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Following the new ESPEN Standard Operating Procedures, the previous 2019 guideline to provide best medical nutritional therapy to critically ill patients has been shortened and partially revised. Following this update, we propose this publication as a practical guideline based on the published scientific guideline, but shortened and illustrated by flow charts. The main goal of this practical guideline is to increase understanding and allow the practitioner to implement the Nutrition in the ICU guidelines. All the items discussed in the previous guidelines are included as well as special conditions.
Recommendations on anticoagulation in patients with short bowel syndrome (SBS) following acute mesenteric ischaemia (AMI) or complicated by catheter-related thrombosis (CRT), are limited. Guidance is specifically lacking on antithrombotic drug selection, dosing, treatment duration and monitoring. Moreover, current recommendations do not account for the potentially impaired drug absorption in patients with SBS. This multidisciplinary position paper aims to develop a practical management guide for antithrombotic therapy in patients with SBS following AMI, as well as CRT. Nineteen intestinal failure experts, coagulation specialists, and clinical pharmacists completed a three-round Delphi voting procedure on 52 initial statements regarding antithrombotic drug and dose selection, duration and monitoring of treatment and testing for underlying diseases in case of AMI. After three voting rounds, 46 statements were retained with good agreement (i.e., >80%) for 38 of them, moderate agreement (i.e., >70-80%) for two statements, and low agreement (i.e., ≤70%) for the remaining six. While robust evidence is lacking regarding antithrombotic therapy in patients with SBS, consensus was reached on the majority of statements. More research in this field is required, particularly on oral drug absorption in SBS, development of alternative oral drug formulations, treatment strategies following arterial mesenteric stenting and direct oral anticoagulant (DOAC) dosing for secondary prophylaxis of CRT in SBS.
Hospitalized children with chronic and complex conditions are particularly vulnerable to nutritional deterioration, which has been associated with adverse clinical outcomes. Early identification of nutritional risk (NR) and nutritional status (NS) may support timely nutritional interventions; however, evidence on the combined use of STRONGkids and mid-upper arm circumference-for-age z-scores (zMUAC/A) in tertiary pediatric wards remains limited. To evaluate the association of NR, NS, energy-protein adequacy, nutritional evolution, length of hospital stay (LOS), infection, and 30-day hospital readmission in children admitted to a tertiary pediatric ward. This prospective observational cohort included 216 children and adolescents (1 month-18 years) admitted to a tertiary teaching hospital in a low- and middle-income country. NR was assessed using STRONGkids, and NS was assessed using zMUAC/A. Associations between nutritional variables and clinical outcomes were evaluated using regression models and complementary statistical analyses. The median age was 5.2 years, with a predominance of infants (34.7%) and males (55%). Undernutrition was more frequently identified by zMUAC/A than by zBMI/A (49.5% vs. 17.6%), and 31.5% of patients presented low height-for-age z-scores. STRONGkids demonstrated good performance for identifying undernutrition at admission (AUC = 0.858). Higher NR was associated with longer LOS and infection occurrence, whereas impaired NS was associated with infection occurrence and 30-day hospital readmission. Energy-protein adequacy and short-term nutritional evolution were not associated with the evaluated clinical outcomes. Overweight/obesity showed a descriptive trend toward shorter LOS than undernutrition; however, this finding should be interpreted cautiously because of the small subgroup size. Hospitalized pediatric patients in this tertiary care setting presented a high burden of undernutrition and nutritional risk, both of which were associated with clinically relevant outcomes. The combined use of STRONGkids and MUAC-based nutritional assessment may improve the early identification of nutritionally vulnerable patients and support targeted nutritional interventions in children with complex clinical conditions.
The impact of preoperative malnutrition on clinical outcomes in patients undergoing laryngeal cancer surgery remains incompletely defined. This study aimed to evaluate the association between malnutrition and postoperative complications, long-term prognosis, and other clinical outcomes, and to compare the predictive performance of the GLIM criteria versus the ESPEN 2015 criteria. A retrospective analysis was conducted on prospectively maintained records of 294 laryngeal cancer patients who underwent surgical resection. Malnutrition was diagnosed according to the Global Leadership Initiative on Malnutrition (GLIM) criteria, and the ESPEN 2015 criteria were additionally applied for comparison. The cohort was chronologically divided into a training set (n = 191) and a validation set (n = 103). Independent risk factors for severe postoperative complications (POCs) were identified using LASSO regression followed by multivariate logistic regression, and a nomogram was constructed and validated. Cox regression analysis was performed to evaluate associations with overall survival. Propensity score matching (PSM) was applied to balance baseline characteristics between the GLIM-malnutrition group and the normal nutrition group, followed by comparative and subgroup analyses. The prevalence of preoperative malnutrition was 25.9% (76/294) according to GLIM criteria and 13.6% (40/294) according to ESPEN criteria. Malnutrition defined by both criteria was an independent risk factor for severe POCs, and the GLIM criteria demonstrated superior predictive performance. Age >65 years, diabetes, GLIM-malnutrition, and neck dissection were identified as independent risk factors for severe complications. The nomogram constructed based on these predictors exhibited robust predictive performance, with AUC values of 0.803 in the training set and 0.812 in the validation set, along with good calibration and net clinical benefit. In terms of prognosis, the 5-year overall survival rates were 55.0% in the GLIM-malnutrition group and 60.8% in the normal nutrition group, with no significant difference (p = 0.077); malnutrition was not an independent prognostic factor. After PSM, the GLIM-malnutrition group showed a significantly higher incidence of severe POCs and a longer postoperative length of stay (PLOS). Subgroup analyses consistently demonstrated more severe POCs and longer PLOS in the GLIM-malnutrition group across all strata, with a greater number of total POCs observed in elderly patients. Preoperative malnutrition diagnosed by GLIM criteria is highly prevalent in patients undergoing laryngeal cancer surgery and significantly increases the risk of severe complications and prolongs hospital stay. Compared with ESPEN criteria, GLIM criteria show stronger predictive performance for severe postoperative complications. However, preoperative malnutrition does not independently affect long-term overall survival.
Adequate nutrition during hospitalization is essential for recovery and for reducing complications and mortality. This emphasizes the importance of nutritional treatment for patients at nutritional risk. The aim of the present study was to 1) assess the prevalence of nutritional risk, malnutrition, and coverage of energy and protein requirements over time and 2) to compare 30-day survival by nutritional risk and nutritional intake. Three cross-sectional studies using a flash-mob approach were conducted at Herlev Hospital in 2019, 2023, and 2025. Inpatients ≥18 years and hospitalized ≥4 days were included. Intensive care-, palliative-, maternity-, and emergency wards were excluded. Data collected included nutritional risk, nutritional intake, disease-related malnutrition, and 30-day survival. Of the 410 patients included, 65% were at nutritional risk in 2019 and 2023, compared with 75% in 2025, with an increasing trend observed from 2019 to 2025 (p = 0.040). Energy and protein requirements were met by 35% and 24% of patients in 2019, 70% and 51% in 2023, and 60% and 47% in 2025, respectively. From 2019 to 2025, an increasing trend was observed in the proportion of patients achieving ≥75% of energy (p = 0.028) and protein requirements (p = 0.013). The proportion classified as malnourished remained stable in 2023 and 2025 (60% vs. 59%). No difference in 30-day survival was observed between patients at nutritional risk who met ≥75% of estimated nutritional requirements and those who did not. After adjustment for age, sex, BMI, and length of hospital stay, nutritional risk was associated with lower 30-day survival (OR 0.46; 95% CI 0.23-0.94; p = 0.03). The prevalence of nutritional risk remained consistently high across all audit years, while the proportion of patients meeting their estimated energy and protein requirements varied over time. Nutritional risk was associated with reduced 30-day survival, and the prevalence of malnutrition according to the GLIM criteria was also high. Taken together, these findings highlight the need to strengthen in-hospital nutritional interventions and ensure continuity of nutritional care after hospital discharge.
Schizophrenia is a serious mental disorder involving cognitive, metabolic and functional impairments, often exacerbated by the side effects of pharmacological treatment. In this context, nutritional interventions have been investigated as adjunctive strategies aimed at improving clinical and metabolic outcomes. This study aimed to evaluate the effectiveness of nutritional interventions in schizophrenia, considering different dietary approaches and nutritional supplements. A systematic review was conducted according to Cochrane recommendations, including randomised clinical trials investigating nutritional supplementation or dietary interventions in patients with schizophrenia and evaluating clinical, metabolic and cognitive outcomes. Data selection and extraction were performed independently by two reviewers, and methodological quality was assessed using validated instruments. Nine randomised clinical trials were included. Probiotic-based interventions, particularly when combined with vitamin D or selenium, were associated with improvements in metabolic parameters and selected inflammatory markers. n-3 fatty acid supplementation demonstrated effects on triglyceride concentrations and neurotrophic markers. Plant-derived bioactive compounds were associated with improvements in negative symptoms and stress-related measures. However, findings varied across studies, reflecting heterogeneity in intervention protocols, dosage regimens and outcome assessment. Findings suggest that nutritional interventions may act as adjunctive strategies in schizophrenia, with observed effects on metabolic, inflammatory and selected neuropsychiatric parameters. However, methodological heterogeneity, limited sample sizes and short follow-up durations warrant cautious interpretation. Further well-designed, adequately powered randomised clinical trials are needed to clarify clinical applicability and long-term implications.
Nutritional therapy can help balance effluent loss and fistula healing, and nutritional status is crucial for successful outcomes. The latest guidelines on the topic were published in 2016, and to answer the question "What are the nutritional strategies and tools used in the assessment and treatment of enterocutaneous and enteroatmospheric fistulas?", this scoping review included publications from 2016 onward, without age, sex, or language restrictions, identified through searches on PubMed, CENTRAL, BVS, and Embase databases. Search, study selection, eligibility analysis, and data extraction were performed independently by two authors, and a third reviewer resolved disagreements. Of the 5144 manuscripts found, 85 were eligible: 44 case reports, 39 cohort studies, and two clinical trials. Enterocutaneous fistulas were the most cited. At least one nutritional assessment method was reported by 59 of 85 manuscripts, mainly biochemical tests. Few authors evaluated nutritional risk and malnutrition. To determine nutritional requirements, two manuscripts used indirect calorimetry, and 16 considered kcal/kg and grams of protein/kg. It was not possible to stratify the feeding route regarding fistula location or output. Parenteral nutrition was most prevalent, followed by enteral nutrition, oral nutrition, chyme reinfusion, and fistuloclysis. It was not possible to establish dosage, frequency, or duration of treatment for specific nutrient supplementation (n = 10, 11.8%). Based on the findings of this review, it is suggested that future studies should assess the impact of body composition and nutritional status on clinical outcomes in these patients; validate appropriate methods and equations for determining basal energy expenditure; compare the use of oligomeric and polymeric formulas and evaluate the impact of early versus delayed nutritional therapy; explore criteria for choosing and transitioning the feeding route and; determine whether there is effectiveness in supplementation with specific nutrients. Additionally, it is important that studies provide a detailed description of the included population. The use of reporting guidelines is recommended. OSF registration: T92BQ.
Malnutrition is a known complication in systemic sclerosis (SSc), yet longitudinal data using standardised diagnostic criteria in Asian populations are limited. We aimed to determine the prevalence and incidence of malnutrition, identify risk factors for its development and evaluate its association with mortality in the SSc cohort using the Global Leadership Initiative on Malnutrition (GLIM) criteria. Patients aged 18 years and above, fulfilling the 2013 American College of Rheumatology/European Alliance of Associations for Rheumatology or 1980 ACR classification criteria for SSc who were consecutively recruited into the Singapore Systemic Sclerosis Cohort (SCORE) between January 2008 and December 2020 were eligible for inclusion. Patients were included if they had at least one baseline assessment and ≥6 months of follow-up. Patients with follow-up of less than 6 months were excluded. Malnutrition was defined using the GLIM criteria. Demographics, clinical, serological, treatment and mortality data were collected. Cox proportional hazards regression was used to assess predictors of incident malnutrition and factors associated with mortality. Among 341 patients with SSc, baseline malnutrition was 14.4%, with an incidence rate of 16.83 per 1000 person-years. No baseline clinical variables were significantly associated with the development of malnutrition. In contrast, increasing age [HR 1.04 (95% CI: 1.01-1.08), p = 0.005], disease duration [HR 0.99 (95% CI: 0.99-1.00), p = 0.001], and malnutrition [HR 2.76 (95% CI: 1.25-6.10), p = 0.012] were independently associated with increased mortality among patients with SSc. Despite a relatively low incidence, GLIM-defined malnutrition had a strong independent association with mortality in SSc. These findings are of prognostic value and support the integration of routine screening and standardized malnutrition diagnosis in SSc care in Asian populations.
The nasogastric tube (NGT) is commonly used to provide short-term enteral nutrition in patients with swallowing disorders and/or malnutrition. Its impact on dysphagia appears to depend on its position in the pharynx. Given oesophageal anatomy, we hypothesise that the insertion side influences NGT positioning in the pharynx. This is a monocentric, retrospective, descriptive study was conducted between January 2013 and October 2025. The inclusion criteria were: 1) patients undergoing Fiberoptic Endoscopic Evaluation of Swallowing (FEES) and 2) patients receiving an artificial nutrition 3) via a NGT or nasojejunal tube (NJT). Patients were excluded if there was no video or if the video did not show an NGT or NJT. Data collected included the nostril through which the tube was inserted, as well as the position of the NGT/NJT in the pharynx (retro-cricoid or piriform sinus), which indicates the side (left or right). We identified 3,161 swallowing evaluations, of which 1,296 were FEES. Artificial nutrition was present in 244 of the evaluations, but only 52 of these involved an NGT/NJT (representing 1.1% of ward patients and 6.0% of ICU patients). Of the 47 videos reviewed, we observed that the NGT/NJT was found to be on the same side of the pharynx as the insertion nostril in 22 videos (70% on the left and 33% on the right). The position of the NGT/NJT in the pharynx was found to be related to the side of insertion (p = 0.014). According to our results, the position of the NGT in the pharynx depends on the side of insertion. If possible, the left nasal cavity should be used for NGT insertion. Further studies are needed to confirm this finding. It would also be interesting to report the side of NGT insertion in studies on pharyngo-laryngeal complications, in order to determine its impact.
The international guidelines recommend nutrition evaluation in all patients with mild and moderately severe acute pancreatitis (AP). The Global Leadership Initiative on Malnutrition (GLIM) criteria were developed for evaluating malnutrition. However, no prospective study has validated GLIM criteria in AP, and research on nutrition assessment tools in AP remains limited. This study aimed to validate GLIM criteria and evaluate nutrition assessment tools in patients with mild and moderately severe AP. This prospective study enrolled patients diagnosed with mild and moderately severe AP from July 2022 to April 2023. GLIM criteria and subjective global assessment (SGA) were assessed by different trained clinicians. SGA was used as a semi-gold standard for diagnosis of malnutrition according to GLIM validation guidance. Clinical outcomes, including mortality, complications, length of stay (LOS), and 90-day readmission, were evaluated. Sixty-five patients were enrolled. Mild and moderately severe AP were observed in 90.8% and 9.2% of patients, respectively. The prevalence of malnutrition, as assessed by GLIM criteria and SGA, was 21.5%. GLIM criteria showed a significant strong agreement (weighted κ = 0.817, 95% CI 0.57-1.00, p < 0.001) and strong diagnostic performance, with a sensitivity of 85.7%, specificity of 96.1%, positive predictive value of 85.7%, and negative predictive value of 96.1%. Only SGA was independently associated with LOS≥6 days (OR 4.67; 95% CI: 1.22-17.89, p = 0.025). GLIM criteria demonstrated strong validity in diagnosing malnutrition in mild and moderately severe AP. Only SGA was independently associated with longer LOS. Further multicenter studies with larger populations are warranted to confirm these findings.
Morphofunctional deterioration, resulting from muscle depletion, accompanied by reduced strength and functional impairment, limits the autonomy and quality of life of patients surviving critical illness. However, studies exploring the impact of nutritional therapy on the morphofunctional trajectory of critically ill patients during and after Intensive Care Unit (ICU) admission are still scarce. To synthesize and critically discuss the available evidence on the effects of nutritional therapy on morphofunctional outcomes in critically ill adult ICU patients, delineating the state of the art on the topic and highlighting current methodological gaps and limitations in the literature. This is a literature review, conducted through systematic searches in major databases and grey literature. Primary studies published between 2015 and 2025 that evaluated nutritional interventions on muscle mass, strength, and/or physical function were included. Studies that combined non-nutritional interventions were excluded. Twenty-nine studies were included. High-protein strategies concentrate the greatest proportion of positive effects, especially on muscle mass, with variable repercussions on strength and limited effects on physical function. Supplementation with β-hydroxy-β-methyl butyrate and adequate nutritional intake also showed a predominance of favorable effects, especially in structural outcomes. In contrast, interventions such as high-calorie nutrition, isolated amino acid supplementation, intermittent enteral feeding, early initiation of enteral nutrition, and the use of symbiotics mostly demonstrated no effect. Muscle mass was the most investigated parameter, with consistently favorable results. Although less evaluated, muscle strength showed the highest proportion of positive responses, especially when associated with concomitant effects on muscle mass. Physical function showed less responsiveness to interventions. Only eight studies evaluated more than one morphofunctional parameter, and only three investigated muscle mass, strength, and function in an integrated manner. Nutritional therapy impacts the morphofunctional parameters of critically ill patients by preserving structural integrity, with conditional repercussions on strength, while functional recovery requires multimodal approaches. The need for studies that evaluate these parameters in an integrated manner is highlighted, as well as the inclusion and contextualization of longitudinal follow-up that extends beyond the ICU.
The survival benefit of achieving nutritional adequacy in critically ill patients remains uncertain and may vary across physiological conditions. This study aimed to identify specific physiological windows in which adequate nutritional intervention is associated with improved survival and to provide supportive evidence for these findings using an independent cohort. We conducted a retrospective cohort study using longitudinal data from the MIMIC-IV database. Adult ICU patients with a length of stay ≥7 days who received nutritional support were included. Marginal structural Cox models were applied to evaluate the time-varying associations between daily energy and protein adequacy and 28-day mortality while accounting for time-dependent confounding. Stratified analyses based on key physiological indicators were performed to identify potential physiological windows of benefit. These windows were subsequently evaluated in an independent cohort from the NEED study using stratified Cox regression analyses. A total of 5370 patients from MIMIC-IV were included. In the overall cohort, higher energy adequacy (HR 0.61, 95% CI 0.50-0.74; P < 0.001) and protein adequacy (HR 0.51, 95% CI 0.42-0.63; P < 0.001) were associated with lower 28-day mortality. However, these associations were restricted to specific physiological conditions. For energy adequacy, the association with lower mortality was observed when the norepinephrine equivalent dose was <0.3 μg/kg/min and lactate was <2 mmol/L. For protein adequacy, similar associations were observed when norepinephrine was <0.3 μg/kg/min, lactate was <2 mmol/L, and creatinine was <5 mg/dL. These associations were attenuated or no longer significant outside these windows. In the NEED cohort (n = 1322), higher energy and protein adequacy were likewise associated with lower 28-day mortality only within the corresponding physiological strata. The association between nutritional adequacy and survival in critically ill patients appears to depend on physiological status rather than being uniform across all patients. Relatively stable hemodynamics and lower lactate levels may help identify patients most likely to benefit from more adequate nutritional support. These indicators may help inform individualized nutritional strategies in critical care.
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Cancer cachexia is a debilitating syndrome associated with poor prognosis. Nutritional support is a cornerstone of management, but its effectiveness remains uncertain due to inconsistent evidence. We synthesized the effects of nutritional support on key outcomes in patients with cancer cachexia. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs), following PRISMA guidelines (PROSPERO: CRD42024570706). We searched four electronic databases for RCTs evaluating any nutritional support in adults with cancer cachexia. Outcomes included body weight and body composition, biochemical markers, handgrip strength, quality of life, and appetite. A random-effects model pooled the data, reported as mean differences (MD) or standardized mean differences (SMD). 32 RCTs were included. Nutritional support was associated with modest increases in body weight (MD: 1.43 kg; 95% CI: 0.55-2.31 kg), fat-free mass (MD: 1.11 kg; 95% CI: 0.16-2.05 kg), fat mass (MD: 1.00 kg; 95% CI: 0.41-1.59 kg) and C-reactive protein (MD: -1.47 mg/L; 95% CI -2.55 to -0.39). However, CRP results were not robust in sensitivity analysis. No effects were observed handgrip strength, albumin, transferrin, quality of life, or appetite. The evidence base was limited by a predominant high risk of bias across the included studies. Nutritional support in patients with cancer cachexia provides small body composition improvements. However, most body composition measures were performed through bioimpedance assessments, which limits their robustness. Additionally, this approach seem insufficient to reverse metabolic alterations or improve function alone. The certainty of this evidence highlights the need for higher quality, rigorously conducted trials.
Percutaneous endoscopic gastrostomy (PEG) is widely used to provide long-term enteral nutrition; however, mortality remains substantial, particularly among frail and multimorbid patients. Data on how specific metabolic and inflammatory phenotypes influence both early and long-term survival after PEG are limited. This study aimed to identify predictors of 30-day and long-term mortality following PEG, with a particular focus on nutritional and inflammatory biomarkers. This single-center retrospective cohort study included 495 adult patients who underwent PEG insertion between December 2013 and May 2024. Predictors of 30-day mortality were assessed using multivariable logistic regression. Long-term survival, with follow-up of up to 10 years, was evaluated using Kaplan-Meier analysis and multivariable Cox proportional hazards regression. The mean age of the cohort was 72.5 ± 15.5 years, and 30-day all-cause mortality occurred in 97 patients (19.6%). In multivariable logistic regression analysis, low serum creatinine (<0.40 mg/dL; OR=2.64), elevated neutrophil-to-lymphocyte ratio (NLR > 5; OR=2.31), hypoalbuminemia, and a higher Age-Adjusted Charlson Comorbidity Index were independently associated with early mortality. Long-term survival analysis demonstrated a pronounced gradient according to metabolic status. Patients with severe hypoalbuminemia (<2.0 g/dL) had a median survival of only 40 days, compared with 776 days in the highest albumin category (≥3.2 g/dL) (p < 0.001). Marked systemic inflammation (CRP > 150 mg/L) was associated with a median survival of 46 days. Notably, very low serum creatinine (<0.40 mg/dL), interpreted as an indirect marker of reduced creatinine generation and potentially reduced muscle reserve, was independently associated with long-term mortality (HR= 1.77, 95% CI 1.15-2.71) and in contrast, elevated creatinine was not independently associated with mortality in the adjusted model. In this retrospective cohort, markers of metabolic depletion and systemic inflammation, particularly hypoalbuminemia, elevated CRP/NLR, and low serum creatinine, were independently associated with short- and long-term mortality after PEG insertion. These associations remained clinically relevant after considering procedural indication, although the heterogeneity of PEG candidates and the retrospective nature of the study preclude causal inference. Low serum creatinine may reflect a high-risk phenotype characterized by reduced muscle reserve, but it should be interpreted as an indirect surrogate rather than a diagnostic marker of sarcopenia. Incorporating routinely available pre-procedural markers such as albumin, CRP, NLR, and creatinine into the clinical assessment may support more individualized PEG candidate evaluation and shared decision-making.
The Mediterranean diet (MedDiet), a plant-based diet that primarily relies on vegetables, fruits, and fiber, has been suggested to modulate the gut microbiota and improve quality of life (QoL), particularly in patients with inflammatory bowel diseases (IBDs). This study aimed to review and evaluate the impact of adherence to the MedDiet in patients with IBDs. The following Databases were systematically searched from inception to May 2025: PubMed, EMBASE, Scopus, and Web of Science (WOS) to identify studies that met our eligibility criteria. Randomized controlled trials and observational studies evaluating the MedDiet in adults with ulcerative colitis or Crohn's disease and reporting clinical, inflammatory, or quality-of-life outcomes were included, while pediatric, animal, and non-MedDiet studies were excluded; study quality was assessed using RoB 2 for randomized trials, ROBINS-I for observational studies, and a modified Newcastle-Ottawa Scale for cross-sectional studies. The protocol was registered on PROSPERO (CRD420251053638). A total of 12 studies were included in this review, involving 1615 patients. Four studies were interventional (three randomized controlled trials (RCTs) and one single-arm trial. The remaining eight studies were observational with varying designs (four cohort, three cross-sectional, and one case-control). These studies examined the relationship between adherence to the MedDiet and various clinical outcomes, including C-reactive protein (CRP) levels, QoL, and disease severity. Overall, observational studies suggested beneficial associations between greater MedDiet adherence and lower inflammatory markers, improved quality of life, and reduced disease activity. In contrast, randomized controlled trials showed mixed, generally non-significant effects on inflammatory biomarkers. Adherence to the MedDiet may enhance QoL and support remission. However, the findings should be interpreted with caution due to substantial heterogeneity in study designs, populations, outcome measures, and risk of bias, which precluded meta-analysis and limited the strength of the evidence. There is a strong need for well-designed, large-scale RCTs to further investigate MedDiet's impact on clinical outcomes in IBD patients and to identify specific nutritional components that can be applied to patients who cannot tolerate certain dietary components.
Malnutrition remains common in patients with hematological diseases, where nutrition impact symptoms (NIS) may impair dietary intake and consequently clinical outcomes. However, current tools often assess either symptom presence or intake limitation. This study aimed to determine the prevalence of NIS and discrepancies between NIS presence and intake limitation, assess changes following stem cell treatment initiation, and explore NIS associations with weight change and short-term mortality. Observational study with a cross-sectional baseline assessment and longitudinal follow-up, including patients with hematological cancer referred to dietetic care. Baseline cross-sectional analyses described NIS (presence [NIS-P] and limiting intake [NIS-L] in two referral groups (stem cell vs. selectively referred patients with other treatments). In patients undergoing stem cell treatment, NIS were reassessed ∼1 week after initiation to evaluate within-patient changes. In a subset with a 2-month follow-up, associations between baseline NIS, weight change, and mortality were explored for the combined population. Eighty patients were included in the analysis. Median NIS-points in the total population were 15.5 [IQR 0; 26]. In the group that received stem cell treatment, total NIS-points increased significantly after initiation of treatment with an increase in median from 0 to 19 points (p = 0.002). The relationship between baseline NIS and short-term weight change could not be reliably assessed, likely reflecting methodological constraints rather than a true absence of association. However, higher baseline NIS-points were observed among patients who died within 2 months in the unadjusted analysis (all p ≤ 0.05). NIS were prevalent, with a consistent discrepancy between NIS-P and NIS-L, indicating that symptom presence alone does not reflect nutritional vulnerability. Initiation of stem cell treatment was associated with increased NIS burden. Higher symptom burden was observed among patients who died during follow-up; however, causal inferences cannot be drawn.
This study aimed to examine the effects of omega-3 supplementation on anthropometric measures, thyroid hormone concentrations, and anti-TPO in Hashimoto's disease patients. This double-blind randomized clinical experiment randomly split 50 Hashimoto's disease patients into two groups, including treatment and placebo, which received 2000 mg/day omega-3 or placebo for 12 weeks. Before and after the trial, anthropometric measurements and plasma thyroid hormone concentrations T3, T4, thyroid-stimulating hormone (TSH), and anti-thyroid peroxidase antibody (TPO) were measured. This research found that omega-3 supplementation in comparison with placebo significantly increased the serum level of group T4 (p = 0.032). Compared to the control group, the omega-3 group had a significant effect on the level of Anti-TPO (p = 0.040). The changes of TSH and T3 were not significantly different between intervention and control groups (p = 0.694 and p = 0.567). This research found that administrating omega-3 in Hashimoto's disease enhanced thyroid function and less autoimmune activity.
Children with cerebral palsy (CP) frequently experience growth impairment. Weight-for-age is commonly assessed using growth charts from the Centers for Disease Control and Prevention (CDC), whereas CP Growth Charts define weight thresholds associated with increased morbidity-mortality risk. This study aimed to compare and harmonise weight-for-age cutoff points from the CP Growth Charts and CDC growth charts and to examine the alignment of U.S. CP morbidity-mortality risk thresholds within the CDC weight-for-age z-score framework in a rehabilitation-centre-based cohort of Argentine children with CP. This multicenter cross-sectional study included 809 children and adolescents with CP aged 2-20 years from rehabilitation centers. Weight-for-age was expressed as z-scores using both growth references. Morbidity-mortality risk zones were defined using CP Growth Chart thresholds according to Gross Motor Function Classification System (GMFCS). For the statistical analyses Fisher's exact test, and odds ratios (OR) with 95% confidence intervals were used to evaluate associations between motor severity, nutritional status, and morbidity-mortality risk. Cutoff points were harmonised using LMS-derived z-scores. Overall, 49.6% of participants had weight-for-age z-scores below -2 according to CDC charts. 15.1% met morbidity-mortality risk criteria, predominantly among children with GMFCS V tube feed (OR 3.91; 95% CI: 2.4, 6.4; p < 0.0001). In this Argentine rehabilitation-centre cohort, CP Growth Charts morbidity-mortality risk thresholds correspond to extremely low CDC weight-for-age z-scores (approximately -4 to -5), particularly in children with severe motor impairment (GMFCS III-V). Harmonisation using LMS parameters improves cross-reference interpretation, though replication in other LMIC and high-income country settings is warranted.
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