Journal of Parenteral and Enteral Nutrition最新文献

Background and aims: Life expectancy for patients with chronic intestinal failure (CIF) recieving home parenteral nutrition (HPN) has improved over the past decades. Consequently, more children on HPN grow into adulthood. Until now, no assessment of transition readiness of these patients exists. Aim is to assess readiness of adolescents recieving HPN.

Methods: This is an international, prospective, cross-sectional multicenter study in collaboration with members of the Intestinal Failure working group-European Reference Network for Rare Inherited and Congenital (Digestive and Gastrointestinal) Anomalies and the Network of Intestinal Failure and Intestinal Transplant in Europe-European Society for Pediatric Gastroenterology Hepatology and Nutrition conducted between April and November 2023. A validated Transition Readiness Assessment Questionnaire was used to measure patient- and parent-reported transition readiness in adolescents on HPN.

Results: A total of 57 participants aged 16 to 24 years were included across eight countries. Patient-reported outcomes show a lack of readiness for transition among the total cohort with 65% scoring below the threshold. Younger patients (aged 16-18 years), male patients, and those in pediatric settings reported significant lower readiness. Parent-reported scores were higher compared with the patient-reported outcomes, reaching the threshold for transition readiness.

Conclusion: The transition readiness of adolescents with CIF receiving HPN presents is proven to be low. This study underscores the necessity for the use of a standardized transition protocol. Emphasizing the importance of successful transition in this vulnerable patient group will enhance the outcomes and independence of adolescents during their transition into the adult healthcare system.

Background: Better understanding the impact of dietetic services on nutrition practices seems required as it may represent an opportunity for optimization in post-cardiac surgery patients. The present study aims to evaluate and compare nutrition practices and clinical outcomes in post-cardiac surgery intensive care unit (ICU) patients with and without dietetic services.

Methods: This is a secondary analysis of a multinational prospective observational study in patients (n = 237) with >72 h of post-cardiac surgical ICU stay with and without dietetic services describing nutrition practices and outcomes up to 12 days after ICU admission.

Results: Dietetic services were available in 61.5% (8 of 13) ICUs (1.0 ± 0.5 full-time equivalents/10 beds). Enteral nutrition was initiated <48 h from ICU admission in 49.6% and 59.1% of patients at sites with vs without dietetic services, respectively. Parenteral nutrition was started within 118.3 ± 56.5 and 131.5 ± 69.2 h at sites with vs without dietetic services, respectively. Energy target (23.7 ± 4.8 vs 24.6 ± 4.8 kcal/kg body weight/day) and actual supply (10.5 ± 6.7 vs 10.3 ± 6.2 kcal/kg body weight/day) did not differ between the groups. Protein targets (1.4 ± 0.4 vs 1.1 ± 1.3 g/kg body weight/day) and actual protein provision (0.6 ± 0.4 vs 0.4 ± 0.3 g/kg body weight/day) were higher in patients at sites with vs without dietetic services.

Conclusion: Improvements in medical nutrition therapy practices in patients after cardiac surgery are needed in ICUs with and without dietetic services. Appropriately staffed dietetic services as essential members of the medical care team may be crucial to transfer knowledge on adequate medical nutrition therapy strategies into practice.

Parenteral nutrition (PN) is essential for patients with chronic intestinal failure but poses significant challenges during pregnancy because of increased nutrition needs and associated risks such as central line-associated bloodstream infections. We report a case of a 29-year-old primigravid woman with Crohn's disease who required chronic PN. Despite these complexities, her pregnancy was managed successfully with tailored PN adjustments. She developed intrahepatic cholestasis of pregnancy at 38 weeks and delivered a healthy, full-term newborn. Meticulous planning and individualized nutrition management are crucial in navigating the complexities of PN during pregnancy, demonstrating the potential for successful outcomes with strategic and personalized interventions.

Background: Patients with critical illness may present with disease-related malnutrition upon intensive care unit (ICU) admission. They are at risk of development and progression of malnutrition over the disease trajectory because of inflammation, dysregulated metabolism, and challenges with feeding.

Methods: The Global Leadership Initiative on Malnutrition (GLIM) convened a panel of 36 clinical nutrition experts to develop consensus-based guidance statements addressing the diagnosis of malnutrition during critical illness using a modified Delphi approach with a requirement of ≥75% agreement.

Results: (1) To identify pre-existing malnutrition, we suggest evaluation within 48 h of ICU admission when feasible (100% agreement) or within 4 days (94% agreement). (2) To identify the development and progression of malnutrition, we suggest re-evaluation of all patients every 7-10 days (97% agreement). (3) To identify progressive loss of muscle mass, we suggest evaluation of muscle mass as soon as feasible (92% agreement) and again after 7-10 days (89% agreement). (4) To identify the development and progression of malnutrition before and after ICU discharge, we suggest re-evaluating nutrition status before ICU discharge and during clinical visits that follow (100% agreement).

Conclusion: Research using consistent etiologic and phenotypic variables offers great potential to assess the efficacy of nutrition interventions for critically ill patients with malnutrition. Assessment of these variables during and beyond the ICU stay will clarify the trajectory of malnutrition and enable exploration of impactful treatment modalities at each juncture. GLIM offers a diagnostic approach that can be used to identify malnutrition in critically ill patients.

Background: Oral intake is the most common route of nutrition following intensive care unit (ICU) discharge; yet is associated with inadequate intake, and barriers are largely unknown. This study aimed to determine the prevalence and severity of symptoms that may impact oral intake (termed nutrition-impacting symptoms) in ICU survivors.

Methods: A single-center descriptive cohort study quantified prevalence and severity of nutrition-impacting symptoms in ICU survivors at ICU (T1) and hospital (T2) discharge and at 1 month posthospital discharge (T3) via patient-reported questionnaires. Secondary outcomes were nutrition status (via Subjective Global Assessment) and energy and protein intakes (via 24-h recall). Data are median (IQR) or (percent).

Results: Forty-nine ICU survivors (64 [51-71] years; 31% female) were included. The most prevalent nutrition-impacting symptoms were T1: tiredness (96%), loss of appetite (82%), and early satiety (82%); T2: tiredness (93%), early satiety (88%), and dry mouth (78%); and T3: tiredness (95%), early satiety (81%), and low mood (66%). Nutrition-impacting symptoms with the greatest severity (out of 10, higher equates to worse) at each time point were T1: tiredness, constipation, diarrhea, nausea (all 8 [5-10]); T2: tiredness and constipation (both 7 [5-8]); and T3: tiredness (6 [3-8]) and diarrhea (6 [2-7]). Malnutrition rates were 34% at T1. Energy and protein intakes were T1: 1046 [548-1481] kcal, 45.2 [23.9-61.0] g; T2: 1370 [958-1962] kcal, 70.9 [39.0-92.2] g; T3: 1580 [1168-2042] kcal, 45.2 [54.6-100.4] g.

Conclusions: ICU survivors experience multiple nutrition-impacting symptoms of varying prevalence and severity, which improve across the post-ICU continuum.