Journal of Parenteral and Enteral Nutrition最新文献

Background

Investigations on the association among bioelectrical impedance analysis, handgrip strength, and metabolic dysfunction–associated steatotic liver disease (MASLD) in children and adolescents are limited. Therefore, the present study explored the relationship between bioelectrical impedance analysis parameters, handgrip, and MASLD in youth.

Methods

This study extracted 337 youths from population-based data. Pearson correlation analyses were conducted to assess the relationship between muscle-related bioelectrical impedance analysis and handgrip parameters. Logistic regression analysis investigated the associations among MASLD, bioelectrical impedance analysis, and handgrip strength. Areas under the receiver operating characteristic (ROC) curve were calculated to compare diagnostic performances of these markers in predicting MASLD.

Results

Grip strength, handgrip to weight, and handgrip to body mass index (BMI) were correlated with all muscle-related bioelectrical impedance analysis parameters, including the fat-free mass, appendicular muscle mass, skeletal muscle mass index, and muscle to fat ratio. Multivariable logistic regression analyses—adjusting for age, sex, energy intake, and nutrition—showed that skeletal muscle mass index, muscle to fat ratio, handgrip to weight, and handgrip to BMI were negatively associated with MASLD, whereas body fat mass and percentage of body fat were positively associated. The areas under the ROC curve of handgrip to weight, skeletal muscle mass index, muscle to fat ratio, body fat mass, and percentage of body fat in predicting MASLD were 0.71, 0.76, 0.81, 0.94, and 0.87, respectively.

Conclusions

Combining bioelectrical impedance analyses and handgrip assessments may be beneficial for MASLD screening in youth.

Background

The influences of nutrition on the infant's developing gastrointestinal (GI) microbiome, intestinal tract, and brain is unclear. Human milk (HM) is associated with beneficial immune and cognitive development compared with infant formula (IF). This study used a neonatal piglet model to determine the effects of infant feeding exposures (HM vs IF) on the GI microbiome, intestinal inflammation, and brain oligodendrocyte maturation.

Methods

Six pairs of piglets received HM or IF for 28 days. Fecal samples were collected weekly and GI regions (jejunum, ileum, and colon) and brains were harvested at necropsy. Fecal microbiome composition was determined by 16S ribosomal RNA (16S rRNA) sequencing. Intestinal inflammation was assessed via quantification of intestinal interleukin (IL)-1β, IL-8, IL-10, tumor necrosis factor (TNF)-α, and fecal calprotectin. Neurodevelopment was evaluated by quantifying mature and immature oligodendrocytes in gray and white matter.

Results

Bacterial community composition differed between feeding groups (P < 0.002) and over time (P = 0.001). Various highly abundant genera were associated with changes over time (P < 0.05) and only Escherichia-Shigella was associated with feeding group by time interactions (P < 0.05). No differences were found in intestinal inflammatory markers between feeding types, but mature oligodendrocytes in white matter were higher in HM-fed piglets (P = 0.004). Various intestinal inflammatory markers and relatively highly abundant genera were significantly associated.

Conclusion

Piglet fecal bacterial compositions differed by feeding group and over time, with several relatively highly abundant genera associated with intestinal inflammatory markers. Additionally, HM may support proper white matter development. Future research should investigate mechanisms underlying these relationships.

Background

For parenteral nutrition (PN)–dependent neonates, soybean oil intravenous lipid emulsions (SO-ILEs) and mixed emulsions (SO, medium-chain triglyceride [MCT], olive oil [OO], and fish oil [FO] ILEs) are likely not providing adequate amounts of key fatty acids (FAs) arachidonic acid (AA) and docosahexaenoic acid (DHA) and are devoid of choline. Current FO-containing ILEs provide excessive amounts of eicosapentaenoic acid (EPA). In neonatal piglets, we compared a novel lipid (NOV-C) with the addition of AA, DHA, and choline while sparing EPA with SO-ILE and SO,MCT,OO,FO-ILE.

Methods

We compared FA deposition in serum and tissues among groups of neonatal piglets fed exclusive PN based on SO-ILE (n = 7), SO,MCT,OO,FO-ILE (n = 7), or NOV-C (n = 8). On day 14, serum, liver, lung, brain, retina, and jejunum were collected and FAs in total phospholipid (PL) measured using gas liquid chromatography.

Results

In total PL, AA was higher for NOV-C compared with SO,MCT,OO,FO-ILE in serum (P = 0.003) and all tissues except brain (P = 0.08). DHA was higher for NOV-C and SO,MCT,OO,FO-ILE compared with SO-ILE in the liver (P = 0.001), jejunum (P < 0.001), and lung (P < 0.001). In the retina, DHA was higher for NOV-C compared with SO,MCT,OO,FO-ILE and SO-ILE (P = 0.004). EPA was higher for SO,MCT,OO,FO-ILE compared with SO-ILE and NOV-C in serum (P = 0.002) and all tissues except brain (P = 0.48).

Conclusion

Compared with SO-ILE and SO,MCT,OO,FO-ILE, a novel lipid designed to deliver optimal AA, DHA, EPA, and choline for neonates resulted in higher AA and DHA in blood and tissues. The impact on neonatal immune development and key organ functions needs further exploration.

Background

Enteral nutrition (EN) is a common nutrition intervention for a variety of conditions, including eating disorders; however, validated methods for capturing administrative data are lacking. We used administrative billing data to identify the use of EN among patients hospitalized with eating disorders and validated using clinical documentation at our institution.

Methods

Using billing data from the Pediatric Health Information System (PHIS), we identified patients aged 9–20 years hospitalized at our institution from 2018 to 2022 with a primary diagnosis of an eating disorder. EN was identified using International Classification of Diseases, Tenth Revision procedure codes and Clinical Transaction Classification codes for clinical services, supply, and/or other transacted services. We verified enteral feeding information from PHIS via medical record review to identify discrepancies. We calculated the performance of EN identified by PHIS data compared with medical record review including sensitivity, specificity, overall accuracy, and kappa.

Results

We included N = 483 hospitalizations for patients with eating disorders. Based on PHIS data, 16.2% received EN during admission vs 30.0% from medical record review. The overall accuracy = 85.3%, sensitivity = 52.4%, specificity = 99.4%, positive predictive value = 97.4%, negative predictive value = 83.0%, and κ = 0.60.

Conclusion

Our results from a single center suggest that EN may be underestimated using administrative data; however, specificity and positive predictive value were high with moderate agreement among patients with eating disorders. These findings have implications in health services research allowing for identification in PHIS and other data sources and quantifying the potential underestimation.

Background

Appendicular lean mass index is a major determinant of cardiorespiratory fitness in patients with obesity-related heart failure with preserved ejection fraction (HFpEF). Moreover, appendicular lean mass index can be used to diagnose sarcopenia and sarcopenic obesity in this population. We aimed to validate the ability of segmental single-frequency bioelectrical impedance analysis (SF-BIA) to assess body composition compared with dual-energy x-ray absorptiometry (DXA) in patients with HFpEF and obesity, with a focus on appendicular lean mass index for its critical role in diagnosing sarcopenia and sarcopenic obesity.

Methods

We analyzed 62 euvolemic patients from a heart failure outpatient clinic with persistent obesity-related HFpEF (83.8% women, 60.8 ± 2.8 years of age). We used DXA and segmental SF-BIA.

Results

Strong correlations were found between segmental SF-BIA and DXA for appendicular lean mass index (r = 0.897), appendicular fat mass index (r = 0.864), fat mass (r = 0.968), fat mass percentage (r = 0.867), fat-free mass (r = 0.954), fat-free mass percentage (r = 0.852), fat mass index (r = 0.97), and fat-free mass index (r = 0.88) (all p < 0.001), without significant proportional bias for all parameters, except for appendicular fat mass index.

Conclusions

Segmental SF-BIA–measured body composition shows strong correlations, appropriate agreements, and no proportional bias compared with DXA. Segmental SF-BIA should be considered in patients with obesity-related HFpEF.

Data on pregnancy in patients with Crohn's disease receiving Janus kinase (JAK) inhibitors, with concomitant short bowel syndrome and chronic intestinal failure requiring long-term parenteral support, are extremely limited. We report the case of a patient with refractory Crohn's disease, short bowel syndrome–associated chronic intestinal failure, and long-term home parenteral nutrition who achieved a successful full-term pregnancy while receiving upadacitinib. The 34-year-old woman had a history of severe, treatment-resistant ileocolonic Crohn's disease and multiple intestinal resections, leaving 145 cm of small bowel and resulting in high-output stoma and chronic intestinal failure. After inadequate response to multiple biologics, upadacitinib was initiated with clinical and endoscopic improvement. The patient became pregnant unintentionally while receiving upadacitinib 45 mg daily. Through intensive multidisciplinary management, she achieved clinical remission, stable parenteral support needs, and adequate weight gain and delivered a healthy infant at term. This case illustrates that with close multidisciplinary follow-up, successful pregnancy is possible in patients with chronic intestinal failure and active Crohn's disease receiving parenteral support, even with concurrent exposure to upadacitinib. Further data are needed to assess the safety of JAK inhibitors in pregnancy and to guide care in this complex patient population.

Background

Limited evidence exists regarding the cognitive and physical improvement effects of medium-chain triglyceride (MCT) intake in patients with stroke. This study aimed to investigate the association between MCT-enhanced rice consumption and enhancements in outcomes, including cognitive level, in patients following stroke.

Methods

We performed a retrospective cohort study on adults admitted to a rehabilitation center with cognitive decline following acute stroke. Our exposure of interest was 1 cup of MCT-enhanced rice 3 times per day. Our comparator was 1 cup of regular rice 3 times per day. Our primary outcome was the cognitive level, defined as the Functional Independence Measure–cognition (FIM-cognition) score (continuous variable) at discharge. Our secondary outcomes were changes in FIM-cognition from admission to discharge, defined as FIM-cognition gain, activities of daily living (determined by the FIM-motor score), and swallowing function (determined by the Food Intake Level Scale [FILS] at discharge). Propensity score matching and multivariable regression analyses were used to evaluate the association between MCT provision and the outcomes.

Results

After applying the exclusion criteria, 659 patients with baseline cognitive impairment (mean age 76.1 years; 52.8% men) were analyzed. Following propensity score matching, patients who received MCT-enhanced rice showed significantly greater FIM-cognition gain (median [95% CI]: 9 [5,15] vs 8 [5,12]; P = 0.002) compared with those who did not. Additionally, the MCT-enhanced rice group exhibited significantly higher FIM-motor scores (59 [41,79] vs 56 [31,77]; P = 0.019) and FILS scores (10 [9,10] vs 9 [8,10]; P = 0.027) at discharge than those without. Multivariable linear regression analysis using the analytical cohort confirmed the independent association between MCT intake and improved discharge scores of FIM-cognition, FIM-motor, and FILS.

Conclusions

The provision of MCT-enhanced rice was associated with improved cognitive level, activities of daily living, and swallowing function in poststroke patients with cognitive impairment.

Background

Intravenous lipid emulsions are a key component of parenteral nutrition, and their fatty acid compositions may influence immune responses and clinical outcomes.

Methods

This retrospective cohort study conducted from January 2020 to December 2022 compared clinical outcomes of hospitalized non–critical care patients receiving parenteral nutrition with either mixed oil or soybean oil lipid emulsions for at least 48 h. The primary outcome was a composite of the presence of pneumonia, urinary tract infection, or an intra-abdominal collection diagnosed within 14 days of initiating parenteral nutrition. Secondary outcomes included catheter-related bloodstream infection, length of hospital stay, duration of antibiotic therapy, in-hospital mortality, and changes in the aspartate transaminase (AST)/alanine transaminase (ALT) ratio over time.

Results

Among 266 patients (mixed oil lipid emulsion: n = 130; soybean oil lipid emulsion: n = 136) there was no statistically significant difference in all-cause infections (P = 0.21). In patients receiving lipid emulsions for >7 days, the use of mixed oil lipid emulsions was associated with a shorter median antibiotic duration (4 days: interquartile range [IQR] 1–8.5 vs 7 days: IQR 5–10; P = 0.04). Additionally, patients who received mixed oil emulsions for >7 days had a significantly greater change in the AST/alkaline phosphatase ratio after 14 days compared with the soybean oil group (β = –0.51; P = 0.02).

Conclusion

Although there was no difference in all-cause infections between types of lipid emulsions, mixed oil lipid emulsions were associated with shorter antibiotic use and lower AST/ALT ratio in hospitalized, non–critical care patients receiving parenteral nutrition for >7 days.

Background

Soybean oil lipid emulsions have been implicated in the development of parenteral nutrition–associated cholestasis (PNAC) in premature infants. A recent mixed fatty acid emulsion containing soybean oil, medium-chain triglycerides (MCTs), olive oil, and fish oil may reduce the incidence of PNAC, but evidence remains conflicting. The aim of this study was to evaluate the effect of mixed fatty acid emulsion on PNAC in extremely low-birth-weight (ELBW) infants.

Methods

We performed a retrospective cohort study on ELBW infants from 2016 to 2022. ELBW infants who received MCT/long-chain triglyceride (LCT) lipid emulsion or mixed fatty acid emulsion were compared. The primary outcome was the incidence of PNAC. Secondary outcomes included peak levels of direct bilirubin and bronchopulmonary dysplasia. Multivariable analysis was performed to adjust for potential confounders.

Results

A total of 180 ELBW infants were reviewed in this study. Twenty-six of 99 patients (26.2%) in the mixed fatty acid emulsion group and 29 of 81 patients (35.8%) in the MCT/LCT lipid emulsion group developed PNAC (P = 0.17). There was no significant difference in median peak direct bilirubin and the rate of bronchopulmonary dysplasia. The results remained consistent after adjusting for potential confounders. Time to PNAC, rate of rise of direct bilirubin, and age of direct bilirubin normalization were not statistically different between groups.

Conclusions

Compared with MCT/LCT lipid emulsion, mixed fatty acid emulsion did not reduce the incidence or degree of PNAC in ELBW infants.

Background

Patients with type 2 intestinal failure (IF) are metabolically unstable and prone to electrolyte derangements. Nevertheless, the data on the prevalence of hypercalcemia in these patients are lacking to date. The aim of this study was therefore to evaluate the prevalence and causes of hypercalcemia in patients with type 2 IF during their first admission to a dedicated IF unit.

Methods

This was a cohort study of patients with a new diagnosis of type 2 IF admitted to a national UK IF Reference Centre between July 1, 2018, and April 31, 2023. Patients with identified hypercalcemia were followed up from their admission until parenteral support cessation or end of the follow-up on December 31, 2024.

Results

Overall, there were 265 patients included in the analysis. In total, 26/265 (9.8%) patients were diagnosed with hypercalcemia during the admission. In most patients, the cause of hypercalcemia was multifactorial with immobilization, dehydration, and presence of calcium in parenteral support being the most common factors. In all cases, hypercalcemia was transient and resolved by the end of patient admission with continuous optimization of hydration, reduction in supplemented calcium, and/or improved patient mobility. Notably, 11/26 (45.8%) patients with transient inpatient hypercalcemia remained on calcium-free parenteral support after hospital discharge.

Conclusion

Hypercalcemia is present in almost 10% of all admissions with type 2 IF and is multifactorial in origin. Care should be undertaken to optimize patient hydration, parenteral support prescription, and mobilization in the acute hospital setting, with ongoing assessment of calcium requirements following discharge.