Clinical nutrition ESPEN最新文献

Background & aims: Vaso-occlusive crises (VOCs) in sickle cell disease involve nitric oxide deficiency, creating a rationale for L-arginine. This meta-analysis evaluates its efficacy on clinical VOC outcomes including pain, opioid use, and hospitalization by synthesizing evidence from RCTS.

Methods: The PubMed, Embase, and Cochrane databases were searched for RCTs comparing L-arginine with placebo or standard care in SCD patients. Primary outcomes were pain scores, opioid consumption, time to crisis resolution, and length of hospital stay. Pooled estimates were calculated using random-effects models.

Results: Eight RCTs comprising 830 patients were included. Analysis revealed no statistically significant benefit of arginine on primary outcomes. The evidence, of low certainty, indicated no significant effect on pain scores (SMD -1.55, 95% CI [-6.72, 3.62]) or opioid consumption (MD -0.78 mg/kg, 95% CI [-2.80, 1.23]). Similarly, no significant differences were observed for time to crisis resolution (MD -12.64 hours, 95% CI [-25.82, 0.54]) or length of hospital stay (MD -24.83 hours, 95% CI [-71.18, 21.51]). A non-significant 23% increase in hospital readmission risk was observed (RR 1.23, 95% CI [0.92, 1.65]). Pharmacodynamic analysis confirmed increased plasma arginine levels but showed no significant change in the arginine-to-ornithine ratio.

Conclusion: In summary, this meta-analysis found that L-arginine showed no statistically significant benefit on any primary clinical outcome in patients with sickle cell disease experiencing VOC. This absence of proven efficacy, coupled with a potential safety signal regarding hospital readmissions, precludes its recommendation for routine clinical use. Consequently, these findings underscore the urgent need for a large, definitive RCT to determine the efficacy and safety of arginine therapy.

Background & aims: Reduced muscle mass (MM) is frequently underdiagnosed in hospitalized overweight patients due to assessment challenges. This study aimed to examine the association between anthropometric indicators of MM and clinical outcomes, including length of stay (LOS), readmission, and six-month mortality in overweight hospitalized patients.

Methods: This cohort study included adults and older adults admitted to a university hospital in southern Brazil, with body mass index (BMI) thresholds of ≥25 kg/m² and ≥27 kg/m², respectively. Within 72 hours of admission, body weight, height, mid-arm muscle circumference (MAMC), adductor pollicis muscle thickness (APMT), and calf circumference (CC) were measured; CC was also adjusted for BMI due to the adiposity influence in this accuracy to estimate MM. Patients were classified as having low or normal MM according to each indicator. LOS was categorized as prolonged using the sample upper quartile. Post-discharge follow-up for readmission and six-month mortality was conducted by telephone. Logistic regression analyses assessed associations between anthropometric indicators and clinical outcomes. The study was approved by the institutional ethics committee (CAAE: 6397222.9.0000.5327).

Results: A total of 475 patients were included (56±14 years; 52% women, BMI: 31.7±4.4 kg/m²). The majority underwent surgery (84%), and 23% had a cancer diagnosis. The prevalence of low MM was 49.9% based on BMI-adjusted CC, 5.0% using unadjusted CC, 26.8% based on APMT, and 8.7% based on MAMC. Low BMI-adjusted CC was independently associated with 1.63-fold higher odds of prolonged hospitalization (95%CI: 1.04-2.56), while low MAMC was associated with 2.21-fold higher odds (95%CI: 1.10-4.43). No anthropometric measure was associated with readmission or six-month mortality.

Conclusions: Low MM was common among overweight hospitalized patients, particularly when assessed by BMI-adjusted CC, which accounts for adiposity. Among the measures, BMI-adjusted CC and MAMC were independently associated with prolonged hospital stay.

Background & aims: Limited evidence is available regarding the Global Leadership Initiative on Malnutrition (GLIM), a standardized diagnostic criterion for malnutrition, in outpatients with ulcerative colitis (UC). This study aimed to investigate the prevalence and determinants of GLIM-defined malnutrition and their impact on the quality of life (QOL) in this population.

Methods: This multicenter, cross-sectional study included outpatients with UC from two institutes in Gifu, Japan. Malnutrition was diagnosed using the GLIM criteria and Malnutrition Universal Screening Tool for initial screening. QOL was assessed using the Japanese version of the Inflammatory Bowel Disease questionnaire (J-IBDQ). The malnutrition determinants were evaluated using a multivariate logistic regression model.

Results: Of the 240 outpatients, the median age was 53 years and 41.7% were female. Extensive colitis was observed in 45.0% of the patients, and 29.6% experienced advanced therapy. With nutritional assessment, 28.3% were at risk of malnutrition and 10.4% were diagnosed with GLIM-defined malnutrition. Multivariable analysis identified female sex (odds ratio [OR] 3.24, 95% confidence interval [CI] 1.35-8.28), extensive colitis (OR 2.75, 95% CI 1.09-7.45), and a history of advanced therapy (OR 2.71, 95% CI 1.11-6.67) as independent factors for malnutrition. Compared with those of well-nourished patients, those with malnutrition had significantly lower scores in all four domains and total J-IBDQ score.

Conclusions: Malnutrition, as defined by the GLIM criteria, was observed in 10.4% of the outpatients with UC; female sex, extensive colitis, and advanced therapy were robust determinants. Furthermore, patients with malnutrition had a significantly poorer QOL than that of those who were well-nourished.

Clinical trial registration: N/A.

Background: Malnutrition is highly prevalent in advanced cancer patients, contributing to reduced quality of life, impaired physical function, and decreased survival. Although parenteral nutrition (PN) is used to supplement oral intake, its effect on oral feeding behaviors and eating pleasure remains unclear. We therefore aimed to evaluate the impact of supplemental PN on oral food intake and eating pleasure in malnourished advanced cancer patients with an intact bowel function.

Methods: This study presents a sub-analysis of data from a larger, multicenter, randomized controlled trial. In this trial, advanced cancer patients with malnutrition and a functional gastrointestinal tract were assigned (1:1) to receive either supplemental PN plus standard oral feeding or oral feeding alone. Dietary intake was assessed at baseline and one month using a 24-hour dietary recall, and eating pleasure was measured with the Self-Evaluation of Food Intake (SEFI) score.

Results: Eighty-nine patients were analyzed. In the overall cohort, mean daily energy intake assessed by 24-h recall increased significantly from 986 ± 475 kcal at baseline to 1082 ± 420 kcal at one month (p = 0.02), whereas SEFI score remained stable. At baseline, a significant positive correlation was found between the SEFI score and the ratio of calorie intake to estimated energy requirements (Spearman's ρ = 0.55, P < 0.001). In arm-specific analyses using paired t-test, patients in the oral-feeding arm experienced a significant rise at one month in mean energy intake (1009 ± 476 to 1224 ± 474 kcal; p = 0.045) with no significant change for patients in the PN arm (859 ± 437 to 856 ± 234 kcal, p = 0.71). Using McNemar's test, patients from the oral-feeding arm experienced a significant rise in oral nutritional supplement use ate one month compared with patients from the PN arm (6/19% to 20/65%, p = 0.01). Meal frequency, snack consumption, and pleasure to eat did not change in the overall population and in either arm.

Conclusion: Supplemental PN does not negatively impact oral food intake or eating pleasure in malnourished advanced cancer patients with intact bowel function. These findings support the use of PN as a nutritional support option without compromising oral feeding behaviors.

Registration number of clinical trial: NCT02151214.

Background & aims: Functional Bowel Disorders (FBD) are clinically diagnosable conditions impacting the mid to lower gastrointestinal tract. Fibre manipulation (through amount or type) is commonly employed as a first-line treatment for symptom management. This systematic review will investigate the impact of fibre manipulation on symptom management and quality of life in adults diagnosed with FBD.

Methods: Four electronic databases (PubMed, EMBASE, CINAHL, and Cochrane Central) were systematically searched from January 2013 to December 2024. Studies were included if they reported Randomised Controlled Trials (RCTs) examining the impact of fibre manipulation in adults (≥ 18 years) with FBD. The primary outcome was symptom management, and secondary outcome was Quality of Life (QoL). Study quality was assessed using the Cochrane risk of bias tool 2. Data were narratively synthesised.

Results: Searches identified 8864 records; 5167 were screened against the eligibility criteria, and 47 records were assessed at full-text review. Ten studies reporting eight parallel and two crossover RCTs evaluating differing fibre supplements and doses for people with various types of FBD were included. Intervention length ranged from one to eight weeks, and the number of participants ranged from 11 to 250. The reported results varied. Seven studies reported significant improvements in symptom severity, and one study reported significant worsening of symptoms when compared to controls. The results indicated that fibre supplementation with agave fructans improved constipation but worsened flatulence, acacia fibre improved stool frequency, psyllium improved stool consistency, nopal fibre improved symptom severity, vege-powder improved stool hardness and amount, incomplete evacuation, straining and evacuation frequency, pectin powder improved abdominal pain, bloating, stool consistency and symptom severity, and a combination of sugarcane bagasse and resistant starch improved flatulence. One study reported significant worsening in QoL in the intervention group when compared to the placebo control group.

Conclusions: This review concluded that fibre supplementation may be an effective treatment to improve symptom management for patients with FBD, though high heterogeneity precluded meta-analysis. Two studies were assessed as low risk of bias, seven had some concerns, and one was assessed as high risk of bias. The included studies reported short-term interventions for small groups of participants. Further research with greater numbers of participants with FBD that evaluate interventions for longer time periods are warranted.

Background & aims: Malnutrition is prevalent among gastrointestinal cancer patients undergoing surgery. The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines recommend 10-14 days of preoperative nutrition therapy for patients at nutritional risk, and perioperative immunonutrition to improve outcomes. However, benefits of preoperative immunonutrients versus standard formulas remain unclear. This study evaluated a novel curcumin-containing immunonutrient formula compared to a standard formula administered for 10-14 days preoperatively in gastrointestinal cancer patients at nutritional risk.

Methods: This is a randomized, double-blind pilot trial. Patients with Nutrition Risk Score (NRS)2002 ≥3 were assigned to receive 2 servings/day (360 kcal,17 g protein per serving) of either the immunonutrient or standard formula. Serum high-sensitivity C-reactive protein (hs-CRP), interleukin (IL)-6, and tumor necrosis factor (TNF)-alpha were measured at baseline, preoperative, and postoperative periods. Nutrition outcomes, complications, hospital stay, 30-day readmission, mortality, compliance, and acceptance were assessed.

Results: Thirty patients were enrolled (15 per group). Preoperative immunonutrient supplementation was associated with a significant reduction in preoperative hs-CRP concentrations (-4.4 vs. 4.5 mg/L, p=0.030) and a greater increase in body weight (1.9 vs. 0.3 kg, p=0.041) compared with the standard formula. No significant differences were observed in postoperative complications, hospital stay, readmission, or mortality. Compliance and acceptance of the novel formula were high, with minimal gastrointestinal adverse events.

Conclusions: Preoperative supplementation with the curcumin-containing immunonutrient for 10-14 days reduced preoperative inflammatory response and greater weight gain compared to the standard formula in gastrointestinal cancer patients at nutritional risk. Further studies with larger populations are needed to validate these findings.

Registration number: ClinicalTrials.gov (NCT06825221).

Background: Omega-3 polyunsaturated fatty acids (n-3 PUFAs) have unique properties that are advantageous for female. However, no study has explored the effects of omega-3 PUFA supplementation on serum ferritin levels. Thus, the objective of this study was to investigate the effects of omega-3 PUFA supplementation on serum ferritin levels in university female students.

Methods: Thirty-nine iron-deficient university female students aged 18-29 years randomly assigned in a 1:1 ratio to either the intervention group (receiving 525 mg eicosapentaenoic acid [EPA] and 175 mg docosahexaenoic acid [DHA] daily for 8 weeks) or the control group. Hemoglobin and serum ferritin levels, dietary intake, and lipidomics were assessed at baseline and after the 8-week intervention period. Analyses were performed by an independent, blinded statistician.

Results: The adherence rate in the study was 94.9%. n-3 PUFA supplementation increased the omega-3 index (1.8 ± 1.7 vs. 0.4 ± 1.1; p = 0.007), while it decreased the omega-6/3 ratio (-2.6 ± 2.5 vs. -0.9 ± 1.5; p = 0.016) and arachidonic acid/EPA ratio (-9.1 ± 11.6 vs. 1.4 ± 8.5; p = 0.004) compared to those in the control group. These supplementation increased serum ferritin levels (7.8 ± 9.1 vs. 1.8 ± 8.0 ng/mL; p = 0.041); however, it did not change hemoglobin and hepcidin levels compared to those in the control group. No adverse events were observed.

Conclusion: In this pilot study, omega-3 PUFA supplementation was associated with modest changes in iron status markers in young healthy females. These findings are exploratory, and further placebo-controlled trials are needed to confirm the effects.

Name of trial registry: The effect of omega-3 fatty acids intake on hepcidin and anemia Identifying number: UMIN000050570 DATE OF REGISTRATION: 2023/03/14.

Background and aims: Malnutrition is a common issue among hospitalized diabetic patients, often leading to poor outcomes. The Nutritional Risk Screening 2002 (NRS-2002) is a widely used tool for assessing nutritional risk, but its relevance to diabetic patients and correlation with clinical parameters are unclear. This study aims to assess the prevalence of nutritional risk in hospitalized diabetic patients using NRS-2002, explore its relationship with key clinical indicators, and identify independent factors influencing nutritional risk for better management strategies.

Methods: This single-center retrospective study included 329 diabetic inpatients from the Department of Endocrinology at Yuncheng Central Hospital, affiliated with Shanxi Medical University, between December 2022 and June 2025. Data from the Electronic Medical Record (EMR) and Laboratory Information System (LIS) covered demographics, clinical features, anthropometrics, laboratory parameters (nutritional markers, lipids, pancreatic enzymes, inflammatory and metabolic indicators), and comorbidities. Nutritional risk at admission was assessed using NRS-2002 (score ≥3). Associations with clinical indicators were analyzed using Spearman correlation and logistic regression to identify independent predictors.

Results: Of the 329 patients, 91 (27.7%) were at nutritional risk. This group had longer hospital stays, a higher proportion of patients with diabetes duration <5 years, lower BMI, prealbumin, and albumin levels, and higher CRP and HbA1c levels. They also had increased infection and ketosis rates. NRS-2002 scores were positively correlated with ketosis (ρ = 0.468), HbA1c (ρ = 0.386), and infection (ρ = 0.236), and negatively correlated with prealbumin (ρ = -0.404), bicarbonate (ρ = -0.240), and BMI (ρ = -0.205). Multivariate logistic regression identified ketosis (OR = 3.714), HbA1c (OR = 1.265), prealbumin (OR = 0.990), and bicarbonate (OR = 0.896) as independent predictors of nutritional risk. The predictive model showed good performance with an AUC of 0.832.

Conclusion: The NRS-2002 tool effectively assesses nutritional risk in hospitalized diabetic patients, with significant correlations to metabolic issues, inflammation, and complications. Low prealbumin, low bicarbonate, high HbA1c, and ketosis were independent predictors of nutritional risk.

Background & aims: Tuberculosis remains a serious infectious disease worldwide. However, the status of swallowing function in older adults with pulmonary tuberculosis and the impact of systemic inflammation on swallowing decline during hospitalization have not been fully elucidated. We aimed to examine whether systemic inflammation at admission affects swallowing function decline in older patients with pulmonary tuberculosis.

Methods: This was a single-center, retrospective observational study. The inclusion criteria were patients aged ≥ 65 years with pulmonary tuberculosis who were admitted to a tuberculosis medical institution between April 2021, and November 2022. Systemic inflammation on admission was assessed with the modified Glasgow Prognostic Score (mGPS). The primary outcome was a decline in swallowing function during hospitalization, defined by a decrease in the Functional Oral Intake Scale (FOIS) score. All data, including mGPS and FOIS, were obtained from medical records. Patients were categorized into a "maintenance" group and a "decline" group based on changes in FOIS. Differences in FOIS scores across mGPS categories were also examined. Logistic regression analyses were performed to identify whether systemic inflammation at admission was an independent risk factor for swallowing decline. Model 1 was adjusted for age, BMI, miliary tuberculosis, and SARC-F ≥4; Model 2 was adjusted for age, miliary tuberculosis, and malnutrition.

Results: A total of 119 patients were included in the analysis. During hospitalization, 31 patients (26.1%) experienced a decline in swallowing function. Compared with the maintenance group, the decline group was significantly older and showed higher mGPS scores, lower serum albumin, lower Geriatric Nutritional Risk Index values, smaller calf circumference, lower walking ability, and lower FOIS scores at discharge. FOIS scores at both admission and discharge significantly differed across mGPS categories (p < 0.01). The prevalence of dysphagia, defined as FOIS ≤5, was 12.6% (n=15) at admission and 19.3% (n=23) at discharge. Logistic regression analysis revealed that higher mGPS at admission was independently associated with swallowing decline during hospitalization in both Model 1 (odds ratio 2.81, 95% confidence interval 1.28-7.83) and Model 2 (odds ratio 2.77, 95% confidence interval 1.23-7.71).

Conclusion: Systemic inflammation at admission was associated with the development of dysphagia during hospitalization among older adults with pulmonary tuberculosis. Moreover, the prevalence of dysphagia increased from 12.6% at admission to 19.3% at discharge.