Clinical nutrition ESPEN最新文献

Background & aims: Point-of-care (POCUS) ultrasound measurement of the rectus femoris is a useful tool for diagnosing myopenia. Current literature indicates Dietitians are completing these measurements in research settings with high methodological heterogeneity. We aim to determine the reliability and accuracy of dietitians using ultrasound to measure rectus femoris muscle, after rapid training, compared to sonographers.

Methods: A training program was designed by sonographers and completed by two study dietitians in 12 h. In this prospective cohort study, patients with a diagnosis of chronic liver disease (CLD) were recruited from the outpatient clinics and heathy participants (HP) were opportunistically recruited on-site. Two dietitians and two sonographers marked the ultrasound picture. Thickness, width, circumference and surface area were measured. Inter-rater reliability was presented as an intra class correlation (ICC, 95%CI) for reliability, and Bland-Altman assessment for bias and accuracy.

Results: 42 HP and 18 patients with CLD were recruited. ICC across the four raters, four ultrasound measurements and across BMI and sex ranged from minimum 0.73 (good) to 0.96 (excellent) in accuracy. For rectus femoris thickness, ICC was similar across both groups: 0.88 (95 % CI: 0.82-0.93) in HP and CLD patients 0.86 (95%CI: 0.71-0.94). Bland-Altman for thickness systematic error of differences between dietitians and sonographers was not statistically significant (0.032 cm, p = 0.554).

Conclusion: With a standardised training protocol, ultrasound-naïve dietitians achieved both reliable and accurate ultrasound measurements when compared to sonographers in both healthy participants and patients with CLD. Future research should determine the scalability and generalisability of this training protocol.

Background & aims: Home parenteral nutrition (HPN) is life-sustaining for chronic intestinal failure; however, both intestinal failure itself and the demands of long-term HPN are associated with symptoms, complications and treatment burden that may impair quality of life. This study evaluated health-related QoL (HRQoL) in adults receiving long-term HPN and examined associations with sociodemographic, clinical, biochemical and nutritional factors.

Methods: Baseline data were analysed from a prospective multicentre cohort study across three UK HPN centres. Adults (≥18 years) receiving HPN for benign disease completed the EuroQol-5D-5L (EQ-5D-5L) and Short Form-36 (SF-36) questionnaires. Clinical, sociodemographic, anthropometric and nutritional data were collected. Associations between HRQoL outcomes and candidate predictors were examined using univariate and multivariable regression.

Results: One hundred and eighty-three participants were analysed (median age 61 years; 64% female). Median EQ-5D-5L utility and EQ-VAS scores were 0.49 (IQR 0.22-0.67) and 50 (40-70), respectively. SF-36 scores were markedly impaired across all domains, with lowest medians for physical functioning, role limitations, energy/fatigue and general health (0-30). In multivariable models, higher phase angle independently predicted better role limitations due to physical health (β 13.93, 95% CI 1.13-26.72; p=0.035; R²=0.53). Greater handgrip strength was associated with higher energy/fatigue scores (β 0.62, 95% CI 0.18-1.06; p=0.007; R²=0.25). Employment was strongly associated with emotional wellbeing (employed vs unemployed; β 19.19, 95% CI 9.13-29.26; p<0.001; R²=0.21) and general health (β 20.49, 95% CI 10.66-30.32; p<0.001; R²=0.14). Higher oral dietary energy intake was associated with better social functioning (β 0.02, 95% CI 0.01-0.03; p<0.001). Underlying diagnosis, small bowel length and HPN macronutrient composition showed no consistent relationships.

Conclusion: Adults receiving long-term HPN experience profound impairment in HRQoL, comparable with other high-burden chronic diseases. Variation in QoL was more strongly related to employment, education, muscle strength, oral intake and treatment burden than to diagnosis or HPN composition, highlighting modifiable targets for multidisciplinary care.

Background: Metabolic syndrome (MetS) is a significant public health issue in Chile, affecting approximately 40% of the adult population and increasing the risk of chronic disease. Although evidence from Mediterranean countries has shown benefits of the Mediterranean diet (MedDiet) improving metabolic parameters and reversing MetS, its impact in non-Mediterranean populations remains unclear.

Aim: The CHILEan MEDiterranean (CHILEMED) study is evaluating MetS reversal effectiveness of a MedDiet, with or without well-being support, compared to a low-fat diet.

Methodology: CHILEMED is an ongoing 1-year, parallel-group randomized controlled trial, and this report presents an interim analysis with preliminary findings at 6 months of follow-up. A total of 246 participants (men and women, middle-aged, with comparable baseline cardiometabolic risk profiles) diagnosed with MetS have been assigned to low-fat diet (control), MedDiet, or MedDiet with psychological well-being interventions. Participants received face-to-face and online nutritional counseling specific to their assigned dietary intervention. Clinical assessments, including anthropometry, biochemical parameters, and dietary adherence, were performed at baseline and 6 months. The primary outcome was MetS reversal, while secondary outcomes included changes in dietary adherence and MetS components.

Results: Preliminary analyses of 156 participants completing the 6-month follow-up showed a significantly greater increase in MedDiet adherence in the combined MedDiet (with and without psychological well-being interventions) groups compared with the low-fat diet group. Participants in the MedDiet group showed greater reduction in waist circumference, triglycerides, and glucose levels compared to the low-fat diet group. Notably, 36% of individuals in the MedDiet intervention experienced MetS reversal, compared to only 11% in the low-fat diet group (p < 0.01), with an adjusted hazard ratio of 3.84 for MetS reversal in the MedDiet compared to the control group.

Conclusions: These preliminary 6-month results from the ongoing 1-year randomized CHILEMED trial provides evidence supporting MedDiet's effectiveness in improving metabolic health and reversing MetS in Chilean adults. Given changing dietary patterns and rising prevalence of MetS-related conditions, promoting adherence to MedDiet may be a key strategy for chronic disease management and public health policies in Chile.

Background: Advances in health technology have enabled body composition assessments using smartphone photos, offering an accessible, cost-efficient, and portable alternative that can also be used by non-experts. However, it is essential to provide clarity on their technical development and estimation process for clinicians, researchers, and users.

Aim: Here, we aimed to provide a technical description and guidance on the use and interpretation of a selected artificial intelligence (AI)-based app for body composition estimation.

Methods: We selected one app as a representative for in-depth technical analysis, based on a non-systematic review of scientific databases, developer websites, search engines, and digital marketplaces, to generate insights relevant to similar tools.

Results: MeThreeSixty® app was selected due to its availability and validation for several body composition measures (body fat, fat mass, fat-free mass, and appendicular lean mass). The app integrates advanced technologies, such as three-dimensional (3D) imaging and AI, which improves its accuracy with potential for refinement. It also features a self-assessment function to enhance user accessibility. Early findings indicate the app provides reliable group-level results for body circumference and composition estimations, with refinements needed for individual assessments.

Conclusion: MeThreeSixty app used 3D imaging and AI with acceptable group-level accuracy for estimating body circumference and composition, but limited precision at the individual level requires cautious interpretation. Further prospective validation and model refinement are needed, especially in diverse populations, and using longitudinal datasets before supporting personalized nutrition and broader health platform integration.

Background: A reduced appetite in patients with cognitive impairment may be overlooked due to communication difficulties and lack of appropriate screening tools. For this reason, we developed the Appetite Loss in Older adults with and without Cognitive impairment (ALOC) screening scale.

Aim: The aim of the current study was to validate ALOC tool for use in older patients, aged 65 years and over, with and without cognitive impairment.

Methods: We included hospitalized adults aged 65 and over in a cross-sectional study. Appetite was assessed using ALOC and Council on Nutrition Appetite Questionnaire (CNAQ) scales and cognitive status was screened using Mini Mental State Examination (MMSE).

Results: We included 103 hospitalized older patients (63.1 % of women, mean age 77.8 ± 6.7 years). The moderate to high correlations were found between ALOC scale and the Council of Nutrition Appetite Questionnaire (CNAQ) (rho = -0.814, -0.722 and -0.549, for patients with normal cognitive status, suspected mild cognitive impairment, suspected mild to moderate dementia, respectively). We found that routine nutritional screening or check-up of weight loss provide discordant results to appetite screening using a dedicated ALOC tool.

Conclusion: The ALOC scale is currently the only scale validated for use in patients with diminished cognitive reserves. Using it may facilitate a dialogue on the impact and consequences of appetite loss in older adults and appropriate management.

Lifelong dietary restriction is the main approach to managing classical galactosemia, yet maintaining adherence is challenging and poorly understood. Existing research has focused primarily on metabolic outcomes, with limited synthesis of the behavioral, psychosocial, and healthcare system factors shaping long-term dietary management. This systematic review aimed to identify determinants of dietary adherence in individuals with classical galactosemia and to synthesize these factors using the socio-ecological model to provide a multi-level understanding of influences on adherence. A systematic search of PubMed, Scopus, Web of Science, and Embase was conducted following PRISMA guidelines. Studies examining factors related to dietary management in classical galactosemia were included. Extracted determinants were synthesized narratively and deductively mapped to individual, interpersonal, healthcare system, community, and structural levels of the socio-ecological framework. Study quality was assessed using the JBI critical appraisal tool. Evidence directly examining adherence determinants was limited. However, psychosocial and contextual findings revealed consistent multi-level influences. Individual factors included psychological burden and cognitive challenges; interpersonal influences involved caregiver involvement and family dynamics; healthcare-level determinants related to access to specialist metabolic care and variability in dietary guidance; community factors included barriers to social participation; and structural concerns reflected long-term dependency and support needs. These findings suggest that dietary adherence in classical galactosemia is shaped by interacting ecological influences rather than solely individual behavior. Addressing psychosocial burden, family support, healthcare system consistency, and social participation barriers may be critical for improving long-term dietary management. The scarcity of adherence-focused research highlights the need for theory-informed, multi-level intervention studies in this rare metabolic disorder.

Adherence to home parenteral nutrition (HPN) is rarely quantified by direct monitoring. Leveraging device-recorded, time-stamped telemetry from connected infusion pumps, we evaluated three clinically relevant dimensions of adherence: daily volume delivered, weekly total volume received, and weekly session execution. We analyzed 51 patients. The average number of monitoring days per patient was 48.98 ± 46.34. The prescribed daily volume was 1369.6 ± 463.1 mL. Patient-level means were: daily volume adherence, 92.0 ± 11.7 %; weekly total volume adherence, 70.4 ± 22.7 %; and weekly session adherence, 72.4 ± 25.3 %. Overall, 59.2 % of patients fell below the 80 % threshold for weekly total volume adherence. These findings highlight a clinically meaningful discrepancy: missed sessions, rather than per-infusion inaccuracies, account for the majority of under-delivery in HPN. This underscores the potential utility of real-time telemetry as a tool for identifying and addressing adherence gaps in clinical practice.

Background: Inflammatory bowel diseases (IBD) may be linked to an increased risk of malnutrition. However, no previous population-based study has examined the prevalence and risk factors of malnutrition in the general IBD-population. The aim of this study was to determine the prevalence of malnutrition in outpatients with IBD and identify factors associated with malnutrition.

Methods: A total of 306 IBD outpatients, (142 [46.4 %] with Crohn's disease (CD) and 164 [53.6 %] with ulcerative colitis (UC)) were included in this population-based cross-sectional study (response rate: 76.5 %). Malnutrition was assessed using the Global Leadership Initiative on Malnutrition (GLIM) criteria.

Results: Malnutrition was detected in 36 patients (11.8 %, 95 % CI: 8.2-15.4). The prevalence of malnutrition was significantly higher among women compared to men (16.9 % vs 7.0 %) in both UC and CD. Two variables were identified as independent factors related to malnutrition: disease activity last year (OR: 2.42; 95 % CI: 1.04-5.64, p = 0.040) and female sex (OR: 2.84; 95 % CI: 1.34-6.05, p = 0.007). Higher proportion of patients with active disease according to Patient-Reported Outcome 2 (PRO2) was detected for patients with CD compared to UC (25.4 % vs 14.0 %, p = 0.012). Women with IBD had significantly lower body mass index (BMI) and fat-free mass index (FFMI) compared to men in both diagnoses.

Conclusion: Malnutrition is common among IBD patients, even during remission. Patients with IBD should therefore be screened for malnutrition and risk of malnutrition on a regular basis. Nutritional screening might be particularly important for women and individuals with history of disease activity last year.