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Medical nutrition therapy (MNT) is the foundation of the comprehensive treatment of patients with diabetes. In 2010, the Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association developed the first Chinese guideline on MNT for patients with diabetes, and it was updated in 2015. Since then, new evidence has emerged in the field of MNT and metabolic therapy in patients with diabetes. The Nutrition and Metabolic Management Branch of the China International Exchange and Promotive Association for Medical and Health Care organized a team of experts from related institutions, including the Clinical Nutrition Branch of the Chinese Nutrition Society, Chinese Diabetes Society, Chinese Society for Parenteral and Enteral Nutrition, and Chinese Clinical Nutritionist Center of the Chinese Medical Doctor Association. Their task was to develop the Chinese Guidelines of Medical Nutrition Therapy in Diabetes (2022 Edition) in accordance with the requirements of the Guidelines for the Formulation/Revision of Clinical Guidelines in China (2022 Edition) by combining the questions raised and evidence gathered in clinical practices in China, to guide and standardize the clinical MNT. [ABSTRACT FROM AUTHOR]

Obesity has become a global "epidemic". At this stage, overweight / obesity has become a major public health problem that seriously affects not only adults but also children and adolescents worldwide. Medical nutritional therapy is the basic treatment for obesity and an indispensable measure for prevention and control at any stage in the course of obesity. Management of co-morbidities and improving the quality of life of obese patients are also included in treatment aims. In recent years, there have been some guidelines on the nutrition management of overweight/obesity. However, the management of nutrition and lifestyle interventions must be compatible with specific regional dietary habits and social culture. To provide a clinical reference for the standardized treatment and management of overweight / obesity, guidelines for medical nutrition treatment of overweight/obesity in China (2021) were published, which cover the relationship of weight loss with different dietary patterns, meal replacement foods, biorhythms, intestinal microecology, metabolic surgery, and medical nutritional intervention, as well as weight loss in special populations. We hope the guidelines will improve the awareness of the importance of nutrition intervention in the treatment of metabolic disease, further regulate the principle and approach of medical nutrition therapy, and establish a workflow of standardized medical nutrition therapy for weight loss management so that more clinical nutrition professionals and medical staff can use it to provide better services for obese people. [ABSTRACT FROM AUTHOR]

Background and Objectives: To investigate the Intensivists' cognizance of nutritional management and its determinants, and to provide evidence for standardizing nutritional therapy with protocols.Methods and Study Design: From April to July 2021, a multi-stage sampling method was used to investigate the nutritional cognizance of critical care physicians in secondary and tertiary hospitals in Guizhou Province, China; Questionnaires and scales were used as survey tools. The questionnaires sought general information about the respondents and documented their nutrition cognizance and practice. Five scalar dimensions explored nutritional management, with answers scored for 1-5 points, 3 points being the pass score.Results: 322 respondents from 147 hospitals were surveyed. The average score was passable, but not good at 3.37±0.71 (p<0.01 with 3.0 as reference). Among the five dimensions, evaluation and monitoring of nutritional status had the highest score (3.79±0.67, p<0.01), the understanding of nutritional preparations had the lowest (3.09±0.86, p>0.05), and the scores of other dimensions ranged from 3.21 to 3.49. Almost 70% of intensivists said that they would give priority to other than nutritional therapeutic measures in actual clinical practice. But 96% thought it necessary to strengthen and emphasise nutritional management.Conclusions: Critical care physicians' knowledge and understanding of nutritional therapy are limited, especially in the use of supportive preparations; Recourse to protocols and standardized nutritional management of assistance may depend on training, assigned role, peer expectations and health system policy, each of which has the potential for advancement in the interest of better nutritional care in provincial Guizhou. [ABSTRACT FROM AUTHOR]

Background and Objectives: This study aimed to describe and analyze the research outputs on enteral nutrition, which is the administration of food through the gastrointestinal tract for nutrition maintenance.Methods and Study Design: We searched the Web of Science Core Collection database for original publications on enteral nutrition research from 2010 to 2019. HistCite and VOSviewer software were used for analysis and visualization of the publication outputs, journals, institutions, keywords, cocitations, and collaborations among authors in different countries or regions.Results: A total of 963 relevant articles were included. The number of publications in 2010 and 2019 were 68 and 139, respectively. Nutrition in Clinical Practice and the Journal of Parenteral and Enteral Nutrition had the highest number of publications and cocitations (76, 7.89%; 2058), respectively. The United States and China were the top contributors, accounting for 24.1% and 22.3% of the total articles, respectively. Andrew S. Day and Stephen A. McClave were core researchers in this field. Primary authors collaborated closely. Enteral nutrition, parenteral nutrition, and support were the three most common keywords. The top 10 cocited references concerned administering early enteral nutrition therapy in acutely ill patients and patients with acute Crohn's disease. Crohn's disease, acute pancreatitis, upper gastrointestinal malignancy, and other surgical diseases were among the research hotspots.Conclusions: Our findings can help researchers identify notable research trends and clinically relevant articles. New catheterization technologies are a future research direction. [ABSTRACT FROM AUTHOR]

Background and Objectives: The optimal energy intake for early nutrition therapy in critically ill patients is unknown, especially in Chinese patients with a lower BMI. This study investigated the relationship between energy intake and clinical outcomes in this patient population.Methods and Study Design: A retrospective study was carried out at a tertiary hospital. Critically ill patients were recruited and divided into 3 tertiles according to the ratio of actual/target energy intake during the first week of hospitalization in the intensive care unit (ICU) (tertile I, <33.4%; tertile II, 33.4%-66.7%; and tertile III, >66.7%). 60-day mortality and other clinical outcomes were compared. To adjust for potentially confounding factors, multivariate and sensitivity analyses were performed exclusively in patients who stayed in the ICU for ≥7 days.Results: A total of 325 patients with a mean BMI of 22.5±4.7 kg/m2 were recruited. 60-day mortality was similar between the 3 tertiles. In the unadjusted analysis, tertile III had a longer length of stay in the ICU and at the hospital, longer duration of mechanical ventilation, and higher rate of ICU-associated infections, but only the latter showed a significant difference between the 3 tertiles in the multivariate and sensitivity analyses. Logistic regression analysis showed that energy groups was an independent risk factor for ICU-associated infections.Conclusions: Energy intake in early nutrition therapy influences risk of ICU-associated infections in Chinese critically ill patients with lower BMI. Furthermore, patients with near-target energy intake have more frequent ICU-associated infections. [ABSTRACT FROM AUTHOR]

Background and Objectives: To provide a questionnaire, with Shanghai medical interns as respondents, analyzing knowledge (K), attitude (A), and practice (P) in relation to clinical nutrition, and to explore factors that could affect KAP scores.Methods and Study Design: The cross- sectional study used 330 interns from Shanghai medical universities responding to general material data questionnaires and KAP questionnaires on clinical nutrition.Results: The mean KAP score was 210.26±25.9 (X±SD), and the score for each part of the KAP questionnaire was just within the threshold for qualified. Multivariate analysis showed that the factors influencing the proportion of excellent scores for K were preventive medicine major (OR=3.45, p<0.001), senior intern (OR=2.52, p=0.002), and tertiary intern hospital (OR=2.31, p=0.006). The only factor influencing the proportion of excellent scores for P was accessing nutritional information one to three times per week (OR=3.95, p=0.011). Nutrition course had no relation to any scores of K, A, P.Conclusions: The mean scores of overall KAP and the individual K, A, P were all categorized as qualified. The P score was the lowest and only influenced by how frequently information was accessed. In summary, nutrition knowledge and regular practical training gained from intern hospital could be a better way to enable senior interns to quickly and competently address patient nutrition problems at the commencement of their careers. [ABSTRACT FROM AUTHOR]

Background and Objectives: The participation of a nutrition support pharmacist (NSP) in a multidisciplinary team (MDT) for patients receiving nutrition support therapy (NST) may lead to more favourable outcomes and fewer complications and adverse events. However, few studies have demonstrated the role of NSPs in MDTs in China. To investigate pharmacy interventions and physician acceptance of these interventions for patients receiving NST in an intensive care unit (ICU).Methods and Study Design: A prospective study over a 12-month period was conducted in an ICU at an academic hospital in China. Interventions were documented and divided into the following categories: indication of NST, parenteral nutrition (PN) prescription and delivery, enteral nutrition (EN) route and formulation, fluids and electrolytes, laboratory test monitoring, nutritional supplements, and other medication-related problems. Data regarding the intervention categories, timing, acceptance rates, and methods of communication to discuss pharmacy interventions were collected.Results: In total, 247 interventions for 120 patients were identified. The overall acceptance rate of interventions was 85.0% (210/247), and more than half of the interventions (143, 57.9%) were performed during daily follow-up. The most common intervention categories were PN prescription and delivery (81/247, 32.8%), EN route and formula (33/247, 13.4%), indication of NST (33/247, 13.4%), and nutritional supplements (30/247, 12.1%). The most accepted intervention category was PN prescription and delivery (79/81, 97.5%), and the most common method of communication was oral communication during MDT rounds (201/247, 81.4%).Conclusions: This study demonstrated the unique perspectives offered and importance of having pharmacists as members of MDTs. [ABSTRACT FROM AUTHOR]

Background and Objectives: With the development of enteral nutrition in patients with neurological disorders in China, related guidelines were published in 2011. The Chinese Society for Parenteral and Enteral Nutrition conducted a survey to evaluate the status quo of enteral nutrition practices in these patients.Methods and Study Design: This multicenter prospective investigation was conducted from April 2012 to April 2013 and involved 18 tertiary hospitals in China. The survey using standardized questionnaires sought information about the basic protocols for enteral nutrition (devices and staffing) and specific information about patients with neurological conditions who received nutrition by way of enteral feeding.Results: In the 18 hospitals from 13 provinces, 83.3% patients were configured with an enteral nutrition infusion pump, 77.8% had a percutaneous endoscopic gastrostomy (PEG) device, and 88.9% had a clinical nutrition support group. Four hundred four patients participated in this survey (259 men, 145 women; mean age 61.3±14.7 years), 85.7% had suffered a stroke, 83.9% had impaired consciousness, and 98.0% had dysphagia. Of the 10 guidelines for enteral nutrition practices, setting the energy target, choosing the enteral nutrition tube, and monitoring the patient received unsatisfactory ratings were in poor compliance (56.2%, 30.0% and 38.9%, respectively); the remaining seven guidelines were in good compliance (each >75%).Conclusion: The survey suggested that configuration of the enteral nutritional devices and staffing was adequate in China's tertiary hospitals. However, some associated practices had not yet reached the desired levels of competency, indicating a need for this to be understood and for improved training. [ABSTRACT FROM AUTHOR]

The evolution of nutritional status (the prevalence of nutritional risk, malnutrition, overweight and obesity) and the nutritional support of the hospitalized patients from admission to discharge or over a two-week period in orthopedics/ spinal surgery of a teaching hospital in Hohhot were investigated. 432 patients from two wards of the orthopedics/spinal surgery from Jan to Dec 2013, the traditional spinal surgery and the minimally invasive spinal surgery, were selected and detected in this study. The Nutritional Risk Score 2002 (NRS 2002) was used to determine the patients' nutritional status within 48 h after admission and during their hospitalization. The overall prevalence of nutritional risk, malnutrition, overweight and obesity at admission was 11.6%, 12.7%, 35.9% and 7.41%, respectively. Overall, there were 88.0% of the patients who were at nutritional risk received nutritional support, while 14.1% of non-risk patients received a redundant nutritional support. The overall prevalence of nutritional risk changed from 11.6% at admission to 19.4% upon discharge (p<0.05), and the prevalence of malnutrition changed from 12.7% to 20.6% (p<0.05). The prevalence of overweight and obesity, which changed from 35.9% to 31.0% and from 7.41% to 5.79% respectively, didn't experience statistically significant evolution. NRS 2002 was a feasible nutritional risk screening tool for patients in spinal surgery of orthopedics department. Patients' prevalence of nutritional risk and malnutrition increased significantly in spinal surgery of this hospital. Some inappropriate uses of nutritional support were observed in orthopedics/spinal surgery, and nutritional support guidelines or protocols should be promoted by a professional committee. [ABSTRACT FROM AUTHOR]

Objectives: Medium chain triglycerides (MCTs) are of nutritional interest for their unique properties on ingestion, absorption and metabolism. However, dietary and enteral MCTs usage in hospitalized patients in China requires evaluation.Methods: A retrospective analysis was conducted on 46 hospitalized patients who were administered MCTs therapy between January, 2012 and December, 2013 in Peking Union Medical College Hospital. The clinical parameters of subjects were evaluated 2 weeks after intervention. All indications and outcomes of MCTs therapy underwent evidence-based evaluation. A survey was conducted on a random sample of 77 doctors to clarify the awareness and knowledge of MCTs therapy among clinicians.Results: Among 46 cases undergoing MCTs therapy, there were 21 with gastrointestinal dysfunction (with improvement in 15 cases), 15 with lymphatic anomalies (with improvement in 7 cases), 5 with dyslipidemia (with improvement in 3 cases), 4 with exocrine pancreatic insufficiency (with improvement in 2 cases) and 1 with epilepsy (without improvement). All indications were evidence -based. Although MCTs were being utilized in an increasing number of patients, the survey revealed poor knowledge of their physicochemical properties, medical indications and the therapeutic basis of their use among clinicians.Conclusions: MCTs therapy is of benefit in the management of gastrointestinal malabsorption, pancreatic exocrine insufficiency, intestinal lymphangiectasia and dyslipidemia. However, randomized controlled trials with adequate sample size and longer follow-up are required to evaluate further their efficacy, and more educational programs are needed to ensure clinical competence for MCT therapy. [ABSTRACT FROM AUTHOR]

Nutrition therapy is essential for the management of critically ill patients. Some guidelines have been published to standardize and optimize the nutrition therapy. However, there are still many controversies in nutrition practice and there is a gap between guidelines and clinical nutrition therapy for patients in intensive care units (ICUs). This study aimed to assess attitudes and beliefs toward nutrition therapy of Chinese intensive care physicians by using the American guidelines as a surrogate. A questionnaire was sent to 45 adult ICUs in China, in which surveyed physicians were asked to rate their attitudes toward the American guidelines. A total of 162 physicians from 45 ICUs returned the questionnaires. Physicians were categorized into groups according to their professional seniority, hospital levels and whether they were members of Chinese Society for Parenteral and Enteral Nutrition (CSPEN). Overall, 94% of the respondents thought that nutrition therapy for critically ill patients was very important, and 80% mentioned that they used the American guidelines. There was diversity of opinion on the recommendations pertaining to nutrition assessment, supplemental parenteral nutrition and cutoff values for gastric residual volume, negative or neutral attitudes about these recommendations were 43%, 59% and 41%, respectively. Members of CSPEN were more likely to select a greater strength of recommendation than non-members. In conclusion, the overall attitudes of Chinese intensive care physicians toward the American guidelines were positive. Nevertheless, given the great guideline-practice gap, nutrition-focused education is warranted for many intensive care physicians in China. [ABSTRACT FROM AUTHOR]

This study evaluated a structured and integrated intervention program on diabetes management in individuals with type 2 diabetes in Shanghai, China. Men and women with type 2 diabetes and body mass index > 23 kg/m² were randomized into a 24-week, prospective, randomized clinical trial. The Reference Group (n=50) received diabetes education including diet and physical activity instruction only; the Intervention Group (n=100) received more intensive intervention, including diabetes education with frequent blood glucose monitoring, nutritional counseling, meal plans with diabetes-specific nutritional meal replacement, and weekly progress updates with study staff. Major study assessments were obtained at baseline, and after 12 and/or 24 weeks of intervention. The Intervention Group improved fasting blood glucose, insulin, systolic and diastolic blood pressures compared to Reference Group (p<0.05). Importantly, HbA1c was lower (p<0.001) in the Intervention Group at 12 weeks (- 0.6 ± 0.1%) and 24 weeks (-0.8 ± 0.1%). Weight loss was modest, but significant differences were observed between groups (p<0.05). Weight change from baseline after 12 and 24 weeks was -2.8 ± 0.2% and -3.7 ± 0.3%, respectively, in the Intervention Group vs -1.8 ± 0.4% and -2.5 ± 0.4% in the Reference Group. Additionally, waist and hip circumferences and waist:hip ratio decreased in the Intervention compared to the Reference Group (p<0.05). In conclusion, this study demonstrates that Chinese men and women with type 2 diabetes following an integrated intervention program including diabetes education, frequent blood glucose monitoring and daily use of a diabetes-specific meal replacement, can achieve significant improvements in glycemic control and markers of cardiovascular health. [ABSTRACT FROM AUTHOR]

Obesity has become a global "epidemic". At this stage, overweight / obesity has become a major public health problem that seriously affects not only adults but also children and adolescents worldwide. Medical nutritional therapy is the basic treatment for obesity and an indispensable measure for prevention and control at any stage in the course of obesity. Management of comorbidities and improving the quality of life of obese patients are also included in treatment aims. In recent years, there have been some guidelines on the nutrition management of overweight/obesity. However, the management of nutrition and lifestyle interventions must be compatible with specific regional dietary habits and social culture. To provide a clinical reference for the standardized treatment and management of overweight / obesity, guidelines for medical nutrition treatment of overweight/obesity in China (2021) were published, which cover the relationship of weight loss with different dietary patterns, meal replacement foods, biorhythms, intestinal microecology, metabolic surgery, and medical nutritional intervention, as well as weight loss in special populations. We hope the guidelines will improve the awareness of the importance of nutrition intervention in the treatment of metabolic disease, further regulate the principle and approach of medical nutrition therapy, and establish a workflow of standardized medical nutrition therapy for weight loss management so that more clinical nutrition professionals and medical staff can use it to provide better services for obese people.

Objectives: Nutrition support has long been ignored in China's HIV/AIDS treatment and care. The objectives of this project were to evaluate the prevalence of malnutrition among Chengdu urban HIV positive patients, and to provide evidence for further nutritional intervention., Materials and Methods: HIV-infected adults admitted to an infectious diseases inpatient unit were eligible for this study. Nutritional status was evaluated using Subject Global Assessment (SGA), Malnutrition Universal Screening Tool (MUST), body mass index (BMI), food frequency questionnaire and dietary records., Results: 94 hospitalized HIV positive patients were enrolled from April 2009 to May 2010. The median CD4 T cell count was 44.0/mm3. The prevalence of malnutrition is measured by three tools and ranged from 37.2% (by BMI) to 77.2% (by SGA class B/C or MUST scores ≥ 2). Chi-square test showed significant relationship between opportunistic infections and MUST score (OR=5.67, p<0.005, 95% CI=1.96-16.4). Of patients, 59.6% had insufficient total energy intake; while 54.3% had insufficient protein intake., Conclusions: Malnutrition is highly prevalent among Chengdu urban HIV/AIDS patients who underwent inpatient treatment. Calorie and protein deficiency should be given more attention in HIV/AIDS care programs. Nutrition evaluation and support should be considered an integral parts of national and community HIV/AIDS treatment and care guidelines.

Purpose: To assess the nutritional status among rural children under five years in China relative to WHO Child Growth Standards 2006, and to explore risk factors for undernutrition., Design: Cross-sectional study of rural areas in 10 provinces of China. A total of 84,009 children under five recruited through multi-level sampling., Main Findings: A total of 17.92% of children have at least one form of undernutrition. The prevalence of stunting, underweight and wasting, were 14.59%, 7.19% and 3.07%, respectively. The corresponding mean z-score in height-for-age, weight-for-age, and weight-for-height were -0.732, -0.410 and -0.001. An upward trend with age in stunting and underweight was observed, and higher risks noticed among older children in contrast with children under 6 months in terms of stunning and underweight. The inter-provincial variation of undernutrition remains very large. Low birth weight, multi parity, preterm birth, multiple birth, maternal illiteracy, low provincial GDP, and low household income are identified as significant factors associated with stunting. Parity shows no corresponding significant relationship with underweight, and wasting was not found to be associated with either preterm or multiple births., Conclusion: The nutritional status among children under five in rural areas of China, although greatly improved in the past decades, still lags behind the WHO Child Growth Standards. Stunting and underweight occur mostly before two years of age. Intervention strategies and programs should be developed to target the preventable risk factors.