Journal of Parenteral and Enteral Nutrition最新文献

Background: Intestinal failure (IF) is a life-limiting condition that includes a variety of intestinal pathologies. Currently, there are few clinical biomarkers that reflect intestinal function or a patient's potential to wean off parenteral nutrition (PN), making it difficult to predict the clinical trajectory. By associating gut microbiome taxonomic and functional features and blood analytes with the proportion of daily energy delivered via PN-a proxy for intestinal function-our study aimed to discover potential predictors of intestinal function and PN weaning potential.

Methods: In this longitudinal multiomics cohort study, we followed 18 pediatric patients with IF and PN support for ≤1.5 years. Fecal and stoma samples were analyzed using metagenomic shotgun sequencing to assess bacterial taxonomy and function and internal transcribed spacer 2 ribosomal RNA sequencing to characterize the fungal community. Targeted metabolomics was used to quantify 257 blood analytes. Linear mixed models were used to analyze the associations of PN dependence with microbiome features and blood analytes.

Results: The bacterial and fungal taxonomic composition exhibited substantial interpatient and intrapatient variability, with no link to PN dependence. In contrast, bacterial functional analysis revealed 63 MetaCyc pathways significantly associated with PN dependence. Additionally, 32 blood analytes were associated with PN dependence.

Conclusion: In this exploratory study, we found that functional microbiome features and blood metabolomic profiles-particularly urea cycle metabolites, creatinine, asparagine, and tryptophan-derived metabolites-show promise for predicting intestinal function. Furthermore, they may have therapeutic implications for promoting intestinal adaptation. Confirmatory trials with larger sample sizes are needed to validate these findings.

Background: Preterm infants are at risk of refeeding syndrome, a constellation of biochemical changes associated with nutrition. We aimed to determine whether increased early phosphate intake with routine biochemical monitoring is associated with a reduction in refeeding syndrome.

Methods: Retrospective cohort study in two Auckland neonatal intensive care units comparing infants born <1000 g before (2014-2018, standard phosphate intake) and after (2020-2021, early phosphate intake) changes to intravenous nutrition protocols that increased phosphate intake and introduced biochemical monitoring. The standard phosphate intake cohort comprised the participants who received placebo in a randomized controlled trial of early increased amino acid intake. The early phosphate intake cohort was identified prospectively. Data were retrieved from the trial database or prospectively from electronic medical records. Groups were compared using either the chi-square test or pooled t test and logistic or multiple logistic regression analysis. Refeeding syndrome was defined as concurrent hypophosphatemia (serum phosphate <1.4 mmol L^-1) and hypercalcemia (serum calcium >2.8 mmol L^-1).

Results: The incidence of refeeding syndrome in the first 5 days after birth decreased from 11.9% to 2.9%, hypophosphatemia from 53.5% to 21.2%, and severe hypophosphatemia (<0.9 mmol L^-1) from 11.3% to 1.2%. Probable early- and late-onset sepsis reduced from 51.4% to 28.2% and from 62.5% to 28.0%, respectively.

Conclusions: Increased early phosphate intake with routine biochemical monitoring is associated with a lower incidence of refeeding syndrome, hypophosphatemia, and associated comorbidities. Whether these associations are causal requires further investigation.

Background: This study aims to evaluate the impact of early enteral nutrition (EEN) compared with late enteral nutrition on clinical outcomes in critically ill children.

Methods: PubMed, Embase, and the Cochrane Library were systematically searched until December 2024. The primary outcome was all-cause mortality, with secondary outcomes including duration of mechanical ventilation and length of stay in the pediatric intensive care unit (PICU) and hospital. The meta-analysis used a random-effects model with inverse variance weighting.

Results: Twenty-one studies (10,006 children) were included. Definitions of EEN varied across studies, ranging from 24 to 72 h. EEN was associated with decreased mortality in both randomized controlled trials (RCTs) (odds ratio [OR] = 0.64; 95% CI, 0.43-0.96; P = 0.03) and observational studies (OR = 0.38; 95% CI, 0.23-0.62; P < 0.001). A sensitivity analysis was conducted by combining studies with similar EEN definitions. EEN initiated within 24 h of PICU admission was not significantly associated with mortality (OR = 0.72; 95% CI, 0.43-1.20; P = 0.21). However, EEN within 48 h was significantly associated with reduced mortality (OR = 0.37; 95% CI, 0.25-0.56; P < 0.001). The certainty of evidence (Grading of Recommendations Assessment, Development and Evaluation) from RCTs was evaluated as low, whereas that from observational studies was evaluated as very low.

Conclusion: The evidence from this study suggests that EEN benefits critically ill children by reducing mortality and shortening hospital stays. However, the high risk of bias and very low certainty of the evidence highlight the need for further research.

Background: Malnutrition or risk of malnutrition is present in about one-third of patients admitted to Western hospitals and is identified by either screening for malnutrition or further nutrition assessment. To date, there are no commonly accepted biomarkers of malnutrition, which could expedite screening efforts, ease diagnosis, and hasten treatment. We aimed to investigate whether metabolomics could identify markers associated with malnutrition in hospitalized patients and performed a retrospective metabolomic cohort study in this patients' group.

Methods: The study population included adult patients hospitalized in a medical unit. Malnutrition was identified by the second step of the Global Leadership Initiative on Malnutrition criteria independently of the outcome of the screening step (nutritional risk screening 2002). Amino acids were determined by targeted metabolomics using gas chromatography-tandem mass spectrometry and liquid chromatography-tandem mass spectrometry. Logistic regression analyses with Benjamini-Hochberg procedure to reduce false discovery rate were used to identify biomarkers associated with malnutrition.

Results: In total, 218 patients were included in the final analysis, with 62 patients having a diagnosis of malnutrition. In crude analyses, 11 metabolites were associated with malnutrition, but further adjustment attenuated the associations. After multiple adjustment, neopterin and cystatin C were positively associated with malnutrition, whereas His, Cys, and kynurenine to tryptophan ratio were negatively associated.

Conclusion: The observed associations require confirmation in a replication cohort before they can be recommended as biomarkers of malnutrition.

Background: The Global Leadership Initiative on Malnutrition (GLIM) proposes a diagnostic process for malnutrition, including initial screening with nutrition screening tools, followed by diagnostic evaluation. This study aimed to compare the performance of GLIM with different nutrition screening tools in predicting 90-day mortality in adults who are critically ill with acute stroke.

Methods: A comparative study was conducted on 308 adults (who critically ill) with acute stroke. Multiple nutrition screening tools were evaluated upon admission. Nutrition status was assessed using GLIM criteria. The predictive performance of GLIM on mortality was analyzed using Cox regression.

Results: The prevalence of malnutrition ranged from 17.86% to 28.25%, depending on the nutrition screening tools used for classification. During 90-day of follow-ups, 112 (36.36%) deaths occurred. GLIM effectively predicted 90-day mortality, with GLIM and the modified Nutritional Risk in the Critically Ill (mNUTRIC) screening demonstrating the best predictive ability [Hazard Ratio: 2.807 (1.816-4.339)].

Conclusion: Malnutrition identified by GLIM with mNUTRIC demonstrates a good ability to predict mortality in critically ill adults with acute stroke. GLIM criteria anticipate mortality and might guide interventions, with important implications for clinical practice and research.

Objective: This study aimed to compare the effects of enteral nutrition (EN) administered via multiroute or via monoroute on metabolic regulation in intestinal ischemia-reperfusion (II/R) injury rat model.

Methods: The rats were divided into sham operation and II/R injury groups. The rats in each group were further treated with either multiroute or monoroute EN. Rats subjected to multiroute EN were administered a continuous infusion of 30 kcal/kg × day of nutrition via a gastric tube and additionally provided with 0.5 g of standard rat forage for oral intake q8h (for a total of approximately 20 kcal/kg × day) each day. Conversely, rats on the monoroute regimen underwent a continuous infusion of 50 kcal/kg × day of EN through a gastric tube. Hypercatabolism was evaluated by assessing skeletal muscle protein synthesis and atrophy, and insulin resistance. Moreover, serum gastrointestinal hormone levels, hypothalamic ghrelin, and neuropeptide pro-opiomelanocortin (POMC) were detected.

Results: In rats subjected to II/R injury, multiroute EN more effectively restored serum and hypothalamic ghrelin levels, decreased the expression of the POMC neuropeptide, decreased skeletal muscle atrophy, and enhanced skeletal muscle synthesis. These effects collectively contributed to a reduction in muscle wasting, an improvement in hypercatabolic status, and a mitigation of body weight loss.

Conclusion: Compared with monoroute nutrition, multiroute EN may further improve hypercatabolic metabolism, reduce muscle wasting, and prevent weight loss in II/R injury rat. This research suggested that an optimized multiroute EN regimen is superior to the monoroute EN approach.

Background: Advanced glycation end-products (AGEs) can enter patients' circulation through exogenous sources, such as enteral nutrition formulae. Circulating AGEs, specifically carboxymethyllysine, can promote insulin resistance and activation of pro-inflammatory pathways leading to oxidative stress, cell death, and organ failure. Suboptimal kidney function increases the risk of elevated circulating AGEs because levels are controlled through urinary excretion. Our aim was to determine associations between carboxymethyllysine intake and glycemic control as well as clinical outcomes in critically ill patients and explore these in the subset of patients with an acute kidney injury (AKI).

Methods: This was a retrospective cohort study. Data were extracted from electronic medical records. Patients were eligible if they were ≥18 years and received enteral nutrition, with known carboxymethyllysine content, for ≥3 days. AKI was defined using the Kidney Disease: Improving Global Outcomes guidelines. Linear and logistic regression models were used to determine adjusted associations.

Results: Between 2015 and 2021, 2636 patients met the eligibility criteria, with 848 (32%) patients having an AKI. Most were male (n = 1752, 67%) with a median (interquartile range) Acute Physiology And Chronic Health Evaluation III score of 59 (45-77). For every 10-μmol increase in carboxymethyllysine provision, mean blood glucose increased by 0.05 mmol (95% CI, 0.03-0.07), and the odds of dying increased by 16% (odds ratio = 1.16; 95% CI, 1.06-1.27). A subgroup analysis indicated these associations persisted in patients with AKI but not in those without.

Conclusion: Carboxymethyllysine intake was associated with increased mean blood glucose and odds of dying in our study cohort.