Clinical nutrition ESPEN最新文献

Background & aims: Current estimates of the prevalence of iron deficiency anaemia (IDA) in patients with chronic intestinal failure (CIF) exceed those seen in general population, however, the studies to-date are limited. The aim of this study was to determine the point prevalence of IDA in a large cohort of stable home parenteral nutrition (HPN) dependent adults managed by a specialist Intestinal Failure Unit.

Methods: This was a retrospective cohort study of HPN-dependent adults managed by a national UK IF Reference Centre between 01/01/2019 and 31/12/2019. Patients with IDA were followed up until death or the end of the follow-up on 01/05/2024.

Results: 241 patients were included in the analysis. 27/241 (11.2 %) were diagnosed with IDA. Previous hypoferritinaemia, previous IDA and not receiving the recommended amount of iron via parenteral nutrition as per ESPEN guidelines were associated with higher likelihood of IDA diagnosis. Only 2/27 patients with IDA at inclusion fulfilled IDA criteria by the end of the follow up. Long-term outcomes in the patient cohort with IDA were good with no patients displaying evidence of malignancy until the end of the study period.

Conclusion: Our study shows that while IDA is common in patients with CIF, its clinical implications may differ from those in the general non-IF population. Further larger collaborative multi-centre research is necessary to confirm these findings with a view to develop evidence-based guidelines for the investigation of IDA in CIF.

Background & aims: In the general population, 24-h urine potassium excretion is considered the reference standard for estimating potassium intake. However, its agreement with food records and spot urine collections in adults living with chronic kidney disease (CKD) is not well-established. Given the risk of hyperkalemia related to changes in renal potassium handling, understanding if this reference standard is appropriate for the CKD population is important. This study aimed to compare agreement between methods for estimating potassium intake, using food records, 24-h urine measures, and spot urine samples.

Methods: A cross-sectional study was conducted among adults recruited from a kidney care clinic. Participants were instructed to complete a detailed food record and a 24-h urine collection, both performed on the same day. The following day, participants provided a spot urine sample from the second void, at the research site. Potassium excretion was estimated from the spot urine sample using Tanaka's and Kawasaki's equations. Agreement between methods was assessed using the highest p-value for paired t-test and the lowest Bland-Altman bias combined with the narrowest upper and lower limits of agreements (LoA).

Results: 60 adults with Stage 3 and 4 CKD completed the study (48 % male, 62.9 ± 14.6 years; eGFR = 34.9 ± 12.7 mL/min). The food records showed the highest agreement with 24-h urine potassium (1823.9 ± 746.7 vs 1918.2 ± 809.3, p = 0.584). This was followed by Kawasaki's equation for spot urine (1994.8 ± 441.9, p = 0.231) and Tanaka's equation (1630.0 ± 325.9, p = 0.174). Food records and Kawasaki's equation had slightly higher mean values compared to 24-h urine with mean differences <100-200 mg/day (bias; 95%CI: bias = -94.4 mg/day; -438.3 to 249.6 mg/day and -170.9 mg/day; -454.1 to 112.2 mg/day, respectively). Tanaka's equation had a lower mean value compared to 24-h urine with a mean difference of 193.9 mg/day; -88.5 to 476.3 mg/day). The limits of agreement were as follows: in the Kawasaki's equation from -2082.2 to 1740.3 mg/day, in the Tanaka's equation from -1712.2 to 2100.0 mg/day and in the food records from -2416.1 to 2227.4 mg/day.

Conclusion: Mean potassium intake estimates were similar across methods. Food records demonstrated the highest agreement with 24-h urine potassium, followed by Kawasaki's equation. The Tanaka's equation showed the highest bias compared to 24-h urine and was significantly different from food records. Combining food records with potassium excretion estimated using the Kawasaki's equation from spot urine samples may be a clinically useful tool for assessing potassium intake in adults with CKD.

Background & aims: The developmental origin of health and disease hypothesis shows that early adverse exposures can have lifelong health effects. Thus, the aim of this study was to analyze the impact of choline intake during pregnancy and/or lactation on gene expression profiles in the liver of 24-day-old male rat offspring from dams with non-alcoholic fatty liver disease (NAFLD).

Methods: Phenotypic characteristic, histological examination and global transcriptome pattern of liver tissue specimens obtained from offspring of dams suffering from fatty liver, provided with proper choline intake during pregnancy and lactation (NN), fed a choline-deficient diet during both periods (DD), deprived of choline only during pregnancy (DN), or only during lactation (ND), was performed. The global gene expression profile was analyzed by using microarray approach (Affymetrix® Rat Gene 2.1 ST Array Strip). The relative expression of selected genes was validated by real-time polymerase chain reaction (qPCR).

Results: The histological examination of rat liver sections indicated alternations typical for fatty liver in all analyzed groups with increased progression among groups deprived of choline. Choline deficiency in the maternal diet was associated with changes in body mass and composition but not with biochemical marker levels, except for the high density lipoprotein fraction of cholesterol (HDL). Enhanced expression of genes involved in oxidative stress, cell proliferation, activation of catabolic processes related to hepatocyte dysfunction and cell membrane composition were simultaneously observed in all choline-deficient groups.

Conclusions: An adequate amount of choline in the diet of a mother with fatty liver during pregnancy and/or lactation can regulate gene expression in the offspring's liver and contribute to a milder stage of the disease in the progeny. Moreover, proper choline supply during the postpartum period is as crucial as during the prenatal period.

Background & aims: Buprenorphine and methadone are drugs used as medication for addiction treatment for patients with opioid use disorders (OUDs). However, scarce evidence indicates that they induce oxidative stress, which contributes to the deterioration of psychosocial parameters, thus complicating successful rehab. Therefore, a dietary antioxidant intervention such as pomegranate could be beneficial for that group of patients. Therefore, the aim of this study, whose protocol has been registered in the international database ClinicalTrials.gov (Identifier: NCT05861544), was to examine the putative beneficial role of consumption of natural pomegranate juice that possesses potent antioxidant properties on craving, a psychosocial parameter of utmost importance, and blood redox status of patients with OUDs.

Methods: The juice was administered at the following dosage: 250 ml/day, 7 days/week, 120 days. The heroine craving questionnaire was completed to assess craving and blood was collected by the volunteers at three time points, namely days 1, 60 and 120 and well-established redox biomarkers were measured in blood.

Results: Overall, craving of all patients was improved due to the nutritional treatment applied. Moreover, their blood antioxidant potential was enhanced due to pomegranate juice consumption.

Conclusions: As a conclusion, the obtained evidence is promising, thus, it appears that pomegranate juice consumption could be considered as an auxiliary nutritional intervention in parallel with medication towards rehab of opioid-addicted patients.

Background: Gut microbiota disturbance may worsen critical illnesses and is responsible for the progression of multiple organ dysfunction syndrome. In our previous study, there was a trend towards a higher α-diversity of the gut microbiota in sequential feeding (SF) than in continuous feeding (CF) for critically ill patients. We designed this non-blinded, randomized controlled study to confirm these results.

Methods: All the enrolled patients received continuous feeding in the beginning. After achieving ≥80% of the nutrition target calories (25-30 kcal/kg/d), the patients were randomized into the SF group or the CF group. In the SF group, continuous feeding was changed into intermittent feeding. The total daily dosage of enteral nutrition was equally distributed during three periods at 7-9:00, 11-13:00 and 17-19:00. After 7 days of randomization, fresh stool and serum were collected for 16S rRNA gene sequencing and untargeted metabolomics analysis respectively. Meanwhile, routine blood test indicators and metabolic indicators were recorded.

Results: Finally, data from 65 patients in the SF group and 69 patients in the CF group were used for intention-to-treat analysis. There was no difference in the Shannon index between the SF group and CF group [2.5 (1.7-3.4) vs. 2.6 (1.5-3.5), P =0.934]. However, at the genus level, the abundances of Erysipelotrichaceae_UCG-003 and Howardella increased in the SF group. Some metabolic indicators (the albumin level, total cholesterol level and total bile acid level) and the increases in lymphocyte counts in the SF group were different from those in the CF group (P <0.05). In untargeted metabolomic analysis, 58 differentially abundant metabolites between the two groups were found. The pathway with the highest enrichment factors was primary bile acid biosynthesis according to the Kyoto Encyclopedia of Genes and Genomes Database classification. Regarding adverse events, the gut tolerance, average glucose and incidence of hyperglycemia and hypoglycemia were similar between the SF group and CF group. The mortality rate in the SF group was lower than that in the CF group, but there was no statistical difference (9.2% vs. 13.0%, P=0.484).

Conclusion: SF did not increase the diversity of gut microbiota in critically ill patients. However, it did alter the abundances of some gut microbes and affect some metabolites. Its clinical significance requires further exploration. In addition, the gut tolerance and safety of SF were similar to that of CF.

Trial registration: www.

Clinicaltrials: gov, registration number NCT04443335. Registered 21 June, 2020.

Background: Premorbid sarcopenia, osteoporosis, and obesity are epiphenomena that affect survival and functional outcomes in patients with acute ischemic stroke. The effects of preexisting sarcopenia and/or osteopenia on long-term outcome after ischemic stroke were herein prospectively studied.

Methods: Dual-energy x-ray absorptiometry (DeXA), bio-impedance analysis (BIA) and muscle ultrasonography (US) data were prospectively collected within the first 72 h in 297 consecutive acute ischemic stroke patients (45.5 % women, mean age: 67.8 years). Bone mineral density (BMD) and bone mineral content (BMC) were measured by DeXA for the lumbar spine, and hip (femoral neck and total). BIA was used to measure skeletal muscle mass indices (SMMI, normalized to height-squared, weight and body mass index - SMMI-height, SMMI-weight and SMMI-BMI, respectively) and phase angle. Vertical muscle thickness (MT, mm) for biceps brachii (BB), rectus femoris (RF), vastus lateralis (VL) and gastrocnemius medialis (GCM), cross-sectional area (CSA, cm²) for BB and RF, fascicle length (fL) and pennation angle (PeA) for VL and GCM were measured using muscle US. Multiple exploratory logistic regression models were constructed for detect predictors of mortality and unfavorable functional outcome (Modified Rankin score-mRS>1) at the end of the first year. The cut-off value determined by the Younden-J index, and the lower limit of the 95 % confidence interval of the area under the receiver operating characteristic (ROC) curve (AUC) were reported.

Results: Independent predictors for one-year unfavorable prognosis were phase angle (cut-off ≤5°; lower limit of 95%CI of ROC-AUC: 0.704); muscle thickness (AUCs were 0.677 for RF (≤9.29), 0.660 for GCM (≤13.38), 0.655 for R + VIM (vastus intermedius) (≤15.31), 0.605 for BB + brachialis (≤23.98) and 0.592 for VL (≤10.64), 0.619 for VL transverse MT (≤19.95 mm), and cross sectional areas (0.656 for RF (≤4.27 cm²) and 0.609 for BB (≤8.88 cm²). Independent predictors for 1-year mortality were phase angle (95 % lower limit of AUC 0.746 for ≤3.7°), BB + brachialis MT (0.625 for ≤23.98 mm), and BB MT (0.613 for ≤19.27).

Conclusions: Phase angle and ultrasonographic muscle-size parameters (thickness and cross-sectional area) obtained at admission are significant and independent predictors of long-term functional prognosis and mortality in acute ischemic stroke. Ultrasound parameters of muscle architecture (pennation angle, fiber length), DeXA (BMC and BMD), and BIA-derived SMMI have low independent prediction capability of long-term prognosis.

Background and aims: Dysphagia is significantly correlated with prognostic outcomes in patients with stroke; however, the intrinsic mechanism of action between the two remains unclear. This study aimed to model the intrinsic mechanism of action between dysphagia and prognostic outcomes in patients with stroke based on structural equation modeling.

Methods: A retrospective analysis of 900 inpatients with stroke from three large hospitals was performed. AMOS software (version 23.0) was used to construct the structural equation modeling.

Results: The overall model showed a good fit (chi-square = 27.3, root mean square error of approximation = 0.01, standardized root mean square residual = 0.032, comparative fit index = 0.98, and adjusted goodness of fit = 0.94). Structural equation modeling showed that the total effect of dysphagia on the prognosis of patients with stroke was 0.694, with a direct effect of 0.599, accounting for 86.31 % of the total effect. The total indirect effect was 0.095, with the mediating effects of serum albumin level and pneumonia accounting for 6.48 % and 7.35 % of the total effect, respectively. The moderating effects of sex on dysphagia and the relationship between activities of daily living, modified Rankin scale score, and length of hospital stay were insignificant (ΔR² = 0.063, P = 0.145; ΔR² = 0.002, P = 0.620; ΔR² = 0.001, P = 0.307).

Conclusions: Dysphagia can directly affect the prognostic outcomes of patients with stroke and indirectly affect prognosis by triggering pneumonia and lowering albumin levels. Sex was not found to play a moderating role in the relationship between dysphagia and prognosis.

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