Optimal Nutritional Support Research Articles

Nutrition support for patients with renal dysfunction in the intensive care unit: A narrative review.

Providing optimal nutrition support in the intensive care unit (ICU) is a challenging and dynamic process. Energy, protein, fluid, electrolyte, and micronutrient requirements all can be altered in patients with acute, chronic, and acute-on-chronic kidney disease. Given that renal dysfunction occurs in up to one-half of ICU patients, it is imperative that nutrition support providers understand how renal dysfunction, its metabolic consequences, and its treatments, including renal replacement therapy (RRT), affect patients' nutrition needs. Data on nutrient requirements in critically ill patients with renal dysfunction are sparse. This article provides an overview of renal dysfunction in the ICU and identifies and addresses the unique nutrition challenges present among these patients, including those receiving RRT, as supported by the available literature and guidelines.

Metabolic Profiles of Critically Ill COVID-19 Patients: A Comparative Analysis of Energy Expenditure.

Introduction and aims The COVID-19 pandemic has placed a significant burden on healthcare systems worldwide, especially in the management of critically ill patients. Accurate assessment of energy expenditure (EE) is crucial for providing optimal nutritional support and improving clinical outcomes in these patients. Indirect calorimetry (IC) is the preferred method for measuring EE, yet its use in critically ill COVID-19 patients has not been extensively documented. This study aims to evaluate EE in critically ill patients with and without COVID-19 to identify differences that may impact nutritional support strategies. Methods We conducted a retrospective observational study at a large tertiary university hospital, focusing on critically ill patients. The study compared calorimetry data between patients with and without COVID-19. Data collected included resting energy expenditure, energy expenditure per kilogram, and respiratory exchange rate quotient using IC. Statistical analysis was conducted using SPSS Version 28, with a significance level set at p < 0.05. Results The study included 95 critically ill patients, comprising 61 non-COVID-19 patients and 34 COVID-19 patients. It was found that COVID-19 patients had significantly lower Simplified Acute Physiology Score (SAPS) II compared to their non-COVID-19 counterparts. Although no significant differences in energy needs over time were detected between the two groups or within the COVID-19 group alone, there was a trend towards lower energy needs in COVID-19 patients. Significant differences were noted in respiratory quotient among COVID-19 patients, particularly between those with and without pulmonary thromboembolism, with the latter group exhibiting lower RQ values. Conclusion Our study suggests that while overall EE may not significantly differ between critically ill COVID-19 and non-COVID-19 patients, there are potential differences in substrate use that underline the necessity for individualized nutritional support. These findings highlight the importance of tailoring nutritional interventions to meet the specific needs of critically ill patients, particularly those with COVID-19.

CLINICAL APPLICATION OF EARLY POSTOPERATIVE NUTRITIONAL SUPPORT IN PATIENTS WITH HIGH-RISK VALVULAR HEART DISEASE.

Background : The treatment strategy of early nutritional support after cardiac surgery has gradually been adopted. However, there are no scientific guidelines for the timing and specific programs of early nutritional support. Methods: A retrospective, single-center analysis (2021-2023) was carried out including elderly patients who were admitted for valvular heart disease and received open-heart valve replacement surgery. We designated patients who started the optimized nutritional support after surgery as the optimized enteral nutritional support strategy TN (EN) group and those who received traditional nutritional support as the traditional nutritional support strategy (TN) group. The nutritional and immune indexes, postoperative complications, length of hospital stay, and hospitalization cost of the two groups were compared and analyzed. Results: We identified 378 eligible patients, comprising 193 (51%) patients in the EN group and 185 (49%) patients in the TN group. There was no significant difference in hospital mortality between the two groups, but the proportion of nosocomial pneumonia was significantly lower in the EN group than in the TN group ( P < 0.001). In the Poisson regression analysis, EN was not associated with an increase in gastrointestinal complications ( P = 0.549). The EN group also seemed to have shorter hospital stays and lower hospitalization expenses ( P < 0.001). In the comparison of postoperative gastrointestinal complications, fewer patients experienced diarrhea ( P = 0.021) and abdominal distension ( P = 0.033) in the EN group compared with the TN group. Conclusion: The optimal nutritional support strategy could effectively improve the clinical outcome of high-risk patients with valvular heart disease.

Optimizing Nutritional Needs of Burn Patients: An Evaluation of Nutritional Assessment Tools, Feeding Strategies, and Their Impact on Patient Outcomes.

Optimal nutritional support is essential to the recovery and improved outcomes of burn patients. This review aims to explore existing literature to evaluate nutrition assessment tools, feeding formulations' caloric predictive ability, timing of initiation of feeding, optimal nutritional composition, and caloric intake in burn patients. Three databases were searched to glean studies investigating nutrition in acute severe adult burn patient populations in four areas: outcomes based on feeding type and timing, the caloric predictability of nutritional assessment tools, outcomes associated with the composition of feeding formulas, and considerations related to caloric intake. Outcomes of interest included the effects of nutritional assessments using feeding type, nutritional administration timing, formula composition, and caloric intake on mortality rate, length of stay, and infection. A total of 19 studies were included. Nutritional assessment tools were determined to over- or underestimate resting energy expenditure (REE). Milner was the most accurate alternative to indirect calorimetry. Early enteral nutrition in burn patients within 24hours of admission was preferred. 5 studies evaluated micronutrients and yielded variable results. Low-fat high-carbohydrate diets were the ideal macronutrient composition. Burn patients were shown to receive lower caloric intake than recommended. Findings showed that while nutritional assessment tools tend to inaccurately estimate REE in burn patients, the ideal alternative to indirect calorimetry is the Milner equation. Several new equations may be worthy alternatives but require further validation. Enteral feeding should be initiated within the first 24hours of burn injury whenever possible and should contain a high-carbohydrate/low-fat composition.

Nutritional support for the trauma and emergency general surgery patient: What you need to know.

Decades of research have provided insight into the benefits of nutritional optimization in the elective surgical patient. Patients who are nutritionally prepared for surgery enjoy reduced length of hospital and intensive care unit stays and suffer fewer complications. In the trauma and emergency general surgery patient populations, we are not afforded the preoperative period of optimization and patients often suffer longer lengths of hospital stay, discharge to nonhome destinations, and higher infectious and mortality rates. Nonetheless, ongoing research in this vulnerable and time critical diagnosis population has revealed significant outcomes benefits with the meticulous nutritional support of these patients. However, it is important to note that optimal nutritional support in this challenging patient population is not simply a matter of "feeding more and feeding earlier." In this review, we will address assessing nutritional needs, the provision of optimal nutrition, the timing and route of nutrition, and monitoring outcomes and discuss the management of nutrition in the complex trauma and emergency general surgery patient. Literature Synthesis and Expert Opinion; Level V.

Estimates of resting energy expenditure using predictive equations in adults with severe burns: A systematic review and meta-analysis.

Many equations to estimate the resting energy expenditure (REE) of patients with burns are currently available, but which of them provides the best guide to optimize nutrition support is controversial. This review examined the bias and precision of commonly used equations in patients with severe burns. A systematic search of the PubMed, Web of Science, Embase, and Cochrane Library databases was undertaken on June 1, 2023, to identify studies comparing predicted REE (using equations) with measured REE (by indirect calorimetry [IC]) in adults with severe burns. Meta-analyses of bias and calculations of precisions were performed in each predictive equation, respectively. Nine eligible studies and 12 eligible equations were included. Among the equations, the Toronto equation had the lowest bias (26.1 kcal/day; 95% CI, -417.0 to 469.2), followed by the Harris-Benedict equation × 1.5 (1.5HB) and the Milner equation. The Ireton-Jones equation (303.4 kcal/day; 95% CI, 224.5-382.3) acceptably overestimated the REE. The accuracy of all of the equations was <50%. The Ireton-Jones equation had the relatively highest precision (41.2%), followed by the 1.5HB equation (37.0%) and the Toronto equation (34.7%). For adult patients with severe burns, all of the commonly used equations for the prediction of REE are inaccurate. It is recommended to use IC for accurate REE measurements and to use the Toronto equation, 1.5HB equation, or Ireton-Jones equation as a reference when IC is not available. Further studies are needed to propose more accurate REE predictive models.

Effects of Copper Compounds on Phenolic Composition of the Common and Tartary Buckwheat Seedlings

Food producers actively seek effective seed-coating agents to ensure optimal antimicrobial protection and/or nutritional support for young plants. In this context, our study aimed to investigate the impact of various copper compounds on the germination and early growth stages of two important crops, common and Tartary buckwheat. Microparticles (MPs) and nanoparticles (NPs) of copper oxide (CuO) were selected as potential seed treatment agents and compared to Cu salt in a comprehensive germination assay. The results indicated that seed germination remained unaffected by the tested copper compounds after eight days, while there was a significant reduction in seedlings fresh weight and root length. Treated common buckwheat seedlings exhibited extreme increases in all tested phenolic metabolites, even at low concentrations of Cu compounds. In contrast, in Tartary buckwheat seedlings, the already higher concentrations of flavonoids and tannins were mostly slightly decreased. Considering all the results, CuO NPs emerged as the most severe form of Cu, while CuO MPs may have the highest potential for applications in agriculture and food sciences. This finding has implications for producers seeking seedlings enriched in beneficial phenolic compounds for human health, as well as for farmers aiming to boost the antioxidative system of plants to mitigate stress.

Neurocritical Care Nutrition: Unique Considerations and Strategies for Optimizing Energy Supply and Metabolic Support in Critically Ill Patients

Neuro-critically ill patients face unique challenges in nutritional support due to varying metabolic and energy demands arising from clinical situations such as elevated intracranial pressure, trauma, stroke, epilepsy, targeted temperature management (TTM), and pharmacological interventions. Despite these challenges, there is a lack of systematic reviews addressing their specific needs. This study conducts a systematic review and narrative synthesis of the existing literature on nutritional support for neuro-critical patients, focusing on amino acids that act as neurotransmitters or their precursors. We examined nutritional requirements and timing in patients with stroke and traumatic brain injury, as well as energy and metabolic demands during TTM, a common therapeutic intervention in neuro-critical care. Our review aims to clarify uncertainties surrounding amino acid provision in neuro-critical patients and provide up-to-date recommendations on nutritional support for those with elevated intracranial pressure and undergoing TTM, serving as a foundation for future research and evidence-based guideline development. Key findings include the potential benefits of branched-chain amino acids (BCAAs) in neuro-critical care, the roles of methionine and serine, the significance of arginine in vascular constriction, the controversial role of glutamate in nutrition, and the potential benefits of selenium supplementation. We also discussed special considerations in nutritional support for neuro-critical patients, such as changes in energy demand, the influence of sedation on energy demand, and metabolism changes during TTM. Our review highlights the need for a better understanding of the unique metabolic requirements of neuro-critical patients and the development of evidence-based guidelines for optimal nutritional support in this population.

Early oral feeding versus nasojejunal early enteral nutrition in patients following pancreaticoduodenectomy: a propensity score-weighted analysis of 428 consecutive patients.

Notwithstanding that significant medical progress has been achieved in recent years, the optimal nutritional support method following pancreaticoduodenectomy (PD) remains uncertain. This study compared the safety and feasibility of early oral feeding (EOF) with nasojejunal early enteral nutrition (NJEEN) after PD. A retrospective cohort study was conducted on 428 consecutive patients who underwent PD between August 2018 and December 2020. During the first study phase, the routine postoperative feeding strategy was NJEEN, later replaced by EOF during the second study phase. The primary outcome was the incidence of delayed gastric emptying (DGE) following PD. Propensity score weighting (PSW) was used to control for confounding factors. 440 patients underwent PD during the overall study period, with 438 patients aged 18 years and older. Ten patients experienced accidental tube dislodgement or migration and were excluded from the study based on the exclusion criteria. Finally, 211 patients and 217 patients underwent EOF and NJEEN, respectively. After PSW, it was observed that patients who underwent postoperative EOF experienced a significantly lower DGE (B/C) rate compared to those who underwent postoperative NJEEN (7.38% (31/424) vs. 14.97% (62/413), P=0.0005). Subgroup analyses according to the presence of soft pancreatic texture yielded consistent results. The EOF group exhibited lower DGE grade, DGE (B/C) rate (5.90% (11/194) vs. 22.07% (43/193), P<0.0001), postoperative gastrointestinal endoscopic intervention rate, and Clavien-Dindo Grade III or higher rate. EOF is superior to NJEEN in reducing the incidence of grade B/C DGE after PD. The EOF procedure is safe and feasible and should be recommended as the optimal postoperative feeding method following PD.

Emergency nurse and physician perceptions of barriers and facilitators to optimal nutrition in the emergency department: A national cross-sectional survey

IntroductionOptimal nutritional support is becoming increasingly important in Emergency Departments (EDs) as over half of patients presenting to ED are reported to be malnourished or at risk of malnutrition. Few studies have examined the barriers and facilitators to nutritional support in ED. AimTo identify barriers and facilitators to providing optimal nutritional support in the ED from nurse and physician perspectives. MethodsA cross-sectional 31-item electronic survey was developed, validated, and distributed nationally in August 2021 in China. ResultsA total of 1766 eligible respondents completed the survey, including 846 ED nurses and 920 ED physicians from 155 hospitals. Barriers to optimal nutrition were moderate (2.72/5 ± 0.88); the most common barrier was lack of multidisciplinary team-work support. Facilitators to support optimal nutrition were moderately high (3.58/5 ± 1.08); the most common facilitator was technical/professional support and organizational management. Respondents who received recent nutrition training and those with higher levels of nutrition knowledge (self-rated) perceived fewer barriers overall to optimal nutrition in ED (P < 0.01). ConclusionContext specific barriers and facilitators both hinder and support optimal nutrition in ED. Further research is required to develop tailored interventions to address specific barriers to optimal nutrition and enhance facilitators in the ED context.

Agreement between measured energy expenditure and predictive energy equations in paediatric oncology

Purpose: Optimal nutritional support in childhood cancer relies on the adequate provision of energy. This study investigated the impact of chemotherapy on resting energy expenditure (REE) during the first six months of treatment and the accuracy of predictive equations in calculating said requirements of newly diagnosed children with cancer. Methods: REE was measured at diagnosis utilising a validated bioelectrical impedance analysis (BIA) mobile unit and compared with three predictive equations (Schofield 1985, World Health Organization [WHO] 1985 and the Recommended Dietary Allowance [RDA] 1989). Agreement and accuracy of these equations were tested by determining bias and agreement rates and displayed using the Bland–Altman plot. Baseline values were plotted against monthly follow-up measurements over time. Statistical significance was 5% and a priori limits of agreement set between 90% and 110% of measured REE. Results: Forty-three newly diagnosed children with median age 4 years (IQR 2.0–7.6) were measured prior to chemotherapy initiation. Compared with measured REE (mean ± SD) 719.53 ± 206.29 kcal/day, all predictive equations significantly overestimated REE: WHO 1985 (889.75 ± 323.31 kcal/day; 23% overestimation), Schofield 1985 (899.62 ± 336.10 kcal/day; 25% overestimation) and RDA (1647.67 ± 481.06 kcal/day; 129% overestimation) (p < 0.001). Despite significant proportionate bias in all three equations (p < 0.001), the intra-class consistency coefficient showed good reliability for the Schofield 1985 (0.864) and WHO 1985 (0.849) equations. Though statistically significant (chi-square = 23.11, p < 0.003), the overall 1 kcal/kg (1.3%) increase for all cancer types at six months may not be clinically significant. Conclusion: Existing predictive equations are unable to calculate REE accurately at childhood cancer diagnosis, highlighting the need for future investigations into the development of cancer-specific equations.

Optimal Nutritional Support Strategy Based on the Association between Modified NUTRIC Score and 28-Day Mortality in Critically Ill Patients: A Prospective Study.

Malnutrition in critically ill patients is closely linked with clinical outcomes. During acute inflammatory states, nutrition cannot reverse the loss of body cell mass completely. Studies on nutritional screening and strategy considering metabolic changes have not yet been conducted. We aimed to identify nutrition strategies using the modified Nutrition Risk in the Critically ill (mNUTIRC) score. Nutrition support data, laboratory nutrition indicators, and prognosis indices were prospectively collected on the 2nd and 7th day after admission. It was to identify the effect of the changes on the metabolic status and critical target of nutrition intervention. To discriminate the high-risk group of malnutrition, receiver operating characteristic curves were plotted. Risk factors associated with 28 day-mortality were evaluated using multivariable Cox proportional hazards regression. A total of 490 and 266 patients were analyzed on the 2nd and 7th day, respectively. Only the mNUTRIC score showed significant differences in nutritional risk stratification. The use of vasopressors, hypoprotein supply (<1.0 g/kg/day), high mNUTRIC score, and hypoalbuminemia (<2.5 mg/dL) in the recovery phase were strongly associated with a 28-day mortality. The implementation of the mNUTRIC score and protein supply in the post-acute phase is critical to improve 28-day mortality in critically ill patients.

An overview of current research on nutritional support for burn patients: A bibliometric analysis from 1983 to 2022

ObjectivesBurn patients are reportedly prone to complications, such as skeletal muscle wasting, anemia, and slow wound healing, during treatment, due to disease and metabolic depletion, which affect prognosis. Nutritional support is essential in treating burns and can significantly improve patient survival and reduce complications such as infection. This study aimed to perform a bibliometric analysis of the existing literature on nutritional support for burns and to explore possible future research trends. MethodsThe literature related to nutritional support for burns from 1983 to 2022 was searched on Web of Science. The included literature was used for bibliometric analysis using VOSviewer and CiteSpace software. ResultsThere were 260 publications on nutritional support for burns. The United States contributes significantly to research in this area. The United States has the highest number of publications (n = 119) and citations (n = 4424). Nutrition support was the keyword with strongest burst intensity. A diet of ≥ 60% carbohydrates and 12% to 15% fat is suitable for burn patients, but the optimal ratios have not been fully determined. ConclusionsAn optimal nutritional support program is essential for treating burn patients. Individualized nutritional support programs are the trend in this field. At present, more rigorous multicenter prospective studies with large samples are needed to explore the optimal ratios for specific dietary programs, especially macronutrients, to achieve satisfactory nutritional support and improve patient prognosis.

Prevalence of vitamin and iron deficiencies at cancer diagnosis at two pediatric oncology units in South Africa

This study investigates the prevalence of vitamin and iron deficiencies at cancer diagnosis. Newly diagnosed children between October 2018 and December 2020 at two South African pediatric oncology units (POUs) were assessed for nutritional and micronutrient status (Vit A, Vit B12, Vit D, folate, and iron). A structured interview with caregivers provided information regarding hunger and poverty risks. There were 261 patients enrolled with a median age of 5.5 years and a male-to-female ratio of 1:0.8. Nearly half had iron deficiency (47.6%), while a third had either Vit A (30.6%), Vit D (32.6%), or folate (29.7%) deficiencies. Significant associations existed between moderate acute malnutrition (MAM) and low levels of Vit A (48.4%; p = .005), Vit B12 (29.6%; p < .001), and folate (47.3%; p = .003), while Vit D deficiency was associated with wasting (63.6%) (p < .001). Males had significantly lower Vit D levels (respectively, 40.9%; p = .004). Folate deficiency was significantly associated with patients born at full term (33.5%; p = .017), age older than five years (39.8%; p = .002), residing in provinces Mpumalanga (40.9%) and Gauteng (31.5%) (P = .032); as well as having food insecurity (46.3%; p < .001), or hematological malignancies (41.3%; p = .004). This study documents the high prevalence of Vit A, Vit D, Vit B12, folate, and iron deficiency in South African pediatric cancer patients, demonstrating the need to include micronutrient assessment at diagnosis to ensure optimal nutritional support for macro-and micronutrients.

Effects of dietary sulfur amino acid levels on growth performance and intestinal immunity in broilers vaccinated and subsequently infected with coccidiosis

Coccidia vaccination is a common practice in the poultry industry. However, research is lacking regarding the optimal nutritional support for coccidia vaccinated broilers. In this study, broilers were vaccinated with coccidia oocyst at hatch and were fed with a common starter diet from 1 to 10 d. On d 11, the broilers were randomly assigned to groups in a 4×2 factorial arrangement. Briefly, the broilers were fed one of four diets containing 0.6, 0.8, 0.9, and 1.0% of standardized ileal digestible methionine plus cysteine (SID M+C), respectively, from 11 to 21 d. On d 14, the broilers from each diet group were orally gavaged with either PBS (Mock challenge) or Eimeria oocysts. Compared to PBS-gavaged broilers and regardless of dietary SID M+C levels, the Eimeria-gavaged broilers had 1) decreased gain-to-feed ratio (15-21 d, P=0.002; 11-21 d, P=0.011); 2) increased fecal oocysts (P < 0.001); 3) increased plasma anti-Eimeria IgY (P=0.033); and 4) increased intestinal luminal interleukin-10 (IL-10; duodenum, P=0.039; jejunum, P=0.018) and gamma interferon (IFN-γ; duodenum, P < 0.001; jejunum, P=0.017). Regardless of Eimeria gavage, broilers fed 0.6% SID M+C had decreased (P<0.001) body weight gain (15-21 and 11-21 d) and gain-to-feed ratio (11-14, 15-21, and 11-21 d) when compared to those fed ≥ 0.8% SID M+C. Eimeria challenge increased (P < 0.001) duodenum lesions when the broilers were fed with 0.6, 0.8, and 1.0% SID M+C, and increased (P=0.014) mid-intestine lesions when the broilers were fed with 0.6 and 1.0% SID M+C. An interaction between the two experimental factors was detected on plasma anti-Eimeria IgY titers (P=0.022), as coccidiosis challenge increased plasma anti-Eimeria IgY titers only when the broilers were fed with 0.9% SID M+C. In summary, the dietary SID M+C requirement for grower (11-21 d) broilers vaccinated with coccidiosis was ranged from 0.8 to 1.0% for optimal growth performance and intestinal immunity, regardless of coccidiosis challenge.

Nutritional Care in Children with Cystic Fibrosis

Patients with cystic fibrosis (CF) are prone to malnutrition and growth failure, mostly due to malabsorption caused by the derangement in the chloride transport across epithelial surfaces. Thus, optimal nutritional care and support should be an integral part of the management of the disease, with the aim of ameliorating clinical outcomes and life expectancy. In this report, we analyzed the nutrition support across the different ages, in patients with CF, with a focus on the relationships with growth, nutritional status, disease outcomes and the use of the CF transmembrane conductance regulator (CFTR) modulators. The nutrition support goal in CF care should begin as early as possible after diagnosis and include the achievement of an optimal nutritional status to support the growth stages and puberty development in children, that will further support the maintenance of an optimal nutritional status in adult life. The cornerstone of nutrition in patients with CF is a high calorie, high-fat diet, in conjunction with a better control of malabsorption due to pancreatic enzyme replacement therapy, and attention to the adequate supplementation of fat-soluble vitamins. When the oral caloric intake is not enough for reaching the anthropometric nutritional goals, supplemental enteral feeding should be initiated to improve growth and the nutritional status. In the last decade, the therapeutic possibilities towards CF have grown in a consistent way. The positive effects of CFTR modulators on nutritional status mainly consist in the improvement in weight gain and BMI, both in children and adults, and in an amelioration in terms of the pulmonary function and reduction of exacerbations. Several challenges need to be overcome with the development of new drugs, to transform CF from a fatal disease to a treatable chronic disease with specialized multidisciplinary care.

Risk factors for early occurrence of malnutrition in infants with severe congenital heart disease.

To identify the risk factors of early occurrence of malnutrition in infants with severe congenital heart disease (CHD) during their first year of life. Retrospective longitudinal multicenter study carried out from January 2014 to December 2020 in two tertiary care CHD centers. Four CHD hemodynamic groups were identified. Malnutrition was defined by a Waterlow score under 80% and/or underweight under -2standard deviations. A total of 216 infants with a severe CHD, e.g., requiring cardiac surgery, cardiac catheterization, or hospitalization for heart failure during their first year of life, were included in the study. Malnutrition was observed among 43% of the cohort, with the highest prevalence in infants with increased pulmonary blood flow (71%) compared to the other hemodynamic groups (p < 0.001). In multivariate analysis, low birthweight (OR 0.62, 95% CI 0.44-0.89, p = 0.009), CHD with increased pulmonary blood flow (OR 4.80, 95% CI 1.42-16.20, p = 0.08), heart failure (OR 9.26, 95% CI 4.04-21.25, p < 0.001), and the number of hospitalizations (OR 1.35, 95% CI 1.08l-1.69, p = 0.009) during the first year of life were associated with malnutrition (AUC 0.85, 95% CI 0.79-0.90). Conclusions: In infants with a severe CHD, early occurrence of malnutrition during the first year of life affected a high proportion of subjects. CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations were risk factors for malnutrition. Further studies are required to identify optimal nutritional support in this population. What is Known: • Malnutrition is a known morbidity and mortality factor in children with severe congenital heart disease. What is New: • Early occurrence of malnutrition during the first year of life in infant severe congenital heart disease (CHD) was high (43%). • CHD with increased pulmonary blood flow, low birthweight, heart failure, and repeated hospitalizations during the first year of life were risk factors for malnutrition.

Application of STRONGkids method on assessing the risk of malnutrition among hospitalised children in Universitas Sebelas Maret Hospital

Introduction: Hospital malnutrition (HM) in children augments morbidity and mortality, thus early detection is a preventive measure that may improve a patient’s condition. This study identified the risk factors of HM among children hospitalised in Universitas Sebelas Maret (UNS) Hospital using the STRONGkids method. Methods: This observational analytical cross-sectional study was performed in children hospitalised at the paediatric ward of UNS Hospital between February and August 2021. The samples were taken by consecutive sampling technique. Subjects meeting the inclusion criteria were assessed for their underlying disease, nutritional status based on World Health Organization Anthro software, and STRONGkids score. Chi-square test and logistic regression analysis were used, with a p-value of &lt;0.05 considered as statistical significance. Results: A total of 173 children were included in the study, 56% were males, mean age was 62.5 months, 45% had an underlying chronic disease, and 17.9% experienced moderate malnutrition. Based on the STRONGkids score, 39.3% children were at high risk of malnutrition and 60.7% were at moderate risk of malnutrition. Logistic regression analysis showed that high risk of HM was significantly associated with age (OR 2.58, 95% CI 1.38-4.84, p=0.003), chronic disease (OR 7.23, 95% CI 3.3-15.86, p=0.018), and moderate malnutrition (OR 13.5, 95% CI 3.96-45.98, p&lt;0.001). Conclusion: Children hospitalised in UNS Hospital were at risk of malnutrition. Toddlerhood, chronic disease, and moderate malnutrition significantly increased the risk of HM. Thus, these children need optimal nutritional support to improve their clinical condition. STRONGkids is a convenient and easy method to identify malnutrition risk during hospitalisation.

ROLE DE LA PRISE EN CHARGE NURITIONNELLE PERI OPERATOIRE SUR LA REHABILITATION POSTOPERATOIRE EN CHIRURGIE DIGESTIVE A SOISSONS - FRANCE

Perioperative nutritional management plays an essential role in postoperative rehabilitation: postoperative complications increase when perioperative malnutrition is present. Thesecomplications associatedto undernutrition can range from a simple hydro-electrolyte disorders prolonging the duration of hospitalization until death (29% versus 4% in normal subjects). Objective: To assessthe role of perioperative nutritional support on postoperative rehabilitation in digestive surgery. Type of study: Observational, analytical, prospective, monocentric study. Patients and methods: All patients hospitalized from May 2018 to April 2019 (12 months) who underwent digestive surgery by midline laparotomy were included. The Chi² test was used for correlation analysis between perioperative nutrition and postoperative rehabilitation. A p-value of less than 0.05 was considered significant. Results: Forty-seven patients were selected, aged 63 [32-100] years, sex ratio 1.47. Eighteen patients received preoperative nutritional support and 44 received postoperative nutrition. Pre- and postoperative protein intakes was correlated with first rising (p = 0,036 X² = 8,516) and complete ambulation (p &lt;0,001 X² = 26,605), respectively. Postoperativemobilizationwasearlier in patients who beneficiated fromearlyresumption of postoperativeenteral nutrition (p &lt;0,001 X² = 51,547). Perioperative nutrition (especially aminoacids intake) reduced the occurrence of postoperative complications and the duration of hospitalizationand improved survival at D30 (p = 0,002 X² = 14,586 for preoperative amino acids, p = 0,008, X² = 17,283 for postoperative amino acids). Conclusion:Digestive surgery being at risk of high morbidity and mortality, caloric and protein intake must be adequate in the perioperative period. Optimal adequate perioperative nutritional support will thus improve postoperative rehabilitation.

Veterinary nutritional assessment: the importance of an interprofessional approach

Few pet topics provoke more debate and discussion than pet nutrition. The veterinary healthcare team have a central role as the expert source of information for optimal pet nutrition, with each member capable of playing an important part in providing optimal nutritional support and recommendations. This article provides an important reminder of nutritional assessment and specific dietary recommendations as the fifth vital assessment and an essential part of patient care for every pet at every visit. It also presents the non-branded support materials and practical aids available in the WSAVA Global Nutrition Toolkit. Using a patient scenario, consideration is given to how nutritional care and support can be enhanced through interprofessional practice.