Nutrition in Clinical Practice最新文献

{"title":"Validity and agreement of bioelectrical impedance equations against dual energy X-ray absorptiometry for muscle mass assessment in patients on hemodialysis: A cross-sectional study.","authors":"Sheila Borges, Taís Ferreira Martins, Felipe Vilaça Cavallari Machado, Gerson Cipriano Júnior, Graziella França Bernardelli Cipriano","doi":"10.1002/ncp.70192","DOIUrl":"https://doi.org/10.1002/ncp.70192","url":null,"abstract":"<p><strong>Background: </strong>Low muscle mass is common in patients on hemodialysis (HD), and bioelectrical impedance analysis (BIA) predictive equations have been proposed as an alternative for estimating muscle mass. This study aimed to analyze the validity and agreement of different BIA-based prediction equations against dual energy X-ray absorptiometry (DXA) for estimating skeletal muscle mass (SMM) and appendicular skeletal muscle mass (ASMM) in patients on HD.</p><p><strong>Methods: </strong>A cross-sectional study enrolled patients on HD. Clinical and laboratory data and body composition by BIA and DXA were collected. The accuracy of six prediction equations (Janssen, Barbosa-Silva, Kyle, Lin, Macdonald, and Sergi) for estimating SMM and ASMM was tested against DXA as the reference standard. Agreement was assessed using Lin's Concordance Correlation Coefficient (CCC), Bland-Altman analysis, Kappa statistics, Receiver Operating Characteristic (ROC) curves, and Passing-Bablok regression.</p><p><strong>Results: </strong>The sample consisted of 57 participants, age 52 ± 13 years, 32 (56%) male, median dialysis vintage 14 (4-40) months, 17 (30%) with diabetes, and 48 (84%) with hypertension. The best agreement with DXA was observed for the Lin (CCC = 0.911), Sergi (CCC = 0.902) and Kyle (CCC = 0.902) equations. For low muscle mass diagnosis, Kappa values ranged from moderate to substantial, with the Lin equation showing the highest agreement (κ = 0.734). Additionally, the Lin equation demonstrated good accuracy (AUC = 0.794, 95% CI 0.68-0.91), with 68,4% sensitivity and 89.5% specificity.</p><p><strong>Conclusion: </strong>The Lin equation provided the most accurate and reproducible estimates of muscle mass compared with DXA and showed good diagnostic performance for low muscle mass in patients on HD.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a VLBW feeding guideline on central line usage and enteral feeding practices: A quality improvement project.","authors":"Megan Mataga, Kaitlyn Chang, Rissa Landman, Alyssa Schmitt, Priyanka Tiwari","doi":"10.1002/ncp.70195","DOIUrl":"https://doi.org/10.1002/ncp.70195","url":null,"abstract":"<p><strong>Background: </strong>Feeding guidelines (FGs) reduce the incidence of necrotizing enterocolitis (NEC) and improve growth and enteral nutrition (EN) practices in very low birth weight (VLBW) infants. Our unit's baseline data revealed delayed initiation of EN, prolonged time to full EN, prolonged days on parenteral nutrition (PN), and frequent use of peripherally inserted central catheters (PICC). After introduction of this FG, our specific, measurable, attainable, realistic, and time-bound (SMART) aims were to reduce PICC placements in infants 1000-1500 g by 30% and to reduce the time to achieve full EN in VLBW infants by 20% without adversely impacting NEC rate, growth, and mom's own milk (MOM) provision.</p><p><strong>Methods: </strong>We conducted a time-series quality improvement initiative over 48 months. Outcome and process measures included the percentage of PICC placements, nutrition-related central line days, day of life (DOL) EN initiated, and DOL on full EN. Balancing measures included NEC, growth, and MOM provision. Two-tailed t-tests, Mann-Whitney U tests, and chi-square tests were used to analyze demographic data, numerical variables, and categorical variables, respectively. Statistical process control charts and established rules for special cause variation were applied.</p><p><strong>Results: </strong>Our results demonstrate a 54% reduction in PICC placements and a 38% reduction in time to achieving full EN. We saw no increase in NEC rate but observed a decrease in growth and MOM provision.</p><p><strong>Conclusion: </strong>The use of a standardized FG resulted in fewer PICC placements and decreased time to full EN without increasing the NEC rate. Future initiatives will focus on improving growth and MOM provision in VLBW infants.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149228461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prophylactic probiotics and synbiotics for prevention of diarrhea in adults receiving enteral nutrition: A systematic review and meta-analysis.","authors":"Shan Wu, Lu Yao, Zhoulin Tian, Runfa You","doi":"10.1002/ncp.70183","DOIUrl":"https://doi.org/10.1002/ncp.70183","url":null,"abstract":"<p><strong>Background: </strong>Diarrhea is a frequent complication during enteral nutrition (EN) in adults and may interrupt feeding, prolong hospitalization, and increase healthcare burden. Modulation of the intestinal microbiota with probiotics or synbiotics represents a potential preventive strategy, but the evidence remains uncertain.</p><p><strong>Methods: </strong>This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines (PROSPERO: CRD420251183554). We searched PubMed, Embase, the Cochrane Library, Web of Science, CNKI, Wanfang, and CQVIP from database inception to November 6, 2025. Randomized controlled trials (RCTs) comparing prophylactic probiotics or synbiotics with placebo, routine care, or unsupplemented EN in adults were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.</p><p><strong>Results: </strong>Thirty-nine RCTs were included; 36 (3446 participants) contributed to meta-analysis. Probiotics or synbiotics reduced reported diarrhea versus controls (RR 0.35; 95% CI 0.29-0.42; p < 0.00001; I² = 0%). However, I² = 0% may reflect limited power with sparse events. Funnel plot asymmetry and Egger's test (p < 0.001) suggested possible publication bias. Most trials had high risk of bias (unblinded outcome assessment). Certainty was very low, downgraded mainly for serious risk of bias and suspected publication bias.</p><p><strong>Conclusions: </strong>Very low-certainty evidence suggests probiotics or synbiotics may reduce reported diarrhea in adults on EN, but the true effect is likely smaller. Current data do not support routine use or specific recommendations. Larger, blinded trials with standardized definitions are needed.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216479","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of dietitian-controlled IDDSI-based diet modification on nutritional outcomes in patients undergoing neurological rehabilitation: A retrospective study.","authors":"Fatma Ballı Uz, Ebru Umay, Zeynep Aykın Yığman, Zeynep Kıraç Ünal, Şükrü Arman Aksoy","doi":"10.1002/ncp.70196","DOIUrl":"https://doi.org/10.1002/ncp.70196","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to evaluate the association between IDDSI-based versus traditional R1-2-3 texture modifications and nutritional outcomes in patients undergoing neurological rehabilitation who required dietary modification after videofluoroscopic swallowing study (VFSS).</p><p><strong>Materials and methods: </strong>Patients hospitalized for neurological rehabilitation who underwent VFSS between February and December 2023 were retrospectively analyzed. Patients received either the traditional R1-2-3 diet system or IDDSI-based modification, according to the hospitalization period. In both groups, individualized energy and protein requirements were determined by a clinical dietitian. Body mass index (BMI), NRS-2002 scores, hematological parameters, and biochemical parameters were recorded at admission and discharge. Intra- and intergroup comparisons and correlation analyses were performed.</p><p><strong>Results: </strong>A total of 288 patients were included (mean age, 60.59 ± 19.26 years; 44.8% female). Pre-discharge BMI was higher in the IDDSI group (p = 0.046), while the proportions of patients with low protein and albumin levels were lower (p = 0.038 and p = 0.024, respectively). Serum 25-hydroxyvitamin D levels were also higher (p = 0.019). Improvements in BMI, NRS-2002 scores, nutritional risk, hemoglobin, total lymphocyte count, and vitamin D levels were greater in the IDDSI group (p = 0.006-0.045). IDDSI-based modification was negatively associated with underweight BMI, nutritional risk, low protein, and low albumin levels (p < 0.05).</p><p><strong>Conclusion: </strong>Within dietitian-supervised nutritional care, IDDSI-based texture modification was associated with more favorable nutrition-related outcomes than the traditional R1-2-3 system. Given the retrospective, nonrandomized design, these findings should not be interpreted as evidence of causality.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149216517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond conventional anthropometry: Muscle-related indicators and muscle strength in adults with congenital heart disease: A retrospective study with a comparison group.","authors":"Hyan Ribeiro Prudêncio de Sousa, Cláudia Porto Sabino Pinho","doi":"10.1002/ncp.70194","DOIUrl":"https://doi.org/10.1002/ncp.70194","url":null,"abstract":"<p><p>Anthropometric characteristics and muscle strength remain insufficiently characterized in adults with congenital heart disease (CHD). The aim of the study was to characterize anthropometric indicators and muscle strength in hospitalized adults with CHD and examine differences according to cardiac lesion complexity. Exploratory comparisons with adults without CHD were performed as secondary analyses. This cross-sectional study included 109 hospitalized adults with CHD and an external convenience group of 115 adults without CHD. Body mass index (BMI), mid-upper arm circumference (MUAC), triceps skinfold thickness (TSF), mid-arm muscle circumference (MAMC), arm muscle area (AMA), corrected arm muscle area (cAMA), and handgrip strength (HGS) were assessed. Cardiac defects were classified as mild, moderate, or complex. Associations of lesion complexity and previous cardiac surgery with anthropometric indicators and HGS were examined using multivariable linear regression. Comparisons with adults without CHD were conducted as exploratory analyses using the same approach. Among adults with CHD, 57.8% had mild, 24.8% moderate, and 17.4% complex defects. Lesion complexity was associated with MAMC (P = 0.032); participants with complex defects had lower MAMC than those with mild defects (B = -2.44 cm; 95% CI: -4.26 to -0.63). Previous cardiac surgery was associated with higher BMI, MUAC, MAMC, and AMA. In adjusted exploratory comparisons, adults with CHD had lower weight, height, BMI, MUAC, MAMC, AMA, and HGS than adults without CHD, whereas TSF was similar. Values below reference ranges for BMI, MUAC, MAMC, cAMA, and HGS were more frequent in CHD. Greater lesion complexity was associated with lower MAMC, whereas previous cardiac surgery was associated with higher BMI, MUAC, MAMC, and AMA. Muscle-related anthropometric measures and HGS may provide complementary information beyond body size and adiposity in adults with CHD.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183385","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe malnutrition and persistent myopenia despite weight recovery in newly diagnosed stricturing Crohn's disease: A case report.","authors":"Beatriz Gabriela da Costa, Jeniffer Naomy Nobre, Ryan Nunes Yoshio Yoshihara, Amanda Luísa Spiller, Matheus Medeiros Aguiar, Natalia Salvador Castelhano, Enya Julia Zucari Nogueira, Sophia Vidal Roçafa, Giedre Soares Prates Herrerias, Daniéla Oliveira Magro, Ligia Yukie Sassaki","doi":"10.1002/ncp.70191","DOIUrl":"https://doi.org/10.1002/ncp.70191","url":null,"abstract":"<p><p>Protein-energy malnutrition is a common complication in Crohn's disease (CD). In addition to weight loss, patients may develop significant alterations in body composition, including skeletal muscle depletion, which can negatively affect clinical outcomes and quality of life. Herein, we report on a patient with newly diagnosed CD who presented with severe malnutrition and myopenia, which persisted despite improvements in nutritional intake and body weight. A 27-year-old woman was admitted with abdominal pain, decreased appetite, nausea, vomiting, and progressive weight loss (10 kg, 22% of her usual body weight). Based on clinical presentation, family history, and magnetic resonance enterography findings, stricturing CD was diagnosed. Nutritional assessment revealed severe malnutrition (body weight, 31 kg; body mass index, 12.26 kg/m²; phase angle, 4.4°, intracellular-to-extracellular mass ratio, 0.75). Computed tomography-based body composition analysis demonstrated marked skeletal muscle depletion (skeletal muscle index, 27.5 cm²/m²), confirming myopenia. The patient was treated with corticosteroids, infliximab, azathioprine, and multidisciplinary nutritional management. After 12 months of follow-up, she achieved clinical remission and gained approximately 25% of her initial body weight. Despite significant weight recovery and improved dietary intake, computed tomography (CT) revealed low skeletal muscle mass and increased visceral and subcutaneous adipose tissue, indicating persistent myopenia. This case highlights the importance of comprehensive body composition assessments in CD. Clinical remission and weight gain may not accurately reflect recovery of skeletal muscle mass. Early nutritional evaluation and longitudinal body composition monitoring may be helpful in the management of patients with CD to identify persistent muscle depletion and optimize long-term outcomes.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149183358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Etiology, interventions, and predictors of mortality in a tertiary malnutrition clinic: A retrospective cohort study.","authors":"Paramat Thimachai, Jennifer Jin, Lisa Martin, Leah Gramlich","doi":"10.1002/ncp.70186","DOIUrl":"https://doi.org/10.1002/ncp.70186","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition worsens outcomes in chronic diseases, and delayed detection increases morbidity and mortality. This study described the characteristics of malnutrition in a tertiary referral clinic, summarized nutrition interventions, and identified predictors of mortality.</p><p><strong>Materials and methods: </strong>This retrospective cohort study included 431 adults referred to a tertiary malnutrition clinic between 2017 and 2023. Global Leadership Initiative on Malnutrition (GLIM) criteria were applied retrospectively to routinely documented clinical data to classify malnutrition severity. Logistic regression identified factors associated with severe malnutrition, and Cox proportional hazards models evaluated predictors of mortality.</p><p><strong>Results: </strong>Among 431 patients, 66.8% had severe malnutrition by GLIM criteria. Mean body mass index (BMI) was 20.9 ± 5.9 kg/m², with weight loss of 19.0 ± 11.9% from usual weight. Leading etiologies were reduced oral intake (77.7%) and malabsorption (45.2%), including short bowel syndrome. After assessment, 37.6% received dietary counseling, 29.9% were recommended oral supplements, 13.9% initiated enteral feeding, and 18.6% received PN (11.6% newly initiated). Median clinical follow-up was 19 months; mortality ascertainment documented 105 deaths (24.4%). Low hemoglobin was associated with severe malnutrition (adjusted odds ratio, 2.49; 95% CI, 1.56-3.97). In the Cox model stratified by sex, higher Charlson Comorbidity Index (CCI) score (adjusted hazard ratio [aHR] per point, 1.20; 95% CI, 1.12-1.27), severe GLIM malnutrition (aHR, 1.76; 95% CI, 1.09-2.86), and low hemoglobin (aHR, 3.02; 95% CI, 1.99-4.56) were associated with mortality.</p><p><strong>Conclusion: </strong>Severe malnutrition was common in this tertiary referral population. Greater comorbidity burden, severe GLIM malnutrition, and low hemoglobin were associated with higher mortality, supporting risk stratification and close clinical monitoring.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glucose control and clinical outcomes in surgical patients: A narrative review.","authors":"Amir Y Kamel, Erin Vanzant, Andrea Munden, Hannah Kennedy, Thakul Rattanasuwan, Stephen J Lemon, Ashley Thompson, Martin Rosenthal","doi":"10.1002/ncp.70193","DOIUrl":"https://doi.org/10.1002/ncp.70193","url":null,"abstract":"<p><p>Perioperative hyperglycemia occurs in up to 40% of noncardiac and 80% of cardiac surgery patients, frequently independent of a diabetes diagnosis; it is driven by the neuroendocrine stress response, inflammatory cytokine release, and postoperative insulin resistance. Elevated glucose promotes protein glycosylation, which impairs wound healing and immune function, and it has been consistently associated with surgical site infection, anastomotic leak, prolonged length of stay, and increased mortality across surgical subspecialties. This narrative review examines biochemical aspects of glycogen metabolism and stress-induced insulin resistance, synthesizes evidence linking hemoglobin A1c (HbA1c) thresholds to surgical outcomes, and summarizes contemporary guidelines from the American Diabetes Association, Endocrine Society, European Society of Cardiology, Society of Critical Care Medicine, and Surviving Sepsis Campaign. Current consensus favors moderate, protocolized glucose targets (generally 100-180 mg/dL) while avoiding iatrogenic hypoglycemia. Preoperative optimization toward an HbA1c near 7%, judicious carbohydrate loading, and avoidance of glycemic extremes offer meaningful, modifiable strategies to improve outcomes in surgical and critically ill surgical patients.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149168186","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perioperative nutrition therapy in high-risk patients: A narrative review.","authors":"Maria Wobith, Rahel Strobel, Stanislaw Klek, Olle Ljungqvist, Paul Wischmeyer, Arved Weimann","doi":"10.1002/ncp.70187","DOIUrl":"https://doi.org/10.1002/ncp.70187","url":null,"abstract":"<p><p>Enhanced Recovery After Surgery (ERAS), as the plan A and standard for perioperative management, has shifted the focus from routine nutritional support toward the early identification and targeted management of high-risk patients. The new ICD-11 code for undernutrition offers an opportunity to better identify and characterize surgical patients at nutritional risk, while also potentially improving clinical recognition, acceptance of nutritional risk as a relevant perioperative condition, and reimbursement for targeted nutritional interventions. Early preoperative interventions should be considered. While short-term nutritional conditioning over 10-14 days primarily aims to correct nutritional and metabolic deficits, multimodal prehabilitation ideally requires 3-6 weeks to achieve meaningful improvements in physical fitness, functional capacity, and physiological reserve, particularly in patients undergoing major surgery after neoadjuvant therapy. Perioperative targeted strategies include carbohydrate loading (CHO drinks), immunomodulation, omega-3-fatty acids, hydroxymethylbutyrate, and probiotics or synbiotics. While parenteral nutrition is generally not required in low-risk patients with an uncomplicated recovery, the indication for supplemental (peripheral) parenteral nutrition should not be missed in high-risk patients with inadequate oral or enteral intake. Structured postoperative, post-discharge nutritional monitoring and rehabilitation should be integrated more consistently, especially in patients with eventful and complicated clinical courses.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169997","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of enteral nutrition reduction or discontinuation with diarrhea volume and caloric delivery in critically ill adults with diarrhea: A retrospective cohort study.","authors":"Ryohei Yamamoto, Takatoshi Koroki, Yuna Ueta, Fumitaka Yanase, Ryo Ueno","doi":"10.1002/ncp.70188","DOIUrl":"https://doi.org/10.1002/ncp.70188","url":null,"abstract":"<p><strong>Background: </strong>When critically ill patients receiving enteral nutrition (EN) develop diarrhea, clinicians often reduce or discontinue EN, although evidence supporting this practice is limited. We examined the association between EN management after diarrhea and diarrhea volume in critical care patients.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included adult intensive care unit patients who developed new-onset diarrhea (Bristol Stool Form Scale ≥6 on 2 consecutive days) during EN. Based on Day 1 EN management, patients were classified as continuation (infusion rate decrease <10 mL/h) or reduction/discontinuation (decrease ≥10 mL/h or complete discontinuation). The primary outcome was cumulative diarrhea volume (grams) on Days 1-2. Cumulative EN calories (kcal) on Days 1-2 was a key secondary outcome. Inverse probability of treatment weighting with regression adjustment accounted for 8 pre-specified confounders. Sensitivity analyses included alternative exposure thresholds and propensity score models.</p><p><strong>Results: </strong>Of 135 patients analyzed (median age, 74 years; 32% female), 96 (71.1%) continued EN and 39 (28.9%) underwent EN reduction/discontinuation. After adjustment, the reduction/discontinuation group had lower cumulative diarrhea volume on Days 1-2 (adjusted mean difference, -183.4 g; 95% confidence interval [CI], -350.1 to -16.7; p = 0.033) but received substantially fewer calories (-1260.1 kcal; 95% CI, -1464.4 to -1055.9; p < 0.001). The direction of the reduction in diarrhea volume was consistent across sensitivity analyses.</p><p><strong>Conclusion: </strong>Reducing or discontinuing EN after diarrhea was associated with a modest reduction in diarrhea volume but a substantial caloric deficit. This trade-off should be considered when reducing EN for diarrhea.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2026-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}