Abstract While overnight cyclic infusions are considered standard clinical practice for home nutrition support therapy, particularly for parenteral nutrition, there is growing recognition that the optimal timing of infusion may vary among patients. A key clinical dilemma is determining the optimal timing of infusion schedules, which vary based on modality, tolerance, metabolic needs, and patient preference. Guidance from the American Society for Parenteral and Enteral Nutrition (ASPEN) and the European Society for Clinical Nutrition and Metabolism (ESPEN) offers flexibility in selecting between daytime and nighttime infusion schedules. Overnight infusions largely reflect hospital‐based cyclic regimens and offer advantages such as improved daytime independence and mobility, discretion, and potentially enhanced adherence and better tolerance with longer infusion cycles. However, advances in portable technology and a growing understanding of the role of the circadian system in governing metabolism, appetite, immune and inflammatory function, and aging have increased consideration of daytime infusions, which may better align with circadian rhythms and improve sleep quality by reducing nighttime disruptions. Selecting an optimal infusion schedule requires a patient‐centered approach that balances clinical goals with quality of life, psychosocial factors, sleep, daily routines, and safety. Infusion schedule changes should be carefully monitored for tolerance, nutrition adequacy, and safety. Infusion timing should be tailored through ongoing collaboration between patients and interdisciplinary teams, with regular reassessment to ensure safety, effectiveness, and alignment with evolving patient needs.
Abstract Background Low muscle mass is common in patients on hemodialysis (HD), and bioelectrical impedance analysis (BIA) predictive equations have been proposed as an alternative for estimating muscle mass. This study aimed to analyze the validity and agreement of different BIA‐based prediction equations against dual energy X‐ray absorptiometry (DXA) for estimating skeletal muscle mass (SMM) and appendicular skeletal muscle mass (ASMM) in patients on HD. Methods A cross‐sectional study enrolled patients on HD. Clinical and laboratory data and body composition by BIA and DXA were collected. The accuracy of six prediction equations (Janssen, Barbosa‐Silva, Kyle, Lin, Macdonald, and Sergi) for estimating SMM and ASMM was tested against DXA as the reference standard. Agreement was assessed using Lin's Concordance Correlation Coefficient (CCC), Bland‐Altman analysis, Kappa statistics, Receiver Operating Characteristic (ROC) curves, and Passing‐Bablok regression. Results The sample consisted of 57 participants, age 52 ± 13 years, 32 (56%) male, median dialysis vintage 14 (4–40) months, 17 (30%) with diabetes, and 48 (84%) with hypertension. The best agreement with DXA was observed for the Lin (CCC = 0.911), Sergi (CCC = 0.902) and Kyle (CCC = 0.902) equations. For low muscle mass diagnosis, Kappa values ranged from moderate to substantial, with the Lin equation showing the highest agreement ( κ = 0.734). Additionally, the Lin equation demonstrated good accuracy (AUC = 0.794, 95% CI 0.68–0.91), with 68,4% sensitivity and 89.5% specificity. Conclusion The Lin equation provided the most accurate and reproducible estimates of muscle mass compared with DXA and showed good diagnostic performance for low muscle mass in patients on HD.
Abstract Background Feeding guidelines (FGs) reduce the incidence of necrotizing enterocolitis (NEC) and improve growth and enteral nutrition (EN) practices in very low birth weight (VLBW) infants. Our unit's baseline data revealed delayed initiation of EN, prolonged time to full EN, prolonged days on parenteral nutrition (PN), and frequent use of peripherally inserted central catheters (PICC). After introduction of this FG, our specific, measurable, attainable, realistic, and time‐bound (SMART) aims were to reduce PICC placements in infants 1000–1500 g by 30% and to reduce the time to achieve full EN in VLBW infants by 20% without adversely impacting NEC rate, growth, and mom's own milk (MOM) provision. Methods We conducted a time‐series quality improvement initiative over 48 months. Outcome and process measures included the percentage of PICC placements, nutrition‐related central line days, day of life (DOL) EN initiated, and DOL on full EN. Balancing measures included NEC, growth, and MOM provision. Two‐tailed t ‐tests, Mann‐Whitney U tests, and chi‐square tests were used to analyze demographic data, numerical variables, and categorical variables, respectively. Statistical process control charts and established rules for special cause variation were applied. Results Our results demonstrate a 54% reduction in PICC placements and a 38% reduction in time to achieving full EN. We saw no increase in NEC rate but observed a decrease in growth and MOM provision. Conclusion The use of a standardized FG resulted in fewer PICC placements and decreased time to full EN without increasing the NEC rate. Future initiatives will focus on improving growth and MOM provision in VLBW infants.
Abstract Background Diarrhea is a frequent complication during enteral nutrition (EN) in adults and may interrupt feeding, prolong hospitalization, and increase healthcare burden. Modulation of the intestinal microbiota with probiotics or synbiotics represents a potential preventive strategy, but the evidence remains uncertain. Methods This systematic review and meta‐analysis followed the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) 2020 guidelines (PROSPERO: CRD420251183554). We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, and CQVIP from database inception to November 6, 2025. Randomized controlled trials (RCTs) comparing prophylactic probiotics or synbiotics with placebo, routine care, or unsupplemented EN in adults were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random‐effects models. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Thirty‐nine RCTs were included; 36 (3446 participants) contributed to meta‐analysis. Probiotics or synbiotics reduced reported diarrhea versus controls (RR 0.35; 95% CI 0.29–0.42; p < 0.00001; I 2 = 0%). However, I 2 = 0% may reflect limited power with sparse events. Funnel plot asymmetry and Egger's test ( p < 0.001) suggested possible publication bias. Most trials had high risk of bias (unblinded outcome assessment). Certainty was very low, downgraded mainly for serious risk of bias and suspected publication bias. Conclusions Very low‐certainty evidence suggests probiotics or synbiotics may reduce reported diarrhea in adults on EN, but the true effect is likely smaller. Current data do not support routine use or specific recommendations. Larger, blinded trials with standardized definitions are needed.
Abstract Objective This study aimed to evaluate the association between IDDSI‐based versus traditional R1–2–3 texture modifications and nutritional outcomes in patients undergoing neurological rehabilitation who required dietary modification after videofluoroscopic swallowing study (VFSS). Materials and Methods Patients hospitalized for neurological rehabilitation who underwent VFSS between February and December 2023 were retrospectively analyzed. Patients received either the traditional R1–2–3 diet system or IDDSI‐based modification, according to the hospitalization period. In both groups, individualized energy and protein requirements were determined by a clinical dietitian. Body mass index (BMI), NRS‐2002 scores, hematological parameters, and biochemical parameters were recorded at admission and discharge. Intra‐ and intergroup comparisons and correlation analyses were performed. Results A total of 288 patients were included (mean age, 60.59 ± 19.26 years; 44.8% female). Pre‐discharge BMI was higher in the IDDSI group ( p = 0.046), while the proportions of patients with low protein and albumin levels were lower ( p = 0.038 and p = 0.024, respectively). Serum 25‐hydroxyvitamin D levels were also higher ( p = 0.019). Improvements in BMI, NRS‐2002 scores, nutritional risk, hemoglobin, total lymphocyte count, and vitamin D levels were greater in the IDDSI group ( p = 0.006–0.045). IDDSI‐based modification was negatively associated with underweight BMI, nutritional risk, low protein, and low albumin levels ( p < 0.05). Conclusion Within dietitian‐supervised nutritional care, IDDSI‐based texture modification was associated with more favorable nutrition‐related outcomes than the traditional R1–2–3 system. Given the retrospective, nonrandomized design, these findings should not be interpreted as evidence of causality.
