Nutrition in Clinical Practice最新文献

Background: The term "cardiosarcopenia" has been proposed to describe the interrelated decline in both skeletal muscle mass and cardiovascular function. This study aimed to (1) compare cardiac structure and function between individuals with low and normal handgrip strength (HGS) and (2) examine the correlation between cardiac structure and function with HGS, gait speed, and muscle mass measured via muscle ultrasound (US).

Methods: The study population comprised 93 older adults attending a geriatric outpatient clinic who reported no prior instances of atherosclerotic cardiovascular disease. Muscle strength was evaluated using HGS. Muscle mass was assessed using US to measure the thickness of the gastrocnemius medialis (GCM-thickness), rectus femoris (RF-thickness), and anterior thigh (AT-thickness) muscles, as well as the cross-sectional area of the RF (RF-CSA). Transthoracic echocardiography was performed, and left ventricular (LV) mass was calculated using the Devereux formula.

Results: LV mass was significantly lower in the low HGS group compared with the normal HGS group (153.27 [32.31] g vs 175.02 [61.46] g, P = 0.029). Additionally, the low HGS group had lower LV posterior wall thickness compared with the normal HGS group (P = 0.017). LV mass was weakly correlated with GCM-thickness and gait speed, and LV end-diastolic diameter had weak/moderate correlations with HGS, RF-CSA, RF-thickness, and AT-thickness.

Conclusion: Ventricular mass in older adults significantly correlates with parameters of muscle mass, strength, and performance, which decline with age. To reveal the clinical effects of the reduced LV mass in patients with HGS further longitudinal studies are needed.

Background: Increased anticholinergic cognitive burden (ACB) in the geriatric population has been identified as a predisposing factor for various adverse health outcomes, including malnutrition. This study aimed to assess the association between ACB and malnutrition, which has previously only been demonstrated by screening tests, using the Global Leadership Initiative on Malnutrition (GLIM) as a diagnostic criterion and different nutrition assessment tools.

Methods: This cross-sectional study included adults aged ≥65 years who were admitted to the geriatric clinic of a tertiary hospital. Nutrition status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening, and the GLIM criteria. ACB was calculated according to the ACB scale, and multimorbidity was assessed using the Charlson Comorbidity Index.

Results: A total of 629 patients (61.7% female, 77.9 ± 7.3 years) were included in the final analysis. According to different nutrition assessment tools, the prevalence of malnutrition ranged from 27.7% to 37.2%. According to all nutrition tools, the high ACB group (ACB ≥ 3) had a poor nutrition status compared with the reference (ACB:0). According to binary logistic regression analysis, ACB ≥ 3 status was a positive risk factor for malnutrition according to both MNA-SF (odds ratio [OR]: 2.61; 95% CI: 1.03-6.61) and GLIM criteria (OR: 2.38; 95% CI: 1.07-5.26).

Conclusion: Higher ACB use (ACB ≥ 3) was a positive predictor of malnutrition according to both the GLIM diagnostic criteria and MNA-SF. Prescribing medications with anticholinergic properties in the geriatric population deserves more attention as a modifiable risk factor in the management of clinically detected malnutrition.

Background: Enteral nutrition (EN) is the preferred method of nutrition support for critically ill patients, but its continuation during nonclinically important nonvariceal upper gastrointestinal bleeding (NVUGIB) remains controversial.

Methods: This retrospective cohort study was conducted in patients in an intensive care unit (ICU) who developed nonclinically important NVUGIB while receiving EN. Patients were categorized into two groups: continued EN group and suspended EN group after the bleeding episode. The primary outcome was progression to clinically important GIB. Secondary outcomes included mortality and being mechanical ventilation free at 28 days. Propensity score matching (PSM) was performed to account for potential confounding variables.

Results: Among 590 eligible patients, 400 (67.8%) continued EN and 190 (32.2%) had EN suspended. Progression to clinically important GIB was similar between groups (6.0% vs 6.3%, P = 0.88), a finding confirmed after PSM (7.3% vs 7.3%, P > 0.99). Patients continuing EN had more ventilation-free days (9 vs 6 days, P < 0.001; matched: 10 vs 6 days, P = 0.005). Unmatched analysis showed higher in-hospital mortality in the suspension group (45.5% vs 54.7%, P = 0.036), but this was nonsignificant post-PSM (53.3% vs 46.7%, P = 0.12). Continuation of EN was not found to be significantly associated with clinically important GIB (odds ratio = 1.913, P = 0.30).

Conclusion: Continuing EN in critically ill patients with nonclinically important NVUGIB appears to be safe and may be associated with a reduced duration of mechanical ventilation. These findings suggest that EN can be safely continued in patients with nonclinically important NVUGIB, potentially offering benefits in terms of respiratory outcomes and nutrition support.

Human milk is the optimal source of nutrition for infants; when mother's own milk (MOM) is unavailable, pasteurized donor human milk (DHM) is the preferred feeding alternative. DHM does not confer the same benefits as MOM, but as a human milk substrate, it remains distinctly unique from infant formulas. Although the evidence for DHM use is strong for high-risk preterm infants, especially very low birth weight infants, DHM's superiority over infant formula in improving clinical outcomes is less clear for other infant populations. Regardless, for some institutions, DHM use has been inconsistently extended to infants with congenital heart disease, gastrointestinal anomalies, neonatal opioid withdrawal syndrome, and other term or moderate and late preterm infants. Here, we describe the potential benefits and limitations to the expanded use of DHM as well as controversies related to access to DHM, including regulatory, financial, logistical, and distribution barriers.

Background: In individuals with cystic fibrosis (CF), lean mass and muscle strength are important predictors of clinical outcomes. This study evaluated associations among body composition, handgrip strength, muscle quality, physical activity, and health-related quality of life in CF.

Methods: This observational, cross-sectional study included 27 adults with CF and 24 age-matched healthy controls. Body composition was assessed using dual-energy x-ray absorptiometry, physical activity by self-reported questionnaire, strength by handgrip dynamometry, and quality of life by the CF Quality of Life-Revised (CFQ-R) questionnaire. Muscle quality was defined as handgrip strength divided by appendicular lean mass. Analyses included t- tests and Pearson or Spearman correlations.

Results: Demographics, body composition, handgrip strength, and muscle quality were similar between those with CF and controls. Among those with CF, muscle quality was positively associated with total physical activity score (r = 0.49, P = 0.009). Handgrip strength was positively associated with lean mass (r = 0.86, P < 0.001) and bone mineral density (r = 0.64, P < 0.001). Regarding CFQ-R, lean mass was positively associated with body image and emotion (r = 0.41, P = 0.03), and body fat was associated with lower physical functioning (r = -0.63, P = 0.004), greater treatment burdens (r = -0.49, P = 0.01), and worse digestive health (r = -0.45, P = 0.02).

Conclusion: As the CF population ages, these data support continued efforts to promote physical activity and improve body composition for enhanced quality of life while also highlighting the value of integrating accessible measures of muscle function and quality into routine clinical care.

Objective: Considering sarcopenia's major health threat to older adults and the limited efficacy of current treatments, this study aims to unveil the rehabilitation effects of whole-body vibration training (WBVT) combined with blood flow restriction (BFR) training on older patients with sarcopenia.

Methods: This study is a randomized controlled experiment. Seventy-four older patients with sarcopenia were randomly split into observation and control groups (37 each). Both groups received nutrition support; the control group underwent conventional rehabilitation, whereas the observation group underwent an additional 6-week WBVT and BFR training. Outcomes included skeletal muscle mass index (SMI), appendicular SMI (ASMI), grip strength, 6-min walk test (6MWT), self-care ability (Short Physical Performance Battery Score [SPPB]), and daily living ability (Activity of Daily Living Scale [ADL]).

Results: After the intervention, SMI and ASMI increased, with higher values in the observation group (P < 0.05); 6MWT and grip strength improved in both groups, with higher values in the observation group (P < 0.05); and SPPB and ADL scores increased in both groups, with higher scores in the observation group (P < 0.05).

Conclusion: WBVT combined with BFR training effectively enhances muscle strength, improves motor function, and increases the quality of life in older patients with sarcopenia.

Background: This study examined the overlap of sarcopenic obesity and malnutrition using the 2025 Global Leadership Initiative on Malnutrition (GLIM) criteria and their impact on geriatric outcomes.

Methods: In this cross-sectional study, 264 geriatric outpatients (body mass index [BMI] ≥ 25 kg/m²) were assessed. Sarcopenia and sarcopenic obesity were diagnosed using the European Working Group on Sarcopenia in Older People 2 and the European Society for Clinical Nutrition and Metabolism (ESPEN) and The European Association for the Study of Obesity (EASO) consensus definitions. Malnutrition was diagnosed using the GLIM criteria, applied regardless of their Mini Nutritional Assessment Short Form (MNA-SF) results to detect overlooked cases. Outcomes included frailty, disability, incontinence, and falls.

Results: Sarcopenic obesity prevalence was 15.9%, and GLIM-defined malnutrition was 30.3%. More than half (58.8%) of patients with GLIM-defined malnutrition were not at risk per the MNA-SF. In patients without MNA-defined malnutrition risk, GLIM malnutrition was more frequent in patients with sarcopenic obesity than without (42.9% vs 18.7%, P = 0.002). The co-occurrence of sarcopenic obesity and GLIM-defined malnutrition showed a synergistic effect on frailty (odds ratio [OR] = 5.11) and Instrumental Activities of Daily Living disability (OR = 3.74), independent of age and comorbidity.

Conclusion: Standard tools like the MNA-SF markedly underdetect malnutrition in older adults with BMI ≥ 25 kg/m², including those with sarcopenic obesity. Because GLIM's two-step process depends on initial screening, many patients at risk may not proceed to full GLIM assessment. Our findings demonstrate that GLIM, supported by body composition analysis, more accurately identifies malnutrition and highlights the added harm of coexisting sarcopenic obesity.

Background: Heart failure (HF) affects millions of persons worldwide, with malnutrition and sarcopenia as prevalent complications. Both are characterized by low muscle mass (MM), which can be estimated using Body mass index (BMI)-adjusted calf circumference (CC). Although CC is a simple and practical surrogate for MM, it is not routinely included in standard nutrition screening tools, despite recommendations from the Global Leadership Initiative on Malnutrition. In patients with HF, low MM has been linked to elevated N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, a marker of cardiac stress. Including CC in nutrition screening may improve detection of malnourished patients. This study aimed to assess the association between BMI-adjusted CC and NT-proBNP levels in hospitalized patients with HF.

Methods: This retrospectively conducted cross-sectional study included 202 patients with HF across different ejection fraction categories. Data on demographics, anthropometry, and biochemical markers were collected. The association between BMI-adjusted CC and NT-proBNP were analyzed using Spearman correlation and multivariate linear regression.

Results: Low BMI-adjusted CC was prevalent in 74.8% of patients, with higher NT-proBNP levels compared with those with normal CC (11,970 vs 5621 pg/ml, P < 0.001). BMI-adjusted CC was inversely associated with NT-proBNP concentrations (β = -927, 95% CI: -1543 to -311) after adjusting for confounders.

Conclusion: A high prevalence of low MM was detected in patients with HF. Low BMI-adjusted CC is associated with elevated NT-proBNP, highlighting the link between muscle depletion and cardiac stress. Incorporating BMI-adjusted CC into nutrition assessment may improve the identification of malnutrition in patients with HF and enable more targeted nutrition risk stratification and intervention strategies.

Background: Plasma amino acid (AA) profiles in parenteral nutrition (PN)-dependent very preterm infants (VPIs) consistently show overprovision of essential AA (EAA) and arginine deficiency. This may have implications for growth and immune/inflammatory responses.

Aim: To compare plasma AA profiles on day 3 and day 10 in VPIs receiving standard PN (6.3 g/100 g AA arginine) and arginine-supplemented PN (18 g/100 g AA) in VPIs at <30 weeks' gestation.

Methods: VPIs were allocated (according to intervention PN availability) in a series of separate physiological studies to receive standard PN or arginine-supplemented PN. This approach led to a final PN AA formulation design containing 18 g/100 g AA. Clinical, nutrition intake, and biochemical data were collected. Point-of-care testing was used to measure ammonia levels. Plasma AA levels were measured on days 3, 10 and 30 using ion exchange chromatography.

Results: The highest mean daily arginine intake was on day 7: 521 mg/kg/day (142 mg/kg/day) at a dose of 18 g arginine/100 g parenteral AA. The median day 10 plasma arginine level was 85 (52-146) vs 41 (28-54) µmol/L for 18 g/100 g AA arginine vs control, respectively (P < 0.0001) The equivalent data for total EAA were 896 (750-1142) vs 1220 (1031-1428) µmol/L (P < 0.05) and blood ammonia levels were 46 (24-65) vs 51 (40-62) µmol/L (P = 0.28).

Conclusion: In VPIs, PN arginine supplementation of 18 g/100 g AA increases arginine concentrations and reduces provision of EAA as demonstrated in the plasma AA profile. Higher plasma arginine levels are not sustained once parenteral arginine is discontinued. Blood ammonia levels were not useful in identifying individual arginine deficiency.