Nutrition in Clinical Practice最新文献

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.

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.