Nutrients

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15 pages, 833 KiB

Open AccessArticle

Use of Oligomeric Formulas in Malabsorption: A Delphi Study and Consensus

by Carmelo Diéguez Castillo, Maryam Sidahi Serrano, Andrea Martín Aguilar and Daniel De Luis Román

Nutrients 2025, 17(9), 1426; https://doi.org/10.3390/nu17091426 - 24 Apr 2025

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Abstract

Background: Malabsorption syndrome is characterized by chronic diarrhea, abdominal distension, and malnutrition, thereby complicating its diagnosis and treatment. Oligomeric enteral formulas, designed to facilitate absorption in patients with compromised bowel function, have shown clinical efficacy, though their implementation lacks standardization due to [...] Read more.

Background: Malabsorption syndrome is characterized by chronic diarrhea, abdominal distension, and malnutrition, thereby complicating its diagnosis and treatment. Oligomeric enteral formulas, designed to facilitate absorption in patients with compromised bowel function, have shown clinical efficacy, though their implementation lacks standardization due to the lack of uniform protocols. Objective: To establish a multidisciplinary consensus on the use of oligomeric formulas in patients with malabsorption using a Delphi methodology. Material and Method: A Delphi study was conducted with 156 specialists in endocrinology, gastroenterology, oncology, and internal medicine. Two rounds of structured surveys assessed clinical practices, associated symptoms, and the use of oligomeric enteral formulas. Data were analyzed using descriptive statistics and non-parametric tests, defining consensus with a median of ≥7 and an interquartile range of ≤3. Likewise, a Median (MED) score of ≤3 was considered as a consensus to reject the statement, while an Interquartile range (IQR) of ≥4 or a MED of 4–6 was considered as no agreement. These statements were reviewed and included in the second round. Results: Screening for malnutrition is widely supported (79%), but only 38% of participants reported having specific management protocols. Symptoms such as abdominal distension, abdominal pain, and diarrhea were identified as key predictors of intolerance to polymeric formulas, establishing oligomeric enteral formulas as first choice in these cases. In addition, the effectiveness of an approach that progresses from oligomeric to polymeric enteral formulas once symptoms have stabilized was highlighted. The need for standardized protocols was recognized as a priority to guide nutritional assessment and treatment in patients with malabsorption. Conclusions: This consensus reinforces the importance of implementing specific clinical protocols for the nutritional management of malabsorption, including the initial use of oligomeric enteral formulas in patients with severe symptoms and their controlled transition to polymeric enteral formulas. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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14 pages, 919 KiB

Open AccessArticle

The Malnutrition Universal Screening Tool (MUST) Predicts Postoperative Declines in Activities of Daily Living (ADL) in Patients Undergoing Cardiovascular Open-Heart Surgery

by Tomomi Oshima and Rie Tsutsumi

Nutrients 2025, 17(7), 1120; https://doi.org/10.3390/nu17071120 - 24 Mar 2025

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Abstract

Background: Patients undergoing cardiovascular surgery often experience postoperative complications and Activities of Daily Living (ADL) decline, even in the absence of preoperative malnutrition. Since postoperative ADL decline is particularly serious in elderly patients, this study aimed to identify a nutritional assessment tool [...] Read more.

Background: Patients undergoing cardiovascular surgery often experience postoperative complications and Activities of Daily Living (ADL) decline, even in the absence of preoperative malnutrition. Since postoperative ADL decline is particularly serious in elderly patients, this study aimed to identify a nutritional assessment tool that is effective in predicting postoperative ADL decline. Methods: Patients undergoing open-heart surgery with cardiopulmonary bypass were assessed using eight nutritional assessment tools, including the Malnutrition Universal Screening Tool (MUST), the Global Leadership Initiative on Malnutrition (GLIM) criteria, the Nutritional Risk Screening 2002 (NRS-2002), the Subjective Global Assessment (SGA), the Controlling Nutritional Status (CONUT) score, the Prognostic Nutritional Index (PNI), the Geriatric Nutritional Risk Index (GNRI), and the Mini Nutritional Assessment-Short Form (MNA-SF). Results: A total of 197 patients were enrolled in this study, with a mean age of 70.4 ± 11.6 years old; 31.0% were female. Depending on the nutritional assessment tool, 17.8% to 78.2% of patients were identified as at risk of malnutrition. Among the various assessment tools, the MUST was the most effective in predicting postoperative ADL decline (OR 4.75, 95% CI 1.37–16.5, p = 0.014) and was also associated with severe complications and length of hospital stay (OR 3.08, 95% CI 0.20–0.76, p = 0.009). On the other hand, nutritional risk detected by assessment tools other than MUST, including MNA-SF and GLIM, could predict postoperative complications but showed no relationship to ADL decline. Conclusions: We concluded that MUST was the most useful preoperative nutritional assessment tool for predicting outcomes, particularly for assessing the risk of postoperative ADL decline in patients undergoing cardiovascular surgery. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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12 pages, 759 KiB

Open AccessArticle

Use of C-Reactive Protein in Global Leadership Initiative on Malnutrition (GLIM) Etiologic Criteria for Critically Ill Patients: A Retrospective Claims Database Study

by Shinya Suganuma, Naoki Kanda, Minoru Yoshida, Tomoka Miyagi and Kensuke Nakamura

Nutrients 2025, 17(4), 705; https://doi.org/10.3390/nu17040705 - 16 Feb 2025

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Abstract

Background/Objectives: The Global Leadership Initiative on Malnutrition (GLIM) is suggested by major societies. The etiologic criteria for inflammation in critically ill patients remain unclear. Because an initial nutritional assessment is recommended within 48 h, it is also possible to use C-reactive protein [...] Read more.

Background/Objectives: The Global Leadership Initiative on Malnutrition (GLIM) is suggested by major societies. The etiologic criteria for inflammation in critically ill patients remain unclear. Because an initial nutritional assessment is recommended within 48 h, it is also possible to use C-reactive protein (CRP) up to 3 days after admission. The purpose of the present study is to explore the utility of CRP in identifying malnutrition and to determine whether a nutritional assessment incorporating CRP criteria can effectively identify malnourished patients in the intensive care unit (ICU). Methods: This was a retrospective cohort study of ICU patients. The primary outcome was a composite of in-hospital mortality, Barthel index < 60 at discharge, and length of hospital stay of 14 days or more. The area under the curve (AUC) for the primary outcome was calculated using CRP between days 0 and 2. We divided the patients into four groups using inflammation criteria with the optimal cut-off and low body mass index (BMI) criteria of the GLIM: CRP+/−, and BMI+/−. Results: A total of 38,981 patients were included. The AUC of the highest CRP between days 0 and 2 was 0.65, which was higher than the CRP on day 0 and the highest CRP between days 0 and 1 (0.59 and 0.63). The AUC and optimal cut-offs varied depending on diagnoses, with a maximum of 0.75 in neurology. The optimal cut-off for the maximum CRP was 3.82 mg/dL. In the four groups of CRP+BMI+, CRP+BMI-, CRP-BMI+, and CRP-BMI-, the in-hospital mortality values were 22.7, 14.4, 10.8, and 4.8% (p < 0.001 between all the groups). Conclusions: In an initial nutritional assessment of critically ill patients, it would be appropriate to use the maximum CRP over 3 days from ICU admission. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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14 pages, 1633 KiB

Open AccessArticle

Risk Factors for Long-Term Nutritional Disorders One Year After COVID-19: A Post Hoc Analysis of COVID-19 Recovery Study II

by Keiichiro Kawabata, Kensuke Nakamura, Naoki Kanda, Muneaki Hemmi, Shinya Suganuma, Yoko Muto, Arisa Iba, Miyuki Hori, Mariko Hosozawa and Hiroyasu Iso

Nutrients 2024, 16(23), 4234; https://doi.org/10.3390/nu16234234 - 7 Dec 2024

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Abstract

Background/Objectives: COVID-19 patients develop various clinical symptoms, including malnutrition. However, the risk factors for long-term nutritional disorders remain unclear. Identifying these factors is crucial for preventing nutritional disorders by initiating early nutritional interventions. Methods: This was a post hoc analysis of [...] Read more.

Background/Objectives: COVID-19 patients develop various clinical symptoms, including malnutrition. However, the risk factors for long-term nutritional disorders remain unclear. Identifying these factors is crucial for preventing nutritional disorders by initiating early nutritional interventions. Methods: This was a post hoc analysis of COVID-19 Recovery Study II (CORESII). The study included adult patients hospitalized for COVID-19 and discharged from the hospital. Information, including post-COVID-19 symptoms one month after onset and changes in daily life during the first year, was collected using a self-administered questionnaire sent one year after hospital discharge. We examined the association between baseline characteristics, disease severity, and symptoms that persisted one month after onset with malnutrition disorders one year after onset, defined as a Malnutrition Universal Screening Tool score ≥1, using a logistic regression analysis. Results: A total of 1081 patients (mean age of 56.0 years; 34% females; 38% admitted to the intensive care unit) were analyzed. Of these patients, 266 patients (24.6%) had malnutrition one year after onset. In a multivariable logistic regression analysis using variables that were significant in a univariate logistic regression analysis, the following factors were independently associated with malnutrition: BMI < 18.5 kg/m² (odds ratio [95% confidence interval (CI)], 48.9 [14.3–168]), 18.5 ≤ BMI ≤ 20 (10.5 [5.89–18.8]), 30 < BMI (2.64 [1.84–3.75]), length of hospital stay (1.01 [1.00–1.02]), maintenance dialysis (3.19 [1.19–8.61]), and difficulty concentrating one month after onset (1.73 [1.07–2.79]). Conclusions: Being underweight or obese, prolonged hospitalization, maintenance dialysis, and difficulty concentrating one month after onset were associated with a risk of malnutrition one year post-illness. Patients with these factors may be at a high risk of long-term nutritional disorders. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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15 pages, 1421 KiB

Open AccessArticle

Nutritional Intake in Venovenous ECMO Patients: A Single-Center Study in a North American PICU

by Annika Lintvedt, Isabella Purosky, Benjamin Kogelschatz, Megan Brackmann, Erika Heinze, Jessica Parker, Brooke Dudick, Jamie Mcdiarmid, Elizabeth Rosner, Brian Boville and Mara L. Leimanis-Laurens

Nutrients 2024, 16(22), 3813; https://doi.org/10.3390/nu16223813 - 7 Nov 2024

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Abstract

Background/Objectives: Multiple independent variables were analyzed to determine total nutritional intake (caloric and protein), while reviewing vasoactive inotrope scores (VISs). Methods: Retrospective data were collected for nutritional intake (N = 64), daily VISs, extracorporeal membrane oxygenation (ECMO) complications, delays in nutritional intake (>48 [...] Read more.

Background/Objectives: Multiple independent variables were analyzed to determine total nutritional intake (caloric and protein), while reviewing vasoactive inotrope scores (VISs). Methods: Retrospective data were collected for nutritional intake (N = 64), daily VISs, extracorporeal membrane oxygenation (ECMO) complications, delays in nutritional intake (>48 h), reason for delay, and interruptions in nutrition support. Results: VISs and ECMO characteristics analyzed by box–whisker plots demonstrated that ECMO complications prior to 24 h, cardiac arrest 24 h prior to ECMO, pediatric ECMO patients, venoarterial ECMO type, having a cardiac ECMO indication, and ECMO centrifugal pump had higher VISs. A regression analysis revealed that venovenous ECMO patients and the centrifugal pump type had higher caloric and protein intake; subsequently, for each increase in VIS, caloric intake decreased by −0.54. Sixteen patients did not receive nutritional support while on ECMO (9/16; 56% cardiac); 12/48 (25%) had a delay, with the cardiac patients nearing statistical significance. Conclusion: Venovenous ECMO (non-cardiac) correlated with higher nutritional intake. The enteral administration of nutrition had a lower VIS on average compared to the other three groupings, namely enteral vs. parenteral; enteral vs. both enteral and parenteral; enteral vs. no nutrition. This study provides additional clinical insight on nutritional intake in ECMO patients. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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13 pages, 2015 KiB

Open AccessArticle

Association between Poor Outcomes and Risk of Refeeding Syndrome among Patients Urgently Admitted to the High Dependency Unit: A Single-Center Cohort Study in Japan

by Minoru Yoshida, Masako Suzuki, Haruaki Wakatake, Miyuki Kurisu, Hiroki Saito, Yuki Ohshima, Mayumi Kaneko, Kuniyasu Fujiwara, Yoshihiro Masui, Koichi Hayashi and Shigeki Fujitani

Nutrients 2024, 16(19), 3287; https://doi.org/10.3390/nu16193287 - 28 Sep 2024

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Abstract

Background/Objectives: Refeeding syndrome (RFS) is recognized as a potentially fatal metabolic disturbance, particularly concerning for non-critically ill patients who do not receive frequent electrolyte assessments. Assessing the risk of developing RFS and implementing preventive strategies is essential in these cases. We investigated the [...] Read more.

Background/Objectives: Refeeding syndrome (RFS) is recognized as a potentially fatal metabolic disturbance, particularly concerning for non-critically ill patients who do not receive frequent electrolyte assessments. Assessing the risk of developing RFS and implementing preventive strategies is essential in these cases. We investigated the proportion of risk and its association with prognosis in a high-dependency unit (HDU). Method: This observational study was conducted in a tertiary care hospital’s HDU in Japan. We consecutively enrolled all patients who had been admitted urgently to the HDU and hospitalized for three days or more. We evaluated the National Institute for Health and Clinical Excellence (NICE) RFS risk factors at admission and classified patients into four groups based on the modified NICE criteria. The primary outcome was 30-day in-hospital mortality. The secondary outcome was a composite of 30-day in-hospital mortality and transfer to the intensive care unit, or discharge to locations other than home. Using logistic regression, we assessed the association between the four risk groups and outcomes, using the no-risk group as a reference. Results: A total of 955 patients were analyzed, of which 33.1%, 26.7%, 37.8%, and 2.4% were classified into the no-risk, low-risk, high-risk, and very high-risk groups, respectively. The 30-day in-hospital mortality was 4.4%, 5.5%, 5.0%, and 21.7%, respectively (Log-rank trend test: p = 0.047). In multivariable logistic regression, adjusting for sepsis, comorbidities, and age, only the very high-risk group was associated with 30-day in-hospital mortality (odds ratio: 5.54, 95% confidence interval: 1.73–17.79) A similar association was observed for the secondary outcomes. Conclusions: For patients admitted urgently to the HDU, there may be an opportunity to improve outcomes for very high-risk patients through preventive strategies. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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9 pages, 1164 KiB

Open AccessArticle

Effectiveness of Zinc Supplementation for Sepsis Treatment: A Single-Center Retrospective Observational Study

by Muneyoshi Kim, Takaaki Maruhashi and Yasushi Asari

Nutrients 2024, 16(17), 2841; https://doi.org/10.3390/nu16172841 - 25 Aug 2024

Cited by 2 | Viewed by 1699

Abstract

Background: Zinc plays an important role in sepsis; however, the effectiveness of zinc supplementation and the appropriate dose remain unclear. This study aimed to verify the effectiveness of zinc supplementation and the appropriate dose in patients with sepsis. Methods: This single-center retrospective observational [...] Read more.

Background: Zinc plays an important role in sepsis; however, the effectiveness of zinc supplementation and the appropriate dose remain unclear. This study aimed to verify the effectiveness of zinc supplementation and the appropriate dose in patients with sepsis. Methods: This single-center retrospective observational study included 247 patients with sepsis from 1 April 2015 to 31 March 2023 who were receiving ventilatory management. The patients were divided into three groups according to the zinc supplementation dose: <15 mg, 15–50 mg, and ≥50 mg. Results: The <15 mg, 15–50 mg, and ≥50 mg groups had 28 (19%), six (21%), and 16 deaths (22%) at discharge, with no statistically significant difference (p = 0.36). No statistically significant differences were observed in the length of intensive care unit (ICU) stay (p = 0.06). A higher supplementation dose corresponded with a statistically significant increase in blood zinc concentration in the first week (38.5 ± 16.6 µg/dL, 58.8 ± 19.7 µg/dL, 74.2 ± 22.5 µg/dL, respectively; p < 0.01) but not in the second or third weeks (p = 0.08, 0.19, respectively). Conclusions: Zinc supplementation did not reduce the mortality rate or length of ICU stay or contribute to an increased serum zinc concentration. High-dose zinc supplementation may not be effective during acute sepsis. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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14 pages, 838 KiB

Open AccessArticle

A Novel Facet of In-Hospital Food Consumption Associated with Hospital Mortality in Patients with Scheduled Admission—Addition of a Study Protocol to Test the Existence of Effects of COVID-19 in the Same Study in the Post-COVID-19 Period

by Hiroyo Miyata, Ayako Tsunou, Yoko Hokotachi and Teruyoshi Amagai

Nutrients 2024, 16(14), 2327; https://doi.org/10.3390/nu16142327 - 19 Jul 2024

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Abstract

Background: Humankind has faced unexperienced pandemic events since 2020. Since the COVID-19 pandemic has calmed down, we felt the need to verify whether in-hospital mortality had worsened compared to pre-pandemic conditions due to the COVID-19 pandemic. Objective: To test the hypothesis that daily [...] Read more.

Background: Humankind has faced unexperienced pandemic events since 2020. Since the COVID-19 pandemic has calmed down, we felt the need to verify whether in-hospital mortality had worsened compared to pre-pandemic conditions due to the COVID-19 pandemic. Objective: To test the hypothesis that daily food consumption is associated with in-hospital mortality during hospitalization and to provide baseline data to examine whether the effects of COVID-19 exist or not in post-pandemic period. Methods: All hospitalized patients staying in a single institution on the third Thursday of May, August, November, and the following February were included. Compared data: (1) among four seasons, (2) between age < 75 vs. ≥75 years, (3) between <75% vs. ≥75% of in-hospital food, and (4) logistic regression analysis to identify factors associated with in-hospital mortality. Results: In 365 inpatients, the following results were obtained: (1) no seasonality or age effect in in-hospital mortality, (2) the novel cutoff value of 75% of the hospital food requirement was used to identify poor in-hospital survivors, (3) logistic regression analysis showed low food consumption, with <75% of the hospital food requirement as the predictor of high in-hospital mortality. Conclusions: A small eater of in-hospital food < 75% during hospitalization was associated with significantly higher in-hospital mortality in patients with scheduled hospitalization in the pre-pandemic period. Then, a study protocol is proposed to test the existence of the effects of COVID-19 in the same study in the post-COVID-19 period. This study protocol is, to our knowledge, the first proposal to test the effects of food consumption in the post-COVID-19 period on in-hospital mortality in the clinical nutritional areas. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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11 pages, 633 KiB

Open AccessArticle

Combined Effect of Early Nutrition Therapy and Rehabilitation for Patients with Chronic Obstructive Pulmonary Disease Exacerbation: A Prospective Randomized Controlled Trial

by Yohei Oyama, Hiroomi Tatsumi, Hiroko Takikawa, Natsuko Taniguchi and Yoshiki Masuda

Nutrients 2024, 16(5), 739; https://doi.org/10.3390/nu16050739 - 5 Mar 2024

Cited by 2 | Viewed by 3771

Abstract

The effectiveness of rehabilitation programs (RP) for chronic obstructive pulmonary disease (COPD) exacerbation remains controversial. However, few studies have investigated the combined effects of exercise and nutritional therapy. This study aimed to determine the effects of combined nutritional therapy on the physical function [...] Read more.

The effectiveness of rehabilitation programs (RP) for chronic obstructive pulmonary disease (COPD) exacerbation remains controversial. However, few studies have investigated the combined effects of exercise and nutritional therapy. This study aimed to determine the effects of combined nutritional therapy on the physical function and nutritional status of patients with COPD exacerbation who underwent early RP. A randomized controlled trial was conducted in patients hospitalized for COPD exacerbations. Patients were assigned to receive a regular diet in addition to RP (control group) or RP and nutrition therapy (intervention group). Physical function, including quadricep strength and body composition, was assessed. The intervention group was administered protein-rich oral nutritional supplements. A total of 38 patients with negligible baseline differences were included in the analysis. The intervention group showed a notably greater change in quadriceps strength. Lean body mass and skeletal muscle indices markedly decreased in the control group but were maintained in the intervention group. Logistic regression analysis identified nutritional therapy as a significant factor associated with increased muscle strength. No serious adverse events were observed in either group. Therefore, nutritional therapy combined with RP is safe and effective for improving exercise function while maintaining body composition in patients with COPD exacerbation. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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Review

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15 pages, 739 KiB

Open AccessReview

Critical Care Nutrition from a Metabolic Point of View: A Narrative Review

by Takehiko Oami, Akiyuki Yamamoto, Shigenobu Ishida, Kengo Kondo, Nanami Hata and Taku Oshima

Nutrients 2025, 17(8), 1352; https://doi.org/10.3390/nu17081352 - 15 Apr 2025

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Abstract

Background: Critical illness induces profound metabolic alterations, characterized by a hypermetabolic state, insulin resistance, protein catabolism, and gut barrier dysfunction, which contribute to increased morbidity and mortality. Emerging evidence highlights the role of the gut microbiome and its metabolites in modulating systemic inflammation [...] Read more.

Background: Critical illness induces profound metabolic alterations, characterized by a hypermetabolic state, insulin resistance, protein catabolism, and gut barrier dysfunction, which contribute to increased morbidity and mortality. Emerging evidence highlights the role of the gut microbiome and its metabolites in modulating systemic inflammation and immune responses during critical illness. This narrative review explores the metabolic evolution of critically ill patients, the impact of gut dysbiosis on disease progression, and the potential role of nutrition in modulating metabolism and improving patient outcomes. Methods: A comprehensive literature search was conducted across PubMed and Google Scholar for articles published up to February 2025. Search terms included “critical illness”, “metabolism”, “gut microbiota”, “nutrition”, and related keywords. Articles published in English addressing metabolic alterations, microbiome changes, and nutritional strategies in critically ill patients were included. After screening for eligibility, relevant articles were synthesized to outline current knowledge and identify gaps. Results: Metabolic changes in critical illness progress through distinct phases, from catabolism-driven hypermetabolism to gradual recovery. Gut dysbiosis, characterized by a loss of microbial diversity and increased gut permeability, contributes to systemic inflammation and organ dysfunction. Nutritional strategies, including enteral nutrition, probiotics, prebiotics, and metabolomics-driven interventions, may help restore microbial balance, preserve gut barrier integrity, and modulate immune and metabolic responses. Future nutrition therapy should focus on metabolic modulation rather than solely addressing nutrient deficits. Conclusions: Advances in gut microbiome research and metabolomics offer new avenues for personalized nutrition strategies tailored to the metabolic demands of critically ill patients. Integrating these approaches may improve clinical and functional recovery while mitigating the long-term consequences of critical illness. Full article

(This article belongs to the Special Issue The Importance of a Clinical Diet and Nutritional Management for Patients)

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