Nutrition in Clinical Practice最新文献

Background: The administration of home parenteral nutrition improves quality of life for patients with intestinal failure, thus fostering their will to actively participate to social activities. Nevertheless, sports participation can be risky for patients with a central venous catheter (CVC). Despite literature thoroughly proving the positive impact of sports on motor-psychosocial development, no consistent evidence assessing its role on central-line complications is available. This study aimed to report the European centers' approach to children with intestinal failure on home parenteral nutrition and interested in playing sports, further assessing complications and how to prevent them.

Materials and methods: A questionnaire focusing on children with intestinal failure regarding physical activity was circulated to 20 centers. Questions assessed the centers' policy for CVC management, the sports-related recommendations for patients on home parenteral nutrition and complication rates.

Results: Sixteen (80%) centers filled in the questionnaire. Twelve centers reported not to have a standardized formal protocol for catheter care during sports. All centers encouraged patients to perform mild/moderate exercise, whereas high-contact sports were allowed by one center only. Specific dressings were suggested to protect the vascular access device, especially for water sports. Only one sports-related complication (rupture) was reported.

Conclusion: This survey emphasizes that sports should not be restricted in patients with intestinal failure and represents a blueprint for sports-related recommendations for these patients. Prospective studies assessing complication rates are advisable to ensure an improved access to sports for these patients.

Background: Peripheral parenteral nutrition (PPN) provides an alternative nutrition support strategy to centrally administered PN for specific patients requiring short-term PN. Previous studies have demonstrated limited use of PPN and variable complication rates. This study aimed to evaluate PPN complications and usage at this center.

Methods: This was a single-center retrospective observational study of all adult patients who received at least 1 day of PPN from June 2018 to December 2023. Demographic and clinical data were collected, including complications, indications for PN and reason for PPN, duration of therapy, reason for cessation of PPN, nutrition status, energy and protein provision, and central line insertion rates.

Results: 381 patients were included, the median age was 62 (interquartile range = 28-74) years, and 235 were men (61.7%). The most common indication for PN was ileus (n = 153, 40%) followed by gastrointestinal obstruction (n = 93, 24%). The median time receiving PPN was 3 (2-4) days. Patients received a median of 65% (55%-75%) of energy and 58% (50%-69%) of protein requirements with PPN. Malnutrition was diagnosed in 47.5% (n = 181) of this cohort. Total complication rates were 8.7% (n = 33), with cannula infiltration being the most common complication (6.6%, n = 25). 213 (56%) patients proceeded to central line insertion.

Conclusion: PPN proved to be a safe and effective therapy for short-term PN when managed by a nutrition support team. PPN has the potential to attenuate short-term nutrition deficits and prevent central venous access device insertion in selected patients, making it a valuable nutrition support therapy.

Background: A-mode ultrasound (US) is a potential method for directly measuring muscle thickness in patients with cancer, but its utility remains underexplored. We aimed to evaluate the feasibility of using A-mode US to assess muscle thickness, compare it with computed tomography (CT)-derived results, and assess its ability to diagnose sarcopenia.

Methods: A cross-sectional analysis was conducted with hospitalized patients with cancer. Muscle cross-sectional area (CSA) was derived from CT scans. Biceps muscle thickness (BMT) and thigh muscle thickness (TMT) by A-mode US were assessed. BMT + TMT were also combined as an additional phenotype. Muscle strength was assessed using handgrip strength (HGS) test. Sarcopenia was defined as low muscle mass (CT- and US-derived) + low HGS.

Results: We included 120 patients (53.3% women, 45% older adults, and 85.8% with disease stages III-IV). TMT alone and the combined approach (BMT + TMT) were weak and positively correlated and significantly associated with muscle CSA, explaining 35% of CSA variability (R² = 0.35). TMT individual and combined with BMT exhibited the highest accuracy for men (area under the curve >0.70). Sarcopenia diagnosed by BMT + TMT exhibited the highest frequency (34%) and moderate agreement with CT-derived sarcopenia (κ = 0.48).

Conclusion: A-mode US has the potential to be a feasible tool for diagnosing sarcopenia in clinical practice at the bedside for patients with cancer despite the need for further improvements in the tool's accuracy. Our main findings suggest that combining measurements of BMT and TMT may enhance its clinical significance in diagnosing sarcopenia.

Home enteral nutrition (HEN) provides nutrition through a tube to individuals at home who cannot meet their needs by mouth. Systematic reviews have explored the experiences of HEN subpopulations, such as those with head and neck cancers. Given HEN services care for adults with various underlying conditions, a synthesis of the experiences of all adults using HEN and their caregivers is warranted. The purpose of this study is to summarize the experiences of HEN adult users and their caregivers regardless of underlying condition. Medline, PsychINFO, EmBase and CINAHL were systematically searched in January 2024. Studies with qualitative results and adult participants and focused on HEN were included. Studies with participants in nursing facilities, results using word counts, or not in English were excluded. Study quality was assessed using the Johanna Briggs Institute (JBI) qualitative checklist. Study design and participants' details were extracted. Themes were collated using the JBI meta-aggregative method. Forty studies (n = 732) were included. Three synthesized findings were identified: positive experiences (very low ConQual score), negative experiences (low ConQual score), and facilitators and coping mechanisms (moderate ConQual score). Although more negative than positive experiences were reported, users and caregivers who developed coping mechanisms or accessed supports viewed HEN as a worthwhile experience. Those with few supports or coping mechanisms did not. Based on this review, it is proposed that before starting HEN, users and caregivers should be made aware of the available supports and coping mechanisms. As negative experiences arise, healthcare providers should help users and caregivers access supports to improve their experiences.

Background: This study aimed to understand the collective impact of trace elements, vitamins, cholesterol, and prealbumin on patient outcomes in the intensive care unit (ICU) using an advanced artificial intelligence (AI) model for mortality prediction.

Methods: Data from ICU patients (December 2016 to December 2021), including serum levels of trace elements, vitamins, cholesterol, and prealbumin, were retrospectively analyzed using AI models. Models employed included category boosting (CatBoost), extreme gradient boosting (XGBoost), light gradient boosting machine (LGBM), and multilayer perceptron (MLP). Performance was evaluated using area under the receiver operating characteristic curve (AUROC), accuracy, precision, recall, and F1-score. The performance was evaluated using 10-fold crossvalidation. The SHapley Additive exPlanations (SHAP) method provided interpretability.

Results: CatBoost emerged as the top-performing individual AI model with an AUROC of 0.756, closely followed by LGBM, MLP, and XGBoost. Furthermore, the ensemble model combining these four models achieved the highest AUROC of 0.776 and more balanced metrics, outperforming all models. SHAP analysis indicated significant influences of prealbumin, Acute Physiology and Chronic Health Evaluation II score, and age on predictions. Notably, the ratios of selenium to age and low-density lipoprotein to total cholesterol also had a notable impact on the models' output.

Conclusion: The study underscores the critical role of nutrition-related parameters in ICU patient outcomes. Advanced AI models, particularly in an ensemble approach, demonstrated improved predictive accuracy. SHAP analysis offered insights into specific factors influencing patient survival, highlighting the need for broader consideration of these biomarkers in critical care management.

Background: We investigated the effectiveness of a novel, hunger-based outpatient tube weaning program for children with feeding-tube dependency.

Methods: This interdisciplinary program induced hunger via rapid reduction in tube-fed calories, followed by 2 weeks of daily outpatient mealtime support and regular follow-up. Forty-one children (6.9 months to 12.8 years) participated in this retrospective cohort study.

Results: Before the program, children received a median of 90.0% (interquartile range [IQR]: 75.0%-100%) of caloric intake via tube feeds. At the end of the 2-week program, children received 16.0% (IQR: 0.0%-30.0%) of caloric intake via tube feeds, which further reduced to 1.5% (IQR: 0.0%-33.0%) at 6-months, and 0.0% (IQR: 0.0%-35.0%) at 1-year follow-up. The percentage of participants who ate >30 different foods increased from 4.9% at baseline to 81.5% at 1-year follow-up. The baseline median weight z score of -1.24 (IQR: -1.69 to -0.69) decreased to -1.81 (IQR: -2.77 to -1.02) at 1-year follow-up. A linear mixed-effects model demonstrated that weight z score was significantly higher at baseline and 2-weeks compared to the 1-year follow-up (P < 0.001 and P = 0.001, respectively), but was not significantly different between 6 months and 1 year (P = 0.44). Age was not associated with percentage of caloric intake via tube feeds or number of foods eaten.

Conclusion: Children who participated in the hunger-based tube-weaning program had increased and more varied oral intake 1 year following the intervention. The median weight z score decreased over the year after intervention but did not significantly decrease between 6 and 12 months after the program.

Background: In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and healthcare providers across the US.

Methods: A 19-item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected.

Results: Two hundred forty-one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended.

Conclusion: Providers made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.

Malnutrition is estimated to affect roughly 30%-80% of patients with inflammatory bowel disease (IBD). In those patients who cannot tolerate sufficient oral nutrition or there is no possibility for placing an enteral nutrition tube, parenteral nutrition offers a lifesaving alternative. However, this is not without risk. For patients with IBD, understanding the indications, contraindications, and complications associated with parenteral nutrition is crucial. In this review, we will discuss the indications and contraindications for parenteral nutrition in patients with IBD, the common complications associated with intravenous nutrition, the use of parenteral nutrition in special populations, such as in pediatric and perioperative patients, and the impact of parenteral nutrition on IBD-related outcomes.

In pediatric patients with intestinal failure, parenteral nutrition is lifesaving but also has several associated risks. The goals of intestinal rehabilitation include promoting growth, minimizing complications associated with intestinal failure, and reaching enteral autonomy, if possible. Pediatric intestinal rehabilitation programs are interdisciplinary teams that strive to provide optimal care for children dependent on parenteral nutrition. The provision of parenteral nutrition requires close monitoring of patients' growth, nutrition concerns, clinical status, and laboratory parameters. Recent advances in the field of intestinal rehabilitation include new lipid emulsions, considerations regarding enteral feeding, advances in micronutrient provision, and central venous catheter preservation techniques. Challenges in the field remain, including improving overall quality of life with home parenteral nutrition administration and preventing recently recognized complications such as chronic intestinal inflammation.