Nutrition in Clinical Practice最新文献

{"title":"Association of handgrip strength with nutritional and clinical parameters in ICU patients with acute exacerbation of COPD: A prospective cross-sectional study.","authors":"Sümeyra Aslan, Murat Aslan, Fatma Tayhan Kartal","doi":"10.1002/ncp.70139","DOIUrl":"10.1002/ncp.70139","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition and muscle dysfunction frequently coexist in critically ill patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). This study aimed to evaluate the association between handgrip strength (HGS) and nutritional, clinical, and biochemical parameters in this population.</p><p><strong>Methods: </strong>In this prospective study, 44 patients admitted to the intensive care unit with acute COPD exacerbation were evaluated. Nutritional assessment included mid-upper arm circumference (MUAC), body mass index (BMI), Nutritional Risk Screening 2002 (NRS-2002), modified Nutrition Risk in the Critically Ill (m-NUTRIC) score, and dietary intake. Serum albumin levels were evaluated as a laboratory parameter. Correlation analyses and linear regression analyses were performed to identify associations with HGS.</p><p><strong>Results: </strong>HGS was markedly reduced compared with reference values reported in healthy individuals and stable COPD populations. In correlation analyses, HGS showed significant positive associations with serum albumin levels, MUAC, and daily protein intake, and a significant negative association with NRS-2002 scores, while no significant associations were observed with BMI or m-NUTRIC scores. In the linear regression model, serum albumin remained independently associated with HGS (B = 0.781, p = 0.003), while MUAC, NRS-2002 score, and protein intake were not independently associated.</p><p><strong>Conclusion: </strong>Handgrip strength was associated with serum albumin and selected nutritional parameters. It reflects functional status influenced by both nutritional and clinical factors and may complement conventional nutritional assessment in critically ill patients with acute COPD exacerbation.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1401-1409"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148157400","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":"A micro-costing analysis of standardized versus individualized parenteral nutrition in preterm neonates.","authors":"Eleonora Castellana, Francesco Cresi, Alessandra Coscia, Marco Limone, Giampiero Vaudano, Maria Francesca Campagnoli, Maria Rachele Chiappetta","doi":"10.1002/ncp.70123","DOIUrl":"10.1002/ncp.70123","url":null,"abstract":"<p><strong>Background: </strong>The main aim of this study was to compare the costs of using standardized parenteral nutrition (PN) bags versus individualized PN bags for very low birth weight and extremely low birth weight preterm infants in the neonatal intensive care unit.</p><p><strong>Methods: </strong>A micro-costing analysis was conducted from November 1, 2022 through October 31, 2023 on both individualized and standard PN bags.</p><p><strong>Results: </strong>During the analysis period, 660 individual bags and 3700 standard bags were used. The average cost per individualized PN bag versus standardized bag was $160.92 versus $62.92 respectively. Standard bags were found to be 60.9% more cost-effective.</p><p><strong>Conclusion: </strong>The study concluded that standard PN bags are more cost-effective for very low birth weight and extremely low birth weight preterm patients. These findings support the potential shift towards using standardized PN in hospitals to manage resources effectively. Pharmacists can utilize these results to promote guideline-based use of standardized PN.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1485-1490"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691297","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":"Development of a liver cirrhosis-specific nutrition-focused physical examination tool: A modified Delphi study.","authors":"Rucha Modak, Alainn Bailey, Laura Byham-Gray, Diane Rigassio Radler","doi":"10.1002/ncp.70159","DOIUrl":"10.1002/ncp.70159","url":null,"abstract":"<p><strong>Background: </strong>Malnutrition in the form of protein-energy deficits and altered micronutrient status is associated with liver cirrhosis (LC). The study aimed to identify physical findings associated with malnutrition in adult patients with LC and to develop an LC-specific nutrition-focused physical exam (LC-specific NFPE) tool.</p><p><strong>Methods: </strong>A modified Delphi approach was used to obtain consensus among expert panelists who were registered dietitians (RD) working in hepatology, gastrointestinal, transplantation, or other specialized settings treating patients with liver disease. Panelists were recruited through purposive sampling. Each panelist completed a 2-round online survey by scoring potential NFPE components on a 5-point Likert scale and providing optional open-ended feedback.</p><p><strong>Results: </strong>Panelists (N = 16) were ≥25 years of age, 93.75% had a Masters' degree or higher, and 100% reported using NFPE in practice. The 8 NFPE domains that achieved consensus were identified through an evidence-based literature search and include Anthropometrics, Vital Signs, Musculoskeletal and Adipose Exam, Orofacial Exam, Hair, Skin, and Nails Exam, Gastrointestinal Exam, Nervous System Exam, and Disease-specific Exam. Out of 63 initial components, 56 achieved consensus and were included in the LC-specific NFPE tool.</p><p><strong>Conclusion: </strong>Specific domains and components for an evidence-based LC-specific NFPE tool were identified by obtaining consensus from a panel of expert RDs. This tool may further be developed and validated to assist in comprehensive nutritional assessment of patients with LC.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1385-1400"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148605750","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":"Management of ketogenic diet therapy in patients with ileostomy: A report of 2 cases.","authors":"Braden J Baker, Abigail E Olbina, Marissa A Godfrey, Annie E Graber, Taylor N Parrish, Sarah Isis R Delima","doi":"10.1002/ncp.70164","DOIUrl":"10.1002/ncp.70164","url":null,"abstract":"<p><p>This case series explores the feasibility and clinical considerations of implementing the ketogenic diet therapy (KDT) for epilepsy management in patients with ileostomies. Two pediatric patients with medication-resistant epilepsy and ileostomies continued KDT under clinical supervision. The first patient had an ileostomy placed while on KDT. Fluids and electrolytes were increased initially, although sodium (Na) levels remained within a normal range. The second patient had an ileostomy before starting KDT. Hyponatremia and acidosis occurred initially. With routine laboratory monitoring, and electrolyte and bicarbonate supplementation, normal laboratory values were achieved. Overall fluid needs did not change. Both patients maintained adequate hydration and electrolytes. Seizure control was not compromised in either case while having an ostomy. This study supports the feasibility of KDT in patients with ileostomies, while also highlighting the need for individualized monitoring of hydration status and electrolytes, specifically sodium levels.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1514-1520"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622400/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818964","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":"Nutrition support-focused strategies for glycemic management in hospitalized adults with diabetes: A narrative review.","authors":"Christopher T Buckley, Diana W Mulherin, Sarah V Cogle","doi":"10.1002/ncp.70175","DOIUrl":"10.1002/ncp.70175","url":null,"abstract":"<p><p>Diabetes is commonly encountered in hospitalized adult patients. Blood glucose (BG) management in acutely ill hospitalized patients receiving nutrition support therapy with enteral nutrition (EN) or parenteral nutrition (PN) often varies from strategies utilized in stable patients with diabetes in the outpatient setting. Some degree of BG elevation is expected in hospitalized patients due to the acute stress response. However, hyperglycemia should be prevented, if possible, and treated if it occurs, as it has been shown to increase infections, length of stay, and mortality. While a variety of oral and injectable medications are utilized in outpatients who are fed orally, insulin is the primary therapy utilized in hospitalized patients receiving nutrition support therapy. The use of insulin, interruptions in nutrition support therapy, and abrupt changes in clinical status all increase the risk of hypoglycemia, which is associated with increased morbidity and mortality in acutely ill patients. The aim of this review is to discuss application of recent guideline recommendations and offer practical strategies for safe and effective management of hyperglycemia with nutrition support therapy in hospitalized patients with diabetes.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1279-1295"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148866161","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 low-carbohydrate diet on cardiometabolic parameters in individuals with and without diabetes: An 8-year longitudinal study within the ELSA-Brasil cohort.","authors":"Leticia Batista de Azevedo, Haysla Xavier Martins, Oscar Geovanny Enriquez-Martinez, Maria Del Carmen Bisi Molina","doi":"10.1002/ncp.70099","DOIUrl":"10.1002/ncp.70099","url":null,"abstract":"<p><strong>Background: </strong>Low-carbohydrate diets (LCDs) are widely adopted for metabolic management, but their long-term cardiometabolic effects in diverse populations remain unclear. We aimed to evaluate the association between self-selected moderate LCD adherence and cardiometabolic parameters in individuals with and without diabetes.</p><p><strong>Methods: </strong>This prospective cohort study included 9658 participants from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil; baseline: 2008-2010; follow-up: 2017-2019). LCD adherence (carbohydrate <45% of total energy) was assessed through validated food frequency questionnaires. Quantile regression models, adjusted for sociodemographic, lifestyle, and clinical factors, were used to analyze changes in body mass index (BMI), blood pressure, insulin, and homeostatic model assessment for insulin resistance (HOMA-IR) and beta cell function (HOMA-B).</p><p><strong>Results: </strong>Among individuals without diabetes, those who followed an LCD only at the follow-up showed decreased insulin levels (β = -0.33 [95% CI, -0.6 to -0.1] μIU/ml), HOMA-IR (-0.11 [-0.2 to -0.1] μIU/ml), and HOMA-B (-4.95 [-7.2 to -2.1] μIU/ml) alongside modest BMI increases (0.16 [0.1-0.3]). Consistent LCD adherents (at both time points) showed a decrease in HOMA-B (-3.21 [-6.4 to -0.1] μIU/ml) and an increase in BMI (0.29 [0.2-0.4]). In individuals with diabetes, LCD adherence led to reduced HOMA-IR (-1.25 [-2.2 to -0.3] μIU/ml) and insulin levels (-3.61 [-6.0 to -1.2] μIU/ml).</p><p><strong>Conclusion: </strong>Moderate LCD adherence improved insulin sensitivity and reduced pancreatic demand in individuals without diabetes. Despite slight BMI increases, LCD may be a feasible dietary strategy for metabolic risk management in middle-aged and older adults. Personalized nutrition approaches are recommended to optimize outcomes.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1349-1359"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622392/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146132033","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":"Growth and human milk intake outcomes from postdischarge feedings among very-low-birth-weight preterm infants: A systematic review.","authors":"Tara Rebele, Allison Gomes, Melanie Newkirk, Mina Ghajar, Laura Byham-Gray, Jane Ziegler","doi":"10.1002/ncp.70127","DOIUrl":"10.1002/ncp.70127","url":null,"abstract":"<p><strong>Background: </strong>Preterm infants of <34 weeks gestation or <1500 g are at risk for postnatal growth failure and often require nutrition support after discharge. Despite expert recommendations for postdischarge human milk (HM) fortification or nutrient-enriched formula feeding, the effects of current feeding strategies on growth and HM intake remain unclear. This systematic review evaluated the impact of postdischarge fortified expressed HM or direct breastfeeding (BF) with postdischarge formula (PDF) bottle feeds compared to unfortified HM or BF with standard term formula bottle feeds on growth and HM intake outcomes through 6 and 12 months corrected age (CA).</p><p><strong>Methods: </strong>A systematic search of eight databases and grey literature sources was conducted for studies published in English since 2012 identifying 3146 studies. Risk of bias was assessed using standardized Cochrane RoB 2 and ROBINS-I tools. Meta-analysis was not conducted due to heterogeneity in interventions, outcome timing, and outcome metrics; results were narratively synthesized.</p><p><strong>Results: </strong>Four studies (n = 2 randomized controlled trials, n = 2 cohorts), including 548 preterm infants, met eligibility criteria. Two studies showed significantly greater weight gain, and one showed significantly greater head circumference in the fortified groups at 6 months CA compared to the unfortified groups. Length differences were not significant. Three studies reporting HM intake found comparable or greater HM intake in the fortified groups.</p><p><strong>Conclusion: </strong>Current evidence suggests that postdischarge fortified HM or direct BF with supplemental PDF bottle feeds may support improved weight and head circumference outcomes without compromising HM intake. However, methodological variability highlights the need for standardized, prospective studies.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1334-1348"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13622408/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147777373","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":"Analysis of factors driving variations in neonatal parenteral nutrition over a decade: A retrospective study.","authors":"Thanaphong Phongpreecha, Lucas W Y Sin, Shabnam Gaskari, Nima Aghaeepour","doi":"10.1002/ncp.70134","DOIUrl":"10.1002/ncp.70134","url":null,"abstract":"<p><strong>Background: </strong>Parenteral nutrition (PN) is essential for supporting preterm and critically ill neonates who are unable to tolerate adequate enteral feeds. However, PN composition remains highly variable due to differences in guidelines, institutional practices, prescriber discretion, and more. This lack of standardization contributes to inconsistent nutrient delivery and may affect clinical outcomes. A deeper understanding of the sources of variation is needed to inform efforts toward more consistent and evidence-aligned prescribing.</p><p><strong>Methods: </strong>This retrospective study analyzed 54,464 neonatal PN prescriptions issued between 2011 and 2021 to 5052 infants. Patient demographics, prescriber identifiers, and prescription year were linked through electronic health records. Temporal trends in nutrient composition were evaluated using linear mixed-effects models, with covariate adjustment. Dimensionality reduction with t-distributed Stochastic Neighbor Embedding (t-SNE) was applied to visualize temporal clustering of prescriptions and prescriber-level similarity in dosing patterns.</p><p><strong>Results: </strong>PN composition demonstrated clear temporal variability across the decade. Macronutrient shifts diminished after adjusting for patient demographics, indicating that changes were primarily driven by shifts in the NICU population. In contrast, most micronutrients retained significant year effects. Variance partitioning revealed that prescriber identity explained substantially more variability than prescription year for nearly all electrolytes. Guideline updates also shaped certain changes, such as Selenium, which shifted in line with a specific update rather than prescriber preference.</p><p><strong>Conclusion: </strong>Neonatal PN is influenced by multiple factors, with prescriber-level differences emerging as a dominant driver for micronutrients. These findings highlight the need for targeted standardization efforts that reduce unnecessary heterogeneity while preserving flexibility for clinical judgment.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1457-1465"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13436136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147869211","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":"Efficacy of combined supplementation of vitamins A/D/K1/K2 on the growth and development of preterm infants: A randomized controlled trial.","authors":"Yuanyuan Ding, Huiyan Du","doi":"10.1002/ncp.70132","DOIUrl":"10.1002/ncp.70132","url":null,"abstract":"<p><strong>Objective: </strong>This study elucidates the effects of additional supplementation of vitamins A and K2 on skeletal development and growth in preterm infants.</p><p><strong>Methods: </strong>This study was a single-center, single-blind, randomized controlled trial. Eighty-six preterm infants were randomized into the control group (who received vitamin D 400 IU/day and K1 20 μg/day) and intervention group (who additionally received vitamin A 1500 IU/day and K2 (MK-7) 50 μg/day for 12 months). Bone mineral density (BMD), height standard deviation score (HtSDS), serum vitamin levels, and adverse events were assessed.</p><p><strong>Results: </strong>After 12 months, the intervention group had higher lumbar spine and femur BMD, greater HtSDS, and higher serum vitamin A, D, K1, K2, and 25-OH-D levels, with statistically significant differences (all P < 0.05). There was no statistically significant difference in the incidence of adverse reactions between groups (P > 0.05).</p><p><strong>Conclusion: </strong>Supplementing vitamins A and K2 alongside routine vitamin D/K1 was associated with significant improvements in skeletal maturity, bone mineral density, and micronutrient status in preterm infants, without affecting safety.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1491-1502"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147931514","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":"Timing It Right theory-based staged video education for patients on home enteral nutrition: A randomized controlled trial.","authors":"Yuanyuan Li, Meng Liu, Yang Yang, Dongmei Zhu, Juan Ni, Chulin Chen","doi":"10.1002/ncp.70142","DOIUrl":"10.1002/ncp.70142","url":null,"abstract":"<p><strong>Background: </strong>Home enteral nutrition (HEN) is life-sustaining but poses long-term management challenges. One-time discharge education often fails to meet patients' evolving post-discharge needs. Video support offers a promising solution, yet its application in HEN rarely rests on a theoretical foundation to guide when and how support is delivered.</p><p><strong>Methods: </strong>This prospective, two-arm randomized controlled trial randomly assigned 100 eligible patients in a 1:1 ratio to Timing It Right (TIR)-based staged video education (intervention) or video access at discharge (control). Outcomes (quality of life as the primary outcome; anxiety, depression, functional status, patient satisfaction, complications, readmissions as secondary outcomes) were assessed at baseline, 1 and 3 months. Data were analyzed with generalized estimating equations.</p><p><strong>Results: </strong>The intervention group demonstrated significantly greater improvements in functional status (KPS) and reductions in anxiety (SAS) and depression (SDS) scores over time compared with the control group (all P ≤ 0.001), as well as an improvement in patient satisfaction (PSQ-18, P < 0.05). No significant differences were found in quality of life (NutriQoL), readmission rates, or complication incidence. Video engagement data indicated high interest in self-management and complication content.</p><p><strong>Conclusion: </strong>A TIR-based staged video intervention is feasible and effective for improving key patient-centered outcomes in HEN. Tailored information at critical post-discharge timepoints addresses evolving needs. Future research should include multicenter trials with longer follow-up and integrate multidimensional support to enhance quality of life.</p>","PeriodicalId":19354,"journal":{"name":"Nutrition in Clinical Practice","volume":" ","pages":"1360-1374"},"PeriodicalIF":2.7,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148352679","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}