Nutrition in Clinical Practice最新文献

Background: Indirect calorimetry (IC) in patients receiving extracorporeal membrane oxygenation (ECMO) is complicated. This study presents a novel IC method for this population and compares energy expenditure (EE) from IC with predictive equations.

Methods: IC was performed at the native lung using a Q-NRG+ indirect calorimeter. A CO₂ sensor connected to the ECMO oxygenator primary exhalation port collected FeCO₂ during IC studies. ECMO-VO₂ and ECMO-VCO₂ were calculated from sweep gas oxygen concentration, FeCO₂, and sweep flow. EE was calculated from the combined readings. EE was compared with 25 kcal/kg, 30 kcal/kg, and Mifflin St Jeor. Subanalysis compared EE over time (ECMO days 1-3, 4-10, 11-21, and >21) and between venoarterial and venovenous patients.

Results: In total, 90 assessments in 52 patients were analyzed. The cohort was 67.3% male with a median age of 54 years, and median ECMO duration of 207 h. EE was 1523 ± 432 kcal/day (18.9 ± 6.9 kcal/kg/day). Energy needs did not vary significantly over time (P = 0.24); however, readings from days 11 to 21 were higher than days 1-3 (P = 0.0497). No significant differences between cannulation types were observed. EE was significantly lower than all predicted results (P < 0.001). Mean difference between EE and predicted energy ranged from 413 to 1099 kcal/day. No equation was strongly correlated with EE (r_s = 0.15-0.61) overall or after stratification by cannulation type.

Conclusion: This study presents a viable method for incorporating IC in patients receiving ECMO. Using this method, EE in patients receiving ECMO was significantly lower than predicted. Using IC may help prevent overfeeding.

Background: Nutrition impairment negatively affects quality of life (QoL).

Methods: A longitudinal cohort study was carried out with patients with advanced cancer evaluated in the palliative care unit of a reference center for cancer in Brazil. Nutrition risk (NR) was evaluated using the Patient-Generated Subjective Global Assessment Short Form score (≥9 points) (PG-SGA SF), and QoL was assessed using the Quality-of-Life Questionnaire Core 15. Data were collected at baseline (T0) and during follow-up periods up to 40 days (T1). The association between the PG-SGA SF score and QoL changes over time was analyzed using generalized estimating equations (GEEs), adjusted for covariates.

Results: A total of 160 patients were included. The prevalence of NR at baseline (T0) was 55.6%, decreasing significantly to 36.3% at follow-up (T1) (P < 0.001). Most QoL symptom domain scores worsened over time. Patients with NR experienced significantly greater declines in mean scores compared with those without NR (P < 0.001 for all). In the multivariate GEE model, NR was a significant negative predictor for physical function (β: -0.227, 95% confidence interval [95% CI]: -0.322 to -0.133), emotional function (β: -0.181, 95% CI: -0.267 to -0.096), pain (β: 0.185, 95% CI: 0.073 to 0.296), and global health (β: -0.100, 95% CI: -0.173 to -0.026).

Conclusion: NR prevalence significantly decreased during follow-up. However, NR had a persistent negative impact on multiple QoL domains, including physical and emotional function, pain, and global health. These findings underscore the critical role of nutrition status in maintaining QoL in palliative care patients receiving nutrition support therapy.

This study aimed to evaluate the clinical utility of the Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition screening tool and the Global Leadership Initiative on Malnutrition (GLIM) criteria as a diagnostic framework in a cohort of patients with terminal cancer. This single-institution, retrospective cohort study included adults who were diagnosed with cancer and a predicted life expectancy <3 months intolerant to anticancer treatment who received palliative care between October 2023 and March 2024. Of 104 patients screened, 78 (54% male) were included in the analysis and 26 were excluded because of a terminal condition that precluded completion of the PG-SGA. The median age, body mass index, and survival were 73 years, 20.4, and 32 days, respectively. Weight loss occurred in 46% of patients within the previous 3 to 6 months, whereas 17% gained weight. Within the previous 2 weeks, 28% exhibited weight gain. The GLIM classified 35% of patients as well nourished, whereas the PG-SGA identified none as such. Agreement between the two tools was low (kappa coefficient = 0.037). Between the nutrition status screened by PG-SGA and assessed by the GLIM, no significant differences of all symptoms in Edmonton Symptom Assessment Systems or of survival outcomes were observed. In contrast, fluid retention and low handgrip strength emerged as significant predictors of mortality in Cox proportional hazards models. These findings suggest that, in patients with terminal cancer, PG-SGA may serve as a sensitive screening tool, whereas GLIM may have limited diagnostic applicability in end-of-life settings.

This meta-analysis aimed to evaluate the effectiveness and reliability of probiotic interventions in managing chemotherapy-induced complications among patients with leukemia, providing evidence-based insights for clinical decision-making. Studies in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were comprehensively searched up to March 5, 2024. Randomized controlled trials (RCTs) comparing probiotic use with conventional care in leukemia patients undergoing chemotherapy were included. The included studies examined all possible chemotherapy-related adverse effects without selective outcome reporting. Data synthesis was conducted using RevMan 5.4 and STATA 15.0. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of evidence for each outcome. Eight RCTs encompassing 753 participants were analyzed. Compared with conventional care, probiotics significantly reduced constipation (odds ratio [OR] = 0.61, 95% CI = 0.30-1.24, P < 0.05), nausea (OR = 0.51, 95% CI = 0.41-0.63], P < 0.00001), chemotherapy-induced diarrhea (OR = 0.39, 95% CI = 0.26-0.57], P < 0.00001), bloating (OR = 0.38, 95% CI = 0.20-0.76, P = 0.006), vomiting (OR = 0.62, 95% CI = 0.39-0.98, P = 0.04), and indigestion (OR = 0.55, 95% CI = 0.31-0.95, P = 0.03). Notable improvements were observed in procalcitonin and tumor necrosis factor-alpha levels. Evidence quality was high for most outcomes, with moderate ratings for dyspepsia, constipation, and vomiting. In conclusion, probiotic supplementation appears to moderately alleviate chemotherapy-induced complications in patients with leukemia. Nevertheless, because of limitations such as small sample sizes and potential data variability, further validation through large-scale RCTs is necessary.

Background: Hyperglycemia is a complication of parenteral nutrition (PN), which can be exacerbated in patients with obesity. Limited data exist on glycemic control in this population. This study aims to evaluate the association of obesity and body mass index (BMI) classification with glycemic control in patients who are critically ill initiated receiving PN.

Methods: This is a retrospective study of patients who are critically ill receiving PN from January 2013 to February 2024. The primary outcome was glycemic control in patients with BMI ≥ 30 kg/m² or BMI < 30 kg/m² based on hyperglycemic episodes, peak blood glucose, and insulin requirements on the first and second days of therapy. Multivariate analyses were conducted for the occurrence of a hyperglycemic episode. The secondary outcome was to determine the association of BMI classification with glycemic control.

Results: The study included 220 patients with BMI ≥ 30 kg/m² (n = 91) and BMI < 30 kg/m² (n = 129). The BMI < 30 kg/m² group received more total dextrose (1.58 vs 2.36 mg/kg/min; P < 0.0001). There was no difference in the primary outcome during day 1 of PN, but there were increased hyperglycemic episodes (P = 0.0478) and insulin requirements in the BMI ≥ 30 kg/m² group on day 2 (P = 0.0226). The only difference in the secondary outcome was insulin requirements on day 2 (P = 0.0453).

Conclusion: Patients who are critically ill with BMI ≥ 30 kg/m² receiving PN received more conservative dextrose infusion rates yet experienced more hyperglycemic episodes and required more insulin on day 2. However, obesity and BMI classification were not independently associated with hyperglycemic episodes within the first 2 days of PN initiation.

Introduction: Enteral nutrition (EN) is a form of nutrition therapy indicated for patients who cannot eat or do not tolerate oral nutrition. However, because of their nutrient-rich composition, EN formulas provide a favorable environment for microbial growth and present a risk for contamination by pathogens, potentially leading to gastrointestinal disorders and delaying patient recovery. This study analyzed the microbiological safety of two EN feeding systems (the open-system [OS] and the ready-to-hang [RTH] system) using liquid and powdered formulas over different infusion periods.

Method: In the laboratory, RTH formulas were administered via infusion pumps without manual handling, whereas OS formulas were prepared manually and administered by gravity. Samples were collected and analyzed for mesophilic aerobic count, an indicator of microbiological quality, at different infusion intervals.

Results: RTH formulas maintained microbial counts below safety limits after 24 and 48 h of infusion. Both liquid and powdered OS formulas remained microbiologically safe for up to 8 h of administration.

Conclusion: This study demonstrated that both the RTH and OS can maintain microbiological safety within the recommended infusion times of 24 and 4 h, respectively, without significant bacterial growth. The safety of these systems is contingent on the implementation of good handling practices, underscoring the need for continuous training of handlers.

Background: This study aims to evaluate the Global Leadership Initiative on Malnutrition (GLIM) criteria for nutrition assessment in hospitalized heart failure (HF) patients, consider the performance of various combinations of phenotypic and etiologic criteria, and assess their predictive validity for adverse health outcomes.

Methods: A total of 216 patients, consecutively enrolled from June 2022 to October 2022, participated in this prospective cohort study and underwent assessments with 21 GLIM combinations. The 1-year all-cause mortality or HF-related readmission was used as the composite clinical outcome. For testing criterion validity, agreement and accuracy tests and Cox regression analyses were conducted.

Results: The detected prevalence of malnutrition across 21 GLIM criteria combinations reached 26.9%. The GLIM combinations containing reduced muscle mass, inflammation, and/or reduced food intake showed acceptable sensitivity and satisfactory predictive validity (with HRs ranging from 2.043 [95% CI: 1.087-3.837], P = 0.026 to 3.367 [95% CI: 1.652 - 6.863], P = 0.001).

Conclusion: Malnutrition identified by the GLIM criteria was associated with 1-year all-cause mortality or HF-related readmission. Muscle mass is the core GLIM phenotype criterion for identifying hospitalized HF patients at higher risk of adverse outcomes, and it is strongly suggested that relevant assessment be conducted without omission. The occurrence of reduced food intake may fulfill the GLIM etiology criteria, and if testing is available, inflammation levels should be measured to confirm the etiologic criteria.

Background: The prognostic significance of standardized phase angle (StPhA) and bioelectrical impedance vector analysis (BIVA) remains unclear among hospitalized older individuals. Our study aimed to investigate the prognostic significance of StPhA and BIVA patterns concerning overall survival in hospitalized older patients.

Methods: A prospective cohort study was conducted among older adults hospitalized in medical or surgical wards. Single-frequency bioelectrical impedance analysis (BIA) was conducted. Using the raw BIA measurements (resistance and reactance), BIVA plots were graphed and StPhA was calculated. In addition, patients underwent assessments for anthropometry, malnutrition, and muscle strength via handgrip strength test. Follow-up was conducted for up to 24 months after the initial data collection to determine the incidence of mortality as the outcome.

Results: A total of 168 patients were included in this analysis. They were mostly men, with a median age of 68 years. Onco-hematological diagnoses were the most frequent. Patients with low StPhA exhibited significantly lower body mass index and fat mass (%) (P < 0.05). Analysis of BIVA confidence showed that patients with low StPhA and nonsurvivors exhibited a significant downward shift along the y-axis, indicating less cell mass. BIVA ellipses demonstrated that patients with low StPhA and nonsurvivors were mainly concentrated in the cachexia and anasarca quadrants. Low StPhA was an independent predictor of mortality (hazard ratio_adjusted = 2.28; 95% CI, 1.05-4.97).

Conclusion: Our study highlights the prognostic significance of StPhA and demonstrates the clinical relevance of using BIVA to estimate body composition/nutrition phenotypes in hospitalized older patients.

Growing evidence suggests that sarcopenic obesity (SO) may have a more pronounced effect on functionality compared with isolated sarcopenia, but research in this crucial area remains scarce. Therefore, this study aimed to evaluate whether the combination of sarcopenia and obesity is associated with increased functional impairment in hospitalized older adults. This is a cross-sectional study involving hospitalized older patients. SO was defined as the simultaneous presence of obesity and sarcopenia. Obesity was determined based on a high body fat percentage obtained through bioelectrical impedance analysis, whereas both reduced muscle strength and mass identified sarcopenia. Functionality was evaluated using the Barthel Index and the gait speed test. Additional sociodemographic, clinical, nutrition, and behavioral data were assessed. A total of 176 patients were included in our study. The mean age was 69.8 ± 7.8 years. The frequency of sarcopenia was 37.5%, whereas SO was found in 17.6%. Barthel Index indicated that 64.2% of patients exhibited functional dependency, whereas 87.5% had a slow gait speed. Logistic regression analysis revealed that SO was independently associated with poor functionality by the Barthel Index (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.1-8.5) and slow gait speed (OR, 3.3; 95% CI, 1.1-9.8). Patients with SO showed poorer functional capacity compared with those with obesity alone (P < 0.05), but not compared with those with sarcopenia alone (P > 0.05). In conclusion, we observe that SO was associated with diminished functionality but did not elevate the risk compared with sarcopenia alone.

Background: The role of calf circumference (CC) in predicting sarcopenia and mortality of patients undergoing maintenance hemodialysis (MHD) remains debated. This study assessed CC's predictive value, optimal threshold, and mortality association in older patients undergoing MHD.

Methods: An observational cohort study was conducted on older adult patients undergoing MHD. Sarcopenia was defined by European Working Group on Sarcopenia in Older People. Logistic regression and receiver operating characteristic (ROC) analysis were used to explore the relationship between CC and sarcopenia. Kaplan-Meier and Cox regression analyses assessed survival over 2 years.

Results: A total of 979 older adult patients undergoing MHD treatment, with an average age of 73.4 years, were included in this study. The prevalence of sarcopenia was 61.1%. Male sex (odds ratio [OR], 0.17; 95% confidence interval [CI], 0.04-0.45; P = 0.017) and CC (OR, 0.38; 95% CI, 0.26-0.56; P < 0.001) were identified as independent risk factors for sarcopenia through multifactorial logistic regression analysis. ROC curves for CC and sarcopenia indicated that the optimal cutoff value for men was 32.5 cm (area under the curve [AUC], 0.904; sensitivity, 0.958; specificity, 0.841), whereas for women, it was 31.9 cm (AUC, 0.884; sensitivity, 0.922; specificity: 0.756). Kaplan-Meier survival analysis demonstrated lower survival probabilities in patients with sarcopenia and low CC. After adjustment for multiple factors, Cox regression analysis revealed that patients in the sarcopenia group (hazard ratio [HR] = 2.411; P = 0.017) and those in the low-CC group (HR = 2.045; P = 0.046) had significantly shorter overall survival.

Conclusions: CC is an independent predictor of sarcopenia and mortality in older patients undergoing MHD.