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Search Results (430)

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Keywords = hospital nutrition care

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13 pages, 688 KiB  
Article
Metabolomic Patterns at Birth of Preterm Newborns with Extrauterine Growth Restriction: Towards Putative Markers of Nutritional Status
by Marta Meneghelli, Giovanna Verlato, Matteo Stocchero, Anna Righetto, Elena Priante, Lorenzo Zanetto, Paola Pirillo, Giuseppe Giordano and Eugenio Baraldi
Metabolites 2025, 15(8), 518; https://doi.org/10.3390/metabo15080518 - 1 Aug 2025
Viewed by 211
Abstract
Background: Nutrition is of paramount importance during early development, since suboptimal growth in this period of life is linked to adverse long- and mid-term outcomes. This is particularly relevant for preterm infants, who fail to thrive during the first weeks of life and [...] Read more.
Background: Nutrition is of paramount importance during early development, since suboptimal growth in this period of life is linked to adverse long- and mid-term outcomes. This is particularly relevant for preterm infants, who fail to thrive during the first weeks of life and develop extrauterine growth restriction (EUGR). This group of premature babies represents an interesting population to investigate using a metabolomic approach to optimize nutritional intake. Aims: To analyse and compare the urinary metabolomic pattern at birth of preterm infants with and without growth restriction at 36 weeks of postmenstrual age or at discharge, searching for putative markers of growth failure. Methods: We enrolled preterm infants between 23 and 32 weeks of gestational age (GA) and/or with a birth weight <1500 g, admitted to the Neonatal Intensive Care Unit (NICU) at the Department of Women’s and Children’s Health of Padova University Hospital. We collected urinary samples within 48 h of life and performed untargeted metabolomic analysis using mass spectrometry. Results: Sixteen EUGR infants were matched with sixteen non-EUGR controls. The EUGR group showed lower levels of L-cystathionine, kynurenic acid, L-carnosine, N-acetylglutamine, xanthurenic acid, aspartylglucosamine, DL5-hydroxylysine-hydrocloride, homocitrulline, and L-aminoadipic acid, suggesting a lower anti-inflammatory and antioxidant status with respect to the non-EUGR group. Conclusions: Metabolomic analysis suggests a basal predisposition to growth restriction, the identification of which could be useful for tailoring nutritional approaches. Full article
(This article belongs to the Special Issue Metabolomics-Based Biomarkers for Nutrition and Health)
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48 pages, 1556 KiB  
Review
Extemporaneous Compounding, Pharmacy Preparations and Related Product Care in the Netherlands
by Herman J. Woerdenbag, Boy van Basten, Christien Oussoren, Oscar S. N. M. Smeets, Astrid Annaciri-Donkers, Mirjam Crul, J. Marina Maurer, Kirsten J. M. Schimmel, E. Marleen Kemper, Marjolijn N. Lub-de Hooge, Nanno Schreuder, Melissa Eikmann, Arwin S. Ramcharan, Richard B. Lantink, Julian Quodbach, Hendrikus H. Boersma, Oscar Kelder, Karin H. M. Larmené-Beld, Paul P. H. Le Brun, Robbert Jan Kok, Reinout C. A. Schellekens, Oscar Breukels, Henderik W. Frijlink and Bahez Garebadd Show full author list remove Hide full author list
Pharmaceutics 2025, 17(8), 1005; https://doi.org/10.3390/pharmaceutics17081005 - 31 Jul 2025
Viewed by 383
Abstract
Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare [...] Read more.
Background/Objectives: In many parts of the world, pharmacists hold the primary responsibility for providing safe and effective pharmacotherapy. A key aspect is the availability of appropriate medicines for each individual patient. When industrially manufactured medicines are unsuitable or unavailable, pharmacists can prepare tailor-made medicines. While this principle applies globally, practices vary between countries. In the Netherlands, the preparation of medicines in pharmacies is well-established and integrated into routine healthcare. This narrative review explores the role and significance of extemporaneous compounding, pharmacy preparations and related product care in the Netherlands. Methods: Pharmacists involved in pharmacy preparations across various professional sectors, including community and hospital pharmacies, central compounding facilities, academia, and the professional pharmacists’ organisation, provided detailed and expert insights based on the literature and policy documents while also sharing their critical perspectives. Results: We present arguments supporting the need for pharmacy preparations and examine their position and role in community and hospital pharmacies in the Netherlands. Additional topics are discussed, including the regulatory and legal framework, outsourcing, quality assurance, standardisation, education, and international context. Specific pharmacy preparation topics, often with a research component and a strong focus on product care, are highlighted, including paediatric dosage forms, swallowing difficulties and feeding tubes, hospital-at-home care, reconstitution of oncolytic drugs and biologicals, total parenteral nutrition (TPN), advanced therapy medicinal products (ATMPs), radiopharmaceuticals and optical tracers, clinical trial medication, robotisation in reconstitution, and patient-centric solid oral dosage forms. Conclusions: The widespread acceptance of pharmacy preparations in the Netherlands is the result of a unique combination of strict adherence to tailored regulations that ensure quality and safety, and patient-oriented flexibility in design, formulation, and production. This approach is further reinforced by the standardisation of a broad range of formulations and procedures across primary, secondary and tertiary care, as well as by continuous research-driven innovation to develop new medicines, formulations, and production methods. Full article
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14 pages, 1726 KiB  
Systematic Review
Mucous Fistula Refeeding in Newborns: Why, When, How, and Where? Insights from a Systematic Review
by Layla Musleh, Ilaria Cozzi, Anteo Di Napoli and Fabio Fusaro
Nutrients 2025, 17(15), 2490; https://doi.org/10.3390/nu17152490 - 30 Jul 2025
Viewed by 221
Abstract
Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed [...] Read more.
Background/Objectives: Infants with high-output enterostomies often require prolonged parenteral nutrition (PN), increasing risks of infections, liver dysfunction, and impaired growth. Mucous fistula refeeding (MFR) is proposed to enhance intestinal adaptation, weight gain, and distal bowel maturation. This systematic review and meta-analysis assessed its effectiveness, safety, and technical aspects. Methods: Following PRISMA guidelines, studies reporting MFR-related outcomes were included without data or language restrictions. Data sources included PubMed, EMBASE, CINAHL, Scopus, Web of Science, Cochrane Library, and UpToDate. Bias risk was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analysis employed random- and fixed-effects models, with outcomes reported as odds ratios (ORs) and 95% confidence interval (CI). Primary outcomes assessed were weight gain, PN duration, and complications and statistical comparisons were made between MFR and non-MFR groups. Results: Seventeen studies involving 631 infants were included; 482 received MFR and 149 did not. MFR started at 31 postoperative days and lasted for 50 days on average, using varied reinfusion methods, catheter types, and fixation strategies. MFR significantly improved weight gain (4.7 vs. 24.2 g/day, p < 0.05) and reduced PN duration (60.3 vs. 95 days, p < 0.05). Hospital and NICU stays were also shorter (160 vs. 263 days, p < 0.05; 122 vs. 200 days, p < 0.05). Cholestasis risk was lower (OR 0.151, 95% CI 0.071–0.319, p < 0.0001), while effects on bilirubin levels were inconsistent. Complications included sepsis (3.5%), intestinal perforation (0.83%), hemorrhage (0.62%), with one MFR-related death (0.22%). Conclusions: Despite MFR benefits neonatal care, its practices remain heterogeneous. Standardized protocols are required to ensure MFR safety and efficacy. Full article
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14 pages, 536 KiB  
Article
Malnutrition and Frailty as Independent Predictors of Adverse Outcomes in Hospitalized Older Adults: A Prospective Single Center Study
by Abdurrahman Sadıç, Zeynep Şahiner, Mert Eşme, Cafer Balcı, Burcu Balam Doğu, Mustafa Cankurtaran and Meltem Gülhan Halil
Medicina 2025, 61(8), 1354; https://doi.org/10.3390/medicina61081354 - 26 Jul 2025
Viewed by 264
Abstract
Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine [...] Read more.
Background and Objectives: Adverse clinical outcomes are associated with malnutrition and frailty, which are highly prevalent among hospitalized older patients. This study aimed to evaluate their predictive value for the duration of hospitalization, short-term survival, and rehospitalization of patients admitted to internal medicine wards. Materials and Methods: This prospective cohort study included 134 acutely ill patients aged ≥50 years who were hospitalized in an internal medicine department and evaluated within the first 48 h of admission. Nutritional status was evaluated using the Mini nutritional assessment–short form (MNA-SF), Nutritional Risk Screening 2002 (NRS-2002), and Global Leadership Initiative on Malnutrition (GLIM) criteria. Frailty was evaluated using the FRAIL scale and Clinical Frailty Scale (CFS). The primary outcomes were prolonged hospitalization (>10 days), mortality, and rehospitalization at 3 and 6 months post-discharge. Results: According to MNA-SF, 33.6% of patients were malnourished; 44% had nutritional risk per NRS-2002, and 44.8% were malnourished per GLIM. Frailty prevalence was 53.7% (FRAIL) and 59% (CFS). Malnutrition defined by all three scales (MNA-SF, NRS-2002, GLIM) was significantly associated with prolonged hospitalization (p = 0.043, 0.014, and 0.023, respectively), increased rehospitalization at both 3 months (p < 0.001) and 6 months (p < 0.001). Mortality was also significantly higher among malnourished patients. Higher CFS scores and low handgrip strength were additional predictors of adverse outcomes (p < 0.05). In multivariable analysis, GLIM-defined malnutrition and CFS remained independent predictors of rehospitalization and mortality. Conclusions: Frailty and malnutrition are highly prevalent and independently associated with prolonged hospital stay, short-term rehospitalization and mortality. Routine screening at admission may facilitate early identification and guide timely interventions to improve patient outcomes. These findings might guide hospital protocols in aging health systems and support the development of standardized geriatric care pathways. Full article
(This article belongs to the Section Epidemiology & Public Health)
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14 pages, 236 KiB  
Article
The Prognostic Nutritional Index (PNI) Is a Powerful Biomarker for Predicting Clinical Outcome in Gastrointestinal Emergency Patients: A Comprehensive Analysis from Diagnosis to Outcome
by Ramazan Kıyak and Bahadir Caglar
Appl. Sci. 2025, 15(15), 8269; https://doi.org/10.3390/app15158269 - 25 Jul 2025
Viewed by 234
Abstract
Objective: This study aimed to evaluate the relationship between the Prognostic Nutritional Index (PNI) and demographic characteristics, presenting complaints, clinical diagnoses, and patient outcomes in patients admitted to the emergency department for gastrointestinal (GI) emergencies. The predictive value of PNI for the clinical [...] Read more.
Objective: This study aimed to evaluate the relationship between the Prognostic Nutritional Index (PNI) and demographic characteristics, presenting complaints, clinical diagnoses, and patient outcomes in patients admitted to the emergency department for gastrointestinal (GI) emergencies. The predictive value of PNI for the clinical course of patients with GI emergencies was investigated. Method: This retrospective cross-sectional study included 583 patients with a diagnosis of GI emergencies in the emergency department of a tertiary university hospital between January 2021 and December 2024. Data such as age, sex, presenting complaints, final diagnosis, and emergency department outcomes (discharge, ward admission, and transfer to intensive care unit) were collected. The PNI value was calculated using serum albumin (g/dL) and total lymphocyte count (/mm3) with the formula PNI = 10 × albumin + 0.005 × lymphocyte. The PNI was calculated based on serum albumin levels and peripheral lymphocyte counts. Results: The mean age of the study group was 63.4 ± 17.4 years, and 52.1% of the patients were female. The number of patients with a PNI value < 38 was significantly higher in the intensive care unit (p < 0.001). PNI values were considerably lower, especially in patients diagnosed with malignancy, cirrhosis, and GI hemorrhage (X2 = 71.387; p < 0.001). The PNI was an independent predictor of outcomes in patients with GI emergencies. The mean PNI was significantly higher in discharged patients but significantly lower in patients admitted to the intensive care unit (p < 0.002). The cut-off score for PNI was calculated using the median value, and the cut-off score for PNI was <38. Conclusion: PNI is a powerful biomarker for predicting the clinical severity and prognosis of patients with GI emergencies. Since it can be easily calculated from routine biochemical tests, it can be used as a practical and effective risk stratification tool. The evaluation of PNI, especially for the early detection of critically ill patients at high risk of malnutrition, may contribute to the reduction of morbidity and mortality through the timely initiation of appropriate supportive therapies. Full article
(This article belongs to the Special Issue Diet, Nutrition and Human Health)
13 pages, 1454 KiB  
Article
Association Between Sarcopenia Measured by Computed Tomography at the Third Lumbar Vertebra and Mortality in Inpatients with Delirium Referred to a Liaison Psychiatry Team: A Follow-Up Study
by Miguel Alonso-Sánchez, Fernando Sebastian-Valles, María Robles-Camacho, Víctor Rodríguez-Laval, Víctor Navas-Moreno, Miguel Antonio Sampedro-Nuñez, Mónica Marazuela, Jose Luis Ayuso-Mateos and Eduardo Delgado-Parada
J. Clin. Med. 2025, 14(14), 5065; https://doi.org/10.3390/jcm14145065 - 17 Jul 2025
Viewed by 393
Abstract
Background and objectives: Delirium is a prevalent disorder that is associated with morbidity and mortality in hospitalized older adults. Recent evidence highlights sarcopenia, defined by low muscle mass, as a prognostic factor of importance. This study aims to investigate the association between [...] Read more.
Background and objectives: Delirium is a prevalent disorder that is associated with morbidity and mortality in hospitalized older adults. Recent evidence highlights sarcopenia, defined by low muscle mass, as a prognostic factor of importance. This study aims to investigate the association between sarcopenia, assessed by L3-level computed tomography (CT) and clinical outcomes, particularly mortality, in inpatients with delirium managed by a liaison psychiatry team (LPT). Methods: This single-center, retrospective observational study included 57 consecutive patients diagnosed with delirium and referred to the LPT at a tertiary care hospital between 2021 and 2023. Patients with available abdominal CT scans were included. Sarcopenia was defined based on the presence of low muscle mass observed at the L3 level on CT imaging, following established diagnostic criteria. The analysis included demographic data, clinical history, laboratory parameters, and treatment-related variables. Cox proportional hazards models and Kaplan–Meier survival curves were utilized to evaluate the association between sarcopenia and mortality during follow-up. Results: Of the 57 patients included, 52.6% (n = 30) were sarcopenic. Sarcopenia was associated with lower albumin levels (p = 0.038) and higher mortality rates (56.7% vs. 33.3%). Kaplan–Meier analysis showed reduced survival in sarcopenic patients (p = 0.038). Cox regression identified sarcopenia as an independent predictor of mortality (HR = 2.95; 95% CI: 1.03–8.46; p = 0.04), alongside the Charlson comorbidity index. Conclusions: Sarcopenia represents a robust and independent predictor of mortality in patients with delirium. Early nutritional assessment and targeted interventions addressing sarcopenia hold the potential to improve clinical outcomes. Further prospective studies with larger sample sizes are needed to validate these findings. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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12 pages, 602 KiB  
Article
Prognostic Factors Affecting Mortality Among Patients Admitted to the Intensive Care Unit with Acute Hypoxemic Respiratory Failure
by Kerem Ensarioğlu, Melek Doğancı, Mustafa Özgür Cırık, Mesher Ensarioğlu, Erbil Tüksal, Münire Babayiğit and Seray Hazer
Diagnostics 2025, 15(14), 1784; https://doi.org/10.3390/diagnostics15141784 - 15 Jul 2025
Viewed by 291
Abstract
Background/Objectives: Acute hypoxemic respiratory failure is a significant condition commonly seen in intensive care units (ICUs), yet specific prognostic markers related to it for mortality remain largely unstudied. This study aimed to identify parameters that influence mortality in ICU patients diagnosed with type [...] Read more.
Background/Objectives: Acute hypoxemic respiratory failure is a significant condition commonly seen in intensive care units (ICUs), yet specific prognostic markers related to it for mortality remain largely unstudied. This study aimed to identify parameters that influence mortality in ICU patients diagnosed with type 1 respiratory failure. Methods: A retrospective cohort study was conducted at a tertiary care hospital, including patients admitted to the ICU between March 2016 and March 2020. The study included patients with type 1 respiratory failure, while exclusion criteria were prior long-term respiratory support, type 2 respiratory failure, and early mortality (<24 h). Data on demographics, comorbidities, support requirements, laboratory values, and ICU scoring systems (APACHE II, SOFA, SAPS II, NUTRIC) were collected. Binomial regression analysis was used to determine independent predictors of 30-day mortality. Results: Out of 657 patients screened, 253 met the inclusion criteria (mean age 70.6 ± 15.6 years; 65.6% male). Non-survivors (n = 131) had significantly higher CCI scores; greater vasopressor requirements; and elevated SAPS II, APACHE, SOFA, and NUTRIC scores. Laboratory findings indicated higher inflammatory markers and lower nutritional markers (albumin and prealbumin, respectively) among non-survivors. In the regression model, SAPS II (OR: 13.38, p = 0.003), the need for inotropic support (OR: 1.11, p = 0.048), NUTRIC score (OR: 2.75, p = 0.014), and serum albumin (inverse; OR: 1.52, p = 0.001) were independently associated with mortality. The model had an AUC of 0.926 and classified 83.2% of cases correctly. When combined, SAPS II and mNUTRIC had more AUC compared to either standalone scoring. Conclusions: SAPS II, vasopressor requirements, mNUTRIC score, and low serum albumin are independent predictors of 30-day mortality in patients with acute hypoxemic respiratory failure. These findings support the integration of nutritional assessment, a combination of available scoring systems and comprehensive scoring into routine ICU evaluations for this patient group. Full article
(This article belongs to the Special Issue Diagnostics in the Emergency and Critical Care Medicine)
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17 pages, 951 KiB  
Article
Food Tolerance and Quality of Eating After Bariatric Surgery—An Observational Study of a German Obesity Center
by Alexandra Jungert, Alida Finze, Alexander Betzler, Christoph Reißfelder, Susanne Blank, Mirko Otto, Georgi Vassilev and Johanna Betzler
J. Clin. Med. 2025, 14(14), 4961; https://doi.org/10.3390/jcm14144961 - 13 Jul 2025
Viewed by 407
Abstract
Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: [...] Read more.
Background: Bariatric surgeries, specifically laparoscopic sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB), are a common intervention for morbid obesity, significantly affecting food tolerance and quality of eating. Understanding these changes is crucial for improving postoperative care and long-term success. Methods: This observational study at University Hospital Mannheim involved 91 patients, aged between 18 and 65 year, who underwent SG or RYGB between 2009 and 2019. Food tolerance was assessed between 25 days and 117 months after surgery using the validated score by Suter et al. (Food Tolerance Score, FTS) and an additional score evaluating tolerance to specific food groups and quality of life. Data on body composition were collected through Bioelectrical Impedance Analysis (BIA) at follow-up visits. Statistical analyses included linear mixed models to analyze the association of food tolerance with body composition changes. Results: The FTS indicated moderate or poor food tolerance in 62.6% of patients, with no significant differences between SG and RYGB. Considering the results of the additional score, food groups such as red meat, wheat products, raw vegetables, carbon dioxide, fatty foods, convenience food, and sweets were the most poorly tolerated food groups. A total of 57 of the participants had a baseline and follow-up BIA measurement. Postoperatively, a significant reduction in body weight and BMI as well as in BIA parameters (fat mass, lean mass, body cell mass, and phase angle) was found. Quality of life improved after bariatric surgery and 76.9% rated their nutritional status as good or excellent, despite possible food intolerances. Conclusions: Bariatric surgery significantly reduces weight and alters food tolerance. Despite moderate or poor food tolerance, patients reported high satisfaction with their nutritional status and quality of life. Detailed food tolerance assessments and personalized dietary follow-ups are essential for the early detection and management of postoperative malnutrition, ensuring sustained weight loss and improved health outcomes. Full article
(This article belongs to the Section Endocrinology & Metabolism)
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17 pages, 2905 KiB  
Review
Perioperative Immunonutrition in Gastrointestinal Oncology: A Comprehensive Umbrella Review and Meta-Analysis on Behalf of TROGSS—The Robotic Global Surgical Society
by Aman Goyal, Christian Adrian Macias, Maria Paula Corzo, Vanessa Pamela Salolin Vargas, Mathew Mendoza, Jesús Enrique Guarecuco Castillo, Andrea Garcia, Kathia Dayana Morfin-Meza, Clotilde Fuentes-Orozco, Alejandro González-Ojeda, Luis Osvaldo Suárez-Carreón, Elena Ruiz-Úcar, Yogesh Vashist, Adolfo Pérez Bonet, Adel Abou-Mrad, Rodolfo J. Oviedo and Luigi Marano
Nutrients 2025, 17(14), 2304; https://doi.org/10.3390/nu17142304 - 13 Jul 2025
Viewed by 582
Abstract
Introduction: Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as [...] Read more.
Introduction: Gastrointestinal (GI) cancers are associated with high morbidity and mortality. Surgical resection, the primary treatment, often induces immunosuppression and increases the risk of postoperative complications. Perioperative immunonutrition (IMN), comprising formulations enriched with omega-3 fatty acids, arginine, nucleotides, and antioxidants, has emerged as a potential strategy to improve surgical outcomes by reducing complications, enhancing immune function, and promoting recovery. Methods: A systematic search of PubMed, Scopus, and the Cochrane Library was conducted on 28 October 2024 in accordance with PRISMA guidelines. Systematic reviews and meta-analyses evaluating perioperative IMN versus standard care in adult patients undergoing GI cancer surgery were included in the search. The outcomes assessed included infectious and non-infectious complications, wound healing, hospital stay, and nutritional status. The study quality was evaluated using AMSTAR 2, and the meta-analysis was conducted using random-effects models to calculate the pooled effect sizes (risk ratios [RRs], odds ratios [ORs], mean differences [MDs]) with 95% confidence intervals (CIs). Results: Sixteen systematic reviews and meta-analyses, including a total of 41,072 patients, were included. IMN significantly reduced infectious complications (RR: 0.62, 95% CI: 0.55–0.70; I2 = 63.0%), including urinary tract infections (RR: 0.74, 95% CI: 0.61–0.89; I2 = 0.0%) and wound infections (OR: 0.64, 95% CI: 0.55–0.73; I2 = 34.4%). Anastomotic leak rates were notably lower (RR: 0.68, 95% CI: 0.62–0.75; I2 = 8.2%). While no significant reduction in pneumonia risk was observed, non-infectious complications decreased significantly (RR: 0.83, 95% CI: 0.75–0.92; I2 = 30.6%). IMN also reduced the length of hospital stay by an average of 1.92 days (MD: −1.92, 95% CI: −2.36 to −1.48; I2 = 73.5%). Conclusions: IMN provides significant benefits in GI cancer surgery, reducing complications and improving recovery. However, variability in protocols and populations highlight the need for standardization and further high-quality trials to optimize its application and to validate its efficacy in enhancing surgical care. Full article
(This article belongs to the Section Nutritional Immunology)
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17 pages, 1864 KiB  
Article
The Neurological Metabolic Phenotype in Prolonged/Chronic Critical Illness: Propensity Score Matched Analysis of Nutrition and Outcomes
by Levan B. Berikashvili, Alexander E. Shestopalov, Petr A. Polyakov, Alexandra V. Yakovleva, Mikhail Ya. Yadgarov, Ivan V. Kuznetsov, Mohammad Tarek S. M. Said, Ivan V. Sergeev, Andrey B. Lisitsyn, Alexey A. Yakovlev and Valery V. Likhvantsev
Nutrients 2025, 17(14), 2302; https://doi.org/10.3390/nu17142302 - 12 Jul 2025
Viewed by 416
Abstract
Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads [...] Read more.
Background: Brain injuries, including stroke and traumatic brain injury (TBI), pose a major healthcare challenge due to their severe consequences and complex recovery. While ischemic strokes are more common, hemorrhagic strokes have a worse prognosis. TBI often affects young adults and leads to long-term disability. A critical concern in these patients is the frequent development of chronic critical illness, compounded by metabolic disturbances and malnutrition that hinder recovery. Objective: This study aimed to compare changes in nutritional status parameters under standard enteral nutrition protocols and clinical outcomes in prolonged/chronic critically ill patients with TBI or stroke versus such a population of patients without TBI or stroke. Methods: This matched prospective–retrospective cohort study included intensive care unit (ICU) patients with TBI or stroke from the Federal Research and Clinical Center of Intensive Care Medicine and Rehabilitology and patients without these conditions from the eICU-CRD database. Inclusion criteria comprised age 18–74 years, ICU stay >5 days, and enteral nutrition. Patients with re-hospitalization, diabetes, acute organ failure, or incomplete data were excluded. Laboratory values and clinical outcomes were compared between the two groups. Propensity score matching (PSM) was used to balance baseline characteristics (age, sex, and body mass index). Results: After PSM, 29 patients with TBI or stroke and 121 without were included. Univariate analysis showed significant differences in 21 laboratory parameters and three hospitalization outcomes. On day 1, the TBI/stroke group had higher hemoglobin, hematocrit, lymphocytes, total protein, and albumin, but lower blood urea nitrogen (BUN), creatinine, and glucose. By day 20, they had statistically significantly lower calcium, BUN, creatinine, and glucose. This group also showed less change in lymphocytes, calcium, and direct bilirubin. Hospitalization outcomes showed longer mechanical ventilation duration (p = 0.030) and fewer cases of acute kidney injury (p = 0.0220) in the TBI/stroke group. Conclusions: TBI and stroke patients exhibit unique metabolic patterns during prolonged/chronic critical illness, differing significantly from other ICU populations in protein/glucose metabolism and complication rates. These findings underscore the necessity for specialized nutritional strategies in neurocritical care and warrant further investigation into targeted metabolic interventions. Full article
(This article belongs to the Section Nutrition and Metabolism)
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12 pages, 247 KiB  
Article
Restoring Control: Real-World Success with Imipenem–Relebactam in Critical MDR Infections—A Multicenter Observational Study
by Andrea Marino, Giuseppe Pipitone, Emmanuele Venanzi Rullo, Federica Cosentino, Rita Ippolito, Roberta Costa, Sara Bagarello, Ylenia Russotto, Chiara Iaria, Bruno Cacopardo and Giuseppe Nunnari
Pathogens 2025, 14(7), 685; https://doi.org/10.3390/pathogens14070685 - 11 Jul 2025
Viewed by 441
Abstract
Background: Multidrug-resistant (MDR) Gram-negative infections, particularly those caused by carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), present a growing global healthcare challenge, especially in critically ill populations. Imipenem–relebactam (I/R), a novel β-lactam/β-lactamase inhibitor combination, has shown efficacy in clinical trials, but [...] Read more.
Background: Multidrug-resistant (MDR) Gram-negative infections, particularly those caused by carbapenem-resistant Enterobacterales (CRE) and difficult-to-treat Pseudomonas aeruginosa (DTR-Pa), present a growing global healthcare challenge, especially in critically ill populations. Imipenem–relebactam (I/R), a novel β-lactam/β-lactamase inhibitor combination, has shown efficacy in clinical trials, but real-world data remain limited. Methods: We conducted a multicenter, retrospective–prospective observational study across tertiary-care hospitals in Italy between January 2020 and May 2025. Adult patients (≥18 years) treated with I/R for ≥48 h for suspected or confirmed MDR Gram-negative infections were included. Primary endpoints were clinical success at the end of therapy and 30-day all-cause mortality. Secondary endpoints included microbiological eradication, recurrence, safety, and predictors of treatment failure. Statistical analysis involved descriptive methods and correlation analysis for mortality predictors. Results: Twenty-nine patients were included (median age 66 years; 58.6% ICU admission; 71.4% mechanical ventilation). Clinical success was achieved in 22/29 patients (75.9%), while 30-day mortality was 24.1% (7/29). The most common pathogen was Klebsiella pneumoniae (62.1%), with 41.4% of infections being polymicrobial. Microbiological eradication was confirmed in all the BSIs. Parenteral nutrition (p = 0.016), sepsis at presentation (p = 0.04), candidemia (p = 0.036), and arterial catheter use (p = 0.029) were significantly more frequent in non-survivors. Survivors showed significant reductions in CRP, PCT, and bilirubin at 48 h, while non-survivors did not. Parenteral nutrition (rho = 0.427, p = 0.023), sepsis (rho = 0.378, p = 0.043), and arterial catheter use (rho = 0.384, p = 0.04) were significantly correlated with mortality. Conclusions: In this Italian multicenter cohort of critically ill patients, imipenem–relebactam demonstrated high clinical success and acceptable mortality rates in the treatment of severe MDR Gram-negative infections, particularly those caused by KPC-producing K. pneumoniae. Early biomarker dynamics may aid in monitoring treatment response. Larger prospective studies are needed to confirm these findings and define optimal treatment strategies. Full article
22 pages, 1617 KiB  
Article
Determining Patient Satisfaction, Nutrition, and Environmental Impacts of Inpatient Food at a Tertiary Care Hospital in Canada: A Prospective Cohort Study
by Annie Lalande, Stephanie Alexis, Penelope M. A. Brasher, Neha Gadhari, Jiaying Zhao and Andrea J. MacNeill
Dietetics 2025, 4(3), 29; https://doi.org/10.3390/dietetics4030029 - 10 Jul 2025
Viewed by 327
Abstract
While hospital meals are designed to meet the nutritional requirements associated with illness or surgery, competing priorities often take precedence over food quality, contributing to poor patient satisfaction, in-hospital malnutrition, and high food waste. The environmental impacts of hospital food services are a [...] Read more.
While hospital meals are designed to meet the nutritional requirements associated with illness or surgery, competing priorities often take precedence over food quality, contributing to poor patient satisfaction, in-hospital malnutrition, and high food waste. The environmental impacts of hospital food services are a less well-characterized dimension of this complex problem. A prospective cohort study of patients admitted for select abdominal surgeries between June and October 2021 was conducted at a tertiary care hospital in Canada. Greenhouse gas emissions and land-use impacts associated with all food items served were estimated, and patient food waste was weighed for each meal. Patients’ experience of hospital food was measured at discharge. Nutrition was assessed by comparing measured oral intake to minimum caloric and protein requirements. On average, food served in hospital resulted in 3.75 kg CO2e/patient/day and 6.44 m2/patient/day. Average food waste was 0.88–1.39 kg/patient/day (37.5–58.9% of food served). Patients met their caloric and protein requirements on 9.8% and 14.8% of days in hospital, respectively. For patient satisfaction, 75% of overall scores were lower than the industry benchmark, and food quality scores were inversely correlated with quantities of food wasted. Redesigning inpatient food offerings to feature high-quality, low-emissions meals could lessen their environmental impacts while improving patient nutritional status and experience. Full article
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27 pages, 658 KiB  
Review
Why High-Volume Post-Dilution Hemodiafiltration Should Be the New Standard in Dialysis Care: A Comprehensive Review of Clinical Outcomes and Mechanisms
by Stefano Stuard, Franklin W. Maddux and Bernard Canaud
J. Clin. Med. 2025, 14(14), 4860; https://doi.org/10.3390/jcm14144860 - 9 Jul 2025
Viewed by 1237
Abstract
The management of end-stage kidney disease (ESKD) poses a substantial clinical and economic challenge, characterized by a growing patient burden, rising healthcare costs, and persistent unmet needs to enhance survival outcomes and quality of life. Background/Objectives: Conventional high-flux hemodialysis (HD) remains the dominant [...] Read more.
The management of end-stage kidney disease (ESKD) poses a substantial clinical and economic challenge, characterized by a growing patient burden, rising healthcare costs, and persistent unmet needs to enhance survival outcomes and quality of life. Background/Objectives: Conventional high-flux hemodialysis (HD) remains the dominant form of renal replacement therapy for ESKD but is still associated with substantial morbidity and mortality. High-volume post-dilution online hemodiafiltration (HVHDF) offers a promising alternative by enhancing the convective removal of uremic toxins. Methods: We conducted a narrative review of randomized controlled trials, meta-analyses, real-world cohort studies, and registry analyses published between 2010 and 2024. Evidence was categorized into short-term, medium-term, and long-term outcomes, including hemodynamic stability, inflammation, anemia, infection risk, cardiovascular events, cognitive decline, quality of life, and survival. Results: HVHDF improves short-term outcomes by enhancing toxin clearance, stabilizing blood pressure, reducing inflammation and oxidative stress, and improving anemia management. Medium-term benefits include improved nutritional status, reduced hospitalizations related to infections, and improved neurological and immune function. Long-term data from major trials (e.g., ESHOL, CONVINCE) and large real-world studies show consistent reductions in all-cause and cardiovascular mortality, particularly with convection volumes ≥ 23 L/session. A clear dose–response relationship supports the clinical relevance of convection volume targets. HVHDF has also shown benefits in preserving cognitive function and enhancing health-related quality of life. Conclusions: Strong and converging evidence supports HVHDF as a superior dialysis modality. Given its survival benefits, better tolerance, and broader impact on patient outcomes, HVHDF should be considered the new standard of care in dialysis, especially in light of the recent regulatory approval of the machine that provides the ability to perform HDF in the United States. Full article
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25 pages, 1099 KiB  
Review
Nutritional Management of Liver Failure in the Intensive Care Unit
by Zsófia Verzár, Rudolf Kiss, Csaba Pál Bálint, Annamária Pakai and Tímea Csákvári
Medicina 2025, 61(7), 1210; https://doi.org/10.3390/medicina61071210 - 3 Jul 2025
Viewed by 624
Abstract
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute [...] Read more.
Liver failure, both acute and chronic, represents a complex, life-threatening condition frequently requiring intensive care unit (ICU) admission. Nutritional management is a crucial component of supportive therapy, aiming to mitigate catabolism, preserve lean body mass, and support immune and organ function. In acute liver failure (ALF), early nutritional intervention within 24–48 h and individualized energy–protein prescriptions are essential, even in the presence of hepatic encephalopathy. Chronic liver failure (CLF) and acute-on-chronic liver failure (ACLF) are often associated with severe malnutrition, sarcopenia, and systemic inflammation, necessitating tailored nutritional strategies. Subjective Global Assessment (SGA) and Royal Free Hospital Global Assessment (RFH-GA) tools are instrumental in identifying nutritional risk. Enteral nutrition (EN) is preferred across all stages, with parenteral nutrition (PN) reserved for contraindications. Special considerations include micronutrient repletion, prevention of refeeding syndrome, and perioperative nutritional support in transplant candidates and recipients. This clinical overview summarizes current evidence and guidelines on ICU nutrition in liver failure, emphasizing a multidisciplinary approach to improve outcomes. Full article
(This article belongs to the Section Gastroenterology & Hepatology)
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17 pages, 665 KiB  
Article
The Impact of a Multidisciplinary Residential Program (MRP) on Body Composition, Psychological Well-Being, and Hematochemical Parameters in Hospitalized Obese Patients
by Simone Perna, Giuseppe Mazzola, Michela Seniga, Gaetan Claude Barrile, Ilaria Torello, Alessia Moroni, Francesca Mansueto, Alessandro Lazzarotti, Vai Veronica, Clara Gasparri and Mariangela Rondanelli
Nutrients 2025, 17(13), 2108; https://doi.org/10.3390/nu17132108 - 25 Jun 2025
Viewed by 378
Abstract
Introduction: Obesity is a multifactorial condition strongly associated with physical and psychological comorbidities. This study aimed to evaluate changes in psychological symptoms and their correlation with anthropometric and body composition improvements in hospitalized obese patients undergoing a multidisciplinary rehabilitation program (MRP). Methods [...] Read more.
Introduction: Obesity is a multifactorial condition strongly associated with physical and psychological comorbidities. This study aimed to evaluate changes in psychological symptoms and their correlation with anthropometric and body composition improvements in hospitalized obese patients undergoing a multidisciplinary rehabilitation program (MRP). Methods: A total of 178 obese patients (61 males and 117 females; mean age 58.5 ± 14.0 years; mean BMI 41.3 ± 6.1 kg/m2) completed a two-month structured intervention combining a low-energy Mediterranean-style diet, individualized physical activity, and psychological support. Body composition by DXA, biochemical markers, and psychological outcomes (Beck Depression Inventory [BDI] and Binge Eating Scale [BES]) were assessed at baseline and discharge. Results: At baseline, 72.3% of participants showed depressive symptoms (BDI > 10), and 42.7% exhibited binge eating behaviors (BES ≥ 17). The intervention led to significant reductions in weight (−7.08 kg), BMI (−2.68 kg/m2), fat mass (−4.43 kg), and visceral adipose tissue (−329 g) (all p < 0.001). Mean BDI and BES scores decreased by 5.9 and 6.4 points, respectively (both p < 0.001). Moderate correlations were observed between reductions in adiposity and improvements in psychological symptoms, such as r = −0.45 for depressive symptoms (BDI) and r = −0.39 for binge eating behaviors (BES) (p-values < 0.001). Conclusions: A structured multidisciplinary intervention significantly improved body composition and psychological well-being in hospitalized obese patients. The moderate association between reduced adiposity and alleviation of depressive symptoms and binge eating behaviors underlines the value of integrated physical, nutritional, and psychological care. Level of Evidence: Level 3, according to the Oxford Centre for Evidence-Based Medicine. Full article
(This article belongs to the Special Issue Biostatistics Methods in Nutritional Research)
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