Clinical Nutrition Research Articles

Impact of daily cyclic enteral nutrition versus standard continuous enteral nutrition in critically ill patients: a study protocol for a randomised controlled trial in three intensive care units in France (DC-SCENIC)

IntroductionCurrent guidelines on clinical nutrition of ventilated patients in the intensive care unit (ICU) recommend initiating continuous enteral nutrition within 48 hours of ICU admission when feasible. However, discontinuous feeding...

Pregorexia and its significance for physiological processes in the fetus - a review of current knowledge.

Anorexia occurring during pregnancy can have a devastating effect on the pregnant woman's physiological clinical picture, mental health, and fetal development. This is because eating behaviors, the fetal programming process, and behavioral-cognitive relationships all contribute to shaping intrauterine conditions. Dysfunction at the neural level predisposes to a disturbed relationship with food, reduced self-acceptance, perinatal depression, and a negative perception of body image. The health consequences of reduced energy intake in the course of anorexia during pregnancy contribute to the manifestation of maternal ketonuria, ketonemia, increased excretion (excretion) of nitrogen during diuresis, decreased synthesis of gluconeogenic amino acids after starvation in pregnancy. Scientific reports confirm the destructive impact of behavioral disorders focused on significant food restriction. Medical and psychological care in pregorexia (anorexia of pregnancy) is an integral part of support during pregnancy and the perinatal period. Support includes psychoeducation and includes monitoring of weight, mental and physical health, and identified risk factors. The interdisciplinary team taking care of a pregnant woman with anorexia should include a gynecologist, midwives, a psychiatrist, a clinical nutritionist, a psychodietitian, a psychotherapist, a psychologist and involved family members. Long-term, consecutively implemented nutrition education along with the use of dedicated diagnostic tools in the form of Eating Disorders Diagnostic Scale (EDDS) and psychodietetic intervention based on motivational dialogue should be an integral part of cognitive-behavioral therapy.

Patient preferences in diabetes care: a bibliometric analysis

Background: The purpose of the study was to explore patient preferences in diabetes care by analyzing network visualization, overlay visualization, and density visualization. Main body: The study used bibliometric analysis for assessing related topics and patient preferences in diabetes care based on the repetition terms received. The data sources were based on online searches via https://app.dimensions.ai/ collected on August 22, 2023. The literature search was restricted to publications years 2015-2023, focused on the fields of Health sciences, biomedical and clinical science, nursing, public health, psychology, human society, nutrition and diabetes. Data were analysed using VOSviewer, The type of analysis is selected to create a map based on text data, further reviewed by co-occurrence and co-authors. From the network visualization, it was identified that there were 172 terminology items which were divided into 8 clusters with 6247 links with a strength of 34258. From each cluster, patient preferences among patients with diabetes were identified. Through overlay visualization analysis, it identified that a new topic being researched by scholars in various countries was racism toward patients with diabetes. Furthermore, in density visualization, a topic that few researchers have explored related to fulfilling patient preferences in diabetes care by maximizing telemedicine technology. Conclusion: Patient preferences in diabetes care are necessary. If patient preferences are considered, patients will feel involved in every decision-making as a result, they will be more responsible for the behaviour changes they have to make in diabetes care.

Applicability of the Diagnostic Criteria for Sarcopenic Obesity Defined by ESPEN/EASO Criteria in Acutely Admitted Patients with Stroke: Prevalence and Association with Outcomes.

Few reports have described sarcopenic obesity in patients with stroke. This study aimed to investigate the prevalence of sarcopenic obesity, as defined by the European Society for Clinical Nutrition and Metabolism (ESPEN) and European Association for the Study of Obesity (EASO) consensus statement, in patients with acute stroke and to determine whether it was associated with improved physical function at discharge. This retrospective cohort study was conducted from May 2020 to November 2021 in patients with acute stroke. Sarcopenic obesity was determined using the ESPEN and EASO consensus statement. The main outcome was physical function based on the Functional Independence Measure motor score at discharge. Multiple regression analysis was conducted to evaluate the association between sarcopenic obesity and the Functional Independence Measure motor score. This study included 276 patients (182 men; mean age, 72.4 y). Sarcopenic obesity screened for obesity with body mass index >27.5 was found in 11 (4%) patients. Multiple regression analysis revealed that sarcopenic obesity screened for obesity with body mass index >27.5 was not significantly associated with the Functional Independence Measure motor score at discharge (β=0.038; 95% confidence interval: -0.046, 0.123; p=0.369). This study revealed a prevalence rate of 4% for sarcopenic obesity diagnosed by the ESPEN and EASO criteria and showed that sarcopenic obesity was not statistically associated with activities of daily living at acute discharge in patients with stroke.

The Effectiveness of Modified Atkins Ketogenic Diet on Children with Intractable Epilepsy: A Pilot Study from Indonesia.

The ketogenic diet has recently been explored as a potential treatment approach for intractable epilepsy in children and has been applied in various parts of the world. The ketogenic diet is also effective for the treatment of mood disorders, especially for adolescent and young adults with epilepsy. The Modified Atkins Diet (MAD) is the less restrictive type of ketogenic diet with similar principles as the classic type. However, no study has been conducted to evaluate the use of MAD in children with severe epilepsy in Indonesia. This study aims to assess the effectiveness, tolerance, compliance, and the adverse effects of MAD in children with intractable epilepsy during a 6-month monitoring period. This is a pilot experimental study involving children aged 2-18 years old with intractable epilepsy at the Pediatric Neurology and the Pediatric Nutrition & Metabolic Diseases Clinics at the Dr. Cipto Mangunkusumo Hospital Jakarta between November 2021 and June 2022. A total of 31 subjects met the inclusion criteria and received the MAD in the first month, followed by 13 (41.9%) subjects in the third month, and 9 (29%) subjects in the sixth month. The MAD reduced the seizure frequency by 50% (p = 0.144), 62% (p = 0.221), and 83.3% (p = 0.028) in the first, third, and sixth months, respectively. The most frequent adverse effects are vomiting and diarrhea. Noncompliance was observed in 18 (58.1%) subjects. A sample of the MAD food menu guidebook was developed to make it easier for parents to adhere to the diet. The MAD reduces the mean seizure frequency in children with intractable epilepsy in the first, third, and sixth months, with a statistical significance in the sixth month. A further randomized, controlled, and multicenter clinical trial with a larger sample size and longer observation period is required. This trial is registered with Protocol ID 20-10-1323.

Evidence-Based Practice Competencies among Nutrition Professionals and Students: A Systematic Review

BackgroundEvidence-based practice (EBP) promotes shared decision-making between clinicians and patients. ObjectiveThe aim was to determine EBP competencies among nutrition professionals and students reported in the literature. MethodsWe conducted a systematic review by searching Medline, Embase, CINAHL, ERIC, CENTRAL, ProQuest Dissertations and Theses Global, BIOSIS Citation Index, and clinicaltrials.gov up to March 2023. Eligible primary studies had to assess one of the 6 predefined EBP competencies: formulating clinical questions; searching literature for best evidence; assessing studies for methodological quality; effect size; certainty of evidence for effects; and determining the applicability of study results considering patient values and preferences. Two reviewers independently screened articles and extracted data, and results were summarized for each EBP competency. ResultsWe identified 12 eligible cross-sectional survey studies, comprising 1065 participants, primarily registered dietitians, across 6 countries, with the majority assessed in the United States (n = 470). The reporting quality of the survey studies was poor overall, with 43% of items not reported. Only 1 study (8%) explicitly used an objective questionnaire to assess EBP competencies. In general, the 6 competencies were incompletely defined or reported (e.g., it was unclear what applicability and critical appraisal referred to and what study designs were appraised by the participants). Two core competencies, interpreting effect size and certainty of evidence for effects, were not assessed. ConclusionsThe overall quality of study reports was poor, and the questionnaires were predominantly self-perceived, as opposed to objective assessments. No studies reported on competencies in interpreting effect size or certainty of evidence, competencies essential for optimizing clinical nutrition decision-making. Future surveys should objectively assess core EBP competencies using sensible, specific questionnaires. Furthermore, EBP competencies need to be standardized across dietetic programs to minimize heterogeneity in the training, understanding, evaluation, and application among dietetics practitioners.This study was registered at PROSPERO as CRD42022311916.

Nutrition in Alzheimer’s disease

Dementia in Alzheimer’s disease leads to the loss of independence and the onset of disability, which, combined with the deficits common in old age, creates a barrier to maintaining good nutritional status and represents a risk factor to the development of malnutrition. The aims of this synthesis were to collect data on the role of diet in the prevention of dementia and discuss the appropriate nutrition for patients at different stages of Alzheimer’s disease. In addition, the study aimed to provide an overview of methods for assessing nutritional status to allow the selection of an appropriate management strategy for patients with dementia. Findings on the role of diet in dementia prevention have identified certain dietary patterns that can be considered beneficial. The article also discusses the European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines published in 2015, which address nutritional care for dementia patients. These include recommendations for dietary assessment, dietary modifications, and nutrient supplementation. An important aspect of the article is the subject of dysphagia, which affects a significant number of Alzheimer’s disease sufferers. The paper highlights selected recommendations for dietary modification from the European Society for Swallowing Disorders (ESSD) and the European Geriatric Medicine Society (EuGMS).

“Light through Life”– an inter-disciplinary long-term integrated health promotion programme for overweight and obese people

Introduction/Background: In 2019, around half of the Austrian adult population was overweight or obese, and this has only worsened during the COVID-19 pandemic. While research is clear that sustainable weight loss needs a long-term and holistic approach to support lifestyle changes and address the underlying causes of overweight and obesity, most weight loss programmes offer only short-term and single intervention solutions, with a focus on either raising physical activity or changing nutritional habits. To raise the potential for success and translate research into practice, the Austrian Social Insurance Fund for Public Service, Railway and Mining Industries developed “Light through Life”, a long-term integrated health promotion programme, which started in January 2022.
 Who is it for? The programme was developed by an interdisciplinary team of the social insurance fund and is offered to their adult insurees, who are overweight or obese. They can register themselves, be transferred by their GP or continue after other health promotion and rehabilitation programmes offered by the social insurance fund. The programme itself consists of three phases, which are designed to progressively enable participants to not only manage their weight, but self-sufficiently design their own healthy lifestyle. Regular monitoring, participant feedback and an independent evaluation ensure that a continuous improvement process takes into account the needs of the participants and adjust the programme accordingly.
 What did you do? “Light through Life” aims to strengthen health literacy and self-management skills of the participants by focussing on four themes: clinical aspects, physical activity, nutrition, and mental health. In addition they receive ongoing support through prevention coordinators. The first phase is a 6-months intensive basic programme, which combines face to face lectures with practical classes covering the four topics. The focus is on creating an understanding of what influences their health and thus their weight and how to manage it differently. The participants learn in groups to create a community of practice. The programme encourages participants to set their own goals and monitor them. In the second phase, the year- long “Pro” programme the support offered changes to coaching and more person-focussed training. In this phase, participants should be able to manage themselves, with thematic workshops and trainings reinforcing the learned content or addressing specific needs. Participation throughout the programme is voluntary.
 What results did you get? What impact did you have? The programme was introduced with an independent evaluation in place. The evaluation uses a mixed methods approach, analysing both process and outcome measures for participants and professionals. The comprehensive quantitative data collected through regular clinical examinations and an extensive lifestyle questionnaire will enable a better understanding of which elements work and which need improvement. A first, preliminary analysis of the baseline data and after 6 months shows weight and waist circumference reductions in all groups safe obese men (above BMI of 36). More detailed analyses also including mental health and e.g. the urban-rural divide will be available for the conference.
 With a comprehensive analysis of the first year of the programme, recommendations will be formulated.
 
 

Integrated care for endometriosis: a qualitative study investigating nutrition and lifestyle factors.

Introduction: Endometriosis is estimated to affect around one in 10 women in the UK and an estimated 200 million women worldwide. Despite evidence in the current literature around the benefits of using dietary and lifestyle interventions there has been limited research into incorporating these into person-centred care for the condition. Studies have supported a reduction in endometriosis pain when anti-inflammatory and anti-oestrogen dietary interventions were introduced. Also pain reduction has been reported in small studies on gluten free diets. Further studies have also identified that diets high in cruciferous vegetables, fresh fruit and antioxidants helped to reduce oestrogen, oxidative stress, and inflammatory processes. The researcher team comprised of two researchers, both diagnosed with endometriosis. So, this is a patient-led research project, devised as self-management of the condition has been important in managing both of the researchers’ symptoms. 
 Aims: To explore the potential role for nutrition and lifestyle medicine in endometriosis as a self-management tool, and the barriers and challenges women with endometriosis face which prevent them from implementing beneficial nutrition and lifestyle changes. 
 Methods: A qualitative methodology was used, with an anonymous online survey including open questions as the form of data collection. Snowball and purposive sampling were used to obtain participants. The inclusion criteria were women who live in the UK, 18 years or over who have diagnosed endometriosis. The data was analysed using inductive coding and thematic analysis.
 Results: A total of 42 participants completed the online survey. Eight subordinate themes were derived from 80 data codes and developed into four main superordinate themes: 1. Advice and support provided from healthcare professionals or nutrition professionals, 2. Diet and lifestyle changes already implemented and effects, 3. Endometriosis symptoms and 4. Barriers and motivation to change. The study found that women with diagnosed endometriosis received either no or poor-quality advice from their medical or health care professionals in relation to dietary changes. Most of the advice sought and implemented was from a variety of self-researched sources such as books, online websites and endometriosis support groups. Women had tried and reported benefits from a variety of different dietary or lifestyle interventions including, removal of gluten, increasing fruit and vegetable consumption, walking, yoga, Pilates, and meditation. There appeared to be very little or no professional support for patients with endometriosis in terms of implementing person centred nutrition or lifestyle goals.
 
 Conclusion: The existing dietary advice to women with endometriosis remains poor and participants specifically highlighted their desire for more evidence-based support with this. Identifying barriers to implementing dietary and lifestyle interventions will likely assist and facilitate the implementation of nutrition and lifestyle person-centred goals. Due to the wide variety of symptoms women with endometriosis can experience, a more individualised nutrition and lifestyle approach alongside existing care can provide a key role in improving practice in this area. More studies are needed on both nutritional and lifestyle approaches to managing endometriosis. This project has demonstrated that patient-led research has the potential to inform practice and shape research priorities.
 
 

Trans-disciplinary learnings from lived experience: person-centred integrated infertility care.

Introduction: Infertility is a stigmatising condition with profound psychosocial impacts. It is estimated it affects 48.5 million couples globally (Mascarenhas et al., 2012) and in the UK, one in seven couples have problems conceiving (NHS, 2020). Rates of infertility are increasing in both genders (Sun et al, 2019).
 Aims: To explore the lived experience of patients with infertility to identify opportunities for improvements in care and education of healthcare professionals (HCPs), and to investigate the potential of nutrition and lifestyle medicine as an adjunct to care.
 Methods: Critical reflections on a trans-disciplinary portfolio of seven publications about infertility authored or co-authored by a researcher with personal experience of infertility. These were published from 2015, and include peer-reviewed research articles, a case report, a textbook, a performance, creative artefacts including poems and a story. All embed patient voice as a fundamental element. The overall methodological framework adopted reflects a multi-lens interpretive, phenomenological, heuristic inquiry informed by a relativist ontology. Synthesis connectivity has been used to analyse the works, this approach is recommended by both Grant (2011) and Smith (2015). 
 Findings: Three research questions and findings were identified.
 1.How to improve care / outcomes? 
 Explored in publications 1, 2, 3, 4, 6, 7. Findings were optimal nutritional status and weight management supports fertility in both men and women, so nutrition care should be an integral part of care. Additionally, understanding the lived experience of infertility better facilitates effective care/counselling and improves patient experience. 
 2.How lived experience of infertility can shape clinical education/research?
 Explored in publications 2, 3, 4, 4a, 4b, 4c, 5, 6, 7. Findings were that co-creation of educational resources with people experiencing infertility, narratives of lived experience and interdisciplinary approaches have the potential to improve HCP & medical education; however, this needs to be aligned with involvement and engagement within research and curricula design.
 3.The role of gluten (a protein in grains) in infertility?
 Considered in publications 1,2,3,4,6,7. Gluten can negatively affect fertility in people diagnosed with coeliac disease, but fertility can also be affected in women with non-coeliac gluten sensitivity and more education is needed as professional awareness of the fertility implications of both coeliac disease and gluten sensitivity is low.
 Conclusions: Person-centred integrated infertility care needs to take account of the psycho-social impacts associated with infertility, include psycho-therapeutic support and also nutritional and lifestyle medicine. Where there is unexplained infertility or recurrent miscarriage, the potential role of gluten should be considered. Lived experience of infertility can be used as tool in HCP and medical education and socially to lessen stigmatisation and improve communication about infertility. Involvement needs to be aligned across the entirety of healthcare delivery, from clinical settings, through to both education and research (a 3-dimensional model called PRISM has been developed to triangulate involvement).

Implementation and participation of an online nutrition curriculum for pediatric gastroenterology fellows.

Our team of nutrition experts developed an online nutrition curriculum consisting of 21 modules to serve as a resource for a stand-alone nutrition curriculum or as a supplement to existing nutrition electives during the Pediatric Gastroenterology fellowship. From April 2020 through January 2023, 2090 modules were completed by 436 fellows from 75 different programs across North America. The program was accessed most during tight restrictions on in-person learning during the COVID-19 pandemic. Overall, participants posttest scores improved from baseline pretest scores indicating retention of information from the modules. The overall success of this program suggests that there should be continued efforts to develop and offer online learning opportunities in clinical nutrition. There is an opportunity to expand the audience for the curriculum to include pediatric gastroenterologists from across the globe.

ESPEN practical guideline on clinical nutrition in acute and chronic pancreatitis

Both acute and chronic pancreatitis are frequent diseases of the pancreas, which, despite being of benign nature, are related to a significant risk of malnutrition and may require nutritional support. Acute necrotizing pancreatitis is encountered in 20% of patients with acute pancreatitis, is associated with increased morbidity and mortality, and may require artificial nutrition by enteral or parenteral route, as well as additional endoscopic, radiological or surgical interventions. Chronic pancreatitis represents a chronic inflammation of the pancreatic gland with development of fibrosis. Abdominal pain leading to decreased oral intake, as well as exocrine and endocrine failure are frequent complications of the disease. All of the above represent risk factors related to malnutrition. Therefore, patients with chronic pancreatitis should be considered at risk, screened and supplemented accordingly. Moreover, osteoporosis and increased facture risk should be acknowledged in patients with chronic pancreatitis, and preventive measures should be considered.

Which is the best diet to reduce cardiometabolic risk: dietary counseling or home-delivered diet?

Non-compliance with medical nutrition therapy can lead to an increase in cardiometabolic risk factors, resulting in an increase in the frequency of morbidity and mortality. This study aims to compare the effectiveness of two different medical nutrition therapies designed to reduce cardiometabolic risk factors. The study was conducted on voluntary overweight and obese women who sought services at a specialized Nutrition and Dietary Counseling Clinic. The clinic offered dietary counseling (n = 47) and home-delivered diet (n = 53) services, and the participants themselves decided which method they preferred. Both groups were followed for a period of 4 weeks. The general information, physical activity (PA) status, biochemical findings, blood pressure, anthropometric measurements, and bioelectrical impedance analysis (BIA) of the voluntary participants were evaluated. Taking into consideration the participants' dietary habits and health status, an appropriate dietary plan (55-60% carbohydrates, 15-20 protein%, 25-30% fat) was prepared. The anthropometric measurements, blood pressure, and biochemical parameters of overweight and obese individuals who received dietary counseling and home-delivered diet services were evaluated before and after the diet. In both groups, cardiometabolic risk factors were found to decrease. It was determined that those who received the home-delivered diet service had a greater reduction in body weight, Body Mass Index values, body fat percentages, and waist circumferences compared to those who received dietary counseling (P < 0.001). Similarly, fasting blood glucose, triglyceride, and blood pressure values were found to decrease more significantly in individuals receiving the home-delivered diet service (P < 0.001). Additionally, both groups showed an increase in High-Density Lipoprotein Cholesterol (HDL-C) levels, with a greater increase observed in those receiving the home-delivered diet service (P < 0.001). According to the findings of this study, participants who received the home-delivered diet service, which is particularly beneficial for individuals who struggle with healthy meal preparation and portion control, exhibited better adherence to medical nutrition therapy and experienced a greater reduction in cardiometabolic risk factors compared to those who received dietary counseling.

An Atypical Course of Cardiomyopathy Syndrome (CMS) in Farmed Atlantic Salmon (Salmo salar) Fed a Clinical Nutrition Diet.

Cardiomyopathy syndrome (CMS) poses a significant threat to farmed Atlantic salmon (Salmo salar), leading to high mortality rates during the seawater phase. Given that controlled experimental challenge trials with PMCV do not reproduce the mortality observed in severe field outbreaks of CMS, field trials on natural CMS outbreaks are warranted. This field study explored the impact of a clinical nutrition intervention, specifically a diet enriched with eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), on a severe CMS outbreak in a commercial sea farm. CMS was diagnosed in a single sea cage with high mortality rates. Histopathological analysis, RT-qPCR in situ hybridization for virus detection, and fatty acid composition analysis were used to monitor the impact of disease and the inclusion of EPA and DHA in heart tissue. Following the implementation of clinical nutrition, a decline in mortality rates, regression of CMS-associated changes, and a significant reduction in piscine myocarditis virus (PMCV) RNA load were observed within the salmon population. Fatty acid composition analysis of heart samples demonstrated increased levels of EPA and DHA, reinforcing the association between dietary factors, viral load dynamics, and overall fish health. Although further validation is needed in future studies, as field trials may not be sufficient to establish causation, our results indicate that optimizing the EPA + DHA levels may prove beneficial in severe CMS outbreaks.

Changes in the urinary proteome of rats after short-term intake of magnesium L-threonate(MgT).

Magnesium (Mg) is an important mineral in living organisms. Magnesium has multiple functions in the human body, wherein it plays an important therapeutic and preventive role in a variety of diseases. Urine samples of rats before and after gavage of magnesium L-threonate (MgT) were collected, and the urinary proteome was identified using the LC-MS/MS technique and analyzed using various databases. The results illustrated that the urinary proteome of rats was significantly altered after short-term intake of magnesium supplements and that the differential proteins and the biological functions were related to magnesium. This study innovatively establishes a method to study nutrients from the perspective of urine proteomics. This work demonstrates that the urinary proteome is capable of reflecting the effects of nutrient intake on the organism in a more systematic and comprehensive manner and has the potential to provide clues for clinical nutrition research and practice.

Octanoic acid-rich enteral nutrition attenuated hypercatabolism through the acylated ghrelin-POMC pathway in endotoxemic rats

ObjectivesMetabolic disorders and no response to intravenous nutrition because of sepsis have been urgent problems for clinical nutrition support. Enteral nutrition (EN) has been an important clinical therapeutic measure in septic patients; however, simple EN has not demonstrated good performance. This study aimed to investigate the effects of different concentrations of octanoic acid (OA)-rich EN on hypercatabolism in endotoxemic rats and test whether OA-rich EN could attenuate hypercatabolism through the acylated ghrelin-proopiomelanocortin (POMC) pathway. MethodsRats were randomly divided into six groups: sham, lipopolysaccharide (LPS), LPS + EN and LPS + EN + OA (0.25, 0.5, and 1 g/kg, respectively) groups to investigate the effects of different concentrations of OA-rich EN on hypercatabolism in endotoxemic rats. The rats were then randomly divided into four groups: sham, LPS, LPS + OA, and LPS + OA + Go-CoA-Tat, to test whether OA-rich EN attenuated hypercatabolism through the acylated ghrelin-POMC pathway. Rats received nutrition support via a gastric tube for 3 d (100 kcal/kg daily). Insulin resistance, muscle protein synthesis and atrophy, inflammatory cytokines, ghrelin in circulation and hypothalamus, ghrelin O-acyltransferase (GOAT), and the adenosine 5′-monophosphate-activated protein kinase (AMPK)-autophagy-POMC pathway were measured. ResultsCompared with simple EN, OA-rich EN promoted the acylation of ghrelin in a dose-dependent manner and attenuated POMC-mediated hypercatabolism in endotoxemic rats. Inhibition of GOAT activity decreased the level of acylated ghrelin and aggravated POMC-mediated hypercatabolism conferred by OA-rich EN. ConclusionsOA-rich EN could increase the level of acylated ghrelin and attenuate hypercatabolism through the acylated ghrelin-POMC pathway compared with simple EN in endotoxemic rats.

Impact of cardiac rehabilitation on pre- and post-operative transcatheter aortic valve replacement prognoses.

Transcatheter aortic valve replacement (TAVR) is a relatively new treatment method for aortic stenosis (AS) and has been demonstrated to be suitable for patients with varying risk levels. Indeed, among high-risk patients, TAVR outcomes are comparable to, or even better, than that of the traditional surgical aortic valve replacement (SAVR) method. TAVR outcomes, with respect to post-surgical functional capacity and quality of life, have also been found to be improved, especially when combined with cardiac rehabilitation (CR). CR is a multidisciplinary system, which integrates cardiology with other medical disciplines, such as sports, nutritional, mind-body, and behavioral medicine. It entails the development of appropriate medication, exercise, and diet prescriptions, along with providing psychological support, ensuring the cessation of smoking, and developing risk factor management strategies for cardiovascular disease patients. However, even with CR being able to improve TAVR outcomes and reduce post-surgical mortality rates, it still has largely been underutilized in clinical settings. This article reviews the usage of CR during both pre-and postoperative periods for valvular diseases, and the factors involved in influencing subsequent patient prognoses, thereby providing a direction for subsequent research and clinical applications.

The science of micronutrients in clinical practice – Report on the ESPEN symposium

The European Society for Clinical Nutrition and Metabolism published its first clinical guidelines for use of micronutrients (MNs) in 2022. A two-day web symposium was organized in November 2022 discussing how to apply the guidelines in clinical practice. The present paper reports the main findings of this symposium. Current evidence was discussed, the first day being devoted to clarifying the biology underlying the guidelines, especially regarding the definition of deficiency, the impact of inflammation, and the roles in antioxidant defences and immunity. The second day focused on clinical situations with high prevalence of MN depletion and deficiency. The importance of the determination of MN status in patients at risk and diagnosis of deficiencies is still insufficiently perceived, considering the essential role of MNs in immune and antioxidant defences. Epidemiological data show that deficiencies of several MNs (iron, iodine, vitamin D) are a global problem that affects human health and well-being including immune responses such as to vaccination. Clinical conditions frequently associated with MN deficiencies were discussed including cancer, obesity with impact of bariatric surgery, diseases of the gastrointestinal tract, critical illness, and aging. In all these conditions, MN deficiency is associated with worsening of outcomes. The recurrent problem of shortage of MN products, but also lack of individual MN-products is a worldwide problem. Despite important progress in epidemiology and clinical nutrition, numerous gaps in practice persist. MN depletion and deficiency are frequently insufficiently searched for in clinical conditions, leading to inadequate treatment. The symposium concluded that more research and continued education are required to improve patient outcome.

Explanatory sequential mixed-methods approach to understand how registered dietitians implemented computed tomography skeletal muscle assessments in clinical practice.

There is a need to adopt valid techniques to assess skeletal muscle (SM) in clinical practice. SM can be precisely quantified from computed tomography (CT) images. This study describes how registered dietitians (RDs), trained to quantify SM from CT images, implemented this technique in clinical practice. This was an explanatory sequential mixed-methods design with a quantitative and a qualitative phase. RDs collected data describing how they implemented CT SM assessments in clinical practice, followed by a focus group exploring barriers and enablers to using CT SM assessments. RDs (N = 4) completed 96 CT SM assessments, with most (94%, N = 90/96) taking <15 min to complete. RDs identified reduced muscle mass in 63% (N = 45/72) of men and 71% (N = 17/24) of women. RDs used results of CT SM assessments to increase protein composition of the diet/nutrition support, advocate for initiation or longer duration of nutrition support, coordinate nutrition care, and provide nutrition education to patients and other health service providers. The main barriers to implementing CT SM assessments in clinical practice related to cumbersome health system processes (ie, CT image acquisition) and challenges integrating CT image analysis software into the health system computing environment. Preliminary results suggest RDs found CT SM assessments positively contributed to their nutrition care practice, particularly in completing nutrition assessments and in planning, advocating for, and implementing nutrition interventions. Use of CT SM assessments in clinical practice requires innovative IT solutions and strategies to support skill development and use in clinical nutrition care.

A bibliometric analysis and visualization of research on heart failure complicated with malnutrition

Abstract Objective This study aimed to have a good knowledge of heart failure complicated with malnutrition research status, hotspots, and forecast research trends using bibliometric analysis and visualization of studies of heart failure complicated with malnutrition in the past 10 years. Methods Articles related to malnutrition-induced heart failure were obtained from the Web of Science Core Collection (WoSCC) series from January 2012 to January 2022. Two software (Java CiteSpace 5.8R3 and Microsoft Excel 2019) were used to perform bibliometric and knowledge-map analysis, including analyzing the annual publication and trend of articles, authors and co-cited authors, institutions/countries, co-cited journals, co-occurrence, clusters, and burst of keywords, co-cited references, and reference burst. Results A total of 672 articles appeared in 180 scientific journals by 4249 authors from 1453 institutions in 71 countries. Over the past 10 years, the number of related studies released has shown an upward trend, and the range of increases has been larger over the past 5 years. Takatoshi Kasai released the most papers, while Anker S D had the most co-quotes. Simultaneously, active cooperation existed in complicated heart failure with researchers on malnutrition. Circulation, Journal of The American College of Cardiology, and Clinical Nutrition were the top 3 co-cited journals. The USA, Japan, and China were the most productive countries, while Johns Hopkins University was the most active institution. In addition, the reference published by Ponikowski P had the most co-citations, relating to as a knowledge base. The latest hotspots of heart failure complicated with malnutrition mainly included research on: (1) assessment of nutrition status, the impact/risk factor of nutrition, and the prevalence and outcome of the patients; (2) heart failure complicated with malnutrition when complicated with other diseases, for example, chronic kidney disease and diabetes mellitus; (3) the nutrition of child patients with heart failure complicated with malnutrition; and (4) the treatment of heart failure complicated with malnutrition, including assist devices, organ transplantation, and drug therapy. While the frontier topics included research on: (1) the index of heart failure complicated with malnutrition; (2) the effect of sarcopenia to heart failure complicated with malnutrition patients and the use of geriatric nutritional risk index to assess the nutritional statue; and (3) find the nutritional risk index. Conclusions This study conducted a full overview of the present research situation, hotspots, and frontiers by using bibliometric and visualization analysis methods in heart failure complicated with malnutrition, which would provide a helpful reference for future research.