An evaluation of intensive care nurses' performance of indirect calorimetry measurements.

BACKGROUND: Indirect calorimetry (IC) is the gold standard to monitor energy expenditure in critically ill patients. In several intensive care units (ICUs), nurses are responsible for carrying out the measurements. AIM: The aim of this study was to assess nurses' perception of their involvement in IC. STUDY DESIGN: This was a prospective survey conducted in the surgical ICU of a French university hospital after 18 months of use of the Q-NRG + ® calorimeter (COSMED©, Italy). All nurses who have used the calorimeter in the previous 6 months in this ICU were questioned through a questionnaire about their theoretical and practical knowledge and experience in using it. RESULTS: The participation rate was 93% (28/30 surveyed). All the respondents understood the objectives of performing an IC and 23 of them (82%) had used the device at least once in the previous 6 months. All the users thought it was pertinent that ICU nurses were in charge of the IC measurements, 16 of them (70%) reported having been formally trained, mostly by a colleague, and 17 (77%) felt comfortable with the device after 2 to 5 uses. The five non-users (8%) did not have the opportunity to do so. Theoretical and practical knowledge could be improved as only 5 of the users (22%) declared to know the main criteria of reliability of the IC measurement and 4 of them (18%) declared to know the maintenance and cleaning protocol of the device. CONCLUSION: Nurses quickly felt comfortable with the Q-NRG + ® in this ICU. Formal initial and ongoing training of all staff completing IC is essential to perform IC measurements safely and to obtain reliable and interpretable results in practice. RELEVANCE TO CLINICAL PRACTICE: Involving the nursing team in nutritional care, even if it is technical, seems to bring satisfaction in terms of overall patient care.

Sex-dependent circadian alterations of both central and peripheral clock genes expression and gut-microbiota composition during activity-based anorexia in mice.

RATIONALE: Patients with anorexia nervosa (AN) often present sleep disorders and circadian hormonal dysregulation. The role of the microbiota-gut-brain axis in the regulation of feeding behavior has emerged during the last decades but its relationships with the circadian rhythm remains poorly documented. Thus, we aimed to characterize the circadian clock genes expression in peripheral and central tissues in the activity-based anorexia mouse model (ABA), as well as the dynamics of the gut-microbiota composition. METHODS: From day 1 to day 17, male and female C57Bl/6 mice were submitted or not to the ABA protocol (ABA and control (CT) groups), which combines a progressive limited access to food and a free access to a running wheel. At day 17, fasted CT and ABA mice were euthanized after either resting (EoR) or activity (EoA) phase (n = 10-12 per group). Circadian clock genes expression was assessed by RT-qPCR on peripheral (liver, colon and ileum) and central (hypothalamic suprachiasmatic nucleus or SCN) tissues. Cecal bacterial taxa abundances were evaluated by qPCR. Data were compared by two-way ANOVA followed by post-tests. RESULTS: ABA mice exhibited a lower food intake, a body weight loss and an increase of diurnal physical activity that differ according with the sex. Interestingly, in the SCN, only ABA female mice exhibited altered circadian clock genes expression (Bmal1, Per1, Per2, Cry1, Cry2). In the intestinal tract, modification of clock genes expression was also more marked in females compared to males. For instance, in the ileum, female mice showed alteration of Bmal1, Clock, Per1, Per2, Cry1, Cry2 and Rev-erbα mRNA levels, while only Per2 and Cry1 mRNAs were affected by ABA model in males. By contrast, in the liver, clock genes expression was more markedly affected in males compared to females in response to ABA. Finally, circadian variations of gut-bacteria abundances were observed in both male and female mice and sex-dependent alteration were observed in response to the ABA model. CONCLUSIONS: This study shows that alteration of circadian clock genes expression at both peripheral and central levels occurs in response to the ABA model. In addition, our data underline that circadian variations of the gut-microbiota composition are sex-dependent.

Anorexia nervosa is an eating disorder with a female predominance. However, the underlying pathophysiological mechanisms are still incompletely understood. Patients with anorexia nervosa often show alterations in circadian rhythm, including sleep disorders and modifications in hormone circadian rhythm. The circadian rhythm is controlled in the central nervous system, particularly in the suprachiasmatic nucleus, but clocks have also been described in peripheral tissues. To better understand the putative role of circadian rhythm in the pathophysiology of anorexia nervosa, we have conducted an experimental study in a rodent model of anorexia nervosa called "activity-based anorexia" on both males and females. Interestingly, we observed that the expression of genes involved in the circadian rhythm is affected by the activity-based anorexia model in both the suprachiasmatic nucleus and peripheral tissues, such as the small intestine and liver. In addition, gut­microbiota also shows circadian variation. Interestingly, the anorexia-induced alterations of circadian variations (clock genes expression and gut­microbiota composition) are sex- and tissue-dependent. For instance, female mice exhibited more marked alterations in the ileum, whereas, in males, modifications were more pronounced in the liver. This study highlights sex-dependent alterations of circadian clock genes expression and of gut­microbiota in response to the anorexia rodent model. Further experiments should be performed to investigate the contribution of these mechanisms in the etiology of anorexia nervosa and the higher prevalence in females.

Reducing diarrhoea in an adult surgical intensive care unit: A quality improvement study.

BACKGROUND: Although diarrhoea is a real source of morbidity for critically ill patients, this issue has been little studied, making it difficult to understand its mechanisms and management. AIMS: We conducted a quality improvement study in an adult surgical intensive care unit before/after the implementation of a specific protocol to firstly improve diarrhoea management for patient benefit and secondly to understand the impact on caregivers. STUDY DESIGN: The first part of this before/after study consisted in assessing the proportion of patients receiving an anti-diarrheal treatment before (phase I)/after (phase II) the implementation of the protocol. The second part of the study was to survey the caregivers on this topic. RESULTS: Sixty four adults were included (33 in phase I; 31 in phase II) with 280 diarrheal episodes (129 in phase I; 151 in phase II). The proportion of patients who received at least one anti-diarrheal treatment was similar between the two phases (79% (26/33) vs. 68% (21/31), p = .40). Diarrhoea incidence was also similar (9% (33 patients/368 admissions) vs. 11% (31 patients/275 admissions), p = .35). The delay to initiate at least one treatment was significantly shorter in phase II (2 days [1-7] vs. 0 day [0-2]; p < .001). The patients' rehabilitation was no longer impacted by the occurrence of a diarrheal episode in phase II (39% (13/33) vs. 0% (0/31), p < .001). Eighty team members completed the surveys in phase I and 70 in phase II. Caregivers perceived diarrhoea like a burden and its economic impact remained high. CONCLUSIONS: The implementation of a protocol for the management of ICU diarrhoea did not increase the proportion of patients treated, but it did significantly improve the delay to initiate a treatment. The patients' rehabilitation was no longer affected by diarrhoea. RELEVANCE TO CLINICAL PRACTICE: The use of specific anti-diarrhoea guidelines may help to reduce the burden of diarrhoea in an ICU.

High prevalence of pre-existing sarcopenia in critically ill patients with hematologic malignancies admitted to the intensive care unit for sepsis or septic shock.

BACKGROUND & AIMS: We aimed to evaluate body composition (BC) by computed tomography (CT) in hematologic malignancy (HM) patients admitted to the intensive care unit (ICU) for sepsis or septic shock. METHODS: We retrospectively assessed BC and its impact on outcome of 186 patients at the 3rd lumbar (L3) and 12th thoracic vertebral levels (T12) using CT-scan performed before ICU admission. RESULTS: The median patient age was 58.0 [47; 69] years. Patients displayed adverse clinical characteristics at admission with median [q1; q3] SAPS II and SOFA scores of 52 [40; 66] and 8 [5; 12], respectively. The mortality rate in the ICU was 45.7%. Overall survival rates at 1 month after admission in the pre-existing sarcopenic vs. non pre-existing sarcopenic patients were 47.9% (95% CI [37.6; 61.0]) and 55.0% (95% CI [41.6; 72.8]), p = 0.99), respectively, at the L3 level and 48.4% (95% CI [40.4; 58.0]) vs. 66.7% (95% CI [51.1; 87.0]), p = 0.062), respectively, at the T12 level. CONCLUSIONS: Sarcopenia is assessable by CT scan at both the T12 and L3 levels and is highly prevalent in HM patients admitted to the ICU for severe infections. Sarcopenia may contribute to the high mortality rate in the ICU in this population.

Invasion of intestinal cells by Staphylococcus warneri, a member of the human gut microbiota.

Coagulase negative staphylococci (CoNS) are a heterogeneous group of bacteria that colonize different types of human epithelia. These bacteria have a highly variable pathogenic potential ranging from avirulent species to major nosocomial pathogens. Staphylococcus warneri is a CoNS species considered to be nonpathogenic. Here, we identify that S. warneri is a natural member of both human and mouse gut microbiota. In addition, we demonstrate that this bacterium is able to get internalized into human cells. We show that S. warneri efficiently invades several human cell types and, more specifically, intestinal epithelial cells, using actin-dependent mechanisms. In contrast to bona fide pathogens, S. warneri does not actively replicate within intestinal cells or resist killing by macrophages. Together, our results highlight that bacteria from the human gut microbiota that are not associated with a high pathogenic potential, can actively invade intestinal cells and may, in this way, impact intestinal physiology.

Women's visibility at European Society for Clinical Nutrition and Metabolism congresses from 2011 to 2019: Is the floor yours?

Purpose: Participating in international conferences is an essential way to promote scholarly work. We aimed to assess the trend of women's visibility at the European Society for Clinical Nutrition and Metabolism (ESPEN) congress by describing the evolution of the proportion of women speakers between 2011 and 2019. Materials and methods: This is a retrospective study including public data obtained from the 2011, 2015, and 2019 ESPEN congresses. The primary endpoint was the percentage of women speakers in major oral sessions (oral communications and specific conferences including prestigious lectures). The secondary endpoints were the proportion of women in other high-visibility positions (moderators, industry-led symposia interventions) and countries of origin. Results: The proportion of women speakers in oral communications remained stable between 2011 and 2019 [43% (43/100) vs. 41% (46/111), respectively; p = 0.89]. The proportion of women moderators in oral communications sessions significantly increased between 2011 and 2019 [13% (6/45) vs. 41% (19/46), respectively; p = 0.004]. The percentage of women speakers and moderators in industry-led symposia significantly increased between 2011 and 2019 [11% (2/18) vs. 41% (11/27), p = 0.05; 0% (0/6) vs. 60% (6/10), p = 0.03, respectively]. The percentage of women moderators in educational sessions also remained stable during the period with a marked under-representation of women in 2015. During all three congresses, women from the host countries were over-represented as moderators compared to women from other countries. Conclusion: The percentage of women speakers in oral communications remained stable in the last 8 years at ESPEN congresses, although women's representation in other high-visibility positions has increased. As men remained over-represented, women should be more encouraged to promote their academic work in the field of clinical nutrition, particularly during this international congress.

Mental health and health behaviours among patients with eating disorders: a case-control study in France.

BACKGROUND: Eating disorders (ED) are a public health concern due to their increasing prevalence and severe associated comorbidities. The aim of this study was to identify mental health and health behaviours associated with each form of EDs. METHODS: A case-control study was performed: cases were patients with EDs managed for the first time in a specialized nutrition department and controls without EDs were matched on age and gender with cases. Participants of this study filled self-administered paper questionnaire (EDs group) or online questionnaire (non-ED group). Collected data explored socio-demographics, mental health including anxiety and depression, body image, life satisfaction, substances and internet use and presence of IBS (Irritable Bowel Syndrome). RESULTS: 248 ED patients (broad categories: 66 Restrictive, 22 Bulimic and 160 Compulsive) and 208 non-ED subjects were included in this study. Mean age was 36.0 (SD 13.0) and 34.8 (SD 11.6) in ED and non-ED groups, respectively. Among patients and non-ED subjects, 86.7% and 83.6% were female, respectively. Body Shape Questionnaire mean score was between 103.8 (SD 46.1) and 125.0 (SD 36.2) for EDs and non-ED group, respectively (p < 0.0001). ED patients had a higher risk of unsatisfactory friendly life, anxiety, depression and IBS than non-ED s (all p < 0.0001) Higher risk of anxiety, depression and IBS was found for the three categories of EDs. Higher risk of smoking was associated only with restrictive ED, while or assault history and alcohol abuse problems were associated only with bulimic ED. The risk of binge drinking was lower in all EDs categories than in non-ED. CONCLUSION: This study highlights the common comorbidities shared by all EDs patients and also identifies some specific features related to ED categories. These results should contribute to the conception of future screening and prevention programs in at risk young population as well as holistic care pathways for ED patients. This case-control study evaluated mental health and health behaviours associated with the main categories of Eating Disorders (EDs). Cases were patients with EDs initiating care in a specialized nutrition department and controls without ED were matched on age and gender with cases. Self-administered paper questionnaires were filled by ED 248 patients (66 Restrictive, 22 Bulimic and 160 Compulsive) and online questionnaire by 241 non-ED controls. Body image satisfaction was significantly worse in ED patients than in controls. (p < 0.0001). Dissatisfactory life, anxiety, depression and irritable bowel syndrome were more found in patients with all EDs categories than in non-ED (p < 0.0001). Smoking risk was increased only in restrictive patients while and assault history and alcohol abuse was increased only in bulimic patients. These results highlight the global burden of ED and related comorbidities and provide useful information for future screening, prevention and care programs.

Association between Endometriosis, Irritable Bowel Syndrome and Eating Disorders: ENDONUT Pilot Study.

Background and aim: Irritable bowel syndrome (IBS), eating disorders (ED) and endometriosis share common pathophysiological mechanisms, involving alterations of the gut−brain axis. The aim of the ENDONUT pilot study was to investigate an association between these three diseases by screening for IBS and ED in patients with endometriosis. Method: We included patients from the CIRENDO cohort (Inter-Regional North-West Cohort of women with ENDOmetriosis) with a recent documented diagnosis of endometriosis of less than 4 years, regardless of age, date of onset of symptoms, type of endometriosis (digestive or not), with or without endometriosis-related digestive surgery. Validated questionnaires were used to screen for IBS (Rome IV, Francis score), ED (SCOFF-F, EAT-26), and anxiety/depression (HAD). Anthropometric data and lifestyle habits were also collected. The primary composite endpoint was SCOFF-F and ROME-IV scores. Results: Among 100 patients meeting inclusion criteria, 54 patients completed all the questionnaires. Of these, 19 had a positive SCOFF-F score (35.2%), 26 had a positive ROME-IV score (48.1%), and 14 patients (25.9%) had both a positive SCOFF-F score and a positive ROME-IV score (p = 0.006). Patients with positive SCOFF-F and ROME-IV scores had significantly higher HAD-anxiety and depression scores (p < 0.05). Conclusion: These results suggest a significant association between IBS, ED and endometriosis. The prevalence of IBS and ED in our population is higher than in the general population. Larger studies are needed to confirm these results, to better understand this triad, and to improve the diagnostic and multidisciplinary therapeutic management of these patients.

Intestinal Epithelial Toll-like Receptor 4 Deficiency Modifies the Response to the Activity-Based Anorexia Model in a Sex-Dependent Manner: A Preliminary Study.

The role of microbiota in eating disorders has recently emerged. Previous data reported that lipopolysaccharides induce anorexia and a decrease of body weight through the activation of toll-like receptor 4 (TLR4). In the activity-based anorexia (ABA) mouse model, an increase of TLR4 expression in intestinal epithelial cells (IEC) has been described. We thus aimed to characterize the role of TLR4 in IEC in the ABA model in male and female mice. For this purpose, Vill-CreERT2-TLR4 LoxP, which are depleted for TLR4 in IEC in response to 4-OH tamoxifen, were submitted (ABA) or not (CT) to the ABA procedure that combined free access to a running wheel and progressive time-limited access to food. We thus compared CT and ABA TLR4IEC-/- mice to CT and ABA TLR4IEC+/+ mice. In response to the ABA model, TLR4IEC+/+ male and female mice exhibited a body weight loss associated to a decrease of lean mass. In TLR4IEC-/- male mice, body weight loss was delayed and less pronounced compared to TLR4IEC+/+ male mice. We did not observe a difference of body weight loss in female mice. The body composition remained unchanged between TLR4IEC-/- and TLR4IEC+/+ mice in both sexes. In both sexes, ABA TLR4IEC+/+ mice exhibited an increase of food-anticipatory activity, as well as an increase of immobility time during the open field test. However, female TLR4IEC-/- mice showed a decrease of the time spent at the centre and an increase of the time spent at the periphery of the open field area, whereas we did not observe differences in the male mice. In conclusion, the invalidation of TLR4 in IEC modified the response to the ABA model in a sex-dependent manner. Further studies should decipher the underlying mechanisms.

Evaluation of a Supervised Adapted Physical Activity Program Associated or Not with Oral Supplementation with Arginine and Leucine in Subjects with Obesity and Metabolic Syndrome: A Randomized Controlled Trial.

Background: In patients with obesity and metabolic syndrome (MetS), lifestyle interventions combining diet, in particular, and physical exercise are recommended as the first line treatment. Previous studies have suggested that leucine or arginine supplementation may have beneficial effects on the body composition or insulin sensitivity and endothelial function, respectively. We thus conducted a randomized controlled study to evaluate the effects of a supervised adapted physical activity program associated or not with oral supplementation with leucine and arginine in MetS-complicated patients with obesity. Methods: Seventy-nine patients with obesity and MetS were randomized in four groups: patients receiving arginine and leucine supplementation (ALs group, n = 20), patients on a supervised adapted physical activity program (APA group, n = 20), patients combining ALs and APA (ALs+APA group, n = 20), and a control group (n = 19). After the baseline evaluation (m0), patients received ALs and/or followed the APA program for 6 months (m6). Body composition, MetS parameters, lipid and glucose metabolism markers, inflammatory markers, and a cardiopulmonary exercise test (CPET) were assessed at m0, m6, and after a 3-month wash-out period (m9). Results: After 6 months of intervention, we did not observe variable changes in body weight, body composition, lipid and glucose metabolism markers, inflammatory parameters, or quality of life scores between the four groups. However, during the CPET, the maximal power (Pmax and Ppeak), power, and O2 consumption at the ventilatory threshold (P(VT) and O2(VT)) were improved in the APA and ALs+APA groups (p < 0.05), as well as the forced vital capacity (FVC). Between m6 and m9, a gain in fat mass was only observed in patients in the APA and ALs+APA groups. Conclusion: In our randomized controlled trial, arginine and leucine supplementation failed to improve MetS in patients with obesity, as did the supervised adapted physical activity program and the combination of both. Only the cardiorespiratory parameters were improved by exercise training.

Accuracy of bioimpedance equations for measuring body composition in a cohort of 2134 patients with obesity.

INTRODUCTION: Measuring body composition is an important issue to phenotype patients with obesity and to follow the nutritional care efficiency. Bioelectrical Impedance Analysis (BIA) is a simple and rapid technique. However, validity of BIA in patients with obesity remains controversial. Thus, we aimed to evaluate the validity of several BIA equations to assess body composition in a large cohort of patients with obesity by using dual X ray absorptiometry (DXA) as reference. METHODS: Seven BIA equations have been retrospectively applied on electrical data measured by BIA in patients with obesity with BMI equal or higher than 30 kg/m2 and results were compared to DXA-derived fat mass (FM) and fat-free mass (FFM). BIA and DXA were done the same day after an overnight fasting. Results were compared with Bland-Altman method and Pearson correlation. We also calculated the accuracy defined as the percentage of patients with DXA-BIA difference within ± 10% of DXA measures for FFM and FM. RESULTS: Data from 2134 patients with class I and II obesity (ob1/2, n = 1452, 47.4 ± 14.2 y; 35.0 ± 2.7 kg.m-2) and class III obesity (ob3, n = 682, 48.2 ± 13.9 y; 44.1 ± 3.5 kg.m-2) were analyzed. The best results to evaluate FFM both in ob1/2 and ob3 groups were obtained with Roubenoff's equation: Bland Altman bias at -1.96 and -0.82 kg, Pearson correlation r at 0.93 and 0.87, accuracy at 75.7% and 83.3%, respectively. However, limits of agreements at 95% were high: [-9.42; 5.49 kg] and [-8.16; 6.52 kg]. For FM evaluation, Roubenoff's equation also showed best results for ob1/2 group (bias at -1.17 kg; correlation r at 0.89 and accuracy at 79.1%) but not for ob3 group. In this latter group, Deurenberg's equation exhibited the best results (bias at 2.09 kg; correlation r at 0.81 and accuracy at 76.8%). However, limits of agreements remained high. CONCLUSION: In patients with obesity, Roubenoff BIA equation should be recommended to assess fat free mass, even if limits of agreements remain high.

Intestinal permeability and appetite regulating peptides-reactive immunoglobulins in severely malnourished women with anorexia nervosa.

BACKGROUND & AIMS: In the last decades, the role of microbiota-gut-brain axis has emerged in the regulation of eating behavior and in the pathophysiology of anorexia nervosa (AN) that remains poorly understood. Particularly, a gut-derived dysregulation of immune response has been proposed leading to immunoglobulins directed against appetite-regulating peptides. However, intestinal permeability in patients with anorexia nervosa has been poorly documented. METHODS: In the present prospective case-control study, we thus compared intestinal permeability, appetite-regulating peptides and their reactive immunoglobulins measured in severely malnourished women with AN (n = 17; 28 [21-35] y; 14.9 [14.1-15.2] kg/m2) to healthy volunteers (HV, n = 34; 26 [23-35] y; 22.3 [20.6-23.6] kg/m2). RESULTS: Patients with AN exhibited an increased urinary lactulose/mannitol ratio, both in 0-5 h (0.033 [0.013-0.116]) and 5-24 h samples (0.115 [0.029-0.582]), when compared to HV (0.02 [0.008-0.045], p = 0.0074 and 0.083 [0.019-0.290], p = 0.0174, respectively), suggesting an increased intestinal permeability. Urinary excretion of sucralose and plasma zonulin were not different. The levels of plasma total ghrelin and desacyl-ghrelin were increased in patients with AN compared to HV, whereas plasma leptin concentration was decreased. In addition, αMSH remained unchanged compared to HV. Finally, we did not observe any modification of the levels of total or free αMSH, leptin or ghrelin-reactive immunoglobulin G and M, as well as for their affinity properties. Only, a weak decrease of the dissociation constant (kd) for acyl-ghrelin-reactive IgG was observed in patients with AN (p = 0.0411). CONCLUSIONS: In conclusion, severely malnourished patients with AN show a higher intestinal permeability than HV without evidence of an effect on appetite regulating peptides-reactive immunoglobulins.

Dynamic metabolic changes measured by indirect calorimetry during the early phase of septic shock: a prospective observational pilot study.

BACKGROUND AND AIMS: Energy metabolism (energy deficit, substrate consumption) in the early phase of septic shock is not clearly understood. The objective of this study was to describe its evolution using indirect calorimetry. METHODS: Prospective observational pilot study including ventilated adult patients with septic shock admitted in a surgical intensive care unit (ICU). Metabolic data were collected using the COSMED Q-NRG + ® calorimeter: carbon dioxide production (VCO2), oxygen consumption (VO2), resting energy expenditure (REE), respiratory quotient (RQ) and the rate of substrate utilization (proteins, lipids, and carbohydrates). The main criterion was the evolution of the energy deficit (dE) from D1 to D6. RESULTS: In total, 34 patients were included and 15 patients (age: 57.6 ± 12.8 years; Simplified Acute Physiology Score II: 52 ± 11) were eligible for final analysis. Time for initiation of nutritional support was 2.5 ± 1.5 days. The dE improved during the study period (slope = 2.9 [1.8; 4.2]; p < 0.001). The REE remained stable during the first week with no significant variation (slope = -0.16 [-1.49; 0.79]; p = 0.78). The RQ remained stable overall (slope = 0.01 [0.00; 0.03]; p = 0.10). The substrates utilization significantly changed at D3 in favor of protein consumption (slope = 6.50 [4.44; 8.85]; p < 0.001) with an overall significant decrease in the consumption of non-protein substrates. CONCLUSION: Energy deficit improved while REE and RQ remained relatively stable during the first week of ICU stay. The significance of the variations of substrates consumption was unclear. These preliminary results should be further explored with larger studies.

Food intake and weight loss of surviving inpatients in the course of COVID-19 infection: A longitudinal study of the multicenter NutriCoviD30 cohort.

OBJECTIVES: NutriCoviD30 is a longitudinal multicenter cohort study that aimed to provide nutritional objective data of inpatients during COVID-19 infection. The aims of this study were to describe the nutritional effects of COVID-19 infection on adult inpatients on the short- to mid-term (≤30 d after hospital discharge), using food intake and weight measurements and to identify factors associated with a decrease in food intake and weight. METHODS: Food intake and weight trajectories, as well as clinical signs of the disease, preexisting chronic diseases, and nutritional strategies were collected and analyzed during the course of the disease. Their association was estimated using mixed-effect regression modeling. Patients were recruited from French university hospitals from May to July 2020. For the 403 included patients (mean 62.2 ± 14.2 y of age; 63% men), median (interquartile range [IQR]) hospital length of stay was 13 d (IQR = 8, 20), and 30% of patients were admitted to the intensive care unit. RESULTS: Patients declared a median 70% food intake decrease in the acute phase, and the disease resulted in an average loss of 8% of predisease weight (corresponding to -6.5 kg). Although most patients recovered their usual food intake 1 month after hospital discharge, they only regained half of their weight loss, such that malnutrition, which affected 67% of patients during hospitalization, persisted in 41%. Patients with overweight, obesity, and diabetes reported an additional weight loss of >1.5% of their initial bodyweight during hospitalization and recovery phase. CONCLUSIONS: To prevent malnutrition and its long-term effects, mainly combined with a rapid weight loss predominantly affecting lean body mass, implementation of nutritional support is needed for COVID-19 inpatients. It should be started early in the course of the infection, and be extended up to the recovery phase.

Role of microbiota-gut-brain axis dysfunctions induced by infections in the onset of anorexia nervosa.

Anorexia nervosa (AN) is an eating disorder characterized by low food intake, severe body weight loss, intense fear of gaining weight, and dysmorphophobia. This chronic disease is associated with both psychiatric and somatic comorbidities. Over the years, clinical studies have accumulated evidence that viral or bacterial infections may promote the onset of eating disorders such as AN. This review aims to describe how infections and the subsequent immune responses affect food intake regulation in the short term and also how these processes may lead to long-term intestinal disorders, including gut barrier disruption and gut microbiota dysbiosis, even after the clearance of the pathogens. We discuss in particular how infection-mediated intestinal dysbiosis may promote the onset of several AN symptoms and comorbidities, including appetite dysregulation, functional gastrointestinal disorders, and mood disorders.

Identification and Characterization of Human Observational Studies in Nutritional Epidemiology on Gut Microbiomics for Joint Data Analysis.

In any research field, data access and data integration are major challenges that even large, well-established consortia face. Although data sharing initiatives are increasing, joint data analyses on nutrition and microbiomics in health and disease are still scarce. We aimed to identify observational studies with data on nutrition and gut microbiome composition from the Intestinal Microbiomics (INTIMIC) Knowledge Platform following the findable, accessible, interoperable, and reusable (FAIR) principles. An adapted template from the European Nutritional Phenotype Assessment and Data Sharing Initiative (ENPADASI) consortium was used to collect microbiome-specific information and other related factors. In total, 23 studies (17 longitudinal and 6 cross-sectional) were identified from Italy (7), Germany (6), Netherlands (3), Spain (2), Belgium (1), and France (1) or multiple countries (3). Of these, 21 studies collected information on both dietary intake (24 h dietary recall, food frequency questionnaire (FFQ), or Food Records) and gut microbiome. All studies collected stool samples. The most often used sequencing platform was Illumina MiSeq, and the preferred hypervariable regions of the 16S rRNA gene were V3-V4 or V4. The combination of datasets will allow for sufficiently powered investigations to increase the knowledge and understanding of the relationship between food and gut microbiome in health and disease.

Indirect calorimetry: The 6 main issues.

BACKGROUND AND AIMS: Optimal nutritional therapy, including the individually adapted provision of energy, is associated with better clinical outcomes. Indirect calorimetry is the best tool to measure and monitor energy expenditure and hence optimize the energy prescription. Similarly to other medical techniques, indications and contra-indications must be acknowledged to optimise the use of indirect calorimetry in clinical routine. Measurements should be repeated to enable adaptation to the clinical evolution, as energy expenditure may change substantially. This review aims at providing clinicians with the knowledge to routinely use indirect calorimetry and interpret the results. METHOD: We performed a bibliographic research of publications referenced in PubMed using the following terms: "indirect calorimetry", "energy expenditure", "resting energy expenditure", "VCO2", "VO2", "nutritional therapy". We included mainly studies published in the last ten years, related to indirect calorimetry principles, innovations, patient's benefits, clinical use in practice and medico-economic aspects. RESULTS: We have gathered the knowledge required for routine use of indirect calorimetry in clinical practice and interpretation of the results. A few clinical cases illustrate the decision-making process around its application for prescription, and individual optimisation of nutritional therapy. We also describe the latest technical innovations and the results of tailoring nutrition therapy according to the measured energy expenditure in medico-economic benefits. CONCLUSION: The routine use of indirect calorimetry should be encouraged as a strategy to optimize nutrition care.

Hypermetabolism is a reality in amyotrophic lateral sclerosis compared to healthy subjects.

RATIONALE: Hypermetabolism (HM) in Amyotrophic lateral sclerosis (ALS) is the reflection of a high energy metabolic level, but this alteration seems controversial. The main objective of the study was to confirm the existence of HM during ALS compared to healthy subjects. METHODS: A cohort of ALS patients was compared to a control group without metabolic disorder. The assessment included anthropometric criteria measurements, body composition by bioelectric impedance analysis and resting energy expenditure (REE) by indirect calorimetry. HM was defined as a variation > +10% between measured and calculated REE. Statistical analysis used Mann-Withney and Chi2 tests. Multivariate analysis included logistic regression. RESULTS: 287 patients and 75 controls were included. The metabolic level was higher in ALS patients (1500 kcal/24 h [1290-1693] vs. 1230 kcal/24 h [1000-1455], p < 0.0001) as well as the REE/fat free mass ratio (33.5 kcal/kg/24 h [30.4-37.8] vs. 28.3 kcal/kg/24 h [26.1-33.6], p < 0.0001). 55.0% of ALS patients had HM vs. 13.3% of controls (p < 0.0001). HM was strongly and positively associated with ALS (OR = 9.50 [4.49-20.10], p < 0.0001). CONCLUSIONS: HM in ALS is a reality, which affects more than half of the patients and is associated with ALS. This work confirms a very frequent metabolic deterioration during ALS. The identification of HM can allow a better adaptation of the patients' nutritional intake.