American Society For Parenteral And Enteral Nutrition Research Articles

Modification of the GLITEROS diabetes-specific hospital enteral formula based on jicama flour and tempeh flour with the addition of sunflower seed flour

The diabetes-specific enteral formula is necessary to assist glycemic control for critically ill diabetic patients. The GLITEROS enteral formula is an innovative diabetes-specific hospital enteral formula made from local food, jicama flour and tempeh flour. However, the fat content in the GLITEROS enteral formula does not meet the fat requirements for a diabetes-specific enteral formula. Sunflower seeds are a good food source of monounsaturated fatty acids, specifically oleic acid which has antidiabetic effects. The addition of sunflower seeds to the GLITEROS enteral formula as a modification can optimize the lack of fat content. This study aimed to analyze the macronutrient content, dietary fiber, protein digestibility, and physical properties, including viscosity and osmolality of the modified GLITEROS enteral formula. This research was an experimental study with four formula groups, Formula A, B, C, and D, with different ratios of tempeh flour, jicama flour, and sunflower seed flour; (1:1:1), (1:1:2), (1:2:1), and (2:1:1). The variables of this study were energy density, calories, carbohydrates, fat, protein, dietary fiber, protein digestibility, viscosity, and osmolality were tested with three repetitions in duplicate. Data analysis used One-way ANOVA and the Kruskal-Wallis test. Formula B had the highest density of energy, energy, fat, and dietary fiber compared to the four formulas. Meanwhile, Formula C had the highest protein content and digestibility value compared to other formulas. The highest viscosity and osmolality values were in formula A. Formula C was the most qualified formula in terms of macronutrient content, dietary fiber, protein digestibility, and physical properties of diabetes-specific enteral formulas according to the requirements of the American Diabetes Association (ADA), Canadian Diabetes Association (CDA), American Society of Parenteral and Enteral Nutrition (ASPEN)

Knowledge and clinical practice of ASPEN registered dietitian nutritionist members regarding blenderized tube feedings.

Blenderized tube feedings (BTFs) are used by patients/caregivers who report improvements in gastrointestinal tolerance compared with standard commercial feedings. Despite positive outcomes, registered dietitian nutritionists or international equivalents (RDN/Is) hesitate to recommend BTFs. We aimed to determine if an association exists between dietitian characteristics and willingness to recommend BTFs. A BTF-specific survey (N = 157) assessed for validity and reliability was administered to the American Society for Parenteral and Enteral Nutrition (ASPEN) RDN/I members. Binary logistic regression analyses examined the association between age, years of clinical practice, BTF training/education, patient population served, and willingness to recommend BTFs. The response rate was 4.3% of ASPEN RDN/I members. Most respondents were White females with a median age of 39.0 years and 12 years of clinical experience. Although 98.7% of respondents expressed a willingness to support and 73% to recommend BTFs, 60% were not using BTFs in clinical practice. For 94.8% of RDN/Is, the primary reason for BTF use was patient/caregiver requests. After adjustment for age and years of clinical practice, RDN/Is who served pediatric populations (odds ratio [OR] = 4.28; 95% CI, 1.52-12.09) or used three or more professional resources (OR = 2.49; 95% CI, 1.12-5.57), industry-sponsored resources (OR = 3.15; 95% CI, 1.39-7.15), or one or more experiential learning resources (OR = 3.14; 95% CI, 1.38-7.17) were more likely to recommend BTFs whereas those serving adults were less likely to recommend BTFs (OR = 0.33; 95% CI, 0.12-0.95). Pediatric RDN/Is and individuals with BTF-specific education/training were more inclined to recommend BTFs.

Evidence-based practice attitudes and nutrition support guideline knowledge between holders and nonholders of the Certified Nutrition Support Clinician credential.

Clinical practice frequently changes, and professionals should stay abreast of evidence-based practice (EBP) guidelines. Negative attitudes towards EBP are a barrier to guideline adoption. This study explored EBP attitudes and knowledge of a complex nutrition support clinical case scenario of individuals holding or not holding the Certified Nutrition Support Clinician (CNSC) credential. This cross-sectional study used an online survey sent to American Society for Parenteral and Enteral Nutrition (ASPEN) members with and without the CNSC credential and all CNSC credential holders from the National Board of Nutrition Support Certification email list. The survey included the Evidence-Based Practice Attitude Scale Score (EBPAS-15) and eight knowledge questions using a nutrition support case scenario. An independent samples t test compared knowledge and EBPAS-15 total scores and subscores between CNSC holders and nonholders. Pearson correlation determined the correlation between knowledge and EBPAS-15 scores. The response rate was 7.8% (N = 706). CNSC holders (n = 536) had significantly higher mean knowledge scores (4.7 ± 1.6 out of 8) than nonholders (n = 159, 4.1 ± 1.7) (P < 0.001). Total EBPAS-15 scores were not significantly different between CNSC holders (n = 542, 2.9 ± 0.4 out of 4) and nonholders (n = 164, 2.8 ± 0.7) (P = 0.434), and knowledge scores and total EBPAS-15 scores (P = 0.639) or subscores were not significantly correlated. Regardless of holding the CNSC credential, EBPAS-15 scores indicated respondents had positive EBP attitudes. CNSC holders had significantly higher knowledge scores of recent nutrition support EBP guidelines compared with non-CNSC credential holders. Positive EBP attitudes are a precursor to clinical decision-making, but future research should determine the use of guidelines in clinical practice.

A98 EFFECT OF A PROLONGED MULTIVITMAIN SHORTAGE ON HOME PARENTERAL NUTRITION PATIENTS: SINGLE CENTRE EXPERIENCE

Abstract Background Multivitamin shortages in home parenteral nutrition (HPN) are scarce but have a significant impact on patient morbidity. Recently, Ontario, Canada experienced a HPN intravenous multivitamin shortage that lasted over 3 months. As per the American Society of Parenteral and Enteral Nutrition (ASPEN) guidelines, patients were instructed to use an over-the-counter multivitamin supplement during the shortage. However, due to the nature of HPN patients, the risk for malnutrition related complications remains high, specifically thiamine deficiency. Aims This study aims to assess the relationship between the multivitamin shortage and thiamine deficiency. We conducted an analysis before and after the intravenous multivitamin shortage in HPN patients and compared anthropometric, biochemical and clinical outcomes in those who followed the oral multivitamin recommendation versus those who did not. Methods This retrospective descriptive study included HPN patients in a single-centre program in Toronto, Canada who required HPN ≥ 5 days/week. These patients were followed throughout the multivitamin shortage which lasted from February - June 2023. Patients were categorized into two groups: those who consumed an oral multivitamin and those who did not. Clinical and biochemical data were collected pre and post-multivitamin shortage. Data was collected on compliance with taking oral multivitamins. The primary outcome was the presence of any adverse clinical outcome related to a micronutrient deficiency. Results Twenty-five HPN patients were included. 56% (n=14) of patients were compliant with oral multivitamin usage and met the ASPEN recommendations for supplementation. Compliant patients were significantly older and were on significantly longer duration of HPN. Two patients were diagnosed with WE and had brief hospitalizations. Both patients experienced complete resolution of their symptoms after treatment with high-dose thiamine. Hence, compliance with oral multivitamins did not correlate to developing WE. The median time from the shortage to the development of WE was 2 months. Though not statistically significant, those who developed WE were more likely to be female, utilized a venting gastrostomy tube, and utilized HPN for longer. Conclusions Complications related to micronutrient deficiency are rare in the HPN population but shortages in intravenous multivitamins can increase the risk of conditions such as WE. In our study, compliance with oral multivitamins did not guarantee protection from developing adverse outcomes, likely due to limitations in absorption due to altered gastrointestinal anatomy. A regimented protocol for screening should be implemented in HPN patients, especially during long shortages of key HPN components like multivitamins. Funding Agencies None

Highlights in the clinical nutrition literature: A critical appraisal of current research.

Within the American Society for Parenteral and Enteral Nutrition (ASPEN), the Physician Engagement Committee (PEC) was created in 2017 by the ASPEN Board of Directors with the goal of growing the physician community both nationally and internationally. The PEC meets each month throughout the year to develop educational and research initiatives. In 2022, the PEC began an initiative to systematically review and evaluate practice-changing literature annually with the overall aim to highlight these studies at the annual ASPEN conferences and to critically discuss the potential clinical implications. The objective of the held meeting session was to present identified key papers in the fields of critical care medicine, gastroenterology and hepatology, and adult internal medicine that were published in 2022, which would complement the knowledge of the pathogenesis, diagnosis, and management of nutrition topics as well as to identify areas of future research. Overall, several large-scale randomized controlled studies were identified in each of these sections, with practice-changing major results. This manuscript summarizes the information that was presented and the discussions that followed.

Parenteral nutrition insecurity: ASPEN survey to assess the extent and severity of parenteral nutrition access and reimbursement issues.

Parenteral nutrition (PN) shortages and lack of qualified professional staff to manage PN impact safe, efficacious care and costs of PN. This American Society for Parenteral and Enteral Nutrition (ASPEN)-sponsored survey assessed the frequency and extent to which PN access affects PNdelivery to patients. Healthcare professionals involved with PN were surveyed. Questions were developed to characterize the respondent population and determine the extent and severity of PN access issues to components, devices, and healthcare professionals, as well as their effects on discharge and transfer issues. Reimbursement issues included cost, adequacy of therapy, and healthcare professional reimbursement. Burdens were types and frequency of errors, adverse events, and nutrition problems resulting from PN access issues. Impact on professionals and organizations was determined. Respondents (N = 350) worked in hospitals (75%) and home infusion (25%). Per day, clinicians cared for <15 patients receiving PN. All age populations were represented. Respondents reported shortages of macronutrients (72%, 233 of 324) and micronutrients (91%, 297 of 324). Issues with access to healthcare workers were observed. PN access issues contribute to increased costs of PN, and knowledge regarding the current rate of PN reimbursement is limited. Respondents (75%, 197 of 261) observed an error due to PN access issues. Adverse events (57%, 149 of 259) were observed leading to temporary or permanent harm (24%, 61 of 259) as well as near death (4%, 9 of 259) and death (1%, 2 of 259). Providers reported time away from other job responsibilities and workplace stress. PN access issues result in "PN insecurity" that negatively impacts patients and healthcare providers and leads to adverse events including death in patients receiving PN.

Assessment of refeeding syndrome definitions and 30-day mortality in critically ill adults: A comparison study.

Patients in the intensive care unit (ICU) are at high risk for refeeding syndrome (RFS), yet there is uncertainty regarding how RFS should be operationalized in the ICU. We evaluated different definitions for RFS and tested how they associated with patient-centered outcomes in the ICU. This was a retrospective comparison study. Patients age ≥18 years were eligible if they were newly initiated on enteral feeding while hospitalized in the ICU. Eight definitions for RFS were operationalized, including that from the American Society for Parenteral and Enteral Nutrition (ASPEN), all based on electrolyte levels from immediately before until up to 5 days after the initiation of enteral nutrition. Patients were followed for death or for ICU-free days, a measure of healthcare utilization. In all, 2123 patients were identified, including 406 (19.1%) who died within 30 days of ICU admission and 1717 (80.9%) who did not. Prevalence of RFS varied from 1.5% to 88% (ASPEN definition) depending on the RFS definition used. The excess risk for death associated with RFS varied from 33% to 92% across definitions. The development of RFS based on the ASPEN definition was associated with a greater decrease in ICU-free days compared with other definitions, but the relationship was not statistically significant. Eight definitions for RFS were evaluated, none of which showed strong associations with death or ICU-free days. It may be challenging to achieve a standardized definition for RFS that is based on electrolyte values and predicts mortality or ICU-free days.

Interprofessional implementation of the Global Malnutrition Composite Score quality measure.

Malnutrition in hospitalized patients can impact health outcomes, quality of life, and health equity. Quality improvement initiatives and quality measurement can help improve the care of those hospitalized patients with malnutrition. The new Global Malnutrition Composite Score (GMCS) was recently adopted by the Centers for Medicare & Medicaid Services (CMS) as a health equity-focused measure. Beginning in 2024, the GMCS is available for reporting through the CMS Hospital Inpatient Quality Reporting Program. The GMCS provides an opportunity to elevate the importance of patient nutrition status and evidence-based interventions throughout the interdisciplinary hospital decision-making process. To promote this opportunity, the American Society for Parenteral and Enteral Nutrition (ASPEN) held an "Interprofessional implementation of the Global Malnutrition Composite Score" webinar as part of its 2022 Malnutrition Awareness Week programming. This article summarizes the underlying rationale and significance of the GMCS measure and showcases clinical observations about integrating quality improvement and measurement into the acute care setting, as presented during the webinar.

775 Increased Reimbursement by Decreasing the Mortality Index Using GLIM in the Elderly for Malnutrition

Abstract Introduction One of the primary factors for burn wound healing is adequate nutrition. Many burn patients require supplemental nutrition during their burn care, however, their pre-existing nutritional status is also a factor in their morbidity and mortality. Malnutrition on admission or during their hospital stay has a significant impact on outcomes including wound healing, infection, and length of stay, along with effects on reimbursement and mortality outcomes predictors. American Society for Parenteral and Enteral Nutrition (ASPEN) criteria have long been used to assess malnutrition in burn patients in our institution though this may not be the ideal assessment tool, especially in patients over 65 years of age. In January 2016, the Global Leadership Initiative on Malnutrition (GLIM) working group created an updated assessment for malnutrition that takes additional factors into account. We aimed to compare ASPEN to GLIM criteria to determine if there is a difference in the number of patients meeting the criteria for malnutrition in the elderly. Methods All patients admitted between July 2013 to June 2021, 65 years or older, burn or skin disorder of at least 20% total body surface area, designated as Normal or underweight based upon body mass index, with registered dietitian assessments and lengths of stay of at least 2 days were included. Patients were identified using the Institutional Burn Center registry, and linked to the clinical and administrative data. Primary outcome was whether or not those patients triggered malnutrition diagnosis based upon ASPEN or GLIM criteria. Results Three hundred sixty-five patients were included in the study. Twenty-five patients had burns over 20%, and 14 met the criteria for nutritional assessment. Using ASPEN criteria, 2 out of 14 patients met criteria for malnutrition. Of those same patients, 8 out of 14 patients met criteria for malnutrition using GLIM assessment. Conclusions While this study is not powered for statistical analysis, the results demonstrate that GLIM may be a valuable adjunct to ASPEN to assess malnutrition in burn patients, especially in those patients over 65 years of age. Further study is needed to examine whether GLIM would be a superior tool or at least a worthy addition to our nutritional analysis. Burn patients have a unique need for adequate nutrition to support healing, and accurate evaluation of their requirements warrants a precise tool. Applicability of Research to Practice This study may demonstrate the need for additional evaluation of GLIM as a replacement or adjunct tool for malnutrition in the burn population. This study may also suggest the need for further assessment of other tools to evaluate nutrition on in this population. This study may also suggest impact on mortality index and length of stay that affect reimbursement and rankings.

Evaluation of an electronic medical record-based Paediatric Nutrition Screening Tool.

Nutrition screening is recommended to identify children at risk for malnutrition. A unique screening tool was developed based on American Society for Parenteral and Enteral Nutrition (ASPEN) recommendations and embedded in the electronic medical record to assess for nutrition risk. The components of the tool included the Paediatric Nutrition Screening Tool (PNST) and other elements recommended by ASPEN. To evaluate the screening tool, retrospective data were analysed on all patients admitted to acute care units of Children's Wisconsin in 2019. Data collected included nutrition screen results, diagnosis and nutrition status. All patients who received at least one full nutrition assessment by a registered dietitian (RD) were included in analysis. One thousand five hundred seventy-five patients were included in analysis. The following screen elements were significantly associated with a diagnosis of malnutrition: any positive screen (p < 0.001), >2 food allergies (p = 0.009), intubation (p < 0.001), parenteral nutrition (p = 0.005), RD-identified risk (p < 0.001), positive risk per the PNST (p < 0.001), BMI-for-age or weight-for-length z-score (p < 0.001), intake <50% for 3 days (p = 0.012) and NPO > 3 days (p = 0.009). The current screen had a sensitivity of 93.9%, specificity of 20.3%, positive predictive value (PPV) of 30.9% and negative predictive value (NPV) of 89.8%. This is compared with the PNST which had a sensitivity of 32%, specificity of 94.2%, PPV of 71% and NPV of 75.8% in this study population. This unique screening tool is useful for predicting nutrition risk and has a greater sensitivity than the PNST alone.

The relationship between nutritional status before chemotherapy with nutritional status after chemotherapy in locoregionally advanced nasopharyngeal carcinoma patients

Background: Malnutrition in nasopharyngeal carcinoma (NPC) patients is caused by various factors such as tumor localization, metabolic derangement, and side effects of therapy. Poor nutritional status in cancer patients is associated with serious clinical consequences such as poor quality of life, higher treatment toxicity, and poor prognosis. The purpose of this study was to determine the effect of nutritional status before chemotherapy on the nutritional status after chemotherapy in non-metastatic advance-stage NPC patients. Methods: This study was an observational study with a cross sectional design using secondary data involving non-metastatic advanced-stage NPC patients undergoing chemotherapy at dr. Kariadi Hospital Semarang in January 2020 – June 2022. The sampling technique used was consecutive sampling. Nutritional status was measured by malnutrition criteria according to the American Society for Parenteral and Enteral Nutrition (ASPEN). Statistical analysis was performed with Chi-Square and McNemar analysis test. Results: Total sample of this study was 55 subjects. The results of this study were there was a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients (P&lt;0.05). All subjects were malnourished before chemotherapy, with 12.7% moderately malnourished and 87.3% severely malnourished. All subjects were malnourished after chemotherapy, with 41.8% moderately malnourished and 58.2% severely malnourished, decreased nutritional status of post-chemotherapy non-metastatic advanced NPC patients was related to the length of chemotherapy (p&lt;0.05), but not related to comorbidities, age, and stage of chemotherapy (p&gt;0.05). Conclusion: There is a relationship between nutritional status before chemotherapy and nutritional status after chemotherapy in non-metastatic advanced-stage NPC patients.

Characteristics of Hospitalized Pediatric Patients with a Malnutrition Diagnosis at Riley Hospital for Children

Background: A diagnosis of malnutrition in hospitalized patients has been shown to negatively affect clinical outcomes by impairing immune responses (a subsequently increasing infection and complication rates), increasing the average length of stay in the hospital, and increasing mortality. In the past, there have been efforts to study the characteristics and prevalence of pediatric populations diagnosed with malnutrition in a hospital setting, but until 2014, no universal standards were used for malnutrition diagnosis and documentation. In 2014, The Academy of Nutrition and Dietetics and the American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) introduced a recommendation for standardization of identification and documentation of pediatric malnutrition. These recommendations guided a series of malnutrition awareness initiatives at Riley Hospital for Children (Riley) with a focus on increasing malnutrition documentation efficiency and integrity. Subsequently, the number of malnutrition diagnoses at Riley has increased from 2016 when the initiative started through 2021.&#x0D; Objective: The purpose of this study is to identify characteristics of patient populations diagnosed with malnutrition that may benefit from early intervention.&#x0D; Methods: Individuals with a diagnosis of malnutrition at Riley Hospital for Children (excluding Obstetric patients) from the years 2019-2021 were included in this study. Patient level data was used to study average length of stay (LOS), 30-day readmission percentage, admitting service, primary diagnosis, and demographics of this population.&#x0D; Results: Preliminary data analysis suggests there is a decreasing trend in readmission within 30 days for patients diagnosed with malnutrition. A similar trend is seen in the entire population of patients treated at Riley Hospital for Children in the same period. Of note, the entire patient population of Riley has seen a decreasing average length of stay while the patient population with a malnutrition diagnosis have seen an increasing average LOS. These observations have not been evaluated for significance at this time.

TRANSLATION AND CROSS-CULTURAL ADAPTATION OF THE ROYAL FREE HOSPITAL-NUTRITIONAL PRIORITIZING TOOL (RFH-NPT).

Nutritional screening is defined by American Society for Parenteral and Enteral Nutrition (ASPEN) as a process to identify individuals at risk of malnutrition. Malnutrition is a prevalent condition in cirrhotic patients, and it results in important prognostic implications. Most of the commonly used instruments fail in considering the particularities of cirrhotic patients. The Royal Free Hospital-Nutritional Prioritizing Tool (RFH-NPT) is a nutritional screening tool developed and validated to identify malnutrition risk in patients with liver disease. The study's aim was to conduct the transcultural adaptation (translation and adaptation) of RFH-NPT tool to Portuguese (Brazil). The process of cultural translation and adaptation followed the Beaton et al. methodology. The process involved the steps of initial translation, synthesis translation, back translation pretest of the final version with 40 nutritionists and a specialists committee. The internal consistency was calculated with the Cronbach coefficient and the content validation was verified with the content validation index. Forty clinical nutritionists with experience in treatment of adult patients participated in the step of cross-cultural adaptation. The alpha Cronbach coefficient was 0.84, which means high reliability. In the specialists analyzes all the tool's questions achieved a validation content index higher than 0.8, showing high agreement. The NFH-NPT tool was translated and adapted to Portuguese (Brazil) and showed high reliability.

Malnutrition: Undernutrition or overnutrition?

The definitions and terminology related to malnutrition need to be clarified. The Academy of Nutrition and Dietetics (Academy) and the American Society of Parenteral and Enteral Nutrition (ASPEN) have classified clinical nutrition into malnutrition (undernutrition), sarcopenia, frailty, and overnutrition (overweight and obese). In addition, determining indicators for determining diagnoses related to malnutrition also needs to be clarified. Thus, this information can be used by nurses and other health workers to be able to provide appropriate planning and interventions for patients with malnutrition.

Commentary on the American Society for Parenteral and Enteral Nutrition (ASPEN) position paper: Ethical aspects of artificially administered nutrition and hydration

Commentary on the American Society for Parenteral and Enteral Nutrition (ASPEN) position paper: Ethical aspects of artificially administered nutrition and hydration

2021-2022 ASPEN Physician Engagement Committee.

The American Society for Parenteral and Enteral Nutrition (ASPEN) Physician Engagement Committee was created in 2017 by the ASPEN Board of Directors with the goal to grow the physician community both nationally and internationally within ASPEN This article is protected by copyright. All rights reserved.

Food security and food access during the COVID-19 pandemic: Impacts, adaptations, and looking ahead.

The coronavirus disease 2019 (COVID-19) pandemic continues to alter US household food consumption and food spending. Although terminology used to describe food insecurity has varied during the COVID-19 pandemic, many reliable estimates illustrate a dramatic increase in food insecurity from approximately 10% of US households before the pandemic to 25%-30% of households during the pandemic, with an even higher prevalence reported by more vulnerable and socially disadvantaged populations. To address the increase in food and economic insecurity, food and nutrition assistance policies and programs made innovative and temporary changes, and enrollment in these programs generally increased. However, some changes to food, nutrition, and income assistance programs are now expiring or contracting even as food insecurity prevalence is again on the rise and elevated food and nutrition assistance needs are expected to persist based on historical patterns. American Society for Parenteral and Enteral Nutrition (ASPEN) practitioners can play an important role in identifying clients at elevated risk of food insecurity-related acute and chronic conditions and connecting high-risk clients to resources. ASPEN practitioners can contribute to the evidence base linking food insecurity and nutrition outcomes. ASPEN practitioners can also advocate for addressing the root social and structural determinants of food insecurity and for the continuation of effective food and nutrition policy changes and innovations.

Nutrition support teams: Institution, evolution, and innovation.

The historical institution, evolution, and innovations of nutrition support teams (NSTs) over the past six decades are presented. Focused aspects of the transition to transdisciplinary and patient-centered care, NST membership, leadership, and the future of NSTs are further discussed. NSTs were instituted to address the need for the safe implementation and management of parenteral nutrition, developed in the late 1960s, which requires the expertise of individuals working collaboratively in a multidisciplinary fashion. In 1976, the American Society for Parenteral and Enteral Nutrition (ASPEN) was established using the multidisciplinary model. In 1983, the United States established the inpatient prospective payment system with associated diagnosis-related groupings, which altered the provision of nutrition support in hospitals with funded NSTs. The number of funded NSTs has waxed and waned since; yet hospitals and healthcare have adapted, as additional education and experience grew, primarily through ASPEN's efforts. Nutrition support was not administered in some instances by the "core of four" (physician, nurse, dietitian, pharmacist). The functions may be carried out by a member of the core of four not associated with the parent discipline, in accordance with licensure/privileging. This cross-functioning has evolved into the adaptation of the concept of transdisciplinarity, emphasizing function over form, supported and enhanced by "top-of-license" practice. In some institutions, nutrition support has been incorporated into other healthcare teams. Future innovations will assist NSTs in providing the right nutrition support for the right patient in the right way at the right time, recognizing that nutrition care is a human right.

2022 Peggi Guenter Excellence in Clinical Practice Lectureship: Expanding the clinical practice of nutrition-Challenging the known, exposing inconvenient truths, and engaging the young.

To expand the clinical practice of nutrition, the influence of the American Society for Parenteral and Enteral Nutrition (ASPEN) must reach an audience outside the nutrition community, must be relevant and meaningful to clinicians, and must meet the needs of specific patient populations throughout medical and surgical specialties. Individual members of our society need to share their enthusiasm and expertise with youth through conscious, intentional mentorship. Efforts should be made to promote advanced practice, increasing the skill set of the individual nutritionist. Nutrition research should be of the highest quality, matching that of any current medical or surgical discipline. Members of a nutrition consult service should speak the same language as the physicians they work with, through discussions on rounds and in communication through their charting and consult notes. Our societal guidelines should define clinical practice. Relationships with other societies should be cultivated through these guidelines, position papers, and public health initiatives to increase the relevance and impact of our society. To position itself for future generations, the role of ASPEN should be expanded to be more comprehensive and involve all nutrition aspects of patient care.

Light protection of parenteral nutrition, cholestasis, and other prematurity-related morbidities in premature infants

IntroductionParenteral Nutrition (PN) can lead to intestinal failure associated liver disease (IFALD). There are no human studies to date studying specifically the benefits of light-protection on neonatal IFALD. Recently, the European Medicines Agency and the American Society for Parenteral and Enteral Nutrition (ASPEN) both recommended full light protection of PN to reduce the risk of adverse clinical outcomes.ObjectiveThe primary objective of this study was to evaluate the impact of light-protecting PN on the incidence of cholestasis and peak direct bilirubin levels in premature infants.Study designRetrospective chart review of preterm infants requiring PN for a minimum of 2 weeks with or without light-protection. After light protection of the PN solution, primary outcomes (including cholestasis and direct bilirubin levels) of both groups were compared. Secondary outcomes include evaluation of bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), retinopathy of prematurity (ROP), sepsis and mortality.ResultsA total of 50 preterm infants <37 weeks gestation were included, 25 infants in each group. There was a statistically significant decrease in the rate of cholestasis (12 vs. 3, p = 0.005), median peak direct bilirubin levels (1.7 vs. 0.9 mg/dL, p = 0.02) and total bilirubin levels (4.1 vs. 3.4, p = 0.05) in the light-protection group compared to no light-protection group. There was a decrease in the incidence of severe BPD (with an increase of mild BPD, resulting in the same overall BPD rate) in the light-protection compared to no light-protection group (7 vs. 15, p = 0.0223). There was no difference in NEC, ROP, sepsis or mortality.ConclusionOur study supports that the practice of light-protecting PN may reduce the incidence of IFALD in premature infants. Moreover, there was a trend toward decreased incidence of severe BPD in the light-protection group. Further light protection studies are needed to confirm these findings.