associated with lower IGF-1 and IGFALS levels.

Optimal nutrition during pregnancy and lactation is vital for the health of the mother and fetus. Nutritional needs should begin in the preconception period, as the fetus depends on the placenta for essential nutrients required for growth and development. A balanced diet rich in nutrient-dense foods-such as whole grains, vegetables, fruits, dairy, legumes, fish, and lean meats-is essential to meet caloric needs during pregnancy. Assessment of maternal health, including dietary history and micronutrient status, is critical to identify potential risks and ensure adequate nutrition. The increased need for micronutrients must be met to prevent complications and fetal growth. Exclusive breastfeeding is recommended for the first six months, and continued breastfeeding is recommended throughout the first year and beyond. During pregnancy and lactation, calorie intake should be increased by focusing on protein and healthy fats. The composition of breast milk is adapted during the breastfeeding period, so that it can provide the necessary nutrients for the growth of the infant. Personalized nutrition plans, developed in consultation with health care professionals, are critical to optimizing maternal and infant health outcomes. This manuscript supports the importance of comprehensive nutritional strategies during pregnancy and lactation to reduce risks and support healthy growth and development of mother and child.

Background: Acute lower respiratory tract infection (ALRI) and acute diarrheal disease (ADD) are the leading causes of mortality in children globally. There is emerging evidence of an association between maternal hypovitaminosis D and ALRI/ADD during infancy.

Objective: To determine whether maternal hypovitaminosis D (25(OH)D [<20 ng/ml] during late pregnancy is associated with increased risk of ALRI/ADD in their offspring during infancy.

Methods: This South Indian hospital-based, ambispective cohort study included 140 mother-baby dyads with known maternal vitamin D status before delivery in late third trimester (72 mothers with hypovitaminosis D and 68 mothers with adequate vitamin D level). Babies with cord blood vitamin D deficiency were treated as per consensus guidelines and those with adequate levels were supplemented with 400 IU vitamin D daily for 1 year. All infants were followed up at 6,10,14 weeks and 6, 9, 12 months for the occurrence, frequency, and severity of ALRI (pneumonia, bronchiolitis, viral induced wheezing) and ADD.

Results: Overall incidence of ALRI was 0.23 per child year during infancy. Incidence of ALRI was 0.12 per child year in adequate maternal vitamin D group versus 0.32 per child year in maternal hypovitaminosis D group (p value = 0.024) and that of bronchiolitis/viral wheeze was 0.07 per child year in adequate maternal vitamin D group versus 0.21 per child year in maternal hypovitaminosis D group (p value = 0.047). Cox regression analysis with maternal hypovitaminosis D level as predictor variable, adjusted for gestational age at birth and other covariates, revealed a hazard ratio of 3.18 (95 % CI: 1.17-8.65, p = 0.023) and 3.63 (95 % CI 1.36-9.65, p = 0.010) for ALRI and ADD respectively. No increased risk for occurrence of pneumonia was observed and none had severe pneumonia.

Conclusion: Maternal hypovitaminosis D is associated with increased risk of ALRI and ADD in their babies during infancy. Routine screening of pregnant women at risk for hypovitaminosis D and supplementation based on 25(OH)D level may decrease the burden of ALRI, for which further studies are needed.