The administration of parenteral nutrition (PN) to neonates presents challenges related to the stability and incompatibility of both 2-in-1 and 3-in-1 admixtures when co-administered with drugs. Incompatibility data derived from adult patients cannot be applied to neonates because of distinct clinical conditions and differences in components of the admixture (e.g., neonatal amino acid formulation). This review presents an overview of the stability and influencing factors, along with the incompatibility of drug-PN mixtures in neonates within the neonatal intensive care unit setting. Various nutritional components and non-nutritional factors such as oxygen, light, pH, temperature, containers, and drugs affect the stability of PN. Patient conditions and the dosage of PN and drugs influence the stability and incompatibility of drug-PN admixtures, whether 2-in-1 or 3-in-1. Furthermore, assessing identification methods is crucial to ensure precise data regarding the stability and incompatibility of drug-PN. The standardization of PN formulas is essential for the safe administration of PN in neonates; however, individualized PN formulas offer more advantages in addressing specific nutritional requirements. Collaboration among healthcare professionals, including inter-institutional efforts, is essential to establish a consensus on the safe administration of PN to neonates.
Diabetes is commonly encountered in hospitalized adult patients. Blood glucose (BG) management in acutely ill hospitalized patients receiving nutrition support therapy with enteral nutrition (EN) or parenteral nutrition (PN) often varies from strategies utilized in stable patients with diabetes in the outpatient setting. Some degree of BG elevation is expected in hospitalized patients due to the acute stress response. However, hyperglycemia should be prevented, if possible, and treated if it occurs, as it has been shown to increase infections, length of stay, and mortality. While a variety of oral and injectable medications are utilized in outpatients who are fed orally, insulin is the primary therapy utilized in hospitalized patients receiving nutrition support therapy. The use of insulin, interruptions in nutrition support therapy, and abrupt changes in clinical status all increase the risk of hypoglycemia, which is associated with increased morbidity and mortality in acutely ill patients. The aim of this review is to discuss application of recent guideline recommendations and offer practical strategies for safe and effective management of hyperglycemia with nutrition support therapy in hospitalized patients with diabetes.
BACKGROUND:Personalized meal planning by registered dietitian nutritionists (RDNs) is time-intensive. Large language models (LLMs) may automate drafting meal plans, but their nutritional accuracy in clinical practice is uncertain. METHODS:In this proof-of-concept study, five outpatient RDNs and four LLMs (Gemini, CoPilot, ChatGPT 4.0, and customized ChatGPT 4.0) each generated 3-day meal plans for five validated clinical scenarios. Effectiveness was defined as accuracy in meeting pre-specified energy, protein, carbohydrate, fat, and sodium targets. Time to create plans and RDN comfort (self-rated confidence in nutritional accuracy and clinical appropriateness on 1-5 Likert scale) were recorded. Three independent RDNs, blinded to source, analyzed nutrient content using Nutritionist Pro. Group differences were assessed with t-test and ANOVA. RESULTS:All LLMs and RDNs produced feasible meal plans. LLMs generated meal plans in under 1 min, whereas RDNs required a mean of 44 min per scenario. RDNs reported comfort levels ranging from 3.8 to 4.8. Across most scenarios, LLM plans delivered a smaller proportion of requested energy than RDN plans, which more consistently approached energy targets. Both groups performed similarly for the Mediterranean diet scenario. Overall, protein accuracy did not differ. However, in chronic kidney disease, LLMs undershot the guideline-based protein target, while RDNs tended to modestly exceed it. Accuracy for low-carbohydrate, fat, and sodium diets was comparable. CONCLUSION:LLMs can rapidly generate clinically plausible meal plans but are less reliable than RDNs in achieving prescribed energy and selected macronutrient goals. Prompt precision is essential for nutrient-specific targets. A hybrid model in which RDNs refine LLM-generated drafts may leverage efficiency without sacrificing clinical accuracy.
BACKGROUND:The role of preoperative oral carbohydrate loading (OCHL) in optimizing postoperative metabolic outcomes in major vascular surgery remains unclear. This secondary analysis of a randomized controlled trial was conducted to evaluate the effects of OCHL on perioperative glucose-insulin metabolism and patient-reported well-being following elective open abdominal aortic aneurysm repair. METHODS:Patients undergoing elective open aortic repair due to abdominal aortic aneurysm were randomized to receive OCHL (800 mL the evening before, and 400 mL 2 h before anesthesia induction) or standard overnight fasting. Plasma glucose and insulin concentrations were measured at four predefined perioperative time points, and indices of insulin resistance and sensitivity were calculated. Subjective well-being (anxiety, hunger, thirst, tiredness, pain, and headache) was evaluated using visual analog scales at three perioperative time points. RESULTS:Forty patients completed the study. On postoperative Day 1, insulin levels were significantly lower in the OCHL group compared with controls (median [IQR]: 55.3 [44.4] vs. 90.6 [73.1] pmol/L; p = 0.026). Homeostatic model assessment for insulin resistance was significantly lower (12.65 [13.48] vs. 25.56 [19.64]; p = 0.021), and insulin sensitivity index significantly higher (0.079 [0.068] vs. 0.039 [0.046]; p = 0.021) in OCHL patients. Patients receiving OCHL reported lower levels of hunger (1.25 vs. 4.35; p = 0.013), pain (0.8 vs. 3.85; p = 0.011), and fatigue (0.45 vs. 3.3; p = 0.005) compared with controls. CONCLUSION:Preoperative OCHL seems to be a safe nutritional strategy in patients undergoing open aortic repair, with benefits including improved initial glycemic control and enhanced patient well-being. Further studies are warranted to clarify the role of preoperative OCHL in optimizing metabolic outcomes in vascular surgery.
BACKGROUND:Short bowel syndrome is a debilitating condition often requiring long-term parenteral support to maintain hydration, nutrition, and survival. METHODS:As part of the noninterventional, cross-sectional Landmark Survey study, we evaluated burdens associated with short bowel syndrome and parenteral support dependency from patient and caregiver perspectives in the United States and Europe. The survey assessed disease-related comorbidities, symptoms/complications, healthcare resource utilization, employment impact, and quality of life among patients and quality of life, stress, and employment impact among caregivers. RESULTS:Patients (n = 91) frequently reported comorbidities (e.g., Crohn's disease, 25.3%), disabling symptoms/complications (e.g., fatigue, 73.6%), emergency department visits (41.8%), and overnight hospitalizations (27.5%). Most patients (63.7%) were dependent on both total parenteral nutrition and intravenous hydration: 43.9% and 35.8% reported daily use of each, respectively. Patients experienced substantial impairments in work- and activity-related productivity and, relative to populations with Crohn's disease and ulcerative colitis, had worse general health and physical health states. Caregivers (n = 66) also reported considerable burden: over half provided care for ≥25 h/week. Caregivers reported moderate levels of stress, including financial stress (45.5%), feeling overwhelmed (63.6%), and experiencing impacts to their social lives (65.2%) and daily commitments (51.5%). Employed caregivers (n = 26) experienced caregiver-related work impairment (92.0%) and absenteeism (53.8%). CONCLUSION:These findings from the Landmark Survey underscore the substantial and multidimensional burden of short bowel syndrome for patients and caregivers and highlight a critical unmet need for therapies that reduce complications from parenteral support and improve quality of life.
BACKGROUND:This study aimed to evaluate the effect of oral protein supplementation on malnutrition risk, as assessed by the Malnutrition Universal Screening Tool (MUST), in patients undergoing hemodialysis. METHODS:In this randomized clinical trial, 52 hemodialysis patients at risk of malnutrition (MUST score >1) were recruited from a single center. The intervention group received 24 g of oral vitamins, minerals and casein protein (V.M. protein) daily for 4 months immediately after dialysis sessions on dialysis days. The control group continued their usual diet without supplementation. All participants received standard dietary counseling. The primary outcome was a change in mean body weight. Secondary outcomes included changes in MUST score, bioimpedance parameters (phase angle, body fat mass, visceral fat area, extracellular water-to-total body water ratio [ECW/TBW]), and laboratory markers. Bonferroni correction was applied for multiple comparisons. RESULTS:The mean age of participants was 59.10 ± 14.09 years, and 69.57% were male. A significant improvement in MUST score was observed within the intervention group but not in the control group. Changes in body weight and other secondary outcomes were assessed, with trends suggesting improvement in body composition parameters. CONCLUSION:Oral protein supplementation may improve nutritional status and reduce malnutrition risk in patients undergoing hemodialysis, with potential benefits for body composition and overall health.
BACKGROUND:Sarcopenic obesity (SO) is a complex geriatric syndrome characterized by excess adiposity and impaired muscle function, in which chronic low-grade inflammation plays a key role. Serum-based inflammatory indices may provide accessible tools for identifying individuals at risk. This study investigated the association between SO and serum-based inflammatory indices and evaluated their discriminative performance. METHODS:This cross-sectional study included 156 older adults (≥65 years) with obesity, based on retrospectively collected medical records. SO was defined according to European Society for Clinical Nutrition and Metabolism/European Association for the Study of Obesity criteria. Body composition was assessed using bioelectrical impedance analysis. Serum-based inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio, C-reactive protein-to-albumin ratio, and C-reactive protein-albumin-lymphocyte index, were calculated. Multivariable logistic regression analyses were performed, adjusting for age, sex, marital status, polypharmacy, and Clinical Frailty Scale. Receiver operating characteristic (ROC) analyses were conducted. RESULTS:The prevalence of SO was 28.8%. NLR, SII, and PIV were significantly higher in the SO group (all P < 0.05). In multivariable analyses, NLR (OR 2.56, 95% CI 1.14-5.76, P = 0.023), SII (OR 2.38; 95% CI 1.16-4.89, P = 0.018), and PIV (OR 1.96; 95% CI 1.10-3.48, P = 0.022) remained independently associated with SO. ROC analysis demonstrated modest discriminative ability, with AUC values of 0.643 for NLR, 0.628 for SII, and 0.633 for PIV. CONCLUSIONS:NLR, SII, and PIV are independently associated with SO; however, their discriminative performance is limited, suggesting they should be used as supportive rather than diagnostic markers.
Gastrostomy tube-related concerns result in a significant number of preventable emergency department (ED) visits each year. We conducted a pilot study that sought to prevent unnecessary ED visits with the utilization of a remote patient monitoring (RPM) application (app). We outline our program's design and implementation process and report on patient enrollment, engagement, and healthcare utilization. We utilized descriptive statistics to report on demographics and clinical data obtained from the electronic health record and RPM app. Sixteen participants were included in the study, half of whom were under 1 year of age and the other half between 2 and 9 years of age. Having a preferred language other than English was the primary reason for ineligibility due to constraints of the platform. Half of our patients completed weekly tasks for greater than 8 weeks. Despite having the RPM app, only 16 of 45 alerts (35.6%) occurred via the app while the rest were communicated through traditional means. There were four (10.3%) tube-related concerns that resulted in higher levels of care, including one urgent care visit, two ED visits, and one hospital admission. In summary, RPM technology may be feasible in supporting families with newly placed G-tubes and managing various tube-related complications but further work to enhance digital literacy and engagement is needed.
BACKGROUND:Proposed diagnostic criteria for neonatal malnutrition have not been validated. The objective of this study was to evaluate the reliability of the 2018 neonatal malnutrition criteria for identifying malnutrition in preterm infants. METHODS:A retrospective study of premature infants admitted to a level III neonatal intensive care unit from 2013 to 2022 was performed. Malnutrition diagnoses were assigned using each indicator. Weight and linear growth velocities were defined using the preferred approach (maintaining z-score on Fenton growth chart) and generalized growth goals (weight: 15-20 g/kg/day for infants <2000 g, 20-30 g/day for infants ≥2000 g, length: 1 cm/week). Kappa (k) values assessed the inter-indicator reliability of the full criteria and the inter-indicator and intra-indicator reliability of individual malnutrition criteria. Acceptable reliability was defined as k > 0.8. RESULTS:This study included 2305 infants. The 2018 neonatal malnutrition criteria had poor inter-indicator reliability for diagnosis in the first 2 weeks of life (k = 0.054) and after the first 2 weeks (k = 0.087). Inter-indicator reliability varied but was better among growth-based indicators. Intra-indicator reliability was strong for weight gain velocity definitions (k values ranging from 0.86 to 0.94), but poor for linear growth definitions (k = 0.12). CONCLUSION:Proposed neonatal malnutrition criteria have poor reliability when all indicators are used and limited reliability at the individual indicator level. Utilization of generalized weight gain goals may be appropriate for malnutrition diagnosis, but the generalized linear growth goal of 1 cm/week is not. Differing patterns in malnutrition diagnoses should be investigated for clinical significance. Redevelopment of current indicators is likely warranted.
BACKGROUND:Dietary interventions can serve as an alternative or adjunct to pharmacological intervention in inflammatory bowel disease (IBD). This study aimed to investigate various dietary beliefs, barriers and acceptability of diet among IBD patients. METHODS:A multicenter, cross-sectional survey was conducted across four Asia-Pacific countries. An anonymized online questionnaire was distributed through 10 participating IBD centers. Respondents rated the acceptability of IBD-related diets using a five-point Likert scale, with a score of 4 or more indicating acceptability. RESULTS:A total of 567 responses were received from 56.2% patients with Crohn's disease, and 42.5% with disease duration exceeding 10 years. While only 40.6% believed diet contributes to IBD causation, 80.2% avoided certain food during disease relapse. Respondents receiving advice from friends, family or acquaintances were more likely to avoid certain food during relapse (P < 0.01) and attempt therapeutic diets (P < 0.01) than those who were advised by healthcare professionals. Although many respondents modified diet during flares (46.4%), long term adherence remained low across most dietary patterns (24.4%). Key barriers included difficulties in meal preparation (46.0%) and social interference (42.9%). Respondents prioritized dietary effectiveness in symptom control (77.2%) and ease of meal preparation (69.6%). Low-fiber and Mediterranean diets were most acceptable, whereas exclusive enteral nutrition was least acceptable. CONCLUSION:Dietary choices are influenced by ease of preparation and social factors. A reliance on non-professional advice highlights an opportunity to strengthen clinician-patient communication around dietary modifications. Tailored, culturally sensitive dietary strategies may enhance adherence and acceptability in a diverse population, factors that are important when evaluating the role of dietary interventions in IBD management.
BACKGROUND AND AIM:Constipation affects half of critically ill children in pediatric intensive care units (PICUs). The primary aim was to identify factors associated with constipation. METHODS:A multicenter retrospective review of nutrition support, medication, and defecation in critically ill children in five PICUs with an expected length of stay greater than 48 h. Constipation: defined as ≥3 days from admission without a bowel movement. RESULTS:A total of 250 children, mean age 38.1 ± 56.2 months, of which 155 (62%) were male. Among the 47% (117/250) of children who were constipated, compared to no constipation group, the mean time to passage of first stool was 6.0 ± 3.7 days vs.1.0 ± 1.1 days, respectively (P < 0.001). Children with and without constipation achieved 43% of energy and 36% of protein recommendations, compared with 67% and 56%, respectively. In a multivariate analysis, factors that increased the risk of constipation included children prescribed opioids and muscle relaxants, a cardiac diagnosis (P < 0.0001), and sex (males) (P = 0.04). Conversely, children had a reduced risk of constipation if they were following a bowel-management protocol (30% reduced risk) or prescribed laxatives (P = 0.001). CONCLUSION:In this retrospective study, the incidence of constipation among children admitted to the PICU was 47%. Risk factors for constipation included the use of opioid and muscle relaxants, a cardiac diagnosis, and sex (males). Children with constipation had significantly lower energy and protein intake during their PICU admission. Implementation of a bowel-management protocol and prescription of laxatives was associated with a reduced risk of constipation.
Body composition research utilizing computed tomography (CT) has increased over the past several decades as researchers use clinically acquired CT for opportunistic screening or the identification of phenotypes such as sarcopenia, myosteatosis, and sarcopenic obesity associated with various clinical outcomes. While there continues to be exciting work being done in CT body composition research, including the use of artificial intelligence (AI) to streamline the assessment of body composition, fundamental methodological discrepancies continue to hinder clinical integration. In this narrative review of studies published between 2022 and 2025, we describe newer approaches to normalize skeletal muscle measurements for differences in body size. We provide an overview of the heterogeneity in deriving currently published CT reference criteria for body composition quantity and quality in a limited subset of studies from published literature. We also summarize currently published thresholds from a limited subset of studies, including those most commonly cited, applied to define low muscle quantity or poor muscle composition and compare and contrast these values, as well as their derivation. Finally, we highlight emerging areas utilizing AI technologies and the integration of CT body composition assessment into clinical practice, and on the flip side, the lack of guidance on how this information will be implemented to achieve personalized nutrition care and improve clinical outcomes.
The prevalence of community-dwelling individuals dependent on home enteral nutrition (HEN), commonly delivered via gastrostomy tube (G-tube), continues to rise. Fragmented healthcare approaches often lead to limited follow-up support, inadequate education, and insufficient routine G-tube maintenance. This can lead to preventable complications, such as infection, tube dysfunction, dislodgement, and avoidable emergency department visits. The Registered Dietitian Nutritionist (RDN), already central to HEN management, is uniquely positioned to provide comprehensive G-tube assessment and care. International models demonstrate that RDNs trained in advanced practice roles to deliver G-tube care, including balloon G-tube (BGT) replacement, can improve access, enhance patient satisfaction, and reduce healthcare utilization and costs. Expanding the RDN scope of practice to include G-tube management represents an opportunity to improve continuity of care for HEN consumers while addressing gaps in healthcare access and reducing health care system burden. This narrative review describes current practices for routine BGT care and exchanges and explores the benefits of RDN-led G-tube management. Three U.S.-based institutional approaches to credentialing RDNs in G-tube care and replacement are described. In addition, key implementation components, such as stakeholder engagement, policy development, competency-based training, and interdisciplinary collaboration, are highlighted. Standardized training pathways, broader support, and further research on outcomes are needed to support wider implementation of this advanced practice role.
BACKGROUND:We aimed to evaluate muscle mass, muscle function, and sarcopenia prevalence in patients with Takayasu arteritis (TAK), and to explore associations with disease activity and vascular involvement. METHODS:A total of 103 TAK patients and 75 age- and sex-matched healthy controls (HC) were included. The muscle strength of the participants was assessed using handgrip and chair-stand tests, while muscle mass was evaluated through two separate measurement methods: bioelectrical impedance analysis (BIA) and ultrasonography (US). For US measurement, the quadriceps and the biceps muscle were measured. Prevalence of sarcopenia was defined using the updated European Working Group on Sarcopenia in Older People (EWGSOP2) and International Society of Physical and Rehabilitation Medicine (ISarcoPRM) algorithm. Probable, confirmed and severe sarcopenia were collectively categorized as sarcopenia. RESULTS:Sarcopenia prevalence was 29.1% in TAK and 12% in HC by ISarcoPRM (P < 0.001), and 59.2% versus 26.7% by EWGSOP2 (P < 0.001). Agreement between the EWGSOP2 and ISarcoPRM definitions for sarcopenia were poor (P = 0.062, ĸ = 0.153). No difference in BIA-based muscle mass was observed between the TAK and HC groups; however, quadriceps muscle thickness (MT) and Sarcopenia Thigh Adjusted Ratio (STAR) index were significantly lower in TAK (P < 0.001). CONCLUSION:This first study of sarcopenia in TAK shows that the prevalence of sarcopenia is higher in TAK compared with HC. US-based measurements were more sensitive than BIA, suggesting US may be a practical screening tool in TAK, detecting regional changes due to combined systemic inflammation and vasculitic arterial involvement.
BACKGROUND:Home enteral nutrition (HEN) is life-sustaining but poses long-term management challenges. One-time discharge education often fails to meet patients' evolving post-discharge needs. Video support offers a promising solution, yet its application in HEN rarely rests on a theoretical foundation to guide when and how support is delivered. METHODS:This prospective, two-arm randomized controlled trial randomly assigned 100 eligible patients in a 1:1 ratio to Timing It Right (TIR)-based staged video education (intervention) or video access at discharge (control). Outcomes (quality of life as the primary outcome; anxiety, depression, functional status, patient satisfaction, complications, readmissions as secondary outcomes) were assessed at baseline, 1 and 3 months. Data were analyzed with generalized estimating equations. RESULTS:The intervention group demonstrated significantly greater improvements in functional status (KPS) and reductions in anxiety (SAS) and depression (SDS) scores over time compared with the control group (all P ≤ 0.001), as well as an improvement in patient satisfaction (PSQ-18, P < 0.05). No significant differences were found in quality of life (NutriQoL), readmission rates, or complication incidence. Video engagement data indicated high interest in self-management and complication content. CONCLUSION:A TIR-based staged video intervention is feasible and effective for improving key patient-centered outcomes in HEN. Tailored information at critical post-discharge timepoints addresses evolving needs. Future research should include multicenter trials with longer follow-up and integrate multidimensional support to enhance quality of life.
BACKGROUND AND AIMS:Hyperinsulinism (HI) is the most common cause of persistent neonatal hypoglycemia and requires careful nutritional management to maintain glycemic stability. Infants with transient hyperinsulinism (THI) often recover within months, whereas congenital hyperinsulinism (CHI) frequently requires prolonged medical and nutritional support. This study aimed to compare feeding practices and nutritional management of infants with THI and CHI. METHODS:This single-center retrospective study included infants diagnosed with HI under 12 months of age between January 2020 and January 2023. Infants were classified as THI if diazoxide was discontinued within six months and as CHI if treatment continued beyond six months. Data was collected at baseline and at one, three, and six months post-diagnosis, with an additional one-year follow-up for the CHI group. RESULTS:Ninety-six infants were included (THI n = 74, CHI n = 22). 78% of the THI group and all infants with CHI required support from intravenous dextrose and/or parenteral nutrition at diagnosis. The CHI group demonstrated greater use of glucose polymers, high-energy and hydrolyzed formulas by six months. By six months, 95% of the THI group were exclusively orally fed compared with 59% in the CHI group. Breastfeeding rates were low in both groups, declined over time and did not recover after medication was stopped. CONCLUSIONS:Infants with CHI require more prolonged and complex nutritional management, characterized by sustained reliance on tube feeding and higher carbohydrate feeds. Early optimization of nutritional intake and clearer strategies to support breastfeeding are areas for improving clinical management and feeding outcomes of infants with THI and CHI.
Roux-en-Y gastric bypass (RYGB) surgery is a highly effective technique for treating obesity. However, it may result in nutritional deficiencies. Here we report the case of a 55-year-old woman presenting with chronic diarrhea lasting 2 years, accompanied by lower limb paresthesia, macrocytic anemia, leukopenia, and thrombocytopenia. Her medical history included hypothyroidism treated with levothyroxine, and RYGB surgery performed in 2014, with intermittent micronutrient supplementation. The patient developed copper and zinc deficiencies. To our knowledge, this is the first report of a patient presenting with both deficiencies simultaneously with pancytopenia 10 years after RYGB. This case underscores the need to verify adherence to existing preoperative screening recommendations involving preoperative micronutrient measurements to assess micronutrient deficiency risks and multidisciplinary postoperative follow-up, the importance of monitoring micronutrient levels, close follow-up of both symptomatic and asymptomatic patients and evaluating adherence to supplementation regimens.
BACKGROUND:The association between body mass index (BMI) and clinical outcomes in inflammatory bowel disease (IBD) remains controversial. We aimed to investigate whether BMI independently predicts length of stay (LOS) or if its impact is mediated by nutritional and inflammatory markers. METHODS:This retrospective study included 2545 patients hospitalized with Crohn's disease (CD) and 721 with ulcerative colitis (UC). Patients were categorized into four groups: underweight, normal weight, overweight, and obese. Restricted cubic splines were used to visualize the non-linear relationship between BMI and LOS. Multivariable linear regression models were applied to identify independent predictors of LOS. RESULTS:Univariate analysis showed that in patients with CD, both underweight and obese patients had longer hospital stays than those with normal weight (P = 0.009). BMI showed a U-shaped correlation with serum albumin (ALB) and hemoglobin (Hb). However, in the multivariate model, after adjusting for ALB, Hb, C-reactive protein (CRP), and comorbidities, BMI was no longer a significant predictor of LOS in patients with CD (P = 0.082 to 0.4) or UC (P = 0.2 to 0.9). Instead, lower ALB (P < 0.001) and higher CRP (P < 0.001) were significantly associated with prolonged hospital stays. CONCLUSION:While BMI is associated with LOS in IBD patients, it is not an independent driver. BMI serves as a phenotypic reflection of the underlying inflammatory status. Clinical management should prioritize the correction of inflammation rather than focusing solely on BMI.
BACKGROUND:Sarcopenia and malnutrition are associated with mortality, including in adults admitted to an intensive care unit. However, their relationships with each other and with intensive care unit mortality, independently, in mechanically ventilated adults are unclear. This study explored the prevalence and relationships between sarcopenia risk and malnutrition and their association with intensive care unit mortality. METHODS:This was a pilot, prospective, observational study of adults requiring mechanical ventilation in an intensive care unit. Sarcopenia risk and malnutrition were assessed within 96 h of mechanical ventilation, and participants were followed prospectively until intensive care unit discharge. Three multivariable logistic regression models were developed for the dependent outcome of intensive care unit mortality. RESULTS:In total, 127 participants were included. Most were admitted with a medical diagnosis (88.2%). The mean APACHE II score was 25.2 ± 7.4, and intensive care unit mortality was 33.9%. Sarcopenia risk was present in 40.2% of participants, while 33.9% were mild to moderately malnourished and 4.7% were severely malnourished. Co-existing sarcopenia risk and malnutrition was present in 22.8% of participants. Participants with sarcopenia risk had a significantly higher prevalence of malnutrition (56.9%) than patients without sarcopenia risk (26.3%, P < 0.001). There were no significant associations between sarcopenia risk or malnutrition and intensive care unit mortality in the crude and adjusted logistic regression models. CONCLUSION:Malnutrition and sarcopenia risk are prevalent in mechanically ventilated adults and co-exist in almost a quarter of patients. Malnutrition and sarcopenia risk were not independently associated with intensive care unit mortality.
BACKGROUND:The timing of allergenic food introduction is a recognized modifiable risk factor for the development of IgE-mediated food allergy. There is a paucity of data on the implementation of early introduction of common food allergens in infants fed via feeding tubes. We aimed to compare the characteristics and common food allergen exposure of patients with feeding tubes who received education during their gastroenterology visit versus those who did not. METHODS:We conducted a retrospective chart review of patients aged 4 to 24 months with a feeding tube between September 2020 and July 2024. Differences between patients who received education for common food allergen exposure and those who did not were analyzed using Student's t-test for continuous variables and chi-square test for categorical variables. RESULTS:Seventy-seven patients met the inclusion criteria, contributing a total of 349 visits. Education was associated with younger age (p = 0.01), atopic dermatitis (p = 0.02), English as the primary language (p = 0.02), and non-Hispanic/Latino ethnicity (p < 0.001). Education was frequently missed in infants wholly reliant on their feeding tube (p = 0.01). Although caregivers reported exposure to at least one common food allergen in 63% of all visits, documented exposure to the key allergens, peanut (8%) and egg (12%), was notably low. CONCLUSIONS:These findings suggest the need for improved and targeted education. Future research may aim to establish evidence-based guidelines for introducing allergenic foods to infants fed via feeding tube.
