{"title":"The post ICU trajectory: Post acute and post ICU nutritional care","authors":"Pierre Singer","doi":"10.1016/j.clnesp.2024.10.151","DOIUrl":"10.1016/j.clnesp.2024.10.151","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 441-446"},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496290","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rachana Mehta, Ashok Kumar Balaraman, Muhammed Shabil, Sanjit Sah
{"title":"Letter to the editor: Comment on “effects of probiotics on sleep parameters: A systematic review and meta-analysis\"","authors":"Rachana Mehta, Ashok Kumar Balaraman, Muhammed Shabil, Sanjit Sah","doi":"10.1016/j.clnesp.2024.10.156","DOIUrl":"10.1016/j.clnesp.2024.10.156","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 332-333"},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496288","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Dion C.J. Houtvast , Milan W. Betz , Bas Van Hooren , Sophie Vanbelle , Lex B. Verdijk , Luc J.C. van Loon , Jorn Trommelen
{"title":"Underpowered studies in muscle metabolism research: Determinants and considerations","authors":"Dion C.J. Houtvast , Milan W. Betz , Bas Van Hooren , Sophie Vanbelle , Lex B. Verdijk , Luc J.C. van Loon , Jorn Trommelen","doi":"10.1016/j.clnesp.2024.10.152","DOIUrl":"10.1016/j.clnesp.2024.10.152","url":null,"abstract":"<div><div>Biomedical research frequently employs null hypothesis testing to determine whether an observed difference in a sample is likely to exist in the broader population. Null hypothesis testing generally assumes that differences between groups or interventions are non-existent, unless proven otherwise. Because biomedical studies with human subjects are often limited by financial and logistical resources, they tend to have low statistical power, i.e. a low probability of statistically confirming a true difference. As a result, small but potentially clinically important differences may be overseen or ignored simply due to the absence of a statistically significant difference. This absence is often misinterpreted as ‘equivalence’ of treatments. In this educational paper, we will use practical examples related to the effects of exercise and nutrition on muscle protein metabolism to illustrate the most important determinants of statistical power, as well as their implications for both investigators and readers of scientific articles.</div><div>Changes in muscle mass occur at a relatively slow rate, making it practically challenging to detect differences between treatment groups in a long-term setting. One way to make it ‘easier’ to differentiate between groups and hence increase statistical power is to have a sufficiently long study duration to allow treatment effects to become apparent. This is especially relevant when comparing treatments with relatively small expected differences such as the effect of modest changes in daily protein intake. Secondly, one could try to minimize the variance and response heterogeneity within groups, for example by using strict inclusion criteria and standardization protocols (e.g., meal provision), by using cross-over designs, or even within-subject designs where two interventions are compared simultaneously (e.g., studying an exercised limb vs a contralateral control limb) although this might limit the generalizability of the findings (e.g. such single-limb exercise training is not common in practice). In terms of data interpretation, investigators should obviously refrain from drawing strong conclusions from underpowered studies. Yet, such studies still provide valuable data for meta-analyses. Finally, because muscle protein synthesis rates are highly responsive to anabolic stimuli, acute metabolic studies are more sensitive to detect potentially clinically relevant differences in the anabolic response between treatments. Apart from further elaborating on these topics, this educational article encourages readers to more critically question null findings and scientists to more clearly discuss limitations that may have compromised statistical power.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 334-343"},"PeriodicalIF":2.9,"publicationDate":"2024-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Melanie Baker , Mark Hann , Simon Lal , Sorrel Burden
{"title":"A descriptive analysis of individually compounded home parenteral nutrition prescriptions provided to adults with chronic intestinal failure","authors":"Melanie Baker , Mark Hann , Simon Lal , Sorrel Burden","doi":"10.1016/j.clnesp.2024.10.007","DOIUrl":"10.1016/j.clnesp.2024.10.007","url":null,"abstract":"<div><h3>Background & aims</h3><div>Home Parenteral Nutrition (HPN) prescriptions should be tailored to a patient's nutritional requirements and comprise of individually compounded regimens (IC-HPN) or standard licensed multi-chamber bags (MCB). There is a paucity of research exploring factors associated with admixture type. This study aimed to evaluate the nutrient composition of adult IC-HPN prescriptions and variance in nutrient dosing, make comparisons with the range of MCB available and dosing recommendations stated in international guidelines.</div></div><div><h3>Methods</h3><div>This cross-sectional observational study analysed anonymised prescription data for adults under the care of a single home care company in England, commencing IC-HPN after January 2021.</div></div><div><h3>Results</h3><div>There were 155 patient prescriptions (245 HPN bags) included, with body weight available in 82 (52.9 %) cases. Data were reported for each HPN bag, and summarised as an average daily amount, considering the number of different HPN bags and their daily frequency per patient prescription.</div><div>A vast range of nutrients were prescribed, with variance in dosing highest for lipid, phosphate, and calcium; with coefficient of variance of 106 %, 74 % and 67 %, respectively. One-hundred-thirty-four (54.7 %) bags contained lipid, resulting in variable ratios of lipid to aqueous bags provided weekly.</div><div>Negligible amounts of at least one electrolyte were prescribed in 93 (38.0 %) bags, of which 52 (21.2 %) contained ≤2 mmol calcium. Compared with MCB (65 bags), IC-HPN bags contained higher amounts of all nutrients, apart from nitrogen and phosphate. Mean sodium intake differed substantially between types of bags (IC-HPN 187.5, SD 100.1 mmol versus MCB 49.1, SD 31.7 mmol, p < 0.001). A substantial number of patients received HPN dosages beyond guideline recommendations, with higher amounts of sodium and fluid provided in 41 (50.0 %) cases; conversely, lower than recommended dosages were seen in 55 (67.1 %) for potassium and 61 (74.4 %) for calcium.</div></div><div><h3>Conclusions</h3><div>This study has demonstrated vast variance in IC-HPN parenteral nutrient dosing, with minimal or an omission of at least one nutrient seen. Further research is needed to explore factors that influence usage of IC-HPN, clinical reasons related to lipid dosing and around the variation in doses prescribed outside of guideline recommendations.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 324-331"},"PeriodicalIF":2.9,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142496286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
N. Eid , R. Mosli , S. Enani , R. Saqr , E. Al-ofi , K. Qutah , S. Eid
{"title":"Corrigendum to “A pilot randomized controlled trial of a telenutrition weight loss program supported with telemonitoring and health coaching in overweight and obese adults” [Clin Nutr ESPEN 63 (2024) 1312–1322]","authors":"N. Eid , R. Mosli , S. Enani , R. Saqr , E. Al-ofi , K. Qutah , S. Eid","doi":"10.1016/j.clnesp.2024.10.144","DOIUrl":"10.1016/j.clnesp.2024.10.144","url":null,"abstract":"","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Page 236"},"PeriodicalIF":2.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142535297","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Nutrition in phenylketonuria","authors":"Saeedeh Talebi , Peyman Eshraghi","doi":"10.1016/j.clnesp.2024.09.032","DOIUrl":"10.1016/j.clnesp.2024.09.032","url":null,"abstract":"<div><div>Phenylketonuria (PKU) is a genetic metabolic disease resulting from a deficiency in the enzyme phenylalanine hydroxylase. This defect prevents the conversion of phenylalanine to tyrosine, and as a result, the level of phenylalanine in the body increases abnormally. The accumulation of this amino acid may cause brain damage and grows development in these patients.</div><div>The primary approach to treating the disease involves dietary management that restricts protein and phenylalanine intake, often alongside Tetrahydrobiopterin (BH4) supplementation. Medical foods specifically formulated for these patients are utilized to supply the necessary energy, protein, and tyrosine. Other treatment options, including the use of large neutral amino acids (LNAAs) and the enzyme Phenylalanine ammonia lyase (PAL), can be utilized to manage symptoms in adult patients. Advancements in gene therapy aimed at correcting defective genes in patients may help restore phenylalanine metabolism, though further research in this area is necessary. Effective personal management of phenylketonuria necessitates enhanced knowledge and collaboration among healthcare professionals to achieve optimal treatment outcomes for patients. This article emphasis the nutritional management of individuals with phenylketonuria across various stages of their lives.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 307-313"},"PeriodicalIF":2.9,"publicationDate":"2024-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459558","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Poor oral status at stroke onset negatively affects activities of daily living at discharge: A propensity-score analysis","authors":"Takuma Mogamiya , Yuki Ohshima , Hiromasa Takashima , Shinya Matsushima , Takuma Watanabe , Misako Mori , Yuta Hagiwara , Hidetaka Onodera","doi":"10.1016/j.clnesp.2024.10.147","DOIUrl":"10.1016/j.clnesp.2024.10.147","url":null,"abstract":"<div><h3>Background & aims</h3><div>Poor oral status during stroke recovery can cause malnutrition, which can markedly affect activities of daily living and prevent patients from being discharged home. Therefore, prompt evaluation and treatment of oral disorders immediately after stroke is essential. This study aimed to examine the impact of poor oral status on the post-stroke recovery of independence in activities of daily living and home discharge.</div></div><div><h3>Methods</h3><div>This single-center retrospective observational study included 137 patients with acute stroke, divided into two groups based on their Oral Assessment Guide (OAG) scores: the normal OAG group (score = 8) and the impaired OAG group (scores ≥9). Propensity-score matching was performed to minimize confounding variables. The χ2 test and odds ratios were used to compare the percentage of independence and home discharges between the two groups.</div></div><div><h3>Results</h3><div>The normal and impaired OAG groups exhibited no difference in neurological severity or nutritional intake after matching. The percentage of patients achieving independence in activities of daily living in the normal OAG group (86.8 %) was significantly higher than that in the impaired OAG group (65.8 %) (p = 0.03, odds ratio [OR] 0.29, 95 % confidence interval [CI] 0.09–0.92). Conversely, no significant difference in the percentage of patients discharged home was found (p = 0.15, OR 0.49, 95%CI 0.19–1.29).</div></div><div><h3>Conclusions</h3><div>This study found that poor oral status after stroke onset was an independent factor affecting independence in activities of daily living at discharge, irrespective of neurological severity and dietary intake.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 237-243"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459559","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Saba Aljasir , Noura M.S. Eid , Emanuela V. Volpi , Ihab Tewfik
{"title":"Nutrigenomics-guided lifestyle intervention programmes: A critical scoping review with directions for future research","authors":"Saba Aljasir , Noura M.S. Eid , Emanuela V. Volpi , Ihab Tewfik","doi":"10.1016/j.clnesp.2024.10.149","DOIUrl":"10.1016/j.clnesp.2024.10.149","url":null,"abstract":"<div><div>Genetic testing is increasingly used in clinical practice to provide personalized information and recommendations about health risks and lifestyle habits at a relatively low cost. Research on the effectiveness of nutrigenomics-guided lifestyle interventions is growing. A scoping review approach was adopted to identify pertinent published studies on nutrigenomics-guided intervention programmes from 2007 to 2023. The review shows that despite the growing interest in nutrigenomics-guided lifestyle interventions, there are still few empirically supported studies, primarily based on developed countries. Furthermore, the findings on the impact of personalised genetic advice are mixed, leaving the field unclear. Existing studies have some empirical strength, contributing to further understanding of the relationship between food and gene expression. However, some limitations that affect the robustness of findings exist, such as a small sample size, insufficient monitoring of the data collection process, and a short follow-up period. Future research needs to address reliability concerns and provide more robust practical evidence.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 296-306"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bruna Lima Chechin Catussi , Edson Guimarães Lo Turco , Dirceu Mendes Pereira , Rafael Matheus Nunes Teixeira , Bárbara Prestes Castro , Irineu Francisco Delfino Massaia
{"title":"Metabolomics: Unveiling biological matrices in precision nutrition and health","authors":"Bruna Lima Chechin Catussi , Edson Guimarães Lo Turco , Dirceu Mendes Pereira , Rafael Matheus Nunes Teixeira , Bárbara Prestes Castro , Irineu Francisco Delfino Massaia","doi":"10.1016/j.clnesp.2024.10.148","DOIUrl":"10.1016/j.clnesp.2024.10.148","url":null,"abstract":"<div><div>Precision nutrition, an expanding field at the intersection of nutrition science and personalized medicine, is rapidly evolving with metabolomics integration. Metabolomics, facilitated by advanced technologies like mass spectrometry (MS) and nuclear magnetic resonance (NMR) spectroscopy, facilitates comprehensive profiling of metabolites across diverse biological samples. From the perspective of health care systems, precision nutrition gains relevance due to the substantial impact of prevalent non-communicable diseases (NCDs) on societal well-being, which is directly linked with dietary habits and eating behavior. Furthermore, biomarker products derived from metabolomics have been utilized in Europe, the USA, and Brazil to understand metabolic dysregulations and tailor diets accordingly. Despite its burgeoning status, metabolomics holds great potential in revolutionizing nutritional science, particularly with the integration of artificial intelligence and machine learning, offering novel insights into personalized dietary interventions and disease prediction. This narrative review emphasizes the transformative impact of metabolomics in precision and delineates avenues for future research and application, paving the way for a more tailored and practical approach to nutrition management.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 314-323"},"PeriodicalIF":2.9,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Judwin Ndzo , Sudheer K. Vuyyuru , Thomas Trimble , Kaung Yan , Grazziela Figueredo , Gordon W. Moran
{"title":"Association between nutritional status assessed by body mass index and Crohn's disease phenotype: A Nation-wide analysis","authors":"Judwin Ndzo , Sudheer K. Vuyyuru , Thomas Trimble , Kaung Yan , Grazziela Figueredo , Gordon W. Moran","doi":"10.1016/j.clnesp.2024.09.033","DOIUrl":"10.1016/j.clnesp.2024.09.033","url":null,"abstract":"<div><h3>Background & aims</h3><div>Incidence of obesity and Crohn's disease (CD) is increasing globally. Therefore, understanding any associations between adiposity and disease phenotype is crucial. We aimed explore the relationship between nutritional status measured by body mass index (BMI) and phenotypes of CD using a large national recallable data set.</div></div><div><h3>Methods</h3><div>Using National Institute for Health and Care Research-IBD Bioresource data base, we retrospectively assessed the relationship between BMI and stenosing CD by logistic regression. BMI was the primary variable of interest; CD behaviour was the dependent variable; stenosing CD was the primary outcome. Confounders were adjusted for in a multivariate model.</div></div><div><h3>Results</h3><div>8797 patients diagnosed between 1942 and 2020 were included. Mean overall BMI was 26.3 kg/m<sup>2</sup> (SD5.5). 52.7 % had a BMI ≥25 kg/m<sup>2</sup> (mean 30.2 kg/m<sup>2</sup>, SD 4.5). Majority had inflammatory CD (62.9 %) followed by stenosing (25.1 %) and penetrating CD (12 %). Stenosing and penetrating phenotypes were more common in the <25 kg/m<sup>2</sup> BMI group (50.7 %, 50.3 % respectively) p < 0.001. Colonic disease location was more common (27.8 % vs 24.3 %, p = 0.001) in patients with high BMI. On univariate analysis, stenosing disease was positively associated with ileal disease location, disease duration, previous surgery, use of infliximab, ustekinumab, vedolizumab, adalimumab and azathioprine but negatively associated with BMI (OR 0.98, 95%CI [0.968–0.99]). On multivariate analyses, BMI remained negatively associated with stenosing CD (OR 0.98, 95%CI [0.97–0.99]); ileal disease location (OR 3.69, 95%CI [3.22–4.24]), adalimumab (OR 1.47, 95%CI [1.30–1.66]), ustekinumab usage (OR 1.51, 95%CI [1.14–2.01] and azathioprine (OR 1.35, 95%CI [1.19–1.53]).</div></div><div><h3>Conclusions</h3><div>After multivariate analyses, BMI, ileal disease location and biologic use was negatively associated with a stenosing disease phenotype. This might reflect a change in eating behaviour due to persistent postprandial symptoms related to stenosing disease. Large longitudinal studies are needed to investigate any possible temporal relationship between the obesogenic state and intestinal fibrosis.</div></div>","PeriodicalId":10352,"journal":{"name":"Clinical nutrition ESPEN","volume":"64 ","pages":"Pages 290-295"},"PeriodicalIF":2.9,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142459538","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}