Journal of Parenteral and Enteral Nutrition最新文献_第5页

Fat-free mass index cutoff values for reduced muscle mass in older community-dwelling adults in Japan: A descriptive cohort study 日本老年社区居民肌肉量减少的无脂肪质量指数临界值：一项描述性队列研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-07-11 DOI: 10.1002/jpen.2806

Sahoko Takagi RD, MSc, Keisuke Maeda MD, PhD, Shosuke Satake MD, PhD, Shuzo Miyahara MD, DDS, PhD, Yuria Ishida RD, PhD, Hiroyasu Akatsu MD, PhD, Hidenori Arai MD, PhD

Background

The Global Leadership Initiative on Malnutrition criteria emphasize the importance of assessing muscle mass, recommending the fat-free mass index (FFMI) as a key measure. This study aimed to establish FFMI cutoff values for Japanese individuals and examine the risk factors of falls using these values.

Methods

This descriptive cohort study included 696 older adults from a Japanese outpatient frailty clinic located within a hospital. FFMI was measured via bioelectrical impedance analysis, and the appendicular skeletal muscle index (ASMI) was measured using dual-energy X-ray absorptiometry. Receiver operating characteristic analysis identified optimal FFMI cut-offs against low ASMI (<7.0 kg/m² for men; <5.4 kg/m² for women). Logistic regression was used to analyze the relationship between reduced muscle mass and falls over 1 year.

Results

Participants (mean age 76.1 ± 7.4 years; 64.8% female) experienced falls in 180 cases (25.9%), with 244 participants (35.1%) exhibiting low ASMI. The optimal FFMI cut-offs were <17.5 kg/m² for men (area under the curve [AUC]: 0.926; 95% confidence interval [CI]: 0.893–0.958) and <14.4 kg/m² for women (AUC: 0.927; 95% CI: 0.902–0.953), yielding 84.0% sensitivity, 91.2% specificity, and 88.6% accuracy. Low ASMI was not significantly linked to falls (odds ratio [OR: 1.04; 95% CI: 0.70–1.53; P = 0.860), whereas low FFMI was predictive (OR: 1.49; 95% CI: 1.01–2.20; P = 0.044).

Conclusion

FFMI cut-offs of <17.5 kg/m² for men and <14.4 kg/m² for women effectively identified reduced muscle mass and predicted falls. The results suggest that FFMI may be a useful tool in malnutrition diagnosis.

背景：营养不良标准全球领导倡议强调评估肌肉质量的重要性，建议将无脂肪质量指数（FFMI）作为关键衡量标准。本研究旨在建立日本个体的FFMI临界值，并利用这些值检查跌倒的危险因素。方法：这项描述性队列研究包括来自日本一家医院门诊虚弱诊所的696名老年人。采用生物电阻抗法测定FFMI，双能x线吸收法测定阑尾骨骼肌指数（ASMI）。接受者工作特征分析确定了低ASMI的最佳FFMI截止值(男性为2；女性2个)。采用Logistic回归分析1年内肌肉量减少与跌倒之间的关系。结果：参与者(平均年龄76.1±7.4岁；其中180例（25.9%）出现跌倒，244例（35.1%）出现低ASMI。男性的最佳FFMI截点为2(曲线下面积[AUC]: 0.926；95%置信区间[CI]: 0.893-0.958)，女性为2 (AUC: 0.927；95% CI: 0.902-0.953)，敏感性84.0%，特异性91.2%，准确性88.6%。低ASMI与跌倒无显著关联(优势比[OR: 1.04；95% ci: 0.70-1.53；P = 0.860)，而低FFMI具有预测意义(OR: 1.49；95% ci: 1.01-2.20；p = 0.044)。结论：FFMI截断值男性为2，女性为2，可有效识别肌肉量减少并预测跌倒。结果表明FFMI可能是营养不良诊断的有用工具。

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引用次数: 0

Energy and protein intake adequacy in geriatric rehabilitation inpatients: A descriptive cohort study 老年康复住院患者的能量和蛋白质摄入充足性：一项描述性队列研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-07-06 DOI: 10.1002/jpen.2804

Jeewanadee Hettiarachchi APD, PhD, Esmee M. Reijnierse PhD, Andrea B. Maier MD, PhD, Kate Fetterplace APD, PhD

Background

Indirect calorimetry (IC) provides an accurate measure of energy expenditure, which informs energy requirements. Achieving energy and protein requirements is fundamental in nutrition care. This study aims to determine if the energy requirements informed by IC and estimated protein requirements are met in geriatric rehabilitation inpatients receiving dietitian-led individualized nutrition care.

Methods

Geriatric rehabilitation inpatients referred to dietitians were included. Resting metabolic rate was measured using IC at inclusion in the study and within 48 h before discharge. Food intake was assessed using plate waste observation. The patient's energy requirement was calculated using the resting metabolic rate and physical activity factor and adjusted for the weight goal. Protein requirements were estimated by the dietitian. The energy and protein intake adequacy was calculated as a percentage of the individual requirement and defined “adequate” if ≥100%.

Results

Fifty-three patients were included (mean age, 84.3 [standard deviation, 8.44] years; 22 [41.5%] women). The median energy and protein intake adequacy was 101.7% (interquartile range [IQR], 76.4–112.9) and 87.6% (IQR, 71.9–122.2) at the start of the nutrition care (n = 53) and 99.9% (IQR, 63.9–113.8) and 80.1% (IQR, 65.1–99.6) at discharge (n = 29), respectively. Only 15 of 53 (28.3%) patients at the start of nutition care and 6 of 29 (20.7%) patients at discharge achieved both energy and protein intake adequacy.

Conclusions

Energy requirements were met, but the protein requirements were not met in geriatric rehabilitation inpatients receiving nutrition care. However, less than one-third of patients achieved both energy and protein intake adequacy.

背景：间接量热法（IC）提供了一种准确的能量消耗测量方法，它可以告知能量需求。实现能量和蛋白质需求是营养保健的基础。本研究旨在确定在接受营养师主导的个性化营养护理的老年康复住院患者中，IC所告知的能量需求和估计的蛋白质需求是否满足。方法：纳入由营养师转诊的老年康复住院患者。静息代谢率在纳入研究时和出院前48小时内用IC测量。通过盘子剩余物观察评估食物摄取量。使用静息代谢率和体力活动因子计算患者的能量需求，并根据体重目标进行调整。蛋白质需要量由营养师估算。能量和蛋白质摄入充分性以个体需要量的百分比计算，如果≥100%则定义为“充足”。结果：纳入53例患者(平均年龄84.3岁[标准差8.44]岁；22[41.5%]女性)。营养护理开始时（n = 53）的能量和蛋白质摄入充足度中位数分别为101.7%（四分位数间距[IQR]， 76.4-112.9）和87.6% (IQR, 71.9-122.2)，出院时（n = 29）的能量和蛋白质摄入充足度中位数分别为99.9% （IQR, 63.9-113.8）和80.1% （IQR, 65.1-99.6）。53例患者中只有15例（28.3%）在开始营养护理时达到能量和蛋白质摄入充足，29例患者中只有6例（20.7%）在出院时达到能量和蛋白质摄入充足。结论：接受营养护理的老年康复住院患者能量需求满足，蛋白质需求不满足。然而，不到三分之一的患者达到了能量和蛋白质摄入充足。

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引用次数: 0

Association between late parenteral nutrition initiation and length of hospital stay in late preterm and term infants: A retrospective cohort study 晚期早产儿和足月婴儿肠外营养起始时间与住院时间的关系：一项回顾性队列研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-07-06 DOI: 10.1002/jpen.2805

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 the association between timing of parenteral nutrition initiation and length of hospital stay in late preterm and term infants.

Methods

This retrospective cohort study includes infants ≥35 weeks gestation admitted to a Pediatrix Medical Group neonatal intensive care unit in 2009–2019. Propensity score matching was used to control for demographics, delivery characteristics, and severity of illness. The primary outcome was length of hospital stay. Secondary outcomes were duration of mechanical ventilation, late-onset sepsis, and mortality. Early parenteral nutrition was defined as initiation on the day of birth and late as initiation after.

Results

The total cohort has 475,708 infants; of 259,495 eligible infants, 97,577 (37.6%) received parenteral nutrition. After propensity score matching, outcomes were analyzed for 13,712 infants. Infants receiving late parenteral nutrition (n = 6856) have no difference in length of hospital stay compared with early. Analysis of secondary outcomes reveals no differences between groups. Negative binomial regression shows decreased length of hospital stay when parenteral nutrition is initiated on days of life 1–3 compared with day of birth or days 4–10.

Conclusion

Initiating parenteral nutrition on day 1 or later vs day of birth is not associated with increased length of hospital stay in late preterm and term infants. Exploratory analysis suggests that initiation of parenteral nutrition on days 1–3 instead of day of birth or days 4–10 is associated with decreased hospital stay. Prospective clinical trials are needed to better understand optimal timing of parenteral nutrition in this population.

背景：我们的目的是确定肠外营养开始时间与晚期早产儿和足月婴儿住院时间之间的关系。方法：本回顾性队列研究纳入2009-2019年儿科医疗集团新生儿重症监护室收治的妊娠≥35周的婴儿。倾向评分匹配用于控制人口统计学、分娩特征和疾病严重程度。主要观察指标为住院时间。次要结局是机械通气持续时间、迟发性败血症和死亡率。早期肠外营养定义为出生当天开始，晚为出生后开始。结果：总队列有475,708名婴儿；在259,495名符合条件的婴儿中，97,577名（37.6%）接受了肠外营养。倾向评分匹配后，对13712名婴儿的结果进行了分析。接受晚肠外营养的婴儿（n = 6856）在住院时间上与早期没有差异。次要结果分析显示两组间无差异。负二项回归显示，与出生当天或4-10天相比，在出生后1-3天开始肠外营养的住院时间缩短。结论：在出生第1天或更晚开始肠外营养与晚期早产儿和足月儿住院时间的增加无关。探索性分析表明，在1-3天而不是出生当天或4-10天开始肠外营养与住院时间缩短有关。需要前瞻性临床试验来更好地了解在这一人群中肠外营养的最佳时机。

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引用次数: 0

Roles, responsibilities, and opportunities for the nutrition support physician working with adults: A critical review 与成人一起工作的营养支持医师的角色、责任和机会：一个批判性的回顾。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-07-02 DOI: 10.1002/jpen.2790

Manpreet S. Mundi MD, Jeffrey I. Mechanick MD, Jayshil Patel MD, Carolyn Newberry MD, Senthilkumar Sankararaman MBBS, Martin Rosenthal MD, Osman Mohamed Elfadil MBBS, Jamie Bering MD, Jennifer Katz MD, Christian Stoppe MD, Robert Martindale MD, PhD, Stephen McClave MD

The dual burden of undernutrition and overnutrition requires a greater understanding and commitment to physician training and specialization in nutrition support. Despite the significant healthcare need and existence of organizations focused on nutrition support such as the American Society for Parenteral and Enteral Nutrition (ASPEN), physician involvement in the nutrition care of high-risk patients remains low. In an ASPEN survey of members, inadequate training among physicians was reported along with significant barriers to involvement in nutrition support, such as insufficient protected time, reduced reimbursement and financial support, inadequate support from administrators or supervisors, as well as a nationwide reduction in number of nutrition support teams. These changes in the healthcare landscape prompted the ASPEN Physician Engagement Committee to develop a critical review focused on domains of nutrition risk assessment, enteral and parenteral access and support, scholarly activities, board certification, administrative responsibilities, education and training opportunities, coding, and reimbursement. The aim of this critical review is to capacitate physicians to engage in nutrition support and enhance their acumen in clinical nutrition to improve patient care and enrich personal and professional development.

营养不良和营养过剩的双重负担需要对营养支持方面的医生培训和专业化有更深入的了解和承诺。尽管有大量的医疗保健需求和组织的存在，如美国肠外和肠内营养协会（ASPEN），医生参与高危患者的营养护理仍然很低。在ASPEN对成员的调查中，医生的培训不足，以及参与营养支持的重大障碍，如保护时间不足，报销和财政支持减少，管理人员或主管的支持不足，以及全国范围内营养支持小组数量的减少。医疗保健领域的这些变化促使ASPEN医师参与委员会对营养风险评估、肠内和肠外获取和支持、学术活动、委员会认证、行政责任、教育和培训机会、编码和报销等领域进行了重要审查。这篇重要综述的目的是使医生能够从事营养支持，提高他们在临床营养方面的敏锐度，以改善患者护理，丰富个人和职业发展。

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引用次数: 0

Association between enteral essential fatty acids and plasma phospholipid essential fatty acids related immune response in critically ill adults with COVID-19: A prospective cohort study 危重成人COVID-19患者肠内必需脂肪酸与血浆磷脂必需脂肪酸相关免疫反应的相关性：一项前瞻性队列研究

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-27 DOI: 10.1002/jpen.2783

Vera C. Mazurak PhD, Irma Magaly Rivas-Serna PhD, Sarah R. Parsons RD, Md Monirujjaman PhD, Krista E. Maybank RD, Oleksa G. Rewa MD, Andrew J. Cave MD, Caroline Richard RD, PhD, M. Thomas Clandinin PhD

Background

Coronavirus disease 2019 (COVID-19) is a complicated disease with widely varying outcomes. Up to 20% of unvaccinated, hospitalized patients infected with COVID-19 may die during the initial three weeks. Our research shows that COVID-19 infection results in rapid, remarkable change in the balance between essential fatty acid constituents of plasma phospholipids that are substrates for synthesis of signals that regulate immunity, inflammation, and thrombosis.

Methods

We assessed if enteral feeding of EPA (eicosapentaenoic acid, 20:5n-3) and DHA (docosahexaenoic acid; 22:6n-3) normalizes remodeling of plasma phospholipid essential fatty acid content caused by COVID-19 viral infection and modifies immune response. Blood samples were taken on day 1 of hospital admission. From the patient record, patients were categorized into two groups based on enteral formula fed by day 5 after admission: enteral feeds that contained EPA + DHA or not. These two groups were compared at 1 week and 3 weeks postadmission for plasma phospholipid fatty acids, cytokines, and chemokines.

Results

Feeding EPA + DHA increases plasma content of these fatty acids in specific species of plasma phosphatidylcholine. Change in essential fatty acid status was associated with downregulation of the inflammatory signal macrophage inflammatory protein-1β and increase in interleukin-17, monocyte chemoattractant protein (MCP)-4, macrophage-derived chemokine and thymus- and activation-regulated chemokine signals. Plasma arachidonic acid content correlated with chemoattractant protein MCP-4 during early stages of infection.

Conclusion

We conclude that feeding COVID-19 infected intensive care unit patients enteral formulas containing EPA and DHA may alter response to infection; however, the potential benefit to clinical outcome is not clear.

背景：2019冠状病毒病（COVID-19）是一种复杂的疾病，其结局多种多样。在感染COVID-19的未接种疫苗的住院患者中，多达20%可能在最初三周内死亡。我们的研究表明，COVID-19感染导致血浆磷脂中必需脂肪酸成分之间的平衡迅速显著改变，血浆磷脂是合成调节免疫、炎症和血栓形成的信号的底物。方法：评估肠内喂养EPA（二十碳五烯酸，20:5n-3）和DHA(二十二碳六烯酸；22:6n-3)使COVID-19病毒感染引起的血浆磷脂必需脂肪酸含量重塑正常化，并改变免疫反应。入院第1天采血。根据患者记录，根据入院后第5天的肠内配方饲料将患者分为两组：肠内饲料中含有EPA + DHA和不含EPA + DHA。两组在入院后1周和3周比较血浆磷脂脂肪酸、细胞因子和趋化因子。结果：饲喂EPA + DHA增加了特定种类血浆磷脂酰胆碱中这些脂肪酸的血浆含量。必需脂肪酸状态的改变与炎症信号巨噬细胞炎症蛋白-1β的下调和白细胞介素-17、单核细胞趋化蛋白(MCP)-4、巨噬细胞来源的趋化因子以及胸腺和激活调节的趋化因子信号的增加有关。感染早期血浆花生四烯酸含量与趋化蛋白MCP-4相关。结论：给重症监护病房感染的患者喂食含EPA和DHA的肠内配方可能会改变患者对感染的反应；然而，对临床结果的潜在益处尚不清楚。

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引用次数: 0

Development of home-based methods to defat human milk for infants with chylothorax: An experimental study 发展以家庭为基础的方法使乳糜胸婴儿的母乳脱脂：一项实验研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-23 DOI: 10.1002/jpen.2782

Kaitlin Berris RD, Kendall Plant BSc, Frances Jones IBCLC, Diego Marquez MD, Vicki Hsieh RN, Rajavel Elango PhD

Background

Chylothorax is a postoperative complication for infants with congenital heart defects; with high nutrition risk. Defatted human milk is recommended; however, refrigerated centrifugation to process milk poses accessibility barriers for many hospitals and families at home. Creation of a simplified home-based defatted milk protocol allows infants with chylothorax to be provided the immunological benefits of human milk postoperatively.

Methods

Milk from 20 mothers was tested to compare refrigerated centrifugation as the standard defatting technique against gravity-based methods: syringe tip-down and gravy separator. Two timeframes, 24 h and 48 h, were tested to determine if additional time had a significant impact on fat reduction. The MIRIS human milk analyzer provided results for fat, true protein, carbohydrate, and energy content. One-way analysis of variance was used to determine a significant difference on fat content among methods.

Results

All methods had a significant reduction in fat content, with centrifugation having the largest mean decline from 3.4 to 0.5 g/100 ml (P < 0.0001). The second most effective method to defat milk was 48-h gravy separator with a mean decline to 0.7 g/100 ml (P < 0.0001). Postpartum age of milk impacted the degree of fat removal in all methods. True protein content remained the same as baseline in all methods.

Conclusion

A simplified home-based gravity separation method over 48 h reduced human milk fat by 80%. This is the first protocol to defat human milk without use of the more resource-intensive centrifugation method, that shows significant fat reduction with easy-to-use and accessible equipment for management of infants with chylothorax.

背景：乳糜胸是婴儿先天性心脏缺陷的术后并发症；营养风险高。推荐使用脱脂人乳；然而，对许多医院和家庭来说，用冷冻离心法加工牛奶是一种障碍。创建一个简化的家庭脱脂奶方案，允许乳糜胸婴儿术后获得母乳的免疫益处。方法：对来自20位母亲的乳汁进行测试，比较冷冻离心作为标准脱脂技术与基于重力的方法：注射器向下倾斜和肉汁分离器。研究人员测试了24小时和48小时两个时间段，以确定额外的时间是否对脂肪减少有显著影响。MIRIS人乳分析仪提供了脂肪、真蛋白质、碳水化合物和能量含量的结果。采用单因素方差分析确定不同方法间脂肪含量差异显著。结果：所有方法的脂肪含量均有显著降低，其中离心法的平均降幅最大，从3.4 g/100 ml降至0.5 g/100 ml (P)。结论：简化的家庭重力分离方法在48 h内可使人乳脂肪减少80%。这是第一个不使用资源更密集的离心方法来脱除母乳的方案，该方法表明，使用易于使用和可获得的设备来管理乳糜胸婴儿，可以显著减少脂肪。

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引用次数: 0

Association between insulin dose and hyperglycemia in hospitalized adults with ischemic stroke receiving continuous enteral nutrition: A retrospective cohort study 一项回顾性队列研究：接受持续肠内营养的住院成人缺血性卒中患者胰岛素剂量与高血糖之间的关系

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-23 DOI: 10.1002/jpen.2787

Heather M. Wallhauser PharmD, Leslie A. Hamilton PharmD, Skyler R. Brown PharmD, Thomas J. Christianson MD, Brian F. Wiseman MD, Olivia N. Bray PharmD, Hayden W. Caldwell PharmD, A. Shaun Rowe PharmD

Background

Hyperglycemia following an acute ischemic stroke has been linked to increased morbidity and mortality. Because of changes in a hospital-wide sliding-scale insulin protocol to incorporate half-doses at midnight due to hypoglycemia risk, we aimed to evaluate the safety and efficacy of half-dose sliding-scale insulin at midnight compared with full doses in patients with acute ischemic stroke receiving enteral nutrition.

Methods

This single-center, retrospective cohort study involved 151 patients with acute ischemic stroke and receiving enteral nutrition in a neurocritical care unit between January 1, 2014, and December 31, 2021. The exposure of interest was half-dose sliding-scale insulin at midnight compared with full-dose sliding-scale insulin at midnight. The primary outcome was the incidence of hyperglycemia for a 48-h period after stability while receiving enteral nutrition. Secondary outcomes were new infections, incidence of hypoglycemia, and incidence of delirium.

Results

In the full-dose group, 52 patients experienced hyperglycemia compared with 60 patients in the half-dose group; however, after propensity matching for carbohydrate content in enteral nutrition and hemoglobin A1c, the results are not noninferior (risk difference, 3.9%; 95% CI, −21.2% to 13.3%; P = 0.1041). Delirium was significantly higher in the full-dose group, whereas the half-dose group had a higher rate of suspected bacterial infections.

Conclusion

The study indicates that administering half-dose sliding-scale insulin at midnight in patients with acute ischemic stroke receiving enteral nutrition is not noninferior to full doses in controlling hyperglycemia. However, differences in delirium and infection rates suggest that glycemic changes may influence other outcomes.

背景：急性缺血性脑卒中后高血糖与发病率和死亡率增加有关。由于考虑到低血糖风险，医院范围内的滑动刻度胰岛素方案发生了变化，纳入了午夜半剂量胰岛素，我们的目的是评估在接受肠内营养的急性缺血性卒中患者中，午夜半剂量滑动刻度胰岛素与全剂量胰岛素的安全性和有效性。方法：这项单中心、回顾性队列研究纳入了2014年1月1日至2021年12月31日期间在一家神经重症监护病房接受肠内营养治疗的151例急性缺血性卒中患者。所关注的暴露是午夜半剂量滑动刻度胰岛素与午夜全剂量滑动刻度胰岛素的比较。主要结局是在接受肠内营养稳定后48小时内高血糖的发生率。次要结局为新发感染、低血糖发生率和谵妄发生率。结果：全剂量组52例出现高血糖，半剂量组60例；然而，在肠内营养中碳水化合物含量和血红蛋白A1c倾向匹配后，结果并非不佳(风险差异为3.9%；95% CI, -21.2% ~ 13.3%；p = 0.1041)。全剂量组谵妄发生率明显增高，半剂量组疑似细菌感染发生率明显增高。结论：本研究提示急性缺血性脑卒中肠内营养患者在午夜给予半剂量滑标胰岛素控制高血糖的效果不亚于给予全剂量胰岛素。然而，谵妄和感染率的差异表明血糖变化可能影响其他结果。

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引用次数: 0

Prognostic evaluation of GLIM-defined severe malnutrition via skeletal muscle mass index in critically ill adults: A comparative analysis 通过骨骼肌质量指数对危重症成人的严重营养不良进行预后评估：一项比较分析。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-22 DOI: 10.1002/jpen.2789

Tomoka Miyagi RD, Minoru Yoshida MD, PhD, Shinya Suganuma MD, Kensuke Nakamura MD, PhD, Shunsuke Takaki MD, PhD

Background

The Global Leadership Initiative on Malnutrition (GLIM) criteria are recommended by major academic societies; however, their application to critically ill patients is limited because of the difficulties associated with assessing muscle mass and the lack of standardized methods and cutoff values. We herein applied GLIM criteria to intensive care unit (ICU) patients by accurately assessing total skeletal muscle volume using computed tomography (CT) with sarcopenia diagnostic cutoff values.

Methods

We included consecutive adult patients admitted to our ICU who underwent CT of the trunk. Total skeletal muscle area at the third lumbar vertebra was measured, and the skeletal muscle index was calculated. Reduced muscle mass was defined with Iritani criteria. A positive result in any of the phenotypic criteria was regarded as severe malnutrition. The primary outcome was in-hospital mortality. We also examined the agreement with the Subjective Global Assessment (SGA) using Cohen kappa coefficient.

Results

Among 147 patients, 38 had weight loss, 39 had a low body mass index (BMI), and 41 had reduced muscle mass. In-hospital mortality was associated with reduced muscle mass (13.2% vs 43.9%, P < 0.001) and low BMI (15.7% vs 38.5%, P = 0.003). The concordance of individual and sole phenotypic criteria with SGA was low, whereas concordance was the highest at κ = 0.70 when all three criteria were combined.

Conclusions

GLIM criteria with accurate muscle mass evaluation using sarcopenia diagnostic cutoffs by CT may facilitate the identification of ICU patients with malnutrition whose prognosis is poor.

背景：营养不良全球领导倡议（GLIM）标准是由主要学术团体推荐的；然而，由于与评估肌肉质量相关的困难以及缺乏标准化方法和临界值，它们在危重患者中的应用受到限制。在此，我们将GLIM标准应用于重症监护病房（ICU）患者，通过计算机断层扫描（CT）准确评估骨骼肌总体积，并确定肌肉减少症的诊断临界值。方法：我们纳入了连续入住ICU并接受躯干CT检查的成年患者。测量第三腰椎总骨骼肌面积，计算骨骼肌指数。肌肉量减少以Iritani标准定义。任何表型标准的阳性结果都被认为是严重营养不良。主要终点是住院死亡率。我们还使用Cohen kappa系数检查了与主观全局评估（SGA）的一致性。结果：147例患者中，38例体重减轻，39例身体质量指数（BMI）较低，41例肌肉质量减少。住院死亡率与肌肉量减少相关（13.2% vs 43.9%）。结论：采用CT肌少症诊断截止值准确评估肌肉量的GLIM标准有助于鉴别预后较差的营养不良ICU患者。

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引用次数: 0

Incidence of catheter-related bloodstream infections with sodium citrate lock therapy in adult patients receiving home parenteral nutrition: A descriptive cohort study 接受家庭肠外营养的成人患者应用柠檬酸钠锁栓治疗后导管相关血流感染的发生率：一项描述性队列研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-22 DOI: 10.1002/jpen.2788

Rachel Leong PharmD, Nisha J. Dave PharmD, Daniel P. Griffith RPh, Anna Guo MS, Kirk A. Easley MS, John R. Galloway MD, Thomas R. Ziegler MD, Vivian M. Zhao PharmD

Background

We determined the incidence of catheter-related bloodstream infections in adult patients requiring home parenteral nutrition (HPN) while receiving sodium citrate locks.

Methods

We conducted a single-center descriptive cohort study involving 38 adults who required HPN from January 1, 2020, to August 31, 2022. The exact method, assuming a Poisson distribution, was used to estimate the incidence rate of catheter-related bloodstream infections per 1000 catheter days among patients receiving sodium citrate locks. Univariate and multivariate analyses using Poisson regression and frailty models were employed to evaluate predictive factors.

Results

Thirty-eight patients received sodium citrate locks, with 65.8% women (mean age, 50.2 ± 14.5 years). The average length of HPN was 3.6 years. Forty-six catheter-related bloodstream infections occurred during 20,085 catheter days, demonstrating an incidence rate of 2.3 (95% confidence interval, 1.7–3.1) per 1000 catheter days. Peripheral-inserted central catheters had a higher incidence rate (3.9 per 1000 catheter days) than Hickman catheters (2.2 per 1000 catheter days), with a hazard ratio of 1.27, indicating a 27% increased risk of catheter-related bloodstream infections. Univariate and multivariate Poisson regression analyses revealed that for every 1-h increase in HPN infusion duration (h/day), the incidence rate of catheter-related bloodstream infections is expected to increase by 10%.

Conclusion

Catheter-related bloodstream infections are common in adult patients requiring HPN. Sodium citrate locks may help prevent these infections. Recognizing predictive factors, such as the duration of parenteral infusion, can help healthcare providers develop more effective prevention strategies.

背景：我们确定了在接受柠檬酸钠锁剂治疗时需要家庭肠外营养（HPN）的成年患者导管相关血流感染的发生率。方法：我们进行了一项单中心描述性队列研究，纳入了2020年1月1日至2022年8月31日期间需要HPN的38名成年人。假设泊松分布的精确方法被用来估计接受柠檬酸钠锁栓的患者每1000个导管日导管相关血流感染的发生率。采用泊松回归和脆弱性模型进行单因素和多因素分析，评估预测因素。结果：38例患者接受柠檬酸钠锁药治疗，女性占65.8%（平均年龄50.2±14.5岁）。HPN的平均长度为3.6年。20,085天内发生46例导管相关血流感染，每1000天发生率为2.3（95%置信区间为1.7-3.1）。外周插入中心导管的发生率（3.9 / 1000导管天）高于Hickman导管（2.2 / 1000导管天），风险比为1.27，表明导管相关血流感染的风险增加27%。单因素和多因素泊松回归分析显示，HPN输注时间（h/天）每增加1小时，导管相关血流感染的发生率预计会增加10%。结论：导管相关性血流感染在需要HPN的成人患者中很常见。柠檬酸钠锁可以帮助预防这些感染。认识到预测因素，如肠外输液的持续时间，可以帮助医疗保健提供者制定更有效的预防策略。

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引用次数: 0

Essential fatty acid deficiency in children treated with long-term 100% fish-oil lipid injectable emulsion: A longitudinal descriptive cohort study 长期100%鱼油脂类注射乳剂治疗儿童必需脂肪酸缺乏症：一项纵向描述性队列研究。

IF 4.1 3区医学 Q2 NUTRITION & DIETETICS

Journal of Parenteral and Enteral Nutrition

Pub Date : 2025-06-19 DOI: 10.1002/jpen.2785

Kathleen M. Gura PharmD, Muralidhar H. Premkumar MBBS, Kara L. Calkins MD, Mark Puder MD, PhD

Background

To assess severity and risk of an essential fatty acid deficiency in children <2 years with parenteral nutrition–associated cholestasis on long-term 100% fish-oil lipid injectable emulsion.

Methods

This longitudinal descriptive cohort study included patients receiving fish-oil lipid injectable emulsion (1 g/kg/day). Triene: tetraene ratios were monitored for up to 4 years and classified as mildly elevated (≥0.05 and <0.2) or essential fatty acid deficiency (≥0.2).

Results

One hundred and twenty-seven patients with a baseline median age of 14 weeks were included. Serum docosahexaenoic acid and eicosapentaenoic acid levels markedly increased, whereas arachidonic acid, linoleic acid, and α-linolenic acid levels decreased before stabilizing. Median triene: tetraene ratios peaked at 0.027 at week 8 and then stabilized within a range of 0.015 and 0.020 from week 16 until the end of the study. Seven patients had mildly elevated triene: tetraene ratio at the end of the study. Three infants had an essential fatty acid deficiency, but none demonstrated clinical signs consistent with this deficiency. One deficiency was attributed to a laboratory error; two were associated with adverse events. All patients resolved with the continuation of fish-oil lipid injectable emulsion.

Conclusion

Children with parenteral nutrition–associated cholestasis on long-term fish-oil lipid injectable emulsion are at low risk for a clinical or biochemical essential fatty acid deficiency. These findings indicate that despite its low content of linoleic acid and α-linolenic acid, long-term 1 g/kg/day of 100% fish-oil lipid injectable emulsion is not associated with an essential fatty acid deficiency.

背景：评估儿童必需脂肪酸缺乏的严重程度和风险方法：这项纵向描述性队列研究纳入了接受鱼油脂类注射乳剂（1 g/kg/天）的患者。对三烯：四烯比率进行长达4年的监测，并将其分类为轻度升高（≥0.05）。结果：纳入127例基线中位年龄为14周的患者。血清二十二碳六烯酸和二十碳五烯酸水平显著升高，花生四烯酸、亚油酸和α-亚麻酸水平下降后趋于稳定。中位数三烯：四烯比率在第8周达到峰值0.027，然后从第16周到研究结束稳定在0.015和0.020的范围内。在研究结束时，7名患者的三烯：四烯比例轻度升高。三个婴儿有必需脂肪酸缺乏症，但没有表现出与这种缺乏症相一致的临床症状。其中一个缺陷归因于实验室错误；2例与不良事件相关。所有患者均通过继续服用鱼油脂类注射乳剂得以解决。结论：长期服用鱼油脂类注射乳剂的肠外营养相关性胆汁淤积症患儿临床或生化必需脂肪酸缺乏的风险较低。上述结果表明，尽管其亚油酸和α-亚麻酸含量较低，但长期1 g/kg/天的100%鱼油脂类注射乳剂与必需脂肪酸缺乏无关。

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引用次数: 0