Nutrition in Clinical Practice最新文献

Background: Patients with chronic intestinal failure (CIF) may be predisposed to poor oral health outcomes. This study explored the self-reported oral health status, function, and psychological impacts of oral health of adult patients with CIF, their access to dental care, and how these compare with the broader population.

Methods: All patients >18 years old receiving home intravenous therapies for CIF were invited to complete a self-reported questionnaire providing information on oral health status and access to oral health services. Collateral information was provided by treating clinicians. Descriptive data analysis was undertaken, including subgroup analysis of clinical characteristics, and was compared with the available population-level data.

Results: Twenty-four patients participated. Short gut and dysmotility accounted for 88% of the etiologies of CIF. Respondents reported good preventative oral health behaviors (96%), accessing dental care within the last 12 months (75%), and limited barriers to receiving care. Dry mouth (96%), oral pain (59%), and temperature sensitivity (60%) were commonly reported across the cohort. Smoking history and reduced oral diet were associated with significantly worse self-reported oral health outcomes. Patients with CIF reported worse oral health outcomes despites better oral health access than the general population.

Conclusion: Patients with CIF appear to be at risk of poor oral health outcomes, especially where smoking or reduced oral intake are concurrently involved. Clinicians involved in CIF care should be alert to the oral health needs of this population and consider oral and dental health as part of the multidisciplinary care required for optimal CIF care.

There has been increasing interest in the role of micronutrient supplementation in critical care. This narrative review summarizes the recent studies on micronutrients in critically ill patients. We searched two databases for primary randomized controlled trials that investigated the effects of micronutrient supplementation in patients with critical illness published from January 2021 to August 2023. Personal files, reference lists of included studies, and previous reviews were also screened. Twelve studies reported on vitamin C, four studies on vitamin D, three studies on thiamin, two studies on multivitamins, and one study on cobalamin. The therapeutic effects of vitamin C appear mixed, although vitamin C monotherapy appears more promising than vitamin C combination therapy. Intramuscular administration of vitamin D appeared to lower mortality, mechanical ventilation duration, and intensive care unit stay, whereas enteral administration showed limited clinical benefits. Intravenous thiamin was not associated with improved outcomes in patients with septic shock or hypophosphatemia. Preliminary evidence suggests reduced vasopressor dose with cobalamin. Decreased disease severity and hospital stay in patients with COVID-19 with vitamins A-E requires further investigation, whereas providing solely B-group vitamins did not demonstrate therapeutic effects. It is currently premature to endorse the provision of high-dose micronutrients in critical illness to improve clinical outcomes. This review may help to inform the design of future trials that will help better elucidate the optimal dosage and form of micronutrients, methods of administration, and subgroups of patients with critical illness who may most benefit.

Background: Initiation of feeding after percutaneous endoscopic gastrostomy (PEG) placement has been debated. Randomized controlled trials (RCTs) have been performed on early feeding compared with delayed feeding after PEG placement with varying results. Therefore, a meta-analysis was conducted examining early vs delayed feeding after placement of a PEG.

Methods: A comprehensive search of databases was conducted in January 2024. Peer-reviewed published RCTs comparing early feeding (≤4 h) with delayed feeding (>4 h) were identified and included in the meta-analysis. Meta-analysis was completed using pooled estimates of overall complications, individual complications, mortality ≤72 h, and number of day 1 significant gastric residual volumes.

Results: Six RCTs (n = 467) were included in the analysis. Comparison of early feeding with delayed feeding after PEG showed no statistically significant differences for overall complications (P = 0.18), mortality ≤72 h (P = 0.3), and number of day 1 significant gastric residual volumes (P = 0.05). No differences were also noted for individual complications, including vomiting, wound infection, bleeding, or diarrhea.

Conclusion: Feeding ≤4 h after PEG have no differences in minor and major complications compared with that of delayed feeding. Early feeding ≤4 h is safe and should be recommended in future guidelines.

Background: Several screening tools have been developed to identify sarcopenia. However, data on the use of these screening tools in hospital settings are limited. This study assessed the diagnostic accuracy of three screening methods-strength, assistance walking, rising from a chair, climbing stairs, and falls (SARC-F); SARC-F combined with calf circumference (SARC-CalF); and the Ishii tests-for detecting sarcopenia in older individuals who are hospitalized.

Methods: This study included 204 older people who were hospitalized. Sarcopenia was assessed relative to the diagnostic criteria established by the European Working Group on Sarcopenia in Older People 2 (EWGSOP2). Muscle mass, muscle strength, and physical performance were evaluated using bioimpedance analysis, handgrip strength, and usual gait speed, respectively. Sensitivity and specificity analyses were conducted for the SARC-F, SARC-CalF, and Ishii tests to determine their effectiveness. Receiver operating characteristics curves were generated, and the area under curve was calculated to compare the overall diagnostic accuracy of the SARC-F, SARC-CalF, and Ishii tests.

Results: The SARC-F, SARC-CalF, and Ishii tests demonstrated sensitivities of 72%, 88.6%, and 93.5%, respectively, and specificities of 41%, 78.5%, and 30.3%, respectively.

Conclusions: SARC-CalF demonstrates the highest performance in terms of sensitivity and specificity compared with the other two tests, making it a valuable tool for detecting sarcopenia in hospital settings. In contrast, the Ishii test exhibits high sensitivity but low specificity within this population. Based on our results, we found that SARC-CalF can be used as a simple, effective test for identifying sarcopenia in older patients in the hospital setting.

Background: This study investigated the prevalence of sarcopenic obesity (SO) among older adults in Chinese communities and its association with chronic diseases.

Methods: We conducted a post-hoc analysis of a 2014-2015 multicenter cross-sectional study involving adults aged ≥60 years from three representative cities in China. The Asian Working Group for Sarcopenia diagnostic criteria and Chinese local cutoffs were employed to define SO. Data on medical history, lifestyle, quality of life, and cognitive function were collected.

Results: The overall prevalence of SO was 3.58% in men and 2.88% in women among 2821 participants. There was a notable increase in prevalence with age, with rates reaching 6.58% for men and 4.40% for women aged 70-79 years. In the group aged ≥80 years, the prevalence rate increased significantly, reaching 13.16% for men and 18.18% for women. Those with SO had higher body mass index (25.29 ± 1.55 kg/m² vs 24.16 ± 2.48 kg/m²; P < 0.001) and triceps skinfold thickness (21.17 ± 5.93 mm vs 19.34 ± 6.87 mm; P < 0.05) than the normal group. The prevalence of cardiovascular disease (15.38% vs 6.59%; P < 0.01), hypertension (56.04% vs 38.93%; P < 0.01), and stroke (7.69% vs 2.25%; P < 0.01) was also significantly higher in the SO group. Logistic regression showed that those with SO were more likely to have cardiac disease (odds ratio [OR] = 2.20; P = 0.016) and stroke (OR = 2.61; P = 0.039).

Conclusion: The prevalence of SO increases with age among the older adult population in China, notably after age 80 years. SO individuals were more likely to have cardiac disease and stroke. It is important to focus on early identification and management strategies.

Background: Phase angle (PhA) correlates with body composition and could predict the nutrition status of patients and disease prognosis. We aimed to explore the feasibility of predicting PhA-diagnosed malnutrition using facial image information based on deep learning (DL).

Methods: From August 2021 to April 2022, inpatients were enrolled from surgery, gastroenterology, and oncology departments in a tertiary hospital. Subjective global assessment was used as the gold standard of malnutrition diagnosis. The highest Youden index value was selected as the PhA cutoff point. We developed a multimodal DL framework to automatically analyze the three-dimensional (3D) facial data and accurately determine patients' PhA categories. The framework was trained and validated using a cross-validation approach and tested on an independent dataset.

Results: Four hundred eighty-two patients were included in the final dataset, including 176 with malnourishment. In male patients, the PhA value with the highest Youden index was 5.55°, and the area under the receiver operating characteristic curve (AUC) = 0.68; in female patients, the PhA value with the highest Youden index was 4.88°, and AUC = 0.69. Inpatients with low PhA had higher incidence of infectious complications during the hospital stay (P = 0.003). The DL model trained with 4096 points extracted from 3D facial data had the best performance. The algorithm showed fair performance in predicting PhA, with an AUC of 0.77 and an accuracy of 0.74.

Conclusion: Predicting the PhA of inpatients from facial images is feasible and can be used for malnutrition assessment and prognostic prediction.

Gastroschisis is a leading cause of pediatric intestinal failure. Feeding guidelines may lead to improved patient outcomes including decreased time to reach full feeds, a reduction in the duration of parenteral nutrition, and reduced length of stay. However, there is limited evidence on what the ideal feeding guidelines are for this complex gastrointestinal diagnosis. In this quality improvement project, after completing a literature review, we created three pathways based on the complexity of the gastroschisis. We reviewed historical data without a defined feeding pathway/guideline to our newly created pathways in the intervention group. The study included 35 patients with varying degrees of gastroschisis complexity, consisting of 9 current patients (October 2021-December 2022) who were provided with defined feeding pathways and 26 historical patients before the protocol was implemented (January 2015-August 2021). There were no significant differences in the number of days required for full feeds between the two groups. However, the mean duration of parenteral nutrition was 18.9 days (95% CI, -31.8 to -7.0) shorter in the intervention group. Although not statistically significant, the patients in the intervention group had a mean length of stay that was 13.1 days (95% CI, -50.0 to 25.4) shorter than the historical group. The creation of standardized feeding guidelines for the gastroschisis population resulted in a statistically nonsignificant decrease in time to reach full enteral feeds, a statistically significant reduced duration of parenteral nutrition, and a statistically nonsignifiant decreased length of stay.

Background: Ethical competencies dealing with decision-making for clinicians involved in artificially administered nutrition and hydration (AANH) have not been defined in the literature. Although clinical assessments identify nutrition needs and appropriate routes of nutrition administration, an assessment of the ethical, cultural, and spiritual implications of the medical nutrition therapy may be overlooked.

Methods: Eleven competency statements were developed by members of two international sections of the American Society for Parenteral and Enteral Nutrition. This descriptive cross-sectional survey study was conducted to measure the importance of the competency statements to the membership of two sections using a five-point Likert scale of 1-5 (1-low to 5-high).

Results: A total of 113 responses (12.5% response rate) were obtained predominantly from physicians and dietitians from 25 countries. There was a wide range of world regions of the 49% respondents outside of the United States. Means and SDs were calculated for agreement with the 11 competency statements with overall means ranging from 4.32 to 4.67. Most of the participants cared for adult/older adult patients (63.7%) exclusively, and 12.4% cared for pediatric/neonate patients exclusively; the remainder (23.9%) cared for both populations. Respondents reported they were either experienced, competent, or expert (88.6%) in dealing with ethical issues related to AANH.

Conclusion: This international interdisciplinary group agreed that the integration of ethical, cultural, and spiritual competencies into clinical decision-making regarding artificially AANH is important.

Background: Patient-reported outcome measures have been associated with survival in oncology patients. Altered intake and malnutrition are common symptoms for patients treated for head and neck cancer and esophageal cancer (HNC/EC). The purpose of this study was to examine the relationship between patient-reported satisfaction with medical care and nutrition status.

Methods: This prospective cohort study collected data from 11 international cancer care sites.

Results: One hundred and sixtythree adult patients (n = 115 HNC; n = 48 EC) completed a patient satisfaction questionnaire (the Canadian Health Care Evaluation Project Lite) and were included. HNC/EC patient global satisfaction with medical care was 88.3/100 ± 15.3 at baseline and remained high at 86.6/100 ± 16.8 by 6 months (100 max satisfaction score). Poor nutrition status, as defined by the Patient-Generated Subjective Global Assessment Short Form, was associated with lower patient satisfaction with overall medical care, relationship with doctors, illness management, communication, and decision-making 6 months into treatment (P < 0.01). There was no difference in global satisfaction between patients who did and did not report swallowing difficulty (P = 0.99) and patients with and without feeding tube placement (P = 0.36). Patients who were seen by a dietitian for at least one nutrition assessment had global satisfaction with care that was 16.7 percentage points higher than those with no nutrition assessment (89.3 ± 13.8 vs 72.6 ± 23.6; P = 0.005) CONCLUSION: In HNC/EC patient-centered oncology care, decreasing malnutrition risk and providing access to dietitian-led nutrition assessments should be prioritized and supported to improve patient satisfaction and standard of care. Feeding tube placement did not decrease patient satisfaction with medical care.