Shameer J. Mehta MD, Alexandra Zissimopoulos MBBS, Konstantinos Fragkos PhD, Sarah Williams MSc, Sarah Faloon MBChB, Michael Taylor, Priya Mistry MRes, Vipin Gupta MD, Martyn Dibb MD, James Baker MPharm, Philip Smith BMBS, MSc, Philip Allan DPhil, Charlotte Rutter MBChB, Clare Donnellan MD, Arun Abraham FRCS, Simon Lal PhD
Background
No consensus exists regarding diagnostic tools for adult intestinal failure–associated liver disease (IFALD). This study aimed to determine correlations between histological pathology, noninvasive diagnostic tools, and IFALD severity. Secondary objectives included correlations between noninvasive diagnostic tools in adult patients with a clinical diagnosis of IFALD.
Methods
This was a multicenter, cross-sectional retrospective study conducted across six UK IF units. All patients judged to have IFALD were included. Included data were as follows: demographics, IF pathophysiological mechanism, radiological findings, blood results, elastography, and histological findings. Fisher exact tests, Kruskal-Wallis tests, and Spearman correlations were performed.
Results
Of 745 patients, 234 patients with IFALD were included (prevalence: 31.4%; median age: 56 years), with 95.3% meeting European Society of Clinical Nutrition and Metabolism criteria. Three fibrosis scores were used in 51 liver biopsies (Brunt et al.: 5 [9.8%]; Ishak et al.: 10 [19.6%]; and Metavir et al.: 10 [19.6%]). Elastography was performed in 57 patients (24.4%), with a median stiffness of 7.35 kPa. Histology grade inversely correlated with liver stiffness (n = 23; P = 0.01). No correlation was found between histology and imaging (n = 34; P = 0.22; chi-squared). Serum platelet count and enhanced liver fibrosis correlated with imaging (steatosis vs fibrosis/cirrhosis) (n = 85 (P < 0.01) and n = 12 (P = 0.05), respectively; Spearman). AST:ALT and FIB-4 scores correlated with liver stiffness at a threshold of 12 kPa (Spearman correlation coefficient: 0.943 [P < 0.01; n = 6]; Spearman correlation coefficient: 0.417 [P = 0.02; n = 31]; respectively).
Conclusion
Variations in the use and performance of noninvasive tools and histological reporting in adult IFALD were found. Prospective studies of noninvasive tools and expert histological consensus on reporting practice are justified.
{"title":"Diagnosis of adult patients with intestinal failure–associated liver disease: A descriptive cross-sectional study","authors":"Shameer J. Mehta MD, Alexandra Zissimopoulos MBBS, Konstantinos Fragkos PhD, Sarah Williams MSc, Sarah Faloon MBChB, Michael Taylor, Priya Mistry MRes, Vipin Gupta MD, Martyn Dibb MD, James Baker MPharm, Philip Smith BMBS, MSc, Philip Allan DPhil, Charlotte Rutter MBChB, Clare Donnellan MD, Arun Abraham FRCS, Simon Lal PhD","doi":"10.1002/jpen.2769","DOIUrl":"10.1002/jpen.2769","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>No consensus exists regarding diagnostic tools for adult intestinal failure–associated liver disease (IFALD). This study aimed to determine correlations between histological pathology, noninvasive diagnostic tools, and IFALD severity. Secondary objectives included correlations between noninvasive diagnostic tools in adult patients with a clinical diagnosis of IFALD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was a multicenter, cross-sectional retrospective study conducted across six UK IF units. All patients judged to have IFALD were included. Included data were as follows: demographics, IF pathophysiological mechanism, radiological findings, blood results, elastography, and histological findings. Fisher exact tests, Kruskal-Wallis tests, and Spearman correlations were performed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 745 patients, 234 patients with IFALD were included (prevalence: 31.4%; median age: 56 years), with 95.3% meeting European Society of Clinical Nutrition and Metabolism criteria. Three fibrosis scores were used in 51 liver biopsies (Brunt et al.: 5 [9.8%]; Ishak et al.: 10 [19.6%]; and Metavir et al.: 10 [19.6%]). Elastography was performed in 57 patients (24.4%), with a median stiffness of 7.35 kPa. Histology grade inversely correlated with liver stiffness (<i>n</i> = 23; <i>P</i> = 0.01). No correlation was found between histology and imaging (<i>n</i> = 34; <i>P</i> = 0.22; chi-squared). Serum platelet count and enhanced liver fibrosis correlated with imaging (steatosis vs fibrosis/cirrhosis) (<i>n</i> = 85 (<i>P</i> < 0.01) and <i>n</i> = 12 (<i>P</i> = 0.05), respectively; Spearman). AST:ALT and FIB-4 scores correlated with liver stiffness at a threshold of 12 kPa (Spearman correlation coefficient: 0.943 [<i>P</i> < 0.01; <i>n</i> = 6]; Spearman correlation coefficient: 0.417 [<i>P</i> = 0.02; <i>n</i> = 31]; respectively).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Variations in the use and performance of noninvasive tools and histological reporting in adult IFALD were found. Prospective studies of noninvasive tools and expert histological consensus on reporting practice are justified.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"650-658"},"PeriodicalIF":4.1,"publicationDate":"2025-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143977414","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}
Meiliana Meiliana MS, Frank H. Bloomfield PhD, Jane E. Harding DPhil, Luling Lin PhD
There are inconsistent recommendations in available guidelines and uncertainty regarding the exact nutrient requirements for preterm infants, partly because of inconsistent outcome reporting in nutrition intervention studies. To support development of a minimum reporting set, we undertook a scoping review to identify measures of nutrition intake and growth outcomes reported in recent preterm nutrition studies. We searched for publications from 2018 to 2023 reporting individuals born preterm at any gestational age and study location whose nutrition intake was assessed before first hospital discharge and whose growth was assessed at any age. One reviewer screened articles and extracted the measures. Any uncertainties were resolved by a second reviewer. The results were tabulated and analyzed descriptively. We identified 6365 records, and included 250 studies. Only 10 of 236 studies (4%) reported how nutrition intake was calculated. There were five different ways of reporting weight and 13 of weight gain, each at many different time points. Furthermore, 27 of 105 studies (26%) did not report how weight gain was calculated, and those that did reported five different calculation methods. Our findings demonstrate significant variation and incomplete reporting of nutrition intake and growth outcomes in preterm nutrition studies. This lack of standardization limits the utility of existing evidence and highlights the need for a standardized reporting framework to improve comparability and support evidence-based guidelines in preterm nutrition.
{"title":"Measures of nutrition intake and growth reported in preterm nutrition studies: A scoping review","authors":"Meiliana Meiliana MS, Frank H. Bloomfield PhD, Jane E. Harding DPhil, Luling Lin PhD","doi":"10.1002/jpen.2768","DOIUrl":"10.1002/jpen.2768","url":null,"abstract":"<p>There are inconsistent recommendations in available guidelines and uncertainty regarding the exact nutrient requirements for preterm infants, partly because of inconsistent outcome reporting in nutrition intervention studies. To support development of a minimum reporting set, we undertook a scoping review to identify measures of nutrition intake and growth outcomes reported in recent preterm nutrition studies. We searched for publications from 2018 to 2023 reporting individuals born preterm at any gestational age and study location whose nutrition intake was assessed before first hospital discharge and whose growth was assessed at any age. One reviewer screened articles and extracted the measures. Any uncertainties were resolved by a second reviewer. The results were tabulated and analyzed descriptively. We identified 6365 records, and included 250 studies. Only 10 of 236 studies (4%) reported how nutrition intake was calculated. There were five different ways of reporting weight and 13 of weight gain, each at many different time points. Furthermore, 27 of 105 studies (26%) did not report how weight gain was calculated, and those that did reported five different calculation methods. Our findings demonstrate significant variation and incomplete reporting of nutrition intake and growth outcomes in preterm nutrition studies. This lack of standardization limits the utility of existing evidence and highlights the need for a standardized reporting framework to improve comparability and support evidence-based guidelines in preterm nutrition.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 7","pages":"806-815"},"PeriodicalIF":4.1,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://aspenjournals.onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2768","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144004815","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}
Susan A. Gutierrez MD, Vikram Raghu MD, MS, Stephanie B. Oliveira MD, CNSC, Vivien Nguyen MD, Amy M. Shui MA, Debra L. Sudan MD, Conrad Cole MD, MPH, MSc, Chiung-Yu Huang PhD, Sue Rhee MD, Jennifer C. Lai MD, MBA, Sharad I. Wadhwani MD, MPH
Background
Central line–associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.
Methods
Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023. Patients were stratified into neighborhood income groups based on zip code–based median household income. CLABSI rates were assessed with mixed-effects Poisson regression over four eras (2016–2017, 2018–2019, 2020–2021, 2022–2023).
Results
Of 8772 hospitalizations of 2048 children with short bowel syndrome at 43 institutions, CLABSI was the principal diagnosis for 30% of hospitalizations. Univariable analysis showed decreased CLABSI rates during 2018–2019 (rate ratio [RR] 0.71, 95% CI 0.63–0.81; P < 0.001), 2020–2021 (RR 0.66, 95% CI 0.57–0.75; P < 0.001), and 2022–2023 (RR 0.60, 95% CI 0.52–0.70; P < 0.001), relative to 2016–2017. In multivariable analyses, 2022–2023 was associated with lower CLABSI rates relative to 2016–2017 (RR 0.61, 95% CI 0.52–0.70; P < 0.001). Low neighborhood income (RR 1.59, 95% CI 1.14–2.21; P < 0.001), public insurance (RR 1.59, 95% CI 1.37–1.84; P < 0.001), and non-Hispanic Black race (RR 1.19, 95% CI 1.01–1.39; P = 0.03) were associated with higher CLABSI rates relative to high neighborhood income, private insurance, and non-Hispanic White race, respectively.
Conclusion
CLABSI rates in pediatric short bowel syndrome have decreased over the past 8 years, yet socioeconomic and racial disparities persist. Efforts to prevent CLABSI across the socioeconomic spectrum should be prioritized to improve short bowel syndrome outcomes.
背景：中心线相关血流感染（CLABSIs）是儿童短肠综合征住院的主要原因，对社会经济条件较差的儿童影响较大。我们检查了总体CLABSI率随时间的变化，并评估了社会经济差异是否持续存在。方法：利用儿科健康信息系统数据库，对老年短肠综合征患者进行研究。结果：在43所医院的2048例短肠综合征患儿的8772例住院中，CLABSI是30%住院患者的主要诊断。单变量分析显示，2018-2019年CLABSI发生率下降(比率比[RR] 0.71, 95% CI 0.63-0.81；结论：小儿短肠综合征的CLABSI发生率在过去8年中有所下降，但社会经济和种族差异仍然存在。应优先努力预防跨社会经济范围的CLABSI，以改善短肠综合征的结局。
{"title":"Central line–associated bloodstream infection rates in pediatric short bowel syndrome in the United States: A retrospective cohort study from 2016 to 2023","authors":"Susan A. Gutierrez MD, Vikram Raghu MD, MS, Stephanie B. Oliveira MD, CNSC, Vivien Nguyen MD, Amy M. Shui MA, Debra L. Sudan MD, Conrad Cole MD, MPH, MSc, Chiung-Yu Huang PhD, Sue Rhee MD, Jennifer C. Lai MD, MBA, Sharad I. Wadhwani MD, MPH","doi":"10.1002/jpen.2766","DOIUrl":"10.1002/jpen.2766","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Central line–associated bloodstream infections (CLABSIs) are the leading cause of hospitalization in pediatric short bowel syndrome, disproportionately impacting socioeconomically disadvantaged children. We examined changes in overall CLABSI rates over time and assessed whether socioeconomic disparities persist.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Pediatric Health Information System database, we studied short bowel syndrome patients aged <18 years hospitalized between 2015 and 2023. Patients were stratified into neighborhood income groups based on zip code–based median household income. CLABSI rates were assessed with mixed-effects Poisson regression over four eras (2016–2017, 2018–2019, 2020–2021, 2022–2023).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 8772 hospitalizations of 2048 children with short bowel syndrome at 43 institutions, CLABSI was the principal diagnosis for 30% of hospitalizations. Univariable analysis showed decreased CLABSI rates during 2018–2019 (rate ratio [RR] 0.71, 95% CI 0.63–0.81; <i>P</i> < 0.001), 2020–2021 (RR 0.66, 95% CI 0.57–0.75; <i>P</i> < 0.001), and 2022–2023 (RR 0.60, 95% CI 0.52–0.70; <i>P</i> < 0.001), relative to 2016–2017. In multivariable analyses, 2022–2023 was associated with lower CLABSI rates relative to 2016–2017 (RR 0.61, 95% CI 0.52–0.70; <i>P</i> < 0.001). Low neighborhood income (RR 1.59, 95% CI 1.14–2.21; <i>P</i> < 0.001), public insurance (RR 1.59, 95% CI 1.37–1.84; <i>P</i> < 0.001), and non-Hispanic Black race (RR 1.19, 95% CI 1.01–1.39; <i>P</i> = 0.03) were associated with higher CLABSI rates relative to high neighborhood income, private insurance, and non-Hispanic White race, respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>CLABSI rates in pediatric short bowel syndrome have decreased over the past 8 years, yet socioeconomic and racial disparities persist. Efforts to prevent CLABSI across the socioeconomic spectrum should be prioritized to improve short bowel syndrome outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"572-579"},"PeriodicalIF":4.1,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026610","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}
Francesca Deli MSc, Kevin Whelan PhD, Danielle E. Bear PhD
Background
Noninvasive ventilation (NIV) is increasingly being used in critical care, yet limited evidence exists guiding nutrition practices for patients who are critically ill receiving NIV. This study aimed to describe the nutrition practices and adequacy of nutrition intake among patients who are critically ill receiving NIV.
Methods
This descriptive cohort study included adult patients admitted to critical care who received NIV on ≥3 consecutive days. Prospectively recorded clinical data were retrospectively extracted from electronic medical records and compared between patients who received solely noninvasive ventilation (NIV only) and those who received invasive mechanical ventilation (IMV) and were extubated onto noninvasive ventilation (post-IMV group).
Results
Of the 220 patients included (107 NIV only; 113 post-IMV), 142 (64.5%) received exclusive oral nutrition, 66 (30.0%) received artificial nutrition support, and 12 (5.5%) received no nutrition. Enteral nutrition was more prevalent in the post-IMV group (36 [31.9%] vs NIV only 19 [17.8%]; P = 0.01), whereas exclusive oral nutrition was more prevalent in the NIV-only group (86 [80.4%] vs post-IMV 66 [58.4%]; P < 0.001). Most patients who received purely exclusive oral nutrition (n = 152) had inadequate intake (94 [61.8%]).
Conclusion
Most patients with critically illness receiving NIV received exclusive oral nutrition, which was found to be inadequate in the majority. Patients receiving NIV represent a nutritionally at-risk population, and future studies are needed to understand the barriers to oral intake and the feasibility, safety, and effectiveness of enteral nutrition.
{"title":"Nutritional adequacy in critically ill adults receiving noninvasive ventilation: A descriptive cohort study","authors":"Francesca Deli MSc, Kevin Whelan PhD, Danielle E. Bear PhD","doi":"10.1002/jpen.2764","DOIUrl":"10.1002/jpen.2764","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Noninvasive ventilation (NIV) is increasingly being used in critical care, yet limited evidence exists guiding nutrition practices for patients who are critically ill receiving NIV. This study aimed to describe the nutrition practices and adequacy of nutrition intake among patients who are critically ill receiving NIV.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This descriptive cohort study included adult patients admitted to critical care who received NIV on ≥3 consecutive days. Prospectively recorded clinical data were retrospectively extracted from electronic medical records and compared between patients who received solely noninvasive ventilation (NIV only) and those who received invasive mechanical ventilation (IMV) and were extubated onto noninvasive ventilation (post-IMV group).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of the 220 patients included (107 NIV only; 113 post-IMV), 142 (64.5%) received exclusive oral nutrition, 66 (30.0%) received artificial nutrition support, and 12 (5.5%) received no nutrition. Enteral nutrition was more prevalent in the post-IMV group (36 [31.9%] vs NIV only 19 [17.8%]; <i>P</i> = 0.01), whereas exclusive oral nutrition was more prevalent in the NIV-only group (86 [80.4%] vs post-IMV 66 [58.4%]; <i>P</i> < 0.001). Most patients who received purely exclusive oral nutrition (<i>n</i> = 152) had inadequate intake (94 [61.8%]).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Most patients with critically illness receiving NIV received exclusive oral nutrition, which was found to be inadequate in the majority. Patients receiving NIV represent a nutritionally at-risk population, and future studies are needed to understand the barriers to oral intake and the feasibility, safety, and effectiveness of enteral nutrition.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"609-618"},"PeriodicalIF":4.1,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2764","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144018622","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}
Zhou Jing MPharm, Jiang Zhengli MPharm, Su Ying BD, Man Shiyu BD, Ma Jingjing MPharm, Pang Mujuan MPharm, Xu Hongyan MPharm, Hu Yan MPharm
Background
Parenteral nutrition can be administered through various infusion modalities. However, limited research has examined the differences in adverse reactions associated with these modalities.
Methods
Data from the Food and Drug Administration adverse event reporting system database were analyzed using disproportionality analysis to identify and compare adverse event signals across different infusion modalities.
Results
A total of 1642 adverse event reports related to parenteral nutrition were included: 356 in the all-in-one group, 85 in the two-in-one group, 1086 in the fat emulsion group, and 115 in the amino acid supplementation group. Across all reports, 4159 preferred terms were identified, distributed as follows: 858 in the all-in-one group, 152 in the two-in-one group, 2975 in the fat emulsion group, and 174 in the amino acid supplementation group, with these events spanning 20 system organ classes. In the all-in-one group, the top three preferred terms were lymphangitis, increased blood magnesium, and incorrect drug administration rate. In the two-in-one group, the leading preferred terms were fungemia, extravasation, and disease complications. In the fat emulsion group, the most significant preferred terms included fat overload syndrome, fatty acid deficiency, and parenteral nutrition–associated liver disease. In the amino acid supplementation group, key preferred terms were impaired glucose tolerance, hyperglycemia, and elevated hepatic enzymes.
Conclusion
This study identified significant variations in the adverse events associated with different parenteral nutrition infusion modalities. These findings underscore the need for tailored interventions to ensure the safe and effective use of parenteral nutrition, thereby optimizing therapeutic outcomes in clinical practice.
{"title":"Variations in adverse events associated with different infusion modalities of parenteral nutrition: A pharmacovigilance study","authors":"Zhou Jing MPharm, Jiang Zhengli MPharm, Su Ying BD, Man Shiyu BD, Ma Jingjing MPharm, Pang Mujuan MPharm, Xu Hongyan MPharm, Hu Yan MPharm","doi":"10.1002/jpen.2763","DOIUrl":"10.1002/jpen.2763","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Parenteral nutrition can be administered through various infusion modalities. However, limited research has examined the differences in adverse reactions associated with these modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the Food and Drug Administration adverse event reporting system database were analyzed using disproportionality analysis to identify and compare adverse event signals across different infusion modalities.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 1642 adverse event reports related to parenteral nutrition were included: 356 in the all-in-one group, 85 in the two-in-one group, 1086 in the fat emulsion group, and 115 in the amino acid supplementation group. Across all reports, 4159 preferred terms were identified, distributed as follows: 858 in the all-in-one group, 152 in the two-in-one group, 2975 in the fat emulsion group, and 174 in the amino acid supplementation group, with these events spanning 20 system organ classes. In the all-in-one group, the top three preferred terms were lymphangitis, increased blood magnesium, and incorrect drug administration rate. In the two-in-one group, the leading preferred terms were fungemia, extravasation, and disease complications. In the fat emulsion group, the most significant preferred terms included fat overload syndrome, fatty acid deficiency, and parenteral nutrition–associated liver disease. In the amino acid supplementation group, key preferred terms were impaired glucose tolerance, hyperglycemia, and elevated hepatic enzymes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified significant variations in the adverse events associated with different parenteral nutrition infusion modalities. These findings underscore the need for tailored interventions to ensure the safe and effective use of parenteral nutrition, thereby optimizing therapeutic outcomes in clinical practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"659-669"},"PeriodicalIF":4.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144030492","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}
Mar Romero-Lopez MD, PhD, Mamta Naik PharmD, RD, BCPPS, Teresa Hartman MLS, Ann Anderson-Berry MD, PhD, Melissa Thoene PhD, RD
With advancements in neonatal care, the viability of extremely low-birth-weight (ELBW) infants, especially those born extremely preterm, is increasing. However, specific recommendations for managing parenteral nutrition (PN) support in nanopreterm infants (<750 g or <25 weeks' gestation) are lacking. We aim to evaluate current recommendations and highlight considerations for applying them to nanopreterm infants. The author team used English-language articles related to nutrition in ELBW with emphasis on nanopreterm infants, along with studies on fetal growth and metabolism. Current PN support recommendations for ELBW infants may not suit nanopreterm infants due to physiological and developmental differences. Key considerations for nanopreterm infants include:
This review highlights the limitations of available PN support recommendations for nanopreterm infants. Further research is needed to establish precise guidelines that optimally meet their nutrition needs.
{"title":"Evidence and unknowns for the relevancy of applying current parenteral nutrition support recommendations among infants born less than 750 g or younger than 25 weeks' gestation: A narrative review","authors":"Mar Romero-Lopez MD, PhD, Mamta Naik PharmD, RD, BCPPS, Teresa Hartman MLS, Ann Anderson-Berry MD, PhD, Melissa Thoene PhD, RD","doi":"10.1002/jpen.2761","DOIUrl":"10.1002/jpen.2761","url":null,"abstract":"<p>With advancements in neonatal care, the viability of extremely low-birth-weight (ELBW) infants, especially those born extremely preterm, is increasing. However, specific recommendations for managing parenteral nutrition (PN) support in nanopreterm infants (<750 g or <25 weeks' gestation) are lacking. We aim to evaluate current recommendations and highlight considerations for applying them to nanopreterm infants. The author team used English-language articles related to nutrition in ELBW with emphasis on nanopreterm infants, along with studies on fetal growth and metabolism. Current PN support recommendations for ELBW infants may not suit nanopreterm infants due to physiological and developmental differences. Key considerations for nanopreterm infants include:\u0000\u0000 </p><p>This review highlights the limitations of available PN support recommendations for nanopreterm infants. Further research is needed to establish precise guidelines that optimally meet their nutrition needs.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"560-571"},"PeriodicalIF":4.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2761","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144031446","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}
Gordon L. Jensen MD, PhD, Tommy Cederholm MD, PhD, M. Isabel T. D. Correia MD, PhD, M. Cristina Gonzalez MD, PhD, Ryoji Fukushima MD, PhD, Veeradej Pisprasert MD, PhD, Renee Blaauw PhD, RD, Diana Cardenas Braz MD, PhD, Fernando Carrasco MD, MS, Alfonso J. Cruz Jentoft MD, PhD, Cristina Cuerda MD, PhD, David C. Evans MD, Vanessa Fuchs-Tarlovsky PhD, MD, Leah Gramlich MD, Han Ping Shi MD, PhD, Jeanette M. Hasse PhD, RD, Michael Hiesmayr MD, Naoki Hiki MD, PhD, Harriët Jager-Wittenaar PhD, RD, Shukri Jahit MD, Anayanet Jáquez MD, Heather Keller PhD, RD, Stanislaw Klek MD, PhD, Ainsley Malone MS, RD, Kris M. Mogensen MS, RD-AP, Naoharu Mori MD, PhD, Manpreet Mundi MD, Maurizio Muscaritoli MD, Doris Ng MRCP, DPhil, Ibolya Nyulasi MSc, APD, Matthias Pirlich MD, PhD, Stephane Schneider MD, PhD, Marian de van der Schueren PhD, RD, Soranit Siltharm MD, Pierre Singer MD, Alison Steiber PhD, RDN, Kelly A. Tappenden PhD, RD, Jianchun Yu MD, PhD, André van Gossum MD, PhD, Jaw-Yuan Wang MD, PhD, Marion F. Winkler PhD, RD, Charlene Compher PhD, RD, Rocco Barazzoni MD, PhD
Background
The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years.
Methods
A working group (n = 43 members) conducted a literature search spanning 2019–2024 using the keywords “Global Leadership Initiative on Malnutrition or GLIM.” Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus.
Results
More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update.
Conclusion
Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.
{"title":"GLIM consensus approach to diagnosis of malnutrition: A 5-year update","authors":"Gordon L. Jensen MD, PhD, Tommy Cederholm MD, PhD, M. Isabel T. D. Correia MD, PhD, M. Cristina Gonzalez MD, PhD, Ryoji Fukushima MD, PhD, Veeradej Pisprasert MD, PhD, Renee Blaauw PhD, RD, Diana Cardenas Braz MD, PhD, Fernando Carrasco MD, MS, Alfonso J. Cruz Jentoft MD, PhD, Cristina Cuerda MD, PhD, David C. Evans MD, Vanessa Fuchs-Tarlovsky PhD, MD, Leah Gramlich MD, Han Ping Shi MD, PhD, Jeanette M. Hasse PhD, RD, Michael Hiesmayr MD, Naoki Hiki MD, PhD, Harriët Jager-Wittenaar PhD, RD, Shukri Jahit MD, Anayanet Jáquez MD, Heather Keller PhD, RD, Stanislaw Klek MD, PhD, Ainsley Malone MS, RD, Kris M. Mogensen MS, RD-AP, Naoharu Mori MD, PhD, Manpreet Mundi MD, Maurizio Muscaritoli MD, Doris Ng MRCP, DPhil, Ibolya Nyulasi MSc, APD, Matthias Pirlich MD, PhD, Stephane Schneider MD, PhD, Marian de van der Schueren PhD, RD, Soranit Siltharm MD, Pierre Singer MD, Alison Steiber PhD, RDN, Kelly A. Tappenden PhD, RD, Jianchun Yu MD, PhD, André van Gossum MD, PhD, Jaw-Yuan Wang MD, PhD, Marion F. Winkler PhD, RD, Charlene Compher PhD, RD, Rocco Barazzoni MD, PhD","doi":"10.1002/jpen.2756","DOIUrl":"10.1002/jpen.2756","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Global Leadership Initiative on Malnutrition (GLIM) introduced an approach for malnutrition diagnosis in 2019 that comprised screening followed by assessment of three phenotypic criteria (weight loss, low body mass index [BMI], and low muscle mass) and two etiologic criteria (reduced food intake/assimilation and inflammation/disease burden). This planned update reconsiders the GLIM framework based on published knowledge and experience over the past 5 years.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A working group (<i>n</i> = 43 members) conducted a literature search spanning 2019–2024 using the keywords “Global Leadership Initiative on Malnutrition or GLIM.” Prior GLIM guidance activities for using the criteria on muscle mass and inflammation were reviewed. Successive rounds of revision and review were used to achieve consensus.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>More than 400 scientific reports were published in peer-reviewed journals, forming the basis of 10 systematic reviews, some including meta-analyses of GLIM validity that indicate strong construct and predictive validity. Limitations and future priorities are discussed. Working group findings suggest that assessment of low muscle mass should be guided by experience and available technological resources. Clinical judgment may suffice to evaluate the inflammation/disease burden etiologic criterion. No revisions of the weight loss, low BMI, or reduced food intake/assimilation criteria are suggested. After two rounds of review and revision, the working group secured 100% agreement with the conclusions reported in the 5-year update.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Ongoing initiatives target priorities that include malnutrition risk screening procedures, GLIM adaptation to the intensive care setting, assessment in support of the reduced food intake/assimilation criterion, and determination of malnutrition in obesity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 4","pages":"414-427"},"PeriodicalIF":4.1,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.2756","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143908921","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}
Julia W. Korzilius MD, Manon Dumont MSc, Harriët Jager-Wittenaar PhD, Geert J. A. Wanten PhD, Heidi E. E. Zweers- van Essen PhD
{"title":"Response to “Parenteral nutrition and bioelectrical impedance analysis estimated fat-free mass in adult patients with chronic intestinal failure: A descriptive cohort study”","authors":"Julia W. Korzilius MD, Manon Dumont MSc, Harriët Jager-Wittenaar PhD, Geert J. A. Wanten PhD, Heidi E. E. Zweers- van Essen PhD","doi":"10.1002/jpen.2762","DOIUrl":"10.1002/jpen.2762","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":""},"PeriodicalIF":4.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026611","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}
Alaa H. Al-Rawhani MSc, Siti Nur'Asyura Adznam PhD, Zalina Abu Zaid PhD, Nor Baizura Md. Yusop PhD, Hakimah M. Sallehuddin PhD, Mohammed A. Alshawsh PhD
Protein and amino acid supplementation is an effective intervention that significantly enhances physical function and reduces frailty and sarcopenia in older adults. This scoping review aims to map and synthesize the available evidence on the effects of various types of protein and amino acid supplementation in this population. Following the PRISMA-ScR guidelines, we conducted a literature search to identify clinical trials examining the effects of protein and amino acid supplementation, with or without physical exercise, on muscle strength, physical performance, and body composition in healthy, frail, or sarcopenic older adults. Our analysis of 80 trials with a total of 5290 participants examines the evidence for the effectiveness of protein supplementation in enhancing muscle strength and body composition. Whey protein, creatine, milk protein, leucine, essential amino acids, and soy protein were the most used types of protein, and our findings indicate that whey protein, creatine, and milk protein yield the best results when used in conjunction with resistance training. Additionally, leucine and milk protein have shown the potential to enhance body composition even without concurrent resistance training. In conclusion, studies on the effectiveness of whey protein in improving muscle strength and body composition in older adults with resistance training are inconsistent. More research is required to explore the potential benefits of soy and leucine-enriched supplements. Protein supplementation's impact on physical performance remains inconclusive. Further studies are needed to determine the effects of protein types and supplementation on muscle-related parameters in older adults.
{"title":"Effect of protein and amino acids supplements on muscle strength and physical performance: A scoping review of randomized controlled trials","authors":"Alaa H. Al-Rawhani MSc, Siti Nur'Asyura Adznam PhD, Zalina Abu Zaid PhD, Nor Baizura Md. Yusop PhD, Hakimah M. Sallehuddin PhD, Mohammed A. Alshawsh PhD","doi":"10.1002/jpen.2749","DOIUrl":"10.1002/jpen.2749","url":null,"abstract":"<p>Protein and amino acid supplementation is an effective intervention that significantly enhances physical function and reduces frailty and sarcopenia in older adults. This scoping review aims to map and synthesize the available evidence on the effects of various types of protein and amino acid supplementation in this population. Following the PRISMA-ScR guidelines, we conducted a literature search to identify clinical trials examining the effects of protein and amino acid supplementation, with or without physical exercise, on muscle strength, physical performance, and body composition in healthy, frail, or sarcopenic older adults. Our analysis of 80 trials with a total of 5290 participants examines the evidence for the effectiveness of protein supplementation in enhancing muscle strength and body composition. Whey protein, creatine, milk protein, leucine, essential amino acids, and soy protein were the most used types of protein, and our findings indicate that whey protein, creatine, and milk protein yield the best results when used in conjunction with resistance training. Additionally, leucine and milk protein have shown the potential to enhance body composition even without concurrent resistance training. In conclusion, studies on the effectiveness of whey protein in improving muscle strength and body composition in older adults with resistance training are inconsistent. More research is required to explore the potential benefits of soy and leucine-enriched supplements. Protein supplementation's impact on physical performance remains inconclusive. Further studies are needed to determine the effects of protein types and supplementation on muscle-related parameters in older adults.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"548-559"},"PeriodicalIF":4.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000882","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}
Ruoshu Duan MD, PhD, Suxiu Chen MM, Suxia Li MM, Jie Ding MD, Lei Wang MD, PhD, Yangli Li MM, Jingjing Ren MD, Sujing Jiang MD
Background
The Global Leadership Initiative on Malnutrition (GLIM) criteria have been validated in various clinical settings since 2018, but prospective validation in patients with congestive heart failure (CHF) who are hospitalized remains limited. This study compares the prognostic performance of the GLIM criteria and Mini-Nutritional Assessment (MNA)-defined malnutrition for all-cause mortality in CHF patients and explores the strongest predictive indicator within the GLIM criteria.
Methods
This single-center prospective cohort study included inpatients with CHF. Agreement between the GLIM criteria and MNA was assessed using Cohen κ coefficient. Survival data were analyzed using Kaplan-Meier curves and adjusted Cox regression analyses.
Results
Among 498 CHF inpatients, 84 (16.9%) died during the 18-month follow-up. Malnutrition prevalence was 47.2% and 50.4% based on the GLIM criteria and MNA, respectively (κ = 0.68; P < 0.001). Malnutrition was independently associated with a higher risk of all-cause mortality (GLIM criteria: hazard ratio, 2.16 [95% confidence interval (CI), 1.13–4.13]; MNA: hazard ratio, 4.28 [95% CI, 1.98–9.22]). Low body mass index was the strongest predictor of all-cause mortality in multivariable analysis (hazard ratio, 5.14; 95% CI, 3.19–8.27).
Conclusion
The GLIM criteria showed strong consistency with MNA and effectively predicted all-cause mortality in CHF patients within 18 months.
{"title":"Association between GLIM diagnosed malnutrition and 18-month mortality in hospitalized adults with congestive heart failure: A prospective cohort study","authors":"Ruoshu Duan MD, PhD, Suxiu Chen MM, Suxia Li MM, Jie Ding MD, Lei Wang MD, PhD, Yangli Li MM, Jingjing Ren MD, Sujing Jiang MD","doi":"10.1002/jpen.2760","DOIUrl":"10.1002/jpen.2760","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Global Leadership Initiative on Malnutrition (GLIM) criteria have been validated in various clinical settings since 2018, but prospective validation in patients with congestive heart failure (CHF) who are hospitalized remains limited. This study compares the prognostic performance of the GLIM criteria and Mini-Nutritional Assessment (MNA)-defined malnutrition for all-cause mortality in CHF patients and explores the strongest predictive indicator within the GLIM criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This single-center prospective cohort study included inpatients with CHF. Agreement between the GLIM criteria and MNA was assessed using Cohen <i>κ</i> coefficient. Survival data were analyzed using Kaplan-Meier curves and adjusted Cox regression analyses.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 498 CHF inpatients, 84 (16.9%) died during the 18-month follow-up. Malnutrition prevalence was 47.2% and 50.4% based on the GLIM criteria and MNA, respectively (<i>κ</i> = 0.68; <i>P</i> < 0.001). Malnutrition was independently associated with a higher risk of all-cause mortality (GLIM criteria: hazard ratio, 2.16 [95% confidence interval (CI), 1.13–4.13]; MNA: hazard ratio, 4.28 [95% CI, 1.98–9.22]). Low body mass index was the strongest predictor of all-cause mortality in multivariable analysis (hazard ratio, 5.14; 95% CI, 3.19–8.27).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>The GLIM criteria showed strong consistency with MNA and effectively predicted all-cause mortality in CHF patients within 18 months.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"49 5","pages":"633-642"},"PeriodicalIF":4.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144026421","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号