Clinical nutrition ESPEN最新文献

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.

Background: Prostate cancer (PCa) is one of the most prevalent malignancies among men worldwide, yet evidence-based nutritional recommendations for its prevention and progression remain limited. Growing research indicates that diet may play a significant role in modulating PCa risk, tumor behavior, and mortality.

Objective: This narrative review synthesizes current evidence on major dietary components, including carbohydrates, protein sources, fats, vegetables, vitamins, and minerals. It evaluates their associations with PCa incidence, progression, and disease-specific mortality.

Methods: This narrative review synthesized evidence from PubMed/MEDLINE, Embase, and Web of Science (up to 2025), including randomized trials, observational studies, and meta-analyses, to evaluate associations between dietary factors and prostate cancer incidence, progression, and mortality.

Findings: High intake of simple sugars and refined carbohydrates is associated with elevated PCa risk, whereas complex carbohydrates are associated with a more favorable metabolic profile. Evidence consistently supports increased fish consumption and suggests potential benefit from soy products. In contrast, high intake of red/processed meats and full-fat dairy may increase the risk of aggressive disease. Total and saturated fat intake is associated with poorer outcomes, although evidence on omega-3 fatty acids is mixed. Cruciferous vegetables show a strong protective factor, supported by epidemiologic data, whereas evidence for allium vegetables is emerging. Findings for micronutrients were highly heterogeneous: lycopene and physiologic vitamin E levels may confer benefit, whereas high-dose vitamin A derivatives, supplemental folic acid, selenium, and excessive dairy-derived calcium may increase PCa risk.

Conclusion: Although evidence is often inconsistent, several dietary patterns appear promising for PCa prevention and decreasing mortality. Emphasizing complex carbohydrates, fish, soy, plant-based fats, and cruciferous vegetables-while limiting simple sugars, red/processed meats, whole milk, saturated fats, and unnecessary supplementation-may support improved outcomes. High-quality randomized trials remain urgently needed to clarify causality and refine clinical nutrition guidance for PCa.

Background & aims: Lipid emulsions are key components of parenteral nutrition (PN); however, concerns persist that soybean oil-based lipid emulsions may increase the risk of infection and catheter occlusion. In pediatric intensive care settings, evidence on the safety of these emulsions remains limited. This study investigated the impact of soybean oil-based lipid emulsion on central venous catheter-related complications and clinical outcomes in children receiving PN in a pediatric intensive care unit (PICU).

Methods: We conducted a single-center retrospective study of children admitted to the PICU between 2018 and 2023 who underwent PN for >7 days. Patients who received PN before PICU admission were excluded. Of the 4589 PICU admissions, 172 patients were included and divided into two groups based on soybean oil-based lipid emulsion administration: 67 patients received the lipid emulsion, and 105 did not. The primary outcomes were catheter occlusion and central line-associated bloodstream infection (CLABSI). Secondary outcomes included duration of mechanical ventilation, length of stay in the PICU, and mortality. Catheter-level analysis was also performed to evaluate the complication rates and catheter survival based on lipid emulsion exposure.

Results: At the patient level, catheter occlusion occurred in 4.5 % of the lipid emulsion-treated group and 2.9 % of the non-treated group (p = 0.68), whereas CLABSI occurred in 7.5 % of the lipid emulsion-treated group and 3.8 % of the non-treated group (p = 0.31), with no significant differences. In the catheter-level analysis, the incidence of CLABSI per 1000 catheter-days was 2.69 in the treated group and 1.40 in the non-treated group (p = 0.30). No significant differences were observed in catheter survival or complication rates.

Conclusion: Soybean oil-based lipid emulsions administered via a central venous catheter did not increase the risk of catheter occlusion nor of CLABSI in critically ill pediatric patients. These findings support the safe use of soybean oil-based intravenous lipid emulsions in PICUs when enteral nutrition is not feasible.

Background: Reduced food intake is one of the etiologic criteria proposed by the Global Leadership Initiative on Malnutrition (GLIM). Various tools for the assessment of food intake exist, however, to diagnose malnutrition, as in GLIM, they should be validated against established reference standards, and quick and easy to complete by various members of the health care team.

Aim: This scoping review synthesizes the current evidence related to validated assessment measures of food intake for adult patients in healthcare settings and reports on the application of these measures within the GLIM diagnostic framework.

Methods: A comprehensive search strategy was performed using four bibliographic databases. To be included, studies needed to be conducted on adults in a healthcare setting, have a dietary intake assessment component (i.e. index method) that can be completed by various healthcare staff members, with minimal training and in a short time period, and make comparison of this method to an established dietary assessment reference. Studies needed to report energy and protein intake data and provide appropriate validation statistics. Two reviewers independently reviewed all abstracts and relevant full-text articles, and extracted data.

Results: After duplicate removal, 7866 abstracts were screened; 51 articles were eligible for full article review, 13 articles fulfilled the inclusion criteria and one further article was obtained from grey literature, for a total of 14 articles included in the scoping review. Food weighing before and after consumption was used as a reference method by most studies. For index methods, four different measurement tools, with variations, were used. This included visual estimation methods (VEM) using a 1-10-point scale without any pictorials (2 studies); VEM based on plate-model pictures (8 studies); VEM based on plate-models with associated defined nutritional values (4 studies) and digital technology (2 studies). Various levels of accuracy were found, with accuracy increasing when more options are provided and when employing digital technology. Index methods could be completed by participants themselves, nurses, food service workers and dietitians. Adequate training on completion of the tools is associated with improved results.

Conclusion: Index methods to assess food intake accurately for energy and protein intake can determine inadequate intake as compared to the reference method. Yet, a further step is required to interpret food intake relative to the patient's energy requirement to determine sufficiency of that intake for determination of the GLIM criterion. However, visual estimation methods identified in this review can be used by diverse clinicians with confidence to determine patient food intake.