The American Society for Parenteral and Enteral Nutrition (ASPEN) is dedicated to improving patient care by advancing the science and practice of clinical nutrition and metabolism. Founded in 1975, ASPEN is an interprofessional organization whose members are involved in the provision of clinical nutrition therapies, including parenteral and enteral nutrition. With more than 6000 members from around the world, ASPEN is a community of dietitians, nurses, pharmacists, physicians, scientists, students, and other health professionals from every facet of nutrition support clinical practice, research, and education.
ASPEN hosts an annual forum for clinical nutrition research and education, the ASPEN Nutrition Science & Practice Conference. The ASPEN Abstract Review Committee reviewed all abstracts submitted for the conference and selected those published herein for presentation. Selected abstracts feature data relevant to nutrition therapy and metabolic support, many of which were eligible for several of ASPEN's prestigious abstract awards.
The abstracts in this supplement have not been copyedited. Any errors contained within the abstracts are the sole responsibility of the authors. ASPEN does not assume liability for any errors herein. This content does not constitute medical or other professional advice. Please visit ASPEN's conference webpage for more information: https://www.nutritioncare.org/conference/
Intestinal failure–associated liver disease (IFALD) is a major complication of chronic intestinal failure. Few data exist about hepatic monitoring of IFALD using the liver stiffness measurement. The aim of this study was to provide a descriptive analysis of IFALD and its prevalence in a tertiary center and to determine the IFALD risk factors and high liver stiffness measurement values using FibroScan.
Adult patients with chronic intestinal failure treated with home parenteral nutrition and followed in a tertiary center with no underlying liver disease and at least one liver stiffness measurement record were included between January 1, 2007, and June 6, 2023.
Eighty-nine patients were included from this cohort of 145 patients. The prevalence of IFALD was 34%. A total of 14% had a liver stiffness measurement >10 kPa, and 49% had a liver stiffness measurement <5 kPa. In multivariate analysis, IFALD was positively associated with the use of a customized admixture (odds ratio [OR] = 7.04; 95% CI, 1.44–43.64; P = 0.017) and negatively associated with the colon in continuity (OR = 0.25; 95% CI, 0.07–0.87; P = 0.029). No significant association was observed between liver stiffness measurement values and IFALD.
The prevalence of IFALD was low in our study. Absence of the colon and the use of a customized admixture were risk factors for IFALD. Liver stiffness measurement was abnormal in 51% of cases. A long-term follow-up of this cohort will help to assess the prognostic relevance of IFALD and liver stiffness measurement in these patients.
Predictive equations often inaccurately estimate energy needs in critically ill patients. This study evaluated the level of agreement between resting energy expenditure using 12 and 25 kcal/kg as recommended by the 2021 American Society for Parenteral and Enteral Nutrition critical care guidelines for nutrition support and energy expenditure measured by indirect calorimetry in patients in the intensive care unit.
An agreement study was conducted on mechanically ventilated adults who had a documented measured energy expenditure within 10 days of intensive care unit admission. Agreement was assessed using Bland-Altman plots and Wilcoxon signed rank tests. A subgroup analysis was performed for patients with a body mass index of ≥30 kg/m² using actual body weight, adjusted body weight, and ideal body weight. Correlations between measured energy expenditure and patient characteristics were also explored.
Fifty-eight patients were included and were a median age of 64 years, 63.8% male, and a median body mass index of 28.0 kg/m2. The 12 kcal/kg and 25 kcal/kg differed significantly from measured energy expenditure (P < 0.001). Bland-Altman plots showed mean biases of −644.6 kcal/day for 12 kcal/kg and 406.5 kcal/day for 25 kcal/kg. In the body mass index ≥30 kg/m² subgroup (n = 22), 12 kcal/kg underestimated measured energy expenditure across all weights, and 25 kcal/kg was more accurate when using ideal or adjusted body weights.
Predicted energy expenditure using 12 kcal/kg and 25 kcal/kg based on the 2021 American Society for Parenteral and Enteral Nutrition critical care guidelines for nutrition support had poor agreement with measured energy expenditure in mechanically ventilated patients.
Trauma patients have historically been considered profoundly hypermetabolic. The purpose of this study was to describe energy expenditure using indirect calorimetry and to compare indirect calorimetry to predictive equations in trauma patients.
Indirect calorimetry was performed using a Q-NRG+ by a trained dietitian nutritionist. Results were obtained in mechanically ventilated trauma patients between September 2023 and June 2024. Demographic data, injury characteristics, and outcomes were collected. Results were compared with energy expenditure predicted with 20, 25, and 30 kcal/kg; Penn State 2003b; and Schofield in adolescents on the day of indirect calorimetry using the Wilcoxon test. Subanalysis was completed in adolescents and older adults. Energy expenditure was evaluated over time.
A total of 164 indirect calorimetry results from 117 patients were analyzed. Among participants, median age was 43 (28–62) years, 85% were with blunt mechanism of injury, and and 80% were male. Median energy expenditure was 1869 kcal/day (1618–2265 kcal/day). In the full cohort, 20 kcal/kg underestimated energy needs, whereas other equations overestimated needs. In adolescents, 25 kcal/kg and Schofield were not significantly different than indirect calorimetry (P = 0.15 and 0.64). In older adults, 20 kcal/kg was not significantly different from indirect calorimetry (P = 0.58). A weak association was observed between prescribed and measured energy (r = 0.32, P < 0.001).
Predictive equations recommended in critical care do not accurately reflect energy expenditure in trauma patients. Indirect calorimetry remains the preferred method for determining energy needs and the availability of the bedside dietitian nutritionist to perform these assessments facilitates timely, serial testing.
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