Nutrition in Clinical Practice最新文献

{"title":"Implementing a screening protocol for food insecure patients within a long-term acute care hospital (LTACH): A community health needs assessment (CHNA).","authors":"Molly MacDonald, Christopher Stimson, Marti Samsel, Tina Gross","doi":"10.1002/ncp.11292","DOIUrl":"https://doi.org/10.1002/ncp.11292","url":null,"abstract":"<p><p>Food insecurity is a prevalent yet overlooked issue within the inpatient setting. Despite food insecurity being predictive of poor health outcomes and increased hospital readmission rates, the development of efficient screening protocols remains a gap in care for high-risk, hospitalized patients. As part of a community health needs assessment (CHNA), a screening protocol for food insecurity has been implemented within a long-term acute care hospital (LTACH). This is a multistep protocol in which each newly admitted patient is asked pertinent questions related to food insecurity during the initial nutrition consult, led by a registered dietitian, followed by dissemination of a nutrition-resource packet upon positive screening. The packet includes a registry of county-based community nutrition resources and samples of recommended oral nutrition supplements. Additionally, the interdisciplinary team is informed of positive food insecurity status during weekly rounding to facilitate appropriate coordination of care in preparation for patient discharge. During the first year of implementation, 2022-2023, an average 95% of identified food insecure LTACH patients per the CHNA screening protocol were provided the appropriate nutrition-related resources during admission. This was improved upon from 2023-2024 as 100% of LTACH patients identified as food insecure received appropriate CHNA nutrition resources. Further, 93% of food insecure patients captured from 2023-2024 reported living within geographical proximity, or within the same county as this healthcare facility. As this protocol continues to be refined, future considerations include embedding a brief, validated food insecurity questionnaire within the initial nutrition consult as well as tracking metrics related to protocol effectiveness.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012718","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":"Levodopa and nutrition support: A case report of Parkinsonism-hyperpyrexia syndrome.","authors":"Ryan Burslem, Liz Ramos, Chou Chou, Carolina Szlufman, Jane Ziegler","doi":"10.1002/ncp.11297","DOIUrl":"https://doi.org/10.1002/ncp.11297","url":null,"abstract":"<p><p>Levodopa is competitively inhibited by amino acids for absorption across the intestinal wall and blood-brain barrier. An acute withdrawal of levodopa increases the risk of Parkinsonism-hyperpyrexia syndrome, a life-threatening condition characterized by muscular rigidity, mental status changes, hyperthermia, and autonomic instability. This report discusses the case of a patient with Parkinson's disease who was critically ill who developed Parkinsonism-hyperpyrexia syndrome while receiving enteral and parenteral nutrition support. Clinicians should be aware of this potential drug-nutrient interaction when prescribing nutrition support to patients taking levodopa.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144034026","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":"Clinical application of equation predicting appendicular skeletal muscle mass in patients with esophageal cancer: A retrospective analysis of a cross-sectional study.","authors":"Genya Okada, Yoshinari Matsumoto, Daiki Habu, Yasunori Matsuda, Shigeru Lee, Harushi Osugi","doi":"10.1002/ncp.11299","DOIUrl":"https://doi.org/10.1002/ncp.11299","url":null,"abstract":"<p><strong>Background: </strong>Dual-energy X-ray absorptiometry and bioelectrical impedance analysis (BIA) are used to measure appendicular skeletal muscle mass (ASM). However, these two methods can be contraindicated in some cases. Therefore, equations have been developed to predict ASM using anthropometric parameters, which is a less expensive and more feasible approach. This study evaluated the correlation between the predicted ASM calculated using a previously reported prediction equation and the actual ASM measured using BIA. Moreover, we determined their degree of agreement in diagnosing sarcopenia in patients with esophageal cancer.</p><p><strong>Materials and methods: </strong>From a previous study involving 119 patients with esophageal cancer, perioperative anthropometric parameters (height, weight, waist and circumference), and grip strength (GS) were obtained to calculate ASM in Japanese participants using a previously reported prediction equation (Furushima equation). The validity of the predicted ASM was evaluated by comparing it with the actual ASM measured using BIA. Moreover, we determined the ability of the predicted ASM and GS results to diagnose sarcopenia in patients with esophageal cancer before and 4 weeks after surgery.</p><p><strong>Results: </strong>A moderate agreement (before surgery: Lin concordance correlation coefficient [CCC] = 0.88; 4 weeks after surgery: Lin CCC = 0.89) was observed between the predicted ASM and the actual ASM. Furthermore, the predicted and measured ASM values showed substantial agreement in diagnosing sarcopenia (before surgery: κ statistics = 0.61; 4 weeks after surgery: κ statistic = 0.65).</p><p><strong>Conclusion: </strong>The equation developed for predicting ASM in Japanese participants can be applied to patients with esophageal cancer.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":""},"PeriodicalIF":2.1,"publicationDate":"2025-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144038355","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":"Transitioning to oral feeding: A retrospective cohort study of a family-centered, hunger-based tube weaning program.","authors":"Rochelle H Stokes, Anna L Willms, Heather K Cowie, Alison Browes, Soleina Karamali, Vishal Avinashi, Jill G Zwicker","doi":"10.1002/ncp.11220","DOIUrl":"10.1002/ncp.11220","url":null,"abstract":"<p><strong>Background: </strong>We investigated the effectiveness of a novel, hunger-based outpatient tube weaning program for children with feeding-tube dependency.</p><p><strong>Methods: </strong>This interdisciplinary program induced hunger via rapid reduction in tube-fed calories, followed by 2 weeks of daily outpatient mealtime support and regular follow-up. Forty-one children (6.9 months to 12.8 years) participated in this retrospective cohort study.</p><p><strong>Results: </strong>Before the program, children received a median of 90.0% (interquartile range [IQR]: 75.0%-100%) of caloric intake via tube feeds. At the end of the 2-week program, children received 16.0% (IQR: 0.0%-30.0%) of caloric intake via tube feeds, which further reduced to 1.5% (IQR: 0.0%-33.0%) at 6-months, and 0.0% (IQR: 0.0%-35.0%) at 1-year follow-up. The percentage of participants who ate >30 different foods increased from 4.9% at baseline to 81.5% at 1-year follow-up. The baseline median weight z score of -1.24 (IQR: -1.69 to -0.69) decreased to -1.81 (IQR: -2.77 to -1.02) at 1-year follow-up. A linear mixed-effects model demonstrated that weight z score was significantly higher at baseline and 2-weeks compared to the 1-year follow-up (P < 0.001 and P = 0.001, respectively), but was not significantly different between 6 months and 1 year (P = 0.44). Age was not associated with percentage of caloric intake via tube feeds or number of foods eaten.</p><p><strong>Conclusion: </strong>Children who participated in the hunger-based tube-weaning program had increased and more varied oral intake 1 year following the intervention. The median weight z score decreased over the year after intervention but did not significantly decrease between 6 and 12 months after the program.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"439-449"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504878","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":"Practice changes and infant health risks during the 2022 infant formula shortage: Results of a US healthcare provider survey.","authors":"Marguerite Drowica Sheehan, Diana Orenstein, Leeyu Addisu, Sujata Patil, Devon Kuehn","doi":"10.1002/ncp.11210","DOIUrl":"10.1002/ncp.11210","url":null,"abstract":"<p><strong>Background: </strong>In February 2022, an infant formula recall and closing of a major manufacturing center exacerbated a nationwide shortage initiated by COVID-19-related supply chain disruptions. The effects were far-reaching, impacting families and healthcare providers across the US.</p><p><strong>Methods: </strong>A 19-item web survey was developed to better understand how the infant formula shortage impacted healthcare provider practices, resources needed and those already used, and patient health, including malnutrition. Subjective data on providers' experience were also collected.</p><p><strong>Results: </strong>Two hundred forty-one providers responded, primarily registered dietitians (94%) practicing in inpatient/academic hospitals in urban and metropolitan areas. Practice adjustments included increases in patient education (100%), communication with pharmacies/durable medical equipment companies (65%), and visit durations (28%). Feeding adjustments by caregivers included new infant formula (99%), toddler (55%) or homemade (23%) formula, cow's milk (46%) or milk alternatives (32%), formula dilution (41%), and early food introduction (14%). Providers indicated an increase in malnutrition (33%), related diagnoses (including failure to thrive [31%] and deceleration in z score [27%]), and associated symptoms. Of the providers who reported malnutrition and related diagnoses, 93% also reported caregiver feeding practices that are generally not recommended.</p><p><strong>Conclusion: </strong>Providers made practice adjustments to mitigate the consequences associated with formula unavailability and misuse yet saw an increase in malnutrition and related diagnoses or symptoms. Subjectively, providers reported frustration that greater workloads did not result in improved outcomes, contributing to burnout. These data underscore the essentiality of supporting healthcare providers as they guide families in safe infant feeding practices.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"475-483"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879906/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142365956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the role of parenteral nutrition in the management of the patient with severe acute pancreatitis?","authors":"Stephen A McClave, Robert G Martindale","doi":"10.1002/ncp.11266","DOIUrl":"10.1002/ncp.11266","url":null,"abstract":"<p><p>Severe acute pancreatitis often presents as a complex critical illness associated with a high rate of infectious morbidity, multiple organ failure, and in-hospital mortality. Breakdown of gut barrier defenses, dysbiosis of intestinal microbiota, and exaggerated immune responses dictate that early enteral nutrition (EN) is preferred over parenteral nutrition (PN) as the primary route of nutrition therapy. EN, however, is not feasible in all cases because of intolerance, risk of complications, or a direct contraindication to enteral feeding. For these patients, PN can be provided in a manner that is safe, is metabolically appropriate, and follows the principles of modern critical care nutrition. Adherence to goal-directed fluid resuscitation, provision of trophic doses of PN to meet 20%-25% of protein and/or calorie requirements through the acute phases of illness, use of less-inflammatory intravenous lipid emulsions, and close monitoring of electrolytes, triglyceride levels, and signs of refeeding syndrome all serve to optimize the response to this route of nutrition support. For these reasons, prescribing PN remains an important strategy in the management of this difficult population of patients.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"319-325"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872677","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":"Exploring the experiences of patients who receive nutrition education for ostomy care: A qualitative research design.","authors":"Leslee Hasil, Stephanie Krug, Marlis Atkins, Sue Buhler","doi":"10.1002/ncp.11257","DOIUrl":"10.1002/ncp.11257","url":null,"abstract":"<p><strong>Background: </strong>Ileostomy and colostomy patients benefit from more nutrition education than patients who receive bowel resections without ostomy creation. Nutrition can influence the adaptation to a stoma and may help manage complications. The impact of nutrition education on health outcomes is known, but a gap exists for the type and timing of nutrition information for patients with newly formed ostomies.</p><p><strong>Methods: </strong>A survey of open-ended and closed-ended questions was designed to evaluate experiences about nutrition education provided for living with an ostomy. The survey was conducted during hospital admission for ostomy reversal: 39 patients were approached, 36 consented, and all 36 completed the survey.</p><p><strong>Results: </strong>Of the 36 patients who took part in the study, 20 (56%) were male. The mean age was 57.7 years. Twenty-four (67%) patients were admitted for an ileostomy reversal and 12 (33%) patients for a colostomy reversal. When patients were asked about their preferred timing of nutrition education, 28% (n = 10) wanted information before surgery, 58% (n = 21) wanted the information in the hospital when admitted for ostomy creation, and 14% (n = 5) wanted to receive it after discharge. A total of 25% (n = 9) of patients commented on the need for a follow-up phone call after discharge to ask questions.</p><p><strong>Conclusion: </strong>Nutrition education is valuable for patients, and most patients want to receive nutrition information while in the hospital. A follow-up session with a dietitian after discharge could assist patients in developing strategies to manage weight changes, prevent dehydration, and lower the risk of malnutrition.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"397-404"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142813730","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":"Homemade formulas for nutrition support in chronic kidney disease: A narrative review of the opportunity for education, research, and innovation.","authors":"Brandon M Kistler, Annabel Biruete, Michelle M Y Wong, Angela Yee-Moon Wang, Fabiola Martin-Del-Campo, Fabiana B Nerbass, Anna Hardy, Qiwei Zhu, Ban-Hock Khor, Lloyd Vincent, Zarina Ebrahim, Ana Figueiredo","doi":"10.1002/ncp.11271","DOIUrl":"10.1002/ncp.11271","url":null,"abstract":"<p><p>Protein-energy wasting is common in people with chronic kidney disease (CKD), especially in those undergoing kidney replacement therapy. Oral nutrition supplements and enteral nutrition are strategies that have been shown to improve nutrition status, and potentially outcomes. However, access to specialized commercial products for people with CKD is limited by factors including cost and regional availability. Homemade formulas represent a potentially cheaper, accessible, and more flexible option than commercial products, but they come with their own unique set of challenges. Furthermore, some aspects of homemade products, including consistency of nutrients, physical properties, and food safety, may pose challenges in the context of physiological changes that occur in CKD. Despite evidence of their use in CKD clinics, there have been few studies using homemade formulas in this population. This narrative review article summarizes the available literature on the potential usage, benefits, and concerns related to homemade formulas, emphasizing the unique challenges in people with CKD. Given the potential usage and limited research on homemade formulas in people with CKD, additional education and research are warranted to optimize the use of these tools in this clinical population.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"307-318"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879924/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143075023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Essential fatty acid deficiency in parenteral nutrition: Historical perspective and modern solutions, a narrative review.","authors":"Jodi Wolff, Mary Petrea Cober, Katie A Huff","doi":"10.1002/ncp.11278","DOIUrl":"10.1002/ncp.11278","url":null,"abstract":"<p><p>Essential fatty acid deficiency (EFAD) may occur in the setting of inadequate fat intake, malabsorption, malnutrition, and altered fat metabolism. Humans lack the enzymes to synthesize the essential acids linoleic acid and alpha-linolenic acid, so they must be obtained from the diet. Patients dependent on parenteral nutrition need adequate amounts of these essential fatty acids supplied in lipid injectable emulsions (ILEs). With the increasing use of multicomponent ILEs that are lower in linoleic and alpha-linolenic acid, it is imperative that clinicians understand appropriate dosing to prevent EFAD. An understanding of fatty acid composition and metabolic pathways is important, as the use of the Holman Index (triene:tetraene ratio) alone may lead to an inaccurate diagnosis of EFAD.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"350-367"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11879921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring the lived experiences of adults using home enteral nutrition and their caregivers: A meta-aggregation qualitative systematic review.","authors":"Rebekah Sandhu, Treeva Elliott, Whitney Hussain, John Engbers, Rosemin Kassam","doi":"10.1002/ncp.11225","DOIUrl":"10.1002/ncp.11225","url":null,"abstract":"<p><p>Home enteral nutrition (HEN) provides nutrition through a tube to individuals at home who cannot meet their needs by mouth. Systematic reviews have explored the experiences of HEN subpopulations, such as those with head and neck cancers. Given HEN services care for adults with various underlying conditions, a synthesis of the experiences of all adults using HEN and their caregivers is warranted. The purpose of this study is to summarize the experiences of HEN adult users and their caregivers regardless of underlying condition. Medline, PsychINFO, EmBase and CINAHL were systematically searched in January 2024. Studies with qualitative results and adult participants and focused on HEN were included. Studies with participants in nursing facilities, results using word counts, or not in English were excluded. Study quality was assessed using the Johanna Briggs Institute (JBI) qualitative checklist. Study design and participants' details were extracted. Themes were collated using the JBI meta-aggregative method. Forty studies (n = 732) were included. Three synthesized findings were identified: positive experiences (very low ConQual score), negative experiences (low ConQual score), and facilitators and coping mechanisms (moderate ConQual score). Although more negative than positive experiences were reported, users and caregivers who developed coping mechanisms or accessed supports viewed HEN as a worthwhile experience. Those with few supports or coping mechanisms did not. Based on this review, it is proposed that before starting HEN, users and caregivers should be made aware of the available supports and coping mechanisms. As negative experiences arise, healthcare providers should help users and caregivers access supports to improve their experiences.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"368-388"},"PeriodicalIF":2.1,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142504874","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}