Journal of Parenteral and Enteral Nutrition最新文献

{"title":"Nutrition impact symptoms and the risk of malnutrition, frailty, and sarcopenia in adults with cancer: A cross-sectional latent class analysis","authors":"Xite Zheng BSc,&nbsp;Fen Liu PhD,&nbsp;Hanping Shi PhD, MD,&nbsp;Investigation on Nutrition Status and Clinical Outcome of Common Cancers (INSCOC) Group","doi":"10.1002/jpen.70103","DOIUrl":"10.1002/jpen.70103","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Malnutrition, frailty, and sarcopenia are common and interrelated in patients with cancer, yet their associations with nutrition impact symptom clusters remain unclear. This study examined the overlap of these conditions, and their relationships with symptom clusters in adults with cancer.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Malnutrition was assessed using the Patient-Generated Subjective Global Assessment and Global Leadership Initiative on Malnutrition criteria, frailty using the FRAIL scale, and sarcopenia using the 2019 Asian Working Group for Sarcopenia consensus. Latent class analysis identified nutrition impact symptom clusters. Logistic regression models evaluated associations between symptom clusters and the three conditions.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>This cross-sectional latent class analysis included 28,377 hospitalized adults with cancer (median age 58 years; 55.3% male). Gastrointestinal (41.0%) and lung (23.1%) cancers were the most common diagnoses. The prevalence of malnutrition, frailty and sarcopenia was 56.4%, 37.7%, and 16.9%, respectively. Weight loss and low muscle mass represent key shared features of their coexistence. Five nutrition impact symptom clusters were identified and ranked by severity. Patients with severe multi-symptom cluster had 3.87-fold higher odds of malnutrition and 6.03-fold higher odds of frailty. Patients with the gastrointestinal-dominant symptom cluster were most likely to experience malnutrition, whereas those with the sensory-alteration symptom cluster were most likely to exhibit frailty.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Maintaining stable body weight, particularly muscle mass, is crucial for cancer patients to reduce the risk of comorbidity among these conditions. Identifying nutrition impact symptom clusters and providing targeted interventions may help reduce the burden of these conditions and improve the efficiency of nutritional care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"832-844"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960676","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":"Propofol-induced hypertriglyceridemia in critically ill trauma patients requiring nutrition therapy: A descriptive cohort study","authors":"Emma S. Lemke PharmD,&nbsp;Jonathon K. Walker PharmD,&nbsp;Julie E. Farrar PharmD,&nbsp;Saskya Byerly MD,&nbsp;Dina M. Filiberto MD,&nbsp;Roland N. Dickerson PharmD","doi":"10.1002/jpen.70105","DOIUrl":"10.1002/jpen.70105","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>This study aimed to assess the incidence and identify risk factors associated with the development of propofol-induced hypertriglyceridemia in critically ill trauma patients who required nutrition therapy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Adult patients (aged &gt;17 years) admitted to the trauma intensive care unit who received propofol for &gt;24 h and had a serum triglyceride concentration determination during the infusion were retrospectively evaluated. Hypertriglyceridemia was defined as a serum triglyceride concentration &gt; 400 mg/dL. Potential risk factors for hypertriglyceridemia as well as linear and nonlinear correlative relationships between propofol-associated lipid injectable emulsion dose and serum triglyceride concentration were evaluated.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>One hundred and ninety-five serum triglyceride determinations were obtained from 100 patients. Twenty-five patients (25%) developed hypertriglyceridemia. The greatest risk factor for hypertriglyceridemia was lipid injectable emulsion dose (0.48 [0.36, 0.64] vs 0.28 [0.20, 0.49] g/kg/day; <i>P</i> &lt; 0.01). Those who exhibited hypertriglyceridemia had a higher C-reactive protein (<i>P</i> &lt; 0.02), lower prealbumin (<i>P</i> = 0.001), higher serum creatinine (<i>P</i> &lt; 0.04), and required more days of nutrition therapy (<i>P</i> &lt; 0.03). The hypertriglyceridemia group exhibited a nonlinear concave lipid dose–serum triglyceride concentration response relationship (<i>r</i> = 0.731, <i>P</i> = 0.001) whereas those without hypertriglyceridemia had a flattened and variable linear relationship (<i>r</i> = 0.115, <i>P</i> = 0.34).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Hypertriglyceridemia is common during propofol therapy, reflective of lipid injectable emulsion dose, and is associated with greater inflammation, organ dysfunction, and severe critical illness requiring prolonged nutrition therapy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"794-804"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147960664","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":"Reply to: “Amino acid strategy in early postoperative parenteral nutrition”","authors":"Yoshikuni Kawaguchi MD, PhD,&nbsp;Kenta Murotani PhD,&nbsp;Nahoki Hayashi MS,&nbsp;Satoru Kamoshita BA","doi":"10.1002/jpen.70114","DOIUrl":"10.1002/jpen.70114","url":null,"abstract":"<p>We appreciate the thoughtful and insightful comments by Shen et al concerning our recent publication—Association between prescribed parenteral energy doses and the composite of clinical adverse events in adult patients after gastrointestinal cancer surgery: A retrospective cohort study.<span>¹</span></p><p>We agree that, in the early postoperative phase after gastrointestinal cancer surgery, prescribed amino acid doses and the nonprotein energy-to-amino acid balance are metabolically and physiologically important. Increased body protein breakdown leads to decreases in body weight, muscle mass, and immune function,<span>^{2, 3}</span> suggesting that prescribed amino acid doses and the nonprotein energy-to-amino acid balance may influence clinical outcomes. However, the primary aim of our study was to evaluate the association between prescribed parenteral energy doses and clinical outcomes; therefore, analyses modeling the nonprotein energy-to-amino acid balance were beyond the scope of the current study.</p><p>In this context, we conducted a separate study evaluating the association between the mean prescribed amino acid doses during postoperative days 1 to 7 and a composite of clinical adverse events (in‑hospital mortality, postoperative complications, decline in activities of daily living, or hospital readmission) in patients who exclusively received parenteral nutrition in the early phase after gastrointestinal cancer surgery.<span>⁴</span> We found that higher prescribed amino acid doses were associated with a lower incidence of the composite of clinical adverse events. We divided study patients into the low-amino acid group (&lt;0.8 g/kg/day) and the high-amino acid group (≥0.8 g/kg/day) based on the mean prescribed amino acid doses during postoperative days 1 to 7. Assessment using propensity score matching showed that in hospital mortality was significantly lower in the high-amino acid group (4.2% vs. 5.4%, <i>p</i> = 0.045).<span>⁴</span></p><p>Taken together, our findings may support that postoperative prescribed amino acid doses and the nonprotein energy-to-amino acid balance may influence clinical outcomes. However, these analyses did not adequately account for the nonprotein energy-to-amino acid balance as proposed by Shen et al. Therefore, further investigation of the impact of the nonprotein energy-to-amino acid balance on clinical outcomes is a critically important next step toward refining parenteral nutrition management in patients after gastrointestinal cancer surgery.</p><p>Y. Kawaguchi received adviser and lecture fees from Otsuka Pharmaceutical Factory, Inc. K. Murotani received adviser fees from Otsuka Pharmaceutical Factory, Inc. N. Hayashi and S. Kamoshita were employed by Otsuka Pharmaceutical Factory, Inc.</p><p>This study received no funding, and it was conducted by Otsuka Pharmaceutical Factory, Inc.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 6","pages":"763-764"},"PeriodicalIF":3.3,"publicationDate":"2026-08-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70114","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148280711","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":"Human milk storage conditions and bactericidal activity: An experimental study","authors":"Merve Yilmaz Yeşilalan MD,&nbsp;Belma Saygili Karagöl,&nbsp;Deniz Yaprak MD,&nbsp;Bülent Ünay,&nbsp;Aylin Var MD,&nbsp;Tuğrul Hoşbul","doi":"10.1002/jpen.70096","DOIUrl":"10.1002/jpen.70096","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Breast milk is crucial for neonatal nutrition and provides antimicrobial protection. While breastfeeding for at least 6 months is ideal, situations may arise where stored milk is necessary. This study examines how storage in polyethylene bags and Pyrex bottles affects breast milk's antimicrobial effectiveness against common neonatal pathogens: <i>Escherichia coli, Staphylococcus aureus</i>, and <i>Streptococcus agalactiae.</i></p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Materials and Methods</h3>\u0000 \u0000 <p>Conducted from December 15, 2023, to March 15, 2024, the prospective study involved 30 term infants and their mothers, aged 18–40, at Gülhane Training and Research Hospital. Milk was manually expressed into both container types and stored at 4°C for 0, 24, and 48 h. Bactericidal activity was evaluated using standard strains of <i>E. coli, S. aureus</i>, and <i>S. agalactiae</i>, with colony counts analyzed after 24 h of cultivation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>No significant differences were found between storage types for overall colony counts. However, <i>S. agalactiae</i> showed a significant increase in colonies at 48 h in Pyrex bottles (<i>p</i> = 0.003), while <i>S. aureus</i> colonies increased significantly in polyethylene bags at 48 h (<i>p</i> = 0.036).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Bactericidal activity against <i>S. agalactiae</i> and <i>S. aureus</i> decreased significantly in stored milk after 24 and 48 h in the refrigerator. Short-term storage of human milk may compromise its antimicrobial properties depending on bacterial strain and container type, indicating the need for further research on optimal storage conditions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"693-700"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147849263","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 blenderized tube feeds and differential oropharynx, stomach, and stool microbiome signatures relative to conventional formula feeds in children fed via enteral tube: A cross-sectional study","authors":"Bridget M. Hron MD, MMSc,&nbsp;Yanjia Jason Zhang MD, PhD,&nbsp;Clare Golden BS,&nbsp;Christopher Chalmers BA,&nbsp;Grace Nemec BS,&nbsp;Elise Delaney BA,&nbsp;Evrim Ozcan BS,&nbsp;Michael Kim BS,&nbsp;Lauren Jalali MS, RD, LDN,&nbsp;Toni Solari RD, LDN,&nbsp;Jasper Brezsny-Feldman MS, RD, LDN,&nbsp;Eric J. Alm PhD,&nbsp;Lynn Bry MD, PhD,&nbsp;Rachel Rosen MD, MPH","doi":"10.1002/jpen.70097","DOIUrl":"10.1002/jpen.70097","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Blenderized gastrostomy tube feeds are associated with reduced gastrointestinal symptoms. We hypothesize that patients receiving blenderized tube feeds, compared with standard formula, will have less gastric-oropharyngeal microbial overlap, a possible biomarker of less gastroesophageal refluxate, and differences in beta diversity in the oropharynx, stomach, and stool.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Children requiring enteral tube feeds for &gt;3 months were prospectively recruited to provide saliva via posterior tongue swabs, gastric aspirates, and stool samples. Exclusion criteria were history of cystic fibrosis or solid organ transplant or antibiotic treatment course within 4 weeks. The primary exposure was diet category (formula vs. blenderized feeds). The primary outcome was Jaccard similarity between the gastric and oral microbiomes. Relationships of diet to Jaccard and relative bacterial abundance were analyzed by multivariate linear regression models adjusting for age, sex and proton pump inhibitor use.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Sixty (60.6%) children received blenderized tube feeds and 39 (39.4%) received formula. Beta diversity in the oral and rectal samples differed significantly between patients on blenderized versus formula feeds. Importantly, gastric and tongue microbiomes had significantly less overlap (by Jaccard distance) in patients receiving blenderized feeds, adjusting for covariates. Several key oral, gastric and stool commensal organisms were present in higher relative abundance in the blenderized versus formula group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Oropharyngeal microbiomes are more distinct from the gastric microbiomes in patients receiving blenderized feeds, and the oropharyngeal and stool microbiomes demonstrated differential bacterial abundance compared with formula. Overall, these findings suggest a highly favorable microbial profile with blenderized feeds.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"665-675"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70097","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147877197","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":"JPEN Journal Club 98. When to select an outcome","authors":"Ronald L. Koretz MD","doi":"10.1002/jpen.70057","DOIUrl":"10.1002/jpen.70057","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"747-749"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146014174","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":"Mechanical tension and autophagy suppression: Unmasking the confounders in ICU muscle preservation strategies","authors":"Yani Lou B.NS.","doi":"10.1002/jpen.70093","DOIUrl":"10.1002/jpen.70093","url":null,"abstract":"","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147795293","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":"Care transition from a pediatric intestinal rehabilitation program to adult care and the risk of all-cause mortality: A retrospective cohort study","authors":"Gillian R. Goddard MD,&nbsp;Stephanie Oliveira MD,&nbsp;Crystal Slaughter,&nbsp;Kim Klotz MSN, RN,&nbsp;Marilyn Stoops APRN,&nbsp;Julie Schletker APRN,&nbsp;Jackie Wessel MEd, RDN,&nbsp;Michael Helmrath MD,&nbsp;Samuel Kocoshis MD,&nbsp;Monique Goldschmidt MD,&nbsp;Paul W. Wales MD, MSc","doi":"10.1002/jpen.70070","DOIUrl":"10.1002/jpen.70070","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>As patients with intestinal failure reach adulthood, transitioning to adult care remains challenging because of a lack of specialized programs. This study evaluated outcomes of patients who transitioned care from a pediatric intestinal rehabilitation program.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A retrospective cohort study was conducted of intestinal failure patients who turned 20 years old between 2013 and 2022 with follow-up through February 2025. Patient characteristics, including demographics, anatomy, nutrition, and comorbidities, were collected for all patients at the age of 18 years. Patients were classified into exposure groups based on whether they transitioned to adult care or continued follow-up at our institution. Univariate analysis comparing groups was performed with Mann-Whitney <i>U</i> test or chi-square/Fisher's exact test, with <i>P</i> &lt; 0.05 being significant.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Forty-six patients were included, with 68% having short bowel syndrome. Nine patients (20%) had an ostomy and 14 of 46 (30%) continued to receive parenteral nutrition. Twenty-seven patients (59%) transitioned to adult care at a median age of 20.8 (interquartile range [IQR], 3.8) years. No demographic, nutrition, or comorbidity differences were observed between groups. Higher mortality rates occurred among patients who transitioned care compared with patients continuing care at our institution (33% vs 5%; <i>P</i> = 0.02). The median time duration to death was 12 months (IQR, 43.5).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients transitioned to adult care have a higher mortality rate, despite no obvious difference in medical complexity based on medical devices or comorbidities. Additional studies are needed to understand this difference. Increased awareness and structured transition programs are essential to ensuring optimal long-term outcomes.</p>\u0000 </section>\u0000 </div>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"677-683"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147319376","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":"Addressing metabolic demands during veno-venous extracorporeal life support: A narrative review","authors":"Daniel T. Lammers MD,&nbsp;Perry Wiseman MD,&nbsp;Nafis Deen MD,&nbsp;Sarita Thanedar MD,&nbsp;Nawsin Baset MD,&nbsp;Gongkai Liu MD,&nbsp;Jeffrey D. DellaVolpe MD,&nbsp;Linda E. Sousse PhD","doi":"10.1002/jpen.70088","DOIUrl":"10.1002/jpen.70088","url":null,"abstract":"<p>When critical illness is further complicated by severe respiratory failure, such as in cases of acute respiratory distress syndrome (ARDS) requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO), patients may be at an even greater risk for nutritional deficits, immobility, and persistent metabolic stress. Although highly efficacious for cardiopulmonary failure, VV-ECMO introduces the potential for additional metabolic complexities, including altered thermoregulation, increased inflammatory burden, and, traditionally, impaired physical activity from increased lengths of intensive care unit (ICU) stays and prolonged periods of bedrest. Emerging data suggest that comprehensive metabolic and rehabilitative strategies can attenuate muscle loss, reduce ICU-acquired weakness, and improve post-discharge outcomes. This narrative review will discuss the metabolic demands faced by VV-ECMO patients and current strategies to address them. We characterize the catabolic state during VV-ECMO while highlighting the metabolic demand placed on patients. We then examine nutritional support on VV-ECMO, including the assessment of energy expenditure and its limitations, optimal calorie-protein requirements, timing and route of nutritional support, and outcomes associated with nutritional adequacy based on current evidence and guidelines. Next, we explore the potential of pharmacologic agents to possibly reduce hypermetabolism and reverse catabolism. Finally, we discuss the role of physical rehabilitation in VV-ECMO patients by focusing on physical therapy, mobilization, and strategies such as awake ECMO to facilitate activity. Throughout this review, we integrate findings from recent studies and guidelines, with the goal of providing a comprehensive narrative of how to support the metabolic needs of critically ill patients on VV-ECMO.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"625-634"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147597728","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":"Guidance for the assessment of the dietary intake and gastrointestinal or nutrition impact symptoms etiologic criterion of Global Leadership Initiative on Malnutrition: A modified-Delphi study","authors":"Renée Blaauw PhD,&nbsp;Heather Keller PhD,&nbsp;Christine Marie Mills PhD,&nbsp;Gert Bischoff MD,&nbsp;Charlene Compher PhD,&nbsp;Marian de van der Schueren PhD,&nbsp;Krista Haines DO,&nbsp;Nicole Kiss PhD,&nbsp;Charles Lew PhD,&nbsp;Ainsley Malone MS,&nbsp;Claudia Maza Moscoso MSc,&nbsp;Nancy Stoner MSN,&nbsp;Rocco Barazzoni MD,&nbsp;Jack J. Bell PhD,&nbsp;Madeleine Coetzee BSc, Hons,&nbsp;M. Isabel T. D. Correia MD, PhD,&nbsp;Ryoji Fukushima MD, PhD,&nbsp;Elena George PhD,&nbsp;M. Cristina Gonzalez PhD,&nbsp;Leah Gramlich MD,&nbsp;Yen Peng Lim PhD,&nbsp;Roseann Nasser MSc,&nbsp;Matthias Pirlich MD, Phd,&nbsp;Jacqueline A. E. Langius PhD,&nbsp;Terese Scollard MBA,&nbsp;Nicolette Wierdsma PhD,&nbsp;Marion Winkler PhD,&nbsp;Tommy Cederholm MD, PhD,&nbsp;Gordon L. Jensen MD, PhD","doi":"10.1002/jpen.70073","DOIUrl":"10.1002/jpen.70073","url":null,"abstract":"<p>The GLIM malnutrition diagnostic framework includes the etiologic criterion for reduced dietary intake or assimilation (i.e., digestion or absorption). This criterion required further specification to support consistent use in clinical practice. Three rounds of a modified Delphi was undertaken to develop consensus on guidance to support identification of this criterion. A working group (<i>n</i> = 10) developed surveys iteratively. Invited global experts with diverse disciplines and practice contexts (<i>n</i> = 30) fully completed surveys; consensus was determined at 75% agreement. Three surveys and rounds of voting resulted in 15 guidance statements. Notable points include: (a) using usual intake as the comparator for reduced dietary intake rather than energy requirement, (b) use of gastrointestinal symptoms and nutrition impact symptoms to determine challenges with absorption or assimilation, rather than solely gastrointestinal conditions, and (c) using clinical judgment to determine severity of these symptoms. The final criterion is “less than or equal to 50% dietary intake in the last week or any reduction in intake greater than 2 weeks OR severe gastrointestinal or nutrition impact symptoms (e.g., dysphagia, nausea, vomiting, diarrhea) as a result of an acute or chronic condition or therapy.” Future work should confirm the feasibility of this criterion in clinical practice and its criterion validity within the GLIM framework.</p>","PeriodicalId":16668,"journal":{"name":"Journal of Parenteral and Enteral Nutrition","volume":"50 5","pages":"614-624"},"PeriodicalIF":3.3,"publicationDate":"2026-07-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/jpen.70073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148020540","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}