Zenzi Rosseel MPharm, Pieter-Jan Cortoos MPharm, PhD, Lynn Leemans PhD, Arthur R. H. van Zanten MD, PhD, Claudine Ligneel MPharm, Elisabeth De Waele MD, PhD
Background
Adequate energy and protein provision is mandatory to optimize survival chances in critical illness, prevent loss of muscle mass, and reduce length of stay. Data are available concerning feeding adequacy in intensive care unit (ICU) participants, but little is known about the adequacy in post-ICU participants. This systematic review aimed to evaluate feeding adequacy in post-ICU participants and addressed causes of feeding interruption leading to suboptimal adequacy.
Methods
For this systematic review, a bibliographic search was performed in PubMed, Scopus, and Web of Science. Randomized controlled studies, non-randomized controlled studies, and observational studies conducted between January 1990 and November 2023 fulfilling the inclusion criteria were withheld.
Results
Eight studies were included. Outcomes reported were energy and protein adequacy, barriers, and feeding routes. Energy and protein requirements were determined in various ways, including indirect calorimetry and standardized and weight-based formulas. Energy adequacy ranged from 52% to 102% and protein adequacy between 63% and 86%. Participants were mainly fed with enteral nutrition (EN) or a combination of oral nutrition and EN. The main barrier reported for inadequate nutrition intake was feeding tube removal.
Conclusion
Next to different ways in calculating targets and reporting results, a wide range in energy and protein adequacy was observed, but with constant protein underfeeding. Participants fed with EN or a combination of EN and oral nutrition had the best adequacy; inappropriate tube removal is a common barrier leading to inadequate therapy. Standardized reporting and larger studies are needed to guide nutrition care for post-ICU participants.
{"title":"Energy and protein nutrition adequacy in general wards among intensive care unit survivors: A systematic review and meta-analysis","authors":"Zenzi Rosseel MPharm, Pieter-Jan Cortoos MPharm, PhD, Lynn Leemans PhD, Arthur R. H. van Zanten MD, PhD, Claudine Ligneel MPharm, Elisabeth De Waele MD, PhD","doi":"10.1002/jpen.2699","DOIUrl":"10.1002/jpen.2699","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Adequate energy and protein provision is mandatory to optimize survival chances in critical illness, prevent loss of muscle mass, and reduce length of stay. Data are available concerning feeding adequacy in intensive care unit (ICU) participants, but little is known about the adequacy in post-ICU participants. This systematic review aimed to evaluate feeding adequacy in post-ICU participants and addressed causes of feeding interruption leading to suboptimal adequacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>For this systematic review, a bibliographic search was performed in PubMed, Scopus, and Web of Science. Randomized controlled studies, non-randomized controlled studies, and observational studies conducted between January 1990 and November 2023 fulfilling the inclusion criteria were withheld.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eight studies were included. Outcomes reported were energy and protein adequacy, barriers, and feeding routes. Energy and protein requirements were determined in various ways, including indirect calorimetry and standardized and weight-based formulas. Energy adequacy ranged from 52% to 102% and protein adequacy between 63% and 86%. Participants were mainly fed with enteral nutrition (EN) or a combination of oral nutrition and EN. The main barrier reported for inadequate nutrition intake was feeding tube removal.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Next to different ways in calculating targets and reporting results, a wide range in energy and protein adequacy was observed, but with constant protein underfeeding. Participants fed with EN or a combination of EN and oral nutrition had the best adequacy; inappropriate tube removal is a common barrier leading to inadequate therapy. Standardized reporting and larger studies are needed to guide nutrition care for post-ICU participants.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"18-32"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11717489/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583335","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}
Jarson P. da Costa Pereira RD, MSc, Carla M. Prado RD, PhD, M. Cristina Gonzalez MD, PhD, Poliana C. Cabral RD, PhD, Francisco F. de Oliveira Guedes RD, Alcides da Silva Diniz MD, PhD, Ana P. T. Fayh RD, PhD
Background
This study aimed to investigate and propose novel approaches to calculate muscle quality index (MQI) using muscle mass derived from single-frequency bioelectrical impedance analysis (SF-BIA) and calf circumference in both unadjusted and body mass index (BMI)–adjusted forms. In addition, we examined their prognostic significance in patients with cancer.
Methods
A secondary analysis was conducted on a prospective cohort study of patients with cancer. Handgrip strength was measured. SF-BIA was conducted to estimate appendicular lean soft tissue (ALST, in kilograms). MQI was calculated using three approaches: (1) the ratio of handgrip strength to ALST (MQISF-BIA), (2) the ratio of handgrip strength to calf circumference (MQIcalf circumference), and (3) the ratio of handgrip strength to BMI-adjusted calf circumference (MQIadj. calf circumference). Maximally selected log-rank was calculated to estimate their cutoff values to predict survival.
Results
Two hundred eighty-four patients were included (51.1% men; median age, 61 years). Solid tumors were the most frequent (89.8%). All approaches to MQI (MQISF-BIA, MQIcalf circumference, and MQIadj. calf circumference) were independent predictors of 6-month mortality. The found cutoffs were (1) MQISF-BIA (<1.52 for men, <0.63 for women), (2) MQIcalf circumference (<0.74 for men, <0.24 for women), and (3) MQIadj. calf circumference (<0.75 for men, <0.25 for women).
Conclusion
This study introduces MQISF-BIA, MQIcalf circumference, and MQIadj. calf circumference as future potential surrogate methods for computing MQI in clinical practice when other robust procedures are unavailable, pending further validation.
{"title":"Prognostic significance of novel muscle quality index utilization in hospitalized adults with cancer: A secondary analysis","authors":"Jarson P. da Costa Pereira RD, MSc, Carla M. Prado RD, PhD, M. Cristina Gonzalez MD, PhD, Poliana C. Cabral RD, PhD, Francisco F. de Oliveira Guedes RD, Alcides da Silva Diniz MD, PhD, Ana P. T. Fayh RD, PhD","doi":"10.1002/jpen.2701","DOIUrl":"10.1002/jpen.2701","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to investigate and propose novel approaches to calculate muscle quality index (MQI) using muscle mass derived from single-frequency bioelectrical impedance analysis (SF-BIA) and calf circumference in both unadjusted and body mass index (BMI)–adjusted forms. In addition, we examined their prognostic significance in patients with cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A secondary analysis was conducted on a prospective cohort study of patients with cancer. Handgrip strength was measured. SF-BIA was conducted to estimate appendicular lean soft tissue (ALST, in kilograms). MQI was calculated using three approaches: (1) the ratio of handgrip strength to ALST (MQI<sub>SF-BIA</sub>), (2) the ratio of handgrip strength to calf circumference (MQI<sub>calf circumference</sub>), and (3) the ratio of handgrip strength to BMI-adjusted calf circumference (MQI<sub>adj. calf circumference</sub>). Maximally selected log-rank was calculated to estimate their cutoff values to predict survival.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Two hundred eighty-four patients were included (51.1% men; median age, 61 years). Solid tumors were the most frequent (89.8%). All approaches to MQI (MQI<sub>SF-BIA</sub>, MQI<sub>calf circumference</sub>, and MQI<sub>adj. calf circumference</sub>) were independent predictors of 6-month mortality. The found cutoffs were (1) MQI<sub>SF-BIA</sub> (<1.52 for men, <0.63 for women), (2) MQI<sub>calf circumference</sub> (<0.74 for men, <0.24 for women), and (3) MQI<sub>adj. calf circumference</sub> (<0.75 for men, <0.25 for women).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study introduces MQI<sub>SF-BIA,</sub> MQI<sub>calf circumference</sub>, and MQI<sub>adj. calf circumference</sub> as future potential surrogate methods for computing MQI in clinical practice when other robust procedures are unavailable, pending further validation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"112-121"},"PeriodicalIF":3.2,"publicationDate":"2024-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142583339","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 Chen MS, Dongze Wu MS, Yajin Chen MS, Ang Shi MS, Wanda Cai MS, Xinxin Yang MD, PhD, Xiaodong Chen MD, PhD
Background
Diets high in antioxidants are associated with decreased prevalence of sarcopenia. This study aimed to investigate whether the composite dietary antioxidant index (CDAI) and sarcopenia have an underlying relationship.
Methods
We used the data from the National Health and Nutrition Examination Survey 2011–2018. According to dietary antioxidant intake, the CDAI was calculated for each individual. Appendicular skeletal muscle mass index was employed to determine sarcopenia. Multivariate weighted logistic models and restricted cubic spline regression analysis was undertaken to determine the association between CDAI and sarcopenia.
Results
A total of 7012 participants were enrolled in this study, including 473 with sarcopenia (weighted percentage, 5.6%). Compared with the lowest tertile, those in the highest tertile of the CDAI exhibited a greater likelihood of being male, with lower body mass index, higher education level and economic standard, and more chance of being single or separated. In multivariate weighted logistic models, model 3 revealed a noteworthy inverse association between the CDAI and sarcopenia (odds ratio = 0.94; 95% CI, 0.91–0.98; P = 0.003). Compared with the lowest tertile, the highest tertile of CDAI was associated with a 0.57-fold risk of sarcopenia (95% CI, 0.42–0.77; P < 0.001). The inverse association between CDAI and sarcopenia strengthened in the participants with elevated education levels (P for interaction = 0.003).
Conclusion
The CDAI was inversely correlated with the prevalence of sarcopenia. As a comprehensive measurement representing antioxidant status, the CDAI may help manage and prevent sarcopenia.
{"title":"Association between the composite dietary antioxidant index and sarcopenia among United States adults: A cross-sectional study","authors":"Hao Chen MS, Dongze Wu MS, Yajin Chen MS, Ang Shi MS, Wanda Cai MS, Xinxin Yang MD, PhD, Xiaodong Chen MD, PhD","doi":"10.1002/jpen.2697","DOIUrl":"10.1002/jpen.2697","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diets high in antioxidants are associated with decreased prevalence of sarcopenia. This study aimed to investigate whether the composite dietary antioxidant index (CDAI) and sarcopenia have an underlying relationship.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used the data from the National Health and Nutrition Examination Survey 2011–2018. According to dietary antioxidant intake, the CDAI was calculated for each individual. Appendicular skeletal muscle mass index was employed to determine sarcopenia. Multivariate weighted logistic models and restricted cubic spline regression analysis was undertaken to determine the association between CDAI and sarcopenia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 7012 participants were enrolled in this study, including 473 with sarcopenia (weighted percentage, 5.6%). Compared with the lowest tertile, those in the highest tertile of the CDAI exhibited a greater likelihood of being male, with lower body mass index, higher education level and economic standard, and more chance of being single or separated. In multivariate weighted logistic models, model 3 revealed a noteworthy inverse association between the CDAI and sarcopenia (odds ratio = 0.94; 95% CI, 0.91–0.98; <i>P</i> = 0.003). Compared with the lowest tertile, the highest tertile of CDAI was associated with a 0.57-fold risk of sarcopenia (95% CI, 0.42–0.77; <i>P</i> < 0.001). The inverse association between CDAI and sarcopenia strengthened in the participants with elevated education levels (<i>P</i> for interaction = 0.003).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The CDAI was inversely correlated with the prevalence of sarcopenia. As a comprehensive measurement representing antioxidant status, the CDAI may help manage and prevent sarcopenia.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"103-111"},"PeriodicalIF":3.2,"publicationDate":"2024-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502425","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}
Zhou Jing MPharm, Xu Hongyan MPharm, Ma Jingjing MPharm, Pang Mujuan MPharm, Man Shiyu BD, Su Ying BD, Hu Yan MPharm
Background
Parenteral nutrition (PN) plays a crucial role in nutrition support therapy, yet data on related adverse events (AEs) in practical settings are scarce. To address this, we analyzed AE signals associated with PN treatment from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database.
Methods
We extracted data from the FAERS database, covering the period from the first quarter (Q1) of 2004 to Q1 of 2024. Drug names and AEs were standardized. We then conducted disproportionality analyses using four different algorithms to evaluate the association between PN and its associated AEs.
Results
We collected a total of 48,890,925 reports from the FAERS database, of which 1642 involved PN-related AEs. After categorization, we identified 21 system organ classes (SOCs), and hepatobiliary disorders were the only significant SOC across all four algorithms. At the preferred term (PT) level, we identified 99 PTs that showed significant disproportionality in all four algorithms. Fat overload syndrome, fatty acid deficiency, parenteral nutrition–associated liver disease (PNALD), Malassezia infection, and Pantoea agglomerans infection were the most prominent PTs. In addition, several potential new AE signals included nervous, cardiac, immune, psychiatric, blood, renal, urinary, and eye disorders.
Conclusion
Our study identified several common and rare PN-related AEs reported in the FAERS database. Patients and healthcare providers should remain vigilant about these AEs. Understanding the risks of PN therapy and establishing practical procedures can help reduce AEs.
{"title":"Adverse events associated with parenteral nutrition support therapy: A pharmacovigilance study","authors":"Zhou Jing MPharm, Xu Hongyan MPharm, Ma Jingjing MPharm, Pang Mujuan MPharm, Man Shiyu BD, Su Ying BD, Hu Yan MPharm","doi":"10.1002/jpen.2698","DOIUrl":"10.1002/jpen.2698","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parenteral nutrition (PN) plays a crucial role in nutrition support therapy, yet data on related adverse events (AEs) in practical settings are scarce. To address this, we analyzed AE signals associated with PN treatment from the United States Food and Drug Administration Adverse Event Reporting System (FAERS) database.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We extracted data from the FAERS database, covering the period from the first quarter (Q1) of 2004 to Q1 of 2024. Drug names and AEs were standardized. We then conducted disproportionality analyses using four different algorithms to evaluate the association between PN and its associated AEs.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We collected a total of 48,890,925 reports from the FAERS database, of which 1642 involved PN-related AEs. After categorization, we identified 21 system organ classes (SOCs), and hepatobiliary disorders were the only significant SOC across all four algorithms. At the preferred term (PT) level, we identified 99 PTs that showed significant disproportionality in all four algorithms. Fat overload syndrome, fatty acid deficiency, parenteral nutrition–associated liver disease (PNALD), <i>Malassezia</i> infection, and <i>Pantoea agglomerans</i> infection were the most prominent PTs. In addition, several potential new AE signals included nervous, cardiac, immune, psychiatric, blood, renal, urinary, and eye disorders.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Our study identified several common and rare PN-related AEs reported in the FAERS database. Patients and healthcare providers should remain vigilant about these AEs. Understanding the risks of PN therapy and establishing practical procedures can help reduce AEs.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"122-131"},"PeriodicalIF":3.2,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142502424","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}
Elaine B. Trujillo MS, RDN, Kunal C. Kadakia MD, Cynthia Thomson PhD, RDN, Fang Fang Zhang MD, PhD, Alicia Livinski MA, MPH, Kim Pollard RN, Todd Mattox PharmD, Anne Tucker PharmD, Valaree Williams MS, RDN, Declan Walsh MD, Steven Clinton MD, PhD, Aaron Grossberg MD, PhD, Gordon Jensen MD, PhD, Rhone Levin MEd, RDN, Jeannine Mills MS, RDN, Anurag Singh MD, Meredith Smith RN, Renee Stubbins PhD, RDN, Kathleen Wiley MSN, RN, Kristen Sullivan MPH, MS, Mary Platek PhD, RDN, Colleen K. Spees PhD, RDN
Background
Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use.
Methods
Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients?
Results
Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8).
Conclusion
Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.
{"title":"Malnutrition risk screening in adult oncology outpatients: An ASPEN systematic review and clinical recommendations","authors":"Elaine B. Trujillo MS, RDN, Kunal C. Kadakia MD, Cynthia Thomson PhD, RDN, Fang Fang Zhang MD, PhD, Alicia Livinski MA, MPH, Kim Pollard RN, Todd Mattox PharmD, Anne Tucker PharmD, Valaree Williams MS, RDN, Declan Walsh MD, Steven Clinton MD, PhD, Aaron Grossberg MD, PhD, Gordon Jensen MD, PhD, Rhone Levin MEd, RDN, Jeannine Mills MS, RDN, Anurag Singh MD, Meredith Smith RN, Renee Stubbins PhD, RDN, Kathleen Wiley MSN, RN, Kristen Sullivan MPH, MS, Mary Platek PhD, RDN, Colleen K. Spees PhD, RDN","doi":"10.1002/jpen.2688","DOIUrl":"10.1002/jpen.2688","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malnutrition screening is not widely practiced in outpatient cancer centers. This review aims to determine the validity of malnutrition screening tools and provide recommendations for clinical use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Studies identified by a systematic review assessed the general validity of screening tools in adult oncology outpatients from five databases through 2022. The American Society for Parenteral and Enteral Nutrition (ASPEN) convened a working group of members from the Academy of Nutrition and Dietetics, Academy of Oncology Nurse and Patient Navigators, American Cancer Society, American Society for Clinical Oncology, American Society for Nutrition, American Society for Radiation Oncology, Association of Cancer Care Centers, and Oncology Nursing Society to answer the following questions: (1) should clinicians screen for malnutrition, (2) which malnutrition screening tools are recommended, and (3) what are the clinical applications for malnutrition risk screening in adult oncology outpatients?</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty of 738 studies met the criteria and were reviewed. Six screening tools with specific cut-points demonstrated validity and are recommended, including the Mini Nutritional Assessment (≤23.5), Malnutrition Screening Tool (MST; MST ≥ 2 and patient-led MST ≥ 2), Malnutrition Universal Screening Tool (MUST; MUST ≥ 1 and MUST ≥ 2), Nutrition Risk Screening-2002 (NRS-2002; NRS-2002 ≥ 2 and NRS-2002 ≥ 3), NUTRISCORE ≥ 5, and Patient-Generated Subjective Global Assessment Short Form (PG-SGA SF; PG-SGA SF ≥ 7 and PG-SGA SF ≥ 8).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Six screening tools are valid for malnutrition risk identification in oncology ambulatory settings and recommended before treatment initiation and regularly thereafter, depending on treatment course. Research is needed to understand to what extent early diagnosis and management of malnutrition improves the clinical care of oncology patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 8","pages":"874-894"},"PeriodicalIF":3.2,"publicationDate":"2024-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2688","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468197","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}
Vladislav Mihnovits MD, Annika Reintam Blaser MD, PhD, Thomas Gualdi MS, Alastair Forbes MD, PhD, Gael Piton MD, PhD
Critically ill patients are at risk of presenting with gastrointestinal dysfunction at intensive care unit admission or during their stay. However, identifying gastrointestinal dysfunction is difficult because clinical evaluation is frequently nonspecific and validated biomarkers are lacking. In this context, ultrasound of the digestive tract may help to identify gastrointestinal dysfunction. In this narrative review, we summarize available evidence and propose a protocol for assessment of the gastrointestinal tract with ultrasound. First, we report available evidence from use of four available protocols: the gastrointestinal and urinary tract sonography protocol, the acute gastrointestinal injury ultrasound score, the transabdominal gastrointestinal ultrasound protocol, and the Lai protocol, each addressing somewhat different aspects. Outputs from these protocols have been associated with clinical scores of gastrointestinal failure, feeding intolerance, and 28-day mortality. Second, we describe the potential pitfalls of using ultrasound in the critically ill, such as obesity, abdominal dressings, or the presence of intraluminal gas. Third, we suggest perspectives of ultrasound in monitoring the response to enteral nutrition and for early identification of nonocclusive mesenteric ischemia. Fourth, we propose a structured protocol for gastrointestinal ultrasound describing all the different structures that should be evaluated and provide detailed guidance for a clockwise abdominal examination. In conclusion, the use of a specific and structured protocol might help to identify patients presenting with gastrointestinal dysfunction, guide nutrition, and allow the proposal of pathophysiological hypotheses (complications of enteral nutrition, intra-abdominal infection, bowel ischemia, etc.). The benefit of using a structured protocol requires further investigation.
重症患者在进入重症监护室或住院期间有可能出现胃肠功能紊乱。然而，由于临床评估往往没有特异性，而且缺乏有效的生物标志物，因此很难识别胃肠功能紊乱。在这种情况下，消化道超声检查可能有助于识别胃肠功能紊乱。在这篇叙述性综述中，我们总结了现有证据，并提出了用超声波评估胃肠道的方案。首先，我们报告了四种现有方案的可用证据：胃肠道和泌尿道超声检查方案、急性胃肠道损伤超声评分、经腹部胃肠道超声检查方案和 Lai 方案，每种方案都针对不同的方面。这些方案的结果与胃肠功能衰竭、喂养不耐受和 28 天死亡率的临床评分相关。其次，我们介绍了在重症患者中使用超声的潜在隐患，如肥胖、腹部敷料或腔内气体的存在。第三，我们提出了超声在监测肠内营养反应和早期识别非闭塞性肠系膜缺血方面的应用前景。第四，我们提出了一个结构化的胃肠道超声检查方案，描述了应评估的所有不同结构，并为顺时针腹部检查提供了详细指导。总之，使用特定的结构化方案可能有助于识别出现胃肠道功能障碍的患者，指导营养，并提出病理生理假说（肠内营养并发症、腹腔内感染、肠缺血等）。使用结构化方案的益处需要进一步研究。
{"title":"Gastrointestinal ultrasound in the critically ill: A narrative review and a proposal for a protocol","authors":"Vladislav Mihnovits MD, Annika Reintam Blaser MD, PhD, Thomas Gualdi MS, Alastair Forbes MD, PhD, Gael Piton MD, PhD","doi":"10.1002/jpen.2687","DOIUrl":"10.1002/jpen.2687","url":null,"abstract":"<p>Critically ill patients are at risk of presenting with gastrointestinal dysfunction at intensive care unit admission or during their stay. However, identifying gastrointestinal dysfunction is difficult because clinical evaluation is frequently nonspecific and validated biomarkers are lacking. In this context, ultrasound of the digestive tract may help to identify gastrointestinal dysfunction. In this narrative review, we summarize available evidence and propose a protocol for assessment of the gastrointestinal tract with ultrasound. First, we report available evidence from use of four available protocols: the gastrointestinal and urinary tract sonography protocol, the acute gastrointestinal injury ultrasound score, the transabdominal gastrointestinal ultrasound protocol, and the Lai protocol, each addressing somewhat different aspects. Outputs from these protocols have been associated with clinical scores of gastrointestinal failure, feeding intolerance, and 28-day mortality. Second, we describe the potential pitfalls of using ultrasound in the critically ill, such as obesity, abdominal dressings, or the presence of intraluminal gas. Third, we suggest perspectives of ultrasound in monitoring the response to enteral nutrition and for early identification of nonocclusive mesenteric ischemia. Fourth, we propose a structured protocol for gastrointestinal ultrasound describing all the different structures that should be evaluated and provide detailed guidance for a clockwise abdominal examination. In conclusion, the use of a specific and structured protocol might help to identify patients presenting with gastrointestinal dysfunction, guide nutrition, and allow the proposal of pathophysiological hypotheses (complications of enteral nutrition, intra-abdominal infection, bowel ischemia, etc.). The benefit of using a structured protocol requires further investigation.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 8","pages":"895-905"},"PeriodicalIF":3.2,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2687","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142468180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"JPEN Journal Club 88. Determining the hypothesis of a study.","authors":"Ronald L Koretz","doi":"10.1002/jpen.2696","DOIUrl":"https://doi.org/10.1002/jpen.2696","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142400538","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}
Limited understanding exists regarding the association between daily total dietary nutrient intakes and immune-inflammation states in US adults exposed to various pathogens. This study sought to examine the correlation between nutrient intakes and immune-inflammation indicators and to assess their performance in distinguishing immune-inflammation states.
Methods
This study was derived from the National Health and Nutrition Examination Survey (NHANES), which included 33,804 participants aged 20 years or older between 2005 and 2018. Multivariable linear regression and restricted cubic spline regression were conducted to evaluate the association between nutrient intakes and immune-inflammation indicators. Receiver operating characteristic curve analysis was performed to evaluate the discriminatory performance of identified nutrients for various immune-inflammation states measured by the systemic immune-inflammation index (SII).
Results
Ten key nutrients were significantly associated with immune-inflammation responses, including calcium, saturated fatty acid (SFA) 4:0, SFA 6:0, SFA 12:0, SFA 14:0, SFA 16:0, vitamin B2, total SFAs, retinol, and lutein + zeaxanthin, which show potential as dietary indicators. The area under the curve for discriminating various immune-inflammation states was improved by at least 0.03 compared with a model that included only covariates, with all P values <0.05 in the Delong tests, indicating a significant enhancement in model performance.
Conclusions
Ten nutrients, including calcium, various SFAs, vitamin B2, retinol, and lutein + zeaxanthin, exhibit significant association with SII and potential as dietary indicators for distinguishing between different immune-inflammation states in US adults with seropositivity to various viruses.
背景：人们对暴露于各种病原体的美国成年人每日膳食总营养素摄入量与免疫炎症状态之间的关系了解有限。本研究旨在探讨营养素摄入量与免疫炎症指标之间的相关性，并评估其在区分免疫炎症状态方面的性能：本研究来源于美国国家健康与营养调查（NHANES），其中包括2005年至2018年期间年龄在20岁或20岁以上的33804名参与者。为评估营养素摄入量与免疫炎症指标之间的关联，进行了多变量线性回归和限制性立方样条回归。进行了接收者操作特征曲线分析，以评估已确定的营养素对以全身免疫炎症指数（SII）测量的各种免疫炎症状态的判别性能：结果：10种关键营养素与免疫炎症反应明显相关，包括钙、饱和脂肪酸4:0、饱和脂肪酸6:0、饱和脂肪酸12:0、饱和脂肪酸14:0、饱和脂肪酸16:0、维生素B2、总饱和脂肪酸、视黄醇和叶黄素+玉米黄质，它们显示出作为膳食指标的潜力。与仅包含协变量的模型相比，判别各种免疫炎症状态的曲线下面积至少提高了 0.03，所有 P 值均为结论：包括钙、各种 SFAs、维生素 B2、视黄醇和叶黄素 + 玉米黄质在内的十种营养素与 SII 有显著的关联，并有可能作为膳食指标，用于区分美国成年人对各种病毒的血清反应呈阳性的不同免疫炎症状态。
{"title":"Systemic immune-inflammation states in US adults with seropositivity to infectious pathogens: A nutrient-wide association study","authors":"He Xie MPH, Mairepaiti Halimulati MPH, Yuqi Dou MPhil, MSc, Hanyue Zhang PhD, Xiaowen Jiang MPhil, MSc, Lei Peng MPhil, MSc","doi":"10.1002/jpen.2695","DOIUrl":"10.1002/jpen.2695","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Limited understanding exists regarding the association between daily total dietary nutrient intakes and immune-inflammation states in US adults exposed to various pathogens. This study sought to examine the correlation between nutrient intakes and immune-inflammation indicators and to assess their performance in distinguishing immune-inflammation states.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was derived from the National Health and Nutrition Examination Survey (NHANES), which included 33,804 participants aged 20 years or older between 2005 and 2018. Multivariable linear regression and restricted cubic spline regression were conducted to evaluate the association between nutrient intakes and immune-inflammation indicators. Receiver operating characteristic curve analysis was performed to evaluate the discriminatory performance of identified nutrients for various immune-inflammation states measured by the systemic immune-inflammation index (SII).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Ten key nutrients were significantly associated with immune-inflammation responses, including calcium, saturated fatty acid (SFA) 4:0, SFA 6:0, SFA 12:0, SFA 14:0, SFA 16:0, vitamin B<sub>2</sub>, total SFAs, retinol, and lutein + zeaxanthin, which show potential as dietary indicators. The area under the curve for discriminating various immune-inflammation states was improved by at least 0.03 compared with a model that included only covariates, with all <i>P</i> values <0.05 in the Delong tests, indicating a significant enhancement in model performance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Ten nutrients, including calcium, various SFAs, vitamin B<sub>2</sub>, retinol, and lutein + zeaxanthin, exhibit significant association with SII and potential as dietary indicators for distinguishing between different immune-inflammation states in US adults with seropositivity to various viruses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"94-102"},"PeriodicalIF":3.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391296","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}
Jéssica Lavanholi Pinho MSc, Renata Germano Borges de Oliveira Nascimento Freitas PhD, Roberto Jose Negrão Nogueira PhD
Objectives
The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital.
Methods
We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels.
Results
A total of 264 patients, with a median age of 2.2 years (IQR: 0.3–9.0 years), comprising intensive care (n = 216; 81.8%) and malnourished (n = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (n = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (n = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (n = 226) of cases in the first 48 h; 96.2% (n = 177) of cases on the fourth day; and 90.1% (n = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age z score and number of second individualizations (r = −0.222; P = 0.002).
Conclusion
Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.
{"title":"Parenteral nutrition customization in pediatrics: A descriptive cohort study","authors":"Jéssica Lavanholi Pinho MSc, Renata Germano Borges de Oliveira Nascimento Freitas PhD, Roberto Jose Negrão Nogueira PhD","doi":"10.1002/jpen.2694","DOIUrl":"10.1002/jpen.2694","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objectives</h3>\u0000 \u0000 <p>The main objective of this study was to analyze the reasons for customizing parenteral nutrition (PN) in pediatric patients admitted to a quaternary hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a descriptive cohort study on 264 hospitalized children receiving PN. Anthropometric, biochemical, and hospitalization data were collected from patient records. Unequivocal reasons for customizing PN were defined as situations precluding prescription of a standard adult/teenager PN and included renal and/or liver failure, energy-protein adequacy, and elevated mineral and triglyceride levels.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 264 patients, with a median age of 2.2 years (IQR: 0.3–9.0 years), comprising intensive care (<i>n</i> = 216; 81.8%) and malnourished (<i>n</i> = 91; 36.1%) patients, were evaluated. In the first 48 h, 87.9% (<i>n</i> = 232) of the sample required customized PN for energy-protein adequacy (210 of 232), maintained over subsequent days in most cases. Among patients requiring second individualization, mineral disturbance was the main reason observed, especially within the first 4 days of PN use (<i>n</i> = 21; 60%). Unequivocal reasons for customizing PN occurred in 97.4% (<i>n</i> = 226) of cases in the first 48 h; 96.2% (<i>n</i> = 177) of cases on the fourth day; and 90.1% (<i>n</i> = 92) of cases on the seventh day of PN use. An inverse correlation was found between weight/age <i>z</i> score and number of second individualizations (<i>r</i> = −0.222; <i>P</i> = 0.002).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Customized PN proved essential, especially for younger, malnourished, and intensive care patients. Investment in training a Nutritional Multidisciplinary Therapy Team and acquiring a specific electronic system for prescribing PN is suggested.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 1","pages":"77-84"},"PeriodicalIF":3.2,"publicationDate":"2024-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391295","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}
Katie M. Strobel MD, MSCR, Katelin Kramer MD, Catherine Rottkamp MD, PhD, Cherry Uy MD, Erika Fernandez MD, Laurel Moyer MD, David Elashoff PhD, Animesh Sabnis MD, MSHS, Daniel A. DeUgarte MD, MSCR, Kara L. Calkins MD, MSCR
Background
The University of California Fetal Consortium published that 55% of infants with gastroschisis develop growth faltering by hospital discharge. To address this problem, we developed a nutrition pathway emphasizing (1) early provision of parenteral macronutrients, (2) use of human milk, and (3) growth faltering treatment. This study's goals were to assess adherence to and efficacy of this pathway in infants with gastroschisis across six California hospitals.
Methods
In 2015, the consortium standardized the care for infants with gastroschisis. To decrease growth faltering rates, between 2019 and 2020, nutrition guidelines were proposed, discussed, revised, and initiated. This study's primary outcome was weight or linear growth faltering (z score decline ≥0.8 in weight or length) at hospital discharge. Adherence measures were assessed.
Results
One hundred twenty-six infants with gastroschisis were born prepathway; 52 were born postpathway. Median gestational age was similar between cohorts. Adherence to components of the pathway ranged from 58% to 95%. The proportion of infants with weight or linear growth faltering at discharge was lower after pathway initiation (59.4% vs 36.2%, P = 0.0068). Adjusting for gestational age and fetal growth restriction, the pathway was associated with decreased weight or linear growth faltering (odds ratio [OR] 0.35 [0.16–0.75], P = 0.0060) and decreased linear growth faltering (OR 0.24 [0.096–0.56], P = 0.0062) at discharge. Hypertriglyceridemia, cholestasis, and days to full feeds were similar to published cohorts.
Conclusion
Fewer infants with gastroschisis experienced weight or length growth faltering at hospital discharge following the implementation of a multicenter nutrition pathway.
背景：加利福尼亚大学胎儿联盟（University of California Fetal Consortium）公布，55% 的胃裂婴儿在出院时会出现生长迟缓。为了解决这个问题，我们开发了一种营养路径，强调（1）早期提供肠外宏量营养素，（2）使用人乳，以及（3）生长迟缓治疗。本研究的目标是评估加利福尼亚州六家医院对患有胃裂的婴儿采用该路径的依从性和有效性：2015 年，联合医院对患有胃裂的婴儿进行了标准化护理。为了降低生长迟缓率，在 2019 年至 2020 年期间，提出、讨论、修订并启动了营养指南。本研究的主要结果是出院时体重或线性生长迟缓（体重或身长的 Z 值下降≥0.8）。研究还对坚持治疗的措施进行了评估：126名患有胃裂的婴儿在路径前出生，52名在路径后出生。两组婴儿的中位胎龄相似。坚持路径的比例从58%到95%不等。启动路径后，出院时体重或线性生长迟缓的婴儿比例较低（59.4% vs 36.2%，P = 0.0068）。调整胎龄和胎儿生长受限因素后，出院时体重减轻或线性生长迟缓（几率比 [OR] 0.35 [0.16-0.75]，P = 0.0060）和线性生长迟缓（OR 0.24 [0.096-0.56]，P = 0.0062）与路径相关。高甘油三酯血症、胆汁淤积症和完全进食天数与已发表的队列相似：结论：实施多中心营养路径后，出院时出现体重或身长生长迟缓的胃螺裂婴儿减少了。
{"title":"Association between consensus-based nutrition pathway and growth faltering in infants with gastroschisis: A retrospective cohort study","authors":"Katie M. Strobel MD, MSCR, Katelin Kramer MD, Catherine Rottkamp MD, PhD, Cherry Uy MD, Erika Fernandez MD, Laurel Moyer MD, David Elashoff PhD, Animesh Sabnis MD, MSHS, Daniel A. DeUgarte MD, MSCR, Kara L. Calkins MD, MSCR","doi":"10.1002/jpen.2692","DOIUrl":"10.1002/jpen.2692","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The University of California Fetal Consortium published that 55% of infants with gastroschisis develop growth faltering by hospital discharge. To address this problem, we developed a nutrition pathway emphasizing (1) early provision of parenteral macronutrients, (2) use of human milk, and (3) growth faltering treatment. This study's goals were to assess adherence to and efficacy of this pathway in infants with gastroschisis across six California hospitals.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>In 2015, the consortium standardized the care for infants with gastroschisis. To decrease growth faltering rates, between 2019 and 2020, nutrition guidelines were proposed, discussed, revised, and initiated. This study's primary outcome was weight or linear growth faltering (<i>z</i> score decline ≥0.8 in weight or length) at hospital discharge. Adherence measures were assessed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred twenty-six infants with gastroschisis were born prepathway; 52 were born postpathway. Median gestational age was similar between cohorts. Adherence to components of the pathway ranged from 58% to 95%. The proportion of infants with weight or linear growth faltering at discharge was lower after pathway initiation (59.4% vs 36.2%, <i>P</i> = 0.0068). Adjusting for gestational age and fetal growth restriction, the pathway was associated with decreased weight or linear growth faltering (odds ratio [OR] 0.35 [0.16–0.75], <i>P</i> = 0.0060) and decreased linear growth faltering (OR 0.24 [0.096–0.56], <i>P</i> = 0.0062) at discharge. Hypertriglyceridemia, cholestasis, and days to full feeds were similar to published cohorts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fewer infants with gastroschisis experienced weight or length growth faltering at hospital discharge following the implementation of a multicenter nutrition pathway.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"48 8","pages":"940-948"},"PeriodicalIF":3.2,"publicationDate":"2024-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2692","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377978","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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