Search Results (471)

This review examines the physical foundations, predictive models, emerging technologies and recent research trends in bioimpedance for clinical nutrition. A bibliometric analysis of cumulative scientific production from 1980 to 2025 shows that weighted logistic models provide a good descriptive fit to the evolution of the literature (R² ≥ 0.999). Bioimpedance research remains in an expanding phase, with its projected inflection point lying beyond 2026. These fits are descriptive and model-dependent: high coefficients of determination on cumulative counts are not in themselves evidence of predictive validity, and inflection points beyond the observation window are extrapolations. We introduce the Measurement-Independent Factor (MIF), which isolates the anthropometric contribution from the bioimpedance measurement in predictive equations. Phase Angle (PhA) has emerged as the most extensively studied bioimpedance descriptor, since it avoids the population-specific prediction equations required for estimates such as FFM or FM, although its absolute value remains dependent on measurement conditions, instrumentation and biological characteristics. Body-composition estimates obtained with devices from different manufacturers should not be interpreted interchangeably. Electrode technologies, bioimpedance wearables, and bioimpedance imaging are reviewed as major emerging research directions. A second bibliometric analysis covering the most-cited literature from 2020 to 2026 and 1655 original articles published during 2025–2026 show that recent research focuses primarily on obesity and adiposity, together with sarcopenia and frailty, whereas critical and acute care remain underrepresented. Full article

Background: Nutritional support in critically ill patients remains one of the most debated aspects of intensive care medicine. Although international guidelines have long recommended early nutritional support with progressive protein delivery, recent clinical evidence has questioned the benefit of aggressive early calorie and protein provision during the acute phase of critical illness, highlighting the need for phase-adapted nutritional strategies. Methods: This narrative review summarizes current evidence on individualized, phase-adapted nutritional therapy in critically ill adults and post-ICU survivors, focusing on protein dose and timing, anabolic resistance, muscle wasting, and nutritional management during recovery. Relevant studies published between January 2011 and June 2026 were identified through structured searches of PubMed/MEDLINE, supplemented by reference screening and forward citation tracking. A total of 59 publications were included in the final narrative synthesis. Results: Recent clinical trials indicate that early high-dose protein administration does not consistently improve survival or functional outcomes and may be associated with harm in selected patient subgroups, particularly those with acute kidney injury, severe organ dysfunction, or shock. More conservative early calorie and protein delivery during the early acute phase has been associated with improved gastrointestinal tolerance and faster clinical stabilization without increasing mortality. Complementary mechanistic evidence supports these findings, highlighting persistent endogenous energy production, anabolic resistance, impaired protein utilization, and reduced autophagy during early critical illness. In contrast, the post-ICU recovery phase is characterized by ongoing muscle wasting, weakness, reduced oral intake, and persistent nutritional deficits, while structured nutritional support after ICU discharge remains inconsistently implemented. Conclusions: Current evidence increasingly supports an individualized, phase-adapted approach to nutritional therapy rather than uniform early aggressive calorie and protein targets. Nutritional strategies should consider illness severity, metabolic phase, organ dysfunction, gastrointestinal tolerance, and recovery trajectory. Further studies are needed to define optimal nutritional targets during post-ICU recovery. An evidence-informed practical framework for phase-adapted nutritional therapy is proposed. Full article

Background/Objectives: Protein–energy malnutrition is common in children with congenital heart disease (CHD) due to increased metabolic demand and limited oral intake capacity. Achieving adequate protein intake in this population through oral feeding remains a critical yet underexplored challenge. This review aims to synthesize the currently available evidence on protein requirements, barriers to oral intake, and strategies for optimization of protein delivery in children with CHD. Methods: A narrative review was conducted using PubMed/MEDLINE, Scopus, and Web of Science. Relevant observational studies, randomized trials, guidelines, and recent reviews addressing nutritional management and oral feeding in pediatric CHD were included. Evidence was synthesized across metabolic, clinical, and practical domains. Results: Children with CHD exhibit increased protein requirements driven by hypermetabolism, inflammation, and perioperative stress, often reaching a requirement of 3–4 g/kg/day in high-risk settings. However, feeding limitations—including fatigue, gastrointestinal dysfunction, and oral motor impairment—restrict intake capacity and contribute to protein inadequacy in this population. Evidence supports the use of nutrient-dense feeding, optimized feeding frequency, food fortification, oral nutritional supplementation, and multidisciplinary care to improve protein delivery efficiency and nutritional status. Conclusions: Achieving adequate protein delivery through oral feeding requires a shift toward targeted, protein-focused strategies that address intake limitations. Early attention to protein adequacy may support nutritional recovery and growth, although its independent effects on postoperative and long-term outcomes remain uncertain. Further research is needed to establish standardized, evidence-based protocols tailored to this population. Full article

Paediatric Inflammatory Bowel Disease (PIBD), encompassing Crohn’s Disease (CD), Ulcerative Colitis (UC) and IBD-Unclassified (IBDU), onsets during a critical window for growth, pubertal development, and bone accrual, making nutrition a primary, disease-modifying component of care rather than a purely supportive one. This review summarises current evidence and clinical experience on nutritional assessment, monitoring, and dietary treatment in PIBD. Malnutrition, growth faltering and micronutrient deficiency are common at diagnosis and during flares, and the interpretation of biochemical markers is complicated by systemic inflammation, hence requiring a combined dietary, biochemical, and clinical approach. Exclusive Enteral Nutrition (EEN) remains the first-line induction therapy for mild-moderate Crohn’s Disease, achieving remission in 60–80% of patients, although its restrictive, liquid-only nature limits long-term adherence. Food-based alternatives including the Crohn’s Disease Exclusion Diet with partial enteral nutrition, CD-TREAT, and the “Tasty and Healthy” diet offer comparable induction efficacy with improved palatability and adherence in appropriately selected patients. Maintenance strategies, including cyclic EEN, dose-dependent partial enteral nutrition, and adjunct therapies such as curcumin may have a role in selected patients, and are discussed alongside emerging evidence on emulsifiers, fibre, and the Mediterranean diet. Selecting an appropriate therapy requires balancing disease severity against patient motivation, family support, and other pragmatic and lifestyle factors. Psychological and quality-of-life dimensions of dietary therapy require consideration, underscoring the need for individualised care that protects both nutritional status, child’s relationship with food and overall wellbeing. Full article

Acute pancreatitis is a common and heterogeneous inflammatory disorder whose clinical course ranges from a self-limited illness to persistent organ failure, infected pancreatic necrosis, and prolonged critical illness. Contemporary management has moved away from protocolised aggressive fluid loading, prolonged fasting, prophylactic antibiotics, and early open necrosectomy. Instead, current care emphasises repeated physiological assessment, moderate goal-directed resuscitation, early enteral or oral nutrition, organ-specific support, antimicrobial stewardship, and delayed minimally invasive intervention within a multidisciplinary step-up strategy. This narrative review examines acute pancreatitis from an intensive care perspective. Particular attention is given to early risk stratification, intensive care unit triage, haemodynamic and respiratory support, acute kidney injury, intra-abdominal hypertension, nutrition, biliary source control, diagnosis and treatment of infected necrosis, and the timing and selection of endoscopic, radiological, and surgical interventions. The implications of obesity, pregnancy, advanced age, and multimorbidity are also discussed. Recent randomised trials have clarified several clinically important questions: aggressive hydration increases fluid overload without improving outcomes; routine urgent endoscopic retrograde cholangiopancreatography is not beneficial in predicted severe biliary pancreatitis without cholangitis; postponed drainage may avoid invasive intervention in a substantial proportion of patients with infected necrosis; and endoscopic or minimally invasive approaches reduce treatment burden compared with primary open surgery. Persistent organ failure remains the principal determinant of mortality, while infected necrosis further increases risk and complexity. Future progress will depend on dynamic prediction models, biomarker-guided antimicrobial decisions, personalised haemodynamic strategies, phenotype-directed immunomodulation, and regionalised multidisciplinary care. Full article

Background/Objectives: Early feeding intolerance (FI) affects 20–50% of critically ill patients receiving enteral nutrition, yet no validated predictive tool exists and diagnosis remains retrospective. Plasma citrulline, mainly synthesized by enterocytes, is considered as the “factor V of the intestine”. The citrulline generation test (CGT) evaluates small bowel mucosal function by measuring the increase in plasma citrulline after glutamine administration. We hypothesized that patients with a lower CGT would be more prone to FI. We aimed to compare CGT results according to the presence or absence of FI and to identify factors associated with CGT. Methods: This prospective study was conducted in the medical intensive care unit (ICU) of Besancon Hospital. Plasma citrulline and glutamine concentrations were measured at admission and after an alanine–glutamine dipeptide bolus. CGT was defined as the slope between basal and 90 min peak plasma citrulline concentrations. Signs of FI were collected during follow-up. Results: Among the sixty-six included patients, nine (14%) developed FI by day three, only characterized by vomiting and gastric residual volumes above 500 mL; abdominal pain or diarrhea were not observed. CGT values did not differ between patients with and without FI. CGT correlated positively with baseline citrulline and peak glutamine concentrations. Conclusions: FI was not associated with CGT, possibly because FI was predominantly gastric rather than intestinal. Low CGT values were associated with low plasma citrulline concentrations, suggesting reduced functional enterocyte mass. The positive correlation between CGT and peak plasma glutamine suggests that CGT not only reflects enterocyte function but also glutamine bioavailability. Full article

Background/Objectives: Obesity is a chronic, progressive, and relapsing disease that requires long-term, multidisciplinary management rather than episodic weight-loss treatment. Although novel incretin-based anti-obesity pharmacotherapies, including GLP-1 receptor agonists and dual GIP/GLP-1 receptor agonists, have markedly improved the clinical management of obesity, weight reduction alone does not fully capture treatment success. Body composition, lean mass preservation, physical function, nutritional adequacy, psychological well-being, adherence, and long-term weight-loss maintenance are increasingly recognized as essential therapeutic outcomes. This narrative review critically examines the role of lifestyle medicine as a co-therapeutic strategy during modern anti-obesity pharmacotherapy, with particular attention to physical activity, nutrition, behavioral support, and individualized monitoring. Methods: A narrative literature search was conducted in PubMed up to June 2026. The review included studies addressing adults with overweight or obesity and evidence related to anti-obesity pharmacotherapy, physical activity, nutrition, body composition, functional outcomes, eating behavior, quality of life, treatment tolerability, adherence, weight regain, and long-term maintenance. Results: Current evidence indicates that incretin-based therapies produce substantial and clinically meaningful weight loss, but pharmacological efficacy may be limited by reductions in lean mass, gastrointestinal adverse events, inadequate nutritional intake, treatment discontinuation, and weight regain after drug withdrawal. Physical activity should be considered a therapeutic component rather than only a tool for increasing energy expenditure, as aerobic exercise supports cardiometabolic health and cardiorespiratory fitness, while resistance training helps preserve muscle strength, bone health, and functional capacity. Nutritional strategies are equally important, particularly during appetite suppression, to maintain adequate protein, fiber, fluids, micronutrients, and diet quality. Behavioral factors, including sleep, stress, mood, stigma, self-regulation, and the food environment, may influence adherence and long-term outcomes. Conclusions: Novel anti-obesity drugs should not be viewed as replacements for lifestyle medicine but as powerful tools within an integrated chronic-care model. The goal of treatment should move beyond maximal body-weight reduction to durable improvements in body composition, metabolic health, physical function, nutritional status, quality of life, and weight-loss maintenance. Full article

Background/Objectives: GLP-1 receptor agonists are an established component of obesity treatment that should complement nutritional and lifestyle interventions. Social media narratives may shape public understanding and acceptance of these therapies. This study examined whether exposure to GLP-1-related narratives and their perceived credibility were associated with perceptions of obesity pharmacotherapy. Methods: An anonymous cross-sectional online survey was conducted among Polish-speaking adults aged ≥ 18 years who used social media at least weekly and reported exposure to GLP-1-related content within the preceding 3 months. Five exploratory composite scores assessed narrative exposure, perceived credibility, perceptions of communication, attitudes toward obesity pharmacotherapy, and GLP-1 treatment evaluation. Associations were examined using univariable and multivariable linear regression. Results: The final sample comprised 279 participants (84.6% women; mean age, 38.14 ± 8.58 years). In adjusted models, greater perceived narrative credibility was associated with less favorable GLP-1 treatment evaluations (B = −0.311, 95% CI: −0.359 to −0.263; p < 0.001) and greater endorsement of negative pharmacotherapy-related statements (B = 0.401, 95% CI: 0.350 to 0.453; p < 0.001). Greater narrative exposure was associated with more favorable GLP-1 treatment evaluations (B = 0.072, 95% CI: 0.026 to 0.118; p = 0.002) and more negative perceptions of social media communication (B = 0.235, 95% CI: 0.161 to 0.309; p < 0.001). Conclusions: Greater perceived credibility of GLP-1-related narratives was associated with less favorable perceptions of obesity pharmacotherapy, but the cross-sectional design precludes conclusions about direction or causality. The findings highlight the importance of evidence-based communication that supports critical evaluation of treatment-related claims and presents pharmacotherapy, nutrition, and lifestyle support as complementary components of comprehensive obesity care. Full article

Background and Objectives: Critically ill surgical patients frequently fail to achieve prescribed enteral nutrition targets because of feeding interruptions and variability in conventional physician-directed feeding practices. Although volume-based feeding (VBF) has been proposed to improve nutritional delivery, concerns remain regarding refeeding syndrome and gastrointestinal intolerance. The aim of this study was to evaluate whether a Volume-Based Plus (VBF+) protocol integrating volume-targeted feeding with mandatory refeeding risk stratification and a standardized semi-elemental enteral formula improves nutritional delivery without increasing gastrointestinal or metabolic complications. Materials and Methods: We conducted an ambispective before-and-after implementation study (retrospective control phase, prospective intervention phase) in the surgical intensive care unit of a tertiary care center between January 2023 and March 2026. Ninety-six patients requiring enteral nutrition for ≥3 days were enrolled (48 control and 48 intervention). Both groups underwent the same refeeding risk stratification to guide feeding strategy, while the intervention group additionally received the standardized VBF+ protocol with risk-stratified caloric advancement and volume-based compensation for feeding interruptions, and a standardized semi-elemental enteral formula. The primary outcomes were median daily caloric delivery (% of target) and mean daily protein delivery (g/kg/day). Multivariable regression analyses adjusted for Nutritional Assessment Form (NAF), APACHE II score, and Charlson Comorbidity Index (CCI) were performed. Results: The VBF+ protocol was independently associated with higher caloric delivery (β = 31.2 percentage points, 95% CI 17.6 to 44.8; p < 0.001) and higher protein delivery (β = 0.168 g/kg/day, 95% CI 0.040–0.297; p = 0.011). Longitudinal analysis showed a significantly faster increase in protein delivery in the intervention group (p < 0.001), while the group-by-time interaction for caloric delivery did not reach statistical significance (p = 0.073). Rates of gastrointestinal intolerance and metabolic complications were comparable between groups; as VBF+ bundled the compensatory algorithm with a semi-elemental formula, this gastrointestinal benefit is hypothesis-generating. Conclusions: In this before-and-after study, the VBF+ bundle protocol was associated with improved caloric and protein delivery and reduced gastrointestinal intolerance; because the algorithm and formula were not evaluated independently, the gastrointestinal benefit remains hypothesis-generating and requires confirmation in randomized trials. Full article

Obesity is a complex, multifactorial chronic disease characterized by excessive and/or aberrant adiposity that requires interventions beyond conventional calorie-restriction models. Current clinical guidelines converge on behavioral modification, encompassing nutritional therapy, physical activity, stress reduction, and sleep improvement, as the cornerstone of obesity management, with psychological therapy, pharmacotherapy, and bariatric procedures as adjunctive or escalating options. While traditional “one-size-fits-all” dietary approaches frequently yield suboptimal long-term outcomes, precision nutrition has emerged as a promising strategy for individualized obesity care. This review critically appraises the evidence underlying each pillar of precision nutrition: genetic profiling shows clear utility in monogenic obesity but variable benefit when diet is matched to common polygenic variants; microbiome-targeted studies reveal that the Bacillota to Bacteroidota ratio shows inconsistent associations with obesity across studies, with genus-level and functional alterations offering more reproducible targets; and metabolomic profiling of postprandial glycemic responses has progressed from foundational predictive algorithms to large-scale clinical validation. It also highlights chrono-nutrition, the alignment of food timing with individual chronotype, as an emerging pillar of personalization. Beyond dietary composition, the review addresses how personalized nutrition can mitigate the adverse effects of incretin-based pharmacotherapy and discusses how artificial intelligence can integrate multi-omics and behavioral data into real-time dietary guidance. Future clinical implementation will require overcoming challenges related to data integration, predictive accuracy, and accessibility, paving the way for more effective, evidence-based obesity management. Full article

Background: Although advances in critical care have improved short-term outcomes, sepsis survivors continue to face substantial chronic morbidity and impaired long-term survival. Conventional threshold-based tools such as the Sequential Organ Failure Assessment (SOFA) and Modified Early Warning Score (MEWS) show moderate and variable discrimination across cohorts. Reported areas under the receiver operating characteristic curve (AUROCs) must therefore be interpreted in relation to the population, prediction horizon, and outcome used in each study rather than as direct head-to-head comparisons. Objectives: This review evaluates how artificial intelligence (AI) could be linked with dynamic plasma metabolites, particularly citrulline and β-hydroxybutyrate (3-HB), to support biologically informed sepsis phenotyping, while critically examining mechanistic evidence, clinical limitations, and translational readiness. Data Synthesis: Machine-learning and natural language processing architectures have shown promising discrimination in many early-detection studies, with pooled AUROCs near 0.87 and reported prediction windows extending to 48 h. However, performance estimates vary with cohort composition, outcome definition, and validation design, and they should not be ranked against unrelated biomarker studies. Human sepsis studies generally associate low or persistently low citrulline with impaired intestinal function and organ injury, but no sepsis-specific decision cutoff has been externally validated. For 3-HB, an AUROC of 0.8429 for septic liver injury was derived from a cohort of 57 patients and has not been shown to add value beyond routine liver tests or illness-severity measures. Murine experiments provide mechanistic hypotheses for ketone-mediated organ protection, but model-specific and sometimes opposing nutritional effects limit direct translation. These metabolites are therefore best considered candidate longitudinal features for multimodal phenotyping rather than stand-alone clinical triggers. Conclusions: Biologically informed algorithmic surveillance is a promising direction, but clinical implementation requires prospective serial sampling, explicit adjustment for renal, hepatic and nutritional confounders, head-to-head comparison with routine markers, and external validation of calibration and clinical utility. Until these requirements are met, citrulline and 3-HB should support research phenotyping rather than direct treatment selection. Full article

Background: Obesity is a chronic, multifactorial disease that demands personalized and sustainable management approaches. Digital health technologies, such as artificial intelligence, wearable devices, mobile health apps, and virtual reality (VR), may support obesity care by providing enhanced behavioral monitoring, personalized feedback, and patient engagement. Objective: This critical narrative review discusses the current evidence on artificial intelligence, wearable technologies, and VR in the context of precision nutrition and obesity management and their possible clinical applications and limitations. Method: A critical narrative review was conducted using peer-reviewed literature published between 2019 and 2026 and identified through PubMed and Google Scholar. Search terms included combinations of “precision nutrition,” “personalized nutrition,” “obesity,” “weight management,” “metabolic health,” “digital health,” “artificial intelligence,” “machine learning,” “mobile health,” “wearable devices,” and “omics” using Boolean operators. Evidence from randomized controlled trials, systematic reviews, meta-analyses, and key conceptual studies was critically synthesized due to substantial heterogeneity in interventions and outcomes. Result: Wearables and mobile applications can enable continuous self-monitoring of physical activity, dietary intake, sleep, and physiological measures. Artificial intelligence may improve dietary personalization, risk prediction, glycemic control, and adaptive feedback. VR offers an immersive way to tackle behavioral and cognitive mechanisms related to overeating such as cravings, food cue reactivity, and inhibitory control. However, the evidence is heterogeneous, with many studies limited by short follow-up periods, small samples, variable adherence, and insufficient clinical validation. Conclusions: Artificial intelligence, wearable technologies, and VR are promising tools for precision obesity management, but their long-term clinical effectiveness remains uncertain. Future research should prioritize adequately powered trials, longer follow-up, standardized outcomes, transparent algorithms, ethical data governance, and integration with multidisciplinary nutrition and obesity care. Full article

Intensive Care Unit-Acquired Weakness (ICU-AW) is a secondary neuromuscular disorder diagnosed during a critical illness and related to ICU stay and intensive treatments, once other possible etiologies have been excluded. Micronutrients are essential components of human nutrition that are needed in small amounts to maintain pivotal organ functions, but their role in critical care nutrition and in prevention and treatment of ICU-AW is unclear. This narrative review aimed to provide a synthesis of the current evidence on the potential role of micronutrients in ICU-AW, with a glance at what is known in medical settings outside the ICU. Available evidence is fragmented, showing controversial results. Studies on vitamin K1 and vitamin D suggest potential benefits on handgrip strength, skeletal muscle mass and mobility, while Coenzyme Q10 may have a role in improving skeletal muscle composition. Moreover, zinc homeostasis may influence muscle degradation, whereas copper levels may represent a risk factor. Evidence on iron and carnitine showed uncertain results. Conversely, more robust evidence on muscle weakness is available for medical settings outside the ICU. Larger observational studies and RCTs are needed to further evaluate the possible efficacy of micronutrient supplementation in the critical care setting. Full article

Background/Objectives: Enteral nutrition is an essential component of care for critically ill patients, and nurses play a key role in its assessment, delivery, and monitoring. Although the Spanish version of the Persenius Scale has previously undergone translation, cross-cultural adaptation, and content validation, its structural validity has not yet been evaluated. Therefore, this study aimed to evaluate the structural validity of the Spanish version of the Persenius Scale in a sample of intensive care unit nurses in Spain. Methods: A cross-sectional study was conducted using an online questionnaire administered to intensive care unit nurses. The analytical sample included 329 participants recruited through non-probability snowball sampling. Sampling adequacy was assessed using the Kaiser–Meyer–Olkin index and Bartlett’s test of sphericity. Principal component analysis with Varimax rotation was performed to evaluate the structural validity of the instrument. Hierarchical cluster analysis was also used to examine the coherence of item grouping. Results: The Kaiser–Meyer–Olkin value was 0.88, and Bartlett’s test of sphericity was significant, supporting the suitability of the data for component analysis. A five-component solution was retained, explaining approximately 58% of the total variance. The components were organizational resources, specialized training, professional responsibility, perceived competence, and technical modality of enteral administration. Organizational resources and professional responsibility showed the most homogeneous loading patterns, whereas several technical practice items demonstrated higher uniqueness and weaker structural integration. Conclusions: The present study provides preliminary evidence regarding the internal structure of the Spanish version of the Persenius Scale by demonstrating a clinically interpretable five-component structure. The instrument may support the assessment of educational, organizational, and professional aspects of enteral nutrition practice among intensive care unit nurses. Full article

Dental caries is one of the most prevalent chronic diseases affecting older adults and remains an important, underrecognized contributor to pain, impaired nutrition, systemic illness, and reduced quality of life. Older adults access medical care more often than dental care, positioning non-dental clinicians to identify risk, initiate prevention, and facilitate timely referral. A narrative review of English-language literature was conducted using PubMed and Google Scholar. Search terms included “dental caries,” “root caries,” and “older adults.” Sources included original studies, clinical guidelines, consensus statements, and high-quality reviews, with an emphasis on relevance to older adults and applicability to non-dental clinicians. Dental caries in older adults commonly presents as root and recurrent decay and isstrongly associated with xerostomia, polypharmacy, chronic disease, functional impairment, cognitive decline, and limited access to dental care. The literature supports fluoride-based prevention, management of salivary dysfunction, dietary counseling, minimally invasive therapies such as silver diamine fluoride, and interprofessional care models. Non-dental providers play a critical role in screening, risk assessment, preventive counseling, symptom triage, and referral. Integrating oral health into routine medical care is an essential and achievable strategy to reduce morbidity and improve health outcomes in older adults. Full article