Clinical nutrition ESPEN最新文献

Background & aims: Sepsis-associated acute kidney injury (SA-AKI) is associated with high mortality rates and lacks effective interventions. Omega-3 polyunsaturated fatty acids, abundant in fish oil, possess anti-inflammatory and immune-regulatory properties; however, their impact on the prognosis of SA-AKI remains unclear. This study aims to explore the association between fish oil supplementation and clinical outcomes in critically ill patients with SA-AKI.

Method: A retrospective cohort study was conducted using the MIMIC-IV database. A total of 14,234 patients with SA-AKI were included, with 142 patients in the fish oil supplementation group and 142 in the control group, matched by propensity scores. Cox regression, logistic regression, and linear regression models were employed to evaluate the impact of fish oil supplementation on survival, renal function recovery, and length of hospital stay. Sensitivity analyses were performed to assess the robustness of the results.

Results: Survival analysis suggested that the fish oil supplementation group had a higher 21-day survival rate compared to the control group. Cox regression indicated that fish oil supplementation was associated with lower 21-day mortality (HR = 0.74, 95% CI: 0.59-0.99, P= 0.032). Logistic regression also showed that it was associated with improved renal function recovery (OR = 1.76, 95% CI: 1.03-3.01, P= 0.040). Subgroup analysis suggested that the effect of fish oil supplementation may vary based on the presence of congestive heart failure and CRRT/RRT treatment status. No significant difference was observed in ICU length of stay between the two groups.

Conclusion: Fish oil supplementation in critically ill patients with SA-AKI was associated with reduced 21-day mortality and improved renal function recovery. These findings support the need for prospective randomized controlled trials to confirm the therapeutic potential of ω-3 PUFA in sepsis-related organ dysfunction.

Background & aims: The bioimpedance phase angle (PhA) was suggested to represent muscle deterioration. This study investigated whether segmental PhA was superior to whole-body PhA in the association with physical performance measures and whether it was useful for identifying older adults with poor muscle characteristics.

Methods: This cross-sectional study included 1,779 community-dwelling individuals aged 65 years or older. Segmental PhA was measured by bioelectrical impedance analysis. Physical performance was assessed using handgrip strength, gait speed, and the five-times chair-stand test. We used computed tomography images at the midthigh to assess skeletal muscle mass and fat infiltration into the muscle.

Results: Leg PhA was significantly associated with conventional physical performance measures compared with the PhA of other body segments. Among participants with low leg PhA (<4.5° in men, <4.0° in women), 64% had a normal physical performance. Participants were then divided into four groups according to low leg PhA and low physical performance, revealing that the mid-thigh skeletal muscle cross-sectional area (representative of muscle mass) was significantly lower in groups with low physical performance (β = -0.12, P < 0.001), low leg PhA (β = -0.10, P < 0.001), and both (β = -0.17, P < 0.001). In contrast, the mean attenuation value, representing fat infiltration into the muscle, decreased in groups with low leg PhA (β = -0.22, P < 0.001) and both low leg PhA and low physical performance (β = -0.19, P < 0.001), but not in the group with only low physical performance (β = -0.03, P = 0.330).

Conclusions: Leg PhA may help identify individuals with reduced skeletal muscle mass and increased fat infiltration into the muscle who were overlooked by conventional physical performance assessments alone.

Background & aims: Although nutritional therapy is crucial for children undergoing allogeneic hematopoietic stem cell transplantation (HSCT) standard equations used for calculating energy requirements in healthy children may be misleading in these heavily treated patients. High-dose chemotherapy, total body irradiation, and acute graft-versus-host disease may increase energy needs, while immobilization may reduce it. This study aimed to assess energy requirements during HSCT in children and compare resting energy expenditure (REE) measured by indirect calorimetry (IC) with REE calculated using standard equations for healthy children.

Methods: We included 12 children (9 males) undergoing myeloablative HSCT for benign diseases (n=6) or malignant disorders (n=6). REE was measured by IC before conditioning, at day of transplant, and between days +7-14, +21-28 and beyond day +90 post transplantation, under generally standardized conditions. A planned fasting interval could not always be achieved due to clinical needs, and in 16/53 cases, measurements were performed approximately two hours after the last meal. REE was further calculated using The Oxford Equation for REE in healthy children, based on the patients' weight at referral to transplant. Energy intake, enteral and parenteral nutrition (PN) including intravenous fluids, were recorded.

Results: Measured REE decreased during the early phase of transplantation, reaching a nadir at day +7-14 post-transplant (1408 vs 1154 kcal, p=0.007), corresponding to 89.9% of the calculated REE (75.8-93.4%, P=0.007), indicating a risk of overestimation of energy expenditure by the standard equation during the most toxic phase of the treatment. Dietary intake was generally reduced during the study period, with the most significant reduction observed at day 0, prior to initiation of parenteral nutrition (PN). At this time point, median intake covered 35% of measured REE (26-52%) and was given primarily through glucose-containing IV fluids. On day +7-14, where 92% (11/12) of the patients received PN, measured REE requirements were covered by the diet in 50% of patients. On day 21-28, where 50% of patients remained on PN, 19% of REE was met, while on day 90, when none of the patients received PN, sufficient coverage by enteral intake was observed in 7/9 patients (77%).

Conclusion: Our findings suggest that the standard equation for calculating REE may overestimate energy needs during the early toxic phase of pediatric HSCT. However, even with these conservative estimates based on IC measurements, energy needs are not sufficiently met in a significant proportion of the patients. Overall, this study emphasizes the importance of increased focus on individualized dietary support based on measured energy demands.

Background: Gastrointestinal dysfunction (GD) is common in intensive care patients with a wide range of admission diagnoses. Whether GD increases the severity and worsens outcomes from critical illness remains contentious. The aim of this study was to determine the frequency, severity, and risk factors associated with the development of GD in intensive care patients and to correlate these with clinical outcomes.

Methods: Adult critically ill patients receiving enteral and/or parenteral nutrition with an expected ICU stay ≥72 hours were prospectively studied between February 2019 to July 2020. Predefined GI signs and symptoms, ICU interventions, organ scoring, and clinical outcomes were documented from admission to ICU discharge or at 90 days. Data on GD using the Acute Gastrointestinal Injury (AGI) and Gastrointestinal Dysfunction Score (GIDS) scoring systems were collected, and associations between GD and clinical outcomes (ICU length of stay, mechanical ventilation duration, and mortality) were analysed using logistic regression and Poisson mixed-effects models with fixed and random effects, adjusting for age, illness severity, and other covariates.

Results: Of 2247 ICU patients screened, a convenience sample of 100 patients were enrolled (75 general ICU, 25 cardiac ICU; 61% male; median age 53 years [range 41-82]). All patients had at least one GI dysfunction sign/symptom. Gut dysfunction was present in all patients based on the AGI and 79% by the GIDS. Severe GD occurred in 46% (AGI) and 25% (GIDS). A gut-related ICU admission diagnosis was present in 23% of patients, which increased the odds of severe GD (AGI OR 9.8, 95% CI 2.66-31.83, p < 0.001; GIDS OR 4.3, 95% CI 1.4-13.0, p = 0.01). Elevated serum lactate was associated with GD severity (AGI OR 1.30, p = 0.04; GIDS OR 1.32, p = 0.02). Severe GD was associated with longer ICU stays (median 13 vs 10 days, p = 0.02) and mechanical ventilation duration (12 vs 10.5 days, p = 0.05). A 1-litre fluid balance was associated with an increase in AGI grading of 5.1% (p = 0.02) and GIDS of 7.9% (p < 0.001). Aggressive enteral feeding increased AGI odds by 82% (OR 1.82, p = 0.015). Multiple inotropes were associated with higher GIDS at 72h (p = 0.023). ICU mortality was 21%, with no differences by GD .

Conclusion: These findings support the importance of consistent GD assessment to guide clinical decision-making in critical care. There is an urgent need for a robust, standardised, and objective approach to GD assessment in ICU practice, one that accounts for severity, dynamic risk factors, and the potential to alter clinical outcomes through timely recognition and intervention.

Background: Parenteral nutrition (PN) plays a crucial role in providing nutritional support to premature and small for gestational age (SGA) neonates. In this randomized controlled study, we evaluated PN administration in preterm SGA neonates using the corrected weight estimated at the 10th percentile, as guided by a clinical decision support system (CDSS).

Methods: A total of 100 SGA neonates were randomly assigned to either the Control group (n = 50) or the Intervention group (n = 50). Both groups received PN support using a specialized CDSS. In the Control group, the CDSS calculated the PN regimen based on the actual birth weight, whereas in the Intervention group, calculations were based on the corrected weight corresponding to the 10th percentile. Growth indicators (i.e., body weight, length, and head circumference) were measured at baseline and at the time of exclusive enteral feeding initiation (endpoint).

Results: At baseline, no differences were observed between the two groups regarding gestational age, sex, birth weight, length, level of prematurity (all p's>0.05). At the endpoint, the median weight gain was greater in the intervention group (+0.16 kg) than that of the control group (+0.09 kg), p=0.034. The relative change in body weight was higher in the intervention group (+13.6%) compared to the control group (+6.4%), p=0.047.

Conclusions: Nutrient estimation based on the 10^th percentile of weight with the assistance of CDSS, appears to be the most favorable combination for faster weight gain among SGA neonates.

Trial registration: ClinicalTrials.gov NCT07236957.

Background: Endometriosis is a chronic estrogen-dependent inflammatory disease frequently associated with gastrointestinal symptoms, metabolic comorbidities, and impaired quality of life. Growing interest in nutrition has led to the widespread dissemination of restrictive dietary recommendations, often unsupported by robust clinical evidence and potentially associated with nutritional and psychological risks.

Methods: This article presents an evidence-based clinical position paper based on a critical narrative review of the scientific literature addressing nutritional interventions in endometriosis. Data were identified through systematic searches of PubMed/MEDLINE, Embase, and the Cochrane Library, focusing on observational studies, randomized controlled trials, systematic reviews, and meta-analyses. Dietary patterns, restrictive diets, targeted nutritional interventions for digestive symptoms, and their clinical implications were analyzed.

Results: Current evidence does not support any specific dietary strategy as an effective treatment for endometriosis. Restrictive diets, such as gluten-free, dairy-free, or so-called "anti-inflammatory" diets, are insufficiently supported by high-quality clinical trials and may expose patients to avoidable nutritional deficiencies and psychological burden. In contrast, global dietary patterns such as the Mediterranean diet or the DASH diet are supported by robust public health evidence and may offer indirect benefits on systemic inflammation, cardiometabolic health, and overall well-being, although disease-specific data remain limited. Targeted interventions, particularly low-FODMAP diets, may be considered in selected patients presenting with symptoms compatible with irritable bowel syndrome, provided they are time-limited and professionally supervised.

Conclusion: At present, nutrition should not be considered a specific therapeutic treatment for endometriosis. However, evidence-based global dietary models may serve as a safe nutritional foundation within a multidisciplinary care approach. Individualized, cautious, and professionally guided nutritional management is essential to prevent dietary excesses and support long-term health and quality of life in women with endometriosis. Further high-quality interventional studies are required to clarify the role of nutrition and identify subgroups most likely to benefit from targeted interventions.

Background & aims: Malnutrition is common in hospitalised patients and contributes to poor clinical outcomes. To support adequate nutritional intake in patients, accurate assessment of dietary food intake is critical, but it remains challenging and time-consuming. The present study aims to assess how accurate patients and family members estimate food intake using food record charts (FRCs) compared with weighed food records (WFRs).

Methods: In a cross-sectional study, 30 patients (≥18 years, Dutch-speaking, no delirium and no isolation restrictions) and 30 family members (≥18 years, Dutch-speaking, non-healthcare professionals) estimated simulated food consumption of nine different hospital meals (three breakfasts, three lunches, and three dinners) consisting of 79 different food items with FRCs, and these estimates were compared to WFRs. Subgroup analyses were performed for food consumption estimations by food item, including energy and protein content, food consistency, consumed amount, and food groups. Bland-Altman plots and inter-rater agreement were used to identify the accuracy of food intake estimation. Values are presented as mean±SD.

Results: Food consumption estimated by patients using FRCs was comparable to food consumption measured by WFRs with a mean overestimation of 1.2±8.1% (p=0.178), whereas family members overestimated intake by 2.2±7.5% with FRCs compared to WFRs (p=0.012). Protein-dense products (>10g/100g) were underestimated by ∼2%, while products with lower consumption (<25% consumption) were overestimated by ∼8% by patients and family members. The inter-rater agreement was W = 0.71 for patient FRCs (p<0.001) and W = 0.74 for family members' FRCs (p<0.001).

Conclusions: FRCs provide comparable estimates to WFRs for patients. Although family members slightly overestimated food intake (∼2%), the deviation remained within acceptable limits. Therefore, FRCs present an accurate assessment tool to quantify food consumption of hospital meals by both patients and family members. The engagement of patients and families in assessing food consumption forms an important opportunity to monitor nutritional intake during hospitalisation, rehabilitation, and at home.

Objective: This study aimed to investigate the association of abdominal obesity indicators (Waist circumference (WC), lipid accumulation product (LAP), a body shape index (ABSI), body roundness index (BRI), weight-adjusted waist index (WWI), and visceral adiposity index (VAI)) with the risk of all-cause mortality in familial hypercholesterolemia (FH) and to compare their prognostic performance.

Methods: A cohort of 1,188 FH patients from the National Health and Nutrition Examination Survey (1999-2018) was analyzed. Mortality outcomes through 2019 were identified via linkage to the National Death Index. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) and 95 % confidence intervals (CIs) for mortality. The incremental predictive value of each indicator beyond a base model was assessed using the C-statistic, integrated discrimination improvement (IDI), and net reclassification improvement (NRI).

Results: During a median follow-up of 8.4 years, 215 patients (18.1 %) died. After full multivariable adjustment, individuals in the highest tertile of ABSI exhibited a significantly elevated mortality risk compared to the lowest tertile (HR = 1.97, 95 % CI: 1.31-2.95). Similarly, the highest WWI tertile was associated with increased mortality (HR = 1.49, 95 % CI: 1.01-2.22). No significant associations were observed for WC, LAP, BRI, or VAI. Among all evaluated indicators, ABSI conferred the most substantial incremental predictive value when added to the base model, significantly improving discrimination (C-statistic: 0.809, 95 % CI: 0.781-0.838), integrated discrimination (IDI: 0.033, 95 % CI: 0.011-0.063), and risk reclassification (NRI: 0.256, 95 % CI: 0.138-0.347).

Conclusions: Elevated ABSI and WWI independently predicted increased all-cause mortality in familial hypercholesterolemia patients. Crucially, ABSI demonstrated superior prognostic performance, significantly enhancing mortality risk stratification beyond established factors, and its incorporation into clinical models may improve prognostication and guide tailored management.

Background: Trauma survivors often develop early muscle wasting and long-term frailty, but still maintain ambiguous relationships among them. Herein, we aimed to determine a correlation among changes in skeletal muscle index (ΔSMI) during intensive care unit (ICU) stay, the development of frailty 1-year post-discharge, and the metabolic profiles in patients with trauma with varying ΔSMI.

Methods: In this single-center, prospective, observational study, the SMI in the third lumbar vertebra (L3SMI) and ΔSMI were evaluated on day 1 and day 7 after ICU admission in trauma patients. Based on the cut-off value of ΔSMI, the patients were grouped into high (HSMW) and low acute skeletal muscle wasting (HSMW VS LSMW) groups. We assessed the correlation between ΔSMI and frailty 1-year post-discharge and the metabolic profiles with untargeted metabolomics.

Results: A total of 99 eligible patients with trauma completed follow-up. ΔSMI using the cut-off value of 3.022 cm²/m² was significantly associated with frailty 1-year post-discharge. The metabolic profiles between the HSMW and LSMW groups were distinct, primarily involving amino acid and carbohydrate metabolism, with a potential link to muscle mass. Among the differential metabolites, glycine showed the most significant change and strong potential to distinguish between groups, suggesting an involvement of the serine-glycine metabolism pathway in muscle wasting.

Conclusions: In patients with trauma, an ΔSMI >3.022 cm²/m² during the first 7 days of ICU admission predicts frailty 1-year post-discharge. Metabolic analyses may help identify new therapeutic targets for reducing acute skeletal muscle wasting and ultimately improving clinical outcomes.