Junzhuo Li MD, Xin Li MD, Jiajia Yang MD, Yaqi Wang MD, Wenmei Gong MD
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.
{"title":"Performance of GLIM with different nutrition risk screening tools in predicting 90-day mortality in critically ill adults with acute stroke: A comparison study","authors":"Junzhuo Li MD, Xin Li MD, Jiajia Yang MD, Yaqi Wang MD, Wenmei Gong MD","doi":"10.1002/jpen.2730","DOIUrl":"10.1002/jpen.2730","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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)].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"332-340"},"PeriodicalIF":4.1,"publicationDate":"2025-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374178","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}
{"title":"JPEN Journal Club 90. Emulated clinical trials","authors":"Ronald L. Koretz MD","doi":"10.1002/jpen.2729","DOIUrl":"10.1002/jpen.2729","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"670-672"},"PeriodicalIF":4.1,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256052","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}
Jianfeng Duan PhD, Jiali Liu PhD, Jiawen Chen MMed, Suwan Qian MMed, Xinran Liang MMed, Yanyu Han MMed, Beiyuan Zhang MMed, Tao Gao PhD, Gang Wang PhD, Xiaoyao Li PhD, Wenkui Yu PhD
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.
{"title":"Enhanced metabolic regulation in II/R injury: Comparing multiroute and monoroute enteral nutrition","authors":"Jianfeng Duan PhD, Jiali Liu PhD, Jiawen Chen MMed, Suwan Qian MMed, Xinran Liang MMed, Yanyu Han MMed, Beiyuan Zhang MMed, Tao Gao PhD, Gang Wang PhD, Xiaoyao Li PhD, Wenkui Yu PhD","doi":"10.1002/jpen.2726","DOIUrl":"10.1002/jpen.2726","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"379-388"},"PeriodicalIF":4.1,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2726","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143256045","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}
{"title":"JPEN Reviewer Acknowledgment","authors":"","doi":"10.1002/jpen.2732","DOIUrl":"10.1002/jpen.2732","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"144-145"},"PeriodicalIF":4.1,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143111720","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}
Ra'eesa Doola PhD, Alison Griffin MBiostat, Josephine M. Forbes PhD, Peter S. Kruger PhD, MBBS, Adam M. Deane PhD, MBBS, Casper G. Schalkwijk PhD, Kyle C. White MBBS, MPH
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.
{"title":"Association between enteral carboxymethyllysine intake and daily glycemic variability in critically ill adults: A retrospective cohort study","authors":"Ra'eesa Doola PhD, Alison Griffin MBiostat, Josephine M. Forbes PhD, Peter S. Kruger PhD, MBBS, Adam M. Deane PhD, MBBS, Casper G. Schalkwijk PhD, Kyle C. White MBBS, MPH","doi":"10.1002/jpen.2727","DOIUrl":"10.1002/jpen.2727","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Between 2015 and 2021, 2636 patients met the eligibility criteria, with 848 (32%) patients having an AKI. Most were male (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Carboxymethyllysine intake was associated with increased mean blood glucose and odds of dying in our study cohort.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"324-331"},"PeriodicalIF":4.1,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2727","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059255","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}
Jakub Visek PhD, Lenka Ryskova PhD, Petra Cesakova MD, Jana Stanclova MD, Marie Vajrychova PhD, Vladimir Blaha
Background
Antimicrobial lock therapy is recommended for preventing and treating catheter-related bloodstream infections, but different solutions have uncertain efficacy.
Methods
Two locks, 1.35% taurolidine and 4% ethylenediaminetetraacetic acid (EDTA), were tested on Staphylococcus epidermidis, Staphylococcus aureus, methicillin-resistant S. aureus, Pseudomonas aeruginosa, multidrug-resistant P. aeruginosa, vancomycin-resistant Enterococcus faecium, Klebsiella oxytoca (carbapenemase producing), K. pneumoniae (extended-spectrum β-lactamase producing), Candida albicans, and Candida glabrata. Broviac catheter segments were incubated with these organisms and then exposed to various lock solutions. Colony-forming units (CFUs) were counted after 2, 4, and 24 h of incubation.
Results
Taurolidine showed a significant decrease in CFUs after 2 h in S. aureus, S. epidermidis, methicillin-resistant S. aureus, vancomycin-resistant E. faecium, P. aeruginosa (both sensitive and multidrug-resistant strains), K. oxytoca, C. albicans, and C. glabrata. After 4 h, significant reductions were noted in S. aureus, S. epidermidis, methicillin-resistant S. aureus, P. aeruginosa, multidrug-resistant P. aeruginosa, K. pneumoniae, K. oxytoca, and C. albicans. Taurolidine was also effective after 24 h, especially against methicillin-resistant S. aureus and multidrug-resistant P. aeruginosa. Four percent EDTA acid showed a significant reduction in CFUs after 2 h in S. aureus, vancomycin-resistant E. faecium, P. aeruginosa, K. oxytoca, C. albicans, and C. glabrata. After 4 h, reductions occurred in P. aeruginosa, multidrug-resistant P. aeruginosa, K. oxytoca, and C. albicans and after 24 h in methicillin-resistant S. aureus, P. aeruginosa, and K. oxytoca.
Conclusion
Taurolidine is more effective than 4% EDTA acid in eradicating Gram-positive and Gram-negative microorganisms and fungi.
{"title":"Comparison of taurolidine with 4% ethylenediaminetetraacetic acid on antimicrobial lock effectiveness: An experimental study","authors":"Jakub Visek PhD, Lenka Ryskova PhD, Petra Cesakova MD, Jana Stanclova MD, Marie Vajrychova PhD, Vladimir Blaha","doi":"10.1002/jpen.2725","DOIUrl":"10.1002/jpen.2725","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Antimicrobial lock therapy is recommended for preventing and treating catheter-related bloodstream infections, but different solutions have uncertain efficacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Two locks, 1.35% taurolidine and 4% ethylenediaminetetraacetic acid (EDTA), were tested on <i>Staphylococcus epidermidis</i>, <i>Staphylococcus aureus</i>, methicillin-resistant <i>S. aureus</i>, <i>Pseudomonas aeruginosa</i>, multidrug-resistant <i>P. aeruginosa</i>, vancomycin-resistant <i>Enterococcus faecium</i>, <i>Klebsiella oxytoca</i> (carbapenemase producing), <i>K. pneumoniae</i> (extended-spectrum β-lactamase producing), <i>Candida albicans</i>, and <i>Candida glabrata</i>. Broviac catheter segments were incubated with these organisms and then exposed to various lock solutions. Colony-forming units (CFUs) were counted after 2, 4, and 24 h of incubation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Taurolidine showed a significant decrease in CFUs after 2 h in <i>S. aureus</i>, <i>S. epidermidis</i>, methicillin-resistant <i>S. aureus</i>, vancomycin-resistant <i>E. faecium</i>, <i>P. aeruginosa</i> (both sensitive and multidrug-resistant strains), <i>K. oxytoca</i>, <i>C. albicans</i>, and <i>C. glabrata</i>. After 4 h, significant reductions were noted in <i>S. aureus</i>, <i>S. epidermidis</i>, methicillin-resistant <i>S. aureus</i>, <i>P. aeruginosa</i>, multidrug-resistant <i>P. aeruginosa</i>, <i>K. pneumoniae</i>, <i>K. oxytoca</i>, and <i>C. albicans</i>. Taurolidine was also effective after 24 h, especially against methicillin-resistant <i>S. aureus</i> and multidrug-resistant <i>P. aeruginosa</i>. Four percent EDTA acid showed a significant reduction in CFUs after 2 h in <i>S. aureus</i>, vancomycin-resistant <i>E. faecium</i>, <i>P. aeruginosa</i>, <i>K. oxytoca</i>, <i>C. albicans</i>, and <i>C. glabrata</i>. After 4 h, reductions occurred in <i>P. aeruginosa</i>, multidrug-resistant <i>P. aeruginosa</i>, <i>K. oxytoca</i>, and <i>C. albicans</i> and after 24 h in methicillin-resistant <i>S. aureus</i>, <i>P. aeruginosa</i>, and <i>K. oxytoca</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Taurolidine is more effective than 4% EDTA acid in eradicating Gram-positive and Gram-negative microorganisms and fungi.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"373-378"},"PeriodicalIF":4.1,"publicationDate":"2025-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046924","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}
Asil Mansour MA, Boaz M. Ben-David PhD, Ady Sasson MD, Jalal Farraj MD, Anwar Mansour MD, Yehonatan Roth PhD, Michal Icht PhD
Background
Chewing involves jaw movements that propel cerumen along the ear canal. This mechanism may be reduced in dysphagia, especially for older individuals who are enterally fed. Those patients may be at a higher risk for cerumen impaction and may require longer hospital stays. Examining the relationship between diet type, cerumen impaction, and hospital stay duration was the focus of the present study.
Methods
We performed a retrospective cohort study (not registered) among 114 hospitalized older adults. Data were collected on diet type: (1) oral feeding (individuals fed a solid diet or a pureed diet) or (2) enteral feeding (individuals fed via a feeding tube). The results of an otoscopy that quantified cerumen were recorded, as well as hospital stay duration.
Results
In a mediation analysis, a hospital stay of >1 month was associated with an increased risk of enteral feeding, which in turn, increased the risk of cerumen impaction. Analysis indicated that the link between longer hospitalization and a more severe level of cerumen impaction was fully mediated by diet type (enteral feeding).
Conclusions
Enteral feeding seems to be a risk factor for cerumen impaction, rather than merely hospitalization length, in our sample of geriatric patients. These results highlight the importance of continuous monitoring by ear, nose, and throat specialists, as well as regular auditory assessments for patients who are enterally fed for early detection and treatment of cerumen impaction. Particular attention should be paid to cases of prolonged hospitalization, which is associated with the severity of dysphagia.
{"title":"Association between oral feeding versus enteral feeding and cerumen impaction in older hospitalized adults: A retrospective cohort study","authors":"Asil Mansour MA, Boaz M. Ben-David PhD, Ady Sasson MD, Jalal Farraj MD, Anwar Mansour MD, Yehonatan Roth PhD, Michal Icht PhD","doi":"10.1002/jpen.2724","DOIUrl":"10.1002/jpen.2724","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chewing involves jaw movements that propel cerumen along the ear canal. This mechanism may be reduced in dysphagia, especially for older individuals who are enterally fed. Those patients may be at a higher risk for cerumen impaction and may require longer hospital stays. Examining the relationship between diet type, cerumen impaction, and hospital stay duration was the focus of the present study.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study (not registered) among 114 hospitalized older adults. Data were collected on diet type: (1) oral feeding (individuals fed a solid diet or a pureed diet) or (2) enteral feeding (individuals fed via a feeding tube). The results of an otoscopy that quantified cerumen were recorded, as well as hospital stay duration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In a mediation analysis, a hospital stay of >1 month was associated with an increased risk of enteral feeding, which in turn, increased the risk of cerumen impaction. Analysis indicated that the link between longer hospitalization and a more severe level of cerumen impaction was fully mediated by diet type (enteral feeding).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Enteral feeding seems to be a risk factor for cerumen impaction, rather than merely hospitalization length, in our sample of geriatric patients. These results highlight the importance of continuous monitoring by ear, nose, and throat specialists, as well as regular auditory assessments for patients who are enterally fed for early detection and treatment of cerumen impaction. Particular attention should be paid to cases of prolonged hospitalization, which is associated with the severity of dysphagia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"341-348"},"PeriodicalIF":4.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143007181","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}
Many nutrition risk screening tools include low body mass index (BMI). It remains uncertain whether it affects the validity of these tools in patients with overweight or obesity. We aimed to determine the frequency of malnutrition risk and evaluate its association with hospital length of stay in hospitalized adults according to BMI classification.
Methods
Secondary analysis involving inpatients with BMI ≥ 18.5 kg/m2. Malnutrition risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool, Short Nutritional Assessment Questionnaire, and Nutritional Risk in Emergency-2017. Length of hospital stay, in-hospital mortality, readmission, and mortality within 6 months postdischarge were considered as outcomes.
Results
Among the 582 patients analyzed, the malnutrition risk ranged from 34.5% to 49.7% in patients with normal weight (n = 171), 20.8% to 33.9% in patients with overweight (n = 221), and 5.3% to 22.1% in patients with obesity (n = 190). Malnutrition risk by the NRS-2002 was associated with prolonged hospital stay, regardless of BMI category, and with 6-month hospital readmission in normal weight and those with obesity. The MST was associated with prolonged hospital stay, mortality, and hospital readmission in 6 months in normal-weight patients and with the first two outcomes in patients with overweight. No tool was associated with in-hospital death.
Conclusion
The prognostic value of nutrition risk screening tools varies according to BMI: the MST appears to be more appropriate for normal-weight and overweight patients, whereas the NRS-2002 may be more suitable for patients with obesity.
{"title":"Prognostic evaluation of nutrition risk screening tools in hospitalized adults with normal weight range, overweight, or obesity: A comparative analysis","authors":"Victória Silva Chites MSc, RD, Camila Ferri Burgel MSc, RD, Jussara Carnevale de Almeida PhD, RD, Flávia Moraes Silva PhD, RD","doi":"10.1002/jpen.2712","DOIUrl":"10.1002/jpen.2712","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many nutrition risk screening tools include low body mass index (BMI). It remains uncertain whether it affects the validity of these tools in patients with overweight or obesity. We aimed to determine the frequency of malnutrition risk and evaluate its association with hospital length of stay in hospitalized adults according to BMI classification.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Secondary analysis involving inpatients with BMI ≥ 18.5 kg/m<sup>2</sup>. Malnutrition risk was assessed using the Nutritional Risk Screening 2002 (NRS-2002), Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool, Short Nutritional Assessment Questionnaire, and Nutritional Risk in Emergency-2017. Length of hospital stay, in-hospital mortality, readmission, and mortality within 6 months postdischarge were considered as outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among the 582 patients analyzed, the malnutrition risk ranged from 34.5% to 49.7% in patients with normal weight (<i>n</i> = 171), 20.8% to 33.9% in patients with overweight (<i>n</i> = 221), and 5.3% to 22.1% in patients with obesity (<i>n</i> = 190). Malnutrition risk by the NRS-2002 was associated with prolonged hospital stay, regardless of BMI category, and with 6-month hospital readmission in normal weight and those with obesity. The MST was associated with prolonged hospital stay, mortality, and hospital readmission in 6 months in normal-weight patients and with the first two outcomes in patients with overweight. No tool was associated with in-hospital death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The prognostic value of nutrition risk screening tools varies according to BMI: the MST appears to be more appropriate for normal-weight and overweight patients, whereas the NRS-2002 may be more suitable for patients with obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"229-238"},"PeriodicalIF":4.1,"publicationDate":"2025-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932022","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}
Parenteral nutrition (PN), a high-alert medication, is an important lifesaving modality. The American Society for Parenteral and Enteral Nutrition (ASPEN) has historically provided guidelines and recommendations for the safe and efficacious use of PN. These recommendations have included detailed guidance regarding the compounding of this highly complex medication. Compounding standards have been recently updated, and PN is no longer listed in a dedicated category in the United States Pharmacopeia General Chapter <797>. Along with this change, the use of commercially available multichamber PN bags has increased in the United States. I will discuss PN from a historical perspective, review the state of compounding, and discuss concerns regarding the safe use of PN.
{"title":"Forty-seventh ASPEN Presidential Address: Parenteral nutrition compounding—Advancement or regression, where do we stand?","authors":"Phil Ayers BS, PharmD","doi":"10.1002/jpen.2720","DOIUrl":"10.1002/jpen.2720","url":null,"abstract":"<p>Parenteral nutrition (PN), a high-alert medication, is an important lifesaving modality. The American Society for Parenteral and Enteral Nutrition (ASPEN) has historically provided guidelines and recommendations for the safe and efficacious use of PN. These recommendations have included detailed guidance regarding the compounding of this highly complex medication. Compounding standards have been recently updated, and PN is no longer listed in a dedicated category in the United States Pharmacopeia General Chapter <797>. Along with this change, the use of commercially available multichamber PN bags has increased in the United States. I will discuss PN from a historical perspective, review the state of compounding, and discuss concerns regarding the safe use of PN.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"146-151"},"PeriodicalIF":4.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932001","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}
Julia W. Korzilius MD, Manon Dumont MSc, Harriët Jager-Wittenaar PhD, Geert J. A. Wanten PhD, Heidi E. E. Zweers- van Essen PhD
Background
In patients with chronic intestinal failure, the content and type of parenteral nutrition are individually determined based on various factors, including body composition. In clinical practice, bioelectrical impedance analysis is used to assess body composition using standardized protocols. However, these protocols lack specific recommendations for patients receiving parenteral nutrition. Therefore, this study described the effect of parenteral nutrition infusion on fat-free mass as evaluated by single-frequency bioelectrical impedance analysis.
Methods
We performed a descriptive cohort study using bioelectrical impedance analysis to assess adult patients with chronic intestinal failure receiving parenteral nutrition. Measurements were performed at baseline (before parenteral nutrition infusion) and 0, 1, 2, and 4 h after (usually) 18-h parenteral nutrition infusion using hand-to-foot single-frequency bioelectrical impedance analysis (Bodystat 500). The primary outcome of fat-free mass was calculated using the Kyle equation. A linear mixed model was used to compare baseline values with other time points. A difference of >1 kg in fat-free mass compared with baseline was considered clinically relevant.
Results
Twenty patients (70% female) with a mean age of 58 (SD, 14) years and a median body mass index of 22.3 (IQR, 21.2–24.8) kg/m2 were included in the analysis. No significant change in fat-free mass after parenteral nutrition infusion was observed, and 90% (69/77 measurements) of all fat-free mass outcomes after parenteral nutrition infusion remained within the ≤1-kg clinically relevant range.
Conclusion
This study found that parenteral nutrition infusion does not affect fat-free mass estimation as assessed by hand-to-foot single-frequency bioelectrical impedance analysis.
{"title":"Parenteral nutrition and bioelectrical impedance analysis estimated fat-free mass in adult patients with chronic intestinal failure: A descriptive cohort study","authors":"Julia W. Korzilius MD, Manon Dumont MSc, Harriët Jager-Wittenaar PhD, Geert J. A. Wanten PhD, Heidi E. E. Zweers- van Essen PhD","doi":"10.1002/jpen.2723","DOIUrl":"10.1002/jpen.2723","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In patients with chronic intestinal failure, the content and type of parenteral nutrition are individually determined based on various factors, including body composition. In clinical practice, bioelectrical impedance analysis is used to assess body composition using standardized protocols. However, these protocols lack specific recommendations for patients receiving parenteral nutrition. Therefore, this study described the effect of parenteral nutrition infusion on fat-free mass as evaluated by single-frequency bioelectrical impedance analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a descriptive cohort study using bioelectrical impedance analysis to assess adult patients with chronic intestinal failure receiving parenteral nutrition. Measurements were performed at baseline (before parenteral nutrition infusion) and 0, 1, 2, and 4 h after (usually) 18-h parenteral nutrition infusion using hand-to-foot single-frequency bioelectrical impedance analysis (Bodystat 500). The primary outcome of fat-free mass was calculated using the Kyle equation. A linear mixed model was used to compare baseline values with other time points. A difference of >1 kg in fat-free mass compared with baseline was considered clinically relevant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty patients (70% female) with a mean age of 58 (SD, 14) years and a median body mass index of 22.3 (IQR, 21.2–24.8) kg/m<sup>2</sup> were included in the analysis. No significant change in fat-free mass after parenteral nutrition infusion was observed, and 90% (69/77 measurements) of all fat-free mass outcomes after parenteral nutrition infusion remained within the ≤1-kg clinically relevant range.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study found that parenteral nutrition infusion does not affect fat-free mass estimation as assessed by hand-to-foot single-frequency bioelectrical impedance analysis.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 3","pages":"358-364"},"PeriodicalIF":4.1,"publicationDate":"2025-01-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2723","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932018","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号