Background & aims: This study aimed to clarify the association between physical activity (PA) and physical functions, including both muscle quantity and quality of ankle plantar flexor muscles in patients with knee osteoarthritis (OA).
Methods: A retrospective cohort study was conducted with ninety-two patients with knee OA. PA, leg muscle cross-sectional area (CSA), knee strength, passive knee angle, and knee pain of the affected side were assessed. PA was assessed by the 2011 Knee Society scoring system. CSA of the quadriceps and ankle plantar flexor muscles on the affected side was measured using a computed tomography image. Based on muscle attenuation assessed with Hounsfield units (HU), the muscle quality of targeted muscle was divided into 4 groups as follows: fat tissue (-190 to -30 HU), very low-density muscle (-29 to -1 HU), low-density muscle (0 to 34 HU), and normal-density muscle (NDM, 35 to 100 HU). The CSA was obtained for each of the 4 groups. Univariate and multivariate linear regression analyses were performed to determine the factors associated with PA.
Results: The regression analysis revealed that higher PA was independently associated with the NDM CSA of ankle plantar flexor (β = 0.51), higher knee extension strength (β = 0.28), and milder knee pain (β = -0.29) after adjustment with age, sex, height, weight, and body mass index.
Conclusion: The present study suggested that NDM CSA of ankle plantar flexor in addition to knee function is one of the factors determining the PA in patients with knee OA.
{"title":"Muscle characteristics of lower limb in association with physical activity in candidates of total knee arthroplasty with knee osteoarthritis.","authors":"Gakuto Kitamura, Manabu Nankaku, Takuma Yuri, Takumi Kawano, Shinichi Kuriyama, Shinichiro Nakamura, Kohei Nishitani, Ryosuke Ikeguchi, Shuichi Matsuda","doi":"10.1016/j.clnesp.2024.10.160","DOIUrl":"10.1016/j.clnesp.2024.10.160","url":null,"abstract":"<p><strong>Background & aims: </strong>This study aimed to clarify the association between physical activity (PA) and physical functions, including both muscle quantity and quality of ankle plantar flexor muscles in patients with knee osteoarthritis (OA).</p><p><strong>Methods: </strong>A retrospective cohort study was conducted with ninety-two patients with knee OA. PA, leg muscle cross-sectional area (CSA), knee strength, passive knee angle, and knee pain of the affected side were assessed. PA was assessed by the 2011 Knee Society scoring system. CSA of the quadriceps and ankle plantar flexor muscles on the affected side was measured using a computed tomography image. Based on muscle attenuation assessed with Hounsfield units (HU), the muscle quality of targeted muscle was divided into 4 groups as follows: fat tissue (-190 to -30 HU), very low-density muscle (-29 to -1 HU), low-density muscle (0 to 34 HU), and normal-density muscle (NDM, 35 to 100 HU). The CSA was obtained for each of the 4 groups. Univariate and multivariate linear regression analyses were performed to determine the factors associated with PA.</p><p><strong>Results: </strong>The regression analysis revealed that higher PA was independently associated with the NDM CSA of ankle plantar flexor (β = 0.51), higher knee extension strength (β = 0.28), and milder knee pain (β = -0.29) after adjustment with age, sex, height, weight, and body mass index.</p><p><strong>Conclusion: </strong>The present study suggested that NDM CSA of ankle plantar flexor in addition to knee function is one of the factors determining the PA in patients with knee OA.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564060","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background and aims: Early detection and management of sarcopenia in patients with connective tissue diseases (CTDs) are essential. However, the relationship between the phase angle and sarcopenia in patients with CTDs is unknown. This study investigated the association between the phase angle and sarcopenia in patients with (CTDs) and determined the optimal phase angle cutoff values for the early detection of sarcopenia.
Methods: A retrospective cross-sectional study was conducted in 279 hospitalized patients with CTDs undergoing rehabilitation (median age 73.3 years; 80 men and 199 women). Bioimpedance analysis was used to measure the phase angle, and sarcopenia was assessed according to the Asian Working Group for Sarcopenia criteria.
Results: Sarcopenia was identified in 134 patients (36 men and 98 women). Patients with sarcopenia had a significantly smaller phase angle than those without sarcopenia. Multivariate analysis revealed that phase angle was significantly associated with sarcopenia after adjusting for confounding factors in each sex. The optimal phase angle cutoff value for identifying sarcopenia was 4.6° for men and 4.3° for women, with area under the curve values of 0.795 and 0.754, respectively.
Conclusion: Phase angle is a valuable marker for identifying sarcopenia in patients with CTDs. The established phase angle cutoff values of 4.6° in men and 4.3° in women can facilitate the early detection and management of sarcopenia.
{"title":"Association between phase angle and sarcopenia in patients with connective tissue diseases.","authors":"Toshiyuki Moriyama, Mizuki Tokunaga, Ryoko Hori, Akiko Hachisuka, Hideaki Itoh, Mitsuhiro Ochi, Yasuyuki Matsushima, Satoru Saeki","doi":"10.1016/j.clnesp.2024.10.159","DOIUrl":"https://doi.org/10.1016/j.clnesp.2024.10.159","url":null,"abstract":"<p><strong>Background and aims: </strong>Early detection and management of sarcopenia in patients with connective tissue diseases (CTDs) are essential. However, the relationship between the phase angle and sarcopenia in patients with CTDs is unknown. This study investigated the association between the phase angle and sarcopenia in patients with (CTDs) and determined the optimal phase angle cutoff values for the early detection of sarcopenia.</p><p><strong>Methods: </strong>A retrospective cross-sectional study was conducted in 279 hospitalized patients with CTDs undergoing rehabilitation (median age 73.3 years; 80 men and 199 women). Bioimpedance analysis was used to measure the phase angle, and sarcopenia was assessed according to the Asian Working Group for Sarcopenia criteria.</p><p><strong>Results: </strong>Sarcopenia was identified in 134 patients (36 men and 98 women). Patients with sarcopenia had a significantly smaller phase angle than those without sarcopenia. Multivariate analysis revealed that phase angle was significantly associated with sarcopenia after adjusting for confounding factors in each sex. The optimal phase angle cutoff value for identifying sarcopenia was 4.6° for men and 4.3° for women, with area under the curve values of 0.795 and 0.754, respectively.</p><p><strong>Conclusion: </strong>Phase angle is a valuable marker for identifying sarcopenia in patients with CTDs. The established phase angle cutoff values of 4.6° in men and 4.3° in women can facilitate the early detection and management of sarcopenia.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.clnesp.2024.10.158
Austin J Graybeal, Caleb F Brandner, Abby T Compton, Sydney H Swafford, Ryan S Aultman, Anabelle Vallecillo-Bustos, Jon Stavres
Background & aims: Given the technological advances in 3D smartphone (SP) anthropometry, this technique presents a unique opportunity to improve metabolic syndrome (MetS) screening through optimal waist circumference (WC) landmarking procedures. Thus, the purpose of this study was to evaluate the associations between individual MetS risk factors and nine independent WC sites collected using tape measurement or SP anthropometrics and to determine the differences in MetS severity and prevalence when using these different WC measurement locations.
Methods: A total of 130 participants (F:74, M:56; age: 27.8 ± 11.1) completed this cross-sectional evaluation. Using traditional tape measurement, WC was measured at the lowest rib (WCRib), superior iliac crest (WCIliac), and between the WCRib and WCIliac (WCMid). Additionally, WC measurements were automated using a SP application at six sites along the torso. MetS risk factors were used to calculate MetS severity (MetSindex) and prevalence. Associations were evaluated using multiple linear regression, the effect of each WC site on MetSindex was analyzed using mixed-models ANCOVA, and differences in MetS prevalence using WCIliac as the current standard were determined using sensitivity, specificity, chi-squared tests, and odds ratios.
Results: The reference SP-WC (SPRef) and WCRib demonstrated the largest associations (all p < 0.001) with HDL cholesterol (SPRef: -0.48; WCRib: -0.49), systolic (SPRef: 0.32; WCRib: 0.30) and diastolic blood pressure (SPRef: 0.34; WCRib: 0.32), and fasting blood glucose (SPRef: 0.38; WCRib: 0.37). SPRef and WCRib were the only WC without significantly different MetSindex; yet demonstrated lower MetSindex and sensitivity (SPRef: 77.8 %; WCRib: 74.1 %) relative to WCIliac, the conventional (or standard) WC measure.
Conclusions: Compared to the current standard, SPRef and WCRib protocols are more highly associated with individual MetS risk factors and produce different MetSindex and diagnoses; highlighting the need for new MetS WC protocols. Given the surge in remote/mobile healthcare, SPRef may be an alternative to traditional methods in this context but requires further investigation before implementation.
{"title":"Differences in metabolic syndrome severity and prevalence across nine waist circumference measurements collected from smartphone digital anthropometrics.","authors":"Austin J Graybeal, Caleb F Brandner, Abby T Compton, Sydney H Swafford, Ryan S Aultman, Anabelle Vallecillo-Bustos, Jon Stavres","doi":"10.1016/j.clnesp.2024.10.158","DOIUrl":"10.1016/j.clnesp.2024.10.158","url":null,"abstract":"<p><strong>Background & aims: </strong>Given the technological advances in 3D smartphone (SP) anthropometry, this technique presents a unique opportunity to improve metabolic syndrome (MetS) screening through optimal waist circumference (WC) landmarking procedures. Thus, the purpose of this study was to evaluate the associations between individual MetS risk factors and nine independent WC sites collected using tape measurement or SP anthropometrics and to determine the differences in MetS severity and prevalence when using these different WC measurement locations.</p><p><strong>Methods: </strong>A total of 130 participants (F:74, M:56; age: 27.8 ± 11.1) completed this cross-sectional evaluation. Using traditional tape measurement, WC was measured at the lowest rib (WC<sub>Rib</sub>), superior iliac crest (WC<sub>Iliac</sub>), and between the WC<sub>Rib</sub> and WC<sub>Iliac</sub> (WC<sub>Mid</sub>). Additionally, WC measurements were automated using a SP application at six sites along the torso. MetS risk factors were used to calculate MetS severity (MetS<sub>index</sub>) and prevalence. Associations were evaluated using multiple linear regression, the effect of each WC site on MetS<sub>index</sub> was analyzed using mixed-models ANCOVA, and differences in MetS prevalence using WC<sub>Iliac</sub> as the current standard were determined using sensitivity, specificity, chi-squared tests, and odds ratios.</p><p><strong>Results: </strong>The reference SP-WC (SP<sub>Ref</sub>) and WC<sub>Rib</sub> demonstrated the largest associations (all p < 0.001) with HDL cholesterol (SP<sub>Ref</sub>: -0.48; WC<sub>Rib</sub>: -0.49), systolic (SP<sub>Ref</sub>: 0.32; WC<sub>Rib</sub>: 0.30) and diastolic blood pressure (SP<sub>Ref</sub>: 0.34; WC<sub>Rib</sub>: 0.32), and fasting blood glucose (SP<sub>Ref</sub>: 0.38; WC<sub>Rib</sub>: 0.37). SP<sub>Ref</sub> and WC<sub>Rib</sub> were the only WC without significantly different MetS<sub>index</sub>; yet demonstrated lower MetS<sub>index</sub> and sensitivity (SP<sub>Ref</sub>: 77.8 %; WC<sub>Rib</sub>: 74.1 %) relative to WC<sub>Iliac</sub>, the conventional (or standard) WC measure.</p><p><strong>Conclusions: </strong>Compared to the current standard, SP<sub>Ref</sub> and WC<sub>Rib</sub> protocols are more highly associated with individual MetS risk factors and produce different MetS<sub>index</sub> and diagnoses; highlighting the need for new MetS WC protocols. Given the surge in remote/mobile healthcare, SP<sub>Ref</sub> may be an alternative to traditional methods in this context but requires further investigation before implementation.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The growing prevalence of obesity has become a major concern worldwide, therefore a great number of studies are conducted every day in the field of obesity. Since postbiotics are a newly introduced term, there is not much systematic evidence about their function and impact on obesity. We designed this study to systematically review the effect of different types of postbiotics on obesity.
Methods: A systematic search was conducted using PubMed, SCOPUS, and Web of Science databases up to August 2023. Both human and animal interventional studies that investigated the effects of any type of postbiotic on obesity and obesity-related factors were eligible. Screening, data extraction, and quality assessment were conducted independently by two researchers. The quality of the studies was appraised using Cochrane and Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) risk of bias tool.
Results: Of the 19373 retrieved studies, finally, 49 studies were included (9 human studies and 40 animal studies). Short-chain fatty acids and heat-killed (inactivated) bacteria were the most used postbiotics. In human clinical trials, inactivated Lactobacillus amylovorus (CP1563), Bifidobacterium animalis subsp. lactis (CECT 8145) and Pediococcus pentosaceus (LP28) were administered orally as postbiotics which improved body composition and anthropometric indices. Animal studies evaluated other types of postbiotics including muramyl dipeptide, cell-free extracts, urolithin A&B, extracellular Vesicles, exopolysaccharides, and surface Layer Proteins, supporting the anti-obesity effects of postbiotics.
Conclusion: Postbiotics seem to be a safe intervention and the results were in favor of a reduction in adipogenesis as well as an increase in energy expenditure. Further high-quality studies are required in this relatively new topic.
背景：肥胖症的发病率越来越高，已成为全世界关注的一个主要问题，因此，每天都有大量关于肥胖症的研究在进行。由于益生菌是一个新引入的术语，关于其功能和对肥胖的影响的系统性证据并不多。我们设计了这项研究，以系统回顾不同类型的益生菌对肥胖的影响：方法：我们使用 PubMed、SCOPUS 和 Web of Science 数据库对截至 2023 年 8 月的研究进行了系统检索。研究任何类型的益生菌对肥胖和肥胖相关因素影响的人类和动物干预性研究均符合条件。筛选、数据提取和质量评估由两名研究人员独立完成。研究质量采用 Cochrane 和实验动物实验系统综述中心（SYRCLE）的偏倚风险工具进行评估：在检索到的 19373 项研究中，最终纳入了 49 项研究（9 项人类研究和 40 项动物研究）。使用最多的益生菌是短链脂肪酸和热杀死（灭活）细菌。在人体临床试验中，口服灭活的淀粉乳杆菌（CP1563）、动物双歧杆菌亚种（CECT 8145）和五味子球菌（LP28）作为益生元，可改善身体组成和人体测量指数。动物研究评估了其他类型的益生元，包括氨酰二肽、无细胞提取物、尿石素 A 和 B、细胞外囊泡、外多糖和表面层蛋白，支持益生元的抗肥胖作用：结论：益生菌后似乎是一种安全的干预措施，其结果有利于减少脂肪生成和增加能量消耗。对于这个相对较新的课题，还需要进一步开展高质量的研究。
{"title":"The anti-obesity effects of postbiotics: A systematic review of pre-clinical and clinical studies.","authors":"Maysa Eslami, Azin Pakmehr, Farzad Pourghazi, Atefe Kami, Hanieh-Sadat Ejtahed, Mohammadreza Mohajeri-Tehrani, Shirin Hasani-Ranjbar, Bagher Larijani","doi":"10.1016/j.clnesp.2024.10.153","DOIUrl":"10.1016/j.clnesp.2024.10.153","url":null,"abstract":"<p><strong>Background: </strong>The growing prevalence of obesity has become a major concern worldwide, therefore a great number of studies are conducted every day in the field of obesity. Since postbiotics are a newly introduced term, there is not much systematic evidence about their function and impact on obesity. We designed this study to systematically review the effect of different types of postbiotics on obesity.</p><p><strong>Methods: </strong>A systematic search was conducted using PubMed, SCOPUS, and Web of Science databases up to August 2023. Both human and animal interventional studies that investigated the effects of any type of postbiotic on obesity and obesity-related factors were eligible. Screening, data extraction, and quality assessment were conducted independently by two researchers. The quality of the studies was appraised using Cochrane and Systematic Review Centre for Laboratory Animal Experimentation (SYRCLE's) risk of bias tool.</p><p><strong>Results: </strong>Of the 19373 retrieved studies, finally, 49 studies were included (9 human studies and 40 animal studies). Short-chain fatty acids and heat-killed (inactivated) bacteria were the most used postbiotics. In human clinical trials, inactivated Lactobacillus amylovorus (CP1563), Bifidobacterium animalis subsp. lactis (CECT 8145) and Pediococcus pentosaceus (LP28) were administered orally as postbiotics which improved body composition and anthropometric indices. Animal studies evaluated other types of postbiotics including muramyl dipeptide, cell-free extracts, urolithin A&B, extracellular Vesicles, exopolysaccharides, and surface Layer Proteins, supporting the anti-obesity effects of postbiotics.</p><p><strong>Conclusion: </strong>Postbiotics seem to be a safe intervention and the results were in favor of a reduction in adipogenesis as well as an increase in energy expenditure. Further high-quality studies are required in this relatively new topic.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.clnesp.2024.10.154
Mengmeng Wang , Degang Mo , Chi Zhou , Mengqi Guo , Wenqiang Zhang , Rui Chen , Jiachao Xu , Ning Zhang , Haichu Yu
Background & aims
Despite extensive research into the cardiovascular implications of abdominal aortic calcification (AAC), there is a scarcity of robust studies exploring its association with Ward's triangle bone mineral density (BMD). This study aimed to evaluate this relationship in a nationally representative sample and compare the predictive value with femoral neck BMD and total femur BMD.
Methods
We conducted a cross-sectional analysis of 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, utilizing a complex, stratified, multistage, cluster sampling design. BMD measurements at Ward's triangle, femoral neck, and total femur were assessed using DXA scans. AAC severity was defined by a Kauppila score of ≥5. Predictors of AAC-24 scores were identified through correlation and linear regression models. Stratified regression and restricted cubic splines were applied to explore subgroup and dose–response relationships.
Results
Of the 2965 participants representing 116, 562, 500 individuals in the U.S., 11 % had severe AAC. Ward's triangle BMD showed a significant negative association with AAC-24 scores (β = −1.90, 95 % CI: −2.80 to −1.00, P < 0.002) and a reduced risk of severe AAC (OR = 0.85, 95 % CI: 0.76 to 0.95, P = 0.010). Non-linear associations were observed between Ward's triangle BMD and AAC outcomes. Ward's triangle BMD outperformed femoral neck and total femur BMD in predicting AAC.
Conclusions
Higher Ward's triangle BMD is linked to lower odds of severe AAC, highlighting its potential for improved early detection of AAC over femoral neck and total femur BMD. Healthcare providers should consider the implications of reduced Ward's triangle BMD for systemic atherosclerosis and recommend early AAC screening for enhanced cardiovascular risk management.
{"title":"Association between Ward's triangle bone mineral density levels and abdominal aortic calcification: Data from the national health and nutrition examination survey 2013–2014","authors":"Mengmeng Wang , Degang Mo , Chi Zhou , Mengqi Guo , Wenqiang Zhang , Rui Chen , Jiachao Xu , Ning Zhang , Haichu Yu","doi":"10.1016/j.clnesp.2024.10.154","DOIUrl":"10.1016/j.clnesp.2024.10.154","url":null,"abstract":"<div><h3>Background & aims</h3><div>Despite extensive research into the cardiovascular implications of abdominal aortic calcification (AAC), there is a scarcity of robust studies exploring its association with Ward's triangle bone mineral density (BMD). This study aimed to evaluate this relationship in a nationally representative sample and compare the predictive value with femoral neck BMD and total femur BMD.</div></div><div><h3>Methods</h3><div>We conducted a cross-sectional analysis of 2013–2014 National Health and Nutrition Examination Survey (NHANES) data, utilizing a complex, stratified, multistage, cluster sampling design. BMD measurements at Ward's triangle, femoral neck, and total femur were assessed using DXA scans. AAC severity was defined by a Kauppila score of ≥5. Predictors of AAC-24 scores were identified through correlation and linear regression models. Stratified regression and restricted cubic splines were applied to explore subgroup and dose–response relationships.</div></div><div><h3>Results</h3><div>Of the 2965 participants representing 116, 562, 500 individuals in the U.S., 11 % had severe AAC. Ward's triangle BMD showed a significant negative association with AAC-24 scores (β = −1.90, 95 % CI: −2.80 to −1.00, P < 0.002) and a reduced risk of severe AAC (OR = 0.85, 95 % CI: 0.76 to 0.95, P = 0.010). Non-linear associations were observed between Ward's triangle BMD and AAC outcomes. Ward's triangle BMD outperformed femoral neck and total femur BMD in predicting AAC.</div></div><div><h3>Conclusions</h3><div>Higher Ward's triangle BMD is linked to lower odds of severe AAC, highlighting its potential for improved early detection of AAC over femoral neck and total femur BMD. Healthcare providers should consider the implications of reduced Ward's triangle BMD for systemic atherosclerosis and recommend early AAC screening for enhanced cardiovascular risk management.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.clnesp.2024.10.151
Pierre Singer
ICU survivors are growing but a persistent physical and mental disability may occur. The patients discharged from ICU are frequently malnourished and their medical nutritional support is impaired by oral intake limitation due to respiratory support such as non invasive ventilation or high flow nasal cannula oxygen therapy, dysphagia and difficulties to determine energy and protein targets. ICU acquired weakness must be recognized and could be minimized by better energy intake determined by indirect calorimetry, optimal protein intake and physical activity. Early physical activity has become a pivotal element of the improvement of the physical and cognitive condition in the post ICU.
{"title":"The post ICU trajectory: Post acute and post ICU nutritional care.","authors":"Pierre Singer","doi":"10.1016/j.clnesp.2024.10.151","DOIUrl":"10.1016/j.clnesp.2024.10.151","url":null,"abstract":"<p><p>ICU survivors are growing but a persistent physical and mental disability may occur. The patients discharged from ICU are frequently malnourished and their medical nutritional support is impaired by oral intake limitation due to respiratory support such as non invasive ventilation or high flow nasal cannula oxygen therapy, dysphagia and difficulties to determine energy and protein targets. ICU acquired weakness must be recognized and could be minimized by better energy intake determined by indirect calorimetry, optimal protein intake and physical activity. Early physical activity has become a pivotal element of the improvement of the physical and cognitive condition in the post ICU.</p>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.clnesp.2024.10.156
Rachana Mehta, Ashok Kumar Balaraman, Muhammed Shabil, Sanjit Sah
{"title":"Letter to the editor: Comment on “effects of probiotics on sleep parameters: A systematic review and meta-analysis\"","authors":"Rachana Mehta, Ashok Kumar Balaraman, Muhammed Shabil, Sanjit Sah","doi":"10.1016/j.clnesp.2024.10.156","DOIUrl":"10.1016/j.clnesp.2024.10.156","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-24DOI: 10.1016/j.clnesp.2024.10.152
Dion C.J. Houtvast , Milan W. Betz , Bas Van Hooren , Sophie Vanbelle , Lex B. Verdijk , Luc J.C. van Loon , Jorn Trommelen
Biomedical research frequently employs null hypothesis testing to determine whether an observed difference in a sample is likely to exist in the broader population. Null hypothesis testing generally assumes that differences between groups or interventions are non-existent, unless proven otherwise. Because biomedical studies with human subjects are often limited by financial and logistical resources, they tend to have low statistical power, i.e. a low probability of statistically confirming a true difference. As a result, small but potentially clinically important differences may be overseen or ignored simply due to the absence of a statistically significant difference. This absence is often misinterpreted as ‘equivalence’ of treatments. In this educational paper, we will use practical examples related to the effects of exercise and nutrition on muscle protein metabolism to illustrate the most important determinants of statistical power, as well as their implications for both investigators and readers of scientific articles.
Changes in muscle mass occur at a relatively slow rate, making it practically challenging to detect differences between treatment groups in a long-term setting. One way to make it ‘easier’ to differentiate between groups and hence increase statistical power is to have a sufficiently long study duration to allow treatment effects to become apparent. This is especially relevant when comparing treatments with relatively small expected differences such as the effect of modest changes in daily protein intake. Secondly, one could try to minimize the variance and response heterogeneity within groups, for example by using strict inclusion criteria and standardization protocols (e.g., meal provision), by using cross-over designs, or even within-subject designs where two interventions are compared simultaneously (e.g., studying an exercised limb vs a contralateral control limb) although this might limit the generalizability of the findings (e.g. such single-limb exercise training is not common in practice). In terms of data interpretation, investigators should obviously refrain from drawing strong conclusions from underpowered studies. Yet, such studies still provide valuable data for meta-analyses. Finally, because muscle protein synthesis rates are highly responsive to anabolic stimuli, acute metabolic studies are more sensitive to detect potentially clinically relevant differences in the anabolic response between treatments. Apart from further elaborating on these topics, this educational article encourages readers to more critically question null findings and scientists to more clearly discuss limitations that may have compromised statistical power.
{"title":"Underpowered studies in muscle metabolism research: Determinants and considerations","authors":"Dion C.J. Houtvast , Milan W. Betz , Bas Van Hooren , Sophie Vanbelle , Lex B. Verdijk , Luc J.C. van Loon , Jorn Trommelen","doi":"10.1016/j.clnesp.2024.10.152","DOIUrl":"10.1016/j.clnesp.2024.10.152","url":null,"abstract":"<div><div>Biomedical research frequently employs null hypothesis testing to determine whether an observed difference in a sample is likely to exist in the broader population. Null hypothesis testing generally assumes that differences between groups or interventions are non-existent, unless proven otherwise. Because biomedical studies with human subjects are often limited by financial and logistical resources, they tend to have low statistical power, i.e. a low probability of statistically confirming a true difference. As a result, small but potentially clinically important differences may be overseen or ignored simply due to the absence of a statistically significant difference. This absence is often misinterpreted as ‘equivalence’ of treatments. In this educational paper, we will use practical examples related to the effects of exercise and nutrition on muscle protein metabolism to illustrate the most important determinants of statistical power, as well as their implications for both investigators and readers of scientific articles.</div><div>Changes in muscle mass occur at a relatively slow rate, making it practically challenging to detect differences between treatment groups in a long-term setting. One way to make it ‘easier’ to differentiate between groups and hence increase statistical power is to have a sufficiently long study duration to allow treatment effects to become apparent. This is especially relevant when comparing treatments with relatively small expected differences such as the effect of modest changes in daily protein intake. Secondly, one could try to minimize the variance and response heterogeneity within groups, for example by using strict inclusion criteria and standardization protocols (e.g., meal provision), by using cross-over designs, or even within-subject designs where two interventions are compared simultaneously (e.g., studying an exercised limb vs a contralateral control limb) although this might limit the generalizability of the findings (e.g. such single-limb exercise training is not common in practice). In terms of data interpretation, investigators should obviously refrain from drawing strong conclusions from underpowered studies. Yet, such studies still provide valuable data for meta-analyses. Finally, because muscle protein synthesis rates are highly responsive to anabolic stimuli, acute metabolic studies are more sensitive to detect potentially clinically relevant differences in the anabolic response between treatments. Apart from further elaborating on these topics, this educational article encourages readers to more critically question null findings and scientists to more clearly discuss limitations that may have compromised statistical power.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-22DOI: 10.1016/j.clnesp.2024.10.007
Melanie Baker , Mark Hann , Simon Lal , Sorrel Burden
Background & aims
Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.
Methods
This cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021.
Results
There were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9 %) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription.
A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106 %, 74 % and 67 %, respectively. One-hundred-thirty-four (54.7 %) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly.
Negligible amounts of at least one electrolyte were prescribed in 93 (38.0 %) bags, of which 52 (21.2 %) contained ≤2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p < 0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0 %) cases; conversely, lower than recommended dosages were seen in 55 (67.1 %) for potassium and 61 (74.4 %) for calcium.
Conclusions
This study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.
{"title":"A descriptive analysis of individually compounded home parenteral nutrition prescriptions provided to adults with chronic intestinal failure","authors":"Melanie Baker , Mark Hann , Simon Lal , Sorrel Burden","doi":"10.1016/j.clnesp.2024.10.007","DOIUrl":"10.1016/j.clnesp.2024.10.007","url":null,"abstract":"<div><h3>Background & aims</h3><div>Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021.</div></div><div><h3>Results</h3><div>There were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9 %) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription.</div><div>A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106 %, 74 % and 67 %, respectively. One-hundred-thirty-four (54.7 %) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly.</div><div>Negligible amounts of at least one electrolyte were prescribed in 93 (38.0 %) bags, of which 52 (21.2 %) contained ≤2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p < 0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0 %) cases; conversely, lower than recommended dosages were seen in 55 (67.1 %) for potassium and 61 (74.4 %) for calcium.</div></div><div><h3>Conclusions</h3><div>This study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-19DOI: 10.1016/j.clnesp.2024.10.144
N. Eid , R. Mosli , S. Enani , R. Saqr , E. Al-ofi , K. Qutah , S. Eid
{"title":"Corrigendum to “A pilot randomized controlled trial of a telenutrition weight loss program supported with telemonitoring and health coaching in overweight and obese adults” [Clin Nutr ESPEN 63 (2024) 1312–1322]","authors":"N. Eid , R. Mosli , S. Enani , R. Saqr , E. Al-ofi , K. Qutah , S. Eid","doi":"10.1016/j.clnesp.2024.10.144","DOIUrl":"10.1016/j.clnesp.2024.10.144","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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