Nutrition In Clinical Practice[JOURNAL]
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200 papers
Mechanical complications after central venous catheter repair: A case series.
O'Daniel EL, Hoch R, Carey AN … +1 more , Modi BP
Nutr Clin Pract · 2026 Mar · PMID 41765765 · Publisher ↗
Repair is an established method of line salvage and treatment for mechanical complications of the external component of long-term tunneled central venous catheters (CVCs). In this Clinical Observations article, the endol...
Repair is an established method of line salvage and treatment for mechanical complications of the external component of long-term tunneled central venous catheters (CVCs). In this Clinical Observations article, the endoluminal metal stent of the repair segment was found to be dislodged and migrated toward the patient, representing a risk for CVC malfunction and embolization into the patient, thus requiring CVC replacement. All four patients required long-term parenteral nutrition for intestinal failure. In two cases, the stent migration was noticed by the caregiver, whereas the other two were discovered after the line was removed. Dislodgment of the metal stent used in CVC repair kits is a rare, although potentially dangerous, complication. Providers caring for patients with long-term tunneled CVCs should be aware of this potential risk.
Surgical reconstruction in a 100-year-old patient with short bowel syndrome under palliative care: A case report.
da Silva PAP, de Carvalho Machado J, Cecato VC … +2 more , Ramos RF, Wischmeyer PE
Nutr Clin Pract · 2026 Mar · PMID 41765762 · Publisher ↗
We present the case of a 99-year-old woman who developed functional short bowel syndrome after an emergency laparotomy for mesenteric ischemia. Her initial management was palliative care because of hemodynamic instabilit...
We present the case of a 99-year-old woman who developed functional short bowel syndrome after an emergency laparotomy for mesenteric ischemia. Her initial management was palliative care because of hemodynamic instability and subsequently because of advanced age. Following 3 months of recurrent infections and 30% weight loss, her dependence on intravenous hydration and her declining quality of life led to a reassessment of treatment goals. Ultimately, she underwent successful intestinal reconstruction with a side-to-side jejuno-jejunal anastomosis after reaching 100 years of age during the preoperative period. She achieved independence from intravenous nutrition and recovered her desired quality of life. This case highlights the dynamic, multidisciplinary approach required for such patients and the need for continuous reassessment of therapeutic plans, even for frail nonagenarians or centenarians.
Improving enteral nutrition in patients requiring neurological intensive care unit care: A retrospective study on a novel bedside nasointestinal tube placement technique.
Niuchenglin, Liujuan, Zhushuibing … +3 more , Dingyuanliang, Yutianhao, Shiguangling
Nutr Clin Pract · 2026 Feb · PMID 41761721 · Publisher ↗
BACKGROUND: This study aimed to develop and assess a bedside nasojejunal tube placement technique designed for resource-limited settings to address the specific challenges of enteral nutrition (EN) delivery in neurocriti...
BACKGROUND: This study aimed to develop and assess a bedside nasojejunal tube placement technique designed for resource-limited settings to address the specific challenges of enteral nutrition (EN) delivery in neurocritical care patients, particularly those at high risk of reflux and aspiration. The technique sought to overcome the drawbacks of conventional placement methods that depend on specialized equipment or are time-consuming, thereby improving accessibility in constrained healthcare environments. METHODS: A simplified nasojejunal tube placement method not requiring specialized equipment was implemented. Fifty-six neurocritically ill patients were enrolled, and outcomes-including success rate, placement time, operator variability, and adverse events-were evaluated. Minor adverse events were managed using standard care protocols. RESULTS: The technique achieved a 91.07% success rate, with a mean placement time of 21.27 min (range, 10-30 min). Comparative analysis showed minimal interoperator variability, with no significant differences in placement time (P = 0.667) or number of attempts (P = 0.644), confirming the method's reproducibility and ease of learning. No severe complications occurred, and minor events such as nasal mucosal bleeding were effectively managed. General adverse events were observed in 32.14% of cases with no long-term complications. CONCLUSION: The bedside nasojejunal tube placement technique is a safe, practical, and cost-effective approach for optimizing EN delivery in neurocritical care patients. By simplifying the procedure and eliminating the need for specialized equipment, this method enhances clinical efficiency and feasibility in resource-limited settings. Its high success rate and adaptability support its potential for broader clinical implementation.
Pilot trial: 8.4% sodium bicarbonate locks for infection prevention in pediatric intestinal failure.
Davis MBH, Smelser A, Rahhal R
Nutr Clin Pract · 2026 Feb · PMID 41741971 · Publisher ↗
BACKGROUND: Pediatric patients with intestinal failure (IF) require long-term central vascular catheters (CVCs) for parenteral nutrition, placing them at high risk for catheter-related bloodstream infections (CRBSIs). So...
BACKGROUND: Pediatric patients with intestinal failure (IF) require long-term central vascular catheters (CVCs) for parenteral nutrition, placing them at high risk for catheter-related bloodstream infections (CRBSIs). Sodium bicarbonate (NaHCO₃) locks have shown potential in reducing CRBSIs in adult populations, but data in pediatric patients with IF remain limited. METHODS: We conducted an open-label prospective cohort study at a tertiary medical center to evaluate the impact of 8.4% NaHCO₃ locks on CRBSI and CVC replacement rates in pediatric patients with IF (ClinicalTrials.gov NCT05927484). The baseline period (heparin locks) was assessed retrospectively, whereas the intervention period (NaHCO₃ locks) was evaluated prospectively. Primary outcome was CRBSI rate; secondary outcomes included CVC replacement because of CRBSI and infection-related hospitalizations. RESULTS: In the per‑protocol analysis, six patients contributed 5733 total catheter days (3244 on heparin, 2489 on NaHCO₃). CRBSI rates decreased from a median of 8.2 to 3.0 per 1000 catheter days after switching to NaHCO₃ locks (P = 0.11). A similar downward trend was observed in the intent‑to‑treat analysis. A statistically significant reduction in CVC replacement because of CRBSI was observed (2.3 vs 0 per 1000 catheter days; P = 0.03). Trends toward reduced hospital and intensive care unit admissions were also noted in the intervention group. No serious adverse events were attributed to NaHCO₃ lock use. CONCLUSION: NaHCO₃ locks appear to be a safe and promising strategy for reducing CRBSI-related complications in pediatric patients with IF, especially where access to more effective lock solutions is limited. Larger prospective studies are needed to confirm these findings.
Nutrition interventions and post-intensive care syndrome: A narrative review.
Dupuis C, Preiser JC, Busch RA … +2 more , Coursin DB, Long MT
Nutr Clin Pract · 2026 Apr · PMID 41731734 · Publisher ↗
Growing attention has been directed toward the long-term consequences of critical illness, particularly the physical, cognitive, and psychological impairments following intensive care unit (ICU) discharge. At the core of...
Growing attention has been directed toward the long-term consequences of critical illness, particularly the physical, cognitive, and psychological impairments following intensive care unit (ICU) discharge. At the core of the physical domain lies ICU-acquired weakness (ICU-AW). ICU-AW is driven by systemic inflammation, prolonged catabolism, malnutrition, and immobility. The resultant sustained muscle loss significantly impairs recovery and causes loss of independence, reduced quality of life, and increased mortality. Malnutrition-either preexisting or acquired in the ICU-is a major determinant of recovery, yet nutrition management remains challenging because of the risks of both overfeeding and underfeeding. Compounding this is the lack of robust biomarkers to guide individualized nutrition strategies. Current evidence supports illness phase-specific, personalized nutrition, starting with hypocaloric feeding during the acute phase of critical illness and progressing to higher-energy, protein-rich support during recovery. Recent studies caution against excessive early protein provision, which may suppress autophagy and induce metabolic stress. Monitoring tools such as indirect calorimetry and body composition analysis may guide tailored interventions. Additionally, immunonutrients, anabolic agents, and early rehabilitation show promise as adjunctive strategies, although further high-quality trials are needed to define their role and risk-to-benefit ratio. This narrative review examines the pathophysiology of muscle wasting during critical illness; reviews recent data addressing the central role of nutrition in modulating outcomes, including post-intensive care syndrome; and reviews recent developments that are improving our understanding of nutrition, biomarkers, and individualized nutrition and nutrition adjuncts.
Lean mass loss in the intensive care unit and its restoration: A narrative review.
Weimann A, Edel A, Lücke L … +2 more , Stoppe C, Kreymann KG
Nutr Clin Pract · 2026 Apr · PMID 41731719 · Publisher ↗
The preservation of lean mass (LM) and its restoration following catabolic loss represents a primary challenge for clinical nutrition in critically ill patients. A comprehensive review of recent literature confirms a cli...
The preservation of lean mass (LM) and its restoration following catabolic loss represents a primary challenge for clinical nutrition in critically ill patients. A comprehensive review of recent literature confirms a clinical dilemma between unresponsiveness for feeding and harm of overfeeding and underfeeding. Time point-specific assessment and monitoring of body composition-via computed tomography, bioelectrical impedance analysis (BIA), and ultrasound-are recommended to become an integral part of daily care for all intensive care unit (ICU) patients. Currently, serial BIA for measuring fat-free mass appears to be the most feasible and promising method. Energy and protein supply throughout the phases of critical illness should be guided by sex-specific fat-free mass rather than total body weight, reinforcing the value of indirect calorimetry. Given the prevalence of post-intensive care syndrome, nutrition therapy and monitoring must continue into the post-ICU period. Combined strategies-rather than isolated interventions-provide the most plausible framework to support LM recovery during ICU care and throughout post-ICU rehabilitation. Future approaches, supported by machine learning, will warrant the combined use of biomarkers and clinical variables to identify anabolic resistance and determine "readiness for feeding." Further research is needed to elucidate the effects of micronutrient supplementation, ketogenic diets, and ω-3 fatty acids on muscle tissue, with a focus on mitochondrial function and anti-inflammation. The potential of orexigenic (eg, ghrelin) and anabolic (eg, nandrolone) hormones in the post-ICU phase warrants further investigation.
Facilitating interprofessional collaboration for effective care transitions of a patient with chronic obstructive pulmonary disease.
Edwards S, Kolcun K, Bochenek J … +7 more , Buatois E, Robinson M, Thomas E, Curtis M, Hechmer C, Taylor T, Thomas S
Nutr Clin Pract · 2026 Apr · PMID 41731644 · Full text
Transitions of care are the movement of a patient from one care setting or provider to another. Interprofessional collaboration is critical in ensuring patient safety and satisfactory health outcomes. Each time an interp...
Transitions of care are the movement of a patient from one care setting or provider to another. Interprofessional collaboration is critical in ensuring patient safety and satisfactory health outcomes. Each time an interprofessional team transfers a patient, the team performs three important roles: representing the patient, providing patient information for other team members, and coordinating the transition. Poor transitions of care may contribute to negative health outcomes, especially for patients with chronic health conditions, complex medication regimens, and high-risk treatments. We present a case study of a patient with complicated chronic obstructive pulmonary disease that depicts the importance of successful interprofessional collaboration during the transition of care from hospital to home illustrating the unique contributions of the various disciplines involved in the patient's care.
Interdisciplinary education for the clinician and consumer to enhance the home enteral nutrition experience: A narrative review.
Lord LM, McGinnis C, Reyen L … +1 more , Irving SY
Nutr Clin Pract · 2026 Apr · PMID 41723005 · Publisher ↗
The increasing use of home enteral nutrition (HEN) underscores the need for clinicians with the expertise to educate individuals, their families, and fellow healthcare professionals. Successful HEN education relies on in...
The increasing use of home enteral nutrition (HEN) underscores the need for clinicians with the expertise to educate individuals, their families, and fellow healthcare professionals. Successful HEN education relies on interdisciplinary collaboration and timely communication led by clinicians knowledgeable in nutrition support who can provide guidance and planning necessary for effective implementation. Well-designed HEN plans align with individual and family goals, respect cultural values, and address unique learning needs to provide a foundation for meaningful education that enhances the individual's health-related quality of life. HEN education entails selecting an appropriate enteral access device, providing clear guidance for its care, and generating nutrition prescriptions and administration strategies that are both safe and aligned with the individual's lifestyle and nutrition requirements. Comprehensive HEN education also encompasses detailed documentation, ongoing monitoring, and timely adjustments to the care plan as needed. Techniques for educating clinicians, individuals, and families along with practical, patient-specific approaches are presented.
Persistent inflammation, immunosuppression, and catabolic syndrome: A new look at a growing problem.
Scarlet S, Vanzant E, Bible L … +1 more , Rosenthal M
Nutr Clin Pract · 2026 Apr · PMID 41703962 · Publisher ↗
Nutrition support among critically ill patients in the intensive care unit remains a cornerstone to standard-of-care strategies. Clinicians rely on a robust body of literature, societal guidelines and recommendations, ev...
Nutrition support among critically ill patients in the intensive care unit remains a cornerstone to standard-of-care strategies. Clinicians rely on a robust body of literature, societal guidelines and recommendations, evidence-based protocols, and more to aid in the appropriate delivery of nutrients to this patient population. Among critically ill patients, there is a growing population of patients with smoldering multiorgan dysfunction (MOD) known as persistent inflammation, immunosuppression, and catabolic syndrome (PICS-1). The growth of this patient population is likely related not only to increasing awareness of chronic critically ill patients but also has evolved as intensive care management has improved following the development of bundles, protocols, evidence-based practice, and multidisciplinary care teams. PICS-1 is being recognized more frequently as these patients have survived and can be salvaged from MOD. Unfortunately, there is no evidence regarding nutrition support for these patients (other than inferences from other bodies of literature). This review will serve to describe the origins, a brief epidemiologic discussion, and potential nutrition supplements that may impact the clinical outcomes of PICS-1.
Energy goal documentation and early initiation of enteral nutrition in critically ill children: A retrospective evaluation of a quality improvement project.
Parikh S, Zhang L, Pan AY … +3 more , Tobert K, Wakeham M, Mikhailov TA
Nutr Clin Pract · 2026 Feb · PMID 41691446 · Publisher ↗
BACKGROUND: Early documentation of energy goals has been associated with better nutrition outcomes. We performed a successful project improving the rate of early documentation of energy goals from 30% to 97%. We then con...
BACKGROUND: Early documentation of energy goals has been associated with better nutrition outcomes. We performed a successful project improving the rate of early documentation of energy goals from 30% to 97%. We then conducted a retrospective study of children admitted to the pediatric intensive care unit (PICU) the year before and after intervention to determine whether we improved initiation and delivery of nutrition. MATERIALS AND METHODS: We identified patients with PICU length of stay (LOS) of at least 48 h from Virtual Pediatrics Systems, LLC (VPS) from May 2020 to April 2022. We obtained clinical, demographic, and nutrition data for the first 96 h of admission from the electronic medical record and VPS. We defined early enteral nutrition (EEN) as delivery of 25% of goal calories within 48 h of admission. We analyzed data using Mann-Whitney test for continuous variables and chi-square test for categorical variables and multivariable regression analyses. RESULTS: A total of 1510 patients were included (702 preintervention, 808 postintervention). Median ICU LOS (4.05 vs 3.64 days; P = 0.030) and hospital LOS (8.25 vs 6.99 days; P = 0.009) were significantly reduced. EEN was significantly more likely to be initiated in the postintervention group than in the preintervention group (P < 0.0001), adjusted for age, sex, race, ethnicity, Pediatric Index of Mortality 3 (PIM3) score, and documentation of energy goal. CONCLUSION: Energy goal documentation improved EEN initiation and demonstrated shorter LOS in multivariable analysis. Findings highlight need for standardized documentation, greater dietitian involvement, and further study of how nutrition planning affects outcomes in critically ill children.
Clinician insights into pediatric temporary feeding tube management: Unseen barriers, unclear roles revealed from a prospective mixed methods study.
Reilly C, Packer R, Marshall J … +2 more , Thapar N, Foley J
Nutr Clin Pract · 2026 Feb · PMID 41674217 · Publisher ↗
BACKGROUND: Temporary feeding tubes are common in pediatric healthcare, but research on understanding how clinicians manage their use and understand the impact on families is limited. Existing research often overlooks cl...
BACKGROUND: Temporary feeding tubes are common in pediatric healthcare, but research on understanding how clinicians manage their use and understand the impact on families is limited. Existing research often overlooks clinician perspectives despite tensions between clinical priorities and family needs. This study aimed to understand clinicians' insights into temporary pediatric feeding tube management, focusing on communication, decision-making, and family-centered practice. METHODS: Using a mixed-methods design, this study integrated quantitative survey data from multidisciplinary clinicians at a leading teaching hospital with qualitative insights from in-depth interviews. Analysis involved descriptive statistics for survey data and reflexive thematic analysis for interviews, as well as a comprehensive synthesis of data. RESULTS: Survey data from 112 multidisciplinary clinicians (54% response rate) and interviews with 12 clinicians revealed tensions between clinical intentions and available resources. Qualitative themes highlighted role ambiguity across disciplines, multilevel systemic barriers, an expanding awareness of comprehensive family burdens, and how clinician perceptions can potentially shape family experiences with temporary feeding tubes. These findings underscore the complexities of navigating temporary feeding tube management within the existing healthcare system. CONCLUSION: This study describes how clinicians navigate temporary feeding tube management within complex healthcare environments, drawing on collaborative expertise while working with limited standardized guidance. Findings reveal evidence-practice gaps, role ambiguities, and system constraints that limit clinicians' ability to provide family-centered care. Addressing these challenges necessitates structured tools, training, and systemic reform to better support clinicians in delivering family-centered management.
Impact of a low-carbohydrate diet on cardiometabolic parameters in individuals with and without diabetes: An 8-year longitudinal study within the ELSA-Brasil cohort.
de Azevedo LB, Martins HX, Enriquez-Martinez OG … +1 more , Molina MDCB
Nutr Clin Pract · 2026 Feb · PMID 41652669 · Publisher ↗
BACKGROUND: Low-carbohydrate diets (LCDs) are widely adopted for metabolic management, but their long-term cardiometabolic effects in diverse populations remain unclear. We aimed to evaluate the association between self-...
BACKGROUND: Low-carbohydrate diets (LCDs) are widely adopted for metabolic management, but their long-term cardiometabolic effects in diverse populations remain unclear. We aimed to evaluate the association between self-selected moderate LCD adherence and cardiometabolic parameters in individuals with and without diabetes. METHODS: This prospective cohort study included 9658 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil; baseline: 2008-2010; follow-up: 2017-2019). LCD adherence (carbohydrate <45% of total energy) was assessed through validated food frequency questionnaires. Quantile regression models, adjusted for sociodemographic, lifestyle, and clinical factors, were used to analyze changes in body mass index (BMI), blood pressure, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) and beta cell function (HOMA-B). RESULTS: Among individuals without diabetes, those who followed an LCD only at the follow-up showed decreased insulin levels (β = -0.33 [95% CI, -0.6 to -0.1] μIU/ml), HOMA-IR (-0.11 [-0.2 to -0.1] μIU/ml), and HOMA-B (-4.95 [-7.2 to -2.1] μIU/ml) alongside modest BMI increases (0.16 [0.1-0.3]). Consistent LCD adherents (at both time points) showed a decrease in HOMA-B (-3.21 [-6.4 to -0.1] μIU/ml) and an increase in BMI (0.29 [0.2-0.4]). In individuals with diabetes, LCD adherence led to reduced HOMA-IR (-1.25 [-2.2 to -0.3] μIU/ml) and insulin levels (-3.61 [-6.0 to -1.2] μIU/ml). CONCLUSION: Moderate LCD adherence improved insulin sensitivity and reduced pancreatic demand in individuals without diabetes. Despite slight BMI increases, LCD may be a feasible dietary strategy for metabolic risk management in middle-aged and older adults. Personalized nutrition approaches are recommended to optimize outcomes.
Addressing the distressing: Pancreatic enzyme replacement therapy mitigates abdominal symptoms and weight loss during chemotherapy for advanced pancreatic cancer: A prospective study.
Klassen PN, Kim CA, Kasnik J … +4 more , Sawyer MB, Ghosh S, Baracos V, Mazurak VC
Nutr Clin Pract · 2026 Feb · PMID 41652656 · Publisher ↗
BACKGROUND: Pancreatic enzyme insufficiency (PEI) contributes to symptom burden and malnutrition in advanced pancreatic cancer (aPC). We aimed to evaluate the impact of pancreatic enzyme replacement therapy (PERT) on sym...
BACKGROUND: Pancreatic enzyme insufficiency (PEI) contributes to symptom burden and malnutrition in advanced pancreatic cancer (aPC). We aimed to evaluate the impact of pancreatic enzyme replacement therapy (PERT) on symptom burden and weight during chemotherapy. METHODS: Patients with aPC who were referred to a dietitian for suspected PEI at the Cross Cancer Institute (Edmonton, Canada) were enrolled. Baseline (BL) PEI symptoms were evaluated prior to PERT initiation; dose was optimized by 1 month. PEI symptom severity was assessed with the Pancreatic Enzyme Insufficiency Questionnaire (PEI-Q) at BL, reassessed after 1 and 3 months, and compared between BL and first reassessment. Mean weight change from BL to 1 month (percentage per 30 days) was compared with change from 1 to 3 months. Continuous and categorical variables were compared using paired samples t tests and McNemar test, respectively. RESULTS: Of 29 patients enrolled, 23 initiated PERT and completed ≥1 symptom reassessment. Median reported PERT dose at reassessment was 200,000 USP lipase units/day (IQR 97,200, 300,000). Improvements in mean severity scores for stomach pain (P = 0.001) bloating (P = 0.049) and stomach noises (P = 0.032) were reported at reassessment, with a trend toward improved appetite (P = 0.053). Prevalence of moderate/severe PEI decreased (11/23 vs 4/23, P = 0.020). Weight loss slowed after 1 month (-4.3 ± 4.8%/30 days [BL to 1 month] vs -0.2 ± 3.9%/30 days, P = 0.033). CONCLUSION: Patients receiving dietitian-directed PERT showed improved abdominal symptoms and attenuated weight loss after dose optimization, addressing a patient priority for those with aPC.
Beyond the intensive care unit: Nutrition challenges and key considerations for survivors of critical illness: A narrative review.
Osagiede LE, Tatucu-Babet OA, Bear DE … +5 more , Chapple LS, Freeman-Sanderson A, Marshall AP, Viner Smith E, Ridley EJ
Nutr Clin Pract · 2026 Apr · PMID 41652654 · Publisher ↗
Suboptimal nutrition provision has been observed during and after the intensive care unit (ICU) stay. Reasons for suboptimal nutrition provision are due to various barriers to intake found across hospitalization and afte...
Suboptimal nutrition provision has been observed during and after the intensive care unit (ICU) stay. Reasons for suboptimal nutrition provision are due to various barriers to intake found across hospitalization and after discharge home. The aim of this narrative review is to provide an overview of the nutrition challenges faced by patients after ICU discharge and in the home, as well as provide suggestions to promote recovery for survivors. Key areas to consider include the role of the patient, caregiver and clinician education, nutrition impact symptoms, the role of communication, and the use of multimodal interventions. Nutrition interventions may be of greatest benefit with longer-term optimization, identifying strategies to overcome barriers and the importance of transition periods as well as a clear follow-up plan.
Dietitian-led very low-calorie diet for preoperative rehabilitation in patients with obesity awaiting non-bariatric elective laparoscopic surgery: A retrospective study.
Wong GWS, Guo C, French CM … +2 more , Bell JJ, Ross LJ
Nutr Clin Pract · 2026 Jun · PMID 41632466 · Full text
BACKGROUND: Obesity increases the risks and complexity of laparoscopic surgeries. Preoperative very low-calorie diets (VLCDs) can demonstrate significant preoperative weight loss. However, the optimal VLCD duration remai...
BACKGROUND: Obesity increases the risks and complexity of laparoscopic surgeries. Preoperative very low-calorie diets (VLCDs) can demonstrate significant preoperative weight loss. However, the optimal VLCD duration remains unclear. Excessive loss of muscle mass associated with VLCDs may elevate surgical and postoperative risks. This study aimed to assess the impact of a dietitian-led preoperative VLCD intervention on changes in weight, muscle, and fat mass and to examine their relationships with intervention duration and surgical time. METHODS: A retrospective chart review of patients attending a dietitian-led VLCD outpatient clinic for 1-8 weeks. Primary outcomes were changes in weight, muscle and fat mass, and their relationships with VLCD duration. Associations between preoperative fat mass and operative time for cholecystectomies and hernia repairs were explored using a general linear model. RESULTS: One hundred fifty-seven participants (97 female; mean body mass index, 39.2) achieved significant weight reduction (6.4 kg, P < 0.001). Muscle mass accounted for 28.5% of mean weight loss and fat mass for 68%, with an increased muscle to fat ratio (P < 0.001). VLCDs of >4 weeks showed greater median muscle mass loss (26.9% vs 8.8%). Operative time decreased by an estimated 0.61 min for every kilogram reduction in preoperative fat mass, after adjusting for surgical type (P < 0.001, adjusted R = 0.262). CONCLUSIONS: A dietitian-led preoperative VLCD intervention for 5-8 weeks can achieve clinically significant weight loss, primarily from fat mass. Exploratory analysis suggested lower preoperative fat mass may contribute to shorter surgical time, but further research is needed to control for other factors, such as complexity and surgeon experience.
Serum triglyceride to high-density lipoproteincholesterol ratio as an independent marker of frailty in older adults: A cross-sectional study.
Cataltepe E, Ceker E, Fadiloglu A … +4 more , Gungor F, Karakurt N, Ulger Z, Varan HD
Nutr Clin Pract · 2026 Jun · PMID 41632444 · Publisher ↗
BACKGROUND: The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio is a well-known marker of cardiometabolic risk and insulin resistance and has been linked to metabolic diseases and sarcopenia in olde...
BACKGROUND: The triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio is a well-known marker of cardiometabolic risk and insulin resistance and has been linked to metabolic diseases and sarcopenia in older adults, yet its association with frailty remains underexplored. Given the association of frailty with these conditions, our study aims to explore the previously unexamined link between TG/HDL-C and frailty. METHODS: This cross-sectional study analyzed 520 patients aged ≥65 years who underwent comprehensive geriatric assessments. Frailty was defined using the Fried Frailty Phenotype. Associations between TG/HDL-C and frailty were evaluated using multivariate logistic regression with adjustments for confounding variables. RESULTS: The mean age of the participants was 75.2 ± 6.4, with 62.1% (n = 323) being women and 20.2% (n = 105) classified as frail. Frail patients exhibited a higher TG/HDL-C ratio than the nonfrail group (P = 0.001). When the relationship between fat measurements and frailty was analyzed separately for men and women, the TG/HDL-C ratio was significantly higher in the frail group for both male and female patients (P < 0.05). Multivariate logistic regression analysis revealed that the TG/HDL-C ratio was significantly and independently associated with frailty even after adjusting for potential confounding factors (β = 1.30, 95% CI = 1.11-1.51, P = 0.001). The optimal TG/HDL-C cutoff for frailty was >2.82 (area under the curve = 0.608; negative predictive value = 89.7%). CONCLUSION: TG/HDL-C is significantly associated with frailty in older adults. Further research is needed to explore causal relationships and clinical implications.
Bridging the gap in nutrition assessment: Barriers and knowledge impact of an educational session on body composition and energy metabolism.
Orsso CE, Caretero A, Ghomashchi H … +15 more , Atkins M, Barbosa-Silva TG, Basualdo-Hammond C, Cardenas D, Chevalier S, Cristina Gonzalez M, Gramlich L, Jager-Wittenaar H, Kiss N, Purcell SA, Quintanilha M, Sidhu S, Tandon P, Tom M, Prado CM
Nutr Clin Pract · 2026 Jun · PMID 41626930 · Full text
BACKGROUND: Body composition and energy metabolism assessments are central to nutrition care but remain underused. This study evaluated dietitians' access, use, education, and beliefs toward these assessments, and the im...
BACKGROUND: Body composition and energy metabolism assessments are central to nutrition care but remain underused. This study evaluated dietitians' access, use, education, and beliefs toward these assessments, and the impact of an educational session. METHODS: Dietitians (≥1 year experience) within Alberta Health Services completed online surveys on their access, use, education, confidence, and clinical protocol awareness regarding body composition and energy metabolism assessments. Participants attended a 4-h virtual educational session on these topics, with presession and postsession knowledge recall compared using Wilcoxon signed rank test. RESULTS: We surveyed 36 participants (97% women), primarily from inpatient care (36%) or oncology (31%). Most (86%) never used body composition methods, despite access to computerized tomography (CT; 31%), ultrasound (US; 25%), bioelectrical impedance analysis (BIA; 6%), and dual-energy x-ray absorptiometry (DXA; 3%). Although 67% received body composition education (47% BIA, 31% DXA, 22% CT, 8% US), 64% lacked confidence. Protocol awareness was 67% for malnutrition and 8% for sarcopenia. Most never (58%) or occasionally (19%) used energy metabolism methods; Q-NRG (COSMED; 28%) and standard metabolic carts (19%) were the most available devices. Although 67% received energy metabolism education (53% metabolic cart, 31% Q-NRG), 50% were not confident in using these methods. After the educational session, body composition knowledge recall improved (median, +20% [IQR, 10-30]; P < 0.001), whereas energy metabolism scores were unchanged (P = 0.530). CONCLUSION: Despite prior education, dietitians used body composition and energy metabolism assessments inconsistently because of limited access, insufficient applied knowledge, lack of protocols, and low confidence. These results underscore the need to strengthen curriculum and professional development to support adoption.
Osmolality of fortified human milk with contemporary human milk fortifiers.
Gardiner A, Flores González I, Smith C … +3 more , Wessel J, Kim JH, Fu TT
Nutr Clin Pract · 2026 Jan · PMID 41608871 · Publisher ↗
BACKGROUND: Human milk fortification is critical to support preterm infant growth. Human milk fortifed to caloric densities above manufacturers' recommendations are often necessary to achieve adequate growth. Fortified m...
BACKGROUND: Human milk fortification is critical to support preterm infant growth. Human milk fortifed to caloric densities above manufacturers' recommendations are often necessary to achieve adequate growth. Fortified milk may be prepared 12-24 h before feeding, although practice variations exist. We investigated how human milk osmolality is affected by contemporary bovine and human milk-derived human milk fortifiers (HMFs) immediately and temporally for standard and higher-calorie recipes. METHODS: This study measured the osmolality of human milk fortified with four current HMFs across a range of caloric concentrations (22-30 kcal/oz) in fresh, previously frozen, and pasteurized human milk. Osmolality was tested at 0, 12, and 24 h after preparation, conducted in triplicate. Differences in initial osmolality were compared between fortifiers. Percentage change in osmolality at 12 vs 24 h was tested with mixed-effects linear regression to study the effect/interaction of time, fortifier, and caloric density. RESULTS: Initial osmolality was significantly different between manufacturers (range, 315-620 mOsm/kg across caloric densities). There was a median 0.3% (IQR, -0.8 to 1.5) difference in change in osmolality at 24 vs 12 h (P = 0.02). In mixed-effects modeling, there appeared to be an interaction between time and fortifier, but after post hoc adjustments, no pairwise comparisons remained significant. At 24 h, there was an interaction between fortifier and milk type (P = 0.003), with up to 4% greater change in osmolality with fresh vs frozen milk. CONCLUSION: Contemporary HMFs increase the osmolality of human milk to variable degrees, with some temporal effects observed, although clinical significance of these findings is unclear.
Sanitary risk in the handling of home-prepared enteral formulations: A cross-sectional assessment of microbiological contamination and food safety.
Fernandes MCP, Beux MR, Martins ECS … +4 more , Karbiak L, Medeiros CO, da Costa RL, Stangarlin-Fiori L
Nutr Clin Pract · 2026 Jan · PMID 41608845 · Publisher ↗
BACKGROUND: Studies show increased use of home enteral nutrition (HEN) owing to its benefits. However, knowledge about the sanitary risks of handling home-prepared formulas remains limited despite their high contaminatio...
BACKGROUND: Studies show increased use of home enteral nutrition (HEN) owing to its benefits. However, knowledge about the sanitary risks of handling home-prepared formulas remains limited despite their high contamination rates. This study aimed to assess the sanitary risks in the handling of home-prepared enteral formulations by analyzing contamination levels at different handling points and their relationship with food safety criteria. METHODS: This is an analytical cross-sectional study in 77 households of patients receiving HEN, with a collection of 268 samples from handling countertops, blenders, enteral feeding bottles, and handlers' hands. Microbiological analyses were performed for aerobic mesophilic, coagulase-positive Staphylococci and Escherichia coli (E coli). At the same time, compliance with food safety criteria was assessed using a validated checklist. RESULTS: Blenders showed the highest contamination, with greater aerobic mesophilic counts than enteral feeding bottles (P = 0.031), whereas handlers' hands had the highest coagulase-positive Staphylococci levels (P < 0.001). Preservation was adequate, but cleaning compliance was low (8.2%-17.3%). Inadequate cleaning of countertops was associated with higher E coli counts (P = 0.044), and poor cleaning of feeding bottles was linked to increased aerobic mesophilic counts (P = 0.019). Additionally, inadequate blender cleaning was associated with elevated levels of all analyzed microorganisms (P < 0.05). CONCLUSION: Cleaning failures were the main sanitary risk in HEN handling, with blenders and handlers' hands identified as key contamination points. Strengthening food safety practices is essential to ensure the benefits and safety of HEN.
From pills to plate: Anticholinergic burden and malnutrition in older adults across three nutrition assessment tools: A cross-sectional study.
Simsek H, Bozkus R, Oguz EO … +2 more , Ucar A, Naharcı MI
Nutr Clin Pract · 2026 Jun · PMID 41581008 · Publisher ↗
BACKGROUND: Increased anticholinergic cognitive burden (ACB) in the geriatric population has been identified as a predisposing factor for various adverse health outcomes, including malnutrition. This study aimed to asses...
BACKGROUND: Increased anticholinergic cognitive burden (ACB) in the geriatric population has been identified as a predisposing factor for various adverse health outcomes, including malnutrition. This study aimed to assess the association between ACB and malnutrition, which has previously only been demonstrated by screening tests, using the Global Leadership Initiative on Malnutrition (GLIM) as a diagnostic criterion and different nutrition assessment tools. METHODS: This cross-sectional study included adults aged ≥65 years who were admitted to the geriatric clinic of a tertiary hospital. Nutrition status was assessed using the Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening, and the GLIM criteria. ACB was calculated according to the ACB scale, and multimorbidity was assessed using the Charlson Comorbidity Index. RESULTS: A total of 629 patients (61.7% female, 77.9 ± 7.3 years) were included in the final analysis. According to different nutrition assessment tools, the prevalence of malnutrition ranged from 27.7% to 37.2%. According to all nutrition tools, the high ACB group (ACB ≥ 3) had a poor nutrition status compared with the reference (ACB:0). According to binary logistic regression analysis, ACB ≥ 3 status was a positive risk factor for malnutrition according to both MNA-SF (odds ratio [OR]: 2.61; 95% CI: 1.03-6.61) and GLIM criteria (OR: 2.38; 95% CI: 1.07-5.26). CONCLUSION: Higher ACB use (ACB ≥ 3) was a positive predictor of malnutrition according to both the GLIM diagnostic criteria and MNA-SF. Prescribing medications with anticholinergic properties in the geriatric population deserves more attention as a modifiable risk factor in the management of clinically detected malnutrition.
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