Sharon Carey PhD, Julia Fox MND, Lina Briek MPH, Chris Walker, Emma Osland MPhil, Morgan Brown MND, Brooke Chapman PhD, Suzie Daniells MSc, Kate Dehlsen BNutDiet, Gil Hardy PhD, Darcy Holt PhD, Juliana Puppi PhD, Katerina Angstmann BNursing, Keats Broom BND, Charmaine Chai MBBS, Pearl Chan MBBS, Peter Cocking MNursing, Tanya Collins GDD, Belinda Errington MBBS, Neal Martin MBBS, Sharifah R. Syed Mustaffa MBBCh, Ola Niewiadomski PhD, Scott Nightingale BMed, Callum B. Pearce MD, Katrina Robertson BNursing, Kenji So MBBS, Wei Ling Teh MBBChir, Melanie Vanderwilk PGDip(Diet), Frank M. P. van Haren PhD, Emma Whelan MND, Darren Wong PhD
Background
Many countries have established national registries monitoring home parenteral nutrition (HPN). This article outlines the development and implementation of a national HPN registry for Australia, including methods, challenges, and initial results.
Methods
Following the establishment of an HPN steering committee, a registry framework was developed with a minimum dataset. During the development phase, key issues were addressed, including resourcing, patient confidentiality, data ownership and access, and ethics requirements. Development encompassed extensive clinician and consumer engagement. The first year of data collection was 2024.
Results
A three-tiered registry was developed including (1) service-level, (2) patient-level, and (3) quality of life (QOL)/patient-reported data, with key quality indicators within each tier. The first year of data collection saw all 29 HPN sites across Australia contribute to service-level data entry, indicating Australia has a total of 244 adults and 84 children currently receiving HPN ± intravenous fluids (IVF) and an additional 39 people receiving IVF alone. Nine sites (n = 107) contributed to patient-level data collection, with a line infection rate equivalent to 0.83 line infections per 1000 days and an average hospital admission rate of 1.38 per patient per year. Tier 3 was out of scope for the first year.
Conclusion
Development of a national HPN registry in Australia has allowed accurate recording of HPN usage and resourcing allocation. National registry development is complex, requiring extensive clinician commitment, particularly when financial support was not available to aid registry development and management. Both this and heterogeneous ethics approval requirements were major barriers.
{"title":"National Australian home parenteral nutrition registry: Development process and initial data insights","authors":"Sharon Carey PhD, Julia Fox MND, Lina Briek MPH, Chris Walker, Emma Osland MPhil, Morgan Brown MND, Brooke Chapman PhD, Suzie Daniells MSc, Kate Dehlsen BNutDiet, Gil Hardy PhD, Darcy Holt PhD, Juliana Puppi PhD, Katerina Angstmann BNursing, Keats Broom BND, Charmaine Chai MBBS, Pearl Chan MBBS, Peter Cocking MNursing, Tanya Collins GDD, Belinda Errington MBBS, Neal Martin MBBS, Sharifah R. Syed Mustaffa MBBCh, Ola Niewiadomski PhD, Scott Nightingale BMed, Callum B. Pearce MD, Katrina Robertson BNursing, Kenji So MBBS, Wei Ling Teh MBBChir, Melanie Vanderwilk PGDip(Diet), Frank M. P. van Haren PhD, Emma Whelan MND, Darren Wong PhD","doi":"10.1002/jpen.70027","DOIUrl":"10.1002/jpen.70027","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many countries have established national registries monitoring home parenteral nutrition (HPN). This article outlines the development and implementation of a national HPN registry for Australia, including methods, challenges, and initial results.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Following the establishment of an HPN steering committee, a registry framework was developed with a minimum dataset. During the development phase, key issues were addressed, including resourcing, patient confidentiality, data ownership and access, and ethics requirements. Development encompassed extensive clinician and consumer engagement. The first year of data collection was 2024.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A three-tiered registry was developed including (1) service-level, (2) patient-level, and (3) quality of life (QOL)/patient-reported data, with key quality indicators within each tier. The first year of data collection saw all 29 HPN sites across Australia contribute to service-level data entry, indicating Australia has a total of 244 adults and 84 children currently receiving HPN ± intravenous fluids (IVF) and an additional 39 people receiving IVF alone. Nine sites (<i>n</i> = 107) contributed to patient-level data collection, with a line infection rate equivalent to 0.83 line infections per 1000 days and an average hospital admission rate of 1.38 per patient per year. Tier 3 was out of scope for the first year.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Development of a national HPN registry in Australia has allowed accurate recording of HPN usage and resourcing allocation. National registry development is complex, requiring extensive clinician commitment, particularly when financial support was not available to aid registry development and management. Both this and heterogeneous ethics approval requirements were major barriers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"97-105"},"PeriodicalIF":4.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145498089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arjun N. Bhatt BS, Rhyan Bingham DO, Philippe Gaillard PhD, Brian K. Stansfield MD
Background
Fortification of human milk is necessary for preterm infant growth. We evaluated the impact of an acidified human milk fortifier and nonacidified human milk fortifiers on growth velocity in preterm infants.
Methods
This retrospective, single-center study compared preterm infants (N = 375) receiving either acidified human milk fortifier (n = 163) or a combination of standard-protein and high-protein human milk fortifier (n = 212) in a tertiary neonatal intensive care unit. Infants with a birth weight of 500–1800 g and feeding initiation by day of life 7 were eligible for inclusion. The coprimary outcome was weight velocity (g/kg/day) at day of life 28 and 36 weeks' postmenstrual age. Multivariable linear regression model for the coprimary outcomes and growth-related secondary outcomes were adjusted for gestational age, birth weight, sex, and race.
Results
Infants receiving standard-protein/high-protein human milk fortifiers demonstrated higher weight velocity at day of life 28 (12.09 ± 3.27 vs 10.92 ± 3.06 g/kg/day, P < 0.001) and 36 weeks' postmenstrual age (13.31 ± 2.23 vs 12.67 ± 2.28 g/kg/day, P = 0.02) compared with those receiving acidified human milk fortifier. Length velocity at day of life 28 was greater in the standard-protein/high-protein group (1.09 ± 0.54 vs 0.97 ± 0.43 cm/week, P = 0.02) but not at 36 weeks' postmenstrual age (P = 0.06). Human milk exposure and incidence of comorbidities were similar between groups.
Conclusions
Standard- and high-protein human milk fortifiers were associated with improved weight and length growth in preterm infants.
{"title":"Association between nonacidified standard and high-protein human milk fortifiers and increased weight velocity relative to acidified human milk fortifiers in preterm infants: A retrospective cohort study","authors":"Arjun N. Bhatt BS, Rhyan Bingham DO, Philippe Gaillard PhD, Brian K. Stansfield MD","doi":"10.1002/jpen.70026","DOIUrl":"10.1002/jpen.70026","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fortification of human milk is necessary for preterm infant growth. We evaluated the impact of an acidified human milk fortifier and nonacidified human milk fortifiers on growth velocity in preterm infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective, single-center study compared preterm infants (<i>N</i> = 375) receiving either acidified human milk fortifier (<i>n</i> = 163) or a combination of standard-protein and high-protein human milk fortifier (<i>n</i> = 212) in a tertiary neonatal intensive care unit. Infants with a birth weight of 500–1800 g and feeding initiation by day of life 7 were eligible for inclusion. The coprimary outcome was weight velocity (g/kg/day) at day of life 28 and 36 weeks' postmenstrual age. Multivariable linear regression model for the coprimary outcomes and growth-related secondary outcomes were adjusted for gestational age, birth weight, sex, and race.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Infants receiving standard-protein/high-protein human milk fortifiers demonstrated higher weight velocity at day of life 28 (12.09 ± 3.27 vs 10.92 ± 3.06 g/kg/day, <i>P</i> < 0.001) and 36 weeks' postmenstrual age (13.31 ± 2.23 vs 12.67 ± 2.28 g/kg/day, <i>P</i> = 0.02) compared with those receiving acidified human milk fortifier. Length velocity at day of life 28 was greater in the standard-protein/high-protein group (1.09 ± 0.54 vs 0.97 ± 0.43 cm/week, <i>P</i> = 0.02) but not at 36 weeks' postmenstrual age (<i>P</i> = 0.06). Human milk exposure and incidence of comorbidities were similar between groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Standard- and high-protein human milk fortifiers were associated with improved weight and length growth in preterm infants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"48-55"},"PeriodicalIF":4.1,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aspenjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145508694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mary Beth Hovda Davis PhD, Valerie Boebel Toly PhD, Erin Weber MSN, Riad Rahhal MD, Ann Marie McCarthy PhD
Background
Children with intestinal failure have significant long-term medical needs that require continual complex procedures provided by the family caregiver in the home. This contributes to a high burden of care, leading to increased stress, anxiety, and depression. Understanding caregivers' perceptions of the homecare experience will augment healthcare providers' knowledge of how to prepare a family to provide care in the home setting.
Methods
This study focused on the caregiving experience by examining the current literature. A scoping review was conducted using the Arksey and O'Malley methodology. Comprehensive searches on the caregiver of a child with intestinal failure receiving home parenteral nutrition were conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Embase. Two reviewers screened the abstracts by title and abstract. One reviewer extracted then descriptively and thematically analyzed data to map the current evidence.
Results
The initial search yielded 313 total articles. After inclusion and exclusion criteria were applied, a total of 15 relevant articles were included. Of the 15 studies, 5 studies described the caregiver's quality of life, 5 studies described caregiver's discharge preparedness, 3 studies discussed caregiver well-being (stress, anxiety, and depression), and 2 studies described the caregiver daily experience of providing care.
Conclusion
Preparing families to care for children with intestinal failure in the home may bolster caregiver preparedness but also impose a significant burden. Developing programs that offer optimal training, support, and interventions for caregivers can help alleviate stress and improve outcomes for both children and their families.
{"title":"Caring for the child with intestinal failure on home parenteral nutrition: A scoping review","authors":"Mary Beth Hovda Davis PhD, Valerie Boebel Toly PhD, Erin Weber MSN, Riad Rahhal MD, Ann Marie McCarthy PhD","doi":"10.1002/jpen.70028","DOIUrl":"10.1002/jpen.70028","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Children with intestinal failure have significant long-term medical needs that require continual complex procedures provided by the family caregiver in the home. This contributes to a high burden of care, leading to increased stress, anxiety, and depression. Understanding caregivers' perceptions of the homecare experience will augment healthcare providers' knowledge of how to prepare a family to provide care in the home setting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study focused on the caregiving experience by examining the current literature. A scoping review was conducted using the Arksey and O'Malley methodology. Comprehensive searches on the caregiver of a child with intestinal failure receiving home parenteral nutrition were conducted in PubMed, Cumulative Index to Nursing and Allied Health Literature, Scopus, and Embase. Two reviewers screened the abstracts by title and abstract. One reviewer extracted then descriptively and thematically analyzed data to map the current evidence.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The initial search yielded 313 total articles. After inclusion and exclusion criteria were applied, a total of 15 relevant articles were included. Of the 15 studies, 5 studies described the caregiver's quality of life, 5 studies described caregiver's discharge preparedness, 3 studies discussed caregiver well-being (stress, anxiety, and depression), and 2 studies described the caregiver daily experience of providing care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Preparing families to care for children with intestinal failure in the home may bolster caregiver preparedness but also impose a significant burden. Developing programs that offer optimal training, support, and interventions for caregivers can help alleviate stress and improve outcomes for both children and their families.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"26-38"},"PeriodicalIF":4.1,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aspenjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145461099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeewanadee Hettiarachchi APD, PhD, Esmee M. Reijnierse PhD, Andrea B. Maier MD, PhD, Kate Fetterplace APD, PhD
{"title":"Response to “Energy and protein intake adequacy in geriatric rehabilitation inpatients: A descriptive cohort study”","authors":"Jeewanadee Hettiarachchi APD, PhD, Esmee M. Reijnierse PhD, Andrea B. Maier MD, PhD, Kate Fetterplace APD, PhD","doi":"10.1002/jpen.70029","DOIUrl":"10.1002/jpen.70029","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"11-12"},"PeriodicalIF":4.1,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145433682","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Nutrition care is increasingly integrated into multimodal patient management. This study aimed to describe the evolution of ambulatory nutrition support in outpatients aged ≥15 years in France, including oral nutrition supplements and enteral and parenteral nutrition.
Materials and Methods
We conducted a nationwide population-based descriptive cohort study using data from the French National Health System (SNDS), covering nearly the entire French population. All adolescents and adults who received at least one nutrition support product between 2013 and 2023 were included. Repeated cross-sectional analyses were used to assess the number of users and their sociodemographic characteristics (sex, age, deprivation index, region).
Results
Between 2013 and 2023, the number of oral nutritional supplements and enteral nutrition users increased significantly, with annual variation in use of 4.7% (95% CI [4.0–5.4]) and 4.2% (95% CI [3.6–4.8]), reaching 1,426,827 and 44,663 users in 2023, respectively. In contrast, parenteral nutrition use declined (annual variation in use of −2.9%, 95% CI [−4.3 to −1.4]) to 16,445 users in 2023. Mean age was 70.7 for oral nutritional supplements, 60.6 for enteral nutrition, and 66.5 for parenteral nutrition users. A notable rise was observed in the use of high-protein, high-energy (HP-HE) products across all support types, and in parenteral nutrition with omega-3.
Conclusion
This large real-world study offers the first national overview of outpatient artificial nutrition support in France, highlighting growing use of oral nutritional supplements and enteral nutrition and changing trends in product types over the last decade.
{"title":"Ambulatory artificial nutrition support use in adolescents and adults: A nationwide population-based descriptive cohort study","authors":"Claire Rives-Lange MD, PhD, David Desplas MSc, Mahmoud Zureik MD, PhD","doi":"10.1002/jpen.70022","DOIUrl":"10.1002/jpen.70022","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Nutrition care is increasingly integrated into multimodal patient management. This study aimed to describe the evolution of ambulatory nutrition support in outpatients aged ≥15 years in France, including oral nutrition supplements and enteral and parenteral nutrition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>We conducted a nationwide population-based descriptive cohort study using data from the French National Health System (SNDS), covering nearly the entire French population. All adolescents and adults who received at least one nutrition support product between 2013 and 2023 were included. Repeated cross-sectional analyses were used to assess the number of users and their sociodemographic characteristics (sex, age, deprivation index, region).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2013 and 2023, the number of oral nutritional supplements and enteral nutrition users increased significantly, with annual variation in use of 4.7% (95% CI [4.0–5.4]) and 4.2% (95% CI [3.6–4.8]), reaching 1,426,827 and 44,663 users in 2023, respectively. In contrast, parenteral nutrition use declined (annual variation in use of −2.9%, 95% CI [−4.3 to −1.4]) to 16,445 users in 2023. Mean age was 70.7 for oral nutritional supplements, 60.6 for enteral nutrition, and 66.5 for parenteral nutrition users. A notable rise was observed in the use of high-protein, high-energy (HP-HE) products across all support types, and in parenteral nutrition with omega-3.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This large real-world study offers the first national overview of outpatient artificial nutrition support in France, highlighting growing use of oral nutritional supplements and enteral nutrition and changing trends in product types over the last decade.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"67-76"},"PeriodicalIF":4.1,"publicationDate":"2025-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145396179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yanhui Yang MD, Jian Hu MD, Songchun Liu MD, Zhibo Zou MD
Background
The impact of malnutrition coexisting with obesity on mortality risk in community-dwelling adults remains incompletely understood. This study aimed to examine the individual and combined effects of malnutrition and obesity on the risk of all-cause and cardiovascular disease (CVD) mortality in US adults.
Methods
We performed a cross-sectional study examining the association between malnutrition and obesity, as measured by the Controlling Nutritional Status score and body mass index, with all-cause and CVD mortality in 28,202 adults using data from the 1999–2018 National Health and Nutrition Examination Survey. Participants were categorized into four groups: nourished and nonobese, nourished and obese, malnourished and nonobese, and malnourished and obese.
Results
The prevalence of any degrees of malnutrition and moderate-to-severe malnutrition were 14.03% and 0.16%, respectively. During a median follow-up time of 123 months, 6.19% participants died, of which 28.05% were CVD deaths. Compared with the reference group, the hazard ratios (HRs) of all-cause mortality were 1.58 (95% confidence interval [CI], 1.34–1.86) for the malnourished and nonobese group, 1.03 (95% CI, 0.91–1.16) for the nourished and obese group, and 1.30 (95% CI, 1.06–1.59) for the malnourished and obese group. The HRs of CVD mortality were 1.61 (95% CI, 1.21–2.14) for the malnourished and nonobese group, 1.23 (95% CI, 0.98–1.55) for the nourished and obese group, and 2.09 (95% CI, 1.41–3.10) for the malnourished and obese group.
Conclusion
Malnutrition increases mortality risk regardless of weight status, highlighting the importance of nutrition assessment even in individuals with obesity.
{"title":"Association between nutrition and weight status and mortality among adults: A cross-sectional study","authors":"Yanhui Yang MD, Jian Hu MD, Songchun Liu MD, Zhibo Zou MD","doi":"10.1002/jpen.70024","DOIUrl":"10.1002/jpen.70024","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The impact of malnutrition coexisting with obesity on mortality risk in community-dwelling adults remains incompletely understood. This study aimed to examine the individual and combined effects of malnutrition and obesity on the risk of all-cause and cardiovascular disease (CVD) mortality in US adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a cross-sectional study examining the association between malnutrition and obesity, as measured by the Controlling Nutritional Status score and body mass index, with all-cause and CVD mortality in 28,202 adults using data from the 1999–2018 National Health and Nutrition Examination Survey. Participants were categorized into four groups: nourished and nonobese, nourished and obese, malnourished and nonobese, and malnourished and obese.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The prevalence of any degrees of malnutrition and moderate-to-severe malnutrition were 14.03% and 0.16%, respectively. During a median follow-up time of 123 months, 6.19% participants died, of which 28.05% were CVD deaths. Compared with the reference group, the hazard ratios (HRs) of all-cause mortality were 1.58 (95% confidence interval [CI], 1.34–1.86) for the malnourished and nonobese group, 1.03 (95% CI, 0.91–1.16) for the nourished and obese group, and 1.30 (95% CI, 1.06–1.59) for the malnourished and obese group. The HRs of CVD mortality were 1.61 (95% CI, 1.21–2.14) for the malnourished and nonobese group, 1.23 (95% CI, 0.98–1.55) for the nourished and obese group, and 2.09 (95% CI, 1.41–3.10) for the malnourished and obese group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Malnutrition increases mortality risk regardless of weight status, highlighting the importance of nutrition assessment even in individuals with obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"106-113"},"PeriodicalIF":4.1,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145357475","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Deniz Yaprak MD, Mina Mısırlıgil MD, Belma Saygılı Karagöl MD, Gökçe Çiçek Karaman MD
Background
Freezing human milk for long periods may reduce its antibacterial properties. We assessed antimicrobial effects of human milk against Escherichia coli after 6 months of freezing and to explore daily variations in both fresh and frozen milk to optimize storage protocols.
Methods
A study analyzed 60 breast milk samples from 30 healthy mothers with infants aged 15–30 days, conducted from February to May 2025. The human milk expressed during the daytime and at nighttime was tested for antimicrobial effects against E coli. Fresh samples were analyzed within 24 h, and frozen samples were stored at −80°C for 6 months. Bacterial growth was assessed by diluting milk with E coli, and statistics were calculated using colony counts on MacConkey agar.
Results
Fresh human milk had a median E coli count of 6.5, much lower than 225 in frozen samples stored for 6 months (P < 0.001), showing a 97.1% drop in antimicrobial quality. Daytime frozen samples had lower microbial counts (median 95) than nighttime samples (median 120, P = 0.006). Higher nighttime counts appeared in frozen samples from primiparous women, cesarean deliveries, and male infants. Maternal age correlated positively with daytime frozen milk microbial counts (r = 0.421, P = 0.021), whereas gestational age correlated negatively with counts in both daytime (r = −0.583, P < 0.001) and nighttime samples (r = −0.562, P = 0.001).
Conclusion
Frozen human milk samples substantially lose antibacterial properties after 6 months, with variations influenced by time of day. Samples from primiparous, breastfeeding, male sex infants and those who had cesarean deliveries show diurnal variations following the cryopreservation process.
{"title":"Diurnal variation of microbial colony counts in frozen human milk: An experimental study","authors":"Deniz Yaprak MD, Mina Mısırlıgil MD, Belma Saygılı Karagöl MD, Gökçe Çiçek Karaman MD","doi":"10.1002/jpen.70023","DOIUrl":"10.1002/jpen.70023","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Freezing human milk for long periods may reduce its antibacterial properties. We assessed antimicrobial effects of human milk against <i>Escherichia coli</i> after 6 months of freezing and to explore daily variations in both fresh and frozen milk to optimize storage protocols.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A study analyzed 60 breast milk samples from 30 healthy mothers with infants aged 15–30 days, conducted from February to May 2025. The human milk expressed during the daytime and at nighttime was tested for antimicrobial effects against <i>E</i> coli. Fresh samples were analyzed within 24 h, and frozen samples were stored at −80°C for 6 months. Bacterial growth was assessed by diluting milk with <i>E coli</i>, and statistics were calculated using colony counts on MacConkey agar.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fresh human milk had a median <i>E coli</i> count of 6.5, much lower than 225 in frozen samples stored for 6 months (<i>P</i> < 0.001), showing a 97.1% drop in antimicrobial quality. Daytime frozen samples had lower microbial counts (median 95) than nighttime samples (median 120, <i>P</i> = 0.006). Higher nighttime counts appeared in frozen samples from primiparous women, cesarean deliveries, and male infants. Maternal age correlated positively with daytime frozen milk microbial counts (<i>r</i> = 0.421, <i>P</i> = 0.021), whereas gestational age correlated negatively with counts in both daytime (<i>r</i> = −0.583, <i>P</i> < 0.001) and nighttime samples (<i>r</i> = −0.562, <i>P</i> = 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Frozen human milk samples substantially lose antibacterial properties after 6 months, with variations influenced by time of day. Samples from primiparous, breastfeeding, male sex infants and those who had cesarean deliveries show diurnal variations following the cryopreservation process.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"114-120"},"PeriodicalIF":4.1,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jinjiu Hu BS, Hangyang Li BS, Ziyang Wang MS, Jinsong Zeng BS, Xin Wan BS, Hui Zhang MS, Qiao Shen PhD, Ye Cai BS, Yuqian Meng MS, Peng Liu BS, Xianlan Zheng MS
Children in pediatric intensive care units (PICUs) often experience forced interruptions of enteral nutrition (EN), which can worsen malnutrition. This systematic review aims to assess the prevalence, causes, and clinical consequences of EN interruptions (ENIs) in critically ill children admitted to the PICU. For this review, literature searches were performed in the Web of Science, PubMed, Embase, Cochrane Library, Medline, CNKI, and WanFang Data databases. Studies included those that were cohort, case-control, or cross-sectional designs and were published from the inception of each database to February 2025. Sixteen studies were included, including 14 cohort and 2 cross-sectional studies, involving 4325 children. Thirteen studies reported on the prevalence of ENI, with an overall prevalence of 52.8% (95% CI, 0.415–0.638) for the random-effects combination and high heterogeneity (I² = 94.64%, P < 0.001). Twelve studies detailed the reasons for interruptions, and the three most common reasons were intra-PICU procedures, surgery, and feeding intolerance, with median prevalences of 34.4%, 23.2%, and 19.8%, respectively. Six studies described the impact on clinical outcomes for children. Some results showed that ENI may be associated with a longer PICU stay for critically ill children by 7.02 days (95% CI, 1.16–12.88), with high heterogeneity (I2 = 87.7%; P < 0.001). More than half of PICU children experience ENIs; however, the extreme heterogeneity hinders the meaningful interpretation of the pooled indices. We therefore recommend standardizing the methodology to conduct future internationally representative studies, providing data support for future systematic reviews.
{"title":"Impact of enteral nutrition interruption in critically ill children: A systematic review and meta-analysis","authors":"Jinjiu Hu BS, Hangyang Li BS, Ziyang Wang MS, Jinsong Zeng BS, Xin Wan BS, Hui Zhang MS, Qiao Shen PhD, Ye Cai BS, Yuqian Meng MS, Peng Liu BS, Xianlan Zheng MS","doi":"10.1002/jpen.70021","DOIUrl":"10.1002/jpen.70021","url":null,"abstract":"<p>Children in pediatric intensive care units (PICUs) often experience forced interruptions of enteral nutrition (EN), which can worsen malnutrition. This systematic review aims to assess the prevalence, causes, and clinical consequences of EN interruptions (ENIs) in critically ill children admitted to the PICU. For this review, literature searches were performed in the Web of Science, PubMed, Embase, Cochrane Library, Medline, CNKI, and WanFang Data databases. Studies included those that were cohort, case-control, or cross-sectional designs and were published from the inception of each database to February 2025. Sixteen studies were included, including 14 cohort and 2 cross-sectional studies, involving 4325 children. Thirteen studies reported on the prevalence of ENI, with an overall prevalence of 52.8% (95% CI, 0.415–0.638) for the random-effects combination and high heterogeneity (<i>I</i>² = 94.64%, <i>P</i> < 0.001). Twelve studies detailed the reasons for interruptions, and the three most common reasons were intra-PICU procedures, surgery, and feeding intolerance, with median prevalences of 34.4%, 23.2%, and 19.8%, respectively. Six studies described the impact on clinical outcomes for children. Some results showed that ENI may be associated with a longer PICU stay for critically ill children by 7.02 days (95% CI, 1.16–12.88), with high heterogeneity (<i>I</i><sup>2</sup> = 87.7%; <i>P</i> < 0.001). More than half of PICU children experience ENIs; however, the extreme heterogeneity hinders the meaningful interpretation of the pooled indices. We therefore recommend standardizing the methodology to conduct future internationally representative studies, providing data support for future systematic reviews.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"13-25"},"PeriodicalIF":4.1,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338473","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extracorporeal life support is influenced by membrane integrity and nutrition. The impact of parenteral nutrition with lipid injectable emulsions on membrane function remains uncertain.
Methods
This retrospective cohort included 151 critically ill adults receiving extracorporeal life support at a single center. Patients were classified based on exposure to parenteral nutrition: those exposed to parenteral nutrition (n = 38, 25%) and those not exposed to parenteral nutrition (n = 113, 75%). Data included demographics, clinical, biochemical, and extracorporeal membrane oxygenation–related variables. Our primary outcome was time to first extracorporeal membrane oxygenation circuit dysfunction; secondary outcomes were extracorporeal life support duration, metabolic changes, and transfusion needs, analyzed with Kaplan-Meier curves and Cox models.
Results
Extracorporeal membrane oxygenation circuit life span was similar between groups (8.5 vs 7 days, P = 0.079). Replacement occurred in 18 patients (11.9%): 7 (18.4%) with parenteral nutrition and 11 (9.7%) without. Multivariate analysis showed a hazard ratio (HR) of 2.35 for membrane replacement in parenteral nutrition patients (CI 0.71–7.69, P = 0.157). The parenteral nutrition group had higher D-dimer (3470 vs 650 ng/ml, P = 0.06), lower fibrinogen (159 vs 308 mg/dl, P = 0.05), longer extracorporeal life support (10 vs 7 days, P = 0.047). Parenteral nutrition was also linked to elevated peak triglycerides (352 vs 261 mg/dl, P < 0.01) and lower HDL (14.5 vs 22 mg/dl, P < 0.01). However, these metabolic changes did not significantly impact membrane replacement (HR 0.99, CI 0.99–1.00, P = 0.817).
Conclusions
Although membrane dysfunction seemed more frequent in the parenteral nutrition group, evidence was insufficient to confirm an association, underscoring the need for further research.
背景：体外生命支持受膜完整性和营养的影响。脂质注射乳剂肠外营养对膜功能的影响尚不确定。方法：该回顾性队列包括151名在单一中心接受体外生命支持的危重成人。患者根据肠外营养的暴露程度进行分类：接受肠外营养的患者（n = 38, 25%）和未接受肠外营养的患者（n = 113, 75%）。数据包括人口统计学、临床、生化和体外膜氧合相关变量。我们的主要观察指标是首次出现体外膜氧合回路功能障碍的时间；次要结局为体外生命支持持续时间、代谢变化和输血需求，采用Kaplan-Meier曲线和Cox模型进行分析。结果：两组体外膜氧合回路寿命相近（8.5 d vs 7 d, P = 0.079）。18例患者（11.9%）发生了肠外营养替代，其中7例（18.4%）给予肠外营养，11例（9.7%）未给予肠外营养。多因素分析显示，肠外营养患者的膜置换风险比（HR）为2.35 （CI 0.71-7.69, P = 0.157）。肠外营养组d -二聚体较高（3470 vs 650 ng/ml, P = 0.06），纤维蛋白原较低（159 vs 308 mg/dl, P = 0.05），体外生命维持时间较长（10 vs 7天，P = 0.047）。肠外营养也与甘油三酯峰值升高有关（352 vs 261 mg/dl）。结论：尽管肠外营养组的膜功能障碍似乎更常见，但证据不足以证实两者之间的联系，强调需要进一步的研究。
{"title":"Association between parenteral nutrition and extracorporeal membrane oxygenation circuit dysfunction in critically ill adults requiring extracorporeal life support: A retrospective cohort study","authors":"Sergio Linares-Peña MD, Claudia Poveda-Henao MD, Lina Saucedo-Jaramillo MD, Jenny Paola Garzón-Ruiz MS, Lina Lasso-Ossa MD, Catalina Florez-Navas MD, Gloria Rodriguez-Torres MS, Henry Robayo-Amortegui MD","doi":"10.1002/jpen.70018","DOIUrl":"10.1002/jpen.70018","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Extracorporeal life support is influenced by membrane integrity and nutrition. The impact of parenteral nutrition with lipid injectable emulsions on membrane function remains uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort included 151 critically ill adults receiving extracorporeal life support at a single center. Patients were classified based on exposure to parenteral nutrition: those exposed to parenteral nutrition (<i>n</i> = 38, 25%) and those not exposed to parenteral nutrition (<i>n</i> = 113, 75%). Data included demographics, clinical, biochemical, and extracorporeal membrane oxygenation–related variables. Our primary outcome was time to first extracorporeal membrane oxygenation circuit dysfunction; secondary outcomes were extracorporeal life support duration, metabolic changes, and transfusion needs, analyzed with Kaplan-Meier curves and Cox models.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Extracorporeal membrane oxygenation circuit life span was similar between groups (8.5 vs 7 days, <i>P</i> = 0.079). Replacement occurred in 18 patients (11.9%): 7 (18.4%) with parenteral nutrition and 11 (9.7%) without. Multivariate analysis showed a hazard ratio (HR) of 2.35 for membrane replacement in parenteral nutrition patients (CI 0.71–7.69, <i>P</i> = 0.157). The parenteral nutrition group had higher D-dimer (3470 vs 650 ng/ml, <i>P</i> = 0.06), lower fibrinogen (159 vs 308 mg/dl, <i>P</i> = 0.05), longer extracorporeal life support (10 vs 7 days, <i>P</i> = 0.047). Parenteral nutrition was also linked to elevated peak triglycerides (352 vs 261 mg/dl, <i>P</i> < 0.01) and lower HDL (14.5 vs 22 mg/dl, <i>P</i> < 0.01). However, these metabolic changes did not significantly impact membrane replacement (HR 0.99, CI 0.99–1.00, <i>P</i> = 0.817).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Although membrane dysfunction seemed more frequent in the parenteral nutrition group, evidence was insufficient to confirm an association, underscoring the need for further research.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"88-96"},"PeriodicalIF":4.1,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145260551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Oxylipins, synthesized through the oxidation of polyunsaturated fatty acids (PUFAs), are bioactive downstream lipid mediators that play crucial roles in proinflammatory responses and potential cytotoxicity. Infants received PUFAs from breast milk or formula. This study aimed to describe the oxylipin profile of preterm infants receiving enteral PUFA feeding.
Methods
Twenty-seven preterm infants born at 30–34 weeks of gestation were included. Weekly PUFA intake from breast milk and formula was quantified for 4 weeks, and plasma oxylipin levels were measured on postnatal days 7, 14, 21, and 28 using ultrahigh-performance liquid chromatography mass spectroscopy. Associations between PUFA intake and oxylipins were analyzed using marginal structural models with inverse probability weighting.
Results
Weekly PUFA intake exhibited dynamic changes, with ω-6 linoleic acid (LA) and alpha-linolenic acid (ALA) peaking at Week 2, arachidonic acid (AA) increasing steadily, eicosapentaenoic acid (EPA) rising gradually, and docosahexaenoic acid (DHA) increasing sharply before plateauing. LA-derived oxylipins remained relatively stable, with nominal positive associations that lost significance after multiple testing correction. AA-derived oxylipins several hydroxy-eicosatetraenoic acids exhibited strong inverse correlations with AA intake, maintaining significance after false discovery rate adjustment. DHA-derived oxylipins, including 19,20- epoxy docosapentaenoic acid and several hydroxy-docosahexaenoic acids, consistently demonstrated inverse associations with DHA intake, with all retaining significance postadjustment.
Conclusion
This study demonstrates that the composition of dietary PUFA intake from enteral feeding can influence the oxylipin profile in preterm infants. Negative correlations were identified between AA- and DHA-derived oxylipins and their respective intakes, although the magnitude of change was notably minimal.
{"title":"Association between polyunsaturated fatty acid intake and plasma oxylipin profiles in preterm infants: A retrospective cohort study","authors":"Hiroki Suganuma MD, PhD, Naho Ikeda MD, PhD, Natsuki Ohkawa MD, PhD, Naoko Kaga PhD, Hikari Taka PhD, Yoshiki Miura PhD, Hiromichi Shoji MD, PhD","doi":"10.1002/jpen.70020","DOIUrl":"10.1002/jpen.70020","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Oxylipins, synthesized through the oxidation of polyunsaturated fatty acids (PUFAs), are bioactive downstream lipid mediators that play crucial roles in proinflammatory responses and potential cytotoxicity. Infants received PUFAs from breast milk or formula. This study aimed to describe the oxylipin profile of preterm infants receiving enteral PUFA feeding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Twenty-seven preterm infants born at 30–34 weeks of gestation were included. Weekly PUFA intake from breast milk and formula was quantified for 4 weeks, and plasma oxylipin levels were measured on postnatal days 7, 14, 21, and 28 using ultrahigh-performance liquid chromatography mass spectroscopy. Associations between PUFA intake and oxylipins were analyzed using marginal structural models with inverse probability weighting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Weekly PUFA intake exhibited dynamic changes, with ω-6 linoleic acid (LA) and alpha-linolenic acid (ALA) peaking at Week 2, arachidonic acid (AA) increasing steadily, eicosapentaenoic acid (EPA) rising gradually, and docosahexaenoic acid (DHA) increasing sharply before plateauing. LA-derived oxylipins remained relatively stable, with nominal positive associations that lost significance after multiple testing correction. AA-derived oxylipins several hydroxy-eicosatetraenoic acids exhibited strong inverse correlations with AA intake, maintaining significance after false discovery rate adjustment. DHA-derived oxylipins, including 19,20- epoxy docosapentaenoic acid and several hydroxy-docosahexaenoic acids, consistently demonstrated inverse associations with DHA intake, with all retaining significance postadjustment.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study demonstrates that the composition of dietary PUFA intake from enteral feeding can influence the oxylipin profile in preterm infants. Negative correlations were identified between AA- and DHA-derived oxylipins and their respective intakes, although the magnitude of change was notably minimal.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 1","pages":"39-47"},"PeriodicalIF":4.1,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145254271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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