Terence James M. Camilon MS, Mary Galemmo BS, Whitney Savino NNP, Allison Rohrer RD, Mathew J. Gregoski PhD, Aaron P. Lesher MD, Katherine E. Chetta MD
Background
Prolonged storage of donor human milk may alter its bioactive components, potentially affecting preterm infant outcomes. No prior studies have examined the impact of donor human milk storage duration on necrotizing enterocolitis or spontaneous intestinal perforation.
Methods
In a retrospective case-control study (February 2022 to January 2024) at a single neonatal intensive care unit, we evaluated preterm infants (<32 weeks' gestational age or birth weight <1700 g) receiving donor human milk. Cases (n = 36) had necrotizing enterocolitis (Bell stage ≥2A) or spontaneous intestinal perforation; controls (n = 226) were disease free. Donor human milk storage duration (days from expression to consumption) was calculated using lot expiration dates. Logistic regression assessed associations, adjusting for gestational age, birth weight, and other confounders.
Results
Of 262 infants, 36 developed necrotizing enterocolitis (n = 28) or spontaneous intestinal perforation (n = 8). Mean donor human milk storage duration was 258.6 (SD, 29.9) days in cases and 244.5 (SD, 21.7) days in controls (P = 0.01). Each additional storage day increased the adjusted odds of necrotizing enterocolitis or spontaneous intestinal perforation by 3.6% (95% confidence interval, 1.17–5.5; P < 0.001), after accounting for maternal and infant comorbidities.
Conclusions
Prolonged donor human milk storage is associated with necrotizing enterocolitis and spontaneous intestinal perforation in preterm infants, particularly those <750 g. These findings suggest a need to reevaluate donor human milk storage guidelines for high-risk neonates, pending multicenter validation.
{"title":"Donor human milk storage and gastrointestinal morbidities in preterm infants: A case-control study","authors":"Terence James M. Camilon MS, Mary Galemmo BS, Whitney Savino NNP, Allison Rohrer RD, Mathew J. Gregoski PhD, Aaron P. Lesher MD, Katherine E. Chetta MD","doi":"10.1002/jpen.2780","DOIUrl":"10.1002/jpen.2780","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Prolonged storage of donor human milk may alter its bioactive components, potentially affecting preterm infant outcomes. No prior studies have examined the impact of donor human milk storage duration on necrotizing enterocolitis or spontaneous intestinal perforation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In a retrospective case-control study (February 2022 to January 2024) at a single neonatal intensive care unit, we evaluated preterm infants (<32 weeks' gestational age or birth weight <1700 g) receiving donor human milk. Cases (<i>n</i> = 36) had necrotizing enterocolitis (Bell stage ≥2A) or spontaneous intestinal perforation; controls (<i>n</i> = 226) were disease free. Donor human milk storage duration (days from expression to consumption) was calculated using lot expiration dates. Logistic regression assessed associations, adjusting for gestational age, birth weight, and other confounders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 262 infants, 36 developed necrotizing enterocolitis (<i>n</i> = 28) or spontaneous intestinal perforation (<i>n</i> = 8). Mean donor human milk storage duration was 258.6 (SD, 29.9) days in cases and 244.5 (SD, 21.7) days in controls (<i>P</i> = 0.01). Each additional storage day increased the adjusted odds of necrotizing enterocolitis or spontaneous intestinal perforation by 3.6% (95% confidence interval, 1.17–5.5; <i>P</i> < 0.001), after accounting for maternal and infant comorbidities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Prolonged donor human milk storage is associated with necrotizing enterocolitis and spontaneous intestinal perforation in preterm infants, particularly those <750 g. These findings suggest a need to reevaluate donor human milk storage guidelines for high-risk neonates, pending multicenter validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"717-723"},"PeriodicalIF":4.1,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2780","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144251951","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}
Katrina A. Savioli MD, Carl E. Hunt MD, Anwar E. Ahmed PhD, Cara H. Olsen MS, PhD, Reese H. Clark MD, Nicole R. Dobson MD
Background
We aimed to determine how the use of parenteral nutrition in late preterm and term infants admitted to the neonatal intensive care unit (NICU) affects outcomes, specifically length of stay.
Methods
This is a retrospective cohort study that included infants ≥35 weeks gestation admitted to a Pediatrix Medical Group–affiliated NICU on day of life 0–2 in 2009–2019. Propensity score matching was used to control for demographics, delivery characteristics, and severity of illness. Infants were excluded if they received comfort or palliative care in the delivery room or transferred before discharge home. The primary outcome was length of stay. Secondary outcomes were duration of conventional and high-frequency ventilation, late-onset sepsis, and mortality.
Results
The total cohort had 470,433 neonates; of the 259,495 infants who met inclusion criteria and survived to discharge, 97,577 (37.6%) received parenteral nutrition. Of 59,580 propensity-matched neonates comparing parenteral nutrition vs no parenteral nutrition, those receiving parenteral nutrition (n = 29,790) had a longer median length of stay (10 vs 9 days, P < 0.0001). Analysis of secondary outcomes revealed a higher mean number of conventional ventilation days, higher odds of late-onset sepsis, and higher odds of mortality in neonates receiving parenteral nutrition vs no parenteral nutrition.
Conclusion
Parenteral nutrition in late preterm and term neonates is associated with increased length of stay, duration of conventional ventilation, and odds of late-onset sepsis and mortality. Prospective clinical trials are needed to better understand the optimal use and timing of parenteral nutrition and associated morbidities in this population.
{"title":"Association between parenteral nutrition and length of stay in late preterm and term infants: A retrospective cohort study","authors":"Katrina A. Savioli MD, Carl E. Hunt MD, Anwar E. Ahmed PhD, Cara H. Olsen MS, PhD, Reese H. Clark MD, Nicole R. Dobson MD","doi":"10.1002/jpen.2781","DOIUrl":"10.1002/jpen.2781","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We aimed to determine how the use of parenteral nutrition in late preterm and term infants admitted to the neonatal intensive care unit (NICU) affects outcomes, specifically length of stay.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This is a retrospective cohort study that included infants ≥35 weeks gestation admitted to a Pediatrix Medical Group–affiliated NICU on day of life 0–2 in 2009–2019. Propensity score matching was used to control for demographics, delivery characteristics, and severity of illness. Infants were excluded if they received comfort or palliative care in the delivery room or transferred before discharge home. The primary outcome was length of stay. Secondary outcomes were duration of conventional and high-frequency ventilation, late-onset sepsis, and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The total cohort had 470,433 neonates; of the 259,495 infants who met inclusion criteria and survived to discharge, 97,577 (37.6%) received parenteral nutrition. Of 59,580 propensity-matched neonates comparing parenteral nutrition vs no parenteral nutrition, those receiving parenteral nutrition (<i>n</i> = 29,790) had a longer median length of stay (10 vs 9 days, <i>P</i> < 0.0001). Analysis of secondary outcomes revealed a higher mean number of conventional ventilation days, higher odds of late-onset sepsis, and higher odds of mortality in neonates receiving parenteral nutrition vs no parenteral nutrition.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Parenteral nutrition in late preterm and term neonates is associated with increased length of stay, duration of conventional ventilation, and odds of late-onset sepsis and mortality. Prospective clinical trials are needed to better understand the optimal use and timing of parenteral nutrition and associated morbidities in this population.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 7","pages":"837-845"},"PeriodicalIF":4.1,"publicationDate":"2025-06-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144236749","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}
Lauren J. Lee MD, MS, Esther S. Kim MD, Tahmineh Romero MS, Kara L. Calkins MD, MS
Background
Infants with gastrointestinal (GI) disorders are at risk for parenteral nutrition–associated cholestasis. A multioil intravenous lipid emulsion (MO ILE) contains less phytosterols and more arachidonic and docosahexaenoic acid (DHA) than 100% soybean oil lipid emulsion (SO ILE). This study compares parenteral nutrition–associated cholestasis, growth, and fatty acids in infants with GI disorders who received MO ILE or SO ILE.
Methods
This retrospective cohort study included 48 infants with GI disorders born between 2014 and 2022 who received an intravenous lipid emulsion for ≥14 days. Cholestasis was defined as serum conjugated bilirubin ≥2 mg/dl; growth was assessed by z score changes. Gas chromatography and mass spectrometry was used to measure fatty acid content in the erythrocyte cell membrane.
Results
The incidence of parenteral nutrition–associated cholestasis was similar (MO ILE 30% vs SO ILE 29%, P > 0.99). However, compared with infants who received parenteral nutrition >28 days and SO ILE, infants who received parenteral nutrition >28 days and MO ILE experienced a slower rise in conjugated bilirubin (0.1 ± 0.03 vs 0.26 ± 0.38 mg/dl, P interaction < 0.001). Weight z score decline (discharge to birth) was less in the MO ILE group vs SO ILE group (−1.0 [−2.0, −0.4] vs −0.4 [−0.9, 0], P = 0.04). Although the MO ILE group demonstrated improved DHA status at weeks 1–3 (P < 0.05 for all), arachidonic acid and DHA decreased over time in both groups and there was no difference in the rate of change (P interaction > 0.3 for both).
Conclusion
In infants with GI disorders, MO ILE was associated with improved growth. MO ILE was well tolerated and hepatoprotective in infants who required prolonged parenteral nutrition.
背景：患有胃肠道疾病的婴儿有肠外营养相关性胆汁淤积的风险。多油静脉注射脂质乳（MO ILE）比100%大豆油脂质乳（SO ILE）含有更少的植物甾醇和更多的花生四烯酸和二十二碳六烯酸（DHA）。本研究比较了接受MO ILE或SO ILE的胃肠道疾病婴儿肠外营养相关的胆汁淤积、生长和脂肪酸。方法：本回顾性队列研究纳入了48例2014年至2022年出生的胃肠道疾病婴儿，接受静脉注射脂质乳剂≥14天。胆汁淤积定义为血清结合胆红素≥2 mg/dl；生长通过z分数变化来评估。采用气相色谱-质谱法测定红细胞膜脂肪酸含量。结果：肠外营养相关性胆汁淤积的发生率相似（MO ILE 30% vs SO ILE 29%, P < 0.99）。然而，与接受肠外营养>28天和SO ILE的婴儿相比，接受肠外营养>28天和MO ILE的婴儿共轭胆红素升高较慢（0.1±0.03 vs 0.26±0.38 mg/dl，两者的相互作用P为0.3）。结论：在患有胃肠道疾病的婴儿中，MO ILE与生长改善有关。对于需要长时间肠外营养的婴儿，MO ILE具有良好的耐受性和肝脏保护作用。
{"title":"Association between multioil intravenous lipid emulsion and cholestasis in infants with gastrointestinal disorders: A retrospective cohort study","authors":"Lauren J. Lee MD, MS, Esther S. Kim MD, Tahmineh Romero MS, Kara L. Calkins MD, MS","doi":"10.1002/jpen.2776","DOIUrl":"10.1002/jpen.2776","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Infants with gastrointestinal (GI) disorders are at risk for parenteral nutrition–associated cholestasis. A multioil intravenous lipid emulsion (MO ILE) contains less phytosterols and more arachidonic and docosahexaenoic acid (DHA) than 100% soybean oil lipid emulsion (SO ILE). This study compares parenteral nutrition–associated cholestasis, growth, and fatty acids in infants with GI disorders who received MO ILE or SO ILE.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study included 48 infants with GI disorders born between 2014 and 2022 who received an intravenous lipid emulsion for ≥14 days. Cholestasis was defined as serum conjugated bilirubin<i> ≥</i>2 mg/dl; growth was assessed by z score changes. Gas chromatography and mass spectrometry was used to measure fatty acid content in the erythrocyte cell membrane.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The incidence of parenteral nutrition–associated cholestasis was similar (MO ILE 30% vs SO ILE 29%, <i>P</i> > 0.99). However, compared with infants who received parenteral nutrition >28 days and SO ILE, infants who received parenteral nutrition >28 days and MO ILE experienced a slower rise in conjugated bilirubin (0.1 ± 0.03 vs 0.26 ± 0.38 mg/dl, <i>P</i> interaction < 0.001). Weight <i>z</i> score decline (discharge to birth) was less in the MO ILE group vs SO ILE group (−1.0 [−2.0, −0.4] vs −0.4 [−0.9, 0], <i>P</i> = 0.04). Although the MO ILE group demonstrated improved DHA status at weeks 1–3 (<i>P</i> < 0.05 for all), arachidonic acid and DHA decreased over time in both groups and there was no difference in the rate of change (<i>P</i> interaction > 0.3 for both).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In infants with GI disorders, MO ILE was associated with improved growth. MO ILE was well tolerated and hepatoprotective in infants who required prolonged parenteral nutrition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"707-716"},"PeriodicalIF":4.1,"publicationDate":"2025-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2776","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144218567","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}
Jiao Li MD, Jing Shi MD, Xiaohong Li MD, Xiaoyan Yang MD, Jing Zhao MD, Tingting Zhu MD, Haiting Liu MD, Yanling Hu MS, Jun Tang MD, Dapeng Chen MD, Dezhi Mu MD
Background
This study aimed to assess the necessity of adding heparin to parenteral nutrition for continuous infusion through a peripherally inserted central catheter in very preterm infants.
Methods
This retrospective cohort study was conducted between January 1, 2019, and January 1, 2023. Preterm infants with gestational age <32 weeks requiring a peripherally inserted central catheter for parenteral nutrition were included. The heparin group received parenteral nutrition with 0.5 IU/ml heparin added for infusion through a peripherally inserted central catheter, whereas the nonheparin group did not receive heparin. Propensity score matching was used to balance baseline variables between the two groups. The primary outcome was the incidence of catheter-related complications. A noninferiority margin of 10% was chosen. Nonelective catheter removal, heparin-related side effects, and catheter dwell time were compared between the two groups.
Results
A total of 1089 very preterm infants were included. After propensity score matching, 432 infants from each group were analyzed. The incidence of catheter-related complications was 22.9% in the heparin group and 21.8% in the nonheparin group, with an absolute difference of −1.16% (95% CI: −6.71% to 4.40%). The upper bound was below 10% (P for noninferiority < 0.001), confirming noninferiority. In addition, no significant difference was found between the two groups in the incidence of nonelective catheter removal or heparin-related side effects.
Conclusion
Parenteral nutrition without heparin was noninferior to the addition of heparin during infusion through peripherally inserted central catheter on the risk of catheter-related complications in very preterm infants.
{"title":"Association between heparin addition to parenteral nutrition and catheter-related complications in very preterm infants: A retrospective cohort study","authors":"Jiao Li MD, Jing Shi MD, Xiaohong Li MD, Xiaoyan Yang MD, Jing Zhao MD, Tingting Zhu MD, Haiting Liu MD, Yanling Hu MS, Jun Tang MD, Dapeng Chen MD, Dezhi Mu MD","doi":"10.1002/jpen.2779","DOIUrl":"10.1002/jpen.2779","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to assess the necessity of adding heparin to parenteral nutrition for continuous infusion through a peripherally inserted central catheter in very preterm infants.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective cohort study was conducted between January 1, 2019, and January 1, 2023. Preterm infants with gestational age <32 weeks requiring a peripherally inserted central catheter for parenteral nutrition were included. The heparin group received parenteral nutrition with 0.5 IU/ml heparin added for infusion through a peripherally inserted central catheter, whereas the nonheparin group did not receive heparin. Propensity score matching was used to balance baseline variables between the two groups. The primary outcome was the incidence of catheter-related complications. A noninferiority margin of 10% was chosen. Nonelective catheter removal, heparin-related side effects, and catheter dwell time were compared between the two groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1089 very preterm infants were included. After propensity score matching, 432 infants from each group were analyzed. The incidence of catheter-related complications was 22.9% in the heparin group and 21.8% in the nonheparin group, with an absolute difference of −1.16% (95% CI: −6.71% to 4.40%). The upper bound was below 10% (<i>P</i> for noninferiority < 0.001), confirming noninferiority. In addition, no significant difference was found between the two groups in the incidence of nonelective catheter removal or heparin-related side effects.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Parenteral nutrition without heparin was noninferior to the addition of heparin during infusion through peripherally inserted central catheter on the risk of catheter-related complications in very preterm infants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 7","pages":"855-864"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164466","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}
An Zhou MM, Qun Ye MM, Yonghui Wei MM, Wei-Dong Li MD
Background
We investigated relationships between nutrition assessment tools (Controlling Nutritional Status [CONUT], Geriatric Nutritional Risk Index [GNRI], and Naples Prognostic Score [NPS]) and epigenetic clocks, evaluating malnutrition's impact on biological aging.
Methods
Using National Health and Nutrition Examination Survey database (1999–2002), 2532 participants aged ≥50 years were assessed with three nutrition tools and analyzed against 12 epigenetic clocks using multiple linear regression models adjusted for confounding factors.
Results
Malnutrition prevalence rates were 13.5% (CONUT), 4.2% (GNRI), and 46.8% (NPS). Compared with no-risk groups, moderate-to-severe malnutrition showed significant epigenetic age acceleration, particularly in NPS assessment. GrimAge2Mort demonstrated up to 4.19 years acceleration (in NPS model 3, P < 0.01), DunedinPoAm showed significant increase (in NPS model 3, β = 0.083, P < 0.01), and YangCell significantly decreased (in NPS model 3, β = −0.019, P < 0.01). These associations remained significant after adjusting for confounding factors. A clear dose-response relationship existed between malnutrition and epigenetic age acceleration.
Conclusion
This study provides first systematic evidence of significant associations between malnutrition and epigenetic age acceleration, particularly in moderate-to-severe malnutrition, leading to substantial biological aging acceleration. GrimAge2Mort, DunedinPoAm, and YangCell emerged as stable indicators for assessing nutrition-related biological aging. These findings provide new insights into malnutrition's impact on aging and offer important references for clinical nutrition intervention strategies.
背景：我们研究了营养评估工具（控制营养状态[CONUT]、老年营养风险指数[GNRI]和那不勒斯预后评分[NPS]）与表观遗传时钟之间的关系，评估营养不良对生物衰老的影响。方法：利用国家健康与营养调查数据库（1999-2002），采用3种营养工具对2532名年龄≥50岁的参与者进行评估，并采用校正混杂因素的多元线性回归模型对12种表观遗传时钟进行分析。结果：营养不良患病率分别为13.5% （CONUT）、4.2% （GNRI）和46.8% （NPS）。与无风险组相比，中度至重度营养不良表现出明显的表观遗传年龄加速，特别是在NPS评估中。GrimAge2Mort加速4.19年（在NPS模型3中，P < 0.01）， DunedinPoAm显著增加（在NPS模型3中，β = 0.083, P < 0.01）， YangCell显著降低（在NPS模型3中，β = -0.019, P < 0.01）。在调整混杂因素后，这些关联仍然显著。营养不良与表观遗传年龄加速之间存在明显的剂量-反应关系。结论：本研究首次提供了营养不良与表观遗传年龄加速之间存在显著关联的系统证据，特别是在中度至重度营养不良中，营养不良会导致实质性的生物衰老加速。GrimAge2Mort、DunedinPoAm和YangCell成为评估营养相关生物衰老的稳定指标。这些发现为营养不良对衰老的影响提供了新的认识，并为临床营养干预策略提供了重要参考。
{"title":"Association between epigenetic clock acceleration and malnutrition among adults in the United States: A cross-sectional study","authors":"An Zhou MM, Qun Ye MM, Yonghui Wei MM, Wei-Dong Li MD","doi":"10.1002/jpen.2778","DOIUrl":"10.1002/jpen.2778","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>We investigated relationships between nutrition assessment tools (Controlling Nutritional Status [CONUT], Geriatric Nutritional Risk Index [GNRI], and Naples Prognostic Score [NPS]) and epigenetic clocks, evaluating malnutrition's impact on biological aging.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using National Health and Nutrition Examination Survey database (1999–2002), 2532 participants aged ≥50 years were assessed with three nutrition tools and analyzed against 12 epigenetic clocks using multiple linear regression models adjusted for confounding factors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Malnutrition prevalence rates were 13.5% (CONUT), 4.2% (GNRI), and 46.8% (NPS). Compared with no-risk groups, moderate-to-severe malnutrition showed significant epigenetic age acceleration, particularly in NPS assessment. GrimAge2Mort demonstrated up to 4.19 years acceleration (in NPS model 3, <i>P</i> < 0.01), DunedinPoAm showed significant increase (in NPS model 3, β = 0.083, <i>P</i> < 0.01), and YangCell significantly decreased (in NPS model 3, β = −0.019, <i>P</i> < 0.01). These associations remained significant after adjusting for confounding factors. A clear dose-response relationship existed between malnutrition and epigenetic age acceleration.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study provides first systematic evidence of significant associations between malnutrition and epigenetic age acceleration, particularly in moderate-to-severe malnutrition, leading to substantial biological aging acceleration. GrimAge2Mort, DunedinPoAm, and YangCell emerged as stable indicators for assessing nutrition-related biological aging. These findings provide new insights into malnutrition's impact on aging and offer important references for clinical nutrition intervention strategies.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 7","pages":"903-911"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144153301","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}
Hao-Qing Cheng MM, Hong-Xia Xu PhD, Min Weng MM, Lan Zhou PhD, Fu-Xiang Zhou PhD, Peng-Xia Guo MM, Ge-Ge Zhang MM, Chu-Ying Zhang MM, Han-Ping Shi MD, PhD, Chun-Hua Song MD, PhD
This multicenter retrospective cohort study evaluated the prognostic value of the modified weight loss grading system (mWLGS) in patients with lung cancer by analyzing data from 3601 individuals. The investigation demonstrated that mWLGS effectively stratified patient outcomes, with median overall survival progressively declining from 35.5 months for grade 0 to 26.0 months for grade 4. Multivariate Cox regression showed grades 1, 2, 3, and 4 were independently associated with reduced survival, showing incrementally worsening hazard ratios (HR) (HR 1.56, 95% CI: 1.03–2.37, P = 0.037; HR 1.87, 95% CI: 1.24–2.84, P = 0.003; HR 1.94, 95% CI: 1.27–2.96, P = 0.003; HR: 1.95, 95% CI: 1.27–3.00, P = 0.002, respectively). Sensitivity analyses, in which we excluded patients who died within 30 days, showed that mWLGS remained an independent prognostic indicator. The system significantly enhanced prognostic discrimination when combined with TNM staging, as evidenced by improved C-statistics, continuous net reclassification improvement (NRI), and integrated discriminant improvement (IDI). These findings establish that the mWLGS can better stratification the prognosis of patients with lung cancer and is an effective indicator to predict the survival time and quality of life of lung cancer patients.
这项多中心回顾性队列研究通过分析3601例肺癌患者的数据，评估了改良体重减轻分级系统（mWLGS）对肺癌患者的预后价值。研究表明，mWLGS有效地分层了患者的结局，中位总生存期从0级的35.5个月逐渐下降到4级的26.0个月。多因素Cox回归显示，1、2、3和4级与生存率降低独立相关，风险比（HR）逐渐恶化(HR 1.56, 95% CI: 1.03-2.37, P = 0.037；Hr 1.87, 95% ci: 1.24-2.84, p = 0.003；Hr 1.94, 95% ci: 1.27-2.96, p = 0.003；HR: 1.95, 95% CI: 1.27-3.00, P = 0.002)。敏感性分析（我们排除了30天内死亡的患者）显示mWLGS仍然是一个独立的预后指标。当与TNM分期相结合时，该系统显著提高了预后的辨别性，c统计数据的改善、持续净再分类改善（NRI）和综合判别改善（IDI）证明了这一点。这些结果说明mWLGS能较好地对肺癌患者的预后进行分层，是预测肺癌患者生存时间和生活质量的有效指标。
{"title":"Association between modified weight loss grading system and overall survival in adults with lung cancer: A retrospective cohort study","authors":"Hao-Qing Cheng MM, Hong-Xia Xu PhD, Min Weng MM, Lan Zhou PhD, Fu-Xiang Zhou PhD, Peng-Xia Guo MM, Ge-Ge Zhang MM, Chu-Ying Zhang MM, Han-Ping Shi MD, PhD, Chun-Hua Song MD, PhD","doi":"10.1002/jpen.2775","DOIUrl":"10.1002/jpen.2775","url":null,"abstract":"<p>This multicenter retrospective cohort study evaluated the prognostic value of the modified weight loss grading system (mWLGS) in patients with lung cancer by analyzing data from 3601 individuals. The investigation demonstrated that mWLGS effectively stratified patient outcomes, with median overall survival progressively declining from 35.5 months for grade 0 to 26.0 months for grade 4. Multivariate Cox regression showed grades 1, 2, 3, and 4 were independently associated with reduced survival, showing incrementally worsening hazard ratios (HR) (HR 1.56, 95% CI: 1.03–2.37, <i>P</i> = 0.037; HR 1.87, 95% CI: 1.24–2.84, <i>P</i> = 0.003; HR 1.94, 95% CI: 1.27–2.96, <i>P</i> = 0.003; HR: 1.95, 95% CI: 1.27–3.00, <i>P</i> = 0.002, respectively). Sensitivity analyses, in which we excluded patients who died within 30 days, showed that mWLGS remained an independent prognostic indicator. The system significantly enhanced prognostic discrimination when combined with TNM staging, as evidenced by improved C-statistics, continuous net reclassification improvement (NRI), and integrated discriminant improvement (IDI). These findings establish that the mWLGS can better stratification the prognosis of patients with lung cancer and is an effective indicator to predict the survival time and quality of life of lung cancer patients.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 7","pages":"895-902"},"PeriodicalIF":4.1,"publicationDate":"2025-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144164391","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}
Mudathir Ibrahim MD, Ceilidh McKenney MD, Camilla Sophia Rossi MD, Susan Khader Ibrahim BDS, MSc, Ahmed Alnajar MD, MSPH, MS-BST, Gianmarco Cancelli MD, Matthew McKenney MS, Michelle Demetres MLIS, Zi Yuan MD, MPH, Jeffrey Nicastro MD, FACS, Joel Horovitz MD, FACS
Background
Certain guidelines consider feeding within 4 h of percutaneous endoscopic gastrostomy tube (PEG) placement to be safe. However, the evidence supporting the recommendations has been questioned and variation in feeding initiation practices persists, with feeding delayed up to 24 h after PEG placement. Our objective was to systematically review the current literature on early vs delayed feeding after PEG placement and compare their outcome in a meta-analysis.
Methods
Ovid MEDLINE, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched from inception until December 4, 2023. Randomized and nonrandomized studies comparing feeding initiation ≤4 vs >4 h post-PEG in adults were included. Independent extraction was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines and data were pooled using fixed or random-effects models. Measured outcomes were the odds of postoperative vomiting, diarrhea, stoma leakage, stoma infection, bleeding, intra-abdominal infection, aspiration pneumonia, and 30-day mortality. Assessment of risk of bias was completed using the Cochrane risk of bias tool 2 (RoB 2) for randomized studies and the Newcastle-Ottawa scale for nonrandomized studies. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42023483520.
Results
Of 4751 studies, 11 with 2880 patients met inclusion. There was no significant difference in all the measured outcomes between groups, but the evidence certainty was low to very low. Intra-abdominal infection couldn't be examined because of scarce reporting by authors.
Conclusion
This robust meta-analysis suggests early feeding after PEG placement is likely safe but uncertain, highlighting the need for a high-quality randomized trial.
背景：某些指南认为经皮内镜胃造口管（PEG）放置后4小时内进食是安全的。然而，支持这些建议的证据受到了质疑，而且开始喂养的做法仍然存在差异，在PEG放置后喂养延迟长达24小时。我们的目的是系统地回顾目前关于PEG放置后早期和延迟喂养的文献，并在荟萃分析中比较它们的结果。方法：检索Ovid MEDLINE、EMBASE、Cochrane Library、CINAHL和Web of Science，检索时间为建刊至2023年12月4日。随机和非随机研究比较了成人在peg后4小时开始喂养≤4和4小时开始喂养的情况。按照系统评价和元分析报告指南的首选报告项目进行独立提取，并使用固定或随机效应模型汇总数据。测量的结果是术后呕吐、腹泻、造口漏、造口感染、出血、腹腔内感染、吸入性肺炎和30天死亡率的几率。随机研究使用Cochrane偏倚风险评估工具2 (RoB 2)，非随机研究使用Newcastle-Ottawa量表完成偏倚风险评估。GRADE用于评估证据的确定性。普洛斯彼罗注册：CRD42023483520。结果：4751项研究中，11项2880例患者符合纳入标准。所有测量结果在两组之间没有显著差异，但证据确定性很低甚至很低。由于文献报道较少，无法对腹腔感染进行检查。结论：这项强有力的荟萃分析表明，PEG放置后早期喂养可能是安全的，但不确定，强调需要进行高质量的随机试验。
{"title":"Outcomes of early compared with delayed initiation of feeding after placement of percutaneous endoscopic gastrostomy tube: A systematic review and meta-analysis","authors":"Mudathir Ibrahim MD, Ceilidh McKenney MD, Camilla Sophia Rossi MD, Susan Khader Ibrahim BDS, MSc, Ahmed Alnajar MD, MSPH, MS-BST, Gianmarco Cancelli MD, Matthew McKenney MS, Michelle Demetres MLIS, Zi Yuan MD, MPH, Jeffrey Nicastro MD, FACS, Joel Horovitz MD, FACS","doi":"10.1002/jpen.2774","DOIUrl":"10.1002/jpen.2774","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Certain guidelines consider feeding within 4 h of percutaneous endoscopic gastrostomy tube (PEG) placement to be safe. However, the evidence supporting the recommendations has been questioned and variation in feeding initiation practices persists, with feeding delayed up to 24 h after PEG placement. Our objective was to systematically review the current literature on early vs delayed feeding after PEG placement and compare their outcome in a meta-analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Ovid MEDLINE, EMBASE, Cochrane Library, CINAHL, and Web of Science were searched from inception until December 4, 2023. Randomized and nonrandomized studies comparing feeding initiation ≤4 vs >4 h post-PEG in adults were included. Independent extraction was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis reporting guidelines and data were pooled using fixed or random-effects models. Measured outcomes were the odds of postoperative vomiting, diarrhea, stoma leakage, stoma infection, bleeding, intra-abdominal infection, aspiration pneumonia, and 30-day mortality. Assessment of risk of bias was completed using the Cochrane risk of bias tool 2 (RoB 2) for randomized studies and the Newcastle-Ottawa scale for nonrandomized studies. GRADE was used to assess evidence certainty. PROSPERO registration: CRD42023483520.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 4751 studies, 11 with 2880 patients met inclusion. There was no significant difference in all the measured outcomes between groups, but the evidence certainty was low to very low. Intra-abdominal infection couldn't be examined because of scarce reporting by authors.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This robust meta-analysis suggests early feeding after PEG placement is likely safe but uncertain, highlighting the need for a high-quality randomized trial.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"682-691"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129899","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}
Dane Christina Daoud MD, Katherine J. P. Schwenger RD, PhD, Yasaman Ghorbani MSc, Leah Gramlich MD, George Ou MD, David Armstrong MD, Maitreyi Raman MD, Johane P. Allard MD, Barbara Bielawska MD, MSc
Background
Metabolic and bariatric surgery is one of the most efficacious treatments for obesity. The increasing incidence of referrals to intestinal rehabilitation programs and the necessity for long-term parenteral nutrition because of bariatric surgery complications have gained attention, yet data remain limited. Our objectives were to (1) assess parenteral nutrition-related complication rates of patients requiring long-term parenteral nutrition because of bariatric surgery complications and (2) compare outcomes between types of metabolic and bariatric surgery.
Methods
This was a descriptive cohort (n = 25) study, which gathered data from patients enrolled in the national registry with a history of metabolic and bariatric surgery at baseline and 2 years and included demographics, biochemical parameters, parenteral regimens, line sepsis, hospitalizations, and functional status.
Results
In this study, 92% were women with a mean age of 53.8 ± 8.6 years. The most prevalent procedure performed was Roux-en-Y gastric bypass (60%). Short bowel syndrome was observed in 40% of our cohort (n = 10). After 2 years, there was a significant reduction in the need for parenteral nutrition compared with baseline, with 37.5% of patients achieving weaning. No significant disparities were observed in the incidence of line sepsis, hospitalizations, or Karnofsky performance status between baseline and the 2-year follow-up, regardless of the type of surgery. Roux-en-Y gastric bypass was associated with lower body mass index at the 2-year mark.
Conclusion
In post-metabolic and bariatric surgery patients, long-term parenteral nutrition is well tolerated based on clinical outcomes and functional status is not influenced by the type of surgery.
{"title":"Long-term home parenteral nutrition in chronic intestinal failure following metabolic and bariatric surgery and its clinical outcomes: A descriptive cohort study","authors":"Dane Christina Daoud MD, Katherine J. P. Schwenger RD, PhD, Yasaman Ghorbani MSc, Leah Gramlich MD, George Ou MD, David Armstrong MD, Maitreyi Raman MD, Johane P. Allard MD, Barbara Bielawska MD, MSc","doi":"10.1002/jpen.2772","DOIUrl":"10.1002/jpen.2772","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Metabolic and bariatric surgery is one of the most efficacious treatments for obesity. The increasing incidence of referrals to intestinal rehabilitation programs and the necessity for long-term parenteral nutrition because of bariatric surgery complications have gained attention, yet data remain limited. Our objectives were to (1) assess parenteral nutrition-related complication rates of patients requiring long-term parenteral nutrition because of bariatric surgery complications and (2) compare outcomes between types of metabolic and bariatric surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a descriptive cohort (<i>n</i> = 25) study, which gathered data from patients enrolled in the national registry with a history of metabolic and bariatric surgery at baseline and 2 years and included demographics, biochemical parameters, parenteral regimens, line sepsis, hospitalizations, and functional status.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In this study, 92% were women with a mean age of 53.8 ± 8.6 years. The most prevalent procedure performed was Roux-en-Y gastric bypass (60%). Short bowel syndrome was observed in 40% of our cohort (<i>n</i> = 10). After 2 years, there was a significant reduction in the need for parenteral nutrition compared with baseline, with 37.5% of patients achieving weaning. No significant disparities were observed in the incidence of line sepsis, hospitalizations, or Karnofsky performance status between baseline and the 2-year follow-up, regardless of the type of surgery. Roux-en-Y gastric bypass was associated with lower body mass index at the 2-year mark.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In post-metabolic and bariatric surgery patients, long-term parenteral nutrition is well tolerated based on clinical outcomes and functional status is not influenced by the type of surgery.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"773-782"},"PeriodicalIF":4.1,"publicationDate":"2025-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2772","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144129885","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}
Although handgrip strength is commonly measured in both hands for sarcopenia screening, the nonmaximum readings are frequently discarded. We aimed to evaluate whether handgrip strength asymmetry, in addition to weakness, could provide additional prognostic information in older adults.
Methods
Participants aged ≥60 years from the 2011–2014 National Health and Nutrition Examination Survey with available handgrip strength measurements were included. Study outcomes are all-cause and cardiovascular disease mortality. Participants were categorized into the weakness−/asymmetry− (reference), weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups based on the status of handgrip weakness and asymmetry.
Results
Overall, 3116 older adults (mean age, 69.47 years) were included. Weighted percentages of participants in the reference, weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 54.28%, 39.88%, 2.86%, and 2.97%, respectively. During a median follow-up of 79 months, 679 deaths (232 from cardiovascular causes) occurred. Compared with the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for the weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 1.02 (95% CI 0.84–1.24), 1.57 (95% CI 1.09–2.26), and 2.34 (95% CI 1.47–3.71), respectively, for all-cause mortality (P for trend < 0.01) and 1.19 (95% CI 0.78–1.81), 1.22 (95% CI 0.54–2.78), and 2.30 (95% CI 1.20–4.39), respectively, for cardiovascular disease mortality (P for trend = 0.03). Subgroup analysis indicated anemia and diabetes significantly modified the associations between handgrip strength and/or weakness status with all-cause and cardiovascular disease mortality.
Conclusion
Handgrip strength asymmetry, in addition to weakness, provided additional prognostic information for all-cause and cardiovascular mortality in older adults in the United States.
背景：虽然在肌肉减少症筛查中通常用双手测量握力，但非最大读数经常被丢弃。我们的目的是评估手掌力量不对称，除了虚弱，是否可以为老年人提供额外的预后信息。方法：纳入2011-2014年全国健康与营养调查中年龄≥60岁的参与者，并提供握力测量数据。研究结果为全因死亡率和心血管疾病死亡率。根据手握无力和不对称的状态，将参与者分为软弱/不对称组（参照组）、软弱/不对称+组、软弱+/不对称-组和软弱+/不对称+组。结果：共纳入3116名老年人（平均年龄69.47岁）。参考组、弱势/不对称+组、弱势+/不对称-组和弱势+/不对称+组的加权百分比分别为54.28%、39.88%、2.86%和2.97%。在中位随访79个月期间，发生了679例死亡（232例死于心血管原因）。与参照组相比，弱/不对称+、弱+/不对称-和弱+/不对称+组的全因死亡率风险比（HRs）和95%置信区间（CIs）分别为1.02 （95% CI 0.84-1.24）、1.57 （95% CI 1.09-2.26）和2.34 （95% CI 1.47-3.71）。结论：除了弱外，握力不对称还为美国老年人的全因死亡率和心血管死亡率提供了额外的预后信息。
{"title":"Association between handgrip strength asymmetry and all-cause mortality in United States–based older adults: A cross-sectional study","authors":"Xiufang Kong MD, PhD, Wei Wang MD, PhD","doi":"10.1002/jpen.2777","DOIUrl":"10.1002/jpen.2777","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Although handgrip strength is commonly measured in both hands for sarcopenia screening, the nonmaximum readings are frequently discarded. We aimed to evaluate whether handgrip strength asymmetry, in addition to weakness, could provide additional prognostic information in older adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Participants aged ≥60 years from the 2011–2014 National Health and Nutrition Examination Survey with available handgrip strength measurements were included. Study outcomes are all-cause and cardiovascular disease mortality. Participants were categorized into the weakness−/asymmetry− (reference), weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups based on the status of handgrip weakness and asymmetry.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Overall, 3116 older adults (mean age, 69.47 years) were included. Weighted percentages of participants in the reference, weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 54.28%, 39.88%, 2.86%, and 2.97%, respectively. During a median follow-up of 79 months, 679 deaths (232 from cardiovascular causes) occurred. Compared with the reference group, hazard ratios (HRs) and 95% confidence intervals (CIs) for the weakness−/asymmetry+, weakness+/asymmetry−, and weakness+/asymmetry+ groups were 1.02 (95% CI 0.84–1.24), 1.57 (95% CI 1.09–2.26), and 2.34 (95% CI 1.47–3.71), respectively, for all-cause mortality (<i>P</i> for trend < 0.01) and 1.19 (95% CI 0.78–1.81), 1.22 (95% CI 0.54–2.78), and 2.30 (95% CI 1.20–4.39), respectively, for cardiovascular disease mortality (<i>P</i> for trend = 0.03). Subgroup analysis indicated anemia and diabetes significantly modified the associations between handgrip strength and/or weakness status with all-cause and cardiovascular disease mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Handgrip strength asymmetry, in addition to weakness, provided additional prognostic information for all-cause and cardiovascular mortality in older adults in the United States.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 6","pages":"758-767"},"PeriodicalIF":4.1,"publicationDate":"2025-05-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144121953","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}
Kristin Munroe RD, Anna Bestic RD, Samantha Feczko RD, Jamie Davila RD, Mandy L. Corrigan RD, Donald F. Kirby MD
Background
In response to coronavirus disease 19, healthcare organizations made dramatic and immediate shifts from in-person office to telehealth visits to provide care to patients while adhering to social distancing restrictions. The objective of this study was to test the efficacy of virtual visits compared with “brick and mortar” (in-person visits) for patients receiving home parenteral nutrition for clinical outcomes of the incidence of catheter complications and 30-day readmissions.
Methods
A retrospective cohort study was conducted between January 2020 and December 2020 on eligible patients managed by the Cleveland Clinic Home Nutrition Support and the Center Gut Rehabilitation and Transplant teams. Those receiving home parenteral nutrition who were seen in a follow-up clinic appointment were included.
Results
Of 189 patients studied, 103 had in-person visits and 86 had virtual visits. A total of 7.9% (n = 15) of patients had catheter complications. Virtual visits demonstrated statistical noninferiority of the incidence of catheter-related complications when compared with in-person visits (90% CI, −0.051 to 0.106; margin <0.1). Readmission incidence for in-person visits was 8.5% (n = 16) and 6.3% (n = 12) for virtual visits. Virtual visits demonstrated statistical noninferiority to in-person visits for incidence of readmissions after the visit (90% CI, −0.094 to 0.106; margin <0.1).
Conclusion
Virtual visits demonstrate noninferiority to in-person visits based on the incidence of catheter complications and readmission rates. New evaluation techniques need to be developed for this high-risk populations in virtual visits to establish effective and safe patient management.
{"title":"Association between virtual visits and central line–associated complications in adult patients receiving home parenteral nutrition: A retrospective cohort study","authors":"Kristin Munroe RD, Anna Bestic RD, Samantha Feczko RD, Jamie Davila RD, Mandy L. Corrigan RD, Donald F. Kirby MD","doi":"10.1002/jpen.2771","DOIUrl":"10.1002/jpen.2771","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In response to coronavirus disease 19, healthcare organizations made dramatic and immediate shifts from in-person office to telehealth visits to provide care to patients while adhering to social distancing restrictions. The objective of this study was to test the efficacy of virtual visits compared with “brick and mortar” (in-person visits) for patients receiving home parenteral nutrition for clinical outcomes of the incidence of catheter complications and 30-day readmissions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted between January 2020 and December 2020 on eligible patients managed by the Cleveland Clinic Home Nutrition Support and the Center Gut Rehabilitation and Transplant teams. Those receiving home parenteral nutrition who were seen in a follow-up clinic appointment were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 189 patients studied, 103 had in-person visits and 86 had virtual visits. A total of 7.9% (<i>n</i> = 15) of patients had catheter complications. Virtual visits demonstrated statistical noninferiority of the incidence of catheter-related complications when compared with in-person visits (90% CI, −0.051 to 0.106; margin <0.1). Readmission incidence for in-person visits was 8.5% (<i>n</i> = 16) and 6.3% (<i>n</i> = 12) for virtual visits. Virtual visits demonstrated statistical noninferiority to in-person visits for incidence of readmissions after the visit (90% CI, −0.094 to 0.106; margin <0.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Virtual visits demonstrate noninferiority to in-person visits based on the incidence of catheter complications and readmission rates. New evaluation techniques need to be developed for this high-risk populations in virtual visits to establish effective and safe patient management.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"643-649"},"PeriodicalIF":4.1,"publicationDate":"2025-05-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2771","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144096796","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}
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