Nutrition In Clinical Practice[JOURNAL]
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200 papers
Breathing and balance: Clinical insights and management strategies of respiratory acid-base disorders.
Tucker AM, Johnson TN
Nutr Clin Pract · 2025 Aug · PMID 40483586 · Full text
Respiratory acidosis and alkalosis are two of the four main acid-base processes encountered in clinical practice. These two processes are tightly balanced by breathing. Identification and management of respiratory acid-b...
Respiratory acidosis and alkalosis are two of the four main acid-base processes encountered in clinical practice. These two processes are tightly balanced by breathing. Identification and management of respiratory acid-base disorders are important for clinicians, particularly when caring for patients with underlying pulmonary and neurological conditions. Basic knowledge of respiratory function, alveolar gas exchange, and innate compensation concepts can provide clinicians with the tools to design safe and effective nutrition care plans. These concepts will also aid in monitoring response to medical interventions and drug therapy. An overview of these ideas and management strategies is provided in this review.
ECMO patient energy requirements: A descriptive, retrospective cohort study.
Pelekhaty SL, Rector RP, Wu ZJ … +8 more , Grazioli A, Plazak ME, Taylor BS, Griffith BP, Shah A, Stein DM, Scalea TM, Rabin J
Nutr Clin Pract · 2026 Feb · PMID 40483574 · Publisher ↗
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 I...
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 CO sensor connected to the ECMO oxygenator primary exhalation port collected FeCO during IC studies. ECMO-VO and ECMO-VCO were calculated from sweep gas oxygen concentration, FeCO, 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 = 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.
Sarcopenic obesity is independently associated with frailty in geriatric outpatients: A cross-sectional study from university hospital.
Kahyaoglu Z, Deniz O, Güner M … +6 more , Okyar Baş A, Ceylan S, Çöteli S, Doğu BB, Cankurtaran M, Halil MG
Nutr Clin Pract · 2026 Feb · PMID 40468719 · Publisher ↗
BACKGROUND: Sarcopenic obesity (SO) is an often-overlooked problem in older adults, and ultrasonography (US) is one of the methods that can be used for diagnosis. Frailty, another geriatric syndrome in older adults, is a...
BACKGROUND: Sarcopenic obesity (SO) is an often-overlooked problem in older adults, and ultrasonography (US) is one of the methods that can be used for diagnosis. Frailty, another geriatric syndrome in older adults, is an important clinical marker associated with many physical and cognitive conditions. In this study, we aimed to investigate the relationship between frailty and SO, diagnosed with different muscle mass measurement methods. METHODS: A total of 142 patients with obesity between the ages of 65 and 88 years who were admitted to the geriatric outpatient clinic were included. SO was defined using bioelectrical impedance analysis (BIA) and muscle US. The Clinical Frailty Scale (CFS) was used for the assessment of frailty. RESULTS: The prevalence of SO according to muscle US and BIA were 63.7% (n = 79) and 9.1% (n = 13), respectively. SO was significantly more common in participants living with frailty than robust counterparts according to both diagnostic tools (P < 0.05 for all). In regression analysis, it was found that SO, diagnosed by BIA and US, was independently associated with frailty regardless of confounding factors (odds ratio: 3.30, 95% confidence interval [CI]: 1.38-7.92, and P = 0.007 for US-diagnosed SO; odds ratio: 6.85, 95% CI: 1.19-39.55, and P = 0.032 for BIA-diagnosed SO). CONCLUSION: The study found a higher prevalence of SO in participants living with frailty, with significant and independent associations observed using both muscle US and BIA.
Narrative review of micronutrients and fatty acids in bronchopulmonary dysplasia.
Curtiss J, Miller AN
Nutr Clin Pract · 2025 Aug · PMID 40450561 · Publisher ↗
Bronchopulmonary dysplasia (BPD) is the most common chronic morbidity impacting infants who are born premature. Nutrition plays a pivotal role in lung growth, function, and repair, influencing the risk of developing BPD...
Bronchopulmonary dysplasia (BPD) is the most common chronic morbidity impacting infants who are born premature. Nutrition plays a pivotal role in lung growth, function, and repair, influencing the risk of developing BPD and outcomes once the diagnosis is established. Micronutrients and fatty acids, in particular, are critical aspects of nutrition management for this population. They modulate lung development, oxidative stress, and inflammation. This narrative review examines the existing literature regarding the relevance of micronutrients and fatty acids in the development of BPD and BPD prevention. Additionally, this review aims to identify current gaps in knowledge and calls for future research.
Tackling disease-related malnutrition in resource-limited settings: An international position paper based on expert consensus.
Cardenas D, Ferreira IR, Correia MITD … +5 more , Barbagallo M, Lal S, Barazzoni R, Gomes F, Working Group
Nutr Clin Pract · 2025 Aug · PMID 40448299 · Full text
BACKGROUND: Considering the challenges of providing nutrition care in resource-limited settings (RLSs), the International Working Group for Patients' Right to Nutrition Care (WG) organized an expert meeting to propose re...
BACKGROUND: Considering the challenges of providing nutrition care in resource-limited settings (RLSs), the International Working Group for Patients' Right to Nutrition Care (WG) organized an expert meeting to propose recommendations and strategies to promote access to nutrition care and address disease-related malnutrition (DRM). METHODS: An online survey was developed to assess barriers to providing nutrition care in RLSs and was completed by 58 respondents from low- and middle-income countries between July and August 2024. During the European Society for Clinical Nutrition and Metabolism (ESPEN) Congress in Milan on September 9, 2024, a panel of 30 experts discussed the results of the survey and built consensus statements aimed at defining strategies and recommendations required to address barriers to accessing disease-related nutrition care in RLSs. RESULTS: The survey and expert consensus panel opinions indicated that there are barriers to delivering quality nutrition care in these settings including low or a lack of medical awareness, patient and family knowledge about DRM and its impact, nutrition risk screening and care implementation, reimbursement, medical devices, adapted diets, nutrition protocols, and access to home medical and nutrition therapy. Gaps identified included (1) epidemiological data and evidence for best practices; (2) education, training, and capacity building; and (3) strengthening health systems. CONCLUSION: Tackling DRM in RLSs is challenging because of the high burden of DRM and the fact that current guidelines from high-income countries may not be fully applicable. The WG recommend a three-step strategy to promote access to nutrition care.
Accuracy and reliability of bioelectrical impedance analysis for determining body composition among preterm infants.
Bell KA, Wang W, Nagel EM … +5 more , Pepin H, Plummer E, Buckley LA, Ramel SE, Belfort MB
Nutr Clin Pract · 2025 Aug · PMID 40443193 · Full text
BACKGROUND: Body composition is an important nutritional status indicator among preterm infants, but is challenging to measure in the neonatal intensive care unit (NICU). Bioelectrical impedance analysis (BIA) is highly...
BACKGROUND: Body composition is an important nutritional status indicator among preterm infants, but is challenging to measure in the neonatal intensive care unit (NICU). Bioelectrical impedance analysis (BIA) is highly feasible, but accuracy depends on using a valid prediction equation. We aimed to evaluate the accuracy of available prediction equations, relative to air displacement plethysmography (ADP) as the criterion method, within a cohort of hospitalized preterm infants. METHODS: Preterm infants (23-35 weeks' gestation) underwent concurrent BIA and ADP up to three times between birth and term equivalent age. Using 11 published prediction equations, we estimated infant body composition from BIA data. To determine validity, we used Bland-Altman plots to compare BIA-derived fat-free mass (FFM) with FFM measured concurrently by ADP. RESULTS: One hundred and fifteen infants, with a median 30 6/7 weeks' gestation, underwent 150 instances of concurrent BIA and ADP at ages 1 to 135 (median: 40) days. Agreement between BIA and ADP-derived FFM varied widely depending on the BIA equation used, with mean bias (±95% confidence limits) ranging from 0.14 (±0.24) to 1.34 (±1.51) kg. The Dung, Lingwood, and Tint equations demonstrated the greatest agreement with ADP, with a mean bias of 0.14-0.32 kg and narrow limits of agreement (±0.23-0.28 kg). All equations demonstrated some bias. CONCLUSION: BIA is a feasible tool for measuring body composition among preterm infants. Existing published equations demonstrate reasonable agreement with ADP but require a correction factor to adjust for bias. A novel prediction equation specific to preterm infants might offer improved agreement and reduced bias.
Effect of vitamin D supplementation on incidence of bronchopulmonary dysplasia among preterm infants up to 36 weeks' gestational age.
Rebele T, Hawes C, Johnson S … +1 more , Newkirk M
Nutr Clin Pract · 2025 Aug · PMID 40436817 · Full text
Preterm infants, especially those born at a younger gestational age (GA), are at risk for developing bronchopulmonary dysplasia (BPD), which can lead to longer hospitalizations, chronic pulmonary morbidity, and mortality...
Preterm infants, especially those born at a younger gestational age (GA), are at risk for developing bronchopulmonary dysplasia (BPD), which can lead to longer hospitalizations, chronic pulmonary morbidity, and mortality. Vitamin D plays a role in lung and immune system development, and deficiency at birth is associated with a greater incidence of BPD among preterm infants. The purpose of this literature review was to determine the impact of vitamin D supplementation on BPD incidence among preterm infants born ≤36 weeks GA. A literature search of the PubMed, CINAHL, SCOPUS, and Google Scholar databases was conducted searching for clinical studies published since 2014 that evaluated the effect of vitamin D supplementation on BPD incidence among preterm infants ≤36 weeks GA. We identified and reviewed six clinical studies published between 2014 and 2023, including a total of 545 preterm infants born 25-34 weeks GA. Vitamin D supplementation between 800-1000 IU/day was safe and effective in significantly improving vitamin D status and significantly reducing vitamin D deficiency; however, positive findings regarding the influence of vitamin D supplementation in reducing the incidence of BPD were not consistent. More research is needed in the form of well-designed RCTs investigating the effect of vitamin D supplemented at 800-1000 IU compared with the standard 400 IU dose on the incidence of BPD as the primary outcome.
Microbiological safety of nutrition formulas with different feeding systems.
Bellotti RL, Ferreira DB, Biz AP … +5 more , Zanini AC, Lorini RP, Pereira CM, Dos Santos H, Celes AP
Nutr Clin Pract · 2026 Feb · PMID 40413626 · Publisher ↗
INTRODUCTION: Enteral nutrition (EN) is a form of nutrition therapy indicated for patients who cannot eat or do not tolerate oral nutrition. However, because of their nutrient-rich composition, EN formulas provide a favo...
INTRODUCTION: Enteral nutrition (EN) is a form of nutrition therapy indicated for patients who cannot eat or do not tolerate oral nutrition. However, because of their nutrient-rich composition, EN formulas provide a favorable environment for microbial growth and present a risk for contamination by pathogens, potentially leading to gastrointestinal disorders and delaying patient recovery. This study analyzed the microbiological safety of two EN feeding systems (the open-system [OS] and the ready-to-hang [RTH] system) using liquid and powdered formulas over different infusion periods. METHOD: In the laboratory, RTH formulas were administered via infusion pumps without manual handling, whereas OS formulas were prepared manually and administered by gravity. Samples were collected and analyzed for mesophilic aerobic count, an indicator of microbiological quality, at different infusion intervals. RESULTS: RTH formulas maintained microbial counts below safety limits after 24 and 48 h of infusion. Both liquid and powdered OS formulas remained microbiologically safe for up to 8 h of administration. CONCLUSION: This study demonstrated that both the RTH and OS can maintain microbiological safety within the recommended infusion times of 24 and 4 h, respectively, without significant bacterial growth. The safety of these systems is contingent on the implementation of good handling practices, underscoring the need for continuous training of handlers.
Phase angle as a reproducible bedside tool to assess reduced muscle mass in patients with decompensated cirrhosis and ascites: An observational cross-sectional study.
Hasse JM, Sogbe M, Castro K … +2 more , Asrani SK, Duarte-Rojo A
Nutr Clin Pract · 2025 Oct · PMID 40413624 · Publisher ↗
BACKGROUND: Reduced muscle mass in patients with cirrhosis is linked to poor clinical outcomes. Bioimpedance analysis estimates fat mass (FM), fat-free mass (FFM), and phase angle (PhA), a marker of cell membrane integri...
BACKGROUND: Reduced muscle mass in patients with cirrhosis is linked to poor clinical outcomes. Bioimpedance analysis estimates fat mass (FM), fat-free mass (FFM), and phase angle (PhA), a marker of cell membrane integrity correlating with computed tomography-based muscle mass assessments. We hypothesized that PhA would remain stable after paracentesis. METHODS: Bioelectrical impedance was measured in patients with cirrhosis immediately before and after paracentesis using a 256-frequency bioimpedance spectroscopy device. We assessed median paired differences (with 95% confidence intervals) for FM, FFM, and PhA. Reduced muscle mass was diagnosed using PhA thresholds of 5.4 for women and 5.6 for men, based on previous cross-sectional validation against skeletal muscle index. RESULTS: The study included 32 participants with median age of 60 (IQR: 55-67), 60% male, median model for end stage liver disease Na (MELD-Na) score of 18 (IQR: 14-21), and median paracentesis volume of 6 liters (loss of 5.7 kg). At baseline, 97% had reduced muscle mass based on PhA thresholds. Significant differences were observed between pre-paracentesis and post-paracentesis measurements for FM and FFM (P < 0.05). PhA remained stable (P = 0.208), with a slight nonsignificant increase of 0.1° from pre-paracentesis to post-paracentesis. Sensitivity analysis showed change in reduced muscle mass diagnosis for only one participant. CONCLUSIONS: FM and FFM levels before and after paracentesis were significantly different, suggesting that these tests would not be accurate in patients with large fluid shifts. PhA measurements were not significantly affected by ascitic fluid shifts after paracentesis, suggesting that PhA may reliably monitor muscle mass in patients, regardless of ascites.
Global prevalence of short bowel syndrome-associated intestinal failure in adults and children: A targeted literature review and analysis.
Khokhar B, Pathania V, Nazarey P … +1 more , Parihar N
Nutr Clin Pract · 2025 Oct · PMID 40407362 · Full text
Short bowel syndrome-associated intestinal failure (SBS-IF) is a rare disease caused by loss of function of the intestinal surface area and the subsequent inability to maintain nutrient and fluid balance on a normal diet...
Short bowel syndrome-associated intestinal failure (SBS-IF) is a rare disease caused by loss of function of the intestinal surface area and the subsequent inability to maintain nutrient and fluid balance on a normal diet, which results in the need for parenteral nutrition (PN) and/or intravenous fluids. There is a scarcity of literature regarding the prevalence of SBS-IF and challenges in estimating prevalence. A targeted literature review was conducted to generate prevalence estimates for SBS-IF, primarily defined by the requirement for home PN (HPN), in adults and children across multiple geographies. Country-specific estimates of HPN prevalence and the proportion of HPN cases associated with SBS were obtained from the literature and used to inform SBS-IF prevalence estimates. Adults were defined as those aged ≥18 years and children as those aged 0-17 years, except in Japan, where adults were those aged ≥15 years and children were aged 0-14 years. In total, 15 studies were included and were used to estimate and extrapolate prevalence across 61 countries for the years 2020-2030. The estimated prevalences of diagnosed SBS-IF in the general population in 2024 ranged from 0.12 to 2.74 per 100,000 in adults and 0.09 to 1.67 per 100,000 in children. Prevalence estimates were generally lower in countries with a lower average income. This study provides up-to-date insights into the overall global and country-by-country prevalence of SBS-IF and in defined cohorts of adults and children, addressing important gaps in the current literature.
Quality-of-life changes and influencing factors among patients receiving home enteral nutrition: A longitudinal study.
Chen C, Liu M, Liu S … +2 more , Yang Y, Wang X
Nutr Clin Pract · 2026 Feb · PMID 40392619 · Publisher ↗
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,...
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.
Growing with and within ASPEN: A dietitian's unique group perspective.
Ireton-Jones C, Schwartz DB
Nutr Clin Pract · 2025 Aug · PMID 40384549 · Publisher ↗
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Malnutrition risk in older adults with cancer: A prospective cross-sectional study in one setting.
Değirmenci Aktaş E, Aytulu T, Yildirim D
Nutr Clin Pract · 2025 Oct · PMID 40372080 · Publisher ↗
BACKGROUND: This descriptive and cross-sectional study evaluated the nutrition status of geriatric patients with cancer undergoing chemotherapy. METHODS: Data were collected by researchers in the Medical Oncology Unit of...
BACKGROUND: This descriptive and cross-sectional study evaluated the nutrition status of geriatric patients with cancer undergoing chemotherapy. METHODS: Data were collected by researchers in the Medical Oncology Unit of a university hospital between January and September 2024 to assess the nutrition status of 100 geriatric patients with cancer undergoing chemotherapy. Malnutrition risk was evaluated using the Mini Nutritional Assessment (MNA). RESULTS: The mean ± SD age of the study participants was 72.03 ± 5.40 years. The study found that 21% of the patients were undergoing treatment for colon cancer, 20% for lung cancer, and 16% for pancreatic cancer. Most patients were diagnosed at advanced stages, with 28% at stage III and 65% at stage IV. The nutrition risk assessment of the patients found that 34% had a normal MNA score (24-30 points), 30% were at risk of malnutrition (17-23.5 points), and 36% were malnourished (<17 points). The following symptoms affecting nutrition were observed: nausea and vomiting (39%), taste changes (24%), weakness and fatigue (73%), pain (5%), and weight loss (27%). The most commonly used type of chemotherapy was FOLFOX (folinic acid, 5-fluorouracil and oxaliplatin, 18%). CONCLUSION: Malnutrition was very common in geriatric patients with cancer undergoing chemotherapy. Therefore, it is crucial for healthcare professionals, particularly dietitians and nutritionists, to diagnose and manage malnutrition risk early and effectively.
Moderating role of skeletal bone age and sex in the association between phase angle with muscular strength and aerobic fitness among HIV-infected children and adolescents: A prospective cross-sectional study.
Martins PC, de Lima LRA, Pelegrini A … +2 more , Moreno YMF, Silva DAS
Nutr Clin Pract · 2026 Feb · PMID 40365877 · Publisher ↗
BACKGROUND: The aim of this study was to explore whether skeletal bone age (biological maturation marker) and sex moderate the association between the phase angle with muscular strength and aerobic fitness in children an...
BACKGROUND: The aim of this study was to explore whether skeletal bone age (biological maturation marker) and sex moderate the association between the phase angle with muscular strength and aerobic fitness in children and adolescents with diagnosed with HIV. METHODS: The sample consisted of 62 children and adolescents (aged 8-15 years) diagnosed with HIV. The phase angle was determined using bioelectrical impedance analysis. Muscular strength was assessed by handgrip strength, and aerobic fitness was assessed by an incremental test on a cycle ergometer. Skeletal bone age and sex were determined through hand and wrist x-rays (Greulich-Pyle method) and a questionnaire, respectively. Both simple and multiple linear regression models were performed, and moderation models with P ≥ 0.05 were constructed. RESULTS: Among male children and adolescents with both normal and early skeletal bone age, muscular strength directly impacted phase angle values (b = 0.0197, P = 0.0001; b = 0.0286, P < 0.0001, respectively). However, for female children and adolescents, regardless of skeletal bone age, muscular strength did not influence the phase angle. In male children and adolescents with both normal and early skeletal bone age, aerobic fitness directly influenced the phase angle (b = 0.0007, P = 0.0001; b = 0.011, P = 0.0001, respectively). Similarly, in female children and adolescents with early skeletal bone age, aerobic fitness directly impacted the phase angle (b = 0.0006, P = 0.0282). CONCLUSION: Skeletal bone age and sex moderated the relationship between phase angle and both muscular strength and aerobic fitness, especially in children and adolescents with normal and early skeletal bone age, and predominantly in boys.
Assessing mortality and malnutrition using calf circumference adjusted for body mass index and edema as muscle mass reduction indicators within the Global Leadership Initiative on Malnutrition criteria: A retrospective study.
Ishida Y, Maeda K, Shimizu A … +7 more , Ueshima J, Nagano A, Inoue T, Kawamura K, Sakaguchi T, Murotani K, Mori N
Nutr Clin Pract · 2026 Feb · PMID 40365868 · Publisher ↗
BACKGROUND: Although calf circumference (CC) may be used to distinguish body composition, methods applying adjustment coefficients based on body mass index (BMI) and edema have been reported. This study evaluated whether...
BACKGROUND: Although calf circumference (CC) may be used to distinguish body composition, methods applying adjustment coefficients based on body mass index (BMI) and edema have been reported. This study evaluated whether malnutrition assessed using BMI- and edema-adjusted CC predicts mortality in hospitalized adult patients compared with unadjusted CC across cutoff values. METHODS: This retrospective cohort study used the medical records of patients aged ≥18 years hospitalized between December 2017 and March 2022 and at risk for nutrition disorders through nutrition screening. Low muscle mass was defined using CC cutoff values of 34-30 cm for men and 33-29 cm for women. RESULTS: The data of 11,606 patients were analyzed. The mean age was 71.2 ± 16.3 years, and 5949 patients (51.3%) were women. No significant difference was observed compared with the unadjusted state, regardless of sex, cutoff value, or adjustment method (male: unadjusted hazard ratio [HR]: 2.13 to 2.30 vs adjusted HR: 2.11 to 2.36; memale: unadjusted HR 1.75: to 2.59 vs adjusted HR: 1.75 to 3.00). Furthermore, even when edema was adjusted, no significant difference was observed in the HR for mortality compared with the unadjusted state, regardless of sex, cutoff value, or adjustment method (male: unadjusted HR: 2.13 to 2.30 vs adjusted HR: 2.23 to 2.52; female: unadjusted HR: 1.75 to 2.59 vs adjusted HR: 2.02 to 3.57). CONCLUSION: When assessing low muscle mass using lower CC, we found that adjusting for BMI and edema did not result in a significant mortality difference compared with unadjusted actual measurements.
Diet, nutraceuticals, and lifestyle interventions for the treatment and management of irritable bowel syndrome.
Memel ZN, Shah ND, Beck KR
Nutr Clin Pract · 2025 Oct · PMID 40346863 · Publisher ↗
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 freq...
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.
Current treatment options for adult patients with short bowel syndrome: Do prebiotics, probiotics, and synbiotics play a role?
Reznik E, Newberry C
Nutr Clin Pract · 2025 Oct · PMID 40344579 · Publisher ↗
Short bowel syndrome (SBS) is a malabsorptive disorder characterized by reduced small intestinal length that results in nutrient deficiencies. Most commonly in adults, it occurs in the setting of surgical bowel resection...
Short bowel syndrome (SBS) is a malabsorptive disorder characterized by reduced small intestinal length that results in nutrient deficiencies. Most commonly in adults, it occurs in the setting of surgical bowel resection related to trauma, infarction, or inflammatory bowel disease. Management principles include optimizing nutrition and hydration status via parenteral nutrition and oral diet and utilizing antisecretory, antimotility, and enterohormone agents to enhance intestinal absorption, facilitate intestinal adaptation, and reduce stool output. Other therapeutics include antibiotics to treat small intestinal bacterial overgrowth (SIBO) and microbial dysbiosis. Considering limitations to antibiotic use, in addition to a greater understanding of the nuances of the microbiome in digestive health regulation, there is also burgeoning interest in the role of prebiotics, probiotics, and synbiotics in SBS management. This review highlights current management principles of SBS with a broader discussion of clinical indications and safety considerations for use of prebiotics, probiotics, and synbiotics in this population. Although current research is in its infancy, prebiotics, probiotics, and synbiotics may represent a viable future therapeutic option in the management of this complex disorder, with further studies needed to define definitive regimens and update guidelines.
Development of dietetic staffing requirements for adult intestinal failure services using a best-practice model.
Carey S, Chapman B, Osland E
Nutr Clin Pract · 2025 Oct · PMID 40343384 · Full text
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....
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.
Comparison between the NUTRIC score and modified NUTRIC score to predict hospital mortality in patients undergoing cardiac surgery: A retrospective study.
Xu J, Luo D, Chi R … +6 more , Deng J, Fang H, Wu Q, Xu W, Huang J, Chen C
Nutr Clin Pract · 2026 Feb · PMID 40324924 · Full text
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 spe...
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.
Bowel regimen medication use and its effect on bowel movements in a pediatric intensive care unit: A retrospective study.
Messele E, Hickey S, Hamilton S … +5 more , Akhondi-Asl A, Walton T, Kuriakose T, Mehta NM, Martinez EE
Nutr Clin Pract · 2025 Aug · PMID 40317774 · Publisher ↗
BACKGROUND: Constipation affects up to 50% of critically ill children and is associated with poor clinical outcomes. The best approach to promote bowel movements in critically ill children is not known. METHODS: We perfo...
BACKGROUND: Constipation affects up to 50% of critically ill children and is associated with poor clinical outcomes. The best approach to promote bowel movements in critically ill children is not known. METHODS: We performed a retrospective study including children admitted for >24 h to an intensive care unit who received enteral nutrition (EN). Demographic and clinical characteristics, ordered and administered bowel regimen medications (categorized into enteral softener/osmotic, enteral/intravenous stimulant agents, and rectal softener/osmotic agents), and number of bowel movements were collected for the first 4 days of EN. A multistate model analysis, controlling for severity of illness, assessed the probability of having a bowel movement based on exposure to the categories of medications. RESULTS: We included 121 patients, median age 53 months (<1 month, 118 months) and 45% female. A medication was ordered for 77 of 121 (64%) patients and administered in 59 of 77 (77%). Enteral softener/osmotic agents were ordered in 64%-90% and rectal agents in 38%-56% of instances. The multistate model analysis identified a greater probability of having a bowel movement after receiving a rectal agent for 1 or 2 days compared with other agents. The most common reason for an ordered medication not being administered was an "as needed" order status. CONCLUSION: Rectal agents, the least ordered/administered medication category, were the most effective. Ordering medications in an "as needed" order status reduced the rate of administration. These findings suggest practical changes that may improve the prevention and management of constipation in pediatric critical illness.
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