Journal of Parenteral and Enteral Nutrition最新文献

{"title":"Longitudinal changes of skeletal muscle mass and architecture in critically ill adults: A prospective matched cohort study","authors":"Carolyn Tze Ing Loh BSc, Zheng-Yii Lee PhD, Nor'azim Mohd Yunos PhD, Christian Stoppe MD, PhD, M. Shahnaz Hasan MAnes","doi":"10.1002/jpen.70123","DOIUrl":"10.1002/jpen.70123","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Skeletal muscle loss is a common consequence of critical illness, yet its determinants and prognostic significance remain unclear. This study investigated muscle trajectory during hospitalization in critically ill patients, factors predicting these changes, and the associations between early muscle changes with clinical and functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adults (≥18 years) with severe pneumonia requiring supplemental oxygen were enrolled within 72 h of ICU admission. Two groups were recruited: RT-PCR-confirmed COVID-19 and non-COVID pneumonia, individually matched by age (±10 years), sex, and ventilatory support. Ultrasound assessments of quadriceps muscles (quadriceps muscle layer thickness, rectus femoris cross-sectional area, pennation angle, fascicle length) and forearm muscle thickness were performed in the ICU on study Days 1, 7, and 14, at ICU discharge (if later), and at hospital discharge. Muscle trajectories were evaluated using linear mixed-effects models. Regression analyses examined associations of relative muscle changes with (1) potential predictors, (2) 60-day time-to-discharge alive, and (3) hospital discharge handgrip and knee extension strength.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Fifty-nine patients (29 COVID-19, 30 non-COVID) were analyzed. Quadriceps muscles changed significantly over time, while forearm muscle thickness did not; trajectories were comparable between groups. No patient characteristics, laboratory, or clinical factors were associated with muscle changes on Day 7 or hospital discharge. Day 7 muscle changes were not associated with time-to-discharge-alive at 60 days or muscle strength after baseline adjustment (all <i>p</i> > 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>In critically ill patients, significant muscle changes occurred during hospitalization irrespective of COVID-19 status, but no predictors were identified. Early muscle change alone was not predictive of clinical or functional outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Clinical Relevance Statement</h3>\u0000 \u0000 <p>This study demonstrates that skeletal muscle changes significantly over the course of hospitalization with similar trajectories in COVID-19 and non-COVID patients, independent of patient characteristics or routine clinical and laboratory factors. Early muscle loss alone was not predictive of clinical and functional outcomes, highlighting the need for combined or alternative markers to better identify high-risk patients and guide targeted interventions in ","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"963-975"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148364846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between GLIM-defined malnutrition and in-hospital costs in adults with sepsis: A sub analysis of a prospective cohort study","authors":"Yuki Hashimoto RPh, PhD,&nbsp;Minoru Yoshida MD, PhD,&nbsp;Tomoka Miyagi RD,&nbsp;Akane Kariya RN, MPH,&nbsp;Hitomi Tanoue RD,&nbsp;Naoki Kanda MD, MPH, PhD,&nbsp;Yusuke Hoshi RD,&nbsp;Takahiro Fujita PT,&nbsp;Kensei Togo MD,&nbsp;Tomoaki Obata MD,&nbsp;Kenzo Ishii MD, PhD,&nbsp;Katsuyuki Abe RD,&nbsp;Chihiro Sato RD,&nbsp;Yoshifumi Heshiki RN,&nbsp;Daisetsu Yasumura PT, MHA,&nbsp;Shizuko Gomi PhD,&nbsp;Masafumi Takahashi PT,&nbsp;Takashi Hongo MD, PhD,&nbsp;Keiji Sakurai MD,&nbsp;Miho Nishihara RD,&nbsp;Yuko Matsuda RD,&nbsp;Kiyota Chinen RD,&nbsp;Akiko Arai MD,&nbsp;Michihiro Maeda MD,&nbsp;Yuhei Irie MD, PhD,&nbsp;Hiroshi Kamijo MD, PhD,&nbsp;Kana Hosokawa RD,&nbsp;Daisuke Kasugai MD, PhD,&nbsp;Michiko Higashi MD,&nbsp;Ayaka Matsuoka MD,&nbsp;Hirotaka Ogawa MD,&nbsp;Yuichi Araki MD,&nbsp;Kenji Oike PT,&nbsp;Daigo Shimakura PT,&nbsp;Hajime Katsukawa PT, PhD,&nbsp;Toru Kotani MD,&nbsp;Takayuki Ogura MD, PhD,&nbsp;Keibun Liu MD, PhD,&nbsp;Kensuke Nakamura MD, PhD","doi":"10.1002/jpen.70120","DOIUrl":"10.1002/jpen.70120","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>International statements suggest using the Global Leadership Initiative on Malnutrition (GLIM) criteria in intensive care units (ICUs); however, the economic impact of GLIM-defined malnutrition in sepsis remains unclear. This study investigated the association between GLIM-defined malnutrition and in-hospital costs in sepsis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a sub-analysis of the prospective cohort study, Investing Long-term Outcomes of Sepsis or Septic shock, among medically managed critically ill patients with sepsis in 15 Japanese ICUs. Associations between GLIM-defined malnutrition and cost categories (low, moderate, and high) were assessed using multinomial logistic regression (reference: low-cost group), adjusted for age, sex, Charlson Comorbidity Index, and Sequential Organ Failure Assessment score. Individual GLIM components were also examined. Total in-hospital costs and secondary outcomes were compared between malnutrition and non-malnutrition groups using inverse probability of treatment weighting.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 259 patients, 111 had GLIM-defined malnutrition. GLIM-defined malnutrition was associated with both the moderate-cost (adjusted odds ratio [AOR]: 2.03, 95% confidence interval [CI]: 1.05–3.89) and high-cost classifications (AOR: 2.27, 95% CI: 1.20–4.29). Among GLIM components, reduced muscle mass (AOR: 1.95, 95% CI: 1.04–3.68) and reduced food intake (AOR: 2.61, 95% CI: 1.39–4.92) were associated with the high-cost classification. After weighting, the malnutrition group had significantly higher median in-hospital costs (24,959 vs. 18,651 USD), longer hospital stays, and longer ICU stays than the non-malnutrition group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>GLIM-defined malnutrition—particularly reduced muscle mass and reduced food intake—was associated with higher in-hospital costs in sepsis and may be a potential indicator of high-cost hospitalization.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"985-995"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70120","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148383497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical trajectory of microvillus inclusion disease associated with STXBP2-related familial hemophagocytic lymphohistiocytosis type 5: A case report","authors":"Hiroyuki Tanaka MD, PhD,&nbsp;Mariko Sekiguchi MD,&nbsp;Yuko Kajiho MD, PhD,&nbsp;Tetsuo Ushiku MD, PhD,&nbsp;Jun Fujishiro MD, PhD,&nbsp;Motohiro Kato MD, PhD","doi":"10.1002/jpen.70130","DOIUrl":"10.1002/jpen.70130","url":null,"abstract":"<p>Familial hemophagocytic lymphohistiocytosis type 5 is caused by biallelic pathogenic variants in <i>STXBP2</i>, which encodes syntaxin-binding protein, a key regulator of vesicle trafficking. In addition to immune dysregulation, patients with familial hemophagocytic lymphohistiocytosis type 5 may present with severe, persistent diarrhea associated with microvillus inclusion disease. However, the long-term clinical course of microvillus inclusion disease in this context remains poorly characterized due to limited survival beyond early childhood. We report a 22-year-old male with familial hemophagocytic lymphohistiocytosis type 5 who developed chronic diarrhea in infancy that persisted despite following bone marrow transplantation. The diagnosis of microvillus inclusion disease was established 16 years after transplantation based on characteristic histopathological findings. The patient also developed Fanconi syndrome, a rare complication in this setting, which improved following intensification of parenteral nutrition. Long-term follow-up revealed that the patient was dependent on parenteral nutrition not only for caloric intake but also for the correction of electrolyte imbalance. Growth retardation and multiple endocrine abnormalities improved with nutritional optimization, highlighting the systemic impact of chronic undernutrition. This patient expands the long-term extrahematopoietic phenotype of <i>STXBP2</i>-related familial hemophagocytic lymphohistiocytosis type 5 and underscores the importance of individualized nutritional management.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"1040-1044"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70130","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of methods for defatted human milk and nutrient composition: An experimental study","authors":"Kristin Cheng MS, RD,&nbsp;Gina O'Toole MPH, RD,&nbsp;Stephanie Chang MS, RD,&nbsp;Richard Chang MD,&nbsp;John Miklavcic PhD","doi":"10.1002/jpen.70121","DOIUrl":"10.1002/jpen.70121","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Human milk is considered the gold standard for infant nutrition; however, it is often discontinued in chylothorax and severe very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. As an alternative to complete human milk restriction, defatted human milk may be fed, though it may not fully support optimal infant growth and development. This study aimed to assess the micronutrient profile of defatted human milk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Human milk was obtained from UCSD Human Milk Research Biorepository (San Diego, CA). Thirty samples representing 10 independent expressions in the morning, afternoon, and evening were pooled for analysis. Fat removal was performed by centrifugation at refrigerated and room temperatures, electric cream separator, and gravity separation. Analyses of macronutrients, micronutrients, fat-soluble vitamins, and water-soluble vitamins were conducted in triplicate.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>All defatting methods decreased vitamins A and E by &gt;80%. Folate decreased most by nonrefrigerated centrifugation (52.3, SD &lt; 0.01%) and least by cream separator (22.8, SD &lt; 0.01%). Zinc decreased most by both nonrefrigerated centrifugation (43.5 ± 0.06%) and cream separator (43.5 ± 0.12%), and least by refrigerated centrifugation (17.7 ± 0.10%). Iodine decreased most by refrigerated centrifugation (40.0, SD &lt; 0.01%) and least by cream separator (31.2, SD &lt; 0.01%). Total triglycerides decreased most by refrigerated centrifugation (87.0 ± 0.03%).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>All defatting methods decreased amounts of vitamin A, vitamin E, folate, zinc, and iodine. Refrigerated centrifuge was most effective in removing total triglycerides. These results can inform fortification and supplementation guidelines of key micronutrients for patients with chylothorax and VLCAD deficiency consuming defatted human milk.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"955-962"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70121","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148475746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative nutrition therapy to optimize colorectal patient outcomes: A systematic review and meta-analysis","authors":"Alexander Troester MD,&nbsp;Shelbi Olson MD,&nbsp;Lindsay Welton MD,&nbsp;Lauren Weaver MD,&nbsp;Romil Parikh MBBS,&nbsp;Alexis Li BS,&nbsp;Amy M. Claussen MLIS,&nbsp;Sallee Brandt MPH,&nbsp;Mary Butler PhD, MBA,&nbsp;Bronwyn Southwell MD,&nbsp;Paolo Goffredo MD","doi":"10.1002/jpen.70112","DOIUrl":"10.1002/jpen.70112","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malnutrition is an independent risk factor for postoperative complications—particularly surgical site infections—and recovery delays following colorectal surgery. While some evidence suggests perioperative nutritional interventions have the potential to decrease complication rates, this literature is heterogeneous with difficult to control implementation barriers. We conducted a systematic review and meta-analysis to appraise available evidence regarding perioperative nutritional interventions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched Medline, Embase, CAB Abstracts, and CINAHL between 2000 and 2023 for studies assessing perioperative protein supplementation, immunonutrition, carbohydrate loading, and postoperative diet progression in colorectal surgery patients. Individual study risk of bias and overall strength of evidence (SOE) were evaluated using standardized methods. We used random-effects modeling for meta-analyses of study-level data when ≥3 studies were available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-seven eligible studies underwent data extraction. Ten were low/moderate risk of bias. Compared to dietary advice alone, protein supplementation and immunonutrition may show a benefit in lower surgical site infection rates, and carbohydrate loading may result in no difference (all low SOE). Both immunonutrition and carbohydrate loading probably do not impact anastomotic leak rates (moderate SOE). Immunonutrition and carbohydrate loading may result in no length of stay differences (low SOE). Evidence was insufficient assessing the optimal diet immediately following surgery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Perioperative colorectal surgery nutrition interventions are heterogeneous with current evidence suggesting small to negligible benefits regarding postoperative complications. No studies comparing low-fiber diet to regular diet met inclusion criteria. The majority of evidence is insufficient, highlighting research opportunities to further enhance nutritional optimization and limit complications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"920-937"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148261194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fiber and fluid administration and the risk of constipation in critically ill adults on mechanical ventilation: A prospective cohort study","authors":"Paola Renata Lamoyi-Domínguez MSc,&nbsp;Nadia Carolina Rodríguez-Moguel MSc,&nbsp;Lourdes Guadalupe Pedroza-Terán MD,&nbsp;Lilia Castillo-Martínez PhD,&nbsp;Sebastian Rodríguez-Llamazares MD,&nbsp;Josue Daniel Cadeza-Aguilar MD,&nbsp;Carmen Margarita Hernández-Cardenas MD,&nbsp;Iván Armando Osuna-Padilla PhD","doi":"10.1002/jpen.70137","DOIUrl":"10.1002/jpen.70137","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Constipation is a common complication in critically ill patients and has been associated with adverse clinical outcomes. However, the role of enteral nutrition composition, particularly fiber and fluid administration, remains unclear. The aim of this study was to evaluate the association between dietary fiber and fluid administration and constipation in invasive mechanical ventilated critically ill adults.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a prospective cohort study including 74 critically ill adults requiring invasive mechanical ventilation and enteral nutrition. Patients were followed for up to 144 h from initiation of mechanical ventilation. Fiber and total fluid administration were evaluated as time-varying exposures. Constipation was defined as absence of defecation within 144 h. Discrete-time survival analysis was used to assess associations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Constipation occurred in 54% of patients. Time to first defecation ranged from 48 to 504 h. Most patients (97.3%) received early enteral nutrition, although fiber and fluid delivery were frequently below guideline-recommended targets. No significant association was observed between fiber intake or fluid administration and constipation after adjustment, with results expressed as odds ratios (ORs) and 95% confidence intervals (CIs) (fiber: OR = 1.17, 95% CI: 0.41–3.38; fluids: OR = 1.40, 95% CI: 0.29–6.84).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>In critically ill patients receiving invasive mechanical ventilation, fiber and fluid administration were not associated with constipation. These findings may reflect limited exposure during the early phase of critical illness, when gastrointestinal dysfunction is more strongly influenced by disease severity and pharmacological factors.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"976-984"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148805334","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sex-specific screening of low appendicular skeletal muscle mass index in community dwelling adults: A descriptive cross-sectional study","authors":"Na Young Yeo PhD,&nbsp;Soo-Young Seo MD,&nbsp;Heeji Choi MSc,&nbsp;Dong-Hyun Kim MD, PhD,&nbsp;Jae Jun Lee MD, PhD,&nbsp;Hye-Jin Kim PhD,&nbsp;Chulho Kim MD, PhD","doi":"10.1002/jpen.70136","DOIUrl":"10.1002/jpen.70136","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>The Global Leadership Initiative on Malnutrition criteria has recommended using bioelectrical impedance analysis-derived fat-free mass index as a practical screening tool for low muscle mass. In the present study we evaluated the correlation between this index and dual-energy X-ray absorptiometry-derived appendicular skeletal muscle mass index, and developed sex-specific predictive nomograms according to the 2019 Asian Working Group for Sarcopenia criteria.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This cross-sectional analysis included 369 community-dwelling adults from the Hallym Aging Study. Body composition was assessed by bioelectrical impedance analysis and dual-energy X-ray absorptiometry. Low appendicular skeletal muscle mass index was defined as &lt;7.0 kg/m² for men and &lt;5.4 kg/m² for women. Receiver operating characteristic analysis identified optimal cutoffs. Multivariable logistic regression and sex-specific nomograms were developed, adjusting for age, albumin, creatinine, hypertension, diabetes, and dyslipidemia. Models were internally validated using 1000 bootstrap resamples.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This index moderately correlated with appendicular skeletal muscle mass index (<i>ρ</i> = 0.65 in males, <i>ρ</i> = 0.36 in females; <i>P</i> &lt; 0.001). Optimal cutoffs were 17.7 kg/m² for males (area under the curve, 0.84) and 16.1 kg/m² for females (0.73). This index remained independently associated with low appendicular skeletal muscle mass index after multivariable adjustment. Nomograms showed good discrimination (<i>C</i>-statistics = 0.78 in males, 0.73 = in females) and calibration. In females, metabolic disorders, particularly hypertension and diabetes, significantly increased this risk.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Fat-free mass index is a practical marker for low muscle mass screening. However, its accuracy varies by sex and metabolic health, requiring sex-and disease-specific calibration to improve malnutrition diagnosis and sarcopenia screening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 7","pages":"1031-1039"},"PeriodicalIF":3.3,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148764186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Refeeding syndrome in at-risk hospitalized children: A descriptive study","authors":"Faten Ahmad Alkateb MSc, ABLM,&nbsp;Fawziah Abdulhameed Abdulhalim MBBS,&nbsp;Awatif Khaled Almutairi MBBS,&nbsp;Asmaa Fayez Basakran MBBS,&nbsp;Nora Khaled Alanazy MBBS,&nbsp;Basma Sulaiman Alhamdan PhD,&nbsp;Ohoud Abdulhamid Fatah MBBS","doi":"10.1002/jpen.70117","DOIUrl":"10.1002/jpen.70117","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Refeeding syndrome is a metabolic condition characterized by severe electrolyte disturbances following nutritional rehabilitation in malnourished patients, with limited pediatric evidence. This study evaluated the implementation of locally adapted international guidelines in a Middle Eastern tertiary care setting.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;We performed a descriptive cohort study of 133 children (28 days to 14 years) at the Children's Specialized Hospital, King Fahad Medical City (June 2024 to May 2025), stratified by refeeding syndrome risk. Our primary outcome was refeeding syndrome, defined as hypophosphatemia, hypokalemia, and/or hypomagnesemia 10% or more below normal limits within 5 days of nutritional support initiation. Secondary outcomes were length of stay, intensive care unit admission, hospital mortality, and weight change at 6 months.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Of 1,117 admissions, 133 patients were enrolled (median age 24 months; 44.4% male; 61.7% severe risk). Underlying conditions included failure to thrive (21.1%), syndromic conditions (15.0%), and neurological impairments (12.8%). Refeeding syndrome developed in 13 patients (9.8%; 95% CI: 5.6 to 16.1%). A nonsignificant increase was observed across risk categories (&lt;i&gt;p&lt;/i&gt; = 0.43). Lower body mass index &lt;i&gt;z&lt;/i&gt;-scores correlated with refeeding syndrome (tau &lt;i&gt;b&lt;/i&gt; = 0.163, &lt;i&gt;p&lt;/i&gt; = 0.02). All 13 patients required electrolyte correction. Thiamine prophylaxis reached only 9 of 82 severe-risk patients (11.0%) despite 97.7% risk identification, revealing a critical implementation gap. Weight recovery was significant at 6 months.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusions&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Refeeding syndrome affects 1 in 10 pediatric patients. Risk stratification was associated with the absence of severe complications despite imperfect implementation. A critical gap in thiamine adherence (11.0%) demonstrates that guideline adaptation requires systematic implementation strategies beyond protocol development.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Clinical Relevance Statement&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This descriptive cohort study establishes that refeeding syndrome affects 9.8% (95% confidence interval: 5.6%–16.1%) of at-risk pediatric patients following the implementation of adapted American Society for Parenteral and Enteral Nutrition (ASPEN)/National Institute for Health and Care Excellence (NICE) guidelines in a tertiary care setting. Systematic risk stratification successfully prevented severe complications, with zero pediatric intensive c","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"881-890"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148298819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combined GLIM-defined malnutrition and sarcopenia and the risk of 2-year mortality in adults with heart failure: A FRAGILE-HF study post hoc analysis","authors":"Koji Matsuo PT, BSc,&nbsp;Kentaro Kamiya PT, PhD,&nbsp;Daichi Maeda MD, PhD,&nbsp;Nobuaki Hamazaki PT, PhD,&nbsp;Shota Uchida PT, PhD,&nbsp;Masashi Yamashita PT, PhD,&nbsp;Masaaki Konishi MD, PhD,&nbsp;Takatoshi Kasai MD, PhD,&nbsp;Hiroshi Saito PT, PhD,&nbsp;Yuki Ogasahara RN,&nbsp;Takeshi Kitai MD, PhD,&nbsp;Kentaro Iwata PT, PhD,&nbsp;Kentaro Jujo MD, PhD,&nbsp;Hiroshi Wada MD, PhD,&nbsp;Emi Maekawa MD, PhD,&nbsp;Shin-Ichi Momomura MD, PhD,&nbsp;Nobuyuki Kagiyama MD, PhD,&nbsp;Yuya Matsue MD, PhD","doi":"10.1002/jpen.70110","DOIUrl":"10.1002/jpen.70110","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malnutrition is common in older patients with heart failure and predicts poor outcomes. However, the prognostic value of assessing muscle function and fat stores alongside GLIM remains unclear. We therefore tested whether assessing handgrip strength and fat mass index alongside GLIM improves risk stratification for mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a post hoc analysis of patients ≥65 years in the multicenter observational FRAGILE-HF cohort. Malnutrition was evaluated using GLIM criteria at hospital discharge. Handgrip strength and fat mass index were also measured at discharge; low handgrip strength was defined as &lt;28 kg in men and &lt;18 kg in women, and low fat mass index as &lt;4.62 kg/m² in men and &lt;5.86 kg/m² in women. Patients were classified into four groups by GLIM-defined malnutrition and low handgrip strength and, separately, by GLIM-defined malnutrition and low fat mass index. Associations with 2-year all-cause mortality were examined using Cox proportional hazards regression.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Of 1332 patients, 834 were analyzed (median age, 81 years; 57.6% men). In four-group analyses, GLIM-defined malnutrition with low handgrip strength (HR, 2.06; 95% CI, 1.14–3.73; <i>P</i> = 0.02) and GLIM-defined malnutrition with low fat mass index (HR, 1.87; 95% CI, 1.25–2.80; <i>P</i> = 0.01) had higher mortality than the corresponding reference groups (absence of malnutrition with normal handgrip strength and absence of malnutrition with normal fat mass index).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Assessing handgrip strength or fat mass index alongside GLIM identified subgroups at higher risk of 2-year mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"823-831"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148153083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Computed tomography-derived muscle quality and density and the risk of postoperative decline in exercise capacity in adults who received cardiac surgery: A retrospective cohort study","authors":"Kazuya Shimizu PT, MSc,&nbsp;Ryota Matsuzawa PT, PhD,&nbsp;Shinya Nakamura PT,&nbsp;Hiroyuki Miyoshi PT,&nbsp;Keita Murakawa PT, MSc,&nbsp;Hideo Kawakami MD, PhD,&nbsp;Yasuko Gotake MD,&nbsp;Motoaki Ohnaka MD, PhD,&nbsp;Masamichi Matsumori MD, PhD,&nbsp;Akira Tamaki PT, PhD","doi":"10.1002/jpen.70116","DOIUrl":"10.1002/jpen.70116","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Cardiovascular surgery significantly improves outcomes, yet many, particularly older or frail individuals, face substantial postoperative declines in exercise capacity, prolonging recovery and worsening long-term prognosis. Early, precise risk identification is critical. Routinely performed preoperative computed tomography (CT) offers a pragmatic opportunity to assess muscle quality like psoas muscle density (PMD), reflecting physiological resilience. This study aimed to examine the predictive capabilities of CT-derived muscle mass and quality for postoperative exercise capacity decline following elective cardiovascular surgery, focusing on identifying high-risk patients for timely prehabilitation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective study enrolled 229 consecutive patients undergoing elective thoracic cardiovascular surgery (May 2020 to March 2025). Skeletal muscle index (SMI) and PMD were calculated from preoperative CT images. The primary outcome was a postoperative exercise capacity decline, defined as a ≥50 m reduction in 6-min walk distance on postoperative Day 14.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-seven patients (38%) experienced postoperative exercise capacity decline. PMD was significantly lower in the “6-min walk distance decline ≥50 m” (<i>p</i> &lt; 0.001). Receiver operating characteristic analysis for PMD revealed an area under the curve of 0.693, with an optimal cutoff of 45.0 Hounsfield units. Lower PMD independently associated with higher odds of postoperative decline (odds ratio, 1.08 per 1-Hounsfield unit decrease, 95% CI: 1.03–1.13). SMI was not a significant predictor.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reduced preoperative PMD is a robust, independent predictor of early postoperative exercise capacity decline. The 45.0 Hounsfield units cutoff provides a clinically relevant threshold. Utilizing routinely available CT for muscle quality assessment offers a practical, cost-effective method to identify high-risk patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"845-854"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}