Search Results (734)

Background/Objectives: Cancer is a complex disease that affects patients’ nutritional and psychological status. This study aimed to assess the nutritional status of patients diagnosed with lung and gastrointestinal system cancers and evaluate its association with anthropometric measurements, nutrient intake, and psychological symptoms. Methods: This cross-sectional study was conducted with 180 patients with lung and gastrointestinal system cancers. Data were collected face-to-face by a questionnaire that included the Subjective Global Assessment-(SGA), Cachexia Assessment Criteria, 24 h Food Consumption Record, and Symptom Checklist-90-Revised-(SCL-90-R). Some anthropometric measurements were collected. Results: Body Mass Index (BMI) was found to be significantly lower (p < 0.001) in SGA-B (moderately malnourished) and SGA-C (severely malnourished) compared to those in SGA-A (well-nourished). The calf circumference was significantly lower (p = 0.002) in SGA-C compared to those in SGA-A and SGA-B. The mean SGA scores were found to be higher in cachexia-diagnosed participants (p < 0.001). The energy intake of SGA-C was significantly lower than SGA-A and SGA-B (p < 0.001). In addition, the energy intake of SGA-B was lower than SGA-A (p < 0.001). The protein intake of SGA-C was lower than SGA-A and SGA-B (p < 0.001). The protein intake of SGA-B was lower than SGA-A (p < 0.001). Regarding the intake of vitamins A, C, E, B1, and B6 and carotene, folate, potassium, magnesium, phosphorus, iron, and zinc, SGA-B and SGA-C were significantly lower than SGA-A (p < 0.001). Additionally, only phobic anxiety was found to be significantly higher in SGA-B than in SGA-A (p: 0.024). Conclusions: As the level of malnutrition increased, a reduction in some nutrient intake and anthropometric measurements was observed. No significant difference was found in any psychological symptoms except phobic anxiety. With this in mind, it is important that every cancer patient, regardless of the stage of the disease, is referred to a dietitian from the time of diagnosis. Full article

Background: Congenital diarrhea is persistent diarrhea that manifests during the neonatal period. Mutations in DGAT1, which is crucial for triglyceride synthesis and lipid absorption in the small intestine, are causal factors for congenital diarrhea. In this study, we aimed to determine the value of tissue RNA sequencing (RNA-seq) for assisting with the clinical diagnosis of some genetic variants of uncertain significance. Methods: We clinically evaluated a patient with watery diarrhea, vomiting, severe malnutrition, and total parenteral nutrition dependence. Possible pathogenic variants were detected using whole-exome sequencing (WES). RNA-seq was utilized to explore the transcriptional alterations in DGAT1 variants identified by WES with unknown clinical significance, according to the American College of Medical Genetics guidelines. Systemic examinations, including endoscopic and histopathological examinations of the intestinal mucosa, were conducted to rule out other potential diagnoses. Results: We successfully diagnosed a patient with congenital diarrhea and protein-losing enteropathy caused by a DGAT1 mutation and reviewed the literature of 19 cases of children with DGAT defects. The missense mutation c.620A>G, p.Lys207Arg located in exon 15, and the intronic mutation c.1249-6T>G in DGAT1 were identified by WES. RNA-seq revealed two aberrant splicing events in the DGAT1 gene of the patient’s small intestinal tissue. Both variants lead to loss-of-function consequences and are classified as pathogenic variants of congenital diarrhea. Conclusions: Rare DGAT1 variants were identified as pathogenic evidence of congenital diarrhea, and the detection of tissue-specific mRNA splicing and transcriptional effects can provide auxiliary evidence. Full article

Background/Objectives: Malnutrition is an imbalance of nutrients required for growth, development, and organ function. Its impact on bone development is known, but its effects on cartilage remain unclear. This study aimed to evaluate the femoral cartilage thickness in children with primary malnutrition. Methods: In this cross-sectional observational study, 83 children with primary malnutrition and 62 age- and sex-matched healthy controls were included. Patients with primary malnutrition were classified as mild, moderate and severe. Femoral cartilage thickness measurements of all children were taken by ultrasound from the femoral lateral condyle, femoral medial condyle and intercondylar area for both knees with the patient in a supine position with the knees flexed 90 degrees. Results: The right lateral, right medial, left lateral, and left medial femoral cartilages were significantly thicker in patients with malnutrition compared to those without malnutrition (p = 0.002, 0.004, <0.001, and 0.001, respectively). A significant negative correlation was found between age, weight Z-score, and height Z-score and triceps skinfold thickness. Conclusions: Distal femoral cartilage thickness is significantly greater in children with primary malnutrition. This demonstrates the effect of nutritional factors on cartilage tissue and suggests that children with chronic malnutrition are at risk for both knee joint problems and short stature later in life. Full article

There is a well-established association between cystic fibrosis (CF) and malnutrition. Several comorbid conditions have also been associated with undernutrition in people with cystic fibrosis (PwCF). Highly effective modulator therapy has allowed for a paradigm shift altering disease progression and management. Modulator use has even been associated with acceleration of weight trajectory causing overnutrition, which can lead to cardiovascular and metabolic comorbid conditions. This review explores how nutritional status is evolving in the era of cystic fibrosis transmembrane conductance regulator (CFTR) modulators in people with CF, specifically in children. By synthesizing current research, we aim to support pediatric healthcare providers and nutritionists in delivering tailored, proactive nutritional care in this new therapeutic landscape. Full article

Background/Objectives: A growing body of literature has demonstrated that living with food insecurity (FI) increases risk for mental health concerns in addition to nutritional deficits (e.g., suboptimal micronutrient consumption, excessive macronutrient consumption, malnutrition). Yet, research is needed to improve our understanding of subpopulations potentially at increased risk for mental health concerns when living in the context of FI. The current study examined psychosocial health across women of different developmental life stages all living with FI. Methods: Female clients of a large, urban food bank (N = 680) living with FI completed measures of mental health and health-related quality of life (HRQOL) in a cross-sectional design conducted on site at the food bank. Results: Consistent with past research, FI severity was correlated with poorer psychosocial health across all variables. A multivariate analysis of covariance compared women living with FI across 4 developmental life stages (young adult, early midlife, late midlife, and older adult; age range = 18–94 years), controlling for FI severity and race/ethnicity, on outcomes related to mental health and HRQOL. Women in early and late midlife reported higher anxiety, eating disorder symptoms, and eating-related psychosocial impairment than younger and older women. Conclusions: The mental health toll of living with FI is profound; midlife may comprise a developmental period of increased vulnerability to experience this mental health burden of living with FI for women. Thus, efforts are needed to develop innovative pathways for interventions to support the mental health of midlife women living with FI, likely involving multi-level and/or multicomponent approaches to resource access. Full article

Dietary protein is an essential macronutrient derived from both plant and animal sources required for muscle building, immune function, and wound healing. However, in the United States, protein consumption worsens as individuals age, with 30% of men and 50% of women over 71 consuming inadequate dietary protein due to a variety of factors, including changes in gut function, loss of appetite, tooth loss, financial concerns, and social isolation. The aim of this review is to underscore the need for increased protein requirements in aging populations, highlight potential barriers, synthesize these protein requirements, and also recommend strategies to meet these increased protein needs. Achieving adequate protein status, especially when facing chronic or acute health concerns, is essential to promote muscle and bone strength (because aging is associated with significant decreases in postprandial muscle protein synthesis), to support immune health (due to immunosenescence), and to maintain a good quality of life. For older adults, the literature suggests that a dietary protein intake of at least 1.0–1.2 g/kg/day is required in healthy, aging populations, and intakes of 1.2–1.5 g/kg/day are necessary for those with chronic or acute conditions. These protein intake recommendations can increase to 2.0 g/kg/day in more severe cases of illness, malnutrition, and chronic conditions. The reviewed literature also suggests that evenly balanced protein distributions of 25–30 g of dietary protein (0.4 g/kg) per meal from animal and plant protein sources alike are sufficient to maximize muscle protein synthesis (MPS) rates in older populations. Additionally, pre-sleep protein feeds of 40 g/night may be another strategy to improve daily MPS and amino acid utilization. Full article

Epilepsy is a chronic neurological disease with a relatively high incidence in the pediatric population. Anti-seizure medication (ASM) may cause adverse drug reactions (ADRs), which may occur repeatedly. Objective: This study aimed to analyze the recurrence of ADRs caused by ASMs over a period of 122 months in hospitalized Mexican pediatric epilepsy patients. The patients were under monotherapy or polytherapy treatment, with valproic acid (VPA), phenytoin (PHT), and levetiracetam (LEV), among others. A total of 313 patients met the inclusion criteria: 211 experienced ADRs, whereas 102 did not. Patient sex, age, seizure type, nutritional status and related drugs were considered explanatory variables. Methods: Four statistical models were used to analyze recurrent events that were defined as “one or more ADRs occurred on a single day”, considering both the classification of ADR seriousness and the ASM causing the ADR. Results: A total of 499 recurrence events were identified. The recurrence risk was significantly greater among younger patients for both nonsevere and severe ADRs and among those with focal seizures for nonsevere ADRs. Interestingly, malnutrition was negatively associated with the risk of nonsevere ADRs, and obesity was positively associated with the risk of severe ADRs. Finally, LEV was associated with a significantly greater risk of causing nonsevere ADRs than VPA. However, LEV significantly reduced the risk of severe ADRs compared with VPA, and PHT increased the risk in comparison with VPA. In conclusion, this study offers a robust clinical tool to predict risk factors for the presence and recurrence of ASM-ADRs in pediatric patients with epilepsy. Full article

Background: Malnutrition and cancer-related fatigue (CRF) are prevalent in cancer patients, significantly impacting prognosis and quality of life. Oral nutritional supplements (ONSs) enriched with protein and ω-3 fatty acids may improve nutritional status and mitigate CRF. This study evaluates the effects of a high-protein, fish oil-enriched ONS (FOHP-ONS) on nutritional intake, body composition, fatigue, and quality of life in malnourished cancer patients. Methods: Cancer patients with malnutrition or inadequate food intake received 8 weeks of FOHP-ONS (2 cans/day, providing 4.2 g/day of ω-3 fatty acids). Dietary intake, body weight, handgrip strength, serum biochemical markers, nutritional status (PG-SGA), fatigue (BFI-T), and quality of life (EORTC QLQ-C30) were assessed at baseline, week 4, and week 8. Results: Of the 33 enrolled patients, 30 completed the study. Energy and protein intake significantly increased (p < 0.05), and body BMI and handgrip strength showed significant improvements (p < 0.05), while muscle mass did not change significantly. Nutritional status, assessed by PG-SGA, improved, with the proportion of severely malnourished patients (Stage C) decreasing from 46.7% to 13.3%, and moderately malnourished patients (Stage B) improving to well-nourished status (Stage A) from 10.0% to 30.0% (p < 0.001). Serum albumin levels increased significantly (p < 0.05), while fasting blood glucose significantly decreased (p < 0.05). Additionally, triglyceride levels significantly decreased (p < 0.05), while total cholesterol and LDL-C showed a downward trend. Cancer-related fatigue scores improved across all domains (p < 0.05), and quality of life significantly increased, particularly in physical and role functioning (p < 0.05). Conclusions: FOHP-ONS supplementation improved nutritional intake, body composition, and muscle strength while alleviating CRF and enhancing quality of life in malnourished cancer patients. These findings support its potential role in nutritional intervention for malnourished cancer patients. Full article

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

Background: Malnutrition is associated with adverse clinical and economic outcomes. We recently reported that the hospital mortality rate in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected inpatients was higher in malnourished patients than in those without malnutrition. The present study aimed to determine if SARS-CoV-2-infected inpatients who received oral nutrition supplementation (ONS) had improved survival. We performed a retrospective cohort study including 37,215 adults (aged 18 and older) admitted with COVID-19 to five Johns Hopkins–affiliated hospitals between 1 March 2020, and 31 March 2023. Malnutrition risk was initially screened using the Malnutrition Universal Screening Tool (MUST), with cases subsequently confirmed by registered dietitians via a standardized, validated assessment protocol. Logistic regression analysis predicting hospital mortality examined the association of ONS with hospital survival in SARS-CoV-2-infected inpatients, incorporating covariates and weights for ONS receipt. Results: Malnutrition was an independent predictor of higher hospital mortality from COVID-19 illness. The prevalence of malnutrition among adult inpatients with SARS-CoV-2 infection in our cohort was 15.22%. Inpatient adults with moderate or severe malnutrition in the context of acute illness or injury who were given ONS had lower odds of inpatient mortality (moderate OR = 0.72, 95% CI 0.62–0.85; severe OR = 0.76, 95% CI 0.67–0.87; both p < 0.001). Overweight and obese patients who received ONS had higher odds of inpatient mortality (overweight OR = 1.15, 95% CI 1.08–1.22, p < 0.0001; obese OR = 1.08, 95% CI 1.01–1.14, p = 0.02, respectively). For inpatients who were underweight, receiving ONS was protective against inpatient mortality (OR = 0.78, 95% CI 0.68–0.88, p = 0.0001). Thus, among adult inpatients with SARS-CoV-2 infection, malnourished and underweight individuals appeared to experience improved survival when provided with oral nutritional supplements (ONS), whereas overweight or obese patients remain at an elevated risk of mortality. The timing of ONS receipt in hospitalized patients with SARS-CoV-2 influenced mortality. Patients who had earlier time to ONS had 13% lower odds of inpatient mortality (OR = 0.87, 95% CI 0.79–0.97, p = 0.0105). Conclusions: In a cohort of SARS-CoV-2 adult inpatients, those with confirmed malnutrition receiving oral nutrition supplements had a higher likelihood of hospital survival. This is the first study demonstrating an association of oral nutrition intervention with reduced hospital mortality in malnourished SARS-CoV-2-infected adults. Full article

Objectives: The relationship between oral health and general health of geriatric in-hospital patients (GIH) who are poly-morbid and edentulous is currently unclear. This study determined the relationship between oral health and general health, and further implications and recommendations were derived. Methods: This retrospective cohort study included 81 GIH patients with impairment of oral state and masticatory function and need for immediate prosthetic treatment. The number of medical diagnoses, particularly main diagnoses of being hospitalized, comorbid diagnoses and the dental/oral state, were evaluated. Laboratory data of vitamin D3 and albumin concentrations were measured. Intraoral risk factors (IRF) affecting the masticatory function were intraoral inflammation, mucogingival impairment (MGI) and severe bone crest atrophy (SBCA). Masticatory function was evaluated by DMF*-T Index (number of destroyed/diseased, missing teeth and artificial fabrication), Eichner Index and Scores. The clinical relevance was surveyed by significance and effect size calculations. Results: In GIH, the number of medical diagnoses correlated significantly with the occurrence of IRFs. SBCA was the most affecting IRF, as measured by Eichner Index at baseline (p = 0.001). Single main diagnoses CNS and gastro-intestinal disease (GID) correlated with both deficiency of vitamin D3 levels (p = 0.011; p = 0.028) and hypoalbuminemia (p = 0.013; p = 0.023). Single comorbid diagnoses significantly correlated with both vitamin D3 deficiency and hypoalbuminemia (CVD (p = 0.031); DM (p = 0.042). Hypoalbuminemia was further found to be correlated with the sum of comorbid diagnoses (p = 0.033). Conclusions: GIH patients suffered from general and dental poly-morbidity. The prevalence of diseases was higher due to SBCA and impaired masticatory function. Deficiency of vitamin D3 and hypoalbuminemia were possible malnutrition markers. Full article

Polycystic liver disease (PLD) is a rare genetic disorder characterized by the development of >10 fluid-filled cysts in the liver. While PLD can occur in isolation, it is most commonly associated with autosomal dominant polycystic kidney disease, adding complexity to its management. PLD is often asymptomatic but can lead to hepatomegaly, causing symptoms such as abdominal distension, pain and discomfort, early satiety, gastroesophageal reflux, and malnutrition, ultimately affecting patients’ quality of life. Current treatment strategies, including pharmacological and interventional approaches, focus on reducing liver volume and alleviating symptoms. However, management remains largely symptomatic, as no definitive therapies exist to halt cyst progression. Liver transplantation is the only curative option for patients with severe, progressive disease and refractory complications. The EASL guidelines recognize that PLD-related symptoms, primarily due to hepatomegaly, can contribute to involuntary weight loss and recommend assessing symptomatic patients for malnutrition and sarcopenia. Although evidence suggests that patients with PLD may be at risk of malnutrition, original data on the quality and extent of nutritional alterations remain scarce. The potential influence of nutrition on disease progression, symptom burden, and overall well-being is also largely unexplored. Given these knowledge gaps, addressing nutritional challenges, such as early satiety, is essential for optimizing symptom management and maintaining overall nutritional status. This review outlines a possible pathophysiology of malnutrition, specific dietary considerations and recommendations, and weight management in patients with PLD. Additionally, dietary complexities in patients with concurrent renal involvement are discussed, offering a practical framework for clinicians and dietitians in managing this challenging condition. Full article

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

Cell membrane capacitance (C_m) is a potential biomarker that reflects the structural and functional integrity of cell membranes. It is essential for physiological processes such as signal transduction, ion transport, and cellular homeostasis. In clinical practice, C_m can be determined using bioimpedance spectroscopy (BIS), a non-invasive technique for analysing the intrinsic electrical properties of biological tissues across a range of frequencies. C_m may be relevant in various clinical fields, where high capacitance is associated with healthy and intact membranes, while low capacitance indicates cellular damage or disease. Despite its promise as a prognostic indicator, several knowledge gaps limit the broader clinical application of C_m. These include variability in measurement techniques (e.g., electrode placement, frequency selection), the lack of standardised measurement protocols, uncertainty on how C_m is related to pathology, and the relatively low amount of C_m research. By addressing these gaps, C_m may become a valuable tool for examining cellular health, early disease detection, and evaluating treatment efficacy in clinical practice. This review explores the fundamental principles of C_m measured with the BIS technique, its mathematical basis and relationship to the biophysical Cole model, and its potential clinical applications. It identifies current gaps in our knowledge and outlines future research directions to enhance the understanding and use of C_m. For example, C_m has shown promise in identifying membrane degradation in sepsis, predicting malnutrition in anorexia nervosa, and as a prognostic factor in cancer. Full article

This review aims to summarize the global prevalence of healthcare-associated infections in patients with acute heart failure who have been admitted to coronary care units, highlighting the underrepresented burden of infection in this high-risk population. Coronary care units (CCUs) play a pivotal role in the care of patients experiencing acute or decompensated heart failure, offering a highly monitored environment with immediate access to advanced cardiac interventions. The management of heart failure in CCUs involves a multidisciplinary approach that includes hemodynamic monitoring, pharmacologic therapy, respiratory support, and, in selected cases, mechanical circulatory assistance. The early identification of deterioration, rapid therapeutic escalation, and close monitoring of cardiac function are hallmarks of CCU care. However, the complexity and severity of illness in this population are compounded by a high risk of infections, including hospital-acquired pneumonia, bloodstream infections, and device-related infections. These infections not only increase morbidity and prolong hospitalization but also significantly impact mortality and healthcare costs. The immunocompromised state of many heart failure patients—due to poor perfusion, malnutrition, and the use of invasive devices—further elevates their vulnerability. Effective infection prevention, early diagnosis, and targeted antimicrobial therapy are, therefore, critical components of heart failure management within CCUs. This intersection of advanced cardiac care and infection control highlights the need for integrated, multidisciplinary strategies to improve outcomes in this high-risk population. Full article