Clinical nutrition ESPEN最新文献

Background: Accurate assessment of body composition beyond BMI is necessary in clinical care. Bioelectrical impedance analysis (BIA) and 3D scanning (3DS) are practical two-compartment (2C) methods estimating % body fat (%BF), fat mass (FM), and fat-free mass (FFM). Precision and validity are essential components of all body composition devices, yet BIA and 3DS have rarely been compared simultaneously against a reference method.

Objectives: To evaluate the precision of BIA and 3DS and their validity versus dual-energy X-ray absorptiometry (DXA).

Methods: Forty-four healthy women (40-65 y) underwent body composition assessment by DXA, BIA, and 3DS. Outcomes were whole-body 2C estimates for all devices and regional estimates for DXA and BIA. Precision was derived from duplicate measures; validity was assessed using Bland-Altman analyses between devices.

Results: Precision error (%CV) for %BF, FM, FFM was: DXA 1.17, 1.14, 0.72; BIA 1.25, 1.26, 0.57; 3DS 2.78, 2.76, 1.08. All met preset acceptability limits (%BF 2%, FM 3%, FFM 2%) except 3DS %BF. Bland-Altman analyses showed poor individual-level agreement across devices. Despite only minor biases between devices in some cases, there were wide limits of agreement that crossed zero, had proportional bias, or a combination of the two.

Conclusion: BIA and 3DS exhibited acceptable precision for most whole-body 2C outcomes, yet measurements were not interchangeable with DXA at the individual level. These findings caution against applying cross-device normative data or clinical cut-points and underscore the limitations of substituting BIA or 3DS for DXA in general practice.

Physical activity and nutrition are inextricably linked in maintaining muscle and overall health, enhancing metabolic resilience, and preventing age-related muscle loss. Exercise acts as a powerful physiological stressor, inducing acute metabolic, endocrine, and immunological responses, while long-term training elicits structural and functional adaptations at the muscular, cardiovascular, and systemic levels. Proper nutritional strategies, aligned with the type, intensity, and duration of physical activity, provide the necessary substrates to fuel exercise, optimize recovery, and support muscle protein synthesis and immune resilience. This integrative approach not only enhances athletic performance but also serves as a critical tool in the prevention and management of chronic diseases, including obesity, type 2 diabetes and cardiovascular disease. Emerging evidence further underscores the importance of skeletal muscle as a metabolic and endocrine organ, producing myokines which, with other exerkines, mediate the systemic health benefits of exercise. As a result, the evolving field of clinical sports nutrition bridges the gap between performance-oriented sports nutrition and evidence-based clinical care for physically active individuals across the health spectrum. By combining exercise physiology, clinical nutrition, and applied sports science, this multidisciplinary model provides a robust framework for advancing metabolic health, functional capacity, and performance in diverse populations.

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 1779 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 10th 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.