Nutrition in Clinical Practice最新文献

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.

Background: Muscle mass is a strong predictor of clinical outcomes. However, its continuous monitoring is not always feasible in critically ill patients. Surrogate methods, such as bioelectrical impedance analysis (BIA), may be affected by overhydration (OH). The aim of this study was to evaluate the agreement of BIA-derived fat-free mass (FFM) adjusted for hydration status in comparison with muscle mass assessed by computed tomography (CT) in critically ill patients with pneumonia due to COVID 19.

Methods: This secondary analysis includes patients with a CT scan of the third lumbar vertebra (L3) and a BIA performed within the first 24 to 48 h of hospital admission. FFM and hydration status were estimated using BIA (FFM_BIA), and then adjusted to OH (FFM_OH). Images from the skeletal muscle area obtained from L3 were used to calculate the FFM derived from CT (FFM_CT). The concordance between FFM derived from CT and BIA was analyzed using Bland-Altman and Student t test.

Results: Seventy-four patients were included. FFM_BIA overestimated compared with CT (54.6 ± 10.3 kg vs 47.4 ± 10.9 kg) with a mean difference of 7.2 kg (limits of agreement, -5.1 to 19.5; P < 0.01). Overestimation decreased by FFM_OH, with a mean difference of 3.5 kg (limits of agreement, -9.6 to 16.8; P = 0.06).

Conclusion: FFM_OH assessed by BIA shows a better agreement with FFM_CT in comparison with FFM_BIA.

Background: Children with spinal muscular atrophy (SMA) do not follow standard anthropometric growth trajectories; disease-specific curves were published in 2021. Our aim was to apply these in SMA children comparing their growth and body composition longitudinally, relative to the World Health Organization (WHO) standard.

Methods: This was a retrospective cohort of 19 SMA pediatric patients in a long-stay hospital with monthly anthropometric measurements from admission to discharge. We calculated body mass index) and length‑for‑age z scores (BMIz and LAzs) using WHO and SMA‑specific curves. Triceps skinfold and mid-upper arm circumference z scores (TSFz and MUACz) used WHO reference.

Results: Participants had a median age of 9 (IQR, 7-14) months, followed up for 19 months (IQR, 6.5-32). At admission, BMIz was -1.31 ± 0.66 by WHO and 0.77 ± 0.50 by SMA curves (P < 0.01). According to WHO, 11 (57.9%) were malnourished, 8 (42.1%), eutrophic, and 0 overweight, but with SMA curves the comparable values were 2 (10.5%), 9 (47.4%), and 8 (42.1%), respectively. MUACz was -0.3 ± 0.7 and TSFz 2.01 ± 0.84. TSFz correlated better with BMIz based on SMA (R² = 0.46) than with WHO curves (R² = 0.27). Over time, BMIz remained stable, HAz rose slightly by both curves, MUACz showed a declining trend, and TSFz increased 0.38 annually (R² = 0.34; 95% CI, 0.11-0.63; P = 0.006).

Conclusion: SMA‑specific growth curves assess better the nutrition status in children with SMA compared with WHO standards, aligning more closely with body composition. The cohort demonstrated increased fat accretion, normal length growth, and stable BMI over time.

Background: Diagnosing malnutrition in patients with pediatric cancer is challenging because tumor masses can interfere with anthropometric measurements. STRONGkids considers cancer a general risk factor, whereas Screening Tool for Childhood Cancer (SCAN) classifies patients as at risk or not, potentially missing those who need nutrition monitoring. This study describes development and validation of a new nutrition risk screening tool for childhood cancer in Brazil.

Methods: Nutrition Risk Screening for Childhood Cancer (NUTRICCAN) underwent online expert content validation. Twelve nutritionists applied it to oncology inpatients (0-19 years old) at the Pediatric Oncology Institute at Federal University of São Paulo from June to August 2024. Nutrition risk was assessed using NUTRICCAN, STRONGkids, and SCAN. Logistic regression identified screening variables associated with malnutrition (body mass index-for-age z score < -2, mid-upper arm circumference [MUAC] <5^th percentile, calf circumference below cutoff, or met any of the criteria for malnutrition). Receiver operating characteristic analysis determined cutoff scores, and sensitivity/specificity analyses allowed comparisons among instruments.

Results: Patients not receiving intensive care were almost three times more likely to have an inadequate MUAC (odds ratio [OR], 4.505; 95% confidence interval [CI], 1.446-14.033; P = 0.009). Low socioeconomic status or caregiver education increased the risk of malnutrition (OR, 2.845; 95% CI, 1.070-7.566; P = 0.036). Dietitians' subjective assessments were associated with a fourfold increased risk of malnutrition. NUTRICCAN was 70% accurate (area under the curve, 0.701; 95% CI, 0.617-0.785), outperforming the other tools.

Conclusion: NUTRICCAN better stratifies nutritional risk, considering clinical and socioeconomic factors, and may allow for more targeted interventions, especially in resource-limited settings.

Background: Parenteral nutrition (PN) supports patients unable to absorb sufficient nutrients from their gastrointestinal tracts. Yet, information about the patterns and extent of PN's in-hospital use is lacking. Data on this topic should provide comparison points for nutrition support teams and hospital administrators examining PN use in their institutions.

Methods: A retrospective cohort study using 9 years of routinely collected administrative data from a healthcare system with tertiary care and community hospitals explored the extent, patterns, and trends of PN use in hospitals and individual clinical departments.

Results: PN was administered to 2984 patients during 4121 admissions to the tertiary facility for 68,047 days and to 298 patients on 367 admissions to the community hospital for 4925 days. Both hospitals' general surgery, surgical intensive care unit, and other surgical services accounted for half the patients receiving PN. The tertiary care hospital's adult and pediatric oncology/hematology/bone marrow transplantation services, services not provided in the community hospital, accounted for 29% of the hospital's patients receiving PN. Fifty-two percent of surgical patients accounted for 46% of PN-days, whereas the 29% of patients from the hematology/oncology/bone marrow transplantation services utilized 39% of PN-days, with longer durations of PN administration reflected in the latter group. Adult oncology admissions involving PN tripled (from 38 to 116 patients) between the first and last 3 years.

Conclusion: Different case mixes in the tertiary and community hospitals affected the extent and patterns of PN use. Dataset analysis provided an analytic framework for examining PN usage within and among hospitals.

Background: Evidence-based guidelines (EBGs) in the nutrition management of advanced liver disease and enhanced recovery after surgery recommendations state that normal diet should recommence 12-24 h following liver transplantation. This study aimed to compare postoperative nutrition practices to guideline recommendations, explore clinician perceptions regarding feeding after transplant surgery, and implement and evaluate strategies to improve postoperative nutrition practices.

Methods: A pre-post multimethod implementation study was undertaken, guided by the knowledge-to-action framework. A retrospective chart audit of postoperative dietary practice and semistructured interviews with clinicians were undertaken. Implementation strategies were informed by the Consolidated Framework for Implementation Research-Expert Recommendations for Implementing Change matching tool and then evaluated.

Results: An evidence-practice gap was identified, with the median day to initiation of nutrition (free-fluid or full diet) on postoperative day (POD) 2 and only 25% of patients aligning with the EBGs. Clinician interviews identified belief in the importance of nutrition, with variation in surgical practice in relation to early nutrition, competing clinical priorities, and vulnerabilities in communication contributing to delays in returning to feeding. An endorsed postoperative nutrition protocol was implemented along with a suite of theory- and stakeholder-informed intervention strategies. Following implementation, the median time to initiate nutrition reduced to POD1 and alignment with EBGs improved to 60%.

Conclusion: This study used implementation frameworks and strategies to understand, implement, and improve early feeding practices in line with EBGs after liver transplant. Ongoing sustainability of practice change as well as the impact on clinical outcomes have yet to be determined.

Parenteral nutrition (PN) is a life-sustaining therapy for patients unable to meet nutrition needs via enteral routes, but its use presents significant ethical complexity. This narrative review provides clinicians with a practical, principle-based framework to navigate the ethical dilemmas inherent in PN across diverse clinical contexts. Grounded in the four pillars of medical ethics-autonomy, beneficence, nonmaleficence, and justice-the review explores decision-making challenges in vulnerable populations, long-term PN, and end-of-life care. Clinically relevant scenarios are examined, including initiation or withdrawal of PN in terminal illness, informed consent in cognitively impaired patients, and balancing parental wishes with a child's best interests in pediatric care. The ethical tension between prolonging life and enhancing quality of life is critically appraised, particularly in oncology and palliative settings. The review also addresses disparities in PN access and resource allocation, with actionable insights for clinicians practicing in low-resource settings. Key take-home strategies include using structured ethical frameworks such as the Four-Quadrant and Shared Decision-Making models, involving ethics committees in complex cases, and prioritizing transparent, compassionate communication. Clinicians are encouraged to consider both the clinical utility and psychosocial burden of PN, and to integrate multidisciplinary perspectives into care planning. Ultimately, this review underscores the need for ethically attuned, patient-centered PN decisions that align with individual goals, values, and context. It provides structured guidance to assist nutrition support teams in translating ethical principles into clinical practice, thereby ensuring that PN is administered judiciously, safely, and in accordance with the patient's best interests.