Clinical nutrition ESPEN最新文献

Purpose: Multiple inflammatory and nutritional biomarkers have been established as independent prognostic factors across various solid tumors, but their role in outcomes prediction for glioma is still under investigation. Aim of the present systematic review is to report the available evidence regarding the impact of nutritional assessment and intervention for glioma prognosis and patients' quality of life (QoL).

Materials and methods: Our systematic review conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The PubMed and EMBASE databases were searched to identify studies assessing the impact of nutritional status and intervention and hematological biomarkers on survival outcomes and quality of life in patients with newly diagnosed gliomas. In the search strategy Medical Subject Headings (MeSH) terms were used. Search terms included ("nutritional status" or "nutritional assessment" or "nutritional intervention") AND ("glioma" or "glioblastoma" or "high-grade glioma" or "low-grade glioma" or "anaplastic astrocytoma" or "anaplastic oligodendroglioma") AND ("prognosis" or "survival outcomes"). The quality of each study was investigated based on the Newcastle-Ottawa Scale (NOS) criteria. Selected papers were in English and included publications in humans. This study was registered on PROSPERO (Registration No. CRD42024555442).

Results: Our search retrieved 20 papers published between 2015 and 2023, all aiming at investigating correlations between hematological biomarkers (albumin, prealbumin, fibrinogen) and/or nutritional tools (Controlling Nutritional Score, CONUT; Prognostic Nutritional Index, PNI) and survival outcomes and quality of life of glioma patients. Nutritional intervention as well was evaluated for outcomes prediction. Overall, most papers contributed to the evidence of how nutritional assessment and inflammatory biomarkers could play an independent prognostic role also in the management of glioma patients.

Conclusions: PNI, CONUT score and hematological biomarkers (e.g. albumin, globulin, neutrophils, lymphocytes) may serve as useful predictors in patients with gliomas, potentially influencing clinical decisions. Additional large-scale studies are required to validate these findings and determine the mechanisms by which nutritional status, systemic inflammation and immune status affect prognosis in glioma patients.

Background: Intensive care unit-acquired weakness (ICU-AW) is a complication characterized by decreased muscle mass and impairments in strength and physical function and is associated with poor quality of life and worse clinical outcomes. The primary objective of this study is to analyze the prevalence of ICU-AW, and secondary objectives were to assess risk factors and analyze the associations with clinical outcomes.

Methods: This is a prospective cohort study of patients on mechanical ventilation (MV). Nutritional risk (mNUTRIC) and the presence of malnutrition (GLIM criteria) were evaluated. A nutritional assessment was performed upon admission and post-extubation. Cumulative energy and protein deficit (CPD) were calculated. ICU-AW was assessed. Post-extubation dysphagia (P-ED), hospital readmission, length of ICU stays post-extubation, and hospital stay post-ICU were reported as clinical outcomes. Comparison tests between groups, univariate and multivariate logistic, and linear regressions were performed.

Results: ICU-AW was diagnosed in 55% of patients. Differences were observed between ICU-AW and normal strength group for sex, days on MV, hospital length of stay, pharmacological therapy for sedation and CPD. The interaction of vecuronium prescription with MV time (RR=1.09, 95%CI=1.03-1.16, p<0.01) and female sex (RR=4.16, 95%CI=1.3-13.38, p=0.01) were independent predictors for ICU-AW development. ICU-AW was associated with P-ED (RR=11.2, 95%CI=2.6-48.4, p<0.01) and length of ICU stay post-extubation (β=2.11, 95%CI=0.5-3.7, p=0.01).

Conclusion: ICU-AW is a highly frequent condition in critical patients. Pharmacological therapy, duration of MV and sex were independent predictors for ICU-AW development. This condition was also associated with P-ED development and length of ICU stay post-extubation.

Background and aims: Alcohol Use Disorder (AUD) is a psychiatric disorder characterized notably by gut microbial dysbiosis and insufficient dietary fiber intake. This study aims to investigate the effect of dietary fiber placebo-controlled intervention in patients suffering from AUD during a three-week period of alcohol withdrawal, in order to discover microbial-derived metabolites that could be involved in metabolic and behavioral status.

Methods: A randomized, double-blind, placebo-controlled study was performed with 50 AUD patients supplemented with inulin (prebiotic dietary fiber) or maltodextrin (placebo) during 17 days. Fecal microbiota composition, plasma and fecal metabolomics (liquid chromatography coupled to mass spectrometry), blood markers of inflammation and hepatic alterations and psychological assessment (questionnaires) were analyzed before and after the intervention.

Results: Fecal metabolomics revealed 14 metabolites significantly modified by inulin versus placebo treatment (increased N8-acetylspermidine and decreased indole-3-butyric acid, 5-amino valeric acid betaine (5-AVAB) and bile acids). 13 plasma metabolites differentiated both treatments (higher levels of long-chain fatty acids, medium-chain acylcarnitines and sphingomyelin species, and reduced 3-methylhistidine by inulin versus placebo). Fecal Lachnoclostridium correlated with 6 of the identified fecal metabolites, whereas plasma lipidic moieties positively correlated with fecal Ruminococcus torques group and Flavonifractor. Interestingly, parameters reflecting liver alterations inversely correlated with sphingomyelin (SM 36:2).

Conclusions: Three weeks of inulin supplementation during alcohol withdrawal leads to specific and different changes in the plasma and fecal metabolome of AUD patients, some of these gut microbiota-related metabolites being correlated with liver function.

Trial registration: NCT03803709, https://clinicaltrials.gov/ct2/show/NCT03803709.

The increasingly complex health care systems, the large and diverse population to whom nutritional therapy is addressed, and the need of specialized health care professionals implies an organizational strategy to be defined. The organization of nutritional care is a fundamental strategy to promote an optimal, quality and safety nutritional therapy. This is why, the organization of nutritional care should be based on 4 principles, including: Nutritional care should be considered as a process, a multidisciplinary approach is essential to a good nutritional care, the economic approach and the patient centered approach are essential to the organization of nutritional care. In this paper we will address the organization of nutritional care and its 4 principles.

Background and aims: Chemotherapy is one of the treatments of choice for patients with hematological or head and neck neoplasms. However, chemotherapy promotes elevate occurrence of adverse events and many of them directly impact nutritional status and patients' quality of life, which may include a low treatment tolerance. Suggested mechanisms include inflammation and oxidative stress as contributing factors to adverse effects of chemotherapy. Recently, we developed an adapted ice cream, source of protein and fiber, fat lower content, free of trans fat, gluten and lactose, one of the foods that are best accepted during chemotherapy, which have the potential of protein, cryotherapeutic and with the potential to alleviate gastrointestinal effects. The aim of this study is to develop a two-phase randomized clinical trial protocol. In this trial, the intake of an adapted ice cream will be tested during chemotherapy in adults of both sexes, with a recent diagnosis of hematological or head and neck cancer, with an indication to start chemotherapy, and who are able to take oral intake.

Methods: The study will be divided into two phases, with different intervention times. The adapted ice cream will be offered daily two 60 g plastic packaging (total 120g/day), as a dessert for lunch and dinner for 21 days in phase 1 or 63-days post day one of chemotherapy in phase 2. Participants will be randomized by stratified randomization into the control (n=26) and intervention (n=26) groups. The primary outcomes are nutritional status and the incidence, duration, and severity of oral mucositis. Secondary outcomes are food consumption, inflammatory and oxidative stress indicators, taste disorders, and quality of life.

Discussion: Understanding the effect of this nutritional intervention on the outcomes we intend to analyze in this population may provide relevant information to assist with nutritional approaches during treatment. In this protocol, the methods for data collection are well based on the literature and have good validity for this population. The results of this study, whether positive or negative, will contribute to the clear scientific gap demonstrated in recent systematic reviews involving this topic.

Registration number: RBR-5dvnbqx in ensaiosclinicos.gov.br.

Objective: To analyze the relationship between body fat, motor skills, and physical fitness in children and adolescents.

Methods: 216 children and adolescents (143 males and 73 females, aged 5-15 years) from a social project composed this study. Body mass and height were measured to calculate the body mass index (BMI). DXA was used to estimate the percentage of body fat (BF). The Körperkoordinationstest für Kinder (KTK) was used to assess motor skills (jumping sideways test corresponds to speed, walking backwards to balance and moving sideways to laterality), modified pull-ups to measure upper limb strength and the 1-mile run/walk test to estimate maximal oxygen uptake.

Results: In unadjusted models, BF was a significant negative predictor for almost all motor skills and physical fitness variables measured (jumping sideways: β= -0.16; 95%CI= -0.40 to 0.03/ walking backwards: β= -0.25; 95%CI= -0.54 to -0.18/ modified pull-ups: β= -0.43; 95%CI= -0.17 to -0.09/ 1-mile run/walk: β= -0.18 95%CI= -0.39 to -0.06). Except moving sideways (β= -0.05; 95%CI= -0.12 to 0.05). Subsequently, it was inserted confounders in the regression models. In the model considering sex and age, the significance remained exactly the same compared to the model without adjustment. When considering the BMI adjustment, only walking backwards (β= -0.37; 95%CI= -0.88; -0.17) and modified pull-up (β= -1.01; 95%CI= -0.39; -0.23) remained significant.

Conclusion: In children and adolescents socially assisted, BF was negatively related to motor skills and physical fitness regardless of age, sex, and BMI.

Background and aims: Measurement of the urine sodium concentration (USC) is a simple procedure that in many patients adequately indicates their hydration status. This is of particular importance in patients suffering from short bowel syndrome (SBS), who may very rapidly dehydrate and are at risk for permanently compromising their kidney function. A point of care test (POCT) that allows reliable measurement of USC would enable these patients to effectively evaluate their sodium- and water balance in the at home setting, thereby avoiding hospital visits and delayed test results. In this study, a POCT device to assess USC was first analytically validated after which it was applied for the at home evaluation of the hydration status in patients with SBS.

Methods: First, we validated the imprecision, bias and limit of quantification of USC as measured with the Fisic Medimate POCT device in comparison to an automated routine chemistry system. Next, the device was used for monitoring USC at home in 21 patients with SBS, including an evaluation of user friendliness System Usability Scale (SUS) and accuracy for detecting low sodium levels as compared to the routine chemistry system.

Results: The imprecision of the POCT device at low USC was 6.1 %. In samples at the clinical decision threshold to identify patients at the verge of dehydration of 20 mmol/l as measured by routine chemistry USC, the POCT device demonstrated a mean estimation of USC of 20.6 mmol/l (95% CI 18.8-22.4). Dehydration was detected with a sensitivity of 95% when the medical decision limit for urinary sodium on the POCT device was set at a safe concentration of 30 mmol/l. Using the device was straightforward and easy to learn for patients with an overall System Usability Scale (SUS) score of 86.

Conclusion: USC measurements using this POCT device can be safely integrated into daily practice for early detection of dehydration in patients with SBS. Clear patient instructions to ensure accurate drop dispensing and a higher clinical decision threshold of USC of 30 mmol/l will allow a high sensitivity for detecting dehydration in patients with short bowel syndrome.

Background & aims: Improving diet quality is a crucial aspect of cardiovascular disease (CVD) risk management. However, in clinical practice, there is limited time to evaluate diet quality and to provide dietary advice. Patients therefore mostly depend on self-management to address their diet quality. This study aimed to investigate whether the web-based Eetscore tool could improve the diet quality of CVD patients.

Methods: A pre-posttest study with a duration of three months was performed in 65 (64 +/- SD years) CVD patients. At baseline, participants were asked to complete the Eetscore: a brief web-based questionnaire to assess diet quality on a scale of 0-160 and provides dietary advice. Diet quality was assessed again after three months. The change in diet quality over time was assessed with a paired sample T-test.

Results: The average diet quality score at baseline was 102.5±19.2 (95% confidence interval (CI): 97.8; 107.3). Participants who completed both baseline and follow-up measurements (n= 41) showed no statistically significant changes in mean diet quality scores, with mean diet quality scores 101.9 at baseline and 103.4 after three months (95%CI for change -2.7; 5.8, p = 0.74).

Conclusion: Implementation of Eetscore did not lead to significant improvements in diet quality of CVD patients over time. Participants mostly indicated that Eetscore provided insight into their diet quality, however this was not sufficient to induce dietary changes. We suggest that, in addition to a web-based tool, a healthcare professional emphasizing the importance of higher diet quality may be needed to improve the diet quality of CVD patients.

Introduction: We performed a systematic review and meta-analysis to investigate the effects of combining omega-3 polyunsaturated fatty acids (n-3 PUFAs) supplementation with exercise training, as compared to exercise training alone, on body composition measures including body weight, body mass index (BMI), fat mass, body fat percentage, and lean body mass. Additionally, we determined the effects on cardiometabolic health outcomes including lipid profiles, blood pressure, glycemic markers, and inflammatory markers.

Method: Three primary electronic databases including PubMed, Web of Science, and Scopus were searched from inception to April 5^th, 2023 to identify original articles comparing n-3 PUFA supplementation plus exercise training versus exercise training alone, that investigated at least one of the following outcomes: fat mass, body fat percentage, lean body mass, triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL), systolic (SBP) and diastolic (DBP) blood pressures, fasting glucose and insulin, interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Standardized mean differences (SMD) or weighted mean differences (WMD), and 95% confidence intervals (CIs) were calculated using random-effects models.

Results: A total of 21 studies involving 673 participants with BMIs ranging from 24-37 kg.m2 and ages ranging from 30-70 years were included in the meta-analysis. Overall, the results indicated that as compared with exercise training alone, adding omega-3 supplementation to exercise training decreased fat mass [WMD: -1.05 kg (95% CI: -1.88 to -0.22), p = 0.01], TG [WMD: -0.10 mmol/L (95% CI: -0.19 to -0.02)], SBP [WMD: -4.09 mmHg (95% CI: -7.79 to -2.16), p = 0.03], DBP [WMD: -4.26 mmHg (95% CI: -6.46 to -2.07), p = 0.001], and TNF-α [SMD: -0.35 (95% CI: -0.70 to -0.00), p = 0.04], and increased LDL [WMD: 0.14 mmol/L (95% CI: 0.02 to 0.26), p = 0.01] and lower-body muscular strength [SMD: 0.42 (95% CI: 0.01 to 0.84), p = 0.04]. However, omega-3 supplementation with exercise training had no additional effects compared with training alone, for other body composition or cardiometabolic outcomes.

Conclusion: This systematic review and meta-analyses suggestes that adding omega-3 supplementation to exercise training may augment some effects of exercise training on body composition and cardiometabolic health in adults, although such effects appear to be modest.