Search

International audience; In hospitals through Europe and worldwide, the practices regarding hospital diets are very heterogeneous. Hospital diets are rarely prescribed by physicians, and sometimes the choices of diets are based on arbitrary reasons. Often prescriptions are made independently from the evaluation of nutritional status, and without taking into account the nutritional status. Therapeutic diets (low salt, gluten-free, texture and consistency modified, …) are associated with decreased energy delivery (i.e. underfeeding) and increased risk of malnutrition. The European Society for Clinical Nutrition and Metabolism (ESPEN) proposes here evidence-based recommendations regarding the organization of food catering, the prescriptions and indications of diets, as well as monitoring of food intake at hospital, rehabilitation center, and nursing home, all of these by taking into account the patient perspectives. We propose a systematic approach to adapt the hospital food to the nutritional status and potential food allergy or intolerances. Particular conditions such as patients with dysphagia, older patients, gastrointestinal diseases, abdominal surgery, diabetes, and obesity, are discussed to guide the practitioner toward the best evidence based therapy. The terminology of the different useful diets is defined. The general objectives are to increase the awareness of physicians, dietitians, nurses, kitchen managers, and stakeholders towards the pivotal role of hospital food in hospital care, to contribute to patient safety within nutritional care, to improve coverage of nutritional needs by hospital food, and reduce the risk of malnutrition and its related complications.

BACKGROUND & AIMS Bioelectrical impedance analysis (BIA) could be facilitated in subjects who are able to stand by using scales without (BIAstd4) or with a retractable handle (BIAstd8), provided that they are as precise as BIA devices commonly used in the supine position in the hospital setting (BIAsup). This observational prospective cross-sectional study aimed to compare the precision and accuracy of BIAstd4, BIAstd8 and BIAsup in a Caucasian population. METHODS Fat mass percentage (FM%) was measured in 160 healthy Caucasian subjects (80 men/80 women) aged 20-60 years, with a body mass index (BMI) ≥18.5 and

Background & aims: The year 2019 marked the centenary of the publication of the Harris and Benedict equations for estimation of energy expenditure. In October 2019 a Scientific Symposium was organized by the European Society for Clinical Nutrition and Metabolism (ESPEN) in Vienna, Austria, to celebrate this historical landmark, looking at what is currently known about the estimation and measurement of energy expenditure. Methods: Current evidence was discussed during the symposium, including the scientific basis and clinical knowledge, and is summarized here to assist with the estimation and measurement of energy requirements that later translate into energy prescription. Results: In most clinical settings, the majority of predictive equations have low to moderate performance, with the best generally reaching an accuracy of no more than 70%, and often lead to large errors in estimating the true needs of patients. Generally speaking, the addition of body composition measurements did not add to the accuracy of predictive equations. Indirect calorimetry is the most reliable method to measure energy expenditure and guide energy prescription, but carries inherent limitations, greatly restricting its use in real life clinical practice. Conclusions: While the limitations of predictive equations are clear, their use is still the mainstay in clinical practice. It is imperative to recognize specific patient populations for whom a specific equation should be preferred. When available, the use of indirect calorimetry is advised in a variety of clinical settings, aiming to avoid under-as well as overfeeding. (C)2020 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Summary Background & aims Indirect calorimetry (IC) is the only way to measure in real time energy expenditure (EE) and to optimize nutrition support in acutely and chronically ill patients. Unfortunately, most of the commercially available indirect calorimeters are rather complex to use, expensive and poorly accurate and precise. Therefore, an innovative device (Q-NRG®, COSMED, Rome, Italy) that matches clinicians’ needs has been developed as part of the multicenter ICALIC study supported by the two academic societies ESPEN and ESICM. The aim of this study was to evaluate the accuracy and intra- and inter-unit precision of this new device in canopy dilution mode in vitro and in spontaneously breathing adults. Methods Accuracy and precision of oxygen consumption (VO2) and carbon dioxide production (VCO2) measurements were evaluated in vitro and in 15 spontaneously breathing healthy adults by interchanging three Q-NRG® units in a random order. In vitro validation was performed by gas exchange simulation using high-precision gas mixture and mass flow controller. Accuracy was calculated as error of measured values against expected ones based on volume of gas infused. Respiratory coefficient (RQ) accuracy was furthermore assessed using the ethanol-burning test. To evaluate the intra- and inter-unit precisions, the coefficient of variation (CV% = SD/Mean*100) was calculated, respectively, from the mean ± SD or the mean ± SD of the three mean values of VO2, VCO2, RQ and EE measured by each Q-NRG® units. In vivo accuracy measurement of the Q-NRG® was assessed by simultaneous comparison with mass spectrometry (MS) gas analysis, using Bland-Altman plot, Pearson correlation and paired t-test (significance level of p = 0.05). Results In vitro evaluation of the Q-NRG® accuracy showed measurement errors Conclusion Both in vitro and in vivo measurements of VO2, VCO2, RQ and EE on three Q-NRG® units showed minimal differences compared to expected values and MS and very low intra- and inter-unit variability. These results confirm the very good accuracy and precision of the Q-NRG® indirect calorimeter in canopy dilution mode in spontaneously breathing adults.

Increased and specific nutritional requirements occurring during critical illness need to be covered by appropriate administration of energy, nitrogen and micronutrients, especially in case of pre-existing malnutrition, chronic insufficient oral intakes or expected delay before recovery of eating. The use of artificial nutrition (enteral or parenteral) is recommended whenever the oral intakes are insufficient, in order to avoid the detrimental consequences of malnutrition and promote the best possible outcome of severely ill patients. This paper aims to provide an overview and practical recommendations of artificial nutrition therapy in the ICU setting.

Cancer patients suffer from metabolic and pathophysiological changes that contribute to malnutrition. These metabolic changes lead to loss of cell integrity, which induces dehydration intracellular and increase extracellular fluid. Bioelectrical impedance analysis (BIA)-derived phase angle (PhA) is considered a good tool to evaluate hydration status, but in cancer patients it is not fully elucidated. Thus, in cancer patients the aims of this study were to (1) verify the association between PhA and fatigue, (2) verify the association between PhA and fatigue after adjustment for extracellular fluid accumulation, and (3) assess the prevalence of fatigue. This cross-sectional study was conducted with 124 patients of both genders on cancer treatment. Body weight, height, body mass index, handgrip strength, performance status, and cachexia were collected. In addition, body composition was evaluated by BIA to obtain hydration status and PA. The cut-off point used to classify patients with low PhA was set 4° had lower risk for fatigue (OR: 0.92 95% CI [0.86–0.99], p = 0.03) in the crude model, however after adjustments by weight loss percentage in 6 months, age, sex, and hydration the association was not maintained (OR: 0.94 95% CI [0.85–1.04], p = 0.26). In conclusion, we found that ~26% of cancer patients have fatigue. In spite of adjustment for extracellular fluid, PhA is not associated with fatigue. The importance of measuring PhA to assess intra and extracellular hydration in cancer patients is highlighted.

Purpose of review Controversies about the adequate amount of energy to deliver to critically ill patients are still going on, trying to find if hypocaloric or normocaloric regimen is beneficial in this population. Our purpose is to review recent publications using or not indirect calorimetry. Recent findings Numerous studies have compared hypocaloric to normocaloric regimen using predictive equations. However, these equations have been demonstrated to be inaccurate in most of the cases. Some recent PRCT using indirect calorimetry are finding some advantages to isocalorie regimens, but others not. Timing of the nutrition respecting or not the early substrate endogenous production, use of an adequate amount of protein, respect of the daily variability of needs may explain the divergent results observed. Summary Indirect calorimetry should be used to define the energy expenditure of the patient and to determine its requirements. More studies comparing isocalorie to hypocalorie regimens with fixed protein intake are necessary to confirm the observational and some of the PRCT-positive studies.

The new indirect calorimeter developed in the framework of the ICALIC project was first evaluated in ventilation mode. This second phase aimed to compare its ease of use and precision with another commonly used device in spontaneously breathing adult patients using a canopy hood or a face mask.The time required to measure resting energy expenditure (REE) with Q-NRG® in canopy and face mask mode was compared with Quark RMR® in canopy mode by sequential measurements in 45 and 40 spontaneously breathing adult patients, respectively. Their precision was assessed at different time intervals, using coefficients of variation (CV%) and repeated measures one-way ANOVA. Agreement between the two devices was evaluated by correlation coefficients, Bland-Altman plots, and paired t-test. Patients' characteristics potentially affecting the measurement were assessed using linear regression analysis.REE measurement with Q-NRG® was faster than Quark RMR® (19.7 ± 2.9 min vs 24.5 ± 4.3 min, P 0.001). In canopy mode, Q-NRG® gave values similar to Quark RMR®, with 73% of patients achieving a steady state (CV%10%) within the 5-15 min interval. In face mask mode, Q-NRG® was less stable than Quark RMR® in canopy mode, and steady state was achieved in only 40% of the patients within the 5-15 min interval. Correlation between the two devices was stronger when Q-NRG® was used in canopy than in face mask mode, with Pearson coefficients of 0.96 and 0.86, respectively. Compared to Quark RMR® in canopy mode, systematic bias±1.96∗SD with Q-NRG® was -14 ± 236 kcal/day in canopy and 73 ± 484 kcal/day in face mask mode. Q-NRG® in face mask mode overestimated REE by 150 ± 51 kcal/day in men compared to Quark RMR® in canopy mode.Q-NRG® in canopy mode made it possible to save at least 5 min compared to Quark RMR® while maintaining the same measurement precision. However, its use in face mask mode could lead to REE overestimation in men and, therefore, should not be recommended in the clinical setting.ClinicalTrials.gov no. NCT03947294.

Background: Cancer and its treatments often lead to sarcopenia and fatigue. However, whether these factors are associated remains unproven.Objective: To evaluate whether the risk of sarcopenia predicts the presence of fatigue.Methods: A cross-sectional study was completed and included 198 cancer patients of both sexes, undergoing in- and outpatient treatment. The Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) and the Functional Assessment of Cancer Therapy Fatigue (FACT-F) were used to assess the risk of sarcopenia and the presence of fatigue, respectively. The cut-off values used to identify the risk of sarcopenia and the severity of fatigue scale were SARC-F ≥ 4 and Fatigue Results: Out of 198 patients, 35% were at risk of sarcopenia and of these 87% had fatigue. Patients at risk of sarcopenia had lower scores in the FACT-F subscales, lower handgrip strength, lower performance status, were mostly hospitalized and were sedentary. Logistic regression analysis revealed that patients with SARC-F < 4 had a lower risk of fatigue in both models, crude (OR: 0.83; CI 95% [0.79-0.88], p < 0.0001) as well as adjusted for age, gender, BMI, physical activity, current use of alcoholic beverages, smoking, performance status, cancer type, clinical setting and use of supplements (OR: 0.87; CI 95% [0.81-0.92], p < 0.0001).Conclusion: In patients with cancer, 35% presented risk of sarcopenia and of these 87% had fatigue. In addition, the absence of sarcopenia was considered protective against fatigue.

Energy metabolism is tightly linked with circadian rhythms, exposure to ambient light, sleep/wake, fasting/eating, and rest/activity cycles. External factors, such as shift work, lead to a disruption of these rhythms, often called circadian misalignment. Circadian misalignment has an impact on some physiological markers. However, these proxy measurements do not immediately translate into major clinical health outcomes, as shown by later detrimental health effects of shift work and cardio-metabolic disorders. This review focuses on the effects of shift work on circadian rhythms and its implications in cardio-metabolic disorders and eating patterns. Shift work appears to be a risk factor of overweight, obesity, type 2 diabetes, elevated blood pressure, and the metabolic syndrome. However, past studies showed discordant findings regarding the changes of lipid profile and eating patterns. Most studies were either small and short lab studies, or bigger and longer cohort studies, which could not measure health outcomes in a detailed manner. These two designs explain the heterogeneity of shift schedules, occupations, sample size, and methods across studies. Given the burden of non-communicable diseases and the growing concerns about shift workers’ health, novel approaches to study shift work in real contexts are needed and would allow a better understanding of the interlocked risk factors and potential mechanisms involved in the onset of metabolic disorders.

Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) score is frequently used for screening the sarcopenia risk in older people. However, the agreement between SARC-F and loss of ultrasound-derived muscle thickness in hospitalized older cancer patients is unexplored. The primary objective was to evaluate the relationship between the SARC-F score and ultrasound-derived muscle thickness of rectus femoris and vastus intermedius in older hospitalised cancer patients. The secondary objective was to identify the presence of sarcopenia. A cross-sectional study enrolled forty-one older hospitalised cancer patients ongoing chemotherapy or surgical treatment. Body weight (kg) was measured using a digital scale and height using a portable stadiometer to assess body mass index. SARC-F was performed to assess and classify sarcopenia risk (with (SARC-F: &2265;4), without (SARC-F

Objectives Vitamin D deficiency may be associated with comorbidities and poor prognosis. However, this association in patients in the intensive care unit (ICU) has not been fully elucidated. The aim of this study was to investigate whether the serum concentrations of 25-hydroxyvitamin D (25[OH]D) within the first 48 h after ICU admission are associated with prognostic indicators (Acute Physiology and Chronic Health Evaluation [APACHE] II, Sequential Organ Failure Assessment [SOFA] score, Charlson comorbidity index [CCI]), clinical complications, serum C-reactive protein (CRP) concentrations, mechanical ventilation duration, and mortality. Methods Seventy-one patients were admitted to the ICU, and their concentrations of 25(OH)D in the first 48 h were analyzed. To evaluate the prognostic factors in the ICU, APACHE II scores, SOFA scores, CCI questionnaires, mechanical ventilation time, CRP, and mortality were used. Results The mean concentration of 25(OH)D was 17.7 ± 8.27 ng/mL (range 3.5–37.5 ng/mL), with 91.6% presenting with deficiency at admission. Although no associations were found between serum 25(OH)D concentrations with mechanical ventilation time, CRP, mortality, and APACHE II and SOFA severity scores, we found associations with the CCI when adjusted by age (model 1: odds ratio [OR], 1.64; 95% confidence interval [CI], 1.14–2.34) and by age, sex and body mass index (model 2: OR, 1.59; 95% CI, 1.10–2.34). In addition, among the comorbidities present, 25(OH)D concentrations were inversely associated with cancer (crude model OR, 3.42; 95% CI, 1.21–9.64) and liver disease (crude model OR, 9.64; 95% CI, 2.28–40.60). Conclusion We found a strong association between 25(OH)D concentrations and the prognostic indicator CCI and clinical complications (acute respiratory insufficiency, acute liver failure, and infections), but no associations with the prognostic indicators APACHE II and SOFA score, CRP, mechanical ventilation duration, or mortality. The main comorbidities associated with low 25(OH)D were cancer and liver disease, suggesting that the determination of 25(OH)vitamin D is relevant during the ICU stay.

Following the new ESPEN Standard Operating Procedures, the previous guidelines to provide best medical nutritional therapy to critically ill patients have been updated. These guidelines define who are the patients at risk, how to assess nutritional status of an ICU patient, how to define the amount of energy to provide, the route to choose and how to adapt according to various clinical conditions. When to start and how to progress in the administration of adequate provision of nutrients is also described. The best determination of amount and nature of carbohydrates, fat and protein are suggested. Special attention is given to glutamine and omega-3 fatty acids. Particular conditions frequently observed in intensive care such as patients with dysphagia, frail patients, multiple trauma patients, abdominal surgery, sepsis, and obesity are discussed to guide the practitioner toward the best evidence based therapy. Monitoring of this nutritional therapy is discussed in a separate document.

Background & aims: Systemic inflammation has been reported as a new predictor for COVID-19 outcomes. Thus, we hypothesized that ICU patients infected by COVID-19 had lower blood vitamin D levels and increased systemic inflammation. Therefore, this is the first Brazilian study to evaluate the vitamin D concentrations and NLR as a systemic inflammation in patients infected by COVID-19 admitted in ICU.Methods: This cross-sectional study selected twenty-six patients from COVID-19 Data Sharing/FAPESP, Brazil. Twenty-five patients were enrolled from a single hospital and those with blood vitamin D and neutrophil and lymphocyte data were included and had all available data analyzed. Patients were divided in two groups: low vitamin D concentration when ≤20 ng/mL (low Vit D group, n = 8, 5M/3F, 62.7 ± 8.4 years old), and normal vitamin D when > 20 ng/mL (normal Vit D group, n = 17, 9M/8F, 74 ± 8.2 years old). Serum 25-hydroxy-vitamin D, C reactive protein (CRP), and count of neutrophils and lymphocytes concentrations were collected from COVID-19 Data Sharing/FAPESP. Statistical analyses were performed using the Prism version 5.0 and Student T test was applied to verify any difference between the groups.Results: Low vitamin D group had 15.5 ± 3.3 ng/mL of 25OH Vit D concentrations and normal vitamin D group had 35.9 ± 8.8 ng/mL. Although no difference between groups for CRP concentrations (low Vit D: 4.5 ± 3.3 vs. normal Vit D: 4.2 ± 4.0 mg/dL, p = 0.45), we found higher neutrophil count and NLR values in the low Vit D group when compared to normal Vit D group (low Vit D: 6049.8 ± 3719.7 vs. normal Vit D: 3741.8 ± 1704.1 ng/mL, p = 0.02) and (low Vit D: 9.0 ± 8.6 vs. normal Vit D: 4.2 ± 4.0 ng/mL, p = 0.03), respectively.Conclusion: This data sharing-derived cases of COVID-19 in patients admitted at ICU showed that patients infected by COVID-19 had lower serum 25-hydroxy vitamin D and enhanced systemic inflammation when assessed by NLR values.

Objective: Individuals with cancer are affected by a loss of cell membrane integrity due to electrolyte imbalance between the intra- and extracellular fluids. Cell membrane integrity and hydration status can be assessed according to the phase angle (PhA) and the risk for sarcopenia, by using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F) questionnaire. To our knowledge, this approach has not been validated in patients with cancer. The aims of this study were to verify the prevalence of the risk for sarcopenia, and to analyze the association between PhA and the risk for sarcopenia with and without adjustment for extracellular water content.Methods: This was a cross-sectional study conducted with 124 male and female cancer patients (77.4% men). PhA and hydration status were assessed using bioelectrical impedance analysis (BIA), and the risk for sarcopenia (cutoff ≥4) was assessed using the SARC-F questionnaire.Results: Of the 124 patients, 28 (22.5%) were at risk for sarcopenia (SARC-F ≥4). There was no association between PhA and the risk for sarcopenia in the crude model, nor in the model adjusted for age, sex, smoking, alcohol consumption, and physical activity, nor after adjusting for use of supplements, body mass index, treatment type, performance status, and type and stage of cancer. However, we found an association between lower PhA values and a higher risk for sarcopenia after adjusting for hydration abnormalities (odds ratio, 1.74; 95% confidence interval, 1.03-2.93; P < 0.035).Conclusion: We found that 22.5% of patients with cancer presented with a risk for sarcopenia. Additionally, an association between lower PhA values and enhanced risk for sarcopenia highlighted the importance of adequate hydration and evaluation of fluid status via BIA as a new recommendation to prevent sarcopenia.

Made available in DSpace on 2021-06-25T15:05:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-06-01 Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Purpose: Neuromuscular electrical stimulation (NMES) elicits muscle contraction and has been shown to attenuate muscle atrophy when physical activity is not possible. Thus, we hypothesized that intradialytic NMES would attenuate the loss leg lean mass and improve the phase angle in patients undergoing hemodialysis (HD). Methods: A randomized controlled trial was performed with twenty-one adult HD patients (n = 8 F, n = 13 M; 45.8 +/- 10.6 y) randomly assigned to usual care (control group, n = 11; 4F/7M) or to the NMES group (n = 10; 4F/6M). NMES was applied bilaterally at the origin and insertion points of the quadriceps or gastrocnemius muscles for 40 min during each HD session (3x/wk for one month). Pre-and post-intervention, we measured leg lean mass using dual-energy x-ray absorptiometry and phase angle using bioelectrical impedance analysis. Results: NMES did not change leg lean mass compared to the control group. Phase angle increased in the NMES compared to the control group (Delta: +0.71 +/- 0.27 degrees vs. -0.46 +/- 0.23 degrees, p = 0.004) with interaction time x treatment (ANOVA p = 0.004). Conclusion: Short-term intradialytic NMES targeting muscles of the legs improved the phase angle but did not change leg lean mass. Brazilian registry of clinical trials under the code: RBR-98wzgn. (C) 2021 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved. Univ Fed Goias, Fac Nutr, Clin & Sports Nutr Res Lab Labince, Goiania, Go, Brazil Sao Paulo State Univ, Dept Phys Educ, Immunometab Res Grp, Presidente Prudente, Brazil Geneva Univ Hosp, Clin Nutr, Geneva, Switzerland Univ Roma La Sapienza, Dept Translat & Precis Med, Rome, Italy Univ Exeter, Coll Life & Environm Sci, Dept Sport & Hlth Sci, Exeter, Devon, England Sao Paulo State Univ, Dept Phys Educ, Immunometab Res Grp, Presidente Prudente, Brazil CNPq: 312252/2019-6

Background and Aims: Parenteral nutrition (PN) has become an efficient, safe, and convenient treatment over years for patients suffering from intestinal failure. Home PN (HPN) enables the patients to have a high quality of life in their own environment. The therapy management however implies many restrictions and potentially severe lethal complications. Prevention and therapy of the latter are therefore of utmost importance. This study aims to assess and characterize the situation of patients with HPN focusing on prevalence of catheter-related complications and mortality. Methods: Swiss multicentre prospective observational study collecting demographic, anthropometric, and catheter-related data by means of questionnaires every sixth month from 2017 to 2019 (24 months), focusing on survival and complications. Data were analysed using descriptive statistics. Logistic regression models were fitted to investigate association between infection and potential co-factors. Results: Seventy adult patients (50% women) on HPN were included (≈5 patients/million adult inhabitants/year). The most common underlying diseases were cancer (23%), bariatric surgery (11%), and Crohn’s disease (10%). The most prevalent indication was short bowel syndrome (30%). During the study period, 47% of the patients were weaned off PN; mortality rate reached 7% for a median treatment duration of 1.31 years. The rate of catheter-related infection was 0.66/1,000 catheter-days (0.28/catheter-year) while the rate of central venous thrombosis was 0.13/1,000 catheter-days (0.05/catheter-year). Conclusion: This prospective study gives a comprehensive overview of the adult Swiss HPN patient population. The collected data are prerequisite for evaluation, comparison, and improvement of recommendations to ensure best treatment quality and safety.

Summary Background High protein diet (HDP) promotes improvement of lean body mass in elderly without cancer; but the impact of high protein intake on muscle strength and mortality in cancer patients remains to be elucidated. This study evaluates the association between HPD on handgrip strength (HGS) and survival in older adults outpatients with advanced gastrointestinal cancer. Methods Ninety-one patients with advanced gastrointestinal cancer (>65% tumor stage III-IV) undergoing radiotherapy, chemotherapy or surgery were enrolled. Upon first oncological visit, tumor stage was assessed by a physician. Then, a nutritionist or a dietitian measured the body mass index (BMI), HGS by means of a dynamometer, and dietary food intake by using 24h food recall. Patients were stratified in HPD (i.e, ≥1.5 g/kg/d) or low protein diet (LPD: Results HPD was reported by approximately 30% of patients. Protein intake was significantly higher in HPD vs LPD patients (2.2 ± 0.8 vs. 0.8 ± 0.4 g/kg/d, respectively; p Conclusion HPD is not associated with better muscle function as measured by HGS, but with overall survival in older adults outpatients with advanced gastrointestinal cancer. HPD may represent a strategy to mitigate the cancer-induced mortality and should be further explored.

Background & aims: Systemic inflammation has been reported as a new predictor for cancer outcomes. This study aimed i) to identify the neutrophil to lymphocytes ratio (NLR) cut-off point that best predicts sarcopenia and ii) to verify the association between NLR and sarcopenia risk in hospitalized cancer patients.Methods: A cross-sectional study enrolled a total of 123 hospitalized cancer patients receiving chemotherapy and/or undergoing surgery. Systemic inflammation was assessed as revealed by circulating levels of C-reactive protein, neutrophils, platelet, and by calculating platelet-lymphocytes ratio (PLR) and NLR. Sarcopenia risk was assessed using the Strength, Assistance for walking, Rise from a chair, Climb stairs, and Falls (SARC-F; score≥4 identifies sarcopenia risk). ROC curve were used to identify the best NLR cut-off value which predicts sarcopenia risk. Differences between groups were tested using the T Student, Mann-Whitney, or Chi-Square tests. Logistic regression analyses were done to assess the association between NLR and sarcopenia risk.Results: ROC curve revealed that the best cut-off point to predict sarcopenia risk was NLR ≥6.5 (sensitivity of 45% and specificity of 81%). Those with NLR ≥6.5 presented higher C-reactive protein, neutrophils, platelet-lymphocytes ratio (PLR), and SARC-F than NLR Conclusion: In hospitalized cancer patients, systemic inflammation measured by NLR was associated with increased sarcopenia risk.

Background and aims: Optimal nutritional therapy, including the individually adapted provision of energy, is associated with better clinical outcomes. Indirect calorimetry is the best tool to measure and monitor energy expenditure and hence optimize the energy prescription. Similarly to other medical techniques, indications and contra-indications must be acknowledged to optimise the use of indirect calorimetry in clinical routine. Measurements should be repeated to enable adaptation to the clinical evolution, as energy expenditure may change substantially. This review aims at providing clinicians with the knowledge to routinely use indirect calorimetry and interpret the results.Method: We performed a bibliographic research of publications referenced in PubMed using the following terms: "indirect calorimetry", "energy expenditure", "resting energy expenditure", "VCO2", "VO2", "nutritional therapy". We included mainly studies published in the last ten years, related to indirect calorimetry principles, innovations, patient's benefits, clinical use in practice and medico-economic aspects.Results: We have gathered the knowledge required for routine use of indirect calorimetry in clinical practice and interpretation of the results. A few clinical cases illustrate the decision-making process around its application for prescription, and individual optimisation of nutritional therapy. We also describe the latest technical innovations and the results of tailoring nutrition therapy according to the measured energy expenditure in medico-economic benefits.Conclusion: The routine use of indirect calorimetry should be encouraged as a strategy to optimize nutrition care.

Background: Ursolic acid (UA) is thought to have an anabolic effect on muscle mass in humans. This study sought to compare the effects of UA and a placebo on muscle strength and mass in young men undergoing resistance training (RT) and consuming a high-protein diet.Methods: A clinical, double-blind, placebo-controlled trial was conducted for 8 weeks. The Control + RT group (CON n = 12) received 400 mg/d of placebo, and the UA + RT group (UA n = 10) received 400 mg/d of UA. Both groups ingested ~1.6 g/kg of protein and performed the same RT program. Pre- and post-intervention, both groups were evaluated for anthropometric measures, body composition, food intake and muscle strength.Results: Food intake remained unchanged throughout the study. Both groups showed significant increases in body weight (CON Δ: 2.12 ± 0.47 kg, p = 0.001 vs. UA Δ: 2.24 ± 0.67 kg, p = 0.009), body mass index (BMI) (CON Δ: 0.69 ± 0.15 kg/m2, p = 0.001 vs. UA Δ: 0.75 ± 0.23, p = 0.011) and thigh circumference (CON Δ: 1.50 ± 0.36, p = 0.002 vs. UA Δ: 2.46 ± 0.50 cm, p = 0.003 vs. UA 1.84 ± 0.82 cm, p = 0.001), with differences between them. There was no difference in the arm, waist and hip circumferences. Both groups showed increases in muscle mass (CON Δ: 1.12 ± 0.26, p = 0.001 vs. UA Δ: 1.08 ± 0.28 kg, p = 0.004), but there was no significant difference between them. Additionally, there were significant increases in the one repetition maximum test in the bench press and in the 10-repetition maximum test in the knee extension (CON Δ: 5.00 ± 2.09, p = 0.036 vs. UA Δ: 7.8 ± 1.87, p = 0.340 and CON Δ: 3.58 ± 1.15, p = 0.010 vs. UA Δ: 1.20 ± 0.72, p = 0.133), respectively, with no difference between them.Conclusions: Ursolic acid had no synergic effect on muscle strength and mass in response to RT in physically active men consuming a high-protein diet.

Background & aims: The ICALIC project was initiated for developing an accurate, reliable and user friendly indirect calorimeter (IC) and aimed at evaluating its ease of use and the feasibility of the EE measurements in intensive care unit (ICU).Methods: This was a prospective unblinded, observational, multi-center study. Simultaneous IC measurements in mechanically ventilated ICU patients were performed using the new IC (Q-NRG®) and currently used devices. Time required to obtain EE was recorded to evaluate the ease of use of Q-NRG® versus currently used ICs and EE measurements were compared. Conventional descriptive statistics were used: data as mean ± SD.Results: Six centers out of nine completed the required number of patients for the primary analysis. Mean differences in the time needed by Q-NRG® against currently used ICs were -32.3 ± 2.5 min in Geneva (vs. Deltatrac®; p < 0.01), -32.3 ± 3.1 in Lausanne (vs. Quark RMR®; p < 0.05), -33.7 ± 1.4 in Brussels (vs. V-Max Encore®; p < 0.05), -26.4 ± 7.8 in Tel Aviv (vs. Deltatrac®; p < 0.05), -28.5 ± 3.5 in Vienna (vs. Deltatrac®; p < 0.05), and 0.3 ± 1.2 in Chiba (vs. E-COVX®; p = 0.17). EE (kcal/day) measurements by the Q-NRG® were similar to the Deltatrac® in Geneva and Vienna (mean differences±SD: -63.1 ± 157.8 (p = 0.462) and -22.9 ± 328.2 (=0.650)), but significantly different in Tel Aviv (307.4 ± 324.5, p < 0.001). Significant differences were observed in Lausanne (Quark RMR®: -224.4 ± 514.9, p = 0.038) and in Brussels (V-max®: -449.6 ± 667.4, p < 0.001), but none was found in Chiba (E-COVX®; 55.0 ± 204.1, p = 0.165).Conclusion: The Q-NRG® required a much shorter time than most other ICs to determine EE in mechanically ventilated ICU patients. The Q-NRG® is the only commercially available IC tested against mass spectrometry to ensure gas accuracy, while being very easy-to use.

Background & aims: COVID-19 pandemic had resulted in a massive increase in the number of patients admitted to intensive care units (ICUs). This created significant organizational challenges including numerous non-specialist ICU caregivers who came to work in the ICU. In this context, pragmatic protocols were essential to simplify nutritional care. We aimed at providing a simple and easy-to-prescribe nutritional protocol and evaluated its usefulness with questionnaires sent to physicians involved in the care of ICU COVID-19 patients.Methods: A simplified nutrition protocol was distributed to all physicians (n = 122) of the ICU medical team during COVID-19 pandemic. Clinical dieticians estimated energy targets for acute and post-acute phases at patient's admission and suggested adaptations of nutrition therapy. More complex situations were discussed with clinical nutrition doctors and, if required, a clinical evaluation was performed. To further facilitate the procedure, a chart with prescription aids was also distributed to the whole medical ICU team. At the end of the current pandemic wave, a 13-item questionnaire was emailed to the ICU medical team to obtain their opinion on the suggested nutritional therapy.Results: Answers were received from 81/122 medical doctors (MDs) (66% response rate), from intensive care physicians (41%), anaesthesiologists (53%) and MDs from other specialties (6%). Thirty-two percent of MDs felt that their knowledge of nutrition management was insufficient and 45% of the physicians surveyed did not face nutrition management in their daily practice prior to the pandemic. The initially proposed nutritional protocol, the chart with prescription aids and the suggested nutritional proposals were considered as useful to very useful by the majority of physicians surveyed (89.9, 90.7 and 92.1% respectively). The protocol was followed by 92% of MDs, and almost all participants (95%) were convinced that adaptations of nutritional therapy had beneficial effects on patients' outcomes.Conclusions: Nutritional therapy in critically ill COVID-19 patients is a challenge and the implementation of this specific pandemic simplified nutritional protocol was assessed as useful by a great majority of physicians. Pragmatic and simplified protocols are useful for ensuring the quality of nutritional therapy and could be used in future studies to assess its actual impact on the clinical outcomes of COVID-19 patients.

Ten years ago, European health care professional societies, health associations and members of the European Parliament convened in Brussels to discuss the necessary and urgent actions needed to improve access, initiation and follow up nutritional care for European citizens. As a response to this, in 2014 the Optimal Nutritional Care for All (ONCA) campaign was launched under the leadership of the European Nutritional for Health Alliance and its members. As of today this campaign has been rolled out in 18 European countries, whereby national multi-disciplinary platforms including patient groups work together to implement national nutritional care programs and develop good practices in care, research, education in order to increase awareness on malnutrition and improve nutritional care. This article describes the making of and evolution of the ONCA campaign, the outcomes and impact created, as well as opportunities to accelerate implementation of personalized nutritional care for all European citizens.

To compare safety and effectiveness of prolonged (>28 days) versus short duration (≤28 days) use of nasogastric tube for enteral nutrition and weight loss prevention during curative radiotherapy with or without concurrent chemotherapy or cetuximab for head and neck cancer patients. We performed a retrospective study and database review of all patients at our center, treated with radiotherapy for head and neck cancer receiving enteral nutrition by nasogastric tube. Type of treatment, weight and body mass index changes, and related complications (gastroesophageal reflux, pneumonia, ulcer, feeding tube obstruction, or dislocation) were documented. Comparison between patients with prolonged (>28 days, group A) and short duration (≤28 days, group B) of EN through nasogastric tube was performed. Data expressed as mean ± SD or median (min; max) values as appropriate, and analyzed by ANOVA repeated measures and Kaplan-Meier estimates. We identified 114 patients who fulfilled the inclusion criteria. Among them, 10% were treated with radiotherapy alone, while 90% received concurrent chemotherapy or cetuximab. Ninety-four patients (82%, group A) had a nasogastric tube in place for a period >28 days and 20 (18%, group B) for ≤28 days during treatment. Patients were mainly men (86 patients, 75%), with a median age of 61 years (range 49-73) and advanced stage IV disease in most cases (87 patients, 76%) without differences between both groups (p = 0.53, 0.47, and 0.30, respectively). Treatment discontinuation did not occur within both groups. Fifty-six patients (49%) developed complications, without a significant difference between both groups (P = 0.23). Body weight and BMI changes did not differ during EN (-0.8 ± 4.5 and -0.3 ± 1.6), the oncological treatment (-5.3 ± 4.0 and -1.8 ± 1.4), or 6 months after the end of treatment (-0.6 ± 4.4 and -0.2 ± 1.5). Our findings suggest that prolonged enteral nutrition by nasogastric tube is safe and effective in preventing weight loss during curative radiotherapy or radio-chemotherapy for head and neck cancer.

Despite high prevalence at hospital admission, disease related malnutrition (DRM) remains under recognized and undertreated. DRM is associated with increased morbidity, hospital readmission rate, and burden for the healthcare system. The compelling need to increase awareness and knowledge through an international survey has triggered the launch of the nutritionDay (ND) concept.ND is a worldwide annual systematic collection and analysis of data in hospital wards, intensive care units and nursing homes. ND is based on questionnaires to systematically collect and analyze the patient's characteristics, food intake and nutrition support, as well as the determinants of their environment (facility, health care personal, etc …). Questionnaires, outcome documentation sheets and step-by-step guidance are available as download in 30 languages.ND has described the nutritional status and behavior of over 150,000 hospitalized patients and nursing home's patients in over 56 participating countries. These data allowed a local, regional, national and international benchmarking at different levels (i.e. type of medical pathologies, care facilities, etc.) and over time. Sixteen peer-reviewed publications have already been released and picture the international scene of DRM.This review presents the 10-year of the ND project development and shows how ND serves all health care professionals to optimize nutrition care and nutrition related structures. ND keeps progressing and is likely to become a standard tool for determining the nutritional status and behavior of hospitalized patients and nursing home's population.

Summary Background & aims This review aims to clarify the use of indirect calorimetry (IC) in nutritional therapy for critically ill and other patient populations. It features a comprehensive overview of the technical concepts, the practical application and current developments of IC. Methods Pubmed-referenced publications were analyzed to generate an overview about the basic knowledge of IC, to describe advantages and disadvantages of the current technology, to clarify technical issues and provide pragmatic solutions for clinical practice and metabolic research. The International Multicentric Study Group for Indirect Calorimetry (ICALIC) has generated this position paper. Results IC can be performed in in- and out-patients, including those in the intensive care unit, to measure energy expenditure (EE). Optimal nutritional therapy, defined as energy prescription based on measured EE by IC has been associated with better clinical outcome. Equations based on simple anthropometric measurements to predict EE are inaccurate when applied to individual patients. An ongoing international academic initiative to develop a new indirect calorimeter aims at providing innovative and affordable technical solutions for many of the current limitations of IC. Conclusion Indirect calorimetry is a tool of paramount importance, necessary to optimize the nutrition therapy of patients with various pathologies and conditions. Recent technical developments allow broader use of IC for in- and out-patients.

BACKGROUND Creatine supplementation has been proposed to alleviate muscle loss in various populations, but has not been investigated in hemodialysis (HD) patients. Thus, our objective was to evaluate whether creatine supplementation could attenuate the loss of lean body mass (LBM) and malnutrition-inflammation score (MIS) in HD patients. METHODS A randomized, placebo-controlled, double blind, parallel-design study included HD patients, of both sexes, aged 18-59 years. The patients were allocated to a Placebo Group (PG; n = 15; received maltodextrin, 1st week: 40 g/day and 2nd-4th weeks: 10 g/day) and a Creatine Group (CG; n = 15; received creatine plus maltodextrin, 1st week: 20 g/day of creatine plus 20 g/day of maltodextrin and 2nd-4th weeks: 5 g/day of creatine plus 5 g/day of maltodextrin). Pre and post the intervention, patients were evaluated for food intake, MIS, body composition and biochemical parameters. RESULTS CG group attenuated the MIS (Pre: 5.57 ± 0.72 vs. Post: 3.85 ± 0.47 score, P = 0.003) compared with PG (Pre: 5.71 ± 0.97 vs. Post: 5.36 ± 0.95 score, P = 0.317) (supplement × time P = 0.017, effect size: 0.964). The change of LBM was greater in CG than in PG (CG: Δ0.95 vs PG: Δ0.13 kg). At post-intervention, 28.6% of PG patients presented LBM loss and 71.4% remain stable. In contrast, 14.4% of CG patients had LBM loss, 42.8% remain stable and 42.8% gained. Food intake and quality of life did not change. CG increased the BMI and gait speed in post-compared to pre-moment, but no difference among the groups. CONCLUSION In HD patients, four weeks of creatine supplementation may alleviate the MIS as well as attenuate the LBM loss compared to placebo.

Protein supplements are usually used to control body weight, however, the impact of protein quality on body fat attenuation is unknown. We investigated the effects of isocaloric isoproteic supplementation of either whey protein (WG) or hydrolysed collagen supplementation (CG) on dietary intake, adiposity and biochemical markers in overweight women. Methods: In this randomized double-blind study, 37 women, [mean &plusmn, SE, age 40.6 &plusmn, 1.7 year, BMI (kg/m2) 30.9 &plusmn, 0.6], consumed sachets containing 40 g/day of concentrated whey protein (25 g total protein, 2.4 leucine, 1.0 valine, 1.5 isoleucine, n = 17) or 38 g/day of hydrolysed collagen (26 g total protein, 1.02 leucine, 0.91 valine, 0.53 isoleucine, n = 20) in the afternoon snack. The compliance was set at &gt, 70% of the total theoretical doses. The dietary intake was evaluated by a 6-day food record questionnaire. At the beginning and after eight weeks of follow-up, body composition was evaluated by using dual-energy X-ray absorptiometry and lipid profile, insulin resistance, C-reactive protein, adiponectin, leptin and nesfastin plasma concentrations were analyzed. Results: Supplements were isocaloric and isoproteic. There were no differences in caloric intake (p = 0.103), protein (p = 0.085), carbohydrate (p = 0.797) and lipids (p = 0.109) intakes. The branched chain amino acids (BCAA) (GC: 1.8 &plusmn, 0.1 g vs. WG: 5.5 &plusmn, 0.3 g, p &lt, 0.001) and leucine intake (CG: 0.1 &plusmn, 0.1 g vs. WG: 2.6 &plusmn, 0.1 g, p &lt, 0.001) were higher in WG compared to CG. BMI increased in the CG (0.2 &plusmn, 1.1 kg/m2, p = 0.044) but did not change in WG. WG decreased the android fat (&minus, 0.1 &plusmn, 0.3 kg, p = 0.031) and increased nesfatin concentrations (4.9 &plusmn, 3.2 ng/mL, p = 0.014) compared to CG. Conclusions: Whey protein supplementation in overweight women increased nesfatin concentrations and could promote increase of resting metabolic rate as part of body composition improvement programs compared to collagen supplementation for 8 weeks. Additionally, our findings suggest that collagen may not be an effective supplement for overweight women who are attempting to alter body composition.

A low fat mass is associated with a good running performance. This study explores whether modifications in body composition predicted changes in running speed. We included people who underwent several measurements of body composition by bioelectrical impedance analysis between 1999 and 2016, at the &ldquo, Course de l&rsquo, Escalade&rdquo, taking place yearly in Geneva. Body composition was reported as a fat-free mass index (FFMI) and fat mass index (FMI). Running distances (men: 7.2 km, women: 4.8 km) and running times were used to calculate speed in km/h. We performed multivariate linear mixed regression models to determine whether modifications of body mass index, FFMI, FMI or the combination of FFMI and FMI predicted changes in running speed. The study population included 377 women (1419 observations) and 509 men (2161 observations). Changes in running speed were best predicted by the combination of FFMI and FMI. Running speed improved with a reduction of FMI in both sexes (women: &szlig, &minus, 0.31, 95% CI &minus, 0.35 to &minus, 0.27, p &lt, 0.001. men: &szlig, 0.43, 0.48 to &minus, 0.39, p &lt, 0.001) and a reduction of FFMI in men (&szlig, 0.20, 0.26 to &minus, 0.15, p &lt, 0.001). Adjusted for body composition, the decline in running performance occurred from 50 years onward, but appeared earlier with a body mass, FFMI or FMI above the median value at baseline. Changes of running speed are determined mostly by changes in FMI. The decline in running performance occurs from 50 years onward but appears earlier in people with a high body mass index, FFMI or FMI at baseline.

Summary Background & aims We hypothesize that an optimal and simultaneous provision of energy and protein is favorable to clinical outcome of the critically ill patients. Methods We conducted a review of the literature, obtained via electronic databases and focused on the metabolic alterations during critical illness, the estimation of energy and protein requirements, as well as the impact of their administration. Results Critically ill patients undergo severe metabolic stress during which time a great amount of energy and protein is utilized in a variety of reactions essential for survival. Energy provision for critically ill patients has drawn attention given its association with morbidity, survival and long-term recovery, but protein provision is not sufficiently taken into account as a critical component of nutrition support that influences clinical outcome. Measurement of energy expenditure is done by indirect calorimetry, but protein status cannot be measured with a bedside technology at present. Conclusions Recent studies suggest the importance of optimal and combined provision of energy and protein to optimize clinical outcome. Clinical randomized controlled studies measuring energy and protein targets should confirm this hypothesis and therefore establish energy and protein as a power couple.

This review emphasizes the role of a timely supplemental parenteral nutrition (PN) for critically ill patients. It contradicts the recommendations of current guidelines to avoid the use of PN, as it is associated with risk. Critical illness results in severe metabolic stress. During the early phase, inflammatory cytokines and mediators induce catabolism to meet the increased body energy demands by endogenous sources. This response is not suppressed by exogenous energy administration, and the early use of PN to reach the energy target leads to overfeeding. On the other hand, early and progressive enteral nutrition (EN) is less likely to cause overfeeding because of variable gastrointestinal tolerance, a factor frequently associated with significant energy deficit. Recent studies demonstrate that adequate feeding is beneficial during and after the intensive care unit (ICU) stay. Supplemental PN allows for timely adequate feeding, if sufficient precautions are taken to avoid overfeeding. Indirect calorimetry can precisely define the adequate energy prescription. Our pragmatic approach is to start early EN to progressively test the gut tolerance and add supplemental PN on day 3 or 4 after ICU admission, only if EN does not meet the measured energy target. We believe that supplemental PN plays a pivotal role in the achievement of adequate feeding in critically ill patients with intolerance to EN and does not cause harm if overfeeding is avoided by careful prescription, ideally based on energy expenditure measured by indirect calorimetry.

Summary Rationale Accurate evaluation of the energy needs is required to optimize nutrition support of critically ill patients. Recent evaluations of indirect calorimeters revealed significant differences among the devices available on the market. A new indirect calorimeter (Q-NRG®, Cosmed, Roma, Italy) has been developed by a group of investigators supporting the international calorimetry study initiative (ICALIC) to achieve ultimate accuracy for measuring energy expenditure while being easy to use, and affordable. This study aims to validate the precision and the accuracy of the Q-NRG® in the in-vitro setting, within the clinically relevant range for adults on mechanical ventilation in the ICU. Mass spectrometry is the reference method for the gas composition analysis to evaluate the analytic performances of the Q-NRG®. Methods The accuracy and precision of the O2 and CO2 measurements by the Q-NRG were evaluated by comparing the measurements of known O2 and CO2 gas mixtures with the measurements by the mass spectrometer (Extrel, USA). The accuracy and precision of the Q-NRG® for measurements of VO2 (oxygen consumption) and VCO2 (CO2 production) at clinically relevant ranges (150, 250 and 400 ml/min STPD) were evaluated by measuring simulated gas exchange under mechanically ventilated setting at different FiO2 settings (21–80%), in comparison to the reference measurements by the mass spectrometer-based mixing chamber system. Results The measurements of gas mixtures of predefined O2 and CO2 concentrations by the Q-NRG® were within 2% accuracy versus the mass spectrometer measurements in Passing Bablok regression analysis. In a mechanically ventilated setting of FiO2 from 21 up to 70%, the Q-NRG® measurements of simulated VO2 and VCO2 were within 5% difference of the reference mass spectrometer measurements. Conclusion In vitro evaluation confirms that the accuracy of the Q-NRG® indirect calorimeter is within 5% at oxygen enrichment to 70%; i.e. maximum expected for clinical use. Further recommendations for the clinical use of the Q-NRG® by will be released once the ongoing multi-center study is completed.

Summary Background & aims Inadequate protein intake is associated with lean body mass (LBM) loss. However, it is unclear whether high protein diet and leucine intake are associated with handgrip strength (HGS), a validated marker of muscle function. This study aims to: i) assess the prevalence of patients with low HGS; and ii) verify if HGS is correlated with high protein diet and leucine consumption in hemodialysis patients. Methods This cross-sectional study analysed patients at two center hemodialysis (HD) clinic and sixty-two patients aged ∼39 years with length of time on HD ∼60 months undergoing HD was carried out. Body weight (kg), LBM (kg) and body fat mass (%) assessments were performed by dual-energy X-ray absorptiometry and height (m) through portable stadiometer. Body mass index (BMI) (kg/m2) was calculated using the body weight and height. HGS (kg) was measured using a hydraulic dynamometer. Fisher's exact test, Chi-square, Pearson's correlation, and logistic regression were done to test the hypothesis. Results Out of 62 patients, 47 (75.8%) presented low HGS. In addition, no correlation was found between protein intake (if in percentage or g/kg/d) and HGS (r = 0.07, p = 0.58; r = −0.04, p = 0.70, respectively). Although there is a low correlation among leucine intake (g/d) and HGS (r = 0.39, p = 0.01), low HGS was not associated with leucine intake in the crude model (OR: 0.86 95%CI(0.60–1.24) p = 0.441), nor after adjustment for age, sex and BMI (OR: 0.84 95%CI(0.56–1.26), p = 0.422). Conclusions Approximately 75% of patients undergoing hemodialysis presented low HGS. Additionally, neither a high protein diet nor leucine intake was associated with the HGS values.

Objective The importance of body composition for running performance is unclear in the general population. The aim of this study was to evaluate whether body composition influences running speed and whether it is a better predictor of running speed than body mass index (BMI). Methods The study included 1353 women (38.2 ± 12.1 y of age) and 1771 men (39.6 ± 12.1 y of age) who underwent, for the first time, a measurement of body composition by bioelectrical impedance analysis between 1999 and 2016, before a timed run occurring annually in Geneva. The running distances and times were converted to average speed (km/h). Body composition was expressed as sex-specific quartiles, where quartile 1 (lowest values) was the reference quartile. The relationships between speed and BMI or body composition were analyzed by multivariate linear regressions. Results Multivariate regressions showed that the higher the fat mass index (FMI) quartile, the lower the running speed in women and men (all P 20 kg/m2) was associated with a poor running performance (r = –0.50, P Conclusions Running speed is negatively associated with BMI and FMI in both sexes. Body composition is a better predictor of running performance than BMI.

Individualized supplemental parenteral nutrition (SPN) providing measured energy expenditure from day 4 reduced infectious complications in a previous study including 305 intensive care (ICU) patients. The study aimed at investigating the metabolic, and immune responses underlying the clinical response of the previous trial.Randomized controlled trial enrolling 23 critically ill patients on day 3 (D3) of admission to the ICU who were fed less than 60% of their energy target by the enteral nutrition (EN) alone: allocation to either continued EN or to SPN to a target validated by indirect calorimetry. Protein and glucose metabolism (primary endpoint) were investigated with tracer isotopes on D4 and D9. Secondary endpoints: 1) immune response, investigated in serum and in stimulated peripheral blood mononuclear cells (PMBC), by dosing a panel of cytokines (infectious complications were recorded), and 2) Muscle mass was assessed by ultrasound of the thigh.Comparable at baseline, the SPN group (n = 11) received more energy (median 24.3 versus 17.8 kcal/kg/day: p 0.001) and proteins (1.11 versus 0.69 g/kg/day: p 0.001) than the control group during the five days' intervention, resulting in a less negative energy balance by D9 (p = 0.0027). Net protein breakdown and Glucose kinetics on D9 did not differ, within or between groups. In agreement with a decrease in infection rate, immune response in the SPN group showed decreased serum IL-6 (p = 0.024), IL-1β, IL-10 levels and TNF-α secretion by PBMC (p = 0.018) at D9. Muscle mass loss from D4 to D15 tended to be less in the SPN group (-16% versus -23%: p = 0.06). Clinical course by D28 did not differ.Feeding patients to cover an individualised measured energy target with SPN from D4 to cover needs, was associated with improved immunity, less systemic inflammation and a trend to less muscle mass loss.NCT02022813 at https://clinicaltrials.gov/.

The Swiss supplemental parenteral nutrition (SPN) study demonstrated that optimised energy provision combining enteral nutrition (EN) and SPN reduces nosocomial infections in critically ill adults who fail to achieve targeted energy delivery with EN alone. To assess the economic impact of this strategy, we performed a cost-effectiveness analysis using data from the SPN study. Multivariable regression analyses were performed to characterise the relationships between SPN, cumulative energy deficit, nosocomial infection, and resource consumption. The results were used as inputs for a deterministic simulation model evaluating the cost-effectiveness of SPN administered on days 4-8 in patients who fail to achieve ≥60% of targeted energy delivery with EN by day 3. Cost data were derived primarily from Swiss diagnosis-related case costs and official labour statistics. Provision of SPN on days 4-8 was associated with a mean decrease of 2320 ± 338 kcal in cumulative energy deficit compared with EN alone (p

Since the early 1990s enteral nutrition (EN) has been considered the optimal route of feeding rather than parenteral nutrition (PN), which was considered harmful in critically ill patients with intense inflammation. The aim of this review was to summarize recent developments and progress in PN, which have changed the view on this feeding technique. PubMed and personal databases were searched for studies and reviews reporting historical development of PN, and for clinical trials conducted after 2010 investigating PN in critical illness, comparing it to EN or not. Trials from the past decade have explored modalities and timing of artificial feeding. Trials based on equation-estimated energy targets and applying an early full feeding strategy have generally had negative results in terms of complications (infections, prolonged ventilation, and intestinal complications with EN). The few trials that based their targets on measured energy targets have achieved reduction of complications regardless of the route. Opposing enteral and parenteral feeding is no longer rational in the critical care setting. A pragmatic and reasonable approach offers better options for the individual patient. Although PN is simpler to deliver than EN, its metabolic consequences are more complicated to handle. A combination of both techniques may be a more reasonable approach in the sickest patients.

Discipline Epidemiologie. Introduction et but de l’etude Le lien entre la composition corporelle et la performance en course a pied n’est pas clair dans la population generale. Cette etude vise a evaluer l’influence de la composition corporelle sur la vitesse de course chez les participants d’une competition de course a pied. Materiel et methodes Tous les participants d’une competition de course a pied, ayant lieu en ville de Geneve chaque annee, qui ont beneficie d’une premiere mesure de composition corporelle entre 1999 et 2016 ont ete inclus. Les personnes [1] puis soustraite du poids corporel pour determiner la masse grasse. Les masses grasse et non grasse ont ensuite ete divisees par la taille (m) au carre pour obtenir les indices de masse grasse (FMI) et non grasse (FFMI). Les distances et temps de course ont ete convertis en vitesse (km/h). Les caracteristiques des participants sont exprimees sous forme de moyenne ± DS. Des regressions multiples, ajustees pour l’âge, l’indice de masse corporelle (IMC), l’annee de mesure et la distance de course, ont permis de predire la vitesse de course en fonction des quartiles de FMI et FFMI. Resultats et analyse statistique Un total de 1353 femmes (38,2 ± 12,1 ans ; IMC 22,0 ± 2,4 kg/m2 ; FMI 6,3 ± 1,7 kg/m2 ; FFMI 15,7 ± 1,2 kg/m2) et 1771 hommes (39,6 ± 12,1 ans ; IMC 24,1 ± 2,5 kg/m2 ; FMI 4,9 ± 1,6 kg/m2 ; FFMI 19,2 ± 1,4 kg/m2) ont ete inclus ( Tableau 1 ). Pour les deux sexes, les regressions multiples ont montre que plus le FMI etait eleve, plus la vitesse de course etait basse. Chez les femmes, un FFMI dans les quartiles 2 et 3 etait associe a une vitesse de course plus elevee en comparaison au quartile 1. Chez les hommes, un FFMI dans le quartile 4 etait associe a une diminution de la vitesse de course. Conclusion Le FMI est negativement associe a la vitesse de course chez les deux sexes alors que le FFMI y est positivement associe chez les femmes seulement. Les personnes souhaitant ameliorer leur performance en course a pied devraient garder une masse grasse aussi basse que possible.

Discipline Clinique. Introduction et but de l’etude Une masse maigre basse a l’admission en reanimation, evaluee par l’angle de phase [1] ou l’index d’aire du psoas [2] , predit la mortalite a 28 jours (J28). Objectifs Evaluer : – si, sur une coupe de scanner passant par L3, la composition corporelle : surfaces musculaire totale (SMT) (objectif principal), des psoas, des tissus adipeux sous-cutane (SAT), peri-visceral (VAT), intra-musculaire (IMAT), intra-psoas (PAT) et total (TAT) (objectifs secondaires), predisait la mortalite J28 ; – reproductibilite inter-observateur ; – prevalence de la sarcopenie. Materiel et methodes etude ancillaire du Phase Angle Project (n = 931) [1] , multicentrique internationale. Criteres d’inclusion : scanner abdominal de routine dans les 9 jours entourant l’admission. Analyse de la composition corporelle a l’aide du logiciel ImageJ (NIH, Etats Unis). Statistiques : aire sous la courbe (AUC) ROC. Regression logistique multivariee : variables associees a la mortalite a J28. Analyse de 33 scanners en double lecture en aveugle. Sarcopenie definie par : SMT/taille2 Resultats et Analyse statistique Un total de 210 patients inclus : 55 % H, 62 ± 17 ans, APACHE II 20 ± 9, 50/50 % med./chir. Chez les F, augmentation de l’IMAT, du VAT et du TAT indexes a la taille etaient associees a la mortalite a J28 (p = 0,03 ; p = 0,02 ; p = 0,02, respectivement). Chez les H, diminution de la SMT et des psoas indexes a la taille, de la SMT et la surface du psoas non indexees a la taille etaient associees a la mortalite a J28 (p = 0,01 ; p = 0,003 ; p = 0,003 ; p 65 ans [2,8 (1,1–7,3), p = 0,03], et angle de phase a l’admission (2,71 [1,1–6,6], p = 0,03) associes a la mortalite J28. La reproductibilite inter-observateur etait bonne avec pour les tissus adipeux visceral et total (coefficient de correlation r = 0,99), la surface musculaire totale (r = 0,72), et la surface du psoas (r = 0,90). Prevalence de la sarcopenie : 57 % (total) ; 35 % (F) ; 74 % (H). Conclusion La surface musculaire totale exprimee en cm2est associee a la mortalite a J28. Il existe une bonne reproductibilite inter-observateur des parametres de composition corporelle mesures par scanner passant par L3. Plus de la moitie des patients de reanimation sont sarcopeniques. Cette etude confirme l’importance de la mesure du niveau de masse maigre pour evaluer le pronostic du patient de reanimation.