Early Nutrition Research Articles

Early versus late parenteral nutrition in term and late preterm infants: a randomised controlled trial

BackgroundThere is limited evidence regarding the optimal time to commence parenteral nutrition (PN) in term and late preterm infants.DesignSingle-centre, non-blinded, exploratory randomised controlled trial.SettingA level-3 neonatal unit in a stand-alone...

Exploring cultural influences in perinatal and early childhood nutrition

Exploring cultural influences in perinatal and early childhood nutrition

Monitoring mammary gland development in preweaned dairy heifers using ultrasound imaging

Existing literature on the long-term effects of nutritional manipulation on milk production is incomplete and inconsistent as animals are typically culled before lactation. In addition, longitudinal studies are rarely conducted due to high costs and constraints related to tissue sampling; therefore, additional research is necessary to better understand the effect of early nutrition and growth on subsequent growth and milk production. Thirty Holstein heifer calves were pair-fed high (H; 22% crude protein and 15% fat) or low (L; 27% crude protein and 20% fat) milk replacers. Mammary gland ultrasound images and body weights were collected twice weekly, and blood samples weekly, for the first 8 weeks of life. Calves fed H had higher average daily gain (ADG) and mammary gland growth through 8 weeks of life. Calves from the H group also had larger fat pads at 8 weeks of age. Glucose and insulin concentrations were increased in H calves compared with L calves, whereas NEFA concentrations were not different between treatments. Our results suggest that ultrasound is a practical, noninvasive tool to monitor udder development preweaning, although additional research is necessary to improve image analysis techniques to analyze tissue composition. Our preliminary work provides data suggesting that the use of mammary gland ultrasound could provide a method of longitudinal analysis of the effects of preweaning nutrition on milk production.

The efficacy of nutritional screening indexes in predicting the incidence of osteosarcopenia and major osteoporotic fracture in the elderly.

The effect of nutritional status on osteosarcopenia (OS) and major osteoporotic fracture (MOF) among the elderly is still unclear. So we aimed to compare the efficacy of the Mini-Nutrition Assessment-Short Form (MNA-sf), the Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT) for predicting OS and MOF among the elderly. A total of 409 participants were enrolled in this prospective study. Blood biochemical indexes, nutritional status, and bone- and muscle-related examinations were assessed at initial visit to the outpatient. Participants were divided into 4 groups: (1) control; (2) osteopenia/osteoporosis; (3) sarcopenia; (4) osteosarcopenia, and then followed for 5years, recording the occurrence time of MOF. The frequency values of osteopenia/osteoporosis, sarcopenia, and OS, at baseline, were respectively 13.4, 16.1, and 12% among the study samples. Correlation analysis showed that nutritional status scores were associated with body mass index, handgrip strength, albumin, bone mineral density, and physical functions. According to multivariate models, poor nutritional status was significantly associated with a higher risk of OS and MOF (P<0.05). Survival analysis showed that the MOF rate in malnutrition group was significantly higher than normal nutrition group (P<0.05). The receiver operator characteristic curve shows that the value of MNA-sf to diagnose OS and MOF is greater (P<0.05). The poor nutritional status was associated with a higher risk of both OS and MOF. MNA-sf showed a superior diagnostic power for OS and MOF among the elderly. Early nutrition assessments and interventions may be key strategies to prevent OS and fractures.

Supportive supervision of village, health, sanitation and nutrition day (VHSND) during post-pandemic period in Assam

Background: VHSND, a community platform bringing health, early childhood development, nutrition, and sanitation services by community engagement was affected by COVID-19 pandemic. Aims &amp; Objectives: To assess the process of VHSND implementation during post-pandemic period in Assam. Methodology: This cross-sectional study was conducted as operational research in five districts of Assam, selected based on zonal representation; between Sept’2021- Aug’2022. Standard format (GOI) was used for VHSND monitoring. Descriptive analysis was done along with quarter-wise comparison of observations and knowledge of Auxiliary Nurse and Midwife (ANM). Results: A total of 370 VHSND sessions were observed. VHSND micro plan availability increased from 87.5% to 98.4% over four quarters. Displaying banners varied between 56.3% and 79.5%, and functional toilets increased from 41.3% to 77%. Height measurement improved from 58.8% to 88.5%. Haemoglobin estimation varied between 46.3% and 75.4%. Recognition of high-risk pregnancies due to severe anaemia increased from 60% to 91.8%. Regarding danger signs like bleeding from vagina increased from 50.0% to 95.1%. Conclusion: Notable progress could be documented in logistical readiness and ANM knowledge in different quarters in post-pandemic period. While service delivery and ANM counselling efforts have seen improvement, targeted interventions remain crucial for optimizing maternal and child health outcomes in the region.

Enhancing the Nutrition and Dietary Patterns of Premature Infants by Optimizing Early Neonatal Nutrition

Preterm newborns with very low birth weight, defined as less than 1,500 g, often face challenges in meeting heightened nutritional demands due to physiological and metabolic stress and underdeveloped gastrointestinal systems. This study explored current guidelines and practices in nutritional management for very low birth weight infants, focusing on strategies, including providing human breast milk, donor human milk, parenteral nutrition, and combined nutrition. This retrospective cohort analysis, conducted in an institutional neonatal intensive care unit, reviewed data from medical records of preterm infants weighing 1,000–1,500 g admitted between March–November 2021. Nutritional management involved parenteral or combined nutrition. Data analysis included descriptive statistics, t-tests, Mann–Whitney tests, chi-square tests, and relative risk analysis. Of the 421 reviewed records, 106 met the inclusion criteria. A total of 31 infants received parenteral nutrition, while 75 received combined nutrition. Infants on combined nutrition demonstrated higher weight gain compared to infants on parenteral nutrition (P &lt; 0.05). Relative risk analysis revealed varied associations between nutrition type and comorbidities, suggesting potential benefits and risks of each approach. Combined nutrition effectively met caloric and nutritional needs in very low birth weight infants without increasing morbidity and mortality. It positively impacted weight gain, indicating its viability as an alternative feeding approach.

Association between breastfeeding duration and educational attainment in rural Southwest Uganda: a population-based cohort study

ABSTRACT Background Breastfeeding is important for early childhood nutrition and health. The positive effects on educational outcomes may be attributed to socioeconomic factors. Socioeconomic status is not a strong predictor of breastfeeding in sub-Saharan African countries. Yet, few studies have investigated the association between breastfeeding and educational outcomes in these countries. Objective This study investigated the association between breastfeeding duration and children’s educational attainment in rural Southwest Uganda. Methods We analysed longitudinal data on 3018 children who had information on breastfeeding and were followed for at least 5 years, with at least one primary school grade recorded by 2005. Data on breastfeeding duration were collected from mothers. The highest school grade was recorded repeatedly between ages 6 and 12 years. We calculated age-for-grade based on whether a child was on, over, or under the official age for a grade. Generalised estimating equations and binary logistic regression estimated the effect of breastfeeding duration on being 2 years, 3 or more years, or any years over-age for grade in primary school, adjusting for socioeconomic status and maternal-child characteristics. Results Most mothers breastfed for more than a year. Just over one-third breastfed for 18–23 months, and 30% breastfed for longer. By age eight, 42% of the children were two years over-age for their grade. Three or more years over-age for grade increased from 19% at age nine to 56% at age 12. Both adjusted and unadjusted estimates were consistent in showing reduced odds for children being 2 years, 3 or more years, or any years over-age for grade among children breastfed for 7–12, 13–17, 18–23, and > 23 months compared to those breastfed for 0–6 months. There was no evidence to support an overall association between breastfeeding duration and being over-age for grade. There was no evidence of association in the sex and age sub-group analyses. Conclusion Although we found no association between breastfeeding duration and educational attainment, breastfeeding remains important for children’s health and nutrition, and mothers should be encouraged and supported to breastfeed for the recommended duration.

ERAS Implementation in Thoracic Surgery

This manuscript provides an overview of the principles and requirements for implementing the ERAS program in thoracic surgery.The ERAS program optimises perioperative management of elective lung resection procedures and is based on the ERAS Guidelines for Thoracic Surgery of the ERAS Society. The clinical measures are described as in the current literature, with a focus on postoperative outcome. There are currently 45 enhanced recovery items covering four perioperative phases: from the prehospital admission phase (patient education, screening and treatment of potential risk factors such as anaemia, malnutrition, cessation of nicotine or alcohol abuse, prehabilitation, carbohydrate loading) to the immediate preoperative phase (shortened fasting period, non-sedating premedication, prophylaxis of PONV and thromboembolic complications), the intraoperative measures (antibiotic prophylaxis, standardised anaesthesia, normothermia, targeted fluid therapy, minimally invasive surgery, avoidance of catheters and probes) through to the postoperative measures (early mobilisation, early nutrition, removal of a urinary catheter, hyperglycaemia control). Most of these measures are based on scientific studies, with a high level of evidence and aim to reduce general postoperative complications.The ERAS program is an optimised perioperative treatment approach aiming to improve the postoperative recovery in patients after elective lung resection by reducing the overall complication rates and overall morbidity.

High-Throughput Silica Nanoparticle Detection for Quality Control of Complex Early Life Nutrition Food Matrices.

The addition of nanomaterials to improve product properties has become a matter of course for many commodities: e.g., detergents, cosmetics, and food products. While this practice improves product characteristics, the increasing exposure and potential impact of nanomaterials (<100 nm) raise concerns regarding both the human body and the environment. Special attention should be taken for vulnerable individuals such as those who are ill, elder, or newborns. But detecting and quantifying nanoparticles in complex food matrices like early life nutrition (ELN) poses a significant challenge due to the presence of additional particles, emulsion-droplets, or micelles. There is a pressing demand for standardized protocols for nanoparticle quantification and the specification of "nanoparticle-free" formulations. To address this, silica nanoparticles (SiNPs), commonly used as anticaking agents (AA) in processed food, were employed as a model system to establish characterization methods with different levels of accuracy and sensitivity versus speed, sample handling, and automatization. Different acid treatments were applied for sample digestion, followed by size exclusion chromatography. Morphology, size, and number of NPs were measured by transmission electron microscopy, and the amount of Si was determined by microwave plasma atomic emission spectrometry. This successfully enabled distinguishing SiNP content in ELN food formulations with 2-4% AA from AA-free formulations and sorting SiNPs with diameters of 20, 50, and 80 nm. Moreover, the study revealed the significant influence of the ELN matrix on sample preparation, separation, and characterization steps, necessitating method adaptations compared to the reference (SiNP in water). In the future, we expect these methods to be implemented in standard quality control of formulation processes, which demand high-throughput analysis and automated evaluation.

Early post-natal nutrition and renal consequences in preterm infants.

Early post-natal nutrition and renal consequences in preterm infants.

Pacific Islands Families Study: Food insecurity during pregnancy and secondary school educational achievement

The nutritional environment in early life is a key factor for brain development and function. It is important to understand the relationship between early life nutrition and academic achievement in adolescence. The Pacific Islands families (PIF) birth cohort(1) were born in the year 2000. When their child was 6 weeks old mothers were asked questions concerning food security over the last year. Two binary measures of food security were derived as previously used in PIF and also by the Ministry of Health (MOH). Records of academic achievement for 649 youth were obtained from the National Certificate of Educational Achievement database in 2019. Highest qualifications and a composite ranking score allowed achievement to be assessed at levels 1, 2 and 3 of NCEA and for University Entrance (UE, lowest to highest). More females (27%) than males (18%) achieved UE as their highest qualification and more males (40%) than females (31%) achieved level 1 or 2 as their highest qualification. UE was achieved by 25% of those born into food secure households and 17% from food insecure households. Logistic regression demonstrated that being female increased the odds of achieving UE 1.8 fold and food security a further 1.6 fold. The prevalence of food insecurity was not different by sex but high at 29% and 42% using the PIF and MOH measure of food insecurity respectively. This work emphasises the importance of maternal and early life food security for subsequent academic achievement and the well-being of future generations.

Comparison of Goal Achievement during an Early, Intensive Nutrition Intervention Delivered to People with Upper Gastrointestinal Cancer by Telephone Compared with Mobile Application.

This study is aimed at exploring whether the mode of nutrition intervention delivery affected participant goal achievement in a three-arm randomised controlled trial of early and intensive nutrition intervention delivered to upper gastrointestinal cancer patients. Newly diagnosed upper gastrointestinal cancer patients were recruited from four tertiary hospitals in Melbourne, Australia. Participants in the intervention groups received a regular nutrition intervention for 18 weeks from an experienced dietitian via telephone or mobile application (app) using behaviour change techniques to assist in goal achievement. Univariate and multiple regression models using STATA determined goal achievement, dose, and frequency of contact between groups. A p value <0.05 was considered statistically significant. The telephone group (n = 38) had 1.99 times greater frequency of contact with the research dietitian (95% CI: 1.67 to 2.36, p < 0.001) and 2.37 times higher frequency of goal achievement (95% CI: 1.1 to 5.11, p = 0.03) compared with the mobile app group (n = 36). The higher dose (RR 0.03) of intervention and more behaviour change techniques employed in the telephone group compared with the mobile app group increased participant goal achievement (95% CI: 0.01 to 0.04, p < 0.001). Discussion. Telephone nutrition intervention delivery led to a higher frequency of goal achievement compared to the mobile app intervention. There was also a higher number of behaviour change techniques employed which may have facilitated the greater goal achievement. Mobile app-based delivery may have poorer acceptance in this population with high levels of withdrawal. Practice Implications. We need to ensure that specifically designed technologies for our target populations are fit for purpose, efficacious, and acceptable to both patients and healthcare providers. This trial is registered with ACTRN12617000152325.

Perspective: Nutrition Health Disparities Framework: A Model to Advance Health Equity

Disparities in nutrition, such as poor diet quality and inadequate nutrient intake, arise from multiple factors and are related to adverse health outcomes such as obesity, diabetes, cardiovascular disease, and some cancers. The aim of the current perspective is to present a nutrition-centric socioecological framework that delineates determinants and factors that contribute to diet and nutrition-related disparities among disadvantaged populations. The Nutrition Health Disparities Framework (NHDF) describes the domains (biological, behavioral, physical/built environment, sociocultural environment, and healthcare system) that influence nutrition-related health disparities through the lens of each level of influence (that is, individual, interpersonal, community, and societal). On the basis of the scientific literature, the authors engaged in consensus decision making in selecting nutrition-related determinants of health within each domain and socioecological level when creating the NHDF. The framework identifies how neighborhood food availability and access (individual/built environment) intersect with cultural norms and practices (interpersonal/sociocultural environment) to influence dietary behaviors, exposures, and risk of diet-related diseases. In addition, the NHDF shows how factors such as genetic predisposition (individual/biology), family dietary practices (interpersonal/behavioral), and food marketing policies (societal) may impact the consumption of unhealthy foods and beverages and increase chronic disease risk. Family and peer norms (interpersonal/behavior) related to breastfeeding and early childhood nutrition interact with resource-poor environments such as lack of access to preventive healthcare settings (societal/healthcare system) and low usage of federal nutrition programs (societal/behavioral), which may increase risk of poor nutrition during childhood and food insecurity. The NHDF describes the synergistic interrelationships among factors at different levels of the socioecological model that influence nutrition-related outcomes and exacerbate health disparities. The framework is a useful resource for nutrition researchers, practitioners, food industry leaders, and policymakers interested in improving diet-related health outcomes and promoting health equity in diverse populations.

Nutrition therapy in colorectal cancer patient with severe malnutrition: A case report

Background: Malnutrition in cancer patients generally, and in gastrointestinal cancer specifically, is common, that could be from the cancer itself or the treatment. Thus, it is necessary to follow special nutrition rules in patients with colorectal cancer. This study aims to see the progress of the nutritional status of cancer patients treated with special nutrition rules. Case Description: A 72-year-old man was brought to the ER with the chief complaint of weakness, felt since 1 week ago. Other complaints are loss of appetite and liquid stool. History of weight loss is 12 kg in the last 6 months. He was diagnosed with colorectal cancer 6 months ago. The patient looks pale, with conjunctiva pallor, loss of subcutaneous fat in arms, trunk, and feet, and loss of muscle in the face, ribs, and shoulder. He was then admitted to the ward with a diagnosis of colorectal cancer with severe malnutrition. Nutrition therapy has been given since the beginning. The total energy was 2,100 kkal, with 80gr protein, 280gr carbohydrate, and 70gr fat. The patient was treated for 10 days. Clinically improved: the conjunctiva was no more pallor, arm circumference increased to 19cm, he had gained his appetite, was no longer dripping with norepinephrine, and no longer needed O2 supplementation (SaO2 in room air: 98%). Conclusion: Cancer treatment causes side effects on nutrition status. It is essential to give special nutrition rules to patients with colorectal cancer. Cancer patients also suffer from inadequate food intake, reduced ability to digest food, and disturbed body homeostasis. Malnutrition, especially in cancer patients, could result in general weakening, lower immunity, prolonged recovery period, and lower tolerance to the side effects of cancer therapy. Early nutrition therapy has a good impact on the nutritional status of the cancer patient.

Associations of Infant Feeding, Sleep, and Weight Gain with the Toddler Gut Microbiome.

This study examines how feeding, sleep, and growth during infancy impact the gut microbiome (GM) in toddlers. The research was conducted on toddlers (n = 36), born to Latina women of low-income with obesity. Their mothers completed retrospective feeding and sleeping questionnaires at 1, 6, and 12 months; at 36 months, fecal samples were collected. Sequencing of the 16S rRNA gene (V4 region) revealed that breastfeeding for at least 1 month and the introduction of solids before 6 months differentiated the GM in toddlerhood (Bray-Curtis, pseudo-F = 1.805, p = 0.018, and pseudo-F = 1.651, p = 0.044, respectively). Sleep had an effect across time; at 1 and 6 months of age, a lower proportion of nighttime sleep (relative to 24 h total sleep) was associated with a richer GM at three years of age (Shannon H = 4.395, p = 0.036 and OTU H = 5.559, p = 0.018, respectively). Toddlers experiencing rapid weight gain from birth to 6 months had lower phylogenetic diversity (Faith PD H = 3.633, p = 0.057). These findings suggest that early life nutrition, sleeping patterns, and growth rate in infancy may influence the GM composition. Further verification of these results with objective sleep data and a larger sample is needed.

The Impact of Early Nutrition Following Peroral Endoscopic Myotomy in Achalasia: A Tertiary Center Experience.

This retrospective single-center study aimed to assess the safety of early feeding in patients who met certain criteria following peroral endoscopic myotomy (POEM). Data from 100 patients who underwent POEM at our center between January and December 2022 were collected. Early feeding was defined as the introduction of clear liquid foods at 4 hours post procedure. At 4 and 24 hours, the pain was rated using the visual analog scale (VAS) in all patients. Patients without intraoperative complications (pneumoperitoneum requiring needle drainage, severe arterial bleeding requiring the use of hemostatic forceps, severe mucosal injury) and severe pain (VAS score > 6) and nausea-vomiting at the fourth postoperative hour were given the early feeding approach. In patients who did not meet these requirements, enteral feeding was initiated after 24 hours (late feeding). Among the 100 patients, 50 patients were categorized early feeding. No patients had a control esophagogram. In the early and late enteral feeding groups, VAS scores were 4 (0-6) and 6 (1-8) (P< 001) at 4 hours and 1 (0-3) and 1 (0-6) (P = .043) at 24 hours, respectively. No severe complications were developed after early feeding. The median hospital stay in the early feeding group was 1 (1-3) day. There was no emergency readmission in any of early feeding patients. Our study showed early feeding following POEM can be begun in achalasia patients who do not have intraoperative complications, severe pain, or nausea/vomiting.

Case Report on a Multidisciplinary Approach to Address Malnutrition and Improve a Patient’s Fitness for Treatment

Approximately 5,700 people are diagnosed with myeloma each year in the UK. The standard of care is to receive an autologous stem cell transplant after completion of induction therapy. There are no specific dietary recommendations for people with myeloma, however they are at risk of malnutrition due to symptoms and side effects of treatments. This report describes the journey of a 73-year-old male diagnosed with immunoglobulin A (IgA) lambda myeloma in April 2021. The patient lost 23% of his body weight during 6 months of systemic anti-cancer treatment (SACT), resulting in postponing his transplant twice due to reduced fitness. This report describes an effective, although late, multidisciplinary intervention which was successful for the patient who managed to reestablish a healthy weight and good quality of life. The patient received his transplant in January 2023. This case highlights two important aspects of patient care that should not be underestimated in dietetic clinical practice: early screening and multidisciplinary collaboration. Monitoring the nutritional status of patients and providing early nutrition support can prevent hospital admissions, treatment delays and reduce the associated costs. Multidisciplinary teamwork can improve patient care and clinical outcomes, and it is fundamental to strengthen communication and collaboration among clinical disciplines.

Impact of Early Nutrition Interventions on the Growth and Development of Preterm Infants: A Narrative Review.

Preterm birth remains a significant global health concernas it can lead to various health complications and long-term developmental challenges. Early nutrition intervention plays a crucial role in optimizing the growth, development, and overall health outcomes of premature infants. This review aims to summarize and analyze the existing literature regarding the effect of early nutrition interventions on premature babies. A comprehensive search was conducted through various electronic databases, including PubMed, Scopus, and Google Scholar, focusing on nutrition interventions specifically targeting premature infants. The review highlights the benefits of early nutrition interventions, including enteral and parenteral feeding, human milk, and the provision of specific nutrients. These interventions have been shown to enhance growth rates, promote neurodevelopmental outcomes, reduce the incidence and severity of retinopathy of prematurity (ROP), reduce the risk of infection, and improve overall morbidity and mortality rates in premature babies. Overall, the findings from this review suggest that early nutrition interventions have a positive impact on the health and developmental outcomes of premature babies. However, further research is required to determine the optimal approaches, optimal timing, and long-term effects of various interventions. Collaboration between healthcare providers, researchers, and families is crucial in implementing evidence-based nutrition practices and supporting the growth and development of premature infants.

Early postnatal nutrition and renal consequences in preterm infants.

Perinatal nutritional factors may lead to decreased nephron endowment, decreased kidney function, and long-term development of chronic kidney disease and non-communicable diseases. At the same time, optimal postnatal nutrition and catch-up growth are associated with better neurodevelopmental outcomes in preterm infants. Therefore, nutritional management of preterm infants is a major challenge for neonatologists. In this context, the Section of Nutrition, Gastroenterology and Metabolism reviewed the current knowledge on nutritional issues related to kidney function. This narrative review discusses the clinical impact of early postnatal nutrition on long-term kidney function. In preterm infants, data are largely lacking to determine the extent to which early nutrition contributes to nephrogenesis and nephron endowment. However, some nutritional principles may help clinicians better protect the developing kidney in preterm infants. IMPACT: Clinical data show that preterm infants are an emerging population at high risk for chronic kidney disease. Both undernutrition and overnutrition can alter long-term kidney function. In preterm infants, data are largely lacking to determine the extent to which early postnatal nutrition contributes to nephrogenesis, nephron endowment and increased risk for chronic kidney disease. Some nutritional principles may help clinicians better protect the developing kidney in preterm infants: avoiding extrauterine growth restriction; providing adequate protein and caloric intakes; limiting exposure to high and prolonged hyperglycaemia; avoiding micronutrient deficiencies and maintaining acid-base and electrolyte balance.

Early enteral nutrition versus early supplemental parenteral nutrition in patients undergoing major abdominal surgery: a secondary analysis of 2 randomized clinical trials

BackgroundThe effect of early isoenergetic feeding routes [early enteral nutrition (E-EN) or early supplemental parenteral nutrition (E-SPN)] on the outcome of patients undergoing major abdominal surgery is controversial. ObjectivesThe aim of this study was to investigate the impact of early isoenergetic EN compared with early isoenergetic SPN on nosocomial infections in patients undergoing major abdominal surgery. MethodsThis study is a secondary, post hoc analysis of data from 2 open-label randomized clinical trials. Participants were recruited from the general surgery department of 11 academic hospitals in China undergoing major abdominal surgery and with Nutritional Risk Screening 2002 score ≥3. All eligible patients were categorized into 2 groups based on their achievement of the 100% energy target on postoperative day (POD) 3: the E-EN group (n = 199) and the E-SPN group (n = 115). The primary outcome was the incidence of nosocomial infections between POD 3 and hospital discharge. ResultsIn total, 314 patients [mean (SD) age, 59.2 (11.4) y; 113 (36.0%) females] were included. Patients in the E-EN group showed no significant difference in nosocomial infections compared with those in the E-SPN group {17/199 [8.5%] compared with 10/115 [8.7%], risk difference, 0.2% [95% confidence interval (CI): –6.3, 6.6]}. The hematological nutritional status of the E-EN group showed a significant improvement at discharge compared with the E-SPN group (albumin: 38.0 ± 6.0 g/L compared with 35.5 ± 7.6 g/L; mean difference, –2.5 g/L; 95% CI: –4.0, –1.0 g/L; prealbumin: 200.0 ± 8.0 mg/L compared with 158.4 ± 38.1 mg/L; mean difference, –41.6 mg/L; 95% CI: –41.7, –36.1 mg/L). Other indicators were comparable between groups. ConclusionE-EN compared with isoenergetic SPN may not be associated with a reduced rate of nosocomial infection in patients undergoing major abdominal surgery, but may be associated with improved hematological nutritional status. Trial registration numberThis trial was registered at clinicaltrials.gov as NCT03115957 (https://clinicaltrials.gov/ct2/show/NCT03115957) and NCT03117348 (https://clinicaltrials.gov/ct2/show/NCT03117348).