Nutrients

Editorial

3 pages, 181 KiB

Open AccessEditorial

The Key Role of Patient Empowerment in the Future Management of Cancer-Related Malnutrition

by Amanda Casirati, Valentina Da Prat, Emanuele Cereda, Francesco Serra, Lorenzo Perrone, Salvatore Corallo, Francesco De Lorenzo, Paolo Pedrazzoli and Riccardo Caccialanza

Nutrients 2023, 15(1), 235; https://doi.org/10.3390/nu15010235 - 3 Jan 2023

Cited by 2 | Viewed by 2924

Abstract

Malnutrition is a common condition in cancer patients [...] Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

Research

Jump to: Editorial, Review, Other

12 pages, 1209 KiB

Open AccessEditor’s ChoiceArticle

Controlling Nutritional Status (CONUT) Score as a Potential Prognostic Indicator of In-Hospital Mortality, Sepsis and Length of Stay in an Internal Medicine Department

by Nicoletta Miano, Maurizio Di Marco, Salvatore Alaimo, Giuseppe Coppolino, Giuseppe L’Episcopo, Stefano Leggio, Roberto Scicali, Salvatore Piro, Francesco Purrello and Antonino Di Pino

Nutrients 2023, 15(7), 1554; https://doi.org/10.3390/nu15071554 - 23 Mar 2023

Cited by 15 | Viewed by 2759

Abstract

The controlling nutritional status (CONUT) score represents poor nutritional status and has been identified as an indicator of adverse outcomes. Our aim was to evaluate the prognostic role of the CONUT score on in-hospital outcomes in an Internal Medicine Department. This is a [...] Read more.

The controlling nutritional status (CONUT) score represents poor nutritional status and has been identified as an indicator of adverse outcomes. Our aim was to evaluate the prognostic role of the CONUT score on in-hospital outcomes in an Internal Medicine Department. This is a retrospective study analyzing data from 369 patients, divided into four groups based on the CONUT score: normal (0–1), mild–high (2–4), moderate–high (5–8), and marked high (9–12). In-hospital all-cause mortality increased from normal to marked high CONUT score group (2.2% vs. 3.6% vs. 13.4% vs. 15.3%, p < 0.009). Furthermore, a higher CONUT score was linked to a longer length of hospital stay (LOS) (9.48 ± 6.22 vs. 11.09 ± 7.11 vs. 12.45 ± 7.88 vs. 13.10 ± 8.12, p < 0.013) and an increased prevalence of sepsis. The excess risk of a high CONUT score relative to a low CONUT score remained significant after adjusting for confounders (all-cause mortality: OR: 3.3, 95% CI: 1.1–9.7, p < 0.02; sepsis: OR: 2.7, 95% CI: 1.5–4.9, p < 0.01; LOS: OR: 2.1, 95% CI: 1.2–3.9, p < 0.007). The present study demonstrated that an increased CONUT score is related to a higher risk of short-term in-hospital death and complications. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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11 pages, 827 KiB

Open AccessArticle

COntrolling NUTritional Status (CONUT) as Predictive Score of Hospital Length of Stay (LOS) and Mortality: A Prospective Cohort Study in an Internal Medicine and Gastroenterology Unit in Italy

by Emanuele Rinninella, Raffaele Borriello, Marco D’Angelo, Tiziano Galasso, Marco Cintoni, Pauline Raoul, Michele Impagnatiello, Brigida Eleonora Annicchiarico, Antonio Gasbarrini and Maria Cristina Mele

Nutrients 2023, 15(6), 1472; https://doi.org/10.3390/nu15061472 - 19 Mar 2023

Cited by 7 | Viewed by 3443

Abstract

Background: Hospital malnutrition affects nearly 30% of patients in medical wards and correlates with worse outcomes. An early assessment is necessary to stratify the risk of short-term outcomes and mortality. The predictive role of COntrolling NUTritional status (CONUT) score in this context has [...] Read more.

Background: Hospital malnutrition affects nearly 30% of patients in medical wards and correlates with worse outcomes. An early assessment is necessary to stratify the risk of short-term outcomes and mortality. The predictive role of COntrolling NUTritional status (CONUT) score in this context has not yet been elucidated in Western countries. We aimed to test CONUT at admission as a predictive score of hospital outcomes, in an Internal Medicine and Gastroenterology Department of an Italian Tertiary Care University hospital. Methods: We prospectively enrolled patients admitted to our center, stratifying them into the four CONUT classes (normal = 0–1; mild = 2–4; moderate = 5–8; severe = 9–12 points) according to serum albumin (g/dL), total lymphocyte count (/mm³), and total cholesterol (mg/dL); the primary outcome measure was length of stay (LOS) and the secondary one was in-hospital mortality. Results: Out of a total of 203 patients enrolled, 44 (21.7%) patients had a normal status (0–1), 66 (32.5%) had a mild impairment (2–4), 68 (33.5%) had a moderate impairment (5–8), and 25 (12.3%) a severe impairment (9–12). The mean LOS was 8.24 ± 5.75 days; nine patients died. A moderate-severe CONUT correlated with a higher LOS at the univariate [HR 1.86 (95% CI 13.9–3.47); p < 0.0001] and multivariate analysis [HR 1.52 (95% CI 1.10–2.09); p = 0.01]. The CONUT score was also a predictor of mortality, with an AUC of 0.831 (95% CI 0.680–0.982) and with an optimal cut-off at 8.5 points. Nutritional supplementation within 48 h from admission correlated with lower mortality [OR 0.12 (95% CI 0.02–0.56) p = 0.006]. Conclusions: CONUT is a reliable and simple predictor of LOS and in-hospital mortality in medical wards. Full article

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11 pages, 542 KiB

Open AccessArticle

Fatigue in Patients on Chronic Hemodialysis: The Role of Indoleamine 2,3-Dioxygenase (IDO) Activity, Interleukin-6, and Muscularity

by Alessio Molfino, Giovanni Imbimbo, Maria Ida Amabile, Thomas Ammann, Luana Lionetto, Gerardo Salerno, Maurizio Simmaco, Maria Grazia Chiappini and Maurizio Muscaritoli

Nutrients 2023, 15(4), 876; https://doi.org/10.3390/nu15040876 - 9 Feb 2023

Cited by 5 | Viewed by 2292

Abstract

Fatigue is a frequent symptom in hemodialysis (HD), and the indolamine-2,3-dioxygenase (IDO) metabolic trap has been hypothesized in the pathogenesis of fatigue. The association between IDO activity according to fatigue and its relationship with muscle mass and function in HD patients was verified. [...] Read more.

Fatigue is a frequent symptom in hemodialysis (HD), and the indolamine-2,3-dioxygenase (IDO) metabolic trap has been hypothesized in the pathogenesis of fatigue. The association between IDO activity according to fatigue and its relationship with muscle mass and function in HD patients was verified. Chronic HD patients were considered, and fatigue was assessed. The plasma kynurenines and tryptophan ratio (Kyn/Trp), as surrogate of IDO activity, and interleukin (IL)-6 were measured. Muscularity was assessed by BIA and muscle strength by hand-grip dynamometer. 50 HD patients were enrolled, and fatigue was present in 24% of the cohort. Patients with fatigue showed higher Kyn/Trp (p = 0.005), were older (p = 0.007), and IL-6 levels resulted higher than in non-fatigue patients (p < 0.001). HD patients with fatigue showed lower intracellular water (surrogate of muscle mass) (p < 0.001), as well as lower hand grip strength (p = 0.02). The Kyn/Trp ratio positively correlated with IL-6 and ECW/ICW (p = 0.004 and p = 0.014). By logistic regression analysis, higher ICW/h² was associated with lower odds of fatigue (OR, 0.10; 95% CI, 0.01 to 0.73). In conclusion, our cohort fatigue was associated with a higher Kyn/Trp ratio, indicating a modulation of IDO activity. The Kyn/Trp ratio correlated with IL-6, suggesting a potential role of IDO and inflammation in inducing fatigue and changes in muscularity. Full article

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9 pages, 960 KiB

Open AccessArticle

Neurodevelopmental Outcomes in Preterm Infants Receiving a Multicomponent vs. a Soybean-Based Lipid Emulsion: 24 Month Follow-Up of a Randomized Controlled Trial

by Francesca Gallini, Maria Sofia Pelosi, Domenico Umberto De Rose, Maria Coppola, Simonetta Costa, Domenico Marco Romeo, Carmen Cocca, Luca Maggio, Francesco Cota, Alessandra Piersanti, Daniela Ricci and Giovanni Vento

Nutrients 2023, 15(1), 58; https://doi.org/10.3390/nu15010058 - 23 Dec 2022

Cited by 5 | Viewed by 3451

Abstract

Background: Few studies in the literature have analyzed the long-term neurodevelopmental outcomes of the administration of a multicomponent versus a soybean-based lipid emulsion (LE) in preterm infants receiving parenteral nutrition (PN). A recent randomized controlled trial conducted in our unit provided evidence of [...] Read more.

Background: Few studies in the literature have analyzed the long-term neurodevelopmental outcomes of the administration of a multicomponent versus a soybean-based lipid emulsion (LE) in preterm infants receiving parenteral nutrition (PN). A recent randomized controlled trial conducted in our unit provided evidence of better growth in head circumference during the hospital stay in those who received a multicomponent LE. Methods: This is a 24 month follow-up study of preterm infants, previously enrolled in a randomized trial, who received a multicomponent LE (SMOFlipid^®) or a standard soybean-based one (Intralipid^®). We evaluated neurodevelopmental outcomes at 24 months of corrected age (CA) in the two groups. Results: Ninety-three children were followed up to the age of 24 months CA. Due to the peculiar time frame of the SARS-CoV-2 pandemic, neurodevelopmental outcomes were evaluated only in 77 children: 37 in the SMOFlipid^® group and 40 in the Intralipid^® group. No differences in major disability rates or in Griffith’s evaluation were found between the two groups. Conclusions: In our population study, the administration of a multicomponent LE containing fish oil, compared to a soybean-based LE, had no significant effects on neurodevelopmental outcomes in preterm infants at 24 months CA. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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21 pages, 598 KiB

Open AccessArticle

The Socio-Ecological Context of the Nutrition Transition in Indonesia: A Qualitative Investigation of Perspectives from Multi-Disciplinary Stakeholders

by Oyedolapo A. Anyanwu, Elena N. Naumova, Virginia R. Chomitz, Fang-Fang Zhang, Kenneth Chui, Martha I. Kartasurya and Sara C. Folta

Nutrients 2023, 15(1), 25; https://doi.org/10.3390/nu15010025 - 21 Dec 2022

Cited by 10 | Viewed by 5415

Abstract

Background: Indonesia is undergoing a rapid nutrition transition—a shift in food consumption related to globalization, modernization, urbanization, and economic development—with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on [...] Read more.

Background: Indonesia is undergoing a rapid nutrition transition—a shift in food consumption related to globalization, modernization, urbanization, and economic development—with potentially adverse impacts on diets, health, and the environment. This study sought to understand the perspectives of a multi-disciplinary group of experts on the effects of the nutrition transition on dietary behaviors, cardiovascular disease (CVD) risk factors, and the food environment in Indonesia. Methods: In-depth interviews were conducted online with 27 Indonesian experts, who are either healthcare providers, nutrition researchers, or environmental researchers. Interview question guides were developed based on a socio-ecological framework. We analyzed the data using deductive and inductive approaches. Results: Experts described a disconnect between awareness about and adherence to healthy diets among Indonesians. They highlighted a marked generational divide in food preferences between the younger population (<40y) and older population (40y+), due to the nutrition transition. Experts perceived that the nutrition transition has also resulted in more eating out, which promotes obesity, through the unhealthy menu offerings from restaurants. Experts also implied that traditional diets are no better than modern diets, due to unhealthy cooking practices, especially frying; suggesting that the combination of higher consumption of fast foods and unhealthy cooking practices may have worsened CVD risk factors in the population. Conclusion: Multi-disciplinary experts indicated that the nutrition transition has negatively impacted diets, health, and food environment in Indonesia. Our findings offer potential hypotheses that can be tested using quantitative approaches, to inform policy and the design of programs to reduce the adverse impacts of the nutrition transition in Indonesia. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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13 pages, 6197 KiB

Open AccessArticle

Dietary Emulsifiers Exacerbate Food Allergy and Colonic Type 2 Immune Response through Microbiota Modulation

by Akihito Harusato, Benoit Chassaing, Charlène J. G. Dauriat, Chihiro Ushiroda, Wooseok Seo and Yoshito Itoh

Nutrients 2022, 14(23), 4983; https://doi.org/10.3390/nu14234983 - 23 Nov 2022

Cited by 9 | Viewed by 3044

Abstract

The significant increase in food allergy incidence is correlated with dietary changes in modernized countries. Here, we investigated the impact of dietary emulsifiers on food allergy by employing an experimental murine model. Mice were exposed to drinking water containing 1.0% carboxymethylcellulose (CMC) or [...] Read more.

The significant increase in food allergy incidence is correlated with dietary changes in modernized countries. Here, we investigated the impact of dietary emulsifiers on food allergy by employing an experimental murine model. Mice were exposed to drinking water containing 1.0% carboxymethylcellulose (CMC) or Polysorbate-80 (P80) for 12 weeks, a treatment that was previously demonstrated to induce significant alterations in microbiota composition and function leading to chronic intestinal inflammation and metabolic abnormalities. Subsequently, the ovalbumin food allergy model was applied and characterized. As a result, we observed that dietary emulsifiers, especially P80, significantly exacerbated food allergy symptoms, with increased OVA-specific IgE induction and accelerated type 2 cytokine expressions, such as IL-4, IL-5, and IL-13, in the colon. Administration of an antibiotic regimen completely reversed the emulsifier-induced exacerbated susceptibility to food allergy, suggesting a critical role played by the intestinal microbiota in food allergy and type 2 immune responses. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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12 pages, 721 KiB

Open AccessArticle

Home Artificial Nutrition and Energy Balance in Cancer Patients: Nutritional and Clinical Outcomes

by Enrico Ruggeri, Rita Ostan, Silvia Varani, Raffaella Pannuti and Guido Biasco

Nutrients 2022, 14(20), 4307; https://doi.org/10.3390/nu14204307 - 14 Oct 2022

Cited by 2 | Viewed by 2751

Abstract

Malnutrition is one of the main factors determining cachexia syndrome, which negatively impacts the quality of life and survival. In cancer patients, artificial nutrition is considered as an appropriate therapy when the impossibility of an adequate oral intake worsened nutritional and clinical conditions. [...] Read more.

Malnutrition is one of the main factors determining cachexia syndrome, which negatively impacts the quality of life and survival. In cancer patients, artificial nutrition is considered as an appropriate therapy when the impossibility of an adequate oral intake worsened nutritional and clinical conditions. This study aims to verify, in a home palliative care setting for cancer patients, if home artificial nutrition (HAN) supplies a patient’s energy requirement, improving nutritional and performance status. A nutritional service team performed counseling at a patient’s home and assessed nutritional status (body mass index, weight loss in the past 6 months), resting energy expenditure (REE), and oral food intake; Karnofsky Performance Status (KPS); cachexia degree; and survival. From 1990 to 2021, 1063 patients started HAN. Among these patients, 101 suspended artificial nutrition for oral refeeding. Among the 962 patients continuing HAN until death, 226 patients (23.5%) survived 6 weeks or less. HAN allowed to achieve a positive energy balance in 736 patients who survived more than 6 weeks, improving body weight and KPS when evaluated after 1 month of HAN. Advanced cancer and cachexia degree at the entry of the study negatively affected the positive impact of HAN. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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12 pages, 769 KiB

Open AccessArticle

Phase Angle, a Cornerstone of Outcome in Head and Neck Cancer

by Daniel Sat-Muñoz, Brenda-Eugenia Martínez-Herrera, Javier-Andrés González-Rodríguez, Leonardo-Xicotencatl Gutiérrez-Rodríguez, Benjamín Trujillo-Hernández, Luis-Aarón Quiroga-Morales, Aldo-Antonio Alcaráz-Wong, Carlos Dávalos-Cobián, Alejandro Solórzano-Meléndez, Juan-Daniel Flores-Carlos, Benjamín Rubio-Jurado, Mario Salazar-Páramo, Gabriela-Guadalupe Carrillo-Nuñez, Eduardo Gómez-Sánchez, Arnulfo-Hernán Nava-Zavala and Luz-Ma-Adriana Balderas-Peña

Nutrients 2022, 14(15), 3030; https://doi.org/10.3390/nu14153030 - 24 Jul 2022

Cited by 17 | Viewed by 3833

Abstract

In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects [...] Read more.

In patients with head and neck cancer, malnutrition is common. Most cases are treated by chemo-radiotherapy and surgery, with adverse effects on the aerodigestive area. Clinical and biochemical characteristics, health-related quality of life, survival, and risk of death were studied. The selected subjects were divided into normal- and low-phase-angle (PA) groups and followed up for at least two years. Mean ages were 67.2 and 59.3 years for low and normal PA, respectively. Patients with PA < 4.42° had significant differences in age, anthropometric and biochemical indicators of malnutrition, and inflammatory status compared to patients with PA > 4.42°. Statistical differences were found in the functional and symptom scales, with lower functional scores and higher symptom scores in patients with low PA. Median survival was 19.8 months for those with PA < 4.42° versus 34.4 months for those with PA > 4.42° (p < 0.001).The relative risk of death was related to low PA (2.6; p < 0.001). The percentage of living patients (41.7%) is almost the same as the percentage of deceased subjects (43.1%; p = 0.002), with high death rates in patients with PA < 4.42°. Phase angle was the most crucial predictor of survival and a risk factor for death in the studied cases. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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16 pages, 758 KiB

Open AccessArticle

Effects of Postdischarge High-Protein Oral Nutritional Supplements and Resistance Training in Malnourished Surgical Patients: A Pilot Randomized Controlled Trial

by Poula Patursson, Grith Møller, Bjartur Bernhardson Thomsen, Eyðfinnur Olsen, Jann Mortensen, Guðrið Andorsdóttir, Magni Mohr and Jens Rikardt Andersen

Nutrients 2022, 14(13), 2599; https://doi.org/10.3390/nu14132599 - 23 Jun 2022

Cited by 2 | Viewed by 3697

Abstract

The presence of malnutrition is increasingly becoming a postdischarge problem in surgical patients. We aimed to investigate whether oral nutritional supplements combined with resistance training could minimize skeletal muscle atrophy in surgical patients after discharge. This randomized controlled study was conducted at the [...] Read more.

The presence of malnutrition is increasingly becoming a postdischarge problem in surgical patients. We aimed to investigate whether oral nutritional supplements combined with resistance training could minimize skeletal muscle atrophy in surgical patients after discharge. This randomized controlled study was conducted at the Department of Surgery, National Hospital of Faroe Islands from 2018 to 2020. A total of 45 patients aged 37–74 years participated and were allocated to one of three groups: diet (DI; n = 13), exercise and diet (EX + DI; n = 16), or control (CON; n = 16). The intervention period lasted 8 weeks. The intervention groups received individual dietary counselling and a protein-rich oral nutritional supplement twice a day containing 22 g of protein/day. Patients in the EX + DI group were assigned to resistance training sessions. Patients in the CON group received standard care. The primary outcome was change in lean body mass (LBM). Secondary outcomes were change in body weight, handgrip strength, quality of life, surgery-related side effects, energy and protein intake, length of stay and one-year mortality. To estimate within-group changes, linear mixed models including group–time interactions as fixed effects and patients as random effects were fitted. Within-group change in LBM was 233, 813 and 78 g in the DI, EX + DI and CON groups, respectively, with no significant between-group difference (p > 0.05). Pain score declined more (p = 0.04) in the EX + DI group compared with the CON group. Body weight, handgrip strength, quality of life and surgery-related side effects did not differ between groups. At the end of study, mean cumulative weight change in the DI and EX + DI groups was 0.4% and 1.6%, respectively, whereas the CON group experienced a weight loss of −0.6%. No significant difference in primary outcome between groups was noted. However, our results indicate some benefits from exercise and nutrition for malnourished surgical patients. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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14 pages, 1963 KiB

Open AccessArticle

Effects of Blueberry Consumption on Cardiovascular Health in Healthy Adults: A Cross-Over Randomised Controlled Trial

by Yueyue Wang, Jose Lara Gallegos, Crystal Haskell-Ramsay and John K. Lodge

Nutrients 2022, 14(13), 2562; https://doi.org/10.3390/nu14132562 - 21 Jun 2022

Cited by 19 | Viewed by 5473

Abstract

Blueberries are rich in polyphenols, and their effect on cardiovascular health, including risk factors for endothelial dysfunction and hypertension, has been investigated in interventional studies. However, the difference between blueberry treatments in varied forms for their cardiovascular-protective effect remains poorly understood. The current [...] Read more.

Blueberries are rich in polyphenols, and their effect on cardiovascular health, including risk factors for endothelial dysfunction and hypertension, has been investigated in interventional studies. However, the difference between blueberry treatments in varied forms for their cardiovascular-protective effect remains poorly understood. The current study assessed the effects of whole blueberry and freeze-dried blueberry powder compared to a control on cardiovascular health in young adults. A cross-over randomised controlled trial (RCT) was implemented with 1 week of treatment for three treatment groups, each followed by 1 week of wash out period. Systolic (SBP) and diastolic blood pressure (DBP), pulse wave velocity (PWV), plasma cholesterol (low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and total cholesterol) and triglyceride levels (TAG), and glucose and nitrite (NO2-) concentrations were compared following fresh blueberry, freeze-dried blueberry powder, and control treatments. Thirty-seven participants with a mean age of 25.86 ± 6.81 completed the study. No significant difference was observed among fresh blueberry, blueberry powder, and the control arm. Plasma NO2- levels were improved by 68.66% and 4.34% separately following whole blueberry and blueberry powder supplementations compared to the baseline, whereas the control supplementation reported a decrease (−9.10%), although it was not statistically significant. There were no other effects shown for SBP, DBP, total cholesterol, HDL-C, LDL-C, TAG, or glucose. No difference was shown between whole blueberry and freeze-dried blueberry powder consumption for improving cardiovascular health. Full article

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10 pages, 538 KiB

Open AccessArticle

Incidence and Impact of Refeeding Syndrome in an Internal Medicine and Gastroenterology Ward of an Italian Tertiary Referral Center: A Prospective Cohort Study

by Emanuele Rinninella, Marco D’Angelo, Raffaele Borriello, Tiziano Galasso, Marco Cintoni, Pauline Raoul, Michele Impagnatiello, Brigida Eleonora Annicchiarico, Antonio Gasbarrini and Maria Cristina Mele

Nutrients 2022, 14(7), 1343; https://doi.org/10.3390/nu14071343 - 23 Mar 2022

Cited by 7 | Viewed by 4084

Abstract

Background: Refeeding syndrome (RS) is a neglected, potentially fatal syndrome that occurs in malnourished patients undergoing rapid nutritional replenishment after a period of fasting. The American Society for Parenteral and Enteral Nutrition (ASPEN) recently released new criteria for RS risk and diagnosis. Real-life [...] Read more.

Background: Refeeding syndrome (RS) is a neglected, potentially fatal syndrome that occurs in malnourished patients undergoing rapid nutritional replenishment after a period of fasting. The American Society for Parenteral and Enteral Nutrition (ASPEN) recently released new criteria for RS risk and diagnosis. Real-life data on its incidence are still limited. Methods: We consecutively enrolled patients admitted to the Internal Medicine and Gastroenterology Unit of our center. The RS risk prevalence and incidence of RS were evaluated according to ASPEN. The length of stay (LOS), mortality, and re-admission rate within 30 days were assessed. Results: Among 203 admitted patients, 98 (48.3%) were at risk of RS; RS occurred in 38 patients (18.7% of the entire cohort). Patients diagnosed with RS had a higher mean LOS (12.5 days ± 7.9) than those who were not diagnosed with RS (7.1 ± 4.2) (p < 0.0001). Nine patients (4.4%) died. Body mass index (OR 0.82; 95% CI 0.69–0.97), RS diagnosis (OR 10.1; 95% CI 2.4–42.6), and medical nutritional support within 48 h (OR 0.12; 95% CI 0.02–0.56) were associated with mortality. Conclusions: RS incidence is high among clinical wards, influencing clinical outcomes. Awareness among clinicians is necessary to identify patients at risk and to support those developing this syndrome. Full article

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Review

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27 pages, 961 KiB

Open AccessEditor’s ChoiceReview

The Microbiota–Gut–Brain Axis: Psychoneuroimmunological Insights

by Giuseppe Marano, Marianna Mazza, Francesco Maria Lisci, Michele Ciliberto, Gianandrea Traversi, Georgios Demetrios Kotzalidis, Domenico De Berardis, Lucrezia Laterza, Gabriele Sani, Antonio Gasbarrini and Eleonora Gaetani

Nutrients 2023, 15(6), 1496; https://doi.org/10.3390/nu15061496 - 20 Mar 2023

Cited by 36 | Viewed by 10479

Abstract

There is growing interest in the role that the intestinal microbiota and the related autoimmune processes may have in the genesis and presentation of some psychiatric diseases. An alteration in the communication of the microbiota–gut–brain axis, which constitutes a communicative model between the [...] Read more.

There is growing interest in the role that the intestinal microbiota and the related autoimmune processes may have in the genesis and presentation of some psychiatric diseases. An alteration in the communication of the microbiota–gut–brain axis, which constitutes a communicative model between the central nervous system (CNS) and the gastro-enteric tract, has been identified as one of the possible causes of some psychiatric diseases. The purpose of this narrative review is to describe evidence supporting a role of the gut microbiota in psychiatric diseases and the impact of diet on microbiota and mental health. Change in the composition of the gut microbiota could determine an increase in the permeability of the intestinal barrier, leading to a cytokine storm. This could trigger a systemic inflammatory activation and immune response: this series of events could have repercussions on the release of some neurotransmitters, altering the activity of the hypothalamic–pituitary–adrenal axis, and reducing the presence of trophic brain factors. Although gut microbiota and psychiatric disorders seem to be connected, more effort is needed to understand the potential causative mechanisms underlying the interactions between these systems. Full article

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16 pages, 1032 KiB

Open AccessEditor’s ChoiceReview

Inflammation and Nutrition: Friend or Foe?

by Franziska Stumpf, Bettina Keller, Carla Gressies and Philipp Schuetz

Nutrients 2023, 15(5), 1159; https://doi.org/10.3390/nu15051159 - 25 Feb 2023

Cited by 68 | Viewed by 10385

Abstract

The importance of the interplay between inflammation and nutrition has generated much interest in recent times. Inflammation has been identified as a key driver for disease-related malnutrition, leading to anorexia, reduced food intake, muscle catabolism, and insulin resistance, which are stimulating a catabolic [...] Read more.

The importance of the interplay between inflammation and nutrition has generated much interest in recent times. Inflammation has been identified as a key driver for disease-related malnutrition, leading to anorexia, reduced food intake, muscle catabolism, and insulin resistance, which are stimulating a catabolic state. Interesting recent data suggest that inflammation also modulates the response to nutritional treatment. Studies have demonstrated that patients with high inflammation show no response to nutritional interventions, while patients with lower levels of inflammation do. This may explain the contradictory results of nutritional trials to date. Several studies of heterogeneous patient populations, or in the critically ill or advanced cancer patients, have not found significant benefits on clinical outcome. Vice versa, several dietary patterns and nutrients with pro- or anti-inflammatory properties have been identified, demonstrating that nutrition influences inflammation. Within this review, we summarize and discuss recent advances in both the role of inflammation in malnutrition and the effect of nutrition on inflammation. Full article

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Other

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18 pages, 597 KiB

Open AccessEditor’s ChoiceSystematic Review

Hospital Services to Improve Nutritional Intake and Reduce Food Waste: A Systematic Review

by Emanuele Rinninella, Pauline Raoul, Valeria Maccauro, Marco Cintoni, Andrea Cambieri, Alberto Fiore, Maurizio Zega, Antonio Gasbarrini and Maria Cristina Mele

Nutrients 2023, 15(2), 310; https://doi.org/10.3390/nu15020310 - 7 Jan 2023

Cited by 22 | Viewed by 8394

Abstract

Background and Aims: Patients’ nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic [...] Read more.

Background and Aims: Patients’ nutritional intake is a crucial issue in modern hospitals, where the high prevalence of disease-related malnutrition may worsen clinical outcomes. On the other hand, food waste raises concerns in terms of sustainability and environmental burden. We conducted a systematic review to ascertain which hospital services could overcome both issues. Methods: A systematic literature search following PRISMA guidelines was conducted across MEDLINE, Web of Science, and Scopus for randomised controlled trials (RCTs) and observational studies comparing the effect of hospital strategies on energy intake, protein intake, and plate/food waste. The quality of included studies was assessed using the Newcastle-Ottawa Scale for cohort studies and the Cochrane Risk of Bias tool from the Cochrane Handbook for Systematic Reviews of Interventions for RCTs. Results: Nineteen studies were included, assessing as many hospital strategies such as food service systems—including catering and room service—(n = 9), protected mealtimes and volunteer feeding assistance (n = 4), food presentation strategies (n = 3), nutritional counseling and education (n = 2), plant-based proteins meal (n = 1). Given the heterogeneity of the included studies, the results were narratively analysed. Conclusions: Although the results should be confirmed by prospective and large sample-size studies, the personalisation of the meal and efficient room service may improve nutritional intake while decreasing food waste. Clinical nutritionist staff—especially dietitians—may increase food intake reducing food waste through active monitoring of the patients’ nutritional needs. Full article

(This article belongs to the Special Issue Hot Topics in Clinical Nutrition)

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