Early Nutritional Intervention Research Articles

Nutritional disorders and nutrition-related conditions: an underestimated clinical problem in systemic sclerosis

Nutritional disorders are significant but often underestimated complications in patients with systemic sclerosis (SSc). The most prevalent nutritional disorders in SSc are malnutrition, affecting up to 62.5% of patients, and sarcopenia, with a frequency of up to 42%. Thus, clinical vigilance is recommended for the detection of eating disorders in SSc patients, particularly those with gastrointestinal involvement, cardiopulmonary complications, an advanced disease stage, and high disease activity. Nutritional treatment should be carefully tailored to the patients’ clinical condition to ensure that it effectively addresses their specific needs. Studies focusing on enteral nutrition in SSc patients demonstrate its effectiveness in stabilizing or improving nutritional status in malnourished patients. In severe cases, parenteral nutrition offers viable options to support patient health. The findings highlight the importance of early nutritional assessment and intervention in improving patient outcomes and suggest that individualized nutritional therapy can be a critical component of comprehensive care for SSc patients.

Application of NRS2002 and PG-SGA in nutritional assessment for perioperative patients with head and neck squamous cell carcinoma: An observational study.

This study aimed to compare the effectiveness of 2 nutritional assessment tools, the Nutritional Risk Screening Scale 2002 (NRS2002) and the Patient-Generated Subjective Global Assessment (PG-SGA), for evaluating the nutritional status of perioperative head and neck squamous cell carcinoma (HNSCC) patients, to facilitate early nutritional interventions and improve clinical outcomes. An observational, comparative study was conducted at the Zhejiang Cancer Hospital, recruiting patients diagnosed with HNSCC scheduled for surgical treatment. The NRS2002 and PG-SGA were applied to assess patients' nutritional risk at multiple time points: upon admission, the day before surgery, 2 days after surgery, a week after surgery, and at discharge. Statistical analyses were performed using McNemar and Kappa tests to assess differences and consistency between NRS2002 and PG-SGA. A total of 209 patients were included in this study, predominantly male, with an average age of 60 years. Nutritional risk assessments identified an inverted "V" trend in nutritional risk, with the peak occurring 2 days post-surgery. PG-SGA consistently showed a higher screening positivity rate compared to NRS2002. The receiver operating characteristic curve analysis highlighted the discriminative power of both tools, with PG-SGA and NRS2002 showing high area under the curve values. Both NRS2002 and PG-SGA are effective for nutritional screening in HNSCC patients, with PG-SGA demonstrating a slightly higher sensitivity before surgery. PG-SGA may be more suitable for preoperative application, whereas NRS2002 is more appropriate for postoperative use.

The Role of Parenteral Nutrition in Cancer in Indian Settings

Background: Almost 50% of patients with cancer suffer from malnutrition during their first hospital visit. However, it is often overlooked and undiagnosed and is associated with morbidity, mortality, poor tolerance to treatment, and treatment outcomes. Guidelines recommend supportive nutrition from the early stages of cancer treatment. However, in clinical practice, nutritional support is often prescribed only as an end-of-life intervention or is not prescribed at all; moreover, the use of parenteral nutrition (PN) is not well-defined. There are limited practical guidelines on the use of PN in patients with cancer. Methods: A multidisciplinary group of specialists in India formulated this consensus to guide oncologists on the judicious use of PN in Indian settings. It includes general and cancer-specific recommendations on the use of PN, supplemental PN (SPN), composition of PN, and monitoring patients to prevent adverse events associated with PN. Recommendations: The risk of malnutrition should be assessed at the very first presentation of a patient with cancer. These patients’ nutritional requirements are largely like those of the healthy population. Nutritional assessment of all cancer patients should begin at diagnosis and repeated regularly to initiate and monitor early nutritional intervention, before the general status is severely compromised. Oncologists and nutritionists need to be educated about using the appropriate nutrition support options according to the guidelines. While EN should be the preferred form of nutritional support, in specific circumstances PN might be a better option. Early PN in specific settings provides additional benefits, and is particularly important in some types of cancers. SPN as an additional nutritional support to EN can improve treatment tolerability and quality-of-life of patients with cancer. Education is also necessary for awareness about preventing and managing adverse effects of PN, which is the major reason for poor adoption of PN.

The early nutrition intervention management addition in ICUs

The early nutrition intervention management addition in ICUs

Global Leadership Initiative on Malnutrition Criteria and Immunonutritional Status Predict Chemoadherence and Survival in Stage II/III Gastric Cancer Treated with XELOX Chemotherapy.

Adjuvant chemotherapy is crucial for the treatment of advanced gastric cancer. However, various factors negatively impact chemoadherence, with malnutrition after gastrectomy being a critical determinant. This study aims to analyze the impact of malnutrition, assessed through the Global Leadership Initiative on Malnutrition (GLIM) and other immunonutritional indices, on chemoadherence and its subsequent effect on survival. This retrospective study included 116 patients who underwent curative gastrectomy and received oxaliplatin and capecitabine (XELOX). Preoperative nutritional status was assessed using the GLIM criteria along with other immunonutritional indices, such as the prognostic nutritional index (PNI), C-reactive protein-to-albumin ratio (CAR), neutrophil-lymphocyte ratio (NLR), controlling nutritional status (CONUT) score, and modified Glasgow Prognostic Score (mGPS). Chemotherapy adherence was measured using relative dose intensity (RDI). Statistical analyses included least absolute shrinkage and selection operator (LASSO) regression to identify the key predictors of RDI and Cox proportional hazards models and assess the impact on survival. Overall, 116 patients were included in this analysis. In the multivariate analysis using LASSO regression, higher GLIM severity was independently associated with a lower RDI (coefficient = -0.0216; p < 0.01). Other significant factors influencing RDI included older age (p < 0.01), female sex (p = 0.02), higher mGPS (p = 0.03), higher CONUT score (p = 0.04), and higher CAR (p = 0.05), all of which were associated with a lower RDI. The Cox proportional hazards analysis revealed that higher RDI was significantly associated with better survival (hazard ratio [HR] = 0.06; p < 0.005). This study highlights the critical role of immunonutritional status, particularly as measured using the GLIM criteria, in maintaining adherence to chemotherapy and improving survival outcomes in patients with gastric cancer. Routine preoperative nutritional assessments using GLIM can help identify high-risk patients, and early nutritional interventions may improve chemotherapy adherence and outcomes. These findings support the integration of nutritional strategies, specifically targeting those identified by the GLIM, into standard care to enhance the efficacy and survival of chemotherapy.

Documentation of anthropometrics in people with cancer: a cross-site collaboration audit in four hospital settings in the UK

BackgroundMalnutrition is a significant risk for patients during cancer treatment. Neglecting to monitor or provide timely dietetic support can result in lower tolerance to treatments and reduced quality of life. This audit aimed to assess the completeness and accuracy of the documentation of anthropometric measurements in medical records and dietetic referral practices across four day-treatment units (DTUs) in England.MethodologyData were collected from electronic patient records of 100 patients in each DTU attending for systemic anti-cancer treatment (SACT) over a 2-week period. Data collected included patients’ demographics, anthropometric data, referrals to dietitians, and whether the patients referred had a MUST score ≥ 2, which was calculated by the authors.ResultsFindings revealed that weights and heights were documented for 58–85% and 94–98% of patients attending DTUs, respectively. On average, 55% (range of 7–85%) of patients had their body mass index (BMI) documented on the day of SACT. The Malnutrition Universal Screening Tool (MUST) was rarely completed (≤ 3% in each centre). Dietetic referral practices varied across centres.ConclusionsFindings highlight the need to improve anthropometric documentation practices in cancer centres, in order to allow better monitoring of malnutrition risk and early nutritional support interventions when needed.

Analyzing nutrition risks and blood biomarkers in hospitalized patients with tuberculosis: Insights from a 2020 hospital-based study.

There exists a bidirectional relationship between tuberculosis (TB) and nutrition, wherein they mutually influence and interact causally. However, current guidance for providing nutrition support to individuals diagnosed with TB remains inadequate, leading to a significant gap in comprehensive patient care. This study aims to assess the nutrition status of patients with TB and endeavors to provide insights into early nutrition interventions for individuals vulnerable to TB-associated malnutrition. Data from 2204 newly admitted patients at Beijing Chest Hospital in 2020 were collected, with 1735 patients with confirmed TB aged ≥18 years after exclusions. Patient data, encompassing diagnosis and results from routine blood tests and biochemical analyses conducted on the day after admission, were gathered using the electronic medical records system. Nutrition risk screening was conducted using the Nutritional Risk Screening 2002 (NRS 2002) tool, and questionnaire-based assessments were administered. Statistical analyses were performed using SPSS 17.0 software. Among 1735 patients with TB, the occurrence rate of nutrition risk was 74.58%. Factors such as age ≥65 years, sputum smear positivity for TB, and concurrent illnesses significantly increased the occurrence rate of nutrition risk. Nutrition risk among patients with TB exhibited negative correlations with parameters such as body weight, hemoglobin, and serum albumin level while showing positive correlations with white blood cell count and C-reactive protein, among others. The occurrence rate of nutrition risk among patients with TB at Beijing Chest Hospital was notably high, particularly among older individuals, those with sputum smear positivity, and those with concurrent illnesses.

7315 Does Protein Energy Malnutrition Impact Outcomes in Hypothyroidism? A National Inpatient Sample Analysis

Abstract Disclosure: S. Karki: None. B. Neupane: None. S. Neupane: None. A. Bhandari: None. U. Farooq: None. K. Rajamani: None. Introduction: Hypothyroidism poses a significant public health burden in the United States, affecting approximately 4.6 % of the population. Various nutritional deficiencies can adversely affect thyroid function, potentially leading to thyroid disorders. Despite this, there is limited literature exploring the influence of Protein Energy Malnutrition (PEM) on outcomes in hypothyroidism. Objective of our study:This investigation aims to assess the impact of PEM on the healthcare burden and costs associated with hospitalizations in patients with and without hypothyroidism. Methods: A retrospective study was conducted using the National Inpatient Sample (NIS) data from 2017 to 2020. Among the 14,418,310 patients aged 18 and above with a primary diagnosis of hypothyroidism, two groups were formed based on the presence or absence of PEM, determined by International Classification of Diseases (ICD-10) codes. Statistical analysis was performed using STATA, employing the student’s t-test and Fischer’s exact test for continuous variables and proportions, respectively. Adjusted odds ratio was calculated through multivariate regression analysis. The primary outcome was mortality, with secondary outcomes encompassing mean length of stay (LOS), total cost, and various medical complications. Trends in mortality, LOS and total cost were compared for both groups. Results: Out of 14,418,310 hypothyroid patients, 7.06% (1,1018,310) were diagnosed with PEM. Patients with PEM exhibited higher mortality (6.80 % vs. 2.39 %, p&amp;lt;0.001), extended mean length of hospital stay (8.88 days vs. 4.85 days, p&amp;lt;0.001), and higher increased total hospitalization costs ($96,443 vs. $58,262, p&amp;lt;0.001). Furthermore, patients with PEM had elevated rates of various complications, including acute coronary syndrome, septic shock, pulmonary edema, mechanical ventilation, acute respiratory failure, acute respiratory distress syndrome, acute kidney injury, and cerebrovascular accident. Increasing trends in mortality, length of stay, and total cost of hospitalization were observed in hypothyroid patients with PEM. A similar upward trend was noted in hypothyroid patients without PEM. Conclusion: Our study underscores that the presence of PEM in hypothyroid patients substantially increases the healthcare burden, which is reflected in elevated mortality rates, prolonged hospital stays, higher total costs, and a range of adverse outcomes. Screening of PEM in hypothyroid patients is recommended, and early nutritional interventions, possibly involving dieticians, may mitigate these adverse effects. Further research is warranted to explore the association between PEM and hypothyroidism, as well as strategies for early identification and intervention. Presentation: 6/1/2024

Early nutritional intervention in general practice in case of suspected malignant disease – a feasibility study

Early nutritional intervention in general practice in case of suspected malignant disease – a feasibility study

Association between malnutrition risk and healthcare utilization in a culturally diverse sample of ambulatory patients with cancer.

254 Background: Malnutrition is prevalent among cancer patients placing them at an increased risk for treatment-related complications and poor clinical outcomes. This study investigated the relationship between malnutrition risk and healthcare utilization in a diverse sample of adult ambulatory cancer patients from the Sylvester Comprehensive Cancer Center. Methods: A retrospective analysis was conducted with data collected through the My Wellness Check (MWC), an electronic health record (EHR)-based assessment. Malnutrition was assessed through the NUTRISCORE, an integrated and validated nutritional screening tool within MWC that evaluates self-reported weight loss, appetite, cancer type, and treatment modality to assess risk of malnutrition. A NUTRISCORE greater or equal to 5 is considered malnutrition risk. Time to an emergency room (ER) visit and hospitalization were calculated in days from the first MWC questionnaire assignment and the first event, respectively. All ER visits and hospitalizations in the University of Miami Health System, self-reported patient demographics, and clinical characteristics were captured from the EHR. Uni- and multi-variate logistic regression models were used to examine factors associated with malnutrition risk. For survival analyses, the Kaplan-Meier method was used to calculate the cumulative incidence function of events and the cox proportional hazards regression models adjusting for patient demographics and clinical characteristics. Results: A total of5,984 ambulatory patients completed the MWC assessment between October 2019, and August 2023, with 31.2% (n=1,868) identified at malnutrition risk (NUTRISCORE ≥5). Patients were predominately White (n=5,092, 85.2%), and Hispanic (n=2,341, 39.1%). Hematologic cancer was the most common diagnosis (n=1284, 21.5%) followed by malignancies in digestive system (n=903, 15.1%) and male genitourinary (n=892, 14.9%). After adjusting for covariates, patients at malnutrition risk were at significantly higher risk for both ER visits (HR 1.57, 95% CI; 1.29 - 1.91, p&lt;0.0001) and hospitalizations (17.4% vs. 7.4% at 100 days, p&lt;0.0001) compared to those with low malnutrition risk. Factors associated with malnutrition risk included Hispanic ethnicity (aOR 1.17, 95% CI; 1.01-1.35), fatigue (aOR 1.62, 95%CI; 1.07-2.45), declined physical function (aOR 1.75, 95% CI;1.37 - 2.24), physical inactivity (aOR 1.20, 95%CI;1.04 - 1.38) and low HRQOL (aOR 2.48, 95%CI; 1.93-3.19). Conclusions: Malnutrition was associated with higher healthcare utilization in a diverse sample of ambulatory cancer patients. Hispanic ethnicity and worse PROs are factors associated with higher risk for malnutrition. Results from this work underscore the need of early nutritional interventions to prevent malnutrition and improve clinical outcomes.

Impact of early weaning and nutritional interventions on growth performance, digestive metabolism, and serum biomarkers in lambs: A biomechanical perspective

The aim of this study was to investigate the effects of early weaning and nutritional interventions on growth performance, nutrient digestion and metabolism, and serological indices of hu sheep lambs, with a view to providing a basis for the feasibility of early weaning of hu sheep lambs under conditions of supplemental milk replacer. Ninety neonatal hu sheep lambs were weaned at 21 days (n = 60) (divided into two groups: early weaned, EW; and resveratrol-fed, RSV) as well as 49 days (n = 30) (control group, CON) weaning, and the trial period was 90 days. The results showed that: 1) there was no significant difference (P &gt; 0.05) in the initial and final weights of the lambs, and the average daily gain (ADG) of the EW and RSV groups was significantly lower than that of the CON group (P &lt; 0.05) from 31 to 45 days of age. Early weaned lambs were more susceptible to weaning stress compared to late weaned lambs and the effect of nutritional intervention (feeding resveratrol) on lamb growth performance was not significant. 2) The apparent digestibility of crude protein (CP) in the experimental group was significantly lower than that of the control group (P &lt; 0.05), and the nitrogen intake, net protein utilization and protein biological value indexes of lake lambs in the experimental group were significantly different from those of the control group (P &lt; 0.05). 3) Early feeding of resveratrol was not significant in improving the digestive metabolism of nutrients. 4) Early weaning as well as the addition of resveratrol had a significant effect on the serum GLU and TC indexes of the lambs (P &lt; 0.05), but did not show a significant effect on any of the other indexes.

Effects of early-life amino acids supplementation on fish responses to a thermal challenge.

Nutritional programming is a promising concept for promoting metabolic adaptation of fish to challenging conditions, such as the increase in water temperature. The present work evaluates in ovo arginine or glutamine supplementation as enhancers of zebrafish metabolic or absorptive capacity, respectively, at optimum (28 ºC) and challenging temperatures (32 ºC) in the long-term. Growth performance, free amino acids profile, methylation index and the activity levels of digestive and intermediary metabolism enzymes were analysed to assess the metabolic plasticity induced by an early nutritional intervention. Temperature affected fish larvae growth performance. At the end of the experimental period 28 ºC-fish showed higher dry weight than 32 ºC-fish. The effects of the early supplementation were reflected in the larval free amino acids profile at the end of the experiment. Higher methylation potential was observed in the ARG-fish. In ovo amino acid supplementation modulated the metabolic response in zebrafish larvae, however, the magnitude of this effect differed according to the amino acid and the temperature. Overall, arginine supplementation enhanced carbohydrates metabolism at 32 ºC. In conclusion, the present work suggests that in ovo arginine supplementation may promote a better adaptive response to higher temperatures.

Recruitment feasibility and dietary and behavioral patterns in toddlers with ASD: Preliminary results from the Autism Eats program

BackgroundProblematic mealtime behaviors and inadequate diet quality are pressing concerns for children with autism spectrum disorder (ASD). This study aimed to evaluate recruitment feasibility and baseline outcomes of the Autism Eats program for children under 3 years with ASD. MethodsRecruitment feasibility was assessed through reach and participation rates. The Healthy Eating Index (HEI-2015) scores were calculated from 3-day food records. Problematic mealtime behaviors were assessed with the Brief Autism Mealtime Behavior Inventory. Parental feeding practices were assessed using the Child Feeding Questionnaire. Anthropometric measurements of children and parents were taken. Weight-for-length percentiles were calculated based on the CDC growth charts. Descriptive statistics, one-sample t-tests, and Spearman's rho correlations were used for data analysis. ResultsOf the contacted dyads, 74 % agreed to participate. All 51 enrolled dyads completed baseline survey (100 %), and 98 % completed 3-day food records and anthropometric measurements. Significantly higher problematic mealtime behaviors were observed, compared to the reference (e.g., Total score 55.7 vs. 32.5; p < .001). Children with ASD exhibited lower HEI-2015 scores than national data (e.g., Total score 59 vs. 62). A large proportion of the children (29 %) had a weight-for-length ≥ 95th percentile. Several significant associations were found among mealtime behaviors, diet quality, parental feeding practices, and weight status. ConclusionRecruitment was highly feasible, and the findings suggest that early nutrition intervention may hold promise in addressing problematic mealtime behaviors and promoting healthier dietary habits in young children with ASD.Clinical Trial Registration: This trial has been registered at www.ClinicalTrials.gov (NCT05194345).

Development of Spanish Nutrition Screening Tool for Hispanic Preschoolers.

Nutrition screening tools may facilitate early nutrition interventions specifically with Hispanic populations that are already at higher risk. There is a paucity of culturally competent and validated nutrition screening tools for 3-5-year-old Hispanic children. The purpose of this study was to develop a Spanish nutrition screening tool for 3-5-year-old children to be used by Spanish-speaking parents in community settings to appropriately address malnutrition risk factors with cultural sensitivity. All phases of the study were conducted in Spanish with native Spanish speakers. Face and content validity were established using focus groups, expert reviews, and pilot testing of the tool with Spanish-speaking parents. Parents of children 3-5 years old whose primary language was Spanish (n = 39) completed the nutrition screening, and a nutritionist completed an in-depth nutrition assessment of these children. Criterion validity was measured by comparing the results of the nutrition screening tool with the in-depth nutrition assessment. The nutrition screening tool had a sensitivity of 91.67% and a specificity of 81.48%. The negative predictive value was 69%, and the positive predictive value was 96%. The nutrition screening tool may be used to identify malnutrition in Hispanic children and needs further validation in larger samples.

Relationship between energetic gap and sensitivity to anti-programmed cell death 1 immune checkpoint inhibitors in non-small cell lung cancer patients: The ELY-2 study

Background & aimsWe previously reported in the ELY prospective study that increased resting energy expenditure (REE) – so-called hypermetabolism – worsened tumor response, 6-month progression-free (PFS) and overall survival (OS) in metastatic non-small cell lung cancer (mNSCLC) patients treated with immune checkpoint inhibitors (ICI). Here, we investigated the effect of caloric coverage on the sensitivity to ICI. MethodsWe retrospectively analysed a multicentric database of mNSCLC patients treated with ICI. All patients had a baseline nutritional assessment including REE measured with indirect calorimetry and a dietitian estimation of food intakes. Measured/theoretical REE ≥ 110% defined hypermetabolism. Intakes ≥ 90% of estimated needs defined caloric coverage. The primary endpoint was PFS. Secondary endpoints included response rate and OS. ResultsAmong 162 patients, 84 (51.9%) were normometabolic, and 78 (48.1%) hypermetabolic. In hypermetabolic patients, 40 (51.3%) met their caloric needs (group A) while 38 (48.7%) did not (group B). Median PFS was 4.3 vs. 1.9 months in groups A and B, respectively (HR: 0.49, 95%CI [0.31-0.80], p = 0.004). The PFS achieved in the group A and in normometabolic patients were similar (HR: 0.99, 95%CI [0.65-1.51], p = 0.95). In multivariate analysis, caloric coverage was independently associated with improved PFS in hypermetabolic patients (HR: 0.56, 95%CI [0.31 – 0.99], p = 0.048). Among hypermetabolic patients, the median OS was higher in the group A (HR: 0.58, 95%CI [0.35-0.95], p = 0.03). ConclusionEnergy supply is a critical determinant of the sensitivity to ICI in NSCLC patients. A randomized study to evaluate the benefit of early nutritional intervention is warranted.

Early-life milk replacer feeding mediates lipid metabolism disorders induced by colonic microbiota and bile acid profiles to reduce body weight in goat model

BackgroundDysregulation of lipid metabolism and its consequences on growth performance in young ruminants have attracted attention, especially in the context of alternative feeding strategies. This study aims to elucidate the effects of milk replacer (MR) feeding on growth, lipid metabolism, colonic epithelial gene expression, colonic microbiota composition and systemic metabolism in goat kids compared to breast milk (BM) feeding, addressing a critical knowledge gap in early life nutrition.MethodsTen female goat kids were divided into 2 groups: those fed breast milk (BM group) and those fed a milk replacer (MR group). Over a period of 28 d, body weight was monitored and blood and tissue samples were collected for biochemical, transcriptomic and metabolomic analyses. Profiling of the colonial microbiota was performed using 16S rRNA gene sequencing. Intestinal microbiota transplantation (IMT) experiments in gnotobiotic mice were performed to validate causality.ResultsMR-fed pups exhibited reduced daily body-weight gain due to impaired lipid metabolism as evidenced by lower serum and liver total cholesterol (TC) and non-esterified fatty acid (NEFA) concentrations. Transcriptomic analysis of the colonic epithelium revealed upregulated genes involved in negative regulation of lipid metabolism, concomitant with microbiota shifts characterized by a decrease in Firmicutes and an increase in Actinobacteria. Specifically, genera such as Bifidobacterium and Prevotella were enriched in the MR group, while Clostridium and Faecalibacterium were depleted. Metabolomics analyses confirmed alterations in bile acid and fatty acid metabolic pathways. IMT experiments in mice recapitulated the metabolic phenotype observed in MR-fed goats, confirming the role of the microbiota in modulating host lipid metabolism.ConclusionsMilk replacer feeding in goat kids disrupts lipid metabolism and gut microbiota dynamics, resulting in reduced growth rates and metabolic alterations. These findings highlight the importance of early nutritional intervention on metabolic programming and suggest that modulation of the gut microbiota may be a target for improving growth and metabolic health in ruminants. This study contributes to the understanding of nutritional management strategies in livestock and their impact on animal health and productivity.

Dietary Counseling Outcomes in Patients with Lung Cancer in an Upper-Middle-Income Country: An Open-Label Randomized Controlled Trial.

Background: Malnutrition harms treatment outcomes, QoL, and survival in lung cancer patients. Effective dietary counseling can improve nutrition, but few randomized controlled trials have focused on lung cancer patients. The objective of this study was to determine if dietary counseling improves nutritional and treatment outcomes when compared to routine care. Methods: This open-label parallel RCT was conducted at Maharaj Nakorn Chiang Mai Hospital in Thailand. The investigators used computer-generated blocked randomization to assign patients to dietary counseling by a nutritionist or routine care. The nutritionist sessions occurred before treatment, with follow-ups at 3-4 weeks and 12 weeks. The primary outcome was the mean percentage change in the body weight of patients at 12 weeks. Secondary outcomes included changes in the BMI, nutrition score, QoL, serum albumin level, lymphocyte count, energy and protein intake, treatment response, PFS, and OS. Results: Between April 2020 and May 2022, after completing recruitment, 80 lung cancer patients were randomized: 43 to dietary counseling and 37 to routine care. The dietary counseling group showed significant benefits, with smaller decreases in body weight at 3-4 weeks (-0.8% vs. -2.6%, p = 0.05) and 12 weeks (-1.1% vs. -4.3%, p = 0.05). They also had higher energy and protein intake levels and better treatment response rates. The secondary outcomes and significant adverse events did not differ significantly between the groups. Conclusions: Dietary counseling helps to maintain body weight, maintain dietary intake, and enhance treatment responses in lung cancer patients. Although not all nutritional markers or survival outcomes were affected, these findings highlight the importance of early nutritional interventions.

Elderly patients with dysphagia in the intensive care unit: Association between malnutrition and delirium.

Dysphagia, as a geriatric syndrome, is prevalent in the intensive care unit (ICU). Malnutrition resulting from swallowing disorders is likely to correlate with adverse ICU outcomes, including delirium, thereby escalating the costs of care and hospitalization. However, malnutrition has not received the attention it deserves in ICU clinical nursing practice. As two preventable and correctable conditions-malnutrition and delirium-the advantages of early identification and intervention are substantial. Exploring the relationship between malnutrition and delirium, starting from the high-risk group of elderly patients with swallowing difficulties in the ICU, will aid us in managing patients promptly and effectively. To investigate the relationship between malnutrition and the incidence of delirium in elderly patients with dysphagia in the ICU. This is a retrospective study. Data for this study were obtained from the Medical Information Mart for Intensive Care-IV. All 2273 patients included were dysphagia older patients over 65 years of age admitted to the ICU, and logistic regression was used to explore the relationship between malnutrition and delirium. We also used propensity score matching (PSM) for sensitivity analysis. Among the included patients with swallowing difficulties, 13% individuals (297/2273) exhibited malnutrition, with a delirium incidence rate of 55.9% (166/297). In the non-malnutrition group (1976/2273), the delirium incidence rate is 35.6% (704/1976). After adjusting for 31 covariates, multifactorial logistic regression showed that malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU (adjusted odds ratio (OR) = 1.96, 95% confidence interval (CI) = 1.47-2.62). The results remained stable after analysis by PSM. Malnutrition was significantly positively associated with the incidence of delirium in elderly dysphagic patients in the ICU. Malnutrition should be given adequate attention in the ICU. ICU nurses should pay particular attention to malnutrition, especially among the high-prevalence group of patients with dysphagia. Early identification and nutritional intervention for these patients may help reduce the costs of care and health care expenditures.

Evaluation of Weight, Height, Body Mass Index, and Nutritional Status of Children With and Without Orofacial Cleft in Nigeria.

To compare the weight, height, BMI and nutritional status of patients with and without cleft lip and/or cleft palate (CLP). Cross-sectional study. Lagos University Teaching Hospital. Patients with CLP and a control group of participants without CLP aged between 1 month and 6 years. All patients in the CLP group had not received surgical or nutritional intervention. Weight, height, BMI, their respective percentiles, and nutritional status according to the WHO 2006 growth curves of participants. Patients with CLP (n = 60, 21 males, 39 females, mean age: 19.1 months) had significantly lower percentile weight and height compared to those of controls (n = 60, 26 females, mean age, 23.6 months) in univariate analyses (all p < 0.01). Multivariate linear regression revealed significant interactions with age group for weight. In addition, proportions of underweight and short stature were significantly higher in the CLP group compared to the control group (all p < 0.05), and these significant differences were dependent on the age group with between-group significant differences only in age groups less than 25 months. Overall, patients with CLP had significantly lower weight, height, BMI and nutritional status than their unaffected peers, and these differences were dependent on age group. Significantly lower nutritional status was seen in patients with CLP up to 24 months of age, which highlights the need for early nutritional intervention in the management of CLP.

The dynamic distribution of the rectal microbiota in Holstein dairy calves provides a framework for understanding early-life gut health

The posterior intestinal microbiota plays a vital role in the growth and health of Holstein dairy calves. However, its establishment and dynamic changes during early development remain unclear. The aim of this study was to investigate microbial colonization and development in the rectum of calves within the first 70 d after birth. Here, 96 rectal content samples were collected from 8 Holstein dairy calves at 12 time points and analyzed using 16S rRNA gene sequencing. The microbial alpha diversity increased with age. The bacterial community displayed a distinct dynamic distribution. The phylum Proteobacteria was replaced by Firmicutes and Bacteroidetes after d 3. The colonization process of bacterial genera in the rectum of neonatal calves can be divided into 2 periods: the colonization period (stage 1: d 1 and stage 2: d 3) and the stable period (stage 3: d 7 to 14, stage 4: d 21 to 42, and stage 5: d 49 to 70). The fermentation pattern and metabolic function changed from propionate fermentation dominated by Shigella to lactic acid fermentation dominated by Lactobacillus, Blautia, and Oscillospira. The stable period was more comprehensive and complete than the colonization period. This study revealed the dynamic changes in the posterior intestinal microbiota of Holstein dairy calves during early development. The transition period (d 7 to 14) was identified as a key stage for early nutritional intervention, as the abundance of Lactobacillus increased and the abundance of harmful bacteria (such as Proteobacteria and Shigella) decreased. This study provides a framework for understanding early-life gut health and offers theoretical guidance for future research on host–microbe interactions and early nutritional interventions. It is suggested that nutritional interventions based on microbial characteristics at different stages be implemented to improve calf growth performance and immune function, which may contribute to the reduction of diarrhea and other gastrointestinal disorders during dairy production.