Search Results (932)

Sustainable rabbit production requires effective nutritional strategies to enhance productivity, health status, and immune competence. Following the restriction of antibiotic growth promoters, organic acids (OAs) have gotten increasing attention as promising functional feed additives due to their multiple biological roles. This review aims to offer a comprehensive overview of the functional roles of OAs in rabbit nutrition, with a focus on their effects on gut morphology, nutrient digestibility, intestinal microbiota, antioxidative status, immunity, and growth performance in growing rabbits. The OAs may modulate gut microbiota balance through inhibition of pathogenic bacteria and promotion of beneficial microbial populations, thereby contributing to the establishment of a balanced intestinal ecosystem. This effect is particularly important during the post-weaning period, a critical stage characterized by increased susceptibility to enteric disorders and associated economic losses. The OAs may also enhance digestive enzyme activities, leading to improving nutrient digestibility, feed efficiency, and reducing feed wastage. In addition, OAs have been shown to improve intestinal histomorphology through coordinated effects on epithelial proliferation, mucosal renewal, and tight junction integrity. Furthermore, OAs have been shown to modulate antioxidative status and immune responses, which are essential for maintaining intestinal health and overall production sustainability. Collectively, OAs represent a promising and viable nutritional strategy to enhance the sustainability and efficiency of rabbit production systems through their beneficial effects on gut health, nutrient utilization, immune competence, and antioxidative status. Full article

Background/Objectives: Nutritional support is a key component in the management of chronically ventilated patients, who are at high risk of malnutrition due to prolonged illness and metabolic stress. Enteral nutrition, particularly high-protein formulas (HPFs) and high-density formulas (HDFs), is commonly used to improve clinical outcomes; however, their effects on anthropometric and biochemical parameters remain incompletely understood. Our objective was to evaluate the association of HPFs and HDFs with changes in anthropometric and biochemical parameters in chronically ventilated patients receiving enteral nutrition. Methods: This retrospective study evaluated chronically ventilated patients receiving long-term enteral nutrition. Patients were categorized into four groups based on feeding strategy: continuous HPF, transition to HPF, transition from HPF and transition to HDF. Body weight, serum albumin and total protein were assessed at baseline and follow-up (up to 6 months). Within-group changes were analyzed using paired statistical tests. Results: Within-group analyses demonstrated changes in body weight, body mass index and serum albumin levels over time. Body weight increased significantly across all groups. The greatest increase was observed in patients transitioning to an HPF (70.82–75.35 kg, p = 0.00019), with a significant increase also following HDF administration (59.51–62.57 kg, p = 0.0389). Serum albumin increased significantly only in the transition-to-HPF group. HDF administration showed a non-significant increase in albumin and a near-significant rise in total protein. Conclusions: Enteral nutrition strategies were associated with changes in anthropometric and biochemical parameters in chronically ventilated patients. HPFs and HDFs were associated with improved body weight, with biochemical improvements most evident after HPF initiation and favorable trends observed with HDF administration. Future prospective studies with standardized protocols and objective nutritional markers are warranted. Full article

Background/Objectives: Early enteral nutrition (EN) initiation and progressive EN advancement are critical components of nutritional care in critically ill patients; however, not all patients achieve successful early EN advancement in real-world intensive care unit (ICU) settings. We investigated clinical predictors of early EN initiation and successful early EN advancement at ICU admission in a retrospective cohort study at a single tertiary academic medical center in South Korea. Methods: A total of 2112 critically ill adults receiving EN between January 2020 and December 2024 were included. Successful early EN advancement was defined as EN initiation within 48 h of ICU admission, followed by progressive advancement without any reduction or discontinuation during the subsequent seven days. Using a two-stage multivariable logistic regression approach, we identified predictors of each outcome. Results: Among the total cohort, 722 patients (34.2%) achieved early EN initiation, of whom 449 (62.2%) subsequently achieved successful early EN advancement, representing 21.3% of the total cohort. Male sex (adjusted odds ratio [aOR] 0.87, 95% CI 0.78–0.96), higher admission lactate (aOR 0.85, 95% CI 0.74–0.96), prior surgery (aOR 0.81, 95% CI 0.70–0.93), and higher APACHE II score (aOR 0.88, 95% CI 0.79–0.99) were identified as significant negative predictors (all p < 0.05). Admission-time variables (male sex, elevated lactate, prior surgery, and higher APACHE II scores) effectively identify patients at risk of early EN failure. Conclusions: Reflecting distinct predictor profiles between ICU types, the preliminary nomogram can guide tailored nutritional strategies, although prospective external validation remains essential before clinical implementation. Full article

Oropharyngeal dysphagia (OD) is traditionally managed as a mechanical swallowing impairment. This narrative review proposes a conceptual model that reframes chronic, severe OD as a high-risk clinical condition driving systemic malnutrition and progressive nutritional deterioration. We examine the epidemiological burden of OD-associated malnutrition across geriatric, neurological, and oncological populations, exploring how diagnostic heterogeneity influences reported prevalence ranges. The pathophysiological narrative synthesizes hypotheses regarding the potential disruption of the cephalic phase of digestion, the rheological limitations of texture-modified diets (TMDs), and the theoretical bioenergetic cost of impaired swallowing. Central to this review is the hypothetical sarcopenia–dysphagia vicious cycle, evaluating how molecular pathways—such as systemic inflammation, ubiquitin–proteasome-mediated proteolysis, and suppression of muscle protein synthesis—are inferred from broader cachexia models to affect oropharyngeal function. We discuss structured nutritional management strategies, including micro-volume fortification, application of the IDDSI framework with xanthan gum-based thickeners, and monitoring via GLIM criteria, bioelectrical impedance analysis, and routine laboratory parameters. Finally, we analyze the ethical challenges of transitioning to enteral nutrition and outline the translational limitations of emerging fields like 3D food printing. This model aims to encourage clinical focus on comprehensive nutritional restoration alongside airway safety. Full article

Background: Enterocutaneous fistulas (ECFs) and enteroatmospheric fistulas (EAFs) are rare but highly morbid complications that most commonly arise after abdominal surgery. Outcomes have improved with advances in multidisciplinary care and with increasing research on how to best manage them; however, they remain associated with significant morbidity, high mortality, and prolonged hospitalization. Optimal timing of definitive repair is unknown, with many high-volume centers waiting 6–12 months, though emerging data suggest that earlier intervention may be feasible in carefully selected patients. Given their complexity and variability in management, a comprehensive review of current evidence is needed. Methods: A narrative review of the literature was conducted with emphasis on the classification, pathophysiology, and multidisciplinary management of ECFs and EAFs. Relevant studies addressing fluid and sepsis control, nutritional optimization, wound care, pharmacologic therapies, and interventional strategies were reviewed. Results: The management of ECFs requires a staged approach focused on fluid resuscitation, sepsis control, wound management, and nutritional optimization. Spontaneous closure can occur, and is most commonly within the first two months. Nutritional optimization through enteral and/or parenteral nutrition or fistuloclysis plays a vital role in improving outcomes. Therapies such as negative pressure wound therapy, biologics, and pharmacologic agents may support spontaneous closure and fistula control. In non-healing fistulas, surgical repair remains necessary, with optimal time for surgery at least 6–12 months from fistula development. Conclusions: ECFs and EAFs remain complex surgical challenges. Outcomes have improved due to advances in nutritional support and wound management, and the emergence of minimally invasive techniques. Standardization of treatment protocols and further research into novel therapy may further enhance outcomes and limit variability in management. Full article

Critically ill obese patients with gynecological cancer represent a high-risk population with complex nutritional needs. Although excess adiposity may suggest adequate energy reserves, it often conceals sarcopenia, micronutrient deficiencies, and functional malnutrition, contributing to impaired wound healing, immune dysfunction, prolonged mechanical ventilation, increased susceptibility to infections, and adverse oncologic outcomes. Obesity-associated inflammation, insulin resistance, and tumor-driven catabolism further exacerbate metabolic stress and complicate nutritional management in the intensive care setting. Accurate nutritional assessment requires a multimodal approach incorporating body composition analysis, functional measures, and laboratory parameters, as conventional indices such as body mass index may underestimate nutritional risk. Nutritional support should be individualized and may include early enteral nutrition to preserve gut integrity, supplemental or total parenteral nutrition when gastrointestinal function is compromised, high-protein regimens, and targeted micronutrient replacement. Immunonutrition, including arginine, glutamine, omega-3 fatty acids, and nucleotides, has emerged as a promising strategy to modulate inflammation, enhance immune function, and support tissue repair. This narrative review summarizes current evidence regarding obesity-related metabolic dysfunction, nutritional assessment, enteral and parenteral nutrition, and immunonutrition in obese critically ill patients with gynecological cancer. It highlights the challenges associated with sarcopenic obesity and hidden malnutrition while providing a clinically relevant overview for intensivists, gynecologic oncologists, surgeons, and nutrition specialists. Early recognition of nutritional risk and implementation of individualized multimodal nutritional strategies may improve recovery and clinical outcomes. However, high-quality ICU-specific studies remain limited, and further prospective research is needed to establish evidence-based nutritional protocols and evaluate their impact on survival, treatment tolerance, and quality of life in this vulnerable population. Full article

Microplastics (MPs) are pervasive contaminants that have been detected throughout the food chain. Their presence raises concerns in foods intended for health-related purposes, as these products are often consumed by vulnerable populations such as infants, older adults, and patients requiring clinical nutrition support. These groups may be more susceptible to contaminant exposure and may rely heavily on specialized foods. Therefore, understanding the occurrence and potential risks of MPs in such products is important. This review summarizes the current state of knowledge regarding the presence, sources, and health implications of plastic particles in several categories of health-oriented foods, including dietary supplements, medicinal herbs, plant-based beverages, honey, infant formulas, and clinical nutrition products, including enteral and parenteral formulations. Microplastics have been reported across these matrices. Fibers and fragments dominate, and common polymers include polyamide, polyethylene, polypropylene, and poly(ethylene terephthalate). These particles can originate from polluted water, soil, and air, as well as from production processes, packaging wear, and clinical delivery systems. Current evidence suggests that improving methodological consistency and expanding targeted toxicological research relevant to vulnerable populations will be crucial for strengthening risk assessment. Full article

Background: Malnutrition, encompassing both undernutrition and overnutrition, is a common complication in children with cancer and is associated with impaired treatment tolerance, increased infection risk, altered pharmacokinetics, reduced quality of life, and poorer survival outcomes. Despite its importance, nutritional management in pediatric oncology lacks a unified, systematically organized clinical framework applicable to the full trajectory of the disease. Objective: This study aimed to develop expert consensus recommendations for nutritional intervention in pediatric oncology patients aged 4 to 18 years. Methods: A modified electronic Delphi (e-Delphi) process was conducted with a multidisciplinary expert panel of 22 specialists, including pediatric oncologists, pediatric gastroenterologists, clinical nutrition specialists, radiotherapy specialists, and pediatric surgeons. Statements were rated on a 9-point Likert scale across two anonymous rounds, with consensus predefined as ≥80% agreement. Results: Forty-one consensus recommendations were formulated across nine domains: nutritional screening and assessment, energy and protein requirements, micronutrient supplementation, physical activity, nutritional support escalation, refeeding syndrome prevention, treatment-specific management, survivorship, and palliative care. All recommendations achieved the predefined consensus threshold. Conclusions: This Delphi consensus provides a structured, multidisciplinary, and clinically actionable framework for nutritional management across the full trajectory of childhood cancer and is intended to reduce institutional variability and improve patient outcomes. Full article

Oral health has significant implications for pulmonary outcomes, particularly among individuals with dysphagia who are at risk for aspiration. Moreover, oral health and condition affect nutrition accessibility and status. Inadequate oral hygiene promotes bacterial colonization, plaque accumulation, and aspiration-related respiratory complications. This narrative review aimed to explore current evidence and expert perspectives across palliative medicine, pulmonary and critical care, and dentistry on the role of oral hygiene in supporting pulmonary health and maintaining opportunities for oral nutrition. A comprehensive literature search was conducted through the Texas Tech University Health Sciences Center digital library using Cochrane Library (Wiley), EBSCO Discovery, Embase, Ovid databases, PubMed, SCOPUS, ScienceDirect, Web of Science, and Google Scholar between 14 January 2026 and 1 April 2026. From 1287 identified records, 70 studies were selected to be highlighted in the manuscript after duplicate removal and eligibility screening. Relevant literature was reviewed to examine associations among dysphagia, oral health and condition, oral hygiene and care protocols, feeding route, salivary composition and function, and respiratory outcomes. Emphasis was placed on studies addressing pneumonia, oral versus tube feeding, and evidence-based oral care practices. Findings indicate that pneumonia, depression, and mortality rates are higher in patients receiving tube feeding compared to oral feeding. Evidence-based oral care practices inclusive of mechanical plaque disruption, oral cleansing products (Chlorhexidine, hydrogen peroxide, and sodium bicarbonate), and structured oral hygiene protocols can reduce pulmonary consequences of aspiration and support safer/least risk oral intake. Saliva plays a pivotal role in plaque breakdown, microbial defense, and host immunity; oral feeding helps to preserve salivary function. Results of this review highlight the importance of oral hygiene in both restorative and palliative care contexts. This review establishes a framework for embedding oral cleansing agents and protocols into a nutrition-focused health care infrastructure. Based on the literature analysis and inter- and multidisciplinary clinical expertise of the author group, the manuscript proposes consensus statements intended as expert guidance rather than formal clinical practice guidelines. Adherence to best practices in oral care can mitigate pulmonary consequences of aspiration amid dysphagia, make oral nutrition more accessible and comfortable, sustain opportunities for least risk oral feeding across diagnoses and health care settings, and improve quality of life for patients with dysphagia amid life-limiting illness. Full article

Inflammatory bowel disease (IBD; Crohn’s disease and ulcerative colitis) arises from convergent dysfunction of the epithelial barrier, mucosal immunity, and gut microbiome on a background of genetic susceptibility and environmental exposures. Diet is among the most modifiable of these exposures, yet much of the diet–microbiome research in IBD remains descriptive and poorly aligned with the molecular pathways linking food to mucosal effects. This comprehensive review reframes the field around functional dysbiosis, in which altered microbial metabolic capacity (rather than taxonomic shifts alone) drives disease-relevant biology. We trace how dietary substrates and additives are converted by gut microbes into bioactive metabolites (short-chain fatty acids, secondary bile acids, tryptophan-derived indoles, sulfur compounds, and polyphenol-derived molecules) and map these to host receptors and signaling pathways governing barrier function, mucus and antimicrobial peptide production, and Treg/Th17 balance. Defined dietary therapies (exclusive enteral nutrition, the Crohn’s disease exclusion diet plus partial enteral nutrition, and Mediterranean-style patterns) are reinterpreted as interventions that reshape microbial metabolic output, and candidate biomarkers for microbiome-informed precision nutrition are evaluated. Microbiota-derived metabolites provide the molecular interface between diet and mucosal immunity in IBD; personalized dietary algorithms remain a research goal, not a validated clinical tool, and diet is best framed as adjunctive to pharmacotherapy and dietitian care. Full article

Background/Objectives: Early enteral feeding in preterm infants remains controversial because, despite promoting intestinal maturation, concerns about necrotizing enterocolitis (NEC) persist. Donor human milk (DHM) is recommended when the mother’s milk is unavailable, but the optimal initiation timing is unclear. This study evaluated the association between DHM initiation timing and outcomes in very-low-birth-weight (VLBW) infants in Japan. Methods: This multicenter retrospective cohort study used data from a national human milk bank registry (2018–2023) and the Neonatal Research Network of Japan (NRNJ; 2022). Infants with birth weight <1500 g were categorized by DHM initiation timing (≤24, 25–48, or >48 h), with infants in the NRNJ cohort serving as the comparison group. The primary outcome observed was NEC incidence, including all stages; secondary outcomes included in-hospital mortality and time to full enteral feeding. Bayesian regression models were applied. Detailed feeding data were unavailable in the NRNJ cohort. Results: Among 2962 infants, NEC incidence was low across groups. NEC occurred in 1.31% of the ≤24 h DHM group and 1.83% of the NRNJ group, with mortality rates of 4.53% and 6.23%, respectively. Although NEC incidence was numerically lower in the ≤24 h DHM group, estimates were imprecise because of limited events. Early DHM initiation was associated with lower in-hospital mortality and earlier full enteral feeding, particularly in infants with <1000 g birth weight. Conclusions: Early DHM initiation was associated with lower mortality and earlier achievement of full enteral feeding in VLBW infants without elevated NEC risk. However, because detailed feeding information was unavailable in the comparison cohort, these associations should be interpreted cautiously. Given the observational design and heterogeneous nutritional exposures, further prospective studies are warranted. Full article

Background and Clinical Significance: Chronic intestinal pseudo-obstruction (CIPO) clinically presents as a mechanical obstruction. When patients present with signs of impending ischemia, emergency exploratory laparotomy is indicated. Differentiating CIPO from other etiologies preoperatively is highly challenging, making intraoperative findings and definitive histopathology crucial for an accurate diagnosis. This report aims to elucidate a novel macroscopic presentation of myopathic CIPO and explore the potential biomechanical mechanisms underlying the observed structural anomaly. Case Presentation: A 37-year-old male with no prior abdominal surgery presented with a high-grade bowel obstruction and early signs of ischemia. Emergency laparotomy revealed a unique “braided dough twist” anomaly of the distal small bowel, prompting a segmental resection. Subsequent histopathological and immunohistochemical evaluations revealed severe outer longitudinal muscle atrophy with an intact enteric nervous system, confirming myopathic CIPO. Following surgery, the patient recovered uneventfully with significant nutritional improvement. Conclusions: Myopathic CIPO can manifest as a striking “braided” bowel anomaly—a macroscopic presentation previously undocumented in the literature. This case illustrates that determining the optimal extent of resection relies heavily on intraoperative visual and tactile assessment, and that comprehensive histopathological profiling is essential for establishing a definitive diagnosis and elucidating the underlying biomechanical mechanisms of this unique structural anomaly. Full article

Background/Objectives: The safety of specific parenteral glucose intake values within the range currently recommended by international guidelines for the early acute phase in preterm neonates has not been established. This study aimed to evaluate whether exceeding a data-driven parenteral dextrose intake threshold during the first week of life is independently associated with hyperglycemia, hypertriglyceridemia, metabolic acidosis, and extrauterine growth restriction (EUGR). Methods: This was a single-center retrospective study involving preterm neonates (gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g) admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I, Rome, between 2015 and 2022. The analysis followed two pre-specified steps: (1) data-driven identification of an exposure threshold by restricted cubic spline logistic regression; (2) multivariable analyses with the dichotomized exposure, adjusting for gestational age, birth weight, enteral nutrition timing, neonatal morbidity, and perinatal compromise. Results: 389 preterm neonates met eligibility. The data-driven inflection point of the spline-derived log-odds curve identified a threshold of 7 g/kg/day. Exceeding this threshold during the first week of life was independently associated with both hyperglycemia (adjusted odds ratio 5.55, 95% confidence interval 2.56 to 12.03; p < 0.001) and hypertriglyceridemia (adjusted odds ratio 4.36, 95% confidence interval 1.41 to 13.45; p = 0.010), but not with metabolic acidosis or with EUGR at 36 weeks postmenstrual age. The divergence in daily parenteral glucose intake between cases and controls was apparent from the second day of life. Conclusions: Exceeding 7 g/kg/day of parenteral dextrose was independently associated with early metabolic complications, but not with growth outcomes. A safety threshold for parenteral glucose may exist within the currently recommended intake range; prospective multicenter studies are needed before clinical recommendations can be drawn. Full article

Objectives: This study compared the risk profiles, nutrient intake, and kidney function of calcium oxalate stone formers with and without enteric hyperoxaluria. Methods: Thirty-seven patients with calcium oxalate stone disease and enteric hyperoxaluria (cases) and 37 sex- and age-matched idiopathic calcium oxalate stone formers (controls) were enrolled. Patients did not receive any nutritional counseling prior to the start of the study, and they discontinued medications affecting urinary parameters four weeks before their study participation. Anthropometric, clinical, and metabolic parameters were recorded. Dietary and 24-h urinary variables were measured under the habitual diet and under a balanced, standardized diet. The [¹³C₂] oxalate absorption and calcium loading tests were carried out. Results: The median [¹³C₂] oxalate absorption was significantly higher in cases (14.8%) than in controls (8.9%). Under the balanced diet, hypocitraturia, hypomagnesuria, low urine volume and pH value were significantly more common in the case group, whereas hypercalciuria occurred more frequently in the control group, affecting 45.9% of controls and 5.4% of cases. Furthermore, the control group exhibited a greater reduction in urinary calcium excretion under the balanced diet. Urinary oxalate excretion and the ion-activity product index of calcium oxalate were significantly higher under both diets, with a greater decline observed in the case group under the balanced diet. The estimated glomerular filtration rate (eGFR) was lower in cases. A multivariable linear regression analysis revealed a significant association between urine pH and eGFR. Conclusions: Calcium oxalate stone formers with and without enteric hyperoxaluria benefit from a balanced diet and sufficient fluid intake. The reduction in urinary oxalate excretion and the biochemical risk of recurrent calcium oxalate stone formation were even more pronounced in patients with enteric hyperoxaluria. Particular attention should be paid to low urine pH, as it is hypothesized to be a potential indicator of impaired kidney function. Full article

Background: Malabsorption is a frequent and clinically relevant condition associated with a high risk of disease-related malnutrition across multiple gastrointestinal and systemic disorders. Despite its prevalence, standardized nutritional management algorithms remain limited. Following a previously published Delphi consensus on the use of oligomeric enteral formulas, the present study aimed to develop and validate a practical nutritional management algorithm for patients with malabsorption. Methods: A structured expert questionnaire was conducted among 173 physicians with clinical experience in malabsorption, including specialists in endocrinology, gastroenterology, internal medicine, and oncology. Participants gained experience using the preliminary algorithm by applying it to five real-life cases before completing the questionnaire. The survey addressed symptom type, intensity, and duration required for screening, diagnostic criteria for malnutrition, timing of reassessment, indications for oligomeric oral nutritional supplements (ONSs), and criteria for reintroducing polymeric formulas. Statistical analyses were performed using SAS v9.4. Results: Of the 173 participants, 67.1% were women, with a mean age of 39.6 ± 8.2 years and a mean clinical experience of 10.9 ± 7.9 years. In clinicians’ opinion, diarrhea was the most frequently considered symptom to trigger screening (88.6%), followed by abdominal distension (72.6%), abdominal pain (65.4%), and increased gastric residuals (45.8%). Experts agreed that symptoms should present with at least moderate intensity and persist for more than 3 weeks to justify screening. Most respondents agreed with using the GLIM criteria for malnutrition assessment (97.7%). For patients with poor tolerance to polymeric ONSs or moderate-to-severe symptoms, initiation of oligomeric ONSs was recommended, with diarrhea identified as the main indication (31.1%). Symptom severity prompting oligomeric formulas was rated between 2.8 and 3.3 on a 5-point scale. The mean recommended duration of symptom improvement before transitioning back to polymeric formulas was 6.24 ± 4.45 weeks. Conclusions: This study presents a consensus-based, clinically applicable algorithm for nutritional screening, diagnosis, and intervention in patients with malabsorption. The algorithm provides clear guidance on symptom assessment, use of GLIM criteria, selection of ONS type, and follow-up, potentially improving standardization and quality of nutritional care in this high-risk population. Full article