Therapeutic Food Research Articles

Volume-based enteral feeding for ward patients with acute neurological conditions: a pilot prospective cohort study.

Patients requiring enteral nutrition (EN) after neurological insults experience feeding interruptions, contributing to inadequate nutrition delivery. This prospective cohort study investigated if volume-based enteral feeding (VBF) improved the delivery of prescribed EN volume in ward patients with acute neurological conditions. Over two sequential periods, the usual care group received standard continuous rate-based feeding, and the intervention group received VBF with bi-daily EN rate adjustments to achieve target daily volume. The primary outcome was percentage of prescribed daily EN formula volume delivered. Differences in energy and protein provision, weight, malnutrition and safety were explored. An evaluation survey captured nurse acceptability of the protocol. The intervention group (n = 32) achieved greater median interquartile range (IQR) EN adequacy of prescribed volume at 92% (88-97) compared to 67% (54-78) for usual care (n = 35) (p < 0.001). VBF compared to rate-based feeding resulted in patients receiving more kilojoules (131 [121-138] kJ/kg vs. 84 [64-99] kJ/kg; p < 0.001) and protein (1.3 [1.2-1.5] g/kg vs. 0.9 [0.6-1.1] g/kg; p < 0.001). There were no differences in gastrointestinal intolerance between groups. Compliance to the VBF protocol was 90%, and 78% of staff reported high confidence using the protocol. The intervention group had less median weight loss at discharge (-1.4 [0.1 to -4.3] kg) than usual care (-3.6 [-1.3 to 8.4] kg; p < 0.011), but no differences in malnutrition status were observed. A VBF protocol delivered greater EN volume, energy and protein following neurological injury. The VBF protocol was feasible with high acceptability from nursing staff.

Dietary diversity and associated factors among households and children in internally displaced person camps in Southern Somalia: A cross-sectional study.

The study aimed to assess household and child dietary diversity in Southern Somalia by identifying determinants of adequate dietary diversity in three internally displaced person (IDP) camps in Baidoa, Dayniile and Dharkanley. A total of 1655 female main caregivers with 2370 children (6-59 months old) were included. Data on household dietary diversity score and child dietary diversity score indicators were collected from all households. The questionnaire was read face-to-face to the female main caregivers. Multivariate logistic regression analysis was performed to identify factors associated with adequate dietary diversity, which was defined as the consumption of at least four food groups within 24 h before the survey. The proportion of households achieving adequate HDDS was high in all locations 95.8%, 96.9% and 89.0% in Baidoa, Dharkanley and Dayniile, respectively, and the total adequate household dietary diversity score (AHDDS) was 95.6%. The proportion of adequate child dietary diversity score (ACDDS) was achieved in 63.5%, 8.5% and 38.3%. The main factors associated with AHDDS were larger household size, greater wealth, attendance of antenatal care (ANC) and joint decision-making between husband and wife, while factors associated with ACDDS included ANC attendance, age, the consumption of ready-to-use therapeutic food and deworming tablets. These findings can guide future programmes and policies aimed at improving maternal and child nutrition in IDP camps in Somalia. By tackling these diverse factors, a promising pathway emerges to enhance the nutritional welfare of both households and children in IDP camps.

Algal pigments: Therapeutic potential and food applications.

Algae-derived natural compounds have shown significant potential in treating various health conditions, including cancer, obesity, diabetes, and inflammation. Recent advancements in nanotechnology have enabled the development of precise drug delivery systems and diagnostic tools utilizing these compounds. Central to this innovation are the vibrant pigments found in algae chlorophylls, carotenoids, and phycobiliproteins which not only impart color but also possess notable nutritional, medicinal, and antioxidant properties. These pigments are extensively used in supplements and the food industry for their health benefits. Emerging research highlights the role of algal pigments in promoting gut health by modulating gut microbiota. This review comprehensively examines the therapeutic benefits of algae, recent progress in algal-derived nanoparticle technology, and the synergistic effects of algae and their pigments on gut health. Novel insights and recent data underscore the transformative potential of algal compounds in modern medicine and nutrition.

First occurrence and risk assessment of microplastics in enteral nutrition formulas

Occurrence and characteristics of microplastics were evaluated in enteral nutrition formulas, for the first time. A total of 30 samples belonging to 9 brands were analysed. Physical and chemical characteristics of microplastics were identified by stereomicroscopy and micro-raman spectroscopy, respectively. The mean number of microplastics was 45 ± 63 MP/L. Two different shapes of microplastics were detected with fibres (62%) being the most common microplastics followed by fragments (38%). The most common color of microplastics was black (37%) followed by blue (26%), orange (15%), green (7%), red (7%), grey (4%) and multicolor (4%). The length of microplastics ranged from 10 to 2086 μm with an average of 548 ± 526 μm. Estimated mean daily microplastic intake for four different scenarios varied between 24 to 61 and 30 to 76 MPs/day for women and men, respectively. The mean polymer hazard index and microplastic load index levels were calculated as 380 and 1.30, respectively. The results of this study showed that microplastics are prevalent in enteral nutrition products. The presence of polymers with high hazard risk scores in enteral nutrition formulas may pose a risk to the health of patients with special nutritional needs.

Effects of Formula-100 therapeutic milk and Bregas Nutriroll ready-to-use therapeutic food on Indonesian children with severe acute malnutrition: A randomized controlled trial study.

Severe acute malnutrition (SAM) is a global health concern that affects children and leads to delayed growth. The aim of this study was to compare the impact of F100 milk and Bregas Nutriroll, a local ready-to-use therapeutic food (RUTF), on SAM children. An unmasked, non-blinded, two-group, and simple randomized controlled trial was conducted. Indonesian children aged 12-59 months with SAM were randomly assigned to receive either F100 milk or Bregas Nutriroll. After eight weeks, the increase in the mean weight gain in both groups was assessed. The Bregas Nutriroll group (n=19) had a mean weight gain of 1.07±0.09 kg, while the F100 group (n=17) had a mean weight gain of 1.05±0.11 kg. The Bregas Nutriroll group had a slightly higher gain of mid-upper arm circumference (MUAC) than the F100 group (0.62±0.34 cm vs 0.50±0.37 cm). The gain of children's height of the Bregas Nutriroll group was 0.96±0.42 cm, while the F100 group was shorter at a mean of 0.81±0.44 cm. Statistically significant differences (p<0.001) in nutritional status were observed based on weight, MUAC, and height/length after F100 and Bregas Nutriroll interventions. The intervention with F100 increased hemoglobin (Hb) levels of 0.71±1.25 mg/dL, while the Bregas Nutriroll intervention led to an increase of 0.11±1.39 mg/dL. In conclusion, our study showed that community-based treatment with F100 milk or Bregas Nutriroll resulted in nutritional status in children with SAM. These findings suggested that both treatments could be effective in treating SAM in improving nutritional status and child health outcomes.

Outcome of Severe Acute Malnutrition in Children Aged 6-59 Months Before and After the Institution of the Malnutrition Treatment Centre in the Regional Hospital Limbe, Southwest Region of Cameroon

Background: Malnutrition occurs when nutrient and energy intake do not meet, or exceed an individual’s requirements to maintain growth, immunity, and organ function. In 2020, among children 0-59 months worldwide, 21.3% (144 million) were stunted and 6.9% (47 million) were wasted. The Malnutrition Treatment Centre’s (MTC) establishment in the Regional Hospital Limbe in 2019 brought major changes in management such as free and continuous supply of therapeutic food and basic drugs, the expertise of a nutritionist and closer follow up of patients after discharge. The aim of this research was to evaluate the outcome of children with severe acute malnutrition aged 6-59 months treated at the MTC differed from those treated before the MTC’s creation. Methodology: An analytic cross sectional retrospective study was conducted from February to March 2022. The study period was from March 2016 to February 2019 (before the MTC) and March 2019 to February 2022 (after the MTC). A predesigned data extraction form was used to obtain sociodemographic data of the children and their parents, clinical findings on admission and hospital outcome. The data was entered into CDC Epi info 2.4 and analysed using SPSS. A p-value of &lt;0.05 was considered statistically significant. Results: Out of 129 files included in the study, 35 were pre-MTC and 94 after its creation. The hospital prevalence of SAM increased from 4% to 7% after the MTC’s creation. The mean MUAC (mid-upper arm circumference) was 11.1 ± 0.98 cm. Marasmus was the most common form of SAM (90.7%). The most common admission symptoms were fever (74.4%), diarrhoea (47.2%) and vomiting (32.6%). The most common comorbidities were malaria (29.5%), gastrointestinal infection (20.9%), sepsis (18.6%) and pulmonary infection (14%). There was an increase in the recovery rate (from 71.4% to 76.6%) and the rate of weight gain (from 3.5 g/kg/day to 8.7 g/kg/day). There was also a reduction in the death rate (from 14.3% to 9.6%) and length of in-hospital admission (from 10.24 ±5.4 days to 7.3 ±3.6 days) Conclusion: The MTC led to an increase in the influx of patients with SAM at the RHL, marasmus was the most common form of SAM. There was an increase in the rate of weight gain, a decreased mortality rate and decreased length of hospital stay, thus revealing the pertinent relevance of the MTC in the management of SAM.

Effectiveness of acute malnutrition treatment with a simplified, combined protocol in Central African Republic: An observational cohort study.

A simplified, combined protocol admitting children with a mid-upper-arm circumference (MUAC) of <125 mm or oedema to malnutrition treatment with ready-to-use therapeutic food (RUTF) uses two sachets of RUTF per day of those with MUAC < 115 mm and/or oedemaand one sachet of RUTF per day for those with MUAC 115-<125 mm. This treatment previously demonstrated noninferior programmatic outcomes compared with standard treatment and high recovery in a routine setting. We aimed to observe the protocol's effectiveness in a routine setting at scale, in two health districts of the Central African Republic through an observational cohort study. The pilot enrolled children for 1 year in consortium by the Ministry of Health and nongovernmental partners. A total of 7909 children were admitted to the simplified, combined treatment. Treatment resulted in an 81.2% overall recovery, with a mean length of stay (LOS) of 38.7 days and a mean RUTF consumption of 43.4 sachets per child treated. Among children admitted with MUAC < 115 mm or oedema, 67.9% recovered with a mean LOS of 48.1 days and consumed an average of 70.9 RUTF sachets. Programme performance differed between the two districts, with an overall defaulting rate of 31.1% in the Kouango-Grimari health district, compared to 8.2% in Kemo. Response to treatment by children admitted with severe acute malnutrition(SAM) by MUAC and SAM by oedema was similar. The simplified, combined protocol resulted in a satisfactory overall recovery and low RUTF consumption per child treated, with further need to understand defaulting in the context.

Efficacy of a Reduced Dose of Ready-to-Use Therapeutic Foods in the Management of Severe Acute Malnutrition: A Non-inferiority Randomized Controlled Trial

Efficacy of a Reduced Dose of Ready-to-Use Therapeutic Foods in the Management of Severe Acute Malnutrition: A Non-inferiority Randomized Controlled Trial

The Gut Microbiota-Targeted Treatment of Severe Acute Malnutrition Using Rice Bran in Ready-to-Use Therapeutic Foods: A Randomized Controlled Trial in Indonesia

The Gut Microbiota-Targeted Treatment of Severe Acute Malnutrition Using Rice Bran in Ready-to-Use Therapeutic Foods: A Randomized Controlled Trial in Indonesia

A microbiome-directed therapeutic food for children recovering from severe acute malnutrition.

Severe acute malnutrition (SAM), defined anthropometrically as a weight-for-length z-score more than 3 standard deviations below the mean (WLZ<-3), affects 19 million children under 5-years-old worldwide. Complete anthropometric recovery after standard inventions is rare with children often left with moderate acute malnutrition (MAM; WLZ -2 to -3). Here we conduct a randomized controlled trial (RCT), involving 12-18-month-old Bangladeshi children from urban and rural sites, who after hospital-based treatment for SAM received a 3-month intervention with a microbiota-directed complementary food (MDCF-2) or a ready-to-use supplementary food (RUSF) as they transitioned to MAM. The rate of WLZ improvement was significantly greater with MDCF-2 than the more calorically-dense RUSF, as we observed in a previous RCT of Bangladeshi children with MAM without antecedent SAM. A correlated meta-analysis of aptamer-based measurements of 4,520 plasma proteins in this and the prior RCT revealed 215 proteins positively-associated with WLZ (prominently those involved in musculoskeletal and CNS development) and 44 negatively-associated proteins (related to immune activation), with a significant enrichment in levels of the positively WLZ-associated proteins in the MDCF-2 arm. Characterizing changes in 754 bacterial metagenome-assembled genomes in serially collected fecal samples disclosed the effects of acute rehabilitation for SAM on the microbiome, its transition as each child achieves a state of MAM, and how specific strains of Prevotella copri function at the intersection between MDCF-2 glycan metabolism and the rescue of growth faltering. These results provide a rationale for further testing the generalizability of the efficacy of MDCF and identify biomarkers for defining treatment responses.

Predictors of time to recovery from uncomplicated severe acute malnutrition among children in eastern Ethiopia.

Managing severe acute malnutrition (SAM) involves an outpatient therapeutic program (OTP), targeting more than 80% of SAM children where the quality of primary healthcare remains poor. Treatment success and recovery from SAM remain poor and could be affected by many factors, where such evidence is limited in East Hararghe. This study assessed the predictors of time to recovery from SAM in eastern Ethiopia. A retrospective cohort study was conducted on 402 records of SAM children under 5 years of age enrolled on OTP at 12 health posts retrieved from 2020 to 2021. We used the Kaplan-Meir estimate along with the p-value of the log-rank test and the survival curve to compare the time to recovery across categories. A multivariable Cox proportional hazard model was fitted to identify predictors of time to recovery from SAM. A p-value below 0.05 was used to declare statistical significance. A total of 402 records were reviewed, and the cure rate from SAM was 89.6% [95% confidence interval (CI), 87-93]. Moreover, a death rate of 0.7%, a default rate of 9.5%, and a non-responder rate of 0.2% were obtained with a median length of stay of 7 weeks. The median time to recovery was significantly shorter for children from shorter distances from OTP sites with edema, amoxicillin, (p < 0.05). Edema at admission [adjusted hazard ratio (AHR) = 1.74; 95% CI: 1.33-2.29], without diarrhea (AHR = 1.51; 95% CI: 1.18-1.94), taking amoxicillin (AHR = 1.55; 95% CI: 1.19-2.02), shorter travel time to the OTP site (AHR = 1.44; 95% CI: 1.13-1.85), breastfeeding (AHR = 1.60; 95% CI: 1.27-2.02), adequacy of ready-to-use therapeutic food (RUTF) (AHR = 1.22; 95% CI: 0.90-1.65), and new admission (AHR = 1.62; 95% CI: 0.84-3.10) were important predictors of recovery from SAM. Recovery from SAM was found to be acceptable in comparison with the Sphere Standards and is predicted by edema, diarrhea, distance from the OTP site, amoxicillin, and RUTF adequacy. These allow for focused interventions that address the identified factors for better recovery from SAM.

Nutritional Profile of Locally Produced Ready-to-Use Therapeutic Food (RUTF) for Severe Acute Malnourished Children in Indonesia

Nutritional Profile of Locally Produced Ready-to-Use Therapeutic Food (RUTF) for Severe Acute Malnourished Children in Indonesia

Effect of a diabetes-specific formula in non-diabetic inpatients with stroke: a randomized controlled trial

Background/objectivesIn patients with acute stroke, the presence of hyperglycaemia has been associated with higher morbidity and less neurological recovery. The aim of the study was to evaluate the impact of a diabetes specific enteral nutrition (EN) formula on glycaemia, comorbidities and mortality in patients admitted with a first episode of stroke who received complete EN.MethodsThis was a prospective randomised controlled trial. Patients with acute stroke did not have diagnosis of diabetes mellitus and required nasogastric tube feeding. This study has been registered with code NCT03422900. The patients were randomised into two arms: an isocaloric isoprotein formula (control group (CG), 27 patients) vs a diabetes-specific formula (low glycaemic index carbohydrates, fibre (80% soluble) and higher lipid content) (experimental group (EG), 25 patients). Pre-EN blood glucose, hyperglycaemia during EN treatment, HbA1c, insulin use, oral route recovery, length of stay (LOS) and mortality at 30 days were collected. The complications of enteral nutrition during admission were collected as well.Results52 patients were included, 50% females, with an age of 77.44(11.48) years; 34 (65.4%) had ischaemic stroke, with a Rankin score of 0(0–2), and a National Institute of Health Stroke Scale (NIHSS) of 19 (15–22). In CG, there were more cases of hyperglycaemia on the 5th day post-NE (13(65%) vs7(35%), p < 0.01). CG showed an OR of 7.58(1.49–39.16) (p = 0.02) for the development of hyperglycaemia. There were no differences in LOS between groups (12(8.5) days vs 14(23) days, p = 0.19) or in the death rate (10(37%) vs 10(40%), p = 0.8), although differences were found in terms of oral route recovery (EG: 11(44%) patients vs CG: 5(18.5%) patients, p = 0.04) (OR (EG): 5.53(1.25–24.47); p = 0.02).ConclusionsThe use of a diabetes-specific enteral formula in non-diabetic patients admitted with acute stroke reduced the risk of developing hyperglycaemia and improved the rate of oral route recovery.Registered under ClinicalTrials.gov Identifier no. NCT03422900.

Effects of Combination Antiretroviral Therapy and Nutritional Rehabilitation on Growth in Children Aged 6-36 Months with Severe Acute Malnutrition in IMPAACT Protocol P1092.

Antiretroviral therapy (ART) is known to improve child survival and growth in children living with HIV (CLHIV). We investigated growth outcomes in children with severe nonedematous acute malnutrition (SAM) and without SAM (mild malnutrition and normal nutrition) after initiation of ART in both groups and nutritional support. IMPAACT P1092 enrolled CLHIV aged 6 to <36 months with World Health Organization (WHO)-defined SAM or without SAM across 5 sites in Sub-Saharan Africa and followed them for 48 weeks. The enrollment was conducted in four countries: Malawi, Tanzania, Uganda, and Zimbabwe between October 2015 and September 2017. Weight, height, and mid-upper arm circumference (MUAC) were measured at baseline through 48 weeks. WHO weight-for-length/height Z-scores (WFL/H Z-score) were calculated. SAM children received readily available therapeutic food per WHO guidelines. All participants were initiated on a triple-ART regimen. SAM children entered the study after initial nutritional rehabilitation. Fifty-two CLHIV, 25 in the SAM cohort and 27 in the without SAM cohort, were enrolled. WFL/H Z-scores and MUAC in the SAM cohort increased significantly at weeks 24 and 48 [WFL/H Z-scores: mean change (95% CI) 2.34 (1.77, 2.91) and 2.73 (2.09, 3.37), both P < .001; MUAC: mean change (95% CI) 2.63 (1.98, 3.28) and 3.53 (2.83, 4.24) cm, P < .001]. At week 48, mean SAM height was 4 cm shorter and mean weight 1 kg lighter than without SAM [post hoc mean differences -4.11 (95% CI -8.60, 0.38) cm and -0.92 (95% CI -2.22, 0.39) kg]. CLHIV with SAM who undergo WHO nutritional rehabilitation can achieve significant growth and WFL/H Z-score improvements but continued intensive anthropometric monitoring is needed as SAM may still be behind those without SAM.

Effect of a simplified approach on recovery of children 6-59 months with wasting in Ethiopia: A noninferiority, cluster randomized controlled trial.

Worldwide, nearly 45 million children under the age of 5 years were affected by wasting in 2022. Ethiopia has been challenged by disasters increasing the caseload of children with wasting. This study aimed to determine the effect of a simplified approach on recovery of children with acute malnutrition as compared with the standard protocol. A cluster randomized, controlled, noninferiority trial was carried out in three regions of Ethiopia from December 4, 2021, to July 30, 2022. A total of 58 clusters (health posts) were randomized into intervention and control groups. Children with SAMin the intervention groups received two sachets of Ready-to-Use Therapeutic Food (RUTF),whereas children in the control groups received RUTF based on their body weight. Children with moderate acute malnutrition (MAM)received one sachet of RUTF and one sachet of Ready-to-Use Supplementary Food (RUSF)daily in the intervention and control groups, respectively. Per protocol (PP) andintention-to-treatanalysis were used to compare recovery at a noninferiority margin of 15%. Data were collected from 55 health posts and 1032 children. In the PP analysis, the recovery rate of children with wasting amongthe simplified group (97.8%) was noninferior to the standard protocol group (97.7%), p = 0.399. The RUTF cost per treatment of child with SAM was 56.55 USD for the standard versus 42.78 USD for the simplified approach. The simplified approach is noninferior to the standard protocol in terms of recovery and has a lower cost of RUTF. Further study is recommended to assess the effectiveness of the simplified approach in emergency contexts.

Contribution of Therapeutic Foods to the Nutritional Care of Malnourished Children in West Africa

Undernutrition is the most common form of malnutrition in West Africa, particularly in countries in the Sahel region. It constitutes a major public health problem in Africa and in the world. Caused by deficiency of one or more nutrients, undernutrition remains a major concern around the world and especially in the West African region where it contributes to a high number of deaths in children under five. It denotes an insufficient supply of energy and nutrients to meet an individual&amp;apos;s needs for good health. Moreover, there are more and more centers specialized in nutritional care to help solve the problem of undernutrition in children. Thenceforward, knowledge of the current situation will allow better actions to overcome this form of malnutrition which grieves many families in our African regions and particularly in West Africa. This review reports on the nutritional care of malnourished children in West Africa. To do this, scientific databases such as PubMed, ScienceDirect, Scopus and Google Scholar were used to extract publications on the nutritional care of malnourished children. The data are analyzed to assess the management of cases of undernutrition in West Africa. These results can serve as a basis for better care of malnourished children in countries with limited resources, including those in West Africa.

Comparing time to recovery in wasting treatment: simplified approach vs. standard protocol among children aged 6-59 months in Ethiopia-a cluster-randomized, controlled, non-inferiority trial.

Wasting occurs when the body's nutritional needs are unmet due to insufficient intake or illness. It represents a significant global challenge, with approximately 45 million infants and children under 5 years of age suffering from wasting in 2022. A cluster-randomized, controlled, non-inferiority trial was conducted in three regions of Ethiopia. A non-inferiority margin of 15%, along with a recovery rate of 90% and a minimum acceptable recovery rate of 75%, were considered alongside an intra-cluster correlation coefficient of 0.05 and an anticipated loss to follow-up of 10% in determining the total sample size of 1,052 children. Children with severe acute malnutrition (SAM) in the simplified group received two sachets of ready-to-use therapeutic food (RUTF) daily, while the standard group received RUTF based on their body weight. For moderate acute malnutrition (MAM) cases, the simplified group received one sachet of RUTF, whereas the standard group received one sachet of ready-to-use supplementary food daily. A non-parametric Kaplan-Meir curve was utilized to compare the survival time to recovery. A total of 1,032 data points were gathered. For SAM cases, the average length of stay was 8.86 (±3.91) weeks for the simplified protocol and 8.26 (±4.18) weeks for the standard protocol (P = 0.13). For MAM cases, the average length of stay was 8.18 (±2.96) weeks for the simplified approach and 8.32 (±3.55) weeks for the standard protocol (P = 0.61). There was no significant difference (P = 0.502) observed between the simplified protocol [8 weeks, interquartile range (IQR): 7.06-8.94] and the standard protocol [9 weeks (IQR: 8.17-9.83)] among children with SAM on the median time to cure. There was no significant difference (P = 0.502) in the time to cure between the simplified approach [8 weeks (IQR: 7.53-8.47)] and the standard protocol [8 weeks (IQR: 7.66-8.34)] among children with MAM. The survival curves displayed similarity, with the log-rank test not showing significance (P > 0.5), indicating the non-inferiority of the simplified approach for cure time. The findings showed that the simplified and standard protocols demonstrated no significant differences in terms of the average duration of stay and time required for recovery. https://pactr.samrc.ac.za/, Identifier (PACTR202202496481398).

Immunonutrition with Omega-3 Fatty Acid Supplementation in Severe TBI: Retrospective Analysis of Patient Characteristics and Outcomes.

Early evidence-based medical interventions to improve patient outcomes after traumatic brain injury (TBI) are lacking. In patients admitted to the ICU after TBI, optimization of nutrition is an emerging field of interest. Specialized enteral nutrition (EN) formulas that include immunonutrition containing omega-3 polyunsaturated fatty acids (n-3 PUFAs) have been developed and are used for their proposed anti-inflammatory and proimmune properties; however, their use has not been rigorously studied in human TBI populations. A single-center, retrospective, descriptive observational study was conducted at the LAC + USC Medical Center. Patients with severe TBI (sTBI, Glasgow Coma Scale score ≤ 8) who remained in the ICU for ≥2 weeks and received EN were identified between 2017 and 2022 using the institutional trauma registry. Those who received immunonutrition formulas containing n-3 PUFAs were compared with those who received standard, polymeric EN with regard to baseline characteristics, clinical markers of inflammation and immune function, and short-term clinical outcomes. A total of 151 patients with sTBI were analyzed. Those who received immunonutrition with n-3 PUFA supplementation were more likely to be male, younger, Hispanic/Latinx, and have polytrauma needing non-central nervous system surgery. No differences in clinical markers of inflammation or infection rate were found. In multivariate regression analysis, immunonutrition was associated with reduced hospital length of stay (LOS). ICU LOS was also reduced in the subgroup of patients with polytrauma and TBI. This study identifies important differences in patient characteristics and outcomes associated with the EN formula prescribed. Study results can directly inform a prospective pragmatic study of immunonutrition with n-3 PUFA supplementation aimed to confirm the biomechanistic and clinical benefits of the intervention.

Evidence-Based Investigation of Nurses' Nutrition Interventions in Intensive Care Patients Regarding Enteral Nutrition.

The aim of this study was to examine the practices and knowledge levels of nurses regarding enteral nutrition interventions in intensive care unit patients in terms of evidence. This cross-sectional study was conducted in 2 hospitals between May and August 2021. A total of 136 nurses working in the intensive care units of the hospitals completed online questionnaires including demographic characteristics and questions about enteral nutrition. According to the nurses' knowledge level about the indication of enteral nutrition formulas, the following were incorrect or incomplete: their knowledge about transition to parenteral nutrition in case of nutritional contraindications, what to do when the amount of gastric residual volume in tolerance is >500 mL every 6 hours, the conditions for starting enteral nutrition, and which formulas are appropriate to use. Regarding their knowledge about enteral feeding tubes/sets, their knowledge about radiologic imaging after tube placement, measurement of gastric pH level, and marking the tube location was insufficient. Differently, the correct answer percentages of the nurses in 11 of the 13 questions regarding the principles of enteral nutrition practice were above 70%. Nurses had adequate knowledge of the principles of enteral nutrition practice, but their knowledge of the indication of enteral nutrition formulas and the evidence for enteral feeding tubes/sets varied. The results showed that nurses need to gain information about the indication of enteral nutrition formulas and evidence related to enteral feeding tubes/sets.

Effectiveness of a nonweight-based daily dosage of ready-to-use therapeutic food in children suffering from uncomplicated severe acute malnutrition: A nonrandomized, noninferiority analysis of programme data in Afghanistan.

Severe acute malnutrition (SAM) remains a major global public health problem. SAM cases are treated using ready-to-use therapeutic food (RUTF) at a dosage of ∼200 kcal/kg/day per the standard treatmentprotocol (STD). Emerging evidence on simplifications to the standard protocol, which among other adaptations, includes reducing the daily RUTF dosage, indicates that it is effective and safe for treating children with SAM. In response to a foreseen stock shortage of RUTF, the government of Afghanistan endorsed the temporary use of a modified treatment protocol in which the daily RUTF dosage was prescribed at 1000 kcal/day (irrespective of body weight) until the child achieved moderate acute malnutrition status (weight-for-heightz-score ≥ -3 or mid-upper arm circumference [MUAC] ≥ 115 mm), at which point 500 kcal/day was prescribed until cured (modified treatment protocol [MTP]). In this paper, we report the results of this nonweight-based daily RUTF dosage experience. Data of 2042 children with SAM, treated using either the STD protocol (n = 269) or the MTP protocol (n = 1773) from August 2019 to March 2021 in five provinces, were analyzed. The per-protocol analyses confirmed noninferiority of MTP protocol when compared to STD protocol for recovery rate [93.3% vs. 90.2%; ∆ (95% confidence interval,CI) = 3.1 (-0.9; 7.2) %] and length-of-stay [82.6 vs. 75.6 days; ∆ (95%CI) = 6.9 (3.3; 10.5) days], considering the margin of noninferiority of -10% and +14 days, respectively. Weight gain velocity was smaller in theMTP protocol group than in the STD protocol group [3.7 (1.7) vs. 5.2 (2.9) g/kg/day; ∆ (95%CI) = -1.5 (-1.8, -1.2); p < 0.001]. The STD group had a significantly higher mean than the MTP group for absolute MUACgain [∆ (95%CI) = 1.7 (1.0; 2.3) mm; p < 0.001] and the MUAC velocity [∆ (95%CI) = 0.29 (0.20; 0.37) mm/week; p < 0.001]. Our results confirm the noninferiority of a nonweight-based daily dosage and support the endorsement of this modification as an alternative to the standard protocol in resource-constrained contexts.