Current Pharmacotherapy and Nutrition Therapy of Alcohol-Associated Liver Disease.

Patients with alcohol-associated liver disease (ALD) consume large amounts of empty calories and are at risk for malnutrition. Malnutrition can present with micro- or macro-nutrient deficiencies. The standard-of-care drug treatment for severe alcohol-associated hepatitis (AH) is corticosteroids. While still in the standard treatment there are limitations in efficacy and certain patients do not respond to treatment (Lille score ≥.45). This article will focus on important concepts related to nutrition and ALD and on recent findings on predicting corticosteroid response and prognosis for AH patients.

Microbiome-based treatment helps ease severe malnutrition.

Study in Bangladeshi children builds on earlier trials of food that supports beneficial gut bacteria.

Characteristics and outcome of patients with anorexia nervosa on medical nutritional therapy: an institutional study with review of literature.

INTRODUCTION: Eating disorders (EDs) are debilitating mental illnesses that can lead to significant medical complications from malnutrition. Eating disorders are on the rise in Asia and the prevalence is expected to increase. The aim of this study was to understand the characteristics of local patients and evaluate our current inpatient nutritional rehabilitation protocol for anorexia nervosa (AN). METHODS: Retrospective descriptive data were gathered from 47 patients diagnosed with AN. Patients with admissions were further stratified according to their nutritional management based on whether they were on the AN protocol or standard hospital care. Data on their rate of weight gain, length of stay and calorie prescription were collected. RESULTS: Similar to previous studies, the majority of AN patients were female (96.7%). However, the age at presentation of AN in this study, as compared with previous local studies, had decreased (14 vs. 16 years). We also found that patients on the AN protocol were prescribed a higher amount of calories than those given standard care (2,700 vs. 2,317 calories). Patients on the AN protocol achieved a higher rate of weight gain per week (1.15 vs. 0.29 kg) and had a shorter length of hospital stay (23 vs. 36 days). CONCLUSION: Patients with AN appear to be presenting at a younger age. Medical stabilisation of AN patients can be achieved more quickly through a higher calorie inpatient AN treatment protocol. Future local studies examining actual calorie consumption, its effect on weight gain trajectory, severity of refeeding syndrome and time to remission will be beneficial.

Effectiveness of Nutrition Support Team Intervention in Pediatric Patients with Cancer.

Malnutrition in children with cancer is associated with poor prognosis. This study aimed to determine whether nutritional support team (NST) interventions prevent adverse events and improve the nutritional status in pediatric patients admitted for cancer treatment. This was a historical cohort study of pediatric patients with acute lymphocytic leukemia, acute myeloid leukemia, neuroblastoma, or brain tumor who received chemotherapy or underwent hematopoietic stem cell transplantation. Patients admitted between June 2013 and October 2014 were classified into the intervention group. Those admitted between January 2011 and December 2012 were classified into the control group. We created a homogeneous probability model using the inverse probability of treatment weighting method, and compared outcomes. A total of 75 patients were included in the study (38 and 37 in the intervention and control groups, respectively). The intervention group had significantly fewer incidents of nothing by mouth (nil per os [NPO]) (p=0.037) and days of NPO (p=0.046) than the control group. There was no significant difference between the intervention and control groups regarding the change in body mass index z-score between admission and discharge (p=0.376). NST interventions for children with cancer were associated with a reduction in the number of NPO occurrences and NPO days. These findings suggest that NST interventions contribute to continued oral intake.

[Expert consensus on clinical practice of parenteral nutrition therapy for critically ill patients in China (2024)].

Critical patients have a high incidence of malnutrition, which can lead to adverse outcomes such as infections and ICU-acquired weakness. Improving the nutritional status of critically ill patients is currently an important challenge. Parenteral nutrition (PN) is an important component of medical nutrition, but there is still much controversy over how to implement a reasonable and standardized PN for critically ill patients. To further standardize the PN strategy for critically ill patients, the Critical Care Medicine Branch of the Zhejiang Medical Association convened experts in the field of critical care medicine and formulated the Expert consensus on clinical practice of parenteral nutrition therapy for critically ill patients in China (2024). This consensus is based on the GRADE evidence quality grading standard, problem oriented, and summarizes evidence-based medicine evidence from multiple aspects such as PN timing, suitable population, nutritional plan, and ingredient ratio, providing professional suggestions for the standardization and implementation of PN in clinical nutrition practice.

Intradialytic oral nutrition effects on malnourished hemodialysis patients: a randomized trial.

Oral nutritional supplementation (ONS) is recommended for malnourished hemodialysis patients when their nutritional intake remains inadequate to meet energy and protein requirements. Patients were randomized into two groups: the intradialytic ONS supplements (INTRA-ONS) group (N = 16) and the interdialytic ONS supplements (INTER-ONS) group (N = 16) for a duration of 12 weeks. Malnutrition inflammation score (MIS) and serum albumin levels were assessed. The total MIS decreased significantly in patients from both the INTRA-ONS group (- 6.13, 95% CI - 8.29 to - 3.96) and the INTER-ONS group (- 3.50, 95% CI - 5.56 to - 1.35). A significant difference in the change of MIS was observed between the two groups (- 3.06, 95% CI - 5.94 to - 0.17). No significant differences were observed between the groups concerning serum albumin levels, dietary intake, anthropometric measurements, or body weight. Intradialytic ONS demonstrates similar benefits on nutritional biomarkers but improves the MIS among malnourished ESRD patients compared to interdialytic ONS.Trial registration Thai Clinical Trials Registry (TCTR) identification number is TCTR20220322007: 16/09/2021.

[Oral nutritional supplementation as an intervention in patients with hip fracture]. / Suplementación nutricional oral como intervención en pacientes con fractura de cadera.

Introduction: Fragility hip fracture (FHR) is an increasingly prevalent pathology in industrialized countries, with high social and health costs. Malnutrition or the risk of malnutrition in the population with FHR is too common and negatively impacts the clinical course, the rehabilitation process, and the resulting quality of life after discharge. Technological advances applied to the diagnosis of the nutritional status of patients with FHR contribute to achieving an early intervention of malnutrition and reducing associated morbidity and mortality. Oral nutritional supplementation with a high energy and protein intake could be a safe and effective action to improve the prognosis of patients with FHR, but further research is required to confirm this.

Introducción: La fractura de cadera por fragilidad (FCF) es una patología cada vez más prevalente en países industrializados, con un alto coste social y sanitario. La desnutrición o el riesgo de desnutrición en población con FCF es demasiado común y tiene un impacto negativo en la evolución clínica, en el proceso de rehabilitación y en la calidad de vida resultante tras el alta sanitaria. Los avances tecnológicos aplicados al diagnóstico del estado nutricional del paciente con FCF contribuyen a lograr una intervención precoz de la desnutrición y a reducir la morbimortalidad asociada. La suplementación nutricional oral de alto aporte energético y proteico podría ser una actuación segura y eficaz para mejorar el pronóstico del paciente con FCF, pero se requiere de más investigación que lo confirme.

Prevention and Management of Malnutrition in Patients with Chronic Obstructive Pulmonary Disease: A Scoping Review.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is linked to altered nutritional status due to increased catabolism, leading to muscle mass loss. This study aims to identify and map available evidence regarding multidisciplinary interventions focused on prevention, diagnosis and nutrition education, as well as the role of diet, to prevent and manage malnutrition in patients with COPD. METHODS: A scoping review was conducted using the Cochrane, PubMed/Medline, CINAHL, Embase, Scopus, and Web of Science databases. This study adhered to the Arksey and O'Malley framework and JBI methodology. RESULTS: Of the 1761 records identified, 15 were included. Evidence suggests that the Malnutrition Universal Screening Tool and Mini Nutritional Assessment are the most suitable screening scale. Guidelines have highlighted that personalized nutritional counseling is a very common intervention as it allows for a consideration of all physical, psychological, and social aspects of the patient. CONCLUSIONS: The role of healthcare professionals is crucial in the early identification of nutrition-related issues and in educating patients about the prevention and management of malnutrition, both in hospital and community settings. Key aspects include early malnutrition detection, personalized counseling and patient education, and a multidisciplinary approach. These findings provide a foundation for developing of targeted patient educational initiatives to improve the nutritional management of COPD patients.

[Importance of hydration in people with dysphagia and its consequences]. / Importancia de la hidratación en personas con disfagia y sus consecuencias.

Introduction: Introduction: dysphagia is a difficulty in moving food or drink from the mouth to the stomach, which may consist of a delay or an impossibility of transit or an-error in the direction, with the consequent passage into the airways. Dysphagia increases the risk of malnutrition and dehydration in the patient. However, although dehydration is one of the most common complications of dysphagia and is associated with significant risks, including hospitalization and mortality, it has been little studied in terms of its relationship and associated risk factors. Methods: a review of the scientific literature on the hydration of people with dysphagia and the dangers of inadequate hydration in them was carried out. Results and discussion: the dietary and nutritional approach in patients with dysphagia requires a multidisciplinary and personalized approach and is essential to improve the quality of life of patients with dysphagia. Dehydration is a frequent and serious complication in patients with dysphagia, which can lead to problems such as urinary tract infections, constipation, confusion, and worsening of chronic diseases. Therefore, it is crucial to carefully evaluate and monitor the fluid intake in these patients, and strategies to improve hydration include the use of thickened liquids, stimulating appetite, and adapting the texture and presentation of foods. Conclusión: adequate and protocolized management, from a dietary and nutritional point of view, can have a significant impact on the quality of life of patients, improving their well-being and preventing complications associated with this condition. A comprehensive approach to dysphagia, which includes adequate assessment and management of hydration, is essential to prevent serious complications.

Introducción: Introducción: la disfagia supone una dificultad en el desplazamiento del alimento o de la bebida desde la boca hasta al estómago, que puede consistir en un retraso o una imposibilidad de tránsito o en un error en la dirección, con el consiguiente paso a la vía aérea. La disfagia aumenta el riesgo de desnutrición y deshidratación en el paciente. Pero aunque la deshidratación es una de las complicaciones más comunes de la disfagia y se asocia con riesgos importantes, incluyendo hospitalización y mortalidad, su relación y los factores de riesgo asociados han sido poco estudiados. Métodos: se llevó a cabo una revisión de la literatura científica sobre la hidratación de las personas con disfagia y los peligros de una inadecuada hidratación en ellas. Resultados y discusión: el abordaje dietético y nutricional en pacientes con disfagia requiere un enfoque multidisciplinar y personalizado y es fundamental para mejorar su calidad de vida. La deshidratación es una complicación frecuente y grave en pacientes con disfagia, que puede llevar a problemas como infecciones urinarias, estreñimiento, confusión y empeoramiento de enfermedades crónicas. Por ello, es crucial evaluar y monitorizar cuidadosamente la ingesta hídrica de estos pacientes y establecer estrategias para mejorar la hidratación, incluyendo el uso de líquidos espesados, la estimulación del apetito y la adaptación de la textura y presentación de los alimentos. Conclusión: un manejo adecuado y protocolizado, desde el punto de vista dietético y nutricional, puede llegar a tener un impacto significativo en la calidad de vida de los pacientes, mejorando su bienestar y previniendo complicaciones asociadas a esta condición. El abordaje integral de la disfagia, que incluye una adecuada evaluación y manejo de la hidratación, es fundamental para prevenir complicaciones graves.

Reasons for dropouts in a community-based Management Acute Malnutrition (CMAM) program using local foods in the Far North of Cameroon.

INTRODUCTION: The security crisis caused by the Islamic sect Boko Haram, coupled with arid climatic conditions and a context of poverty, has preyed on populations in the far north of Cameroon, exacerbating malnutrition rates among children under five years old. New evidence has shown that many children with moderate acute malnutrition (MAM) can be treated in their communities (CMAM) without having to be admitted to a health center or therapeutic feeding center. The purpose of our study was to identify factors that may lead to beneficiary dropout in a CMAM program in four health districts in the far north of Cameroon. METHODS: A retrospective descriptive study of children who exited the CMAM program as lost to follow-up. Trained CHWs interviewed mothers in the households of children identified as lost to follow-up in the CMAM program using a questionnaire. The data were analyzed using STATA software. The confidence interval used was 95% and a P-value of 5%. RESULTS: Seven hundred and ten children were identified as being lost to the CMAM program, 686 of whom were present in the households during the interviews. Boys were 40.20%; girls 59.79% and the median age was 19 months. In the post-CMAM period, boys (OR=0.64; p=0.018); children in Moulvoudaye health district (OR=0.32; p=0.0025), and households with ≥10 people were at lower risk of MAM. The risk of being MAM was higher in households located 6-10 km and -=10km from a health facility (OR=4.21, +0.0001). Vitamin A Supplementation (OR=0.37; p=0.0131) and dietary diversity (OR=0.60; p=0.0773) protected children from MAM. The main reasons for dropping out of the CMAM program cited by parents were that health personnel and CHWs had declared and discharged the child as cured (44.4%); mothers received information that the project was over (17.54%); and mothers had traveled (10.2%). Other reasons: parents not keeping appointments (4.5%); children not responding to treatment (4.8%); shortage of food supplies (3.1%); and the long distance between the distribution site and the household (5.6%) etc. Conclusion: Several children were discharged as dropouts while they were still active. These included discharge errors and those due to the end of the project. Distance, stock shortages, failure to keep appointments, parental relocation, and illnesses in children were all reasons for the high dropout rate. We recommend strengthening the quality of training for health personnel and CHWs on the CMAM protocol before implementation.

Survey of international pediatric nutritional supportive care practices: a report from the Pediatric Study Group of the Multinational Association of Supportive Care in Cancer (MASCC).

PURPOSE: Malnutrition is common in children with cancer. While multiple validated malnutrition screens exist, there is no universal, standardized approach to screen or diagnose malnutrition. The Multinational Association of Supportive Care in Cancer (MASCC) Pediatric Study Group is focused on oncologic supportive care for children and young adults. This subgroup designed and administered a pilot study to characterize global malnutrition screening, diagnosis, and treatment practices for pediatric patients with cancer after identifying variations in malnutrition practice patterns within its members. METHODS: A novel, exploratory survey was iteratively developed and distributed in early 2020 to 45 MASCC Pediatric Study Group members. The survey included multiple questions with standard patient presentations and nutritional scenarios, and the respondents selected the answer that best reflected the care patients would receive at their institution. RESULTS: A validated screening tool to assess for malnutrition was routinely used by 15 of 26 respondents (58%). No single validated screen was used by more than 24% of responders, and 11 of 26 (42%) reported not having a standard malnutrition treatment screen. When the same patient was presented with the survey using different malnutrition indicators, patient care plans varied greatly. This was particularly true for z-scores compared to weight percentiles. CONCLUSIONS: Development of consensus recommendations for screening practices, preferred malnutrition indicators, and treatment guidelines could help reduce the underdiagnosis of malnutrition and subsequent variation in its management and ought to be a focus of the global pediatric cancer supportive care community.

Metabolomics study of Shenling Baizhu Powder in the treatment of multiple organ dysfunction syndrome in the elderly (MODSE) with malnutrition.

Malnutrition is an important risk factor for multiple organ dysfunction syndrome in the elderly (MODSE) and seriously affects the occurrence, progression and prognosis of MODSE. Shenling Baizhu Power (SBP), a classic formula from traditional Chinese medicine (TCM), when integrated with enteral nutrition, has been proven to be an effective clinical strategy for treating the patients of MODSE with malnutrition. This study aimed to investigate the metabolic changes during disease occurrence and SBP treatment, and to discover potential metabolic biomarkers for the diagnosis and efficacy evaluation. An untargeted metabolomics strategy based on UHPLC-Q-Orbitrap-HRMS was performed to reveal the differential serum metabolites between MODSE patients with malnutrition (n=59) and healthy controls (n=33), and those between patients treated with enteral nutrition (n=31) and SBP combined with enteral nutrition (n=28). Significantly different metabolites were identified and mapped onto the network of metabolic pathways to explore the metabolic disorders caused by the disease and the metabolic regulatory mechanism of SBP. Additionally, the area under the curve (AUC) of the potential biomarkers was investigated for predicting the disease and the efficacy of SBP. Sixty differential metabolites were identified between the disease and control groups, which were mainly related to amino acid metabolism, energy metabolism and carbohydrate metabolism. In the same way, 50 differential metabolites associated with SBP treatment were identified, which improved metabolic abnormalities in vivo mainly by regulating the above-mentioned metabolic pathways. Finally, 13 differential metabolites in common were selected as the potential biomarkers and the AUC value of each biomarker was within the range of 0.8-1.0, indicating that these biomarkers had high prediction accuracy for the diagnosis and efficacy evaluation of MODSE with malnutrition. This study demonstrates that serum metabolomics approaches based on the UHPLC-Q-Orbitrap-HRMS platform can be applied as a tool to reveal the metabolic changes induced by MODSE with malnutrition and SBP can play an important role in the clinical application.

Systematic nutritional screening and assessment in older patients: Rationale for its integration into oncology practice.

As the global population ages, so does the number of older people being diagnosed, treated and surviving cancer. Challenges to providing appropriate healthcare management stem from the heterogeneity common in this population. Although malnutrition is highly prevalent in older people with cancer, ranging between 30 % and 80 % according to some analyses, is associated with frailty, and has been shown to be a major risk factor for poor treatment response and worse overall survival, addressing nutrition status is not always a priority among oncology healthcare providers. Evaluation of nutritional status is a two-step process: screening identifies risk factors for reduced nutritional intake and deficits that require more in-depth assessment. Screening activities can be as simple as taking weight and BMI measurements or using short nutritional questionnaires and asking the patient about unintentional weight loss to identify potential nutritional risk. Using geriatric assessment, deficits in the nutritional domain as well as in others reveal potentially reversible geriatric and medical problems to guide specific therapeutic interventions. The authors of this paper are experts in the fields of geriatric medicine, oncology, and nutrition science and believe that there is not only substantial evidence to support regularly performing screening and assessment of nutritional status in older patients with cancer, but that these measures lead to the planning and implementation of patient-centered approaches to nutrition management and thus enhanced geriatric-oncology care. This paper presents rationale for systematic nutrition screening and assessment in older adults with cancer.

A Narrative Review of the Diagnosis and Treatment of Sarcopenia and Malnutrition in Patients with Heart Failure.

The prevalence of sarcopenia (loss of muscle strength, mass and function) in individuals with heart failure (HF) stands at a considerable level (approximately 20%), contributing to heightened mortality rates and diminished quality of life. The underlying pathophysiological mechanisms involve the presence of low-grade inflammation and a disturbance of the anabolic-catabolic protein balance. The nutritional assessment of patients with HF is a key aspect, and diverse diagnostic tools are employed based on patient profiles (outpatient, inpatient and nursing home). The Global Leadership Initiative on Malnutrition (GLIM) criteria serves as a consensus for diagnosing malnutrition. Given that edema can impact body mass index (BMI) in patients with HF, alternative body assessment technical methods, such as bioelectrical vector impedance (BiVA), BIA (without vector mode), computer tomography (CT) or clinical ultrasound (US), are useful. Scientific evidence supports the efficacy of both aerobic and resistance physical exercises in ameliorating and preventing muscle wasting associated with HF. Dietary strategies emphasize the importance of protein intake, while certain micronutrients like coenzyme Q10 or intravenous iron may offer benefits. This narrative review aims to present the current understanding of the pathogenesis, diagnosis and treatment of muscle loss in individuals with heart failure and its consequential impact on prognosis.

A Systematic Review of Clinical Practice Guidelines on the Management of Malnutrition in Children with Congenital Heart Disease.

Congenital heart disease (CHD) is one of the most common inborn disorders, with a prevalence of 0.8-1.2%. Affected children are often malnourished due to increased dietary requirements. This may lead to severe long-term complications. Several authoritative organizations have published guidelines addressing nutritional intervention in children with CHD. We aimed to systematically assess the consistency of recommendations, the methodological quality of these guidelines, and the quality of evidence supporting each recommendation. PubMed, Embase, the Cochrane Database, World Health Organization Global Index Medicus, and 16 scientific societies' websites were searched for the period until September 2023. The guideline quality was assessed using the AGREE II tool. After screening 765 records, only 2 guidelines published in 2013 and 2022 met our inclusion criteria. The main reason for exclusion was the absence of any system for rating the evidence. The main issues concerned the lack of implementation advice or tools and the lack of criteria to measure the application of guideline recommendations. The included guidelines were of good quality and within specific recommendations, both publications were largely in agreement, and the score for the overall assessment was high (83%). There is a pressing need for comprehensive, multi-threaded guidelines incorporating implementation strategies and methods for the performance assessment of children with malnutrition and CHD.

Nutritional support in hospitalised patients with diabetes and risk for malnutrition: a secondary analysis of an investigator-initiated, Swiss, randomised controlled multicentre trial.

OBJECTIVES: The main objective of this study was to investigate the effects of nutritional support on mortality in hospitalised patients with diabetes and nutritional risk participating in the Effect of early nutritional support on Frailty, Functional Outcomes, and Recovery of malnourished medical inpatients Trial (EFFORT) trial. DESIGN: Secondary analysis of a Swiss-wide multicentre, randomised controlled trial. PARTICIPANTS: Patients with diabetes and risk for malnutrition. INTERVENTIONS: Individualised nutritional support versus usual care. PRIMARY OUTCOME MEASURE: 30-day all-cause mortality. RESULTS: Of the 2028 patients included in the original trial, 445 patients were diagnosed with diabetes and included in this analysis. In terms of efficacy of nutritional therapy, there was a 25% lower risk for mortality in patients with diabetes receiving nutritional support compared with controls (7% vs 10%, adjusted HR 0.75 (95% CI 0.39 to 1.43)), a finding that was not statistically significant but similar to the overall trial effects with no evidence of interaction (p=0.92). Regarding safety of nutritional therapy, there was no increase in diabetes-specific complications associated with nutritional support, particularly there was no increase in risk for hyperglycaemia (adjusted OR 0.97, 95% CI 0.56 to 1.67 p=0.90). CONCLUSION: Patients with diabetes and malnutrition in the hospital setting have a particularly high risk for adverse outcomes and mortality. Individualised nutritional support reduced mortality in this secondary analysis of a randomized trial, but this effect was not significant calling for further large-scale trials in this vhighly ulnerable patient population. TRIAL REGISTRATION NUMBER: NCT02517476.

[Comparison of prognosis of elderly patients with gastric and colorectal tumors receiving different nutritional support treatments].

Objective: To compare the prognosis of elderly patients with gastric and colorectal cancer treated with different nutritional support methods. Methods: Elderly patients with gastrointestinal tumors who received surgical treatment in Beijing Hospital from January 2019 to June 2020 were retrospectively included and divided into malnourished group and non-malnourished group according to the Global Leadership Initiative on Malnutrition (GLIM). The patients were divided into parenteral nutrition (PN) group, enteral nutrition (EN) group and enteral+parenteral nutrition (EN+PN) group according to the nutritional support. The prognosis of patients with different nutritional support treatment was compared. Results: A total of 426 elderly patients with gastric and colorectal tumors underwent surgical treatment were included, including 287 males and 139 females, aged 65-91 (72±6) years. There were 186 cases in malnourished group and 240 cases in non-malnourished group. A total of 257 patients received nutritional support therapy, including 108 cases in PN group, 48 cases in EN group and 101 cases in EN+PN group. The body mass index (BMI) of malnutrition group was lower than that of non-malnutrition group [(20.5±3.4) vs (23.7±2.8) kg/m2, P<0.001], and the score of nutritional risk screening 2002 (NRS 2002) [M (Q1, Q3)] was higher than that of non-malnutrition group [4 (4, 5) vs 2 (2, 3) points, P<0.001]. The total hospitalization time of patients in EN group was shorter than that in PN group and EN+PN group [(11.9±4.0) vs (16.5±6.5) and (19.2±7.1) d, all P<0.001]. The total hospitalization time in PN group was shorter than that in EN+PN group [(16.5±6.5) vs (19.2±7.1) d, P=0.005]. The total incidence of complications in EN group was lower than that in PN group [0 vs 9.3% (10/108), P=0.030] and EN+PN group [0 vs 19.8% (20/101), P<0.001]. The incidence of total complications in PN group was lower than that in EN+PN group [9.3% (10/108) vs 19.8% (20/101), P=0.030]. Conclusion: Among the three nutritional supportive treatment modalities: EN, PN, and EN+PN, patients receiving EN support treatment have a shorter total hospitalization time and a lower complication rate.