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Background: Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy in the world. Advances in treatment protocols have resulted in survival rates of >80% in most high-income countries (HIC); however, children and young people (CYP) with ALL continue to face significant nutrition-related challenges during treatment., Methods: This narrative review outlines the changing landscape of treatment and survivorship for CYP with ALL and the advances in nutrition knowledge that call for changes to clinical nutrition practice., Results: The incidence of ALL has remained stable in HIC; however, there have been significant advances in survival over the past 30 years. Overweight and obesity are increasingly prevalent in CYP with ALL at diagnosis, during treatment and in survivorship. Coupled with poor diet quality, high-energy and saturated fat intakes, altered eating behaviours and inactivity, this necessitates the need for a shift in nutrition intervention. Undernutrition remains a concern for CYP with high-risk treatment protocols where oral or enteral nutrition support remains a cornerstone of maintaining nutrition status., Conclusions: With improved treatment protocols and high survival rates, a shift to focusing on diet quality, prevention of excessive weight gain and obesity during treatment and survivorship is necessary., (© 2024 The Authors. Journal of Human Nutrition and Dietetics published by John Wiley & Sons Ltd on behalf of British Dietetic Association.)

Evidence of poor nutrition status in a patient present on admission to the intensive care unit is associated with worse clinical outcomes than that for a well-nourished patient who becomes critically ill. Diagnosing malnutrition in this setting is fraught with difficulty, though, because elements of nutrition history are hard to obtain, the interpretation of anthropometric parameters is influenced by the disease process and interventions of critical care and the subjectivity of traditional assessment tools lacks precision. Determining the severity of disease drives the initial management and sets priorities in the derivation of the nutrition plan, focusing on strategies that promote survival. Its design should provide safe and effective nutrition support, avoiding aggressive feeding to make up for deficits in the acute phase of critical illness. In time, with resuscitation and stabilization, addressing pre-existing or developing malnutrition will change management and alter the design of the nutrition therapy., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Nutrition plays an integral role in the management of patients with enterocutaneous fistula (ECF), but practice guidelines are often vague because of limited evidence. As a result, clinicians must rely on expert consensus and sound nutrition principles to guide practice. The initial phase of ECF management involves recognition (eg, fistula location and quantifying output) and stabilization (eg, source control and fluid and electrolyte balance). All patients with ECF should be considered at risk of malnutrition because of malabsorption, high gastrointestinal fluid and nutrient losses, and chronic inflammation. Strict bowel rest in conjunction with parenteral nutrition (PN) is typically warranted on initial presentation, but patients can often transition to oral diet or enteral nutrition if ECF output is low (<500 ml/day) and there is good control of ECF drainage at the skin level. Patients with high-output ECF (>500 ml/day) may require PN to meet fluid, electrolyte, and nutrient requirements to support spontaneous or surgical closure of the ECF. Because the healing process can take months, transfer from the inpatient to home setting should be considered when a patient is medically stable. Preparing for discharge home requires stabilization of fluid and electrolyte balance, achievement of glycemic control, containment of ECF output, and patient and/or caregiver training. A long-term PN treatment plan should be developed that incorporates outpatient monitoring, determination of target weight, and desired PN end point. The purpose of this article is to review the optimal use of PN in adult patients with ECF., (© 2024 The Author(s). Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Background: Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD., Methods: This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons., Results: There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions., Conclusion: Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Background: Acute malnutrition treatment coverage remains low worldwide, causing significant morbidity and mortality. Decentralisation of treatment to Community Health Worker (CHW) sites has shown to be an effective strategy to improve access and increase coverage, but evidence on the cost and cost-effectiveness of this approach as well the use of simplified treatment protocols in conflict settings is lacking. The objective of this study was to determine cost per child treated as well as the cost-effectiveness of the hybrid model of treatment delivery (where treatment is provided at both health facilities and CHW sites) using either a standard protocol (Intervention 1) or simplified protocol (Intervention 2) compared to standard treatment at health facilities only (Control) in the conflict affected region of Gao in Northern Mali., Methods: This economic evaluation was part of a three-arm cluster randomized controlled trial which enrolled 2038 children with moderate and severe acute malnutrition. Outcomes assessed were cost per child treated as well as average and incremental cost-effectiveness ratios for cost per child cured and disability adjusted life year (DALY) averted. A within study trial horizon, from March 2020 to July 2021, was used. Cost data were collected from accountancy records and through key informant interviews using a societal perspective. Treatment admission and outcome data were obtained from the main trial., Results: In the base case scenario the cost per child treated was 272 US$, 179 US$ and 210US$ in the Control, Intervention 1 and 2 groups, respectively. Cost per child cured was 356 US$ in the Control, 219 US$ in the Intervention 1 and 226 US$ Intervention 2 groups. Ready-to-use therapeutic foods (RUTF) costs among SAM children treated with a simplified protocol were 5.7 US$ less per child. The average cost per DALY averted was 173.1 US$ in the Control compared to 60.3 US$ in the Intervention 1 and 53 US$ in the Intervention 2., Conclusion: This study shows that involving CHWs in acute malnutrition treatment reduces the cost per child treated and is a cost-effective strategy, due to lower treatment costs and greater coverage in the decentralised model. Switching to a simplified protocol in a conflict setting can lead to cost savings particularly in terms of RUTF, and should be considered where weight-based admission, monitoring or dosage is not possible or RUTF stocks are running low., Trial Registration: The study protocol was registered under reference ISRCTN-60,973,756 on the 15th of October 2020., Competing Interests: Declarations. Ethics approval and consent to participate: The studies involving humans were approved by Ethics Committee of the Institut National de Santé Publique (INSP), the reference agency of the Ministry of Health of the government of Mali (decision n° 35/2029/CE-EX-INRSP), and the Ethics Committee of the Hospital Clínico San Carlos, reference organism for human studies of the Complutense University of Madrid, Spain (favorable report C.I. 19/363-R-X-BC). The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin. Prior to key informant interviews, participants were provided with information about the study verbally and in writing. Consent for participation was obtained from key informants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background/objectives: Malnutrition and sarcopenia are interrelated health concerns among the elderly. Each condition is associated with increased mortality, morbidity, rehospitalization rates, longer hospital stays, higher healthcare costs, and reduced quality of life. Their combination leads to the development of "Malnutrition-Sarcopenia Syndrome" (MSS), characterized by reductions in body weight, muscle mass, strength, and physical function. Despite being preventable and reversible through nutritional and physical interventions, the clinical competence of physical therapists (PTs) in managing MSS remains underexplored. This study aims to assess the clinical competency of PTs in MSS management., Methods: An anonymous cross-sectional survey was conducted from January to August 2024 among 337 certified PTs in Israel, using the "Qualtrics" platform. The survey assessed prior familiarity with MSS concepts, MSS knowledge levels, screening and treatment skills, attitudes and beliefs toward MSS management, and interprofessional collaboration practices., Results: While 52% of PTs were familiar with MSS, familiarity with diagnostic guidelines was low (EWGSOP2: 3.6%; GLIM: 0.6%). The MSS knowledge score was moderate, but screening and treatment skills were low. Attitudes toward MSS management were moderately positive, but self-belief in diagnosing and treating MSS was low. Interprofessional collaboration was limited, particularly in malnutrition care. PTs familiar with MSS had higher knowledge, better skills, more positive attitudes and beliefs, and greater interprofessional collaboration., Conclusions: Significant gaps exist in the clinical competency of Israeli PTs in MSS management. Integrating MSS content into physical therapy curricula and providing continuing professional development are necessary to enhance competencies. Equipping PTs with essential tools, clarifying roles, and promoting interprofessional collaboration can optimize MSS management and improve patient outcomes.

Introduction: Nutritional care is a cornerstone of cancer treatment, with the potential to significantly improve patient outcomes by addressing malnutrition and enhancing recovery. Despite growing awareness, the integration of evidence-based nutritional strategies into oncology remains inconsistent. Following a 2020 survey that highlighted critical gaps, the NutriOnc Research Group launched targeted initiatives to raise awareness and improve practices. This study reassesses progress in integrating nutritional care and identifies persistent challenges., Methods: A 29-question survey was conducted in 2024 among 73 early-career oncologists, surgeons, radiation oncologists, and nutrition specialists across Italy. Respondents provided insights into clinical nutrition program availability, multidisciplinary team composition, screening practices, and educational needs., Results: Encouraging advancements were noted, with 80.8% of respondents reporting the presence of clinical nutrition programs, compared to fewer structured efforts in 2020. However, only 26.0% included nutrition specialists in multidisciplinary teams, and barriers such as financial constraints, limited product availability, and the absence of trained professionals persisted. While 82.2% performed nutritional screening, variability in tools and practices highlighted the need for standardization. Strikingly, 98.6% expressed a strong demand for advanced education on clinical nutrition, emphasizing the need for innovative and accessible training programs., Conclusions: This study reveals a landscape of progress tempered by persistent inequities. To close the gap, oncology must embrace standardized protocols, expand access to trained nutrition specialists, and invest in educational initiatives. The findings offer actionable insights for transforming cancer care through nutrition, underscoring its potential to improve survival, quality of life, and overall treatment success.

Treatment of acute malnutrition requires novel approaches to improve coverage, reduce costs and improve the efficiency of standard protocols that separate the management of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM). The use of simplified, combined protocols to treat both MAM and SAM has drawn research and policy interest among global, regional and national stakeholders. However, the perspectives of local communities and health care workers regarding the use of protocols to treat acute malnutrition in a routine health care system are generally lacking. This was a cross-sectional mixed-methods study aimed at assessing the perceptions of different stakeholders on the use of a simplified, combined protocol in two districts in the Central African Republic. Most of the respondents preferred the simplified, combined protocol over the standard protocol. They generally agreed that the protocol was easy to understand, allowed more children to receive treatment and was effective in treating acute malnutrition. The protocol modifications were well received, including the expanded admission criteria, use of mid-upper arm circumference (MUAC) only for admission and discharge criteria and reduced and simplified ready-to-use therapeutic food quantity to treat MAM and SAM. Some caregivers expressed concern with the use of MUAC only to declare recovery, flagging that underlying illnesses could still be present. The caregivers recommended the provision of other food basket interventions to improve the treatment. The support by caregivers and health care workers on the idea of training community health volunteers to treat acute malnutrition points to the potential of scaling up decentralized treatment to increase coverage in remote areas., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Nutrition and nutritional care are essential for optimal outcomes, and, therefore of importance for patients with chronic limb threatening ischemia (CLTI) given their high risk of complications. However, insight is lacking in how healthcare professionals directly involved in the care of patients with CLTI perceive nutritional care, as well as in the perceived barriers and facilitators regarding optimal nutritional care., Methods: In this qualitative study with a phenomenological approach, 3 online focus groups were conducted with various healthcare professionals directly involved in the care of patients with CLTI. Sample size was guided by information power. Focus group recordings were transcribed verbatim, and reflexive thematic analysis was performed., Results: Seventeen healthcare professionals participated, including vascular surgeons, fellows in vascular surgery, a medical doctor and researcher, nurse specialized in wound care, general nurse, physical therapists, dietitians, and nutrition assistants. Four themes were generated: (1) nutritional care is crucial for optimal clinical outcomes and a healthy life, (2) insufficient attention to undernutrition and nutritional care by healthcare professionals, (3) patient-related factors challenge healthcare professionals in providing nutritional care, and (4) need for optimizing the organizational process related to nutritional care. Perceived barriers regarding nutritional care included knowledge deficits, nutritional care not being part of the healthcare professionals' routine, missing tools to identify undernutrition, patient-related factors, and time constraints. Facilitators regarding nutritional care included more scientific evidence regarding the effect of nutritional care on clinical outcomes and optimization of organizational processes related to nutritional care., Conclusions: Healthcare professionals perceive nutritional care as important for optimal outcomes, but nutritional care is not routinely implemented in the care of patients with CLTI. This lack of implementation of nutritional care may be due to the barriers perceived in various domains. The findings of this study stress the need to optimize nutritional care, with the aim of improving outcomes in the CLTI population., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Background & Aims: Malnutrition is highly prevalent in those with cancer and more so in those with incurable cancer. In incurable cancer, it is widely agreed that optimal nutritional care has the potential to positively impact patient and caregiver distress and oncological outcomes. The aim of this systematic review was to describe the diversity and frequency of nutritional interventions, whether given in isolation or as part of a multimodal intervention in those with incurable cancer, in randomised controlled trials. The secondary aims were to describe adherence and their efficacy., Methods: This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The following databases were searched electronically: Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica database (EMBASE), Cumulated Index to Nursing and Allied Health Literature (CINAHL) and Cochrane Central Register of Controlled Trials (CENTRAL) with the time frame from January 2000 to 7th September 2023. Eligible studies included adult patients (≥18 years) diagnosed with incurable solid cancer with a sample size ≥40. Studies were to be primary research and delivered for at least 14 days to allow for efficacy. They were to include a nutritional intervention encompassing at least one of the following: dietary counselling, oral nutritional supplements (ONS), enteral tube feeding and/or parenteral nutrition (PN), given in isolation or as part of a multi-modal intervention. Studies were excluded if the population contained patients who had completed curative treatment or are being treated with curative intent, haematological cancers, or if they examined the effects of micronutrients, proteins, amino acids or fatty acids given in isolation. The quality of the included studies was assessed using the Cochrane risk of bias tool for randomised trials (RoB2). A balloon plot was produced to present the results in addition to a table with a narrative summary of the primary outcomes., Results: A total of 7968 studies were identified, of which 18 met the eligibility criteria. This included 2720 study participants. The included studies comprised: multimodal interventions (n = 7), dietary counselling (n = 2), nutritional supplementation with or without dietary counselling (n = 7) and PN (n = 2). Primary outcomes included quality of life (QoL), body composition and nutritional status. For QoL, this was reported in 15 studies, 4 studies showed a significant improvement. Body composition was evaluated in 15 studies, 5 of which showed a significant improvement in body weight and two in fat-free mass (FFM). Nutritional status was reported in 6 studies with one showing a significant difference in Patient-Generated Subjective Global Assessment (PG-SGA) score. The risk of bias was deemed 'low' in 6 studies, with 'some concerns' in 10 studies and a 'high risk' in 2 studies. There was heterogeneity between the studies., Conclusion: This systematic review has highlighted some positive findings in regard to QoL, body weight and nutritional intake. Optimum nutritional intervention was not identified. Future studies should evaluate the effectiveness of earlier nutritional interventions at the point of diagnosis, including regular reviews and the impact this has on nutritional outcomes, QoL and overall survival (OS)., Competing Interests: Conflict of interest Professor Barry Laird has undertaken consultancy for Nutricia and Abbott. Richard Skipworth has undertaken consultancy for Actimed Therapeutics, Faraday Pharmaceuticals and Helsinn and is a member of Advisory Board for Pfizer., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Chronic kidney disease (CKD) encompasses diverse conditions such as congenital anomalies, glomerulonephritis, and hereditary nephropathies, necessitating individualized nutritional interventions. Early detection is pivotal due to the heightened risk of adverse outcomes, including compromised growth and increased healthcare costs. The nutritional assessment in pediatric CKD employs a comprehensive, multidisciplinary approach, considering disease-specific factors, growth metrics, and dietary habits. The prevalence of malnutrition, as identified through diverse tools and guidelines, underscores the necessity for regular and vigilant monitoring. Nutritional management strategies seek equilibrium in calorie intake, protein requirements, and electrolyte considerations. Maintaining a well-balanced nutritional intake is crucial for preventing systemic complications and preserving the remaining kidney function. The nuanced landscape of enteral nutrition, inclusive of gastrostomy placement, warrants consideration in scenarios requiring prolonged support, with an emphasis on minimizing risks for optimized outcomes. In conclusion, the ongoing challenge of managing nutrition in pediatric CKD necessitates continuous assessment and adaptation. This review underscores the significance of tailored dietary approaches, not only to foster growth and prevent complications but also to enhance the overall quality of life for children grappling with CKD., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Malnutrition is a well-studied and significant prognostic risk factor for morbidity and mortality in critically ill perioperative patients. Common nutrition myths in the critically ill may prevent early, consistent, and adequate delivery of enteral nutrition. We outlined 9 common intensive care unit (ICU) nutrition misconceptions and our recommendations to optimize enteral nutrition in critically ill patients based on the review of available literature. Our approach is to treat every patient admitted to the ICU as at risk for malnutrition and to initiate enteral nutrition upon admission in the absence of contraindications. Early enteral nutrition via the gastric route is more beneficial than delaying feeding while awaiting small bowel access and daytime-intermittent nutrition support can safely be initiated over continuous feeding. Gastric residual volumes to assess feeding tolerance should no longer be routinely measured. For perioperative nutrition, we recommend continuing enteral nutrition for most patients with secure airways undergoing anesthesia and resuming nutrition within 24 h of abdominal surgery; even patients with open abdomens can be safely fed in the absence of bowel injury. Critically ill patients who are proned, paralyzed, and on vasopressors can usually continue enteral nutrition. Finally, continuing enteral nutrition before extubation may optimize nutrition without compromising extubation success. In this review, we highlight several common misconceptions regarding ICU nutrition that may prevent achieving nutrition goals and subsequently lead to increased malnutrition, morbidity, and mortality. This knowledge may contribute to increased implementation of early and consistent enteral nutrition strategies to improve outcomes in critically ill adult patients., Competing Interests: Conflict of interest HSD is an Editor for Advances in Nutrition and played no role in the journal’s evaluation of the manuscript. The other authors declared no potential conflicts of interest with respect to the research, authorship, or publication of this article., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Objective: We describe the status of medical nutrition therapy in adult patients in several hospitals in Latin America in 2023. with the aim of deepening understanding of its implementation and thus, in turn, contributing to the advancement of future guidelines., Materials and Methods: This is a descriptive, multicenter, cross-sectional study. An electronic questionnaire was applied, containing screening, nutritional therapy, multidisciplinary nutritional support, and monitoring indicators. Descriptive statistics were used in data processing., Results: A total of 132 hospitals from 14 Latin American countries participated; 68.2% were state-owned with a median of 23,804 patients. In 66% of hospitals (n = 87) nutritional screening is systematically implemented; NRS-2002 (n = 66; 75.9%) applied mostly by dietitians. Median malnutrition at admission was 33% (IQR = 30.8). Median indication for diet therapy was 54.4% (IQR = 44.3); oral supplementation 13.6% (IQR = 18), and enteral and parenteral nutritional support 14.6% (IQR = 10.2). Indication is carried out mostly by dietitians (n = 78; 59.1%). 29.5% (n = 39) of hospitals count on multidisciplinary nutritional support. 75% (n = 99) use industrialized formulas, mostly in closed systems (n = 53; 40.2%). For parenteral nutrition, individually compounded and preprepared solutions are used (n = 71; 53.8%) generally administered by central catheters. Most frequently cited monitoring indicators were hemodynamic instability, metabolic complications, abdominal distension, and gastric residue., Conclusion: There are still low implementation percentages of nutritional screening, formation of nutritional therapy teams, and use of oral supplements. Malnutrition upon admission is within the expected range., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

This case report describes a full-term infant with a cleft palate who experienced malnutrition because of the delayed introduction of a cleft-adapted bottle and identifies potential areas for improvement in clinical practice. The infant's weight for age z-score at birth was 0.05 and dropped to -1.45 by 2 months of age, indicating mild malnutrition. The infant established care with a cleft team and a cleft-adapted bottle was recommended as the primary feeding method. Feeding time subsequently decreased from 60 minutes per feeding to 20 minutes. The infant presented for palate repair at 9 months of age, and his z-score was -0.01, indicating he was no longer malnourished. Cleft-adapted bottles aid in feeding efficiency in infants with cleft palate, which may subsequently impact weight gain. Appropriate weight gain is essential to receive timely cleft palate repair and support healing., Competing Interests: CONFLICTS OF INTEREST None to report. The authors would like to acknowledge the infant and his family for allowing us to complete a case report on their infant's early feeding experience. Their contribution has provided valuable insights into feeding interventions for infants with cleft palate that may improve care for other infants facing similar challenges., (Copyright © 2024 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.)

Background: A high proportion of patients admitted to hospital are at nutritional risk or have malnutrition. However, this risk is often not identified at admission, which may result in longer hospital stays and increased likelihood of death. The Integrated Nutrition Pathway for Acute Care (INPAC) was developed to provide clinicians with a standardized approach to prevent, detect, and treat malnutrition in hospital., Objective: The purpose of this study was to determine if the Advancing Malnutrition Care (AMC) program can be used to spread and scale-up improvements to nutrition care in Canadian hospitals., Methods: A prospective, longitudinal, mixed methods design is proposed to evaluate the spread and scale of INPAC best practices across Canadian hospitals using a mentor-champion model. Purposive and snowball sampling are used to recruit mentors and hospital champions to participate in the AMC program. Mentors are persons with experience improving nutrition care in a clinical setting and champions are health care providers with a commitment to implementing best care practices. Mentors and champions are trained digitally on their roles and activities. Mentors meet with champions in their area monthly to support them with making practice change. Champions created a site implementation team to target practice change in a specific area related to malnutrition care and use AMC program-specific tools and resources to implement improvements and collect site information through quarterly audits of patient charts to track implementation of nutrition care best practices. An online community of practice is held every 3-4 months to provide further implementation resources and foster connection between mentors and champions at a national level. A prospective evaluation will be conducted to assess the impact of the program and explore how it can be sustainably spread and scaled across Canada. Semistructured interviews will be used to gain a deeper understanding of mentor and champion experiences in the program. The capabilities, opportunities, and motivations of behavior model will be used to evaluate behavior change and the Kirkpatrick 4-level framework will facilitate assessment of barriers to change. Aggregated chart audits will assess the impact of implemented care practices. Descriptive analyses will be used to describe baseline mentor and champion and hospital characteristics and mentor and champion experiences; Friedman test will describe these changes over time. Directed content analysis will guide interpretation of interview data., Results: Data collection began in September 2022 and is anticipated to end in June 2025, at which time data analysis will begin., Conclusions: Evaluation of the AMC program will strengthen decision-making, future programming, and will inform program changes that reflect implementation of best practices in nutrition care while supporting regional mentors and hospital champions. This work will address the sustainability of AMC and the critical challenges related to hospital-based malnutrition, ultimately improving nutrition care for patients across Canada., International Registered Report Identifier (irrid): DERR1-10.2196/62764., (©Katherine L Ford, Celia Laur, Rupinder Dhaliwal, Roseann Nasser, Leah Gramlich, Johane P Allard, Heather Keller, AMC Core Team. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 31.12.2024.)

Background: Enteral nutrition (EN) is commonly used for nutritional support in patients with cancer. Whether inflammation, one of the driving factors of malnutrition and cancer, affects the association between EN and short-term prognosis and medical costs in patients with cancer remains unclear. We aimed to investigate the association between EN and short-term prognosis of patients with cancer and the effect of inflammation on EN-associated medical costs., Methods: This multicentre prospective cohort study evaluated patients with pathologically confirmed solid tumours. After admission, all patients who received EN, including oral or tube feeding, were assigned to the EN group. The log-rank test was used to identify the optimal cutoff values for inflammatory markers. Cox regression analysis was used to analyse the associations among EN, inflammation, and prognosis. Propensity score matching was used to balance biases between the EN and non-EN groups and validate the stability of the results., Results: A total of 5121 patients were included, with 2965 (57.90%) men and an average age of 59.06 (11.30) years. A total of 462 patients received EN, with 390 (84.4%) receiving oral nutritional supplementation. During the 90-day follow-up, 304 patients died. In the low inflammation group, there was no association between EN and short-term prognosis (hazard ratio [HR] = 0.92, 95% confidence interval [CI] = 0.39-2.18). In the high inflammation group, EN significantly improved the short-term prognosis (HR = 0.48, 95% CI = 0.30-0.76). In patients with low inflammation (p < 0.001), EN increased hospitalisation costs (p < 0.001) without reducing length of stay (LOS) (p = 0.15). In patients with high inflammation, EN did not increase hospitalisation expenses (p = 0.47) but reduced the LOS (p = 0.004)., Conclusion: EN can improve the short-term prognosis of patients with high inflammation and reduce LOS without increasing the hospitalisation expenses. Baseline inflammation levels may serve as effective indicators for personalised and precise EN treatment., Clinical Trial Registration: ChiCTR1800020329 (chictr.org.cn)., Competing Interests: Declarations. Ethics approval: This study was approved by the ethics committee of Beijing Shijitan Hospital and adhered to the principles of the Declaration of Helsinki. Consent to participate: Participants or their legal representatives provided written informed consent. Conflict of interest: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Background: critically ill patients admitted to the intensive care unit (ICU) are often associated with malnutrition and nutrition therapy is recommended. Previous studies on COVID-19 focused on the recovery of critically ill patients after hospital discharge; however, there are limited data on healthcare resource utilization (HRU) after discharge. Aims: to describe and analyze the HRU and nutritional status of COVID-19 patients during hospitalization and one year after discharge. Methods: during hospitalization and 12-month follow-up after discharge, we collected data on hospital and ICU length of stay, ventilatory support therapies, medical nutrition therapy, and outpatient visits. Factors contributing to outpatient visits and readmissions during the follow-up period were also analyzed. Results: a total of 199 patients were included, with a median hospital and ICU length of stay of 53.0 and 23.5 days, respectively. During hospitalization, 86.4 % of the patients needed invasive ventilation and 51.5 % non-invasive ventilation; 50.3 % of the patients required parenteral nutrition, while 84.3 % required enteral nutrition and 66.0 % oral nutritional supplements. After discharge a mean number of visits per patient to general practitioner, specialized care, and emergency department of 4.5, 14.7, and 0.8, respectively, were registered, most of them directly or possibly related to COVID-19. Additionally, a better health-related quality of life (HRQoL) at discharge and lower weight loss during hospitalization were associated with lower HRU during follow-up. Conclusions: our study shows a high HRU among patients with COVID-19 admitted to ICU in the year following discharge and highlights the importance of the nutrition status during admission and its relation to HRU.

Malnutrition is an important risk factor for multiple organ dysfunction syndrome in the elderly (MODSE) and seriously affects the occurrence, progression and prognosis of MODSE. Shenling Baizhu Power (SBP), a classic formula from traditional Chinese medicine (TCM), when integrated with enteral nutrition, has been proven to be an effective clinical strategy for treating the patients of MODSE with malnutrition. This study aimed to investigate the metabolic changes during disease occurrence and SBP treatment, and to discover potential metabolic biomarkers for the diagnosis and efficacy evaluation. An untargeted metabolomics strategy based on UHPLC-Q-Orbitrap-HRMS was performed to reveal the differential serum metabolites between MODSE patients with malnutrition (n=59) and healthy controls (n=33), and those between patients treated with enteral nutrition (n=31) and SBP combined with enteral nutrition (n=28). Significantly different metabolites were identified and mapped onto the network of metabolic pathways to explore the metabolic disorders caused by the disease and the metabolic regulatory mechanism of SBP. Additionally, the area under the curve (AUC) of the potential biomarkers was investigated for predicting the disease and the efficacy of SBP. Sixty differential metabolites were identified between the disease and control groups, which were mainly related to amino acid metabolism, energy metabolism and carbohydrate metabolism. In the same way, 50 differential metabolites associated with SBP treatment were identified, which improved metabolic abnormalities in vivo mainly by regulating the above-mentioned metabolic pathways. Finally, 13 differential metabolites in common were selected as the potential biomarkers and the AUC value of each biomarker was within the range of 0.8-1.0, indicating that these biomarkers had high prediction accuracy for the diagnosis and efficacy evaluation of MODSE with malnutrition. This study demonstrates that serum metabolomics approaches based on the UHPLC-Q-Orbitrap-HRMS platform can be applied as a tool to reveal the metabolic changes induced by MODSE with malnutrition and SBP can play an important role in the clinical application., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background and Objectives: Malnutrition is common in patients with heart failure (HF) and is associated with poor prognosis. We evaluated the prognostic and clinical impact of a nutritional intervention in malnourished patients with chronic HF., Methods: A randomized controlled clinical trial was carried out in patients with chronic HF who were malnourished or at risk. Participants were randomized to receive an individualized nutritional intervention or conventional management. The primary endpoint was a composite of all-cause mortality or time-to-first HF hospitalizations at the 12-month follow-up. The secondary endpoints were changes in nutritional status and functional capacity., Results: We screened 225 patients, 86 of whom had some degree of malnutrition and were randomized. At 12 months, the primary outcome occurred in 10 patients (23.8%) in the intervention group and in 22 patients (50.0%) in the control group (HR=0.39; 95% CI, 0.19-0.83). This effect was mainly related to a lower risk of hospitalization for HF in the intervention group: 8 patients (19.0%) versus 18 patients (40.9%) in the control group (HR=0.39; 95% CI=0.17-0.89). We observed an improvement in nutritional status and functional capacity in the intervention group versus the control group., Conclusions: In patients with chronic HF and some degree of malnutrition, individualized nutritional intervention may reduce the risk of all-cause mortality or HF hospitalisations and improve nutritional status and functional capacity. These results underline the need for further randomized controlled trials with this approach to confirm the potential prognostic benefit., (Copyright © 2024 Elsevier España, S.L.U. All rights reserved.)

The objective of this study was to investigate the efficacy and safety of intradialytic parenteral nutrition (IDPN) using ENEFLUID® (310 kcal, 550 mL) in mild-moderate malnutrition patients receiving maintenance hemodialysis. A total of 40 adult patients with a Nutritional Risk Index-Japanese Hemodialysis (NRI-JH) score of 5-10 were enrolled in this multicenter, randomized, open-label study. Patients in the intervention group received IDPN using ENEFLUID® via the dialysis circuit 3 times a week for 12 weeks; those in the control group did not. The primary endpoint was change in serum transthyretin (TTR). The secondary endpoints were changes in nutritional laboratory tests, nutritional parameters, food intake, plasma amino acids, and blood glucose. For both groups, mean age (72.1±11.4 years) and BMI (20.3±3.0), and median NRI-JH score [7.0 (interquartile range, 6-8)], did not differ. One patient withdrew before intervention, leaving 20 intervention and 19 control patients. Mean (95% confidence interval) change in serum TTR (mg/dL) at 12 weeks did not differ between groups: Intervention, 1.0 (-1.1-3.2); Control, -0.3 (-2.4-1.9); Intragroup difference, 1.3 (-1.7-4.3); P = 0.41. The values reflecting protein intake at 12 weeks compared to those on the study initiation day increased in the intervention group [the changes of blood urea nitrogen, 9.4 (2.6-16.2) mg/dL; P = 0.007, and normalized protein catabolic rate, 0.10 (0.02-0.18) g/kg/day; P = 0.02]. Mean food protein intake (g/kg/day) at 12 weeks increased in the intervention group and decreased in the control group, and differed between groups: Intervention, 0.12 (-0.03-0.28); Control, -0.18 (-0.43-0.08); Inter-group difference, 0.30 (0.00-0.60); P = 0.050. No adverse events occurred. In patients with mild to moderate malnutrition receiving ENEFLUID® for 12 weeks as IDPN, serum TTR was not improved, decreases in protein intake was mitigated, no adverse events occurred. Trial registration Name of the registry: Japan Registry of Clinical Trials Registration number: jRCTs031220296., Competing Interests: Michihiro Hosojima received lecture fees from Otsuka Pharmaceutical Factory, Inc. Yoshihiko Kanno received lecture fees and advisor fees from Otsuka Pharmaceutical Factory, Inc. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Kabasawa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Malnutrition is a common complication of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) typically associated with poor prognosis. Despite nutritional treatment, the outcomes for these patients are limited by the symptoms and complications associated with ACLF. So far, the benefits of nutritional interventions in these populations have not been proven. This study aims to explore a new nutritional intervention method for patients with HBV-ACLF and evaluate its safety and efficacy., Methods and Analysis: This study is an investigator-initiated, nonblind, randomised controlled clinical trial. We will recruit 60 patients with HBV-ACLF according to the Chinese Group on the Study of Severe Hepatitis B criteria hospitalised in the Infectious Diseases Department of the Third Affiliated Hospital of Sun Yat-Sen University. Eligible patients will be randomly allocated to the nutrition support group (intervention group) and the control group in a 1:1 ratio. Patients in the nutrition support group will receive 10 days of tailor-made nutrition therapy consisting of oral nutritional supplements and supplementary parenteral nutrition. Patients in the control group will receive standard nutrition with dietary advice. All assessments will be conducted at baseline, 30 days and 90 days. The primary outcome measure is the liver transplant-free mortality rate. The secondary indicators include the incidence of clinical adverse outcomes and changes in indicators such as muscle mass, muscle strength, physical function and quality of life (EQ-5D scale)., Ethics and Dissemination: This study has been approved by the Medical Ethics Committee of the Third Affiliated Hospital of Sun Yat-Sen University (approval number: II2023-242-03). The results and conclusions of the clinical trial will be published in academic conferences or journals., Trial Registration Number: NCT06128421., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

In recent years, research on TB multimorbidity has increasingly focused on integrated care delivery, particularly concerning common mental disorders (CMDs). Engagement with relevant stakeholders, including service users and providers, has highlighted the critical intersection of TB and CMD, which affects a substantial percentage of individuals. Studies have found that depression affects approximately 45% of TB patients, and anxiety affects around 40%. Moreover, there is a significant evidence and service gap in delivering CMD care, which emphasises the need for a comprehensive approach to address the dual burden of these health challenges.

Background & Aims: Limited data exist regarding the implementation of the Global Leadership Initiative on Malnutrition (GLIM) criteria for diagnosing malnutrition in Crohn's disease (CD), and its association with CD prognosis. In the present study eighteen GLIM combinations and a combined one were implemented to identify differences in the prevalence of malnutrition and to investigate potential associations with clinical outcomes at 6 months., Methods: Different methodologies to diagnose malnutrition were used at baseline, namely the Subjective Global Assessment (SGA), eighteen different combinations of phenotypic and etiologic GLIM criteria and a combined version based on all GLIM combinations (GLIMcv) to test differences in the estimated prevalence and outcomes' prognosis. At 6 months, data for clinical outcomes were collected (i.e. hospitalization, antibiotics use, intensification/change of biologic agent, initiation of biologic agent/corticosteroids, surgery, disease activity), and an overall adverse clinical outcome index was created., Results: 250 people with CD (54.8 % males, mean age 41.2 ± 14.1 years, 37.2 % with active disease) were enrolled. Prevalence of malnutrition based on SGA and GLIMcv was 23 % and 52 %, respectively, and 5.8-63 % based on different GLIM combinations. Malnutrition diagnosed with GLIMcv was associated with an increased likelihood of intensification/change of biologic agent [Odds ratio (OR): 1.82, 95 % Confidence interval (CI): 1.00-3.42, p = 0.05] and an overall adverse clinical outcome (OR: 2.18, 95 % CI: 1.23-3.87, p = 0.008) at 6 months, after adjustment for age, sex, disease location and duration. Malnutrition diagnosed through SGA was not associated with clinical outcomes at 6 months., Conclusions: Based on GLIMcv, half of the sample was diagnosed with malnutrition. Malnutrition significantly increased the likelihood of uncontrolled disease requiring treatment upgrading and leading to an overall adverse clinical outcome short term., Competing Interests: Conflict of interest Dr Gerassimos J. Mantzaris has served as consultant/advisor board member and/or speaker for AbbVie, Aenorasis, Dr Falk, Ferring, Janssen, Merck Sharp & Dohme, Pfizer, Takeda, Vianex and has received research grants from AbbVie, Genesis, Merck Sharp & Dohme, Takeda. The other authors declare no conflict of interest., (Copyright © 2024 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.)

Healthcare systems and patients today are challenged by high and ever-escalating costs for care. With increasing costs and declining affordability, public and private healthcare payers are all seeking value in care. As the evidence regarding health benefits of nutrition products and interventional nutrition care is increasing, cost-effectiveness of these interventions needs consideration. Health economics and outcomes research (HEOR) examines the value of healthcare treatments, including nutrition interventions. This review summarizes how HEOR tools are used to measure health impact, that is, the burden of illness, the effect of interventions on the illness, and the value of the nutrition intervention in terms of health and cost outcomes. How studies are designed to compile data for economic analyses is briefly discussed. Then, studies that use HEOR methods to measure efficacy, cost-effectiveness, and cost savings from nutrition care across the healthcare spectrum-from hospitals to nursing homes and rehabilitation centers, to care for community-living individuals, with an emphasis on individuals who are older or experiencing chronic health issues-are reviewed. Overall, findings from HEOR studies over the past decade build considerable evidence to show that nutrition care improves the health of at-risk or malnourished patients effectively and at a reasonable cost. As such, the evidence suggests that nutrition care brings value to healthcare across multiple settings and populations., (© 2024 The Author(s). Nutrition in Clinical Practice published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Malnutrition affects 20-30% of hospitalized patients and is associated with increased morbidity and mortality. Regular screening and multiprofessional nutrition teams are crucial for detection and treatment. The aim of this survey is to assess the nutritional medical care situation in German acute care hospitals.The online survey was conducted between 11/2022 and 08/2023, distributed through medical professional societies, and personalized for chief physicians registered in the German Hospital Registry. The survey is based on an instrument from Fulda University.182 physicians participated in the survey, with 53% indicating that their hospital has a nutrition team, which is most often affiliated with the gastroenterology department. In 88% of nutrition teams, a specialist physician, mostly a gastroenterologist, is involved. Common issues addressed by the nutrition teams include malnutrition, parenteral/enteral nutrition, and the transition process. In hospitals with nutrition teams, 83% conduct regular screening for malnutrition, compared to 47% in hospitals without nutrition teams. The most frequently used screening tool is the NRS-2002. In clinics with nutrition teams, 57% automatically involve the team when screening is positive. In facilities without nutrition teams, standardized procedures are often not possible due to staffing shortages.The study reveals an unequal nutritional medical care situation in German hospitals. Hospitals with nutrition teams screen more frequently for malnutrition. Improved financing and standardization are necessary to optimize the nutritional medical care situation., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Background and Purpose: Malnutrition is associated with poor outcomes in different diseases. Our aim was to investigate whether measures of malnutrition could be used to predict 90-day outcomes in patients with vertebrobasilar artery occlusion (VBAO) undergoing endovascular treatment (EVT)., Methods: We retrospectively analyzed patients with VBAO who received EVT at three comprehensive stroke centers. Malnutrition was assessed using the controlling nutritional status (CONUT) score, geriatric nutritional risk index (GNRI), and prognostic nutritional index (PNI). Primary outcome was good functional outcome defined as modified Rankin Scale (mRS) 0-3 measured at 90 days., Results: A total of 285 patients were enrolled, of which 260 (91.22 %) met the requirements. According to the CONUT, GNRI, and PNI scores, the proportions of patients classified as moderately or severely malnourished were 7.3 %, 3.08 %, and 35 %, respectively. In the multivariate regression model after adjusting for potential confounders, malnutrition (severe risk versus normal nutritional status) was significantly associated with an increased risk of poor prognosis for CONUT scores (adjusted odds ratio [OR]14.91, 95 %CI, 1.69 - 131.71; P = 0.015), GNRI scores (adjusted [OR] 10.67, 1.17 - 96.93; P = 0.036) and PNI scores (adjusted [OR] 4.61, 2.28 - 9.31; P < 0.001). Similar results were obtained when malnutrition scores were analyzed as continuous variables. Adding the 3 malnutrition measures to the risk reclassification that included traditional risk factors significantly improved the predictive value of 3-month poor prognosis., Conclusions: Our study showed that malnutrition may be associated with poor prognosis within 3 months of EVT in patients with VBAO., Competing Interests: Declaration of competing interest All authors disclosed no relevant relationships., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aspiration pneumonia (AP) is the most severe complication of oropharyngeal dysphagia (OD). It is highly underdiagnosed and undertreated among older patients hospitalized with community-acquired pneumonia (CAP). Our aim is to review the state of the art in the diagnosis and treatment of swallowing disorders associated with AP. We performed a narrative review, including our experience with prior studies at Hospital de Mataró, on the diagnosis and treatment of AP. AP refers to pneumonia occurring in patients with swallowing disorders, frequently coinciding with poor oral health and vulnerability. Its main risk factors include oropharyngeal aspiration, impaired health status, malnutrition, frailty, immune dysfunction, and oral colonization by respiratory pathogens. Incidence is estimated at between 5 and 15% of cases of CAP, but it is highly underdiagnosed. Diagnostic criteria for AP have not been standardized but should include its main pathophysiological element, oropharyngeal aspiration. Recently, a clinical algorithm was proposed, based on the recommendations of the Japanese Respiratory Society, that includes aspiration risk factors and clinical evaluation of OD. To facilitate the task for health care professionals, new artificial intelligence (AI)-based screening tools for OD combined with validated clinical methods such as the volume-viscosity swallowing test (V-VST) for the detection of AP are being validated. Prevention and treatment of AP require multimodal interventions aimed to cover the main risk factors: textural adaptation of fluids and diets to avoid oropharyngeal aspiration; nutritional support to avoid malnutrition; and oral hygiene to reduce oral bacterial load. The diagnosis of AP must be based on standardized criteria providing evidence on the main etiological factor, oropharyngeal aspiration. Clinical algorithms are valid in the diagnosis of AP and the identification of its main risk factors. Combination of AI-based tools with V-VST can lead to massive screening of OD and save resources and improve efficiency in the detection of AP., Competing Interests: None declared., (Thieme. All rights reserved.)

ICU survivors are growing but a persistent physical and mental disability may occur. The patients discharged from ICU are frequently malnourished and their medical nutritional support is impaired by oral intake limitation due to respiratory support such as non invasive ventilation or high flow nasal cannula oxygen therapy, dysphagia and difficulties to determine energy and protein targets. ICU acquired weakness must be recognized and could be minimized by better energy intake determined by indirect calorimetry, optimal protein intake and physical activity. Early physical activity has become a pivotal element of the improvement of the physical and cognitive condition in the post ICU., Competing Interests: Declaration of competing interest None related to this manuscript., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

This review examines our current understanding of consensus definitions for frailty, sarcopenia, and cachexia and their perceived overlap with malnutrition. Patients with these syndromes will often meet the criteria for malnutrition. It is common for these overlap syndromes to be misapplied by practitioners, and confusion has been further exacerbated by the lack of a common malnutrition language. To address the latter concern, we recommend using either the standalone Global Leadership Initiative in Malnutrition (GLIM) framework or the GLIM consensus criteria integrated with other accepted approaches as dictated by preference and available resources. Established care standards should guide the recognition and treatment of malnutrition to promote optimal clinical outcomes and quality of life. The effectiveness of nutrition interventions may be reduced in settings of severe acute inflammation and in end-stage disease that is associated with cachexia. However, such interventions may still assist patients to tolerate treatments that target the underlying etiology for an overlap syndrome, and they may help to improve select clinical outcomes and quality of life. Recent, large, well-designed randomized controlled trials have demonstrated the compelling positive clinical effects of medical nutrition therapy. The application of concurrent malnutrition risk screening and assessment is therefore a high priority. The necessity to deliver specific interventions that target the underlying mechanisms of these overlap syndromes and also diagnose and address malnutrition is paramount. It must be highlighted that securing beneficial outcomes for frailty, sarcopenia, and cachexia will also require nonnutrition interventions, like comprehensive care plans, pharmacologic agents, and prescribed exercise., (© 2024 American Society for Parenteral and Enteral Nutrition.)

This article will discuss the current medical nutrition therapy (MNT) recommendations for non-hospitalized people with diabetes based on published standards, general principles for healthy meal planning, common dietary methods used with people with diabetes, and matching the prandial insulin dose to food(s) consumed. This article will also discuss MNT for hospitalized patients with diabetes including assessing for malnutrition and identifying contributing factors for the development of malnutrition. Common dietary methods used in the hospital setting will be discussed, as well as the current recommendations for managing diabetes in patients on clear liquid diets, enteral nutrition, and parenteral nutrition., Competing Interests: Disclosure The author does not have any conflicts of interest to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Older adults often experience adverse health outcomes including malnutrition following discharge from emergency departments (ED). Discharge to community care is a transitionary time where nutritional vulnerability could be mitigated with the instigation of targeted nutrition care pathways in ED settings., Aims and Objectives: This scoping review aimed to establish and describe the level of nutrition care provided to older adults admitted and subsequently discharged from EDs., Research Design: Systematic searches of nine academic and grey literature databases (Medline (Ovid), Pubmed, CINAHL Complete (EBSCOhost), EMBASE, Cochrane Library and Scopus), grey literature sources (DART-Europe E-theses portal, Open Grey, and Trip Medical database) and four websites (Google, Google Scholar, NICE and LENUS) for relevant professional and organisational publications of research, policy, practice, and guidelines between January 2011 to 2023 were completed. Eligible studies included a population of older adults (≥ 65 years) with an ED attendance and subsequent community discharge, and where nutrition screening had identified malnutrition. Data were extracted on the level of nutrition and dietetic care initiated for older adults in the ED according to the Nutrition Care Process Model and summarised descriptively., Results: Overall, 22 studies were included in the review. Nutrition status was screened on admission to the ED using validated tools: Mini Nutritional Assessment-Short Form (n = 13), Malnutrition Universal Screening Tool (n = 2), Short Nutritional Assessment Questionnaire (n = 2), NRS-2002 (n = 1) and the Mini Nutritional Assessment - Full Form (n = 1). A full nutrition assessment was reported by 5 studies. Only one study referred to documentation of malnutrition in healthcare records. Subsequent nutrition intervention after discharge from the ED for older adults was not described in any study., Conclusion: While there is evidence to support malnutrition screening is taking place in EDs, there is a lack of information about subsequent nutrition care including assessment and therapy interventions. This points to the need for comprehensive exploration of nutrition care pathways, practice, policy, and research to inform models of integrated care for older persons., (© 2024. The Author(s).)

Patients with alcohol-associated liver disease (ALD) consume large amounts of empty calories and are at risk for malnutrition. Malnutrition can present with micro- or macro-nutrient deficiencies. The standard-of-care drug treatment for severe alcohol-associated hepatitis (AH) is corticosteroids. While still in the standard treatment there are limitations in efficacy and certain patients do not respond to treatment (Lille score ≥.45). This article will focus on important concepts related to nutrition and ALD and on recent findings on predicting corticosteroid response and prognosis for AH patients., Competing Interests: Disclosure The authors have no conflicts of interest to disclose as it pertains to this work. Financial support: This work was supported by the following grants: National Institutes of Health, United States grants R00AA030627 (J.E. Hardesty), U01AA026934 (C.J. McClain), U01AA026926 (C.J. McClain), and U01AA026980 (C.J. McClain) and the VA: 2I01CX002219-05A2 (C.J. McClain). This work was also supported by an Institutional Development Award (IDeA), United States from the National Institute of General Medical Sciences, United States of the National Institutes of Health under grant number P20GM113226 (C.J. McClain), and the National Institute on Alcohol Abuse and Alcoholism, United States of the National Institutes of Health under Award Number P50AA024337 (C.J. McClain). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health., (Published by Elsevier Inc.)

Background: In the UK, about 14% of community-dwelling adults aged 65 and over are estimated to be at risk of malnutrition. Screening older adults in primary care and treating those identified as 'at risk' may help reduce malnutrition risk and associated healthcare use, and improve quality of life. The aim of this study is to explore how primary care practitioners (PCPs) and older adults perceive, use and respond to an intervention to support those identified as 'at risk'., Methods: We developed and optimised an intervention (screen and treat protocol, online tools and printed materials) to support primary care practitioners to identify malnutrition risk among older adults, and intervene where necessary. We recruited older adults (described as 'patients' here) taking part in a feasibility study, and carried out semi-structured interviews to assess PCPs' and patients' engagement with the intervention, and identify any contextual issues that supported or undermined their engagement., Results: Four themes were developed, encompassing patients' and PCPs' perceptions of undernutrition, study measures and appointments, constraints on PCPs' enthusiasm to make a difference, and patients' expectations of nutritional appointments. Key findings included patients commonly not accepting advice for undernutrition/malnutrition but welcoming support for their nutritional needs; checklists potentially distracting patients from recalling discussions about their nutritional needs; a tension between PCPs' desire to recruit less-well patients and logistical difficulties in doing so; and patients compromising their nutritional needs to suit others., Conclusions: Diverse factors influence whether an intervention succeeds in primary care. PCPs learn about an intervention/study in different ways, vary in how they understand and accept its aims, and desire to make a difference to their patients. Patients bring perceptions and expectations about the study's aims, coloured by their habits and preferences, prior experience of research and healthcare, and pressure from social expectations. Each aspect must be considered when developing a successful primary care intervention that is viewed as relevant and meaningful, and presented using language that aligns with participants' values and goals. Our findings suggest that references to 'malnutrition risk' should be avoided in any patient-facing materials/interactions as participants do not accept or identify with this label., (© 2024. The Author(s).)

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

Background: Lennox-Gastaut syndrome (LGS) is a severe form of drug-resistant epilepsy that begins during childhood and frequently leads to significant neurological impairments. Patients with LGS are likely to receive improper oral nutrition because of issues such as dysphagia and aspiration risk, potentially resulting in long-term tube feeding and eventual gastrostomy tube placement. Therefore, we investigated the effects of gastrostomy tube placement on nutrition outcomes and frequency of hospitalization in LGS., Methods: We retrospectively examined 67 patients diagnosed with LGS who had undergone gastrostomy tube placement between January 2005 and August 2022. Comprehensive clinical data and complications arising from the procedure were collected. Patients' nutrition condition and frequency of hospitalizations were analyzed before and after gastrostomy tube placement., Results: Gastrostomy tube placement was performed for the following reasons: high risk of aspiration (50 out of 67, 74.6%), dysphagia (13 out of 67, 25.4%), persistent nasogastric tube feeding (2 out of 67, 3.0%), and severe malnutrition (2 out of 67, 3.0%). After the procedure, z scores for weight-for-age improved significantly, shifting from -3.35 ± 3.57 to -2.54 ± 2.70 over a 2-year interval (P < 0.001). Additionally, the total days of hospitalization and days of hospitalization due to respiratory symptoms reduced significantly from 41.94 ± 51.76 to 15.27 ± 26.68 (P < 0.001) and from 23.75 ± 36.92 to 10.52 ± 22.98 (P = 0.009), respectively. Among the patients, 50 (74.6%) experienced complications resulting from gastrostomy, with a relatively small proportion of major complications (11 out of 67, 16.4%) and no mortality., Conclusion: Gastrostomy tube placement is a relatively safe procedure with favorable effects on nutrition status and hospitalization rates in patients with LGS., (© 2024 American Society for Parenteral and Enteral Nutrition.)

Treatment outcomes for acute malnutrition can be improved by integrating treatment into community case management (iCCM). However, little is known about the cost-effectiveness of this integrated nutrition intervention. The present study investigates the cost-effectiveness of treating moderate acute malnutrition (MAM) through community health volunteer (CHV) and integrating it with routine iCCM. A cost-effectiveness model compared the costs and effects of CHV sites plus health facility-based treatment (intervention) with the routine health facility-based treatment strategy alone (control). The costing assessments combined both provider and patient costs. The cost per DALY averted was the primary metric for the comparison, on which sensitivity analysis was performed. Additionally, the integrated strategy's relative value for money was evaluated using the most recent country-specific gross domestic product threshold metrics. The intervention dominated the health facility-based strategy alone on all computed cost-effectiveness outcomes. MAM treatment by CHVs plus health facilities was estimated to yield a cost per death and DALY averted of US$ 8743 and US$ 397, respectively, as opposed to US$ 13,846 and US$ 637 in the control group. The findings also showed that the intervention group spent less per child treated and recovered than the control group: US$ 214 versus US$ 270 and US$ 306 versus US$ 485, respectively. Compared with facility-based treatment, treating MAM by CHVs and health facilities was a cost-effective intervention. Additional gains could be achieved if more children with MAM are enrolled and treated., (© 2024 The Author(s). Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background and Aims: Intradialytic parenteral nutrition (IDPN) is a safe and effective patient-tailored nutritional strategy for providing nutrient supplementation to malnourished or at risk of malnutrition patients on hemodialysis (HD), who did not adequately respond to intensive dietary counselling and oral nutritional supplementation. Although IDPN is recommended by current ESPEN and KDOQI guidelines for nutrition in HD patients, none of these documents informs how to successfully implement this therapy, being the lack of knowledge on practical aspects of IDPN one of the main limitations to its use. The aim of this narrative review was to provide a practical roadmap for guiding the nephrologists, dietitians, and renal nurses in their everyday clinical practice about the use of IDPN., Methods: A multidisciplinary group formed by specialists from the areas of Nephrology and Nutrition agreed to address different practical aspects related to IDPN in HD patients. Based on the available evidence in the literature and on the authors' clinical experience, different topics were selected to develop a detailed plan for implementing a successful experience with IDPN, proposing a practical IDPN roadmap., Results: This IDPN roadmap provides practical information on when an IDPN should be started; what type of nutrients should be part of an IDPN; how the IDPN should be administered; how the effectiveness and safety of the IDPN should be monitored; how to determine the effectiveness of IDPN; and the conditions that advise discontinuing the IDPN., Conclusions: IDPN is a safe and effective nutritional therapy for HD patients, although the lack of staff training may limit its use. This review addresses different practical aspects of IDPN, helping interdisciplinary teams in their daily clinical practice to improve the nutritional care of HD patients, either malnourished or at risk of malnutrition., Competing Interests: Declaration of competing interest P. Molina has received consulting and/or speaker fees from CSL Vifor, Fresenius Kabi, Abbot, Baxter, Palex and Medtronic. G. Barril has received consulting and/or speaker fees from Baxter, Abbot, Nutricia and Fresenius Kabbi. S. Cigarrán has received speaker fees from Astra Zeneca, ChemoCentrix, Novo Nordisk and Chiessi. J.J. Carrero has received speaker fees from Baxter Healthcare SA. The other authors declare no other conflicts of interest that might be perceived as affecting the objectivity of this study. The funders had no role in the design of this study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results., (Copyright © 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.)

Introduction: Eating disorders (EDs) are debilitating mental illnesses that can lead to significant medical complications from malnutrition. Eating disorders are on the rise in Asia and the prevalence is expected to increase. The aim of this study was to understand the characteristics of local patients and evaluate our current inpatient nutritional rehabilitation protocol for anorexia nervosa (AN)., Methods: Retrospective descriptive data were gathered from 47 patients diagnosed with AN. Patients with admissions were further stratified according to their nutritional management based on whether they were on the AN protocol or standard hospital care. Data on their rate of weight gain, length of stay and calorie prescription were collected., Results: Similar to previous studies, the majority of AN patients were female (96.7%). However, the age at presentation of AN in this study, as compared with previous local studies, had decreased (14 vs. 16 years). We also found that patients on the AN protocol were prescribed a higher amount of calories than those given standard care (2,700 vs. 2,317 calories). Patients on the AN protocol achieved a higher rate of weight gain per week (1.15 vs. 0.29 kg) and had a shorter length of hospital stay (23 vs. 36 days)., Conclusion: Patients with AN appear to be presenting at a younger age. Medical stabilisation of AN patients can be achieved more quickly through a higher calorie inpatient AN treatment protocol. Future local studies examining actual calorie consumption, its effect on weight gain trajectory, severity of refeeding syndrome and time to remission will be beneficial., (Copyright © 2024 Copyright: © 2024 Singapore Medical Journal.)

Abstract: In this narrative review, the authors provide a concise overview of current information on the identification and management of unintentional weight loss (UWL) in clinical care settings. Unintended weight loss can occur widely and is often multifactorial. Clinicians should use screening tools to identify those experiencing UWL. Management includes nutrition assessments and diagnosing malnutrition when present. Nutrition counseling by a registered dietitian nutritionist should address the causes and manifestations of UWL. Individualized dietary plans with supplementation and/or nutrition support and medications for appetite stimulation may be considered. The presence of UWL at the end of life should be addressed in line with the patient's care plan. Managing UWL is part of the multidisciplinary care teams' responsibilities., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Nutrition plays a key role in the comprehensive care of critically ill patients. Determining optimal nutrition strategy, however, remains a subject of intense debate. Artificial intelligence (AI) applications are becoming increasingly common in medicine, and specifically in critical care, driven by the data-rich environment of intensive care units. In this review, we will examine the evidence regarding the application of AI in critical care nutrition. As of now, the use of AI in critical care nutrition is relatively limited, with its primary emphasis on malnutrition screening and tolerance of enteral nutrition. Despite the current scarcity of evidence, the potential for AI for more personalized nutrition management for critically ill patients is substantial. This stems from the ability of AI to integrate multiple data streams reflecting patients' changing needs while addressing inherent heterogeneity. The application of AI in critical care nutrition holds promise for optimizing patient outcomes through tailored and adaptive nutrition interventions. A successful implementation of AI, however, necessitates a multidisciplinary approach, coupled with careful consideration of challenges related to data management, financial aspects, and patient privacy., (© 2024 American Society for Parenteral and Enteral Nutrition.)

A simplified, combined protocol admitting children with a mid-upper-arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready-to-use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedema and one sachet of RUTF per day for those with MUAC 115-<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango-Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition (SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context., (© 2024 International Rescue Committee. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Background: Frailty, a prevalent geriatric syndrome, presents challenges exacerbated by malnutrition. Nutritional Management Interventions (NMIs) offer hope in frailty reversal, necessitating exploration of their multi-dimensional outcomes., Objectives: Assess NMIs' impact on frail and pre-frail older adults across diverse outcomes., Methods: A systematic review and meta-analysis of 13 studies (2012-2023) evaluated NMIs' effects on physical, dietary, psychological, and frailty aspects. Literature quality was assessed, and data analyzed with Review Manager 5.3., Results: A total of 13 studies involving participants were included in the analysis. Participants numbered 968, with the intervention group averaging 77.05±0.77 years and the control group 78.75±0.8 years. Compared to control groups,NMIs significantly increased body weight (SMD = 0.26, P = 0.03) and improved gait speed (SMD = 0.18, P = 0.03). Protein intake showed significance for interventions≤12 weeks (SMD = 1.04, P < 0.001). No significant differences in energy intake (SMD = 0.20, P = 0.60), but >12 weeks NMIs reduced energy intake (SMD = -0.73, P = 0.006). No significant differences in depressive symptoms, frailty scores, BMI, TUG, Handgrip Strength, or SPPB., Conclusion: This meta-analysis underscores NMIs' potential benefits for frail and pre-frail older adults. Personalized, multidimensional interventions are recommended despite study limitations, emphasizing extended interventions and diverse assessments for holistic care., Competing Interests: Declaration of competing interest The authors declare no conflicts of interest., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

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

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

Malnutrition is common in chronic obstructive pulmonary disease (COPD) patients and is associated with worse lung function and greater severity. This review by the Andalusian Group for Nutrition Reflection and Investigation (GARIN) addresses the nutritional management of adult COPD patients, focusing on Morphofunctional Nutritional Assessment and intervention in clinical practice. A systematic literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology, followed by critical appraisal based on Scottish Intercollegiate Guidelines Network (SIGN) guidelines. Recommendations were graded according to the European Society for Clinical Nutrition and Metabolism (ESPEN) system. The results were discussed among GARIN members, with consensus determined using a Likert scale. A total of 24 recommendations were made: 2(A), 6(B), 2(O), and 14(GPP). Consensus exceeded 90% for 17 recommendations and was 75-90% for 7. The care of COPD patients is approached from a nutritional perspective, emphasizing nutritional screening, morphofunctional assessment, and food intake in early disease stages. Nutritional interventions include dietary advice, recommendations on food group intake, and the impact of specialized nutritional treatment, particularly oral nutritional supplements. Other critical aspects, such as physical activity and quality of life, are also analyzed. These recommendations provide practical guidance for managing COPD patients nutritionally in clinical practice.

Oral nutritional supplementation (ONS) is recommended for malnourished hemodialysis patients when their nutritional intake remains inadequate to meet energy and protein requirements. Patients were randomized into two groups: the intradialytic ONS supplements (INTRA-ONS) group (N = 16) and the interdialytic ONS supplements (INTER-ONS) group (N = 16) for a duration of 12 weeks. Malnutrition inflammation score (MIS) and serum albumin levels were assessed. The total MIS decreased significantly in patients from both the INTRA-ONS group (- 6.13, 95% CI - 8.29 to - 3.96) and the INTER-ONS group (- 3.50, 95% CI - 5.56 to - 1.35). A significant difference in the change of MIS was observed between the two groups (- 3.06, 95% CI - 5.94 to - 0.17). No significant differences were observed between the groups concerning serum albumin levels, dietary intake, anthropometric measurements, or body weight. Intradialytic ONS demonstrates similar benefits on nutritional biomarkers but improves the MIS among malnourished ESRD patients compared to interdialytic ONS.Trial registration Thai Clinical Trials Registry (TCTR) identification number is TCTR20220322007: 16/09/2021., (© 2024. The Author(s).)