Nutrition in Clinical Practice最新文献

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.

Background: Sarcopenic obesity (SO) is an often-overlooked problem in older adults, and ultrasonography (US) is one of the methods that can be used for diagnosis. Frailty, another geriatric syndrome in older adults, is an important clinical marker associated with many physical and cognitive conditions. In this study, we aimed to investigate the relationship between frailty and SO, diagnosed with different muscle mass measurement methods.

Methods: A total of 142 patients with obesity between the ages of 65 and 88 years who were admitted to the geriatric outpatient clinic were included. SO was defined using bioelectrical impedance analysis (BIA) and muscle US. The Clinical Frailty Scale (CFS) was used for the assessment of frailty.

Results: The prevalence of SO according to muscle US and BIA were 63.7% (n = 79) and 9.1% (n = 13), respectively. SO was significantly more common in participants living with frailty than robust counterparts according to both diagnostic tools (P < 0.05 for all). In regression analysis, it was found that SO, diagnosed by BIA and US, was independently associated with frailty regardless of confounding factors (odds ratio: 3.30, 95% confidence interval [CI]: 1.38-7.92, and P = 0.007 for US-diagnosed SO; odds ratio: 6.85, 95% CI: 1.19-39.55, and P = 0.032 for BIA-diagnosed SO).

Conclusion: The study found a higher prevalence of SO in participants living with frailty, with significant and independent associations observed using both muscle US and BIA.

Obesity is a growing global health concern and clinicians are frequently faced with developing a nutrition care plan for patients with obesity that includes assessment of energy requirements. Although indirect calorimetry (IC) is the gold standard for determining resting energy expenditure, it is not readily available to all clinicians. This review provides an overview of estimating resting energy expenditure for patients with obesity in the inpatient and outpatient settings, including the use of IC and selecting an appropriate predictive equation when measuring energy expenditure is not possible with IC.

Obesity, clinically defined as an excess of adipose tissue, remains a growing public health concern because of its strong association with cardiometabolic comorbidities and the impact on the quality of life of those affected by this disease. Although body mass index (BMI) is widely used for diagnosing and stratifying obesity, it has limitations, including its inability to capture body fat distribution or differentiate between visceral and subcutaneous fat, key determinants in metabolic disease. This article reviews the incorporation of anthropometric and body composition assessment tools, including waist circumference (WC), waist to hip ratio, waist to height ratio, body roundness index, conicity index, sagittal abdominal diameter, a body shape index, and skinfold measurements in obesity diagnosis and their potential to offer greater insight into obesity-related health risks than BMI alone. Additionally, we explore home-based assessment tools-including digital scales, at-home WC measurements, bioelectrical impedance analysis, body scanning apps, and commercial dual-energy x-ray absorptiometry (DEXA)-in supporting remote weight management in telehealth settings. Although these tools show promise, they vary in accuracy, accessibility, and usability. Integrating both clinic-based and home-based assessments into routine obesity care may improve risk stratification and support individualized interventions.

Background: Hospital nutrition services rarely offer Indigenous-specific menu options, an essential element of delivering "Indigenous cultural safety" in nutrition care to Indigenous patients.

Methods: Indigenous participants (n = 370) completed a semistructured Indigenous Food Ways survey (paper-based and online) from 2021 to 2022 as part of continuous healthcare quality improvement. Descriptive statistics summarized cultural/traditional foods respondents wanted to see or did not want to see as options on hospital menus.

Results: A majority of respondents (83%) agreed that a menu option for cultural/traditional foods was important, with 716 unique items reported. Seafood and meat/alternatives were common cultural/traditional items for menu options, specifically salmon (22%), traditional meat (14%), moose (12%), and venison (12%). Grain items reported were mostly Bannock (22%). Nearly 20% of the sample listed traditional foods, medicine, or tea as options for hospital menus. Respondents identified 254 items they did not want to see on hospital menus, which were commonly energy-dense/processed foods (16%) or poorly prepared/flavored items (13%), as well as peas and carrots (7%). Notably, some foods (eg, Bannock, salmon, fish eggs) were listed among both desired and not desired menu options.

Conclusion: Results showed that offering cultural or traditional foods on hospital menus is considered important by Indigenous people, and that a wide range of foods would be desired. Specific cultural foods to include on menus were salmon, traditional meats, or traditional teas. Foods not to include were also identified. Improving future nutrition care and services will require menu modifications to provide culturally safe options for Indigenous patients.

Background: Patients with hemorrhagic stroke often have dysphagia and delayed oral feeding after extubation. Fewer than 33% of intensive care units (ICUs) implement swallow screens, with limited evidence-based early oral feeding protocols. We evaluated a nurse-administered "swallow screen and education" (SSE) program on oral feeding status, pneumonia incidence, and weight trajectory.

Methods: A pre-post intervention study with matched historical controls was conducted in a neurosurgical ICU. Twenty-eight consecutive patients with hemorrhagic stroke (aged ≥20 years) received the SSE program 24-h after extubation. Twenty-eight matched controls received the usual care. Outcomes included 24-h and 7-day nothing by mouth (NBM) rates, 30-day pneumonia incidence, and 4-week weight trajectory.

Results: The SSE group showed lower 24-h NBM rates vs controls (42.86% vs 78.57%; odds ratio [OR] = 0.21; 95% CI, 0.063-0.661; P = 0.006). By day 7, differences persisted but were not statistically significant (28.57% vs 38.46%). The SSE group exhibited lower pneumonia incidence (3.57% vs 17.86%). After adjusting for confounders, SSE independently predicted reduced pneumonia risk (adjusted OR = 0.029; 95% CI, 0.001-0.708; P = 0.030). Weight decreased significantly in both groups (week 3: -2.681 kg, P < 0.001; week 4: -2.965 kg, P = 0.008).

Conclusion: Our preliminary findings suggest that the SSE program was associated with lower 24-h NBM rates after extubation and reduced pneumonia risk without affecting weight trajectories in this small hemorrhagic stroke cohort. This pragmatic intervention demonstrates potential clinical utility and scalability in neurosurgical ICUs. Future research should include larger randomized controlled trials with instrumental swallowing assessments while addressing weight loss in this vulnerable population.