Nutrition in Clinical Practice最新文献

Background: Although calf circumference (CC) may be used to distinguish body composition, methods applying adjustment coefficients based on body mass index (BMI) and edema have been reported. This study evaluated whether malnutrition assessed using BMI- and edema-adjusted CC predicts mortality in hospitalized adult patients compared with unadjusted CC across cutoff values.

Methods: This retrospective cohort study used the medical records of patients aged ≥18 years hospitalized between December 2017 and March 2022 and at risk for nutrition disorders through nutrition screening. Low muscle mass was defined using CC cutoff values of 34-30 cm for men and 33-29 cm for women.

Results: The data of 11,606 patients were analyzed. The mean age was 71.2 ± 16.3 years, and 5949 patients (51.3%) were women. No significant difference was observed compared with the unadjusted state, regardless of sex, cutoff value, or adjustment method (male: unadjusted hazard ratio [HR]: 2.13 to 2.30 vs adjusted HR: 2.11 to 2.36; memale: unadjusted HR 1.75: to 2.59 vs adjusted HR: 1.75 to 3.00). Furthermore, even when edema was adjusted, no significant difference was observed in the HR for mortality compared with the unadjusted state, regardless of sex, cutoff value, or adjustment method (male: unadjusted HR: 2.13 to 2.30 vs adjusted HR: 2.23 to 2.52; female: unadjusted HR: 1.75 to 2.59 vs adjusted HR: 2.02 to 3.57).

Conclusion: When assessing low muscle mass using lower CC, we found that adjusting for BMI and edema did not result in a significant mortality difference compared with unadjusted actual measurements.

Background: The prognostic value of nutrition status assessed by the Patient-Generated Subjective Global Assessment (PG-SGA) in postoperative patients with recurrent or metastatic (R/M) cancer remains unclear. This study assessed whether combining PG-SGA-defined malnutrition with systemic inflammation indices improves mortality prediction accuracy.

Methods: Nutrition status was evaluated via PG-SGA, with systemic inflammation assessed by systemic immune-related inflammation index (SII), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), and monocyte to lymphocyte ratio (MLR). Kaplan-Meier and Cox regression analyses examined associations （individual/combined) of PG-SGA-defined malnutrition and systemic inflammation with all-cause mortality. Receiver operating characteristic curves and concordance index (C index) evaluated accuracy.

Results: Among 537 postoperative patients with R/M cancer, multivariable Cox regression analysis showed malnutrition significantly increased mortality risk (malnourished: hazard ratio [HR] = 1.82 [95% CI, 1.23-2.72; P < 0.001]; severely malnourished: HR = 2.46 [95% CI, 1.67-3.62; P < 0.001]). In joint analysis, severely malnourished patients with high systemic inflammation burden had the highest overall mortality risks. The C index was 0.626 for PG-SGA-SII, 0.630 for PG-SGA-NLR, 0.618 for PG-SGA-PLR, and 0.630 for PG-SGA-MLR. Subgroup analyses revealed amplified composite risks in women, older adults, and those with chemotherapy history.

Conclusion: This study highlights the synergistic prognostic impact of PG-SGA-assessed malnutrition and systemic inflammation in postoperative R/M cancer, identifying a high-risk subgroup requiring prioritized nutrition and immunomodulatory interventions. Prospective multi-center validition is warranted.

Background: Several publications demonstrate the impact of home parenteral nutrition (HPN) in reducing healthcare costs. The question is are HPN practices in Latin America also cost saving when compared with hospital PN? This study aimed to compare the direct healthcare and nonhealthcare costs of HPN with hospital PN through a prospective, analytical, and longitudinal, multicenter noninterventional study.

Materials and methods: Adult patients receiving PN were included during the last week of hospital PN (week -1 before discharge), through the first week of HPN (week +1), and up to the first month of HPN (month +1). Clinical, nutrition, and cost variables were recorded. The total direct cost from hospital PN week -1 was compared with HPN week +1. Additionally, HPN month +1 was compared with an estimate of the total costs of hospital PN month -1.

Results: Forty-four patients were included for analysis. Comparing HPN week +1 vs hospital PN week -1. HPN was associated with lower total direct healthcare costs (mean difference -$1498.1, 95% CI -1203.2 to -1789.9). Lastly, the total direct cost (healthcare and nonhealthcare) was lower in the HPN setting vs the hospital setting for 1 week (mean difference $ -1452.0, 95% CI -1756.28 to -1148.4). The cost reduction of HPN for 1 week was 32% (20.3%-42.8%) and for 1 month was 36% (27.5%-48.5%).

Conclusion: HPN is cost saving compared with hospital PN, with most of the cost reduction related to direct healthcare costs.

Background: We aim to explore the impacts of comprehensive nursing care combined with nutrition and exercise interventions on nutrition parameters and balance ability in older adult patients with sarcopenia.

Methods: This was a randomized controlled trial with 100 older adult patients with sarcopenia split into control (underwent routine nursing) and intervention (received comprehensive nursing plus nutrition and exercise interventions) groups (n = 50 each). Preintervention and postintervention bone metabolism markers, physical function, grip strength, appendicular skeletal muscle mass index, balance and gait ability, nutrition status, and quality of life were assessed. Patient satisfaction with nursing care was compared between groups.

Results: Primary indicators: postintervention, both groups improved in gait/balance and nutrition, with the intervention group excelling. Significant group × time interactions were found (gait/balance: F = 39.640-303.484, P < 0.001, ηP² = 0.288-0.756; nutrition: F = 14.855-107.323, P < 0.001, ηP² = 0.132-0.523). Secondary indicators: both groups improved in bone metabolism (25-hydroxyvitamin D₃ and alkaline phosphatase), physical function, and quality of life, with the intervention group showing superior results. Significant group × time interactions were also observed (bone metabolism: F = 72.721-18.673, P < 0.001, ηP² = 0.426-0.160; physical function: F = 866.322-168.097, P < 0.001, ηP² = 0.898-0.632; quality of life: F = 907.259-570.078, P < 0.001, ηP² = 0.903-0.853). The intervention group had higher patient satisfaction with nursing (χ² = 14.581, P < 0.05).

Conclusion: Comprehensive nursing care combined with nutrition and exercise interventions effectively improves nutrition parameters and balance ability in older adult patients with sarcopenia.

Background: Home enteral nutrition (HEN) is a reliable and effective intervention. However, the impact of HEN on the changes in quality of life (QoL) over time remains unexplored. We aimed to investigate changes in QoL, emotional well-being, and functional status over time and identify the factors associated with QoL in patients requiring HEN.

Methods: We retrospectively analyzed the data of 288 patients requiring HEN who were discharged from the Clinical Nutrition Therapy Center of a tertiary care teaching hospital in China between December 1, 2014, and April 31, 2024. Data on demographics, laboratory analysis results, bioelectrical impedance analysis results, physical function, emotional status, and QoL were retrieved from a prospectively maintained database.

Results: Patients requiring HEN had QoL scores of 52.83 ± 14.01, 54.11 ± 14.79, and 56.78 ± 14.29 at discharge, 3-month follow-up, and 6-month follow-up, respectively. The Short Form 36 scores increased by 0.66 points per month (95% confidence interval [CI] 0.40-0.91; P < 0.05), whereas the Karnofsky Performance Scale (KPS) scores increased by 2.56 points per month (95% CI: 2.38-2.75; P < 0.05). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) declined by 1.33 (95% CI: -1.46 to -1.21; P < 0.05) and 0.38 (95% CI: -0.57 to -0.20; P < 0.05) points, respectively, each month. Multivariate analysis identified that complications (β = 7.191; P < 0.001), SAS (β = -0.135; P = 0.029), SDS (β = -0.293; P < 0.001), and KPS (β = 0.126; P = 0.003) were factors associated with QoL.

Conclusion: QoL improved continuously among patients receiving HEN; however, it remained suboptimal. Healthcare providers should offer comprehensive, continuous, and dynamic support to help patients reintegrate into their social lives.

Nutrition support therapy (NST) requires continuous monitoring and interdisciplinary collaboration to optimize nutrition status and prevent complications. Registered dietitian nutritionists (RDNs) are pivotal in managing NST, using their expertise to assess malnutrition risk, evaluate suitable nutrition routes, and lead teams in evidence-based nutrition care. However, not all RDNs operate at an expert level owing to varying education, training, and clinical experiences. A survey to determine expert-level RDN NST practices was created and distributed through the Dietitians in Nutrition Support Dietetic Practice Group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society for Parenteral and Enteral Nutrition. The survey gathered data on demographics, practice characteristics, and frequency of and barriers to performing select expert-level practice indicators using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 Standards of Practice and Standards of Professional Performance for RDNs (competent, proficient, and expert) in Nutrition Support. A total of 668 RDNs completed the survey (12.4% response). Findings revealed that RDNs frequently performed nutrition-focused physical examinations (83%) and determined micronutrient supplementation (59%). RDNs performed the following activities less frequently: evaluating body composition using diagnostic results (9%), inserting nasogastric/nasoenteric tubes (19%), and leading quality-improvement initiatives (30%). Key barriers identified included lack of training/experience and institutional support, and regulatory constraints. These results underscore the need for enhanced professional development, including training programs and interprofessional collaboration, to promote RDN expert-level NST practice and advance the dietetics profession.

Obesity is common, affecting >40% of Americans and increasing at rapid rates worldwide. Defined by the presence of excess body fat, obesity is tied to a multitude of poor health conditions, including cardiovascular disease, insulin resistance, and malignancy. Although lifestyle modifications such as diet and physical activity are cornerstones of management and crucial to enhance the health benefits achieved via targeted treatment plans, highly efficacious obesity medications are also now available. In particular, glucagon-like peptide-1 receptor agonists, have been found to be safe and efficacious, inducing clinically significant weight loss that is sustainable. Their effect on nutrition status is still being defined. In addition to medications, bariatric endoscopy and bariatric surgery are also highly effective options for durable weight loss, although these treatments are associated with malnutrition if they are not appropriately monitored. This review aims to define the current landscape of obesity medicine today, highlighting both current therapies and discussing their associated nutrition considerations, to educate the nutrition-focused provider. Multimodal therapies, combining medications and procedures, are an active area of research and will likely define care in future years.

Background: Nutrition status evaluation is essential for patients undergoing cardiac surgery. The Nutrition Risk in the Critically Ill (NUTRIC) and modified NUTRIC (mNUTRIC) scores are nutrition risk assessment tools specifically for patients in the intensive care unit (ICU). The objective of this study was to validate and compare the accuracy of these two nutrition scores in predicting hospital mortality in patients undergoing cardiac surgery.

Methods: This retrospective study screened adult patients undergoing cardiopulmonary bypass cardiac surgery in the ICU from June 2020 to August 2022. Patients were grouped according to NUTRIC score and mNUTRIC score within 24 h of ICU admission. Logistic regression was used to analyze the risk factors affecting the prognosis of these patients. The area under the receiver operating characteristic curve (AUC-ROC) was used to compare the predictive performance of these two nutrition scores for hospital mortality.

Results: Data from 252 eligible patients (55.6% of whom were male) were analyzed. It was found that Acute Physiological and Chronic Health Evaluation Ⅱ score, aortic surgery, serum albumin level, NUTRIC score, and mNUTRIC score were independent influencing factors of hospital mortality. The AUC-ROC of the NUTRIC score and the mNUTRIC score for predicting hospital mortality were 0.830 (95% confidence interval [CI]: 0.778-0.874) and 0.824 (95% CI: 0.771-0.869), respectively. There was no significant difference in ROC curves between the two scores (P = 0.492).

Conclusions: Both the NUTRIC and mNUTRIC scores showed good predictive performance for hospital mortality in patients undergoing cardiac surgery, and the mNUTRIC score might be a more convenient and cost-effective tool for nutrition risk assessment.

Background: Hypoalbuminemia, often induced by acute stress and inflammation in patients who are neurocritically ill, is adversely associated with prognosis. This study investigates whether supplementing nutrition support with anti-inflammatory whey protein powder formulations (experimental group) can improve serum albumin levels and overall patient outcomes compared with traditional liquid intact protein formulations (control group) while monitoring for enteral feeding complications and inflammatory markers.

Methods: In a randomized controlled trial conducted at a neurointensive care unit from January 2020 to May 2022, 116 out of 597 patients who required enteral nutrition (EN) for at least 7 days were randomly assigned to receive either the formula from experimental group or control group. The primary end point was serum albumin levels at 14 days. Secondary outcomes included functional status (modified Rankin Scale [mRS]) at 90 days, EN-related complications, and changes in serum inflammatory and infectious markers.

Results: No significant differences were observed in serum albumin levels or mRS scores (P > 0.05). Complication rates from EN and changes in inflammatory and biochemical markers were comparable between groups. The post hoc analysis showed that the experimental group had a significantly higher median daily protein intake (1.7 g/kg/day; interquartile range [IQR]: 1.6-1.8) compared with the control group (1.5 g/kg/day; IQR: 1.3-1.7), with P ＜ 0.001.

Conclusion: Although no significant difference was observed in serum albumin levels on day 14 between the whey protein powder supplementation group and the control group, protein supplementation with whey protein powder may be a viable strategy to meet protein requirements in patients who are neurocritically ill.