BACKGROUND:Metabolic dysfunction-associated steatohepatitis (MASH) is associated with altered intestinal permeability, allowing microbial products to translocate to the liver via the enterohepatic circulation and contributes to disease progression. The aim of our study was to evaluate the association between probiotic supplementation and serum claudin-3 levels in patients with MASH. METHODS:We conducted a secondary analysis of a randomized, double-blind, placebo-controlled trial including adult outpatients with biopsy-confirmed MASH (Activity Score >4). Participants received either a probiotic mixture (Lactobacillus acidophilus, L. rhamnosus, L. paracasei, Bifidobacterium animalis subsp. lactis; 1 × 109 CFU or placebo (2 sachets/day) for 24 weeks. Serum claudin-3 levels and dietary intake were assessed before and after the intervention. Changes were analyzed using Generalized Estimating Equations. RESULTS:Forty-four patients completed the trial. Baseline claudin-3 concentrations were similar between groups. After 24 weeks, serum claudin-3 levels significantly decreased in both the probiotic (14.7 to 6.1 ng/mL) and placebo groups (16.7 to 6.0 ng/mL), with no significant between-group difference. Both groups reported reduced intake of calories, carbohydrates, proteins, and fats, but no differences in weight or waist circumference. CONCLUSION:In conclusion, serum claudin-3 levels decreased significantly over the 24-week study period in patients with MASH. However, probiotic supplementation did not result in additional reductions in intestinal permeability compared to placebo.
BACKGROUND:While early enteral nutrition (EN) is standard for critically ill patients with functional gastrointestinal tracts, parenteral nutrition (PN) is needed when EN is contraindicated or insufficient. Optimal PN timing/selection remains controversial. This meta-analysis evaluated the impact of early PN on mortality and clinical outcomes in critically ill adults. METHODS:We searched PubMed, Web of Science, Embase, and the Cochrane Library for randomized controlled trials (RCTs) published from January 2000 up to January 2025 comparing PN (total or supplemental) with EN alone in critically ill adults. The primary outcome was all-cause mortality. Risk of bias was evaluated via the Cochrane Risk of Bias 2.0 tool, and evidence quality was graded using the grading of recommendations assessment, development and evaluation (GRADE) framework. The study was registered in international prospective register of systematic reviews (PROSPERO) (CRD42023462386). RESULTS:Twenty RCTs enrolling 12,865 patients were included. Early PN yielded comparable 30-day (risk ratio [RR] 0.96, 95% confidence interval [CI] 0.90-1.03, P = 0.29) and 90-day all-cause mortality (RR 0.95, 95% CI 0.86-1.04, P = 0.26) relative to EN alone. However, PN was associated with lower ICU mortality (RR 0.92, 95% CI 0.86-0.99, P = 0.03), shorter mechanical ventilation duration, and reduced gastrointestinal intolerance. Conversely, PN increased the risk of overall infections (RR 1.12, P = 0.002) and bloodstream infections (RR 1.27, P = 0.005). CONCLUSION:In critically ill adults, early PN was associated with reduced ICU mortality and mechanical ventilation duration, as well as lower gastrointestinal intolerance, but it was also associated with an increased risk of infections, notably bloodstream infections. Individualized PN strategy with rigorous infection control is warranted when EN alone is insufficient.
BACKGROUND:Infants in neonatal intensive care are at risk of both deficiency and excess of fat-soluble vitamins, particularly E and A, due to limited reserves and the need for prolonged intravenous nutrition. We aimed to determine the effects of increased intravenous vitamin intake and to characterise the relationships between vitamin intake and serum concentrations. METHODS:Retrospective cohort of infants admitted to neonatal intensive care who had serum vitamin E or A concentrations quantified in the hospital laboratory using high-performance liquid chromatography. Associations between vitamin intakes, serum concentrations, neonatal outcomes, and maternal ethnicity were explored. RESULTS:Longer duration of intravenous nutrition was associated with higher serum concentrations of vitamin E (Spearman's ρ = 0.45, p < 0.001), but not vitamin A (ρ = 0.01, p = 0.93). Enteral vitamin intake from supplements was not associated with serum concentrations. Necrotising enterocolitis was associated with prolonged intravenous nutrition and may be a risk factor for high serum vitamin E. High vitamin E may be a risk factor for gastrointestinal bleeding. No differences in morbidity, mortality, or vitamin intake were observed between ethnicity groups. CONCLUSION:Serum vitamin A and E concentrations in neonatal intensive care infants did not consistently reflect intakes. Prolonged intravenous nutrition increases the risk of high serum vitamin E concentrations. Prospective studies are needed to clarify these risks and to inform targeted formulation of intravenous vitamin products for preterm infants.
BACKGROUND:Children admitted to pediatric intensive care units requiring nutrition support receive enteral nutrition formula. Guidelines recommend concentrated formula in fluid restriction, meet 2/3 estimated energy need, a minimum 1.5 g/kg/day dietary protein and dietary recommended intakes for micronutrients. The objective of this retrospective cohort study was to compare nutrition delivery in critically ill children 1-18 years against current guidelines. METHODS:Three years of charts were included over two cohorts: September 2018 to December 2020 and February 2022 to March 2023. The first cohort included demographics and nutrient intake, while the second included feeding interruption details. Logistic and linear regression models were employed to assess associations of macro-nutrient and micro-nutrient intake with age and formula type. Pearson correlations examined relationship between interruption hours and energy goal. RESULTS:Children (n = 86) that were included spanned 459 nutrition support days. Concentrated formula was provided in 34% of nutrition support days, goal of 2/3 estimated energy need met in 43.9% and 24.9% met minimum protein intake. Micronutrients were mostly met with prescribed volumes; however, vitamin D and selenium intakes were inadequate in pediatric formula products. Length of interruptions was 5 h per day with an average of two interruptions. CONCLUSION:Nutrient intake recommendations are unable to be met in critically ill children when comparing one enteral nutrition formula product against multiple different age group recommendations. The age ranges for formula use needs to be reviewed on an institutional basis with strong consideration of concentrate products.
BACKGROUND:Constipation is a common complication in critically ill patients and has been associated with adverse clinical outcomes. However, the role of enteral nutrition composition, particularly fiber and fluid administration, remains unclear. The aim of this study was to evaluate the association between dietary fiber and fluid administration and constipation in invasive mechanical ventilated critically ill adults. METHODS:We conducted a prospective cohort study including 74 critically ill adults requiring invasive mechanical ventilation and enteral nutrition. Patients were followed for up to 144 h from initiation of mechanical ventilation. Fiber and total fluid administration were evaluated as time-varying exposures. Constipation was defined as absence of defecation within 144 h. Discrete-time survival analysis was used to assess associations. RESULTS:Constipation occurred in 54% of patients. Time to first defecation ranged from 48 to 504 h. Most patients (97.3%) received early enteral nutrition, although fiber and fluid delivery were frequently below guideline-recommended targets. No significant association was observed between fiber intake or fluid administration and constipation after adjustment, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs) (fiber: OR = 1.17, 95% CI: 0.41-3.38; fluids: OR = 1.40, 95% CI: 0.29-6.84). CONCLUSION:In critically ill patients receiving invasive mechanical ventilation, fiber and fluid administration were not associated with constipation. These findings may reflect limited exposure during the early phase of critical illness, when gastrointestinal dysfunction is more strongly influenced by disease severity and pharmacological factors.
BACKGROUND:The Global Leadership Initiative on Malnutrition criteria has recommended using bioelectrical impedance analysis-derived fat-free mass index as a practical screening tool for low muscle mass. In the present study we evaluated the correlation between this index and dual-energy X-ray absorptiometry-derived appendicular skeletal muscle mass index, and developed sex-specific predictive nomograms according to the 2019 Asian Working Group for Sarcopenia criteria. METHODS:This cross-sectional analysis included 369 community-dwelling adults from the Hallym Aging Study. Body composition was assessed by bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Low appendicular skeletal muscle mass index was defined as <7.0 kg/m2 for men and <5.4 kg/m2 for women. Receiver operating characteristic analysis identified optimal cutoffs. Multivariable logistic regression and sex-specific nomograms were developed, adjusting for age, albumin, creatinine, hypertension, diabetes, and dyslipidemia. Models were internally validated using 1000 bootstrap resamples. RESULTS:This index moderately correlated with appendicular skeletal muscle mass index (ρ = 0.65 in males, ρ = 0.36 in females; P < 0.001). Optimal cutoffs were 17.7 kg/m2 for males (area under the curve, 0.84) and 16.1 kg/m2 for females (0.73). This index remained independently associated with low appendicular skeletal muscle mass index after multivariable adjustment. Nomograms showed good discrimination (C-statistics = 0.78 in males, 0.73 = in females) and calibration. In females, metabolic disorders, particularly hypertension and diabetes, significantly increased this risk. CONCLUSION:Fat-free mass index is a practical marker for low muscle mass screening. However, its accuracy varies by sex and metabolic health, requiring sex-and disease-specific calibration to improve malnutrition diagnosis and sarcopenia screening.
The first 1000 days of life represent a critical window for gut microbiome assembly, with lifelong implications for child growth, immune development, and disease risk. This review synthesizes evidence on maternal, perinatal, and especially nutritional factors that influence early-life intestinal colonization and highlights the consequences of microbial disruptions during this period. In utero exposures and birth-associated factors can profoundly shape microbial development, reducing diversity and beneficial taxa. Nutrition exerts a particularly dominant and modifiable influence: breastfeeding supports Bifidobacterium-rich communities, while formula use and early complementary feeding shape microbiota diversity and metabolic function. Dietary quality, fiber intake, and food diversity are key determinants of microbial maturation and resilience. Undernutrition and inadequate diets contribute to microbial dysbiosis, creating a self-reinforcing cycle of malabsorption, growth failure, and long-term metabolic consequences. Early microbial perturbations are associated with a range of acute and chronic diseases, including necrotizing enterocolitis, obesity, type 1 diabetes, inflammatory bowel disease, and atopic disorders. Strategies to restore microbial balance require further validation, particularly in nutritionally vulnerable populations. The absence of a universal definition for a "healthy" pediatric microbiome limits the development of targeted interventions. Emerging metrics, such as microbiota-for-age z-scores and functional microbiome profiling, may help define microbiota maturity and therapeutic efficacy.
BACKGROUND:Blended tube feeding (BTF)-enteral nutrition based on whole foods-is increasingly adopted as an alternative to commercial formulas in children requiring long-term tube feeding. While parents often initiate this practice, healthcare professionals are crucial for its safe and effective implementation. This study explored the perspectives of Dutch pediatric healthcare professionals regarding BTF to identify knowledge gaps and support future clinical guidance. METHODS:We performed a cross-sectional survey in 252 participants based in the Netherlands from February to May 2025. The self-developed 30-item questionnaire addressed BTF knowledge, attitudes, and experiences. Responses were analyzed descriptively. RESULTS:A total of 252 respondents completed the survey, primarily pediatric dietitians (n = 89) and pediatricians (n = 64). Familiarity with BTF was high (82%), and 56% had cared for children receiving it, most commonly via gastrostomy, although practices varied. Attitudes were generally positive (65%), particularly among dietitians (81%). Reported benefits included improved feeding tolerance (79%), reduced reflux/vomiting (72%), and improved stool patterns (67%); while caregiver burden (61%) and perceived parental insecurity regarding nutrition (28%) were the main challenges. Awareness of the 2022 national BTF position paper was low (54%), especially among physicians (20%), although 77% of healthcare professionals expressed interest in further education. CONCLUSION:This nationwide survey reveals high familiarity and positive attitudes toward BTF among pediatric healthcare professionals but considerable variation in practice and limited awareness of existing guidelines. Future interventional studies, evidence-based recommendations and professional training are needed to support consistent, family-centered implementation.
BACKGROUND:There is limited information regarding real-world use of parenteral nutrition in hospitals. The objective of the study was to provide a real-world description of parenteral nutrition administration in hospitalized patients. METHODS:This was a descriptive cohort study in 507 hospitalized adults who received parenteral nutrition at five Australian hospitals from 2015 to 2020. Adult patients (≥18 years) receiving parenteral nutrition in the hospital were eligible. Data collected included baseline demographics, comorbidities, clinician-determined indication and administration details for parenteral nutrition. The primary outcome was the indication for parenteral nutrition. Secondary outcomes included the use of supplemental parenteral nutrition and the vascular access devices used. RESULTS:Of the 507 enrolled patients, 263 (52%) were in the intensive care unit and 244 (48%) in the ward at the time of enrolment. The most common indication for parenteral nutrition was a non-functioning gastrointestinal tract (45% [390/864 indications]), mostly because of ileus (18% [71/390]), followed by inadequate nutrition (35% [304/864]). More than half the patients (347/507, 68%) had a nil by mouth order by their treating team. The median duration of parenteral nutrition administration was 7 (4;14) days. Supplemental parenteral nutrition was more common for patients in the intensive care unit. Vascular access was most achieved via central venous catheter in intensive care unit patients (81%) compared to a peripherally inserted central catheter line in ward patients (75%). CONCLUSION:This study provides novel real-world data on the demographics, indications, provision and outcomes of parenteral nutrition for hospitalized patients. Commonly reported indications for parenteral nutrition were ileus and nil by mouth orders, which may warrant further study.
Clinicians face a paucity of evidence-based recommendations for provision of enteral nutrition in infants born <750 g or <25 weeks' gestation, termed "nano-preterm." Current enteral nutrition recommendations for extremely low birth weight infants may not be broadly applicable to nano-preterm infants due to physiological and developmental differences, while others may be appropriate. Key enteral nutrition-related considerations include: the unique anatomy and physiology of the gastrointestinal tract, altered metabolic capacity, availability of maternal milk and use of alternative substrates, detailed methods of initiation and advancement of enteral feeding, methods of human milk fortification, targeted requirements for macronutrient and micronutrients, and the safety and efficacy of enteral nutrition support management to optimize the growth and development of the nano-preterm infant. This comprehensive review focused on enteral nutrition provision in nano-preterm infants, thoroughly evaluating available literature and identifying knowledge gaps about the unique physiology and metabolism of the nano-preterm infant as it pertains to enteral nutrition. Ultimately, prospective multicenter research is needed to establish evidence-based guidelines to promote optimal growth and development while minimizing complications of extreme prematurity.
BACKGROUND:Refeeding-like syndrome (RLS) occurs in very low birth weight (VLBW) (<1500 g) infants receiving parenteral nutrition. Little is known about prevalence, risk factors, or outcomes. METHODS:We performed a single-center descriptive cohort study in 739 VLBW infants born between October 2016 and December 2023. The co-primary outcomes were RLS during the first week of life (any serum phosphate <4 mg/dL [<1.29 mmol/L]) and severe RLS (<2.5 mg/dL [<0.81 mmol/L]). We also examined clinical outcomes associated with RLS, as well as associations of infant gestation length, fetal growth, and maternal hypertensive disorders with RLS outcomes, as well as associations of RLS with infant outcomes, adjusting for covariates in logistic regression. RESULTS:Mean (standard deviation, SD) gestational age was 29.1 (2.8) weeks, 174 (23.5%) infants were small for gestational age (SGA), 36.6% had RLS, and 6.6% had severe refeeding-like syndrome (sRLS). Maternal hypertension was associated with higher odds of RLS (unadjusted odds ratio [OR] 1.8; 95% CI: 1.3, 2.4). Having gestational age <27 + 0 weeks (adjusted OR [aOR] 1.8; 95% CI: 1.2, 2.6) and being small for gestational age (aOR: 4.62; 95% CI: 3.2, 6.6) both increased the odds of RLS. Refeeding-like Syndrome was associated with higher odds of severe intraventricular hemorrhage and severe retinopathy of prematurity. CONCLUSIONS:Refeeding-like syndrome is common among VLBW infants, particularly those born with lower gestational age and impaired fetal growth, and may contribute to morbidities associated with VLBW infants. These findings support the importance of screening and preventive strategies.
Clinical decisions about enteral nutrition timing and dose in critically ill adults are largely guided by visible markers of feeding intolerance (e.g., vomiting, ileus), which signal dysmotility risk but provide little insight into nutrient assimilation or metabolic benefit. This creates a "visibility problem," whereby practice is shaped by observable adverse effects rather than nutritional effectiveness. We propose a phase-specific framework that conceptualizes enteral nutrition as a titratable therapy based on biologic responsiveness. Enteral nutrition responsiveness is defined as the likelihood that delivered nutrients achieve phase-specific therapeutic goals within physiologic and metabolic constraints. Reinterpretation of trials comparing restricted versus full-dose enteral nutrition suggests that during the acute phase, many patients have limited responsiveness to higher doses, consistent with a narrow therapeutic window in which the primary rationale for feeding may be gut barrier support rather than correction of energy deficits. As patients transition into later phases, physiologic stability improves, and enteral nutrition responsiveness increasingly reflects nutrient assimilation and metabolic utilization that may contribute to recovery. Conceptualizing enteral nutrition as a phase-dependent, titratable therapy may help reconcile conflicting trial data, support individualized strategies, and highlight the need for bedside tools and biomarkers that assess nutrient assimilation and utilization rather than delivery alone.
Familial hemophagocytic lymphohistiocytosis type 5 is caused by biallelic pathogenic variants in STXBP2, which encodes syntaxin-binding protein, a key regulator of vesicle trafficking. In addition to immune dysregulation, patients with familial hemophagocytic lymphohistiocytosis type 5 may present with severe, persistent diarrhea associated with microvillus inclusion disease. However, the long-term clinical course of microvillus inclusion disease in this context remains poorly characterized due to limited survival beyond early childhood. We report a 22-year-old male with familial hemophagocytic lymphohistiocytosis type 5 who developed chronic diarrhea in infancy that persisted despite following bone marrow transplantation. The diagnosis of microvillus inclusion disease was established 16 years after transplantation based on characteristic histopathological findings. The patient also developed Fanconi syndrome, a rare complication in this setting, which improved following intensification of parenteral nutrition. Long-term follow-up revealed that the patient was dependent on parenteral nutrition not only for caloric intake but also for the correction of electrolyte imbalance. Growth retardation and multiple endocrine abnormalities improved with nutritional optimization, highlighting the systemic impact of chronic undernutrition. This patient expands the long-term extrahematopoietic phenotype of STXBP2-related familial hemophagocytic lymphohistiocytosis type 5 and underscores the importance of individualized nutritional management.
BACKGROUND:Human milk is considered the gold standard for infant nutrition; however, it is often discontinued in chylothorax and severe very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. As an alternative to complete human milk restriction, defatted human milk may be fed, though it may not fully support optimal infant growth and development. This study aimed to assess the micronutrient profile of defatted human milk. METHODS:Human milk was obtained from UCSD Human Milk Research Biorepository (San Diego, CA). Thirty samples representing 10 independent expressions in the morning, afternoon, and evening were pooled for analysis. Fat removal was performed by centrifugation at refrigerated and room temperatures, electric cream separator, and gravity separation. Analyses of macronutrients, micronutrients, fat-soluble vitamins, and water-soluble vitamins were conducted in triplicate. RESULTS:All defatting methods decreased vitamins A and E by >80%. Folate decreased most by nonrefrigerated centrifugation (52.3, SD < 0.01%) and least by cream separator (22.8, SD < 0.01%). Zinc decreased most by both nonrefrigerated centrifugation (43.5 ± 0.06%) and cream separator (43.5 ± 0.12%), and least by refrigerated centrifugation (17.7 ± 0.10%). Iodine decreased most by refrigerated centrifugation (40.0, SD < 0.01%) and least by cream separator (31.2, SD < 0.01%). Total triglycerides decreased most by refrigerated centrifugation (87.0 ± 0.03%). CONCLUSIONS:All defatting methods decreased amounts of vitamin A, vitamin E, folate, zinc, and iodine. Refrigerated centrifuge was most effective in removing total triglycerides. These results can inform fortification and supplementation guidelines of key micronutrients for patients with chylothorax and VLCAD deficiency consuming defatted human milk.
BACKGROUND:International statements suggest using the Global Leadership Initiative on Malnutrition (GLIM) criteria in intensive care units (ICUs); however, the economic impact of GLIM-defined malnutrition in sepsis remains unclear. This study investigated the association between GLIM-defined malnutrition and in-hospital costs in sepsis. METHODS:We conducted a sub-analysis of the prospective cohort study, Investing Long-term Outcomes of Sepsis or Septic shock, among medically managed critically ill patients with sepsis in 15 Japanese ICUs. Associations between GLIM-defined malnutrition and cost categories (low, moderate, and high) were assessed using multinomial logistic regression (reference: low-cost group), adjusted for age, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score. Individual GLIM components were also examined. Total in-hospital costs and secondary outcomes were compared between malnutrition and non-malnutrition groups using inverse probability of treatment weighting. RESULTS:Among 259 patients, 111 had GLIM-defined malnutrition. GLIM-defined malnutrition was associated with both the moderate-cost (adjusted odds ratio [AOR]: 2.03, 95% confidence interval [CI]: 1.05-3.89) and high-cost classifications (AOR: 2.27, 95% CI: 1.20-4.29). Among GLIM components, reduced muscle mass (AOR: 1.95, 95% CI: 1.04-3.68) and reduced food intake (AOR: 2.61, 95% CI: 1.39-4.92) were associated with the high-cost classification. After weighting, the malnutrition group had significantly higher median in-hospital costs (24,959 vs. 18,651 USD), longer hospital stays, and longer ICU stays than the non-malnutrition group. CONCLUSIONS:GLIM-defined malnutrition-particularly reduced muscle mass and reduced food intake-was associated with higher in-hospital costs in sepsis and may be a potential indicator of high-cost hospitalization.
BACKGROUND:Esophagectomy is an invasive procedure, frequently complicated by long-term weight loss and nutritional deficiencies. Although outpatient nutritional support is recommended, specific target body mass index (BMI) has not been established. Accordingly, we aimed to identify the threshold of postoperative BMI associated with unfavorable outcomes following esophagectomy. METHODS:We analyzed 317 patients who underwent minimally invasive esophagectomy for esophageal cancer, measuring their postoperative BMI at 3, 6, and 12 months. Unfavorable outcomes were defined as a composite of mortality, unplanned readmission, or pneumonia requiring outpatient treatment. Restricted cubic spline models were employed to determine the BMI threshold, and multivariable generalized estimating equation logistic regression was used to examine the significance of the threshold on unfavorable outcomes. RESULTS:The median preoperative BMI was 21.6 kg/m2, which decreased to 18.7 kg/m2 at 12 months. The BMI threshold was determined to be 19.5 kg/m2 via restricted cubic spline analysis. Multivariable generalized estimating equation logistic regression confirmed that a BMI <19.5 kg/m2 was significantly associated with a higher risk of unfavorable outcomes at 3 months (odds ratio: 2.29; P = 0.02), 6 months (odds ratio: 2.27; P = 0.03), and 12 months (odds ratio: 2.89; P = 0.009). CONCLUSION:A BMI of 19.5 kg/m2 could serve as a clinically relevant reference point for postoperative recovery. Maintaining a BMI above this threshold may be the primary goal of outpatient nutritional management to reduce unfavorable outcomes after esophagectomy.
BACKGROUND AND AIMS:Dutch intestinal failure centers are increasingly confronted with patients started on total parenteral nutrition because of reported intolerance to enteral feeding without meeting clinical criteria for intestinal failure. This study aimed to describe clinical characteristics, medical consumption, and treatment status of patients with medically unexplained intolerance to enteral feeding treated with home parenteral nutrition. METHODS:We performed a descriptive cohort study in three intestinal failure expert centers in the Netherlands. We identified adult patients on total parenteral nutrition without a medical explanation for intolerance to enteral feeding via an electronic medical record search. We investigated patient characteristics, diagnostic procedures, and treatments these individuals had undergone. We also evaluated the impact of caring for these patients on physicians, using a questionnaire. RESULTS:78 patients on total parenteral nutrition and with medically unexplained intolerance to enteral feeding were analyzed. Most patients were female (91%), 80% were ≤45 years at the start of gastrointestinal complaints, 63% were on opioids, and in 83% discontinuation of total parenteral nutrition was not achieved. The impact on treating physicians was rated as at least very burdensome. CONCLUSION:Treating patients with medically unexplained intolerance to enteral feeding with total parenteral nutrition is challenging for involved professionals in Dutch intestinal failure expert centers. This mainly concerns relatively young, female patients, most using opioids, and weaning off total parenteral nutrition is not successful in most cases. We suggest using caution when initiating total parenteral nutrition in patients with unexplained enteral intolerance before consultation with and/or assessment at an expert center.
BACKGROUND:Metabolic bone disease, which includes osteopenia and osteoporosis, is a recognized complication of chronic intestinal failure, occurring in up to 67% of patients, such that international guidelines recommend screening every 12-18 months for those on home parenteral nutrition. However, data on the prevalence and risk factors for metabolic bone disease in acute type 2 intestinal failure are lacking. METHODS:This was a descriptive cross-sectional study on adults with type 2 intestinal failure admitted to a national UK Intestinal Failure Reference Center between July 1, 2018 and April 30, 2023. Collected variables included demographics, clinical characteristics, medications, laboratory results and bone mineral density measured using dual-energy X-ray absorptiometry. RESULTS:A total of 150 patients were included in the analysis. Mechanisms of intestinal failure included short bowel syndrome (57.4%), intestinal fistula (30.0%), and dysmotility (8.0%). Osteopenia was identified in 46.0% and osteoporosis in 15.3% of patients. Multivariable analysis identified dysmotility and prolonged steroid use as being independently associated with decreased bone mineral density, whereas calcium supplementation and higher body mass index were associated with increased bone mineral density. CONCLUSIONS:Metabolic bone disease is prevalent among patients with type 2 intestinal failure. In addition to established risk factors, gastrointestinal dysmotility, often diagnosed late, is independently associated with lower bone mineral density. These findings support the consideration of routine baseline assessment of bone mineral density at the point of presentation with type 2 intestinal failure, with a potential need now to review existing guidelines which focus primarily on monitoring in type 3 intestinal failure.
