Research

15 pages, 906 KiB

Open AccessArticle

Parenteral Nutrition: Current Use, Complications, and Nutrition Delivery in Critically Ill Patients

by Juan Carlos Lopez-Delgado, Teodoro Grau-Carmona, Esther Mor-Marco, Maria Luisa Bordeje-Laguna, Esther Portugal-Rodriguez, Carol Lorencio-Cardenas, Paula Vera-Artazcoz, Laura Macaya-Redin, Beatriz Llorente-Ruiz, Rayden Iglesias-Rodriguez, Diana Monge-Donaire, Juan Francisco Martinez-Carmona, Laura Sanchez-Ales, Angel Sanchez-Miralles, Monica Crespo-Gomez, Cristina Leon-Cinto, Jose Luis Flordelis-Lasierra, Lluis Servia-Goixart and on behalf of the ENPIC Study Group

Nutrients 2023, 15(21), 4665; https://doi.org/10.3390/nu15214665 - 03 Nov 2023

Cited by 1 | Viewed by 1601

Abstract

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when [...] Read more.

Background: Parenteral nutrition (PN) is needed to avoid the development of malnutrition when enteral nutrition (EN) is not possible. Our main aim was to assess the current use, complications, and nutrition delivery associated with PN administration in adult critically ill patients, especially when used early and as the initial route. We also assessed the differences between patients who received only PN and those in whom EN was initiated after PN (PN-EN). Methods: A multicenter (n = 37) prospective observational study was performed. Patient clinical characteristics, outcomes, and nutrition-related variables were recorded. Statistical differences between subgroups were analyzed accordingly. Results: From the entire population (n = 629), 186 (29.6%) patients received PN as initial nutrition therapy. Of these, 74 patients (11.7%) also received EN during their ICU stay (i.e., PN-EN subgroup). PN was administered early (<48 h) in the majority of patients (75.3%; n = 140) and the mean caloric (19.94 ± 6.72 Kcal/kg/day) and protein (1.01 ± 0.41 g/kg/day) delivery was similar to other contemporary studies. PN showed similar nutritional delivery when compared with the enteral route. No significant complications were associated with the use of PN. Thirty-two patients (43.3%) presented with EN-related complications in the PN-EN subgroup but received a higher mean protein delivery (0.95 ± 0.43 vs 1.17 ± 0.36 g/kg/day; p = 0.03) compared with PN alone. Once adjusted for confounding factors, patients who received PN alone had a lower mean protein intake (hazard ratio (HR): 0.29; 95% confidence interval (CI): 0.18–0.47; p = 0.001), shorter ICU stay (HR: 0.96; 95% CI: 0.91–0.99; p = 0.008), and fewer days on mechanical ventilation (HR: 0.85; 95% CI: 0.81–0.89; p = 0.001) compared with the PN-EN subgroup. Conclusion: The parenteral route may be safe, even when administered early, and may provide adequate nutrition delivery. Additional EN, when possible, may optimize protein requirements, especially in more severe patients who received initial PN and are expected to have longer ICU stays. NCT Registry: 03634943. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

9 pages, 970 KiB

Open AccessArticle

Mid-Term Evolution of the Serum Acylcarnitine Profile in Critically Ill Survivors: A Metabolic Insight into Survivorship

by Anne-Françoise Rousseau, Arsène Ngongan, Camille Colson, Pauline Minguet, Sarah Neis-Gilson, Etienne Cavalier, Grégory Minguet, Benoit Misset and François Boemer

Nutrients 2023, 15(16), 3595; https://doi.org/10.3390/nu15163595 - 16 Aug 2023

Viewed by 708

Abstract

It is unknown if the abnormal acylcarnitine (AC) profile observed early after discharge of a prolonged stay in an intensive care unit (ICU) would persist over time. This prospective observational study aimed to describe the mid-term AC profile evolution in survivors of a [...] Read more.

It is unknown if the abnormal acylcarnitine (AC) profile observed early after discharge of a prolonged stay in an intensive care unit (ICU) would persist over time. This prospective observational study aimed to describe the mid-term AC profile evolution in survivors of a prolonged ICU stay (≥7 days). Adults enrolled in our post-ICU follow-up program and who attended the consultation 3 months (M3) after discharge were included. Serum AC concentrations were assessed within 7 days following ICU discharge (T0) and at M3. A total of 64 survivors were analyzed after an ICU stay of 15 (9–24) days. Free carnitine (C0) concentration decreased from 45.89 (35.80–127.5) to 28.73 (20.31–38.93) µmol/L (p < 0.001). C0 deficiency was not observed at T0 but in 7/64 (11%) survivors at M3. The total AC/C0 ratio (normal ≤ 0.4) was 0.33 (0.24–0.39) at T0 and reached 0.39 (0.30–0.56) at M3 (p = 0.001). A ratio >0.4 was observed in 16/64 (25%) at T0 and in 32/64 (50%) at M3 (p = 0.006). The short-chain ACs decreased from 1.310 (0.927–1.829) at T0 to 0.945 (0.709–1.127) µmol/L at M3 (p < 0.001). In parallel, the urea/creatinine ratio and the Sarcopenic Index, respectively, decreased and increased between T0 and M3. This AC profile is suspected to signal a mitochondrial dysfunction and was, especially for short-chain ACs, a marker of protein catabolism. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

22 pages, 2522 KiB

Open AccessArticle

The Impact of Estimated Energy and Protein Balances on Extrauterine Growth in Preterm Infants

by Ioanna Lygerou, Stavroula Ilia, Panagiotis Briassoulis, Anna Manousaki, Marina Koropouli, Eleftheria Hatzidaki and George Briassoulis

Nutrients 2023, 15(16), 3556; https://doi.org/10.3390/nu15163556 - 11 Aug 2023

Viewed by 1008

Abstract

Background: Nutritional support of preterm infants remains a field of debate in the literature and clinical practice varies significantly. Adequate nutrition should promote growth and aim for optimal later neurodevelopment. However, it is often impaired by prematurity-associated morbidity and the physiologic immaturity of [...] Read more.

Background: Nutritional support of preterm infants remains a field of debate in the literature and clinical practice varies significantly. Adequate nutrition should promote growth and aim for optimal later neurodevelopment. However, it is often impaired by prematurity-associated morbidity and the physiologic immaturity of preterm infants. This study assessed the impact of energy and macronutrient provision on growth velocity and outcome and explored differences attributed to the heterogeneity of the preterm population. Methods: We retrospectively collected clinical and nutritional data from neonates hospitalized in two separate Neonatal Intensive Care Units (NICUs). Estimated energy and protein balance were calculated based on the ESPGHAN guidelines and their association with the growth outcome was explored. Growth assessment was based on somatometry Delta (Δ) z-scores at discharge. Results: In total, 174 neonates were included in the study. By day 14, most preterm infants were exclusively enterally fed, whereas there were infants in the <28 and 28–31⁺⁶ subgroups fed exclusively parenterally. Energy balance was positive for all gestational age (GA) subgroups except for those born <28 weeks. Protein balance was consistently positive for extremely premature but negative for late preterms. Cumulative substrates provisions were strong predictors of a positive energy or protein balance in the <34 weeks GA preterms on days 14 (ROC analyses, p < 0.001) and 7 (p < 0.05). A higher GA (p = 0.013) and enteral nutrition (p = 0.005) were additional predictors of a positive energy balance. All GA subgroups had a negative Δ z-score of weight at discharge. In the <34 GA subcohorts, a positive protein balance on day 14 (p = 0.009) and a short time to regain birth weight (exp(B) 3.1 (p = 0.004)) were independently associated with a positive Δ z-score of weight at discharge. Conclusions: Early achievement of a positive energy and protein balance, based on the ESPGHAN guidelines, is crucial to ensure optimal postnatal growth and prevent extrauterine growth restriction, a relatively common occurrence in preterm infants. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

12 pages, 2291 KiB

Open AccessArticle

Using Machine-Learning to Assess the Prognostic Value of Early Enteral Feeding Intolerance in Critically Ill Patients: A Retrospective Study

by Orit Raphaeli, Liran Statlender, Chen Hajaj, Itai Bendavid, Anat Goldstein, Eyal Robinson and Pierre Singer

Nutrients 2023, 15(12), 2705; https://doi.org/10.3390/nu15122705 - 10 Jun 2023

Cited by 2 | Viewed by 1281

Abstract

Background: The association between gastrointestinal intolerance during early enteral nutrition (EN) and adverse clinical outcomes in critically ill patients is controversial. We aimed to assess the prognostic value of enteral feeding intolerance (EFI) markers during early ICU stays and to predict early EN [...] Read more.

Background: The association between gastrointestinal intolerance during early enteral nutrition (EN) and adverse clinical outcomes in critically ill patients is controversial. We aimed to assess the prognostic value of enteral feeding intolerance (EFI) markers during early ICU stays and to predict early EN failure using a machine learning (ML) approach. Methods: We performed a retrospective analysis of data from adult patients admitted to Beilinson Hospital ICU between January 2011 and December 2018 for more than 48 h and received EN. Clinical data, including demographics, severity scores, EFI markers, and medications, along with 72 h after admission, were analyzed by ML algorithms. Prediction performance was assessed by the area under the receiver operating characteristics (AUCROC) of a ten-fold cross-validation set. Results: The datasets comprised 1584 patients. The means of the cross-validation AUCROCs for 90-day mortality and early EN failure were 0.73 (95% CI 0.71–0.75) and 0.71 (95% CI 0.67–0.74), respectively. Gastric residual volume above 250 mL on the second day was an important component of both prediction models. Conclusions: ML underlined the EFI markers that predict poor 90-day outcomes and early EN failure and supports early recognition of at-risk patients. Results have to be confirmed in further prospective and external validation studies. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

15 pages, 349 KiB

Open AccessArticle

Response to Intravenous N-Acetylcysteine Supplementation in Critically Ill Patients with COVID-19

by Yenifer Gamarra-Morales, Lourdes Herrera-Quintana, Jorge Molina-López, Héctor Vázquez-Lorente, Juan Francisco Machado-Casas, José Castaño-Pérez, José Miguel Pérez-Villares and Elena Planells

Nutrients 2023, 15(9), 2235; https://doi.org/10.3390/nu15092235 - 08 May 2023

Cited by 2 | Viewed by 2441

Abstract

Administering N-acetylcysteine (NAC) could counteract the effect of free radicals, improving the clinical evolution of patients admitted to the Intensive Care Unit (ICU). This study aimed to investigate the clinical and biochemical effects of administering NAC to critically ill patients with COVID-19. A [...] Read more.

Administering N-acetylcysteine (NAC) could counteract the effect of free radicals, improving the clinical evolution of patients admitted to the Intensive Care Unit (ICU). This study aimed to investigate the clinical and biochemical effects of administering NAC to critically ill patients with COVID-19. A randomized controlled clinical trial was conducted on ICU patients (n = 140) with COVID-19 and divided into two groups: patients treated with NAC (NAC-treated group) and patients without NAC treatment (control group). NAC was administered as a continuous infusion with a loading dose and a maintenance dose during the study period (from admission until the third day of ICU stay). NAC-treated patients showed higher PaO₂/FiO₂ (p ≤ 0.014) after 3 days in ICU than their control group counterparts. Moreover, C-reactive protein (p ≤ 0.001), D-dimer (p ≤ 0.042), and lactate dehydrogenase (p ≤ 0.001) levels decreased on the third day in NAC-treated patients. Glutathione concentrations decreased in both NAC-treated (p ≤ 0.004) and control (p ≤ 0.047) groups after 3 days in ICU; whereas glutathione peroxidase did not change during the ICU stay. The administration of NAC manages to improve the clinical and analytical response of seriously ill patients with COVID-19 compared to the control group. NAC is able to stop the decrease in glutathione concentrations. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

14 pages, 1544 KiB

Open AccessArticle

Citrulline, Intestinal Fatty Acid-Binding Protein and the Acute Gastrointestinal Injury Score as Predictors of Gastrointestinal Failure in Patients with Sepsis and Septic Shock

by Maciej Tyszko, Anna Lemańska-Perek, Jakub Śmiechowicz, Paulina Tomaszewska, Przemyslaw Biecek, Waldemar Gozdzik and Barbara Adamik

Nutrients 2023, 15(9), 2100; https://doi.org/10.3390/nu15092100 - 27 Apr 2023

Cited by 3 | Viewed by 1361

Abstract

Gastrointestinal (GI) failure can be both a cause of sepsis and a consequence of the systemic pro-inflammatory response in sepsis. Changes in biomarkers of enterocyte damage, citrulline and I-FABP (intestinal fatty acid binding protein), may indicate altered intestinal permeability and damage. The study [...] Read more.

Gastrointestinal (GI) failure can be both a cause of sepsis and a consequence of the systemic pro-inflammatory response in sepsis. Changes in biomarkers of enterocyte damage, citrulline and I-FABP (intestinal fatty acid binding protein), may indicate altered intestinal permeability and damage. The study group consisted of patients with sepsis (N = 28) and septic shock (N = 30); the control group included patients without infection (N = 10). Blood samples were collected for citrulline and I-FABP and a 4-point AGI score (acute GI injury score) was calculated to monitor GI function on days 1, 3, 5, 7, and 10. Citrulline concentrations in the study group were lower than in the control. Lower values were also noted in septic patients with shock when compared to the non-shock group throughout the study period. I-FABP was higher in the septic shock group than in the sepsis group only on days 1 and 3. Citrulline was lower in patients with GI failure (AGI III) when compared to AGI I/II, reaching significance on days 7 (p = 0.034) and 10 (p = 0.015); moreover, a higher AGI score was associated with an increased 28 day mortality (p = 0.038). The results indicate that citrulline measurements, along with the AGI assessment, have clinical potential in monitoring GI function and integrity in sepsis. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

13 pages, 741 KiB

Open AccessArticle

The NUTRIC Score as a Tool to Predict Mortality and Increased Resource Utilization in Intensive Care Patients with Sepsis

by Marek Wełna, Barbara Adamik, Andrzej Kübler and Waldemar Goździk

Nutrients 2023, 15(7), 1648; https://doi.org/10.3390/nu15071648 - 28 Mar 2023

Cited by 1 | Viewed by 1906

Abstract

The Nutrition Risk in Critically Ill score (NUTRIC) is an important nutritional risk assessment instrument for patients in the intensive care unit (ICU). The purpose of this study was to evaluate the power of the score to predict mortality in patients treated for [...] Read more.

The Nutrition Risk in Critically Ill score (NUTRIC) is an important nutritional risk assessment instrument for patients in the intensive care unit (ICU). The purpose of this study was to evaluate the power of the score to predict mortality in patients treated for sepsis and to forecast increased resource utilization and nursing workload in the ICU. The NUTRIC score predicted mortality (AUC 0.833, p < 0.001) with the optimal cut-off value of 6 points. Among patients with a score ≥ 6 on ICU admission, the 28-day mortality was 61%, and 10% with a score < 6 (p < 0.001). In addition, a NUTRIC score of ≥6 was associated with a more intense use of ICU resources, as evidenced by a higher proportion of patients requiring vasopressor infusion (98 vs. 82%), mechanical ventilation (99 vs. 87%), renal replacement therapy (54 vs. 26%), steroids (68 vs. 31%), and blood products (60 vs. 43%); the nursing workload was also significantly higher in this group. In conclusion, the NUTRIC score obtained at admission to the ICU provided a good discriminative value for mortality and makes it possible to identify patients who will ultimately require intense use of ICU resources and an associated increase in the nursing workload during treatment. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

13 pages, 1157 KiB

Open AccessArticle

Oxygen Consumption Predicts Long-Term Outcome of Patients with Left Ventricular Assist Devices

by Cecilia Veraar, Arabella Fischer, Martin H. Bernardi, Isabella Worf, Mohamed Mouhieddine, Thomas Schlöglhofer, Dominik Wiedemann, Martin Dworschak, Edda Tschernko, Andrea Lassnigg and Michael Hiesmayr

Nutrients 2023, 15(6), 1543; https://doi.org/10.3390/nu15061543 - 22 Mar 2023

Viewed by 1257

Abstract

Reduced oxygen consumption (VO₂), either due to insufficient oxygen delivery (DO₂), microcirculatory hypoperfusion and/or mitochondrial dysfunction, has an impact on the adverse short- and long-term survival of patients after cardiac surgery. However, it is still unclear whether VO₂ [...] Read more.

Reduced oxygen consumption (VO₂), either due to insufficient oxygen delivery (DO₂), microcirculatory hypoperfusion and/or mitochondrial dysfunction, has an impact on the adverse short- and long-term survival of patients after cardiac surgery. However, it is still unclear whether VO₂ remains an efficient predictive marker in a population in which cardiac output (CO) and consequently DO₂ is determined by a left ventricular assist device (LVAD). We enrolled 93 consecutive patients who received an LVAD with a pulmonary artery catheter in place to monitor CO and venous oxygen saturation. VO₂ and DO₂ of in-hospital survivors and non-survivors were calculated over the first 4 days. Furthermore, we plotted receiver-operating curves (ROC) and performed a cox-regression analysis. VO₂ predicted in-hospital, 1- and 6-year survival with the highest area under the curve of 0.77 (95%CI: 0.6–0.9; p = 0.0004). A cut-off value of 210 mL/min VO₂ stratified patients regarding mortality with a sensitivity of 70% and a specificity of 81%. Reduced VO₂ was an independent predictor for in-hospital, 1- and 6-year mortality with a hazard ratio of 5.1 (p = 0.006), 3.2 (p = 0.003) and 1.9 (p = 0.0021). In non-survivors, VO₂ was significantly lower within the first 3 days (p = 0.010, p < 0.001, p < 0.001 and p = 0.015); DO₂ was reduced on days 2 and 3 (p = 0.007 and p = 0.003). In LVAD patients, impaired VO₂ impacts short- and long-term outcomes. Perioperative and intensive care medicine must, therefore, shift their focus from solely guaranteeing sufficient oxygen supply to restoring microcirculatory perfusion and mitochondrial functioning. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

13 pages, 1405 KiB

Open AccessArticle

Prevalence of Four Sarcopenia Criteria in Older Patients with Cancer, and Their Predictive Value for 6-Month Mortality: The NutriAgeCancer National Prospective Cohort Study

by Claudia Martinez-Tapia, Kevin Rougette, Virginie Fossey-Diaz, Tristan Cudennec, Cherifa Taleb, Laurent Balardy, Cécile Mertens, Nathalie Mitha, Michael Bringuier, Karin Maley, Sandrine Estivin, Valérie Quipourt, Florence Canoui-Poitrine, Capucine Baldini, Johanne Poisson and Elena Paillaud

Nutrients 2023, 15(6), 1508; https://doi.org/10.3390/nu15061508 - 21 Mar 2023

Cited by 2 | Viewed by 1705

Abstract

Older cancer patients have an elevated risk of sarcopenia. The aim was to estimate the prevalence of four criteria for sarcopenia case finding, assessment, diagnosis, and severity determination: abnormal strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F), low [...] Read more.

Older cancer patients have an elevated risk of sarcopenia. The aim was to estimate the prevalence of four criteria for sarcopenia case finding, assessment, diagnosis, and severity determination: abnormal strength, assistance with walking, rising from a chair, climbing stairs, and falls (SARC-F), low hand-grip strength (HGS), low arm circumference (AC, a muscle mass proxy), and low physical performance (PP). Sarcopenia (low HGS and AC) and severe sarcopenia (low HGS, AC, and PP) and their predictive values for 6-month mortality were estimated in the whole population and by metastatic status. We analyzed data from the NutriAgeCancer French nationwide study of cancer patients aged ≥70 referred for geriatric assessment before anti-cancer treatment. We performed Cox proportional hazards analysis for each criterion separately and all criteria combined. Overall, 781 patients from 41 geriatric oncology clinics were included (mean age: 83.1; females: 53%; main cancer types: digestive (29%) and breast (17%); metastases: 42%). The prevalence of abnormal SARC-F, low HGS, a low AC, low PP, sarcopenia, and severe sarcopenia were, respectively, 35.5%, 44.6%, 44.7%, 35.2%, 24.5%, and 11.7%. An abnormal SARC-F and/or low HGS, sarcopenia, and severe sarcopenia were associated with 6-month mortality in patients with metastases (adjusted hazard ratios [95% confidence interval]: 2.72 [1.34–5.49], 3.16 [1.48–6.75] and 6.41 [2.5–16.5], respectively). Sarcopenia was strongly predictive of 6-month mortality in patients with metastatic cancer. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

11 pages, 1396 KiB

Open AccessArticle

Effect of Immuno-Nutrition on Malnutrition, Inflammatory Response and Clinical Course of Semi-Critically Ill COVID-19 Patients: A Pilot Perspective Study

by Marialaura Scarcella, Emidio Scarpellini, Sara Piergallini, Emanuele Rinninella, Karen Routhiaux, Carlo Rasetti, Ludovico Abenavoli, Edoardo De Robertis, Pietro Manzi, Rita Commissari, Riccardo Monti and Michela Zanetti

Nutrients 2023, 15(5), 1250; https://doi.org/10.3390/nu15051250 - 02 Mar 2023

Cited by 3 | Viewed by 2397

Abstract

Background: The SARS-COV 2 pandemic has hit on our lives since early 2020. During different contagion waves, both malnutrition and overweight significantly correlated with patient mortality. Immune-nutrition (IN) has shown promising results in the clinical course of pediatric inflammatory bowel disease (IBD) and [...] Read more.

Background: The SARS-COV 2 pandemic has hit on our lives since early 2020. During different contagion waves, both malnutrition and overweight significantly correlated with patient mortality. Immune-nutrition (IN) has shown promising results in the clinical course of pediatric inflammatory bowel disease (IBD) and in both the rate of extubation and mortality of patients admitted to an intensive care unit (ICU). Thus, we wanted to assess the effects of IN on a clinical course of patients admitted to a semi-intensive COVID-19 Unit during the fourth wave of contagion that occurred at the end of 2021. Methods: we prospectively enrolled patients admitted to the semi-intensive COVID-19 Unit of San Benedetto General hospital. All patients had a biochemical, anthropometric, high-resolution tomography chest scan (HRCT) and complete nutritional assessments at the time of admission, after oral administration of immune-nutrition (IN) formula, and at 15 days interval follow-up. Results: we enrolled 34 consecutive patients (age 70.3 ± 5.4 years, 6 F, BMI 27.0 ± 0.5 kg/m²). Main comorbidities were diabetes (20%, type 2 90 %), hyperuricemia (15%), hypertension (38%), chronic ischemic heart disease (8 %), COPD (8%), anxiety syndrome (5%), and depression (5%). 58% of patients were affected as moderately-to-severely overweight; mini nutritional assessment (MNA) score (4.8 ± 0.7) and phase angle (PA) values (3.8 ± 0.5) suggestive of malnutrition were present in 15% of patients, mainly with a history of cancer. After 15 days upon admission, we recorded 3 deaths (mean age 75.7 ± 5.1 years, BMI 26.3 ± 0.7 kg/m²) and 4 patients were admitted to the ICU. Following IN formula administration, inflammatory markers significantly decreased (p < 0.05) while BMI and PA did not worsen. These latter findings were not observed in a historical control group that did not receive IN. Only one patient needed protein-rich formula administration. Conclusions: in this overweight COVID-19 population immune-nutrition prevented malnutrition development with a significant decrease of inflammatory markers. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

14 pages, 859 KiB

Open AccessArticle

Factors Associated with Interruptions of Enteral Nutrition and the Impact on Macro- and Micronutrient Deficits in ICU Patients

by Arezina N. Kasti, Maria Theodorakopoulou, Konstantinos Katsas, Kalliopi D. Synodinou, Maroulla D. Nikolaki, Alice Efstathia Zouridaki, Stylianos Fotiou, Aliki Kapetani and Apostolos Armaganidis

Nutrients 2023, 15(4), 917; https://doi.org/10.3390/nu15040917 - 11 Feb 2023

Cited by 2 | Viewed by 2737

Abstract

Background and Aim: Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. [...] Read more.

Background and Aim: Feeding interruptions in critical care patients are often unjustified. We aimed to determine the causes, duration, and frequency of enteral nutrition interruptions (ENIs) and to assess macronutrients and antioxidant deficits according to European Society of Parenteral Enteral Nutrition (ESPEN) guidelines. Methods: We prospectively enrolled Intensive Care Unit (ICU) patients admitted for more than 48 h with an inability to orally eat from April to December 2019. The type of enteral nutrition, the number of calories administered, the time of feeding initiation, the reasons for delaying feeding, and the causes for ENI were recorded. Results: 81 patients were enrolled, with a median duration of ENIs of 5.2 (3.4–7.4) hours/day. Gastric residual volume (GRV) monitoring—a highly controversial practice—was the most common cause of ENI (median duration 3 (2.3–3) hours/day). The mean energy intake was 1037 ± 281 kcal/day, while 60.5% of patients covered less than 65% of the total energy needs (1751 ± 295 kcal/day, according to mean Body Mass Index (BMI)). The median daily protein intake did not exceed 0.43 ± 0.3 gr/kg/day of the actual body weight (BW), whereas ESPEN recommends 1.3 gr/kg/day for adjusted BW (p < 0.001). The average administration of micronutrients and antioxidants (arginine, selenium, zinc, vitamins) was significantly less than the dietary reference intake (p < 0.01). Conclusion: ENIs lead to substantial caloric, protein, and antioxidant deficits. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Graphical abstract

16 pages, 1627 KiB

Open AccessArticle

Do Body Mass Index and Nutritional Risk Score 2002 Influence the In-Hospital Mortality of Patients Following Cardiac Arrest?

by Piotr Fehler, Marzena Zielińska, Bartosz Uchmanowicz, Raúl Juárez-Vela, Łukasz Lewandowski, Stanisław Zieliński and Michał Czapla

Nutrients 2023, 15(2), 436; https://doi.org/10.3390/nu15020436 - 14 Jan 2023

Cited by 5 | Viewed by 2268

Abstract

Background: Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS [...] Read more.

Background: Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS 2002) results and in-hospital mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. Methods: A retrospective study and analysis of medical records of 161 patients admitted to the ICU of the University Clinical Hospital in Wrocław (Wrocław, Poland) was conducted. Results: No significant differences in body mass index (BMI) and nutritional risk score (NRS 2002) values were observed between non-survivors and survivors. Non-survivors had significantly lower albumin concentration (p = 0.017) and total cholesterol (TC) (p = 0.015). In multivariate analysis BMI and NRS 2002 scores were not, per se, associated with the in-hospital mortality defined as the odds of death (Model 1: p: 0.700, 0.430; Model 2: p: 0.576, 0.599). Univariate analysis revealed significant associations between the hazard ratio (HR) and TG (p ≈ 0.017, HR: 0.23) and hsCRP (p ≈ 0.018, HR: 0.34). In multivariate analysis, mortality risk over time was influenced by higher scores in parameters such as BMI (HR = 0.164; p = 0.048) and hsCRP (HR = 1.006, p = 0.002). Conclusions: BMI and NRS 2002, on their own (unconditionally – in the whole study group) did not alter the odds of mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. The risk of in-hospital mortality (expressed as hazard ratio – the risk over the time period of the study) increased with an increase in BMI but not with NRS 2002. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

13 pages, 520 KiB

Open AccessArticle

Dairy Food Consumption Is Associated with Reduced Risk of Heart Disease Mortality, but Not All-Cause and Cancer Mortality in US Adults

by Yanni Papanikolaou and Victor L. Fulgoni III

Nutrients 2023, 15(2), 394; https://doi.org/10.3390/nu15020394 - 12 Jan 2023

Cited by 2 | Viewed by 2366

Abstract

Previous evidence has linked animal protein intake, including dairy foods, with an increased risk in mortality from all-causes and certain chronic diseases, including cancer and heart disease. The objective of the current analysis was to examine associations between total dairy consumption with mortality [...] Read more.

Previous evidence has linked animal protein intake, including dairy foods, with an increased risk in mortality from all-causes and certain chronic diseases, including cancer and heart disease. The objective of the current analysis was to examine associations between total dairy consumption with mortality from all-causes, cancer, and heart disease. Data for adults (≥19 y; n = 54,830) from the Third National Health and Nutrition Examination Survey (NHANES) and NHANES 1999–2014 were linked with mortality data through 2015. Individual usual intake for dairy foods were estimated using the National Cancer Institute method. Hazard ratio (HR) models were fit for mortality types (all cause, cancer, heart disease) and measures of usual intakes of dairy. Multivariable analysis further adjusted for age, gender, ethnicity, waist circumference, smoking status, education level, chronic condition status (i.e., based on cancer, myocardial infarct, and diabetes/diabetes medication reported), weight loss attempts, and % kcal from animal protein. No associations were seen between dairy food intake and mortality risk from all-causes [HR = 0.97; confidence intervals (CI): 0.85–1.11; p = 0.67], and cancer [HR = 0.95; CI: 0.75–1.20; p = 0.65] when comparing the lowest quartile to the highest quartile of consumption. Dairy food consumption was associated with a 26% reduced risk for heart disease mortality when comparing the lowest quartile to the highest quartile [HR = 0.74; CI: 0.54–1.01; p = 0.05]. Further analyses in different age groups showed that dairy food consumption was associated with 39% and 31% reduced risk for heart disease mortality in older adults 51–70 and ≥51 y, respectively [adults 51–70 y: HR = 0.61; CI: 0.41–0.91; p = 0.01; adults ≥51 y: HR = 0.69; CI: 0.54–0.89; p = 0.004]. These results contradict previous findings that have linked dairy foods to increased mortality risk. Further, dairy foods as part of a healthy dietary pattern, may help lower heart disease mortality risk. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

15 pages, 1003 KiB

Open AccessArticle

Resting Energy Expenditure in the Critically Ill and Healthy Elderly—A Retrospective Matched Cohort Study

by Matthias Lindner, Corinna Geisler, Kristina Rembarz, Lars Hummitzsch, David I. Radke, Dominik M. Schulte, Manfred J. Müller, Anja Bosy-Westphal and Gunnar Elke

Nutrients 2023, 15(2), 303; https://doi.org/10.3390/nu15020303 - 07 Jan 2023

Cited by 2 | Viewed by 2215

Abstract

The use of indirect calorimetry to measure resting energy expenditure (mREE) is widely recommended as opposed to calculating REE (cREE) by predictive equations (PE). The aim of this study was to compare mREE with cREE in critically ill, mechanically ventilated patients aged ≥ [...] Read more.

The use of indirect calorimetry to measure resting energy expenditure (mREE) is widely recommended as opposed to calculating REE (cREE) by predictive equations (PE). The aim of this study was to compare mREE with cREE in critically ill, mechanically ventilated patients aged ≥ 75 years and a healthy control group matched by age, gender and body mass index. The primary outcome was the PE accuracy rate of mREE/cREE, derived using Bland Altman plots. Secondary analyses included linear regression analyses for determinants of intraindividual mREE/cREE differences in the critically ill and interindividual mREE differences in the matched healthy cohort. In this retrospective study, 90 critically ill patients (median age 80 years) and 58 matched healthy persons were included. Median mREE was significantly higher in the critically ill (1457 kcal/d) versus the healthy cohort (1351 kcal/d), with low PE accuracy rates (21% to 49%). Independent predictors of mREE/cREE differences in the critically ill were body temperature, heart rate, FiO₂, hematocrit, serum sodium and urea. Body temperature, respiratory rate, and FiO₂ were independent predictors of interindividual mREE differences (critically ill versus healthy control). In conclusion, the commonly used PE in the elderly critically ill are inaccurate. Respiratory, metabolic and energy homeostasis variables may explain intraindividual mREE/cREE as well as interindividual mREE differences. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

21 pages, 3648 KiB

Open AccessArticle

Ex Vivo Evaluation of Glutamine Treatment in Sepsis and Trauma in a Human Peripheral Blood Mononuclear Cells Model

by Efrossini Briassouli, Marianna Tzanoudaki, Dimitris Goukos, Kostas Vardas, Panagiotis Briassoulis, Stavroula Ilia, Maria Kanariou, Christina Routsi, Serafim Nanas, George L. Daikos and George Briassoulis

Nutrients 2023, 15(1), 252; https://doi.org/10.3390/nu15010252 - 03 Jan 2023

Viewed by 2693

Abstract

We aimed to assess the lipopolysaccharide (LPS), or heat shock (HS) induction, and glutamine-modulating effects on heat shock protein-90α (HSP90α) and cytokines in an ex vivo model using peripheral blood mononuclear cells (PBMCs). The PBMCs of patients with septic shock, trauma-related systemic inflammatory [...] Read more.

We aimed to assess the lipopolysaccharide (LPS), or heat shock (HS) induction, and glutamine-modulating effects on heat shock protein-90α (HSP90α) and cytokines in an ex vivo model using peripheral blood mononuclear cells (PBMCs). The PBMCs of patients with septic shock, trauma-related systemic inflammatory response syndrome (SIRS), and healthy subjects were incubated with 1 μg/mL LPS at 43 °C (HS). Glutamine 10 mM was added 1 hour before or after induction or not at all. We measured mRNA HSP90α, monocyte (m) and lymphocyte (l) HSP90α proteins, interleukin (IL)-1b, -6, -8, -10, tumor necrosis factor-α (TNF-α), and monocyte chemoattractant protein-1 (MCP-1) supernatant levels. Heat shock increased the HSP90α mRNA and mHSP90α in all groups (10-fold in sepsis, p < 0.001 and p = 0.047, respectively). LPS induced the mHSP90α and lHSP90α in healthy (p < 0.001) and mHSP90α in SIRS (p = 0.004) but not in sepsis. LPS induced the cytokines at 24 and 48 h in all groups, especially in trauma (p < 0.001); HS only induced the IL-8 in healthy (p = 0.003) and septic subjects (p = 0.05). Glutamine at 10 mM before or after stimulation did not alter any induction effect of LPS or HS on HSP90α mRNA and mHSP90α protein in sepsis. In SIRS, glutamine before LPS decreased the mHSP90α but increased it when given after HS (p = 0.018). Before or after LPS (p = 0.049) and before HS (p = 0.018), glutamine decreased the lHSP90α expression in sepsis but increased it in SIRS when given after HS (p = 0.003). Regarding cytokines, glutamine enhanced the LPS-induced MCP-1 at 48 h in healthy (p = 0.011), SIRS (p < 0.001), and sepsis (p = 0.006). In conclusion, glutamine at 10 mM, before or after LPS and HS, modulates mHSP90α and lHSP90α in sepsis and SIRS differently and unpredictably. Although it does not alter the stimulation effect on interleukins, glutamine enhances the LPS induction effect on supernatant MCP-1 in all groups. Future research should seek to elucidate better the impact of glutamine and temperature modulation on HSP90α and MCP-1 pathways in sepsis and trauma. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Graphical abstract

17 pages, 1866 KiB

Open AccessArticle

External Validation with Accuracy Confounders of VCO₂-Derived Predicted Energy Expenditure Compared to Resting Energy Expenditure Measured by Indirect Calorimetry in Mechanically Ventilated Children

by Panagiotis Briassoulis, Stavroula Ilia, Efrossini Briassouli and George Briassoulis

Nutrients 2022, 14(19), 4211; https://doi.org/10.3390/nu14194211 - 10 Oct 2022

Cited by 4 | Viewed by 1658

Abstract

Optimal energy provision, guided by measured resting energy expenditure (REE) and determined by indirect calorimetry (IC), is fundamental in Intensive Care Units (ICU). Because IC availability is limited, methods to predict REE based on carbon dioxide production (VCO₂) measurements (REE_VCO2 [...] Read more.

Optimal energy provision, guided by measured resting energy expenditure (REE) and determined by indirect calorimetry (IC), is fundamental in Intensive Care Units (ICU). Because IC availability is limited, methods to predict REE based on carbon dioxide production (VCO₂) measurements (REE_VCO2) alone have been proposed as a surrogate for REE measured by IC (REE_IC). The study aimed at externally and internally validating the accuracy of the REE_VCO2 as an alternative to REE_IC in mechanically ventilated children. A ventilator’s integrated gas exchange module (E-COVX) was used to prospectively measure REE_IC and predict REE_VCO2 on 107 mechanically ventilated children during the first 24 h of admission. The accuracy of the REE_VCO2 compared to REE_IC was assessed through the calculation of bias and precision, paired median differences, linear regression, and ROC analysis. Accuracy within ±10% of the REE_IC was deemed acceptable for the REE_VCO2 equation. The calculated REE_VCO2 based on respiratory quotient (RQ) 0.89 resulted in a mean bias of −72.7 kcal/day (95% limits of agreement −321.7 to 176.3 kcal/day) and a high coefficient of variation (174.7%), while 51.4% of the calculations fell outside the ±10% accuracy rate. REE_VCO2 derived from RQ 0.80 or 0.85 did not improve accuracy. Only measured RQ (Beta 0.73, p < 0.001) and no-recorded neuromuscular blocking agents (Beta −0.13, p = 0.044) were independently associated with the REE_VCO2−REE_IC difference. Among the recorded anthropometric, metabolic, nutrition, or clinical variables, only measured RQ was a strong predictor of REE_VCO2 inaccuracy (p < 0.001). Cutoffs of RQ = 0.80 predicted 89% of underestimated REE_IC (sensitivity 0.99; specificity 0.89) and RQ = 0.82 predicted 56% of overestimated REE_IC (sensitivity of 0.99; specificity 0.56). REE_VCO2 cannot be recommended as an alternative to REE_IC in mechanically ventilated children, regardless of the metabolic, anthropometric, or clinical status at the time of the evaluation. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

15 pages, 1761 KiB

Open AccessArticle

External Validation of Equations to Estimate Resting Energy Expenditure in Critically Ill Children and Adolescents with and without Malnutrition: A Cross-Sectional Study

by George Briassoulis, Efrossini Briassouli, Stavroula Ilia and Panagiotis Briassoulis

Nutrients 2022, 14(19), 4149; https://doi.org/10.3390/nu14194149 - 06 Oct 2022

Cited by 3 | Viewed by 1391

Abstract

We evaluated the validity of sixteen predictive energy expenditure equations for resting energy expenditure estimation (eREE) against measured resting energy expenditure using indirect calorimetry (REE_IC) in 153 critically ill children. Predictive equations were included based on weight, height, sex, and age. [...] Read more.

We evaluated the validity of sixteen predictive energy expenditure equations for resting energy expenditure estimation (eREE) against measured resting energy expenditure using indirect calorimetry (REE_IC) in 153 critically ill children. Predictive equations were included based on weight, height, sex, and age. The agreement between eREE and REE_IC was analyzed using the Bland–Altman method. Precision was defined by the 95% limits of the agreement; differences > ±10% from REE_IC were considered clinically unacceptable. The reliability was assessed by the intraclass correlation coefficient (Cronbach’s alpha). The influence of anthropometric, nutritional, and clinical variables on REE_IC was also assessed. Thirty (19.6%) of the 153 enrolled patients were malnourished (19.6%), and fifty-four were overweight (10.5%) or obese (24.8%). All patients received sedation and analgesia. Mortality was 3.9%. The calculated eREE either underestimated (median 606, IQR 512; 784 kcal/day) or overestimated (1126.6, 929; 1340 kcal/day) REE_IC compared with indirect calorimetry (928.3, 651; 1239 kcal/day). These differences resulted in significant biases of −342 to 592 kcal (95% limits of agreement (precision)−1107 to 1380 kcal/day) and high coefficients of variation (up to 1242%). Although predicted equations exhibited moderate reliability, the clinically acceptable ±10% accuracy rate ranged from only 6.5% to a maximum of 24.2%, with the inaccuracy varying from −31% to +71.5% of the measured patient’s energy needs. REE_IC (p = 0.017) and eREE (p < 0.001) were higher in the underweight compared to overweight and obese patients. Apart from a younger age, malnutrition, clinical characteristics, temperature, vasoactive drugs, neuromuscular blockade, and energy intake did not affect REE_IC and thereby predictive equations’ accuracy. Commonly used predictive equations for calculating energy needs are inaccurate for individual patients, either underestimating or overestimating REE_IC compared with indirect calorimetry. Altogether these findings underscore the urgency for measuring REE_IC in clinical situations where accurate knowledge of energy needs is vital. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

10 pages, 633 KiB

Open AccessArticle

Measured Energy Expenditure Using Indirect Calorimetry in Post-Intensive Care Unit Hospitalized Survivors: A Comparison with Predictive Equations

by Anne-Françoise Rousseau, Marjorie Fadeur, Camille Colson and Benoit Misset

Nutrients 2022, 14(19), 3981; https://doi.org/10.3390/nu14193981 - 25 Sep 2022

Cited by 5 | Viewed by 1991

Abstract

Actual energy needs after a stay in intensive care units (ICUs) are unknown. The aims of this observational study were to measure the energy expenditure (mEE) of ICU survivors during their post-ICU hospitalization period, and to compare this to the estimations of predictive [...] Read more.

Actual energy needs after a stay in intensive care units (ICUs) are unknown. The aims of this observational study were to measure the energy expenditure (mEE) of ICU survivors during their post-ICU hospitalization period, and to compare this to the estimations of predictive equations (eEE). Survivors of an ICU stay ≥ 7 days were enrolled in the general ward during the first 7 days after ICU discharge. EE was measured using the Q-NRG calorimeter in canopy mode. This measure was compared to the estimated EE using the Harris–Benedict (HB) equation multiplied by a 1.3 stress factor, the Penn–State (PS) equation or the 30 kcal weight-based (WB) equation. A total of 55 adults were included (67.3% male, age 60 (52–67) y, body mass index 26.1 (22.2–29.7) kg/m²). Indirect calorimetry was performed 4 (3–6) d after an ICU stay of 12 (7–16) d. The mEE was 1682 (1328–1975) kcal/d, corresponding to 22.9 (19.1–24.2) kcal/kg/day. The eEE values derived using HB and WB equations were significantly higher than mEE: 3048 (1805–3332) and 2220 (1890–2640) kcal/d, respectively (both p < 0.001). There was no significant difference between mEE and eEE using the PS equation: 1589 (1443–1809) kcal/d (p = 0.145). The PS equation tended to underestimate mEE with a bias of −61.88 kcal and a wide 95% limit of agreement (−717.8 to 594 kcal). Using the PS equation, agreement within 15% of the mEE was found in 32/55 (58.2%) of the patients. In the present cohort of patients who survived a prolonged ICU stay, mEE was around 22–23 kcal/kg/day. In this post-ICU hospitalization context, none of the tested equations were accurate in predicting the EE measured by indirect calorimetry. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

13 pages, 690 KiB

Open AccessArticle

Adequacy of Nutritional Intakes during the Year after Critical Illness: An Observational Study in a Post-ICU Follow-Up Clinic

by Anne-Françoise Rousseau, Sara Lucania, Marjorie Fadeur, Anne-Marie Verbrugge, Etienne Cavalier, Camille Colson and Benoit Misset

Nutrients 2022, 14(18), 3797; https://doi.org/10.3390/nu14183797 - 15 Sep 2022

Cited by 6 | Viewed by 1597

Abstract

Whether nutritional intakes in critically ill survivors after hospital discharge are adequate is unknown. The aims of this observational study were to describe the energy and protein intakes in ICU survivors attending a follow-up clinic compared to empirical targets and to explore differences [...] Read more.

Whether nutritional intakes in critically ill survivors after hospital discharge are adequate is unknown. The aims of this observational study were to describe the energy and protein intakes in ICU survivors attending a follow-up clinic compared to empirical targets and to explore differences in outcomes according to intake adequacy. All adult survivors who attended the follow-up clinic at 1, 3 and 12 months (M1, M3, M12) after a stay in our intensive care unit (ICU) ≥ 7 days were recruited. Average energy and protein intakes over the 7 days before the face-to-face consultation were quantified by a dietician using food anamnesis. Self-reported intakes were compared empirically to targets for healthy people (FAO/WHO/UNU equations), for critically ill patients (25 kcal/kg/day and 1.3 g protein/kg/day). They were also compared to targets that are supposed to fit post-ICU patients (35 kcal/kg/day and 1.5 g protein/kg/day). Blood prealbumin level and handgrip strength were also measured at each timepoint. A total of 206 patients were analyzed (49, 97 and 60 at the M1, M3 and M12, respectively). At M1, M3 and M12, energy intakes were 73.2 [63.3–86.3]%, 79.3 [69.3–89.3]% and 82.7 [70.6–93.7]% of healthy targets (p = 0.074), respectively. Protein intakes were below 0.8 g/kg/day in 18/49 (36.7%), 25/97 (25.8%) and 8/60 (13.3%) of the patients at M1, M3 and M12, respectively (p = 0.018), and the protein intakes were 67.9 [46.5–95.8]%, 68.5 [48.8–99.3]% and 71.7 [44.9–95.1]% of the post-ICU targets (p = 0.138), respectively. Prealbumin concentrations and handgrip strength were similar in patients with either inadequate energy intakes or inadequate protein intakes, respectively. In our post-ICU cohort, up to one year after discharge, energy and protein intakes were below the targets that are supposed to fit ICU survivors in recovery phase. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

11 pages, 646 KiB

Open AccessArticle

Vitamin D Status in Critically Ill Patients with SIRS and Its Relationship with Circulating Zn and Related Parameters during ICU Stay

by Lourdes Herrera-Quintana, Héctor Vázquez-Lorente, Jorge Molina-López, Yenifer Gamarra-Morales, Javier Ignacio Martín-López and Elena Planells

Nutrients 2022, 14(17), 3580; https://doi.org/10.3390/nu14173580 - 30 Aug 2022

Cited by 2 | Viewed by 1541

Abstract

Critically ill patients are exposed to different stressors which may generate Systemic Inflammatory Response Syndrome (SIRS). This situation hinders the assessment of micronutrients status, such as vitamin D or Zinc (Zn), potentially affecting patients’ treatment and recovery. The aim of the present study [...] Read more.

Critically ill patients are exposed to different stressors which may generate Systemic Inflammatory Response Syndrome (SIRS). This situation hinders the assessment of micronutrients status, such as vitamin D or Zinc (Zn), potentially affecting patients’ treatment and recovery. The aim of the present study was to assess the evolution of circulating 25–Hydroxyvitamin D (25–OH–D) levels after seven days of Intensive Care Unit (ICU) stay and the influence on changes in plasma and erythrocyte Zn levels, as well as other parameters related to phosphorus–calcium metabolism. A prospective analytical study was conducted on 65 critically ill patients (42% women) aged 31–77 years with SIRS. Total 25–OH–D levels were measured in plasma samples by liquid chromatography-tandem mass spectrometry, and Zn content was analyzed by flame atomic absorption spectrometry. Both 25–OH–D and 25–OH–D₃ levels were directly associated with erythrocyte Zn concentration at follow-up (p = 0.046 and p = 0.011, respectively). A relationship between erythrocyte and plasma Zn was also found at this follow-up point. No such clear associations were found when considering 25–OH–D₂. Different disturbances in levels of phosphorus–calcium metabolism parameters were found, suggesting a relationship between the changes of 25–OH–D₃ levels and parathormone (p = 0.019) and phosphorus (p = 0.005). The findings of the present study suggest an interaction between vitamin D and Zn, in which the correct status of these micronutrients could be a potentially modifiable factor and a beneficial approach in the recovery of critically ill patients. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

Review

Jump to: Research, Other

11 pages, 281 KiB

Open AccessReview

Biomarkers and Functional Assays of Epithelial Barrier Disruption and Gastrointestinal Dysmotility in Critical Illness—A Narrative Review

by Julianna Martinez, K. Marco Rodriguez Hovnanian and Enid E. Martinez

Nutrients 2023, 15(18), 4052; https://doi.org/10.3390/nu15184052 - 19 Sep 2023

Viewed by 1020

Abstract

Enteral nutrition in critically ill children has been associated with improved clinical outcomes. Gastrointestinal dysfunction often impedes the timely initiation and advancement of enteral nutrition and can contribute to immune dysregulation and systemic inflammation. Therefore, assessing gastrointestinal function, at a cellular and functional [...] Read more.

Enteral nutrition in critically ill children has been associated with improved clinical outcomes. Gastrointestinal dysfunction often impedes the timely initiation and advancement of enteral nutrition and can contribute to immune dysregulation and systemic inflammation. Therefore, assessing gastrointestinal function, at a cellular and functional level, is important to provide optimal enteral nutrition therapy and reduce the gastrointestinal tract’s contribution to the inflammatory cascade of critical illness. In this narrative review, we present an overview of biomarker and functional assays for gastrointestinal dysfunction, including epithelial barrier disruption and gastrointestinal dysmotility, that have been considered for critically ill patients. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

19 pages, 319 KiB

Open AccessReview

Favism: Clinical Features at Different Ages

by Alice Beretta, Matteo Manuelli and Hellas Cena

Nutrients 2023, 15(2), 343; https://doi.org/10.3390/nu15020343 - 10 Jan 2023

Cited by 2 | Viewed by 5353

Abstract

Favism is a hemolytic disease due to the ingestion of fava beans in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. There is wide inter- and intra-individual variability in the development of hemolytic crisis, and several factors influence it: quantity, quality, ripeness of fava beans, [...] Read more.

Favism is a hemolytic disease due to the ingestion of fava beans in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. There is wide inter- and intra-individual variability in the development of hemolytic crisis, and several factors influence it: quantity, quality, ripeness of fava beans, and age of onset. In this narrative review of case reports and case series, we reported the predisposing factors and clinical features for four different age groups classified as follows: pregnant women and infants (i.e., exclusively breastfed children); children, from weaned to 11 years; preadolescents and adolescents, from 11 to 18 years; and adults (18 years and older). Some symptoms developed only in specific age groups: death in infants; visual impairment in children; systolic murmur in infants, children, and adolescents; and renal failure in adults. In youngest children or pregnant women the severity is the highest. Some other symptoms were present in all: jaundice, increased bilirubin, splenomegaly, hepatomegaly, discolored urine, tachycardia, pallor, abdominal pain, malaise, vomit, nausea, and dizziness. Laboratory findings are characterized by anemia, reticulocytosis, elevated bilirubin level, and sometimes urinary urobilinogen and methemoglobinemia. In most cases the symptomatology is self-limited and does not release sequelae, but hospitalization and transfusion are often required. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

Other

Jump to: Research, Review

11 pages, 853 KiB

Open AccessSystematic Review

The Effectiveness of Early Enteral Nutrition on Clinical Outcomes in Critically Ill Sepsis Patients: A Systematic Review

by Sun Jae Moon, Ryoung-Eun Ko, Chi-Min Park, Gee Young Suh, Jinseub Hwang and Chi Ryang Chung

Nutrients 2023, 15(14), 3201; https://doi.org/10.3390/nu15143201 - 19 Jul 2023

Cited by 1 | Viewed by 2036

Abstract

The optimal timing of enteral nutrition (EN) in sepsis patients is controversial among societal guidelines. We aimed to evaluate the evidence of early EN’s impact on critically ill sepsis patients’ clinical outcomes. We searched the MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, and ICTRP [...] Read more.

The optimal timing of enteral nutrition (EN) in sepsis patients is controversial among societal guidelines. We aimed to evaluate the evidence of early EN’s impact on critically ill sepsis patients’ clinical outcomes. We searched the MEDLINE, Embase, CINAHL, Cochrane Library, ClinicalTrials.gov, and ICTRP databases on 10 March 2023. We included studies published after 2004 that compared early EN versus delayed EN in sepsis patients. We included randomized controlled trials (RCTs), non-RCTs, cohort studies, and case–control studies. Forest plots were used to summarize risk ratios (RRs), including mortality and mean difference (MD) of continuous variables such as intensive care unit (ICU) length of stay and ventilator-free days. We identified 11 eligible studies with sample sizes ranging from 31 to 2410. The RR of short-term mortality from three RCTs was insignificant, and the MD of ICU length of stay from two RCTs was −2.91 and −1.00 days (95% confidence interval [CI], −5.53 to −0.29 and −1.68 to −0.32). Although the RR of intestinal-related complications from one RCT was 3.82 (95% CI, 1.43 to 10.19), indicating a significantly higher risk for the early EN group than the control group, intestinal-related complications of EN reported in five studies were inconclusive. This systematic review did not find significant benefits of early EN on mortality in sepsis patients. Evidence, however, is weak due to inconsistent definitions, heterogeneity, risk of bias, and poor methodology in the existing studies. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

► Show Figures

Figure 1

9 pages, 273 KiB

Open AccessBrief Report

Serum Acylcarnitines Profile in Critically Ill Survivors According to Illness Severity and ICU Length of Stay: An Observational Study

by Anne-Françoise Rousseau, Alice Dongier, Camille Colson, Pauline Minguet, Jean-Olivier Defraigne, Grégory Minguet, Benoit Misset and François Boemer

Nutrients 2023, 15(10), 2392; https://doi.org/10.3390/nu15102392 - 19 May 2023

Cited by 2 | Viewed by 938

Abstract

The acylcarnitine (AC) profile has been shown to be altered in survivors of a prolonged stay in intensive care unit (ICU), with higher short-chain derivates compared to reference ranges. The present study aimed at describing the AC profile of patients surviving a short [...] Read more.

The acylcarnitine (AC) profile has been shown to be altered in survivors of a prolonged stay in intensive care unit (ICU), with higher short-chain derivates compared to reference ranges. The present study aimed at describing the AC profile of patients surviving a short ICU stay versus patients surviving a >7-day multiple organ dysfunction. Patients discharged from ICU after an elective and non-complicated cardiac surgery (CS) were recruited. For each CS, one to two adults, matched for gender and age, were recruited among patients enrolled in our post-ICU follow-up program after an ICU stay ≥7 days (PS). In both groups, the AC profile was determined during the week following ICU discharge. A total of 50 CS patients (SAPS II 23 (18–27)) survived an ICU stay of 2 (2–3) days and were matched to 85 PS patients (SAPS II 36 (28–51), p < 0.001) who survived an ICU stay of 11 (8–15.5) days. No carnitine deficiency was observed in either group. Their total AC/C0 ratio was similar: 0.355 (0.268–0.415) and 0.358 (0.289–0.417), respectively (p = 0.391). A ratio >0.4 representing a disturbed mitochondrial metabolism was observed in 26/85 (30.6%) PS patients and in 15/50 (30%) CS patients (p > 0.999). The long-chain ACs were elevated in both groups, with a greater increase in the CS group. The short-chain ACs were higher in the PS group: 1.520 (1.178–1.974) vs. 1.185 (0.932–1.895) μmol/L (p < 0.001). The role of the AC profile as potential marker of catabolism and/or mitochondrial dysfunction during the critical illness trajectory should be further investigated. Full article

(This article belongs to the Special Issue Nutrition and Critical Illness)

Journal Menu

Journal Browser

Nutrition and Critical Illness

Share This Special Issue

Special Issue Editors

Special Issue Information

Keywords

Published Papers (24 papers)

Research

Review

Other

Further Information

Guidelines

MDPI Initiatives

Follow MDPI