Nutrition In Clinical Practice[JOURNAL]
Sun
200 papers
Influence of dietary intake and eating patterns on reactive hypoglycemic events in patients postesophagectomy: A prospective observational study using continuous glucose monitoring.
O'Kelly R, Quigley E, Byrne K … +7 more , Kareem MA, Mhaoinigh NN, Healy P, Fanning M, Reynolds JV, Donohoe CL, Doyle SL
Nutr Clin Pract · 2026 Jun · PMID 40914827 · Full text
BACKGROUND: Esophagectomy causes anatomical changes that can lead to rapid food transit and reactive hypoglycemia (RH). Patients are advised on eating patterns postesophagectomy to prevent RH, but its true incidence and...
BACKGROUND: Esophagectomy causes anatomical changes that can lead to rapid food transit and reactive hypoglycemia (RH). Patients are advised on eating patterns postesophagectomy to prevent RH, but its true incidence and the impact of dietary recommendations remain under-researched. MATERIALS AND METHODS: Individuals >12 months postesophagectomy were recruited from the National Centre for Oesophageal and Gastric Cancer at St James's Hospital in Dublin, Ireland. Over 7 days, continuous glucose monitoring (CGM) captured glucose readings, with food and symptom diaries documenting dietary intake and symptoms. The nutrition composition of meals was calculated, and food diaries were coded for the following eating patterns: leaving >3 h between meals, simple sugars with meals, fluid with meals, and alcohol with meals. Data analysis compared eating patterns preceding asymptomatic and symptomatic RH events. In all cases, P < 0.05 was considered statistically significant. RESULTS: Thirty-two participants completed the study, with 21,504 glucose readings and 1276 meals analyzed. CGM identified 226 meals (17.7%) followed by RH events, 19 of which were symptomatic. Meals associated with RH events were higher in carbohydrate (35.3 g vs 31.7 g; P = 0.036), fiber (4.11 g vs 3.15 g; P = 0.020), and sugar (12.65 g vs 10.96 g; P = 0.048). Leaving >3 h between meals and consuming alcohol with meals also increased RH risk. Nutrient composition and eating patterns did not differentiate symptomatic from asymptomatic RH events. CONCLUSIONS: Total carbohydrate content and specific eating patterns appeared to significantly influence RH incidence, with most RH events being asymptomatic. CGM may serve as a useful adjunct to dietary interventions in the management of RH in patients postesophagectomy.
Global Leadership Initiative on Malnutrition as a predictor of mortality and prolonged hospitalization in emergency department patients: A prospective cohort study.
Wolf R, Maffini LF, Santos JGD … +2 more , Saueressig C, Dall'Alba V
Nutr Clin Pract · 2026 Jun · PMID 40914823 · Full text
BACKGROUND: Early diagnosis of malnutrition is essential for rapid decision-making regarding nutrition care to improve patient outcomes. We aimed to evaluate the prevalence of malnutrition using the Global Leadership Ini...
BACKGROUND: Early diagnosis of malnutrition is essential for rapid decision-making regarding nutrition care to improve patient outcomes. We aimed to evaluate the prevalence of malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and to assess the association of GLIM with 1-year mortality and length of hospital stay (LOS) in patients admitted to an emergency department (ED). METHODS: Prospective cohort study conducted in the ED of a university hospital. Nutrition assessment included anthropometry, Subjective Global Assessment (SGA), and GLIM criteria. The receiver operating characteristic curves and logistic regression were used for analysis. RESULTS: The SGA identified 53.9% of patients as malnourished and the GLIM criteria, 50.9%. GLIM showed good accuracy compared with the SGA, with an area under the curve (86.8%) and high sensitivity (84.8%) and specificity (88.8%) values. Malnutrition assessed by SGA demonstrated predictive validity for LOS (odds ratio [OR] = 2.2, 95% CI: 1.4-3.2; P < 0.001) and 1-year mortality (OR = 8.7; 95% CI: 4.3-17.7; P < 0.001). Similarly, malnutrition identified by GLIM increased the risk of LOS (OR = 2.2, 95% CI: 1.3-3.9; P = 0.007) and 1-year mortality (OR = 6.7, 95% CI: 3.6-12.5; P < 0.001). CONCLUSION: GLIM criteria and SGA demonstrated predictive power for LOS and 1-year mortality. However, the GLIM criteria stand out for adopting more objective and standardized criteria, making it a viable and reproducible approach for diagnosing malnutrition in ED patients.
Achieving full oral feeds in extremely low birth weight infants in the neonatal intensive care unit: a retrospective study.
Proels E, Dako J
Nutr Clin Pract · 2026 Apr · PMID 40914821 · Publisher ↗
BACKGROUND: The purpose of our study was to describe the time to full oral enteral feeding for extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU). METHODS: We conducted a retrospective c...
BACKGROUND: The purpose of our study was to describe the time to full oral enteral feeding for extremely low birth weight (ELBW) infants in the neonatal intensive care unit (NICU). METHODS: We conducted a retrospective chart review of ELBW infants born at a regional medical center between July 1, 2021, and December 31, 2022. Infants who died or were transferred before discharge from the NICU were excluded from the study. Fifty four ELBW infants met the inclusion criteria for the study. Survival analysis was conducted using Kaplan-Meier curves to estimate the time to full oral feeds over an observation period of up to 153 days. RESULTS: A total of 25% of all ELBW infants achieved full oral feeding by 94 days of life, and 33.3% achieved full oral feeding before discharge from the NICU. The median time to full oral feeding for ELBW infants born at 27 to 30 weeks gestational age was 82 days. After adjusting for gestational age and birthweight, infants who did not achieve full oral feeds were discharged 12 days later (95% confidence interval: 2-23 days; P = 0.02) than infants who achieved full oral feeds. CONCLUSION: The majority of ELBW infants did not achieve full oral feeding before NICU discharge. Early discussion of an alternate home feeding plan may shorten the duration of NICU stay.
Evaluation of food safety in the handling of home enteral nutrition based on a new contamination risk classification: A cross-sectional study.
Martins ECS, Medeiros CO, Costa RLD … +4 more , Karbiak L, Beux MR, Leal DAG, Stangarlin-Fiori L
Nutr Clin Pract · 2025 Sep · PMID 40903863 · Publisher ↗
BACKGROUND: Home enteral nutrition (HEN) offers clinical benefits and is increasingly used, although handling-related health risks remain unclear. This study assessed food safety in HEN using a new contamination risk cla...
BACKGROUND: Home enteral nutrition (HEN) offers clinical benefits and is increasingly used, although handling-related health risks remain unclear. This study assessed food safety in HEN using a new contamination risk classification. METHODS: First, the inter-rater reliability of the Food Safety for Handling HEN checklist was analyzed in 25 households by four evaluators. Then, contamination risk classification was proposed in 64 households, relating food safety adequacy to unacceptable microorganisms in samples of enteral formulations. Food safety was also assessed in these households based on adequacy percentage and contamination risk, considering three HEN categories (food based, mixed, and commercial). RESULTS: The inter-rater reliability indicated substantial agreement (≥0.61) in 88% of the evaluations using the 95% confidence interval. In the proposed classification of contamination risk, households were categorized as high risk (food safety adequacy <57.00%) and low risk (food safety adequacy ≥57.00%; p = 0.0011; Spearman R = -0.428) of contamination. The households that handled commercial enteral formulas (72.75%) showed a higher percentage of compliance compared with preparations with foods (58.68%) and mixed ones (57.27%; p = 0.009). However, all evaluated households were classified as low contamination risk. CONCLUSION: Although it is necessary to improve food safety, especially in the handling of enteral formulations containing food, the three categories of manipulated enteral formulations have proven to be safe options for home use. Furthermore, the proposal for classifying the risk of contamination can be considered a useful tool for identifying the level of contamination risk in handling the HEN.
Relationship between nutrition support and clinical outcomes in post-lung transplant patients in intensive care unit settings: A retrospective study.
Udagedara M, Schwenger KJP, Ghorbani Y … +5 more , Patel T, Heusser M, Zidar D, Mak J, Allard JP
Nutr Clin Pract · 2026 Apr · PMID 40900434 · Full text
BACKGROUND: Nutrition status significantly influences outcomes after solid organ transplantation, yet data on energy and protein intake in lung transplantation (LTx) patients in the intensive care unit (ICU) are scarce....
BACKGROUND: Nutrition status significantly influences outcomes after solid organ transplantation, yet data on energy and protein intake in lung transplantation (LTx) patients in the intensive care unit (ICU) are scarce. The objective is to examine the medical nutrition therapy and clinical outcomes in mechanically ventilated post-LTx adults. METHODS: This retrospective study (2022-2023) included adults post-LTx receiving mechanical ventilation admitted to the ICU. Clinical and nutrition parameters were recorded for the first 14 days of ICU stay. The Wilcoxon rank sum test or Fisher exact test were used to compare variables followed by a multivariate analysis to determine predictors of ICU length of stay (LOS). RESULTS: One hundred patients were included in this study: 65 (65%) were male with a median age of 65 years and body mass index of 26.3 kg/m. Both ICU and total hospital LOS were prolonged in patients who received >1.2 g/kg/day of protein, but LOS was not affected by energy intake or nutrition status. There were no associations with mortality or infection rate. In a multivariate analysis, no individual main effect variable was significantly associated with ICU LOS. However, a significant interaction between protein intake and Acute Physiology and Chronic Health Evaluation Score (β = 0.0216; p = 0.0092) indicted that the effect of protein intake on ICU LOS is modified by illness severity. CONCLUSION: In critically ill post-LTx patients, higher protein intake was associated with a longer ICU and hospital LOS. This relationship appears to be influenced by illness severity, emphasizing the importance of individualized nutrition strategies in this high-risk population.
Implementation science in nutrition practice: A review of the Consolidated Framework for Implementation Research.
Sivakumar B, Mak J, Bafagih S … +1 more , Arcand J
Nutr Clin Pract · 2025 Dec · PMID 40886064 · Full text
Many nutrition interventions and innovations are supported by strong evidence; however, their adoption, implementation, and long-term sustainability in real-world healthcare settings too frequently remain a challenge. Im...
Many nutrition interventions and innovations are supported by strong evidence; however, their adoption, implementation, and long-term sustainability in real-world healthcare settings too frequently remain a challenge. Implementation science offers methodologies to equip practitioners with tools to identify and address the contextual factors that influence implementation success in health settings (e.g., adoption, implementation, sustainability). Among the various frameworks and theories used in implementation science, the Consolidated Framework of Implementation Research (CFIR) is one of the most widely used. The CFIR synthesizes constructs from multiple behavioral and implementation theories into a comprehensive tool that can be used to systematically assess the barriers and facilitators that influence implementation outcomes. The framework enables practitioners and researchers to identify context-specific implementation determinants and to design tailored implementation strategies across diverse contexts and settings. Given its adaptability, the CFIR is highly relevant to the field of nutrition and dietetics to support sustained adoption and delivery of nutrition innovations (e.g., screening tools, educational programs, quality improvement initiatives); but it is relatively underutilized in nutrition practice. This article provides an overview of the CFIR and illustrates how it can be used to guide the implementation of nutrition innovations in clinical practice through two pragmatic case studies. We highlight the potential of the CFIR to be used as a guiding framework to advance the adoption, implementation, and sustainability of nutrition innovations and improve nutrition care and patient outcomes.
A case of yogurt central line-associated bloodstream infection in a child with intestinal failure.
Rahim N, Keller E, Wagner E … +4 more , Berkemeyer A, Johnson T, Johnson D, Sentongo T
Nutr Clin Pract · 2026 Jun · PMID 40886059 · Full text
Central line-associated bloodstream infections (CLABSI) are a significant cause of morbidity in children with intestinal failure (IF). Probiotic therapy is discouraged in patients with IF because of the increased risk of...
Central line-associated bloodstream infections (CLABSI) are a significant cause of morbidity in children with intestinal failure (IF). Probiotic therapy is discouraged in patients with IF because of the increased risk of bacteremia with the probiotic organism. We report an unusual, previously undescribed, clinical presentation of a Lactobacillus-species CLABSI linked to yogurt consumption in a toddler with IF secondary to Megacystis-microcolon-intestinal hypoperistalsis syndrome. Lactobacillus is abundant in fermented foods like yogurt and among the commensal constituents of the oral cavity microbiome and mucosal surfaces in the gastrointestinal tract. It is rarely implicated as the causative organism in CLABSI. At the time of presentation with fever, blood cultures were collected from the patient's central venous catheter (CVC), and peripherally. Both grew Lactobacillus species. Comparative genetic analysis predicted ~99% similarity between the CLABSI isolate and Lactobacillus isolates from the Greek yogurt the patient regularly consumed. Our patient's Lactobacillus CLABSI was linked to the consumption of Greek yogurt. We speculate that daily consumption of yogurt with live cultures posed a high cumulative exposure to Lactobacillus species either through external contamination of our patient's CVC or translocation of the ingested organisms from his gastrointestinal tract into the bloodstream. This is the first case report that links CLABSI in children with IF to yogurt consumption.
A case report on the long-term use of teduglutide in a pediatric patient with short bowel syndrome.
Sakurai T, Kudo H, Megumi N … +6 more , Ando R, Kazama T, Okubo R, Hashimoto M, Minoshima K, Wada M
Nutr Clin Pract · 2025 Aug · PMID 40886056 · Publisher ↗
Short bowel syndrome (SBS) is the leading cause of intestinal failure, frequently necessitating long-term parenteral nutrition (PN). Teduglutide (TED), a glucagon-like peptide-2 analog, has demonstrated efficacy in reduc...
Short bowel syndrome (SBS) is the leading cause of intestinal failure, frequently necessitating long-term parenteral nutrition (PN). Teduglutide (TED), a glucagon-like peptide-2 analog, has demonstrated efficacy in reducing PN dependence in both adults and children. However, long-term data in pediatric populations remain limited. We present a case of a male child with SBS who underwent extensive small bowel resection at 5 days of age, resulting in a residual small bowel length of 9 cm, with the total colon and ileocecal valve preserved. Despite home PN and multiple interventions, including management of catheter-related infections and intestinal complications, PN dependence persisted. At the age of 5 years, the patient was enrolled in a TED clinical trial and continued treatment after its commercial approval. During >6 years of TED therapy, gradual and sustained reductions in PN volume and caloric intake were achieved, ultimately resulting in complete weaning from PN. Growth and nutrition status remained stable, and no severe TED-related adverse events were reported. This is the first known case documenting TED use for >6 years in a pediatric patient with SBS. Although the response was slower than in previously reported cases, long-term TED administration led to favorable outcomes, including PN independence. This case underscores the potential for TED to support intestinal adaptation over extended periods and highlights the importance of individualized, long-term treatment strategies in managing severe pediatric SBS.
Response to the Letter to the Editor titled "Fish oil intravenous lipid emulsion monotherapy and essential fatty acids. Comment on Essential fatty acid deficiency in parenteral nutrition: Historical perspective and modern solutions, a narrative review".
Wolff J, Cober MP, Huff KA
Nutr Clin Pract · 2025 Oct · PMID 40878722 · Publisher ↗
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Using the Theoretical Domains Framework and Behavior Change Wheel Framework within the world of nutrition support.
Carey S, Hogan S
Nutr Clin Pract · 2025 Dec · PMID 40878445 · Full text
Attempts at behavior change have been shown to be more effective when interventions are based on evidence linked to an implementation framework. The Theoretical Domains Framework (TDF) and Behavior Change Wheel (BCW) pro...
Attempts at behavior change have been shown to be more effective when interventions are based on evidence linked to an implementation framework. The Theoretical Domains Framework (TDF) and Behavior Change Wheel (BCW) provide a systematic way to map effective implementation strategies to address barriers and enablers to behavior change. This paper aims to outline the steps involved in designing and evaluating an intervention using the TDF and BCW, including (1) identifying barriers and enablers (TDF); (2) mapping barriers and enablers to the Capabilities, Opportunities, Motivation hub; and (3) identifying key interventions and specific strategies that are known to bring about behavior change. Real world gaps in the implementation of malnutrition screening and implementation of a preoperative prehabilitation clinic are used as examples to highlight the functionality of the framework. Given the TDF and BCW have been designed specifically to change clinician behavior, it is an ideal framework for addressing evidence-practice gaps in nutrition support.
Development and implementation of a multifaceted strategy to reduce excessive fasting in an acute surgical setting using the behavior change wheel framework.
Carey S, Hardy R, Waller K
Nutr Clin Pract · 2025 Dec · PMID 40867032 · Full text
BACKGROUND: Excessive fasting for tests and procedures within the hospital setting remains commonplace, despite clear evidence of the benefits related to reduced fasting. There is minimal research addressing the issue of...
BACKGROUND: Excessive fasting for tests and procedures within the hospital setting remains commonplace, despite clear evidence of the benefits related to reduced fasting. There is minimal research addressing the issue of prolonged preoperative fasting. The aim of this study was to undertake a pre/post implementation study using multifaceted interventions to reduce excessive fasting on acute surgical wards within a quaternary hospital in Sydney, Australia, using the behavior change wheel (BCW) framework. METHODS: The BCW was used to identify key strategies to address barriers to implementing evidence-based fasting guidelines. A pre/post implementation study using multifaceted interventions to reduce excessive fasting on acute surgical wards was implemented over a 3-month period. The primary outcome was preoperative fasting time in hours. Clinician interviews were conducted to assess the benefit of each of the interventions within the study. RESULTS: On completion of preimplementation data collection, strategies were implemented including ward education, guideline promotion, patient stories, patient-facing flyers, and audit and feedback. There was no significant difference between fasting times pre and post intervention. Clinician interviews showed increased awareness and increased confidence. CONCLUSION: This pre/post implementation study was unable to significantly reduce fasting times, but did show increased clinician awareness and a trend towards improved patient-reported outcomes. Future research needs to ensure a larger sample size, as well as incorporating emerging strategies such as "sip-to-send" or "think-drink."
Ethical biopsy.
Barrocas A, Evans A
Nutr Clin Pract · 2025 Oct · PMID 40843628 · Full text
Artificially administered nutrition and hydration (AANH) often trigger complex decision-making that intersects medical technology, ethical practice, and legal responsibility. Inspired by ASPEN's 50th anniversary clinical...
Artificially administered nutrition and hydration (AANH) often trigger complex decision-making that intersects medical technology, ethical practice, and legal responsibility. Inspired by ASPEN's 50th anniversary clinical ethics discussions, this article introduces the concept of an "ethical biopsy," a structured ethical inquiry process modeled after the diagnostic medical biopsy. By aligning medical and ethical criteria, this framework equips clinicians, nutrition support teams, and ethics committees with a compassionate and patient-centered method for resolving dilemmas. Just as a biopsy is invasive but necessary, confronting ethical dilemmas is a crucial but often uncomfortable process for reaching patient-centered decisions surrounding AANH, particularly at the end of life. A case report is presented of a patient with untreatable, advanced cancer who wishes to have parenteral nutrition with the goal of living longer and spending more time with her young children, although her medical team disagrees because of concerns for risk of infection. Components of an ethical biopsy are presented that can be used to resolve such an ethical dilemma.
A comparative evaluation of the Global Leadership Initiative on Malnutrition vs the Patient-Generated Subjective Global Assessment in assessing nutrition status in patients diagnosed with terminal cancer: A retrospective study.
Sakaguchi T, Maeda K, Takeuchi T … +5 more , Tsuchida M, Ishida Y, Kawamura K, Amano K, Mori N
Nutr Clin Pract · 2026 Feb · PMID 40836600 · Publisher ↗
This study aimed to evaluate the clinical utility of the Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition screening tool and the Global Leadership Initiative on Malnutrition (GLIM) criteria as a dia...
This study aimed to evaluate the clinical utility of the Patient-Generated Subjective Global Assessment (PG-SGA) as a nutrition screening tool and the Global Leadership Initiative on Malnutrition (GLIM) criteria as a diagnostic framework in a cohort of patients with terminal cancer. This single-institution, retrospective cohort study included adults who were diagnosed with cancer and a predicted life expectancy <3 months intolerant to anticancer treatment who received palliative care between October 2023 and March 2024. Of 104 patients screened, 78 (54% male) were included in the analysis and 26 were excluded because of a terminal condition that precluded completion of the PG-SGA. The median age, body mass index, and survival were 73 years, 20.4, and 32 days, respectively. Weight loss occurred in 46% of patients within the previous 3 to 6 months, whereas 17% gained weight. Within the previous 2 weeks, 28% exhibited weight gain. The GLIM classified 35% of patients as well nourished, whereas the PG-SGA identified none as such. Agreement between the two tools was low (kappa coefficient = 0.037). Between the nutrition status screened by PG-SGA and assessed by the GLIM, no significant differences of all symptoms in Edmonton Symptom Assessment Systems or of survival outcomes were observed. In contrast, fluid retention and low handgrip strength emerged as significant predictors of mortality in Cox proportional hazards models. These findings suggest that, in patients with terminal cancer, PG-SGA may serve as a sensitive screening tool, whereas GLIM may have limited diagnostic applicability in end-of-life settings.
Can probiotics reduce chemotherapy-induced complications in leukemia patients? A systematic review and meta-analysis of randomized controlled trials.
Chen M, Lan H, Huang J … +3 more , Sun L, Chen C, Liu Y
Nutr Clin Pract · 2026 Feb · PMID 40836501 · Publisher ↗
This meta-analysis aimed to evaluate the effectiveness and reliability of probiotic interventions in managing chemotherapy-induced complications among patients with leukemia, providing evidence-based insights for clinica...
This meta-analysis aimed to evaluate the effectiveness and reliability of probiotic interventions in managing chemotherapy-induced complications among patients with leukemia, providing evidence-based insights for clinical decision-making. Studies in PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were comprehensively searched up to March 5, 2024. Randomized controlled trials (RCTs) comparing probiotic use with conventional care in leukemia patients undergoing chemotherapy were included. The included studies examined all possible chemotherapy-related adverse effects without selective outcome reporting. Data synthesis was conducted using RevMan 5.4 and STATA 15.0. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to evaluate the quality of evidence for each outcome. Eight RCTs encompassing 753 participants were analyzed. Compared with conventional care, probiotics significantly reduced constipation (odds ratio [OR] = 0.61, 95% CI = 0.30-1.24, P < 0.05), nausea (OR = 0.51, 95% CI = 0.41-0.63], P < 0.00001), chemotherapy-induced diarrhea (OR = 0.39, 95% CI = 0.26-0.57], P < 0.00001), bloating (OR = 0.38, 95% CI = 0.20-0.76, P = 0.006), vomiting (OR = 0.62, 95% CI = 0.39-0.98, P = 0.04), and indigestion (OR = 0.55, 95% CI = 0.31-0.95, P = 0.03). Notable improvements were observed in procalcitonin and tumor necrosis factor-alpha levels. Evidence quality was high for most outcomes, with moderate ratings for dyspepsia, constipation, and vomiting. In conclusion, probiotic supplementation appears to moderately alleviate chemotherapy-induced complications in patients with leukemia. Nevertheless, because of limitations such as small sample sizes and potential data variability, further validation through large-scale RCTs is necessary.
Treatment outcomes of pediatric patients on high dose pure fish oil-based fat emulsion: A retrospective study.
Bashir A, Karel L, Begany M … +6 more , Blandine A, Palpant C, Paul E, McCoy T, Maqbool A, Panganiban J
Nutr Clin Pract · 2026 Apr · PMID 40836492 · Publisher ↗
BACKGROUND: Pure fish oil-based fat emulsion (FO-ILE) dosed at 1 g/kg/day is FDA approved for the treatment of intestinal failure associated liver disease. However, this limited fat provision can lead to suboptimal weigh...
BACKGROUND: Pure fish oil-based fat emulsion (FO-ILE) dosed at 1 g/kg/day is FDA approved for the treatment of intestinal failure associated liver disease. However, this limited fat provision can lead to suboptimal weight gain and excessive caloric intake from dextrose, particularly in neonates. There is limited data on the use of FO-ILE at doses higher than 1 g/kg/day. This study describes our experience with pediatric patients receiving 1.5 g/kg/day of FO-ILE. METHODS: A retrospective chart review was performed on patients receiving parenteral nutrition aged 0-18 years and receiving FO-ILE at a dose of 1.5 g/kg/day for at least 14 days. Clinical outcomes of interest included weight gain, glucose infusion rates (GIRs) and adverse effects including cholestasis, postprocedure hemorrhage, hypertriglyceridemia and essential fatty acid (EFA) deficiency. RESULTS: Nine patients (range 2 months-12.9 years) receiving 1.5 g/kg/day of FO-ILE were included. Seven patients showed improved weight gain. Decrease of GIR was noted in four patients. One patient experienced worsening cholestasis with no clear etiology which prompted the decrease of FO-ILE to 1 g/kg/day with later resolution of cholestasis. Seven patients underwent invasive procedures, with one patient experiencing more than expected bleeding after circumcision not necessitating a decrease in dose. None of the patients developed hypertriglyceridemia. Eight patients had an EFA panel collected, all within normal limits. CONCLUSION: Our findings suggest that higher doses of FO-ILE may be safe and beneficial in patients with suboptimal weight gain, and elevated GIR. Larger and long-term studies are required to validate these observations.
"It's just us": Families' experiences with temporary tube feeding.
Reilly C, Marshall J, Foley J … +2 more , Thapar N, Packer R
Nutr Clin Pract · 2026 Apr · PMID 40836419 · Full text
BACKGROUND: Children with temporary feeding tubes are discharged home with increasing frequency, yet little is known about how families adapt and manage in their home environment. Whereas the physical side effects of tem...
BACKGROUND: Children with temporary feeding tubes are discharged home with increasing frequency, yet little is known about how families adapt and manage in their home environment. Whereas the physical side effects of temporary feeding tubes are well documented, the psychosocial impact on families remains underresearched. Understanding families' evolving needs is critical to improving care and reducing caregiver burden. AIM: To explore parents' experiences of caring for children with temporary feeding tubes, from insertion to removal and to identify their challenges and evolving needs. METHODS: A longitudinal qualitative descriptive design was used. Parent participants completed diaries and semistructured interviews across three key time points in their child's tube feeding journey (initial, maintenance, final) over a 4-month period. Inductive content analysis was used to analyze data. RESULTS: Thirty-six parent participants completed 81 interviews and 223 diary entries, documenting their experiences over time. An integrative theme identified was families' critical need for ongoing support. Parents were unprepared for tube feeding and faced persistent challenges managing the feeding tube. Their journey transformed from initial uncertainty to self-taught expertise, as they adapted to changing demands. Their need for professional and peer support remained constant throughout. CONCLUSION: These findings underscore the need for systematic improvements, including structured education, consistent follow-up, accessible clinical expertise, and support across the tube feeding journey. Addressing these gaps could improve family well-being, reduce healthcare inequities, and enhance clinical outcomes.
Association of obesity and body mass index classification with glycemic control in adults who are critically ill receiving parenteral nutrition: A retrospective study.
Mackie EL, Dang M, Sharpe K … +7 more , Delic J, Hollands JM, Oh S, Pasciolla S, Pontiggia L, Solomon D, Bingham A
Nutr Clin Pract · 2026 Feb · PMID 40835375 · Full text
BACKGROUND: Hyperglycemia is a complication of parenteral nutrition (PN), which can be exacerbated in patients with obesity. Limited data exist on glycemic control in this population. This study aims to evaluate the asso...
BACKGROUND: Hyperglycemia is a complication of parenteral nutrition (PN), which can be exacerbated in patients with obesity. Limited data exist on glycemic control in this population. This study aims to evaluate the association of obesity and body mass index (BMI) classification with glycemic control in patients who are critically ill initiated receiving PN. METHODS: This is a retrospective study of patients who are critically ill receiving PN from January 2013 to February 2024. The primary outcome was glycemic control in patients with BMI ≥ 30 kg/m or BMI < 30 kg/m based on hyperglycemic episodes, peak blood glucose, and insulin requirements on the first and second days of therapy. Multivariate analyses were conducted for the occurrence of a hyperglycemic episode. The secondary outcome was to determine the association of BMI classification with glycemic control. RESULTS: The study included 220 patients with BMI ≥ 30 kg/m (n = 91) and BMI < 30 kg/m (n = 129). The BMI < 30 kg/m group received more total dextrose (1.58 vs 2.36 mg/kg/min; P < 0.0001). There was no difference in the primary outcome during day 1 of PN, but there were increased hyperglycemic episodes (P = 0.0478) and insulin requirements in the BMI ≥ 30 kg/m group on day 2 (P = 0.0226). The only difference in the secondary outcome was insulin requirements on day 2 (P = 0.0453). CONCLUSION: Patients who are critically ill with BMI ≥ 30 kg/m receiving PN received more conservative dextrose infusion rates yet experienced more hyperglycemic episodes and required more insulin on day 2. However, obesity and BMI classification were not independently associated with hyperglycemic episodes within the first 2 days of PN initiation.
Application of the Knowledge-to-Action framework in translating nutrition and dietetic knowledge into practice: A systematic review.
Kossinna C, Lau CL, Mayr HL … +6 more , Wilkinson SA, Young AM, Meloncelli N, Cameron A, Rigby RR, Hickman IJ
Nutr Clin Pract · 2025 Dec · PMID 40835269 · Full text
BACKGROUND: The Knowledge-to-Action (KTA) framework was first developed in 2006 and has become a widely used tool to support translating evidence into practice. Despite its broad application, no systematic review has exa...
BACKGROUND: The Knowledge-to-Action (KTA) framework was first developed in 2006 and has become a widely used tool to support translating evidence into practice. Despite its broad application, no systematic review has examined its use in studies of nutrition research translation. This systematic review (PROSPERO ID: CRD42024613147) aims to describe the characteristics of nutrition translation studies that use the KTA, the application of the KTA stages, and the actors involved in the knowledge translation effort and study quality. METHODS: Searches were performed across four databases to include original nutrition studies in English that cite and apply the KTA from 2006 to April 2025. Data were extracted by two independent reviewers. The appraisal of the study quality used the Mixed Methods Appraisal Tool. RESULTS: Twenty-three studies met the inclusion criteria, and most were conducted in a hospital setting (n = 15) by multidisciplinary teams targeting change in healthcare workforce practices. Studies addressed a range of evidence-practice gaps in topics such as malnutrition (n = 5), postsurgical feeding or enteral nutrition (n = 5), infant feeding (n = 2), and dietary patterns (n = 2). The KTA was used flexibly either partly or as a complete cycle, often with integration of other implementation frameworks and mixed methodologies, tailored to project context. Although the quality of studies was generally high, the lack of quantitative baseline data in most studies limited assessment of effectiveness. CONCLUSION: The KTA framework is an adaptable and valuable tool that has been used to address evidence-practice gaps across broad topics related to nutrition and dietetics.
Techniques and procedures for advancing feeds for children with intestinal failure due to short bowel syndrome: A narrative review.
Bobo E, King LM
Nutr Clin Pract · 2025 Oct · PMID 40826818 · Publisher ↗
For children with intestinal failure secondary to short bowel syndrome, weaning parenteral nutrition and advancing towards enteral autonomy is a complex process that may take many years. Multiple factors impact feeding a...
For children with intestinal failure secondary to short bowel syndrome, weaning parenteral nutrition and advancing towards enteral autonomy is a complex process that may take many years. Multiple factors impact feeding advancement in this population including oral feeding difficulties, feeding intolerances, and malabsorption. Oral and enteral feedings are vital in promoting intestinal adaptation and should be initiated as soon as medically appropriate. Oral feedings are also necessary to lessen the risk of developing food aversion. In this review, appropriate diet and feeding modalities for pediatric intestinal failure are discussed as well as complications that may impact feeding progression. The primary aim is to summarize current strategies to advance enteral and, particularly, oral nutrition, and make this information applicable for caregiver education.
Response to "Challenging the role of nutrition as a primary determinant of quality of life in advanced cancer patients".
Santos LP, Calixto-Lima L, Wiegert EVM
Nutr Clin Pract · 2025 Aug · PMID 40819251 · Publisher ↗
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