Nutrition in Clinical Practice最新文献

Background: We aim to explore the impacts of comprehensive nursing care combined with nutrition and exercise interventions on nutrition parameters and balance ability in older adult patients with sarcopenia.

Methods: This was a randomized controlled trial with 100 older adult patients with sarcopenia split into control (underwent routine nursing) and intervention (received comprehensive nursing plus nutrition and exercise interventions) groups (n = 50 each). Preintervention and postintervention bone metabolism markers, physical function, grip strength, appendicular skeletal muscle mass index, balance and gait ability, nutrition status, and quality of life were assessed. Patient satisfaction with nursing care was compared between groups.

Results: Primary indicators: postintervention, both groups improved in gait/balance and nutrition, with the intervention group excelling. Significant group × time interactions were found (gait/balance: F = 39.640-303.484, P < 0.001, ηP² = 0.288-0.756; nutrition: F = 14.855-107.323, P < 0.001, ηP² = 0.132-0.523). Secondary indicators: both groups improved in bone metabolism (25-hydroxyvitamin D₃ and alkaline phosphatase), physical function, and quality of life, with the intervention group showing superior results. Significant group × time interactions were also observed (bone metabolism: F = 72.721-18.673, P < 0.001, ηP² = 0.426-0.160; physical function: F = 866.322-168.097, P < 0.001, ηP² = 0.898-0.632; quality of life: F = 907.259-570.078, P < 0.001, ηP² = 0.903-0.853). The intervention group had higher patient satisfaction with nursing (χ² = 14.581, P < 0.05).

Conclusion: Comprehensive nursing care combined with nutrition and exercise interventions effectively improves nutrition parameters and balance ability in older adult patients with sarcopenia.

Background: Home enteral nutrition (HEN) is a reliable and effective intervention. However, the impact of HEN on the changes in quality of life (QoL) over time remains unexplored. We aimed to investigate changes in QoL, emotional well-being, and functional status over time and identify the factors associated with QoL in patients requiring HEN.

Methods: We retrospectively analyzed the data of 288 patients requiring HEN who were discharged from the Clinical Nutrition Therapy Center of a tertiary care teaching hospital in China between December 1, 2014, and April 31, 2024. Data on demographics, laboratory analysis results, bioelectrical impedance analysis results, physical function, emotional status, and QoL were retrieved from a prospectively maintained database.

Results: Patients requiring HEN had QoL scores of 52.83 ± 14.01, 54.11 ± 14.79, and 56.78 ± 14.29 at discharge, 3-month follow-up, and 6-month follow-up, respectively. The Short Form 36 scores increased by 0.66 points per month (95% confidence interval [CI] 0.40-0.91; P < 0.05), whereas the Karnofsky Performance Scale (KPS) scores increased by 2.56 points per month (95% CI: 2.38-2.75; P < 0.05). The Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) declined by 1.33 (95% CI: -1.46 to -1.21; P < 0.05) and 0.38 (95% CI: -0.57 to -0.20; P < 0.05) points, respectively, each month. Multivariate analysis identified that complications (β = 7.191; P < 0.001), SAS (β = -0.135; P = 0.029), SDS (β = -0.293; P < 0.001), and KPS (β = 0.126; P = 0.003) were factors associated with QoL.

Conclusion: QoL improved continuously among patients receiving HEN; however, it remained suboptimal. Healthcare providers should offer comprehensive, continuous, and dynamic support to help patients reintegrate into their social lives.

Nutrition support therapy (NST) requires continuous monitoring and interdisciplinary collaboration to optimize nutrition status and prevent complications. Registered dietitian nutritionists (RDNs) are pivotal in managing NST, using their expertise to assess malnutrition risk, evaluate suitable nutrition routes, and lead teams in evidence-based nutrition care. However, not all RDNs operate at an expert level owing to varying education, training, and clinical experiences. A survey to determine expert-level RDN NST practices was created and distributed through the Dietitians in Nutrition Support Dietetic Practice Group of the Academy of Nutrition and Dietetics and the Dietetics Practice Section of the American Society for Parenteral and Enteral Nutrition. The survey gathered data on demographics, practice characteristics, and frequency of and barriers to performing select expert-level practice indicators using the Academy of Nutrition and Dietetics and American Society for Parenteral and Enteral Nutrition: Revised 2021 Standards of Practice and Standards of Professional Performance for RDNs (competent, proficient, and expert) in Nutrition Support. A total of 668 RDNs completed the survey (12.4% response). Findings revealed that RDNs frequently performed nutrition-focused physical examinations (83%) and determined micronutrient supplementation (59%). RDNs performed the following activities less frequently: evaluating body composition using diagnostic results (9%), inserting nasogastric/nasoenteric tubes (19%), and leading quality-improvement initiatives (30%). Key barriers identified included lack of training/experience and institutional support, and regulatory constraints. These results underscore the need for enhanced professional development, including training programs and interprofessional collaboration, to promote RDN expert-level NST practice and advance the dietetics profession.

Obesity is common, affecting >40% of Americans and increasing at rapid rates worldwide. Defined by the presence of excess body fat, obesity is tied to a multitude of poor health conditions, including cardiovascular disease, insulin resistance, and malignancy. Although lifestyle modifications such as diet and physical activity are cornerstones of management and crucial to enhance the health benefits achieved via targeted treatment plans, highly efficacious obesity medications are also now available. In particular, glucagon-like peptide-1 receptor agonists, have been found to be safe and efficacious, inducing clinically significant weight loss that is sustainable. Their effect on nutrition status is still being defined. In addition to medications, bariatric endoscopy and bariatric surgery are also highly effective options for durable weight loss, although these treatments are associated with malnutrition if they are not appropriately monitored. This review aims to define the current landscape of obesity medicine today, highlighting both current therapies and discussing their associated nutrition considerations, to educate the nutrition-focused provider. Multimodal therapies, combining medications and procedures, are an active area of research and will likely define care in future years.

Background: Nutrition status evaluation is essential for patients undergoing cardiac surgery. The Nutrition Risk in the Critically Ill (NUTRIC) and modified NUTRIC (mNUTRIC) scores are nutrition risk assessment tools specifically for patients in the intensive care unit (ICU). The objective of this study was to validate and compare the accuracy of these two nutrition scores in predicting hospital mortality in patients undergoing cardiac surgery.

Methods: This retrospective study screened adult patients undergoing cardiopulmonary bypass cardiac surgery in the ICU from June 2020 to August 2022. Patients were grouped according to NUTRIC score and mNUTRIC score within 24 h of ICU admission. Logistic regression was used to analyze the risk factors affecting the prognosis of these patients. The area under the receiver operating characteristic curve (AUC-ROC) was used to compare the predictive performance of these two nutrition scores for hospital mortality.

Results: Data from 252 eligible patients (55.6% of whom were male) were analyzed. It was found that Acute Physiological and Chronic Health Evaluation Ⅱ score, aortic surgery, serum albumin level, NUTRIC score, and mNUTRIC score were independent influencing factors of hospital mortality. The AUC-ROC of the NUTRIC score and the mNUTRIC score for predicting hospital mortality were 0.830 (95% confidence interval [CI]: 0.778-0.874) and 0.824 (95% CI: 0.771-0.869), respectively. There was no significant difference in ROC curves between the two scores (P = 0.492).

Conclusions: Both the NUTRIC and mNUTRIC scores showed good predictive performance for hospital mortality in patients undergoing cardiac surgery, and the mNUTRIC score might be a more convenient and cost-effective tool for nutrition risk assessment.

Background: Hypoalbuminemia, often induced by acute stress and inflammation in patients who are neurocritically ill, is adversely associated with prognosis. This study investigates whether supplementing nutrition support with anti-inflammatory whey protein powder formulations (experimental group) can improve serum albumin levels and overall patient outcomes compared with traditional liquid intact protein formulations (control group) while monitoring for enteral feeding complications and inflammatory markers.

Methods: In a randomized controlled trial conducted at a neurointensive care unit from January 2020 to May 2022, 116 out of 597 patients who required enteral nutrition (EN) for at least 7 days were randomly assigned to receive either the formula from experimental group or control group. The primary end point was serum albumin levels at 14 days. Secondary outcomes included functional status (modified Rankin Scale [mRS]) at 90 days, EN-related complications, and changes in serum inflammatory and infectious markers.

Results: No significant differences were observed in serum albumin levels or mRS scores (P > 0.05). Complication rates from EN and changes in inflammatory and biochemical markers were comparable between groups. The post hoc analysis showed that the experimental group had a significantly higher median daily protein intake (1.7 g/kg/day; interquartile range [IQR]: 1.6-1.8) compared with the control group (1.5 g/kg/day; IQR: 1.3-1.7), with P ＜ 0.001.

Conclusion: Although no significant difference was observed in serum albumin levels on day 14 between the whey protein powder supplementation group and the control group, protein supplementation with whey protein powder may be a viable strategy to meet protein requirements in patients who are neurocritically ill.

Glucagon-like peptide-1 (GLP-1) receptor agonists are becoming an increasingly important tool in addressing obesity in the US, with burgeoning use in pediatric and adolescent populations. Although their use is expanding, there is a notable gap in the literature regarding optimal dietary guidelines for these patients. This review synthesizes current evidence on dietary recommendations for patients using GLP-1 receptor agonists for weight management, with particular emphasis on strategies for pediatric and adolescent populations. Key strategies include prioritizing protein in the diet to help maintain lean body mass, gradually increasing fiber content to minimize gastrointestinal side effects, focusing on nutrient-dense meals in smaller, more frequent portions, and monitoring micronutrients to prevent deficiencies. Successful implementation of these dietary guidelines relies on an interdisciplinary approach to optimize both short- and long-term success.

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.