Sergio Henrique Loss MD, PhD, Klara Muller Alves RD, Aline Camargo Nunes RN, Joel Stefani MD, Giovanna Peres Loureiro RD, Adriana Píscopo MD, Luciana Verçoza Viana MD, PhD
Background
Parenteral nutrition (PN) provides nutrition to patients who cannot use the digestive tract. Some patients experience delayed appetite recovery after PN, but the factors contributing to this remain unclear. This study aimed to investigate whether hospitalized patients receiving PN experience reduced hunger or appetite.
Methods
A descriptive cohort study was conducted on adults who underwent PN between April 2022 and July 2023. Data on patient characteristics and nutritional support were collected from medical records. Hunger and satiety were assessed using a validated tool during three phases: clinical stability with calorie-protein targets on PN, transition to oral/enteral feeding, and PN withdrawal. The primary outcome was the absence of hunger assessed by the tool.
Results
Of 231 screened patients, 102 were included. Among these, 62.7% reported hunger during PN. Lipid doses and energy reduction strategies did not affect hunger or satiety. Transition success to oral/enteral nutrition was 2.38 times higher in patients who experienced hunger compared to those who did not (95% CI: 1.59–3.54). Poisson regression identified higher age, inflammation, and metastatic cancer as independent factors associated with the absence of hunger.
Conclusion
This study suggests that PN does not suppress hunger and that factors other than nutritional therapy (age, inflammation, and cancer) could explain the absence of appetite. Considering individual conditions and needs, these findings could guide decision-making strategies regarding the transition from PN to oral/enteral feeding.
{"title":"Hunger and the transition from parenteral nutrition in hospitalized adults: A descriptive cohort study","authors":"Sergio Henrique Loss MD, PhD, Klara Muller Alves RD, Aline Camargo Nunes RN, Joel Stefani MD, Giovanna Peres Loureiro RD, Adriana Píscopo MD, Luciana Verçoza Viana MD, PhD","doi":"10.1002/jpen.2710","DOIUrl":"10.1002/jpen.2710","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parenteral nutrition (PN) provides nutrition to patients who cannot use the digestive tract. Some patients experience delayed appetite recovery after PN, but the factors contributing to this remain unclear. This study aimed to investigate whether hospitalized patients receiving PN experience reduced hunger or appetite.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive cohort study was conducted on adults who underwent PN between April 2022 and July 2023. Data on patient characteristics and nutritional support were collected from medical records. Hunger and satiety were assessed using a validated tool during three phases: clinical stability with calorie-protein targets on PN, transition to oral/enteral feeding, and PN withdrawal. The primary outcome was the absence of hunger assessed by the tool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 231 screened patients, 102 were included. Among these, 62.7% reported hunger during PN. Lipid doses and energy reduction strategies did not affect hunger or satiety. Transition success to oral/enteral nutrition was 2.38 times higher in patients who experienced hunger compared to those who did not (95% CI: 1.59–3.54). Poisson regression identified higher age, inflammation, and metastatic cancer as independent factors associated with the absence of hunger.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study suggests that PN does not suppress hunger and that factors other than nutritional therapy (age, inflammation, and cancer) could explain the absence of appetite. Considering individual conditions and needs, these findings could guide decision-making strategies regarding the transition from PN to oral/enteral feeding.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"256-266"},"PeriodicalIF":3.2,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142837195","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 89. Signal-finding studies.","authors":"Ronald L Koretz","doi":"10.1002/jpen.2709","DOIUrl":"https://doi.org/10.1002/jpen.2709","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807486","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}
Yinghong Wang MD, Xiaolian Song MD, PhD, Min Tan MD, PhD
Background
Fractional exhaled nitric oxide (FeNo) is a convenient and noninvasive test that measures the concentration of nitric oxide in exhalation as a surrogate biomarker of airway inflammation. This cross-sectional study aimed to determine the associations between Dietary Inflammatory Index (DII) and FeNo in US adults.
Methods
Adults participating in the 2007–2012 cycles of the US National Health and Nutrition Examination Survey with complete information and available measurement data of DII and FeNo were included. Associations between DII and FeNo were assessed using univariable and multivariable logistic regression models, restricted cubic spline analysis, stratified analysis, and sensitivity analysis.
Results
A total of 7677 participants (mean age 45.68 years, 53.03% men) with a mean DII of 1.28 and FeNo of 17.33 ppb were included. The multivariable-adjusted linear regression analysis showed that a one-unit increase in DII was associated with a 0.283-ppb reduction in FeNo level. The beta and 95% CI for the second, third, and fourth DII quartile groups were −1.19 (−2.04 to −0.35), −1.07 (−2.26 to 0.12), and −1.60 (−2.85 to −0.36), respectively (P for trend = 0.04), with the lowest quartile group as the reference. The restricted cubic spline curve showed an inversely linear relationship between DII and FeNo. The study result is robust and did not appear to be affected by the participant's age, sex, race, body mass index, physical activity, diabetes status, or white blood cell or eosinophil counts.
Conclusion
A proinflammatory diet, as indicated by a higher DII, is cross-sectionally associated with lower FeNo levels in US adults.
{"title":"Associations between the Dietary Inflammatory Index and fractional exhaled nitric oxide among United States adults: A cross-sectional study","authors":"Yinghong Wang MD, Xiaolian Song MD, PhD, Min Tan MD, PhD","doi":"10.1002/jpen.2708","DOIUrl":"10.1002/jpen.2708","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Fractional exhaled nitric oxide (FeNo) is a convenient and noninvasive test that measures the concentration of nitric oxide in exhalation as a surrogate biomarker of airway inflammation. This cross-sectional study aimed to determine the associations between Dietary Inflammatory Index (DII) and FeNo in US adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults participating in the 2007–2012 cycles of the US National Health and Nutrition Examination Survey with complete information and available measurement data of DII and FeNo were included. Associations between DII and FeNo were assessed using univariable and multivariable logistic regression models, restricted cubic spline analysis, stratified analysis, and sensitivity analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7677 participants (mean age 45.68 years, 53.03% men) with a mean DII of 1.28 and FeNo of 17.33 ppb were included. The multivariable-adjusted linear regression analysis showed that a one-unit increase in DII was associated with a 0.283-ppb reduction in FeNo level. The beta and 95% CI for the second, third, and fourth DII quartile groups were −1.19 (−2.04 to −0.35), −1.07 (−2.26 to 0.12), and −1.60 (−2.85 to −0.36), respectively (<i>P</i> for trend = 0.04), with the lowest quartile group as the reference. The restricted cubic spline curve showed an inversely linear relationship between DII and FeNo. The study result is robust and did not appear to be affected by the participant's age, sex, race, body mass index, physical activity, diabetes status, or white blood cell or eosinophil counts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A proinflammatory diet, as indicated by a higher DII, is cross-sectionally associated with lower FeNo levels in US adults.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"249-255"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786080","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}
Marion Winkler PhD, RD, Kelly A. Tappenden PhD, RD, M. Molly McMahon MD, Michelle Spangenburg MS, RD, Charlene Compher PhD, RD
The vision of the ASPEN Rhoads Research Foundation is to promote innovation and research discovery to improve nutrition care and health. The Foundation was launched in 1993, incorporated in 2002, and established as a nonprofit 501(c)(3) organization in 2007. On the occasion of American Society for Parenteral and Enteral Nutrition (ASPEN)'s 50th anniversary, this article examines the creation of the Foundation, the state of clinical nutrition research funding, the Foundation's philanthropic mission, and the return on investment of Foundation grant support. To date, 114 investigators have received 2.78 million dollars in funding. The article examines the success of ASPEN research programs and Foundation grant support in career development, leadership, and mentorship. It is important to document a historical account of the ASPEN Rhoads Research Foundation and encourage innovation and discovery and ongoing financial support.
{"title":"The ASPEN Rhoads Research Foundation: Supporting and advancing clinical nutrition research","authors":"Marion Winkler PhD, RD, Kelly A. Tappenden PhD, RD, M. Molly McMahon MD, Michelle Spangenburg MS, RD, Charlene Compher PhD, RD","doi":"10.1002/jpen.2707","DOIUrl":"10.1002/jpen.2707","url":null,"abstract":"<p>The vision of the ASPEN Rhoads Research Foundation is to promote innovation and research discovery to improve nutrition care and health. The Foundation was launched in 1993, incorporated in 2002, and established as a nonprofit 501(c)(3) organization in 2007. On the occasion of American Society for Parenteral and Enteral Nutrition (ASPEN)'s 50th anniversary, this article examines the creation of the Foundation, the state of clinical nutrition research funding, the Foundation's philanthropic mission, and the return on investment of Foundation grant support. To date, 114 investigators have received 2.78 million dollars in funding. The article examines the success of ASPEN research programs and Foundation grant support in career development, leadership, and mentorship. It is important to document a historical account of the ASPEN Rhoads Research Foundation and encourage innovation and discovery and ongoing financial support.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"10-17"},"PeriodicalIF":3.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786084","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}
Ella Terblanche PGDip Dietetics, MSc, Judith Merriweather PhD, Mina Bharal MRes, Rhiannon Lewis PGDip Dietetics, Liesl Wandrag PhD
Background
Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes.
Methods
A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions.
Results
Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral).
Conclusion
Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.
背景：危重患者面临营养不良风险，使营养管理具有挑战性。营养师通过运用他们的专业知识来解决这些挑战，在重症监护病房（ICU）中发挥着至关重要的作用。本综述探讨了以营养师为主导的干预措施及其对患者预后的影响。方法：对1995年1月至2023年7月的MEDLINE、Embase、CINAHL、EBSCO、Web of Science和ProQuest数据库进行回顾性分析。包括在成人重症监护中以营养师为主导的干预研究。数据提取遵循乔安娜布里格斯研究所的方法，重点关注研究设计、人口和干预措施。结果：751项研究中，39项符合纳入标准。大多数研究是观察性的，只有三个干预性试验。营养师主导的干预措施包括(1)指南的制定和实施，(2)个体化营养治疗，(3)肠内营养管的插入。结果分为(1)患者临床结果（ICU住院时间、机械通气、感染、成本节约、再入院、死亡率、不良反应和血糖控制）和(2)营养相关结果（营养开始、能量和蛋白质输送、胃肠道耐受性、肠外营养使用和适当的饮食转诊）。结论：营养师主导的干预改善了营养结果，可能有助于更好的临床结果。未来的研究应优先报告核心结果，包括营养状况和身体功能，以进一步量化营养师在ICU护理中的有效性，并提高他们在多专业团队中的认可度。
{"title":"Dietetic-led interventions in critically ill adults that influence outcome: A scoping review","authors":"Ella Terblanche PGDip Dietetics, MSc, Judith Merriweather PhD, Mina Bharal MRes, Rhiannon Lewis PGDip Dietetics, Liesl Wandrag PhD","doi":"10.1002/jpen.2705","DOIUrl":"10.1002/jpen.2705","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Critically ill patients face malnutrition risks, making nutrition management challenging. Dietitians play a crucial role in the intensive care unit (ICU) by applying their expertise to address these challenges. This review examines dietitian-led interventions and their impact on patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A scoping review of MEDLINE, Embase, CINAHL, EBSCO, Web of Science, and ProQuest databases from January 1995 to July 2023 was conducted. Studies involving dietitian-led interventions in adult critical care were included. Data extraction followed Joanna Briggs Institute methodology, focusing on study design, population, and interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 751 studies, 39 met the inclusion criteria. Most studies were observational, with only three interventional trials. Dietitian-led interventions included (1) guideline development and implementation, (2) individualized nutrition treatment, and (3) enteral nutrition tube insertion. Outcomes were classified into (1) patient clinical outcomes (ICU stay duration, mechanical ventilation, infections, cost savings, readmissions, mortality, adverse effects, and glycemic control) and (2) nutrition-related outcomes (nutrition initiation, energy and protein delivery, gastrointestinal tolerance, parenteral nutrition use, and appropriate dietetic referral).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Dietitian-led interventions improved nutrition outcomes and may have contributed to better clinical outcomes. Future research should prioritize reporting core outcomes, including nutrition status and physical function, to further quantify the effectiveness of dietitians in ICU care and enhance their recognition within the multiprofessional team.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"165-179"},"PeriodicalIF":3.2,"publicationDate":"2024-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142769986","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}
Bioelectrical impedance is used clinically to assess body composition. To determine true (rather than chance/measurement error) change in bioelectrical impedance analysis measurements over time, it is necessary to know their least significant change. Least significant change represents values exceeding the 95% prediction interval of the precision error of repeat measurements. The least significant change of repeat bioelectrical impedance analysis measurements in children with obesity and metabolic dysfunction–associated steatotic liver disease is currently unknown.
Methods
This is a prospective, single-center, descriptive cohort study in youth 6–20 years of age with obesity and metabolic dysfunction–associated steatotic liver disease. Two same-day bioelectrical impedance analysis measurements were performed on a multifrequency, octopolar device (InBody 370). Fat mass and fat-free mass were adjusted for age using respective indices (dividing by height squared). Fasting status was determined by patient report. Descriptive statistics (medians with interquartile ranges and means with standard deviations and proportions) were used; the least significant change between repeat measurements with precision interval was calculated.
Results
We recruited 43 patients (81% male; 33% Hispanic; median age: 14 years [interquartile range: 11–16]; median body mass index z score: 2.31 [interquartile range: 2.84–2.65]). A total of 60% were fasting, for a median of 12 h. The least significant change of fat mass index was 0.5 (precision interval: −0.4 to 0.5) kg/m2, fat-free mass index was 0.3 (precision interval: −0.3 to 0.3) kg/m2, and body fat percent was 1.5% (precision interval: −1.3 to 1.50). Fasting status affected least significant change measurements.
Conclusion
In youth with obesity and metabolic dysfunction–associated steatotic liver disease, repeat bioelectrical impedance analysis measurements beyond least significant change and precision interval determined in this study likely represent true changes in body composition over time, vs measurement error.
{"title":"Least significant change with repeat bioelectrical impedance analysis measurements in children with metabolic dysfunction–associated steatotic liver disease: A descriptive cohort study","authors":"Alexandria Speakman DO, Kathryn Hitchcock MS, RD, Emily Romantic RD, Venancio Quiambao RD, Abigail Lepolt RD, CSP, Ana Catalina Arce-Clachar MD, Kristin Bramlage MD, Lin Fei PhD, Qin Sun MS, Stavra Xanthakos MD, MS, Marialena Mouzaki MD, MSc","doi":"10.1002/jpen.2706","DOIUrl":"10.1002/jpen.2706","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Bioelectrical impedance is used clinically to assess body composition. To determine true (rather than chance/measurement error) change in bioelectrical impedance analysis measurements over time, it is necessary to know their least significant change. Least significant change represents values exceeding the 95% prediction interval of the precision error of repeat measurements. The least significant change of repeat bioelectrical impedance analysis measurements in children with obesity and metabolic dysfunction–associated steatotic liver disease is currently unknown.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a prospective, single-center, descriptive cohort study in youth 6–20 years of age with obesity and metabolic dysfunction–associated steatotic liver disease. Two same-day bioelectrical impedance analysis measurements were performed on a multifrequency, octopolar device (InBody 370). Fat mass and fat-free mass were adjusted for age using respective indices (dividing by height squared). Fasting status was determined by patient report. Descriptive statistics (medians with interquartile ranges and means with standard deviations and proportions) were used; the least significant change between repeat measurements with precision interval was calculated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We recruited 43 patients (81% male; 33% Hispanic; median age: 14 years [interquartile range: 11–16]; median body mass index <i>z</i> score: 2.31 [interquartile range: 2.84–2.65]). A total of 60% were fasting, for a median of 12 h. The least significant change of fat mass index was 0.5 (precision interval: −0.4 to 0.5) kg/m<sup>2</sup>, fat-free mass index was 0.3 (precision interval: −0.3 to 0.3) kg/m<sup>2</sup>, and body fat percent was 1.5% (precision interval: −1.3 to 1.50). Fasting status affected least significant change measurements.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In youth with obesity and metabolic dysfunction–associated steatotic liver disease, repeat bioelectrical impedance analysis measurements beyond least significant change and precision interval determined in this study likely represent true changes in body composition over time, vs measurement error.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"200-206"},"PeriodicalIF":3.2,"publicationDate":"2024-12-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142770017","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}
Manisha B. Bhatia MD, MPH, Sai Nelanuthala MD, Tasha Sparks Joplin MD, MPH, Cassandra Anderson MD, MPH, Michael Sobolic MD, Brian W. Gray MD
Background
The optimal feeding strategy for postoperative neonatal patients with congenital bowel obstruction is widely debated. This study aims to evaluate perioperative characteristics and postoperative nutrition practices for patients with congenital bowel obstruction. We hypothesized that earlier introduction of enteral nutrition (EN) is associated with shorter hospital stays and increased weight gain velocities.
Methods
We performed a retrospective cohort study on neonatal patients (<30 days old) admitted to a pediatric referral hospital who underwent an operation for bowel obstruction between 2010 and 2020. Demographic information, clinical characteristics, and feeding characteristics were collected. Associations between early EN (EEN), defined as commencement of enteral feeding within 5 days of surgery, and perioperative characteristics were analyzed with SAS 9.4.
Results
Of the 97 neonates with congenital bowel obstruction, 36 patients received EEN. Sex, gestational age, and ethnicity were similar between groups. Patients receiving EEN were more likely to have a diagnosis of malrotation, anorectal malformation, or annular pancreas (P = 0.04). Patients receiving EEN weaned from parenteral nutrition earlier (9 vs 17 days, P = 0.005). Receiving EEN was associated with shorter median hospital stay (16 vs 29 days, P < 0.0001). Weight gain velocities at the 2-month follow-up were greater for patients receiving EEN (8.02 vs 7.00 g/kg/day, P = 0.04) with the difference dissipating at 6 months.
Conclusion
EEN was more likely provided in patients with certain operative diagnoses and was associated with improved outcomes. Creating and implementing an EEN protocol in congenitally obstructed neonates may lead to shorter hospital stays and improved outcomes.
背景：先天性肠梗阻新生儿患者术后的最佳喂养策略广受争议。本研究旨在评估先天性肠梗阻患者的围手术期特征和术后营养措施。我们假设，较早引入肠内营养（EN）与缩短住院时间和提高体重增长速度有关：我们对新生儿患者进行了一项回顾性队列研究：在 97 名患有先天性肠梗阻的新生儿中，有 36 名患者接受了 EEN。各组间的性别、胎龄和种族相似。接受 EEN 的患者更有可能被诊断为旋转不良、肛门直肠畸形或环状胰腺（P = 0.04）。接受 EEN 的患者较早脱离肠外营养（9 天 vs 17 天，P = 0.005）。接受 EEN 与缩短中位住院时间有关（16 天 vs 29 天，P = 0.005）：某些手术诊断的患者更有可能接受肠外营养，并与改善预后有关。为先天性梗阻新生儿制定并实施 EEN 方案可缩短住院时间并改善预后。
{"title":"Association between early enteral nutrition and length of stay in neonates with congenital bowel obstruction: A retrospective cohort study","authors":"Manisha B. Bhatia MD, MPH, Sai Nelanuthala MD, Tasha Sparks Joplin MD, MPH, Cassandra Anderson MD, MPH, Michael Sobolic MD, Brian W. Gray MD","doi":"10.1002/jpen.2702","DOIUrl":"10.1002/jpen.2702","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The optimal feeding strategy for postoperative neonatal patients with congenital bowel obstruction is widely debated. This study aims to evaluate perioperative characteristics and postoperative nutrition practices for patients with congenital bowel obstruction. We hypothesized that earlier introduction of enteral nutrition (EN) is associated with shorter hospital stays and increased weight gain velocities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study on neonatal patients (<30 days old) admitted to a pediatric referral hospital who underwent an operation for bowel obstruction between 2010 and 2020. Demographic information, clinical characteristics, and feeding characteristics were collected. Associations between early EN (EEN), defined as commencement of enteral feeding within 5 days of surgery, and perioperative characteristics were analyzed with SAS 9.4.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 97 neonates with congenital bowel obstruction, 36 patients received EEN. Sex, gestational age, and ethnicity were similar between groups. Patients receiving EEN were more likely to have a diagnosis of malrotation, anorectal malformation, or annular pancreas (<i>P</i> = 0.04). Patients receiving EEN weaned from parenteral nutrition earlier (9 vs 17 days, <i>P</i> = 0.005). Receiving EEN was associated with shorter median hospital stay (16 vs 29 days, <i>P</i> < 0.0001). Weight gain velocities at the 2-month follow-up were greater for patients receiving EEN (8.02 vs 7.00 g/kg/day, <i>P</i> = 0.04) with the difference dissipating at 6 months.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EEN was more likely provided in patients with certain operative diagnoses and was associated with improved outcomes. Creating and implementing an EEN protocol in congenitally obstructed neonates may lead to shorter hospital stays and improved outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"69-76"},"PeriodicalIF":3.2,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739770","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}
Angelique M.E. de Man MD, PhD, Christian Stoppe MD, Kristine W.A.C. Koekkoek MD, George Briassoulis MD, PhD, Lilanthi S.D.P. Subasinghe MD, Cristian Cobilinschi MD, Adam M. Deane MD, PhD, William Manzanares MD, PhD, Ioana Grințescu MD, PhD, Liliana Mirea MD, PhD, Ashraf Roshdy MD, PhD, Antonella Cotoia MD, PhD, Danielle E. Bear PhD, Sabrina Boraso MD, PhD, Vincent Fraipont MD, Kenneth B. Christopher MD, SM, Michael P. Casaer MD, PhD, Jan Gunst MD, PhD, Olivier Pantet MD, Muhammed Elhadi MD, Giuliano Bolondi MD, MSc, Xavier Forceville MD, PhD, Matthias W.A. Angstwurm MD, PhD, Mohan Gurjar MD, Rodrigo Biondi MD, MSc, Arthur R.H. van Zanten MD, PhD, Mette M. Berger MD, PhD, ESICM/FREM MN group
Micronutrient (MN) status alterations (both depletion and deficiency) are associated with several complications and worse outcomes in critically ill patients. On the other side of the spectrum, improving MN status has been shown to be a potential co-adjuvant therapy. This review aims to collect existing data to better guide research in the critical care setting. This narrative review was conducted by the European Society of Intensive Care Medicine Feeding, Rehabilitation, Endocrinology, and Metabolism MN group. The primary objective was to identify studies focusing on individual MNs in critically ill patients, selecting the MNs that appear to be most relevant and most frequently investigated in the last decade: A, B1, B2, B3, B6, folate, C, D, E, copper, iron, selenium, zinc, and carnitine. Given the limited number of interventional studies for most MNs, observational studies were included. For each selected MN, the review summarizes the main form and functions, special needs and risk factors, optimal treatment strategies, pharmacological dosing, and clinical implications all specific to critically ill patients. A rigorous rebalancing of research strategies and priorities is needed to improve clinical practice. An important finding is that high-dose monotherapy of MNs is not recommended. Basal daily needs must be provided, with higher doses in diseases with known higher needs, and identified deficiencies treated. Finally, the review provides a list of ongoing trials on MNs in critically ill patients and identifies a priority list of future research topics.
{"title":"What do we know about micronutrients in critically ill patients? A narrative review","authors":"Angelique M.E. de Man MD, PhD, Christian Stoppe MD, Kristine W.A.C. Koekkoek MD, George Briassoulis MD, PhD, Lilanthi S.D.P. Subasinghe MD, Cristian Cobilinschi MD, Adam M. Deane MD, PhD, William Manzanares MD, PhD, Ioana Grințescu MD, PhD, Liliana Mirea MD, PhD, Ashraf Roshdy MD, PhD, Antonella Cotoia MD, PhD, Danielle E. Bear PhD, Sabrina Boraso MD, PhD, Vincent Fraipont MD, Kenneth B. Christopher MD, SM, Michael P. Casaer MD, PhD, Jan Gunst MD, PhD, Olivier Pantet MD, Muhammed Elhadi MD, Giuliano Bolondi MD, MSc, Xavier Forceville MD, PhD, Matthias W.A. Angstwurm MD, PhD, Mohan Gurjar MD, Rodrigo Biondi MD, MSc, Arthur R.H. van Zanten MD, PhD, Mette M. Berger MD, PhD, ESICM/FREM MN group","doi":"10.1002/jpen.2700","DOIUrl":"10.1002/jpen.2700","url":null,"abstract":"<p>Micronutrient (MN) status alterations (both depletion and deficiency) are associated with several complications and worse outcomes in critically ill patients. On the other side of the spectrum, improving MN status has been shown to be a potential co-adjuvant therapy. This review aims to collect existing data to better guide research in the critical care setting. This narrative review was conducted by the European Society of Intensive Care Medicine Feeding, Rehabilitation, Endocrinology, and Metabolism MN group. The primary objective was to identify studies focusing on individual MNs in critically ill patients, selecting the MNs that appear to be most relevant and most frequently investigated in the last decade: A, B<sub>1</sub>, B<sub>2</sub>, B<sub>3</sub>, B<sub>6</sub>, folate, C, D, E, copper, iron, selenium, zinc, and carnitine. Given the limited number of interventional studies for most MNs, observational studies were included. For each selected MN, the review summarizes the main form and functions, special needs and risk factors, optimal treatment strategies, pharmacological dosing, and clinical implications all specific to critically ill patients. A rigorous rebalancing of research strategies and priorities is needed to improve clinical practice. An important finding is that high-dose monotherapy of MNs is not recommended. Basal daily needs must be provided, with higher doses in diseases with known higher needs, and identified deficiencies treated. Finally, the review provides a list of ongoing trials on MNs in critically ill patients and identifies a priority list of future research topics.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"33-58"},"PeriodicalIF":3.2,"publicationDate":"2024-11-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717498/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142647509","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}
This study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status.
Methods
A retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations.
Results
Phase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge.
Conclusion
Segmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living.
背景：本研究调查了脑卒中患者的节段相位角与功能预后之间的关系：本研究调查了脑卒中患者的节段相位角与功能预后之间的关系，假设节段相位角的增加与功能状态的改善相关：方法：对 1012 名中风后患者进行了回顾性队列研究。方法：对 1012 名脑卒中患者进行了回顾性队列研究，在入院 3 天内使用生物电阻抗分析测量了全身和节段相位角。我们关注的暴露是通过多频生物电阻抗分析仪测量的节段相位角，计算公式为相位角 = 正切 (Xc/R) × (180/π)，其中 R 是右半身的电阻，Xc 是在 50 kHz 频率下测量的电抗。主要结果是出院时的功能独立性测量（FIM）运动分量表以及入院和出院之间的 FIM 变化。次要结果包括特定活动的 FIM 分数。进行了多元线性回归分析以评估相关性：与全身或瘫痪肢体的相位角相比，健康上肢和下肢的相位角与出院时的 FIM 运动评分（分别为 β = 0.175 和 β = 0.105）和 FIM 运动增益（分别为 β = 0.242 和 β = 0.092）有更强的相关性。上肢相位角与梳理和如厕能力的关系更为密切，而下肢相位角则与出院时的如厕和运动能力有关：结论：节段相位角，尤其是非瘫痪肢体的节段相位角，是预测中风后患者功能预后的有效指标。评估节段相位角可指导有针对性的干预和康复策略，以改善特定的日常生活活动。
{"title":"Association between segmental phase angles and functional independence measure scores in hospitalized adults following stroke: A retrospective cohort study","authors":"Yoshihiro Yoshimura MD, PhD, Hidetaka Wakabayashi MD, PhD, Fumihiko Nagano, Ayaka Matsumoto, Sayuri Shimazu, Ai Shiraishi, Yoshifumi Kido, Takahiro Bise, Aomi Kuzuhara, Takenori Hamada, Kouki Yoneda","doi":"10.1002/jpen.2703","DOIUrl":"10.1002/jpen.2703","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study investigated the association between segmental phase angles and functional outcomes in patients after stroke, hypothesizing that increased segmental phase angle correlates with improved functional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study of 1012 patients after stroke was conducted. Whole body and segmental phase angles were measured using bioelectrical impedance analysis within 3 days of admission. Our exposure of interest was segmental phase angle measured via a multifrequency bioelectrical impedance analyzer and calculated as phase angle = arctangent (Xc/R) × (180/π), where R is the resistance of the right half of the body and Xc is the reactance measured at 50 kHz. The primary outcomes were the motor subscale of the functional independence measure (FIM) at discharge and FIM change between admission and discharge. Secondary outcomes included FIM scores for specific activities. Multiple linear regression analysis was performed to assess associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Phase angles of the healthy upper and lower limbs demonstrated stronger associations with discharge FIM motor scores (β = 0.175 and β = 0.105, respectively) and FIM motor gain (β = 0.242 and β = 0.092, respectively) compared with whole body or paretic limb phase angles. Upper limb phase angles were more closely related to grooming and toileting abilities, whereas lower limb phase angles were associated with both toileting and locomotion at discharge.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Segmental phase angles, particularly those of the nonparetic limbs, are promising predictors of functional outcomes in patients after stroke. Assessing segmental phase angles may guide targeted interventions and rehabilitation strategies for improving specific activities of daily living.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 2","pages":"239-248"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622541","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}
Kirstine Farrer MPhil, Maja Kopczynska MBBCh, Maria Barrett MSc, Simon Harrison MPharm, Antje Teubner MD, Arun Abraham MD, Derek McWhirter MD, Jonathan Epstein MD, Simon Lal PhD, Gordon L. Carlson CBE, MD
Background
Chyme reinfusion therapy treats patients with high-output fistulas or stomas by returning chyme to the distal gut. The role of this treatment in severe acute intestinal failure is currently unclear. The primary outcome of this study was a successful establishment of chyme reinfusion therapy, defined by the ability to replace parenteral nutrition for nutrition support.
Methods
A descriptive cohort study of adult patients with severe acute intestinal failure due to a high-output stoma and distal mucus fistula or a high-output small intestinal fistula receiving chyme reinfusion therapy was undertaken. The effect of chyme reinfusion therapy on parenteral nutrition requirements, medication, nutrition status, liver function, and treatment cost were studied.
Results
Twenty-four patients commenced treatment for a median of 44 (range, 3–571; total, 2263) days. Fifteen (62.5%) were successfully established for 1208 days, and nine continued treatment at home. Parenteral requirements, including volume, energy and nitrogen content, and frequency, were significantly reduced (P = 0.002), whereas anthropometric measurements remained stable. However, chyme therapy was not tolerated in nine patients (37.5%), and only two (8.3%) weaned fully from parenteral nutrition. Chyme reinfusion therapy was associated with a 47.6% reduction in parenteral energy requirements, 42.8% reduction in nitrogen, and 33.3% reduction in volume of parenteral nutrition requirements. Treatment was associated with a net cost of £30.05 ($40.27) per patient per day.
Conclusion
Chyme reinfusion therapy was associated with reductions in the need for parenteral therapy and medication but did not replace parenteral nutrition or result in a significant cost saving.
{"title":"Chyme reinfusion therapy in adults with severe acute intestinal failure: A descriptive cohort study","authors":"Kirstine Farrer MPhil, Maja Kopczynska MBBCh, Maria Barrett MSc, Simon Harrison MPharm, Antje Teubner MD, Arun Abraham MD, Derek McWhirter MD, Jonathan Epstein MD, Simon Lal PhD, Gordon L. Carlson CBE, MD","doi":"10.1002/jpen.2704","DOIUrl":"10.1002/jpen.2704","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Chyme reinfusion therapy treats patients with high-output fistulas or stomas by returning chyme to the distal gut. The role of this treatment in severe acute intestinal failure is currently unclear. The primary outcome of this study was a successful establishment of chyme reinfusion therapy, defined by the ability to replace parenteral nutrition for nutrition support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A descriptive cohort study of adult patients with severe acute intestinal failure due to a high-output stoma and distal mucus fistula or a high-output small intestinal fistula receiving chyme reinfusion therapy was undertaken. The effect of chyme reinfusion therapy on parenteral nutrition requirements, medication, nutrition status, liver function, and treatment cost were studied.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-four patients commenced treatment for a median of 44 (range, 3–571; total, 2263) days. Fifteen (62.5%) were successfully established for 1208 days, and nine continued treatment at home. Parenteral requirements, including volume, energy and nitrogen content, and frequency, were significantly reduced (<i>P</i> = 0.002), whereas anthropometric measurements remained stable. However, chyme therapy was not tolerated in nine patients (37.5%), and only two (8.3%) weaned fully from parenteral nutrition. Chyme reinfusion therapy was associated with a 47.6% reduction in parenteral energy requirements, 42.8% reduction in nitrogen, and 33.3% reduction in volume of parenteral nutrition requirements. Treatment was associated with a net cost of £30.05 ($40.27) per patient per day.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Chyme reinfusion therapy was associated with reductions in the need for parenteral therapy and medication but did not replace parenteral nutrition or result in a significant cost saving.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"85-93"},"PeriodicalIF":3.2,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142622494","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}
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