Nutrition Therapy Research Articles

Prevalence of hospital malnutrition in patients using nutritional support.

To investigate the prevalence of malnutrition in hospitalized patients using nutritional support, considering it's difficult to achieve nutritional goal and great risk to increase malnutrition. A cross-sectional study with 102 patients over 18 years in use of enteral and/or parenteral nutritional therapy and monitored by the Nutritional Therapy Committee between December 2021 and August 2022. All data were collected from electronic medical records. Patients were diagnosed with Subjective Global Assessment (SGA) and Global Leadership Initiative on Malnutrition (GLIM) tools by the researchers. A total of 102 patients were evaluated, with a mean age of 57.5 years (±16.7) and 63.7% were male. According to the SGA, 26.5% were classified as moderately and 44.1% as severely malnourished. According to the GLIM, 19.6% were moderately and 43.1% were severely malnourished. The two diagnoses showed a moderate agreement (0.46). When evaluating only the 26 patients with overweight or obesity, the GLIM identified one patient with malnutrition and the SGA identified six patients. The SGA and the GLIM tool identified a high prevalence of malnutrition in patients using nutritional support in the hospital. The use of GLIM for diagnosis of malnutrition in hospitalized patients using nutritional support proved to be an excellent and practical tool, despite being less sensitive for patients with obesity. Subjective Global Assessment was a more sensitive tool in evaluating patients with malnutrition and using nutritional support. More studies are needed to confirm the use of lean mass reduction markers to identify the degree of malnutrition defined by GLIM in hospitalized patients.

Parenteral Nutrition in the Health-Care Setting: A Comprehensive Review

Parenteral Nutrition (PN) is a critical therapeutic technique that delivers necessary nutrients straight into the circulation, bypassing the gastrointestinal system. This strategy is critical for people who are unable to acquire appropriate nourishment through oral or enteral routes owing to a variety of medical issues. PN first appeared in the mid-twentieth century, primarily to help those who were very malnourished or recuperating from significant surgery. As medical understanding of nutrition grew, so did the complexity and customization of PN formulations, allowing for personalized nutritional support depending on metabolic demands. The indications for PN are diverse, including gastrointestinal diseases, cancer therapies, severe illnesses, neurological issues, and pediatric demands. Patients suffering with Crohn's illness, short gut syndrome, and severe malnutrition caused by cancer therapies frequently rely on PN to maintain their nutritional status. Furthermore, critically sick patients in intensive care settings typically encounter elevated metabolic demands, needing efficient nutritional therapies that oral feeding cannot deliver. While PN has considerable advantages, such as increased recovery, malnutrition prevention, and quality of life, it is not without hazards. Infections, metabolic abnormalities, and liver dysfunction are all possible complications, emphasizing the importance of thorough monitoring and following best practices in PN administration. A multidisciplinary approach including healthcare specialists from several professions is required to achieve the best outcomes for patients seeking PN. Looking ahead, technological developments, personalized dietary techniques, and artificial intelligence integration promise to improve the safety and efficacy of PN. Continuous research and innovation are required to solve current difficulties and enhance the overall quality of care for patients requiring parenteral feeding. As the healthcare environment shifts, PN will remain an important component of nutritional support, requiring continuing attention and development in clinical practice.

The usefulness of an application-supported nutritional intervention on non-high-density lipoprotein cholesterol in people with a risk of lifestyle-related diseases.

Lifestyle-related diseases, such as diabetes, are mostly caused by poor lifestyle habits; therefore, modifying these habits is important. In Japan, a system of specific health checkups (SHC) and specific health guidance (SHG) was introduced in 2008. The challenges faced include low retention rates and difficulty in maintaining results. Digital technologies can support self-management and increase patient convenience, although evidence of the usefulness of this technology for SHG is limited. This study evaluated the usefulness of nutritional guidance using a smartphone application (app) added to conventional SHG. We recruited eligible participants for SHG in Japan from November 2018 to March 2020. We assigned them to "Intervention Group: Application-Supported Nutrition Therapy" or "Control Group: Human Nutrition Therapy" based on their desire to use the app. The primary outcome was a change in non-high-density lipoprotein cholesterol (non-HDL-C) levels post-intervention. The secondary outcomes were a change in lipid profile, metabolic indices, and frequency of logins to the app. We assessed 109 participants in two cohorts: 3-month (short-term) and 6-month (long-term). The short-term cohort had 23 intervention and 29 control participants, while the long-term cohort had 35 and 22, respectively. There was a significant improvement in non-HDL-C levels in the short-term intervention group compared to the control group. There was no significant difference in non-HDL-C levels in the long-term groups or at 1 year. There were significant improvements in body weight (BW) in the short-term cohort until 1 year compared within the groups. The retention rate remained high in the short-term cohort (92%) but decreased to 57.8% at 6 months in the long-term cohort. Using an app system to facilitate dietary recordings and guidance for patients at risk of lifestyle-related diseases led to improved lipid levels and BW. These benefits persisted to some extent after 1 year. This app may partially supplement conventional SHG.

Nutrition Management in Pediatric Traumatic Brain Injury: An Exploration of Knowledge Gaps and Challenges

AbstractTraumatic brain injury (TBI) stands as the leading cause of morbidity and mortality among children, as evidenced by the most contemporary statistics. Undernutrition in pediatric TBI (PTBI) leads to increased mortality, heightened infectious complications, and more severe neurological consequences. Therefore, timely and effective nutritional therapy is crucial in managing PTBI to improve patient prognosis and outcomes. Limited investigations have been conducted on the nutritional requirements specific to these patients and management often relies on data from adults with TBI for guidance. We have meticulously searched different databases to compile a broad range of the most up-to-date clinical research. This review analyses the challenges associated with providing nutritional support to children with TBI and provides a clearer understanding of the current evidence-based recommendations for optimal nutritional therapy. The review primarily focuses on recommendations and suggestions for energy requirements, nutritional assessment, initiation of nutrition, various feeding methods offered, identification of malnutrition, the impact of malnutrition on patient outcomes, and areas of further research.

Nutritional therapy among adult patients with severe burns: A retrospective observational study.

The objective of this study was to examine the effects of nutritional therapy in adult patients with severe burns. Sixty adult patients with severe burns were enrolled. Data on nutritional intake through enteral nutrition (EN) or parenteral nutrition (PN) on days 7, 14, 21, and 28 post-injury were collected. Patients were divided into target and non-target groups according to whether their energy or protein intake reached the target. Age, length of ventilation, and total bilirubin (TBIL), albumin (ALB), prealbumin (pALB), and C-reactive protein (CRP) concentrations of patients were recorded. The percentage of protein targets with protein delivery was lower than that of energy target with energy delivery. The ratio of PN protein to total protein was lower than that of PN energy to total energy on days 7, 14, 21, and 28 (p<0.001, p<0.001, p=0.001, and p=0.003, respectively). Compared to the non-target group on day 21, the target group was younger, had lower TBIL on day 7, higher ALB and pALB on day 21, and lower CRP on day 14 (p=0.025, p=0.021, p=0.028, p=0.029, and p=0.049, respectively). Multivariate logistic regression analysis showed that older age and longer ventilation were independent risk factors in patients who did not meet the nutritional target on day 21 (p=0.026 and p=0.043, respectively). The protein intake of adult patients with severe burns was low. Compared to the non-target group, the target group had better laboratory test results. Older age and longer ventilation were independent risk factors for patients not meeting the nutritional target.

Efficacy and safety of individual nutrition support in patients with hepatitis B virus-related acute-on-chronic liver failure at nutrition risk: a study protocol for a randomised controlled clinical trial

IntroductionMalnutrition is a common complication of hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF) typically associated with poor prognosis. Despite nutritional treatment, the outcomes for these patients are limited by the...

The SMHP™ position statement on therapeutic carbohydrate reduction for type 1 diabetes

This article presents the position of the Society of Metabolic Health Practitioners (SMHP) regarding therapeutic carbohydrate reduction (TCR) nutrition interventions for type 1 diabetes mellitus (T1DM). A modified Delphi methodology was used to arrive at a consensus consisting of several focus groups, multiple rounds, and an anonymous survey. The field of endocrinology has seen many new advances for the treatment of T1DM including hybrid closed-loop insulin delivery systems and continuous glucose monitors for better glycaemic control, monoclonal antibodies to delay the onset of disease and increased access to paediatric endocrinologists, among many other noteworthy achievements. Despite these advancements, standard of care approaches to T1DM result in higher than acceptable morbidity and mortality, with a high prevalence of microvascular and macrovascular complications. Insulin resistance in type 1 diabetes is an independent risk factor for adverse outcomes even in well controlled type 1 diabetes. In 2021, only 21% of adults with T1DM in the United States achieved the American Diabetes Association’s (ADA’s) target haemoglobin A1C goal of 7.0%, while data in the paediatric and adolescent population have demonstrated worse glycaemic control. Supported by observational and interventional evidence, the SMHP advocates for the reevaluation of the prevailing nutritional therapy for T1DM with more broad consideration for TCR. The SMHP recommends open access and clinical support for TCR nutrition interventions for individuals with T1DM of all ages and calls upon the medical community to help foster more attention and research on TCR for T1DM.

Effect of multidisciplinary medical nutrition therapy on the nutrition status of patients receiving peritoneal dialysis: A randomized controlled trial.

Malnutrition is a prevalent complication in patients undergoing peritoneal dialysis (PD). This study established a multidisciplinary team for medical nutrition therapy (MNT) to investigate the impact of this approach on enhancing the nutrition, anemic, and microinflammatory status of patients receiving PD. This randomized controlled trial study involved 81 patients undergoing PD (n = 41 in the intervention group, n = 40 in the control group). The intervention group received comprehensive MNT management, whereas the control group received standard nutrition care. The intervention spanned a 6-month period. Various nutrition parameters, markers of anemia, and microinflammatory indexes were assessed before the intervention, at 3 months, and at 6 months postintervention. Repeated-measures analysis of variance and the nonparametric Scheirer-Ray-Hare test were used for within-group and between-group comparisons. There were no statistically significant differences between the groups in terms of age, sex, duration of dialysis, primary disease, or baseline prenutrition inflammation data. At 6 months postintervention, the intervention group exhibited higher levels of serum albumin, blood calcium, serum iron, hemoglobin, total iron-binding capacity, body mass index, midarm circumference, triceps skinfold thickness, handgrip strength, and daily energy and protein intake compared with the control group (P < 0.05). Additionally, the intervention group demonstrated lower levels of subjective nutrition assessment value, C-reactive protein, and neutrophil-to-lymphocyte ratio than the control group (P < 0.05), with no statistically significant differences in other markers after interventions. Multidisciplinary MNT can ameliorate the nutrition status of patients receiving PD, decrease the incidence of malnutrition, and improve anemia and microinflammatory outcomes.

Sulforaphane alleviates renal fibrosis through dual regulation on mTOR-mediated autophagy pathway.

Renal fibrosis is a common pathological process of progressive chronic kidney disease (CKD). However, effective therapy is constrained currently. Autophagy is an important mechanism in kidney injury and repairment but its exact role in renal fibrosis was discrepant according to previous studies. Sulforaphane (SFN), a natural plant compound, has been explored as a promising nutritional therapy for a variety of diseases. But the salutary effect and underlying mechanism of SFN on CKD have not been fully elucidated. In this study, we investigated the effect of SFN on renal fibrosis in unilateral ureteral obstruction (UUO) mice. Then we examined the regulatory effect of SFN on autophagy-related proteins in renal fibroblasts and renal tubular epithelial cells. Our results showed that sulforaphane could significantly alleviate renal fibrosis in UUO mice. In vitro, the expression levels of autophagy-related protein showed that SFN could upregulate the autophagy activity of renal interstitial fibroblasts and downregulate the autophagy activity of renal tubular epithelial cells. Furthermore, we found that phosphorylated mTOR protein levels was reduced in renal fibroblasts and increased in renal tubular epithelial cells after SFN treatment. Our results strongly suggested that SFN could alleviate renal fibrosis through dual regulation of mTOR-mediated autophagy pathway. This finding may provide a new perspective on the renal salutary effect of SFN and provide a preclinical rationale for exploring the therapeutic potential of SFN to slow down renal fibrosis.

A Scoping Review of Tools to Assess Digital Health Literacy Among Middle-Aged and Older Adults for Application to Dietetic Practice

A Scoping Review of Tools to Assess Digital Health Literacy Among Middle-Aged and Older Adults for Application to Dietetic Practice

Critical Assessment of the Role of Diet and Nutrition in Mental Health Treatment Plans

It has been the focus of research for the last decade as to how nutritional intake interacts with the diet, and lots of faith is being given to dietary intervention in the management of mental health disorders. This paper critically examines the current evidence regarding the relationship between diet nutrition and mental health and discusses how nutritional therapies may be applied. Based on literature analysis and the present data, this paper is aimed at bringing insight into the promising effects of diets to manage some of the symptoms of anxiety, depression, and other psychiatric disorders. Moreover, the paper presents the limitations of the present study and directions for further research in nutritional psychiatry. It ends by arguing that diet and nutrition may or ought to be considered part of the fundamental care for mental health issues and could be useful additions to medication.

Therapeutic potential of Lacticaseibacillus rhamnosus grx10 and its derived postbiotic through gut microbiota and MAPK/MLCK/MLC pathway-mediated intestinal barrier repairment in ulcerative colitis.

Lacticaseibacillus rhamnosus grx10 (grx10) has shown promising potential in promoting intestinal health as predicted by genomic and metabolomic analyses. Given the increasing prevalence of ulcerative colitis (UC) and the limitations of existing treatments, exploring alternative therapeutic strategies is essential. This study explored the therapeutic effects and underlying mechanisms of grx10 and its derived postbiotic (P-grx10) in a mouse model of dextran sulfate sodium (DSS)-induced chronic UC. The intervention with grx10 and P-grx10 significantly alleviated clinical symptoms and improved biochemical markers in UC mice. These effects included reducing the disease activity index (DAI), improving colon length and histopathological damage, decreasing the secretion of inflammatory cytokines, and preventing the reduction of antioxidant enzymes. Additionally, grx10 and P-grx10 downregulated key proteins in the Mitogen-Activated Protein Kinase (MAPK)/myosin light chain kinase (MLCK)/myosin light chain (MLC) pathway, prevented the dissociation of tight junction (TJ) proteins and E-cadherin, reduced intestinal permeability, and restored the integrity of the intestinal barrier. Furthermore, both grx10 and P-grx10 modulated the composition and abundance of gut microbiota, helping to maintain intestinal microbiome homeostasis. In conclusion, this study provided evidence regarding the role of grx10 and P-grx10 in alleviating intestinal barrier dysfunction associated with UC and restoring gut microbiota balance. Notably, P-grx10 exhibited higher anti-inflammatory activity and better restoration of intestinal barrier function, whereas the live probiotic grx10 showed a stronger regulatory effect on the gut microbiota. These findings suggest that grx10 and P-grx10 could serve as promising nutritional adjunct therapies for UC, providing novel insights into the distinct roles of probiotic and its derived postbiotic in UC treatment.

Energy expenditure measured by indirect calorimetry in a neuroscience intensive care unit: a retrospective observational study

Objectives: To compare indirect calorimetry (IC) readings with the Harris–Benedict equation (HBE) predictions of resting energy expenditure (REE) in intubated acute brain-injured patients in a tertiary hospital’s Neuroscience Intensive Care Unit (ICU). Design: A single-centre, retrospective study. Setting: Neuroscience Intensive Care Unit at a tertiary hospital. Subjects: All adult patients admitted to the Neuroscience Intensive Care Unit between June 1, 2020, and June 30, 2021, who had an IC reading. Outcome measures: Comparison of the measured REE using IC and the predicted REE using the HBE modified for critically ill adults. Subgroup analysis based on body mass index (BMI) was also performed. Results: A total of 108 patients had IC readings taken during the study period. There was a significant difference between the REE predicted by the HBE and the measured IC readings, with a mean difference of 465.3 kcal (95% CI 408.1–522.5, p = 0.001). A moderate positive correlation was observed (coefficient r = 0.565, p < 0.001). In patients with BMI ≥ 30 kg/m², the HBE significantly overestimated REE compared with IC readings (p = 0.005). Conclusions: The Harris–Benedict equation tends to overestimate resting energy expenditure, especially in acute brain-injured patients with a BMI ≥ 30 kg/m². Utilising IC-directed nutrition therapy in intensive care units could help in delivering personalised caloric intake, reducing the risks of underfeeding or overfeeding.

Adequate nutrological treatment for patients with chronic kidney disease: a systematic review

Introduction: In the scenario of chronic kidney disease (CKD), data from the World Health Organization show that CKD affects approximately 10% of the world population, particularly in low- and middle-income countries. In the USA alone, approximately 37 million adults are affected, given that diagnosis is late due to the lack of apparent symptoms in the early stages. Due to limited access to diagnosis and treatment, CKD has become the 12th leading cause of death in the world, making adequate nutritional therapy necessary as the main treatment. Objective: It was to highlight the importance of adequate nutrological treatment for patients with chronic kidney disease. Methods: The systematic review rules of the PRISMA Platform were followed. The research was carried out from August to September 2024 in Scopus, PubMed, Science Direct, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: 124 articles were found. 22 articles were evaluated and 18 were included in this systematic review. Considering the Cochrane tool for risk of bias, the overall assessment resulted in 28 studies with a high risk of bias and 22 studies that did not meet GRADE. Most studies showed homogeneity in their results, with X2 =84.6% &gt;50%. It was concluded that chronic kidney disease is a growing health crisis in the world, accompanying the increase in the number of patients with obesity. Diabetes and hypertension are the main causes of the development of chronic kidney disease. Lifestyle changes, adequate nutritional therapy, and lipid-lowering medications can contribute to improving the clinical outcome of patients with chronic kidney disease. Medical nutritional therapy is fundamental and vital for the treatment of chronic kidney disease, as it can delay disease progression and prevent comorbidities and mortality.

Functional Food Nutrients, Redox Resilience Signaling and Neurosteroids for Brain Health.

The interplay between functional food nutrients and neurosteroids has garnered significant attention for its potential to enhance stress resilience in health and/or disease. Several bioactive nutrients, including medicinal herbs, flavonoids, and bioavailable polyphenol-combined nanoparticles, as well as probiotics, vitamin D and omega-3 fatty acids, have been shown to improve blood-brain barrier (BBB) dysfunction, endogenous neurosteroid homeostasis and brain function. These nutrients can inhibit oxidative stress and neuroinflammation, which are linked to the pathogenesis of various neurological disorders. Interestingly, flavonoids exhibit dose-dependent effects, activating the nuclear factor erythroid 2-related factor 2 (Nrf2) pathway at the physiological/low dose (neurohormesis). This leads to the upregulation of antioxidant phase II genes and proteins such as heme oxygenase-1 (HO-1) and sirtuin-1 (Sirt1), which are activated by curcumin and resveratrol, respectively. These adaptive neuronal response mechanisms help protect against reactive oxygen species (ROS) and neurotoxicity. Impaired Nrf2 and neurosteroid hormone signaling in the brain can exacerbate selective vulnerability to neuroinflammatory conditions, contributing to the onset and progression of neurodegenerative and psychiatric disorders, including Alzheimer's disease, anxiety and depression and other neurological disorders, due to the vulnerability of neurons to stress. This review focuses on functional food nutrients targeting Nrf2 antioxidant pathway and redox resilience genes to regulate the neurosteroid homeostasis and BBB damage associated with altered GABAergic neurotransmission. By exploring the underlying molecular mechanisms using innovative technologies, we aim to develop promising neuroprotective strategies and personalized nutritional and neuroregenerative therapies to prevent or attenuate oxidative stress and neuroinflammation, ultimately promoting brain health.

Subclinical Hypothyroidism and Gestational Hypertensive Disorders in a Cohort of Romanian Pregnant Women with Gestational Diabetes Mellitus: A Pilot Study.

This study aimed to explore whether subclinical hypothyroidism (SCH) treated with levothyroxine in pregnancy complicated by gestational diabetes mellitus (GDM) is associated with an increased risk of gestational hypertensive disorders (GHDs) (gestational hypertension and preeclampsia). 96 pregnant women with GDM were enrolled in this study and grouped as per the European Thyroid Association criteria into the SCH (n = 21) and euthyroid groups (n = 75). All subjects were tested for anthropometric parameters, maternal glucose homeostasis parameters, lipid levels, thyroid function tests, and blood pressure. All GDM pregnant women received nutritional and insulin therapy where needed, and the SCH group received levothyroxine treatment. Then, the maternal and newborn outcomes were compared. Data were analyzed using Student's t-test, Mann-Whitney U, and Chi-square tests wherever applicable. p values of <0.05 were considered significant. Patients with GDM and SCH had a pre-pregnancy BMI and BMI at inclusion in the study smaller than those of the euthyroid group (p = 0.0004, p = 0.0009). There were no significant differences between groups regarding the incidence of GHD, preterm prelabor rupture of membranes (PPROMs), macrosomia, low birth weight, and fetal distress (p > 0.05). Patients with GDM and SCH treated with levothyroxine had more premature delivery than the euthyroid group (p = 0.03). Subclinical hypothyroidism treated with levothyroxine in women with GDM does not increase the risk of gestational hypertensive disorders, but is associated with increased risk for prematurity.

Association of phenylalanine and tyrosine metabolism with mortality and response to nutritional support among patients at nutritional risk: a secondary analysis of the randomized clinical trial EFFORT.

Elevated phenylalanine serum level is a surrogate marker of whole-body proteolysis and has been associated with increased mortality in critically ill patients. Tyrosine is a metabolite of phenylalanine and serves as a precursor of thyroid hormones and catecholamines with important functions in the oxidative stress response among others. Herein, we examined the prognostic significance of phenylalanine, tyrosine, as well as its metabolites nitrotyrosine, L-3,4-dihydroxyphenylalanine (DOPA), and dopamine regarding clinical outcomes and response to nutritional therapy in patients at nutritional risk. This is a secondary analysis of the Effect of Early Nutritional Support on Frailty, Functional Outcomes, and Recovery of Malnourished Medical Inpatients Trial (EFFORT), a randomized controlled trial investigating individualized nutritional support compared to standard care in patients at risk of malnutrition. The primary outcome was 30-day all-cause mortality. We analyzed data of 238 patients and found a significant association between low plasma levels of phenylalanine [adjusted HR 2.27 (95% CI 1.29 to 3.00)] and tyrosine [adjusted HR 1.91 (95% CI 1.11 to 3.28)] with increased 30-day mortality. This association persisted over a longer period, extending to 5 years. Additionally, trends indicated elevated mortality rates among patients with low nitrotyrosine and high DOPA and dopamine levels. Patients with high tyrosine levels showed a more pronounced response to nutritional support compared to patients with low tyrosine levels (HR 0.45 versus 1.46, p for interaction = 0.02). In medical inpatients at nutritional risk, low phenylalanine and tyrosine levels were associated with increased short-and long-term mortality and patients with high tyrosine levels showed a more pronounced response to nutritional support. Further research is warranted to gain a deeper understanding of phenylalanine and tyrosine pathways, their association with clinical outcomes in patients at nutritional risk, as well as their response to nutritional therapy. www.clinicaltrials.gov, identifier NCT02517476.

Nutritional, Metabolic, and Inflammatory Alterations in Children with Chylous Effusion in the Postoperative Period of Cardiac Surgery: A Descriptive Cohort.

The occurrence of chylous effusion in children undergoing cardiac surgery is progressively increasing due to technical advances that have led to a rise in the number of surgeries. In this context, the objective was to describe the clinical profile of a cohort of patients at the time of chylous effusion diagnosis. A retrospective cohort analysis was conducted between January 2011 and July 2023, involving 23 patients, aged 0 to 18 years, treated at a quaternary university hospital in southeastern Brazil. Data were obtained from the follow-up records of the Multidisciplinary Nutritional Therapy Team (MNTT) for patients who received nutritional support after developing chylous effusion in the postoperative period of cardiac surgery. The younger population predominated (median age of 6 months), with a high prevalence of malnutrition (60.9%). At the time of chylous effusion diagnosis, 83% had lymphopenia, and 74% had hypoalbuminemia. The longer the time elapsed after surgery for the onset of chylous effusion, the lower the HDL cholesterol, the lower the albumin levels, the greater the surgical complexity, the younger the patient, and the lower their weight. Hypocalcemia occurred in nearly half of the sample and hypophosphatemia in 26% of the analyzed cases. There was a notable presence of lymphopenia, hypoalbuminemia, and low HDL cholesterol, as well as a high incidence of mineral imbalances, particularly hypocalcemia and hypophosphatemia, which, if untreated, may lead to unfavorable outcomes. Therefore, clinical and laboratory monitoring of children in the postoperative period of cardiac surgery is important and can aid in the early diagnosis of chylous effusion and, consequently, in the timely initiation of treatment.

Integrating the new pharmacological standard of care with traditional nutritional interventions in non-dialysis CKD.

Chronic kidney disease (CKD) is widely recognized as a leading and growing contributor to global morbidity and mortality worldwide. Nutritional therapy is the basic treatment for metabolic control, and may contribute to nephroprotection; however, the absence of solid evidence on slowing CKD progression together with poor adherence to dietary prescription limit de facto itsefficacy and prevent itsmore widespread use. Sodium-glucose transport protein 2 inhibitors (SGLT2is) are now considered the new standard of care in CKD; in addition, novel potassium binders, glucagon-like peptide-1 receptor antagonists (GLP1-RAs) and nonsteroidal mineralocorticoid receptor antagonists (nsMRAs) show either direct (SGLT2i, GLP1-RA, nsMRA) or indirect (potassium binders that enable the optimal use of renin-angiotensin-aldosterone system inhibitors) nephroprotective effects. These drugs could potentially lead to a more permissive diet, thereby allowing the patient to reap the benefits of this approach. In particular, SGLT2is, and to a lesser extent also GLP1-RAs and nsMRAsin patients with diabetic kidney disease, can counterbalance hyperfiltration as well as the higher protein intake often recorded in obese patients; on the other hand, potassium binders can facilitate following plant-based diets, which are considered healthy because of the high content of essential micronutrients such as antioxidant vitamins, minerals, alkalies, and fibers. In this review paper, we discuss the current pharmacological paradigm shift that places a new, broader standard of care in light of its interaction with nutritional therapy in order to optimize the global approach to patients with CKDnotondialysis.

PREVALENCE OF NUTRITIONAL DEFICIENCIES IN CRITICALLY ILL PATIENTS ADMITTED TO INTENSIVE CARE UNIT

Objective: This study was conducted to assess the incidence of the excisting malnutrition in critically ill patients who are admitted to ICU. So that this can help in improving the nutrition therapy in these critically ill patients. And, to identify the comorbidities which as associated with severe malnutrition. Methods: All patients who are above 18 years admitted to ICU irrespective of sex, diagnosis and severity of disease are assessed for nutritional status with SGA score within 24 hours of admission. Results: In males severe malnourishment was noted in elderly age group with mean age of 64.33 ±17.32 compared to patients with &lt; 60 years. In female patients moderately nourished patients were older with mean age of 61.37±12.69. there is no difference between male and female in well-nourished and severely malnourished group. But in moderately nourished group females are more than males(32.09% vs 24.92%). Diabetes mellitus seem to be the most common comorbidity noted. In diabetes mellitus 81.39% of patients were severely malnourished. Conclusion: it is shown that most of the patients admitted to ICU presents with pre excisting malnutrition. So nutrition therapy plays import role in management of these patients.