Nutrition in Clinical Practice最新文献

Catheter-related thrombosis (CRT) is a consequential complication in patients receiving long-term home parenteral nutrition (HPN), compromising central venous access, nutrition support and, in some cases, survival. Yet whether routine prophylactic anticoagulation should be used to prevent CRT remains a clinical dilemma: although thrombosis prevention may preserve venous access, anticoagulation introduces bleeding risk, monitoring demands, added treatment burden, lifestyle restrictions, and cost. Proponents cite the relatively high incidence and clinical consequences of CRT, supported by observational data suggesting reduced thrombosis risk with prophylaxis. Opponents emphasize bleeding risks, lack of randomized controlled trial (RCT) evidence, and the improved safety of modern catheter care without anticoagulation. Consequently, practice varies widely, from routine anticoagulation to selective, risk-based approaches. This review critically evaluates the arguments on both sides, drawing on evidence from adult and pediatric cohorts. Beyond clinical outcomes, it considers the quality-of-life implications that daily anticoagulation imposes on an already complex HPN regimen. Routine anticoagulation in HPN sits at the intersection of prevention and harm: it may be appropriate for selected high-risk patients, but it is not a one-size-fits-all solution. An individualized, multidisciplinary approach, balancing thrombotic and bleeding risk alongside patient preference, is essential. Future research, including RCTs and predictive risk tools, is needed to refine patient selection and optimize strategies to preserve the venous lifelines sustaining HPN.

Background: Multidisciplinary care under intestinal rehabilitation programs (IRPs) improves survival in pediatric intestinal failure (IF). Professional societies recommend the management of pediatric patients with IF by an IRP. Whether these recommendations are followed in cases of neonatal IF is currently unclear. The objective of this study was to describe the current state of neonatal IF care across North America through the Children's Hospitals Neonatal Consortium.

Methods: A web-based survey was sent in July 2023. This survey consisted of adaptive questioning and contained 10-54 questions. The survey covered topics regarding IF care: diagnosis, rehabilitation program management, protocol use, and follow-up. To determine correlation of respondent role and answer given, Spearman correlation was used to analyze a portion of responses.

Results: There was a response rate of 93% (42/45). A total of 79% (33/42) of centers report having an IRP caring for neonatal patients. The composition and care provided by the program varied by center, with 60% (25/42) having protocols for neonatal IF management. A total of 76% (32/42) of centers report a multidisciplinary intestinal rehabilitation follow-up.

Conclusions: Neonatal IF care varies across North America. Although the presence of a rehabilitation program is known to improve pediatric patient outcomes, a relevant minority of centers in this consortium do not have access to this care. Future studies comparing neonatal specific IF care strategies are critically important to optimize outcomes.

Background: Although pediatric temporary (e.g., nasogastric) feeding tubes are widely used for short-term nutrition support, family impacts remain poorly defined. Research from long-term (e.g., gastrostomy) feeding tubes does not generalize because management and burdens differ. This study aimed to explore the financial, time and family burdens of temporary feeding tubes, and their impact on children's quality of life.

Methods: A prospective mixed-methods longitudinal cohort study was conducted, following families over 4 months. Data were collected using diaries, interviews, Pediatric Quality of Life Inventory (PedsQL^TM) 4.0 Generic Core Scales, and a caregiver burden questionnaire. Analyses included descriptive statistics for financial and time burdens, a multiple linear regression model fitted to identify factors associated with health-related quality of life, and qualitative content analysis.

Results: Thirty-six parents participated. Parents reported spending an average of 3.1 h daily on tube-related care. Indirect costs (e.g., lost income) averaged USD$1494.15/month (SD = $339.11), and out-of-pocket nonmedical costs (e.g., hiring help) represented 44% of monthly family income. Employment disruptions were reported by n = 18 (61%) of parents. Key predictors of lower quality of life for children were toddler age group, prior home tube feeding experience, and regional/rural residence. Preterm birth status and involvement of 4-6 medical teams were associated with higher quality of life. Parents reported challenges managing mealtimes, outings, and holidays.

Conclusion: Temporary tube feeding imposes substantial financial burdens, time demands, and disruptions to family life, with impacts on children's quality of life. Supporting successful management for children requiring this intervention requires integrated family-centered care, including structured support, education, and psychosocial interventions.

Background: Malnutrition worsens gastrointestinal (GI) cancer outcomes in older adults; long-term US mortality trends and disparities remain insufficiently understood. This study analyzed demographic/geographic mortality trends related to malnutrition and GI cancer among older adults in the United States.

Methods: Mortality data from 1999 to 2020 were obtained via CDC WONDER for adults aged ≥65 years, in which malnutrition and GI cancer were listed as underlying or contributing causes of death. Age-adjusted mortality rates (AAMRs) per 100,000 population and annual percentage changes (APCs) were calculated and stratified by year, sex, race/ethnicity, and region.

Results: A total of 31,806 deaths were recorded. AAMRs declined from 4.4 in 1999 to 2.6 in 2013 (APC: -7.7 to -1.4), then rose to 5.5 in 2020 (APC: 11.6, 95% CI: 10.7-12.8). Men had higher AAMRs (4.3) than women (2.7). Among men, AAMRs dropped from 5.4 in 1999 to 3.3 in 2006, then increased to 7.2 in 2020 (APC: 11.9, 95% CI: 10.5-14.1). Women's rates declined from 3.8 in 1999 to 2.0 in 2013, before rising to 4.2 in 2020 (APC: 11.8, 95% CI: 10.2-14.0). Black or African American individuals (5.3), Alaska (7.1), and the Western United States (7.0) had the highest mortality. Nonmetropolitan areas consistently had higher AAMRs (4.0) than metropolitan areas (3.3).

Conclusions: After years of decline, mortality from malnutrition and GI cancers has sharply increased among older adults, with notable sex, racial, and regional disparities. These findings underscore the need for focused public health strategies to address these growing inequalities.

Background: Calf circumference (CC) is a recognized proxy for muscle mass, yet few studies have established specific cutoff points across diverse populations. This study aimed to define CC cutoffs for detecting low muscle mass in older adults, using appendicular lean mass (ALM) from dual-energy x-ray absorptiometry (DXA) as the reference, stratified by sex and age.

Methods: A total of 254 adults ≥60 years of age were recruited from two outpatient clinics at the Reference Center for Older Adults of the Federal University of Minas Gerais. Participants underwent comprehensive geriatric assessments and DXA scans. CC was measured on the left leg. Low muscle mass was defined using the ALM index, and cutoff points were determined through receiver operating characteristic (ROC) curves. The participants were categorized through self-reported ethnicity.

Results: Most participants were female (63.0%), with a mean age of 81.4 ± 8.2 years. The most commonly identified race was White (49.4%), followed by mixed race (43.8%) and Black (6.8%). For men, the CC cutoff was 35.0 cm (AUC = 0.90; sensitivity = 90.2%, specificity = 72.6%), with no differences across age groups. For women aged 60-84, the cutoff was 34.0 cm (AUC = 0.74; sensitivity = 77.1%, specificity = 60.8%), and for those ≥85 years of age, the cutoff was 32.0 cm (AUC = 0.74; sensitivity = 86.8%, specificity = 58.3%). Ethnicity did not influence the results.

Conclusion: The proposed CC cutoffs provide a practical and low-cost method for identifying low muscle mass and supporting sarcopenia screening among ethnically diverse older adults.

Somatostatin is a naturally occurring polypeptide hormone that exerts its effect on the gastrointestinal tract by reducing exocrine and endocrine secretion, resulting in decreased motility, gastric emptying, splanchnic blood flow, fat absorption, lymphatic flow, and gallbladder contraction. Octreotide is a synthetic somatostatin analogue that has a variety of clinical applications in the gastrointestinal tract, including in the treatment of gastrointestinal bleeding, motility disorders, lymphatic disorders, pancreatic disorders, and high-output states. Clinicians may hesitate to use octreotide because of its potential side effects and the lack of robust pediatric data. Here we describe potential side effects of the drug and review the use of octreotide in the above pediatric indications.

Irritable bowel syndrome (IBS) is the most common gastrointestinal (GI) disorder of the gut-brain interaction and causes significant GI distress. The etiology of IBS is multifactorial, with food intolerances being a frequent contributing factor to IBS symptoms. Diet and lifestyle interventions are key components in comprehensive IBS care. In this review, we examine the current evidence-based dietary approaches for treating IBS. The low-FODMAP diet has the most robust data for improving overall symptom burden. In conjunction with guidance from a registered dietitian, certain patients may benefit from targeted dietary elimination of specific carbohydrates such as lactose or fructose or gluten. Among the nutraceuticals used to treat IBS, peppermint oil has sufficient evidence and appropriate safety data to recommend adjunctive use to reduce IBS symptoms. Although prebiotic and probiotic food sources may be beneficial to the microbiome, there is not enough evidence to support the routine use of prebiotic or probiotic supplements. Given the complexity of IBS, a holistic approach in which clinicians address a patients' diet, culture, sleep hygiene, exercise habits, and mental health may improve patients' overall quality of life.

Background: The Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition were established to provide a standardized approach for diagnosing malnutrition in clinical practice using a nutrition screening tool (NST) as the first step for this process. This study aimed to compare the complementarity of NSTs with the GLIM criteria for malnutrition diagnosis in patients with cancer.

Methods: Hospitalized patients with different cancer types were evaluated in a prospective cohort study in which they were initially screened using the Patient-Generated Subjective Global Assessment (PG-SGA), Protocol for Nutritional Risk in Oncology (PRONTO), Malnutrition Universal Screening Tool, Nutritional Risk Screening 2002, Malnutrition Screening Tool, and NutriScore for nutrition risk. Malnutrition diagnosis involved phenotypic and etiological criteria as proposed by the GLIM. Complementarity of NST to GLIM criteria was evaluated by calculating accuracy metrics and investigating association with 12-month mortality.

Results: Nutrition risk ranged from 14.8% (NutriScore) to 82.8% (PRONTO) and frequency of malnutrition from 13.8% (with NutriScore) to 88.9% (with PG-SGA). NutriScore presented the lowest negative predictive value (25.1%) whereas PG-SGA presented the highest (58.32%). Regardless of the NST applied, the risk of malnutrition and diagnosis of malnutrition according to the GLIM criteria, combined or isolated, increased the risk of 12-month mortality.

Conclusion: All NSTs presented low negative predictive value when their complementarity to GLIM criteria for malnutrition diagnosis was tested. Indeed, patients "at risk" presented similar increased risk of 12-month after discharge mortality in comparison with those at risk and malnourished by the GLIM criteria when all NSTs were applied.

Background: The number of people diagnosed with chronic intestinal failure (CIF) worldwide is low. The condition is clinically complex to manage and resource intense. Guidance on best-practice staffing levels is lacking. This paper proposes a methodology for determining dietetic staffing levels for adult CIF to estimate dietetic staffing levels allowing patients access to best-practice care.

Methods: After undertaking a literature search, a novel method for developing recommended adequate dietetic staffing within adult CIF services was utilized. This included (1) mapping the current patient journey and best-practice dietetic care throughout the journey, (2) allocating clinical and nonclinical hours at each phase of the patient journey, and (3) calculating percentage clinical time, and (4) finalizing estimated dietetic staffing requirements per patient.

Results: Current literature informed mapping the patient journey and dietetic best practice for CIF. Australian data were included where possible to reflect patient care locally. Direct and indirect clinical hours were allocated to each activity. Allowing for nonclinical activity of 40% for a senior clinician, total hours required to provide best-practice care per patient was calculated as 0.028 of a full-time dietitian per adult with CIF. This equates to the management of 36 people with CIF per full-time dietitian.

Conclusion: Use of a bottom-up methodology allows calculation of staffing to meet best practice. Proposed dietetic staffing levels obtained from this study are far greater than current allocated staffing within the Australian adult CIF setting. Adequate dietetic resourcing may reduce patient complications and improve quality of life, resulting in enhanced patient and clinical outcomes.