Nutrition In Clinical Practice[JOURNAL]
Sun
200 papers
Drink lemonade! Implementation of drinking 2 h before elective orthopedic surgery to reduce prolonged fasting.
Heijnen IMS, Dierselhuis EF, Frijlink MMS … +3 more , Musters SCW, Waal GJH, van Noort HHJ
Nutr Clin Pract · 2025 Dec · PMID 41089044 · Full text
BACKGROUND: Prolonged fasting before surgery remains common despite guidelines recommending liquid fasting for 2 h and solid fasting for 6 h preoperatively. Consuming carbohydrate-rich drinks until 2 h before surgery imp...
BACKGROUND: Prolonged fasting before surgery remains common despite guidelines recommending liquid fasting for 2 h and solid fasting for 6 h preoperatively. Consuming carbohydrate-rich drinks until 2 h before surgery improves patient well-being and reduces postoperative complications and insulin resistance. Given the persistence of implementation barriers, including logistical challenges and insufficient patient education, this study aimed to implement drinking up to 2 h before elective orthopedic surgery. METHODS: The Grol and Wensing implementation approached was followed in a before-after study conducted at a Dutch academic orthopedic ward (April 2023 to May 2024), after approval by the Scientific Ethical Committee. Current practices and barriers were assessed, and tailored strategies were developed using implementation theory and taxonomies to develop implementation strategies for the identified factors, followed by integration and evaluation. RESULTS: Implementation included dissemination, patient-oriented, organizational, educational, and risk prevention strategies. A total of 39 patients participated in the initial analysis and 48 patients participated in the evaluation. Preoperative fasting from liquids significantly reduced from 8:20 h (IQR: 4:42-12:19 h) to 4:38 h (IQR: 2:58-6:12) by informing patients about the importance of drinking up to 2 h before surgery and to 2:45 h (IQR: 2:21-3:26) by facilitating drinking lemonade after admission when surgery would start in ≥2 h. Patients' comfort improved regarding thirst, whereas no effect was found for other symptoms. Adverse events, including postponement of surgeries and pulmonary aspirations, during surgery did not occur while accepting >1 h of fasting at the start of surgery. CONCLUSIONS: Scalable implementation strategies for patient education on fasting and coordinated provision of lemonade reduced fasting duration among elective orthopedic patients.
Preimplementation of malnutrition screening in the context of outpatient memory care: A quality improvement project.
Sullivan AM, Burns JM, Sullivan DK … +3 more , Taylor MK, Mazzotti DR, Gibbs HD
Nutr Clin Pract · 2025 Dec · PMID 41076570 · Publisher ↗
BACKGROUND: Older adults with dementia are at heightened risk of malnutrition, but nutrition screening is an uncommon practice in this population. This study aimed to determine the feasibility of malnutrition screening a...
BACKGROUND: Older adults with dementia are at heightened risk of malnutrition, but nutrition screening is an uncommon practice in this population. This study aimed to determine the feasibility of malnutrition screening and to determine nutrition risk prevalence in an outpatient memory care clinic. METHODS: This quality improvement project used the eight-item Seniors in the Community: Risk Evaluation for Eating and Nutrition screener to determine nutrition risk. The Organizational Readiness to Change Assessment (ORCA) determined providers' views on readiness for change. RESULTS: During the 12-week trial, 15.3% of eligible memory care clinic patients were screened. Of these, 58.3% (n = 123) had high nutrition risk. Lack of staffing was the most significant barrier to completion of nutrition screening. Clinic staff responses on the ORCA indicated moderate agreement that screening among persons with dementia is evidence based (mean = 3.7 of 5; SD = 0.26) and strong agreement for evidence of organizational support (mean = 4.12 of 5; SD = 0.38). A majority of patients and/or caregivers reported nutrition screening was easy (n = 79 of 211) or extremely easy (n = 44 of 211). A total of 69 patients (33.7%) who completed the screener indicated interest in a nutrition consultation. The most common barriers to nutrition services reported by caregivers and/or patients were difficulty accessing the clinic and unwillingness to use nutrition services. CONCLUSIONS: This study detected barriers and facilitators to administering nutrition screening in a memory care clinic. These preliminary findings suggest further efforts to implement nutrition screening in outpatient memory care clinics are warranted.
Calf circumference as a screening tool for muscle mass in older adults of mixed ethnicities: Cutoff points based on dual-energy x-ray absorptiometry.
Graciano GF, Jansen AK, Dos Santos RR … +5 more , Soares TO, Malheiro OB, Rocha CDN, Cintra MTG, Bicalho MAC
Nutr Clin Pract · 2026 Jun · PMID 41059637 · Publisher ↗
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 muscl...
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.
The effects of a dietitian-supported multidisciplinary nutrition intervention on optimizing nutrition care in older patients with hip fracture and at nutrition risk-A quality improvement study.
Munk T, Beck AM, Møller CM … +6 more , Pudselykke FE, Mikkelsen GØH, Filtenborg HT, Pedersen TS, Alva-Jørgensen JP, Knudsen AW
Nutr Clin Pract · 2025 Dec · PMID 41059595 · Full text
INTRODUCTION: A 1-day cross-sectional study at our hospital found that only 22% of patients with hip fractures at nutrition risk met their energy and protein requirements during hospitalization. This study aimed to test...
INTRODUCTION: A 1-day cross-sectional study at our hospital found that only 22% of patients with hip fractures at nutrition risk met their energy and protein requirements during hospitalization. This study aimed to test whether closer collaboration between a clinical dietitian and ward staff, guided by the Model for Improvement, could optimize nutrition care for hospitalized older patients with hip fractures at nutrition risk. METHOD: A dietitian was embedded to facilitate staff-led enhancements in nutrition care at an orthopedic ward in from September to December 2024. Two Plan-Do-Study-Act cycles were implemented. Cycle 1 focused on nutrition documentation. Cycle 2 targeted nutrition intake. The primary outcome was the proportion of patients meeting individual energy and protein requirements (≥80%). Secondary process indicators were (1) ≥80% of patients screened using Nutrition Risk Screening 2002, and (2) ≥80% of at-risk patients with intake documented in the medical record. Preintervention data served as the baseline. RESULTS: The primary outcome was achieved, with 80% (8 of 10) of patients meeting both energy and protein requirements, a significant improvement from 22% (2 of 9) at baseline (P < 0.05). Documentation of nutrition risk increased from 10% (1 of 10) to 80% (8 of 10) (P < 0.01), and intake documentation improved from 30% (3 of 10) to 100% (10 of 10) (P < 0.01). CONCLUSION: This quality improvement study demonstrates that applying the Model for Improvement to integrate a clinical dietitian into ward practice strengthened interdisciplinary nutrition care and led to measurable gains in screening, documentation, and nutrition intake among older patients with hip fractures at nutrition risk.
Comparative analysis of the relationship of sarcopenia or sarcopenic obesity with functional impairment: A cross-sectional study.
Gomes FA, Nascimento SBD, Santos LS … +4 more , Mendes TSR, Santos RCBD, Lemos MCC, Pinho CPS
Nutr Clin Pract · 2026 Feb · PMID 41047529 · Full text
Growing evidence suggests that sarcopenic obesity (SO) may have a more pronounced effect on functionality compared with isolated sarcopenia, but research in this crucial area remains scarce. Therefore, this study aimed t...
Growing evidence suggests that sarcopenic obesity (SO) may have a more pronounced effect on functionality compared with isolated sarcopenia, but research in this crucial area remains scarce. Therefore, this study aimed to evaluate whether the combination of sarcopenia and obesity is associated with increased functional impairment in hospitalized older adults. This is a cross-sectional study involving hospitalized older patients. SO was defined as the simultaneous presence of obesity and sarcopenia. Obesity was determined based on a high body fat percentage obtained through bioelectrical impedance analysis, whereas both reduced muscle strength and mass identified sarcopenia. Functionality was evaluated using the Barthel Index and the gait speed test. Additional sociodemographic, clinical, nutrition, and behavioral data were assessed. A total of 176 patients were included in our study. The mean age was 69.8 ± 7.8 years. The frequency of sarcopenia was 37.5%, whereas SO was found in 17.6%. Barthel Index indicated that 64.2% of patients exhibited functional dependency, whereas 87.5% had a slow gait speed. Logistic regression analysis revealed that SO was independently associated with poor functionality by the Barthel Index (odds ratio [OR], 2.9; 95% confidence interval [CI], 1.1-8.5) and slow gait speed (OR, 3.3; 95% CI, 1.1-9.8). Patients with SO showed poorer functional capacity compared with those with obesity alone (P < 0.05), but not compared with those with sarcopenia alone (P > 0.05). In conclusion, we observe that SO was associated with diminished functionality but did not elevate the risk compared with sarcopenia alone.
Implementation of clinical practice guidelines using the Plan-Do-Study-Act framework: The methodology and experiences of the Academy of Nutrition and Dietetics Health Informatics Infrastructure Registry Study on gestational diabetes mellitus.
Knippen KL, Woodcock L, Papoutsakis C … +1 more , Gonzales-Pacheco DM
Nutr Clin Pract · 2025 Dec · PMID 41039660 · Full text
BACKGROUND: Registered dietitian nutritionists (RDNs) use clinical practice guidelines (CPGs) to inform evidence-based practice. Despite the availability of CPGs, guidelines are not always translated into practice. This...
BACKGROUND: Registered dietitian nutritionists (RDNs) use clinical practice guidelines (CPGs) to inform evidence-based practice. Despite the availability of CPGs, guidelines are not always translated into practice. This challenge is central to implementation science (IS), which seeks to understand how evidence can be adopted and sustained. METHODS: The Gestational Diabetes Mellitus (GDM) Registry Study was a multiphase, multisite hybrid implementation study that explored guideline implementation using quality improvement (QI) methods grounded in the Model of Improvement and guided by Plan-Do-Study-Act (PDSA) cycles. Following a baseline period, RDNs completed training, conducted a gap analysis, and identified 2 CPG implementation aims. Sites completed iterative PDSA cycles. Deidentified nutrition care data were entered into the GDM Study Registry and manually audited to evaluate process outcomes. RDNs participated in a closing interview. Qualitative data were analyzed using a constructivist approach and reflexive thematic analysis, supported by artificial intelligence (AI)-assisted qualitative software. RESULTS: Six themes were identified, highlighting the value of assessing current practices and the flexibility of PDSA as an implementation strategy. Themes were mapped against the Normalization Process Theory and Consolidated Framework for Implementation Research and showed alignment between PDSA and implementation principles. The registry audit demonstrated improved process measures. The median normalization score across RDNs (9.00) and sites (9.42) was high, suggesting normalization. CONCLUSION: PDSA facilitated the work of normalization and enabled practice changes. This study contributes to IS by demonstrating how QI strategies, such as PDSA can help RDNs translate evidence into everyday nutrition care.
Determining VO in the ECMO patient.
Brown P, Soulé Z, Whitman G
Nutr Clin Pract · 2026 Feb · PMID 41024462 · Publisher ↗
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Implementation science using the Plan-Do-Study-Act (PDSA) cycle: Addressing hospital malnutrition with the global malnutrition composite score.
Bechtold ML, Matteson-Kome ML
Nutr Clin Pract · 2025 Dec · PMID 41015886 · Publisher ↗
Quality improvement is utilized to improve system issues within healthcare. Although many models have been identified for quality improvement, the Plan-Do-Study-Act (PDSA) model is used commonly. The PDSA cycle is a qual...
Quality improvement is utilized to improve system issues within healthcare. Although many models have been identified for quality improvement, the Plan-Do-Study-Act (PDSA) model is used commonly. The PDSA cycle is a quality improvement tool that has produced numerous system-wide changes. Since its conception, the PDSA has been used in a variety of nutrition-related quality improvement initiatives. Furthermore, the PDSA cycle has been applied in implementation science to bridge the gap between the literature and clinical nutrition practice. Implementation science using the PDSA cycle can be beneficial in the introduction of the Global Malnutrition Composite Score (GMCS) to identify, diagnose, and treat malnutrition in hospitalized patients. This manuscript describes the PDSA cycle in detail with direct application to GMCS implementation.
Determining VO in the ECMO Patient: Authors' reply.
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 41015824 · Publisher ↗
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Improved energy goal documentation in pediatric intensive care unit with standardized electronic health records: A quality improvement initiative.
Vendiola DF, Pan AY, Andres J … +7 more , Fabus N, Froh MM, Heisler R, Nielson MR, Seidl MRC, Wakeham MK, Mikhailov TA
Nutr Clin Pract · 2025 Dec · PMID 40994022 · Publisher ↗
We conducted a quality improvement (QI) initiative to increase documentation of energy goals within 48 h of admission to the pediatric intensive care unit (PICU) for all children. Malnutrition remains one of the most pre...
We conducted a quality improvement (QI) initiative to increase documentation of energy goals within 48 h of admission to the pediatric intensive care unit (PICU) for all children. Malnutrition remains one of the most prevalent issues in the PICU. Research shows early estimation and documentation of energy goals in the electronic health record (EHR) is associated with higher daily energy intake. Energy goals are often not documented early in patient admission, which can be improved. By revising critical care progress notes to prompt providers to estimate an energy goal when no goal has been documented within the first 48 h we expected an increased rate of goal documentation. A QI initiative was performed from May 2021 to April 2022 using the Plan-Do-Study-Act methodology. Interventions included (1) an automated smart-text element on the EHR progress note template and (2) a review of calculated and documented energy goals in calories by registered dietitians. A review team monitored the rate of documentation of energy goals monthly. Before the QI interventions, the baseline rate of documentation of an estimated energy goal was 44%. After adding standardized prompts to the EHR system, the rate of a documented energy intake goal within 48 h of admission by critical care providers increased to >90%. Using automated prompts in EHRs resulted in an increased frequency of energy goal documentation exceeding 90% monthly. Establishing a standardized prompting system within the EHR directly led to an overall increased frequency of energy goals documented in calories.
Addressing bias to facilitate accurate nutrition assessment in obesity.
Schneider ML, Tewksbury C
Nutr Clin Pract · 2026 Jun · PMID 40993984 · Publisher ↗
Malnutrition is often overlooked in patients with obesity because of pervasive weight bias and the misconception that excess body weight precludes undernutrition. Current malnutrition diagnostic criteria from the America...
Malnutrition is often overlooked in patients with obesity because of pervasive weight bias and the misconception that excess body weight precludes undernutrition. Current malnutrition diagnostic criteria from the American Society for Parenteral and Enteral Nutrition, the Academy of Nutrition and Dietetics, and the Global Leadership Initiative on Malnutrition are intended to be applied to patients of all body sizes, although biases and perceived challenges in applying these criteria can hinder objective clinical evaluations. This review explores the prevalence of malnutrition among patients with obesity, the impact of weight bias on care, and practices that support accurate nutrition assessment in this population. We also emphasize the importance of a comprehensive nutrition-focused physical examination and offer practical guidance for clinicians, including key physical findings relevant to patients with obesity. Through education, communication, and fostering inclusive environments, healthcare providers can successfully assess and manage malnutrition in patients with obesity.
Wasting syndrome as a predictive factor for adverse health outcomes in older adults: A prospective cohort study.
Dos Santos RCB, Pinho CPS, Santos EMC … +5 more , Patricio MCDS, do Nascimento SB, Santos LS, Mendes TSR, Diniz ADS
Nutr Clin Pract · 2026 Jun · PMID 40985964 · Full text
Wasting syndrome (WS), also known as unintentional weight loss, is defined as a 5% reduction in body weight over a period of 6-12 months. The mortality associated with WS in older adults has not been adequately explored....
Wasting syndrome (WS), also known as unintentional weight loss, is defined as a 5% reduction in body weight over a period of 6-12 months. The mortality associated with WS in older adults has not been adequately explored. The objective of this study was to investigate this relationship in hospitalized older individuals over an 18-month period. 175 older adults who were hospitalized were observed for 18 months to observe outcomes such as new hospitalizations within this timeframe, length of hospital stay, and death. Weight loss was defined as the difference between measured weight and self-reported weight over the last 6-12 months. Outcomes were obtained through telephone tracking. WS was observed in 45.7% of older individuals at study baseline, with 46.8% experiencing hospital stays of ≥10 days. 26.9% of these patients died, and 43.4% were rehospitalized during the follow-up. Deaths occurred earlier among patients with WS compared with unexposed individuals (P = 0.028) according to the Kaplan-Meier curve, but in the Cox regression WS was not significantly associated with mortality. In conclusion, a high prevalence of WS was observed in hospitalized older people, with a significant association with functional dependence. Although WS was not an independent predictor of mortality in the multivariate model, it was associated with earlier deaths in the unadjusted survival analysis.
Predictors of overall survival based on the nutrition and morphofunctional assessment of patients with cancer: A prospective observational study.
García-Moreno RM, Mola Reyes L, Llaro Casas MG … +4 more , Mantellini González I, Rogic Valencia S, López-Plaza B, Palma Milla S
Nutr Clin Pract · 2026 Jun · PMID 40985961 · Publisher ↗
BACKGROUND: Disease-related malnutrition (DRM) is a common complication of cancer and is associated with poor prognosis. Morphofunctional assessment has emerged as a new approach with high reliability for assessing body...
BACKGROUND: Disease-related malnutrition (DRM) is a common complication of cancer and is associated with poor prognosis. Morphofunctional assessment has emerged as a new approach with high reliability for assessing body composition and nutrition status. This study performed a nutrition and morphofunctional evaluation in patients with cancer to identify predictors of overall survival. METHODS: This observational prospective study was conducted on patients with cancer who underwent nutrition assessment, which included morphofunctional techniques. The follow-up period lasted 1 year after the initial evaluation, during which mortality rates were recorded. Survival analysis methods were used for statistical analysis. RESULTS: Among the 192 patients with cancer recruited, 24% died during the follow-up. The reactance to height ratio (Xc/H) (hazard ratio [HR] 0.94, 95% confidence interval [CI] 0.90-0.98), the phase angle (PhA) (HR 0.52, 95% CI 0.34-0.78), the standardized PhA (SPhA) (HR 0.61, 95% CI 0.38-0.96), the body cell mass index (BCMI) (HR 0.83, 95% CI 0.71-0.97), the C-reactive protein to prealbumin (CP) ratio (HR 1.89, 95% CI 1.04-3.46), the nonlimited physical capacity (HR 0.50, 95% CI 0.27-0.93), and the exercise practice (HR 0.12, 95% CI 0.02-0.88) were independent predictors of overall survival after adjusting for age, sex, and stage of cancer. CONCLUSION: This research identifies several predictors of overall survival in cancer, including bioelectrical impedance analysis parameters (PhA, SPhA, Xc/H, and BCMI), as well as CP, nonlimited physical capacity, and exercise practice. Therefore, nutrition assessment, incorporating morphofunctional evaluation, can be benifical in patients with cancer.
Enteral nutrition safety practices in pediatric transplant: Perspectives of dietitians in pediatric transplant.
Sun T, Leonard J, Potvin R … +2 more , Bastardi H, Hron BM
Nutr Clin Pract · 2025 Sep · PMID 40985927 · Publisher ↗
BACKGROUND: Our objective was to characterize enteral nutrition safety practices and education for pediatric solid organ transplant recipients and compare practices with the 2017 American Society for Parenteral and Enter...
BACKGROUND: Our objective was to characterize enteral nutrition safety practices and education for pediatric solid organ transplant recipients and compare practices with the 2017 American Society for Parenteral and Enteral Nutrition (ASPEN) Safe Practices for Enteral Nutrition Therapy. METHODS: A 43-question electronic survey was distributed through the national registered dietitian pediatric transplant listserv. Questions reviewed formula hang-time, preparation, storage during initial transplant admission, and discharge education. RESULTS: Sixty-six of 216 (31%) individuals completed at least one survey section. Forty-one of 47 (87%) reported a standard inpatient policy, and 40/40 (100%) reported ASPEN Safe Practices compliance for nonsterile powder formula with or without additives or unfortified and fortified human milk, whereas 33/39 (85%) complied for sterile liquid formula in an open system. Hospital size, type, and location did not predict compliance practices. Discharge education was primarily provided by dietitians (98%) and nurses (37%). Four-hour hang-time education was provided by 18/42 (43%) respondents for sterile formula in an open system, 31/42 (74%) for nonsterile powder formula in an open system, and 35/42 (83%) for nonsterile formula with additives. Educator type (dietitian vs non-dietitian or nurse vs non-nurse) did not predict compliance for sterile liquid in open system or nonsterile powder formula in an open system. CONCLUSION: Inpatient policies for formula hang-time are highly compliant with 2017 ASPEN recommendations. However, formula hang-time discharge education varied, particularly for sterile liquid formula in an open system. Standardizing enteral nutrition safety education for transplant patients is critical for minimizing infection risk within this immunocompromised population.
Bar code scanning of infant formulas at the time of feeding reduces risk of formula misadministration.
Alessi S, Desai P, Steele C
Nutr Clin Pract · 2025 Sep · PMID 40974271 · Publisher ↗
The use of bar code scanning technology to reduce risk of human error has become common in the healthcare setting, particularly with the administration of medications, blood products, and human milk (HM). However, the pr...
The use of bar code scanning technology to reduce risk of human error has become common in the healthcare setting, particularly with the administration of medications, blood products, and human milk (HM). However, the practice of using bar code scanning when administering infant formulas is highly variable between organizations, although administering an incorrect formula could have significant clinical impact, including metabolic or electrolyte disturbances, allergic reactions, or gastrointestinal intolerance. Studies have been published evaluating near misses in HM administration, and emerging data have considered the benefits of bar code scanning with adult enteral nutrition; however, there is little discussion in the literature about the use of such technology when feeding infant formulas. This study found that scanning the infant's armband and the bar code on ready-to-feed or prepared infant formulas prevented formula misadministration on average 105.5 times per month, suggesting that such technology improves patient safety.
Pilot study on the use of a multimorbidity index in patients receiving home parenteral nutrition.
Rothkopf MM, Pant M, Rothkopf Z … +5 more , Brown R, Haselhorst J, Stevenson DL, DePalma A, Saracco M
Nutr Clin Pract · 2026 Apr · PMID 40958398 · Full text
BACKGROUND: Home parenteral nutrition (HPN) patients often have multiple comorbidities. A validated multimorbidity index (MMI) could help determine resource needs and risks with HPN. We evaluated MMI scoring to determine...
BACKGROUND: Home parenteral nutrition (HPN) patients often have multiple comorbidities. A validated multimorbidity index (MMI) could help determine resource needs and risks with HPN. We evaluated MMI scoring to determine if it predicted HPN resource use and outcomes. METHODS: We performed a secondary analysis of 60 HPN patients from a previous study based on Cumulative Illness Rating Scale (CIRS) scoring. We examined three variables: PN formula changes, hospitalizations, and hospital length of stay (LOS). Density plots were produced to select a CIRS score cutoff value. Spearman correlations among the three variables of interest were computed. The data were then subjected to Wilcoxon rank sum tests and negative binomial regression models to determine if the measured variables differed significantly between the groups. RESULTS: In 60 HPN patients, CIRS scores ranged from 9 to 25 with a mean ± SD of 17.0 ± 3.85. Patients with CIRS scores ≥ 17 had higher rates of the three variables than those with CIRS scores < 17 (PN formula changes = 367 vs 297, hospitalizations = 19 vs 12, and total hospital LOS days = 122 vs 100). Although these raw data did not differ significantly, negative binomial regression analysis indicated that the interaction of total hospital LOS and PN formula changes was significantly higher in patients with a CIRS score ≥ 17 than a CIRS score < 17. CONCLUSION: CIRS data from HPN patients showed a trend wherein higher multimorbidity scores were associated with PN changes and LOS. This approach requires further study and validation.
Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework in nutrition research and practice: A narrative review.
Bell D
Nutr Clin Pract · 2025 Dec · PMID 40947794 · Publisher ↗
Implementation science is a growing field, affecting disciplines such as nutrition and dietetics. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework is an evaluation framework used to...
Implementation science is a growing field, affecting disciplines such as nutrition and dietetics. The Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework is an evaluation framework used to assess outcomes of interventions. The Practical, Robust Implementation and Sustainability Model (PRISM) is an extension of RE-AIM, further assessing contextual factors. This paper reviews the RE-AIM framework's composition and history, its application in nutrition research and practice, and its implications for future endeavors of nutrition and dietetics. Sources of information contributing to the findings of this narrative review include systematic reviews, original research articles, and web-based resources. Articles were grouped by purpose, area of specialization, and framework use. Within each group, studies were analyzed by examining the application of RE-AIM and findings yielded from each study. Synthesis of these articles revealed many systematic reviews covering the use of RE-AIM and PRISM in clinical and community interventions. Whereas RE-AIM has been thoroughly used to evaluate nutrition interventions in clinical and community settings, PRISM has been underused, specifically in community-based research. Additionally, both frameworks have consistent use in the evaluation of programs but are found to be underused in program design and implementation. With more consistent use across settings and phases, RE-AIM and PRISM frameworks will contribute to the field of implementation science, informing best clinical practices for dietary interventions, as well as the applicability and scalability of public health interventions.
The cachexia index as a prognostic indicator in patients with cervical cancer treated with radiotherapy: A retrospective study.
Tian M, Yuan Z, Wang H … +2 more , Liu T, Jin X
Nutr Clin Pract · 2026 Apr · PMID 40931387 · Publisher ↗
OBJECTIVE: The cachexia index (CXI) demonstrates potential as both a diagnostic tool for cachexia and a prognostic tool for survival in cancer. However, CXI's predictive value has not been verified in cervical cancer. Th...
OBJECTIVE: The cachexia index (CXI) demonstrates potential as both a diagnostic tool for cachexia and a prognostic tool for survival in cancer. However, CXI's predictive value has not been verified in cervical cancer. The purpose of this study is to investigate the prognostic value of the CXI in patients with cervical cancer treated with radiotherapy. METHODS: We retrospectively screened patients diagnosed with cervical cancer who underwent radiotherapy in a single institution between September 2013 to September 2015. The CXI was calculated as the skeletal mass index (SMI) × albumin/neutrophil-to-lymphocyte ratio. SMI was measured by computed tomography using the muscles of the third lumbar vertebra. Survival times were evaluated using the Kaplan-Meier method and Cox proportional hazards regression. A nomogram for predicting survival was developed. RESULTS: A total of 81 patients with cervical cancer were included. The cutoff value of the CXI was set at 59.7 using receiver operating characteristic (ROC) analyses. According to this cutoff value, 47 patients were assigned to the high-CXI group, and 34 were assigned to the low-CXI group. The Cox regression analysis showed that a low CXI was associated with decreased overall survival (hazard ratio [HR]: 3.15; 95% confidence interval [CI]: 1.24-8.00; P = 0.016). Patients in the low-CXI group also had shorter progression-free survival than those in the high-CXI group, but the difference was of borderline significance (HR: 2.26; 95% CI: 1.00-5.11; P = 0.05). CONCLUSION: The pretreatment CXI is an independent prognostic factor in patients with FIGO II-III cervical cancer treated with radiotherapy.
Use of the i-PARIHS framework in nutrition and dietetics research and practice: A citation analysis of the literature and case studies.
Young AM, Byrnes A, McRae P … +1 more , Mudge A
Nutr Clin Pract · 2025 Dec · PMID 40931363 · Full text
Theoretical approaches can help to plan, guide, and evaluate implementation projects that target real-world practice problems. This paper provides an overview of the integrated Promoting Action on Research Implementation...
Theoretical approaches can help to plan, guide, and evaluate implementation projects that target real-world practice problems. This paper provides an overview of the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and summarizes its use in nutrition and dietetics research and practice. A narrative summary of its use was compiled from the published literature based on citations from two key reference sources of the i-PARIHS framework. Searches were performed in Web of Science Core Collection, Scopus, and PubMed. Data were extracted about the study characteristics and the application of i-PARIHS. Thirty articles from 20 implementation studies were included, with studies mostly originating from Australia (n = 9) and focused on adult patients/clients (n = 17) in the hospital setting (n = 13) and other practice settings. Studies included diverse clinical areas categorized as malnutrition (n = 9) or nutrition-related chronic disease (n = 10). Studies used i-PARIHS across phases of planning, implementing, and evaluating (n = 6 planning only, n = 6 evaluating only, n = 8 a combination of phases, and n = 5 across all three phases) and often in combination with other theoretical approaches (n = 10). The facilitation process and/or role were a common feature of implementation and evaluation studies. The framework's ability to aid comprehensive identification of barriers and enablers across the constructs was highlighted as a strength. The i-PARIHS framework can be a useful tool to support all phases of implementation in nutrition practice and research, particularly where facilitation is a core component of the implementation process. Two case studies are presented to demonstrate how it might be practically applied.
Where comfort and nutrition meet: A case series of children with severe neurologic impairment receiving home parenteral nutrition at the end of life.
Steien D, Alexander E, Hager M … +2 more , Armellino A, Thorvilson M
Nutr Clin Pract · 2026 Apr · PMID 40914833 · Publisher ↗
Home parenteral nutrition (HPN) is a life-sustaining therapy traditionally used as a bridge to enteral autonomy or intestinal transplantation. Increasingly, it is used for intractable feeding intolerance (IFI), which can...
Home parenteral nutrition (HPN) is a life-sustaining therapy traditionally used as a bridge to enteral autonomy or intestinal transplantation. Increasingly, it is used for intractable feeding intolerance (IFI), which can occur near the end of life (EOL) in children with severe neurological impairment (SNI). In these cases, HPN use differs from its historical role and requires tailored outpatient planning. We report a retrospective case series of four children with SNI who developed IFI and received HPN as part of their EOL care. The pediatric palliative care team (PPCT) was involved in all cases during HPN decision-making and planning. The pediatric nutrition support team (PNST) and PPCT collaborated to provide individualized, goal-directed care. Patients ranged from 1 to 12 years old, with HPN durations between 5 weeks and 2 years. All were enrolled in hospice while receiving HPN. Plans were made through shared decision-making, reflecting each family's values, and included tailored approaches to laboratory monitoring, febrile episodes, line care, growth assessment, and follow-up. HPN at EOL requires careful ethical consideration, particularly of autonomy because families often find comfort in providing nutrition. IFI is often unanticipated, and prognoses are uncertain. With the combined expertise of PNST and PPCT, HPN can be used meaningfully at EOL, supporting family values, easing suffering, and creating space for peace and connection.
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