Aggressive Nutritional Therapy Research Articles

Risk Factors and Management of Acute Pancreatitis; A Systematic Review

Pancreatitis, characterized by pancreatic inflammation, commonly stems from triggers such as gallstones and excessive alcohol consumption. Gene-environment interactions intricately contribute to disease onset and progression, challenging the traditional classification of acute, recurring, and chronic pancreatitis as distinct entities. Instead, a disease continuum has emerged, where 30% of acute pancreatitis cases progress into a chronic form, often involving episodes of recurrence. This systematic study aims to explore the Risk Factors and Management of Acute Pancreatitis. Data from PubMed/Medline, Scopus databases, and Embase were analyzed following PRISMA guidelines (2010–2023). Among 329 identified studies, 15 met inclusion criteria, primarily employing surveys and national database analyses. Enhanced comprehension of risk factors, diagnosis, and treatment is crucial for refining future evaluation and management strategies. Pancreatitis exhibits multifaceted characteristics, presenting diverse causes, symptoms, and outcomes. Current understanding of its natural history and treatment remains limited. Long-term follow-up and randomized studies are imperative to unravel gene-environment interactions and formulate innovative therapeutic approaches. The increased incidence has facilitated progress in defining pancreatitis, with identified risk factors including biliary issues, anatomical abnormalities, systemic diseases, medications, trauma, genetics, infections, and metabolic factors. Notably, the proportion of idiopathic cases has decreased due to improved recognition of genetic and anatomical variants. Effective acute pancreatitis management necessitates early and aggressive fluid and nutritional therapy, pain control, and addressing precipitating factors.

Sarcopenic Dysphagia and Simplified Rehabilitation Nutrition Care Process: An Update.

Sarcopenic dysphagia is characterized by weakness of swallowing-related muscles associated with whole-body sarcopenia. As the number of patients with sarcopenia increases with the aging of the world, the number of patients with sarcopenic dysphagia is also increasing. The prevalence of sarcopenic dysphagia is high in the institutionalized older people and in patients hospitalized for pneumonia with dysphagia in acute care hospitals. Prevention, early detection and intervention of sarcopenic dysphagia with rehabilitation nutrition are essential. The diagnosis of sarcopenic dysphagia is based on skeletal and swallowing muscle strength and muscle mass. A reliable and validated diagnostic algorithm for sarcopenic dysphagia is used. Sarcopenic dysphagia is associated with malnutrition, which leads to mortality and Activities of Daily Living (ADL) decline. The rehabilitation nutrition approach improves swallowing function, nutrition status, and ADL. A combination of aggressive nutrition therapy to improve nutrition status, dysphagia rehabilitation, physical therapy, and other interventions can be effective for sarcopenic dysphagia. The rehabilitation nutrition care process is used to assess and problem solve the patient's pathology, sarcopenia, and nutrition status. The simplified rehabilitation nutrition care process consists of a nutrition cycle and a rehabilitation cycle, each with five steps: assessment, diagnosis, goal setting, intervention, and monitoring. Nutrition professionals and teams implement the nutrition cycle. Rehabilitation professionals and teams implement the rehabilitation cycle. Both cycles should be done simultaneously. The nutrition diagnosis of undernutrition, overnutrition/obesity, sarcopenia, and goal setting of rehabilitation and body weight are implemented collaboratively.

The Reduced Ability to Perform Activities of Daily Living Is Associated with Prolonged Duration before Rehabilitation Initiation and Lower Dietary Intake of Patients with Chronic Obstructive Pulmonary Disease Exacerbation

Introduction: Patients with exacerbated chronic obstructive pulmonary disease (COPD) have a reduced ability to perform activities of daily living (ADLs). Rehabilitation programs (RPs) and nutritional therapy may affect the ability to perform ADLs. Objective: The objective of the study was to clarify the factors associated with reduced ability to perform ADLs in patients with COPD exacerbation. Subjects/Methods: A multivariate analysis of 75 patients (mean age, 77 years) with COPD exacerbation, divided into the Barthel index (BI) decline (△BI decreased ≥15) and without BI decline (△BI decreased ≤10) groups, was performed. Patient characteristics, duration before RP initiation, functional variables, and nutrition-related variables were compared between the groups. Results: The degree of dyspnea and serum albumin levels before and at RP initiation were significantly lower in the BI decline group. The Hoffer classification score and duration between hospital admission and RP initiation were significantly higher and longer, respectively, in the BI decline group. The duration between hospital admission and RP initiation and dietary intake at RP initiation were independent predictors of reduced ability to perform ADLs. Conclusions: Early RP initiation and aggressive nutritional therapy may mitigate the risk of reduced ability to perform ADLs, thus decreasing dependence and disability in patients with COPD exacerbation.

Modified Nutrition Risk in Critically ill is an effective nutrition risk screening tool in severely burned patients, compared with Nutrition Risk Screening 2002.

The present study aimed to evaluate the value of Modified Nutrition Risk in Critically ill (mNUTRIC) and Nutrition Risk Screening 2002 (NRS2002) in the prognosis of severely burned patients. The retrospective cohort study used medical data of severely burned patients admitted to the burn center of Shanghai Ruijin Hospital between January 2015 and September 2021. Demographics, clinical characteristics, laboratory nutritional indicators, mNUTRIC score and NRS2002 score were collected and analyzed in evaluation the value of two nutrition risk screening tools. Spearman correlation analysis was carried out to show the correlation between variables. The area under receiver operating characteristic (ROC) curve was used to assess the ability of mNUTRIC and NRS2002 to predict mortality. Kaplan-Meier survival curves and log-rank tests were conducted to compare the overall survival (OS). Multivariate Cox proportional hazard regression model was used to identify risk factors for 28-day mortality of severely burned patients. A total of 429 adult patients with burn area larger than 30% total body surface area (TBSA) were included in this study. Incidence of nutrition risk was detected in 52.21% by mNUTRIC and 20.51% by NRS2002. However, mNUTRIC was superior to NRS2002 in predicting 28-day mortality (area under ROC curve: 0.795 vs. 0.726). Multivariate Cox regression analysis showed that high mNUTRIC [hazard ratio (HR) = 4.265, 95% CI = 1.469-12.380, P = 0.008] and TBSA (HR = 1.056, 95% CI = 1.033-1.079, P < 0.001) were independent predictors for 28-day mortality. After adjusting for covariates, high NRS2002 was not associated with 28-day mortality (P = 0.367). The present study illustrated the effectiveness of mNUTRIC as nutrition risk screening tool among severely burned patients. Early identification of nutrition risk may help to maximize benefits of nutritional therapy by providing more aggressive nutritional therapy for patients at nutrition risk.

The concept of aggressive nutrition therapy and clinical indication: A position paper

Aggressive nutrition therapy is a nutritional management method that sets energy intake requirements by adding the amount of energy accumulated to energy consumption. It is used to treat patients with undernutrition and sarcopenia. However, evidence for aggressive nutrition therapy is insufficient, and validation through high-quality clinical research is essential. Therefore, this paper aimed to clarify the concept of aggressive nutrition therapy, present indications and contraindications; and describe the effects, limitations, and the need to individualize aggressive nutrition therapy for different pathological conditions. Aggressive nutrition therapy should be accompanied by the etiology of undernutrition, sarcopenia, and nutritional metabolism in various states. In addition to calculating nutritional requirements, the nutritional management methods of oral intake, tube feeding, and parenteral nutrition should be appropriately selected. A nutrition plan with the amount of energy accumulated should also be a vital issue. This position paper was authored by the Registered Dietitian Subcommittee of the Japanese Association of Rehabilitation Nutrition and was approved by the Japanese Association of Rehabilitation Nutrition.

Сучасні погляди на харчування дітей з муковісцидозом

Cystic fibrosis (CF) is an autosomal recessive, life-shortening disease in which generalized exocrine gland involvement occurs with predominantly pancreatic insufficiency, airway obstruction, and progressive lung involvement. Due to pancreatic insufficiency, malabsorption and malnutrition are observed in patients. The close attributive association of CF with nutritional status and adverse clinical outcomes determines a thorough assessment of the nutritional status, individual management and monitoring of all children with CF. Attainment of optimal physical development and adequate nutrition in patients with CF is currently possible through early diagnosis and aggressive nutritional medical therapy. Medical dietary interventions are aimed at ensuring normal growth and preventing of malnutrition, thus will upgrade the prognosis and quality of life of pediatric patients with CF. The reasons for the development of malnutrition in CF, specific screening tools for monitoring the growth of ill children, criteria for stratifying children into nutritional risk groups are reviewed in the lection. The procedure for calculating energy needs, taking into account activity, the severity of the disease and pancreatic insufficiency is presented. Attention is drawn to the ratio of macronutrients and the need to consume energy-dense and nutrient-rich foods. The prescription of medical nutritional therapy with the inclusion of special foods for medical purposes (clinical nutrition) to meet increased energy requirements and avoid the consumption of energy-dense but nutrient-poor foods also is discussed. It is meaningful to involve into a multidisciplinary team of a psychologist who can on a regular basis correct eating behavior and promote compliance with nutritional recommendations in order to achieve optimal physical development of patients. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors. Key words: cystic fibrosis, children, malnutrition, medical nutrition therapy.

Effect of long-term aggressive nutrition therapy on survival in patients with alcohol-related cirrhosis: A randomized controlled trial.

The aim of this study was to assess the effect of long-term aggressive nutritional therapy on clinical outcomes and survival in patients with alcoholic liver cirrhosis (ALC). Malnourished patients assessed by Royal Free Hospital-Subjective Global Assessment (RFH-SGA) were randomized to control group (CG) (35-40 kcal and 1.2 g protein/kg/day; diet alone) or intervention group (IG) (40-45 kcal and 1.5 g protein/kg/day; diet plus polymeric formula) for 3 months. Patients were followed up at 3 and 12 months. Malnourished patients (age 44.0 ± 9 years; M [100%]; Child A:B:C [%] = 11:39:50) were randomized to the CG (n = 50) or IG (n = 54); 21 patients in CG and 27 in IG completed 3 months of follow-up. The RFH-SGA improved in 7 (33.3%; p = 0.016) in IG vs. 3 (14.2%; p = 0.625) in CG. Over 3 months, increments (CG vs. IG) were seen in calories (1554 ± 972 to 1823 ± 398; p = 0.001 vs.1542 ± 603 to 2254 ± 372; p=0.001), protein (53.1 ± 18.4 to 72.5 ± 19.6; p = 0.001 vs. 53 ± 21 to 86.9 ± 18.8; p = 0.00), dry body weight (64 ± 10 to 66 ± 11; p = 0.04 vs. 60.8 ± 9.2 to 63.2 ± 10.7; p = 0.009), and mid-upper arm circumference (MUAC) (24.7 ± 3.3 to 25.5 ± 3.3; p = 0.116 vs. 23.5 ± 2.7 to 24.1 ± 2.9; p = 0.015), with better ascites resolution in IG (53.3%; p = 0.008) vs. CG (44.4%; p = 0.227). Median 12-month survival was comparable in both the groups (p = 0.864). Irrespective of the intervention group, energy intake > 25 kcal and protein > 0.8 g/kg/day significantly improved 12-month survival. Aggressive nutritional therapy improves nutritional status and resolves ascites, however fails to show long-term survival benefit, though higher calorie and protein intake has the potential to impact survival. NCT02140294.

Stored Energy Increases Body Weight and Skeletal Muscle Mass in Older, Underweight Patients after Stroke.

We conducted a retrospective observational study in 170 older, underweight patients after stroke to elucidate whether stored energy was associated with gains in body weight (BW) and skeletal muscle mass (SMM). Energy intake was recorded on admission. The energy requirement was estimated as actual BW (kg) × 30 (kcal/day), and the stored energy was defined as the energy intake minus the energy requirement. Body composition was measured by bioelectrical impedance analysis. The study participants gained an average of 1.0 ± 2.6 kg of BW over a mean hospital stay of 100 ± 42 days with a mean stored energy of 96.2 ± 91.4 kcal per day. They also gained an average of 0.2 ± 1.6 kg of SMM and 0.5 ± 2.3 kg of fat mass (FM). This means about 9600 kcal were needed to gain 1 kg of BW. In addition, a 1 kg increase in body weight resulted in a 23.7% increase in SMM and a 45.8% increase in FM. Multivariate regression analyses showed that the stored energy was significantly associated with gains in BW and SMM. Aggressive nutrition therapy is important for improving nutritional status and function in patients with malnutrition and sarcopenia.

Rehabilitation nutrition for individuals with frailty, disability, sarcopenic dysphagia, or sarcopenic respiratory disability.

Purpose of reviewWe describe the recent advances in rehabilitation nutrition, which is especially important for disabled or frail older individuals.Recent findingsRecent evidence pertaining to rehabilitation nutrition conducted in rehabilitation wards and acute care hospitals has been accumulating. The combination of rehabilitation nutrition and rehabilitation pharmacotherapy is important for eliciting higher functions. The 2020 update of the clinical practice guidelines for rehabilitation nutrition provides a weak recommendation for enhanced nutritional care for patients with cerebrovascular disease, hip fracture, cancer, or acute illness who are undergoing rehabilitation. Rehabilitation nutritional care process and the International Classification of Functioning, Disability and Health-Dietetics are used to implement high-quality rehabilitation nutrition. Aggressive nutrition therapy incorporates the daily energy expenditure plus daily energy accumulation to increase body weight and muscle mass. Preventing and treating sarcopenic dysphagia should include iatrogenic sarcopenia prevention and aggressive nutrition therapy. The diagnosis criteria for respiratory sarcopenia and sarcopenic respiratory disability have been established.SummaryThe International Association of Rehabilitation Nutrition and Total Nutrition Therapy Rehabilitation program may contribute to international expansion of rehabilitation nutrition. Improving evidence–practice gaps in rehabilitation nutrition and increasing national health insurance coverage of aggressive nutrition therapy and rehabilitation nutrition teams are warranted.

Effect of low tongue pressure on nutritional status and improvement of swallowing function in sarcopenic dysphagia

ObjectivesThis study aimed to evaluate the effect of low tongue pressure on the improvement of swallowing function in people with sarcopenic dysphagia and ongoing dysphagia or physical rehabilitation. In addition, we investigated whether sarcopenic dysphagia at admission was associated with severity of malnutrition. MethodsThis was a prospective cohort study of 146 people with sarcopenic dysphagia (mean age 84.6 ± 7.4 y; 68.4% women, 31.6% men) in a postacute rehabilitation hospital. Sarcopenic dysphagia was defined as the presence of both sarcopenia and dysphagia but not neurogenic dysphagia, such as dysphagia due to stroke. Low tongue pressure was classified as “probable” and normal tongue pressure as “possible” sarcopenic dysphagia. Swallowing function was assessed using the Food Intake Level Scale. Malnutrition was diagnosed using the Global Leadership Initiative on Malnutrition criteria. Study outcomes included the amount of change in Food Intake Level Scale score during the rehabilitation period and the association between probable sarcopenic dysphagia and the severity of malnutrition on admission. Statistical significance was set at P < 0.05. ResultsThere were 83 participants (58.6%) with probable sarcopenic dysphagia. The severity of malnutrition (moderate malnutrition: adjusted odds ratio, 3.388; P = 0.042) and severe malnutrition (adjusted odds ratio, 3.663; P = 0.015) was a contributing factor to probable sarcopenic dysphagia. Probable sarcopenic dysphagia (regression coefficient, −0.384; P = 0.017) was negatively associated with the amount of change in Food Intake Level Scale score. ConclusionsProbable sarcopenic dysphagia with low tongue pressure was associated with poorer improvement in swallowing function and severe malnutrition during postacute rehabilitation. Patients with probable sarcopenic dysphagia may require aggressive nutritional therapy.

Low‐dose steroids do make a difference: Independent risk factors for impaired linear growth after pediatric liver transplantation

Growth failure persists after pediatric liver transplantation and impairs pediatric development and quality of life. Steroid dose minimization attempts to prevent growth impairment, yet long-term assessment in pediatric liver recipients is lacking. We identified risk factors for impaired linear growth after pediatric liver transplantation, with a special focus on low-dose steroid therapy. This is a single-center retrospective analysis of height development in pediatric liver recipients up to 5years after transplantation. Risk factors for impaired linear growth (height Z-scores≤-2) at transplantation, after two (n=347) and five years (n=210) were identified by univariate and multivariate logistic regression. At transplantation, growth retardation was found in 52.2%, predominantly younger children. Height Z-scores improved from -2.23 to -1.40 (SE 0.11; 95%CI 0.74-1.16; p<.001) two years and -1.19 (SE 0.07;0.08-0.34; p=.017) five years post-transplant. Multivariate analysis showed previous growth impairment (OR=1.484; 95%-CI=1.107-1.988; p=.004), graft loss (49.006;2.232-1076; p=.006), and prolonged cold ischemic time (1.034;1.007-1.061; p=.011) as main long-term risk factors; steroid use was a significant predictor of 2-year but not 5-year growth impairment. In univariate analysis, impaired growth after 2 and 5years was associated with continuous low-dose (2.5mg/m2 BSA) steroid therapy (OR=3.323;1.578-6.996; p<.001/OR=8.352;1.089-64.07; p=.006)and graft loss (OR=2.513;1.395-4.525; p=.003/OR=3.378;1.815-7.576; p<.001). Furthermore, indication and era of transplantation affected growth. Our results show significant catch-up growth after pediatric liver transplantation, yet growth failure strongly affects particularly young liver recipients. The main influenceable long-term risk factor is pre-existing growth failure, emphasizing the importance of early aggressive nutritional therapy. Moreover, low-dose steroid therapy might impair growth and should therefore be critically questioned in long-term immunosuppression.

Comparison of Modified NUTRIC, NRS-2002, and MUST Scores in Iranian Critically Ill Patients Admitted to Intensive Care Units: A Prospective Cohort Study.

There are no data on the validity of the modified Nutrition Risk in the Critically Ill (m-NUTRIC)-score and Nutritional Risk Screening 2002 (NRS-2002)-score in Iranian intensive care unit (ICU) patients. The Malnutrition Universal Screening Tool (MUST) is still used in most Iranian ICUs. Our goal was to test the validity of these tools in the Iranian ICU population. The association between nutrition risk scores and outcomes (longer length of stay [LOS], prolonged mechanical ventilation [MV], and 28-day mortality) was assessed using the multivariable logistic regression. The performance of nutrition risk tools to predict 28-day mortality was assessed using the receiver operating characteristic curve. A logistic regression model was used to test the interaction between nutrition risk category, energy adequacy, and 28-day mortality. Four hundred forty patients were included. Both the m-NUTRIC and NRS-2002 scores were significantly associated with all 3 outcomes (all P < .001). However, no significant association was identified between the MUST and all 3 outcomes (P > .05). The area under the curve for predicting 28-day mortality was 0.806 (95% CI, 0.756-0.851), 0.695 (95% CI, 0.632-0.752), and 0.551 (95% CI, 0.483-0.612) for m-NUTRIC, NRS-2002, and MUST, respectively. Greater energy adequacy was associated with a lower 28-day mortality rate in patients with high m-NUTRIC but not in those with low m-NUTRIC score (P interaction = .015). In the Iranian ICU population, the m-NUTRIC score may be a valid tool for identifying patients who would benefit from more aggressive nutrition therapy.

Pancreatitis aguda. Artículo de revisión

Resumen: La pancreatitis aguda (PA) se define como un proceso inflamatorio agudo del páncreas el cual puede comprometer otros órganos y tejidos. El diagnóstico requiere al menos 2 de las siguientes características: dolor abdominal de moderada a fuerte intensidad, acompañado de náuseas y vómito; evidencia bioquímica de pancreatitis y/o evidencia por imágenes a través de tomografía axial computarizada dinámica (TACD) y/o la resonancia magnética (RM) del páncreas. Es la enfermedad gastrointestinal aguda más común que requiere ingreso hospitalario, siendo la evolución favorable en la mayoría de los casos (80%). Sin embargo, la pancreatitis necrotizante puede desarrollarse en hasta el 20% de los pacientes y se asocia con tasas significativas de insuficiencia orgánica temprana (38%). Los trastornos metabólicos y el ayuno comprometen el estado nutricional lo que podría agravar el curso de la enfermedad, por ello la vía de administración de la terapia nutricional ha demostrado tener un impacto en la evolución de los pacientes. Ahora existe una mejor definición de cuales pacientes con PA necesitan una terapia nutricional agresiva y cuales son aquellos que probablemente se beneficiarán de una nutrición enteral temprana.

Visceral adiposity is an independent risk factor for high intra-operative blood loss during living-donor liver transplantation; could preoperative rehabilitation and nutritional therapy mitigate that risk?

Blood loss during liver transplantation (LT) is one of the major concerns of the transplant team, given the potential negative post-transplant outcomes related to it. Blood loss was reported to be higher in certain body compositions, such as obese patients, undergoing LT. Therefore, we aimed to study the risk factors for high blood loss (HBL) during adult living donor liver transplant (ALDLT) including the body composition markers; visceral-to-subcutaneous adipose tissue area ratio (VSR), skeletal muscle index and intramuscular adipose tissue content. In June 2015, an aggressive perioperative rehabilitation and nutritional therapy (APRNT) program was prescribed in our institute for the patients with abnormal body composition. We retrospectively analyzed 394 patients who had undergone their first ALDLT between 2006 and 2019. Risk factors for HBL were analyzed in the total cohort. Differences in blood loss and risk factors were analyzed in relation to the APRNT. Multivariate risk factor analysis in the total cohort showed that a high VSR (odds ratio (OR): 1.98, 95% confidence interval (CI): 1.19-3.29, P=0.009), was an independent risk factor for HBL during ALDLT, as well as a history of upper abdominal surgery, simultaneous splenectomy and the presence of a large amount of ascites. After the introduction of the APRNT, a significantly lower blood loss was observed during the ALDLT recipient operation (P=0.003). Moreover, the significant difference in blood loss observed between normal and high VSR groups before the application of the APRNT (P<0.001), was not observed with the APRNT (P=0.85). Likewise, before the APRNT, only high VSR was a risk factor for HBL by multivariate analysis (OR: 2.34, CI: 1.33-4.09, P=0.003). Whereas with the APRNT, high VSR was no longer a significant risk factor for HBL even by univariate analysis (OR: 0.89, CI: 0.26-3.12, P=0.86). Increased visceral adiposity was an independent risk factor for high intraoperative blood loss during ALDLT recipient operation. With APRNT, high VSR was not associated with high blood loss. Therefore, APRNT might have mitigated the risk of high blood loss related to high visceral adiposity.

88 Validation of the Modified NUTrition Risk Score (mNUTRIC) in Burn Victims: Evidence from a Multi-centre, Multi-national, Double-blind, Controlled Randomized Clinical Trial

Abstract Introduction Nutrition is an essential therapy in burn victims. However, whether nutrition therapy provide benefits equally to all burn victims is unknown. The NUTRIC score identifies patients who may not benefit more from aggressive nutrition therapy (score &amp;lt; 5) and those who may benefit more from aggressive nutrition (High score ≥ 5). It can be estimated from age, SOFA, APACHE scores, comorbidities, and IL-6. If the latter is not available, the modified NUTRIC score (mNUTRIC) can be computed. The mNUTRIC score has been validated in ICU settings. In burn victims, the association between mNUTRIC score, nutritional intake, and clinical outcomes is unknown. We hypothesize that a higher mNUTRIC score will be associated with worst clinical outcomes and that greater nutritional adequacy will be associated with better clinical outcomes in nutritionally high-risk burn victims. Methods In the context of a double-blind, placebo-active, multi-centre RCT of adult burn patients, we evaluated the association between mNUTRIC score, nutritional adequacy, and clinical outcomes. Patients with deep second and/or third-degree burns with a total body surface area percentage (TBSA%) ≥10 were enrolled in the RCT. Patients demographics, type of burn, %TBSA, nutrition intake, hospital length of stay (LOS), Burn Unit (BU) LOS, and hospital mortality were collected. The nutritional adequacy was calculated from all sources, except intravenous glucose and oral intake. Descriptive and inferential analyses for quantitative data were performed. Results Six hundred and sixty patients were included. The majority were Caucasian (78%) males (74%) with a BMI between 25–35 (53%), median age of 50 ±18 years and severely ill (Apache Score II; 14 ±8, SOFA score; 2.9 ±3). The most common type of burn was fire (87%), with %TBSA of 31 ±16, Table 1. EN alone was provided to 79% of the patients and the daily average energy and protein adequacy was 73% and 76%, accordingly. Table 2. Compared to low mNUTRIC, the high mNUTRIC group had less ventilator free days (11 [6–19] vs. 28 [11–28] days), worse survival (52% vs. 9.5%), and longer hospital LOS (181 [81–181] vs. 34 [20–68] days), Table 3. Compared to the low mNUTRIC, the high mNUTRIC group had better clinical outcomes with increasing energy (by 20% of goal), interaction for energy, mNUTRIC, and mortality was p=0.11 and for time-discharge-alive was &amp;lt; p=0.0001. Similarly, more protein tended towards better outcomes in the high mNUTRIC group but not the low NUTRIC group (interaction for protein, mNUTRIC, mortality was p=0.20; time-to-discharge alive was p=0.08, Table 4. Conclusions A high mNUTRIC score identifies high risk burn victims and may identify those who may benefit more from an aggressive nutrition therapy. Applicability of Research to Practice Nutrition therapy in burns can be more efficient.

Dietary management of blood glucose in medical critically ill patients with overweight/obesity.

As the obesity epidemic continues, there is a greater proportion of patients with overweight, obesity, and other forms of adiposity-based chronic disease that require intensive care. Nutrition therapy in the ICU is a vital part of critical care but can be challenging in this setting because of the increased risk of stress hyperglycemia and adverse impact of obesity- and diabetes-related complications. Current guidelines favor early nutritional therapy with a hypocaloric, high-protein diet in patients with overweight/obesity. More aggressive protein intake may be useful in those with greater severity of overweight/obesity with an upper limit of 3 g/kg ideal body weight per day. Although there is no specific recommendation, choosing enteral formulas with higher fat content and slower digesting carbohydrates may assist with glucose control. Supplementation with immunonutrients is recommended, given their known benefits in obesity and in reducing inflammation, but must be done in an individualized manner. Aggressive nutritional therapy is crucial in patients with overweight/obesity to support ongoing metabolic demands. Although a hypocaloric high-protein feeding strategy is a starting point, nutritional therapy should be approached in an individualized manner taking into account age, weight and BMI, basal metabolism, nutrition status, complications, and comorbidities.

The role of maximum compressed thickness of the quadriceps femoris muscle measured by ultrasonography in assessing nutritional risk in critically-ill patients with different volume statuses.

In this prospective observational study, we aimed to investigate the role of the maximum compressed (MC) and uncompressed (UC) thickness of the quadriceps femoris muscle (QFMT) measured by ultrasonography (USG) in the detection of nutritional risk in intensive care patients (ICPs) with different volume status. 55 patients were included. Right, left, and total ucQFMT and mcQFMT measurements were obtained by a standard USG device within the first 48 hours after ICU admission. Clinical examination and the USG device were used to determine the volume status of the patients. SOFA, APACHE II, modified NUTRIC scores, and demographic data were collected. There was a significant difference between the nutritional risk of patients in terms of left, right, and total mcQFMT measurements (p=0.025, p=0.039; p=0.028, respectively), mechanical ventilation requirement (p=0.014), presence of infection (p=0.019), and sepsis (p=0.006). There was no significant difference between different volume statuses in terms of mcQFMT measurements. In the multi-variance analysis, mcQFMT measurements were found to be independently associated with high nutritional risk (p=0.019, Exp(B)=0.256, 95%CI=0.082-0.800 for modified NUTRIC score ≥ 5), and higher nutritional risk (p=0.009, Exp(B)=0.144, 95%CI=0.033-0.620 for modified NUTRIC score ≥ 6). a Total mcQFMT value below 1.36 cm was a predictor for higher nutritional risk with 79% sensitivity and 70% specificity (AUC=0.749, p=0.002, likelihood ratio=2.04). Ultrasonographic measurement of total mcQFMT can be used as a novel nutritional risk assessment parameter in medical ICPs with different volume statuses. Thus, patients who could benefit from aggressive nutritional therapy can be easily identified in these patient groups.

Complementarity of NUTRIC score and Subjective Global Assessment for predicting 28-day mortality in critically ill patients

AimsTo compare the prognostic power of nutritional screening (NUTRIC score) and Subjective Global Assessment (SGA), executed alone or their complementarity, for predicting 28-day mortality risk in ICU patients. We also aimed to identify the cut-off point obtained in the NUTRIC that presented the best validity parameters for predicting mortality in this population. MethodsA sample of 159 patients was evaluated in the first 24 hours of ICU admission. Modified NUTRIC score was performed (without interleucina-6). ROC curve and Youden criterion were used to identify the best cut-off point. Poisson regression and the number needed to screen (NNS) were used to test the complementarity between the tools and their ability to predict 28-day mortality. ResultsA sample of 159 patients was evaluated (51% male, 56.6 ± 20 years) and the APACHE II, SOFA and NUTRIC score medians were 22 (IQR:15;26), 6 (IQR:2;9) and 3 (IQR: 2;5), respectively. Almost 60% of the patients were malnourished (SGA B or C) and 32.7% died during 28-day follow-up. The area under ROC curve for NUTRIC score was 0.79. Using a new cutoff (NUTRIC score ≥ 4), patients with nutritional risk have a 28-day mortality risk almost 6 times higher than subjects without nutritional risk. Patients classified as SGA C showed a 28-day mortality risk 2.19 times higher compared to nourished ones. Evaluating the complementarity of the tools, patients classified as nutritional risk (NUTRIC score ≥ 4) and SGA C showed a 28-day mortality risk 7 times higher and a lower NNS when compared to those patients with a NUTRIC < 4 and any SGA category. ConclusionsA new cutoff value was identified for this population. Simultaneous SGA assessment in patients with nutritional risk may enhance the predictive power of 28-day mortality, providing better identification of higher risk patients who may benefit from a more aggressive nutritional therapy.

The predictive value of the nutrition risk in the critically ill (NUTRIC) in comparison to the modified subjective global assessment (SGA) nutritional assessment tool for 28-day intensive care unit (ICU) mortality in a philippine tertiary hospital

Rationale: Effective nutritional screening is used to determine patients who will most likely benefit from an aggressive nutrition therapy in the critically ill. Currently, the modified SGA is being used in the St. Luke's Medical Center – Quezon City, Philippines (SLMC – QC ICU), but recent studies have shown that a newer tool, the NUTRIC is more appropriate for use in the ICU.

Role of Nutrition Support in Cardiac Surgery Patients - an Overview

Cardiac surgery patients regularly experience a systemic inflammation response to the surgery and a postoperative stay in the intensive care unit. Nutritional support is one strategy to improve the outcome of cardiosurgical patients. A preoperatively diagnosed malnutrition contributes to a higher morbidity and mortality in this patient group. Preoperative fasting, glucose-free infusions during long and invasive operations and delayed postoperative nutrition therapy aggravate the nutrition situation. However, conclusive evidence for this population, consisting of well-conducted clinical trials is lacking.This article outlines the main causes for malnutrition in cardiosurgical patients and summarizes possibilities to identify patients at high nutritional risk, who are most likely to profit from aggressive nutritional therapy. Despite conspicuous knowledge and evidence gaps, a rational nutritional support therapy based on current recommendations of ASPEN, ESPEN and an international multidisciplinary consensus group is presented. The amount and kind of nutrition, as well as the best time to initiate nutrition support, ways to monitor nutrition therapy and the potential use of pharmaconutrition to modulate the inflammatory response to cardiopulmonary bypass are presented to benefit patients undergoing cardiac surgery.