Managing hyperphosphatemia remains a challenging feat in the dialysis population. In 2023, tenapanor, a sodium hydrogen exchanger inhibitor, was approved in the United States for treating hyperphosphatemia in adults with chronic kidney disease receiving dialysis. This narrative review evaluated the recent literature on tenapanor, its effects on serum phosphate, and the achievement of target serum phosphate reference ranges in individuals undergoing peritoneal and hemodialysis. In addition to efficacy, this review examined the prevalence of drug-induced diarrhea. Twelve articles met the inclusion criteria. Results indicate clinical and statistical differences in the mean change in serum phosphate and a greater tendency to achieve serum phosphate target reference ranges among individuals receiving dialysis who take tenapanor compared with those who do not. These findings support using tenapanor independently or in conjunction with phosphate binders to treat hyperphosphatemia. However, drug-induced diarrhea may lead to discontinuation of tenapanor therapy. Future research should focus on nutrition counseling to mitigate drug-induced diarrhea and extend tenapanor tolerance in individuals receiving dialysis.

BACKGROUND:Registered dietitian nutritionists (RDN) should be essential contributors to weight management and diabetes care for people using glucagon-like peptide-1 receptor agonist-based therapy (GLP-1 RA-based therapy), as they provide education, prevent and manage side effects, and address nutritional deficiencies. Little is known about the practice behaviors of RDNs , providing care to people using these medications. OBJECTIVE:To determine demographic, professional characteristics, and practice behaviors of RDNs who provide medical nutrition therapy (MNT) to people using GLP-1 RA-based therapy diagnosed with either obesity or diabetes. DESIGN:An online, cross-sectional survey was distributed from May 28, 2025, through June 25, 2025, consisting of 55 questions covering topics such as screening for eating disorders and malnutrition, nutrition assessment, diagnosis, intervention, monitoring, and evaluation within the nutrition care process. RESPONDENTS:The sample included 212 RDNs who were members of the Weight Management Dietetic Practice Group and/or the Diabetes Dietetic Practice Group of the Academy of Nutrition and Dietetics and had experience working with people receiving GLP-1 RA-based therapy. STATISTICAL ANALYSIS PERFORMED:Survey data were analyzed via descriptive statistics. RESULTS:Respondents were female (95.3%), with 20.4 (SD + 11.9) years of experience, 64.1% held a master's degree, and 61.5% worked in an outpatient or ambulatory clinic. Regarding assessment practices, 26.4% screen for eating disorders, 42.9% perform a nutrition-focused physical exam, and 31.1% routinely assess body composition. The RDN respondents most commonly recommend monitoring for Vitamin D (78.2%) and iron (75%) deficiencies. Over 80% of respondents "strongly agree" (62.0%) or "somewhat agree" (22.4%) that there is a need to create specific GLP-1 RA-based therapy MNT practice guidelines. CONCLUSIONS:This survey not only identifies key patterns of consistency and variation in practice among RDNs but also reinforces the integral role that RDNs play in supporting and managing people on GLP-1 RA-based therapy. A majority of RDNs indicated a need to develop dietetic-specific MNT guidelines for GLP-1 RA-based therapy.

Protein intake recommendations for patients with chronic kidney disease (CKD) stages 3–5 without kidney replacement therapy (KRT) remain controversial. This study investigated current practice trends related to the 2020 Kidney Disease Outcomes Quality Initiative (KDOQI) protein guidelines and dietitians’ perspectives on low-protein diets (LPDs) and plant-based diets in CKD. This mixed-methods explanatory sequential study included a secondary analysis of an online survey (N = 87), followed by a conventional content analysis of two virtual focus groups (N = 11). Most survey respondents reported prescribing the KDOQI-recommended protein amounts of 0.55–0.6 g/kg/d in patients without diabetes (65.9%) and 0.6–0.8 g/kg/d in patients with diabetes (81.5%). Use of keto-acid analogs (KAs) was low among survey participants (18.4%). Focus group participants described varied approaches for calculating protein goals but overwhelmingly stressed the importance of individualized care. Key factors influencing recommendations included nutritional status, food preferences, comorbidities, current intake, and knowledge, beliefs, attitudes, and motivations. In summary, most participants recommended LPDs consistent with the KDOQI guidelines; however, KA use was uncommon. Despite differences in decision-making, participants emphasized individualizing protein recommendations to each patient’s unique needs. Given the exploratory nature of this work and the small, self-selected sample, these results provide preliminary insights that warrant further investigation in more diverse samples.

BACKGROUND:Preterm infants of <34 weeks gestation or <1500 g are at risk for postnatal growth failure and often require nutrition support after discharge. Despite expert recommendations for postdischarge human milk (HM) fortification or nutrient-enriched formula feeding, the effects of current feeding strategies on growth and HM intake remain unclear. This systematic review evaluated the impact of postdischarge fortified expressed HM or direct breastfeeding (BF) with postdischarge formula (PDF) bottle feeds compared to unfortified HM or BF with standard term formula bottle feeds on growth and HM intake outcomes through 6 and 12 months corrected age (CA). METHODS:A systematic search of eight databases and grey literature sources was conducted for studies published in English since 2012 identifying 3146 studies. Risk of bias was assessed using standardized Cochrane RoB 2 and ROBINS-I tools. Meta-analysis was not conducted due to heterogeneity in interventions, outcome timing, and outcome metrics; results were narratively synthesized. RESULTS:Four studies (n = 2 randomized controlled trials, n = 2 cohorts), including 548 preterm infants, met eligibility criteria. Two studies showed significantly greater weight gain, and one showed significantly greater head circumference in the fortified groups at 6 months CA compared to the unfortified groups. Length differences were not significant. Three studies reporting HM intake found comparable or greater HM intake in the fortified groups. CONCLUSION:Current evidence suggests that postdischarge fortified HM or direct BF with supplemental PDF bottle feeds may support improved weight and head circumference outcomes without compromising HM intake. However, methodological variability highlights the need for standardized, prospective studies.

BACKGROUND:Malnutrition in the form of protein-energy deficits and altered micronutrient status is associated with liver cirrhosis (LC). The study aimed to identify physical findings associated with malnutrition in adult patients with LC and to develop an LC-specific nutrition-focused physical exam (LC-specific NFPE) tool. METHODS:A modified Delphi approach was used to obtain consensus among expert panelists who were registered dietitians (RD) working in hepatology, gastrointestinal, transplantation, or other specialized settings treating patients with liver disease. Panelists were recruited through purposive sampling. Each panelist completed a 2-round online survey by scoring potential NFPE components on a 5-point Likert scale and providing optional open-ended feedback. RESULTS:Panelists (N = 16) were ≥25 years of age, 93.75% had a Masters' degree or higher, and 100% reported using NFPE in practice. The 8 NFPE domains that achieved consensus were identified through an evidence-based literature search and include Anthropometrics, Vital Signs, Musculoskeletal and Adipose Exam, Orofacial Exam, Hair, Skin, and Nails Exam, Gastrointestinal Exam, Nervous System Exam, and Disease-specific Exam. Out of 63 initial components, 56 achieved consensus and were included in the LC-specific NFPE tool. CONCLUSION:Specific domains and components for an evidence-based LC-specific NFPE tool were identified by obtaining consensus from a panel of expert RDs. This tool may further be developed and validated to assist in comprehensive nutritional assessment of patients with LC.

OBJECTIVE:To explore the perspectives of African American mothers of low income regarding children's food and identify their culturally specific nutrition education needs to inform the design of nutrition education within a community-led, culturally responsive health promotion campaign countering the marketing of ultraprocessed foods to African American children. METHODS:A basic descriptive qualitative design with focus groups of African American mothers of low income (n = 33) with preschool-aged children enrolled in a Newark, NJ, Head Start. Zoom-based discussions were recorded, transcribed, and analyzed using reflexive thematic analysis. RESULTS:Three themes emerged: (1) mothers know that food and health are connected, (2) cultural foodways matter, and (3) mediators at every level of the Social Ecological Framework influence children's food choices. Differences by nativity revealed a distinct subset of food-related beliefs and practices between US-born mothers and their foreign-born counterparts. CONCLUSIONS AND IMPLICATIONS:Personal, cultural, and environmental influences shape the early childhood feeding practices of African American mothers of low income. Differences within this population underscore the need for a culturally responsive campaign-grounded in sociocultural context and inclusive of both US and foreign-born families-to effectively support healthier eating in early childhood.

Bariatric surgery (BS) is effective for treating obesity but carries significant nutritional risks. Patients often develop micronutrient deficiencies, loss of muscle mass, and other physiological complications. Standardized methods such as the Nutrition-Focused Physical Exam (NFPE) may not adequately capture physical findings specific to BS. This study aimed to develop an expanded and modified bariatric-specific NFPE tool and achieve expert consensus on its essential components using a modified Delphi methodology. A literature review identified clinical signs of malnutrition and nutritional complications unique to patients undergoing BS, which informed proposed BS-NFPE components. A three-round modified Delphi study with expert bariatric dietitians (n = 25) achieved consensus (>= 75% agreement) on 43 BS-NFPE components, including physical signs of micronutrient deficiencies and toxicities, changes in muscle and fat stores, indicators of surgical complications, gastrointestinal symptoms, and mental health effects. Experts also supported incorporating functional considerations and social determinants of health. This study introduces the first evidence-informed modified BS-NFPE tool to address limitations of the standard NFPE in bariatric populations. Use of BS-specific features may help clinicians identify malnutrition earlier, tailor care, and improve long-term patient support. Future research should evaluate this tool in clinical practice.

Background: Excess adiposity induces low-grade inflammation, including increased C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (TNF-α). Green tea contains epigallocatechin gallate (EGCG), with anti-inflammatory potential. EGCG metabolism is influenced by individual variations in catechol-O-methyltransferase (COMT) genotypes. Objectives: To evaluate the effect of green tea extract (GTE) supplementation on circulating inflammatory cytokines among postmenopausal women with overweight or obesity and differing COMT genotypes. Methods: This study is a secondary analysis of a random subset (N = 97) from the Minnesota Green Tea Trial (MGTT), a randomized double-blinded placebo-controlled trial. The intervention was a high-dose GTE supplement (843 ± 44 mg EGCG/day) or placebo for 1 year. Serum CRP, TNF-α, and IL-6 were measured at 0, 6, and 12 months. Absolute changes in inflammatory cytokines from baseline to month 12 were evaluated using linear mixed-effects models adjusted for age, body mass index (BMI), smoking history, physical activity, and vitamin supplement use. Results: The changes from month 0 to month 12 were not statistically different between the groups for any of the inflammatory cytokines measured. The overall treatment effect was not statistically significant for CRP (p = 0.24), IL-6 (p = 0.59), TNF-α (p = 0.36), nor for the interaction between treatment group and time (all Ps > 0.40). There was no significant interaction between treatment group and COMT genotype for the stated markers. Conclusions: A high-dose GTE supplement consumed daily for one year did not significantly decrease inflammatory cytokines among postmenopausal women with overweight or obesity. The COMT genotype did not modify the effects of GTE supplementation on inflammatory cytokines. Future studies with a larger sample size among those at high risk of systemic inflammation are warranted.

Abstract Background Older adults frequently take both gabapentinoids and dihydropyridine calcium channel blockers (DHP-CCBs), often started years apart as new conditions emerge. A common pattern is the late addition of gabapentin to a regimen that has long included a DHP-CCB. Prior work links concurrent gabapentinoid–DHP-CCB exposure to elevated incident dementia risk, but whether the order in which the two medications are introduced matters has not been examined. We asked whether incident dementia risk differs by the order in which gabapentinoid and DHP-CCB therapy are introduced . Methods Using the Rutgers Clinical Research Data Warehouse (2018–2024) and active-comparator new-user designs with IPTW Cox models, we examined two prescribing scenarios in a hypertensive cohort: gabapentin or pregabalin added after prior DHP-CCB exposure (forward sequence; N=7,141), and a DHP-CCB or ACE inhibitor/ARB added after chronic gabapentinoid therapy (reverse sequence; N=685). Results When gabapentin was added to a regimen that already included a DHP-CCB, incident dementia risk was elevated relative to pregabalin ( IPTW HR 2.44, 95% CI 1.06–5.63, p=0.036 ). When the order was reversed — a DHP-CCB added to chronic gabapentinoid therapy — no elevated risk was observed ( IPTW HR 0.64, 95% CI 0.17– 2.39 ). Pre-specified sensitivity analyses supported the forward-sequence finding. Conclusions In hypertensive older adults, the same two medications were associated with very different dementia signals depending on which was started first: elevated risk when gabapentin was added to chronic DHP-CCB therapy, no elevated signal in the reverse direction. The two prescribing sequences may not be clinically equivalent. If replicated, this pattern would support targeted medication review at the time gabapentin is added to regimens that already include a DHP-CCB.

Objective:Hypertensive disorders of pregnancy (HDP) contribute to maternal mortality and morbidity globally. Mobile health technologies may improve HDP management through patient education, facilitating patient-provider communication, and supporting blood pressure self-monitoring through tailored feedback and reminder prompts. Our objective was to understand the digital health needs of women with HDP from low-socioeconomic backgrounds. Methods:An interactive HDP management digital prototype was developed and evaluated through usability and acceptability testing. Participants included nine pregnant or postpartum women with diagnosed HDP and three maternal-fetal medicine specialists, recruited from two clinics in a predominantly low-income city, Newark, N.J., in 2024 The Technology Acceptance Model was used to guide the assessment of the prototype's acceptability and usability. Data were collected from interviews, a digital literacy questionnaire, and a system usability questionnaire, with quantitative data analyzed descriptively and qualitative data through content analysis. Results:The median gestational age among pregnant women was 22.0 (17.0, 29.0) weeks, with 89 % identifying as Black/African American. Most women (78 %) reported moderate or high digital health literacy. The mean System Usability score was 81 ± 17, indicating good usability. Three themes were identified: high acceptability and usability, the importance of tailored feedback, and the need for real-time provider-patient communication to support treatment decisions. Conclusions:These findings indicate a high acceptability and usability of a digital application for HDP management and home blood pressure monitoring among pregnant and postpartum women diagnosed with HDP and their providers in a low-income urban setting.

BACKGROUND:The number of older adults will double worldwide by 2050, impacting the social system with higher healthcare personnel needs and economic costs. Registered dietitian nutritionists play a critical role in the holistic management of chronic diseases and related nutritional problems. Thereby, a comprehensive nutritional assessment should include a nutrition-focused physical examination (NFPE) to ensure early identification of nutrition-related problems. However, explicit NFPE components across different assessment categories (NFPE+) of the Nutrition Care Process for older adults are lacking. METHODS:This modified Delphi study aimed to identify NFPE+ components specific to older adults (≥ 65 years) through a literature review and to obtain consensus about the relevance and usefulness of these components among international dietitian experts in gerontology nutrition. Experts rated how useful and relevant the identified NFPE+ domains and components were using a 5-point Likert-type scale. Open-ended answers allowed the experts to suggest new components or propose adjustments to the identified components. Consensus was defined a priori at 75% agreement. RESULTS:The literature review identified 30 NFPE+ components specific to older adults. The Delphi panel comprised of 15 experts from eight countries with 23.5 (±11.5) years of experience in geriatric nutrition. All 30 proposed NFPE+ components and three newly suggested components achieved consensus through two Delphi rounds. These 33 components were categorized into five NFPE+ domains in a finalized NFPE+ tool. CONCLUSIONS:NFPE+ domains and components specific to older adults may significantly contribute to a focused and comprehensive nutritional assessment in older adults.

ObjectiveThe Subjective Global Assessment (SGA) is a validated tool for identifying nutritional status in patients receiving maintenance dialysis (MHD), but it is not without limitations. Current research identifies additional clinical characteristics such as phase angle (PhA) associated with SGA. This study aimed to assess the overall correlation between PhA and SGA; associations between PhA and SGA by body mass index (BMI), and to identify clinical characteristics associated with SGA.Design and MethodsThis is a secondary analysis of the Rutgers Nutrition & Kidney Database, which enrolled participants from four primary studies that included adults diagnosed with chronic kidney disease who were receiving MHD. Multivariable binary logistic regression analyses were conducted to estimate odds ratio (OR) and corresponding 95% confidence intervals.ResultsThe study sample included 60.0% males with 81.1% of the sample identifying as African American. Additionally, 38.9% were obese according to the BMI classification, and 57.0% were moderately malnourished. Patients with obesity had 44% lower odds of being moderately malnourished (OR=0.56, 95% CI= 0.37, 0.85). In the model adjusted for age and ethnicity and other clinical characteristics, increasing PhA values by one unit was associated with 28% lower odds (OR= 0.72, 95% CI= 0.53, 0.97) of being moderately malnourished while increasing waist circumference (WC) values by one unit was associated with 12% higher odds (OR= 1.12; 95% CI= 1.06, 1.19) of being moderately malnourished than well-nourished. In this fully adjusted model, increasing FFM (OR= 0.95, 95% CI=0.91, 0.99) and FM (OR = 0.92, 95% CI= 0.87, 0.97) by 1 kg was also associated with a 5% and 8% lower odds of being moderately malnourished, respectively.ConclusionPhA and SGA were significantly associated only among patients classified as obese. PhA, WC, FM, and FFM were identified as potential clinical determinants of SGA. Patients receiving MHD and who have obesity may benefit from utilizing SGA along with WC, PhA, FM, and FFM to assess nutritional status.

Objective: This study aimed to identify components of a trauma-informed, culturally sensitive eating-disorder-specific nutrition-focused physical examination (ED-NFPE) tool. Method: The modified Delphi methodology was used to develop a consensus on the clinical relevance of nine evidence-informed ED-specific nutrition examination domains and 46 components within those domains. Purposive sampling was used to recruit a panel of registered dietitian nutritionist (RDN) experts in the ED field. The panelists responded to survey statements on a five-point Likert scale. The panelists also provided qualitative feedback on domain and component additions, exclusions, modifications, and trauma-informed culturally sensitive examination practice techniques. Results: Twenty-two RDN expert panelists completed Round One of the study, and eighteen panelists completed Round Two (82% retention). Twenty-one were female. Fifteen panelists had ten or more years of experience in ED dietetics. Fifty percent held an advanced practice credential from the International Association of Eating Disorders Professionals (IAEDP). After the two survey rounds, the nine ED-NFPE domains and 46 of the 48 components achieved a consensus for clinical relevance. The panelists proposed two new examination components and provided qualitative feedback for trauma-informed culturally sensitive practice techniques in all nine domains. Conclusions: This modified Delphi study design was chosen to reach a consensus on developing an ED-NFPE tool, as there are few current evidence-based guidelines for nutrition examinations in ED care. An NFPE tool specifically designed to detect the nutrition-related findings of individuals with EDs would strengthen the overall nutrition assessment. RDNs at every level of care and with all degrees of experience could use an ED-NFPE to inform patient treatment goals.

BACKGROUND:Healthcare teams evaluating candidates for lung transplant seek to identify and address modifiable factors to improve their clinical outcomes. Frailty may be a modifiable factor, and poor nutrition may be a contributor to frailty. This study evaluated the relationship between nutrition risk and frailty in lung transplant candidates. METHODS:This was a secondary analysis of data from 62 adult lung transplant candidates. Nutrition risk was assessed with the Seniors in the Community: Risk Evaluation for Eating and Nutrition (SCREEN-14) questionnaire, and frailty was measured using two methods: physical frailty with the Fried frailty index (FFI) and multidimensional frailty using a cumulative deficits frailty index (CDFI), where higher scores on a 0-1 scale denote increasing frailty. Pearson correlation, independent-samples t-test, and Fisher's exact tests analyzed associations between SCREEN-14 and both FFI and CDFI scores. RESULTS:Most participants were at high nutrition risk (83.9%) and were pre-frail (69.4%) or frail (17.7%) when assessed using FFI. Mean CDFI score was 0.26. Higher nutrition risk was associated with a higher degree of frailty as measured using FFI (r = -0.303; p = 0.017) but not CDFI. Participants at high nutrition risk were significantly more likely to be pre-frail or frail by FFI than those at low nutrition risk (92.3% vs. 60.0%, respectively; p = 0.019). CONCLUSIONS:High nutrition risk is highly prevalent and associated with physical frailty in lung transplant candidates. Future studies should investigate how to best identify nutrition risk and whether interventions that reduce this risk also decrease frailty.

BACKGROUND:Research has sought to identify optimal protein doses during acute phases of critical illness to optimize outcomes. METHODS:A secondary analysis of the EFFORT Protein trial, which compared high vs usual protein (N = 1301). Only participants with 8 evaluable days of protein intake were included in our analysis. Mean protein intake was categorized as low (<0.8), medium (0.8-1.3), or high (>1.3 g/kg/day). Acute illness phases were define as early (days 1-4) and late (days 5-8). Participants were grouped by protein dose received in each phase. Based on prior evidence, early phase medium protein/late phase high protein served as the referent. The primary outcome was time-to-discharge-alive; secondary outcomes included 60-day mortality and discharge home. RESULTS:We identified 819 participants (median [IQR] age 59.0 [46.0, 69.0] years; 60% male). Time-to-discharge-alive did not differ significantly across groups (P = 0.19). The early low/late high-protein and early high/late high-protein groups had hazard ratios of 0.63 (95% CI, 0.35-1.11) and 0.70 (95% CI, 0.46-1.06), respectively. Mortality and discharge-home rates did not differ significantly across protein dose/acute phase groups (P = 0.85 and 0.65, respectively). CONCLUSION:We hypothesized that early medium and late high protein would improve outcomes; however, no significant differences between were observed across protein dose/acute phase groups. These findings are hypothesis-generating and highlight the need for future research to identify biomarkers or scoring tools that better define phase transitions in critical illness, enabling more precise nutrition strategies. TRIAL REGISTRATION (PRIMARY):NCT03160547.

BACKGROUND:The effect of dietary modifications on pain and joint function in adults with osteoarthritis (OA) is an emerging area of study. This systematic review aimed to evaluate if adults with OA who consume diets with a higher proportion of plant phenols and omega-3 fatty acids would have less pain and improved joint function than those with a higher proportion of saturated fatty acids, omega-6 fatty acids and refined carbohydrates. METHODS:Database searches of CINAHL (EBSCO), Clinical Trials (NIH-NLM), Cochrane Library (Wiley), Dissertation & Thesis Global (ProQuest), Embase (Elsevier), Medline (OVID), PubMed (NLM), Scopus (Elsevier), Web of Sciences (Clarivate) for clinical trials identified 7763 articles published between January 2015 and May 2023. After an independent review of the articles, seven randomised clinical trials and one nonrandomised clinical trial were included in the analysis. Because of the heterogeneity of the outcome measures, a meta-analysis was not possible. RESULTS:Participants who were instructed to consume high-phenol/high-omega-3 fatty acid diets reported significant improvements in pain and physical function scores. The greatest improvement was reported by those who consumed a diet that had the most omega-3 fatty acids. CONCLUSION:Because of the high risk of bias, the strength of the evidence is limited. However, there is evidence that counselling adults with OA to replace refined grains and processed foods with whole plant foods, fish and plant oils may have a favourable effect on pain and physical function. Routine follow-up care regarding these diet modifications may be necessary to ensure adherence to this therapy.